Treatment Of Acute Respiratory Infections Research Articles

Acute Respiratory Tract Infection Visits of Veterans With Spinal Cord Injuries and Disorders: Rates, Trends, and Risk Factors

Background/Objectives: Respiratory complications are a major cause of illness and death in persons with spinal cord injuries and dysfunction (SCI&Ds). The objectives of this study were to examine rates of outpatient visits over 5 years for acute respiratory tract infections (ARIs), including pneumonia and influenza (P&l), lower respiratory tract infections (LRIs), and upper respiratory tract infections (URIs), in veterans with SCI&Ds and to determine whether individual characteristics were associated with the number of annual visits for each type of ARI.Methods: This was a longitudinal (fiscal years 1998-2002) study of ARI visits at the Veterans Health Administration (VA) in 18,693 veterans with SCI&Ds. To examine the associations between time, patient characteristics, and annual number of ARI visits, we used random effect negative binomial models.Results: Veterans with SCI&Ds had a total of 11,11 3 ARI visits over the 5-year period. There was a slightly decreasing trend for LRI visits over time (P < 0.01) but no significant change for other ARIs over time. There were 30 to 35 pneumonia visits and 21 to 30 acute bronchitis visits per 1,000 SCI&D veterans per year. Older veterans were more likely than younger to have P&l visits and less likely to have URI visits (P < 0.01). Veterans with paraplegia had fewer P&l visits than subjects with tetraplegia (IRR = 0.58; Cl = 0.51-0.67).Conclusions: Visit rates for ARIs are stable for veterans with SCI&Ds. Identifying risk factors associated with ARI visits is an important first step to improve prevention and treatment of ARIs and to improve the health of veterans with SCI&Ds.

How Do Antimicrobial Agents Lead to Resistance in Pathogens Causing Acute Respiratory Tract Infections?

Whereas the principles of successful antimicrobial treatment-hit hard, hit early, and combine drugs-are well established for infections like tuberculosis and human immunodeficiency virus infection, they are not as well established for treatment of acute respiratory infections (ARIs) in which the target organisms are typically carried as commensals in the nasopharynx, drug resistance may be all-or-none or incremental, and (except for fluoroquinolones), resistance usually requires acquisition of foreign DNA. For these pathogens, most notably Streptococcus pneumoniae, any use of an effective antibiotic is likely to promote resistance at the population level, but different antimicrobial classes do so in different ways and to different degrees. Data on the effects of different classes on susceptible and nonsusceptible bacterial flora are reviewed, and the consequences for selecting resistance are discussed. It is concluded that, with certain caveats, these considerations support prescribing of high-dose amoxicillin (when necessary) for ARIs, although continued monitoring for the emergence of strains against which this high dose has no effect (increasing minimal inhibitory concentration) is needed. Other strategies, such as reserving certain highly effective antibiotics for use in severe cases and avoiding their routine use in children who are the reservoir of transmission of many ARI pathogens, should be considered. These considerations argue strongly against the use of fluoroquinolones for routine treatment in pediatrics.

Antibiotic Treatment of Acute Respiratory Infections in Acute Care Settings

Objectives: To examine the patterns of antibiotic use for acute respiratory tract infections (ARIs) in acute care settings. Methods: Chart reviews were performed retrospectively on a random sample of adult ARI visits to seven Veterans Affairs (VA) and seven non-VA emergency departments (EDs) for the period of November 2003 to February 2004. Visits were limited to those discharged to home and those with primary diagnoses of antibiotic-responsive (pneumonia, acute exacerbation of chronic bronchitis, pharyngitis, sinusitis) and antibiotic-nonresponsive conditions (acute bronchitis, nonspecific upper respiratory tract infection [URI]). Results are expressed as adjusted odds ratios with 95% confidence intervals. Results: Of 2,270 ARI visits, 62% were for antibiotic-nonresponsive diagnoses. Seventy-two percent of acute bronchitis and 38% of URI visits were treated with antibiotics (p < 0.001). Stratified analyses show that antibiotic prescription rates were similar among attending-only and housestaff-associated visits for antibiotic-responsive diagnoses (p = 0.11), and acute bronchitis (76% vs. 59%; p = 0.31). However, the antibiotic prescription rate for URIs was greater for attending-only visits compared with housestaff-associated visits (48% vs. 15%; p = 0.01). Antibiotic prescription rates for total ARIs varied between sites, ranging from 42% to 89%. Patient age, gender, race and ethnicity, smoking status, comorbidities, and clinical setting (VA vs. non-VA) were not independently associated with antibiotic prescribing. Conclusions: Acute care settings are important targets for reducing inappropriate antibiotic prescribing. The mechanisms accounting for lower antibiotic prescription rates observed with housestaff-associated visits merit further study.

Antibiotic Treatment of Acute Respiratory Infections in Acute Care Settings

To examine the patterns of antibiotic use for acute respiratory tract infections (ARIs) in acute care settings. Chart reviews were performed retrospectively on a random sample of adult ARI visits to seven Veterans Affairs (VA) and seven non-VA emergency departments (EDs) for the period of November 2003 to February 2004. Visits were limited to those discharged to home and those with primary diagnoses of antibiotic-responsive (pneumonia, acute exacerbation of chronic bronchitis, pharyngitis, sinusitis) and antibiotic-nonresponsive conditions (acute bronchitis, nonspecific upper respiratory tract infection [URI]). Results are expressed as adjusted odds ratios with 95% confidence intervals. Of 2,270 ARI visits, 62% were for antibiotic-nonresponsive diagnoses. Seventy-two percent of acute bronchitis and 38% of URI visits were treated with antibiotics (p < 0.001). Stratified analyses show that antibiotic prescription rates were similar among attending-only and housestaff-associated visits for antibiotic-responsive diagnoses (p = 0.11), and acute bronchitis (76% vs. 59%; p = 0.31). However, the antibiotic prescription rate for URIs was greater for attending-only visits compared with housestaff-associated visits (48% vs. 15%; p = 0.01). Antibiotic prescription rates for total ARIs varied between sites, ranging from 42% to 89%. Patient age, gender, race and ethnicity, smoking status, comorbidities, and clinical setting (VA vs. non-VA) were not independently associated with antibiotic prescribing. Acute care settings are important targets for reducing inappropriate antibiotic prescribing. The mechanisms accounting for lower antibiotic prescription rates observed with housestaff-associated visits merit further study.

Developing Infectious Disease Strategies for the Developing World

Publisher SummaryThis chapter discusses various drugs for human influenza A (H5N1) and multidrug-resistant mycobacterium tuberculosis (MDR-TB). The H5N1 avian influenza does not presently meet the criteria of an antigenically shifted strain. It is presently an avian strain that has not undergone reassortment with a human strain and is not well adapted to humans. H5N1 isolates are resistant to the M2 inhibitors amantadine and rimantadine; these antivirals do not have a role for the treatment or prophylaxis against the strain. The neuraminidase inhibitors, oseltamivir and zanamivir, have in vitro activities against the human H5N1 isolates; however, recent data suggest that higher doses for longer periods may be required to be effective. Oseltamivir is an oral agent approved for prophylaxis and the treatment of influenza infections. Zanamivir is delivered topically to the respiratory tract with similar indications. The drugs discussed in the chapter for MDR-TB fall into three categories—quinolones, nitroimidazoles, and pyrroles. Drugs such as moxifloxacin are methoxyfluoroquinolones, which are already available and approved for the treatment of acute respiratory infections, such as community-acquired pneumonia, intra-abdominal infections, acute sinusitis, and skin infections. Gatifloxacin 5, is another methoxyfluoroquinolone that is in clinical development for tuberculosis treatment.

Randomized trial of a fixed combination (KanJang®) of herbal extracts containing Adhatoda vasica, Echinacea purpurea and Eleutherococcus senticosus in patients with upper respiratory tract infections

The clinical efficacy of KanJang oral solution, a fixed combination of standardised extracts of Echinacea purpurea, Adhatoda vasica and Eleutherococcus senticosus, was compared with the combined extracts of Echinacea purpurea and Eleutherococcus senticosus alone (Echinacea mixture) in a controlled, double blind, randomized trial, and with Bromhexine (a standard treatment) in a controlled, open, randomized clinical trial on patients with non-complicated acute respiratory tract infections. Many of the parameters evaluated, such as severity of coughing, frequency of coughing, efficacy of mucus discharge in the respiratory tract, nasal congestion and a general feeling of sickness, showed significantly greater improvement in patients treated with KanJang compared with those receiving the standard treatment. However, no significant differences in the improvement of these symptoms (except in a reduced frequency of coughing) were observed between patients treated with the Echinacea mixture and those receiving the standard treatment. The only explanation is that the lack of extract of A. vasica in the Echinacea mixture reduces its efficacy compared with the complete KanJang oral solution even though direct double-blind comparison yielded no significant differences between these two groups of patients. The recovery time of patients being treated with KanJang or Echinacea mixture was 2 days shorter than that of patients receiving the standard treatment. None of the patients completing the study reported adverse reactions to the medication taken. The significance of the results obtained in this study is discussed with respect to the efficacy of KanJang in the treatment of acute respiratory infection and to the concept that multi-drug therapy offers higher efficacy compared with mono-drug treatment of such infections.

Disminución de la mortalidad infantil en Chile entre 1990 y 2001

To present the change in infant mortality (IM) in Chile and its possible explanations. We performed a time-series study. Data on infant mortality were gathered from the demographic yearbooks of the National Institute of Statistics and from the health programs implemented by the Ministry of Health. The IM rate fell from 16 per 1000 live newborns in 1990 to 8.3 per 1000 in 2001. Programs for the use of surfactant and for the surgical management of cardiac malformations in newborns were implemented. Programs for the early treatment of acute respiratory infection were also implemented and new vaccines were introduced into the National Immunization Program in infants. The fall in infant mortality in Chile between 1990 and 2001 may be partly due to the implementation of the above-mentioned programs.

The molecular biologist against infectious disease: Infectious diseases, in both the developing and the developed world, still pose considerable challenges to biomedical research. But science alone is clearly not sufficient to overcome the burden of disease in the world

The molecular biologist against infectious disease: Infectious diseases, in both the developing and the developed world, still pose considerable challenges to biomedical research. But science alone is clearly not sufficient to overcome the burden of disease in the world

A household survey on morbidity and treatment of acute respiratory infections in communities in Vietnam.

To ascertain the extent of under-utilization and insufficiency or inappropriateness in provision of health services as one of the possible causes of high mortality from pediatric pneumonia in pilot areas in Vietnam. The household survey on morbidity and treatment of acute respiratory infections, simple cough, and cold and pneumonia, was conducted in two communities with 10% sampling of the child population. Both under-treatment of "fast breathing", a proxy for pneumonia, and over-treatment of simple cough and cold with antimicrobials by health workers, mothers, and private practitioners were common. A household survey on morbidity and treatment was found to be useful to clarify actual practices in the treatment of acute respiratory infections in the community, which cannot be obtained by mere interview with health workers or mothers. Since a change of knowledge did not automatically lead to change of practice, the training of health workers, health education of mothers and provision of antimicrobials at village health stations would not guarantee improved practice of health workers and mothers. Therefore, constant supervision for health workers, continued health education of mothers and involvement of private practitioners are needed to improve the situation.

A Household Survey on Morbidity and Treatment of Acute Respiratory Infections in Communities in Vietnam

A Household Survey on Morbidity and Treatment of Acute Respiratory Infections in Communities in Vietnam

Relationship between acute respiratory infection and malnutrition in children under 5 years of age

Data from a population‐based survey, conducted in the northeast of Brazil, were used to examine the association between acute respiratory infection (ARI) and malnutrition in children under 5 y of age. Current and past malnutrition were associated with acute lower respiratory infection (ALRI), even after adjusting for potential confounders (odds ratio: 2.03; 95% confidence interval: 1.20‐2.43). Decreasing malnutrition along with timely and proper treatment of ARI may improve children's health in developing countries.

Report from University of Bristol

Professor Debbie Sharp was appointed to the foundation Chair of Primary Health Care at Bristol in 1994, initially as part of the Department of Public Health and Epidemiology. The subsequent creation of an autonomous Division of Primary Health Care, re-located within the Department of Clinical Medicine, has resulted in a signiŽcant upgrading of the academic standing of the discipline within the University. This has been achieved by increasing the ow of high quality research output from the Division and a much-enhanced contribution to the Medical School’s demanding teaching programme. The Division has been very successful in obtaining high quality external research grant funding and in obtaining research fellowships from a variety of different bodies. Primary Health Care has now achieved an enviable balance of senior:training and clinical:non-clinical staff. The Division’s research portfolio continues to show the breadth associated with a generalist area. However, activity is consolidating around several clear areas of expertise, each being developed under the auspices of one of the Division’s senior academic staff. Professor Debbie Sharp leads the focus on mental health in primary care, including projects examining aspects of post-natal depression, dementia, deliberate self-harm and depression:anxiety. Other current projects under her guidance include those researching emergency contraception, breast screening, cancer genetics, multiple sclerosis and childhood immunisation. Doctor Tom Fahey has recently been awarded the prestigious Žve-year NHS Primary Care Career Scientist award. His Želd of investigation includes decision-support, hypertension, cardiovascular disease in primary care and the treatment of acute respiratory infections. Doctor Fahey has also had great success in guiding the careers of junior research staff towards, for example, the achievement of national training fellowships. Doctor Chris Salisbury’s research interests include the organisation of primary care services, such as out-of-hours services, the development of a new health park and the establishment of walk-in centres. His research responsibilities also encompass care for children with life-threatening illnesses and schoolbased services for teenagers diagnosed with asthma. The strategy for the next Žve years is to further develop programmes of work which play to the strengths of the Division’s senior researchers alongside the ability to respond swiftly and appropriately to government initiatives. Therefore, the research portfolio will balance commissioned research and responsive funding. In line with government policy to expand the research capacity in primary care, the Division of Primary Health Care has been instrumental in developing a practice-based research network, GANG (Gloucestershire and Avon Network Group for primary care research). The primary care practitioners within the network receive education and training in research methods and participate in university initiated research. There is also a smaller group of sixteen practices with whom the Division has developed very close relationships in terms of being major collaborators with or, in some instances, co-principal investigators on major research projects. All these practices are essential players in the studies that require the participation of large populations. Health-related research is also in progress elsewhere within the University, notably in the Department of Social Medicine and the MRC Health Services Research Unit (HSRC). Several ongoing projects involve principal investigators from the HSR Division of Social Medicine. With regard to teaching, the Division remains a very active contributor to the new curriculum (introduced 1995) and now teaches across all Žve years of the curriculum. We have initiated clinical teaching in general practice in the Žrst term of Year 1 and built on this experience in each of the subsequent years. We also take overall responsibility for communication skills teaching throughout the curriculum. The Division of Primary Health Care is located in Canynge Hall on Whiteladies Road in Clifton, adjacent to the main university campus and facilities. Canynge Hall has its own library and excellent computer resources. Primary Health Care shares this

Knowing when but not how!--mothers' perceptions and use of antibiotics in a rural area of Viet Nam.

Given the world-wide focus on how to rationally use antibiotics, national drug policy programmes have been developed in many countries in order to minimize the environmental antibiotic pressure and thereby hopefully limit increasing bacterial resistance. This study investigated perceptions of antibiotics in a health system with weak drug regulation. The study was conducted in two rural communes in Viet Nam, with a drug market characterized by the increased accessibility and consumption of pharmaceuticals. The study focused on rural mothers' perceptions and use of antibiotics in the treatment of acute respiratory infections (ARI) in children 5 years and under. A combination of qualitative and quantitative methods were used including key informant interviews, focus group discussions, and interviews with mothers and drug vendors. The study demonstrated that using a combination of qualitative and quantitative methods gives a better understanding of the prevailing perceptions and use of antibiotics in communities. The results showed that the mothers recognized well the signs of severe ARI and that antibiotics were reserved for more severe illness episodes, where penicillin V and ampicillin were first drugs of choice. However, the mothers' perceptions and use of antibiotics reflects indigenization of antibiotics into traditional Vietnamese thinking and medical practice. This resulted in self-medication and a respect for antibiotics from the mothers' point of view. A first step towards the rational use of antibiotics is already taken where mothers, as the health decision-maker, know when to initiate antibiotic treatment and try to limit unnecessary use of antibiotics. The next step is to develop a well-functioning health education programme in order to promote the correct use of antibiotics for a successful clinical outcome. This requires acknowledgement of the mothers' culture based behaviour.

Pattern of Use of Drugs for Treatment of Acute Respiratory Infections in Children by Female Health Workers in Rewa Division of Madhya Pradesh

Pattern of Use of Drugs for Treatment of Acute Respiratory Infections in Children by Female Health Workers in Rewa Division of Madhya Pradesh

Relationship between acute respiratory infection and malnutrition in children under 5 years of age.

Data from a population-based survey, conducted in the northeast of Brazil, were used to examine the association between acute respiratory infection (ARI) and malnutrition in children under 5 y of age. Current and past malnutrition were associated with acute lower respiratory infection (ALRI), even after adjusting for potential confounders (odds ratio: 2.03; 95% confidence interval: 1.202.43). Decreasing malnutrition along with timely and proper treatment of ARI may improve children's health in developing countries.

Prophylactic Lactobacillus GGReduces Antibiotic-Associated Diarrhea in Children With Respiratory Infections: A Randomized Study

Antimicrobial treatment may disturb the colonization resistance of gastrointestinal microflora, which may induce clinical symptoms, most commonly diarrhea. The severity of antibiotic-associated diarrhea may range from a brief, self-limiting disease to devastating diarrhea with electrolyte disturbances, dehydration, crampy abdominal pain, pseudomembranous colitis, toxic megacolon, or even death. The incidence of diarrhea in children receiving a single antimicrobial treatment is unclear. In addition to more critical use of antimicrobials, adjunctive preventive measures to antibiotic-associated diarrhea are needed. The objective of this study was to evaluate the incidence of diarrhea after antimicrobial treatment in children with no history of antimicrobial use during the previous 3 months. Another aim of this study was to assess the preventive potential of Lactobacillus rhamnosus GG (Lactobacillus GG; American Type Culture Collection 53103), a probiotic strain with a documented safety record and a therapeutic effect in viral gastroenteritis on antibiotic-associated diarrhea. Oral antimicrobial agents were prescribed for the treatment of acute respiratory infections at the clinics of the Health Care Center of the City of Tampere or Tampere University Hospital, Finland, to 167 patients who were invited to participate in the study. Of the patients, 48 were lost to follow-up; therefore, the final study population consisted of 119 children from 2 weeks to 12. 8 years of age (mean: 4.5 years). All study subjects met the inclusion criteria: they had not received any antimicrobial medication during the previous 3 months, they did not suffer from gastrointestinal disorders, and they did not need intravenous antimicrobial treatment. The patients were randomized to receive placebo or 2 x 10(10) colony-forming units of Lactobacillus GG in capsules given twice daily during the antimicrobial treatment. Lactobacillus GG and placebo capsules were indistinguishable in appearance and taste. The parents kept a daily symptom diary and recorded stool frequency and consistency at home for 3 months. Diarrhea was defined as at least three watery or loose stools per day for a minimum of 2 consecutive days. In the case of diarrhea, viral (adenovirus, rotavirus, calicivirus and astrovirus) and bacterial (Salmonella, Shigella, Yersinia, Campylobacter, Clostridium difficile, Staphylococcus aureus, and yeasts) analyses were studied in fecal samples. The metabolic activity of the gut microflora was assessed by analysis of fecal urease, beta-glucosidase, and beta-glucuronidase activities. The primary outcome measure was diarrhea during the first 2 weeks after the beginning of the antimicrobial treatment, because this period most likely reflects the effects of antimicrobial use. Secondary outcome measures were the activities of fecal urease, beta-glucuronidase, and beta-glucosidase. On the entire follow-up, 80% of any gastrointestinal symptoms were reported during the first 2 weeks after the beginning of the antimicrobial treatment. The incidence of diarrhea was 5% in the Lactobacillus GG group and 16% in the placebo group within 2 weeks of antimicrobial therapy (chi(2) = 3.82). The treatment effect (95% confidence interval) of Lactobacillus GG was -11% (-21%-0%). In diarrheal episodes, the viral and bacterial analyses were positive for Clostridium difficile in 2 cases and for Norwalk-like calicivirus in 3 cases. The age of the patients with diarrhea was between 3 months and 5 years in 75% of cases in both groups. The severity of diarrhea was comparable in the study groups, as evidenced by similar stool frequency (mean: 5 per day; range: 3-6) and the duration of diarrhea (mean: 4 days; range: 2-8). The activities of fecal urease and beta-glucuronidase, but not beta-glucosidase, changed significantly after the beginning of the antimicrobial treatment in the Lactobacillus GG group and in the placebo group alike. (ABSTRACT TRUNCATED)

Integrated approach to child health in developing countries

This article focuses on the integrated approach to child health in developing countries. The Integrated Management of Childhood Illness (IMCI) is a strategy developed by ten programs of WHO working with UN International Childrens Emergency Fund and many other agencies institutions and individuals. IMCI focuses on the disease of childhood that causes the greatest global burden while allowing for the content to be adapted to an individual countrys needs. An integrated approach is justified by good clinical practice and most importantly treating the child as a whole and not simply his or her most obvious disease. The strategy involves not only curative care but also interventions to promote healthy growth and development and prevent diseases. In health facilities the IMCI strategy promotes the accurate identification of childhood illnesses in outpatient settings ensures appropriate combined treatment of all major illnesses strengthens the counseling of caretakers and the provision of preventive services and speed up the referral of severely ill children. The strategy also aims to improve the quality of care of sick children at the referral level. In the home setting it promotes appropriate early home care and care seeking improved nutrition and prevention and the correct implementation of prescribed care. Through improving the coordination and quality of services provided by existing child health and other programs the IMCI strategy will help increase the effectiveness of care and in time reduce recurrent costs.

Primary ciliary dyskinesia

Most medical students can remember that Kartagener Syndrome is the association of situs inversus, bronchiectasis and sinusitis as a result of defective ciliary function. What is equally important but seldom remembered is that 50% of patients with primary ciliary dyskinesia (PCD) do not have situs inversus. It is these patients in whom the diagnosis of PCD, the universal term for this disorder, may be delayed. This has important implications because the early initiation of physiotherapy combined with aggressive treatment of acute respiratory infections can prevent deterioration in lung function. Recognition of the diagnosis of PCD also has implications for ENT intervention. In common with many paediatric diseases, an understanding of the normal anatomy and physiology enables a more complete understanding of the possible clinical presentation and complications of PCD. This article begins with a brief description of normal ciliary ultrastructure and the role of cilia in health.

The Clinical Effect of Sparfloxacin for the Treatment of Acute Respiratory Infection

Sparfloxacin is a new synthetic quinolone antimicrobial developed at the Research Laboratories of Dainippon Pharmaceutical Co, Ltd. To evaluate the efficacy and safety of sparfloxacin in acute pulmonary infection, we administered sparfloxacina(100mg) twice in a day to 30 patients who had signs and symptoms of acute pulmonary infectious diseases regardless of their underlying lung disease for 7 days. The results were as follows: 1) A total 30 patients were enrolled in the trial. Among them, 24 cases(80%) had underlying lung problems such as chronic obstructive pulmonary disease(36.4%), bronchiectasis(36.4%), bronchial asthma(3.3%), or lung cancer(3.3%). 2) In 26 cases(86.6%), we observed effective improvement, and 4 cases(13.4%) show mildly effective improvement of symptoms and signs of respiratory infection. 3) In 23 cases(73.4%), we observed bacteriological eradication in culture or decreased the number of bacteria by Gram stain which found dominantly in previous Gram stain. 4) The significant side effect was not noted. The above results suggested that sparfloxacin was effective as a first line therapy in patients with acute respiratory infection.

Patterns and determinants of use of antibiotics for acute respiratory tract infection in children in China.

Use of antibiotics for acute respiratory infection (ARI) of presumed viral etiology is a worldwide problem. The World Health Organization (WHO) has provided guidelines for diagnosis and treatment of ARI for developing countries. Specially trained observers applied the WHO criteria to study the diagnosis and treatment of ARI given by 100 randomly selected health care workers (HCWs) in a rural county in China. A total of 750 cases of ARI were evaluated. Before the parents sought medical care, 47% of children in the county hospitals, 25% of those in the townships and 18% of those in the villages had already received antibiotics, available without prescription. Among the HCWs antibiotic abuse (antibiotics for presumably viral disease) was detected in the treatment of 97% of cases, and severe abuse (such as prescription of two incompatible antibiotics) was detected in 37%. Most (197 of 200) patients with bacterial disease received antibiotics, but inappropriate antibiotic treatment (dose or type) was observed in 63% of these cases. HCWs with university training and those with higher test scores on knowledge and attitude prescribed antibiotics more judiciously than those lacking those attributes. Abuse of antibiotics for ARI is a serious and costly problem in rural China, potentially leading to widespread antibiotic resistance. Educating HCWs in the management of ARI and proper use of antibiotics has high priority in China.