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At least 865 records · Page 48Linked to original sources
PubMed1983

Cephalexin in lower respiratory tract infections.

Cephalexin has had 12 years of extensive clinical usage in the management of respiratory tract and other infections. It is reliably absorbed from the gastrointestinal tract and reaches therapeutic levels in serum and tissues. Toxicity and adverse side effects are minimal. The antimicrobial spectrum includes a majority of the pathogens usually associated with community-acquired lower respiratory tract infections with the significant exception of Haemophilus influenzae. Resistance of H. influenzae strains reduces the uses of cephalexin in the paediatric population and may limit its effectiveness in some patients with acute exacerbations of chronic bronchitis. In contrast, it is inordinately effective in managing most adult patients with lower respiratory tract infections, either as a primary agent, as a substitute for penicillins or other antimicrobial agents in patients unable to receive these, or for continuation of therapy in individuals who no longer require parenteral compounds. As with other cephalosporins, caution should be exercised to exclude meningitis when treating patients with respiratory tract infections since the majority of these compounds, including cephalexin, produce little or no cerebrospinal fluid levels.

Adult↗
PubMed2006

Indoor air quality risk factors for severe lower respiratory tract infections in Inuit infants in Baffin Region, Nunavut: a pilot study.

Inuit infants have extremely high rates of lower respiratory tract infection (LRTI), but the causes for this are unclear. The aims of this study were to assess, in young Inuit children in Baffin Region, Nunavut, the feasibility of an epidemiologic study of the association between indoor air quality (IAQ) and respiratory health; to obtain data on IAQ in their housing; and to identify and classify risk factors for LRTI. Twenty houses in Cape Dorset, Nunavut with children below 2 years of age, were evaluated using a structured housing inspection and measurement of IAQ parameters, and a respiratory health questionnaire was administered. Twenty-five percent of the children had, at some time, been hospitalized for chest illness. Houses were very small, and had a median of six occupants per house. Forty-one percent of the houses had a calculated natural air change rate <0.35 air changes per hour. NO(2) concentrations were within the acceptable range. Smokers were present in at least 90% of the households, and nicotine concentrations exceeded 1.5 microg/m(3) in 25% of the dwellings. Particulates were found to be correlated closely with nicotine but not with NO(2) concentrations, suggesting that their main source was cigarette smoking rather than leakage from furnaces. Mattress fungal levels were markedly increased, although building fungal concentrations were low. Dust-mites were virtually non-existent. Potential risk factors related to IAQ for viral LRTI in Inuit infants were observed in this study, including reduced air exchange and environmental tobacco smoke exposure. Severe lower respiratory tract infection is common in Inuit infants. We found reduced air change rates and high occupancy levels in houses in Cape Dorset, which may increase the risk of respiratory infections. This suggests the measures to promote better ventilation or more housing may be beneficial. Further health benefits may be obtained by reducing bed sharing by infants and greater turnover of mattresses, which were found to have high levels of fungi.

Air Pollutants↗
PubMed1986

Efficacy of a twice-daily regimen of cefadroxil in the treatment of respiratory tract infections.

This multicentre open study evaluated the responses of 474 adult and paediatric patients with upper or lower respiratory tract infections to treatment with cefadroxil (25 to 50 mg/kg in children and 500 mg to 1 g in adults) twice daily for 10 to 30 days. Complete or partial cures seen in 81% to 100% of all patients correlated with the eradication of 87% to 100% of the causative pathogens, most commonly beta-haemolytic streptococci, S. aureus or S. pneumoniae. Mild, transient side effects, usually gastrointestinal disturbances or hypersensitivity reactions, were reported in 4.8% of patients. Thus, the safety and efficacy of this oral cephalosporin recommends its use in the treatment of infections of the respiratory tract.

Cefadroxil↗
PubMed2003

Ribosomal immunostimulation: assessment of studies evaluating its clinical relevance in the prevention of upper and lower respiratory tract infections in children and adults.

OBJECTIVE: To review the efficacy of the ribosomal immunostimulant Ribomunyl in preventing upper and lower respiratory tract infections. DESIGN AND SETTING: Review of studies of 3 and 6 months' duration comprising part of the international registration file. PATIENTS: Data from 2117 patients (1215 children and 902 adults); ribosomal immunostimulant n = 1062, placebo n = 1055. RESULTS: Nineteen randomised, double-blind, placebo-controlled clinical trials were performed between 1983 and 1994 in Europe. In children with ear-nose-throat (ENT) infections, 3 months' ribosomal immunostimulant treatment significantly decreased the mean number of recurrences (27-68% reduction), and reduced the duration of infection (28-66% reduction) and antibacterial requirement (29-60% reduction). Ribosomal immunostimulant was similarly effective in children with ENT and bronchopulmonary infections, reducing the mean number of recurrences by 32-61% compared with placebo. In children with otitis media, ribosomal immunostimulant reduced recurrences by 10-53% and also reduced the duration of infection, antibacterial use and local surgery requirement. Results obtained from studies of 6 months' duration confirmed or extended these results. In adult patients with ENT or mixed respiratory infections, ribosomal immunostimulant produced similar reductions to those seen in children for recurrent infections (54-78% reduction), duration of infection (42-79% reduction) and antibacterial use (38% reduction). CONCLUSIONS: These results clearly demonstrate that ribosomal immunostimulant is effective in preventing and in reducing upper and lower respiratory tract infections in children and adults.

Administration, Oral↗
PubMed2004

[Moraxella catarrhalis in chronic and relapsing respiratory tract infections in children].

Examination of 700 children with chronic and relapsing respiratory tract infections showed that during the period from 1996 to 2003 Moraxella catarrhalis strains were isolated from the sputum of 5.5-9.7% of the patients. The frequency of the emergence was the third after Haemophilus influenzae and Streptococcus pneumoniae. In healthy children M. catarrhalis was isolated in 2.7% of the cases. The most frequent detection of M. catarrhalis was stated in children under 1 year (4.5%). The antibiotic susceptibility tests revealed that the majority of the M. catarrhalis isolates had beta-lactamase activity, were resistant to benzylpenicillin, ampicillin and lincomycin and highly susceptible to amoxycillin/clavulanate, macrolides, certain cephalosporins and levofloxacin. The isolates were most frequent in the patients of the rather severe contingent (congenital lung disease, alveolitis, chronic pneumonia, bronchial asthma). In such patients the bronchoobstructive syndrome was more frequent (46.6%). High frequency of the affection of the upper respiratory tracts in the examined children was stated (62.1%).

Adolescent↗
PubMed1987

[In vitro antibacterial activity and pharmacokinetics of ofloxacin in chronic respiratory tract infections].

Serum and sputum levels of ofloxacin (OFLX) were measured in 5 patients with chronic respiratory tract infections and were compared with antibacterial activity in vitro. Sputum OFLX levels higher than the MIC's against H. influenzae and K. pneumoniae were maintained during the period when daily oral administrations were continued. The MIC70 of OFLX against S. aureus was under 0.78 microgram/ml and the MIC70 of OFLX against P. aeruginosa was 1.56 micrograms/ml. The maximum OFLX levels in sputum were higher than these MIC's during the period when 200-300 mg X 2 times/day oral administrations were maintained. From these results, OFLX was considered to be effective and useful for the treatment of patients with chronic respiratory tract infections.

Anti-Bacterial Agents↗
PubMedDate not supplied

Radionuclide detection of gastroesophageal reflux in children suffering from recurrent lower respiratory tract infection.

Radionuclide gastro-esophageal scintigraphy was performed on 25 control and 183 children suffering from recurrent lower respiratory tract infection. Gastro-esophageal reflux (GER) of varying grades was observed in 135 patients. The severity of clinical symptoms in the patients was found to be directly related to the severity of reflux observed in the radionuclide study. In some patients an attempt was also made to quantitate GER by calculating the Gastro-esophageal reflux index. The results of the scintigraphic study were correlated with the results of the other commonly used and more conventional Barium swallow and fluoroscopy study. Gastro-esophageal scintigraphy was found to be much superior in terms of sensitivity, specificity and accuracy in detecting GER. It was also possible to objectively evaluate and monitor response to treatment following conservative or corrective surgical therapy using the radionuclide technique. The results of the study demonstrated a remarkably high incidence of GER in the patients. Whether GER is the cause of recurrent lower respiratory tract infection or not is difficult to establish firmly. But within the preview of the study the association seems to be very strong and cannot be easily ignored.

Child↗
PubMed1993

Efficacy and safety of clarithromycin compared to cefixime as outpatient treatment of lower respiratory tract infections.

BACKGROUND: Clarithromycin is a new acid-stable, 14-membered macrolide active against many of the organisms responsible for lower respiratory tract infections. It has been administered to over 5,000 patients worldwide and has been shown to be a safe and effective treatment for acute bacterial exacerbations of chronic bronchitis and bacterial pneumonia when given twice daily (250 to 500 mg). Cefixime is an amino-thiazolyl cephalosporin with an extended spectrum of antibacterial activity inhibiting beta-lactamase-producing respiratory pathogens. It has a long half-life, allowing once-daily administration. METHODS: This randomized, double-blind multicenter study compared clarithromycin and cefixime as treatment for patients with community-acquired lower respiratory tract infections (n = 213). Patients had bacterial pneumonia (clarithromycin, 19 percent; cefixime, 21 percent) or acute bacterial exacerbation of chronic bronchitis or asthmatic bronchitis (clarithromycin, 81 percent; cefixime, 79 percent). Patients received 500 mg of clarithromycin twice daily (n = 103) or 400 mg of cefixime once daily (n = 110) for 7 to 14 days. RESULTS: Clinical cure or improvement occurred in 86 percent of the clarithromycin-treated patients and 88 percent of the cefixime-treated patients. When only patients with identified infections with Haemophilus influenzae, Moraxella catarrhalis, or Streptococcus pneumoniae were considered, clinical success rates were 97 percent for clarithromycin and 96 percent for cefixime; the rate of bacteriologic eradication was 91 percent for clarithromycin and 90 percent for cefixime. Adverse events occurred in 29 percent of the clarithromycin-treated patients and 23 percent of the cefixime-treated patients. CONCLUSIONS: This study demonstrates that clarithromycin and cefixime are effective treatments for pneumonia and acute bacterial exacerbations of bronchitis of mild to moderate severity caused by the most common infecting organisms.

Adult↗
PubMed1997

Acute lower respiratory tract infections in children in Kuwait.

The features of community-acquired acute lower respiratory tract infections in 390 children are described. Half (50%) presented with bronchiolitis, 37% with pneumonia and 13% with croup. Respiratory syncytial virus was the commonest agent identified (52% of bronchiolitis, 29% of pneumonia, 51% of croup). Positive bacterial blood cultures were obtained in 10% of the patients, all except one with pneumonia. Fever (> 39 degrees C), a toxic ill look, bronchial breathing, WCC > 20 x 10(9)/l, neutrophils > 5 x 10(9)/l, platelet count > 500 x 10(9)/l, ESR > 45 mm/hr, lobar consolidation and pleural effusion were more likely to be associated with bacterial than with viral pneumonia (relative risk > 1.81; p < 0.05). In areas with limited resources, a high fever, a toxic ill look, bronchial breathing and simple laboratory tests may help to identify patients with bacterial pneumonia.

Acute Disease↗
PubMed1990

[Respiratory tract infection and sudden infant death].

Among the risk factors for sudden infant death, respiratory tract infections are often reported. In this review, after a presentation of the particularities of the respiratory functions in the infant, the interactions between infection and ventilatory function are discussed.

Apnea↗
PubMed1998

Prevalence and risk factors for nosocomial lower respiratory tract infections in German hospitals.

The prevalence and risk factors for nosocomial lower respiratory tract infections (LRTI) in Germany were determined as part of a national survey on nosocomial infections. The study included 14,966 patients in 72 representatively selected hospitals with departments of general medicine, surgery, obstetrics, gynecology, and intensive care units (ICU). Surveillance was carried out by four previously validated medical doctors who strictly applied the CDC-criteria for diagnosis of nosocomial infections. The overall prevalence of hospital-acquired LRTI was 0.72% with the highest rate in hospitals with more than 600 beds (1.08%) and among the patients on intensive care units (9.00%). Ventilator-associated pneumonia rates were highest in patients on ICUs (13.27). Polytrauma, impaired consciousness, chronic airway disease, prior surgery, and cardiovascular disease were significantly related to the occurrence of nosocomial LRTI. P. aeruginosa was the predominant organism causing nosocomial LRTI. Nosocomial LRTI remain a problem mainly on ICUs. Patients at risk should be monitored with extra care.

Cross Infection↗
PubMed1999

Clinical and immunoregulatory effects of roxithromycin therapy for chronic respiratory tract infection.

The clinical and immunoregulatory effects of long-term macrolide antibiotic therapy for patients with chronic lower respiratory tract infections (CLRTI) were investigated. Clinical parameters and neutrophil chemotactic mediators in the epithelial lining fluid (ELF) of CLRTI patients (n = 10) were examined before and after 3 months oral administration of roxithromycin (RXM). The in vitro effects of RXM were also examined on the release of these mediators from alveolar macrophages (AM) and neutrophils. Arterial oxygen tension (p<0.05), vital capacity (VC) (p<0.001), %VC (p<0.05) and forced expiratory volume in one second (p<0.01) were improved after RXM treatment, but airway bacteria were not eradicated. Among the mediators, the levels of interleukin (IL)-8, neutrophil elastase (NE) and leukotriene B4 (LTB4) were higher in ELF than in plasma of CLRTI patients and they decreased after RXM treatment (n = 7, p<0.05 for each). RXM concentrations were significantly increased in the bronchoalveolar lavage cells of the treated patients. In in vitro experiments, RXM showed inhibitory effects on IL-8 release from AM and neutrophils. In conclusion, interleukin-8, neutrophil elastase and leukotriene B4 contribute to the neutrophilic inflammation in the airways of chronic lower respiratory tract infection patients and the clinical effects of roxithromycin may, in part, be attributable to the suppression of excess release of the chemotactic mediators from inflammatory cells.

Anti-Bacterial Agents↗
PubMed1995

Anaesthesia in children with viral respiratory tract infections.

The effects and consequences of anaesthesia in a child with a respiratory tract infection (RTI) are controversial. There is a high incidence of viral RTI in children presenting for surgery and anaesthesia. The social and economic impact of postponing the procedure is significant; for the child, family and institution. The clinical effects of the common cold are well known, affecting the respiratory tract from the nose down to the small airways and lung parenchyma. The systemic effects of the toxic viraemic phase are also well recognized but not so the potential risk of a viral myocarditis. There is an increased incidence of intra- and postoperative respiratory related complications up to six weeks after a RTI. These include airway obstruction, laryngeal spasm, vagally mediated reflex bronchoconstriction, increased bronchial secretions, desaturation, atelectasis and postoperative respiratory complications. Children with symptoms of a moderate to severe RTI presenting for elective surgery should be postponed for six weeks. Emergency surgery should proceed with a mask anaesthetic for minor surgery or by adopting a modified rapid sequence induction (atropine but no cricoid pressure) to gain rapid control of the airway to avoid laryngeal spasm and vagally mediated reflex bronchoconstriction; IPPV, awake extubation, postoperative monitoring of respiratory function and appropriate analgesia.

Anesthesia↗
PubMed1989

Ciprofloxacin (intravenous/oral) versus ceftazidime in lower respiratory tract infections.

The efficacy and safety of intravenous ciprofloxacin was compared with intravenous ceftazidime in 80 hospitalized patients with lower respiratory tract infection. There were 40 patients in each treatment group. Patients and physicians were blinded to the randomized scheme for treatment groups until patient consent was obtained. The 37 evaluable ciprofloxacin-treated patients received 200 mg every 12 hours intravenously as initial therapy and 29 completed their course receiving oral ciprofloxacin. The 34 evaluable ceftazidime-treated patients received 1 to 2 g intravenously every eight to 12 hours. The two groups did not differ with respect to patient age, infection severity, and admitting diagnosis. Clinical outcomes were similar with greater than 95 percent of treatments in each group being successful. Headache was the most commonly reported complaint (four patients) in the ciprofloxacin group. Three patients experienced substantial increases in serum theophylline concentrations while receiving ciprofloxacin. The predominant pathogens isolated were Haemophilus influenzae and Pseudomonas aeruginosa, and susceptibility rates for all organisms were similar for both drugs. The mean peak serum concentration at steady state while receiving intravenous ciprofloxacin was 2.3 micrograms/ml, and the mean trough concentration was 0.5 micrograms/ml. Patients randomly assigned to ciprofloxacin therapy received 2.6 fewer days of intravenous antibiotic therapy than those receiving ceftazidime. This 80-patient comparative trial demonstrates that ciprofloxacin and ceftazidime are similar in efficacy and safety when treating gram-negative lower respiratory tract infections. There appears to be potential for cost-reducing benefits through decreased length of intravenous therapy and earlier hospital discharge.

Administration, Oral↗
PubMed1989

Evaluation of intravenous ciprofloxacin in patients with nosocomial lower respiratory tract infections. Impact of plasma concentrations, organism, minimum inhibitory concentration, and clinical condition on bacterial eradication.

Fifty patients with gram-negative lower respiratory tract infections were treated with intravenous ciprofloxacin to evaluate efficacy and safety. Relationships between individual pharmacokinetics and clinical and bacteriologic outcome were studied. Ciprofloxacin concentrations in plasma were determined by high-performance liquid chromatography. Respiratory secretion cultures were obtained daily to determine the eradication day of the infecting organism. Susceptibility (minimum inhibitory concentration) to ciprofloxacin and other antimicrobials was determined using standard microdilution techniques. The mean age of the patients was 70 years. They had multiple underlying diseases, and two thirds of them were ventilator dependent at entry. Approximately 50% of the patients had failed previous treatment for the same infections. Patients infected with Enterobacteriaceae or Haemophilus influenzae with minimum inhibitory concentrations of less than 0.25 mg/L responded well to intravenous ciprofloxacin therapy (200 mg every 12 hours). The organisms were eradicated from sputum cultures usually within 1 day after ciprofloxacin therapy was started. Most clinical failures occurred in patients who were infected with Pseudomonas aeruginosa and had multiple underlying diseases. Pseudomonas aeruginosa was isolated from 10 patients with pneumonia, 2 patients with lung abscess, and 1 patient with bronchiectasis. The Pseudomonas isolate acquired resistance during ciprofloxacin treatment in 7 patients with pneumonia and in all of the remaining 3 patients. We conclude that ciprofloxacin is safe and effective at a dosage of 200 mg administered intravenously every 12 hours for nosocomial lower respiratory tract infections caused by Enterobacteriaceae or Haemophilus species. Many patients who had failed previous antibiotic treatment for Enterobacteriaceae infections had good clinical response to ciprofloxacin therapy. Studies using either higher dosages of ciprofloxacin or combination therapy should be conducted to determine if acquired resistance can be avoided in Pseudomonas infections.

Aged↗
PubMed1999

The relation between purulent manifestations and antibiotic treatment of upper respiratory tract infections.

OBJECTIVE: To describe the clinical features of patients diagnosed with upper respiratory tract infections (URIs), and determine which clinical features are associated with antibiotic use. DESIGN: Prospective cohort study. SETTING: Three ambulatory care practices at a group-model HMO in the Denver metropolitan area. PATIENTS: Adults (aged 18 years or older) seeking care for acute respiratory illnesses. MEASUREMENTS: Clinical features were documented on standardized encounter forms. Clinician type, secondary diagnoses, and antibiotic treatment were extracted from administrative databases. Results are presented as adjusted odds ratios (ORs) with 95% confidence intervals (CIs). MAIN RESULTS: Antibiotics were prescribed to 33% (95% CI 28%, 38%) of patients diagnosed with URI, after excluding patients with coexisting antibiotic-responsive conditions (e.g., sinusitis, pharyngitis) or a history of cardiopulmonary disease. Multivariate logistic regression analysis identified tobacco use (OR 2.8; 95% CI 1.5, 5.1), history of purulent nasal discharge (OR 2.0; 95% CI 1.1, 3.6) or green phlegm (OR 4.8; 95% CI 2.1, 11.1), and examination findings of purulent nasal discharge (OR 5.2; 95% CI 2.4, 11.2) or tonsillar exudate (OR 3.7; 95% CI 1.1, 12.1) to be independently associated with antibiotic use. The majority of patients treated with antibiotics (82%) had at least one of these factors present. CONCLUSIONS: Antibiotic treatment of URIs is most common when purulent manifestations are present. Efforts to reduce antibiotic treatment of URIs should educate clinicians about the limited value of purulent manifestations in predicting antibiotic-responsive disease.

Acute Disease↗
PubMed1977

A prospective study of acute respiratory tract infections among children in a kibbutz: the role of secretory IgA and serum immunoglobulins.

Absolute concentrations of IgA in nasal secretions and concentrations of immunoglobulins in serum were determined in a prospective study of acute respiratory tract infections. The study was carried out in 48 children aged six months to four years liveing in a kibbutz with a homogeneous environment. No correlation was demonstrated between mean base-line levels of secretory IgA or serum IgA and number of episodes of acute resporatory tract infection. However, children who responded to infection by the production of higher levels of secretory IgA had a lower incidence of acute respiratory tract infection than those who did not. Thisfinding supports the hypothesis that the responsiveness of the host in the production of secretory IgA during infection is important in protection against mucosal infections.

Child↗