861 LANCET(526238) Annual Surveillance Report & Antibiotic Guide Family Practitioners 217
1 CONTENTS RESPIRATORY TRACT PATHOGENS 2 Viral 2 Bacterial 4 COMMON URINARY TRACT PATHOGENS 6 ANTIBIOTIC GUIDELINES 7 Trade names and route of administration 7 Antibiotic dosages for upper respiratory tract infections 1 REFERENCES 1 Disclaimer These guidelines are based on current literature reviews and the expert opinion of Lancet microbiologists. The authors have made every effort to provide accurate information. However, they are not responsible for any errors, omissions, or for any outcomes related to the use of the contents of this book. Treatments and side effects described here may not be applicable to all patients; likewise, some patients may require a dose not described herein.
2 RESPIRATORY TRACT PATHOGENS Most respiratory tract infections are viral in aetiology, thus requiring no antibiotic therapy. Bacterial infections may complicate these. The following gures highlight the common pathogens detected in KZN in 216. Viral 9 856 8 753 Number of posites on PCR 7 6 5 4 3 2 1 517 453 375 37 254 254 224 223 19 Rhinovirus RSV M. pneumoniae Adenovirus Influenza A PIV (1-4) Influenza B Other (Parechovirus and Bocavirus) hmpv Enterovirus hcov (Oc43, 229E, Nl63, HKU1) Figure 6a: Respiratory viruses plus Mycoplasma pneumoniae as detected on polymerase chain reaction (PCR) for 216. Rhinovirus was the most frequently detected viral respiratory pathogen. It was detected consistently throughout the year. It is associated with prolonged hospitalisation and increased risk for the development of asthma. Mycoplasma pneumoniae was the third most frequently detected organism indicating its importance as part of the differential diagnosis when presented with an atypical pneumonia. Adenovirus is an important pathogen in both children and adults, presenting with conditions ranging from conjunctitis and pharyngitis to pneumonia and lifethreatening systemic infections. It is present at consistent levels throughout the year.
3 RESPIRATORY TRACT PATHOGENS 4 Number of posites on PCR 35 3 25 2 15 1 5 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 In uenza A In uenza B Rhinovirus RSV Adenovirus Figure 6b: Seasonal distribution of respiratory viruses in 216 (PCR). RSV was detected throughout the year, but infections peaked over February-April. A second smaller peak was noted over November-December 216. This second peak falls outside the period over which palizumab (Synergis ) is usually gen to premature infants for the prevention of RSV infection. The in uenza season was prolonged in 216 and atypical in that the initial peak was due to in uenza B, followed by in uenza A. In preceding years, the reverse has been the norm. Cases of in uenza B were early as March, increasing from May, and peaking in June. Cases of in uenza B infection were detected into November. In uenza A cases were also detected in March, but increased over the months of June-August. Cases of in uenza A infection were also detected into November. The in uenza A cases were a mixture of subtype H3N1 and H1N1.
4 RESPIRATORY TRACT PATHOGENS Bacterial S. PNEUMONIAE 277 288 32 H. PARAINFLUENZAE 85 159 115 H. INFLUENZAE 828 873 172 2 4 6 8 1 12 Number of isolates 214 215 216 Figure 7a: Streptococcus pneumoniae, Haemophilus parain uenzae and Haemophilus in uenzae in 216. The commonest bacterial pathogens are H. in uenzae and Streptococcus pneumoniae. Haemophilus parain uenzae is a commensal of the nasopharynx but has also been implicated in respiratory tract infections, such as pneumonia and sinusitis. STREPTOCOCCUS PNEUMONIAE HAEMOPHILUS PARAINFLUENZAE 2 6 2 19 24 49 98 1 HAEMOPHILUS INFLUENZAE 9 5 2 4 6 8 1 12 85 BLD CSF LRT ENT OTHER Figure 7b: Specimen source distribution of Streptococcus pneumoniae, Haemophilus parain uenzae and Haemophilus in uenzae isolates in 216. The predominant specimen type was sputum/endotracheal aspirates. Twenty-four percent of S. pneumoniae isolates were from blood cultures.
5 RESPIRATORY TRACT PATHOGENS Penicillin non-susceptible S. pneumoniae (all sites) Penicillin non-susceptible S. pneumoniae (blood) Macrolide R S.pneumoniae (all sites) Macrolide R S.pneumoniae (blood) Quinolone R S.pneumoniae (all sites) Quinolone R S.pneumoniae (blood) Quinolone R H. parain uenzae Quinolone R H. in uenzae 5 1 15 2 25 3 35 4 45 Percent non-susceptible isolates 214 215 216 Figure 7c: Percentage of S. pneumoniae isolates, from all sites or blood, that were non-susceptible to penicillin, macrolides and quinolones, and percent of H. in uenzae and H. parain uenzae that were non-susceptible to quinolones. The common bacterial respiratory pathogens H. in uenzae and S. pneumoniae were susceptible to amoxicillin-clavulanate(>99%). Less than 5% of S. pneumoniae isolates, from blood and all sites, were nonsusceptible to penicillin and quinolones. Note the macrolide resistance in S. pneumoniae isolates.
6 COMMON URINARY TRACT PATHOGENS E. coli remains the commonest cause of community-acquired urinary tract infections in the province. 12 Percentage E.coli urinary isolates 1 8 6 4 2 ESBL posite Cipro oxacin S Nitrofurantoin S Fosfomycin S Ertapenem S 212 216 Figure 8: Percentage of Cipro oxacin susceptible and ESBL posite E. coli urinary isolates from 212 216. The percentage of cipro oxacin susceptible isolates have dropped to below 6% in 5 years, and the rate of ESBL positity, and therefore resistance to most betalactams and cephalosporins, has increased signi cantly from 17 to 26%. This is of concern as an increasing proportion of patients with communityacquired urinary tract infections may require parenteral antimicrobials. The high level of susceptibility to urinary antiseptics such as fosfomycin and nitrofurantoin make these agents suitable for the treatment of uncomplicated cystitis. Patients with suspected pyelonephritis, however, will require investigations such as urine for microscopy and culture, and/or admission for parenteral antimicrobials, as guided by antimicrobial susceptibility test results
7 ANTIBIOTIC GUIDELINES Trade names and route of administration GENERIC NAME Benzyl penicillin Procaine benzylpenicillin Benzathine penicillin Phenoxymethyl penicillin Amoxicillin Ampicillin Piperacillin Cloxacillin Amoxicillin/ ucloxacillin Amoxicillin clavulanate Piperacillin-Tazobactam Cefadroxil Cefalexin Cefalothin Cefazolin Cephadrine Cefamandole Cefoxitin Cefprozil Cefuroxine Cefpodoxine Ce xime Cefotaxime Ceftriaxone Ceftazidime Cefepime Cefpirome Ceftaroline TRADE NAMES PENCILLINS Novopen, Bio-pen Biocillin Penilente Betapen,Len V.K Amoxil, Betamox Petercillin,Ranamp Piperacillin Cloxin,Floxapen Suprapen,Macropen ß LACTAM - ß LACTAMASE INHIBITORS Augmentin Tazocin,Tazobax CEPHALOSPORINS 1ST GENERATION Dacef / Cipadur Belex Ke in Kefzol Cefril CEPHALOSPORINS 2ND GENERATION Mandokef Cefoxitin Prozef Zinnat/Zinacef CEPHALOSPORINS 3RD GENERATION Orelox Fixime Cefotaxime Rocephin Fortum CEPHALOSPORINS 4TH GENERATION Maxipime Cefrom CEPHALOSPORINS 5TH GENERATION Zinforo ROUTE OF ADMINISTRATION im, im im, im, im, po, im, po, im,, im, im, im,, im, im, im, im, im,
8 ANTIBIOTIC GUIDELINES Imipenem Meropenem Doripenem Ertapenem GENERIC NAME TRADE NAMES CARBAPENEMS Tienam Meronem Doribax Invanz ROUTE OF ADMINISTRATION im, Nalidixic acid Cipro oxacin Enoxacin Levo oxacin Lome oxacin Nor oxacin O oxacin Gemi oxacin Moxi oxacin Erythromycin Roxyithromycin Clarithromycin Azithromycin Telithromycin Tetracycline Doxycycline Minocycline Clindamycin Amikacin Gentamycin Teicoplanin Vancomycin QUINOLONES - 1ST GENERATION Wintomylon QUINOLONES - 2ND GENERATION Ciprobay Bactidron Tavanic Maxaquin Utin Tarid QUINOLONES - 3RD GENERATION Facte Avelon MACROLIDES/LINCOSAMIDES/KETOLIDE Ilosone Rulide Klacid Zithromax Ketek TETRACYCLINES Tetracyclines Doxycyl, Cyclidox Cyclimycin LINCOSAMIDES Dalacin AMINOGLYCOSIDES Amikacin Garamycin GLYCOPEPTIDES Targocid,Teicowin Vancocin po,,,,,.,, im, im, im, im, im,
9 ANTIBIOTIC GUIDELINES Metronidazole Cotrimoxazole Fusidic Acid Nitrofurantoin Colistin Aztreonam Linezolid Fosfomycin Daptomycin Amphotericin B Clotrimazole Fluconazole Griseofulvin Ketoconazole Itraconazole Voriconazole Posaconazole Caspofungin Anidulafungin Micafungin GENERIC NAME TRADE NAMES OTHER Flagyl Purbac/ Bactrim Fucidin Macrodantin Azactam Zyvoxid Urizone Cubicin ANTIFUNGALS Fungizone Canesten Di ucan Folan Nizoral Sporanox Vfend Noxa l Cancidas Eraxis Mycamine ROUTE OF ADMINISTRATION,,, po (troche),,
1 ANTIBIOTIC GUIDELINES Antibiotic dosages for upper respiratory tract infections A) Acute Pharyngotonsillitis Adults Paediatrics 1.Amoxicillin 2.If penicillin allergic: a) Azithromycin b) Clarithromycin 5-1mg twice daily, OR, 5mg/kg/day once daily (maximum 3mg) for 1 days 5 mg once daily for 3 days. 5 mg twice daily or 5 mg modi ed-release once daily for 1 days. 5mg/kg/d once daily (maximum 1 mg) for 1 days. 1-2 mg/kg/d once daily for 5 days. 15 mg/kg/d dided into 2 doses, for 1 days. B)AOM or ABRS Adults Paediatrics AOM(acute otitis media) and ABRS ( acute bronchial rhinosinusitis) 1.Amoxicillin 1 g 8 hourly for 5 days. 8-9 mg/kg/d dided into 2 doses. <2 years 7days >2 years 5days Amoxicillin-clavulanate 2 mg amoxicillin - 125 mg clavulanate 12 hourly for 5 days. 9 mg/kg/d Cefuroxime 1 mg 12 hourly for 5 days. 3 mg/kg/d dided into 2 doses. Cefpodoxime 4 mg 12 hourly for 5 days. 16 mg/kg/d dided into 2 doses. <2 years 7 days >2 years 5 days 2. If penicillin allergic: a) Azithromycin b) Clarithromycin c) Erythromycin estolate d) Levo oxacin e) Telithromycin f) Gemi oxacin g) Moxi oxacin 5 mg 12 hourly or 75 mg once daily for 5 days. 8 mg once daily for 5 days. 32 mg once daily for 5 days. 4 mg once daily for 5 days. 1 mg/kg once daily for 3 days. 15 3 mg/kg/d dided into 2 doses for 5 days. 4 mg/kg/d dided into 4 doses for 5 days. 2 mg/kg/d once daily or dided into 2 doses for 5 days. Adapted from: Brink A, et al. Updated recommendations for the management of upper respiratory tract infections in South Africa. S Afr Med J 215 1 REFERENCES 1. South African Medicines Formulary, 11 th Edition 2. Brink A, et al. Updated recommendations for the management of upper respiratory tract infections in South Africa. S Afr Med J 215; 15(5):345-352. DOI:1.7196/SAMJ.8716 3. Communicable diseases surveillance bulletin, Volume 13. No 1 April 215?! For further information please contact : Dr AKC Peer, Dr CN Govind or Dr K Moodley on 31 38 65
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