Category Respiratory

Do we need to cover ‘atypical’ community acquired pneumonia?

Guest posting: Dr John Burston, Staff Specialist, Infectious Diseases, Calvary Mater Hospital, Newcastle.  Most antibiotic guidelines1-3 , including the HNELHD Community Acquired Pneumonia (CAP) guideline, suggest empirically treating community acquired pneumonia (CAP) with a macrolide or tetracycline to cover ‘atypical’ organisms. But is this necessary and what should be our approach?  Beta-lactam monotherapy was non-inferior […]

Antibiotic gel for acute otitis media – quo vadis?

Chemical engineers at Boston’s Laboratory for Biomaterials have created a single-application bioengineered gel that could deliver a full course of antibiotic therapy for paediatric middle ear infections. While current Australian guidelines state that the vast majority of children do not need antibiotics for otitis media, the gel is claimed to offer hard-to-treat cases a “safer […]

Acute otitis media- clarifying the role of antibiotics – a new case study from NPS-MedicineWise

National Case Study – Otitis Media: Clarifying the role of antibiotics – this was released by NPS-MedicineWise in May 2016. The expert commentary is provided by Prof. Chris Del Mar. The case study is customised for the profession of the participant: GP, Pharmacist, Nurse or ‘other’. Other case studies of interest from NPS:  Urinary tract infections: […]

Acute sinusitis and sore throat in primary care – what evidence?

An excellent paper by Professor Chris Del Mar in Australian Prescriber unpacks the Cochrane reviews on the (quite minimal) value of antimicrobial treatment of these conditions.  The evidence level is quite robust.  For a summary, see below. It couples nicely with a recent pragmatic randomized controlled trial that examined the  effectiveness of steam inhalation and nasal irrigation […]

Extrapolating antibiotic susceptibility for streptococci including the pneumococcus

This posting concerns betahaemolytic species of streptococci including S. pyogenes (Lancefield group A strep), S. agalactiae ((group B strep), S. dysgalactiae group (betahaemolytic large colony, groups C or G) (several species included) which are usually associated with pyogenic infection, especially of skin and soft tissue.   S. pneumoniae (the pneumococcus ) is also considered.  A key misunderstanding about […]

Pertussis questions from one of our general practitioners

An 8 year old child with a history of cough for 2 weeks +.  The GP tested the child by throat swab and PCR which was positive. A 7 day course of erythromycin was prescribed.  Reviewed then and patient complaining that the cough worsening. Q & A : The cough is worsening – does he […]

Childhood pneumonia and its prevention (World pneumonia day yesterday!)

Learn about Pneumonia: Facts, Figures and What You Can Do  [link fixed]  Pneumonia Innovation Summit proceedings 2015 Preventing Pneumonia – CDC resource (USA): in the USA, pcv-13 vaccine is used initially to optimise the immunogenicity of subsequent 23-valent polysaccharide vaccine dose (Australia does not currently recommend this approach – repeat doses, 5 years apart to a maximum of […]

Is penicillin enough for aspiration pneumonia?

There has been quite a tradition for including Gram negative anaerobic cover for patients suspected to have aspiration pneumonia. There are virtually no randomised trials that directly address the issue with nearly all such trials including agents that have Gram negative anaerobic cover across all treatment arms.   One exception was a small trial from 1997 in a paediatric […]

Human metapneumovirus causes severe pneumonia at any age

Further to another hMPV case managed in one of our intensive care units (an adult with acute COPD deterioration), I’m sharing this presentation concerning local experience with hMPV infections that also summarises current hMPV knowledge. Metapneumovirus presentation  2014 im id meeting.  Picture: acute severe pneumonia due to human Metapneumovirus infection in an 82 year old diabetic […]

Community Acquired Pneumonia – updated HNELHD Guideline

The updated Hunter New England guideline,  Adult Community Acquired Pneumonia: Initial Investigation and Empiric Antibiotic Therapy has now been released. Community acquired pneumonia (CAP) is a common cause of hospital admission, carrying a significant risk of morbidity and mortality.  Approximately 1/3 of patients require admission to hospital.  Streptococcus pneumoniae remains the commonest pathogen ( see here for […]