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PubMed2000

Outcomes after judicious antibiotic use for respiratory tract infections seen in a private pediatric practice.

BACKGROUND: Most respiratory tract infections (RTIs) in children have a viral cause, they resolve on their own, and antibiotics need not be prescribed. OBJECTIVE: We sought to provide evidence that judicious antibiotic use can be accomplished in private pediatric practice without observing an increase in return office visits or in the rate of bacterial infections that may follow. STUDY DESIGN: This was a prospective 12-month study from July 1, 1996 through June 30, 1997. On the same 1 day each week, a representative convenience sample of acute respiratory tract illness patients was enrolled, and laboratory studies performed as appropriate, including viral cultures on all. Children were then followed for 30 days to ascertain the outcomes of not prescribing antibiotics except when specific bacterial infections were present at the initial visit. RESULTS: Three hundred eighty-three children were enrolled; 293 (77%) did not receive antibiotics at the enrollment visit. Ninety children (23%) received antibiotics based on a diagnosis of acute otitis media (n = 53), acute streptococcal tonsillopharyngitis (n = 18), or other presumed or documented bacterial infections (n = 19). An unscheduled return visit related to the initial visit occurred for 86 (29%) of the 293 children not receiving antibiotics initially and in 40 (44%) of 90 children receiving antibiotics initially. Eighty-seven children (23%) had positive viral culture results. The most frequently isolated viruses were adenovirus, enterovirus, parainfluenzae virus, and influenza virus. CONCLUSION: Children with RTIs without a concomitant presumed or proven bacterial infection do not require antibiotics. In this busy office practice, >75% of the children presenting with an RTI did not have a presumed or proven bacterial infection. These children did not have a higher rate of return office visits or an increase in bacterial infections. This reinforces the judicious use of antibiotics in managing children with RTIs.outcomes, antibiotic, respiratory infections.

Agglutination Tests↗
PubMed1994

[Clinical evaluation of combination therapy of sulbactam/cefoperazone and aminoglycoside in respiratory tract infections].

We compared clinical efficacy and safety of sulbactam/cefoperazone (SBT/CPZ) with those of SBT/CPZ combined with aminoglycoside (amikacin (AMK), tobramycin (TOB), etc.) in treatment of respiratory tract infections in patients with underlying respiratory diseases, with cancer, or with acute exacerbation of chronic respiratory infections. Clinical evaluations of monotherapy with SBT/CPZ in a total of 30 patients showed excellent results in 5, good results in 17. Clinical effects of combined therapy of SBT/CPZ plus different aminoglycosides in a total of 33 patients were excellent in 18, good in 5. The efficacy rates (excellent plus good) were 73.3% in the monotherapy and 69.7% in the combined therapy. AMK was used concomitantly with SBT/CPZ in 16 of 33 patients. Clinical effects of SBT/CPZ plus AMK were excellent in 10, good in 3, and the efficacy rate was 81.3%. Bacteriological effects were evaluable against 11 strains in the monotherapy group, and against 17 strains in the combined therapy group. The eradication rates were 54.5% in the monotherapy group, and 81.3% in the combination therapy group. Diarrhea was observed in a patient who received the monotherapy. Abnormal laboratory test results were observed on in 5 patients who received the monotherapy, and in 4 patients who received one of the combined therapies. All abnormalities disappeared after the completion or discontinuation of therapies. We considered SBT/CPZ combined with an aminoglycoside is a useful chemotherapy for respiratory tract infections in patients with underlying diseases and acute exacerbation of chronic respiratory tract infections.

Adult↗
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↗
PubMed1987

Ciprofloxacin for respiratory tract infection with Pseudomonas aeruginosa.

Thirty one patients were treated with oral ciprofloxacin for bronchitis with Pseudomonas aeruginosa. Twenty eight patients had permanent and 14 transient risk factors. Nine patients had a hospital infection with Pseudomonas aeruginosa. Sixteen patients were cured, complete or partial, but Pseudomonas aeruginosa persisted or recurred in 19 patients. Patients with hospital infection did better than other patients. There was a significant decrease in in vitro susceptibility of persisting strains of Pseudomonas aeruginosa to ciprofloxacin and a tendency of recovery of susceptibility for the drug after treatment.

Adolescent↗
PubMed1977

Transfer factor in chronic and recurrent respiratory tract infections in children.

Five cases with abnormal sensitivity to respiratory tract infections are described. The cases showed a marked impairment in their cell mediated immunity state. Administration of a chromatographically purified transfer factor component increased the skin test sensitivity to common recall antigens. Interestingly, a similar effect in skin reactivity was observed with repeated skin tests alone, when antigen concentrations, initially high enough to cause a positive reaction, were used. Neither the administration of transfer factor nor skin testing with high antigen concentrations had an effect on blast transformation percentages. The therapy with chromatographically purified transfer factor appeared promising on the clinical condition of the patients.

Antibody Formation↗
PubMed1991

Exercise and the incidence of upper respiratory tract infections.

We examined illness patterns in a cohort of 530 male and female runners who completed a monthly log for 12 months. The average number of upper respiratory tract infections (URTIs) per person per year for the cohort was 1.2. An upper respiratory tract infection was indicated by the report of any of the following symptoms; runny nose, sore throat, or cough. Using a multiple logistic regression model, the following factors were found to be associated with having one or more URTIs in the follow-up period: living alone (odds ratio = 2.27, 95% CI = 1.01, 5.09), running mileage (486-865 miles, odds ratio = 2.00, 95% CI = 1.01, 2.78; 866-1388 miles, odds ratio = 3.50, 95% CI = 1.52, 4.44; greater than 1388 miles, odds ratio = 2.96, 95% CI = 1.30, 3.68), body mass index greater than the 75th percentile (odds ratio = 0.58, 95% CI = 0.35, 0.94), and male gender (odds ratio = 0.14, 95% CI = 0.03, 0.68). A significant interaction was found to exist between gender and alcohol use, with the association between alcohol use and upper respiratory tract infections being positive in males and negative in females. These results suggest that running dosage (mileage) is a significant risk factor for upper respiratory tract infections in this group of exercisers.

Adolescent↗
PubMed1985

Clinical evaluation of cefotiam and cefamandole in respiratory tract infections.

Eighty-two adult hospitalized patients suffering from respiratory tract infections were treated with cefotiam or cefamandole in an open comparative study. The patients were allocated randomly to one of the two treatments. The recommended dosage regimens (i.m. or i.v.) were used for both groups (cefotiam 1 g b.i.d., cefamandole 1 g t.i.d.). The duration of treatment was 7 to 14 days according to the response of the disease condition. 80 patients were analyzed. The tolerability of both drugs was good and comparable. The clinical and bacteriological efficacy of both drugs was equivalent. The radiological examinations showed a better improvement of the patients treated with cefotiam.

Adolescent↗
PubMed1984

[Clinical studies of cefoxitin with special reference to pulmonary suppuration and pyothorax with respiratory tract infection].

Cefoxitin (CFX) was administered to 12 patients with respiratory tract infections, including mainly patients with pulmonary suppuration or pyothorax. The results were as follows: CFX was effective in 75% of the total patients, and in 83% of the 6 patients with pulmonary suppuration or pyothorax. Microorganisms which were considered to be causative were isolated in 8 of 12 patients. Bacteriological responses were "eradicated" in 4 patients, "replaced" in 3 patients, "unchanged" in 1 patient. A slight elevation of S-GPT was observed in one patient and elevation of A1-P in another following CFX administration; however, these values returned to normal shortly after completion of drug administration. No adverse effects, allergic symptoms or laboratory abnormalities were observed.

Adolescent↗
PubMedDate not supplied

Clinical judgment predicts culture results in upper respiratory tract infections.

BACKGROUND: We wanted to describe the natural history, familial transmission, microbiology, and accuracy of clinical judgment of potential pathogens of respiratory tract infections in a community family practice. METHODS: The study was a prospective case series in which consecutive patients requesting treatment for respiratory tract infections were evaluated after nurse triage during 3 fall-spring months in a solo family practice in suburban Cleveland, Ohio. According to the physician's usual practice, patients were classified into high-, medium-, and low-risk groups for bacterial illness based on their clinical signs and symptoms. Cultures were performed and sensitivities were determined for pathogens from the infected throat, nasopharynx, conjunctiva, or other sites. Patient symptoms and well-being were scored at the initial visit and at 3, 7 and 14 days later. RESULTS: There were 111 illness episodes in 86 patients; 94% had cultures taken, of which 38% grew a potentially pathogenic bacteria, most commonly group A streptococci, Branhamella catarrhalis or Staphylococcus aureus. The physician's judgment of bacterial infection was associated (P < .001) with having a positive culture (sensitivity 53%, specificity 78%, positive and negative predictive values 60% and 73%, respectively). A positive culture was associated with 2 of 16 signs or symptoms: purulent discharge from any site or a red swollen eye. There was no association of treatment status with clinical outcomes during 2 weeks of follow-up observation. CONCLUSION: Infection with a potentially pathogenic bacteria is difficult to determine solely by clinical signs and symptoms, but clinical judgment is associated with positive culture results. The effect of selective treatment of upper respiratory tract infection based on clinical signs and symptoms and patient and family culture results remains to be determined, but using clinical judgment could result in more selective antibiotic use than found in current practice patterns.

Anti-Bacterial Agents↗
PubMed1988

Respiratory tract infections increase susceptibility to neurogenic inflammation in the rat trachea.

This study reveals that respiratory tract infections make the tracheal mucosa of rats more susceptible to neurogenic inflammation, which is a type of inflammation mediated by neuropeptides released from sensory nerves. Neurogenic inflammation was produced in the tracheas of 2 groups of Long-Evans rats by electrical stimulation of the vagus nerve (5 V, 1 ms, 20 Hz for 5 min) or by an injection of capsaicin (15 to 200 micrograms/kg i.v.) or substance P (0.05 to 5.0 micrograms/kg i.v.). Rats of one group were pathogen-free; the others had serologic evidence of naturally occurring airway infections caused by Sendai virus, coronavirus, and Mycoplasma pulmonis. The stimuli produced neurogenic inflammation in both groups of rats, but the magnitude of this inflammation was much greater in the infected rats. The susceptibility of the infected rats to neurogenic inflammation was manifested by a 2.0 to 3.1 times larger increase in vascular permeability to Monastral blue, 5 times larger increase in number of neutrophils adhering to the endothelium of venules, and conspicuous morphologic changes in the tracheal epithelium. When pathogen-free rats acquired respiratory tract infections, they too became susceptible to neurogenic inflammation. Other experiments showed that infection by Sendai virus was essential for the change, although infection by M. pulmonis or coronavirus may also be necessary. The susceptibility to neurogenic inflammation outlasted the transient pathologic changes caused in the airway mucosa by the viral infections and may have been permanent.

Animals↗
PubMedDate not supplied

The administration regimen of isepamicin in patients with chronic respiratory tract infection.

A total of 34 patients with intractable chronic respiratory tract infections were treated with isepamicin and/or piperacillin in different dosage regimens. A comparison of the bacteriological effect using a cross over method showed a reduction in the count of Pseudomonas aeruginosa in sputum in the group receiving once-a-day isepamicin combined with piperacillin, compared with the twice-a-day combined administration. A comparison of the clinical and bacteriological efficacy between the different regimen groups revealed no noticeable difference. The clinical effect of this regimen is comparable to the conventional regimen, but has the advantages of a safer dosage and ease of administration.

Adult↗
PubMed2006

Olfactory disorders following upper respiratory tract infections.

Postviral olfactory disorders usually occur after an upper respiratory tract infection (URTI) associated with a common cold or influenza. With a prevalence between 11 and 40% they are among the common causes of olfactory disorders. Women are more often affected than men and post-URTI disorders usually occur between the fourth and eighth decade of life. The exact location of the damage in post-URTI is not yet known even though from biopsies a direct damage of the olfactory receptor cells is very likely. Nevertheless, central mechanisms cannot completely be ruled out. The diagnosis is made according to the history, clinical examination and olfactory testing. Affected patients usually recall the acute URTI and a close temporal connection should be present to establish the diagnosis. Spontaneous recovery might occur within 2 years. So far, no effective therapy exists even though specific olfactory training might be promising.

Humans↗
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↗
PubMed2003

Procalcitonin as a diagnostic tool in lower respiratory tract infections and tuberculosis.

The diagnostic significance of procalcitonin concentrations in lower respiratory tract infections and tuberculosis is not known. A prospective analysis was, therefore, performed in patients with acute exacerbation of chronic bronchitis (AECB), community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP) and tuberculosis and their procalcitonin levels compared with those of patients with noninfectious lung diseases (controls). In addition, standard inflammatory parameter data were collected. A prospective clinical study was performed with four different groups of patients and a control group that consisted of patients with noninfectious lung diseases. A total of 129 patients were included: 25 with HAP, 26 CAP, 26 AECB, 27 tuberculosis, and 25 controls. C-reactive protein level, blood cell counts and procalcitonin concentration were evaluated on the first day after onset of clinical and inflammatory symptoms prior to treatment. The median procalcitonin concentrations in HAP, CAP, AECB and tuberculosis were not elevated in relation to the cut-off level of 0.5 ng x mL(-1). In the HAP group, in four of five patients who subsequently died, procalcitonin concentrations of >0.5 ng x mL(-1) were found. In acute lower respiratory infections, such as HAP, CAP and AECB, significantly elevated levels were found in comparison to the control group, but below the usual cut-off level. No differences were observed between tuberculosis and the control group. Relative to the current cut-off level of 0.5 ng x mL(-1), procalcitonin concentration is not a useful parameter for diagnosis of lower respiratory tract infections. However, compared to the control group, there were significantly elevated levels in patients with hospital-acquired pneumonia, community-acquired pneumonia and acute exacerbation of chronic bronchitis below the current cut-off level, which should be further investigated.

Acute Disease↗
PubMed1990

An open multicentre study of the efficacy and tolerance of cefodizime 1 g bd intravenously or intramuscularly in lower respiratory tract infections.

The efficacy and tolerance of cefodizime in lower respiratory tract infections in hospitalized adults was evaluated in an open, non-comparative multicentre trial. Cefodizime (HR 221), was administered as a dose of 1 g by slow iv or im injection every 12 h (2 g daily) to 301 hospitalized patients aged 18-91 years. The mean duration of treatment was 10 +/- 3 days (median 9, range 1.23). All 301 patients were evaluable for tolerance, 270 were evaluable for clinical efficacy, and 204 were evaluable for bacteriological efficacy. A satisfactory clinical response was achieved in 87.8% (237/270) of patients and a satisfactory bacteriological response in 90.2% (184/204). Of the patients given the drug iv, 3.9% (6/153) had pain at the site of the injection compared with 7.4% (11/148) of those given the drug im. Tolerance was good; only five patients experienced an adverse reaction, and a relationship with cefodizime was considered probable in four of these cases. Haematological, hepatic and renal function tests revealed 27 abnormalities, all considered to have a doubtful relationship with treatment.

Adolescent↗
PubMed1991

[Clinical and experimental research on prevention and treatment of child reversal respiratory tract infection by feibao].

This article reports the child reversal respiratory tract infection treated with Feibao syrup which produced in accordance with the TCM theory of "the evil factor can't attack the body with vital-Qi" and "the evil factor will attack the body which vital-Qi is weak". Feibao syrup consisted of Radix Astragali, Herba Hedyotis diffusae, etc. The clinical research proved that after taking the medicine, the general condition, appetite and anemia were improved, the profuse sweating disappeared, the tolerance against cold was improved, the frequency of occurrence of the disease was decreased or ceased. Even if the disease occurred, the symptoms were mild, the disease course was short. The efficacy of the medicine was 95.2%. It was better than that of levamisole (78.6%), P less than 0.05. This medicine can obviously improve the level of serum IgA and the cellular immunity (P less than 0.01). The experiment on mice manifested that it could obviously enhance the macrophage phagocytic rate, lymphocyte transformation rate, EAC rosette forming rate, and hemolysin generating rate.

Animals↗
PubMed1981

Therapy of lower respiratory tract infections with moxalactam.

Moxalactam was evaluated in the therapy of lower respiratory tract infections in 40 patients. The most common organisms isolated were Streptococcus pneumoniae (37.2%) and Haemophilus influenzae (21.5%). Gram-negative enteric organisms were isolated from six patients. No patient was evaluated as a treatment failure; however, two patients died of unrelated causes either during therapy or in the immediate posttherapy period. We determined the comparative minimal inhibitory concentrations of moxalactam, cefamandole, and cephalothin for our aerobic clinical isolates. Susceptibilities of the anaerobic isolates were measured by the Kirby-Bauer method. All isolates were susceptible to moxalactam. Moxalactam was found to be highly effective in the therapy of lower respiratory tract infections.

Adult↗
PubMed2006

The use of macrolides in treatment of upper respiratory tract infections.

Antimicrobial resistance is a growing problem among upper respiratory tract pathogens. Resistance to beta-lactam drugs among Streptococcus pneumoniae, Haemophilus influenzae, and Streptococcus pyogenes is increasing. As safe and well-tolerated antibiotics, macrolides play a key role in the treatment of community-acquired upper respiratory tract infections (RTIs). Their broad spectrum of activity against gram-positive cocci, such as S. pneumoniae and S. pyogenes, atypical pathogens, H. influenzae (azithromycin and clarithromycin), and Moraxella catarrhalis, has led to the widespread use of macrolides for empiric treatment of upper RTIs and as alternatives for patients allergic to beta-lactams. Macrolide resistance is increasing among pneumococci and recently among S. pyogenes, and is associated with increasing use of the newer macrolides, such as azithromycin. Ribosomal target modification mediated by erm(A) and erm(B) genes and active efflux due to mef(A) and mef(E) are the principal mechanisms of resistance in both S. pneumoniae and S. pyogenes. Recently, ribosomal protein and RNA mutations have been found to be responsible for acquired resistance to macrolides in S. pneumoniae, S. pyogenes, and H. influenzae. Although macrolides are only weakly active against macrolide-resistant streptococci species, producing an efflux pump (mef), and are inactive against pathogens with ribosomal target modification (erm), treatment failures are uncommon. Therefore, macrolide therapy, for now, remains a good alternative for treatment of upper RTIs; however, continuous monitoring of the local resistance patterns is essential.

Anti-Bacterial Agents↗