Respiratory

Lower Respiratory Tract Infection (Bacterial)

سینے کا انفیکشن

Bacterial chest infection with high fever and productive cough. Management depends on whether the cause is bacterial or viral.

ICD-10: —
Source: OPD handbook pp.28–31
Status: Draft

Not yet reviewed by a clinician. Check doses and brands against current national guidelines before use.

Symptoms

Fever: high grade, with rigors and chills
Cough: dry suggests viral, productive suggests bacterial

Diagnosis

Take vitals: tachycardia, temperature about 102 °F
Chest examination: crepitations (may be more prominent in paediatrics)
Investigations: CBC (raised WBC; predominantly neutrophils in bacterial infection)
Investigations: chest X-ray (lobar pneumonia / interstitial pattern)

Treatment

Step 1 of 4

1. Antibiotics

Prescription

LevofloxacinFluoroquinolone antibiotic

Dose250 mg BD (1+1)

Brand L-Cyn / Leflox / Efflox

Also sold as L-Cyn, Leflox, Efflox (spelling unclear in book), Levo

Cefixime3rd-generation cephalosporin

Dose400 mg OD

Brand Caricef / Mixel / Tixomer

Also sold as Cefspan, Cefim, Caricef, Tixomer, Cefiget

Rising resistance in Salmonella Typhi; not reliable as a sole agent in XDR typhoid.

Amoxicillin + Clavulanic acidPenicillin antibiotic + β-lactamase inhibitor

Dose625 mg TDS

Brand Augmentin

Also sold as Augmentin, Co-Amoxiclave, Calamox

Caution: Penicillin allergy; Cholestatic jaundice risk with prolonged use

MoxifloxacinFluoroquinolone antibiotic

Dose400 mg OD

Brand Mofest / Moxef

Also sold as Mofest, Moxef, Avelox, Moxiget

Ceftriaxone3rd-generation cephalosporin

Dose1 g BD (injectable)

Brand Inj Dayline 1 g / Inj Oxidil 1 g

Also sold as Rocephin, Dayline, Oxidil

Resistance is widespread in Salmonella Typhi in Sindh and Punjab; use culture guidance.

Step 2 of 4

2. Fever and pain (NSAIDs)

Prescription

Paracetamol (Acetaminophen)Analgesic / antipyretic

Dose2 tabs TDS

Brand Panadol

Also sold as Panadol, Calpol, Febrol, Pedrol, Calpol 6 Plus (250 mg/5 mL)

Caution: Do not exceed 4 g/day in adults or 60 mg/kg/day in children; Avoid in severe liver disease

NimesulideNSAID

Dose100 mg BD

Brand Nims

Also sold as Nims, Nimusil

Paracetamol injectionAnalgesic / antipyretic

Dose1 g TDS

Brand Inj Provas

Step 3 of 4

3. Expectorants

Nebulization with normal saline QID

Prescription

Normal saline nebulization (0.9%)Nebulization / mucolytic support

DoseNebulization with N/S QID

Brands Generic / hospital supply

Terbutaline (expectorant/bronchodilator syrup)Beta-2 agonist

Dose2 tsf TDS

Brand Syp Britanyl (alternates: Muconyl, Bricanyl)

Also sold as Britanyl, Bricanyl, Muconyl

Step 4 of 4

4. Supportive care

Steam inhalation
Take soup, yakhni and eggs
Review after 2 days

Sample prescription from the book (patient details removed)

Adult male, 40 y, fever and cough with greenish sputum, rigors and chills; T 102 °F, pulse 130. Plan: CBC shows raised TLC with predominant neutrophils; CXR shows opacification. Rx: Tab L-Cyn 250 mg 1+1; Tab Nims 100 mg 1+1; Syp Britanyl 2+2+2; steam inhalation; soup, yakhni and eggs; review after 2 days.