Pneumonia

consolidation of alveoli or infiltration of the intestinal tissue with inflammatory cells or both.

Cause 

1. 0-2 month- stepttococcus, staphylococcus,staphylococcus aureus , listerai E-coli, H ifluenza, s. pneumonia
2. 2-6 month-RSV(respiratiory system virus), Hinfluenza, chlamydia, s.pneumonial,streptococuss aureus, influenza virus
3. 6 month -5yrs -RSV, parainfluenza,H influenza,Adeno virus
4. >5yrs-mycoplasma chlamydia, H infuenza

Risk factor

1. Low birth wt
2. Malnutrition
3. Vit A deficiency
4. Passive smoking
5. Air polution

S/s

1. Fever
2. Chest pain
3. Tachypnea
4. Respiratory distress

Complication

1. Empyemia lung abscess
2. pneumthorax

Diagnosis(WHO)

• Children younger than 2 months: Greater than or equal to 60 breaths/min
• Children aged 2-11 months: Greater than or equal to 50 breaths/min
• Children aged 12-59 months: Greater than or equal to 40 breaths/min

Investigation

1. TC
2. DC
3. ESR
4. Hb%
5. Platelate
6. CRP
7. CR
8. BLD- c/s
9. Decrease WBC

Treatment

Oral

Amoxycilin

Dosing & Uses

Pediatric

Dosing Forms & Strengths

Ear, Nose, & Throat Infections

Mild to moderate infections

• <3 months: ≤30 mg/kg/day PO divided q12hr for 48-72 hours; for ≥10 days for S pyogenes infections
• >3 months and <40 kg: 25 mg/kg/day PO divided q12hr or 20 mg/kg/day PO divided q8hr 
• >40 kg: 500 mg PO q12hr or 250 mg PO q8hr for 10-14 days

Severe infections

• <3 months: ≤30 mg/kg/day PO divided q12hr for 48-72 hours; for ≥10 days for S pyogenes infections
• >3 months and <40 kg: 45 mg/kg/day PO divided q12hr or 40 mg/kg/day PO divided q8hr  
• >40 kg: 875 mg PO q12hr or 500 mg PO q8hr for 10-14 days

Tonsillitis/Streptococcal pharyngitis

• 50 mg/kg PO qDay for 10 days, not to exceed 1 g/day, OR 25 mg/kg PO BID for 10 days, not to exceed 500 mg/dose 
• >12 years: 775 mg (Moxatag) PO qDay for 10 days, taken within 1 hour after meal (swallow tablet whole; do not crush or chew)

Spectrum of action

• α- and β-hemolytic Streptococcus, S pneumoniae, Staphylococcus, H influenzae

Acute Otitis Media

>3 months and <40kg: 80-90 mg/kg/day PO divided q8-12hr 

>40 kg: 500 mg PO q12hr or 250 mg PO q8hr for 10-14 days

Lower Respiratory Tract Infections

Mild, moderate, or severe infections

• <3 months: ≤30 mg/kg/day PO divided q12hr for 48-72 hours; for ≥10 days for S pyogenes infections  
• >3 months and <40 kg: 45 mg/kg/day PO divided q12hr or 40 mg/kg/day PO divided q8hr
• >40kg: 875 mg PO q12hr or 500 mg PO q8hr for 10-14 days

Spectrum of action

• α- and β-hemolytic Streptococcus, S pneumoniae, Staphylococcus, H influenzae

Gonorrhea

Acute, uncomplicated anogenital or urethral infections

>2 years old to prepuberty: 50 mg/kg PO, with 25 mg/kg probenecid, once as single dose  

Spectrum of action

• N gonorrhoeae

Anthrax

Postexposure inhalational prophylaxis

<40 kg: 15 mg/kg PO q8hr (minimum recommended dose; should not be <45 mg/kg/day or >q8hr 

>40 kg: 500 mg PO q8hr

80 mg/kg/day PO divided q8hr for 4 weeks (with concomitant vaccine) or for 60 days (without vaccine)

Infective Endocarditis

Prophylaxis

50 mg/kg PO 30-60 min before procedure 

Dosing & Uses

Adult

Dosing Forms & Strengths

Ear, Nose, & Throat Infections

Mild to moderate infections

• 500 mg PO q12hr or 250 mg PO q8hr for 10-14 days

Severe infections

• 875 mg PO q12hr or 500 mg PO q8hr for 10-14 days

Tonsillitis/pharyngitis

• Moxatag: 775 mg PO qDay for 10 days, taken within 1 hour after finishing a meal

Spectrum of action

• α- and β-hemolytic Strep, S pneumoniae, Staph spp, H influenzae

Genitourinary Tract Infections

Mild to moderate infections

• 500 mg PO q12hr or 250 mg PO q8hr

Severe infections

• 875 mg PO q12hr or 500 mg PO q8hr

Spectrum of action

• E coli, P mirabilis, or E faecalis

Skin & Skin Structure Infections

Mild to moderate infections

• 500 mg PO q12hr or 250 mg PO q8hr

Severe infections

• 875 mg PO q12hr or 500 mg PO q8hr

Spectrum of action

• α- and β-hemolytic Strep, Staph spp, E coli

Tonsilitis

775 mg (ER tabs) PO qDay for 10 days

Lower Respiratory Tract Infections

875 mg PO q12hr or 500 mg PO q8hr for 10-14 days

Spectrum of action

• α- and β-hemolytic Strep, S pneumoniae, Staph spp, H influenzae

Helicobacter Pylori

H pylori infection and active or 1-year history of duodenal ulcer

Triple therapy

• 1 g PO q12hr for 14 days with lansoprazole (30 mg) and clarithromycin (500 mg)

Dual therapy

• 1 g PO q8hr for 14 days with lansoprazole (30 mg) in patients intolerant of, or resistant to, clarithromycin

Gonorrhea

Acute, uncomplicated anogenital or urethral infections

3 g PO once as a single dose

Spectrum of action

• N gonorrhoeae

Anthrax

Postexposure inhalational prophylaxis

500 mg PO q8hr

Infective Endocarditis

Prophylaxis

2 g PO 30-60 min before procedure

Cotrimoxazole

(trimethoprim/sulfamethoxazole (Rx) )

Dosing & Uses

Pediatric

Dosing Forms & Strengths

Mild to Moderate Infections

<2 months: Contraindicated

>2 months

• 8 mg TMP/kg/day PO divided q12hr 

Serious Infections

<2 months: Contraindicated

>2 months

• 15-20 mg TMP/kg qDay PO divided q6hr 
• 8-12 mg TMP/kg/day IV divided q6-12hr

Acute Otitis Media

Acute otitis media in pediatric patients due to susceptible strains of Streptococcus pneumoniae or Haemophilus influenzae

<2 months: Contraindicated

>2 months: 6-10 mg TMP/kg/day PO divided q12hr for 10 days 

Pneumocystis (Carinii) Jiroveci Pneumonia

<2 months: Contraindicated

>2 months

• Treatment: 15-20 mg TMP/kg/day PO/IV divided q6-8hr for 21 days 
• Prophylaxis: 150 mg TMP/m²/day PO divided q12 hr for 3 days/week on consecutive or alternate days 

Shigellosis

<2 months: Contraindicated

>2 months

• 8 mg TMP/kg/day PO divided q12hr for 5 days 
• 8-10 mg TMP/kg/day IV divided q6-12hr for 5 days

Urinary Tract Infection

<2 months: Contraindicated

>2 months

• 6-12 mg TMP/kg/day PO divided q12hr for 7-14 days if serious infection 
• 8-10 mg TMP/kg/day IV divided q6-12hr for 14 days if serious infection
• Prophylaxis: 2 mg TMP/kg/dose qDay or 5 mg TMP/kg/dose twice dail

Skin/soft Tissue Infection Due to Community Acquired MRSA (Off-label)

4-6 mg TMP/kg/dose PO q12hr for 5-10 days; add beta-lactam antibiotic to regimen if beta-hemolytic Streptococcuts spp also suspected

Dosing & Uses

Adult

Dosing Forms & Strengths

Dosing Guidelines for Infections

1-2 DS tablets PO q12-24hr

8-20 mg TMP/kg/day IV q6-12hr 

Chronic Bronchitis

Acute exacerbations of chronic bronchitis due to susceptible strains of Streptococcus pneumoniae or Haemophilus influenzae

DS tablet: 1 PO q12h for 10-14 days

Meningitis, Bacterial

10-20 mg TMP/kg/day IV divided q6-12hr 

Pneumocystis (Carinii) Jiroveci Pneumonia

Documented Pneumocystis jiroveci pneumonia (PCP); also, prophylaxis against PCP in individuals who are immunosuppressed

Prophylaxis

• Tablet: 80-160 mg TMP PO qDay or 160 mg TMP 3 times/week on consecutive or alternate days

Treatment

• 15-20 mg TMP/kg/day PO/IV divided q6-8hr 

Sepsis

20 mg TMP/kg/day IV divided q6hr 

Shigellosis

Enteritis caused by susceptible strains of Shigella flexneri and S sonnei

DS tablet: 1 tab PO q12hr for 5 days

Alternatively, 8-10 mg TMP/kg/day IV divided q6-12hr for up to 5 days 

Traveler's Diarrhea

Traveler's diarrhea due to susceptible strains of enterotoxigenic Escherichia coli

DS tablet: 1 tab PO q12hr for 5 days

Urinary Tract Infections

UTIs caused by susceptible strains of Escherichia coli, Klebsiella species, Enterobacter species, Morganella morganii, Proteus mirabilis, and Proteus vulgaris

Pyelonephritis: 1 DS tab or 2 regular-strength tabs PO q12hr x 14 days

Prostatitis: 1 DS tab or 2 regular-strength tabs PO q12hr x 14 days or 2-3 months if chronic infection

A 3-day course may be used for acute, uncomplicated cystitis

Prophylaxis (off-label): Various regimens exist; may use regular-strength tablet once/twice per week

Acne Vulgaris (Off-label)

1 DS tab or 1 regular-strength tab PO qDay or q12hr for up to 18 weeks

Community Acquired Pneumonia (Off-label)

1 DS tab PO q12hr for 10-14 days

1. penicillin-I/V or 
2. Ampicilin+gentamycin-I/V or 
3. Cefotaxim+Flucloxacillin-I/V* 7dys

supportive

1. Paracetamol
2. Oxygen and fluid maintenance
3. Monitor vital regularly
4. Broncho dilator if needed
1. Salbutamol- Normal
2. Aminophyline-severe I/V