The Effect of Cephalosporins in

the Treatment of Upper and

Lower Respiratory Tract
Infections.
OGELE A. Joseph
Upper Respiratory Tract Infections
Upper respiratory tract infections include:
common cold, pharyngitis, epiglottitis, and
laryngotracheitis
IOW, ENT infections and sinusitis
Etiologic agents associated with URI include
viruses, bacteria, Mycoplasma and fungi
 Common Cold
Caused by viruses
Symptoms include: classic symptoms of nasal
discharge and obstruction, sneezing, sore throat
and cough occur in both adults and children
sinusitis and otitis media may ensue
Fever rarely occur
 Common Cold contd
Diagnosis
Classical symptoms as basis
Esinophils absent in the nasal secretions
 Common Cold contd
Treatment
Symptomatic treatment
Decongestants
Antipyretics
Adequate fluid intake
Frequent hand washing
Restriction from activities to avoid infecting others
 Acute Sinusitis
results from infections of other sites of the
respiratory tract
since the paranasal sinuses are contiguous to, and
communicate with, the upper respiratory tract.
maxillary sinuses infection may follow dental
extractions or an extension of infection from the
roots of the upper teeth.
 Acute Sinusitis contd
Etiologic agents include Streptococcus
pneumoniae, Haemophilus influenzae, and
Moraxella catarrhalis
At times, Staphylococcus aureus, Streptococcus
pyogenes, gram-negative organisms and
anaerobes
Chronic sinusitis is often a mixed infections of
both aerobes an anaerobes
 Symptoms of Sinusitis
Pain, sensation of pressure and tenderness over
the affected sinus
Malaise and low grade fever
a purulent nasal discharge associated with
chronic sinusitis
 Treatment of Sinusitis
symptomatic treatment with analgesics and
moist heat over the affected sinus pain
decongestant to promote sinus drainage
a beta-lactamase resistant antibiotic such as
amoxicillin-clavulanate or a cephalosporin
may be used.
 otitis
Otitis externa Otitis media
Infection of external auditory Infection of the middle ear
canal Streptococcus pneumoniae,
skin flora such Hemophilus influenzae
as Staphylococcus epidermidis, beta-lactamase
Staphylococcus aureus, producing Moraxella catarrhalis
diphtheroids
follows an upper respiratory
Occassionaly caused by infection
anaerobic
organism, Propionibacterium Vigorous nose blowing during a
acnes common cold
 Otitis contd
Otitis externa
Pseudomonas aeruginosa
causes a necrotizing malignant
otitis externa
itching, pain and tenderness of
the ear lobe
Loss of hearing may be due to
obstruction of the ear canal by
swelling and the presence of
purulent debris.
Otitis media
sudden changes of air pressure,
and perforation of the
tympanic membrane
Purulent fluid accumulates
behind a tense, red tympanic
membrane
discharge externally after
rupture of the membrane
 Otitis contd
Malignant otitis externa tends to secretory otitis media and
occur in elderly diabetic patients
impaired hearing
persistent earache,
foul smelling purulent discharge
and the presence of granulation
tissue in the auditory canal
spread and lead to osteomyelitis
of the temporal bone
 Treament of Otitis
A combination of topical antibiotics such as
neomycin sulfate, polymyxin B sulfate and
corticosteroids used as eardrops preferred to tx
otitis externa
amoxicilline-clavulanate
2nd and 3rd gen cephalosporins
Cotrimoxazole
Tetracyclines and macrolides
Cephalosporins in the tx of Respiratory
Tract Infections
In general progression from 1st to 4th
generations is with
a the Gram N antibacterial activity,
a in the Gram positive
and enhanced resistance to beta lactamases
 Cephalexin

Used in respiratory-tract infections, otitis

media, sinusitis, and skin and soft-tissue
infections.
particularly recommended for the treatment of
UTI but it is also sometimes used for URTI
Used when infection is not responding to other
drugs or when in pregnancy
 Cephalexin contd
Doses:
CHILD 25 mg/kg daily in divided doses,
doubled for severe infections, max. 100 mg/kg daily;
or under 1 year 125 mg q12h,
15 years 125 mg q8h,
512 years 250 mg q8h.
Adult 250 mg q6h or 500 mg q812h increased to 1
1.5 g q68 hours for severe infections.
 Cefaclor
infections due to sensitive Gram-positive
and Gram-negative bacteria, respiratory-tract infections, otitis
media, sinusitis, and
skin and soft-tissue infections
the drug is recommended for the treatment of non life threatening
infection caused by H. influenza, particularly strains resistant to
other penicillins.
Very useful mainly in the tx of URTI (and also UTI not responding
to other drugs or when in pregnancy)
Dose:
 Cefaclor contd
CHILD over 1 month, 20 mg/kg daily in
3 divided doses, doubled for severe infections, max.1 g
daily; or
1 month1 year, 62.5 mg every 8 hours;
15 years, 125 mg; over 5 years, 250 mg; doses
doubled for severe infections
Adult 250 mg every 8 hours, doubled for severe
infections;max. 4 g daily.
 Cefadroxil
claimed to have advantage of prolonged
duration of action due to slow urinary
excretion
and so boast of once daily dosing
it has poor activity against H. influenzae
Used for UTI and URTI
 Cefadroxil contd.
Doses:
0.51 g twice daily; skin, soft-tissue, and
uncomplicated
urinary-tract infections, 1 g daily; CHILD 618
years, body-weight under 40 kg, 500 mg twice
daily; body-weight over 40 kg, adult dose
 Cefuroxime
Active against both Gram N and Gram Positive bacteria
active against beta lactamase producing organisms
such as E.coli, K.pneumonia, N. gonorrhea,and
H.infuenza.other
important Gram negative pathogens such as serratia,
indole-positive proteus spp,
P.aeruginosa and B. fragilis are resistant.
 Cefuroxime contd.
Used for both U LRTIs
Doses: cefuroxime sodium is dosed tds,
cefuroxime axetil is dosed bid.
CHILD over 3 months, 125 mg twice daily, if
necessary
Doubled in child over 2 years with otitis media
 Cefuroxime contd.
By mouth (as cefuroxime axetil), 250 mg twice
daily in most infections including mild to
moderate lower
respiratory-tract infections (e.g. bronchitis);
doubled for more severe lower respiratory-tract
infections or if pneumonia suspected
Urinary-tract infection, 125 mg twice daily,
doubled in pyelonephritis.
 Cefuroxime contd.
By intramuscular injection or intravenous
injection or infusion, 750 mg every 68 hours;
1.5 g every 68 hours in severe infections;
single doses over 750 mg intravenous route
only
 Cefpodoxime proxetil
spectrum of activity includes S. pneumonia, S.pyogenes,
S.aureus, H.influenza, M. catarrhalis, Neisseria spp.
also active against members of Enterobacteriaceae family,
including E.coli, K.pneumonia,and P. mirabilis.
tx of URTI and LRTI such as
pharyngitis,
bronchitis,
otitis media,
and community acquired pneumonia
 Doses: Upper respiratory-tract infections (but in
pharyngitis and tonsillitis reserved for infections which
are recurrent, chronic, or resistant to other
antibacterials), 100 mg twice daily (200 mg twice daily
in sinusitis);
CHILD 15 days6 months 4 mg/kg q12h
6months2 years 40 mg q12 h,
38 years 80 mg q12h, over 9 years 100 mg q12h.
 Cefpodoxime contd.
Lower respiratory-tract infections (including
bronchitis and pneumonia), 100200 mg twice
daily; CHILD 15days6 months 4 mg/kg q12h,
6 months2years 40 mg q12h,
38 years 80 mg q12h,
over 9 years 100 mg q12h
 cefixime
Cefixime has a longer duration of action than the other
cephalosporins that are active by mouth.
resistant to many beta lactamases
particularly effective against Gram N bacilli such as
E.coli, Klebsiela spp, P.mirabilis, indole positive
Proteus spp. and some Citrobacter spp.
active against Streptococci, Gonococci, H.influenza and
M.catarrhalis. used in the tx of URTI and LRTI and
otitis media.
 Cefixime contd.
Most Pseudomonas, Enterobacters and bacteroides are resistant.
So should combined with other drugs such as doxycycline in severe
U LRTIs
ADULT and CHILD over 10 years, 200400 mg daily in 12
divided doses;
CHILD over 6 months 8 mg/kg daily in 12 divided doses or
6 months1 year 75 mg daily;
14 years 100 mg daily;
510 years 200 mg daily
 Cefotaxime sodium
excellent broad spectrum of activity against
Gram positive and Gram negative aerobic and
anaerobic bacteria including beta lactamase
producing orgsm such as S.aureus,
H.influenza, N. gonorrhea, Klebsiela spp,
also active against Pseudomonas.
 Cefotaxime contd.
Doses: IV or IM, 1 g q12h increased in severe
infections (e.g. meningitis) to 8 g daily in 4 divided
doses; higher doses (up to 12 g daily in 34 divided
doses) may be required;
NEONATE 50 mg/kg daily in 24 divided doses
increased to 150200 mg/kg daily in severe infections;
CHILD 100150 mg/kgdaily in 24 divided doses
increased up to 200 mg/kg daily in very severe
infections
 Ceftazidime sodium
fortum 1g inj
excellent broad spectrum of activity against
Gram positive and Gram negative aerobic and
anaerobic bacteria including beta lactamase
producing orgsm such as S.aureus,
H.influenza, N. gonorrhea, Klebsiela spp,
good activity against Pseudomonas.
 Ceftazidime contd
Doses: 1 g every 8 hours or 2 g 12qh; 2 g q812h
or 3 g q12h in severe infections; single doses over
1 g intravenous route only.
Pseudomonal lung infection in cystic fibrosis,
ADULT 100150 mg/kg daily in 3 divided doses;
CHILD up to 150 mg/kg daily (max. 6 g daily) in
3 divided doses;
intravenous route recommended for children.
 ceftriaxone
possesses excellent activity against Gram positive and
Gram negative aerobic and anaerobic bacteria including
beta lactamase producing orgsm such as S.aureus,
H.influenza, N. gonorrhea, Klebsiela spp,
and also Pseudomonas but generally less active than
cefotaxime against Gram positive bacteria and
B.fragilis.
once daily dosing.
 1 g daily; 24 g daily in severe infections;
intramuscular doses over 1 g divided between more than one site;
single intravenous doses above 1 g by intravenous infusion only
NEONATE, by intravenous infusion over 60 minutes, 2050 mg/kg
daily (max. 50 mg/kg daily);
INFANT and CHILD under 50 kg, by deep intramuscular injection,
or by intravenous injection over 24 minutes, or by intravenous
infusion, 2050 mg/kg daily; up to 80 mg/kg daily in severe
infections; doses of 50 mg/kg and over by intravenous infusion only;
50 kg and over, adult dose
 summary
Cephalosporins are very effective in the tx of
URTI and LRTIs
They have no activity against Listeria,
Mycoplasma, Chlamydia, MRSA and
Enterococci
There4 they cannot be solely used in RTI
involving the above named orgnsms.
 Summary contd
If MRSA is suspected, vancomycin can be
combined with cefotaxime
If Mycoplasma or Chlamydia is suspected,
doxycycline can be added.
Fluoroquinolone can be added if resistant
Pseudomonas is suspected.