Canterbury DHB

Respiratory Tract Infections

Community-Acquired Pneumonia

Patients admitted with a community-acquired pneumonia should be treated with amoxicillin + clavulanic acid plus PO azithromycin 500 mg ONCE daily. (If known to have a penicillin allergy, use cefuroxime in place of amoxicillin+clavulanate.) If the pneumonia is severe, give IV clarithromycin, ceftriaxone, and gentamicin.

Note: Clarithromycin interacts with many drugs via inhibition of CYP3A including simvastatin, atorvastatin, many benzodiazepines, and the calcium channel blockers – check for possible interactions before prescribing.

See also:

• Augmentin®, clarithromycin, and cefuroxime Data Sheets on Medsafe
• CYP3A interaction in the Pink Book.

Upper Respiratory Viruses

Per Nasal Swab

A dry sterile cotton tip swab on a flexible wire stem is inserted into the nostril as far back as possible and allowed to remain in place for a few seconds. Slowly withdraw the swab with a rotating motion, then place it in viral culture medium and send it to the laboratory. Request a DFA (direct fluorescent antigen) for respiratory viruses on the laboratory form. For particularly high risk patients, discuss PCR for specific viruses with the microbiologist.

Ribavirin for RSV Infections

Ribavirin inhibits a wide range of DNA and RNA viruses, by disrupting viral protein synthesis. It is generally given by inhalation for the treatment of severe bronchiolitis caused by the respiratory syncytial virus (RSV). It may occasionally be administered intravenously for infection in sites other than the lungs. The inhaled form needs to be given with special equipment including a modified CPAP machine to reduce the small risk associated with it. Dr Geoff Shaw makes this available. The drug needs to be ordered by talking with the company in Sydney.

Oral ribavirin is unregistered in NZ, however it is available to named patients, and is usually used in combination with interferon for the treatment of viral hepatitis C.

Ribavirin is classed as a hazardous medication, and has teratogenic properties.

Administration Guidelines

CAUTION: Healthcare workers who are considering becoming pregnant, or who suspect or know they are pregnant, OR who are breast-feeding, should NOT administer Ribavirin. In addition, they should NOT enter the patient's room during administration of ribavirin by nebulisation.

• Charting: Ribavirin is charted on the QMR4 and is checked as per the hospital standards.
• Dose: 6 g (standard dose for inhalation regardless of size).

  The drug is nebulised over 18 hours (usually from 1600 – 1000 hrs).

The prescription and administration of this drug is given in the Ribavirin Data Sheet. These must be consulted. The Infectious Disease Service must also be involved.

Topic Code: 5018