Tract Infections In Outpatients Research Articles

Respiratory Syncytial Virus

Respiratory syncytial virus (RSV) is the most important cause of lower respiratory tract infection in outpatients, as well as the major viral cause of nosocomial illness in pediatric inpatients. Immunity to this common pathogen is short lived and reinfection can occur later in life, even into adulthood. Virtually all children have one infection before 24 months and 50% experience two or more episodes of infection. The attack rate is substantial with about half of all infants in a community becoming ill during the season's first epidemic. About 100,000 children in the US each year become ill enough to require hospitalization, the hospitalization rate being 1411,000 during epidemic periods. In certain locations, RSV accounts for about 45% of hospital admissions for respiratory disease in children under two years of age.

Respiratory syncytial virus.

RSV is now understood to be the most significant viral respiratory pathogen of infants and is capable of causing both bronchiolitis and pneumonia. It is a particular risk to hospitalized infants as the virus is easily spread through close contact. The most vulnerable infants are those who suffer with either congenital heart disease or bronchopulmonary dysplasia who easily fall prey to pulmonary complications of infection. Strict environmental control and the use of protective clothing and eyewear should be implemented to decrease the nosocomial spread of RSV. Available diagnostic studies include viral isolation, fluorescent antibody stains, and enzyme immunoassays. Treatment of the disease is usually supportive but hospitalized patients frequently benefit from aerosolized ribavirin therapy. Hopefully, current vaccine trials will be successful and this pathogen will not only be treatable but will also be preventable.

Amoxicillin plus clavulanic acid in the treatment of recurrent urinary tract infections.

Forty-four patients (43 female, 1 male), all with a history of recurrent urinary tract infections, were treated with 250 mg of amoxicillin plus 125 mg of clavulanic acid (one tablet of Augmentin) every 8 h for 7 days. The microbiological cure rates were 84% 1 week after the end of treatment and 67% 1 month later. Side effects, which were reported by 20% of the patients, were mild and in no case caused interruption of treatment. In view of the increasing trend in resistance to agents commonly used for the treatment of urinary tract infections in outpatients, the combination of amoxicillin and clavulanic acid may now be considered a first-line drug in patients with recurrent urinary tract infections.

Trimethoprim alone in the treatment of urinary tract infections: eight years of experience in Finland.

In Finland the usage of trimethoprim (TMP) alone constitutes about 25% of all drug usage for urinary tract infections. Despite this widespread use the proportion of TMP-resistant strains is almost same as it is in countries where only the combination of trimethoprim-sulfamethoxazole (TMP-SMZ) has been used. In general, strains resistant to TMP were seldom found; only in closed wards did the use of trimethoprim result in an increase in the proportion of resistant strains. In the treatment of acute urinary tract infections, TMP alone (dose, 160 mg taken twice daily for seven days) gave a result as good as that of TMP-SMZ (94.5% vs. 90.6%) and a better result than cephalexin (98.3% vs. 82.1%). TMP proved suitable as a single agent in the treatment of urinary tract infections in outpatients. In a study of long-term treatment, TMP (dose, 100 mg taken once daily), was more effective than nitrofurantoin, methenamine hippurate, TMP-SMZ, or placebo. Fewer adverse effects were associated with TMP than with the other drugs.

Comparison of sulfamethoxazole alone and combined with trimethoprim in urinary tract infections

In a double blind, randomized study, sulfamethoxazole was compared alone and in combination with trimethoprim as commonly used in therapeutic regimes for the treatment of uncomplicated acute urinary tract infections in out-patients. The cure of sulfamethoxazole alone was 92.2%, and for sulfamethoxazole plus trimethoprim 97.6%. The rate of side-effects for the former was 5%, for the latter 21.8%. If the failure rate plus the rate of occurrence of rash, which necessitated discontinuing the drug, are combined, it appears that 8.8% of the patients were at a disadvantage receiving sulfamethoxazole compared to 9.7% for the combination of sulfamethoxazole plus trimethoprim. When considering the cure rate and rate of side-effects together, therefore, the position of sulfamethoxazole alone as a suitable drug in this type of infection is defended.