II. 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, 46:297-9 [PubMed]
  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: Levaquin, Avelox (<1%)
      5. Clindamycin (9%)
      6. Vancomycin (0%)
    3. References
      1. Jones (2003) Diagn Microbiol Infect Dis 46:77-80 [PubMed]

III. Risk Factors

  1. Age over 65 years (Odds Ratio 3.8)
  2. Within last 3 months, beta-lactam antibiotic - Penicillins, Cephalosporins, carbapenems, and monobactams (Odds Ratio 2.8)
  3. Alcohol Abuse (Odds Ratio 5.2)
  4. Immunosuppression
  5. Multiple comorbid medical conditions
  6. Exposure to day-care attending children
  7. Reference
    1. Fraboni (2012) Board Review Express, San Jose

IV. 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)

V. 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

VI. Management: Otitis Media

  1. Intermediate Resistance
    1. Amoxicillin (75 mg/kg/d)
    2. Clindamycin
      1. No coverage for HaemophilusInfluenzae
      2. No coverage for Moraxella catarrhalis
    3. Cefuroxime
    4. Cefprozil
    5. Cefpodoxime
  2. High Resistance
    1. Base on Tympanocentesis culture

VII. Prevention

  1. Pneumococcal Vaccine
    1. Public Health may add to 2 year old Immunizations
    2. Would create herd immunity to some pneumococcus

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Ontology: Platelet rich plasma (C0370220)

Definition (NCI) A plasma sample that is prepared from whole blood, which has undergone a number of centrifugation steps to concentrate the amount of platelets.
Definition (NCI_CDISC) A plasma sample that is prepared from whole blood, which has undergone a number of centrifugation steps to concentrate the amount of platelets. (NCI)
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.
Concepts Body Substance (T031)
MSH D053657
SnomedCT 116203006
LNC LP7506-1, MTHU003693
English Plasma, Platelet-Rich, Platelet Rich Plasma, Platelet-Rich Plasma, plasma rich platelet, platelet rich plasma, plasma platelet rich, plasma platelets rich, PLATELET RICH PLASMA, PRP, Platelet-rich Plasma, Platelet rich plasma (substance), Platelet rich plasma
Portuguese Plasma Rico em Plaquetas
Spanish Plasma Rico en Plaquetas, plasma rico en plaquetas (sustancia), plasma rico en plaquetas
Italian Plasma ricco di piastrine
German Thrombozytenreiches Plasma, Blutplättchenreiches Plasma
French Plasma riche en plaquettes, PRP (Plasma Riche en Plaquettes), Plasma enrichi en plaquettes
Swedish Trombocytrikplasma
Finnish Verihiutaletiiviste
Czech plazma bohatá na destičky
Polish Osocze bogatopłytkowe
Norwegian Trombocyttkonsentrater, Blodplaterik plasma