Bacterial Infections Of Upper Respiratory Tract Research Articles

Clinical manifestations of COVID-19 versus other upper respiratory tract infections in pediatric patients

To explore the differences between COVID-19 and upper respiratory tract infections (URTI) in the pediatric population, emphasizing smell and taste disturbances. A case-control study included 468 patients, 234 with COVID-19 (cases) and 234 with URTI (controls) at a tertiary hospital, Riyadh, Saudi Arabia, from 2020-2021. Patients with bacterial URTI, lower tract respiratory infections, and speech or developmental delays were excluded. Statistical analysis was carried out using Statistical Analysis System, 9.2 version. A p-value of ≤0.05 was considered significant. The male-to-female ratio was almost equal, with a mean age of 9.90±2.34. Multivariable logistic regression analysis showed that a change in taste significantly increases the probability of COVID-19 by 21.98 times. On the other hand, sore throat (81.5%), dyspnea (63.5%), nasal obstruction (72.7%), and otalgia significantly (74.8%) decrease the likelihood of COVID-19. Taste disturbances increase the probability of COVID-19 infections, whereas sore throat, dyspnea, nasal obstruction, and otalgia increase the likelihood of other URTIs. The described differences might aid physicians in their differential diagnosis and treatment during the pandemic.

Evaluation of the rate, pattern and appropriateness of antibiotic prescription in a cohort of pilgrims suffering from upper respiratory tract infection during the 2018 Hajj season.

Hajj is associated with an increased risk of the transmission of infectious diseases including upper respiratory tract infections (URTIs). It can be a focal point for the emergence, persistence and dissemination of antimicrobial-resistant (AMR) bacteria. The overuse of antibiotics during Hajj can promote the development of antimicrobial resistance. Little information is known regarding the true appropriateness of prescribing antibiotics for treating URTIs during Hajj. Here we studied the rate, patterns and appropriateness of antibiotic prescription among a cohort of pilgrims who were treated for URTIs during the 2018 Hajj season. Adult pilgrims who sought medical services for URTIs [presenting with coryza, runny nose, nasal irritation, nasal congestion, cough, sore throat, headache or fever (even if subjective)] within the Holy sites were enrolled in this study and consented to provide swabs and medical information. A total of 121 pilgrims were enrolled, with the majority (60.3 %) originating from North African Arab countries. Most were male (89.3 %) with a median age of 45 years. Bacterial infections were detected in 7.3 % (n=9) of the URTI cases. The identified bacteria included Haemophilus influenzae (n=6, all resistant to ampicillin), Streptococcus pneumoniae (n=2), Staphylococcus aureus (n=1, resistant to oxacillin) and Moraxella catarrhalis (n=1, resistant to ampicillin and trimethoprim/sulfamethoxazole). The antibiotic prescription rate was 52.1%, most of which was amoxicillin (81 %). The data demonstrated that the proportion of appropriate practices in treating bacterial URTIs in this cohort was 45.5 %. This study highlights the need for implementing laboratory identification of the aetiological agents and related AMR profiles when treating URTIs in Hajj, rather than relying on clinical assessment alone.

Fitoterapija akutnih infekcija gornjih respiratornih puteva kod dece

Acute upper respiratory tract infections (URIs) are the most common infections in the population, especially in children. URIs are mostly of viral origin and tend to resolve spontaneously in approximately one week. Bacterial URIs are less common, and come mostly as superinfections of acute viral diseases. The therapy is symptomatic and aimed at alleviating cough, maintaining the patency of airways and preventing disease progression. If there are no reasons to see a doctor, parents should be advised to apply general measures and give herbal medicinal products to their children, in an attempt to relieve cough, sore throat and nasal symptoms. In productive cough, herbal expectorants, such as, for example, Hederae helicis folium extracts, are used to facilitate the elimination of mucus. On the other hand, demulcents (Althaeae radix, Plantaginis lanceolatae folium) alleviate dry cough by reducing local irritation. Honey also significantly reduces the frequency and severity of acute cough episodes. Extracts of Sisymbrii officinalis herba and Pelargonii radix are useful for the alleviation of nasal symptoms and sore throat. If the application of the proposed herbal products does not resolve the symptoms within a week, advice of a medical doctor should be sought.

Antimicrobial and Antibiofilm Activities of Weissella cibaria against Pathogens of Upper Respiratory Tract Infections.

Recently discovered preventive effects of probiotics on oral health have attracted interest to their use for the prevention and treatment of various diseases. This study aimed to evaluate the antimicrobial and antibiofilm properties of Weissella cibaria against Streptococcus pyogenes, Staphylococcus aureus, S. pneumoniae, and Moraxella catarrhalis, the major pathogens of upper respiratory tract infections (URTIs). The antimicrobial activities of W. cibaria were compared with those of other oral probiotics using a competitive inhibition assay and the determination of the minimum inhibitory concentrations (MICs). In addition, a time-kill assay, spectrophotometry, and confocal laser scanning microscopy were used to confirm the antimicrobial and antibiofilm abilities of W. cibaria CMU (oraCMU) and CMS1 (oraCMS1). Both live cells and cell-free supernatants of all tested probiotics, except Streptococcus salivarius, showed excellent antimicrobial activities. All target pathogens were killed within 4 to 24 h at twice the MIC of oraCMU and oraCMS1, which showed the highest antimicrobial activities against M. catarrhalis. The antimicrobial substances that affected different target pathogens were different. Both oraCMU and oraCMS1 showed excellent abilities to inhibit biofilm formation and remove preformed biofilms. Our results suggest that the W. cibaria probiotics offer new possibilities for the prevention and treatment of bacterial URTIs.

Intermittent Education and Audit and Feedback Reduce Inappropriate Prescribing of Oral Third-Generation Cephalosporins for Pediatric Upper Respiratory Tract Infections

In June 2017, leaders within a pediatric ambulatory care network in Houston approached the antimicrobial stewardship team at Texas Children's Hospital with concerns for high oral third-generation cephalosporin (oTGC) use in their clinics. An outpatient quality improvement (QI) team was formed. The specific aim was to reduce inappropriate oTGC prescribing at one clinic ("Clinic A") by 15% in one year. Following a benchmark analysis of oTGC use at Clinic A, Plan-Do-Study-Act (PDSA) cycles were designed and conducted over one year: one educational session, three individual audit and feedback sessions, and one group feedback session. The primary outcome was the percentage of oTGCs not aligning with American Academy of Pediatrics (AAP) guidelines for bacterial upper respiratory tract infections. Monthly oTGC prescribing at Clinic A was also compared to four control clinics. In June 2017, 72% (231/322) of oTGCs prescriptions at Clinic A did not align with AAP guidelines. The most common diagnosis was primary/nonrecurrent acute otitis media. Following interventions, the mean percentage inappropriate oTGCs decreased from 72% to 45% (absolute reduction 27%, p < 0.001), which was sustained the year following the last PDSA cycle (absolute reduction 26%, p < 0.001). Total monthly oTGC prescribing at Clinic A decreased over time, but not in four control clinics. Provider active participation in stewardship activities decreased over time. Intermittent education and audit and feedback were associated with reduced oTGC misuse at Clinic A but not at four control clinics. Improvements were maintained despite decreased participation in stewardship activities, suggesting that perceptions of ongoing antibiotic audits can help sustain prescribing improvements.

Variations in antibiotic prescribing among village doctors in a rural region of Shandong province, China: a cross-sectional analysis of prescriptions

ObjectivesTo assess variation in antibiotic prescribing practices among village doctors in a rural region of Shandong province, China.Design, setting and participantsAlmost all outpatient encounters at village clinics result in a prescription being issued. Prescriptions were collected over a 2.5-year period from 8 primary care village clinics staffed by 24 doctors located around a town in rural Shandong province. A target of 60 prescriptions per clinic per month was sampled from an average total of around 300. Prescriptions were analysed at both aggregate and individual-prescriber levels, with a focus on diagnoses of likely viral acute upper respiratory tract infections (AURIs), defined as International Classification of Diseases, 10th Revision codes J00 and J06.9.Main outcome measuresProportions of prescriptions for AURIs containing (1) at least one antibiotic, (2) multiple antibiotics, (3) at least one parenteral antibiotic; classes and agents of antibiotics prescribed.ResultsIn total, 14 471 prescriptions from 23 prescribers were ultimately included, of which 5833 (40.3%) contained at least 1 antibiotic. Nearly two-thirds 62.5% (3237/5177) of likely viral AURI prescriptions contained an antibiotic, accounting for 55.5% (3237/5833) of all antibiotic-containing prescriptions. For AURIs, there was wide variation at the individual level in antibiotic prescribing rates (33.1%–88.0%), as well multiple antibiotic prescribing rates (1.3%–60.2%) and parenteral antibiotic prescribing rates (3.2%–62.1%). Each village doctor prescribed between 11 and 21 unique agents for AURIs, including many broad-spectrum antibiotics. Doctors in the highest quartile for antibiotic prescribing rates for AURI also had higher antibiotic prescribing rates than doctors in the lowest quartile for potentially bacterial upper respiratory tract infections (pharyngitis, tonsillitis, laryngopharyngitis; 89.1% vs 72.4%, p=0.002).ConclusionsAll village doctors overused antibiotics for respiratory tract infections. Variations in individual prescriber practices are significant even in a small homogenous setting and should be accounted for when developing targets and interventions to improve antibiotic use.

Clinical And Bacteriological Impact Of Clarithromycin In Streptococcal Pharyngitis: Findings From A Meta-Analysis Of Clinical Trials.

IntroductionAmong the bacterial upper respiratory tract infections (UTRIs), the most medically significant is pharyngitis due to Group A beta-hemolytic Streptococci (GABHS). A 2012 meta-review and a 2016 Cochrane systematic review reported favorably on the comparative efficacy and safety of clarithromycin in pediatric patients with URTIs and in adults with GABHS pharyngitis. In this paper, the evidence base for clarithromycin in patients with URTIs is augmented by a meta-analysis of comparative studies in GABHS pharyngitis.MethodsA series of five outpatient trials of clarithromycin for the treatment of streptococcal pharyngitis from an internal database were subjected to meta-analysis. Active comparators comprised penicillin VK and erythromycin.ResultsRates of clinical cure or improvement were very similar in all treatment assignments, but the rates of bacteriological cure were numerically higher with clarithromycin than with comparator antibiotics. Adverse events data indicated that clarithromycin was generally well tolerated in these studies, with a relatively low incidence of adverse events and few severe incidents.DiscussionThough currently not advised as a first-line therapy for URTI in most guidelines, the results of the meta-analysis indicate that clarithromycin is nevertheless a valid, effective and largely well-tolerated treatment option for GABHS pharyngitis patients who cannot benefit from other agents.

Association between otitis media infection and failed hearing screenings in children

This study aims to assess prospectively whether there is an association between frequencies of upper respiratory tract infections (URTI) or asthma in early childhood and failed otoacoustic emission (OAE) screenings later in life. There are no clear recommendations for hearing testing following acute otitis media (AOM) infection. This is a retrospective, practice based chart review. Participants from a primary care setting were 517 pre-adolescent and adolescent children (49.9% female) (ages 10–21; mean, 15 y/o), who had presented with at least one specific bacterial URTI (AOM, Group A Streptococcus (GAS) tonsillitis, or Influenza) during childhood. Hearing testing was recorded incidentally at all subsequent routine health care maintenance visits (OAE hearing screen). Simple linear regression analyses were performed using R (v3.4.4). We found that number of episodes of AOM infections strongly correlated with number of failed OAE screenings later in life (F = 76.37; P = <0.001; R2 = 0.1279), while GAS (F = 1.859; P = 0.1733; R2 = 0.0016) or Influenza infection (F = 2.624; P = 0.1059; R2 = 0.0031) were not associated with failed OAE screening. Correlation between number of AOM infections and number of failed OAE screenings was not strengthened by presence of asthma. This study found evidence of an association between childhood history of AOM and failed OAE screenings in adolescence. Since this population may be at a higher risk for developing permanent or fluctuating hearing losses, further studies to clarify indications and timing of standard audiological testing among these children should be considered.

Investigation on the rational use of antibacterial agents by Chinese pediatricians in 2016

Objective: To obtain baseline data of pediatricians' clinical use of antibacterial agents in children in China, and provide evidence for the follow-up of guidelines for the diagnosis and treatment of children's clinical medications and the development of rational drug management measures and norms. Methods: A multi-center cross-sectional study was designed to conduct a network electronic questionnaire survey of doctors with child prescription rights in hospitals of all provinces, municipalities and autonomous regions across the country through cluster sampling to understand the current status of antibacterial drugs use in 2016. Results: The survey information of 3 494 pediatricians in tertiary hospitals was finally included. (1) Ranking of the importance of children's medication focus: 54.5% of doctors ranked first the "safety" and 43.5% ranked second the "efficacy" . (2) The most urgent antibacterial agents for children are reported as macrolides (11.9%), third-generation cephalosporins (4.8%), penicillins (4.2%), sulfonamides (2.5%), and carbapenems (2.4%). (3) The top five drugs that are urgently needed to obtain children's indications are: macrolides (26.4%), quinolones (19.9%), aminoglycosides (10.4%), and other antibacterials (9.0%) and the 3rd generation cephalosporins (5.1%). (4) For children with bacterial upper respiratory tract infections, antibacterial drugs should be used in the order of penicillins, second-generation cephalosporins, third-generation cephalosporins, azithromycin or erythromycin, medicamycin or unscented erythromycin or ester erythromycin. (5) The most important basis for empirical use of antibacterials, 42.0% of doctors chose "clinical signs and symptoms", followed by "imaging results" (41.0%). (6) 87.0% of the doctors chose" to read the drug instructions manual before using the drug" as the main way to understand the drug; for the adverse reactions of the antibacterial drugs, the top three rankings of the surveyed doctors were "allergic reactions" (93.3%). "hepatic/kidney functional side effects" (91.1%) and "myelosuppression" (48.2%). (7) The three main problems of children's drug risk selected by the surveyed doctors are "lack of indications for children's medication" (85.5%), "abuse of antimicrobials" (71.2%) and"formulations and specifications for lack of children's drugs". (69.2%). (8) The key link for children's rational drug use, the choice of the doctors to investigate is "clarifying and improving the indications for children's medication" (89.0%), "strengthening the rational use of drugs and clinical guidelines for children" (66.2%) and "developing and producing pharmaceutical dosage form for children and its specifications" (62.6%). Conclusions: Pediatricians are generally reasonable in the basic concepts and knowledge, attitudes and practices of rational use of antibiotics: they can put the safety of medications first, pay attention to reading the instructions before using drugs, and pay attention to the adverse reactions of children. For the drugs that result in adverse reactions in children, it is urgent to understand their indications. Pediatricians use clinical symptoms, signs and imaging findings as an empirical basis for the selection of drugs for bacterial upper respiratory tract infections and antimicrobial agents. The investigation found that macrolides, third-generation cephalosporins, penicillins and other drugs are the most urgent antibacterial drugs in pediatrics, and found that a considerable number of antibacterials lack the indications for children, lack of dosage forms and specifications for children, presence of abuse, etc. The problem is that there are hidden dangers in the use of antibiotics in children. The survey concluded that for pediatricians, the basic concepts and knowledge, attitudes and practices of the rational use of antimicrobials continue to be strengthened. It is necessary to clarify and improve the indications for children's medications, strengthen the training of rational medications and clinical guidelines, and vigorously develop and produce children's medicine dosage forms and their specifications for existing antibacterial drugs. All these are the key links for children's rational use of antibacterials.

Impact of a homeopathic medication on upper respiratory tract infections in COPD patients: Results of an observational, prospective study (EPOXILO).

Chronic obstructive pulmonary disease (COPD) is a progressive lung disorder in which airflow is obstructed. Viral or bacterial upper respiratory tract infections (URTIs) may lead to exacerbations. Homeopathic medication administration to COPD patients during the influenza-exposure period may help to reduce the frequency of common URTIs. This prospective, observational, multicenter study was carried out in Cantabria, Spain. Patients with COPD were divided into two groups: group 1 received conventional treatment+homeopathic medication (diluted and dynamized extract of duck liver and heart; Boiron) (OG); group 2 received conventional treatment only (CG). The primary endpoint was the number of URTIs between the 4-5 months follow up (mean 4.72±0.96) from basal to last visit. Secondary endpoints included the duration of URTIs, number and duration of COPD exacerbations, use of COPD drugs, changes in quality of life (QoL), compliance, and adverse events (AEs). 219 patients were analyzed (OG = 109, CG = 110). There was a significant reduction in mean number of URTIs during the follow-up period in OG compared to CG (0.514 ± 0.722 vs. 1.037 ± 1.519, respectively; p = 0.014). Logistic regression analysis showed a 3.3-times higher probability of suffering ≥2 URTI episodes in CG (p = 0.003, n = 72). OG patients having ≥1 URTI also had a significant reduction in mean URTI duration per episode (3.57 ± 2.44 days OG vs. 5.22 ± 4.17 days CG; p = 0.012). There was no significant difference in mean number of exacerbations, mean duration of exacerbations, or QoL between OG and CG. There was a greater decrease in proportion of patients using corticosteroids for exacerbations between baseline and visit 2 in OG compared to CG (22.1% vs. 7.5% fewer respectively, p = 0.005). Exacerbator phenotype patients had a significant decrease in number of URTIs (0.54 ± 0.72 vs. 1.31 ± 1.81; p = 0.011), and fewer COPD exacerbations (0.9 ± 1.3 vs. 1.5 ± 1.7; p = 0.037) in OG vs. CG, respectively. Homeopathic medication use during the influenza-exposure period may have a beneficial impact at reducing URTIs' number and duration in COPD patients and at reducing the number of COPD exacerbations in patients with the exacerbator phenotype. Further studies are needed to confirm the effects observed in this study.

Infections in Older Adults: A Case-Based Discussion Series Emphasizing Antibiotic Stewardship.

Compared with younger populations, adults 65 years and older are more likely to suffer infection-related morbidity and mortality, experience antibiotic-related adverse events, and acquire multidrug-resistant organisms. We developed a series of case-based discussions that stressed antibiotic stewardship while addressing management of common infections in older adults. Five 1-hour case-based discussions address recognition, diagnosis, and management of infections common in older adults, including those living in long-term care settings: urinary tract infections, upper respiratory tract infections, lower respiratory tract infections, skin and soft tissue infections, and Clostridium difficile infection. The education was implemented at the skilled nursing centers at 15 Veterans Affairs medical centers. Participants from an array of disciplines completed an educational evaluation for each session as well as a pre- and postcourse knowledge assessment. The number of respondents to the educational evaluation administered following each session ranged from 68 to 108. Learners agreed that each session met its learning objectives (4.80-4.89 on a 5-point Likert scale, 5 = strongly agree) and that they were likely to make changes (2.50-2.89 on a 3-point scale, 3 = highly likely to make changes). The average score on the five-question knowledge assessment increased from 3.6 (72%) to 3.9 (78%, p = .06). By stressing recognition of atypical signs and symptoms of infection in older adults, diagnostic tests, and antibiotic stewardship, this series of five case-based discussions enhanced clinical training of learners from several disciplines.

Microbiological Features of Upper Respiratory Tract Infections in Bulgarian Children for the Period 1998-2014.

Across the globe, upper respiratory tract infections (URTIs) are the most prevalent cause of morbidity in childhood. The aim of our study is to analyze the incidence and etiology of bacterial URTIs in Bulgarian children, as well as the increasing antimicrobial resistance to the most common etiologic agents over a period of 17 years. Retrospective study. The study material comprised the data from 4768 patients (aged 1-16 years) with URTI during the period from 1998-2014. Specific microbiology agent detection was performed by culture examination. Susceptibilities to the investigated pathogens were determined by the disk diffusion method and minimal inhibitory concentration according to the criteria of the Clinical and Laboratory Standards Institute (CLSI). Polymerase chain reaction was used to detect the presence of β-lactam resistance genes. We identified the following as the most common URTI bacterial pathogens: Streptococcus pneumoniae (40.94%), Streptococcus pyogenes (34.16%), Haemophilus influenzae (44.23%), Moraxella catarrhalis (39.19%) and Staphylococcus aureus (23.88%). In more than 70% of cases, a polymicrobial etiology was found. The most commonly affected individuals were pre-school-aged children, which accounted for more than 36% of all patients. During the study period, a dramatic increase in resistance to antibiotic agents was observed. The most frequent types of resistance were the enzymatic inactivation of penicillins and cephalosporins (close to 100% in staphylococci and moraxellae) and inducible macrolide-lincozamide resistance (about 20% of Gram-positive cocci). Due to mandatory immunization against pneumococci and H. influenzae in Bulgaria and the vast expanding resistance to the most popular antimicrobial agents changes in the etiology of URTI have recently been noted. Regular analysis of this etiological dynamic and the antimicrobial resistance of respiratory pathogens is important for choosing the correct therapy and successful treatment.

Principles of Judicious Antibiotic Prescribing for Upper Respiratory Tract Infections in Pediatrics

Most upper respiratory tract infections are caused by viruses and require no antibiotics. This clinical report focuses on antibiotic prescribing strategies for bacterial upper respiratory tract infections, including acute otitis media, acute bacterial sinusitis, and streptococcal pharyngitis. The principles for judicious antibiotic prescribing that are outlined focus on applying stringent diagnostic criteria, weighing the benefits and harms of antibiotic therapy, and understanding situations when antibiotics may not be indicated. The principles can be used to amplify messages from recent clinical guidelines for local guideline development and for patient communication; they are broadly applicable to antibiotic prescribing in general.

Azithromycin in Acute Bacterial Upper Respiratory Tract Infections: An Indian Non-Interventional Study

To assess the effectiveness, safety and tolerability of azithromycin in acute bacterial upper respiratory tract infections (URTIs). In this open-label, prospective, multi-center, non-interventional study in bacterial URTI, the decision to prescribe azithromycin was independent of enrolment. Follow up was 1week after treatment and if possible, at Week 2. Investigators' assessment of clinical outcome (Success/Failure) at the end of study was the primary endpoint for efficacy analysis. Clinical outcome of 'Success' was defined as the global response of Cure or Improvement. A pharmacoeconomic analysis of management of URTIs was also attempted. Of the 410 patients recruited, all were evaluated for safety and 278 for efficacy. The median treatment duration was 3days. Following treatment with azithromycin, overall success rate was 98.92% (95% CI 96.88-99.78%; Clopper-Pearson method). The success rate was similar across the sub-groups of acute otitis media-100%, bacterial sinusitis-95.83%, and pharyngotonsillitis-99.38%. The success rate was 100% among children and adolescents (age ≤18years) and 98.6% among adults (age >18years). Most of the common signs and symptoms of URTI reported during baseline, significantly improved at the end of the study. Sixteen (3.90%) patients reported treatment emergent adverse events, the most common being diarrhea-5 (1.2%) and flatulence-2 (0.5%). The average cost of treating bacterial URTI was INR 716 per patient. Azithromycin is effective and well tolerated in Indian patients with bacterial URTIs.

Bacterial interference in upper respiratory tract infections: A systematic review

Published definitions of bacterial interference (BI) differ, some focusing on changes in the normal flora and others on changes in subsequent infection. A need for consensus was identified at a roundtable discussion of BI in upper respiratory tract infections (URTI). We conducted a systematic review of the available data to justify a consensus definition of BI specific to URTI as "a dynamic, antagonistic interaction between at least 2 organisms that affects the life cycle of each, changes the microenvironment, and alters the organisms' colonization, invasiveness, and ability to affect the health of the host." Continued communication among the faculty postroundtable was used to identify and refine the search criteria to (1) in vitro and in vivo studies assessing bacterial URTI, (2) BI evaluated by response to treatment of URTI with antimicrobial agents, and (3) bacterial function in relation to interactions between normal (nonpathogenic) and pathological flora. The criteria were applied to systematic searches of MEDLINE (1950 onward), EMBASE (1974 onward), and the Cochrane Library (2007). Twenty-nine studies met the inclusion criteria, most focused on children with recurrent infections. Qualitative analysis supports the consensus definition. Interfering organisms affected the life cycle of test pathogens and inhibited their colonization, invasiveness, and health outcomes. Data were insufficient for statistical analysis. Interactions between interfering organisms and potential pathogens isolated from the same host can alter response to infection and treatment. More studies are needed, particularly in adults, to understand the role of interfering organisms, the influence of antibiotics, and the potential for recolonization posttreatment.

C-Reactive Protein and Serum Procalcitonin Levels as Markers of Bacterial Upper Respiratory Tract Infections

Problem statement: Upper Respiratory Tract Infections (URTIs) are the most frequent of the community with major social and financial impact. Hence, early and proper diagnosis is of utmost importance. Biomarkers such as the circulating levels of Procalcitonin (PCT) have been shown to be elevated in systemic bacterial infections, but remain relatively low in viral infections and inflammatory diseases and have been suggested as signals for the initiation of antimicrobial therapy. Experience evaluating the value of PCT as a marker of URTIs is limited. Approach: Forty patients with bacterial URTIs were studied in order to assess the role of PCT, measured by using the semi-quantitative test, as bacterial inflammation marker and to compare with other markers, such as C-Reactive Protein (CRP), White Blood Cell (WBC) counts and Polymorphonuclear (PMN) cell counts. Results: In all cases, 22 with tonsillopharyngitis, 10 with peritonsillar abscess and 8 with rhinosinusitis, PCT levels remained below detection limits. On the other hand, serum CRP levels strongly correlated with body temperature, WBC and PMN cell counts. Patients with rhinosinusitis were older than those with peritonsillar abscess, had lower body temperature than those with tonsillopharyngitis and had lower serum CRP levels than patients with either peritonsillar abscess or tonsillopharyngitis. Conclusion: Therefore CRP could be used as a marker to predict the severity of URTIs while PCT, although promising in cases of other severe bacterial infections, did not prove to be suitable for patients with less severe or localized infections, such as URTIs.

Antibiotic Prescriptions for Upper Respiratory Tract Infection in Japan

The overuse of antibiotics results in the unnecessary spread of resistant strains. A common setting for antibiotic overuse is in the treatment of upper respiratory tract infections (URIs), which are predominantly due to viruses. To investigate the type and frequency of antibiotic prescription for URI without apparent bacterial infection in Japan, based on both visits and facilities. Cross-sectional analysis of insurance claims submitted to an employer-sponsored health insurance plan in Japan between January and March, 2005 for diagnoses of URI. Claims having a potentially valid reason for antibiotic prescription (e.g., secondary diagnosis of pneumonia) were excluded. Antibiotics prescribed for these URI visits. From a total of 24,134 claims, 2,577 claims (non-bacterial URI, one visit per claim) were analyzed; antibiotics were prescribed in 60% of these visits. Third-generation cephalosporins were the most commonly-prescribed drug class (46%), followed by macrolides (27%) and quinolones (16%). In general, visits to physician offices were more likely to result in an antibiotic prescription than visits to hospital outpatient clinics. No statistically significant difference was identified among hospital types, including private and public ownership or teaching hospital status. Analysis of the frequency of antibiotic prescription by facility revealed two peaks in distribution, with one group prescribing to about 90% of URI patients and the second appearing to prescribe to about 40% of patients. Antibiotics are frequently prescribed to URI patients in Japan. Although overuse results from the difficulty in accurately distinguishing viral from bacterial URIs, some facilities appear to attempt to differentiate the underlying cause of the URI while others do not.

Decreased Erythromycin Use after Antimicrobial Reimbursement Restriction for Undocumented Bacterial Upper Respiratory Tract Infections Significantly Reduced Erythromycin Resistance in Streptococcus pyogenes in Taiwan

Decreased Erythromycin Use after Antimicrobial Reimbursement Restriction for Undocumented Bacterial Upper Respiratory Tract Infections Significantly Reduced Erythromycin Resistance in Streptococcus pyogenes in Taiwan

Introduction

Upper respiratory tract infections (URTIs) are among the most common diseases in children, and they can be very distressing not only for the sick child and his or her parents but also for the physician. The burden of these URTIs is reflected by: (1) high incidence; (2) substantial morbidity and potential sequelae; (3) tendency to overdiagnosis (especially in streptococcal pharyngitis and acute otitis media); (4) associated overuse and misuse of antibiotics. Many URTIs are viral in etiology, and many bacterial URTIs are self-limiting. Unnecessary antibiotic therapy (overuse) and poor therapeutic choice, dosage and/or duration (misuse) both contribute to bacterial resistance, avoidable toxicity and increased costs. OPTIMUM APPROACH A key issue in modern antibacterial thinking is the relationship among body systems, antibiotics and causative pathogens. In particular the pharmacokinetics and pharmacodynamics of an antibiotic are central to its efficacy for a given indication. The ideal therapy for URTIs must combine excellent clinical efficacy with a high rate of bacteriologic eradication. To achieve this an antibiotic requires outstanding antibacterial potency and must be able to act in synergy with host defenses. In addition a good tolerability profile and a simple dosing regimen are vital to maximize patient compliance. Azithromycin, an azalide antibiotic, fulfills these criteria, which explains its established role for treatment of numerous infectious diseases including URTIs. TREATMENT STUDIES Current expert and advisory committees agree that clinical trials in URTIs must adhere to the best science, be acceptable to patients and parents and be feasible for sponsors. Adherence to best possible science takes into account the often self-limiting course of URTIs on the one side and balances that with possible complications and sequelae on the other. This approach also takes into account available efficacy and safety data and recognizes the gaps in these data. Science also must acknowledge that children should not be included in certain experimental study designs. Acceptability to patients and parents requires that trials are ethically justifiable. As such, particularly invasive procedures such as tympanocentesis need a clear indication. Moreover drug characteristics supporting patient compliance merit priority, e.g. simple dosage regimen, good tolerability and agreeable palatability. Feasibility for sponsors demands logistically doable trials without unnecessarily restrictive governing criteria. Industry certainly weighs research effort vs. profit differently for acute and chronic therapies. In addition competition for the small number of suitable study centers should be avoided. PURPOSE OF SUPPLEMENT On July 21, 2003 a small panel of experts met for a closed symposium to discuss and review the key azithromycin studies for treatment of pediatric URTIs. The major aim of this meeting was to publish proceedings that address the role of azithromycin in URTIs in an everyday clinical context, i.e. with a focus on the clinical relevance to patients and their parents. In particular the rationale for single dose and high dose treatment regimens with azithromycin were discussed, and the available studies with these novel regimens in acute otitis media and streptococcal pharyngitis were reviewed. Emphasis was placed on study design (science, acceptability, feasibility), clinical efficacy and bacteriologic eradication, bacterial resistance issues, safety, tolerability and compliance.

Flurithromycin versus clarithromycin in upper respiratory tract infections

The efficacy and tolerability of flurithromycin and clarithromycin in the treatment of bacterial upper respiratory tract infections were compared in a multicenter, parallel-group, double-masked, double-dummy study of 320 adult patients who were randomized to two treatment groups. Flurithromycin was administered as one 375-mg tablet twice daily and clarithromycin as one 250-mg tablet twice daily for up to 14 days. In the flurithromycin group, 3 patients were lost to observation, 1 withdrew because of poor compliance and 1 because of diarrhea, and 2 were considered clinical failures at treatment completion. In the clarithromycin group, 2 patients withdrew for treatment inefficacy and 12 were considered clinical failures at treatment completion. All other patients were judged to be cured or improved. Thus the intent-to-treat success rates were 153 (95.6%) of 160 patients in the flurithromycin group and 146 (91.3%) of 160 patients in the clarithromycin group; the difference was not statistically significant. The eradication rate of the baseline pathogens, mostly gram-positive cocci, was 123 (90.4%) of 136 patients in the flurithromycin group and 126 (91.3%) of 138 patients in the clarithromycin group. Response rates did not vary appreciably by infection site or baseline pathogen. Adverse events, mostly mild-to-moderate gastrointestinal disturbances, were observed in 8 patients (5.0%) in the flurithromycin group and in 11 patients (6.9%) in the clarithromycin group. These results suggest that flurithromycin 375 mg twice daily is as effective and well tolerated as clarithromycin 250 mg twice daily in the treatment of upper respiratory tract infections.