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Because Streptococcus pneumoniae is the most commonly isolated community-acquired respiratory tract pathogen, the reports of high rates of antibiotic resistance throughout the world highlight the need for intervention to stem any further increases in resistance. Efforts to reduce the incidence of pneumococcal resistance have been mainly 2-fold, involving attempts to reduce unnecessary antibiotic prescribing, as well as to assure early childhood immunization with the pneumococcal heptavalent conjugate vaccine. To reduce unnecessary prescribing for infections that are typically viral in etiology, such as acute bronchitis, education efforts have been focused not only on clinicians but also on parents and patients. These education efforts significantly reduce unnecessary antibiotic prescribing, and initial evidence suggests that they may stabilize, if not reduce, the incidence of penicillin and macrolide-resistant pneumococcal isolates. Utilization of the relatively new pneumococcal heptavalent conjugate vaccine not only reduces the incidence of acute otitis media caused by pneumococcal serotypes included in the vaccine as well as disease caused by related serotypes but also has a highly significant effect on reducing the incidence of invasive pneumococcal disease in children and potential adult contacts. In addition more recent data have established that vaccination is also decreasing the carriage and transmission of antibiotic-resistant pneumococcal isolates. Education and vaccine programs that attempt to stabilize and/or reduce the rate of pneumococcal resistance are at least as important as having effective antibiotic treatments for pneumococcal disease. These efforts to address pneumococcal resistance have been highly successful to date.
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PMID:Pneumococcal resistance in perspective: how well are we combating it? 1477 75

We used a new polymerase chain reaction (PCR) system to identify the 16S rRNA gene of Mycoplasma pneumoniae and to diagnose lower respiratory tract infections caused by the microorganism. Nasopharyngeal swabs collected from 21 patients (22 episodes) tested positive for M. pneumoniae with the PCR. The age distribution of the patients was between 2 and 13 years. The diagnosis, including concomitant infection, was as follows: pneumonia (n = 11), acute bronchitis (n = 10), bronchial asthma (n = 4), and acute otitis media (n = 1). Six patients had bacterial superinfections. Positive findings for M. pneumoniae were noted together with exacerbation of asthma symptoms, suggesting that M. pneumoniae infection may play the role of an inducer. The PCR system constructed by us will contribute to revealing the clinical features of M. pneumoniae infection, and as a result, an appropriate chemotherapeutic agent can be chosen. We propose the usefulness of this PCR system to detect the microorganism in younger children.
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PMID:Characterization of children with Mycoplasma pneumoniae infection detected by rapid polymerase chain reaction technique. 1499 24

From July 1999 to June 2004, we evaluated Streptococcus pneumoniae bacteremia in 40 children in Kamikawa and Soya Subprefectures in Hokkaido by obtaining the patient's information from 7 out of 9 hospitals in the area. The incidences of S. pneumoniae bacteremia in children aged < 2 years and < 5 years were 79.1 and 63.4. Median age was 19.6 months with a range from 4 months to 4 years. Thirty-one (77.5%) of the total were less than 2 years old. All of the children were admitted. The diagnoses were occult bacteremia in 12 patients, pneumonia or bronchitis in 11, pharyngitis in 7, pneumonia and acute otitis media in 5, acute otitis media in 3, orbital cellulitis in 1, and arthritis in 1. All of the patients had fever and temperatures and 35 (87.5%) of them were more than 39 degrees C. Ten patients had a febrile convulsion. Twenty-nine had a high total white blood cell counts (> 15,000/microg/ml) and 31 had positive CRP values (> 0.6 mg/dl) on admission. Meningitis and poor prognosis did not occur after occult bacteremia in our patients. We studied the susceptibility to penicillin G in 22 strains of S. pneumoniae isolated from the children. One and 18 strains were penicillin-resistant (MIC > or = 2.0 microg/ml) and intermediate (MIC 0.1-1.0 microg/ml).
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PMID:[Study of Streptococcus pneumoniae bacteremia in children]. 1571 76

Acute upper respiratory infections are one of the main causes of office visits in family practice worldwide. If antimicrobial drugs were used judiciously, it is estimated that 50 million of these prescriptions could be avoided. The vast majority of acute rhinopharyngitis (common cold) and acute sinusitis cases are resolved without using antibiotics. Acute otitis media must be distinguished from otitis media with effusion: the former may be successfully treated, in many cases, without prescribing antibiotics, while the latter does not improve with antimicrobial drug use unless its evolution was > 3 months. Acute pharyngitis is better treated if considered as an odynophagia syndrome, employing clinical criteria to distinguish cases that need antimicrobial drug prescription. Acute bronchitis does not improve significantly by utilizing antimicrobial drugs. Drugs from the quinolones group are not a choice for treating acute upper respiratory infections.
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PMID:[Antimicrobial use in acute upper respiratory infections in family medicine]. 1613 60

Upper respiratory tract infections (URTIs) are mostly caused by viruses. Antibiotic misuse for viral URTIs in children is a serious problem that not only results in selection of resistant strains of bacteria but also wastes millions of dollars each year in Taiwan. Antibiotic resistance among common respiratory bacterial pathogens such as Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, and Moraxella catarrhalis has become a major issue for public health. The common cold, acute pharyngotonsillitis, acute otitis media, acute sinusitis, acute bronchitis, influenza and acute epiglottitis are the most frequently encountered acute URTIs in out-patient clinics. This article recommends the judicious use of antimicrobial agents for these seven common pediatric URTIs, based on local epidemiological data and the recommendations of the Infectious Disease Society of Taiwan and the American Academy of Pediatrics. With education and behavior modification, practitioners will help to reduce antibiotic overuse, and the goal of reducing antimicrobial resistance may be accomplished.
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PMID:Use of antimicrobial agents for upper respiratory tract infections in Taiwanese children. 1642 81

There is increasing evidence that antibiotics have limited value for many respiratory illnesses. This study investigates changes in overall antibiotic prescribing rates, and rates for specific conditions, by Australian general practitioners (GPs) between 1990-91 and 2002-03. This is a comparative study of two cross-sectional surveys of general practice activity, the Australian Morbidity and Treatment Survey (AMTS) 1990-91 and Bettering Evaluation and Care of Health (BEACH) 2002-03. Both studies used random samples of GPs, each providing data about a cluster of patient encounters. Outcome measures are the antibiotic prescribing rate per 100 encounters or per 100 selected problems managed. Between 1990-91 and 2002-03, the overall antibiotic prescribing rate decreased 24.3% from 18.9 prescriptions per 100 encounters to 14.3 (P<0.001). For children, the decrease for acute upper respiratory tract infection (URTI) was from 39.0 per 100 URTI problems to 24.4 (P<0.001), while the antibiotic prescribing rate increased for acute otitis media, decreased for bronchitis/bronchiolitis, and remained unchanged for other respiratory problems analysed. For adults the antibiotic prescribing rate for URTI decreased from 58.2 per 100 URTI problems to 40.0 (P<0.001), increased significantly for sinusitis and remained unchanged for all other respiratory problems. Antibiotic prescribing decreased significantly between 1990-91 and 2002-03 but the decrease was selective. The decline has been more pronounced among children than adults, and particularly for URTI. While the message of educators may be achieving its goal for URTI, other approaches targeting specific respiratory problems may be required to reduce antibiotic prescribing in these areas.
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PMID:Antibiotic prescribing in Australian general practice: how has it changed from 1990-91 to 2002-03? 1661 83

Human rhinoviruses (HRV), members of the Picornaviridae family, are comprised of over 100 different virus serotypes. HRV represent the single most important etiological agents of the common cold [Arruda, E., Pitkaranta, A., Witek Jr., T.J., Doyle, C.A., Hayden, F.G., 1997. Frequency and natural history of rhinovirus infections in adults during autumn. J. Clin. Microbiol. 35, 2864-2868; Couch, R.B., 1990. Rhinoviruses. In: Fields, B.N., Knipe, D.M. (Eds.), Virology. Raven Press, New York, pp. 607-629; Turner, R.B., 2001. The treatment of rhinovirus infections: progress and potential. Antivir. Res. 49 (1), 1-14]. Although HRV-induced upper respiratory illness is often mild and self-limiting, the socioeconomic impact caused by missed school or work is enormous and the degree of inappropriate antibiotic use is significant. It has been estimated that upper respiratory disease accounts for at least 25 million absences from work and 23 million absences of school annually in the United States [Anzueto, A., Niederman, M.S., 2003. Diagnosis and treatment of rhinovirus respiratory infections. Chest 123 (5), 1664-1672; Rotbart, H.A., 2002. Treatment of picornavirus infections. Antivir. Res. 53, 83-98]. Increasing evidences also describe the link between HRV infection and more serious medical complications. HRV-induced colds are the important predisposing factors to acute otitis media, sinusitis, and are the major factors in the induction of exacerbations of asthma in adults and children. HRV infections are also associated with lower respiratory tract syndromes in individuals with cystic fibrosis, bronchitis, and other underlying respiratory disorders [Anzueto, A., Niederman, M.S., 2003. Diagnosis and treatment of rhinovirus respiratory infections. Chest 123 (5), 1664-1672; Gern, J.E., Busse, W.W., 1999. Association of rhinovirus infections with asthma. Clin. Microbiol. Rev. 12 (1), 9-18; Pitkaranta, A., Arruda, E., Malmberg, H., Hayden, F.G., 1997. Detection of rhinovirus in sinus brushings of patients with acute community-acquired sinusitis by reverse transcription-PCR. J. Clin. Microbiol. 35, 1791-1793; Pitkaranta, A., Virolainen, A., Jero, J., Arruda, E., Hayden, F.G., 1998. Detection of rhinovirus, respiratory syncytial virus, and coronavirus infections in acute otitis media by reverse transcriptase polymerase chain reaction. Pediatrics 102, 291-295; Rotbart, H.A., 2002. Treatment of picornavirus infections. Antivir. Res. 53, 83-98]. To date, no effective antiviral therapies have been approved for either the prevention or treatment of diseases caused by HRV infection. Thus, there still exists a significant unmet medical need to find agents that can shorten the duration of HRV-induced illness, lessen the severity of symptoms, minimize secondary bacterial infections and exacerbations of underlying disease and reduce virus transmission. Although effective over-the-counter products have been described that alleviate symptoms associated with the common cold [Anzueto, A., Niederman, M.S., 2003. Diagnosis and treatment of rhinovirus respiratory infections. Chest 123 (5), 1664-1672; Gwaltney, J.M., 2002a. Viral respiratory infection therapy: historical perspectives and current trials. Am. J. Med. 22 (112 Suppl. 6A), 33S-41S; Turner, R.B., 2001. The treatment of rhinovirus infections: progress and potential. Antivir. Res. 49 (1), 1-14; Sperber, S.J., Hayden, F.G., 1988. Chemotherapy of rhinovirus colds. Antimicrob. Agents Chemother. 32, 409-419], this review will primarily focus on the discovery and development of those agents that directly or indirectly impact virus replication specifically highlighting new advances and/or specific challenges with their development.
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PMID:Rhinovirus chemotherapy. 1667 37

To help physicians with the appropriate use of antibiotics in children and adults with upper respiratory tract infection, a multidisciplinary team evaluated existing guidelines and summarized key practice points. Acute otitis media in children should be diagnosed only if there is abrupt onset, signs of middle ear effusion, and symptoms of inflammation. A period of observation without immediate use of antibiotics is an option for certain children. In patients with sinus infection, acute bacterial rhinosinusitis should be diagnosed and treated with antibiotics only if symptoms have not improved after 10 days or have worsened after five to seven days. In patients with sore throat, a diagnosis of group A beta-hemolytic streptococcus pharyngitis generally requires confirmation with rapid antigen testing, although other guidelines allow for empiric therapy if a validated clinical rule suggests a high likelihood of infection. Acute bronchitis in otherwise healthy adults should not be treated with antibiotics; delayed prescriptions may help ease patient fears and simultaneously reduce inappropriate use of antibiotics.
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PMID:Guidelines for the use of antibiotics in acute upper respiratory tract infections. 1700 29

Respiratory tract infections are frequent and they are one of the commonest causes of antibiotic prescription. However, there are few clinical guidelines that consider this group of infections. This document has been written by the Andalusian Infectious Diseases Society and the Andalusian Family and Community Medicine Society. The primary objective has been to define the recommendations for the diagnosis and antibiotic treatment of respiratory tract infections apart from pneumonia. The clinical syndromes evaluated have been: a) pharyngitis; b) sinusitis; c) acute otitis media and otitis externa; d) acute bronchitis, laryngitis, epiglottitis; e) acute exacerbation of chronic bronchitis; and f) respiratory infectious in patients with bronchiectasis. This document has focused on immunocompetent patients.
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PMID:[Clinical and therapeutic management of respiratory tract infections. Consensus document of the Andalusian Infectious Diseases Society and the Andalusian Family and Community Medicine Society]. 1738 21

Respiratory tract infections are frequent and they are one of the commonest causes of antibiotic prescription. However, there are few clinical guidelines that consider this group of infections. This document has been written by the Andalusian Infectious Diseases Society and the Andalusian Family and Community Medicine Society. The primary objective has been to define the recommendations for the diagnosis and antibiotic treatment of respiratory tract infections apart from pneumonia. The clinical syndromes evaluated have been: a) pharyngitis; b) sinusitis; c) acute otitis media and otitis externa; d) acute bronchitis, laryngitis, epiglottitis; e) acute exacerbation of chronic bronchitis; and f) respiratory infectious in patients with bronchiectasis. This document has focused on immunocompetent patients.
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PMID:[Clinical and therapeutic management of respiratory tract infections. Consensus document of the Andalusian infectious diseases society and the Andalusian family and comunitary medicine society]. 1742 27


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