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PubMed2003

The reducing incidence of respiratory tract infection and its relation to antibiotic prescribing.

BACKGROUND: There is good evidence of reduced prescribing of antibiotics in recent years, but the reason for this has not been established. AIM: To study the incidence of respiratory tract infections presenting to general practitioners (GPs) in England and Wales in relation to the incidence of other infections and to the prescription of antibiotics. SETTING: Sentinel practices in England and Wales who contribute to the Weekly Returns Service (WRS) of the Royal College of General Practitioners. DESIGN: Time-series analysis of disease incidence data reported by the practices and of antibiotic prescription data from the Prescription Pricing Authority (PPA) during the years 1994-2000. METHOD: Incidence data reported weekly from 73 practices in England and Wales, serving a population of 600,000, for acute respiratory tract infections, otitis media, infectious mononucleosis, shingles, urinary tract infections, and skin infections, were consolidated into quarterly datasets and examined graphically for evidence of secular and seasonal trends. Trends in antibiotic prescription items (data for England only were supplied by the PPA) were examined for association after adjustment for seasonal variation. RESULTS: The incidence of respiratory tract infections and antibiotic prescribing showed virtually identical seasonal variation, with both declining from 1995: respiratory tract infections by 48% in winter and 38% in summer, and antibiotic prescriptions by 34% and 21%, respectively. Trends in both were very highly correlated. The incidence of shingles and skin infections was constant. The incidence of urinary tract infections declined by 10%. The incidence of otitis media in children and acute bronchitis in the elderly followed the all-age trend in the reduction of respiratory tract infections. CONCLUSION: The considerable reduction in the incidence of respiratory tract infections between 1995 and 2000 is the main reason for the decline in antibiotic prescribing rather than changing prescribing thresholds for antibiotics.

Anti-Bacterial Agents↗
PubMed1995

A comparison of ampicillin/sulbactam versus cefotaxime in the therapy of lower respiratory tract infections in hospitalized patients.

Fifty-three hospitalized patients suffering from lower respiratory tract infections were evaluated in a randomized, comparative trial studying the safety and efficacy of ampicillin/sulbactam (2 g ampicillin plus 1 g sulbactam intravenously every 6 h) versus cefotaxime (2 g intravenously every 6 h). Thirty-four of the 36 and 16 of the 17 patients treated with ampicillin/sulbactam and cefotaxime, respectively, were evaluable. Clinical and bacteriologic efficacy did not differ significantly between the two treatment groups (p = 0.828 and p = 0.648, respectively). Twenty-one (61.8%) of the ampicillin/sulbactam-treated patients were cured, eight (23.5%) improved and four (11.8%) were treatment failures. Nine (56.3%) of the cefotaxime treated patients were cured, four (25.0%) improved and two (12.5%) failed therapy. All primary pathogens were eradicated in 19 (55.9%) of the ampicillin/sulbactam group and were partially eradicated in seven (20.6%) patients. In the cefotaxime treatment group bacteriologic eradication occurred in 10 (62.5%) and partial eradication in two (12.5%) patients. Both study drugs were well tolerated, as the number of adverse reactions in each treatment group was small and similar between the two groups. Ampicillin/sulbactam appears to be as safe and effective as cefotaxime in the therapy of hospitalized patients with lower respiratory tract infections caused by beta-lactamase positive and beta-lactamase negative pathogens.

Adult↗
PubMed1997

[The clinical manifestation and drug sensitive tests of lower respiratory tract infection by enterobacter cloacae. The Pulmonary Infection and Fibrosis Group, Thoracic Society Shanghai Medical Association].

OBJECTIVE: To study the clinical characteristics of lowar respiratory tract infection caused by E. cloacae and to investigate the drug sensitivities of E. cloacae strains. METHOD: (1) Analysing the clinical deta of 58 case with lowa respiratory tract infection of enterobacter cloacae defined by a putative standard, including ages, symptoms, signs, underlying diseases, sputum culture, X-ray findings and the prognosis. (2) Determining the drug sensitivities against the E. cloacae strains by K-B method. RESULTS: (1) There were 46 males and 12 females, with the mean age 56 +/- 19% cases diagnosed, who had underlying diseases, most were COPD. 41% cases were mixed infections with other bacteria, most of which were P. aeruginosa and K. pneumoniae. The chief symptoms were fever (72%) and productive cough (87%). The chest X-ray revealed inflammatory infiltration in lower lobes of both sides. The mortality rate was 9%. (2) The antimicrobial tests in vitro showed that these strains were multiresistant to antibiotics, but imipenem, amikacin, tobramycin, ciprofloxacin, cefoaperazone were sensitive. CONCLUSIONS: The lower respiratory tract infections caused by E. cloacae showed no specific clinical manifestations. However, the mortality was high. The diagnosis should be made according to bacteriologic examination combined with clinical and X-ray manifestations. Combining antibiotics therapy was recommanded according to antimicrobial sensitivity test.

Adult↗
PubMed2006

Prevalence of viral respiratory tract infections in children with asthma.

BACKGROUND: Previous studies support a strong association between viral respiratory tract infections and asthma exacerbations. The effect of newly discovered viruses on asthma control is less well defined. OBJECTIVE: We sought to determine the contribution of respiratory viruses to asthma exacerbations in children with a panel of PCR assays for common and newly discovered respiratory viruses. METHODS: Respiratory specimens from children aged 2 to 17 years with asthma exacerbations (case patients, n = 65) and with well-controlled asthma (control subjects, n = 77), frequency matched by age and season of enrollment, were tested for rhinoviruses, enteroviruses, respiratory syncytial virus, human metapneumovirus, coronaviruses 229E and OC43, parainfluenza viruses 1 to 3, influenza viruses, adenoviruses, and human bocavirus. RESULTS: Infection with respiratory viruses was associated with asthma exacerbations (63.1% in case patients vs 23.4% in control subjects; odds ratio, 5.6; 95% CI, 2.7- 11.6). Rhinovirus was by far the most prevalent virus (60% among case patients vs 18.2% among control subjects) and the only virus significantly associated with exacerbations (odds ratio, 6.8; 95% CI, 3.2-14.5). However, in children without clinically manifested viral respiratory tract illness, the prevalence of rhinovirus infection was similar in case patients (29.2%) versus control subjects (23.4%, P > .05). Other viruses detected included human metapneumovirus (4.6% in patients with acute asthma vs 2.6% in control subjects), enteroviruses (4.6% vs 0%), coronavirus 229E (0% vs 1.3%), and respiratory syncytial virus (1.5% vs 0%). CONCLUSION: Symptomatic rhinovirus infections are an important contributor to asthma exacerbations in children. CLINICAL IMPLICATIONS: These results support the need for therapies effective against rhinovirus as a means to decrease asthma exacerbations.

Adolescent↗
PubMed1999

[Forty-seven cases of lower respiratory tract infections due to E. ictaluri].

OBJECTIVE: To study the risk factors and treatment of lower respiratory tract infections due to E. ictaluri, and the cause of its improved detection by sputum culture in recent years. METHODS: To sum up the number of positive cultures and analyze the clinical features of the cases with positive sputum culture tested from 1959 to 1998. RESULTS: Before 1996, there were no positive cultures (0%) in 17,500 sputum samples using manual techniques, in 1997 and 1998 the aggregate positive rate was 2.3% (47/1,962), using SCEPTOR detecting instrument. On chi square testing of the two results derived from the two methods, P < 0.001. On drug sensitivity testing, E. ictaluri was sensitive to imipenem, cefotaxime and tobramycin. CONCLUSIONS: E. ictaluri is an uncommon opportunistic pathogen of lower respiratory tract infections. Lowered body resistance is a risk factor, and improved technology is the principal cause for detection of E. ictaluri infections.

Adolescent↗
PubMed2004

Concurrent serious bacterial infections in 912 infants and children hospitalized for treatment of respiratory syncytial virus lower respiratory tract infection.

The objective of this study was to report the frequency of concurrent serious bacterial infections in infants and young children hospitalized for treatment of respiratory syncytial virus (RSV) lower respiratory tract infection. Data were collected through a retrospective review of the medical records of all 912 patients with a discharge diagnosis of RSV bronchiolitis or pneumonia between July 1, 2000 and June 30, 2002. Two (0.43%) of 470 patients tested had a positive blood culture; both patients were >90 days of age. None of 101 patients tested had a positive cerebrospinal fluid culture, and 28 of 234 (12.0%) patients tested had a positive urine culture. Routine sepsis and meningitis workups are not necessary in non-toxic-appearing infants and young children with RSV lower respiratory tract infection.

Adolescent↗
PubMed1986

A comparative study of cefadroxil and co-trimoxazole in patients with lower respiratory tract infections.

The most common causative pathogens in lower respiratory disease are S. pneumoniae, H. influenzae and S. pyogenes. Cefadroxil and co-trimoxazole, both orally administered broad spectrum antibiotics, are effective against these organisms when given in a twice-daily regimen. In this open randomised study, 42 patients with lower respiratory tract infections received cefadroxil 1 g or co-trimoxazole 1 double-strength tablet every 12 hours for a mean duration of 11 and 13 days, respectively. Pathogens were isolated in the pre-treatment sputum of 51% of patients given cefadroxil and in 25% of those who received co-trimoxazole. Similar overall cure rates were observed after treatment with cefadroxil (67%) and co-trimoxazole (60%); sputum purulence was similarly diminished by both drugs (91% and 85%, respectively). Neither antibiotic caused serious side effects. Thus, in a convenient twice-daily regimen, cefadroxil and co-trimoxazole are comparably effective in treating lower respiratory tract infections.

Cefadroxil↗
PubMed1989

[Respiratory tract infections due to Mycoplasma pneumoniae in elementary school children; a case report].

Epidemic respiratory tract infections occurred among elementary school children in Hiroshima prefecture during June, July and August, 1987. Forty (59%) of 68 children who were enrolled in an elementary school were confirmed to have respiratory diseases during this period, ten of whom were hospitalized with diagnoses of pneumonias. Diagnoses of M. pneumoniae infection were made from secretions obtained by throat swabs, and by serological studies of blood specimens. Twenty-four (77%) of the 31 patients examined were confirmed to have M. pneumoniae infections. Twenty-three of them had upper respiratory tract infections with cough and fever; two had pneumonia, one with myringitis. PPLO-broth, SP-4 broth and diphasic medium were used for M. pneumoniae isolation. Among these, SP-4 broth proved to have the highest isolation rate.

Child↗
PubMed2004

Gender differences in hospitalization rates for respiratory tract infections in Danish youth.

Overall morbidity and mortality rates in childhood are reported to be higher in males than females. As respiratory tract infections constitute the leading cause of childhood hospitalization, we examined the gender difference in rates of hospitalization due to respiratory tract infections in Danish youth (under age 25). We studied a total of 64,049 hospitalizations for otitis media, pneumonia, influenza, and other acute respiratory tract infections from 1995 to 1999, with calculation of hospitalization rates by age and gender. The male-female hospitalization rate ratio (HRR) for admission due to a respiratory tract infection decreased from 1.45 (95% confidence interval (CI) 1.42-1.48) in the age group 0 - < 5 y, to 1.62 (95% CI 1.55-1.70) in the age group 5 - < 10 y, 1.13 (95% CI 1.04-1.22) in the age group 10 - < 15 y, 0.83 (95% CI 0.76-0.90) in the age group 15 - < 20 y, and 0.87 (95% CI 0.80-0.95) in the age group 20 - < 25 y. In young children, boys were hospitalized more often than girls, but the reverse applied in children and adolescents 15-25 y of age. The study generates the hypothesis that gender plays a role in the susceptibility for respiratory infections in early childhood.

Adolescent↗
PubMed2004

The course of C-reactive protein response in untreated upper respiratory tract infection.

BACKGROUND: High C-reactive protein (CRP) values are frequently found in patients with bacterial respiratory infection, and CRP testing has been shown to be useful in differentiating pneumonia from other respiratory infections. Raised CRP values may also be found in viral respiratory infection, and as a result there is a risk that antibiotics may be wrongly prescribed. AIMS: To describe the course of the CRP response during untreated upper respiratory tract infections and associations between the development of CRP values, erythrocyte sedimentation rate (ESR) and respiratory symptoms. DESIGN OF STUDY: Prospective study. SETTING: Seven general practices in northern Norway. METHOD: Patients with upper respiratory tract infection aged 16 years or over, who were not treated with antibiotics and who had been ill for no more than 3 days, were recruited. Microbiological examinations were undertaken, together with measurements of CRP, ESR and recording of symptoms daily during the first week of illness and on days 10, 14 and 21. RESULTS: An aetiological agent was established in 23 of the 41 included subjects. These were: influenza A, influenza B, rhinovirus, and other agents. Among the 15 patients examined on both the second and the third day of illness, the median CRP value increased from 7-10 mg/l, and the mean value was from 19-24 mg/l between day 2 and day 3. Peak CRP values were reached on days 2 to 4. Higher CRP values were found in those infected with influenza A and B than in the other subjects (P <0.001). A CRP value >10 mg/l was found in 26 subjects during the first 7 days, compared to five subjects after 1 week. Evidence of a secondary infection with group A streptococci was found in two of these five subjects. The development of the symptoms of sore throat, fatigue, clamminess, and pain from muscles and joints followed a similar course as the CRP response, while stuffy nose, cough, sputum production, and dyspnoea tended to persist after the CRP values had approached the normal range. CONCLUSION: A moderately elevated CRP value (10-60 mg/l) is a common finding in viral upper respiratory tract infection, with a peak during days 2-4 of illness. Moderately elevated CRP values cannot support a diagnosis of bacterial infection when the illness has lasted less than 7 days, but may indicate a complication of viral infection after a week.

Adolescent↗
PubMed1994

Stomatococcus mucilaginosus lower respiratory tract infection in a patient with AIDS.

We describe a case of recurrent Stomatococcus mucilaginosus lower respiratory tract infection in a patient with AIDS. Apart from S. mucilaginosus no other pathogens were found to account for infection. There was a rapid response to rifampicin, the organism being resistant to penicillin, co-trimoxazole and ciprofloxacin. Infections caused by this organism are increasingly described, but there are few reports of lower respiratory tract infection.

AIDS-Related Opportunistic Infections↗