SEARCH · PubMed Health

Results for “RESPIRATORY TRACT”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 415 records · Page 23Linked to original sources

PubMed2000

Respiratory syncytial virus infection in children hospitalised with acute lower respiratory tract infection.

BACKGROUND: Data are lacking on respiratory syncytial virus. (RSV) respiratory tract infections in children from developing countries. OBJECTIVE: To determine the importance of RSV as a cause of acute lower respiratory tract infection (ALRTI) in Cape Town children. METHODS: Children younger than 2 years of age admitted to hospital with ALRTI over a 15-month period from 1 June 1995 to 31 August 1996 were studied prospectively. Sociodemographic data, risk factors for severe RSV disease, clinical signs, diagnosis and hospital course were documented. A nasopharyngeal aspirate (NPA) for detection of RSV by enzyme immunoassay (EIA) was obtained in all cases. The NPA of every fifth child was sent for viral culture. RESULTS: A total of 1,288 patients (60% male, 40% female) with a median age (25th-75th percentile) of 6 months (2-11 months) was enrolled; 32.4 had one or more risk factors for severe RSV infection. Pneumonia was diagnosed in 62.2%, bronchiolitis in 20.6%, laryngotracheobronchitis (LTB) in 8% and other respiratory illnesses in 9.2%. Mild disease, requiring admission to an overnight ward, was documented in 38.1%, while 48.9% and 13% respectively had moderate and severe disease requiring admission to a general ward and intensive care unit (ICU). Supplemental oxygen and mechanical ventilation were required by 68.9% and 8.5% of patients, respectively. The median duration of hospital stay was 5 days (range 1-10 days). RSV EIA was positive in 16.4% of cases, and there was no difference in detection rates according to diagnosis. Viral culture performed in 162 of the 1,288 study patients (12.6%) grew RSV in 11.7% of cases, adenovirus in 3.7%, para-influenza virus type 3 in 2.5% and influenza B virus in 0.6%. Patients who tested RSV EIA-positive did not significantly differ from those who tested negative with regard to demographic variables, clinical diagnoses, risk factors for RSV or length of hospitalisation. The only significant difference noted was the presence of hyperinflation, which occurred in 70.1% of EIA-positive patients compared with 57.1% of those testing negative (P = 0.0005). The mortality rate (2%) was similar for both groups. CONCLUSION: This study indicates that RSV is an important cause of hospitalisation in infants and young children with ALRTI. Distinguishing RSV from other ALRTIs is difficult because of similarity in clinical presentation among children.

Data Interpretation, Statistical↗

PubMed2001

Diagnosis and treatment of upper respiratory tract infections in the primary care setting.

BACKGROUND: Acute respiratory tract infections such as acute exacerbations of chronic bronchitis (AECB), acute otitis media (AOM), and acute bacterial rhinosinusitis (ABRS) account for approximately 75% of antibiotic prescriptions written and are among the leading reasons for physician office visits in the United States. Resistance of the predominant pathogens in respiratory tract infections (Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis) to available antibiotics has led clinicians to reevaluate the diagnosis and management of these infections. OBJECTIVE: The purpose of this review is to provide primary care practitioners with an accessible combined resource for the management of AECB, AOM, and ABRS. METHODS: This review was based on discussions from a roundtable meeting (sponsored by an educational grant from GlaxoSmithKline) that convened clinicians versed in the management of upper and lower respiratory tract infections. In addition, primary articles were identified by a MEDLINE search and through secondary sources. RESULTS: To reduce the prevalence of resistance, judicious and appropriate use of antibiotics must be implemented in clinical practice. With accurate diagnosis of bacterial and nonbacterial conditions, and patient education on antibiotic use and misuse, the excessive use of antibiotics and ensuing resistance can be reduced. The incorporation of pharmacokinetic and pharmacodynamic data with minimum inhibitory concentration values can provide a more comprehensive assessment of antibiotic activity in vivo. Stratification of patients with AECB according to patient characteristics and frequency of exacerbation can be used to determine which patients will benefit from antibiotic treatment and to guide clinicians in their choice of antibiotic. The Drug-Resistant Streptococcus pneumoniae Therapeutic Working Group has issued recommendations on the management of AOM based on prior antibiotic therapy, which is a risk factor for antimicrobial resistance. The Sinus and Allergy Health Partnership guidelines for the treatment of ABRS in adults and children are based on the predicted efficacy of various antibiotics as well as patient age, severity of disease, likelihood of bacterial infection, likelihood of spontaneous resolution, and in vitro susceptibility of the predominant pathogens based on pharmacokinetic and pharmacodynamic breakpoints. CONCLUSIONS: Guidelines for the management of AECB, AOM, and ABRS emphasize the importance of differentiating between bacterial and nonbacterial infections, choosing an antibiotic based on the likelihood of infection with resistant pathogens, and providing coverage against the predominant pathogens. The judicious use of antibiotics also has been identified as an instrumental part of controlling unnecessary antibiotic use and subsequent resistance.

Acute Disease↗

PubMedDate not supplied

Lower respiratory tract infection therapy--the role of ciprofloxacin.

Lower respiratory tract infections account for a large proportion of prescribed antibiotics and, with emerging resistance to standard agents, the introduction of the fluoroquinolones, in particular ciprofloxacin, has provided a further component in the armamentarium. This review encompasses 37 published clinical trials which featured ciprofloxacin; 3274 patients with lower respiratory tract infections were treated with this agent; in 94.1% of patients treatment was clinically successful and 90.9% of cases showed eradication of the causative pathogen. When these data were supplemented with previously unpublished information from the clinical trial database, specific organism eradication rates of 86.1%, 96.2% and 94.6% for Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis, respectively, were observed. These findings suggest that the high respiratory tissue penetration of ciprofloxacin and the achievable minimum inhibitory concentrations lead to acceptable clinical outcomes in lower respiratory tract infections.

Adult↗

PubMed2000

[Viral infection related to the appearance of acute bacterial respiratory tract infections].

To investigate what viruses are related to acute bacterial respiratory tract infections, we prospectively evaluated 113 cases with respiratory tract infections (always accompanying by purulent sputum) experienced between July 1998 and March 2000. Acute viral infections were detected in 25 cases (22%); 10 cases of influenza A virus and 6 cases of respiratory syncytial (RS) virus. The epidemiology of the influenza A virus and RS virus was mainly identified as from December to February in both winter seasons. A bacteriological examination of sputum cultures isolated 12 cases of Streptococcus pneumoniae and 10 cases of Haemophilus influenzae during the same periods and mixed infections of both viruses and bacteria were recognised in 16 cases (14%). These results suggest a significantly high percentage of mixed infections of both viruses and bacteria. However, it was unknown whether the patients with acute bacterial respiratory infections had been infected with viruses prior to the bacterial infections. The frequency of appearance of respiratory tract infections tended to increase with the seasonale epidemiology of viral infections.

Acute Disease↗

PubMed1985

Effects of inhaled acids on respiratory tract defense mechanisms.

The respiratory tract is endowed with an interlocking array of nonspecific and specific defense mechanisms which protect it from the effects of inhaled microbes and toxicants, and reduce the risk of absorption of materials into the bloodstream, with subsequent systemic translocation. Ambient acids may compromise these defenses, perhaps providing a link between exposure and development of chronic and acute pulmonary disease. This paper reviews the effects of inhaled acids upon the nonspecific clearance system of the lungs.

Acids↗

PubMed2007

Efficacy of azithromycin administration in prevention of respiratory tract infection after bronchoscopic biopsy: a randomized, controlled trial.

BACKGROUND AND OBJECTIVE: Respiratory tract infection is a serious complication associated with bronchoscopic biopsy. This study attempted to examine its incidence and determine an efficacious therapy for preventing such infections. METHODS: Nine hundred and thirty patients who underwent bronchoscopic biopsy in Osaka City University Hospital outpatient clinic were enrolled in the study. All patients were randomly assigned to receive a 3-day course of azithromycin (500 mg/day), cefcapene pivoxil hydrochloride (300 mg/day) or no antibiotics. The primary outcome was the incidence of respiratory tract infection after bronchoscopic biopsy among the three groups. RESULTS: In the no-treatment group, nine of the 310 patients (2.9%) had respiratory tract infection after bronchoscopic biopsy. All patients with infection had abnormal bronchoscopic findings. Of the patients with respiratory tract infection, 60% were in the no-treatment group, 26.7% in the cefcapene group and 13.3% in the azithromycin group. Although not statistically significant, the incidence in the azithromycin group (0.7%) was lower than in the no-treatment group (P = 0.06). Among the patients with abnormal bronchoscopic findings, the incidence in the azithromycin group was significantly lower than that in the no-treatment group (3.0% vs. 14.8%; P = 0.02). Moreover, maximum C-reactive protein values also appeared to be lower in the azithromycin group than in the no-treatment group and the cefcapene group. CONCLUSIONS: A 3-day course of azithromycin administration is well tolerated and effective in preventing infection post bronchoscopy.

Adult↗

PubMed1992

Congenital malformations of the respiratory tract.

Malformations of the respiratory tract were found in 21 out of 205 foetuses (10%) in whom various congenital malformations had been prenatally detected by ultrasonography and amniocentesis. Pulmonary hypoplasia was the most common of all pulmonary malformations and was established in 17 cases (81%). Lung alobulation was established in two cases (9.5%), and pulmonary cysts were recorded in another two cases in post-mortem examinations. Correlations established between ultrasonographic and pathomorphological findings were not satisfactory as only 29% of all ultrasonographic diagnosis were complete and correct. Hence, much closer cooperation between the pathologist and clinician is essential to all investigations of congenital malformations, in particular to those of complex nature.

Abortion, Induced↗

PubMed2002

The value of polymerase chain reaction for the diagnosis of viral respiratory tract infections in lung transplant recipients.

BACKGROUND: Respiratory viruses cause severe infections in lung transplant recipients, which require rapid and accurate diagnosis for appropriate management. OBJECTIVES: To evaluate the added benefit of a multiplex PCR for respiratory viruses (influenza [FLU] A and B, respiratory syncytial virus [RSV] A and B and parainfluenza virus [PIV] 1, 2, and 3) complementing rapid respiratory viral culture (RRV) and FLU-A antigen detection (EIA) in this transplant population. RESULTS: Over 6 months, 116 nasal washes and bronchoalveolar lavages, obtained from 72 lung transplant recipients with symptoms of upper or lower respiratory tract infections, were tested in real time by RRV and FLU-A EIA, and batched frozen by PCR. One or more methods recognized a respiratory virus in 31 (27%) specimens, including 15 FLU-A, nine RSV and seven PIV. PCR identified 26 of 31 positive samples demonstrating a sensitivity of 84%, higher than RRV (67%) or EIA (54%). PCR, RRV and EIA detected 60, 80 and 54%, respectively, FLU-A samples. PCR and RRV were equivalent for RSV-A, PIV-2 and 3, but PCR found a significantly higher number of RSV-B and PIV-1. CONCLUSIONS: These data indicate that routine use of PCR will enhance the number and speed with which viral respiratory tract infections are diagnosed in lung transplant recipients.

Adult↗

PubMed2002

Patients' and doctors' views on respiratory tract symptoms.

OBJECTIVE: To explore the views of patients and doctors on respiratory tract symptoms. DESIGN: Transversal survey among patients and general practitioners. SETTING: Primary health care and community. SUBJECTS: 51 patients attending a general practitioner, 38 patients in the community, 7 general practitioners. MAIN OUTCOME MEASURES: Patients' and doctors' views on respiratory tract symptoms and differences between them: agreement with statements rated on a 5-point scale, ranging from "strongly disagree" to "strongly agree." RESULTS: Patients less than doctors endorsed the self-limiting character of cough, sore throat and earache (mean 3.1, 3.4 and 2.9 versus 4.1, 4.1 and 3.7) and patients--much more than doctors--rated antibiotics as being necessary for cough and sore throat (mean 2.7 and 2.9 versus 1.7 and 17) and believed that antibiotics speed recovery (mean 3.7 versus 2.0). However, there was little difference relating to the necessity to see a doctor after some time period. CONCLUSION: Patients appeared to differ from doctors in views on respiratory tract symptoms. The results stress the importance of exploring patients' views when being confronted by patients suffering from respiratory tract symptoms.

Anti-Bacterial Agents↗

PubMed2003

Baby swimming increases the risk of recurrent respiratory tract infections and otitis media.

AIM: To estimate the association between baby swimming and recurrent respiratory tract infections and otitis media in the first year of life in children of parents without and with atopy. METHODS: Norwegian schoolchildren (n = 2862) was enrolled in a cross-sectional study of asthma and allergy using the questionnaire of the International Study of Asthma and Allergies in Childhood (ISAAC). The outcomes were parental retrospective report of recurrent respiratory tract infections and otitis media diagnosed by a physician in the first year of life. The exposure was baby swimming during the same period. Parental atopy reflects a history of maternal or paternal asthma, hayfever or eczema. RESULTS: The prevalence of recurrent respiratory tract infections was higher (12.3%) among children who took part in baby swimming than among those who did not (7.5%). The prevalence of recurrent respiratory tract infections during the first year of life was 5.6% and 10.5%, respectively, in children of parents without and with atopy, whereas the prevalence of baby swimming was 5.6% and 5.1%, respectively, in the two groups. Stratified analysis using parental atopy as strata showed that the increased risk of recurrent respiratory tract infections was only present among children of parents with atopy [adjusted odds ratio (aOR) 2.08, 95% confidence interval (95% CI) 1.08-4.031. A similar trend was present for otitis media (aOR 1.77, 95% CI 0.96-3.25). CONCLUSION: The results of this study suggest that baby swimming and infant respiratory health may be linked. The findings need to be examined in a longitudinal study.

Child↗

PubMed1997

Lower respiratory tract colonization and infection during severe acute respiratory distress syndrome: incidence and diagnosis.

Ventilator-associated pneumonia (VAP) is difficult to detect and is often unsuspected during adult respiratory distress syndrome (ARDS). We prospectively evaluated lower respiratory tract (LRT) colonization and infection in 30 patients with severe ARDS (PaO2/FIO2 ratio < 150 mm Hg), using repeated quantitative cultures of plugged telescopic catheter (PTC) specimens taken blindly via the endotracheal tube every 48 to 72 h after onset of ARDS. All patients except one were receiving antibiotics. When VAP was suspected on the presence of clinical criteria for infection, a repeated PTC and, when possible, a bronchoalveolar lavage (BAL) were obtained before any new antimicrobials were administered; samples growing > or = 10(3) cfu/ml (PTC) or > or = 10(4) cfu/ml (BAL) were considered diagnostic of infection. Twenty-four VAP episodes were diagnosed in 18 patients (60% of patients or 4.2/100 ventilator-days) a mean of 9.8+/-5.7 d after onset of ARDS. Eighteen LRT colonization episodes were recorded; 16 of 24 (66%) VAP episodes were preceded (by 2 to 6 d) by LRT colonization with the same organism(s), and only two episodes of colonization were not followed by VAP. We conclude that although VAP is of relatively late-onset during severe ARDS, its incidence is much higher than in other conditions and can be underestimated. Lower airways colonization is consistently followed by infection with the same organisms and precedes VAP in two thirds of episodes. Repeated protected specimens taken blindly may provide a useful means to predict infection and therefore allow early antimicrobial therapy in high-risk patients with diffuse lung injury.

Acute Disease↗

PubMedDate not supplied

[Results of ciprofloxacin therapy in urinary and respiratory tract infections].

Ciprofloxacin was administered to 218 patients with various urinary and respiratory tracts infections, including 142 patients with urinary tract infections and 76 patients with respiratory tract infections. Bacteriological tests and routine laboratory tests were performed thrice (before, during and after therapy) in all patients. Ciprofloxacin was administered orally in daily dose of 500 mg for 10 days. Daily dose was increased to 1000 mg in 23 patients with severe respiratory tract infections. Satisfactory results (recovery or regression of the symptoms of exacerbated chronic disease) were achieved in 185 patients (84.9%) and no effect in 10 patients (4.6%). Significant improvement or transient improvement were noted in 23 patients (10.5%).

Adult↗

PubMed2002

Improving care for patients with respiratory tract infections.

The common respiratory tract infections of acute bacterial sinusitis, acute exacerbation of chronic bronchitis, and community-acquired pneumonia are responsible for millions of physician office visits every year. Despite advances in diagnostic testing and the development of new antimicrobial agents, these infections continue to contribute significantly to patient morbidity and mortality worldwide. Physicians are faced with multiple challenges in the management of patients with these diseases. These challenges include the selection of appropriate empiric therapy, the increasing emergence of resistant pathogens, patient noncompliance with therapeutic regimens, and the pressure to use cost-effective agents. Patients expect their antibiotics to work rapidly so that they can feel better quickly and return swiftly to their normal activities. Moxifloxacin has been developed to address many of these problems. Its efficacy has been demonstrated in an extensive clinical trial program the results of which are summarized below. The excellent pharmacokinetics and pharmacodynamics of moxifloxacin are covered elsewhere in this supplement, as is moxifloxacin's impressive safety and tolerability profile. Accordingly, this paper focuses on the clinical trial data currently available.

Anti-Infective Agents↗

PubMed1990

Lower respiratory tract infections.

Although lower respiratory tract infections are frequently diagnosed in a primary care setting, they are still associated with a significant morbidity and mortality, which warrants a careful approach to treatment. Knowledge of the most common cause based on the age of the patient, location where the infection was acquired, and clinical presentation helps to direct empiric treatment. A few basic laboratory studies, especially a sputum Gram stain, can allow for more specific treatment. Identification of patients at increased risk for virulent organisms should make the primary care physician consider inpatient treatment along with an aggressive diagnostic workup and broad-spectrum antimicrobial treatment. Prevention should always be considered.

Acute Disease↗

PubMedDate not supplied

[Simulation of a steady-state mass-heat exchange in the respiratory tract].

On the basis of Weibel respiratory tract model the mathematical model of mass and heat transfer in the lungs was solved for steady-state one-dimensional case. Coefficients of mass and heat transfer were taken from empirical expressions for canals. The model shows that independent water vapour or air heat saturation in the lungs occurs in 12-14 generations of the bronchial tree. The saturation site depends upon volume velocity of the air and functioning of the upper respiratory tract.

Air↗

PubMed2000

Emerging resistance problems among respiratory tract pathogens.

The number-1 indication for antibiotic prescriptions in the United States is a respiratory tract infection. The changing spectrum of pathogens and emerging bacterial resistance are changing the way these infections are managed. The epidemiology of community-acquired pneumonia has changed significantly in the past 20 years, with increased diversity of pathogens and mortality. Emerging resistance in respiratory tract pathogens, particularly to beta-lactams, is an increasing concern. Of the important gram-negative pathogens, more than a third of Haemophilus influenzae isolates are now resistant to beta-lactam antibiotics, as well as virtually all isolates of Moraxella catarrhalis. Of the gram-positive organisms, more than 40% of Streptococcus pneumoniae isolates are no longer susceptible to penicillin, and methicillin resistance has been reported in up to half of Staphylococcus aureus isolates in some institutions. Among staphylococci, resistance to the beta-lactam methicillin is often accompanied by resistance to multiple classes of antibiotics, particularly the macrolides. Little resistance to fluoroquinolones has been reported among gram-negative respiratory tract pathogens and S pneumoniae, although increasing resistance may be seen as these drugs are used with increasing frequency. In contrast, fluoroquinolone resistance can develop rapidly in S aureus and appears to be associated with methicillin resistance. Fortunately, many of the newer fluoroquinolones appear to offer significant activity against methicillin-resistant S aureus isolates and are active against ciprofloxacin-resistant strains of S pneumoniae. Today, to combat respiratory tract infections, a broad-based empiric therapy needs to be used and bacterial resistance must be taken into account. New antimicrobial options must be considered, with an emphasis on effective drug use and optimal dosing. Even if a direct relationship between antibiotic resistance and clinical outcomes in the treatment of pneumonia in adults has not been extensively demonstrated, the increasing problem of resistance has changed treatment approaches for respiratory tract infections as a whole.

Anti-Infective Agents↗

PubMed1992

Changes in the bacterial flora of the upper and lower respiratory tracts and bronchoalveolar lavage differential cell counts in feedlot calves treated for respiratory diseases.

Serial nasopharyngeal swab and bronchoalveolar lavage cultures were used to estimate changes in the bacterial flora of the respiratory tracts of calves during the first month after arrival in the feedlot. Bronchoalveolar lavage (BAL) differential cell counts served to evaluate pulmonary inflammatory changes during this period. Two groups of calves were studied, one consisting of clinically normal controls (n = 60), the other, of cases (n = 59) which received treatment for respiratory disease (penicillin +/- trimethoprimsulfadoxine). A variety of organisms, including Pasteurella multocida, Pasteurella haemolytica, Haemophilus somnus, Mycoplasma bovis and Mycoplasma bovirhinis, were present in the upper and lower airways of both groups during the postarrival period. With the exception of M. bovis, an overall decline in the prevalence of these organisms was observed during the course of the study. In cases, there was a marked decrease in the number of Pasteurella spp. and H. somnus isolates immediately following treatment. For the Pasteurella spp., however, this effect was shortlived as they often appeared to recolonize the respiratory tract within eight days of terminating antimicrobial therapy. Treatment did not appear to affect the frequency of isolating M. bovis. Its prevalence, in both groups of calves, increased to levels approaching 100% during the course of the study. All Pasteurella spp. isolates were tested for susceptibility to several commonly used antimicrobials. Resistance was only evident among P. haemolytica isolated from cases and in every instance this was to a combination of penicillin, ampicillin and tetracycline. Significantly more isolates were resistant after treatment than before. There were BAL differential cell count abnormalities indicative of inflammation in both cases and controls.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed2005

Highlights on the appropriate use of fluoroquinolones in respiratory tract infections.

The impact of respiratory infections on public health is increasing, and lower respiratory tract infections are a major cause of morbidity and mortality. Moreover, most antibiotic prescriptions are related to respiratory infections and this is probably one of the main determinants of the increasing rate of bacterial resistance in both community and hospital settings. This has been the catalyst for the development of new drugs, such as the new fluoroquinolones. The new fluoroquinolones have an excellent spectrum providing cover for the most important respiratory pathogens, including atypical and "typical" pathogens. The pharmacokinetic and dynamic properties of the new fluoroquinolones have a significant impact on their clinical and bacteriological efficacy. They cause a concentration-dependent killing with a sustained post-antibiotic effect. Fluoroquinolones combine exceptional efficacy with cost-effectiveness. Not surprisingly, different guidelines have inserted these agents among the drugs of choice in the empirical therapy of LRTIs. This review discusses the most recent data on the bacteriological and clinical activity of the new fluoroquinolones and critically analyses the risks of a potential overuse of this valuable new class of drugs.

Anti-Infective Agents↗