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PubMed2004

[Drug-resistance analysis of Gram-negative bacilli producing extended-spectrum beta-lactamases in lower respiratory tract infection].

OBJECTIVE: To analyze occurrence of Gram-negative bacteria producing extended-spectrum beta-lactamase (ESBL) in patients with lower respiratory tract infection and assess their drug sensitivity to provide evidence for clinical management of lower respiratory tract infection with drug-resistant ESBL-producing bacteria. METHODS: A total of 312 Gram-negative bacterial strains were isolated from patients with lower respiratory tract infection and identified for the presence of ESBL by Vitek ESBL detection test and double-disk synergy tests as well as standard disk diffusion test. The effects of 10 antibacterial drugs on ESBL-producing strains were compared. RESULTS: A rate of 20.1% of the isolated strains were identified to produce ESBLs, including Klebsiella Pneumoniae, Escherichia coli, Enterobacter cloacae, Pseudomonas aeruginasa and Klebsiella oxytocla (accounting for 30.1%, 29.1%, 27.0%, 11.3%, and 2.5%, respectively, of the ESBL-producing strains). Imipenem possessed the most powerful antibacterial activity against ESBL-producing strains. CONCLUSIONS: Attention should be given to lower respiratory tract infections with ESBL-producing Gram-negative bacilli, and imipenem can be the primary choice for fighting such infections.

Drug Resistance, Bacterial↗
PubMed1989

[Distribution of serotypes of S. pneumoniae in upper respiratory tract infections].

Sixty strains of S. pneumoniae isolated from the patients with upper respiratory tract infections were immunologically classified by use of Danish type/group specific antisera. The percentages of S. pneumoniae serologically defined were 23.3% for Group 23, 20.0% for Group 19, 13.3% for Group 6, 10.0% for Type 3, 3.3% for Type 4, 3.3% each for Type 9 and 18, and 1.6% for Type 14. It was confirmed that in case of acute otitis media Group 19 and Type 3 were characteristic showing 30.0% and 13.4%, while rhinosinusitis were highly related to Group 23 of S. pneumoniae. An additional analyses revealed that Type 3 of S. pneumoniae were mostly found in the patients over 50 years old, though the patients under 5 years old were related to Group 19.

Adolescent↗
PubMed1988

Ciprofloxacin therapy of respiratory tract infection with Pseudomonas aeruginosa.

Forty-two patients with respiratory tract infection caused by Pseudomonas aeruginosa were treated with 500 mg ciprofloxacin administered orally twice daily. Pseudomonas aeruginosa was eradicated in 22 patients but recurred in eight patients. Clinical improvement or resolution was noted in 37 patients (88%). Eradication and cure rates were highest in patients without permanent risk factors, and in patients with hospital-acquired infection. New colonization during treatment was noted in 14 patients (33%), but no superinfection occurred. In persisting strains of Pseudomonas aeruginosa the in vitro sensitivity to ciprofloxacin decreased significantly during therapy.

Adolescent↗
PubMed2001

Pharmacodynamics of fluoroquinolones against Streptococcus pneumoniae in patients with community-acquired respiratory tract infections.

Fluoroquinolone antibiotic agents have demonstrated efficacy in the treatment of respiratory tract infections. This analysis was designed to examine the relationship between drug exposure, as measured by the free-drug area under the concentration-time curve at 24 h (AUC(24))/MIC ratio, and clinical and microbiological responses in patients with community-acquired respiratory tract infections involving Streptococcus pneumoniae. The study population included 58 adult patients (34 males, 24 females) who were enrolled in either of two phase III, randomized, multicenter, double-blind studies of levofloxacin versus gatifloxacin for the treatment of community-acquired pneumonia or acute exacerbation of chronic bronchitis. Clearance equations from previously published population pharmacokinetic models were used in conjunction with dose and adjusted for protein binding to estimate individual patient free-drug AUC(24)s. In vitro susceptibility was determined in a central laboratory by broth microdilution in accordance with NCCLS guidelines. Pharmacodynamic analyses were performed on data from all evaluable patients with documented S. pneumoniae infection using univariate and multivariable logistic regression; pharmacodynamic breakpoints were estimated using Classification and Regression Tree analysis. A statistically significant (P = 0.013) relationship between microbiological response and the free-drug AUC(24)/MIC ratio was detected. At a free-drug AUC(24)/MIC ratio of <33.7, the probability of a microbiological response was 64%, and at a free-drug AUC(24)/MIC ratio of >33.7, it was 100% (P < 0.01). These findings may provide a minimum target free-drug AUC(24)/MIC ratio for the treatment of infections involving S. pneumoniae with fluoroquinolone antibiotics and provide a paradigm for the selection of fluoroquinolones to be brought forward from drug discovery into clinical development and dose selection for clinical trials. Further, when target free-drug AUC(24)/MIC ratios are used in conjunction with stochastic modeling techniques, these findings may be used to support susceptibility breakpoints for fluoroquinolone antibiotics and S. pneumoniae.

Adult↗
PubMed2002

Antibiotic prescribing by primary care physicians for children with upper respiratory tract infections.

OBJECTIVES: To determine if the rate of appropriate antibiotic use in the treatment of children with bronchitis, viral upper respiratory tract infections, sinusitis, otitis media, and pharyngitis has changed in recent years and to identify factors that are associated with the use of inappropriate antibiotic therapy. DESIGN: The National Ambulatory Medical Care Survey was used to examine the antimicrobial prescribing habits of physicians who provide primary care for children. Data were analyzed from 1995-1998. SETTING: Office-based physician practices. PARTICIPANTS: Pediatricians, family physicians, and generalists completing survey forms for patients younger than 18 years. MAIN OUTCOME MEASURE: The appropriate use of antibiotics for upper respiratory tract infections. RESULTS: Multivariate analyses were used to examine factors associated with the use of inappropriate antibiotics to treat either upper respiratory tract infections or bronchitis. Patients seen in 1998 and diagnosed as having upper respiratory tract infections were 0.69 (95% confidence interval, 0.59-0.81) times less likely to be treated with antibiotics compared with patients seen in 1995. Multivariate analyses were also used to assess factors associated with the use of antibiotics with a suboptimal therapeutic profile for the treatment of either sinusitis or otitis media. Children diagnosed as having either sinusitis or otitis media were 0.3 (95% confidence interval [CI], 0.16-0.48) times less likely to receive antibiotics with a suboptimal therapeutic effect in 1998 compared with 1995. CONCLUSIONS: Physicians are slowly improving their antibiotic prescribing patterns but the use of inappropriate antibiotics is still common. Almost half of patients with upper respiratory tract infections receive antibiotics.

Adolescent↗
PubMed2001

Challenges of managed care organizations in treating respiratory tract infections in an age of antibiotic resistance.

Managing respiratory tract infections (RTIs) presents many challenges to managed care organizations (MCOs). RTIs are among the most common illnesses treated by primary care clinicians; they seriously impact patient quality of life and are a leading cause of health-related absences from the workplace. The total direct costs of treating conditions such as acute otitis media, sinusitis, and acute exacerbations of chronic bronchitis are estimated to be $10.1 billion. The development of drug resistance has compounded these challenges by increasing treatment failures and costs and limiting treatment options. MCOs can meet these challenges by implementing clinical practice guidelines for acute respiratory infections, conducting focused studies of antibiotic use, and educating both healthcare clinicians and patients about appropriate antibiotic use.

Acute Disease↗
PubMed1981

[Clinical studies of dibekacin intravenous challenge on respiratory tract infections (author's transl)].

Dibekacin was used for the treatment of 5 patients with bacterial respiratory tract infections (4 cases of Ps. aeruginosa and 1 case of S. marcescens) intravenously. Serum levels of DKB was observed by the method of enzyme immunoassay (EIA) and bioassay and no differentiation was observed between EIA and bioassay. Four cases of Ps. aeruginosa and 1 case of S. marcescens were all disappeared in 5 or 7 days of administration. No side effects were observed. The results obtained in this study indicate that DKB intravenous challenge might become one of the important method on respiratory tract infections.

Adolescent↗
PubMed1999

Basing empiric treatment choices for respiratory tract infection on the results of the Alexander Project.

For respiratory tract infection (RTI), antibiotics should have proven clinical efficacy against the major pathogens involved-Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis. As the pattern of resistance to antimicrobials changes, the clinical effectiveness of these agents should be reviewed. However, clinical trials are time consuming and costly, and alternative ways of predicting clinical efficacy using susceptibility data have been investigated. Pharmacodynamic breakpoints have been suggested as providing the link between susceptibility data and clinical effectiveness and this is supported by emerging clinical evidence. Thus, using the data collected in the Alexander Project, guidelines for the treatment of RTI can be developed which reflect the local resistance profile and maximize the chances of clinical success.

Anti-Bacterial Agents↗
PubMed2005

Predicting the clinical course of suspected acute viral upper respiratory tract infection in children.

BACKGROUND: Suspected acute viral upper respiratory tract infection (SAVURTI) is the commonest acute reason why children consult in general practice. The clinical course varies widely and about one in five children re-consult for the same SAVURTI episode. If clinicians had feasible tools for predicting which children are likely to suffer a prolonged course, then additional explanations and possibly treatments could be provided at the initial consultation that might enable carers to manage the condition without re-consulting. OBJECTIVE: To identify features available on the day of consulting that might predict a prolonged clinical course among children with SAVURTI. METHOD: Regression analysis using Canadian Respiratory Illness and Flu Scale (CARIFS) data from a randomized controlled trial cohort of children aged from 6 months to 12 years consulting in general practice with SAVURTI. RESULTS: Two variables from the clinician's records ('age' and 'cough') and two variables from the CARIFS completed by carers on the day of consulting ('fever' and 'low energy, tired') explained approximately 15% of the variation present in CARIFS scores on day seven. CONCLUSION: Children and carers may benefit from a clear account of the evidence that the clinical course of RTIs in children varies widely and may be longer that expected, and that prediction for individuals is difficult.

Acute Disease↗
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↗
PubMed1989

Clinical efficacy of ciprofloxacin in lower respiratory tract infections.

The sputum pharmacokinetics and clinical efficacy of ciprofloxacin in lower respiratory tract infections is reviewed. Following intravenous administration, ciprofloxacin penetrates rapidly into bronchial tissue; the elimination half life is between 3 and 4 h and a dose dependency is seen. Following oral intake, the time to reach maximal concentrations is approximately two hours and after a dose of 750 mg the concentration may reach 1.7 mg/l in patients without cystic fibrosis and range from 0.5 to 3.4 mg/l in cystic fibrosis patients. Coadministration of ciprofloxacin increases serum levels and decreases total body clearance of theophylline. In controlled comparative clinical trials, ciprofloxacin has been found to have similar clinical efficacy as amoxycillin, ampicillin, cefalexin, doxycycline, co-trimoxazole, imipenem-cilastatin and ceftazidime for the treatment of a range of lower respiratory tract infections. Ciprofloxacin has been found to be superior in clinical efficacy to cefaclor. Experimental animal models suggest a role for ciprofloxacin in infections caused by Legionella pneumophila and Mycoplasma pneumoniae. The clinical and bacteriological efficacy of ciprofloxacin is less pronounced in lung infections caused by Pseudomonas aeruginosa, but is comparable to the combination of beta-lactams and aminoglycosides. Development of resistance is frequently observed during ciprofloxacin treatment of Ps. aeruginosa. Because of the availability of other oral and effective agents, ciprofloxacin is not recommended for empirical treatment of community acquired lower respiratory infections, but should be reserved for infections caused by multiply resistant organisms.

Ciprofloxacin↗
PubMed1993

Brodimoprim in acute respiratory tract infections.

Brodimoprim was studied in the treatment of acute respiratory tract infections in hospitalized, basically healthy, military conscripts. Its efficacy and tolerance were compared to those of doxycycline in a clinical randomized double-blind trial. 60 pts. were divided into two equally large groups. One group received brodimoprim, 400 mg as a loading dose followed by 200 mg daily, for 10 days. The other group received doxycycline, 200 mg as a loading dose followed by 100 mg daily, for 10 days. In the brodimoprim group, 23 patients (77%) were cured, 5 patients (16%) improved and 2 patients (6%) were considered failures. In the doxycycline group, 26 patients (87%) were cured, 3 patients (10%) improved and 1 patient (3%) did not respond. The only side effect in the whole study was moderate diarrhea in 1 patient in the brodimoprim group. Clinically and according to the normalization of laboratory values, the two drugs tested were equally effective.

Acute Disease↗
PubMed1995

Pediatric Investigators Collaborative Network on Infections in Canada (PICNIC) prospective study of risk factors and outcomes in patients hospitalized with respiratory syncytial viral lower respiratory tract infection.

OBJECTIVE: To provide information on disease attributable to respiratory syncytial viral lower respiratory tract infection (RSV LRI) and to quantify the morbidity associated with various risk factors. DESIGN: Prospective cohort study. SUBJECTS: Patients hospitalized with RSV LRIs at seven centers were eligible for study if they were younger than 2 years of age, or hospitalized patients of any age if they had underlying cardiac or pulmonary disease or immunosuppression. MEASUREMENTS AND RESULTS: Enrolled (n = 689) and eligible but not enrolled (n = 191) patients were similar in age, duration of illness and proportion with underlying illness, use of intensive care, and ventilation. Of the enrolled patients, 156 had underlying illness. The isolates from 353 patients were typeable: 102 isolates were subgroup A, 250 were subgroup B, and one isolated grouped with both antisera. The mean hospital stay attributable to respiratory syncytial virus (RSV) was 7 days; 110 patients were admitted to intensive care units, 63 were supported by mechanical ventilation, and 6 patients died. Regression models were developed for the prediction of three outcomes: RSV-associated hospital duration, intensive care unit admission, and ventilation treatment. In addition to previously described risk factors for an increased morbidity, such as underlying illness, hypoxia, prematurity and young age, three other factors were found to be significantly associated with complicated hospitalization: aboriginal race (defined by maternal race), a history of apnea or respiratory arrest during the acute illness before hospitalization, and pulmonary consolidation as shown on the chest radiograph obtained at admission. The RSV subgroup, family income, and day care attendance were not significantly associated with these outcomes. CONCLUSIONS: Hypoxia on admission, a history of apnea or respiratory arrest, and pulmonary consolidation should be considered in the management of children with RSV LRIs. Vaccine trials should target patients with underlying heart or lung disease or of aboriginal race.

Antigens, Viral↗