Infectious Disease Book

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Penicillin Resistant PneumococcusAka: PRP, Streptococcus Pneumoniae Antibiotic Resistance

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  1. Epidemiology
    1. Very serious problem
      1. Pneumococcus infection is common
      2. Otitis Media
      3. Meningitis
    2. Treatment failures common especially in Meningitis
    3. Hot spots of resistance
      1. International
        1. Spain
        2. Hungary
        3. South Africa
      2. United States
        1. Dallas
        2. Memphis
        3. Kansas City
        4. Oklahoma City
    4. High Risk Groups (New York, 1995, n=282)
      1. Children under age 4 (7.5 cases per 100,000)
      2. Children under age 1 (30.3 cases per 100,000)
      3. Adults with Human Immunodeficiency Virus (HIV)
      4. Reference
        1. (1997) MMWR Morb Mortal Wkly Rep 46:297
    5. Day Care Prevalence (multiple U.S. state evaluation)
      1. Nasopharyngeal and middle ear swab: 22-29% PRP
    6. Hospital Prevalence (Minneapolis, MN)
      1. Community Hospitals: 15-22% PRP
      2. Tertiary Care Hospital: 50% PRP
    7. Streptococcus Pneumoniae Resistance Rates (2003)
      1. Highest resistance (19-30%)
        1. Penicillin (21%)
        2. Cephalosporins: Cefprozil, Cefuroxime (23-25%)
        3. Macrolides: All are high resistance (23-28%)
        4. Tetracycline (19%)
        5. Trimethoprim-Sulfamethoxazole (30%)
      2. Lowest resistance rates (<10%)
        1. Amoxicillin-Clavulanate (4%)
        2. Cefepime (<1%)
        3. Ceftriaxone (2%)
        4. Fluoroquinolones: Tequin, Levaquin, Avelox (<1%)
        5. Clindamycin (9%)
        6. Vancomycin (0%)
      3. References
        1. Jones (2003) Diagn Microbiol Infect Dis 46:77
  2. Management: Pneumonia or Sepsis
    1. Intermediate Resistance
      1. Higher Penicillin dosage: 150k-250k U/kg/day
    2. High Resistance
      1. Three drug Combination regimen
        1. Vancomycin (40 mg/kg/day) and
        2. Imipenem and
        3. Rifampin
      2. Two drug combination regimen
        1. Vancomycin
        2. Third generation Cephalosporin (if not resistant)
  3. Management: Meningitis
    1. Intermediate Resistance
      1. Vancomycin (60 mg/kg/day) and
      2. Imipenem
    2. High resistance
      1. Vancomycin (60 mg/kg/day) and
      2. Rifampin and
      3. Imipenem
    3. Follow-Up Spinal Tap in 24 hours
  4. Management: Otitis Media
    1. Intermediate Resistance
      1. Amoxicillin (75 mg/kg/d)
      2. Clindamycin
        1. No coverage for Haemophilus Influenzae
        2. No coverage for Moraxella catarrhalis
      3. Cefuroxime
      4. Cefprozil
      5. Cefpodoxime
    2. High Resistance
      1. Base on Tympanocentesis culture
  5. Prevention
    1. Pneumococcal Vaccine
      1. Public Health may add to 2 year old Immunizations
      2. Would create herd immunity to some pneumococcus

Platelet rich plasma (C0370220)

Definition (MSH)A preparation consisting of PLATELETS concentrated in a limited volume of PLASMA. This is used in various surgical tissue regeneration procedures where the GROWTH FACTORS in the platelets enhance wound healing and regeneration.
ConceptsBody Substance (T031)
MSHD053657
EnglishPlatelet Rich Plasma, Platelet-Rich Plasma, PRP
Spanishplasma rico en plaquetas
Parent ConceptsSpecimen component (C1547766), SpecimenEntityType (C1700255), Plasma (C0032105)
SourcesHL7V2.5, HL7V3.0, LNC, MSH, MTH, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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