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PubMed2003

Lower respiratory tract infection in infancy in relation to feeding pattern.

OBJECTIVE: To assess the relation between lower respiratory tract infection and feeding pattern in infancy. SETTING: Hospital based descriptive. METHODS: Two hundred and five infants presenting with lower respiratory infection (LRTI) admitted in the ward were studied over a period of one year. Criteria for the clinical diagnosis of LRTI were based on the lines of TUCSON CHILDREN RESPIRATORY STUDY. RESULTS: Forty three percent of LRTI in infancy were seen in age group of 0 to 3 months. Sixty percents of pre-lacteal feeding and 71% of bottle-feeding were observed. Late introduction of solid food was very commonly practiced. In 64.7% solid food was introduced at the age of 9 to 12 months. Fifty three percent of LRTI were associated with diarrhoea, which was the commonest factor associated with mortality due to LRTI. There was male preponderance with male:female = 2.8:1(P value <0.001), which is highly significant. Mixed feeding/artificial feeding had more incidence of LRTI than exclusively breast-fed children (1.7:1) and the mortality rate was 10 times more in mixed/artificial fed infants than exclusively breast fed infants.

Bottle Feeding↗
PubMed1989

Two different dosages of ciprofloxacin in patients with respiratory tract infections.

Fifty-one patients with chronic obstructive lung disease with a proven bacterial respiratory tract infection were treated with ciprofloxacin 500 mg twice daily or 750 mg twice daily. Both dosages were given orally for approximately 10 days. The higher dosage showed a reduced amount of reinfections and relapses (19% and 16% versus 5% and 0%). The overall results were the same in both groups. Adverse reactions were mild: nausea and visual disturbances were seen in five patients. Eight patients had slight liver test abnormalities. In one patient a seizure occurred. All adverse reactions were of a temporary nature.

Adult↗
PubMed2001

Risk factors for severe acute lower respiratory tract infection in under-five children.

BACKGROUND: Acute lower respiratory infection (ALRTI) is the leading cause of death in children below five years of age. Identification of modifiable risk factors of severe ALRTI may help in reducing the burden of disease. METHODS: A hospital based case control study was undertaken to determine risk factors associated with severe lower respiratory tract infection (LRTI) in under-five children. A case definition of severe ALRTI as given by World Health Organization (WHO) was used for cases. Healthy children attending Pediatrics out patient department for immunization during study period were enrolled as controls. Details of potential risk factors in cases and controls were recorded in pre-designed proforma. RESULTS: 512 children including 201 cases and 311 controls were enrolled in the study. On stepwise logistic regression analysis it was found that lack of breastfeeding (OR: 1.64; 95 percent CI: 1.23-2.17); upper respiratory infection in mother (OR: 6.53; 95 percent CI: 2.73-15.63); upper respiratory infection in siblings (OR: 24; 95 percent CI: 7.8-74.4); severe malnutrition (OR: 1.85; 95 percent CI: 1.14-3.0); cooking fuel other than liquid petroleum gas (OR: 2.5; 95 percent CI: 1.51-4.16); inappropriate immunization for age (OR: 2.85; 95 percent CI 1.59-5.0) and history of LRTI in the family (OR 5.15, 95 percent CI 3.0-8.8) were the significant contributors of ALRTI in children under five years. Sex of the child, age of the parents, education of the parents, number of children at home, anemia, inadequate caloric intake, type of housing were not documented to be significant risk factors of ALRTI. CONCLUSION: Lack of breast-feeding, upper respiratory infection in mother, upper respiratory infection in siblings, severe malnutrition, cooking fuel other than liquid petroleum gas, inappropriate immunization for age and history of LRTI in the family were the significant risk factors associated with ALRTI

Breast Feeding↗
PubMed1993

The optimal dosage of ceftazidime for severe lower respiratory tract infections.

The optimal dosage of antibiotics for the treatment of patients with severe lower respiratory tract infections (LRTI) has not been determined but may be lower than is commonly administered at present. We have compared the efficacy of a low dosage of ceftazidime (1 g tds) with the more usual dosage (2 g tds) in a prospective, randomized study of the treatment of LRTI in seriously ill patients. Fifty patients on an Intensive Care Unit received one or the other regimen for 5 days; the demographic characteristics of the two groups were comparable. There was no significant difference in terms of clinical and microbiological response rates between the two regimens. Overall, clinical resolution was documented for 86% of patients, there was no change in 8% and 6% deteriorated. Microbiological eradication was achieved in 52% of patients from whom a pathogen was isolated (46% of all patients). We conclude that ceftazidime 1 g tds is effective treatment for severe LRTI in hospitalized patients.

Adult↗
PubMed2004

Data from electronic patient records are suitable for surveillance of antibiotic prescriptions for respiratory tract infections in primary health care.

Diagnoses and antibiotic treatments were analysed in relation to respiratory tract infections (RTI). A 1-y retrospective study was made of electronic patient records (EPR) for encounters concerning RTIs in primary health care in Sweden. The study covered a registered population of 102,050 individuals at 12 primary health care centres in 3 counties. Data were recorded on number of episodes, encounters, diagnostic codes and antibiotic prescriptions. The yearly number of episodes of RTIs was 16,964 or 166 per 1000 inhabitants per y. The total number of encounters was 19,965. The most frequent diagnoses were common cold (40%), acute tonsillitis (18%), and acute bronchitis (15%). The yearly number of antibiotic prescriptions was 7961, accounting for 47% of the episodes or 78 per 1000 inhabitants per y. The most frequently prescribed antibiotics were phenoxymethylpenicillin (61%), tetracyclines (18%) and macrolides 8%). Standard EPRs provide a feasible source of clinical information which, taking limitations into consideration, could be used for the follow-up of trends in antibiotic prescribing and of adherence to guidelines with regard to RTIs.

Adolescent↗
PubMed2004

Pathogens involved in lower respiratory tract infections in general practice.

BACKGROUND: There are few investigations into the aetiology of lower respiratory tract infections (LRTIs) in general practice. AIM: To describe the aetiology of LRTI among adult patients in general practice in The Netherlands. DESIGN OF STUDY: Prospective observational study. SETTING: General practices in the Leiden region, The Netherlands. METHOD: Adult patients with a defined LRTI were included. Standard medical history and physical examination were performed. Sputum, blood and throat swabs were collected for diagnostic tests. Aetiological diagnosis, categorised as definite or possible, was based on the results of bacterial and viral cultures, serological techniques, and on polymerase chain reaction. Proportions of pathogens causing LRTI were assessed in relation to chest X-ray findings. RESULTS: A bacterial cause was established in 43 (30%), and a viral cause in 57 (39%) of the 145 patients with a LRTI. Influenza virus A was the most frequently diagnosed microorganism, followed by Haemophilus influenzae, and Mycoplasma pneumoniae. Streptococcus pneumoniae was found in 6% of the patients. CONCLUSIONS: Pathogens were found in two-thirds of the patients. In half of these patients there was a viral cause. Influenza virus A was the most frequently found pathogen. The treatment with antibiotics of at least one-third of the patients with LRTI was superfluous. This observation should result in changes in the prescription of antibiotics in LRTI.

Adolescent↗
PubMedDate not supplied

Comparison between parental report and results of microbiologic agar assay for presence of antibiotic in urine of Argentinian children with acute lower respiratory tract infection.

This study compares two sources of information on prior use of antibiotics in children with acute lower respiratory tract infection. The presence of antibiotics in respiratory specimens complicates recovery of bacterial pathogens and the selection of appropriate antibiotic treatment. The first source of information is the parents, who are asked about recent use of antibiotics by their child. The second source is an agar diffusion assay that detects antibiotics in urine specimens. In Argentina, where antibiotics are readily available without prescription, parental information about a child's recent antibiotic therapy was found to be relatively reliable only when their answer was affirmative.

Adult↗
PubMed2002

Antibiotic prescribing and admissions with major suppurative complications of respiratory tract infections: a data linkage study.

BACKGROUND: Systematic reviews of antibiotic treatment of common acute respiratory tract infections (RTIs) suggest modest symptomatic benefit, but provide limited evidence that prescribing prevents complications. AIM: To assess the relationship between penicillin prescribing (the most commonly used group of antibiotics for RTIs) and hospital admission with complications. DESIGN OF STUDY: Data linkage study. SETTING: Ninety-six health authorities of England for the year 1997-1998. METHOD: Hospital admissions related to RTIs were linked with prescribing analysis and cost (PACT) data. RESULTS: There was close correlation between items of penicillin use and total antibiotic use (r = 0.96). After controlling for SMR, age, sex, and Townsend score, a one-unit increase in penicillin use (items dispensed per capita) was associated with a reduction in annual incidence per 10,000 of admissions for quinsy (-3.55 admissions, 95% confidence interval [CI] = -6.85 to -0.26), and mastoiditis (square root of incidence of admissions = -1.05, 95% CI = -1.82 to -0.27). This does not represent lower referral thresholds among higher prescribers as higher prescribing was associated with more admissions for tonsillectomy and overall admissions. Increasing prescribing by 2000 items of penicillin for a practice of 10,000 patients could possibly prevent one admission for either mastoiditis or quinsy. CONCLUSION: Higher antibiotic prescribing is associated with significantly fewer admissions with major complications. However, the overall size of the effect is modest and it is difficult to advocate an overall increase in prescribing to prevent complications. Future research should concentrate on finding better methods of targeting antibiotics to individuals at risk of poor outcome.

Acute Disease↗
PubMed2006

Population antibiotic susceptibility for Streptococcus pneumoniae and treatment outcomes in common respiratory tract infections.

PURPOSE: Antibiotic-resistant Streptococcus pneumoniae potentially threatens the successful treatment of common respiratory tract infections (RTIs); however, the relationship between antibiotic resistance and treatment outcomes remains unclear. We aimed to test the hypothesis that higher in vitro penicillin and erythromycin nonsusceptibility levels among clinical isolates of S. pneumoniae are associated with higher risk of treatment failure in suppurative acute otitis media (AOM), acute sinusitis, and acute exacerbation of chronic bronchitis (AECB). METHODS: We conducted a population-level analysis using treatment outcomes data from a national, managed-care claims database, and antibiotic susceptibility data from a national repository of antimicrobial susceptibility results between 1997 and 2000. Treatment outcomes in patients with suppurative AOM, acute sinusitis, or AECB receiving selected macrolides or beta-lactams were assessed. Associations between RTI-specific treatment outcomes and antibiotic nonsusceptibility were determined using Spearman correlation coefficients with condition-specific paired outcome and susceptibility data for each region and each year. RESULTS: There were 649 552 available RTI outcomes and 7252 susceptibility tests performed on S. pneumoniae isolates. There were no statistically significant trends across time for resolution proportions following treatment by either beta-lactams or macrolides among any of the RTIs. Correlation analyses found no statistically significant association between S. pneumoniae susceptibility and RTI treatment outcomes apart from a significant positive association between of erythromycin nonsusceptibility in ear isolates and macrolide treatment resolution for suppurative AOM. CONCLUSION: On the population level, in vitro S. pneumoniae nonsusceptibility to macrolide or beta-lactam antibiotics was not associated with treatment failure in conditions of probable S. pneumoniae etiology.

Acute Disease↗
PubMed2001

Characteristics of patients with upper respiratory tract infection presenting to a walk-in clinic.

OBJECTIVE: To profile patients with upper respiratory tract infection (URI) presenting to a walk-in clinic, to quantify their perspectives on the need for antibiotic therapy, and to find out their predictions of future behavior for similar illnesses. PATIENTS AND METHODS: In the spring of 1998, previsit and postvisit questionnaires were distributed at the clinic to patients 18 years of age or older with URI symptoms. RESULTS: Based on 210 completed previsit questionnaires, 161 respondents (77%) had been ill 5 or more days, 200 (95%) had cough, 177 (84%) had phlegm, 132 (63%) had sinus pain, and 79 (38%) had fever. Additionally, 54 patients (26%) reported a history of chronic obstructive pulmonary disease, asthma, or chronic sinusitis, and 37 (18%) were smokers. Most patients were between 18 and 40 years of age. The 210 patients were categorized into 2 groups: those who believed that antibiotics were necessary (157 [75%]) and those who believed antibiotics were unnecessary (53 [25%]). The only statistically significant difference between the 2 groups was in patients with sinus pain: 109 (69%) wanted antibiotics compared with 23 (43%) who did not (P<.001). Of the 210 patients, 130 completed postvisit questionnaires, 129 (99%) of whom reported satisfaction with the clinic visit. All patients who either desired or received antibiotics indicated they would likely seek medical care for future URIs. CONCLUSIONS: The majority of patients with presumed URI presenting to this walk-in clinic expect to receive treatment with antibiotics. Of our 130 study patients, 83 (64%) received antibiotics regardless of their desire for antibiotic treatment. Satisfaction with the office visit was independent of patients' initial beliefs about antibiotics and whether antibiotics were prescribed.

Adolescent↗
PubMed1991

[An optimum dose-finding study of HR810 (CPR) in chronic respiratory tract infections].

In order to determine the optimal dose of cefpirome sulfate (HR810, CPR) against respiratory tract infections (RTI), an optimal dose-finding study was conducted on cases of chronic RTI, and the clinical properties of the drug were compared with those of ceftazidime (CAZ). Inpatients with chronic RTI were randomly assigned to 3 groups: an HR 0.5 g group, receiving 0.5 g X 2/day of CPR an HR 1.0 g group, receiving 1.0 X 2/day of CPR and a CAZ group, receiving 1.0 g X 2/day of CAZ. As a rule, the drugs were administered by intravenous drip infusion for 14 days, after which period clinical efficacy, bacteriological response, safety, and utility were investigated. Of the total 121 cases, 106 were subject to analysis of clinical efficacy, including 38 cases in the HR 0.5 g group, 32 in the HR 1.0 g group, and 36 in the CAZ group. Efficacy rates in the assessment by the committee were 84.2% for the HR 0.5 g group, 75.0% for the HR 1.0 g group, and 86.1% for the CAZ group, without any significant difference between the 3 groups. The bacterial elimination rates were 73.9%, 75.0% m and 88.5%, respectively, without any significant difference between the 3 groups. Associated reactions were noted in 2 of 36 cases in the HR 1.0 g group (eruption and diarrhea), but not in the other 2 groups. The incidence of abnormal clinical laboratory findings was 23.1% in the HR 0.5 g group, 22.2% in the HR 1.0 g group, and 22.5% in the CAZ group, without any significant difference between the 3 groups. Utility rates were 84.2% for the HR 0.5 g group, 74.2% for the HR 1.0 g group, and 86.1% for the CAZ group, without any significant difference between the 3 groups. The HR 0.5 g and 1.0 groups showed no difference in clinical efficacy, bacteriological response, safety, and utility against RTI, and the results of both groups were about equal to those of the CAZ group.

Adolescent↗
PubMed1991

Genetic relationship between thirteen genome types of adenovirus 11, 34, and 35 with different tropisms.

Eleven genome types of adenovirus serotype 11 (Ad11) were identified among 20 strains isolated from healthy pregnant women and patients with urinary tract infections, respiratory tract infections, or pharyngoconjunctival fever by use of 13 restriction endonucleases: BamHI, BclI, BglI, BglII, BstEII, EcoRI, HindIII, HpaI, PstI, SalI, SmaI, XbaI, and XhoI. All genome types could be grouped into three genomic clusters according to their genetic homology expressed as pairwise comigrating restriction fragments. The genome types within a genomic cluster were very closely related. They shared on an average pairwise comigrating restriction fragments of 91.6-97.7%. The Ad11 strains of genomic clusters 1 and 3 were isolated from urine, whereas all the Ad11 strains isolated from the respiratory tract were identified as members of the genomic cluster 2. One genome type of Ad34 and one genome type of Ad35 were identified from a hemorrhagic cystitis patient and an organ transplant recipient, respectively. Both were closely related to Ad11. The genome type of Ad35 could be located in the Ad11 genomic cluster 1.

Adenoviruses, Human↗
PubMed1980

Airway reactivity in subjects with viral upper respiratory tract infections: the effects of exercise and cold air.

To define airway hyperreactivity further in symptomatic upper respiratory tract infection (URI), we compared in the setting of viral URI the respiratory effects of inhaling histamine to that of exercising with room air (993 +/- 300 kpm/min; 22 degrees +/- 2 degrees C), cold air breathing (-8 +/- 2 degrees C), and exercising with cold air (993 +/- 300 kpm/min; -8 degrees +/- 2 degrees C). Thirteen previously healthy, nonsmoking, nonatopic adults with URI were evaluated at the time of presentation and 1, 3, and 6 wk thereafter. At the initial presentation there was a 28 +/- 14% decrease in mean airway conductance (SGaw) after inhalation of histamine (p > 0.001). By 6 wk, airway reactivity to histamine decreased in 9 of 13 subjects. After exercise with cold air, there was a 12.5 +/- 7.5% decrease in mean SGaw (p < 0.001). By 6 wk, exercise with cold air no longer produced a decrease in SGaw (p > 0.05). In 5 additional subjects this airway reactivity to exercise with cold air was blocked by previous administration of atropine and by oropharyngeal anesthesia. We conclude that during viral URI there occurs transient airway hyperreactivity ot the combination of exercise with cold, dry air and that the upper airway and parasympathetic nervous system have important roles in these responses.

Adult↗
PubMed2002

Total daily energy expenditure and incidence of upper respiratory tract infection symptoms in young females.

UNLABELLED: A group of 31 young females, tennis players and non-athletes, aged 16 +/- 2 years (range: 14 - 21 years), with a wide range of physical activity levels was used to investigate the relationship between total daily energy expenditure and the incidence of upper respiratory tract infection symptoms. METHODS: During a 12 week winter period, habitual daily activity (excluding training) was evaluated using a 3-day physical activity record. Tennis training was quantified using a validated method of estimating energy expenditure during play. Total daily energy expenditure was calculated from the sum of daily training plus mean habitual daily activity energy expenditures. The total group of subjects was divided in quartiles for total daily energy expenditure. A validated symptom checklist was used to assess the incidence and severity of upper respiratory tract infections, on a daily basis. RESULTS: The girls in the highest quartile of total daily energy expenditure (> or = 17,322 kJ/day) and in the lowest quartile (< or = 10,047 kJ/day) had the greatest incidence of URTI symptomatology, although the moderately active girls in quartile three (12,290 - 16,410 kJ/day) presented the lowest incidence. Significant differences in number of upper respiratory tract infection episodes, sickness days and symptomatology index were found between quartiles three and one (p < 0.05) and quartiles three and four (p < 0.01). Peak severity of symptoms was significantly lower in quartile three compared with all other quartiles (p < 0.05).

Adolescent↗
PubMed1986

Sultamicillin--a new antibiotic in the treatment of persistent lower respiratory tract infections caused by Haemophilus influenzae.

Haemophilus influenzae is a frequent cause of recurrent or chronic lower respiratory tract infections in patients suffering from cystic fibrosis (CF) and other chronic obstructive pulmonary disease (COPD). Ampicillin and its derivatives are routinely used in treatment, but resistant strains producing beta-lactamase frequently necessitate the use of other antibiotics. Sultamicillin is a compound agent for oral use in which ampicillin and the beta-lactamase inhibitor sulbactam are linked as a double ester. This combination is active in vitro against many beta-lactamase producing bacteria including ampicillin-resistant H. influenzae. Eight CF children and ten children with other COPD suffering from chronic or recurrent H. influenzae infection of the lower respiratory tract were treated with sultamicillin orally, 25 mg/kg, 12-hourly, for two weeks. Nine infections were caused by ampicillin-resistant strains. At the end of the treatment 65% of the patients were free of H. influenzae. The only adverse reaction was diarrhoea which occurred in 14 patients, and necessitated withdrawal of one patient from the study.

Adolescent↗
PubMed1989

Comparative evaluation of safety and efficacy of cefmetazole and cefoxitin in lower respiratory tract infections.

The efficacy and safety of cefmetazole and cefoxitin were compared in a randomized open-label parallel trial in 68 hospitalized adult patients with lower respiratory tract infections. Of 40 patients evaluable for efficacy, 23/25 (92%) in the cefmetazole group and 13/15 (87%) in the cefoxitin group demonstrated a favourable clinical response. The causative bacteria were eradicated in 30/32 (94%) and 13/14 (93%) of isolates in the cefmetazole and cefoxitin groups, respectively. A total of 51 adverse events was noted in 68 patients: 36 in 26 patients (55%) in the cefmetazole group and 15 in 12 patients (57%) in the cefoxitin group. These events were reversible, and except in one patient who was treated for oral candidiasis, did not require any therapeutic intervention or prolonged hospitalization. Cefmetazole appears to be as safe and effective as cefoxitin in the treatment of lower respiratory tract infections of hospitalized patients.

Aged↗