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PubMed2006

Administration of antibiotics via the respiratory tract for the prevention of ICU-acquired pneumonia: a meta-analysis of comparative trials.

INTRODUCTION: The administration of prophylactic antibiotics via the respiratory tract is one of several strategies for the prevention of ICU-acquired pneumonia. We systematically examined the available evidence regarding the effect of prophylactic antibiotics administered via the respiratory tract on the development of ICU-acquired pneumonia, mortality, colonization of the respiratory tract, emergence of antimicrobial resistance, and toxicity. METHODS: We searched the PubMed database (1/1950 to 9/2005) and references from relevant articles to identify trials that provided comparative data regarding the above-mentioned outcomes. Two investigators independently performed the data extraction to calculate the effect of the studied intervention on clinically relevant outcomes. RESULTS: 8 comparative trials (5 randomized controlled trials (RCTs) and 3 non-randomized trials) studying gentamicin (3 trials) polymyxins (3 trials), tobramycin (1 trial), and ceftazidime (1 trial) that studied 1,877 patients were included in our meta-analysis. Our primary analysis that included the 5 RCTs, revealed that ICU-acquired pneumonia was less common in the group of patients that received the antibiotic prophylaxis (OR = 0.49, 95% CI 0.32-0.76). No difference in mortality was found between the compared groups (OR = 0.86, 95% CI 0.55-1.32). There were limited data to permit an analysis of colonization with Pseudomonas aeruginosa. A secondary analysis by adding the 3 non-randomized comparative trials did not reveal substantially different results regarding ICU-acquired pneumonia and mortality, while fewer patients were colonized with Pseudomonas aeruginosa in the group that received prophylaxis, compared to the group of patients that received no prophylaxis (OR = 0.51, 95% CI 0.30-0.86). No serious drug-related toxicity was noted. No meaningful systematic analysis of the evidence regarding the emergence of resistance could be performed in the studies included in our meta-analysis. CONCLUSIONS: The limited available evidence supports that prophylactic administration of antibiotics via the respiratory tract is associated with reduction of occurrence of ICU-acquired pneumonia. However, there is evidence from non-comparative studies that this preventive strategy may lead to an increase in the emergence of resistant bacteria. Thus, further investigation, at least in ICU patients at high risk for development of ICU-acquired pneumonia is warranted, including a more systematic evaluation of issues related to the emergence of resistance.

Administration, Inhalation↗

PubMed2002

Effect of daily vitamin E and multivitamin-mineral supplementation on acute respiratory tract infections in elderly persons: a randomized controlled trial.

CONTEXT: Immune response in elderly individuals has been reported to improve after micronutrient supplementation. However, efficacy trials evaluating infectious diseases as outcomes are scarce and inconclusive. OBJECTIVE: To investigate the effect of daily multivitamin-mineral and vitamin E supplementation on incidence and severity of acute respiratory tract infections in elderly individuals. DESIGN: A randomized, double blind, placebo-controlled, 2 x 2 factorial trial. SETTING AND PARTICIPANTS: A total of 652 noninstitutionalized individuals aged 60 years or older enrolled from 2 community-based sampling strategies in the Wageningen area of the Netherlands, conducted from 1998 to 2000. At baseline, 6% of participants had suboptimal ascorbic acid and 1.3% had suboptimal alpha-tocopherol plasma concentration. INTERVENTION: Physiological doses of multivitamin-minerals, 200 mg of vitamin E, both, or placebo. MAIN OUTCOME MEASURES: Incidence and severity of self-reported acute respiratory tract infections at 15 months, as assessed by a nurse (telephone contact), home visits, and microbiological and serological testing in subsets of patients. RESULTS: During a median observation period of 441 days, 443 (68%) of 652 participants recorded 1024 respiratory tract infection episodes. The incidence rate ratio of acute respiratory tract infection for multivitamin-mineral supplementation was 0.95 (95% confidence interval, 0.75-1.15; P =.58) and for vitamin E supplementation, 1.12 (95% confidence interval, 0.88-1.25; P =.21). Severity of infections was not influenced by multivitamin-mineral supplementation. For vitamin E vs no vitamin E, severity was worse: median (interquartile range) for illness-duration was 19 (9-37) vs 14 (6-29) days, P =.02; number of symptoms, 6 (3-8) vs 4 (3-8), P =.03; presence of fever, 36.7% vs 25.2%, P =.009; and restriction of activity, 52.3% vs 41.1%, P =.02. CONCLUSIONS: Neither daily multivitamin-mineral supplementation at physiological dose nor 200 mg of vitamin E showed a favorable effect on incidence and severity of acute respiratory tract infections in well-nourished noninstitutionalized elderly individuals. Instead we observed adverse effects of vitamin E on illness severity.

Acute Disease↗

PubMed2000

What's the basis for treating infections your way? Quality assessment of review articles on the treatment of urinary and respiratory tract infections in older people.

OBJECTIVE: To assess the quality of readily available review articles on urinary and respiratory tract infections in older people. METHODS: Data sources were articles identified by MEDLINE search (1988-1998), review of the bibliographies of identified publications, textbooks from the library of a geriatric university hospital, and booklets with general guidelines on antibiotic therapy. Selection was made of review articles or book chapters about urinary and/or respiratory tract infections in older people that were readily available, ie, in Swiss medical libraries. Quality was assessed according to clinical applicability of the recommendations, methodology of the review, type of literature cited in the bibliography, and age of the population included in these reference articles. RESULTS: Only 13 of 29 (45%) review articles about urinary tract infections and seven of 29 (24%) articles about respiratory tract infections satisfied our criteria of applicability. Specifically, dosage, route of administration, and treatment duration were often not described. The overall methodological quality was low (mean score 1.9 +/- 1.0 on a scale of 9). No review specified the methods used to identify, select, and validate included information. Authors of the review articles quoted an important number of other review articles and only a small number of clinical trials. Less than one-quarter of these clinical trials actually comprised primarily an older population. CONCLUSIONS: Review articles on treatment of common infectious diseases in older people are often neither clinically applicable nor of good methodological quality. Therefore, more systematic review articles regarding treatment of older patients, as well as evidence-based practice guidelines, are needed.

Geriatrics↗

PubMed1976

[Therapy and prevention of chronic respiratory tract diseases].

196 patients suffering from chronic infections of the respiratory tract (bronchial asthma, spastic bronchitis, sinobronchitis, increased liability to infections during childhood) were treated with non-specific hyposensitization by Paspat as no improvements had been obtained with other methods. The patients were observed for at least one year after the termination of the therapy: Recovery in 62,2%, clear improvements in 23% of the cases; only 14,8% did not respond. The author can now rely on a total of 466 cases, who have been treated by this method for 21 years. The results obtained after the childhood were significantly improved by modifying the treatment and the remedies and by increasing the numbers of injections. Consequently, repeated applications of Paspat for treating and preventing chronic infections of the respiratory tract are considered a real progress.

Adolescent↗

PubMed2004

Effectiveness of a multiple intervention to reduce antibiotic prescribing for respiratory tract symptoms in primary care: randomised controlled trial.

OBJECTIVES: To assess the effectiveness of a multiple intervention aimed at reducing antibiotic prescription rates for symptoms of the respiratory tract in primary care. DESIGN: Randomised controlled trial. SUBJECTS: Twelve peer review groups including 100 general practitioners with their collaborating pharmacists in the region of Utrecht, Netherlands. INTERVENTION: The intervention consisted of group education meetings, with a consensus procedure on indication for and type of antibiotics and with training in communication skills; monitoring and feedback on prescribing behaviour; group education for assistants of general practitioners and pharmacists; and education material for patients. The control group did not receive any of these elements. MAIN OUTCOME MEASURES: Antibiotic prescription rates for acute symptoms of the respiratory tract and patients' satisfaction. RESULTS: 89 general practitioners completed the study (89%). At baseline, prescription rates for antibiotics for respiratory tract symptoms did not differ between intervention and control group (27% v 29%, respectively). After nine months, the prescription rates in the intervention group fell to 23%, whereas the control group's rose to 37% (mean difference in change -12%, 95% confidence interval -18.9% to -4.0%). Multilevel analysis confirmed the results of the unadjusted analysis (intervention effect -10.7%, -20.3% to -1.0%). Patients' satisfaction was high and did not differ in the two groups at baseline or after the intervention. CONCLUSIONS: A multiple intervention reduced prescribing rates of antibiotics for respiratory tract symptoms while maintaining a high degree of satisfaction among patients. Further research should focus on the sustainability and cost effectiveness of this intervention.

Adult↗

PubMedDate not supplied

Feasibility of a primary care intervention to decrease oral antibiotics for acute upper respiratory tract infections: A pilot study.

BACKGROUND: Antimicrobial resistance in common respiratory tract pathogens is a growing public health threat, especially in the southeastern United States. The excessive use of antibiotics for common infections is a major contributing factor in the emergence of antibiotic resistance. We report results from a multi-site outpatient pilot project in North Carolina to reduce antibiotic prescriptions for acute nonbacterial upper respiratory tract infections (URIs). METHODS: Primary care practices were provided education and symptom therapy kits for patients with URIs, as an alternative to antibiotics, in a project to reduce the overuse of antimicrobial therapy The feasibility of this approach was evaluated with interviews and surveys. A methodology for claims-based evaluation of intervention efficacy in reduction of antibiotics use was developed as part of this project. RESULTS: Of eight contacted practices, four agreed to participate and three participated fully. Physicians reported that symptom therapy kits were useful for patients with URIs and resulted in a meaningful change in antibiotic prescribing behaviors. A claims-based approach is a feasible and promising method to evaluate efficacy in subsequent post-pilot large-scale implementations. LIMITATIONS: Due to the small number of outpatient practices and the lack of controls in this pilot study, the efficacy of the intervention in reducing antibiotic use could not be determined. CONCLUSIONS: Education combined with symptom therapy kits as an alternative to oral antibiotics is a feasible intervention that warrants additional studies to evaluate the efficacy of this approach in the reduction of antibiotic use for URIs.

Administration, Oral↗

PubMedDate not supplied

Summary of worldwide clinical trials of aztreonam in patients with lower respiratory tract infections.

Aztreonam was administered to 226 patients with lower respiratory tract infections--primarily pneumonia (181 patients)--due to gram-negative bacilli. The clinical response rate was 93%, and the microbiologic cure rate was 78%. Most patients received 1-g or 2-g intravenous doses of aztreonam three times daily for at least five days. Ninety-eight of the 226 patients were involved in a randomized comparison of aztreonam with tobramycin; the latter drug was administered to a group of 34 patients. The overall microbiologic cure rates for the two drugs were 86% and 71%, respectively. Aztreonam is effective for the treatment of lower respiratory tract infections due to susceptible gram-negative bacilli.

Aztreonam↗

PubMed2004

[Comparison of antimicrobial resistance pattern of selected respiratory tract pathogens isolated from different animal species].

The antibiotic resistance pattern of respiratory tract pathogens isolated of different animal species suffering from respiratory tract diseases has been investigated by antibiograms performed by agar diffusion test. The results show that the resistance situation in Switzerland is favourable compared with studies from other countries. However, high resistance rates were found in certain species: 61% of Streptococcus spp. were resistant to erythromycin and 44% to tetracycline, 59% of Bordetella bronchiseptica were resistant to ampicillin and 50% of Mannheimia (Pasteurella) haemolytica were multiresistant to tetracycline, ampicillin and streptomycine. The gram negative isolates were widely resistant to streptomycine.

Animals↗

PubMed1997

Effect of transportation on lower respiratory tract contamination and peripheral blood neutrophil function.

OBJECTIVE: To evaluate the effect of transportation on lower respiratory tract contamination and peripheral blood neutrophil function in horses and to compare results from transported horses with those obtained in earlier experiments from horses confined with heads elevated. DESIGN: A prospective study. PROCEDURE: Six horses were transported by road for 12 h. Clinical and haematological examination, transtracheal aspiration and cell function studies were conducted before and after transportation. Results obtained after transportation were compared to pre-transportation values. RESULTS: After transportation, peripheral blood leucocyte and neutrophil numbers were increased and rectal temperatures were evaluated. Transtracheal aspirates showed an accumulation of purulent respiratory tract secretions with increased numbers of bacteria, particularly beta-haemolytic Streptococcus spp and members of the Pasteurellaceae family. Three horses also had increased numbers of bacteria from the Enterobacteriaceae family relative to corresponding samples from earlier studies. Phagocytosis by peripheral blood neutrophils was significantly reduced, while the oxidative burst activity of peripheral blood leucocytes was either unchanged or enhanced. CLINICAL IMPLICATIONS: Bacterial contamination of the lower respiratory tract occurs as a routine consequence of transportation of horses and is likely to be an important determinant in the development of transport-associated respiratory disease. Inflammatory airway secretions and increased numbers of bacteria were rapidly cleared, without clinical evidence of significant pulmonary disease and without additional treatment, in normal horses that were allowed to lower their heads after transportation. Peripheral blood neutrophilia and a reduction in neutrophil phagocytic function were evident for at least 36 h after transportation, suggesting that horses may require a number of days to recover from the stress of transportation. As the potential role of bacteria from the Enterobacteriaceae family in the development of transport-associated respiratory disease has not been elucidated, horses which develop clinical disease following transportation should undergo thorough bacteriological investigation to ensure appropriate treatment.

Animals↗

PubMed1993

[Clinical evaluation of cefpodoxime in respiratory tract infections].

Cefpodoxime (CPDX-PR) was evaluated clinically in respiratory tract infections. The results obtained are summarized as follows; 1. The total number of the patients who were treated with CPDX-PR was 61, out of whom 53 cases were evaluated for clinical efficacy and 55 cases were investigated for the safety of the drug. CPDX-PR was given orally twice a day at 100-200 mg for 5-21 days. 2. Clinical efficacies were excellent in 9 patients, good in 36, fair in 4 and poor in 4. The overall clinical efficacy was 84.9%. In particular, CPDX-PR showed satisfactory efficacy for acute respiratory infections and mild chronic respiratory infections, with efficacy rates of 88.6% (31/35) and 100% (8/8), respectively. 3. No adverse reactions was observed, but slight and transient elevation of BUN was noted. In conclusion, it has been confirmed that CPDX-PR is an excellent and safe drug for the treatment of the respiratory tract infections.

Adolescent↗

PubMed1977

Erythromycin in respiratory tract infection.

One of the main uses of erythromycin in respiratory tract infection has been in the treatment of acute streptococcal tonsillitis as an alternative to penicillin. Studies on the quantitative bacteriology of tonsils obtained at tonsillectomy have shown large numbers of both haemolytic streptococci and Haemophilus species in most samples and these organisms can be effectively reduced in number by preoperative treatment with antibiotics such as erythromycin. Such investigations suggest that erythromycin might have wider use in the treatment of respiratory tract infections, particularly where Haemophilus influenzae and other Haemophilus species are involved. Apart from specific infections such as those due to Mycoplasma pneumoniae, erythromycin is effective in the treatment of acute pneumonia due to organisms such as the pneumococcus, and this paper reports the further use of erythromycin in the treatment of acute exacerbations of chronic bronchitis where the clinical and bacteriological effects of treatment with this antibiotic are compared with those of ampicillin.

Ampicillin↗

PubMed1989

Glutathione deficiency in the epithelial lining fluid of the lower respiratory tract in idiopathic pulmonary fibrosis.

Glutathione (L-gamma-glutamyl-L-cysteinyl-glycine, GSH), a sulfhydryl-containing tripeptide produced by most mammalian cells, is an efficient scavenger of toxic oxidants, including hydrogen peroxide, an oxidant that plays a major role in the oxidant burden placed on the epithelial surface of the lower respiratory tract in chronic inflammatory states. GSH is present in the epithelial lining fluid of the normal lower respiratory tract, where it is thought to play a major role in providing antioxidant protection to the epithelial cells. In this regard, we hypothesized that the lower respiratory tract of patients with IPF may be chronically depleted of this antioxidant, thus leading to an increased susceptibility of lung epithelial cells to oxidant injury. To evaluate this concept, the concentration of glutathione was determined in the epithelial lining fluid of the lower respiratory tract of 15 patients with IPF and compared to that of 19 normal subjects. Strikingly, whereas ELF glutathione concentrations were high in normal subjects (429 +/- 34 microM), a fourfold decrease was found in patients with IPF (97 +/- 18 microM, p less than 0.001). In the context of the known oxidant burden present in the lower respiratory tract of patients with IPF, these observations of a "GSH deficiency" in IPF ELF suggest that there is a marked oxidant-antioxidant imbalance at the alveolar surface of these persons, thus increasing the susceptibility to the severe epithelial cell damage characteristic of this disease.

Adult↗

PubMed2003

Genome type analysis of adenovirus types 3 and 7 isolated during successive outbreaks of lower respiratory tract infections in children.

Adenovirus is an important cause of respiratory infections in infants and children. Fifty-one serotypes have been identified, and adenovirus type 3 (Ad3) and Ad7 have often been associated with outbreaks of severe respiratory tract infections. Each serotype can be further divided into genome types based on the patterns of digestion of their DNAs with restriction enzymes. DNA restriction analysis was performed with 56 strains of Ad3 and 98 strains of Ad7 by using 12 restriction enzymes recognizing 6 bp (BamHI, BclI, BglI, BglII, BstEII, EcoRI, HindIII, HpaI, SalI, SmaI, XbaI, and XhoI). The virus strains were isolated during outbreaks of lower respiratory tract infections in children during an 11-year period from 1990 to 2000 in Seoul, Korea. Among the Ad3 strains, seven genome types were identified; Ad3a and six novel types (Ad3a13, Ad3a14, Ad3a15, Ad3a16, Ad3a17, and Ad3a18). Multiple genome types cocirculated during outbreaks, and some of these were isolated during the 11-year observation period, while others were restricted to particular outbreaks. For Ad7, two genome types, Ad7d and Ad7l, the latter of which is a novel genome type, were identified. A shift in genome types occurred from Ad7d to Ad7l during successive outbreaks. Mortality was 3.6% among children with Ad3 infections and 18% among children infected with either of the Ad7 genome types. In conclusion, the data confirm that Ad3 genome types are more diverse than those of Ad7 and suggest that shifts of genome types may occur during successive outbreaks of Ad3 and Ad7.

Adenovirus Infections, Human↗

PubMed2006

Theoretical evaluation of burns to the human respiratory tract due to inhalation of hot gas in the early stage of fires.

A transient two-dimensional mathematical model for heat and water vapor transport across the respiratory tract of human body was established and applied to predict the thermal impact of inhaled hot gas to the nasal tissues during the early stage of fires. Influences of individual's physiological status and environment variables were comprehensively investigated through numerical calculations. Burn evaluation was performed using the classical Henriques model to predict the time for thermal injury to occur. It was shown that decreasing the air velocity and increasing the respiratory rate is helpful to minimize the burn over the respiratory tract. The effect of relative humidity of surrounding dry hot air could be ignored in predicting burns for short duration exposures. Due to evaporation cooling on the mucousal membrane, the burn often occurs at certain positions underneath the skin of the tract near the inlet of the respiratory tract. Most of the tissues near the surface suffer injury immediately after exposure to fire, while in the deeper tissues, serious damage occurs after a relatively longer time period. The method presented in this paper may suggest a valuable approach to theoretically evaluate the injury of hot air to the human respiratory tract under various fire situations.

Burns, Inhalation↗

PubMed1979

[Therapy of chronic respiratory tract infections in children, including mucoviscidosis (author's transl)].

In respiratory tract infections in children a distinction must be made between frequently recurring infections and genuine chronic infections due to specific anatomical factors, immunological defects or congenital diseases such as mucoviscidosis. The most frequent pathogens are Haemophilus influenzae, pneumococci, Staphylococcus aureus, Streptococcus pyogenes, enterococci, Pseudomonas aeruginosa and Klebsiella, S. aureus predominates in infants. The same applies for mucoviscidosis, in which P. aeruginosa is the second most frequent pathogen, occurring frequently after a primary infection with staphylococci. In order to avoid frequent relapses in mucoviscidosis patients, uninterrupted long-term treatment with an antibiotic which is effective against staphylococci is recommended, commencing the moment the diagnosis has been established. Suitable antibiotics are co-trimoxazole or oral cephalosporins (e. g. cephalexin, cephradine or cefaclor). Other respiratory tract infections should be treated according to the antibiogramme with a suitable antibiotic once the diagnosis has been confirmed.

Cephalosporins↗

PubMed1985

[Evaluation of ceftizoxime in the treatment of respiratory tract infections].

Ceftizoxime (CZX) was used for 33 patients with respiratory tract infections; 22 patients with pneumonia, 3 patients with pulmonary abscess, 4 patients with diffuse panbronchiolitis and 4 patients with acute exacerbation of bronchiectasia. Clinical effects of CZX were evaluated in 33 patients; excellent in 16 and good in 14 patients. The efficacy rate was 91%. Bacteriological effects of CZX were prominent in 7 patients infected with S. pneumoniae, H. influenzae, K. pneumoniae and Citrobacter, but not in a patient infected with P. aeruginosa. The elimination rate was 92% (12/13). As the side effects, exanthema in 1 patient and gastrointestinal symptoms (nausea and vomiting) in 1 patient were observed. However, they improved without any treatment by cessation of CZX use. Abnormal laboratory findings were observed in 2 patients with elevated GOT and/or GPT. They normalized after cessation of drug. The usefulness of CZX was 82% (27/33). Therefore, CZX is a very useful drug and its effects are promising in clinical management of respiratory tract infections.

Adult↗

PubMed1993

Local host response in the lower respiratory tract in nephropathia epidemica.

Various lines of evidence suggest a respiratory route of transmission of nephropathia epidemica (NE). To study the response of the respiratory tract in NE, fiberoptic bronchoscopy with bronchoalveolar lavage (BAL) was performed in 5 patients in the acute phase of the disease. Compared to a reference group of 15 healthy individuals, BAL fluid of NE patients contained significantly higher total numbers of cells (p < 0.05) and significantly higher numbers of lysozyme-positive macrophages (p < 0.01), CD8+ T cells (p < 0.01), and natural killer (NK) cells (p < 0.01). There was no significant difference in numbers of CD4+ T cells, B cells, or neutrophils. When blood samples of 16 patients were examined at various intervals after onset of NE, a significant decrease in the number of NK cells (p < 0.01) was found in the acute phase of the disease. The findings are compatible with the presence of a local host response in the lower respiratory tract to NE virus infection.

Acute-Phase Reaction↗

PubMedDate not supplied

Multicentered clinical evaluation of cefoperazone for the treatment of lower respiratory tract infections.

Adult patients with bacterial infections of the lower respiratory tract were given either cefoperazone or cefamandole in a multicenter clinical study of the clinical and bacteriologic efficacy of cefoperazone. Clinical diagnoses included pneumonia, bronchitis, lung abscess, and bronchiectasis. Efficacy was evaluated in 119 patients given cefoperazone and 73 patients given cefamandole. Major pathogens isolated included Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, Klebsiella pneumoniae, and Pseudomonas aeruginosa. Satisfactory clinical responses were noted for 96% of the patients in both treatment groups, including 14 of 17 patients given cefoperazone who were primarily infected with P. aeruginosa. Satisfactory bacteriologic responses were noted for 88% of the group given cefoperazone and 89% of the group given cefamandole. Adverse reactions related to the antibiotic occurred infrequently in each treatment group. The results of this study indicate that cefoperazone is a safe and effective antibiotic for the treatment of lower respiratory tract infections due to S. pneumoniae, H. influenzae, S. aureus, and many gram-negative bacilli, including susceptible strains of P. aeruginosa, in adult patients.

Adult↗