TASK №12

Diagnosis: Outpatient pneumonia of the lower lobe of the right lung.

Per os
Tab. Amoxicillini 500 mg
1 tabl. 3 times a day.
Tab. Ambroxoli 30mg
1 tabl. 3 times a day.
Parenterally
Sol. Cefotaximi 1g 2 times a day i/m.
Sol. Gentamicini 80 mg 2 times a day
i/v.

Questions:
1. Are the indicated dose, route of administration correct?

Antibiotic therapy is the mainstay of treatment. Appropriate treatment

involves starting empiric antibiotics as soon as possible, preferably ≤8 hours
after presentation. Because organisms are difficult to identify, the empiric
antibiotic regimen is selected based on likely pathogens and severity of
illness.

For outpatient treatment, treatments are dictated by age:

< 5 years: Amoxicillin or amoxicillin/clavulanate is usually the drug of choice. If

epidemiology suggests an atypical pathogen as the cause and clinical findings are
compatible, a macrolide (eg, azithromycin, clarithromycin) can be used instead.
Some experts suggest not using antibiotics if clinical features strongly suggest viral
pneumonia.

≥ 5 years: Amoxicillin or (particularly if an atypical pathogen cannot be excluded)

amoxicillin plus a macrolide. Amoxicillin/clavulanate is an alternative. If the cause
appears to be an atypical pathogen, a macrolide alone can be used.

Recommendations for outpatient CAP treatment in adults may be structured as

follows.

1. Pneumonia suggestive of pneumococcal etiology in young patients without

underlying diseases:

Oral amoxicillin 1 g tid, for 10 days (A-I).

In cases of allergy to betalactams or therapeutic failure: oral moxifloxacin (400

mg q24h) or oral levofloxacin (500 mg q24h) for 7 to 10 days.

When there is no etiological suspicion, an agent active against pneumococcus

should be used. In this case the antimicrobials recommended include:
Amoxicillin (1 g tid) plus a macrolide, both orally, 10 days.

Moxifloxacin (400 mg q24h) or levofloxacin (400 mg q24h), both orally, for 7 to

10 days.

Telithromycin, 800 mg q24h, for 7 to 10 days

Conclusion -

Drugs used in the outpatient treatment of pneumonia must be administered

orally.

2. Are drugs chemically compatible?

The drugs are not very chemically compatible. Active component of

amoxicillin and ambroxol. Can produce a lot of potential safety hazards in
same minimum preparation unit.
Ambroxol – Acidity
Amoxicillin – Alkaline

3. Are drugs pharmacologically compatible?

Ambroxol - a mucolytic agent which has antioxidant properties and

stimulates the release of pulmonary surfactant.

Amoxicillin-ambroxol in a twice daily medication can be administered

safely along without undesirable effects.

The coupling of amoxicillin and ambroxol has improved antibiotic

therapeutic effect, has reduced side effect.

Are there any violations of bioavailability, absorption processes, transport,

metabolism, excretion of drugs present?

Amoxicillin is stable in the acid gastric secretion and is rapidly absorbed from the
gastrointestinal tract after oral administration. Following oral administration,
amoxicillin is approximately 70% bioavailable.
Amoxicillin is stable in the presence of gastric acid and is rapidly absorbed after
oral administration.

Bioavailability of ambroxol administered orally is approximately. 70–80%

Under peroral administration it is quickly and fully absorbed and penetrates well
into the lung’s tissue.

Conclusion – Therefore there is no violation of bioavailability, absorption

processes, transport, metabolism, and excretion present.

4. Suggestions for treatment optimization.

The initial antibiotic regimen is determined empirically because it is impossible to obtain

microbiological results, which would enable the choice of antibiotics directed at specific agents,
immediately after the diagnosis of community acquired pneumonia.

The choice of an antibiotic should take the following into account: 1) the most likely pathogen in
the site of disease acquisition; 2) individual risk factors; 3) presence of concomitant diseases;
and 4) epidemiologic factors, such as recent trips, allergies, and cost-effectiveness ratio.