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PubMed1984

Use of clindamycin in lower respiratory tract infections.

The majority of lower respiratory tract infections (LRTI) are treated "blindly" because the establishment of an aetiological diagnosis is not possible in most cases. The rational choice of therapy mainly rests upon the knowledge of the microbiological epidemiology of LRTI, and on the possible host-parasite relationship. In community-acquired pneumonia, there is general concensus that penicillin maintains its position as the first drug of choice, and that therapy can be changed to erythromycin or tetracycline in cases of therapeutic failure. Treatment of nosocomial pneumonia, and LRTI in immunocompromised patients, calls for antibiotics with a broader antimicrobial spectrum. Clindamycin has an antimicrobial spectrum which makes this antibiotic a possible alternative in community-acquired pneumonia, and its efficacy in pneumococcal pneumonia has been documented. However, as first choice therapy it should be reserved for cases of penicillin allergy, or cases of strongly suspected staphylococcal pneumonia. In aspiration pneumonia--nearly always caused by anaerobic bacteria--penicillin has long been the preferred therapy, even in cases with Bacteroides fragilis. However, recent publications have clearly documented that in primary lung abscess, clindamycin is superior to penicillin. These results are especially important since metronidazole has been shown to be less effective in such cases.

Anti-Bacterial Agents↗

PubMedDate not supplied

[Treatment of acute upper respiratory tract infections in children].

INTRODUCTION: Acute respiratory tract infections are the most common diseases of childhood. A preschool child suffers up to 5-7 infections of upper airways during a year. Upper airway infections make 80-90% of all respiratory infections. ETIOLOGY AND TREATMENT: In 75% of all cases respiratory infections are of viral etiology, 15% of bacterial and 10% are caused by mycoplasma, rickettsiae, fungi, parasites. The treatment of respiratory infections includes antimicrobial therapy (causal), relief of symptoms (symptomatic) and application of general principles of child treatment. The choice of antimicrobial drug is based on the evidence of agents and their sensitivity to antimicrobial drugs, age, patient's condition, previous treatment and possible allergic reactions to the drug. In cases where adequate specimen cannot be obtained for microbiologic tests, when these tests do not reveal the agent, or therapy must start before evidence of the agent is available, we must decide about the therapy, taking in consideration the most frequent agents, and those that would cause the most devastating clinical picture. This therapy can be modified later, according to the isolated agent and its sensitivity to the drug. Considering the incidence and importance of respiratory infections in morbidity and mortality of children, the aim of this article was to present guidelines in treatment of respiratory infections. The main point remains that the treatment should take into consideration the individual patient before all.

Acute Disease↗

PubMed2003

[Analysis of possible causes of recurrent respiratory tract infections in children from Lodz, Poland].

Recurrent respiratory tract infections are responsible for about 85% of all diseases in childhood. Early diagnosis helps to prevent infections and start the appropriate treatment, what in turn prevents lungs from irreversible damage. The aim of this study was the analysis of possible causes of recurrent respiratory tract infections in children in Lodz region. We analyzed cases of 6335 children with recurrent respiratory tract infections, age 3 months to 17 years, referred to the clinic in our hospital by family doctors from 2000 to 2002. Among all children, 41.5% were diagnosed with allergy, 26.9% of patients had persistent Mycoplasma pneumoniae and 1.4% Bordetella pertussis infection. Very disturbing was the fact of very late cystic fibrosis diagnose at the age of 7,11 and 16. Congenital immune disorders were diagnosed late in five children at the age of 6,7,8,9,11, what delayed appropriate therapy and early prevention of infections.

Adolescent↗

PubMed2003

Resistance pattern of bacteria isolated from acute respiratory tract infection (ARI) cases.

Out of 350 acute respiratory tract infection (ARI) patients 110 (31.4%) were positive on culture. Among then (35.5%) yielded from upper respiratory tract infection (URI) and 64.5% yielded from lower respiratory tract infection (LRI). Predominant bacterial isolates from URI were Staph aureus (12.4%) and Strepto. pyogen (9.8%) whereas predominant agent from LRI were Strepto. pneumoniae (14.7%) and Haemophilus influenzae (8.6%). Capsular typing by polymerase chain reaction (PCR) and type specific antisera revealed that 64.7% of the isolates were type-b and rest were non-b. The most frequent resistance pattern of H. influenzae was found resistant to penicillin-ampicillin (64.7%) followed by SMX-TMP (14.7%) and tetracycline (5.9%). Among penicillin-ampicillin resistant strains, 81.8% were beta lectamase positive and 18.2% were beta lectamase negative. Among beta lectamase positive strains 66.7% were capsular type-b and 33.3% were non-b, had MICS < or = 8 microgram/ml. and < or = 4 microgram/ml. respectively. 5.9% strains of Strepto. pneumoniae was found resistant to SMX-TMP, 5.9% to penicillin-ampicillin and 2.9% to cephalexin. Common resistance pattern of Staph aureus was penicillin-ampicillin (60%), SMX-TMP (37.2%) and tetracycline-erythromycine-cephalexin (11.4%). Strepto. pyogen was found resistant to tetracycline in 12.2% cases and to SMX-TMP in 8.3% cases.

Acute Disease↗

PubMed1990

Epidemiological features and chemotherapy of community-acquired respiratory tract infections.

The epidemiology of community-acquired respiratory tract infections (RTI) is reviewed with emphasis on acute pharyngitis, otitis media, sinusitis, epiglottitis and pneumonia. The numerical importance of upper respiratory tract infections is stressed and their economic impact discussed. Community-acquired pneumonia, although less common, is a more serious infection with a frequent requirement for hospitalization. The heterogeneous microbial aetiology of RTI is stressed, together with the impact this has on chemotherapeutic choice. The latter is likely to remain largely empirical and based on the prevalence of identified pathogens, spectrum of activity and the pharmacokinetic behaviour of the selected agents. The increasing frequency of resistance among respiratory pathogens, notably Haemophilus influenzae, and to a lesser extent Streptococcus pneumoniae, together with the high incidence of beta-lactamase production among Branhamella catarrhalis is of concern. In addition, the issue of beta-lactam inactivation by commensal bacteria suggests that chemotherapeutic strategies for the control of community-acquired respiratory tract infection might justifiably be reconsidered.

Epiglottitis↗

PubMed1999

The impact of climate on the prevalence of respiratory tract infections in early childhood in Lahore, Pakistan.

BACKGROUND: Respiratory tract infections are a major health problem in developing countries. The aim of this study was to analyse the impact of the climate on the prevalence of upper respiratory tract infection (URTI) and lower respiratory tract infection (LRTI) in four socioeconomically different groups in a developing country. METHODS: A prospective cohort study was conducted among children in four socioeconomically different groups in Lahore, Pakistan. Monthly observations were made on 1476 infants born during 1984-1987 and followed for 24 months. Prevalence of URTI and LRTI was analysed according to age, area of living, family size, time of birth, the season of the year and climate variables such as rain, temperature and humidity. RESULTS: Low monthly average minimum day temperature was associated with high prevalence of URTI and LRTI. For LRTI the impact of temperature was larger for boys, children living in larger families and children living in the poorer areas. This pattern was not seen for URTI. A peak in prevalence for LRTI was shown at 5-6 months of age for LRTI and at 10-12 months of age for URTI. CONCLUSIONS: Temperature is related to prevalence of URTI and LRTI in a developing society. The effect of temperature on health varies between different subgroups. These effects should be considered in planning health actions to prevent respiratory tract infections.

Age Distribution↗

PubMed2006

A Review of New Fluoroquinolones : Focus on their Use in Respiratory Tract Infections.

The new respiratory fluoroquinolones (gatifloxacin, gemifloxacin, levofloxacin, moxifloxacin, and on the horizon, garenoxacin) offer many improved qualities over older agents such as ciprofloxacin. These include retaining excellent activity against Gram-negative bacilli, with improved Gram-positive activity (including Streptococcus pneumoniae and Staphylococcus aureus). In addition, gatifloxacin, moxifloxacin and garenoxacin all demonstrate increased anaerobic activity (including activity against Bacteroides fragilis). The new fluoroquinolones possess greater bioavailability and longer serum half-lives compared with ciprofloxacin. The new fluoroquinolones allow for once-daily administration, which may improve patient adherence. The high bioavailability allows for rapid step down from intravenous administration to oral therapy, minimizing unnecessary hospitalization, which may decrease costs and improve quality of life of patients. Clinical trials involving the treatment of community-acquired respiratory infections (acute exacerbations of chronic bronchitis, acute sinusitis, and community-acquired pneumonia) demonstrate high bacterial eradication rates and clinical cure rates. In the treatment of community-acquired respiratory tract infections, the various new fluoroquinolones appear to be comparable to each other, but may be more effective than macrolide or cephalosporin-based regimens. However, additional data are required before it can be emphatically stated that the new fluoroquinolones as a class are responsible for better outcomes than comparators in community-acquired respiratory infections. Gemifloxacin (except for higher rates of hypersensitivity), levofloxacin, and moxifloxacin have relatively mild adverse effects that are more or less comparable to ciprofloxacin. In our opinion, gatifloxacin should not be used, due to glucose alterations which may be serious. Although all new fluoroquinolones react with metal ion-containing drugs (antacids), other drug interactions are relatively mild compared with ciprofloxacin. The new fluoroquinolones gatifloxacin, gemifloxacin, levofloxacin, and moxifloxacin have much to offer in terms of bacterial eradication, including activity against resistant respiratory pathogens such as penicillin-resistant, macrolide-resistant, and multidrug-resistant S. pneumoniae. However, ciprofloxacin-resistant organisms, including ciprofloxacin-resistant S. pneumoniae, are becoming more prevalent, thus prudent use must be exercised when prescribing these valuable agents.

Anti-Infective Agents↗

PubMed1998

[Chemotherapeutics for treatment of influenza and other viral respiratory tract infections in children].

Therapeutic efficacy of remantadine and arbidole was studied in the clinical and laboratory observation of pediatric in- and outpatients with grippe and mixed viral infections in various seasonal epidemic. In the trial of remantadine 742 school children and 60 children at the age of 3 to 6 years with type A, B or A + B grippe, grippe in association with other acute viral respiratory tract infections or acute viral respiratory tract infections of nongrippe etiology were observed. 402 and 400 of them were given remantadine and placebo respectively. The drug was used in a single dose of 1.5 mg/kg body weight 3 times a day for 3 days. In the trial of arbidole 158 children at the age of 1 to 14 years with type A grippe, grippe + acute viral respiratory tract infection and acute viral respiratory tract infection of nongrippe etiology were observed. The arbidole daily dose of 10 mg/kg body weight was given in 4 portions for 5 days. Both the drugs were shown to be therapeutically efficient in all the grippe types and acute viral respiratory tract infections. The highest efficacy was observed when the use of the drugs was started at the early stages. With the use of the drugs the periods of fever, other intoxication signs and virus isolation decreased. No adverse reactions were recorded. The drugs had no inhibitory effect on the cellular and humoral immunity and on production of antiviral antibodies. The dynamics of the indices of the cellular immunity and macrophages confirmed the arbidole immunostimulating action.

Adolescent↗

PubMed1992

Evaluation of new anti-infective drugs for the treatment of respiratory tract infections. Infectious Diseases Society of America and the Food and Drug Administration.

These guidelines deal with the evaluation of anti-infective drugs for the treatment of respiratory tract infections. Five clinical entities are described: streptococcal pharyngitis and tonsillitis, otitis media, sinusitis, bronchitis, and pneumonia. A wide variety of microorganisms are potentially pathogenetic in these diseases; these guidelines focus on the bacterial infections. Inclusion of a patient in a trial of a new drug is based on the clinical entity, with the requirement that a reasonable attempt will be made to establish a specific microbial etiology. Microbiologic evaluation of efficacy requires isolation of the pathogen and testing for in vitro susceptibility. Alternatively, surrogate markers may be used to identify the etiologic agent. The efficacy of new drugs is evaluated with reference to anticipated response rates. Establishment of the microbial etiology of respiratory tract infections is hampered by the presence of "normal flora" of the nose, mouth, and pharynx, which may include asymptomatic carriage of potential pathogens. This issue is addressed for each category of infection described. For example, it is suggested that for initial phase 2 trials of acute otitis media and acute sinusitis tympanocentesis or direct sinus puncture be used to collect exudate for culture. Acute exacerbations of chronic bronchitis also present difficulties in the establishment of microbial etiology. These guidelines suggest that clinical trials employ an active control drug but leave open the possibility of a placebo-controlled trial. For pneumonia, the guidelines suggest the identification and enrollment of patients by the clinical type of pneumonia, e.g., atypical pneumonia or acute bacterial pneumonia, rather than by etiologic organism or according to whether it was community or hospital acquired. For each respiratory infection, the clinical response is judged as cure, failure, or indeterminate. Clinical improvement is not acceptable unless quantitative response measures can be applied.

Anti-Bacterial Agents↗

PubMed2005

Antimicrobial treatment of lower respiratory tract infections in the hospital setting.

Respiratory tract infections (RTIs) that may require hospitalization include acute exacerbations of chronic bronchitis (AECB), community-acquired pneumonia (CAP), and hospital-acquired pneumonia (HAP), which includes ventilator-associated pneumonia (VAP). Healthcare-associated pneumonia (HCAP) is treated similar to HAP and may be considered with HAP. For CAP requiring hospitalization, the current guidelines for the treatments of RTIs generally recommend either a beta-lactam and macrolide combination or a fluoroquinolone. The respiratory fluoroquinolones (levofloxacin, gatifloxacin, moxifloxacin, and gemifloxacin) are excellent antibiotics due to high levels of susceptibility among gram-negative, gram-positive, and atypical pathogens. The fluoroquinolones are active against > 98% of Streptococcus pneumoniae, including penicillin-resistant strains. Fluoroquinolones are also recommended for AECB requiring hospitalization. Evidence from clinical trials suggests that levofloxacin monotherapy is as efficacious as combination ceftriaxone-erythromycin therapy in the treatment of patients hospitalized with CAP. For early-onset HAP, VAP, and HCAP without the risk of multidrug resistance, ceftriaxone, ampicillin-sulbactam, ertapenem, or one of the fluoroquinolones is recommended. High-dose, short-course therapy regimens may offer improved treatment due to higher drug concentrations, more rapid killing, increased adherence, and the potential to reduce development of resistance. Recent studies have shown that short-course therapy with levofloxacin, azithromycin, or telithromycin in patients with CAP was effective, safe, and tolerable and may control the rate of resistance.

Anti-Bacterial Agents↗

PubMed1993

Relevance of antibiotic tissue penetration in treating respiratory tract infections.

The majority of bacterial respiratory tract infections are caused by streptococci, Haemophilus spp. and Moraxella catarrhalis. These pathogens are located extracellularly. In logical consequence, the bactericidal action of the antimicrobial is required in these loci. To define the reasonable dosing regimen for effective eradication without creating unnecessary toxic potential we need to know (1) the distribution principles and kinetics, and (2) the correct correlation between concentration profiles in extracellular fluid (ECF) and blood. According to the permeability of the vascular capillaries unbound drug concentrations in plasma and ECF are in a dynamic equilibrium. Thus, for the beta-lactam antibiotics therapeutic efficacy is predictable by maintaining the free drug concentration above the bacterial minimum inhibitory concentration. Tissue homogenate data can only be useful if correctly interpreted by correcting for the partitioning between the tissue components.

Animals↗

PubMed1989

[Therapy of chronic recurrent respiratory tract infections].

In 1987, the most frequently identified pathogens in chronic respiratory tract infections in our clinic were Haemophilus influenzae, Pseudomonas aeruginosa, Branhamella catarrhalis, Streptococcus pneumoniae, Staphylococcus aureus and Klebsiella pneumoniae. Recurrent infection is a common phenomenon in patients with chronic respiratory tract infections, including chronic bronchitis, chronic bronchiolitis and bronchiectasis. H. influenzae is the most common pathogen in such patients. Macrolides, tetracyclines and new quinolones were effective to protect against recurrent infection of H. influenzae and these finding suggested that L-forms of H. influenzae may be significant in the recurrence of infection in patients with chronic respiratory tract infection. Bacterial colonization of the oropharynx is the initial event in most lower respiratory tract infections. Gargling protects against bacteria colonization of the oropharynx and occurrence of acute exacerbation.

Anti-Bacterial Agents↗

PubMed1997

Management of lower respiratory tract infections in out-patients.

Lower respiratory tract infections (LRTIs) are one of the most frequent medical conditions seen in out-patients. They all cause morbidity, and although most are minor some may be life-threatening, thus appropriate disease management is important. Clinical features are usually used to classify LRTIs, but this approach may be inaccurate. It may therefore be simpler to describe a patient's symptoms without applying a label, such as "bronchitis", since the latter means different things to different people. Classification of LRTIs should aim to aid management. The two main management decisions are: whether to manage the patient at home; and whether to prescribe antibiotics. Investigations are carried out in the hospital environment to aid these decisions, however in the community investigation in only a minority of cases are done as they are costly and impractical. Markers of severity of LRTI have been identified in a number of studies and their value in clinical practice is now being assessed, however most studies suggest that severely ill patients are correctly identified and admitted to hospital. Currently, antibiotics are used liberally for lower respiratory tract infections. However most infections are not bacterial in origin and will not be affected by such therapy. The idea that antibiotics are harmless placebos for such illnesses is no longer tenable since the appearance and rapid spread of antibiotic resistance in bacteria. Only in community-acquired pneumonia and some patients with exacerbations of chronic bronchitis do antibiotics actually alter the course of the illness. In those groups antibiotics should be targetted at the casual pathogens and in other groups such therapy should be avoided. Much current research interest is focused on determining which (if any) is the best antibiotic in these situations.

Ambulatory Care↗

PubMed1993

Ecology of Haemophilus influenzae and Haemophilus parainfluenzae in sputum and saliva and effects of antibiotics on their distribution in patients with lower respiratory tract infections.

Nine patients with lower respiratory tract infections were used to study in detail the effect of ampicillin or erythromycin on the colonization patterns of Haemophilus influenzae and Haemophilus parainfluenzae in sputum and saliva. H. influenzae was isolated from purulent sputum of eight patients before the start of treatment. Ampicillin was more effective than erythromycin at clearing H. influenzae from sputum and in decreasing purulence. By careful characterization of multiple strains, the changes in biotype distribution and antibiotic susceptibility patterns were shown. Five biotypes of H. influenzae were associated with chest infection, with type II predominating. Mixed biotype infections occurred in five patients. Most saliva contained multiple biotypes of H. parainfluenzae. Neither antibiotic selected resistant haemophili in saliva or sputum. After treatment with ampicillin, the mucoid sputum was colonized with ampicillin-susceptible H. parainfluenzae biotypes previously found in saliva. We postulate that as inflammation decreases at the bronchial mucosa, the ampicillin concentration drops, allowing ampicillin-susceptible oral H. parainfluenzae isolates to seed the residual mucoid sputum.

Ampicillin↗

PubMed2005

Use of antimicrobial agents for upper respiratory tract infections in Taiwanese children.

Upper respiratory tract infections (URTIs) are mostly caused by viruses. Antibiotic misuse for viral URTIs in children is a serious problem that not only results in selection of resistant strains of bacteria but also wastes millions of dollars each year in Taiwan. Antibiotic resistance among common respiratory bacterial pathogens such as Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, and Moraxella catarrhalis has become a major issue for public health. The common cold, acute pharyngotonsillitis, acute otitis media, acute sinusitis, acute bronchitis, influenza and acute epiglottitis are the most frequently encountered acute URTIs in out-patient clinics. This article recommends the judicious use of antimicrobial agents for these seven common pediatric URTIs, based on local epidemiological data and the recommendations of the Infectious Disease Society of Taiwan and the American Academy of Pediatrics. With education and behavior modification, practitioners will help to reduce antibiotic overuse, and the goal of reducing antimicrobial resistance may be accomplished.

Acute Disease↗

PubMed1990

Quantification of nasopharyngeal bacteria for diagnosis of respiratory tract infection in children.

Agreement between clinical signs of bacterial respiratory tract infections and quantities of respiratory tract pathogens in nasopharynx was studied in 77 children, aged 6-13 years. Specimens were obtained from 27 clinically bacterial and 51 clinically non-bacterial respiratory tract infections, and in 124 instances from healthy children. Viable counts of Streptococcus pneumoniae, Haemophilus influenzae, Branhamella catarrhalis, and beta-haemolytic streptococci were made from swab specimens suspended in saline before being plated on agar media. The frequency of these species in children with clinically bacterial, non-bacterial and no signs of respiratory tract infections were 85%, 47% and 26%, respectively. Bacterial counts greater than 10(4) colony-forming units (CFU)/ml of the pathogens occurred in 59% of clinically bacterial infections, as compared with 18% in clinically non-bacterial infections (p less than 0.001), the corresponding figures for counts greater than 10(3) CFU/ml being 85% and 41% (p less than 0.01), respectively. At neither level of bacterial count (i.e. greater than 10(4) or greater than 10(3], was there a significant difference between the healthy and those with a clinically non-bacterial infection. The quantification of bacteria in nasopharyngeal samples may thus be of clinical diagnostic value.

Bacteria↗

PubMed2004

Vitamin E and respiratory tract infections in elderly nursing home residents: a randomized controlled trial.

CONTEXT: Respiratory tract infections are prevalent in elderly individuals, resulting in increased morbidity, mortality, and use of health care services. Vitamin E supplementation has been shown to improve immune response in elderly persons. However, the clinical importance of these findings has not been determined. OBJECTIVE: To determine the effect of 1 year of vitamin E supplementation on respiratory tract infections in elderly nursing home residents. DESIGN, SETTING, AND PARTICIPANTS: A randomized, double-blind, placebo-controlled trial was conducted from April 1998 to August 2001 at 33 long-term care facilities in the Boston, Mass, area. A total of 617 persons aged at least 65 years and who met the study's eligibility criteria were enrolled; 451 (73%) completed the study. INTERVENTION: Vitamin E (200 IU) or placebo capsule administered daily; all participants received a capsule containing half the recommended daily allowance of essential vitamins and minerals. MAIN OUTCOME MEASURES: Incidence of respiratory tract infections, number of persons and number of days with respiratory tract infections (upper and lower), and number of new antibiotic prescriptions for respiratory tract infections among all participants randomized and those who completed the study. RESULTS: Vitamin E had no significant effect on incidence or number of days with infection for all, upper, or lower respiratory tract infections. However, fewer participants receiving vitamin E acquired 1 or more respiratory tract infections (60% vs 68%; risk ratio [RR], 0.88; 95% confidence interval [CI], 0.76-1.00; P =.048 for all participants; and 65% vs 74%; RR, 0.88; 95% CI, 0.75-0.99; P =.04 for completing participants), or upper respiratory tract infections (44% vs 52%; RR, 0.84; 95% CI, 0.69-1.00; P =.05 for all participants; and 50% vs 62%; RR, 0.81; 95% CI, 0.66-0.96; P =.01 for completing participants). When common colds were analyzed in a post hoc subgroup analysis, the vitamin E group had a lower incidence of common cold (0.67 vs 0.81 per person-year; RR, 0.83; 95% CI, 0.68-1.01; P =.06 for all participants; and 0.66 vs 0.83 per person-year; RR, 0.80; 95% CI, 0.64-0.98; P =.04 for completing participants) and fewer participants in the vitamin E group acquired 1 or more colds (40% vs 48%; RR, 0.83; 95% CI, 0.67-1.00; P =.05 for all participants; and 46% vs 57%; RR, 0.80; 95% CI, 0.64-0.96; P =.02 for completing participants). Vitamin E had no significant effect on antibiotic use. CONCLUSIONS: Supplementation with 200 IU per day of vitamin E did not have a statistically significant effect on lower respiratory tract infections in elderly nursing home residents. However, we observed a protective effect of vitamin E supplementation on upper respiratory tract infections, particularly the common cold, that merits further investigation.

Aged↗

PubMed1997

Empiric therapy in lower respiratory tract infection--an ongoing challenge.

Lower respiratory tract infections are a common cause of morbidity and mortality. The pattern of pneumonia is altering, owing to changes in a number of influencing factors. These include patient characteristics, such as an aging population, increased immunosuppression and chronic disease, and changes in medical practice. There is also an increasing level of resistance to antimicrobial agents by organisms such as Streptococcus pneumoniae and Haemophilus influenzae, the pathogens most commonly associated with community-acquired pneumonia. In the management of pneumonia, it is important to be able to differentiate between atypical and typical pneumonia in the clinical setting and to grade the severity of the infection. Currently, there are no internationally agreed treatment recommendations for pneumonia. The role of antimicrobial agents in acute exacerbations of chronic bronchitis is still a controversial issue.

Humans↗