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PubMedDate not supplied

Cefixime in the treatment of patients with lower respiratory tract infections: results of US clinical trials.

Community-acquired acute lower respiratory tract infections are a common cause of illness, accounting for millions of physician visits and prescriptions each year. Cefixime is an extended-spectrum oral cephalosporin with activity against Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis, the most commonly isolated bacterial pathogens. This review presents the results of eight US studies comparing the efficacy and safety of cefixime with those of amoxicillin, amoxicillin/clavulanate, cefaclor, cephalexin, and cefuroxime axetil in the treatment of patients with acute lower respiratory tract infections. Data for 211 cefixime-treated patients and a range of 19 to 49 patients in the comparator treatment groups were included in the efficacy analysis. Clinical success (cure or improvement) was observed in 94% of cefixime-treated patients; clinical success rates in the comparator treatment groups ranged from 97% for cefuroxime axetil and cefaclor to 79% for amoxicillin/clavulanate. At the end of treatment, the overall eradication rate in the cefixime treatment group was 92% and ranged from 76% (cefaclor) to 98% (cefuroxime axetil) in the comparator treatment groups. The percentage of persistent organisms was highest in the cefaclor (24%) and cephalexin (21%) treatment groups. With the exception of the cephalexin group (4%), the incidence of patients who reported adverse experiences was similar across treatment groups (34% to 50%). Those involving the gastrointestinal tract were by far the most common, and most adverse experiences were rated as mild or moderate in severity.

Adult↗
PubMed2004

[Acute respiratory tract infections due to a human metapneumovirus in children: descriptive study and comparison with respiratory syncytial virus infections].

BACKGROUND: A new paramyxovirus, the human metapneumovirus was recently isolated. We report the first French cases collected between 2000 and 2002. MATERIAL AND METHODS: Samples were obtained from nasopharyngeal aspirates from children hospitalised for acute respiratory tract infection in hospitals of Caen and Flers in Basse-Normandie. Human metapneumovirus was studied by polymerase chain reaction on negative samples for respiratory syncytial virus, influenza A and B virus, parainfluenza (1, 2 and 3) virus, adenovirus, coronavirus and rhinovirus. Comparison between metapneumovirus virus and respiratory syncytial virus infections was done after matching sex, age and infection month. RESULTS: Twenty-six human metapneumovirus infections were identified. A comparative study of a matched group of children infected by respiratory syncytial virus found no significative difference for hospitalisation motive, clinical criteria and treatment. CONCLUSION: The human metapneumovirus is responsible for typical acute bronchiolitis in children.

Acute Disease↗
PubMed1995

Empirical antibiotic therapy and lower respiratory tract infections: European guidelines and current practices.

Guidelines for the management of lower respiratory tract infection have been published in four European countries. The scope of each of these articles is reviewed and the similarities, differences and deficiencies highlighted. Very little is known about how lower respiratory tract infections (LRTIs) are managed in routine practice in Europe, especially in the community. The available data suggest major differences in antibiotic use between countries which is likely to be multifactorial in origin.

Anti-Bacterial Agents↗
PubMed1990

Comparison of oral erythromycin ethylsuccinate and ciprofloxacin in the treatment of acute respiratory tract infections.

A total of 619 patients with acute upper or lower respiratory tract infection were randomised to receive either erythromycin ethylsuccinate tablets at a dose of 1 g twice daily, or ciprofloxacin tablets 500 mg twice daily in a single-blind, multicentre study. The efficacy of each antibacterial was similar, with close to 90% of patients on each treatment being reported as either cured or improved. Gastrointestinal symptoms were the most commonly reported side-effects, being similar in overall incidence for both agents. Nausea, vomiting, dizziness and headache occurred more frequently in the ciprofloxacin group, while abdominal pain and diarrhoea occurred more frequently in the erythromycin ethylsuccinate group. In each group, the number of patients failing to complete treatment was similar and the main reasons cited for discontinuation were gastrointestinal symptoms. This study indicates that both erythromycin ethylsuccinate and ciprofloxacin are well tolerated and are equally effective for routine empirical treatment of acute respiratory tract infections.

Adolescent↗
PubMed2005

Treating respiratory tract infections in ambulatory care in Belgium: fluoroquinolone consumption and resistance development.

This study analyses consumption patterns of fluoroquinolones in treating respiratory tract infections in ambulatory care in Belgium and describes susceptibility of Streptococcus pneumoniae isolates to fluoroquinolones. Consumption data were obtained from IMS Health. Pneumococcal resistance was investigated in 600 blood isolates collected from 1998 to 2003. Although consumption of fluoroquinolones has increased rapidly over the last decade, this trend does not seem to persist more recently. Fluoroquinolones were mainly used to treat urinary and lower respiratory tract infections, but rarely in the management of upper respiratory tract infections. The use of new fluoroquinolones (levofloxacin, moxifloxacin) and the ongoing use of older fluoroquinolones have not led to increased pneumococcal resistance, which remained below 1% for levofloxacin and was 0% for moxifloxacin.

Ambulatory Care↗
PubMed2004

[Use of drugs to treat respiratory tract infections in the community].

OBJECTIVE: This study describes the utilization of drugs to treat respiratory tract infections in a community setting. The description of antimicrobial and non-antimicrobial drugs use is important to design interventions aimed at improving treatment strategies for these common illnesses. METHODS: In a population-based cross-sectional study, 6145 individuals living in an urban area in southern Brazil were inquired about the use of drugs for the treatment of respiratory tract infections in the 30 days previous to the interview. The Pearson chi-square test was used for statistical analyses. RESULTS: The global prevalence of respiratory infections treated with drugs was 6.3%. The prevalence was higher for children under 4 years of age (18%) and lower for the elderly (3%; p<0.001). Fifty-nine percent of the individuals used antimicrobials to treat respiratory infections. "Sore throat" was the main clinical condition associated with drug use (41%). Amoxicilin was the antimicrobial drug most frequently used (38%), while non-steroidal anti-inflamatory drugs were the most frequent among the non-antimicrobial drugs (27%). CONCLUSIONS: Antimicrobials were used in nearly 60% of the respiratory tract infections treated with some drug, even though they are mostly viral in their origin. The indiscriminate use of these drugs not only raises the costs of treatments, but may also lead to the emergence of bacterial resistance against the antimicrobials.

Adolescent↗
PubMedDate not supplied

Amoxicillin/clavulanate therapy of respiratory tract infections: a microbiologic perspective.

The development of beta-lactamase-producing strains of the common respiratory tract pathogens Hemophilus influenzae and Moraxella catarrhalis has caused increasing resistance to a number of antimicrobial agents, including ampicillin and amoxicillin, that are traditionally used to treat respiratory tract infections. Because antimicrobial therapy for upper and lower respiratory tract infections is usually empiric, an understanding of beta-lactamase-mediated resistance and its implications for antibiotic therapy is critical for the successful treatment of these infections.

Amoxicillin↗
PubMed1988

Degradation of host defenses against respiratory tract infection by Klebsiella pneumoniae in aged mice.

The host defense against respiratory tract infection with Klebsiella pneumoniae was much weaker in 60-week-old mice than in 4-week-old mice, but the resistance against systemic infection by intravenous and intraperitoneal challenge with K. pneumoniae in 60-week-old mice did not differ from that in 4-week-old mice. The number of alveolar macrophages at the resting stage in 60-week-old mice was the same as in 4-week-old mice, but the number of macrophages and polymorphonuclear leukocytes in the pulmonary cavity 4 h after challenge with formalinized K. pneumoniae in aerosol doubled in parallel with body weight. Phagocytosis and killing activities and superoxide anion production as measured by the Nitro Blue Tetrazolium reduction test of alveolar macrophages in 60-week-old mice were significantly weaker than in 4-week-old mice. The surfaces of the alveolar macrophages of the 60-week-old mice shrunk and a few adhered weekly to the glass plate, but the alveolar macrophages of the 4-week-old mice stretched to their full length and adhered firmly to the glass plate. These functions of alveolar macrophages clearly differed from those of peritoneal macrophages in 60-week-old mice, but those of the peritoneal phagocytes did not differ between 60-week-old and 4-week-old mice. The results suggest that the susceptibility to respiratory tract infection in 60-week-old mice is affected by a decline in the functions of alveolar macrophages rather than by the number of alveolar macrophages and exudated polymorphonuclear leukocytes in the lungs.

Aging↗
PubMed2005

Efficacy of an extract of North American ginseng containing poly-furanosyl-pyranosyl-saccharides for preventing upper respiratory tract infections: a randomized controlled trial.

BACKGROUND: Upper respiratory tract infections are a major source of morbidity throughout the world. Extracts of the root of North American ginseng (Panax quinquefolium) have been found to have the potential to modulate both natural and acquired immune responses. We sought to examine the efficacy of an extract of North American ginseng root in preventing colds. METHODS: We conducted a randomized, double-blind, placebo-controlled study at the onset of the influenza season. A total of 323 subjects 18-65 years of age with a history of at least 2 colds in the previous year were recruited from the general population in Edmonton, Alberta. The participants were instructed to take 2 capsules per day of either the North American ginseng extract or a placebo for a period of 4 months. The primary outcome measure was the number of Jackson-verified colds. Secondary variables measured included symptom severity, total number of days of symptoms and duration of all colds. Cold symptoms were scored by subjects using a 4-point scale. RESULTS: Subjects who did not start treatment were excluded from the analysis (23 in the ginseng group and 21 in the placebo group), leaving 130 in the ginseng group and 149 in the placebo group. The mean number of colds per person was lower in the ginseng group than in the placebo group (0.68 [standard deviation (SD) 0.82] v. 0.93 [SD 0.91], difference 0.25%, 95% confidence interval [CI] 0.04-0.45). The proportion of subjects with 2 or more Jackson-verified colds during the 4-month period (10.0% v. 22.8%, 12.8% difference, 95% CI 4.3-21.3) was significantly lower in the ginseng group than in the placebo group, as were the total symptom score (77.5 [SD 84.6] v. 112.3 [SD 102.5], difference 1.5%, 95% CI 1.2-2.0) and the total number of days cold symptoms were reported (10.8 [SD 9.7] v. 16.5 [SD 13.8] days, difference 1.6%, 95% CI 1.3-2.0) for all colds. INTERPRETATION: Ingestion of a poly-furanosyl-pyranosyl-saccharide-rich extract of the roots of North American ginseng in a moderate dose over 4 months reduced the mean number of colds per person, the proportion of subjects who experienced 2 or more colds, the severity of symptoms and the number of days cold symptoms were reported.

Adolescent↗
PubMed1998

Hospital-acquired infection in elderly patients.

Increasing numbers of elderly people are being treated in hospitals and are at particular risk of acquiring infections. The incidence, risk factors and types of hospital-acquired infection (HAI) in the elderly are reviewed. Special reference is made to urinary tract infections, respiratory tract infections, gastrointestinal infections including Clostridium difficile, bacteraemia, skin and soft tissue infections and infections with antibiotic-resistant organisms.

Aged↗
PubMed1987

[Flomoxef treatment of patients with respiratory tract infections].

Flomoxef (FMOX, 6315-S) was administered to 22 patients with respiratory tract infections. The patients consisted of 13 patients with pneumonia, 7 with bronchitis, 1 with bronchiectasis and 1 with pyothorax. The drug was administered by intravenous injection or intravenous drip infusion twice a day with doses of 1 to 2 g and total doses ranged from 17 to 64 g. The following results were obtained. 1. Clinical responses to the therapy were excellent in 1 case, good in 10 cases, fair in 4 cases, poor in 4 cases and not determined in 3 cases. Efficacy ratio was 57.9%. 2. As for adverse reactions, exanthema in 1 patient and stomatitis and numbness of tongue in another patient were observed, but these symptoms improved with cessation of the therapy. Abnormal laboratory test values were observed in 5 cases. From these results it appears that FMOX is a valuable antimicrobial agent against patients with respiratory tract infections.

Aged↗
PubMed2002

[Hospital infections in Norway 1999 and 2000].

BACKGROUND: The objective of this investigation was to measure the prevalence of hospital acquired infections in Norway in 1999 and 2000. MATERIAL AND METHODS: The results are based on prevalence reports sent to the Norwegian Institute of Public Health from 41 hospitals in 1999 and 45 in 2000, out of a total of 80 somatic hospitals. With the exception of two hospitals, all registered the four most common hospital infections: urinary tract infection, respiratory tract infection, surgical site infection, and septicaemia. In 1999, 35,612 patients were included; in 2000 35,712. RESULTS: The prevalence of the four most common hospital infections was 5.4% in 1999 and 5.1% in 2000. Urinary tract infections accounted for about 36.5% of all infections during both years. INTERPRETATION: About one in every 20 patients has at any given time a hospital infection. This report identifies the distribution of hospital infections and where to initiate further preventive measures.

Cross Infection↗
PubMed1996

Cefpodoxime proxetil. An appraisal of its use in antibacterial cost-containment programmes, as stepdown and abbreviated therapy in respiratory tract infections.

Cefpodoxime proxetil is an orally administered prodrug which is converted in vivo to the third generation cephalosporin cefpodoxime. Cefpodoxime has a similar spectrum of antibacterial activity to the parenteral cephalosporins ceftriaxone and cefotaxime and a long elimination half-life, which allows once- or twice-daily administration. Cefpodoxime proxetil has proven efficacy in the treatment of community-acquired pneumonia and upper respiratory tract, skin and soft tissue and urinary tract infections. It has been evaluated for use in cost-containment programmes, as stepdown (parenteral-to-oral conversion) therapy in the treatment of community-acquired pneumonia and as abbreviated therapy in upper respiratory tract infections. Substituting oral for parenteral therapy can achieve considerable savings (in acquisition, delivery and labour costs). Moreover, oral administration has advantages for the patient in terms of comfort and mobility, avoids the hazards of parenteral delivery and may allow earlier discharge from hospital, or even allow home treatment from the outset in low-risk patients. As hospitalisation is usually the major cost component in treating serious infections, considerable savings can be made in this way. Pharmacy-driven stepdown programmes in 2 US hospitals have achieved cost savings by targeting patients with community-acquired pneumonia for early conversion from intravenous ceftriaxone therapy to oral cefpodoxime proxetil. Costs were compared with those from a control group of patients who continued to receive intravenous ceftriaxone until physicians deemed that oral therapy (with various agents) was appropriate. In one study, duration of parenteral therapy in the cefpodoxime proxetil group was reduced from 6.18 to 3.82 days and duration of hospitalisation was reduced from 10.06 to 6.23 days (p < 0.02), with corresponding hospitalisation cost reductions of $US7300 per patient. However, clinical trial data relating to the efficacy of cefpodoxime proxetil as stepdown therapy in patients initially requiring parenteral antibacterials are lacking. Abbreviated (4-to 7-day) cephalosporin regimens appear to be as effective as traditional 10-day penicillin regimens in the treatment of upper respiratory tract infections. Short regimens may improve patient compliance and tolerability, thereby reducing the costs of adverse effects and treatment failures. Data from preliminary clinical studies suggest that a 5-day course of cefpodoxime proxetil is as effective as an 8-day course of amoxicillin/clavulanic acid in treating either acute otitis media or sinusitis, and as effective as a 10-day course of amoxicillin/ clavulanic acid and more effective than a 10-day course of phenoxymethyl- penicillin in the treatment of pharyngotonsillitis. Cefpodoxime proxetil tended to be better tolerated and was associated with better compliance than penicillin-based regimens. Indeed, a pharmacoeconomic study showed that a 10-day regimen of cefpodoxime proxetil was associated with lower costs for treating adverse effects and treatment failures than a 10-day regimen of amoxicillin/clavulanic acid in the treatment of acute otitis media in children. A 5-day course of cefpodoxime proxetil had a lower cost per patient treated per month free of recurrence than a 10-day course of phenoxymethylpenicillin (non-generic) or amoxicillin/clavulanic acid in the treatment of recurrent pharyngotonsillitis. Thus, evidence to date suggests that cefpodoxime proxetil has potential for use as stepdown therapy in community-acquired pneumonia and in abbreviated therapy courses in upper respiratory tract infections. These preliminary observations require confirmation in well designed studies.

Ceftizoxime↗