Amoxicillin meaning

The diagnosis is made by the presence of pain and fever, with redness and bulging of the tympanic membrane that fails to respond to positive air pressure. Pneumococcal mastoiditis has been only a rare complication of otitis media in the antibiotic era. Acute purulent sinusitis is caused by the same organisms as acute otitis media; thus, S. The pathogenesis of infection is also similar, with a prominent predisposing role for congestion of the mucosal membranes. Accumulation of fluid in the paranasal sinus cavities, even during simple colds, provides a medium for bacterial proliferation and subsequent infection.

This condition has been shown to be greatly overdiagnosed.

Often the condition is biphasic, with an initial upper respiratory infection that appears to be viral, followed by a worsening, with the appearance of purulent secretions, malaise, fever, tenderness over one or more sinuses and or pain in a tooth.

Diagnosis depends upon these clinical features; computed tomography scans of sinuses regularly show fluid in patients who have harmless, presumably viral upper respiratory infections without symptoms of sinusitis, so this finding does not indicate the presence of bacterial sinusitis. In persons who do not have chronic underlying bronchopulmonary disease, acute bronchitis is amoxicillin 250mg for child thought to be nearly always due to viral infection. Acute exacerbations of bronchitis in patients with chronic bronchitis, asthma, or obstructive lung disease may be caused by S. A clinically recognizable exacerbation of the chronic disease is highly associated with acquisition of a new pneumococcal strain.

Pneumonia results when nonimmunologic and immunologic mechanisms fail to prevent access of pneumococci to the alveoli and their subsequent replication. Most patients who develop pneumococcal pneumonia have one or more of the predisposing conditions that are summarized above, such as a preceding viral respiratory infection, cigarette smoking, chronic obstructive pulmonary disease, alcohol abuse, neurological disease (cerebrovascular accidents, seizures, and dementia), malignancy, liver disease (hepatitis and/or cirrhosis), congestive heart failure, diabetes mellitus, or HIV infection.

Cough, fatigue, fever, chills, sweats, and shortness of breath are the most frequent symptoms of pneumonia; these are all more prominent in younger

than

Elderly patients may have only a slight temperature elevation or be afebrile but are more likely to have an elevated respiratory rate.

The sudden onset of shaking chills followed by the appearance of cough and rusty sputum has been called a “classical presentation” of pneumococcal pneumonia, but is uncommon. Occasionally reveals diminished respiratory excursion on the affected side. Increased fremitus is often overlooked but is very useful in diagnosing pneumonia. Dullness to percussion is present in approximately 50% of cases. Crackles on careful auscultation are heard in nearly all cases but, in patients with chronic lung disease, it is often difficult to be certain that such sounds signify the presence of pneumonia. Bronchial or tubular breath sounds may be heard if consolidation is present. Flatness to percussion at the lung base and an inability to detect the expected degree of diaphragmatic motion with deep inspiration suggest the presence of pleural fluid. Unless all the vital

signs

The finding of a heart murmur raises concern about endocarditis, a rare but serious complication.

Confusion, obtundation, or particularly neck stiffness suggest the presence of meningitis.

In most cases of pneumococcal pneumonia, chest radiography reveals: An area of infiltration involving one or more segments within a single lobe. Airspace consolidation is detected radiographically in most cases, and is more frequent in bacteremic cases.

An air bronchogram, which reflects especially dense air-space consolidation, highly correlates with bacteremia.

Computed tomography may reveal cavitation in 6 to 7% of cases, but this finding does not alter the prognosis. A thick-walled lung abscess is distinctly rare, and its finding raises the likelihood of

other

The majority of patients have leukocytosis (a white blood cell count [WBC] of >12,000/mm 3 ), But 25% may have normal WBC counts, at least at the time of admission. A WBC count less than 6,000/mm 3 occurs in 5 to 10% of persons hospitalized for pneumococcal pneumonia and indicates a very poor prognosis. A low serum albumin level may reflect malnutrition—and therefore indicates a predisposing condition, or may appear as a manifestation of sepsis. Serum bilirubin may be increased to 3 to 4mg/dL; the pathogenesis of this abnormality is multifactorial, with hypoxia, hepatic inflammation, and breakdown of red blood cells in the lung all thought to contribute. Complications.Empyema, the most common infectious complication of pneumococcal pneumonia, occurs in approximately 2% of cases.

Persistence of fever, even if only low grade, and leukocytosis after 4 to 5 days of appropriate antibiotic treatment of pneumococcal pneumonia is suggestive of empyema, and this diagnosis is even more likely if the radiograph shows persistence of any pleural fluid. Under such conditions, attempts should be undertaken to drain the fluid completely.

(As a general matter, drainage is indicated if pleural fluid is present at the time of diagnosis of pneumococcal pneumonia.) The presence of frank pus in the pleural space, a positive Gram stain or fluid with a pH of less than or equal to 7.1 is an indication for aggressive and complete drainage with repeated needle aspiration or prompt insertion of a chest tube.

If no response is seen, immediate removal of infected material by pleuroscopy or open thoracotomy is then indicated. Acute cardiac events have recently been recognized as important noninfectious complications of pneumococcal

pneumonia

In a recently reported series, of 170 veterans hospitalized for this disease: 33 (19.4%) had at least one major cardiac complication including: 12 (7%) with acute myocardial infarction (of whom two also had arrhythmia and five had new-onset or worsening congestive heart

failure

Eight (5%) with new-onset atrial fibrillation or ventricular tachycardia that was transient in every case. 13 (8%) with newly diagnosed or worsening CHF, without myocardial infarction or new arrhythmias. Mechanisms for these cardiac events include: (1) increased local inflammatory response in vulnerable plaques in coronary arteries; (2) decreased oxygen supply because of ventilation/perfusion mismatch; and (3) increased cardiac demand related to fever and shunting. pneumoniae is the most common cause of sporadic bacterial meningitis. No distinctive clinical or laboratory features of pneumococcal meningitis enable the physician to suspect S. Headache, fever, and stiff neck or neck pain predominate.

A clouded sensorium reflects the involvement of the superficial cortex by the inflammatory process. A spinal tap should be done urgently, without even delaying for a computed tomography scan of the head if no localizing signs are present on neurological examination.