Eine Gruppe von Antibiotika antibiotika-wiki.de , zu denen das Natürliche Antibiotikum Lincomycin und sein halbsynthetisches Analogon Clindamycin gehören. Sie haben bakteriostatische oder bakterizide Eigenschaften, abhängig von der Konzentration im Körper und der Empfindlichkeit von Mikroorganismen. Die Wirkung ist auf die Unterdrückung der Proteinsynthese in Bakterienzellen durch Bindung DER 30s-Subeinheit der ribosomalen Membran zurückzuführen. Lincosamide sind resistent gegen die Wirkung von Salzsäure Magensaft. Nach oraler Verabreichung wird schnell absorbiert. Es wird für Infektionen verwendet, die durch Gram-positive Kokken (hauptsächlich als Medikamente der zweiten Reihe) und unvorhersehbare anaerobe Flora verursacht werden.
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Antibiotic Formulary Prescribing Advice Adult V6.4
Printed copies are not controlled and are valid on date of printing only. This version was last printed: 16 Apr. 12
Lower Respiratory Tract Infections Inc. COPD, Pneumonia, TB 4.3.1 Bronchitis, Acute
4.3.2 Bronchitis, Chronic And COPD, Acute Exacerbations Of Doxycycline 200mg loading dose then 100mg od po Amoxicillin 500mg po every 8 hours Clarithromycin 500mg po every 12 hours 4.3.3 Pneumonia Introduction
Specimens: fresh sputum and blood for culture; blood for serology should be collected at onset of disease, and two weeks later. If patient apyrexial for at least 24 hours you may change the route to oral. The following advice has been adapted from the current British Thoracic Society Guidelines on the management of community-acquired pneumonia in adults admitted to hospital. 4.3.4 Community Acquired Pneumonia
CURB-65 (British Thoracic Society) NOTE: Clinical or X-ray evidence of lobar consolidation required.
Score 1 for each
acute unexplained Confusion (mental test score <8, or disorientation in time/place/person) Urea > 7mmol/l Respiratory rate 30/min Blood pressure - systolic <90 mmHg and/or diastolic 60 mmHg
THE CURB-65 SCORE IS NOT A SUBSTITUTE FOR GOOD CLINICAL JUDGEMENT
Mild Pneumonia (CURB Score 0-1) First Line: Amoxicillin 500mg-1g po every 8 hours Second Line (Beta-lactam allergy): Doxycycline 200mg loading dose then 100mg po Clarithromycin 500 mg po 12 hourly BEFORE PRESCRIBING ANY ANTIMICROBIAL, CHECK FOR ALLERGIES, DRUG INTERACTIONS & CONTRAINDICATIONS
Antibiotic Formulary Prescribing Advice Adult V6.4
Printed copies are not controlled and are valid on date of printing only. This version was last printed: 16 Apr. 12
Moderate Pneumonia (CURB Score 2) First Line: Amoxicillin 500mg-1g po every 8 hours plus clarithromycin 500mg po every 12 hours Second Line (Beta-lactam allergy): Doxycycline 200mg loading dose, then 100mg po once daily
Severe Pneumonia (CURB Score ≥3 or Pa O2 <8 KPa or Sa O2 <92% on any Fi O2) Duration of therapy is usually 7 to 10 days but contact microbiology if no significant response to therapy after 72 hours. First Line: Co-amoxiclav 1.2g iv every 8 hours plus clarithromycin 500mg iv or po every 12 hours. Contact microbiologist if suspicion of PVL or other unusual organism. Consider early oral switch for clarithromycin. If penicillin allergy but can tolerate cefuroxime: cefuroxime 1.5g iv every 8 hours plus clarithromycin 500mg iv every 12 hours. Consider early oral switch for clarithromycin.
NOTE: Clarithromycin is aimed at atypical organisms and its concomitant use with a Beta-lactam carries a significant Clostridium difficile risk. Furthermore it may act to antagonise the action of the Beta-lactam antibiotic. ENSURE THE MACROLIDE IS REALLY NECESSARY! Clarithromycin should be stopped once atypical pneumonia is excluded Atypical Pneumonia
Treatment must be directed at the causative agent and may need to be prolonged. Consider underlying disease processes (e.g. need for HIV test). If there are problems with antibiotic allergy, and/or concerns about the response to the above antibiotics, please contact the duty microbiologist for your site. BEFORE PRESCRIBING ANY ANTIMICROBIAL, CHECK FOR ALLERGIES, DRUG INTERACTIONS & CONTRAINDICATIONS
Antibiotic Formulary Prescribing Advice Adult V6.4
Printed copies are not controlled and are valid on date of printing only. This version was last printed: 16 Apr. 12
4.3.5 Hospital-Acquired Pneumonia
Early onset (<5 days admission): Mild First Line: Amoxicillin 500mg-1g po every 8 hours Second Line (Beta-lactam allergy): Doxycycline 200mg loading dose then 100mg po Co-amoxiclav 1.2g iv every 8 hours. Review daily with a view to early iv to oral switch. Second Line (Minor penicillin rash): Cefuroxime 1.5g iv every 8 hours. (Severe Beta-lactam allergy/MRSA risk):
Late onset (>5 days admission) or severe: First Line: Piperacillin/tazobactam 4.5g iv every 8 hours Second Line (Minor penicillin rash): Meropenem 1g iv every 8 hours
Discuss with Consultant Microbiologist(Severe Beta-lactam allergy/MRSA risk): 4.3.6 Pneumonia, Aspiration Of Vomit Known Or Suspected NB This is not appropriate for aspiration in the absence of pneumonia. First Line: Co-amoxiclav 1.2grams iv every 8 hours
5 days. Consider oral therapy if patient's condition permits.Second Line (Minor penicillin rash): Cefuroxime 1.5g iv every 8 hours plus metronidazole 500mg iv every 8 hours (Severe beta-lactam allergy/MRSA risk): BEFORE PRESCRIBING ANY ANTIMICROBIAL, CHECK FOR ALLERGIES, DRUG INTERACTIONS & CONTRAINDICATIONS
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