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PubMed2006

Fiber deposition pattern in two human respiratory tract replicas.

This study consisted of a series of experiments to investigate the factors that might affect the fiber deposition pattern in the human respiratory tract. Carbon fibers with uniform diameter and polydispersed length were chosen as the test material. Two geometry-defined human respiratory tract replicas encompassing the oral cavity, oropharynx, larynx, trachea, and first few bifurcations of the tracheobronchial airways were used in this research. Deposition studies were conducted by delivering aerosolized carbon fibers into the replicas at constant inspiratory flow rates of 15, 43.5, and 60 L/min. The results showed that impaction is the dominant deposition mechanism for both replicas. Most of the fibers with high momentum deposited in the oral airway (oral cavity to larynx), and fibers with low momentum were found to pass through the entire replica easily. When comparing the results between the two replicas, fiber length, inspiratory flow rate, and the geometry of the oral airway were found to be factors that might affect the fiber deposition pattern in the human respiratory tract.

Aerosols↗
PubMed1997

Empiric treatment of hospital-acquired lower respiratory tract infections with meropenem or ceftazidime with tobramycin: a randomized study. Meropenem Lower Respiratory Infection Group.

OBJECTIVE: To evaluate the efficacy and tolerability of intravenous empiric treatment with meropenem compared with ceftazidime-tobramycin in patients with hospital-acquired lower respiratory tract infections. DESIGN: Prospective, nonblind, randomized trial. SETTING: Multicenter trial conducted at 22 centers. PATIENTS: Two hundred eleven patients were enrolled and 121 were evaluable for the analysis of both clinical and bacteriologic efficacy. INTERVENTIONS: One hundred four patients were randomized to receive intravenous meropenem (1000 mg) every 8 hrs and 107 patients were randomized to receive intravenous ceftazidime (2000 mg) plus tobramycin (1 mg/kg) every 8 hrs. Sixty-three meropenem-treated patients and 58 ceftazidime-tobramycin-treated patients were eligible for the analysis of clinical and bacteriologic efficacy. In the ceftazidime-tobramycin group, 32 (55%) evaluable patients received more than six doses of tobramycin, 24 (41%) received six doses or fewer, and two (3%) did not receive any tobramycin. MEASUREMENTS AND MAIN RESULTS: The analysis of efficacy was based on the clinical and bacteriologic responses at the end of treatment. Satisfactory clinical responses occurred in 56 (89%) of 63 of the meropenem-treated patients and in 42 (72%) of 58 of the ceftazidime-tobramycin-treated patients (p = .04). Corresponding bacteriologic response rates were 89% and 67%, respectively (p = .006). The frequency and profile of drug-related adverse events was similar across treatment groups. Seizures were reported in three meropenem-treated patients, but these seizures were considered by the investigator to be unrelated to treatment. CONCLUSIONS: Meropenem is well tolerated and more efficacious than the combination of ceftazidime and tobramycin for the initial empiric treatment of hospital-acquired bacterial pneumonia.

Adolescent↗
PubMed1995

Oral versus intravenous antibiotics for community acquired lower respiratory tract infection in a general hospital: open, randomised controlled trial.

OBJECTIVE: To see whether there is a difference in outcome between patients treated with oral and intravenous antibiotics for lower respiratory tract infection. DESIGN: Open controlled trial in patients admitted consecutively and randomised to treatment with either oral co-amoxiclav, intravenous followed by oral co-amoxiclav, or intravenous followed by oral cephalosporins. SETTING: Large general hospital in Dublin. PATIENTS: 541 patients admitted for lower respiratory tract infection during one year. Patients represented 87% of admissions with the diagnosis and excluded those who were immunocompromised and patients with severe life threatening infection. MAIN OUTCOME MEASURES: Cure, partial cure, extended antibiotic treatment, change of antibiotic, death, and cost and duration of hospital stay. RESULTS: There were no significant differences between the groups in clinical outcome or mortality (6%). However, patients randomised to oral co-amoxiclav had a significantly shorter hospital stay than the two groups given intravenous antibiotic (median 6 v 7 and 9 days respectively). In addition, oral antibiotics were cheaper, easier to administer, and if used routinely in the 800 or so patients admitted annually would lead to savings of around 176,000 pounds a year. CONCLUSIONS: Oral antibiotics in community acquired lower respiratory tract infection are at least as efficacious as intraveous therapy. Their use reduces labour and equipment costs and may lead to earlier discharge from hospital.

Administration, Oral↗
PubMed2004

Prospective population-based study of viral lower respiratory tract infections in children under 3 years of age (the PRI.DE study).

UNLABELLED: Population-based incidence data from Europe on the disease burden of lower respiratory tract infections (LRTI) due to respiratory syncytial viruses (RSV), parainfluenza viruses (PIV) and influenzaviruses (IV) are lacking, especially with respect to the disease burden. In a 2-year prospective multicentre study of children aged <3 years in Germany, we registered population-based cases as outpatients (n=2386), inpatients (n=2924), and nosocomially-acquired (n=141). Nasopharyngeal secretions were tested for viral RNA. The annual incidence for physician visits per 100 children for all LRTI was 28.7, RSV 7.7, PIV 3.8 and IV 1.1. Annual hospitalisation rates per 10(5) children were for all LRTI 2941, RSV 1117, PIV 261 and IV 123. Annual nosocomial cases per 10(5) hospital days were for all LRTI 79, RSV 29, PIV 9 and IV 1.5. All five children (0.27%) who died had an underlying disease and four were nosocomially acquired. CONCLUSION: Hospitalisation rates due to lower respiratory tract infections in healthy children were similar to those reported elsewhere; the rates for outpatient visits were approximately ten times higher.

Child, Preschool↗
PubMed1991

Open randomized controlled parallel study of ofloxacin versus trimethoprim-sulfamethoxazole treatment of lower respiratory tract and urinary infections.

A total of 60 patients with lower respiratory tract or urinary tract infections were enrolled in an open, randomized, controlled, parallel study comparing 300 mg ofloxacin (OFX) b.i.d. with trimethoprim + sulfamethoxazole (TMP 800 mg + SMX 160 mg), 1 tablet, b.i.d. The signs and symptoms of low respiratory tract infection were cured in 12 patients (80%) of the OFX group and improved in 2 other patients (13%); at the end of therapy, the 2 germs that persisted were Streptococcus pneumoniae and Branhamella catarrhalis. Clinical cure was achieved in 13 patients (86%) in the TMP-SMX group, while 2 patients were considered as failures (14%); after therapy, the 3 organisms that persisted were 2 S. pneumoniae and 1 Pseudomonas aeruginosa. As far as urinary tract infections are concerned clinical cure and complete eradication of bacteria were achieved in 14 patients in the OFX group (93%); the germ that persisted was Escherichia coli (100,000 CFU), but the patient was asymptomatic. In patients of the TMP-SMX group the urinary infections were cured in 11 subjects (73%); the germs that persisted were 2 E. coli and 1 Proteus mirabilis. Adverse effects were reported for 3 patients (10%) in the OFX group and 4 patients (13%) in the TMP-SMX group. The measurement of serum and intracellular (polymorphonuclear cells and lymphocytes) levels of OFX and TMP-SMX and the assessment of the host's immunocompetence ruled out the possibility of any immunotoxicological side effect.

Acute Disease↗
PubMed2001

Telithromycin: a new ketolide antimicrobial for treatment of respiratory tract infections.

Telithromycin is a new ketolide antimicrobial, specifically developed for the treatment of community-acquired respiratory tract infections. It has a wide spectrum of antibacterial activity against common respiratory pathogens including Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis and Streptococcus pyogenes. It also has activity against atypical pathogens, such as Chlamydia pneumoniae, Legionella pneumophila and Mycoplasma pneumoniae. Telithromycin maintains activity against beta-lactam and macrolide-resistant respiratory tract pathogens and does not appear to induce cross-resistance to other members of the macrolide-lincosamide-streptogramin (MLS) group of antimicrobials. It demonstrates bactericidal activity against S. pneumoniae and H. influenzae and has a prolonged concentration-dependent post-antibiotic effect (PAE) in vitro. The drug has favourable pharmacokinetics following oral administration. It is well absorbed, achieves good plasma levels and is highly concentrated in pulmonary tissues and white blood cells. In clinical trials, telithromycin given orally at a dose of 800 mg once daily for 5 - 10 days was as effective as comparator antimicrobials for the treatment of adults with community-acquired pneumonia, acute exacerbations of chronic bronchitis, acute maxillary sinusitis and group A-beta-haemolytic streptococcal pharyngitis or tonsillitis. The adverse events and safety profile were similar to comparator antimicrobials. The most common adverse events were diarrhoea, nausea, headache and dizziness. Telithromycin should provide an effective, convenient and well-tolerated once-daily oral therapy for treatment of respiratory infections.

Anti-Bacterial Agents↗
PubMed2002

Intermittent treatment with high dose nebulized beclomethasone for recurrent wheezing in infants due to upper respiratory tract infection.

BACKGROUND: To investigate if high dose inhaled beclomethasone dipropionate started early after upper respiratory tract infection (URTI) could reduce recurrent wheezing in infants. METHODS: Twenty-six ambulatory infants, 7-12 months of age, with recurrent wheezing during upper respiratory tract infection participated. All experienced at least three wheezing attacks. Those with underlying lung or systemic disease were excluded. Infants were divided into two groups in an open unblinded manner, until 13 patients had been recruited for each group. The groups were similar in risk factors for recurrent wheezing. Four treatment periods of 5 days were planned for group 1. The dose regimen was nebulized beclomethasone 400 mg by mask tid for 5 days. Treatment was started at the very first sign of URTI prior to any sign of wheezing. Group 2 did not receive any preventive treatment and constituted the control group. Symptoms scores were recorded. The number of emergency room visits, hospital admissions and short courses with oral steroids was also noted. RESULTS: Twelve infants completed 48 treatment periods. Five visited the emergency room, only one during beclomethasone therapy. Six received oral steroids, two receiving beclomethasone. No patient was admitted to the hospital. Symptom scores were significantly lower during beclomethasone treatment (p<0.05). No apparent adverse events were reported. CONCLUSIONS: The infant with recurrent wheezing during URTI is a therapeutic challenge. Most of these infants have prodromal symptoms for about 24 hours before wheezing starts. In the present study we observed favorable results, decrease in the number the child wheezed and the number of acute attacks, when high dose inhaled beclomethasone is administered during this critical time.

Administration, Inhalation↗
PubMed2003

Influences of parameter uncertainties within the ICRP-66 respiratory tract model: particle clearance.

Quantifying radiological risk following the inhalation of radioactive aerosols entails not only an assessment of particle deposition within respiratory tract regions but a full accounting of clearance mechanisms whereby particles may be translocated to adjacent respiratory tissue regions, absorbed to blood, or released to the gastrointestinal tract. The model outlined in ICRP Publication 66 represents to date one of the most complete overall descriptions of particle deposition and clearance, as well as localized radiation dosimetry, within the respiratory tract. In this study, a previous review of the ICRP-66 deposition model is extended to the study of the subsequent clearance model. A systematic review of the clearance component within the ICRP 66 respiratory tract model was conducted in which probability density functions were assigned to all input parameters for both 239PuO2 and 238UO2/238U3O8. These distributions were subsequently incorporated within a computer code LUDUC (Lung Dose Uncertainty Code) in which Latin hypercube sampling techniques are used to generate multiple (e.g., 1,000) sets of input vectors (i.e., trials) for all model parameters needed to assess mechanical clearance and particle dissolution/absorption. Integral numbers of nuclear disintegrations, U(s), in various lung regions were shown to be well-described by lognormal probability distributions. Of the four extrathoracic clearance compartments of the respiratory tract, uncertainties in U(s), expressed as the ratio of its 95% to 5% confidence levels, were highest within the LN(ET) tissues for 239PuO2 (ratio of 50 to 130) and within the ET(seq) tissues for 238UO2/238U3O8 (ratio of 12 to 50). Peak uncertainties in U(s) in these respiratory regions occurred at particle sizes of approximately 0.5-0.6 microm where uncertainties in ET2 particle deposition fractions accounted for only approximately 10% of the total U(s) uncertainty for 239PuO2, and only approximately 30% of the total U(s) uncertainty for 238UO2/238U3O8 (the remainder is attributed to the clearance model alone). Of the eight clearance compartments within the thoracic regions of the respiratory tract, and for particle sizes below approximately 5 microm, uncertainties in U(s) were highest within the LN(TH) tissues for 239PuO2 (ratio of 60 to 80) and within the BB(seq) tissues for 238UO2/238U3O8 (ratio of 20 and 60). At particle sizes exceeding approximately 5 microm in aerodynamic diameter, peak uncertainties in U(s) are noted for the AI, bb(seq), and bb1 clearance compartments. As the particle size approaches 10 microm in size, uncertainties in U(s) within these three thoracic tissue regions approach a factor of 1,000 and are dominated by corresponding uncertainties in particle deposition.

Aerosols↗
PubMed2001

Evaluation of high-speed treadmill videoendoscopy for diagnosis of upper respiratory tract dysfunction in horses.

OBJECTIVE: To evaluate high-speed treadmill videoendoscopy as a diagnostic technique and document the abnormalities found in Australian horses referred for poor performance associated with abnormal upper respiratory tract noise but where a definitive diagnosis could not be made at rest. DESIGN: A retrospective clinical study using client-owned horses. PROCEDURE: The clinical records and videorecordings of all horses referred to the University of Sydney for poor performance associated with abnormal upper respiratory tract noise during a 13-month period were examined. Only horses with a normal physical examination including absence of lameness, and where a definitive diagnosis of the cause of the abnormal upper respiratory tract noise could not be made from the resting videoendoscopic examination were included in the study. The age, gender, breed of horse and the purpose for which the horse was used were ascertained from the record and videorecordings were reviewed by the authors and any abnormalities noted. RESULTS: There were 37 horses included in the study. An upper airway abnormality was identified during high-speed treadmill videoendoscopy in 73% of horses. One abnormality was identified in 22 horses, 2 abnormalities in 4 horses and 3 abnormalities in 1 horse. Abnormalities identified included laryngeal hemiparesis (n = 15), axial deviation of the aryepiglottic folds (n = 10), pharyngeal collapse (n = 3), dorsal displacement of the soft palate (n = 2), epiglottic collapse (n = 1), axial deviation of the vocal cord (n = 1) and laryngeal collapse (n = 1). CONCLUSIONS: The results of this study are similar to reports from overseas and suggest high-speed treadmill videoendoscopy appears to be a useful technique to diagnose the cause of upper airway dysfunction in Australian horses referred specifically for poor performance associated with abnormal upper respiratory noise. However, a diagnosis will not be made in all horses undergoing this procedure. There were five horses with two or three abnormalities none of which were apparent at rest. This would suggest that in all horses making abnormal upper respiratory noise associated with poor performance, even where an abnormality is identified at rest, high-speed treadmill videoendoscopy should be performed for a complete diagnosis.

Animals↗
PubMed1978

Clinical experience with cefadroxil in upper and lower respiratory tract infections.

Cefadroxil is a new semisynthetic oral cephalosporin with a broad spectrum of activity against both Gram-positive and Gram-negative organisms. Absorption of cefadroxil is unaffected by food, its serum levels are prolonged and it is excreted in the urine at a relatively slow rate compared to cephalexin. In the treatment of 108 patient with upper or lower respiratory tract infections, cefadroxil effected 93% complete cures. Fifty-five of the patients had upper respiratory tract infections and fifty-three had lower respiratory tract infections; among them cefadroxil acheived clinical success rates of 100% and 96%, respectively. Cefadroxil was clinically successful in eight (89%) out of nine patients whose infections were caused by mixed aetiologies. The principal causative agents were Staphylococcus aureus, beta-haemolytic streptococci, Streptococcus pneumoniae and Klebsiella pneumoniae. Overall bacterial eradication produced by cefadroxil was 112 (91%) of 123 organisms isolated from 108 patients. Reports of mild and transient side-effects in only 3.7% of the patients showed that the drug was well tolerated.

Adolescent↗
PubMed1993

Detection of antibodies to a pathogenic mycoplasma in desert tortoises (Gopherus agassizii) with upper respiratory tract disease.

Mycoplasma agassizii (proposed species novum) is the etiologic agent of an upper respiratory tract disease in the desert tortoise (Gopherus agassizii), which is threatened in most of its range. An enzyme-linked immunosorbent assay (ELISA) for the detection of M. agassizii-specific antibodies in desert tortoises was developed with a monoclonal antibody with specificity for desert tortoise immunoglobulin light chain. Plasma samples from one group of tortoises were tested immediately before and 1 month after challenge either with nasal exudate containing M. agassizii or with a purified preparation of M. agassizii. Plasma samples from a second group of known healthy and sick tortoises were also tested. In the first group, the ELISA detected seroconversion in individual tortoises following challenge with M. agassizii. In the second group, ELISA results were positively correlated with the health status of the tortoises, as determined by clinical and pathologic findings. In addition, the ELISA revealed that tortoise antimycoplasma antibodies were specific for M. agassizii when samples were assayed against M. agassizii, M. pulmonis, M. testudinis, and M. gallisepticum antigens. The observed direct correlation between the presence of nasal mucosal lesions and M. agassizii-specific antibodies proved that the ELISA reliably diagnosed M. agassizii infection in desert tortoises and advocates its use for monitoring M. agassizii-induced upper respiratory tract disease in free-ranging desert tortoises.

Animals↗
PubMed2004

Can clinical symptoms or signs accurately predict hypoxemia in children with acute lower respiratory tract infections?

OBJECTIVES: To determine clinical predictors of hypoxemia in children with acute lower respiratory tract infection (ALRI). DESIGN: Cross-sectional study. SETTING: Emergency department of All India Institute of Medical Sciences, a tertiary care hospital. SUBJECTS: 109 under five children, with ALRI. METHODS: Clinical symptoms and signs were recorded. Oxygen saturation was determined by a pulse oximeter. Hypoxemia was defined as oxygen saturation less than 90%. The ability of various clinical symptoms and signs to predict the presence of hypoxemia was evaluated. RESULTS: Twenty-eight (25.7%) children were hypoxemic. No symptoms were statistically associated with hypoxemia. Tachypnea, suprasternal indrawing, intercostal indrawing, lower chest indrawing, cyanosis, crepitations, and rhonchi were statistically significantly associated with hypoxemia. A simple model using the presence of rapid breathing (> or =80/min in children < or =3 m, > or =70/min in >3-12 m and > or =60/min in >12 m) or lower chest indrawing had a sensitivity of 78.5% and specificity of 66.7% for detecting hypoxemia. No individual clinical symptom/sign or a combination had both sufficient sensitivity and specificity to identify hypoxemia. CONCLUSION: None of the clinical features either alone or in combination have desirable sensitivity and specificity to predict hypoxemia in children with acute lower respiratory tract infection.

Acute Disease↗
PubMed1982

[Clinical studies of cefoxitin for the treatment of respiratory tract infections (author's transl)].

A total of 42 patients who were suffering from respiratory tract infections were treated with cefoxitin, and the following results were obtained. 1. Out of 32 patients clinically evaluated, excellent or good responses were observed in 30 patients (94%). 2. Presumed causative organisms were isolated in 14 patients. The organisms were eradicated in 11 patients and the eradication rate was 79% (11/14). The number of the organisms decreased or unchanged in 1 patient each. In other 1 patient the pathogenic agent was replaced with other agents during the course of treatment. 3. As for the side effects, skin eruption was observed in 3 patients. One patient received drugs other than cefoxitin concomitantly that might have caused the eruption. Another patient had an allergic history to many antibiotics. In 4 patients slight elevations of S-GOT and S-GPT were observed but improved soon after the completion of cefoxitin treatment. In 1 patient an elevation of serum creatinine was observed but this was not attributed to the administration of cefoxitin. 4. From the results stated above, cefoxitin is considered to be a safe and effective antibiotic which can be one of the first-choice antibiotics for the treatment of respiratory tract infections.

Adolescent↗
PubMed1996

IgG subclasses in children with recurrent respiratory tract infections in an allergy practice.

Isolated or combined deficiencies of immunoglobulin G (IgG) subclasses have been recognized in children with recurrent infections. In our allergy practice, there are a subset of children with recurrent respiratory tract infections. To investigate the presence of immunoglobulin G subclass deficiency (IgGSD), 60 children with atopy and 14 children without atopy suffering from recurrent respiratory tract infections were studied in an attempt to determine whether atopy is associated with a certain IgG subclass pattern. Ten atopic children were found to have isolated or combined IgG subclass deficiencies: one with IgG1, two with IgG2, four with IgG3 and three children had IgG2-IgG3. Neither IgG subclass concentration nor the frequency of children with high or low IgG subclasses showed any difference between atopic and non-atopic groups. Except for a week correlation with IgG3, no correlation existed between IgE and other IgG subclasses. It was concluded that childhood respiratory diseases complicated by recurrent respiratory tract infections may be associated with IgG subclass deficiencies. Although there have been reports noting some IgG subclass patterns in atopic disorders, in the present study, no distinctive feature between atopics and non-atopics with respect to IgG subclass concentrations and patterns was observed.

Adolescent↗
PubMed1998

Protection of human upper respiratory tract cell lines against sulphur mustard toxicity by hexamethylenetetramine (HMT).

1. Sulphur mustard ('mustard gas', HD) is a highly toxic chemical warfare agent which affects the skin and respiratory tract. The primary targets of inhaled HD are the epithelia of the upper respiratory tract. Hexamethylenetetramine (HMT) has been shown to protect human lung cells against HD toxicity and has also been shown to be effective in vivo against the chemical warfare agent phosgene. The ability of HMT to protect against the toxicity of HD was investigated in the human upper respiratory tract cell lines BEAS-2B and RPMI 2650. 2. HD was highly toxic to both cell lines, with LC50 values of 15-30 microM. HMT, at a concentration of 10 mM, was shown to protect the cell lines against the toxic effects of 20 microM and 40 microM HD. Results demonstrated that it was necessary for HMT to be in situ at the time of exposure to HD for effective cytoprotection. No protection was seen when cells were treated with HMT following exposure to HD, or where HMT was removed prior to HD exposure. 3. Results suggest that HMT may be effective prophylaxis for exposure to HD by inhalation.

Anti-Infective Agents, Urinary↗
PubMed1990

Otitis media with effusion and chronic upper respiratory tract infection in children: a randomized, placebo-controlled clinical study.

This study was performed to investigate the course of spontaneous recovery from otitis media with effusion in children with chronic rhinosinusitis treated in various ways. One hundred forty-one children between 3 and 10 years of age were selected for the presence of chronic rhinosinusitis and unilateral or bilateral otitis media with effusion. The children were assigned at random to one of four treatment groups, i.e., placebo, amoxicillin combined with xylometazoline hydrochloride nose drops, maxillary sinus drainage, or a combination of the latter two forms of therapy. The follow-up period was 6 months. Drainage of the maxillary sinus had no effect on either the recovery of the chronic upper respiratory tract infection or otitis media with effusion. Amoxicillin combined with xylometazoline nose drops had no significant effect on recovery from the upper respiratory tract infection, but did have a small but significant effect on recovery from otitis media with effusion. However, the general tendency of the upper respiratory tract and ears to recover was poor. Persistence of the chronic upper respiratory tract infection during the follow-up period proved to be a negative prognostic factor with respect to cure of otitis media with effusion. Children with chronic rhinosinusitis as defined in this study appear to have a high risk of developing chronic otitis media with effusion. The results of the study are discussed.

Amoxicillin↗
PubMed2002

Antibiotic resistance of oral anaerobic bacteria and their effect on the management of upper respiratory tract and head and neck infections.

Anaerobes of oral origin are common in chronic upper respiratory tract and other head and neck infections. Anaerobes are the predominant components of the normal human oropharyngeal flora, and are therefore a common cause of bacterial infections of the upper respiratory tract that are of endogenous origin. These bacteria can be isolated in chronic otitis media, sinusitis, and tonsillitis, and their complications. Anaerobes also predominate in deep oral and neck infections and abscesses. Their isolation requires appropriate methods of collection, transportation, and cultivation of specimens. In addition to their active pathogenic role in these infections, many anaerobes express an indirect effect through their ability to produce the enzyme beta-lactamase. This enables these organisms to shield non-beta-lactamase-producing bacteria (BLPB) from penicillins. Inadequate therapy against BLPB may lead to clinical failures. Treatment of anaerobic infection is complicated by their slow growth, their polymicrobial nature, and the growing resistance of anaerobic bacteria to antimicrobials. Antimicrobial therapy is often the only form of therapy needed, whereas in other instances it is an important adjunct to a surgical approach. Because anaerobes generally are isolated mixed with aerobic organisms, therapy should provide for adequate coverage of both types of pathogens.

Anti-Bacterial Agents↗