ASOM= acute suppurative otitis media
কোন এন্টিবায়োটিক দিবেন, এই কনসেপ্ট ক্লিয়ার করার আগে জেনে নিই,
ASOM এর causative organism কি কি?
ASOM সহ প্রায় সব ENT infection হয় নিম্নের ব্যক্টেরিয়া গুলি দিয়ে…
1.. Beta hemolytic streptococcus ( gram positive)
2… H. Influenza (gram negative)
3…Moraxella (gram negative)
প্রথম দুইটা ব্যাকটেরিয়া দিয়েই >95% ASOM হয়,
তার মানে কি দাড়ালো?
ASOM গ্রাম পজিটিভ ও নেগেটিভ দুই ব্যাকটেরিয়া দিয়েই হতে পারে..
তাহলে আমাদের করনীয় কি?
এমন একটা এন্টিবায়োটিক দিতে হব্র,
যারা equal gram positive and negative coverage আছে
এবার আসি,
cephalosporin,
1st generation cephalosporin … Cephalexin = গ্রাম পজিটিভ কাভারেজ আছে অনেক বেশি তবে গ্রাম নেগেটিভ কাভারেজ খুব কম
1.Capsule:Cephalen 500 mg (AS A Cephalexin AS A First generation Cephalosporins)
Indications:-
Cephalexin is indicated for the treatment of the following infections when caused by susceptible organisms.
Respiratory tract infections: Acute and chronic bronchitis and infected bronchiectasis.
Genito-urinary tract infections: Acute and chronic nephritis, cystitis, urethritis and prostatitis, prophylaxis of recurrent urinary tract infections.
Skin and soft tissue infections: Caused by staphylococci and/or streptococci.
Ear, Nose and Throat infections: Otitis media, mastoiditis, sinusitis, follicular tonsillitis and pharyngitis.
Bone infections: Caused by staphylococci and/or P. mirabilis.
2nd Generation :Cefuroxime
equal গ্রাম পজিটিভ ও গ্রাম নেগেটিভ কাভারেজ, ASE Duitai.
Tablet:1.Cefotil plus 500mg +100 mg (AS a (Cefuroxime Axetil + Clavulanic Acid) AS A Second generation Cephalosporins.)
Indications:-
This combination is indicated for the treatment of infections caused by sensitive bacteria.
Pharyngitis/Tonsillitis caused by Streptococcus pyogenes.
Acute Bacterial Otitis Media caused by Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis (beta-lactamase producing strains) or Streptococcus pyogenes.
Acute bacterial maxillary sinusitis caused by Streptococcus pneumoniae or Haemophilus influenzae (non beta-lactamase producing strains)
Lower respiratory tract infections including pneumoniae, caused by Streptococcus pneumoniae, Haemophilus influenzae (including beta lactamase-producing strains), Klebsiella spp., Staphylococcus aureus (penicillinase- and non-penicillinase-producing strains), Streptococcus pyogenes, E. coli.
Acute bacterial exacerbation of chronic bronchitis and secondary bacterial infections of Acute bronchitis caused by Streptococcus pneumoniae, Haemophilus influenzae (beta-lactamase negative strains) or Haemophilus parainfluenzae (beta-lactamase negative strains).
Uncomplicated skin and skin-structure infections caused by Staphylococcus aureus (including beta-lactamase producing strains) or Streptococcus pyogenes.
Uncomplicated urinary tract infections caused by E.coli or Klebsiella pneumoniae.
Bone and Joint Infections caused by Staphylococcus aureus (penicillinase- and non-penicillinase-producing strains).
Uncomplicated Gonorrhoea caused by penicillinase-producing and non-penicillinase producing strains of Neisseria gonorrhoeae.
Early Lyme Disease (erythema migrans) caused by Borrelia burgdorferi.
Septicemia caused by Staphylococcus aureus, Streptococcus pneumoniae, E.coli, Haemophilus influenzae (including ampicillin-resistant strains) & Klebsiella spp.
Meningitis caused by Streptococcus pneumoniae, Haemophilus influenzae (including ampicillin-resistant strains), Neisseria meningitidis & Staphylococcus aureus (penicillinase and non-penicillinase producing strains)
Switch therapy (Injectable to oral).
3rd GEN cephalosporin Cefixime
গ্রাম নেগেটিভ কাভারেজ অনেক বেশি, গ্রাম পজিটিভ কাভারেজ একবারি কম,
Capsule1:Afix 400mg (AS A Cefixime Trihydrate AS A Third generation Cephalosporins ).
Indications:-
Cefixime Trihydrate is an orally active cephalosporin antibiotic which has marked in-vitro bactericidal activity against a wide variety of Gram-positive and Gram-negative organism. It is indicated for the treatment of the following acute infections when caused by susceptible microorganisms.
Upper Respiratory Tract Infections (URTI): e.g. otitis media; and other URTI where the causative organism is known or suspected to be resistant to other commonly used antibiotics, or where treatment failure may carry significant risk. Lower Respiratory Tract Infections-e.g. bronchitis.
Urinary Tract Infections: e.g. cystitis, cystourethritis, pyelonephritis. Clinical efficacy has been demonstrated in infections caused by commonly occurring pathogens including Streptococcus pneumonia, Streptococcus pyogenes, Escherichia coli, Proteus mirabilis, Klebsiella species, Haemophilus influenzae (beta-lactamase positive and negative), Moraxella catarrhalis (beta-lactamase positive and negative) and Enterobacter species. Cefixime is highly stable in the presence of beta-lactamase enzymes.
যেহেতু আমরা equal gram positive coverage and gram negative coverage দেবো,
তাই Drug of choice.. Cefuroxime( AS A Second generation Cephalosporins.)/Amoxicillin AS A (Broad spectrum penicillins).
SO We will use Cefuroxime(AS A 2ND Generation Cephalosporins).
Tablet:1.Cefotil plus 500mg +100 mg (AS a (Cefuroxime Axetil + Clavulanic Acid) AS A Second generation Cephalosporins.)
OR Amoxicilline (AS A Broad Spectrum Penicillins).
Tablet4:Moxaclav 500mg+125 mg (AS A Amoxicillin + Clavulanic Acid) AS A Broad spectrum penicillins.
Indications:-
Co-amoxiclav is indicated for short-term treatment of bacterial infections at the following sites:
1.Upper respiratory tract infections (including ENT) e.g.2.tonsillitis,sinusitis,otitis media.
3.Lower respiratory tract infections e.g.acute and chronic bronchitis, lobar and bronchopneumonia.
4.Genito-urinary tract infections e.g.cystitis,urethritis,pyelonephritis.
5.Skin and soft tissue infections.
6.Bone and joint infections e.g.osteomyelitis.
7.Other infections e.g.septic abortion,puerperal sepsis,intra-abdominal sepsis etc.
Moxaclav এর গ্রাম পজিটিভ কাভারেজ আছে, আবার ৫ টা ব্যাকটেরিয়ার বিরুদ্ধে গ্রাম নেগেটিভ কাভারেজ ও দেয়, যার একটা হচ্ছে H.influenza
তাই Moxaclav ও দেওয়া যাবে,
Ciprofloxacin : এইটা 1st Generation fluroquinolone,
গ্রাম নেগেটিভ কাভারেজ আছে, তবে গ্রাম পজিটিভ কাভারেজ একবারি কম
তাই এইটা ENT infection এ ব্যবহার হয়না.
তাহলে এবার লিখে রাখুন-
Acute otitis media –
Rx- Supportive +Symptomatic +Antibiotics
Cefuroxime 250 mg BD (Twice a day) 1+0+1 AM.
(moderate to severe infection হলে 500 mg BD)
Tablet:1.Cefotil plus 500mg +100 mg (AS a (Cefuroxime Axetil + Clavulanic Acid) AS A Second generation Cephalosporins.)
অথবা – Moxaclav 625 mg TDS
Tablet:1.Moxaclav (500mg+125mg) 1+1+1 TDS.(Sever case ).
Tonsillitis — Same Rx.
Tablet:1.Cefotil plus 500mg +100 mg (AS a (Cefuroxime Axetil + Clavulanic Acid) AS A Second generation Cephalosporins.)
OR Tablet 1.Moxaclav(500mg+125mg) 1+1+1 TDS.
Cefuroxime 250 mg BD (Twice a day) 1+0+1 AM.
(moderate to severe infection হলে 500 mg BD)
Tablet:1.Cefotil plus 500mg +100 mg (AS a (Cefuroxime Axetil + Clavulanic Acid) AS A Second generation Cephalosporins.)
অথবা – Moxaclav 625 mg TDS
Tablet:1.Moxaclav (500mg+125mg) 1+1+1 TDS.(Sever case ).
Sinusitis — Same Rx.
Cefuroxime 250 mg BD (Twice a day) 1+0+1 AM.
Tablet:1.Cefotil plus 500mg +100 mg (AS a (Cefuroxime Axetil + Clavulanic Acid) AS A Second generation Cephalosporins.)
(moderate to severe infection হলে 500 mg BD)
OR Tablet 1.Tablet:1.Moxaclav (500mg+125mg) 1+1+1 TDS.(Sever case ).
Supportive কি দিবেন?
Paracetamol +Antihistamine etc
TABLET 1.NAPA Extra 500mg 1+0+1 AFM
tablet2: Fexo 60 mg 1+0+1 AFM.
General Quaries:-
1.Cefuroxime kkhn 500 r kkhn 250 dibo ?
Answer is:
mild infection, hole tokhon 250mg 2 bela
1+0+1 Am.
Severe infection :500
1+0+1 Or 1+1+1 Sever case applied.
For example –
Uncomplicated UTI : mild stage e used hoi 250mg 1+0+1
Abar Complicated UTI : sever stage 500 mg used hoi 1+0+1 OR 1+1+1 AFM.
2.cefuroxim er sathe ki clavulonic acid er dorkar ase?
Answer is:dorkar ni but Dile problem o ni.
3.Sir, clarithromycin এর রোল আছে এক্ষেত্রে?
Answer is: Jodi atypical infection hoi Tobe
Atypical infection এর জন্য দেওয়া যায় ওইটা,
যেমন Mycoplasma pneumonia.
Raiyyan Tahsan Date:-19-01-2025 Sunday Time:-9-12-2025
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