annual surveillance report & antibiotic guide · novopen, bio-pen biocillin penilente...

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Annual Surveillance Report & Antibiotic GuideFamily Practitioners | 2017

CONTENTS01

02

02

04

06

07

07

10

RESPIRATORY TRACT PATHOGENS

Bacterial

Viral

COMMON URINARY TRACT PATHOGENS

ANTIBIOTIC GUIDELINES

Trade names and route of administration

REFERENCES

10Antibiotic dosages for upper respiratory tract infections

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.

Disclaimer

RESPIRATORY TRACT PATHOGENS02

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 2016.

Viral

Figure 6a: Respiratory viruses plus Mycoplasma pneumoniae as detected on polymerase chain reaction (PCR) for 2016. · 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 conjunctivitis and pharyngitis to pneumonia and life- threatening systemic infections. It is present at consistent levels throughout the year.

Rhino

viru

s

RSV

M. p

neum

oniae

Adeno

viru

s

Influ

enza

A

PIV (1

-4)

Influ

enza

B

Oth

er (P

arec

hoviru

s an

d Boc

aviru

s)

hMPV

Enter

oviru

s

hCoV

(Oc4

3, 2

29E, N

l63,

HKU

1)

0

100

200

300

400

500

600

700

800

900 856

753

517

453

375 370

254 254224 223

190

Num

ber

of

po

siti

ves

on

PC

R


Figure 6b: Seasonal distribution of respiratory viruses in 2016 (PCR). · was detected throughout the year, but infections peaked over February-April. RSV A second smaller peak was noted over November-December 2016. This second peak falls outside the period over which palivizumab (Synergis®) is usually given to premature infants for the prevention of RSV infection. · The season was prolonged in 2016 and atypical in that the initial peak in�uenza 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.

Jan-

16

Feb-1

6

Mar

-16

Apr-16

May

-16

Jun-

16

Jul-1

6

Aug-1

6

Sep-1

6

Oct-1

6

Nov-1

6

Dec-1

60

50

100

150

200

250

300

350

400

Num

ber

of

po

siti

ves

on

PC

R

In�uenza A In�uenza B Rhinovirus RSV Adenovirus


Bacterial

Figure 7a: Streptococcus pneumoniae, Haemophilus parain�uenzae and Haemophilus in�uenzae in 2016. · 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.

Figure 7b: Specimen source distribution of Streptococcus pneumoniae, Haemophilus parain�uenzae and Haemophilus in�uenzae isolates in 2016. · The predominant specimen type was sputum/endotracheal aspirates. · Twenty-four percent of S. pneumoniae isolates were from . blood cultures

277288302

8051059

1105

828873

1072

2014 2015 2016

0 200 400 600 800 1000 1200

Number of isolates

S. PNEUMONIAE

H. PARAINFLUENZAE

H. INFLUENZAE

619

49

59

98

2

00

0

10

85

224

0 20 40 60 80 100 120

STREPTOCOCCUS PNEUMONIAE

HAEMOPHILUS PARAINFLUENZAE

HAEMOPHILUS INFLUENZAE

BLD CSF LRT ENT OTHER


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 non- susceptible to penicillin and quinolones. · Note the macrolide resistance in S. pneumoniae isolates.

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

0 5 10 15 20 25 30 35 40 45Percent non-susceptible isolates

2014 2015 2016

E. coli remains the commonest cause of community-acquired urinary tract infections in the province.

Figure 8: Percentage of Cipro�oxacin susceptible and ESBL positive E. coli urinary isolates from 2012 � 2016.

· The percentage of cipro�oxacin susceptible isolates have dropped to below 60% in 5 years, and the rate of ESBL positivity, and therefore resistance to most beta- lactams and cephalosporins, has increased signi�cantly from 17 to 26%. · This is of concern as an increasing proportion of patients with community- acquired 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

COMMON URINARY TRACT PATHOGENS06

Ertapenem SFosfomycin SNitrofurantoin SCipro�oxacin SESBL positive

Per

cen

tag

e E

.col

i uri

nar

y is

olat

es

0

20

40

60

80

100

120

2012 2016

ANTIBIOTIC GUIDELINES 07

Trade names and route of administration

Benzyl penicillin Procaine benzylpenicillin Benzathine penicillin Phenoxymethyl penicillin Amoxicillin Ampicillin Piperacillin Cloxacillin Amoxicillin/�ucloxacillin

GENERIC NAME TRADE NAMES ROUTE OF ADMINISTRATION

PENCILLINS

Novopen, Bio-pen Biocillin Penilente Betapen,Len V.K Amoxil, Betamox Petercillin,Ranamp Piperacillin Cloxin,Floxapen Suprapen,Macropen

im, iv im im p.o p.o p.o, im, iv im, iv po, im, iv po

Amoxicillin clavulanate Piperacillin-Tazobactam

ß LACTAM - ß LACTAMASE INHIBITORS

Augmentin Tazocin,Tazobax

p.o, iv iv

Cefadroxil Cefalexin Cefalothin Cefazolin Cephadrine

CEPHALOSPORINS 1ST GENERATION

Dacef / Cipadur Belex Ke�in Kefzol Cefril

p.o p.o iv im, iv p.o, im, iv

CEPHALOSPORINS 2ND GENERATION

Cefamandole Cefoxitin Cefprozil Cefuroxine

Mandokef Cefoxitin ProzefZinnat/Zinacef

im, iv im, iv p.op.o, im, iv

CEPHALOSPORINS 3RD GENERATION

Cefpodoxine Ce�xime Cefotaxime Ceftriaxone Ceftazidime

Orelox Fixime Cefotaxime Rocephin Fortum

p.o p.o im, iv im, iv im, iv

Cefepime Cefpirome

Maxipime Cefrom

im,iv iv

CEPHALOSPORINS 4TH GENERATION

Zinforo iv

CEPHALOSPORINS 5TH GENERATION

Ceftaroline


Imipenem Meropenem Doripenem Ertapenem


CARBAPENEMS

Tienam Meronem Doribax Invanz

iv iv iv im, iv

Wintomylon po

QUINOLONES - 1ST GENERATION

Nalidixic acid

Cipro�oxacin Enoxacin Levo�oxacin Lome�oxacin Nor�oxacin O�oxacin

QUINOLONES - 2ND GENERATION

Ciprobay Bactidron Tavanic Maxaquin Utin Tarivid

p.o, iv p.o p.o, iv p.o p.o p.o, iv

Gemi�oxacin Moxi�oxacin

QUINOLONES - 3RD GENERATION

Factive Avelon

p.o p.o, iv

Erythromycin Roxyithromycin Clarithromycin Azithromycin Telithromycin

MACROLIDES/LINCOSAMIDES/KETOLIDE

Ilosone Rulide Klacid Zithromax Ketek

p.o, iv p.o p.o.iv p.o, iv p.o

Tetracycline Doxycycline Minocycline

TETRACYCLINES

Tetracyclines Doxycyl, Cyclidox Cyclimycin

p.o p.o p.o

Dalacin p.o, im, iv

LINCOSAMIDES

Clindamycin

Amikacin Gentamycin

AMINOGLYCOSIDES

Amikacin Garamycin

im, iv im, iv

Teicoplanin Vancomycin

GLYCOPEPTIDES

Targocid,Teicowin Vancocin

im, iv im, iv


Metronidazole Cotrimoxazole Fusidic Acid Nitrofurantoin Colistin Aztreonam Linezolid Fosfomycin Daptomycin


OTHER

Flagyl Purbac/ Bactrim Fucidin Macrodantin Azactam Zyvoxid Urizone Cubicin

p.o, iv p.o, iv p.o, iv p.o iv iv iv po

Amphotericin B Clotrimazole Fluconazole Griseofulvin Ketoconazole Itraconazole Voriconazole Posaconazole Caspofungin AnidulafunginMicafungin

ANTIFUNGALS

Fungizone Canesten Di�ucan Folan Nizoral Sporanox Vfend Noxa�l Cancidas Eraxis Mycamine

iv p.o (troche) p.o, iv p.o p.o p.o p.o, iv p.o iv iviv

A) Acute Pharyngotonsillitis Adults Paediatrics

1.Amoxicillin 500 - 1000mg twice daily, OR, 50mg/kg/day once daily (maximum 3000mg) for 10 days

50mg/kg/d once daily (maximum 1000 mg) for 10 days.

2.If penicillin allergic: a) Azithromycin b) Clarithromycin

500 mg once daily for 3 days.

500 mg twice daily or 500 mg modi�ed-release once daily for 10 days.

10 - 20 mg/kg/d once daily for 5 days. 15 mg/kg/d divided into 2 doses, for 10 days.

Antibiotic dosages for upper respiratory tract infections

B)AOM or ABRS Adults Paediatrics

1.Amoxicillin 1 g 8 hourly for 5 days. 80 - 90 mg/kg/d divided into 2 doses. <2 years 7days >2 years 5days

Amoxicillin-clavulanate 2000 mg amoxicillin - 125 mg clavulanate 12 hourly for 5 days.

90 mg/kg/d

Cefuroxime 1000 mg 12 hourly for 5 days. 30 mg/kg/d divided into 2 doses.

Cefpodoxime 400 mg 12 hourly for 5 days. 16 mg/kg/d divided 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

500 mg 12 hourly or 750 mg once daily for 5 days. 800 mg once daily for 5 days. 320 mg once daily for 5 days. 400 mg once daily for 5 days.

10 mg/kg once daily for 3 days. 15 � 30 mg/kg/d divided into 2 doses for 5 days. 40 mg/kg/d divided into 4 doses for 5 days. 20 mg/kg/d once daily or divided 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 2015


REFERENCES 101. 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 2015; 105(5):345-352. DOI:10.7196/SAMJ.8716 3. Communicable diseases surveillance bulletin, Volume 13. No 1 April 2015

? ! For further information please contact : Dr AKC Peer, Dr CN Govind or Dr K Moodley on 031 308 6500

AOM(acute otitis media) and ABRS ( acute bronchial rhinosinusitis)

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