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PubMed1995

The place of tobramycin in lower respiratory tract infections (LRTI).

The Author provides a review of clinical experience with tobramycin as therapy for lower respiratory tract infections, in comparison to other aminoglycosides, including the pharmacokinetics and toxicity, dwelling on oto- and nephrotoxicity. The article includes a discussion of various dosing regimens of the aminoglycosides, focussing on efficacy and toxicity arising from once-daily administration. The Author then provides a more detailed description of tobramycin's pharmacokinetics, indications for its use, and the possibilities of once-daily dosing, concluding that toxicity is favorably influenced by a single daily administration as well as efficacy, and that patient compliance and reduced hospital costs are other advantages of this regimen.

Administration, Oral↗
PubMed1989

Prophylaxis of respiratory tract infection in patients on artificial respiration.

In a pilot study, a prophylactic regimen including ciprofloxacin and amphotericin B was applied in 102 consecutive patients on artificial respiration for greater than or equal to 5 days to prevent respiratory tract infection with aerobic Gram-negative bacilli. Ciprofloxacin was given twice a day, as 500 mg through a gastric tube or 200 mg intravenously, and both applications led to negative cultures for aerobic Gram-negative bacilli from faeces and throat, except for a few periods of carriage lasting only a few days. No patient acquired respiratory tract infection with one of the Enterobacteriaceae or Pseudomonadaceae after 4 days of artificial respiration. In contrast to other prophylactic regimens in intensive care patients, this regimen is relatively simple and effective. These preliminary data suggest that this regimen should be studied further with special emphasis on the induction of resistance in Intensive Care Units using prospective, double-blind study designs.

Amphotericin B↗
PubMed1985

Acute and exacerbated chronic respiratory tract infections: treatment with a combination of cefuroxime and acetylcysteine.

Sixty-five patients, 25 with acute bronchopulmonary respiratory tract diseases and 40 with acute exacerbations of chronic respiratory tract infections, were treated by means of intramuscular injection of an extempore combination of 1 g of cefuroxime and 300 mg of acetylcysteine. Patients were divided into two groups according to the acute or chronic nature of their respiratory tract diseases. Positive clinical results were obtained in 62 of the 65 patients. Of a total of 52 pathogens isolated in pretreatment bacteriological tests on sputum cultures, only three were still detectable after treatment. Tolerance of the treatment was good in all patients, no side-effects of any kind being observed.

Acetylcysteine↗
PubMed1996

Prospective open randomized study comparing efficacies and safeties of a 3-day course of azithromycin and a 10-day course of erythromycin in children with community-acquired acute lower respiratory tract infections.

The efficacies and safeties of a 3-day, 3-dose course of azithromycin (10 mg/kg of body weight per day) and a 10-day, 30-dose course of erythromycin (40 mg/kg/day) for the treatment of acute lower respiratory tract infections in children were compared in an open randomized multicenter study. Sixty-eight of 85 evaluable patients (80%) had radiologically proven pneumonia, and 20% had bronchitis. Treatment success defined as cure or major improvement was achieved in 42 of 45 (93%) azithromycin recipients versus 36 of 40 (90%) erythromycin recipients. Adverse events were reported in 12 of 45 and 6 of 40 of the patients treated with azithromycin and erythromycin, respectively, a difference which was not statistically significant. In conclusion, a 3-day course of azithromycin is as effective as a 10-day course of erythromycin in the treatment of community-acquired lower respiratory tract infections in children, with comparable safety and acceptability profiles. This shorter treatment course might have a beneficial effect on compliance, especially in the pediatric age group.

Adolescent↗
PubMed2003

A multicentric study to evaluate efficacy and safety of cefetamet pivoxyl in lower respiratory tract infections in Indian patients.

This multicentric, open label, non-comparative study was designed to evaluate the extended spectrum of third generation oral cephalosporin, cefetamet pivoxyl in the treatment of patients with lower respiratory tract infections. This study was conducted among 111 patients with clinical, radiological and bacteriological findings consistent with the diagnosis. After obtaining written informed consent, patients were given cefetamet 500 mg tablet twice a day for 7 days. Cefetamet consistently decreased all clinical signs and symptoms at post-therapy visit. All the treated patients were either cured or improved. Cefetamet was well tolerated with a low incidence of drug related adverse events. The findings of this study indicate that cefetamet pivoxyl was well tolerated and is suitable option for the treatment of patients with lower respiratory tract infection.

Adult↗
PubMedDate not supplied

Treatment of recurrent respiratory tract infections with a polyvalent bacterial lysate: results of an open, prospective, multinational study.

This multicenter, open study, carried out in 14 countries in Europe, Latin America, and Asia, recruited 4965 patients suffering from recurrent respiratory tract infections to investigate the safety and acceptability of the oral bacterial lysate immunomodulator LW 50020. Patients remained in the study for 4 months (two 4-week courses of LW 50020 separated by a 28-day treatment-free interval and follow-up). The incidence of all adverse events was 7.2%; that of adverse drug reactions was 0.6%. Adverse drug reactions were mild to moderate and not more frequent in the large subgroup of patients (77%) with a known history of allergies or underlying respiratory diseases; however, the incidence of adverse events in this subgroup was twofold higher than in the study population as a whole, probably indicating a generally increased vulnerability to disease. No clinically relevant changes in laboratory variables followed treatment. Comparison of the first study period (first course of LW 50020 and drug-free interval) with the second study period (second course of LW 50020 and follow-up) showed an overall reduction of at least 50% in the number, severity, and duration of respiratory tract infections, the number of antibiotic and symptomatic treatments, and the number of days absent from school or work. Tolerability and acceptability were assessed as good or very good in 99% of patients who completed the study.

Adjuvants, Immunologic↗
PubMed2002

Patient compliance with antibiotic treatment for respiratory tract infections.

Despite doctors' expectations, non-compliance is common in short-term antibiotic therapy of respiratory tract infections (RTIs). This phenomenon has profound practical implications. It leads to ineffective management, the deterioration of patients' health, hospital admissions, additional costs and the emergence of antibiotic-resistant microorganisms. This article reviews methods of measuring compliance with antibiotics in the outpatient-based management of RTIs and research results. Causes of non-compliance are also discussed. Factors influencing compliance are analysed, as well as practical strategies for addressing non-compliance with antibiotic therapies for RTIs. The influence of the frequency of doses on compliance is particularly stressed, as it has been observed that once daily dosing has almost a 100% compliance rate. As a number of once-daily antibiotic preparations are available now, the possibility of using once-daily schedules for improving compliance in RTI cases is stressed.

Anti-Bacterial Agents↗
PubMed1988

Childhood asthma: prevention of attacks with short-term corticosteroid treatment of upper respiratory tract infection.

In this study, the potential for short courses of glucocorticoids to prevent or reduce the severity of asthma induced by viral respiratory infections in preschool children was investigated. Two groups of children with a mean age of 36.4 +/- 3.9 months and 40.4 +/- 4.9 months were monitored during a 2-year period. Group 1, considered as the control group, received theophylline preparations and orciprenaline either on a continuous basis or during attacks. During severe attacks, albuterol was administered by nebulization, with corticosteroids occasionally added for seven to 14 days in cases of poor response to albuterol. Group 2 received the same treatment during the first year. During the second year, however, a short-term course of prednisone (1 mg/kg) was given as soon as the first symptoms of an upper respiratory tract infection appeared, prior to any signs of wheezing. Results indicate that, whereas morbidity remained constant in the control group during the 2-year observation period, a significant decrease in the number of wheezing days (65%), attacks (56%), visits to the emergency room (61%), and hospitalizations (90%) occurred in group 2. It was concluded that preschool children who suffer from repeated asthma attacks related to upper respiratory tract infections may benefit greatly from the preventive administration of corticosteroids.

Albuterol↗
PubMed1999

[Resistance against oral antibiotics to Streptococcus pneumoniae isolated from adult respiratory tract infections].

The resistance against oral antibiotics to Streptococcus pneumoniae (S. pneumoniae) isolated from adult patients with respiratory tract infections in the Kurume area in 1998 was studied. The frequency of resistant strains, which were isolated penicillin-intermediate S. pneumoniae and resistant S. pneumoniae (PISP, PRSP) were both 41.2%. We examined the minimal inhibitory concentrations (MIC) of oral antibiotics and the susceptibility ratio of the strains for the drugs based on the breakpoint MIC. The breakpoint MIC of pneumonia against oral beta-lactam antibiotics to PISP, PRSP, which were determined by Japan Society of Chemotherapy, were high in the order of FRPM > CDTR, CFPN > CFTM > CFDN, CPDX. In the case of the new oral quinolones, DU6859a > SPFX > LVFX > CPFX showed good results, in this order, DU6859a showed the most significant inhibitory effect to PISP, PRSP (MIC90 0.06 microgram/ml). By serotyping the percentage of 19, 6, 23 was 42.9%, 21.4% and 14.3%.

Adult↗
PubMed2000

[Clinical and experimental study on Shuanghua aerosol in treating infantile upper respiratory tract infection].

OBJECTIVE: To study the effect and mechanism of Shuanghua aerosol (SHA) in treating infantile upper respiratory tract infection (IURTI). METHODS: In the clinical study, 276 cases of IURTI were randomly divided into two groups. The treated group was treated with SHA and the control group was treated with Shuanghuanglian aerosol (SHLA). In the experimental study, the effect of SHA on anti-inflammatory and anti-viral were observed. RESULTS: The clinical total effective rate of SHA was 99.03% and its cure rate 65.38%, while those of the SHLA was 94.11% and 44.12% respectively, significant difference was shown between the two groups (P < 0.01). Experimental study showed that SHA could inhibit the xylol induced ear swelling and the egg white induced paw swelling in mice obviously, suppress the proliferation of influenza virus in rat's lung. CONCLUSION: SHA has obvious anti-inflammatory and anti-viral effect, and has good curative effect in treating IURTI.

Administration, Inhalation↗
PubMed1994

[beta-lactamase activity in sputum of patients with community-acquired lower respiratory tract infections].

beta-Lactamase production and activities in sputa of patients with community-acquired lower respiratory tract infections (LRTI) were determined and following results were obtained: 1) Suspected causative organisms frequently isolated were H. influenzae and Streptococcus pneumoniae. Similar results were previously reported. 2) Various beta-lactamase producing indigenous bacteria were detected. In many cases these indigenous beta-lactamase producing strains were isolated even when suspected causative bacteria were not beta-lactamase producers. 3) beta-Lactamase activities were detected from 61.5% of the sputa tested. Remaining activities of antibiotics added to the sputa were highly correlated with detection of beta-lactamases produced by suspectedly causative and indigenous strains and with presence of beta-lactamase activities in the sputa. Sulbactam/cefoperazone was stable in sputa than other antibiotics tested. 4) We concluded that the beta-lactamase produced by indigenous strains can be one of the factors of indirect pathogenicity in the community-acquired LRTI.

Cefoperazone↗
PubMed2005

Antimicrobial activity of tigecycline tested against organisms causing community-acquired respiratory tract infection and nosocomial pneumonia.

Emerging antimicrobial resistance among respiratory tract pathogens has created a critical need for development of new antimicrobial agents that are not affected by the commonly occurring genetic resistance mechanisms. Tigecycline, a novel broad-spectrum parenteral glycylcycline, has been shown to be active against many of Gram-positive, Gram-negative, atypical, and anaerobic organisms, including strains highly resistant to commonly prescribed antimicrobials and was recently approved by the US Food and Drug Administration for treating infections of skin and skin structures, and for intra-abdominal infections. In this study, tigecycline spectrum and potency were evaluated against a global collection of pathogens (2000-2004) recovered from community-acquired respiratory infections (7580 strains) or from hospitalized patients with pneumonia (3183 strains). Among community-acquired infections, the ranking pathogens were Haemophilus influenzae (52.9%; 21% ampicillin-resistant), Streptococcus pneumoniae (39.2%; 23.7% penicillin-nonsusceptible), and Moraxella catarrhalis (7.9%). Tigecycline displayed potent activity by inhibiting 100% of the 3 species at clinically achievable concentrations (2, 1, and 0.5 microg/mL, respectively). The 10 most prevalent pathogens producing 94.3% of pneumonias in hospitalized patients were Staphylococcus aureus (48.5% of strains; 49.4% oxacillin-resistant), Pseudomonas aeruginosa (15.6%), Klebsiella spp. (5.6%), S. pneumoniae (4.6%), Acinetobacter spp. (4.5%), Enterobacter spp. (4.0%), Escherichia coli (3.8%), Serratia marcescens (2.5%), Enterococcus spp. (2.3%), Stenotrophomonas maltophilia (1.8%), and beta-hemolytic streptococci (1.1%). At a concentration of 4 microg/mL, tigecycline inhibited >96% of these pathogens (exception, P. aeruginosa). S. aureus was readily inhibited by tigecycline (MIC50 and MIC90, 0.25 and 0.5 microg/mL, respectively) with all strains inhibited at < or =1 microg/mL. Streptococci recovered from hospitalized patients (beta-hemolytic and S. pneumoniae) were also very susceptible to tigecycline with the highest MIC being 0.12 microg/mL. All E. coli (including 13.3% with an extended-spectrum beta-lactamase [ESBL] phenotype) were inhibited by < or =1 microg/mL, and all Klebsiella (25.8% ESBL phenotype) and Enterobacter spp. plus 97.0% of Serratia spp. were inhibited by < or =4 microg/mL. Tigecycline was also active against Acinetobacter spp. and S. maltophilia strains (MIC50 and MIC90, 1 and 4 microg/mL, respectively). Further clinical studies should consider the role that tigecycline may play in the therapy for severe respiratory tract infections, both of nosocomial and community origin.

Anti-Bacterial Agents↗
PubMed2002

The safety of azithromycin in the treatment of adults with community-acquired respiratory tract infections.

The comparative safety of azithromycin was assessed in adult patients (> or =12 years) with community-acquired respiratory tract infections. Of 3229 patients evaluated, 1616 received azithromycin 500 mg once daily for 3 days and 1613 received standard regimens of amoxycillin, amoxycillin/clavulanic acid, cefaclor, clarithromycin, or roxithromycin. A similar incidence of treatment-related adverse events occurred with azithromycin (10.3%) and comparators (11.5%). Significantly fewer patients were withdrawn from azithromycin than comparator treatment (0.4 versus 2.1%; P=0.0001). Most adverse events were mild/moderate in intensity and affected the gastrointestinal system. Azithromycin was as well tolerated as other antibiotics commonly used for bacterial infections in adults.

Adult↗
PubMed1990

Pefloxacin in lower respiratory tract infections.

To determine the efficacy and safety of pefloxacin in the treatment of lower respiratory tract infections, a multicentre trial involving four departments of respiratory diseases was performed. One hundred and eight patients were admitted to the study: most of them were affected with exacerbations of chronic bronchitis or with pneumonia complicating lung cancer. Isolation and identification of responsible microorganisms from bronchial secretions was possible in 78 patients. Seven patients were withdrawn, one for worsening of the underlying disease and six for early side-effects. Thus, of 108 patients recruited, 101 completed the course of therapy (pefloxacin 400 mg bd for 5-14 days) and could be submitted to final evaluation. Of these 43 (42.6%) were cured and 48 (47.5%) showed improvement. Eradication of responsible microorganisms was achieved in 70 (90.9%) of 77 patients microbiologically evaluated. Side-effects of moderate severity were observed in 12 patients (gastrointestinal disturbances in 11 and dyspnoea in one); these did not necessitate discontinuation of therapy.

Administration, Oral↗
PubMed2004

Antibiotics for lower respiratory tract infections. Still too frequently prescribed?

OBJECTIVE: To examine how Canadian family physicians currently prescribe for lower respiratory tract infections (LRTIs). DESIGN: Prospective assessment of adults with symptoms of LRTIs. SETTING: Offices of 120 community-based members of the College of Family Physicians of Canada. PARTICIPANTS: Four hundred seven adults (16 years and older). MAIN OUTCOME MEASURES: Clinical findings, diagnoses, tests ordered, and prescriptions for antibiotics were documented on a standardized form. RESULTS: Antibiotics were prescribed to 58.4% of patients presenting with symptoms of LRTIs. Prescribing was higher (77.9%) for those diagnosed with acute bronchitis, which accounted for 70.3% of prescriptions. Physicians were often uncertain about the need for antibiotics, were concerned that patients could become sicker, and felt pressured by patients to prescribe antibiotics. Macrolides were most frequently prescribed; no tests were ordered in 85.0% of encounters. CONCLUSION: The number of antibiotic prescriptions for adults with LRTIs remains high in Canada. Rates of prescribing are increased by diagnosis of acute bronchitis, clinical uncertainty, pressure from patients to receive antibiotics, and concern that patients will deteriorate if left untreated.

Acute Disease↗
PubMed1981

Azlocillin and gentamicin in respiratory tract infections with Pseudomonas aeruginosa in patients with cystic fibrosis.

Azlocillin, 200 mg/kg bodyweight every 8 h, and gentamicin, 2.5-4 mg/kg bodyweight every 12 h, in combination were given intravenously to 10 patients with cystic fibrosis for at least 10 days. The patients were colonized with Pseudomonas aeruginosa and were hospitalized due to symptoms of lower respiratory tract infections. Using an agar well diffusion method the antibiotic concentrations were followed in serum and sputum. The individual sputum concentration of azlocillin varied during 4 h after administration from less than 1.5 to 38 micrograms/ml. The sputum concentration of gentamicin varied from 0.3 to 1.1 micrograms/ml. P. aeruginosa was apparently eliminated in 3 patients. The concentration of the antibiotics in sputum could not predict the outcome of treatment. All patients improved subjectively. No adverse effect was seen.

Adolescent↗
PubMed1997

Moraxella (Branhamella) catarrhalis adherence to human bronchial and oropharyngeal cells: the role of adherence in lower respiratory tract infections.

To study the role of Moraxella (subgenus Branhamella) catarrhalis (B. catarrhalis) adherence to airway cells in lower respiratory tract infections, the in vitro attachments of B. catarrhalis to upper airway (oropharyngeal) and lower airway (bronchial) epithelial cells were compared. The adherence of 4 strains (1 nonfimbriated and 3 fimbriated) of B. catarrhalis to respiratory tract epithelial cells collected from 11 patients with chronic pulmonary disease (CPD) and 11 healthy individuals was evaluated. Both the fimbriated and nonfimbriated strains showed increased attachment to oropharyngeal cells in the CPD patients (mean +/- SEM; 25.0 +/- 3.2/cell; P < 0.01) when compared to the control subjects (12.1 +/- 1.1/cell). On the average, the attachment to bronchial cells was 6.1 to 13.6 times greater per surface area (bacteria/micron2) than the attachment to oropharyngeal cells. The fimbriated strains tended to adhere in higher numbers to bronchial cells (19.0 +/- 1.8/cell) than the nonfimbriated strain (8.7 +/- 1.2/cell), although there was no difference between the CPD and control groups. In conclusion, the attachment of B. catarrhalis to oropharyngeal cells may be an enhancing factor for colonization in the upper respiratory tract in patients with CPD, and elevated adherence of the bacteria to bronchial cells may suggest pathogenic importance when mucociliary function is impaired.

Adult↗
PubMed2004

Clinical usefulness of bronchoalveolar lavage in heart transplant recipients with suspected lower respiratory tract infection.

BACKGROUND: Bronchoscopy with bronchoalveolar lavage (BAL) is the recommended initial invasive diagnostic procedure when lower respiratory tract infection is suspected in solid-organ transplant recipients. In this study, we evaluated the clinical impact and safety of bronchoscopy with BAL in heart transplant recipients. METHODS: We reviewed all 44 consecutive diagnostic bronchoscopies with BAL that were performed in 35 heart transplant recipients at Helsinki University Central Hospital between May 1988 and December 2001. RESULTS: Bronchoscopy findings established specific microbiologic diagnoses in 18 of 44 (41%) cases, and 14 of 44 (32%) bronchoscopic findings led to changes in therapy. The diagnostic yield of bronchoscopy from 1 to 6 months after transplantation was 73%, significantly better (p = 0.002) than diagnostic yield during the first month (18%) and after 6 months (28%). Pneumocystis carinii and cytomegalovirus were the most frequently detected pathogens in the BAL fluid. Cytomegalovirus pneumonia carried a high mortality rate (44%), whereas all patients with P carinii pneumonia recovered. Fourteen episodes were diagnosed as bacterial pneumonia, but because of empiric antibiotic therapy that was started widely before bronchoscopy, a microbiologic diagnosis was established in only 1 case. However, all patients with community-acquired pneumonia responded to empiric therapy. Four cases of major complications occurred after bronchoscopy, all cardiovascular but none fatal. CONCLUSIONS: Bronchoscopy with BAL is a useful diagnostic tool in heart transplant recipients, especially between 1 and 6 months after transplantation.

Adolescent↗