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PubMed1985

[Clinical study of cefminox in respiratory tract infections].

A new cephem cefminox (CMNX, MT-141) was used in the treatment of 22 cases of respiratory tract infections without taking into account background factors of patients. The dosage was 2 to 4 g/day in 2 divided doses and the treatment was continued for a period 2 to 17 days. The breakdown of the diseases treated was; pneumonia in 7 cases, secondary lung abscess (rS3)+middle lobe syndrome in 1 case, chronic bronchitis in 3 cases, bronchiectasis in 10 cases and intrapulmonary lymphangitis carcinomatosa (suspected) in 1 case. The clinical results were rated as excellent in 7 cases, good in 11 cases, fair in 1 case and unknown in 3 cases, with an excellent rate of 36.8% and excellent+good rate of 94.7%. The causative organisms were identified in 10 cases and included H. influenzae for 8 cases, Klebsiella sp. for 1 case and S. aureus for 1 case. The analysis of bacteriological study revealed disappearance of all of these organisms. However, in 3 out of 8 cases where H. influenzae was isolated and in 1 case where Klebsiella sp. was isolated the changes of organisms to P. aeruginosa were observed. As the adverse reactions, rashes developed in 1 case and moreover laboratory test results revealed elevation in transaminase in 3 cases. All of these symptoms were mild in nature and none of our cases experienced serious adverse reactions attributable to CMNX. From these results, we believe that CMNX is one of the useful drugs for the treatment of respiratory tract infections.

Adult↗
PubMed1992

Azithromycin in lower respiratory tract infections.

Azithromycin is a new azalide antimicrobial agent which has a broad spectrum of activity against common lower respiratory tract pathogens including pneumococci, staphylococci, Legionella species, Mycoplasma and Chlamydia species. In particular, it is more active against Haemophilus influenzae than other macrolides. In comparison to other new macrolides, azithromycin achieves higher tissue and intracellular concentrations and these concentrations are sustained for several days after dosing due to a long elimination half-life. The efficacy of azithromycin against lower respiratory tract infections has been proven in several clinical studies. Once-daily dosing with azithromycin, over a 3- or 5- day period was as effective as a 10-day course of other commonly used antibiotics such as amoxycillin/clavulanic acid, erythromycin or cefaclor in lower respiratory tract infections. Azithromycin short-course therapy may offer an advantage in terms of patient compliance and the duration of treatment.

Animals↗
PubMed2006

Frequent detection of bocavirus DNA in German children with respiratory tract infections.

BACKGROUND: In a substantial proportion of respiratory tract diseases of suspected infectious origin, the etiology is unknown. Some of these cases may be caused by the recently described human bocavirus (hBoV). The aim of this study was to investigate the frequency and the potential clinical relevance of hBoV in pediatric patients. METHODS: We tested 835 nasopharyngeal aspirates (NPA) obtained between 2002 and 2005 from pediatric in-patients with acute respiratory tract diseases at the University of Würzburg, Germany, for the presence of hBoV DNA. The specificity of positive PCR reactions was confirmed by sequencing. RESULTS: HBoV DNA was found in 87 (10.3 %) of the NPAs. The median age of the infants and children with hBoV infection was 1.8 years (mean age 2.0 years; range 18 days - 8 years). Infections with hBoV were found year-round, though most occurred in the winter months. Coinfections were found in 34 (39.1 %) of the hBoV positive samples. RSV, influenza A, and adenoviruses were most frequently detected as coinfecting agents. Sequence determination of the PCR products in the NP-1 region revealed high identity (99 %) between the nucleotide sequences obtained in different years and in comparison to the Swedish viruses ST1 and ST2. An association of hBoV with a distinct respiratory tract manifestation was not apparent. CONCLUSION: HBoV is frequently found in NPAs of hospitalized infants and children with acute respiratory tract diseases. Proving the clinical relevance of hBoV is challenging, because application of some of Koch's revised postulates is not possible. Because of the high rate of coinfections with hBoV and other respiratory tract pathogens, an association between hBoV and respiratory tract diseases remains unproven.

Adenoviruses, Human↗
PubMed1997

Clarithromycin. A review of its efficacy in the treatment of respiratory tract infections in immunocompetent patients.

Clarithromycin is a broad spectrum macrolide antibacterial agent active in vitro and effective in vivo against the major pathogens responsible for respiratory tract infections in immunocompetent patients. It is highly active in vitro against pathogens causing atypical pneumonia (Chlamydia pneumoniae, Mycoplasma pneumoniae and Legionella spp.) and has similar activity to other macrolides against Staphylococcus aureus. Streptococcus pyogenes, Moraxella catarrhalis and Streptococcus pneumoniae. Haemophilus influenzae is susceptible or intermediately susceptible to clarithromycin alone, but activity is enhanced when the parent drug and metabolite are combined in vitro. Absorption of clarithromycin is unaffected by food. More than half of an oral dose is systemically available as the parent drug and the active 14-hydroxy metabolite. Pharmacokinetics are nonlinear, with plasma concentrations increasing in more than proportion to the dosage. First-pass metabolism results in the rapid appearance of the active metabolite 14-hydroxy-clarithromycin in plasma. Clarithromycin and its active metabolite are found in greater concentrations in the tissues and fluids of the respiratory tract than in plasma. Dosage adjustments are required for patients with severe renal failure, but not for elderly patients or those with hepatic impairment. Drug interactions related to the cytochrome P450 system may occur with clarithromycin use. In addition to the standard immediate-release formulation for administration twice daily, a modified-release formulation of clarithromycin is now available for use once daily. In dosages of 500 to 1000 mg/day for 5 to 14 days, clarithromycin was as effective in the treatment of community-acquired upper and lower respiratory tract infections in hospital and community settings as beta-lactam agents (with or without a beta-lactamase inhibitor), cephalosporins and most other macrolides. Clarithromycin was similar in efficacy to azithromycin in comparative studies and is as effective as and better tolerated than erythromycin. Adverse events are primarily gastrointestinal in nature, but result in fewer withdrawals from therapy than are seen with erythromycin. Clarithromycin provides similar clinical and bacteriological efficacy to that seen with beta-lactam agents, cephalosporins and other macrolides. It offers a cost-saving alternative to intravenous erythromycin use in US hospitals and is available in both once-daily and twice-daily formulations. The spectrum of activity of clarithromycin against common and emerging respiratory tract pathogens may make it suitable for use in the community as empirical therapy of respiratory tract infections in both children and adults.

Adult↗
PubMed1984

[Current virus diseases in horses. Diseases in foals and respiratory tract infections].

At the moment, horse praxis is confronted by two disease complexes which are difficult to fight against as well in prophylaxis as in therapy, but which get an increasing importance. First they concern virus infections of the foals and second primary virus-caused respiratory diseases. Foals get infected during the embryonal/fetal development, in the perinatal or postnatal period. Normally the infection is caused by latent infected, clinical healthy mares, or in the postnatal period by ubiquitous, normally opportunistic socalled problem-viruses, i.e. equine herpes-viruses 1 and 2, rota-, corona- and adenoviruses. Primary responsible for the virus infections of the respiratory tract are the rhinopneumonitis- and influenza-A-virus, the reo- and rhinoviruses and the arteritis-virus.

Adenoviridae Infections↗
PubMed1995

Oral versus intravenous antibiotics for community acquired lower respiratory tract infection in a general hospital: open, randomised controlled trial.

OBJECTIVE: To see whether there is a difference in outcome between patients treated with oral and intravenous antibiotics for lower respiratory tract infection. DESIGN: Open controlled trial in patients admitted consecutively and randomised to treatment with either oral co-amoxiclav, intravenous followed by oral co-amoxiclav, or intravenous followed by oral cephalosporins. SETTING: Large general hospital in Dublin. PATIENTS: 541 patients admitted for lower respiratory tract infection during one year. Patients represented 87% of admissions with the diagnosis and excluded those who were immunocompromised and patients with severe life threatening infection. MAIN OUTCOME MEASURES: Cure, partial cure, extended antibiotic treatment, change of antibiotic, death, and cost and duration of hospital stay. RESULTS: There were no significant differences between the groups in clinical outcome or mortality (6%). However, patients randomised to oral co-amoxiclav had a significantly shorter hospital stay than the two groups given intravenous antibiotic (median 6 v 7 and 9 days respectively). In addition, oral antibiotics were cheaper, easier to administer, and if used routinely in the 800 or so patients admitted annually would lead to savings of around 176,000 pounds a year. CONCLUSIONS: Oral antibiotics in community acquired lower respiratory tract infection are at least as efficacious as intraveous therapy. Their use reduces labour and equipment costs and may lead to earlier discharge from hospital.

Administration, Oral↗
PubMed1998

Role of the microbiology laboratory in the diagnosis of lower respiratory tract infections.

The appropriate use of the clinical microbiology laboratory for diagnosing lower respiratory tract infections is controversial. As in clinical care, it is crucial to categorize the presenting illness properly as acute bronchitis, an acute exacerbation of chronic bronchitis, community-acquired pneumonia, or nosocomial pneumonia if diagnostic efforts to establish a microbial etiology are to be productive for the individual patient and affordable to society. The greatest potential benefit of microbiological investigations lies in the etiologic diagnosis of pneumonia. For community-acquired pneumonia, evaluation of a gram-stained smear of sputum in terms of both quality and microorganisms present can help guide initial therapy as well as aid interpretation of subsequent culture results. As discussed in this review, the role of the clinical microbiology laboratory in the etiologic diagnosis of nosocomial and complicated pneumonias is more extensive and, in addition to evaluation of respiratory secretions, may include cultures of blood, pleural fluid, and specimens obtained by bronchoscopy. However, a prerequisite for the use of all currently available tests is their deployment for patients with clinical and radiographic evidence of pneumonia.

Acute Disease↗
PubMed1992

Changes in lymphocyte subpopulations in patients treated with cefodizime for acute lower respiratory tract infections.

The influence of cefodizime (CDZ) on CD4 and CD8 lymphocytes was investigated in patients with lower respiratory tract infection and underlying respiratory diseases. Ten men and one woman were treated with CDZ 1 g i.m. b.i.d. for ten days. The infecting organisms were Haemophilus influenzae (5), Streptococcus pneumoniae (2) and Escherichia coli (1). No adverse events were reported. Nine patients were clinically cured; two required further antibiotic therapy. Leucocyte counts decreased significantly during treatment. Lymphocyte counts and CD4 cells both increased significantly in absolute and relative numbers, while there was a much smaller increase in CD8 cells. This resulted in a significant increase in the CD4/CD8 ratio. These effects of CDZ might be of benefit for immunocompromised patients with bacterial infections.

Acute Disease↗
PubMed1992

Lower respiratory tract infections after abdominal operations: epidemiology and risk factors.

OBJECTIVE: To find out the incidence and aetiology of lower respiratory tract infections after abdominal operations and identify predisposing factors. DESIGN: Prospective open study. SETTING: Department of General Surgery, Hospital Germans Trias i Pujol, Barcelona, Spain. SUBJECTS: 2,083 patients having abdominal operations between March 1985 and June 1987 excluding splenectomies, and those requiring thoracoabdominal incisions. MAIN OUTCOME MEASURES: The presence of three or more of the following: temperature of 38 degrees C or more, cough with mucopurulent sputum, raised white cell count, or changes on the chest radiograph or bronchogram. RESULTS: 50 patients (2.4%) developed lower respiratory tract infections. Micro-organisms were isolated from 15 (30%), the most common being Haemophilus influenzae. The most important risk factors were American Society of Anesthesiologist's grade, duration of anaesthesia, age, and operations on the upper gastrointestinal tract. CONCLUSION: Further work is needed to investigate other possible predisposing factors and develop a predictive score.

Abdomen↗
PubMed1993

[A clinical study of chronic lower respiratory tract infections with Pseudomonas aeruginosa by transtracheal aspiration].

We investigated the yearly changes of the incidence of Pseudomonas aeruginosa (P. aeruginosa) isolated from chronic lower respiratory tract infections (CLRTI), and also performed a clinical study on CLRTI with P. aeruginosa by transtracheal aspiration (TTA) to clarify the recent trend of P. aeruginosa infection in CLRTI and the predisposing clinical factors to the acute exacerbation. The isolation rate of P. aeruginosa among the total isolated bacteria in CLRTI between December 1978 and March 1983 was 8.4%, but it increased to 23.1% between April 1988 and March 1993. In 69 episodes (40 cases) of P. aeruginosa isolated from CLRTI between April 1983 and March 1993, monomicrobial infections of P. aeruginosa were 42 episodes (60.9%) and polymicrobial infections were 27 episodes (39.1%). When the diseases were classified into acute exacerbated and non-exacerbated phases, polymicrobial infections were seen more in the former phase, and the principal organisms detected with P. aeruginosa were Haemophilus influenzae and Streptococcus pneumoniae. In the acute exacerbated cases, predisposing conditions concerning the exacerbation were divided into four patterns: 1. polymicrobial infections with H. influenzae or S. pneumoniae, 2. after acute upper respiratory tract infections due to viral superinfection, 3. early phase from bacterial replacement by P. aeruginosa, 4. immunocompromised states such as adrenal corticosteroid administration or systemic underlying diseases. These results suggest that the importance of P. aeruginosa in CLRTI is increasing year by year and we must pay attention to the fact that P. aeruginosa alone may also cause acute exacerbation in the latter 2 patterns of the condition.

Adult↗
PubMed1995

Use of serum bactericidal activity in assessing previous antibiotic therapy in acute lower respiratory tract infection in children.

Bactericidal activity in sera of children with acute lower respiratory tract infection was assayed to determine its effect on the outcome of blood culture. Parental reporting of prior antibiotic therapy was also determined. 14.4% of samples without serum bactericidal activity yielded pathogens from blood culture, whereas only 2.4% of samples with serum bactericidal activity yielded pathogens. A statistically significant correlation was found between isolation of pathogens by blood culture and serum bactericidal activity. Parental reporting could not be relied upon as there was no positive correlation.

Acute Disease↗
PubMed1981

[Prophylaxis and treatment of respiratory tract infection in ventilated patients by endotracheal administration of aminoglycosides (author's transl)].

The effects of intratracheal administration of gentamicin on frequency of bacterial contamination of the trachea and respiratory tract infection were assessed in a controlled and prospective study in 20 patients on a respirator. Gentamicin was instilled undiluted 6-hourly in a dosage of 40 mg into the trachea. Compared with a control group (n = 20), patients with intratracheal gentamicin instillation showed earlier reduction of tracheal bacterial contamination and during further ventilation a diminished rate of colonisation of the trachea. There was no evidence of an increase of Candida albicans. Pneumonic infiltrations regressed earlier in patients with intratracheal gentamicin. Respiratory tract infections were less frequent during continued artificial ventilation than in the control group. In ventilated patients intratracheal aminoglycosides can thus be recommended for prophylaxis of respiratory tract infections.

Female↗
PubMed2002

Evaluation of ventilator-associated lower respiratory tract infection and tracheobronchial aspiration of gastrointestinal contents.

STUDY OBJECTIVE: Ventilator-associated lower respiratory tract infection (LRTI) in a set up of respiratory intensive care unit was evaluated. Also the incidence of tracheobronchial aspiration of gastrointestinal contents was explored among these patients. DESIGN: Twenty eight patients admitted in the respiratory intensive care unit of referral teaching hospital were studied. All patients were evaluated for tracheobronchial aspiration of gastrointestinal contents in the initial 48 hours of initiating mechanical ventilation using methylene blue as marker and glucostix reagent strip. Protected endotracheal aspirate was secured after 48 hours of beginning of mechanical ventilation and was submitted for microbiological assay. RESULTS: Of the 28 mechanically ventilated patients, 82% were found to have developed LRTI. Aerobic gram-negative bacilli accounted for 79% of the infections, Klesiella responsible for 39% while Pseudomonas and Escherichia accounted for 18% each. The remaining 4% were caused by Acinetobacter. Gram-positive cocci were responsible for 21% of infection with Staphylococcus and enterococci 14% and 7% respectively. Tracheobronchial aspiration of GI contents was found to be present in 72% of the patients which was significantly correlated with the incidence of LRTI (p=0.014). Significant association was also found between the incidence of LRTI and mortality (p=0.05). CONCLUSION: The incidence of gastrointestinal aspiration was found to be high and correlation with LRTI was significant. Both glucostix reagent strip and methylene blue were observed to have same positivity rate.

Adolescent↗
PubMedDate not supplied

[In vitro activity of cefetamet compared with other antimicrobial agents against bacteria isolated from respiratory tract infections].

UNLABELLED: Cefetamet pivoxil is a new beta lactamase orally stable administered cephalosporin. Antimicrobial resistance among respiratory pathogens has become an important problem for both the physician and the microbiologist and the patterns of resistance vary greatly depending on geographic location, often requiring in vitro susceptibility testing of isolates. PURPOSE: The in vitro activity of cefetamet, the microbiologically active metabolite of the prodrug cefetamet pivoxil, was compared with other 11 drugs against 376 bacterial strains recently isolated from patients with respiratory tract infections. METHODS: The comparative activity in vitro of cefetamet and other 11 antimicrobial agents was measured against 376 bacterial strains isolated from patients with respiratory tract infections, during a six month period. Through the determination of minimum inhibitory concentration by the microdilution technique, patterns of antimicrobial resistance were reported. RESULTS: Cefetamet showed high in vitro activity against all the bacterial tested, possessing a spectrum of activity similar to that other recently developed oral cephalosporins. The good activity of cefetamet against beta-lactamase producing isolates, like Moraxella catarrhalis, can be due to its beta-lactamase stability. At a concentration of 1.0 microgram/mL, cefetamet inhibited 97% of all the tested bacteria. CONCLUSION: The MIC90 of the cumulative susceptibility results of the 12 antimicrobics tested in the 376 strains studied, confirm the excellent activity of cefetamet against the common respiratory tract pathogens.

Anti-Bacterial Agents↗
PubMed1994

Epidemiology and pharmacoeconomic issues relating to acute respiratory tract infections and acute uncomplicated infections of the urinary tract.

Respiratory and urinary tract bacterial infections are among the most frequently encountered conditions in clinical medicine. Driven by the increasing incidence of antimicrobial resistance and treatment failures in these conditions, newer, and unfortunately more costly, alternatives are constantly being sought. As expenditures on healthcare are currently under greater levels of scrutiny than ever before, the economic aspects of drug therapy have become an important area of inquiry. Cost-effective drug therapy depends on several factors, of which initial drug cost is only one. Clearly, drug efficacy, duration of therapy and dose regimen, diagnostic strategies, route of drug administration, microbial drug resistance and patient compliance all directly impact on cost-effectiveness evaluations. However, to avoid merely shifting costs, true evaluation of cost-benefit must take indirect economic factors such as loss of patient (and parental) income, loss of productivity, opportunity costs, and patient discomfort/suffering into account. In this article, these issues are discussed and illustrated using common respiratory and urinary tract bacterial infections as a model.

Anti-Bacterial Agents↗