Lower respiratory tract infection medical therapy
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Differentiating Lower respiratory tract infection from other Diseases |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
Medicall Therapy
Non-Pharmacological Treatments
The main stay of non pharmacological treatment for many years has been rest and increased fluid intake. Although it is common for doctors and other health professional to recommend extra fluid intake a Cochrane systematic review could find no evidence for or against increased fluid intake. Although the idea of replacing fluids lost through fever and rapid breathing was sound, some observational studies reported harmful effects such as dilution of blood sodium concentration leading to headache, confusion or possibly seizures. Rest will allow the body to conserve energy to fight off the infection. Physiotherapy is indicated in some types of pneumonia and should be encouraged where appropriate.
Antibiotic Choice
With increased development of drug resistance, traditional empirical treatments are becoming less effective, hence it is important to base antibiotic choice on isolated bacteria and sensitivity tests. According to the Cochrane review of antibiotic use in CAP in adults, the current evidence from RCTs is insufficient in order to make evidenced based decisions on the antibiotic of choice. Further studies are required to make these decisions. For children they found amoxicillin or procaine penicillin to have greater effect than co-trimoxazole for the treatment of CAP. In hospital settings, penicillin and gentamycin was found to be more effective than chloramphenicol, with oral amoxicillin giving similar results to injectable penicillins. In another review of children with severe pneumonia oral antibiotics were found to be as effective as injectable ones without the side effects of pain risk of infection and high cost. Also in a Cochrane review azithromycin has been shown to be no better than Amoxycillin or Amoxycillin with clavulanic acid in the treatment of lower respiratory infections. The AMH list Amoxycillin as first line of AECB and community acquired pneumonia where as IV azithromycin is first line if high risk of death. If severe hospital acquired pneumonia it recommends IV gentamicin and ticarcillin with clavulanic acid.