Patterns of Recurrence and Antimicrobial Management in Respiratory Infections: A Real-World Retrospective Study

Abstract

Objectives: Respiratory tract infections (RTIs) significantly contribute to morbidity and mortality. Management of RTIs is complex with several etiological agents, development of resistance to antimicrobials, and multiple risk factors which may result in recurrence of infections. Therefore, choice of antibiotic therapy needs to be evidence-based for appropriate treatment and prevention of recurrence. This study aimed to explore the pattern of recurrence in RTIs and the type of antimicrobials used in real-world clinical settings. Methods: This study was a retrospective, cross-sectional, observational, multicenter study. Electronic medical records of patients with upper RTIs (URTIs) and lower RTIs (LRTIs) visiting three centers from 2014 to 2020 were considered for the analysis. Results: A total of 236 patients had an overall 531 episodes of RTIs with a mean age of 41.75 years. There were 391 LRTIs and 140 URTIs. Majority of the patients were adults (64.83%), and males were predominant (65.68%). In LRTI episodes, the most frequently prescribed antimicrobial monotherapy/fixed dose combination was macrolide (clarithromycin) (12.53%), followed by cefpodoxime-clavulanic acid (9.97%). Majority of the URTIs were managed with clarithromycin (49.28%) and azithromycin (16.43%). Recurrence of LRTI was observed in 23 patients with gram stain positive cocci. Additionally, out of 27 patients with culture-positive pseudomonas infections, 10 had recurrent LRTI episodes. Macrolides and cephalosporins were mostly prescribed in these episodes. Conclusion: This study highlights that one of the major causes of recurrence could be incomplete eradication of pathogens. In the real-world scenario, recurrent URTI and LRTI episodes can be managed by macrolides and cephalosporins.