[Possible interaction between viral and bacterial agents in respiratory tract infections].
Explore the source record for details and available documents.
Bacterial Infections↗
SEARCH · Search PubMed
Results for “RESPIRATORY TRACT INFECTIONS”
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Human metapneumovirus in infants and young children in Thailand with lower respiratory tract infections; molecular characteristics and clinical presentations.
UNLABELLED: Human metapneumovirus (hMPV) is a recently identified Paramyxovirus. The clinical features and molecular characteristics of hMPV in Asian populations have so far remained obscure. OBJECTIVE: The present study was designed to investigate the prevalence of hMPV in infants and young children presented with acute lower respiratory tract infection (ALRI) and to identify the molecular characteristics and clinical presentations. METHODS: There were 236 nasopharyngeal secretions (NPs) collected from infants and children presented with ALRI at King Chulalongkorn Memorial hospital between March 2001 and September 2003. Reverse transcriptase-polymerase chain reaction (RT-PCR) applying specific primers was done to identify hMPV and hRSV. Phylogenetic analysis of hMPV N, F and L genes was also performed. RESULTS: Of the 220 (236) infants and young children tested, positive results were found in 12 specimens (5.4%). The mean age of children with hMPV infections was 22+/-11 months. They mostly presented with fever with cough (100%) and upper respiratory tract symptoms (10/12, 83%). Eleven of twelve infants (92%) were hospitalized. Additionally, phylogenetic analysis identified two distinct lineages of hMPV. CONCLUSION: Our results demonstrated the prevalence, molecular characterization and clinical spectrum of hMPV infection in infants and young children presented with lower respiratory tract infections in Thailand.
Base Sequence↗
Improvements in antimicrobial prescribing for treatment of upper respiratory tract infections through provider education.
BACKGROUND: Inappropriate use of antimicrobials to treat acute upper respiratory tract infections (URIs), which usually have a viral etiology, contributes to emergence and spread of antimicrobial resistance in Streptococcus pneumoniae and other human bacterial pathogens. OBJECTIVE: To reduce antimicrobial use for management of acute URIs in adult and pediatric patients. DESIGN: Prospective, nonrandomized, controlled trial. SETTING: Four primary care clinics within a staff model HMO in Detroit, Mich. PARTICIPANTS: Twenty-one primary care physicians at clinics where the educational intervention was implemented, and 9 primary care physicians at control clinics where no educational programs were implemented. MEASUREMENTS: Antibiotic prescribing for acute URIs during the baseline and study years among the intervention and control groups. RESULTS: A generalized linear mixed-effects model was used and showed that antimicrobial prescribing among the intervention group physicians decreased 24.6% from the baseline to the postintervention period (P<.0001) for both pediatric and adult medicine physicians. From the baseline to the study period, there was no significant decline in rates of antimicrobial prescribing by the control group of physicians (pediatricians, P=.35; internists, P=.42). The rates of decline in antimicrobial prescribing differed significantly between the intervention and control groups (P<.0003 for pediatricians and P<.01 for Internists). CONCLUSIONS: An interactive, case-based educational program for physicians and their staff proved effective for reducing unwarranted prescribing of antibiotics in the treatment of URIs by primary care physicians in a Medicaid HMO setting.
Anti-Bacterial Agents↗
Outcomes of cefazolin versus ceftriaxone therapy in treating lower respiratory tract infections in adults.
OBJECTIVE: To determine whether choice of a first- versus third-generation cephalosporin as initial therapy for lower respiratory tract infections in hospitalized adults affects the course and duration of care, both of which may influence antimicrobial treatment cost. DESIGN: Retrospective analysis of discharge abstracts and hospital pharmacy records. SETTING: Forty-eight US acute-care hospitals. PATIENTS: One thousand ninety-two hospitalized adults (aged > 17 y) with principal diagnoses of lower respiratory tract infections (DRGs 79-80, 89-90). INTERVENTIONS: Cefazolin or ceftriaxone, given as sole antimicrobial therapy for at least one day. MAIN OUTCOME MEASURES: (1) The number of patients who received another parenteral antibiotic anytime prior to hospital discharge; (2) the number of days during which patients received any parenteral antibiotic while in the hospital; and (3) the number of days patients remained hospitalized following the start of antibiotic therapy. RESULTS: Patients treated with cefazolin (n = 763) were more likely to receive another parenteral antibiotic while in the hospital (30.3 vs. 20.7 percent; p < 0.001) and received more total days of therapy (7.2 vs. 6.7 d; p < 0.05) than those treated with ceftriaxone (n = 329). Although the time to hospital discharge did not differ in the full sample (9.2 d for both groups), it was greater among those receiving cefazolin (8.6 vs. 8.0 d; p < 0.05) when patients with lengths of stay exceeding 24 days were excluded from both groups. CONCLUSIONS: In addition to acquisition cost, differences in course and duration of care should be considered when determining the most cost-effective choice for antimicrobial therapy.
Adolescent↗
Sequential intravenous-oral administration of ciprofloxacin vs ceftazidime in serious bacterial respiratory tract infections.
The efficacy and safety of sequential intravenous/oral ciprofloxacin in moderate to severe respiratory tract infections (RTI) were compared with those of ceftazidime in a prospective clinical trial. Sixty-six patients received IV ciprofloxacin (200 to 300 mg twice daily), followed by oral ciprofloxacin (500 mg twice daily). Fifty-six patients received intravenous ceftazidime (1 to 2 g two to three times daily). Ciprofloxacin was as effective as ceftazidime and produced a 91 percent clinical cure rate. Significantly more pretreatment bacterial isolates were susceptible to ciprofloxacin, and ciprofloxacin had a significantly higher rate of sputum bacterial eradication than did ceftazidime. Ciprofloxacin showed broad in vitro antibacterial activity with particularly low minimal inhibitory concentrations for Gram-negative organisms. Ciprofloxacin was well tolerated; there were few adverse effects. Ciprofloxacin was an effective and well-tolerated treatment for severe RTI that had the advantages of broad in vitro antibacterial activity, twice-daily dosing, and sequential availability in an intravenous and oral formulation.
Administration, Oral↗
[A comparative study between cefodizime (CDZM) and cefotaxime (CTX) in respiratory tract infections].
The clinical efficacy and safety of Cefodizime (CDZM), a new cephem antibiotic, was objectively compared with that of Cefotaxime (CTX) in patients with respiratory infections under a well-controlled comparative study. Patients were administered CDZM or CTX by drip infusion b.i.d. for 14 days in principle at a daily dose of two grams. The parameters assessed were clinical efficacy, safety and clinical usefulness. The following results were obtained: 1. On the basis of committee judgement the clinical efficacy rate was 78.1% (125/160) for the CDZM group, 82.7% (124/150) for the CTX group, and no significant difference was observed between the two drug groups. On the other hand, on the basis of judgement by physicians in charge, the clinical efficacy rate was 83.1% (133/160) for the CDZM group, 83.9% (125/149) for the CTX group, and no significant difference was observed between the two groups. 2. The corresponding figures for patients with pneumonia and pulmonary suppuration were 82.4% (70/85) for the CDZM group, 79.7% (59/74) for the CTX group and no significant difference was observed according to the committee judgement. The judgement by physicians in charge also revealed 83.5% (71/85) for the CDZM group and 82.2% (60/73) for the CTX group. No significant difference was noted between the two groups. While, the committee judgement for the clinical efficacy in patients with chronic respiratory tract infections showed 73.3% (55/75) for the CDZM group, 85.5% (65/76) for the CTX group, and no significant difference was observed between the two drug groups. The corresponding figures were 82.7% (62/75) for the CDZM group, 85.5% (65/76) for the CTX group, and no significant difference was observed between the two drug groups on the judgement by physicians in charge. Furthermore, the clinical efficacy of both drugs on chronic respiratory tract infections was assessed according to "Criteria for Evaluation of Clinical Efficacy of Chemotherapeutics on Chronic Respiratory Tract Infection". It was 76.8% (53/69) for the CDZM group, 76.3% (58/76) for the CTX group, and no significant difference was observed between the two groups. 3. The bacteriological eradication rate of causative pathogens was 92.4% out of 66 patients treated with CDZM and 95.5% out of 67 patients treated with CTX in whom judgement was possible. No significant difference was observed between the two drug groups. 4. The adverse reactions occurred in 4 (2.2%) patients for the CDZM group and 8 (4.5%) patients for the CTX group respectively, with no significant inter-group difference in frequency of these reactions for all cases.(ABSTRACT TRUNCATED AT 400 WORDS)
Anti-Bacterial Agents↗
A double-blind pediatric evaluation of levamisole in the prevention of recurrent upper respiratory tract infections.
Levamisole was tested double-blind in 106 children with recurrent upper respiratory tract infections. They received either levamisole (n = 53) or placebo (n = 53) 0.5 ml/kg bodyweight b.i.d. for two consecutive days each week for six months. A control examination was performed every two months. Both groups were compared by means of the Fisher-test and the Mann-Whitney U-test (two-tailed probability each). Improvement was observed more frequently in the levamisole group with regard to the number of episodes of infection, and the total duration and severity of the infections. No side-effects, except for some stomach complaints in one levamisole patient, were reported.
Child↗
Clinical efficacy, tolerance and pharmacokinetics of temocillin in patients with respiratory tract infections.
In this study 13 patients with a history of chronic respiratory disease were treated with temocillin for severe infection of the lower respiratory tract. Eleven patients were clinically improved or cured at the end of treatment and 4 remained free of infection at follow up. However, the 2 remaining patients failed to respond clinically and bacteriologically to temocillin. Blood and sputum pharmacokinetics were studied in patients receiving temocillin at 12-hourly intervals in doses of either 1g by intravenous bolus or 2g by intravenous infusion. On the first day of treatment the mean peak serum concentration was 102 mg/L for the 1g dose and 220 mg/L for the 2g dose, falling to 11 mg/L (1g) and 18.8 mg/L (2g) at 12 hours. Similar results were recorded on the last day of treatment. Temocillin concentrations in the sputum ranged from 1.5 to 2.8 mg/L, with no difference being found in the sputum concentrations of the 2 doses. Temocillin was well tolerated and was found to be an effective treatment for Gram-negative bacterial infections of the lower respiratory tract.
Drug Tolerance↗
Prevalence and serotype distribution of encapsulated Haemophilus influenzae isolates from patients with lower respiratory tract infections in Poland.
Among 1,272 H. influenzae isolates obtained from patients with lower respiratory tract infections, 5.6% were found to be encapsulated. The most common were serotypes b (40.3%) and e (38.9%) followed by serotypes f (16.7%) and d (4.1%). All encapsulated isolates within a particular serotype showed high genetic homogeneity and did not produce beta-lactamases.
Adolescent↗
Antimicrobial susceptibility of 1,422 Haemophilus influenzae isolates from respiratory tract infections in Spain. Results of a 1-year (1996-97) multicenter surveillance study. Spanish Surveillance Group for Respiratory Pathogens.
A Haemophilus influenzae multicenter antimicrobial susceptibility surveillance was carried out. An overall beta-lactamase production rate of 25.7% was found, with significant differences between hospitals ranging between 7.9 and 47.9%. Presumable intrinsic resistance was found in 4.6% of strains. No differences in susceptibility were observed between beta-lactamase positive and beta-lactamase negative strains for all antibiotics, except for penicillin, amoxicillin and cefaclor. A higher prevalence of resistance was found for clarithromycin vs azithromycin (22.6 vs 0.7%). Differences in all these factors make surveillance essential as a guideline for empiric treatment in community-acquired respiratory tract infections.
Drug Resistance, Microbial↗
Efficacy of oral administration of ofloxacin in lower respiratory tract infections in aged patients with chronic lung disease.
The efficacy of ofloxacin for the treatment of lower respiratory tract infection was evaluated in aged patients with chronic lung disease. Results are the following: improvement of leukocytosis and arterial oxygen tension was observed; peripheral blood cell analysis showed a decrease in natural killer cell counts and in helper/suppressor T cell ratio; superoxide production by peripheral blood white cells was decreased after treatment; interleukin-2 production was rather increased. We concluded that improvement in the immunological parameters indicated the efficacy of ofloxacin for lower respiratory tract infection in aged patients with chronic lung disease.
Administration, Oral↗
[Antimicrobial activities of major oral antibacterial agents against clinically isolated microbial strains from outpatients with respiratory tract infection].
Minimum inhibitory concentrations (MICs) were determined for major oral antibacterial agents for clinically isolated microbial strains from materials collected from outpatients with respiratory tract infections in 1988, 1989 and 1990, and the following conclusions were obtained. 1. Methicillin-resistant Staphylococcus aureus (MRSA) appeared to be responsible for community-acquired respiratory tract infections, but there also was a tendency showing that MRSA increased year by year. 2. A tendency was observed indicating that benzylpenicillin (PCG)-insensitive Streptococcus pneumoniae (PISP) increased year by year. 3. Beta-lactamase-producing strains of Haemophilus influenzae were observed in a certain ratio, and also those of Branhamella catarrhalis were found in high ratios. 4. A tendency of increasing resistance of Klebsiella pneumoniae to new quinolones was observed. 5. It is of a great importance to evaluate methods of selecting primary choice antibiotic agents since increasing numbers of new oral antibacterial agents are becoming rapidly available.
Anti-Bacterial Agents↗
[Drug resistance and genotyping of Klebsiella pneumoniae in lower respiratory tract infection].
OBJECTIVE: To understand the current drug resistance of Klebsiella pneumoniae in lower respiratory tract infection and the prevalence trend of extended spectrum beta-lactamase (ESBLs)-producing Klebsiella pneumoniae. METHODS: Drug resistance in 86 strains of Klebsiella pneumoniae and ESBLs-producing strains were genotyped by randomly amplified DNA polymorphisms (RAPD). RESULTS: ESBLs-producing strains accounted for 20.9% of the 86 strains, and 83.3% of the ESBLs-producing strains were from respiratory ICU. The drug resistance rate of ESBLs positive bacteria was much higher than that of ESBLs negative bacteria. ESBLs positive bacteria were resistant to both the quinolones and a minoglylosides. Eighteen ESBLs-producing strains were divided into 12 types. 3 strains had the same profile (genotype A), and 5 strains had an identical profile (genotype B), but other strains had different profiles. CONCLUSIONS: Chromosomal DNA analysis proved that certain types of ESBLs-producing Klebsiella pneumoniae were epidemic in respiratory ICU. RAPD was an economic, simple but reliable method in epidemic study.
Adolescent↗
[Clinical effects of piperacillin and tazobactam/piperacillin on Haemophilus influenzae lower respiratory tract infection in pediatric patients].
OBJECTIVE: The prevalence of beta-lactamase-nonproducing ampicillin-resistant (BLNAR) Haemophilus influenzae (H. influenzae) has been increasing in recent years. Piperacillin (PIPC) is one of a few beta-lactams possessing good activity against BLNAR H. influenzae. We studied clinical efficacy of piperacillin and its beta-lactamase inhibitor, tazobactam/piperacillin (TAZ/PIPC) in children with lower respiratory tract infection caused by H. influenzae including resistance strains. METHODS: Subjects were 20 children with lower respiratory tract infection caused by H. influenzae treated with PIPC 100mg/kg/day (7 cases) or TAZ/PIPC 125mg/kg/day (13 cases). We selected cases from which resistant H. influenzae strains might be detected. Patients received prior antimicrobial therapy within two weeks before admission, or with underlying diseases. We examined patient profiles, clinical efficacy, susceptibilities for 6 beta-lactam antibiotics [PIPC, TAZ/PIPC, ampicillin (ABPC), cefotaxime (CTX), ceftriaxone (CTRX), and meropenem (MEPM)] and analyzed 6 genotype patterns of beta-lactam resistant genes by PCR. RESULTS: Efficacy was 7/7 in patients in PIPC group and 12/13 in patients in TAZ/PIPC group. Diminished efficacy was seen in only one case complicated with severe RSV infection. The susceptibility of all strains but one beta-lactamase producing, ABPC resistant (BLP) strain to PIPC and of all to TAZ/ PIPC was below 0.25 microg/mL. The genotype of the 15 strains isolated from the sputum on administration was as follows; beta-lactamase nonproducing, ABPC-susceptible (gBLNAS) strains were 4, gBLP strain was 1, beta-lactamase nonproducing, and ABPC-resistant (gLow-BLNAR) strains were 2, beta-lactamase nonproducing, ABPC resistant (gBLNAR) strains were 8. CONCLUSION: PIPC and TAZ/PIPC were useful against lower respiratory tract infection caused by H. influenzae including BLNAR in children.
Anti-Bacterial Agents↗
[Overuse of antibiotics with upper respiratory tract infections in a primary care clinic].
UNLABELLED: In the majority of cases upper respiratory tract infections (URI's) are caused by viruses. Nonetheless, in many instances, patients with URI's are over-treated with antibiotics. In order to evaluate the use of antibiotic therapy in patients with URI's, we recorded medications prescribed for URI's in 394 young adults seeking care in a primary care clinic. The following parameters were assessed: rhinnorhea, cough, sore throat, dysphagia, tonsillar exudates, tonsillar enlargement and cervical lymphadenopathy. Throat cultures were taken from all the patients. RESULTS: Antibiotic therapy was prescribed for 99 of the 370 patients (26.8%) with URI's and negative throat cultures. Among these patients, a high prevalence of the following findings was evident: tonsillar enlargement (66.7%), tonsillar exudates (48.5%), cervical lymphadenopathy (42.4%), lack of rhinorrhea (40.4%), lack of cough (32.0%) and fever (31.3%). CONCLUSIONS: Excess antibiotic therapy was prescribed for patients with URI's. Possible explanations are: clinical findings that suggest a diagnosis of follicular tonsillitis, early antibiotic treatment that is not based on throat cultures or antigen detection tests, and multiple treating physicians. RECOMMENDATIONS: We recommend that in cases of patients with URI's, antibiotics should not be prescribed unless diagnosis of a streptococcal infection is supported by results of throat cultures or antigen detection tests. Furthermore, in primary care clinics with a number of physicians, treatment should guarantee appropriate medical follow-up.
Adult↗
Increased disease burden and antibiotic resistance of bacteria causing severe community-acquired lower respiratory tract infections in human immunodeficiency virus type 1-infected children.
To improve the management of lower respiratory tract infections (LRTI) in human immunodeficiency virus type 1 (HIV-1)-infected children, we assessed the burden of disease, clinical outcome and antibiotic susceptibility of bacteria causing severe community-acquired LRTI in children. A prospective, descriptive study was performed in the pediatric wards at a secondary and tertiary care hospital in South Africa. Urban black children aged 2-60 months admitted with severe acute LRTI from March 1997 through February 1998 were enrolled. HIV-1 infection was present in 45.1% of 1215 cases of severe LRTI. Bacteremia occurred in 14.9% of HIV-1-infected and in 6.5% of HIV-1-uninfected children (P<.00001). The estimated relative incidence of bacteremic severe LRTI in children aged from 2 to 24 months were greater in HIV-1-infected than in -uninfected children for Streptococcus pneumoniae (risk ratio [RR], 42.9; 95% confidence interval [CI], 20.7-90.2), Haemophilus influenzae type b (RR, 21.4; 95% CI, 9.4-48.4), Staphylococcus aureus (RR, 97.9; 95% CI, 11.4-838.2) and Escherichia coli (RR, 49.0; 95% CI, 15.4-156). Isolation of Mycobacterium tuberculosis was also more common in HIV-1-infected than in -uninfected children (RR, 22.5; 95% CI, 13.4-37.6). In HIV-1-infected children, 60% of S. aureus and 85.7% of E. coli isolates were resistant to methicillin and trimethoprim-sulfamethoxazole, respectively. The case-fatality rates among HIV-1-infected children was 13.1%, and among HIV-1-uninfected children, 2.1% (adjusted odds ratio [AOR]; 6.52, 95% CI, 3.53-12.05; P<.00001). The changing spectrum of bacteria and antibiotic susceptibility patterns in HIV-1-infected children requires a reevaluation of the empirical treatment of community-acquired severe LRTI in children from developing countries with a high prevalence of childhood HIV-1 infection.
AIDS-Related Opportunistic Infections↗
[Acute upper respiratory tract infections].
Acute infections of the upper respiratory tract are reviewed from an ENT point of view. Only the most frequent pathologies are taken into account. Clinical presentation and an update of current treatment are presented.
Adult↗
Lower respiratory tract infection due to Branhamella catarrhalis, two case reports.
We describe two cases of lower respiratory tract infection due to Branhamella catarrhalis in elderly patients. The diagnosis was confirmed by isolation of the organism from the sputa in pure growth and also by response to treatment with appropriate antibiotics. Both patients had predisposing factors: one had chronic bronchial asthma and was also on corticosteroids during the illness and the other had chronic obstructive lung disease. Previously reported cases are reviewed.
Asthma↗