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Query: UMLS:C0032285 (pneumonia)
 54,520 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The authors studied the frequency of sinusitis in nasotracheally intubated patients in an Intensive Care Unit. All patients intubated nasotracheally during an 8 day period were included in a prospective study which included CT scanning with views of all the paranasal sinuses. Sinusitis was defined as opacification of the sinus with an air-fluid level. Transantral punctures were performed in cases of maxillary sinusitis. Fifty-three patients were included. Local symptoms and/or unexplained fever were present in 22% of cases. CT scanning showed sinusitis in 49 of the 53 cases (pansinusitis 42 cases, maxillary alone 5 cases, sphenoidal 16 cases). Bacteriological cultures of sinus punctures were positive in 39 cases, monomicrobial in 21 and polymicrobial in 18 cases. Twenty of the 53 patients developed a lower respiratory tract infection with the same germ and 10 developed septicemia (3 with isolated sinusitis and 7 with pneumonia). Eighteen patients died (6 of their infection and 12 of the underlying disease). This study shows the high frequency of bacterial sinusitis and the necessity of sinus puncture for bacteriological identification of the causal organism to adapt antibiotic therapy.
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PMID:[Nosocomial sinusitis and nasotracheal intubation. Prospective study of 53 patients]. 274 57

Anti-neutrophil cytoplasmic antibody (ANCA) determinations appear to be useful in the diagnostic evaluation and therapeutic monitoring of patients with necrotizing vasculitis. The purpose of this study was to determine whether semiquantitative ANCA measurements are useful in distinguishing between increases in primary disease activity and complications of cytotoxic or immunosuppressive therapy. The authors reviewed clinical data from 27 consecutive ANCA-positive patients who had at least three ANCA determinations performed at the University of Michigan Medical Center. Eleven patients had Wegener's granulomatosis (WG), 3 had "limited" WG; 9 had "ANCA-positive" vasculitis; and 4 had "pauciimmune" rapidly progressive glomerulonephritis. During a period of 3 months to 3.8 years, 159 ANCA determinations were performed, primarily for the purposes of diagnosis and monitoring disease activity. Eleven episodes were identified in which a single ANCA assay was used to distinguish between increased primary disease activity and a suspected therapeutic complication. The suspected therapeutic complications included pneumonia (8 of 11), bacterial sinusitis (1 of 11), cyclophosphamide-induced pneumonitis (1 of 11), and cyclophosphamide-induced vestibular toxicity (1 of 11). In 10 of 11 instances in which an ANCA assay was used to distinguish between an exacerbation in vasculitic disease activity and a therapeutic complication, interpretation of the ANCA titer was pivotal in arriving at a therapeutically appropriate decision either to increase or discontinue cytotoxic therapy. This study suggests that ANCA determinations can be used reliably to distinguish between increased primary disease activity and complications of therapy that mimic an increase in disease activity.
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PMID:Use of anti-neutrophil cytoplasmic antibody assay to distinguish between vasculitic disease activity and complications of cytotoxic therapy. 794 22

Streptococcus pneumoniae is the most common cause of pediatric invasive infections and an important cause of morbidity and mortality. In the past, S. pneumoniae responded universally to penicillin until nonsusceptible isolates were first noted in the 1960s. Before 1990, penicillin-nonsusceptible isolates remained a minor component of all reported isolates. Since that time, 20-30% of isolates in many centers in the United States and up to 50% of isolates in some other countries are penicillin-nonsusceptible. Of greater concern has been the development of isolates which are nonsusceptible to more than one antimicrobial agent. This review presents data on pediatric invasive pneumococcal disease in Arkansas and outlines the new treatment recommendations which have been developed in response to these problems. Streptococcus pneumoniae is an important pathogen worldwide and is considered the most common etiology of bacterial sinusitis, otitis media, pneumonia, meningitis and bacteremia. Before 1990, 95-96% of pneumococcal isolates were susceptible to penicillin. The first report of penicillin-nonsusceptible S. pneumoniae was made by Hansman and Bullen in 1967, who identified the strain in the sputum of a patient with hypogammaglobulinemia. Soon thereafter, penicillin-nonsusceptible pneumococci were reported in New Guinea and Australia as well. Over the last several years, the incidence of penicillin-nonsusceptible isolates has greatly increased. Of particular concern is the concomitant increase in the number of organisms that are nonsusceptible to more than one antimicrobial agent. Due to the development of such isolates, clinicians are having to approach patients with invasive disease due to pneumococci more cautiously. In an attempt to clarify confusion with terminology, the Centers for Disease Control and Prevention (CDC) have recommended the same nomenclature be used to classify resistance for all organisms: nonsusceptible organisms are those with an MIC (minimal inhibitory concentration) greater than or equal to that defined for the intermediate category of resistance and the term resistant should be reserved for those organisms with an MIC greater than or equal to that defined for the resistant category. Therefore, resistant isolates are a subgroup of the nonsusceptible isolates.
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PMID:The approach to treatment of invasive pneumococcal disease in the 1990s. 939 28

This therapeutic review discusses the pharmacology, pharmacokinetics, in vitro activity, drug interactions, and adverse effects of levofloxacin, a fluoroquinolone antibiotic. Particular emphasis is placed on the clinical efficacy of levofloxacin and its place in therapy. Compared with ciprofloxacin and the earlier quinolone agents, levofloxacin has an improved pharmacokinetic profile that allows convenient once-daily dosing in either an oral or parenteral formulation. Levofloxacin has enhanced activity against gram-positive aerobic organisms, including penicillin-resistant pneumococci. In published comparative trials involving commonly used treatment regimens, levofloxacin had equivalent if not greater activity in the treatment of community-acquired pneumonia, acute bacterial exacerbations of chronic bronchitis, acute bacterial sinusitis, acute pyelonephritis, and complicated urinary tract infection. Levofloxacin is well tolerated and induces minimal adverse drug reactions. Based on the above attributes, it may be reasonable to include levofloxacin on the hospital formulary in place of older quinolones. More recently released quinolones such as trovafloxacin exhibit similar advantages; however, until direct comparative trials between levofloxacin and these newer agents are conducted, it is difficult to advocate one agent over another. Regardless of which quinolone is the primary agent on the formulary, it is imperative that this class of antimicrobial drugs be used with discretion to minimize the development of resistance.
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PMID:Levofloxacin: a therapeutic review. 991 2

Thirty children in the age group of 2 to 12 years were brought with a history of recurrent non-seasonal moderate to severe wheezy episodes associated with symptoms of nasal congestion, sneezing and occasional headache. All of them had maxillary or pan sinusitis with 26 having associated right, left or bilateral lower lobe pneumonitis or bronchiectasis. Serum immunoglobulins were normal in 22 and was not done in eight. There was positive (2 to 4+ above negative control) skin test response to dust and dust mite in 15 of the 22 children tested. Throat swabs/sputum or nasal secretions grew B-hemolytic streptococcus or streptococcus pneumoniae in twenty-seven. All the children were put on bactericidal drugs for 6 to 8 weeks and bronchodilators were used when needed. At the end of 6 to 8 weeks follow-up X-ray of sinuses and chest showed significant clearing of the lesions which coincided with marked clinical improvement. Sinus X-ray should be considered in bronchial asthma resistant to medical management since untreated bacterial sinusitis can be an underlying cause of chronic poorly controlled asthma.
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PMID:Sino-bronchial syndrome in children with asthma. 1083 76

Respiratory tract infections (RTIs) are the most common, and potentially most severe, of infections treated by health care practitioners. Lower RTIs along with influenza, are the most common cause of death by infection in the United States. Risk factors for pneumonia and other respiratory tract infections include: extremes of age (very young and elderly), smoking, alcoholism, immunosuppression, and comorbid conditions. The microbial cause of RTIs vary depending on the infection (i.e., pneumonia compared with acute bacterial sinusitis), setting (i.e., community-acquired compared with nosocomial), and other factors. The causative pathogens associated with CAP have changed in prevalence over time. Although Streptococcus pneumoniae remains the most common causative pathogen, a number of newer pathogens, such as Chlamydia pneumoniae and sin nombre virus, have been recognized in recent years. The emerging antimicrobial resistance of respiratory pathogens (most notably S. pneumoniae) has also increased the challenge for appropriate management of RTI. An awareness of the epidemiology and cause of specific respiratory infections should optimize care.
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PMID:The epidemiology of respiratory tract infections. 1105 19

The activity, pharmacokinetics, pharmacodynamics, efficacy, safety, drug interactions, and dosage and administration of moxifloxacin are reviewed. Moxifloxacin is an oral 8-methoxyquinolone antimicrobial approved in December 1999 for use in the treatment of acute bacterial sinusitis, acute bacterial exacerbations of chronic bronchitis, and community-acquired pneumonia. This fluoroquinolone is active against common community-acquired respiratory pathogens (Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis), atypical pathogens, and many anaerobes. Moxifloxacin has an absolute bioavailability of 90% after oral administration and a mean elimination half-life of 12 hours. The drug is not a substrate or inhibitor of the hepatic cytochrome P-450 isoenzyme system thereby avoiding many potential drug interactions. Moxifloxacin has limited phototoxic potential. In clinical trials, moxifloxacin had clinical success rates of 88-97% and bacteriologic eradication rates of 90-97%. Reported adverse effects were primarily gastrointestinal (nausea, diarrhea) and were mild to moderate in severity. Moxifloxacin prolongs the QT interval by a mean + S.D. of 6 +/- 26 milliseconds above baseline and should be used with caution in patients with proarrhythmic conditions and avoided in patients receiving antiarrhythmia agents, such as quinidine, procainamide, amiodarone, and sotalol. The standard oral dosage is 400 mg once a day. Dosage adjustment is unnecessary in patients with renal dysfunction or mild to moderate hepatic dysfunction. Moxifloxacin is a safe and effective antimicrobial that will be useful for treating acute sinusitis, acute bacterial exacerbations of chronic bronchitis, and community-acquired pneumonia.
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PMID:Moxifloxacin: clinical efficacy and safety. 1125 73

Respiratory tract infections (RTIs), the most common indication for outpatient antimicrobial therapy, impose a heavy medical and societal burden and present a difficult therapeutic challenge in the face of increasing pathogen resistance worldwide. Gatifloxacin is a new broad-spectrum fluoroquinolone with excellent activity against prevalent respiratory bacteria, including penicillin-resistant Streptococcus pneumoniae and atypical pathogens. A multicenter, open-label, noncomparative surveillance study carried out in Mexico evaluated the safety and efficacy of oral gatifloxacin 400 mg once daily in 17,923 adult outpatients with community-acquired pneumonia (CAP) (n = 3322), acute exacerbations of chronic bronchitis (AECB) (n = 5885), and acute bacterial sinusitis (n = 8716). Voluntary, unpaid physician participation contributed to an unbiased study design. Physician-assessed global rate of cure or improvement was 96.3%; efficacy was 95.8% in CAP, 96.1% in AECB, and 96.4% in sinusitis. The incidences of relapse (1.5%) and therapeutic failure (0.7%) were low. The most commonly reported adverse events, nausea (2.76%), headache (2.20%), and dizziness (1.33%), were generally mild and self-limited. Oral gatifloxacin 400 mg once daily is effective and safe for patients with CAP, AECB, and acute sinusitis.
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PMID:Multicenter evaluation of the efficacy and safety of gatifloxacin in Mexican adult outpatients with respiratory tract infections. 1131 29

The ketolide telithromycin (HMR-3647; Ketek), a derivative of clarithromycin, has been launched by Aventis Pharma (formerly Hoechst Marion Roussel) for the treatment of respiratory tract infections with gram-positive or gram-negative cocci, Haemophilus influenzae, Streptococcus pneumoniae, Moraxella catarrhalis, intracellular pathogens, atypical microorganisms, toxoplasma or anaerobic bacteria. By May 2001, filings in the US and EU had been completed and a filing in Japan was expected to take place in the fourth quarter of 2001. In July 2001, telithromycin was granted marketing authorization by the EC for the treatment of community-acquired respiratory tract infections, including those caused by bacteria resistant to commonly used antibiotics. In October 2001, the product was launched in Germany. In March 2000, telithromycin was submitted to the US FDA and the EMEA, under the EU centralized approval procedure, for approval for the treatment of community-acquired pneumonia (CAP), acute sinusitis, acute exacerbations of chronic bronchitis and tonsillitis/pharyngitis. The company had expected to launch the product in early 2001. The CPMP issued a positive opinion for all four indications on April 23 2001. In September 2001, the company indicated that it expected the product to be launched in Japan in 2002. The FDA's Anti-infectives Advisory Committee was due to review telithromycin for all the submitted indications on January 29 2001; however, this was postponed. This postponement was thought to be at Aventis' request in order to discuss the potential for a resistant pneumococcal infection labeling which would boost product sales. The revised date for the meeting was April 26 2001, at which the Anti-Infective Drugs Advisory Committee of the FDA recommended approval of telithromycin for the treatment of CAP in patients 18 years of age or older. The committee failed to recommend approval for the use of the drug for the remaining three indications for which it was filed, citing concerns over potential cardiovascular risk and liver toxicity; at this time, the company was in active discussions with the FDA regarding approval of the remaining three indications. An approvable letter for CAP, acute bacterial exacerbations of chronic bronchitis and acute bacterial sinusitis was received by the company in June 2001; Aventis also received a non-approvable letter for the treatment of tonsillitis/pharyngitis at this time. In April 1999, ABN Amro predicted annual sales of DM 50 million in 2001, rising to DM 100 million in 2002. In February 1999, Lehman Brothers estimated a 70% probability that this ketolide would come to market. The analysts also estimated a launch date of 2001, with peak sales of US $700 million in 2009. Analysts Merrill Lynch predicted in September 200, that the product would be launched by 2001, with sales of euro 50 million in that year, rising to euro 284 million in 2004. Deutsche Bank predicted in August 2001, that sales of the product would reach euro 5 million in 2001, rising to euro 300 million in 2005. Analysts at Merrill Lynch predicted in November 2001, that the product would be resubmitted in the US in mid-2002, and would make sales of US $5 million in 2001, rising to US $250 million in 2004.
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PMID:Telithromycin. Aventis Pharma. 1189 30

The common respiratory tract infections of acute bacterial sinusitis, acute exacerbation of chronic bronchitis, and community-acquired pneumonia are responsible for millions of physician office visits every year. Despite advances in diagnostic testing and the development of new antimicrobial agents, these infections continue to contribute significantly to patient morbidity and mortality worldwide. Physicians are faced with multiple challenges in the management of patients with these diseases. These challenges include the selection of appropriate empiric therapy, the increasing emergence of resistant pathogens, patient noncompliance with therapeutic regimens, and the pressure to use cost-effective agents. Patients expect their antibiotics to work rapidly so that they can feel better quickly and return swiftly to their normal activities. Moxifloxacin has been developed to address many of these problems. Its efficacy has been demonstrated in an extensive clinical trial program the results of which are summarized below. The excellent pharmacokinetics and pharmacodynamics of moxifloxacin are covered elsewhere in this supplement, as is moxifloxacin's impressive safety and tolerability profile. Accordingly, this paper focuses on the clinical trial data currently available.
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PMID:Improving care for patients with respiratory tract infections. 1200 37


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