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PubMed1990

[Methicillin-resistant Staphylococcus aureus (MRSA) infection--significance of MRSA in respiratory tract infection].

We have examined background factors in MRSA infection in cases in which S. aureus had been isolated from sputa. The incidence of isolation of S. aureus was high and still increasing in expectorated sputa, and causative organisms in the cases of pneumonia and autopsied lungs. A significant correlation was observed between high incidence of isolation of S. aureus and abuse of third-generation cephems. MRSA isolation rates of inpatients was higher than that of outpatients. Among the inpatients such cases with severe underlying diseases and prolonged admission showed the highest incidence of isolation of MRSA. There seemed to be a correlation between distribution of patients with S. aureus and that of rooms with S. aureus in the air. This suggests nosocomial infection. Although MRSA was frequently isolated from sputa, most cases showed no signs of infection, and this suggested that they had been transient colonization. Such antimicrobial agents as rifampicin, teicoplanin, vancomycin reveal excellent antibacterial activity against MRSA and minocycline, ofloxacin were moderately effective. The physician must be informed of the significance of MRSA, because their understanding of MRSA still remains insufficient.

Anti-Bacterial Agents↗
PubMed1987

Treatment of respiratory tract infections with pefloxacin in critically ill patients hospitalized in a surgical intensive care unit.

Respiratory tract infections were treated with pefloxacin in fifteen patients, who were hospitalized in the intensive care unit and required artificial ventilation. The treatment was successful in ten patients. Development of resistance was observed in Staphylococcus aureus (two times) and Pseudomonas aeruginosa (four times). No adverse reactions were seen.

Bacterial Infections↗
PubMed1981

Prospective clinical trial on the efficacy of amoxycillin administered twice or four times daily in children with respiratory tract infections.

Thirty-four children with upper or lower respiratory tract infections were randomly allocated to receive either a twice daily or four times daily dose of 50 mg amoxycillin/kg body-weight/day. Mean duration of therapy was identical in both groups. Peak and trough antibiotic concentrations were determined. Eradication of bacteria, clinical improvement and side-effects were comparable in both groups.

Administration, Oral↗
PubMed1994

Piperacillin/tazobactam in the treatment of community-acquired and nosocomial respiratory tract infections: a review.

Investigators assessed the efficacy and safety of piperacillin/tazobactam therapy in a study of patients with community-acquired lower respiratory tract infections and a study of patients with nosocomial, severe lower respiratory tract infections. Piperacillin 4 g/tazobactam 500 mg was given intravenously every 8 h to 193 hospitalized lower respiratory tract infection patients for a minimum of 5 days. There was a favorable response rate of 97% and eradication of the causative pathogen was documented or presumed in 93% of patients. There was a low incidence of adverse experiences and the combination was well tolerated. Seventy-one intensive care patients with severe lung disease received 4 g piperacillin/500 mg tazobactam intravenously every 6 h; afterward they were given amikacin 7.5 mg/kg every 12 h. Minimum duration of treatment was 5 days. Therapy with piperacillin/tazobactam plus amikacin was well-tolerated, produced a 74% favorable clinical response rate, and eradicated the responsible pathogen in 70% of patients.

Adult↗
PubMed1988

[Susceptibility of bacteria isolated from patients with lower respiratory tract infections to antibiotics (1985)].

Collaborated studies on species of respiratory tract infection (RTI)-related organisms for their identification and drug susceptibilities have been carried out since 1981 at about 20 centers in Japan. On this occasion, the data obtained between 1982 and 1985 were reanalyzed to determine whether or not drug susceptibilities differed depending upon diseases, from which the organisms were isolated. The results summarized below were obtained in this study. 1. Among Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, Klebsiella pneumoniae and Pseudomonas aeruginosa examined, differences in drug susceptibilities according to different diseases were found among S. aureus and also mucoid strains of P. aeruginosa. 2. Susceptibility to beta-lactam antibiotics was definitely lower in S. aureus strains isolated from pneumonia than in those isolated from chronic bronchitis and bronchiectasia. 3. The isolation frequency of methicillin-and cefazolin-resistant strains of S. aureus was 30.3% and 25.9%, respectively, and was especially high among strains isolated from pneumonia. The antibiotic potency of minocycline against S. aureus, including methicillin resistant S. aureus, was the strongest among 9 drugs examined; S. aureus maintained relatively sufficient sensitivity to dicloxacillin among beta-lactam antibiotics. 4. Mucoid producing strains of P. aeruginosa isolated from chronic bronchitis had slightly lower drug susceptibility than those isolated from bronchiectasia. 5. When drug susceptibilities of H. influenzae were compared among groups separated according to diseases using MIC50, MIC80 and MIC90 as indicators, there were no clear differences. The isolation frequency of ampicillin (ABPC)-resistant strains, however, was clearly different among diseases; namely, resistant strains were the most and the least frequently isolated from chronic bronchitis and from pneumonia, respectively. In addition, the drug susceptibility of H. influenzae isolated in 1985 was analyzed in relation to the production of beta-lactamase. As a result, it was suspected that some factors, other than beta-lactamase, participated in the mechanism of ABPC-resistance. 6. These results suggest that drugs to be used for the chemotherapy of RTI should be selected considering the fact that drug susceptibilities of the pathogens differ, even among the same species, according to diseases.

Bacteria↗
PubMedDate not supplied

Experience with cefsulodin therapy for lower respiratory tract infections caused by Pseudomonas aeruginosa in adults without cystic fibrosis or granulocytopenia.

Cefsulodin was administered as the sole antipseudomonal therapy to 14 adults without cystic fibrosis or granulocytopenia for infection of the lower respiratory tract caused by susceptible strains of Pseudomonas aeruginosa. At dosages of 1.0-1.5 g intravenously every 6 hr, peak serum antipseudomonal activity consistently exceeded 1:16. Twelve patients (86%) showed a favorable therapeutic response: six (43%) with eradication of P. aeruginosa from the respiratory tract and six (43%) with persistent colonization. Two patients (14%) did not respond to cefsulodin therapy. In five cases (36%), P. aeruginosa resistant to cefsulodin appeared during the course of therapy, in two cases contributing to therapeutic failure; three strains also acquired cross-resistance to two or more other antipseudomonal beta-lactam antibiotics. Cefsulodin was well tolerated, with no evidence of organ toxicity or other adverse effects discerned. These therapeutic results are comparable with or superior to those reported with other antipseudomonal drugs studied in single-drug regimens for treatment of P. aeruginosa lower respiratory tract infections in this patient population.

Adult↗
PubMed1984

Beta-lactam antibiotics in lower respiratory tract infections.

Like in any infection, the choice of antibacterials in pulmonary infections of known bacterial etiology is simple. When etiology is not known, the choice must rest upon knowledge of the epidemiology of lower respiratory infections and the antibacterial spectrum of the antibiotics in question. The epidemiology of community-acquired lower respiratory infections is not too well studied. However, some studies indicate that approximately 50% of lower respiratory infections are caused by bacteria among which Streptococcus pneumoniae prevails, followed by Haemophilus influenzae. Streptococci, Branhamella catarrhalis and other Neisseria species, staphylococci and Enterobacteriaceae account for less than 10% each. The prevalence of Legionella pneumophila is unknown, but it is of limited significance. Mycoplasma pneumoniae varies in prevalence according to time and geographic area. In acute exacerbations of chronic bronchitis, the epidemiology is similar, except that H. influenzae is more commonly found than pneumococci. The traditional strong position of penicillin in the blind, primary treatment of community-acquired lower respiratory infections is challenged by the increasing frequency of penicillin-resistant H. influenzae and the discovery of new agents not sensitive to penicillins. The same can be said for the more recently introduced primary treatment with erythromycin. However, most community-acquired infections in the lower respiratory tract respond to penicillin; tetracycline or erythromycin may be used for treatment when the clinical response is unsatisfactory. In patients who are known or suspected to have compromised host defense, beta-lactams such as ureido-penicillins and the new cephalosporins should be used as primary therapy. In hospital-acquired lower respiratory tract infections, the etiological diagnosis is more likely to be made.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1983

Respiratory tract infections at a community care centre--with emphasis on group A streptococci.

Antibiotics were prescribed for 60% of 1538 patients who consulted a community care centre due to respiratory tract infections. Potential respiratory tract pathogens (betahaemolytic streptococci group A, C, G, Haemophilus influenzae, pneumococci) were isolated from almost half (46%) of the patients. The prescribing of antibiotics was correlated to the isolation of potentially pathogenic bacteria, except for patients with pharyngitis, sinusitis and bronchitis. Betahaemolytic streptococci group A were isolated from 14% of the patients. Recurrence of group A streptococcal infection occurred within 3 months in 24% of patients harbouring such bacteria at the first visit. Poststreptococcal subclinical acute glomerulonephritis (AGN) was diagnosed in 9 (4%) of 220 patients with group A streptococci. The patients with AGN had been treated with antibiotics significantly later than patients without signs of AGN.

Adolescent↗
PubMed1992

Therapeutic considerations: lower respiratory tract infections in smokers.

Tobacco smoke can alter both the structural and the immunologic defenses of the lungs against infection. The gases from smoke can also inhibit repair of the damages they create. Smokers have been found to have increased bacterial adherence to the respiratory tract, decreased IgA and IgG, and a decrease in vital capacity two to three times greater than that of nonsmokers. These and other respiratory tract alterations put smokers at an added disadvantage when acute lower respiratory tract infections strike. A history of smoking influences the diagnosis of respiratory tract infections because smokers are more prone than nonsmokers to infection by certain organisms. The major causes and characteristics of lower respiratory tract infections, methods of outpatient diagnosis, and the pros and cons of various modes of therapy are discussed.

Bacterial Infections↗
PubMed2004

[What is the importance of bacterial eradication in the treatment of respiratory tract infections?].

During the last few years, increasing antibiotic resistance amongst the major respiratory pathogens in the community has compromised the choice of empirical therapy for some respiratory tract infections. Of special interest has been the progressive increase in the resistance rates of Streptococcus pneumoniae to macrolides and penicillin, and of S. pyogenes to macrolides. Several studies have confirmed the association between community use of certain antibiotics and the development of resistance in S. pneumoniae and S. pyogenes. Nevertheless, not all the antibiotics have the same ability to select resistance and not all microorganisms are affected in the same way. The aim of antimicrobial therapy in respiratory tract infections is bacterial eradication. Pharmacokinetic and pharmacodynamics can be used to predict bacteriological eradication with antimicrobial therapy.

Anti-Bacterial Agents↗
PubMed1970

Etiologic diagnosis of lower respiratory tract infections.

Decision as to the role of infection in lower respiratory tract disease requires examination by culture of specimens known to be derived from the infra-laryngeal respiratory tract. Methods that involve the upper respiratory tract in collection of specimens entail the hazard of contamination by microbiota resident in the upper respiratory tract.The extrapulmonary approaches of cutting-needle biopsy and needle aspiration of intrathoracic disease have not been impressively productive of etiologic diagnosis of infections. While open-chest surgical biopsy has been a highly effective means to diagnosis, this approach does have special requirements in facilities and technical skills.Percutaneous transtracheal aspiration of tracheo-broncho-pulmonary secretions-exudates has been productive of useful information. Because of inherent simplicity and safety, transtracheal aspiration should precede resort to more demanding, difficult, dangerous procedures.

Humans↗
PubMedDate not supplied

Efficacy and safety of Sultamicillin (Ampicillin/Sulbactan) and Amoxicillin/Clavulanic acid in the treatment of upper respiratory tract infections in adults--an open-label, multicentric, randomized trial.

UNLABELLED: Upper respiratory tract infections are the most common causes of medical visits in children and adults, demanding massive use of antibiotics. Bacterial resistance caused by beta-lactamase is one of the most serious problems in this matter. Sultamicillin, a double pro-drug of Ampicillin/Sulbactan, is a potent beta-lactamase inhibitor which can face this challenge. AIM: Evaluate efficacy, safety and tolerability of Ampicillin/Sulbactan compared to Amoxicillin/Clavulanate in upper respiratory tract infections in adults. METHODS: 102 patients were enrolled and randomized to receive Ampicillin/Sulbactan or Amoxicillin/Clavulanate during 10 days. They were evaluated 10 and 30 days after treatment to learn about the therapeutic response. RESULTS: There were no differences between the two groups respecting cure at the end of treatment (visit 2) or at the end of the study (visit 3). Cure ratio was 61.7% and 93.2% (visits 2 and 3) in the Amoxicillin/Clavulanate group compared to 64.4% and 97.4%, respectively, in Ampicillin/Sulbactan group. The adverse events ratio for the two groups was the same (p=0.940). The number of patients with diarrhea was greater in the group of patients receiving Amoxicillin/Clavulanate (70.6%) than in the group receiving Ampicillin/Sulbactan (29.4%) (p=0.0164). CONCLUSIONS: Ampicillin/Sulbactan is as safe and efficient as Amoxicillin/Clavulanate in the empiric treatment of upper respiratory infections in adults. The low occurrence of diarrhea in the group receiving Ampicillin/Sulbactan needs confirmation in other studies.

Adult↗
PubMed2001

Prevalence of Chlamydia pneumoniae in acute respiratory tract infection and detection of anti-Chlamydia pneumoniae-specific IgE in Japanese children with reactive airway disease.

We examined the prevalence of Chlamydia pneumoniae in acute respiratory tract infection and association of C. pneumoniae infection and reactive airway disease in Japanese children. Four hundred eleven children with acute respiratory tract infection were enrolled in this study, and C. pneumoniae was isolated from 58 (14.1%) patients by culture. Evidence of infection with C. pneumoniae was detected in 58 children with pneumonia (34.5%), bronchitis (41.4%) and upper respiratory tract infection (24.1%). Twenty-nine (50.0%) out of 58 patients were younger than 5 years old and 18 (31.0%) had wheezing at first visit. A logistic test for anti-C. pneumoniae-specific IgE showed the deference in the fluorescence unit between the patients with C. pneumoniae infection with and without wheezing was statistically significant (Po = 0.02748, to = 2.31891). In conclusion, C. pneumoniae seems to be an important respiratory tract pathogen among young Japanese children, and our results support the association of C. pneumoniae infection and reactive airway disease.

Acute Disease↗
PubMed1992

Epidemiology of acute respiratory tract infections, especially those due to Haemophilus influenzae, in Papua New Guinean children.

Acute lower respiratory tract infections (ALRI) are the most common cause of death in Papua New Guinean children. Haemophilus influenzae and Streptococcus pneumoniae are almost universally carried in the nasopharynx from a young age and commonly cause disease. While most H. influenzae isolates from blood and cerebrospinal fluid are serotype b, other serotypeable and nonserotypeable H. influenzae are more frequently isolated in Papua New Guinea than in developed countries. Low levels of antipneumococcal antibody, malnutrition, and upper respiratory carriage of invasive pneumococcal serotypes are associated with increased risk of ALRI. An oral H. influenzae vaccine given to adults with chronic bronchitis reduced the bacterial load in sputum and may thereby help reduce transmission of bacteria in the community. The efficacy of conjugate H. influenzae type b vaccine in preventing pneumonia must be determined in developing countries; vaccines against other types of H. influenzae will also be needed to control pneumonia and meningitis.

Acute Disease↗