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PubMed1990

Cefpodoxime proxetil: dosage, efficacy and tolerance in adults suffering from respiratory tract infections.

The efficacy of cefpodoxime proxetil has been studied in ten clinical trials conducted in adults suffering from lower respiratory tract infections (pneumonia, acute bronchitis or acute on chronic bronchitis) and upper respiratory tract infections (tonsillitis/pharyngitis or sinusitis). All the trials were controlled, randomized, multicentre and international and seven were double-blind, double-dummy designed. Over a period of 18 months from July 1988 to December 1989, 2448 patients were included. Among them, 2429 (99%) were evaluated for tolerance, 2101 (86%) for tolerance and clinical efficacy and 1018 (42%) for tolerance and clinical and bacteriological efficacy. The clinical response was judged satisfactory in 1205/1263 (95.4%) patients treated with cefpodoxime proxetil and in 788/838 (94%) patients treated with comparative antibiotics. The bacteriological response was judged satisfactory for 662/699 (95%) pathogens for cefpodoxime proxetil treatment versus 427/463 (92, 2%) for comparators. Cefpodoxime proxetil has been given to 7351 patients in the course of its international development with no severe side-effect being observed. Common reactions have been noted with a similar frequency to that seen with the other beta-lactams. No pseudomembranous colitis has been observed during clinical trials. On this basis, cefpodoxime proxetil appears to be efficacious and well tolerated and could be an antibiotic of first choice in the treatment of lower and upper respiratory tract infections in adults and adolescents.

Adult↗

PubMed1986

[Evaluation of T-2588 in the treatment of respiratory tract infection].

T-2588 was used on 55 patients with respiratory tract infections and 44 cases were evaluated; 23 patients with pneumonia, 12 patients with acute bronchitis, 2 patients with chronic bronchitis, 1 patient with diffuse panbronchiolitis and 6 patients with bronchiectasis with infection. Clinical effects of T-2588 were as follows; excellent in 6 and good in 28 patients. The efficacy rate was 77.3% (34/44). Bacteriological effects of T-2588 were prominent in 8 patients infected with B. catarrhalis, H. influenzae, K. pneumoniae and E. coli, but not in a patient infected with P. putida. The elimination rate was 90.0% (9/10 strains). As side effects, stomatitis, anorexia, diarrhea X vomiting and pruritus were observed in one patient each. Abnormal laboratory findings were observed in 4 patients with elevated GOT and/or GPT. These side effects and abnormal laboratory findings were not serious. The usefulness of T-2588 was 68.2% (30/44). Therefore, T-2588 is a useful drug and its effects are promising in clinical management of respiratory tract infections.

Administration, Oral↗

PubMed2000

Outcomes after judicious antibiotic use for respiratory tract infections seen in a private pediatric practice.

BACKGROUND: Most respiratory tract infections (RTIs) in children have a viral cause, they resolve on their own, and antibiotics need not be prescribed. OBJECTIVE: We sought to provide evidence that judicious antibiotic use can be accomplished in private pediatric practice without observing an increase in return office visits or in the rate of bacterial infections that may follow. STUDY DESIGN: This was a prospective 12-month study from July 1, 1996 through June 30, 1997. On the same 1 day each week, a representative convenience sample of acute respiratory tract illness patients was enrolled, and laboratory studies performed as appropriate, including viral cultures on all. Children were then followed for 30 days to ascertain the outcomes of not prescribing antibiotics except when specific bacterial infections were present at the initial visit. RESULTS: Three hundred eighty-three children were enrolled; 293 (77%) did not receive antibiotics at the enrollment visit. Ninety children (23%) received antibiotics based on a diagnosis of acute otitis media (n = 53), acute streptococcal tonsillopharyngitis (n = 18), or other presumed or documented bacterial infections (n = 19). An unscheduled return visit related to the initial visit occurred for 86 (29%) of the 293 children not receiving antibiotics initially and in 40 (44%) of 90 children receiving antibiotics initially. Eighty-seven children (23%) had positive viral culture results. The most frequently isolated viruses were adenovirus, enterovirus, parainfluenzae virus, and influenza virus. CONCLUSION: Children with RTIs without a concomitant presumed or proven bacterial infection do not require antibiotics. In this busy office practice, >75% of the children presenting with an RTI did not have a presumed or proven bacterial infection. These children did not have a higher rate of return office visits or an increase in bacterial infections. This reinforces the judicious use of antibiotics in managing children with RTIs.outcomes, antibiotic, respiratory infections.

Agglutination Tests↗

PubMed1989

Differences in incidence rates of cancers of the respiratory tract by anatomic subsite and histologic type: an etiologic implication.

Data from nine population-based cancer registries participating in the Surveillance, Epidemiology, and End Results Program (1973-1982) were analyzed to determine whether the incidence of different histologic types of respiratory tract cancers varies by anatomic location. The variation in cancer incidence among respiratory tract subsites was remarkable for squamous cell carcinoma, but the variation was less prominent for adenocarcinoma. The rates of squamous cell carcinoma and adenocarcinoma along the airways correspond closely with the deposition pattern of large and small smoke particles, respectively. Also, the rates of adenocarcinoma parallel the distribution of surface glandular cells of the respiratory tract. Our results support the hypothesis that anatomy and physiology, in conjunction with size of particles in inhaled cigarette smoke, play an important role in the genesis of specific histologic types of respiratory tract cancers.

Adenocarcinoma↗

PubMed2006

[Role of rhinovirus in respiratory tract infections in hospitalized children].

BACKGROUND: Rhinovirus is a recognized cause of common cold and has been shown to cause asthma exacerbations in adults and children. The burden of rhinovirus infections in hospitalized children has not been described in Spain. OBJECTIVE: To describe confirmed rhinovirus infections in children hospitalized for respiratory tract infection in a secondary public hospital. PATIENTS AND METHODS: We performed a prospective descriptive study in children admitted to hospital with fever or respiratory tract infection and with a positive isolation of rhinovirus in nasopharyngeal washings between September 2004 and July 2005. Virological diagnosis was made with direct immunofluorescent assay and/or reverse transcription-polymerase chain reaction in specimens obtained from nasopharyngeal washings. The clinical characteristics of the patients were analyzed. RESULTS: There were 76 children with rhinovirus infection, representing 25 % of admissions in 304 children with fever or respiratory tract infection. Rhinovirus was the second most frequent viral agent identified after respiratory syncytial virus (RSV) (29.9 % of admissions). Fifty-four children (71.1 %) were under 2 years of age. The most frequent clinical diagnoses were recurrent wheezing in 60.5 %, bronchiolitis in 23.7 %, pneumonia in 7.9 %, and upper respiratory tract infection in 5.3 %. Fever > 38 degrees C was present in 57.9 % of the patients and radiologic infiltrate was found in 23.7 %. Oxygen saturation less than 95 % was found in 43.4 % of the patients. Of 22 children aged more than 2 years, a diagnosis of asthmatic crisis was made in 21. CONCLUSIONS: Rhinoviruses were frequently identified in hospitalized children with respiratory tract disease and were the second most common viruses after RSV. In our series, it was the most frequent cause of recurrent wheezing in hospitalized children and the second most common cause in infants.

Adolescent↗

PubMed2003

Dysfunction of peripheral blood granulocyte oxidative metabolism in children with recurrent upper respiratory tract infections.

Granulocytes play a key role in the defence against bacterial infections. Their dysfunction may both predispose to and result from infections. The oxidative metabolism of peripheral blood granulocytes was studied in 50 children aged from 1 to 10 years, with recurrent upper respiratory tract infections and/or tonsillar hypertrophy. Four groups of patients were recruited: 15 healthy controls, seven patients with idiopathic tonsillar hypertrophy, 12 patients with upper respiratory tract infections and 16 patients with upper respiratory tract infections with concurrent tonsillar hypertrophy. The ability of granulocytes to produce reactive oxygen species was assessed by nFMLP-induced chemiluminescence. Both increased and depressed granulocyte activity was observed in all studied groups, with the exception of controls. Altered granulocyte function was observed in 30% of patients in the idiopathic tonsillar hypertrophy group. In children with recurrent infections abnormal chemiluminescence results were found in from 75% to nearly 90% of patients. This preliminary study demonstrates the possible relationship between recurrent upper respiratory tract infections, tonsillar hypertrophy and impaired peripheral blood granulocyte chemiluminescence.

Child↗

PubMed1993

Respiratory tract uptake of inhalants and metabolism of xenobiotics.

The combined impact of new research regarding the dosimetry of inhalants, discussed in early paragraphs of this review, and the rapidly developing knowledge regarding the location and substrate specificities of the enzymes responsible for xenobiotic metabolism should soon lead to new insights into the causes and prevention of cancer and other diseases of the respiratory tract and may provide insight into the design of drugs used in the treatment of respiratory tract disease. Among the developments to be expected within the next decade are the following: 1. The issue of extrapulmonary versus intrapulmonary activation of lung prodrugs and protoxicants will be resolved by validation of the different dosimetries predicted for highly lipophilic inhalants compared to less lipophilic ones. 2. The possibly complex roles of P450 isozymes 1A1 and 2D6 and other forms in the causation of human lung cancer will undoubtedly be better understood in the next few years. 3. Interspecies comparisons of respiratory tract enzyme activities--both activating and detoxicating--will lead to improved use of laboratory animals as models for expected toxicological and pharmacological effects in humans. 4. The potential role of nasal uptake and metabolism in causing brain disease will be established or denied experimentally. 5. The complex relationships between host factors--such as hormone levels and the presence of inflammation--and metabolism-mediated toxicity will become clearer. 6. As new research results continue to illuminate the complexities of the interactions of xenobiotics with respiratory tract tissue, clues as to how best to administer drugs via the respiratory tract and understanding of changes in disease patterns--such as the recent shift in sites for lung cancer--will follow.

Aerosols↗

PubMed1982

The histology and fine structure of glands in the rat respiratory tract.

The structure of rat respiratory glands has been investigated by light and electron microscopy. The glands exhibited a tubulo-acinar organization. Individual secretory units were composed of serous tubules or serous demilunes and mucous tubules with narrow lumens at the blind end (proximally), and of mucous ducts with wide lumens which opened to the tracheal lumen distally. Near the junction of the duct with the trachea, mitochondria-rich cells and a few ciliated cells were interspersed with mucous cells. It was found that the histology as well as the ultrastructure of the secretory product of these gland cells varied depending upon the location of the glands in the airway. For this reason, the glands of the epiglottis, larynx and trachea have been described separately. Epiglottal glands consisted of many mucous tubules, a few serous elements and an occasional mucous duct. Laryngeal glands contalned many serous and mucous tubules and a few mucous ducts. Tracheal glands were composed of serous tubules, a few mucous tubules and prominent bucous ducts. Serous tubule cell granules formed a uniform population within a cell profile but varied in cells of the epiglottis, compared with those of the larynx and trachea. Granules in mucous tubule cells differed from those of serous cells. Mucous cell granules also appeared uniform within a single cell but differed from cell to cell and at different levels of the respiratory tract. A particular granule type was predominant at each level. Cells of mucous ducts differed somewhat from those of mucous tubules and comprised two general secretory cell populations. Proximal mucous duct cells contained abundant granules that generally resembled those of mucous tubule cells but were localized in two areas of the cytoplasm. Dilated cisternae of rough endoplasmic reticulum with a bizonal content similar in density of zones seen in mature granules further characterized proximal mucous duct cells. The distal mucous duct cell generally contained sparse apical granules and lacked dilated rough endoplasmic reticulum.

Animals↗

PubMed1992

Clinical comparative study of azithromycin versus erythromycin in the treatment of acute respiratory tract infections in children.

The efficacy and tolerability of azithromycin and erythromycin in the treatment of acute respiratory tract infections in children were compared in an open, multicenter, randomized trial. A total of 151 children, aged from 2 months to 14 years, suffering from upper airways infections (60), or lower respiratory tract infections (91), were randomized to be treated either with azithromycin, 10 mg/Kg/day per os once daily for 3 or 10 mg/Kg/day 1 and 5 mg/Kg/days 2-5 (77 patients) or with erythromycin, 50 mg/Kg/day thrice daily for at least 7 days (74 patients). The two treatment groups did not significantly differ as to sex, age, weight, type and severity of infection, and infecting pathogens. Clinical evaluation was performed prior to therapy, on treatment days 1, 3, 5 and 7, and on day 10. Microbiological and laboratory assessment were carried out at baseline and after the end of therapeutic course. Chest X-ray and serologic assays for Mycoplasma pneumoniae infection were obtained in patients suspected to have lower respiratory tract infections. At the end of therapy, clinical cure was achieved in 73 out of 77 patients (94.8%) in the azithromycin group, and in 60/72 evaluable subjects (83.3%) in the erythromycin group. A significantly more rapid remission of several illness-related signs and symptoms was observed in patients treated with azithromycin. A total of 75 bacterial pathogens were isolated at baseline microbiological examination; at the end of the therapeutic course bacteriological eradication was obtained in 34/34 cases (100%) treated with azithromycin, and in 40/41 children (97.5%) treated with erythromycin.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗

PubMed2004

[Human metapneumovirus--new identified virus infecting human respiratory tract].

Some information regarding some characteristics of new identified virus, causing human respiratory diseases (named human metapneumovirus--hMPV) has been written. Moreover, areas of existing, frequency of infections, the possibility of diagnosis have been included. This virus has been isolated and identified by Dutch researcher, van den Hoogen, for the first time in 2001. It is suggested that hMPV belongs to Paramyxoviridae family, Pneumovirinae subfamily, Metapneumovirus genus, but it has not been confirmed by the Committee of the Taxonomy of Viruses, yet. This virus has been reported and demonstrated to be present mostly in children, but also in elderly people over 65, in Europe, North America, Australia and Asia, suggesting a worldwide distribution. Serological studies showed that all children in Netherlands had been exposed to hMPV by the age of 5; it means that infections with hMPV are common in the childhood. The presence of antibodies in retrospective serum and the presence of virus in numerous retrospective specimens taken from individuals with respiratory infections in which an etiologic agent was not initially detected indicates that this virus had been circulating in human beings for at least 50 years. Clinical diseases associated with hMPV appears to be similar to those ones associated with human respiratory syncytial virus (hRSV), ranging from mild upper respiratory tract infection to bronchiolitis and bronchopneumonia. Preliminary studies indicate that hMPV should be added to the list of pathogens associated with severe respiratory tract infections in immunocompromised patients and in chronic respiratory diseases patients (eg. asthma).

Adult↗

PubMed2002

[Effect of halogen aerosol therapy on resistance parameters of the respiratory tract].

AIM: Assessment of the efficacy of dry high-dispersive aerosol of sodium chloride--the main acting factor of haloaerosol therapy--on defense system of the respiratory tract. MATERIAL AND METHODS: 188 patients with respiratory disease and at risk of pulmonary pathology received course of haloaerosol therapy. 49 matched patients were given placebo. The effect of the treatment was assessed by clinicoendoscopic picture, cytomorphological and bacteriological characteristics of the bronchoalveolar lavage, contamination activity of the microflora, activity of local humoral immunity in pharyngeal brush-biopsies and saliva, rheological indices of the sputum. RESULTS: Dry aerosol of sodium chloride demonstrated antiinflammatory activity in the respiratory tract, mucoregulating action. It enhances drainage of the bronchi, activates alveolar macrophages, improves biocenosis and local humoral immunity. CONCLUSION: Haloaerosol therapy has positive effect on the defense system, improves function of the respiratory tracts.

Administration, Inhalation↗

PubMed1991

Significance of Haemophilus spp. and Branhamella catarrhalis in upper respiratory tract infections.

Haemophilus influenzae and Branhamella catarrhalis can be considered inhabitants of the upper respiratory tract in humans. Although the pathogenetic role of H. influenzae cannot be discussed, the Authors report the mechanisms of pathogenicity of this microorganism; furthermore, they discuss the direct or indirect pathogenicity of B. catarrhalis in respiratory tract diseases and the ability of both microorganisms to produce beta-lactamases. H. influenzae and B. catarrhalis, together with S. pneumoniae, are the most common bacteria responsible for upper respiratory tract infections, namely otitis and sinusitis. The activity of these bacteria in the onset of otitis and sinusitis is reported.

Haemophilus Infections↗

PubMed1995

Outer membrane protein CD of Branhamella catarrhalis: sequence conservation in strains recovered from the human respiratory tract.

Branhamella catarrhalis causes lower respiratory tract infections in patients with chronic obstructive pulmonary disease. The outer membrane protein CD (OMP-CD) of B. catarrhalis is a major, heat-modifiable OMP. The goals of this study are to characterize the degree of conservation of OMP-CD among strains and to investigate if OMP-CD maintains its homogeneity under the effect of host immune selective pressure. Isolates of B. catarrhalis were collected prospectively from patients with bronchiectasis and chronic bronchitis. We studied the OMP-CD gene by analysis of PCR restriction fragment length polymorphisms (PCR-RFLP) and further determined DNA sequence of the CD gene of eight selected isolates. Five patterns of PCR-RFLP of the OMP-CD gene were observed among all isolates when the gene was digested with Sau3AI. The sequence analysis revealed a high degree of homogeneity in OMP-CD among strains of B. catarrhalis. Three regions of OMP-CD with minimal sequence heterogeneity were identified. The sequences of the OMP-CD gene of isolates collected from patients colonized with the same strain for up to 6 months was identical. These observations establish that the OMP-CD of B. catarrhalis recovered from clinical isolates is highly conserved among strains.

Bacterial Outer Membrane Proteins↗

PubMed2002

Upper and lower respiratory tract infection by Streptococcus pneumoniae is affected by pneumolysin deficiency and differences in capsule type.

Pneumococci frequently colonize the upper respiratory tract, and these pneumococci are believed to act as a reservoir for infection of the lower respiratory tract and bacteremia. We investigated how the pneumococcal toxin pneumolysin affects the capacity of pneumococci to infect the upper and lower respiratory tract of the mouse. Wild-type Streptococcus pneumoniae serotype 2 and 3 strains, a serotype 2 pneumolysin-deficient mutant, and a serotype 2 mutant with the pneumolysin gene reinserted were used to study differences in colonization and disease. In addition, we also examined a pneumococcal chimeric mutant (capsule type switched from serotype 2 to serotype 3) to gain further insight into the role that capsule plays in nasopharyngeal infection. Absence of pneumolysin was found to be associated with significantly lower numbers of pneumococci in the nasopharynx, trachea, and lungs. Differences in pneumococcal capsule type were found to have significant effects on pneumococcal infection of the nasopharynx, trachea, and lungs. However, it was the combination of capsule type and genetic background that was important, and the influence of this combination varied with the site of infection. For example, in the nasopharynx the wild-type serotype 3 strain and the capsule-switched mutant behaved similarly, whereas in the lungs the mutant that was switched to serotype 3 survived less well than the wild-type serotype 3 strain. The combination of capsule type and genetic background also determined virulence. Thus, the wild-type serotype 3 strain was virulent, whereas the capsule-switched mutant was avirulent.

Animals↗

PubMed1984

Absorption of lignocaine and bupivacaine from the respiratory tract during fibreoptic bronchoscopy.

Absorption of lignocaine and bupivacaine from the upper and lower respiratory tract was studied in patients undergoing fibreoptic bronchoscopy. No significant differences were found between the drugs and between the routes of administration in terms of the time taken to achieve maximum plasma concentrations. The relative availability of lignocaine was greater following administration via the upper respiratory tract, but bupivacaine availability did not differ. The apparent clearance of lignocaine was not affected by the route of administration but bupivacaine clearance was higher following administration via the lower respiratory tract. Bupivacaine, previously unreported as a topical agent in man, produced adequate anaesthesia at one-eighth of the dose of lignocaine. Plasma bupivacaine concentrations had a very wide safety margin.

Absorption↗

PubMed1995

Bacterial antibody assays in the diagnosis of acute lower respiratory tract infection in children.

Bacterial antibodies were studied in acute, intermediate and convalescent phase sera (mean duration from first to last sample 36 days) of 121 children hospitalized for acute lower respiratory tract infection. Antibody responses were observed in 45% of all cases and in 29% of the 21 children < 1 year old. A total of 15 responses to Streptococcus pneumoniae (pneumolysin), 20 to Haemophilus influenzae, 9 to Moraxella catarrhalis, 3 to chlamydiae and 8 to Mycoplasma pneumoniae were found. In 79 patients with 4 consecutive samples available, 52% of the 31 responses were measurable within 5 days from admission. Overall the responses were not associated with upper respiratory tract bacterial findings or acute otitis media. Significantly more responses were found in the 121 children with acute lower respiratory tract infection than in healthy controls (P < 0.007). We conclude that bacterial antibody assays provide a useful tool in the study of the etiology of acute lower respiratory tract infection in young children, even if the interval between paired serum samples is short.

Acute Disease↗

PubMed1995

Transferrin concentrations in serum and lower respiratory tract fluid of mechanically ventilated patients with COPD or ARDS.

Transferrin serves as the primary iron transport protein in serum, but it also is present in the lower respiratory tract where it has antioxidant and antibacterial properties. Prior studies indicate that patients with respiratory failure (RF) due to ARDS have increased concentrations of transferrin in the lower respiratory tract, which is attributed to increased lung vascular permeability. It is unclear whether mechanical ventilation contributes to increased lung transferrin content in patients with ARDS, although mechanical ventilation may increase lung microvascular permeability. To assess whether mechanical ventilation in patients with RF due to causes other than ARDS is also associated with increased respiratory tract concentrations of transferrin, we compared transferrin concentrations in serum and lung lavage fluid obtained from 12 mechanically ventilated patients with RF attributable to COPD, 6 patients with ARDS, and 15 healthy volunteers. Serum transferrin concentrations in patients with RF due to COPD were variable, but mean concentrations were similar to those in control subjects (336 +/- 58 vs 307 +/- 9 [SE] mg/dL), whereas serum transferrin concentrations were decreased in patients with ARDS (182 +/- 68 mg/dL; p < 0.05). Compared with control subjects, lavage fluid recovered from patients with RF due to COPD contained significantly decreased concentrations of transferrin (1.56 +/- 0.24 vs 4.27 +/- 0.44 micrograms/mL; p < 0.001), whereas transferrin concentrations in lavage fluid recovered from patients with ARDS were increased (15.72 +/- 2.01 micrograms/mL; p < 0.001). Transferrin concentrations of lavage fluid also were decreased in COPD patients when normalized for lavage fluid protein content (4.35 +/- 0.72 vs 19.96 +/- 3.13 micrograms/mg in control subjects, p < 0.001). These data indicate that mechanical ventilation of patients with COPD is associated with decreased lung transferrin concentrations, in contrast to an increased transferrin concentration found in patients with ARDS. Decreased transferrin concentrations in the lower respiratory tract may decrease defenses against oxidant injury and bacterial infection in patients with RF due to COPD.

Adult↗

PubMed2003

Etiology of acute lower respiratory tract infection.

OBJECTIVE: To identify pathogens responsible for acute severe lower respiratory tract infection (ALRTI) in under five children by non-invasive methods. METHOD: 95 children hospitalized with acute severe lower respiratory tract infection were investigated for identification of viruses, bacteria, chlamydia or mycoplasma by nasopharyngeal aspirates, blood culture and serology. RESULT: Etiological agents could be identified in 94% of the patients. Viruses from NP aspirate could be isolated in 36 (38%), bacterial isolates from blood cultures in 15 (16%); mycoplasma was identified in 23 (24%) and chlamydia in 10 (11%) by serological tests; mixed infections were present in 8 (8%) patients. CONCLUSION: Noninvasive methods can be useful in identifying etiological agents in severe ALRTI.

Child, Preschool↗