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PubMed1989

[Clinical studies and sputum levels of ceftriaxone once daily administration in respiratory tract infection].

Ceftriaxone (CTRX), a new cephalosporin, was investigated by once daily administration for its clinical efficacy and safety on respiratory tract infections. The results obtained are summarized as follows: 1. Clinical responses to CTRX of a total of 39 cases with respiratory tract infections were excellent in 12 cases, good in 23, fair in 3, poor in 1 with an efficacy rate of 89.7%. Against acute bronchitis, lung abscess, bronchiectasis, chronic bronchitis and obstructive pneumonia, efficacy rates were 100%. 2. Serum levels and urinary excretion rates of CTRX were investigated in 2 cases after intravenous drip infusion of the drug at doses of 1 g and 2 g, respectively. Although urinary excretion rate tended to decrease with the deterioration of renal functions, prolongation of serum half-life was slight in those patients with normal liver function. In 1 case, it remained at 1.9 micrograms/ml at 12 hours and in another at 0.9 microgram/ml at 22 hours in sputum. According to the results, it appears that once daily administration of CTRX is effective and well tolerated in patients with acute respiratory infections.

Adult↗
PubMed1997

Empiric treatment of hospital-acquired lower respiratory tract infections with meropenem or ceftazidime with tobramycin: a randomized study. Meropenem Lower Respiratory Infection Group.

OBJECTIVE: To evaluate the efficacy and tolerability of intravenous empiric treatment with meropenem compared with ceftazidime-tobramycin in patients with hospital-acquired lower respiratory tract infections. DESIGN: Prospective, nonblind, randomized trial. SETTING: Multicenter trial conducted at 22 centers. PATIENTS: Two hundred eleven patients were enrolled and 121 were evaluable for the analysis of both clinical and bacteriologic efficacy. INTERVENTIONS: One hundred four patients were randomized to receive intravenous meropenem (1000 mg) every 8 hrs and 107 patients were randomized to receive intravenous ceftazidime (2000 mg) plus tobramycin (1 mg/kg) every 8 hrs. Sixty-three meropenem-treated patients and 58 ceftazidime-tobramycin-treated patients were eligible for the analysis of clinical and bacteriologic efficacy. In the ceftazidime-tobramycin group, 32 (55%) evaluable patients received more than six doses of tobramycin, 24 (41%) received six doses or fewer, and two (3%) did not receive any tobramycin. MEASUREMENTS AND MAIN RESULTS: The analysis of efficacy was based on the clinical and bacteriologic responses at the end of treatment. Satisfactory clinical responses occurred in 56 (89%) of 63 of the meropenem-treated patients and in 42 (72%) of 58 of the ceftazidime-tobramycin-treated patients (p = .04). Corresponding bacteriologic response rates were 89% and 67%, respectively (p = .006). The frequency and profile of drug-related adverse events was similar across treatment groups. Seizures were reported in three meropenem-treated patients, but these seizures were considered by the investigator to be unrelated to treatment. CONCLUSIONS: Meropenem is well tolerated and more efficacious than the combination of ceftazidime and tobramycin for the initial empiric treatment of hospital-acquired bacterial pneumonia.

Adolescent↗
PubMed1999

Causative bacteria of respiratory tract infections in Kuwait by quantitative culture of sputum.

To determine the bacterial etiology of lower respiratory tract infections in Kuwait, we performed quantitative culture of sputum and measured the susceptibilities of the isolated bacteria against different antibiotics. A total of 140 sputum samples were collected for a period of 14 months for the study. Single and multiple pathogens as a cause of infection were isolated from 55 and 15 samples, respectively. A total of 53.8% of Streptococcus pneumoniae were penicillin-resistant and 52% and 57% of Hemophilus influenzae and Moraxella catarrhalis were beta-lactamase positive, respectively. We concluded that the major pathogens of respiratory tract infections in Kuwait were H. influenzae, M. catarrhalis, S. pneumoniae, and Pseudomonas aeruginosa, and there was an increased resistance among the isolated bacteria against commonly used antibiotics.

Journal Article↗
PubMed1992

Review of effectiveness of cefodizime in the treatment of lower respiratory tract infections with parenchymal involvement.

The efficacy of cefodizime (CDZ) in lower respiratory tract infections (LRTI) with parenchymal involvement was assessed by the analysis of data from 919 patients who participated in four controlled, randomized studies and three open studies. Sputum bacteriology and a chest x-ray were performed at baseline and after therapy. A total of 778 patients were evaluable for clinical efficacy and 451 for bacteriological efficacy. The most frequent pathogen was Streptococcus pneumoniae, followed by Staphylococcus aureus, Klebsiella pneumoniae and Haemophilus influenzae. CDZ 1 g b.i.d., 2 g b.i.d. and 2 g once daily achieved clinical and bacteriological cure rates above 90%, which matched those observed with the comparators (cefuroxime 1.5 g t.i.d. and cefotaxime 2 g b.i.d.). No significant differences in clinical and bacteriological outcome were detected when the various CDZ dosage regimens were compared. 1 g CDZ b.i.d. is therefore recommended as the regimen of choice for the treatment of LRTI with parenchymal involvement, with CDZ 2 g once daily as an alternative.

Age Factors↗
PubMed1977

Evaluation fo recurrent respiratory tract infections.

We have outlined the appropriate study of patients with recurrent respiratory tract infections. A detailed history and a complete physical examination, together with a chest roentgenogram, will, in most instances, give clues to a possible diagnosis. Among the laboratory studies listed in Table 2, the easily available and relatively informative tests consist of routine hemoglobin, white blood cell and differential count, sputum and throat culture for bacteria isolation, screening pulmonary function tests. Most of the other laboratory tests (including sweat tests) and diagnostic procedures require experienced and trained personnel and special facilities and equipment that are available in pediatric pulmonary centers. Any patient suspected of having a complicated or serious pulmonary disease or a congenital anomaly that is correctable by surgery should be referred to a pediatric pulmonary center for a complete diagnostic evaluation. It is important that this be done as soon as possible so that early institution of appropriate therapy may lead to a cure of the pulmonary disorder.

Biopsy↗
PubMed1994

Exercise, upper respiratory tract infection, and the immune system.

The relationship between exercise and upper respiratory tract infections (URTI) may be modeled in the form of a "J" curve. Various epidemiological studies suggest that unusually heavy acute or chronic exercise is associated with an increased risk of URTI. The risk appears to be especially high during the one or 2-wk period following marathon-type race events. Among runners varying widely in training habits, the risk for URTI is slightly elevated for the highest distance runners, but only when several confounding factors are controlled for. Two randomized experimental trials using small numbers of subjects have provided important preliminary data in support of the viewpoint that moderate physical activity may reduce URTI symptomatology. Clinical data support the concept that heavy exertion increases the athlete's risk of URTI because of negative changes in immune function and elevation of the stress hormones, epinephrine, and cortisol. On the other hand, there is growing evidence that moderate amounts of exercise may decrease one's risk of URTI through favorable changes in immune function without the negative attending effects of the stress hormones.

Exercise↗
PubMed2000

Antimicrobial agents in lower respiratory tract infections in Dutch general practice.

This study describes the prescription of antimicrobial agents in cases of lower respiratory tract infections in Dutch general practice. A secondary analysis of data from the National Study of Illness and Procedures of The Netherlands Institute of Primary Health Care (a nationwide group of 161 general practitioners with data from 334,449 patients) had been carried out. Antimicrobial agents were prescribed in 30% of all contacts: in about half of the first contacts and contacts for recurrences, and in one out of six repeat contacts. The prescription rates were associated with diagnosis and reason for encounter but rarely with older age or comorbidity. Amoxycillin and doxycycline were most frequently prescribed. While most lower respiratory tract infections are virus-induced and antibiotics are not effective in most cases, antimicrobial agents might still be overprescribed.

Anti-Bacterial Agents↗
PubMed1982

Role of exotoxin A and proteases of Pseudomonas aeruginosa in respiratory tract infections.

Hamster tracheal organ culture has been used to study the role of exotoxin A and proteases of Pseudomonas aeruginosa in infections of the respiratory tract. Tracheal explants infected with a toxin producing, protease producing strain or a toxin deficient, protease producing strain displayed evidence of exfoliation and disorganization of the tracheal of the tracheal epithelium 12 h after initiation of infection. A toxin producing protease deficient strain caused some desquamation of cells and cellular swelling, but exfoliation was not evident. Each of the toxin producing and (or) protease producing strains inhibited protein synthesis of the explants. Purified exotoxin inhibited protein synthesis and caused some pathological changes similar to those observed with the toxin producing strain. Purified elastase from P. aeruginosa only inhibited protein synthesis at 10 microgram/mL but caused exfoliation at 0.01 microgram/mL. Alkaline protease had no detectable effect on the explants. The effects of active infection could be prevented by treatment with gentamycin. All the strains tested caused an inhibition of ciliary activity, but no correlation could be made with any of the extracellular products. Exotoxin A and elastase may be responsible for much of the destruction of respiratory tract tissue in Pseudomonas infections although other bacterial factors and host factors are of importance.

ADP Ribose Transferases↗
PubMed1995

Bacterial antibody assays in the diagnosis of acute lower respiratory tract infection in children.

Bacterial antibodies were studied in acute, intermediate and convalescent phase sera (mean duration from first to last sample 36 days) of 121 children hospitalized for acute lower respiratory tract infection. Antibody responses were observed in 45% of all cases and in 29% of the 21 children < 1 year old. A total of 15 responses to Streptococcus pneumoniae (pneumolysin), 20 to Haemophilus influenzae, 9 to Moraxella catarrhalis, 3 to chlamydiae and 8 to Mycoplasma pneumoniae were found. In 79 patients with 4 consecutive samples available, 52% of the 31 responses were measurable within 5 days from admission. Overall the responses were not associated with upper respiratory tract bacterial findings or acute otitis media. Significantly more responses were found in the 121 children with acute lower respiratory tract infection than in healthy controls (P < 0.007). We conclude that bacterial antibody assays provide a useful tool in the study of the etiology of acute lower respiratory tract infection in young children, even if the interval between paired serum samples is short.

Acute Disease↗
PubMed2005

The effect of exercise on salivary IgA levels and the incidence of upper respiratory tract infections in postmenopausal women.

OBJECTIVES: To examine the patterns of upper respiratory tract infections (URTI) in postmenopausal Turkish women and the relationship of moderate aerobic exercise with secretion of salivary IgA and episodes of URTI. MATERIALS AND METHODS: Ninety healthy, sedentary women at ages 45 to 65 years volunteered to participate in a 12-week prospective study. They were randomized to three groups equal in number: indoor exercise, outdoor exercise, and no exercise. The exercising women were supervised during 30 min indoor treadmill walk or outdoor track walking sessions during 5 days/week at 60% of their calculated maximal heart rate. During a 12-week exercise program, episodes suggestive of URTI were recorded. Non-exercising women were followed with weekly telephone calls. The salivary IgA levels were measured in all the subjects before and at the end of the study. RESULTS: There were significant differences between the exercising and non-exercising women with respect to the number of URTI episodes and the length of URTI symptomatology per episode in favor of exercise. No significant difference was found between the indoor and outdoor exercising groups. The salivary IgA levels showed no significant differences between the three groups and within each group. CONCLUSION: Moderate intensity aerobic exercise is associated with fewer episodes of URTI and fewer days of URTI symptomatology per episode in healthy postmenopausal Turkish women, but this does not seem to be related to salivary IgA concentrations.

Aged↗
PubMed2005

[Reported practices of antimicrobial use for upper respiratory tract infections].

AIM: To determine the reported antibiotic prescribing practices for upper respiratory tract infections in children among pediatricians and family physicians. METHODS: Regional survey of practicing pediatricians and family physicians and comparison of the survey responses of 81 physicians with the recently published recommendations of the Centers for Disease Control and Prevention. RESULTS: Whereas almost all the physicians agreed that a diagnosis of acute otitis media required documentation of middle ear effusion and acute illness, 28% of family physicians and 12% of pediatricians reported that they routinely prescribed antibiotics for children with bronchitis, even though this is not recommended. In this survey 39% of pediatricians and 47% of family physicians reported that they omitted laboratory testing for the diagnosis of group A streptococcal pharyngitis, and of those who submitted samples for testing, most reported that they prescribed antibiotics immediately without waiting for the results. Even though these recommendations state that sinus tenderness is rare in young children with sinusitis, more than 48% of the physicians believed that both this and the presence of purulent rhinitis were essential to confirm this diagnosis. While none of the pediatricians reported prescribing antibiotics for the common cold, 17% of the family physicians did so (p = 0.006). CONCLUSIONS: The reported prescribing practices of the physicians in this survey are not in line with the recommendations. Effective intervention is needed to encourage the judicious use of antibiotics in Israel.

Anti-Bacterial Agents↗
PubMed1996

The effect of inhaled and intranasal sodium cromoglycate on symptoms of upper respiratory tract infections.

BACKGROUND: A well established drug for the treatment of asthma and allergy, sodium cromoglycate, was found in open trials to be useful as a symptomatic treatment for upper respiratory tract infections. OBJECTIVE: To compare the efficacy of inhaled and intranasal sodium cromoglycate and matching placebos on the symptoms of upper respiratory tract infections. METHODS: Adult subjects with symptoms of runny nose, throat pain, or cough for less than 24 h were recruited. They were treated for 7 days using a randomized, double-blind, placebo-controlled, group comparative design. The medication given was: sodium cromoglycate dry powder 20 mg per inhalation in spincaps; sodium cromoglycate aqueous nasal spray delivering 5.2 mg per dose; or matching placebo as dry powder and nasal spray. One spincap and one spray per nostril were taken every 2 h during waking hours on days 1 and 2 and then four times daily on days 3-7. Severity of nine symptoms (general malaise, body aches and pains, chills and shivering, sneezing, nasal running, nasal blocking, sore throat, cough and voice disturbance) was recorded twice daily by subjects on diary cards, using a scale of 0 (absent) to 3 (severe). RESULTS: The study was conducted between February and April 1993. One hundred and eighteen patients aged 21-63 years (mean 41 years) were included. Symptoms resolved faster (P < 0.001) and the severity in the last three days of treatment was significantly less in patients treated with sodium cromoglycate than with placebo (P < 0.05-day 5; P < 0.01-day 6; P < 0.001-day 7). Side effects were local and mild and did not differ between the treatment groups. CONCLUSION: Sodium cromoglycate administered both by inhalation and intranasally is an effective treatment for the symptoms of upper respiratory tract infection. Its combined safety and efficacy would make it an acceptable form of treatment for these conditions.

Administration, Inhalation↗
PubMed2005

A multifaceted intervention to improve antimicrobial prescribing for upper respiratory tract infections in a small rural community.

BACKGROUND: Antibiotic prescribing for upper respiratory tract infections (URTIs) is widespread, is often inappropriate, and may contribute to antibiotic resistance among community-acquired pathogens, such as Streptococcus pneumoniae. METHODS: A multifaceted intervention involving health care professionals and patients was introduced to a small rural Utah community and included the repetitive use of printed diagnostic and treatment algorithms by professionals. Data on the quantity and class of antibiotic prescribing, which were collected from multiple sources, were measured for the intervention period (from January through June) in 2001 and compared with data for the baseline period during the same months in 2000. RESULTS: Medicaid claims data revealed that the percentage of patients in the community who received antibiotics for URTIs during the intervention period was 15.6% less than that for the baseline period, whereas the percentage in the rest of rural Utah was relatively stable, with a 1.5% decrease (P=.006). The greatest impact of the intervention was on prescribing for acute bronchitis (decreases of 56.1% and 1.7% in the community and rural Utah, respectively; P=.024) and on prescribing of macrolides (decreases of 13.4% and 0.2% in the community and rural Utah, respectively; P<.001). Community pharmacy data likewise revealed a 17.5% decrease in the rate of antibiotic prescribing during the intervention period (P<.001), with the largest decrease observed for macrolide prescribing (50.9%; P<.001). Chart review data, in contrast, revealed no significant decrease in the percentage of patients with URTI who were prescribed an antibiotic (3.8%; P=.49), although there was a significant decrease of 11.2% in macrolide use (P=.045). CONCLUSIONS: A multifaceted intervention involving the repetitive use of printed algorithms resulted in modest improvements in antibiotic prescribing for outpatient URTIs, although one data source did not corroborate this. However, macrolide prescribing decreased sharply, irrespective of the source of data.

Adolescent↗
PubMed2005

Knowledge, attitudes, and reported practices among obstetrician-gynecologists in the USA regarding antibiotic prescribing for upper respiratory tract infections.

BACKGROUND: Knowledge, attitudes, and practices regarding antibiotic prescribing for upper respiratory tract infections (URIs) have not been well described among obstetrician-gynecologists (OB/GYNs). This information is useful for determining whether an OB/GYN-specific program promoting appropriate antibiotic use would significantly contribute to the efforts to decrease inappropriate antibiotic use among primary care providers. METHODS: An anonymous questionnaire asking about the treatment of URIs was sent to 1031 obstetrician-gynecologists. RESULTS: The overall response rate was 46%. The majority of respondents (92%) were aware of the relationship between antibiotic use and antibiotic resistance, and respondents estimated that 5% of their patients had URI symptoms at their office visits. Overall, 56% of respondents reported that they would prescribe an antibiotic for uncomplicated bronchitis and 43% for the common cold. OB/GYNs with the fewest years of experience were less likely than those with the most years of experience to report prescribing for uncomplicated bronchitis (Odds ratio (OR) 0.46, 95% confidence interval (CI) 0.23 to 0.91) or the common cold (OR 0.44, CI 0.22 to 0.89). The majority of respondents (60%) believed that most patients wanted an antibiotic for URI symptoms, with male OB/GYNs being more likely than female OB/GYNs (OR 2.1, CI 1.2 to 3.8) to hold this belief. Both male OB/GYNs (OR 1.9, CI 1.1 to 3.4) and rural practitioners (OR 2.1, CI 1.1 to 4.0) were more likely to believe that it was hard to withhold antibiotics for URI symptoms because other physicians prescribe antibiotics for these symptoms. OB/GYNs who believed that postgraduate training prepared them well for primary care management were more likely than those who did not (OR 2.1, CI 1.1 to 4.2) to believe that they could reduce antibiotic prescribing without reducing patient satisfaction. CONCLUSION: Multiple demographic factors affect attitudes and reported practices regarding antibiotic prescribing. However, in view of the low proportion of office visits for URIs, an OB/GYN-specific program is not warranted.

Adult↗
PubMed1980

Upper and lower respiratory tract infections. Nursing intervention.

Proper nursing intervention can assist in the reduction of nosocomial respiratory tract infections. Maintaining the integrity of the patient's respiratory defense mechanisms and/or augmenting those that are impaired helps to control endogenous factors that can contribute to infection. Nursing implications in controlling endogenous factors include mobilization of secretions, prevention of aspiration, and reduction of oral resident microorganisms. Strict aseptic technique in caring for artificial airways and respiratory assistance equipment is essential. Advocacy of a patient's right to protection from harm should be exercised if breaks in proper technique by others are observed. The care that nurses provide is relevant to infection control.

Cross Infection↗
PubMed2004

Augmentin (amoxicillin/clavulanate) in the treatment of community-acquired respiratory tract infection: a review of the continuing development of an innovative antimicrobial agent.

Amoxicillin/clavulanate (Augmentin) is a broad-spectrum antibacterial that has been available for clinical use in a wide range of indications for over 20 years and is now used primarily in the treatment of community-acquired respiratory tract infections. Amoxicillin/clavulanate was developed to provide a potent broad spectrum of antibacterial activity, coverage of beta-lactamase-producing pathogens and a favourable pharmacokinetic/pharmacodynamic (PK/PD) profile. These factors have contributed to the high bacteriological and clinical efficacy of amoxicillin/clavulanate in respiratory tract infection over more than 20 years. This is against a background of increasing prevalence of antimicrobial resistance, notably the continued spread of beta-lactamase-mediated resistance in Haemophilus influenzae and Moraxella catarrhalis, and penicillin, macrolide and quinolone resistance in Streptococcus pneumoniae. The low propensity of amoxicillin/clavulanate to select resistance mutations as well as a favourable PK/PD profile predictive of high bacteriological efficacy may account for the longevity of this combination in clinical use. However, in certain defined geographical areas, the emergence of S. pneumoniae strains with elevated penicillin MICs has been observed. In order to meet the need to treat drug-resistant S. pneumoniae, two new high-dose amoxicillin/clavulanate formulations have been developed. A pharmacokinetically enhanced tablet dosage form of amoxicillin/clavulanate 2000/125 mg twice daily (available as Augmentin XR in the USA), has been developed for use in adult respiratory tract infection due to drug-resistant pathogens, such as S. pneumoniae with reduced susceptibility to penicillin, as well as beta-lactamase-producing H. influenzae and M. catarrhalis. Amoxicillin/clavulanate 90/6.4 mg/kg/day in two divided doses (Augmentin ES-600) is for paediatric use in persistent or recurrent acute otitis media where there are risk factors for the involvement of beta-lactamase-producing strains or S. pneumoniae with reduced penicillin susceptibility. In addition to high efficacy, amoxicillin/clavulanate has a well known safety and tolerance profile of the two new high-dose formulations are not significantly different from those of conventional formulations. Amoxicillin/clavulanate is included in guidelines and recommendations for the treatment of bacterial sinusitis, acute otitis media, community-acquired pneumonia and acute exacerbations of chronic bronchitis. Amoxicillin/clavulanate continues to be an important agent in the treatment of community-acquired respiratory tract infections, both now and in the future.

Amoxicillin-Potassium Clavulanate Combination↗
PubMed1991

Clinical observations on lower respiratory tract infections with special reference to serum IgE levels.

To examine if the occurrence of wheezing among children with lower respiratory tract infections is associated with atopic predisposition, serum levels of IgE were determined for groups of children with or without wheezing, during infection with Mycoplasma pneumoniae or respiratory syncytial virus (RSV). In M. pneumoniae infection, more than 60% of wheezy children over 2 years of age showed a high IgE level (200 IU/mL or more), while IgE levels were less than 200 IU/mL in 73% of non-wheezy children. In RSV infection, the incidence of high IgE levels among wheezy children was nearly double that of non-wheezy children, although the difference was not significant. These results suggest that in children an allergic disposition is involved in the occurrence of wheezing during the course of lower respiratory tract infections.

Age Factors↗
PubMed2005

Inflammatory and bronchospastic factors in asthma exacerbations caused by upper respiratory tract infections.

It is still uncertain how viral respiratory infections cause acute exacerbations of bronchial asthma, although several mechanisms have been proposed. We studied the relationship between the airway narrowing and the inflammatory and bronchospastic factors in peripheral venous blood and urine, in 30 patients with asthma at the exacerbations caused by upper respiratory tract infections (URTIs). Acute exacerbations caused decreases in peak expiratory flow rate (PEFR) in all 30 patients with asthma. Asthma exacerbations caused the rises in serum levels of interleukin-6, soluble intercellular adhesion molecule-1 and eosinophil cationic protein, concentrations of urinary leukotriene E4 and plasma histamine, compared with those in patients with asthma at a stable condition and those in 30 control subjects (p < 0.05). The values of PEFR at the exacerbations correlated with the levels of these factors. Treatment with oral glucocorticoids reversed the decreases in PEFR and the increases in these factors. At the onset of URTIs, rhinovirus and influenza type A virus were identified in 13 and 7 patients, respectively. Each of parainfluenza virus, adenovirus, and enterovirus was identified in one patient. These findings suggest that respiratory viral infections may cause acute asthma exacerbations via the production of mediators that induce inflammation and bronchospasm.

Acute Disease↗