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PubMed2003

The reducing incidence of respiratory tract infection and its relation to antibiotic prescribing.

BACKGROUND: There is good evidence of reduced prescribing of antibiotics in recent years, but the reason for this has not been established. AIM: To study the incidence of respiratory tract infections presenting to general practitioners (GPs) in England and Wales in relation to the incidence of other infections and to the prescription of antibiotics. SETTING: Sentinel practices in England and Wales who contribute to the Weekly Returns Service (WRS) of the Royal College of General Practitioners. DESIGN: Time-series analysis of disease incidence data reported by the practices and of antibiotic prescription data from the Prescription Pricing Authority (PPA) during the years 1994-2000. METHOD: Incidence data reported weekly from 73 practices in England and Wales, serving a population of 600,000, for acute respiratory tract infections, otitis media, infectious mononucleosis, shingles, urinary tract infections, and skin infections, were consolidated into quarterly datasets and examined graphically for evidence of secular and seasonal trends. Trends in antibiotic prescription items (data for England only were supplied by the PPA) were examined for association after adjustment for seasonal variation. RESULTS: The incidence of respiratory tract infections and antibiotic prescribing showed virtually identical seasonal variation, with both declining from 1995: respiratory tract infections by 48% in winter and 38% in summer, and antibiotic prescriptions by 34% and 21%, respectively. Trends in both were very highly correlated. The incidence of shingles and skin infections was constant. The incidence of urinary tract infections declined by 10%. The incidence of otitis media in children and acute bronchitis in the elderly followed the all-age trend in the reduction of respiratory tract infections. CONCLUSION: The considerable reduction in the incidence of respiratory tract infections between 1995 and 2000 is the main reason for the decline in antibiotic prescribing rather than changing prescribing thresholds for antibiotics.

Anti-Bacterial Agents↗

PubMed1990

Mast cells in the ovine lower respiratory tract: heterogeneity, morphology and density.

The lower respiratory tract (LRT) of 6 adult sheep was fixed in either isotonic formalin-acetic acid or neutral buffered formalin in order to study the heterogeneity, morphology and density of mast cells (MCs). Two subtypes of MCs were found, one histochemically similar to connective tissue MCs (formalin resistant) and the other similar to mucosal MCs as found in the intestine of the rat (formalin sensitive). Although both subtypes were present at all levels of the tract, formalin-sensitive MCs were significantly more abundant (p less than 0.01) at all levels, and their density increased distally from the trachea to the peripheral lung. The formalin-sensitive MCs were predominantly located in the alveolar septa and in the superficial lamina propria of airways and less frequently within the airway epithelium. The MCs in the ovine LRT were found to be morphologically heterogeneous at both the light-microscopic and electron-microscopic levels. These findings indicate that ovine respiratory tract MCs have similarity to human lung MCs, and therefore potential for use as a model for the study of human allergic disease of the respiratory system.

Animals↗

PubMed1997

Microbiological study of transtracheal aspirates from dogs with suspected lower respiratory tract disease: 264 cases (1989-1995).

OBJECTIVE: To determine the most commonly isolated bacterial species associated with lower respiratory tract disease of dogs and to determine susceptibility of these isolates to antimicrobial agents. DESIGN: Retrospective case series. SAMPLE POPULATION: Transtracheal aspirates from 264 dogs with clinical evidence of lower respiratory tract disease. PROCEDURE: Records of microbiological analyses of transtracheal aspirates obtained from dogs with clinical evidence of lower respiratory tract disease were reviewed. Analyses performed included bacterial culture (anaerobic and aerobic organisms) and susceptibility testing (aerobic organisms). The medical record of each affected dog was evaluated to determine signalment and underlying condition. RESULTS: Bacteria were isolated from 116 of 264 (44%) samples, and 203 bacterial species were identified. Most (57%) of the samples from which bacteria could be isolated contained a single species, whereas 43% yielded cultures of mixed species. Bacterial species belonging to the family Enterobacteriaceae (particularly Escherichia coli) were isolated most commonly (45.7% of samples contained members of this group), followed by members of the genus Pasteurella (22.4%), obligate anaerobes (21.6%), beta-hemolytic Streptococcus (12.1%), Bordetella bronchiseptica (12.1%), nonhemolytic Streptococcus/Enterococcus sp group (12.1%), coagulase-positive Staphylococcus (9.5%), and Pseudomonas sp (7.8%). The most active antimicrobial drugs (inhibiting > 90% of the isolates) for aerobic microorganisms encountered most often (E. coli and Pasteurella sp) included amikacin, ceftizoxime sodium, enrofloxacin, and gentamicin sulfate. CLINICAL IMPLICATIONS: Amikacin, ceftizoxime, enrofloxacin, and gentamicin may be rational choices for treatment of suspected infectious lower respiratory tract disease of dogs, before identification of the causative agent(s) and before results of susceptibility tests become available.

Animals↗

PubMed1996

Respiratory tract disease and mucosal colonization by Pasteurella haemolytica in transported cattle.

OBJECTIVES: To follow incidence of Pasteurella haemolytica (PH) in the upper respiratory tract of healthy calves at the farm and through the marketing process, and to determine the effect of vaccination on PH colonization of the upper respiratory tract and on the incidence of respiratory tract disease (RTD). ANIMALS: 2- to 5-month-old calves (n = 104) from 4 farms. PROCEDURE: Calves were vaccinated with a killed PH serotype-1 product. Nasal secretion and tonsil wash specimens were cultured for PH, and serum antibody was measured by indirect hemagglutination. Calves with RTD were treated with tilmicosin phosphate. RESULTS: At the feedyard, 73 calves had RTD. The incidence of RTD was significantly related to the farm of origin, and was inversely related to the PH serum titer at the farm, but was not influenced by vaccination. Isolations of PH serotype 1, however, were reduced by vaccination. The major serotypes of PH encountered were 1 and 6. CONCLUSION: Vaccination can reduce the frequency of colonization of the upper respiratory tract by PH.

Animals↗

PubMed2005

[Asthma, allergic rhinitis, sinusitis. Concept of the "unified respiratory tracts"].

Epidemiological studies indicate that allergic rhinoconjunctivitis (ARC) is an important risk factor for bronchial asthma. Both asthma and ARC have now been recognized as inflammatory diseases with similar manifestations in the mucous membranes of the upper (nose and paranasal sinuses) and lower respiratory tract (bronchi). Recent studies show that the deposition of allergen into the lower respiratory tract leads to increased inflammation of the upper respiratory tract, even if the patients are only suffering from ARC. These and other findings indicate that allergic diseases have a systemic component, which might be insufficiently targeted with local therapy. It is currently believed that the impaired function of the upper airways due to ARC causing nasal obstruction, retention of secretions, and disturbed conditioning of the inspired air plays an important role in the development of lower airway symptoms. Studies indicate that treatment of the upper respiratory tract inflammation not only reduces the manifestation of allergen-associated symptoms in the lower respiratory tract, but might also have preventive properties if applied early. ARC should no longer be viewed as a harmless disorder but as the early manifestation of a potentially progressive systemic disease and be treated as such.

Asthma↗

PubMed1996

Epidemiologic and pathologic characteristics of respiratory tract disease in dairy heifers during the first three months of life.

OBJECTIVE: To describe the incidence of respiratory tract disease in dairy calves and to compare antibody titers and microbial isolates from transtracheal wash samples between calves with and without respiratory tract disease (cases and controls, respectively). DESIGN: Prospective observational cohort study, with matched case-control substudy. ANIMALS: 410 dairy heifers; in substudy, 105 cases and 59 controls from the same population. PROCEDURE: Calves were examined weekly by a veterinarian during the first 3 months of life. Blood samples were collected for serologic testing at the first visit for each calf and during acute and convalescent periods for cases. Transtracheal wash samples also were obtained during the acute period from cases and controls. RESULTS: Incidence and case-fatality risk for clinician-diagnosed pneumonia were 25.6 and 2.2%, respectively. Mycoplasma sp and Pasteurella multocida together were isolated from 29% of cases and 11% of controls, and Mycoplasma sp alone from 7% of cases and 30% of controls (both P < or = 0.05). From postcolostral to acute-phase serum samples. Mycoplasma dispar titers increased 1.3-fold among cases, compared with 0.7-fold among controls; from acute- to convalescent-phase samples, M dispar titers increased 2.4-fold among cases, compared with 5.6-fold among controls (both P < or = 0.005). CLINICAL IMPLICATIONS: Results of this study suggested a synergistic effect between Mycoplasma sp and P multocida and a possible initiative role of M dispar in the development of respiratory tract disease. Postcolostral total IgG values and antibody titers were not significantly different between cases and controls, implying that other factors have an important role in the development of respiratory tract disease.

Animals↗

PubMed1993

The role of antigen detection in pneumococcal carriers: a comparison between cultures and capsular antigen detection in upper respiratory tract secretions.

During the winter season upper respiratory tract secretions from 166 patients with stable chronic obstructive pulmonary disease (COPD) or asthma were simultaneously cultured for Streptococcus pneumoniae and tested for pneumococcal capsular antigen. Latex agglutination was employed to investigate the effect of pneumococcal carriership on pneumococcal capsular antigen detection in upper respiratory tract secretions. All specimens originating from the oropharynx, nasopharynx and saliva were both cultured and investigated in parallel for the presence of antigen. The recovery of pneumococci from the different areas was unequally distributed (oropharynx 29%, nasopharynx 8%, and saliva 16%), with the highest isolation rate from the oropharynx alone. Only 4 (3%) of the oropharyngeal swabs, 1 (1%) of the nasopharyngeal swabs and 14 (9%) of the saliva specimens yielded both pneumococcal antigen and a positive culture for S. pneumoniae. A further 9 (6%) of the oropharyngeal swabs, 5 (3%) of the nasopharyngeal swabs, and 50 (33%) of the saliva specimens were antigen positive only, with no pneumococci isolated on culture. It is speculated that these reactions were due to cross-reacting microorganisms (especially alpha-haemolytic streptococci) present in saliva and contaminating the oropharynx and the nasopharynx. Quantitative cultures of 9 oropharyngeal swabs yielded S. pneumoniae in concentrations too low to be detectable by latex agglutination. The study indicates that there is a poor relation between pneumococcal colonization and antigen detection in the oropharynx and nasopharynx. Antigen present in these secretions is probably not an important disrupting factor by contamination when detecting pneumococcal antigen in washed sputum. The false positive antigen results in saliva are probably due to cross-reactions with alpha-haemolytic streptococci.

Adult↗

PubMed1988

Role of upper respiratory tract infection in the deaths occurring in neonatal ferrets infected with influenza virus.

Passive immunization of ferret neonates by colostrally-derived anti-influenza virus IgG did not entirely prevent infection when mothers were immunized with 1 or 2 doses of formalin inactivated vaccine with adjuvant (alhydrogel). Influenza virus replication was almost completely prevented in the lower respiratory tract but only slightly reduced in the upper respiratory tract leading to deaths in about 50% of the neonates. Such neonates showed at most only minor lesions in the lower respiratory tract but moderate to severe inflammatory changes in the upper respiratory tract of most animals. This supports previous results suggesting that deaths, reminiscent of the human sudden infant death syndrome (SIDS), may arise purely as a result of upper respiratory tract infection, possibly following obstruction of the airways.

Animals↗

PubMed1991

Dynamic evaluation of the equine upper respiratory tract.

Each case of suboptimal equine athletic performance should be evaluated in a comprehensive manner, including physical examination; clinical pathologic analysis; and evaluation of the neurologic system, the musculoskeletal system, and the upper and lower respiratory system. A vital part of this examination is the clinical evaluation of dynamic upper respiratory tract function of the horse during treadmill exercise, which allows the observation of upper respiratory tract function during conditions simulating competitive racing. It generally is agreed that the endoscopic identification of an upper respiratory tract abnormality in the resting horse does not necessarily indicate a clinical problem. It is equally certain that the absence of an upper respiratory abnormality at rest does not rule out the presence of an intermittent obstruction during strenuous exercise. Although many upper respiratory abnormalities may be diagnosed at rest (specifically, most cases of continual epiglottic entrapment and total laryngeal paralysis) the diagnosis of intermittent DDSP, intermittent EE, and some cases of idiopathic laryngeal neuropathy necessitates the observation of the upper respiratory tract during strenuous exercise. This diagnostic technique allows absolute documentation of whether upper airway dysfunction is a contributing factor to inadequate athletic performance in each individual horse. In the decade to come, it is clear that the evaluation of potential upper respiratory tract dysfunction as a cause of exercise intolerance should be performed before specific recommendations are made for treatment in each equine athlete. In many cases, this evaluation has circumvented the unnecessary attempt at correction of suspected but nonexistent respiratory dysfunction. Thus, these horses benefit from a continuation of a comprehensive performance evaluation, enabling an elucidation of the true cause of inadequate performance. The routine use of this diagnostic technique at Tufts University School of Veterinary Medicine's Equine Sports Medicine Center has greatly expanded the documentation of the diversity of upper respiratory dysfunctions that can occur. It also has enabled a precise description of the anatomic abnormalities resulting in each case of upper airway obstruction. In addition, this new knowledge has made us cautious regarding conventional treatment regimens and allowed the capability to individualize attempts at surgical and managemental correction of each dysfunction to optimize the success of the treatment for each horse.

Animals↗

PubMed1996

Loss of upper respiratory tract immunity with parenteral feeding.

OBJECTIVE: The authors examine the effect of route and type of nutrition on an established upper respiratory tract immunity and investigate potential mechanisms for increased pneumonia rates in critically injured patients fed parenterally. SUMMARY BACKGROUND DATA: The primary immunologic defense against many mucosal infections is IgA. Prior work shows that mice fed total parenteral nutrition (TPN) solutions either intravenously or intragastrically had small intestinal gut-associated lymphoid tissue (GALT) atrophy along with decreased intestinal IgA compared with animals fed complex enteral diets. The small intestine is postulated to be the origin of most mucosal immunity, both intraintestinal and extraintestinal. The impact of diets affecting GALT, small intestine IgA, and upper respiratory tract immunity is studied. METHODS: Male Institute of Cancer Research mice underwent intranasal inoculation with a mouse-specific influenza virus to establish immunity. Three weeks later, the mice were randomized to chow, intragastric Nutren (Clintec, Chicago, IL), intravenous TPN, or intragastric TPN. After 5 days of feeding, mice were challenged with intranasal virus and killed at 40 hours to determine viral shedding from the upper respiratory tract. RESULTS: Despite similar body weights, there was significant atrophy in the Peyer's patch cells from animals fed the TPN solution intravenously or intragastrically. There was no viral shedding in any animal fed via the gastrointestinal tract, whereas 5 of 10 animals fed intravenous TPN had continued viral shedding. CONCLUSIONS: The IgA-dependent upper respiratory tract immunity was preserved with enteral feeding but not with intravenous feeding. Upper respiratory tract immunity is not dependent on intestinal GALT mass but is influenced by route of nutrition. The underlying mechanisms may explain the higher pneumonia rate in critically injured patients fed parenterally.

Animals↗

PubMed2004

Excessive use of rapid tests in respiratory tract infections in Swedish primary health care.

A 1-y retrospective study of problem oriented electronic patient records, for encounters concerning respiratory tract infection, was performed. The aim was to analyse the management of respiratory tract infections in primary health care in terms of diagnostic coding, tests and antibiotic treatment using data from electronic patient records. 12 primary health care centres with a registered population of 102,050 residents in 3 counties in southeast Sweden participated. Data were retrieved electronically from records of patient encounters concerning respiratory tract infections. The data were: patient age and gender, date of contact, diagnostic code, CRP and GABHS tests and results, as well as antibiotic prescriptions. In a total of 19,965 encounters, the most frequent diagnoses were common cold (40%), acute tonsillitis (18%), and acute bronchitis (15%). A total of 4445 GABHS tests (in 22% of encounters) and 6141 CRP tests (31%) were performed, and both tests were done in 1910 encounters (10%). A total of 7934 antibiotic prescriptions were registered. The proportion of patients tested and prescribed an antibiotic varied greatly between centres. We found an excessive, and much varying, use of rapid tests in encounters for respiratory tract infections. Data retrieval from electronic patient record systems was a feasible method to study the use of laboratory tests in relation to pharmacological treatment.

Adolescent↗

PubMed1984

Respiratory tract lesions induced by sensory irritants at the RD50 concentration.

Exposure of mice to airborne sensory irritants causes a concentration-dependent depression of respiratory rate. The RD50 concentration (that concentration which elicits a respiratory rate decrease of 50%) has been predicted to be an unacceptable occupational exposure concentration due to intolerable sensory irritation and possible respiratory tract injury in humans. The purpose of this study was (1) to determine whether lesions occur in the respiratory tract of Swiss-Webster mice after exposure to the RD50 concentrations of ten sensory irritants and (2) to compare these changes with respect to type and severity. The RD50 values (ppm) of the chemicals studied are as follows: 2,4-toluene diisocyanate (0.4), acrolein (1.7), formaldehyde (3.1), chloropicrin (8.0), chlorine (9.3), sulfur dioxide (117), ammonia (303), hydrogen chloride (309), dimethylamine (511), and epichlorohydrin (687). After exposure of mice for 6 hr/day for 5 days, the respiratory tract was examined for histopathologic changes. All irritants produced lesions in the nasal cavity with a distinct anterior-posterior severity gradient. There was considerable variation in the extent, and nature of the lesions. The lesions ranged from slight epithelial hypertrophy or hyperplasia to epithelial erosion, ulceration, and necrosis with variable inflammation of the subepithelial tissues. Only chlorine, chloropicrin, and epichlorohydrin induced lesions in the lower respiratory tract. These findings give additional support to the potential value of the RD50 model for setting occupational exposure guidelines and predicting the risk of injury to the respiratory tract from exposure to airborne sensory irritants.

Animals↗

PubMed1999

Evaluation of combining upper respiratory tract swab samples with cerebrospinal fluid examination for the diagnosis of enteroviral meningitis in children.

In a prospective comparative study, the use of combined analysis of upper respiratory tract swab samples and cerebrospinal fluid (CSF) samples was assessed to improve the detection rate of enteroviral meningitis in children. An enterovirus was detected in 32% of patients with aseptic meningitis when testing CSF samples alone compared with 71.5% when combining CSF and respiratory tract findings. An enterovirus was detected in 17% of respiratory tract samples in an age- and sex-matched control group without meningitis. Thus, combining the examination of upper respiratory tract with CSF findings may improve the detection rate of enteroviral meningitis. Upper respiratory tract samples should be included in the diagnosis scheme to differentiate benign enteroviral meningitis from other life-threatening infections of the central nervous system.

Adolescent↗

PubMed2002

Resistant pathogens in respiratory tract infections in older people.

Bronchitis, bronchiectasis, and pneumonia are the most common respiratory tract infections observed in older people and are the leading causes of morbidity and mortality associated with infection. Accurate diagnosis of respiratory tract infections in older people is problematic because of the lack of clear symptoms and signs that are usually seen in younger patients. In addition, the increasing prevalence of bacterial resistance to antibiotic therapy highlights the importance of appropriate therapy. The following review examines the issues associated with the accurate diagnosis of respiratory tract infections, optimal therapy for older patients, and the mechanisms of emerging bacterial resistance to antibiotic therapy.

Aged↗

PubMed1998

[Isolation and drug susceptibility of Staphylococcus epidermidis from respiratory tract].

OBJECTIVE: In order to realize the significance on the isolation and drug susceptibility of S. epidermidis from patients with lower respiratory tract infections. METHOD: (1) Qualified sputum specimens from inpatients in general wards with lower respiratory tract infections were cultured for bacteria and identification between 1990 and 1996. (2) Drug susceptibility of commonly used antibiotics against isolated S. epidermidis strains was determined by K-B methods or agar dilution method. RESULT: (1) Two thousand and six hundred sixty strains of various kinds of bacteria were isolated from 6228 sputum specimens, 257 strains (9.66%) of which were S. epidermidis (ranking the forth). The isolating rate of S. epidermidis was 4.13%. (2) By determining the drug susceptibility of S. epidermidis to 21 commonly used antibiotics, it was found that this bacterium was resistant to all the agents except vancomycin in different levels, and the resistant rate ranged from 15.2% to 98.1%, of which many strains showed multidrug resistance. Vancomycin, imepinem, cefocefin and cefoperazone were relatively sensitive agents tested, the resistant rates being 0, 17.1%, 18.7% and 30.0%, respectively. The resistant rates of all other agents were higher than 48.5%, some of which higher than 80%. The resistant rate of penicillin G was nearly 100%. CONCLUSION: Attention should be paid to the high isolating rate of S. epidermidis in the respiratory tract infections and the high drug resistance in some strains, and the role of this bacterium in the lower respiratory tract infections needs to be studied.

Anti-Bacterial Agents↗

PubMed1999

What is the place of fluoroquinolones in the treatment of community-acquired respiratory tract infections?

The newest (third generation) fluoroquinolones are potentially useful agents in the management of community-acquired respiratory tract infections. This is mainly due to their increased activity against Streptococcuspneumoniae, a pathogen poorly susceptible to the second-generation compounds, and playing a major role in upper and lower respiratory tract infections. Also, their spectrum includes the other main pathogens involved in those infections, comprising Haemophilus influenzae and intracellular agents, against which the newest fluoroquinolones exhibit a similar activity to that of the previous compounds. The pharmacokinetic and pharmacodynamic properties of the newest quinolones make them suitable for effective therapy of lower respiratory tract infections. However, careful attention should be paid to the dose and dosing regimen of each compound in clinical usage in order to select the most adapted drug. In clinical trials, the fluoroquinolones have been shown to be at least as effective as the comparators in the treatment of community-acquired pneumonia, acute exacerbations of chronic bronchitis (AECB) or sinusitis, including documented pneumococcal infections. Their tolerance is generally considered to be good. The main question regarding the fluoroquinolones in the treatment of community-acquired respiratory tract infections is their role as first-line agents used in single drug therapy. Cost-effectiveness studies are needed to define this role further. Identification of subpopulations of patients at risk of being infected by penicillin-resistant pneumococci or Gram-negative bacilli who could benefit from a fluoroquinolone could be useful. Also, it must be considered that a large use of fluoroquinolones as first-line agents in very common infections such as AECB or sinusitis could contribute to the selection of bacteria, including S. pneumoniae, resistant to this class of antibiotics. Careful control of fluoroquinolone usage and development of bacterial resistance is of great importance.

Anti-Infective Agents↗

PubMed2006

Chlamydia and Mycoplasma serology in respiratory tract infections of children.

One of the challenges in planning the treatment of respiratory tract infection in children is identifying the causative agent. The objective of the present study was to investigate the incidence of Mycoplasma and Chlamydia in the etiology of respiratory tract infections of children. The present study included 100 children, three months to 12 years of age, admitted to the outpatient department of pediatrics with such respiratory symptoms as fever, cough and respiratory distress. Following a detailed clinical history and physical examination, complete blood count, erythrocyte sedimentation rate, peripheral blood smear and chest X-ray were obtained from each patient. At admission, IgG and IgM for Mycoplasma pneumoniae, Chlamydia pneumoniae, Chlamydia trachomatis and Chlamydia psittaci were determined serologically. Positive antibody titer was found for Chlamydia and Mycoplasma in 18 (18%) of the patients. It was found that 2% of the patients had acute C. pneumoniae infection. When the subjects who had infections in the past or had re-infection were also considered; 6% were infected with C. pneumoniae, 3% with C. trachomatis, 1% with C. psittaci and 8% with M. pneumoniae. The presence of eosinophilia (> or = 4%) or the presence of siblings in the house were considered as factors favoring Chlamydial infections. High antibody titers for M. pneumoniae and C. pneumoniae were found more frequently after the age of two. Patients older than two years should be evaluated carefully for antibiotic treatments against atypical agents in pediatric lower respiratory tract infections.

Antibodies, Bacterial↗

PubMed2003

In vitro susceptibility of gram-positive cocci isolated from skin and respiratory tract to azithromycin and twelve other antimicrobial agents.

This study was conducted to evaluate the activity of azithromycin in comparison to 12 other antibacterial agents against recent isolates obtained consecutively from patients with respiratory tract or skin infections, from January to July, 2000. A total of 717 Gram-positive cocci were analyzed in this study and the following species were studied: Staphylococcus aureus (n=576), beta-hemolytic streptococci (n=115), and Streptococcus pneumoniae (n=26). Susceptibility testing was carried out by the disk diffusion method and interpreted according to NCCLS breakpoints. The activity of azithromycin was compared to erythromycin, clindamycin, chloramphenicol, ciprofloxacin, ofloxacin, oxacillin, penicillin, ceftriaxone, tetracycline, trimethoprim/sulfamethoxazole, teicoplanin, and vancomycin. Of the 26 S. pneumoniae isolates recovered from the respiratory tract, 5 (19.2%) were intermediate resistant to penicillin. All of these strains were susceptible to chloramphenicol, ofloxacin, and vancomycin, and 24 (92%) were also susceptible to azithromycin, clindamycin, and erythromycin. Among the 67 beta-hemolytic streptococci strains isolated from the respiratory tract, 66 (99%) were susceptible to azithromycin, erythromycin, clindamycin, and ofloxacin. All 48 beta-hemolytic streptococci strains isolated from skin were susceptible to azithromycin and clindamycin, 47 (98%) were susceptible to erythromycin, and 46 (96%) were susceptible to ofloxacin. Of the 576 strains of S. aureus, 253 (43.9%) were isolated from the respiratory tract and 323 (56.1%) from skin. Among S. aureus isolates from the respiratory tract and skin, 46 (18%) and 78 (24%), respectively were resistant to oxacillin. Isolates from the respiratory tract and skin showed the same percentage of resistance (36%) to azithromycin. These in vitro results suggest that azithromycin can be a therapeutic option for treatment of infections caused by these bacteria since the newer macrolides have several distinct advantages over erytromycin including improved oral bioavailability, longer half-life allowing once or twice daily administration, higher tissue concentrations and less gastrointestinal adverse effects.

Anti-Bacterial Agents↗