Lower Respiratory Tract Infection

12/06/2013 by admin | Respiratory

Lower respiratory tract infection

Definition: An infection below the level of the vocal cords.

  1. LRTIs = can also be applied to other types of infection including lung abscess and acute bronchitis.


  1. Bronchitis can be classified as either acute or chronic. 40/1000 adults/y, and consists of transient inflammation via viral infection of the major bronchi and trachea.


  1. Acute Exacerbations of Chronic Bronchitis (AECB) are frequently due to non-infective causes along with viral ones. 50% of patients are colonised with Haemophilus influenzae, Streptococcus pneumoniae or Moraxella catarrhali (CAP pathogens).


  1. Treatment: amoxillin or doxycycline


  1. Pneumonia, can be either HAP/ CAP. Life-threatening in elderly and immunocompromised. The most common cause of pneumonia is pneumococcal bacteria, Streptococcus pneumoniae accounts for 2/3 of bacteraemic pneumonias


Incidence: 40/1000/y

Treatment and management (conservative/medical/surgical)

  1. Pneumonia severity (including where to treat e.g. Home, hospital or intensive care) – CURB-65 score.
  2. Identification of causative organism – sputum / BAL
  3. Analgesia of chest pain
  4. Oxygen therapy
  5. Physiotherapy
  6. Hydration
  7. SA and LA bronchodilators and possible complications of emphysema or lung abscess.


For community acquired respiratory infections the appropriate use of fluoroquinolones is a therapeutic option.

= Amoxicillin, gentamicin

Other respiratory tree infections of note:

  1. Pharyngitis: Group A Strep, corynebacterium diphtheria, EBV, adenovirus, enterovirus, HIV
  2. Epiglottitis: H.influenzae B (HIB) – vaccinated against these days, medical emergency! Secure airway, avoid distress to avoid tongue falling back and blocking airway. IV CEFUROXIME.
  3. Bronchitis: acute = viral/bacterial, chronic = smoking. 
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