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Lower Respiratory Tract Infection

The lower respiratory tract is located beneath the vocal cords. Lower respiratory tract infection is always referred to pneumonia but it can also refer to other illnesses like acute bronchitis and lung abscess. Symptoms include weakness, shortness of breath, coughing, high fever and fatigue.

Infection in the lower respiratory tract is far more serious than upper respiratory tract infection. There are different diseases associated with lower respiratory tract. The first line treatment for this infection is antibiotics but these are not prescribed for viral infections. It is important to have the right kind of medication based on the bacteria involved to ensure treatment success and to avoid bacterial resistance. M. catarrhalis and haemophilus influenzae are thought to be common in both chronic bronchitis exacerbation and community-acquired pneumonia.

Classification

· Bronchitis

Lower Respiratory Tract InfectionBronchitis is classified as either acute or chronic. Acute bronchitis is an acute viral or bacterial infection of the large airways in people who are healthy without recurrent disease history. Viral infection is mostly the cause therefore, antibiotic use is not indicated. Some use antibiotics as treatment for viral bronchitis but its effects are not that beneficial compared to the side effects it may exhibit such as increased resistance, nausea and vomiting, and cost of treatment. Beta 2 agonist is sometimes used to relieve cough in acute bronchitis.

· Pneumonia

Pneumonia occurs in different situations and the treatment depends on the severity. It is classified as community-acquired or hospital-acquired depending on where the patient has acquired the infection. Pneumonia is life-threatening especially to immunocompromised and elderly patients. It is treated with antibiotics. Pneumococcal bacteria like Streptococcus pneumoniae are the common cause of pneumonia which accounts to 2/3 of the cases. It is a dangerous type of infection with over 25% of mortality rate. Treatment and management include causative-agent identification, pain relievers for chest pain, oxygen, physiotherapy, bronchodilators, and hydration. The patient should be assessed for complications like lung abscess and emphysema.

Antibiotic of Choice

It is important to base the antibiotic of choice on the sensitivity test and isolated bacteria because of increasing bacteria resistant to antibiotics and traditional treatments are now becoming less effective.

In children, procaine penicillin and amoxicillin are found to have greater effect compared to cotrimoxazole for community-acquired pneumonia. In hospitals, penicillin and gentamicin are found to be effective than chloramphenicol. Oral amoxicillin has similar results with penicillins that are injectable. In children with severe pneumonia, oral antibiotics are as effective with injectible once without the need to experience injection pain, high cost and risk for infection. Amoxicillin is the first line drug for community acquired pneumonia while intravenous azithromycin is the first line drug if there is a risk of death. Ticarcillin and gentamicin with clavunalic acid is given intravenously in severe cases of hospital acquired pneumonia.

Non-Pharmalogical Treatment

Increased fluid intake is usually advised by doctors to patients having lower respiratory tract infection. Also, rest will allow conservation of energy, for the body to fight infection. In some types of pneumonia, physiotherapy is indicated if appropriate.

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