Antimicrobial Treatment Of Lower Respiratory Tract Infections In The Hospital Setting
5-day levofloxacin; acute exacerbations; antibiotic-therapy; antibiotics; chronic-bronchitis; community-acquired pneumonia; community-associated pneumonia; drug-interaction; General & Internal Medicine; healthcare-associated; hospital-acquired; open-label; quinolones; randomized-trial; streptococcus-pneumoniae; ventilator-associated; ventilator-associated pneumonia
Respiratory tract infections (RTIs) that may require hospitalization include acute exacerbations of chronic bronchitis (AECB), community-acquired pneumonia (CAP), and hospital-acquired pneumonia (HAP), which includes ventilator-associated pneumonia (VAP). Healthcare-associated pneumonia (HCAP) is treated similar to HAP and may be considered with HAP. For CAP requiring hospitalization, the current guidelines for the treatments of RTIs generally recommend either a beta-lactam and macrolide combination or a fluoroquinolone. The respiratory fluoroquinolones (levofloxacin, gatifloxacin, moxifloxacin, and gemifloxacin) are excellent antibiotics due to high levels of susceptibility among gram-negative, gram-positive, and atypical pathogens. The fluoroquinolones are active against >98% of Streptococcus pneumoniae, including penicillin-resistant strains. Fluoroquinolones are also recommended for AECB requiring hospitalization. Evidence from clinical trials suggests that levofloxacin monotherapy is as efficacious as combination ceftriaxone-erythromycin therapy in the treatment of patients hospitalized with CAP. For early-onset HAP, VAP, and HCAP without the risk of multidrug resistance, ceftriaxone, ampicillin-sulbactam, ertapenem, or one of the fluoroquinolones is recommended. High-dose, short-course therapy regimens may offer improved treatment due to higher drug concentrations, more rapid killing, increased adherence, and the potential to reduce development of resistance. Recent studies have shown that short-course therapy with levofloxacin, azithromycin, or telithromycin in patients with CAP was effective, safe, and tolerable and may control the rate of resistance. (C) 2005 Elsevier Inc. All rights reserved.
Grossman R F; Rotschafer J C; Tan J S
American Journal of Medicine
2005
2005-07
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1016/j.amjmed.2005.05.011" target="_blank" rel="noreferrer noopener">10.1016/j.amjmed.2005.05.011</a>
Diabetic Foot Infections - Treat Now Or Pay Later
antibiotic-therapy; diabetes-mellitus; empiric; infection; Surgery; wound
File T M; Tan J S
Complications in Surgery
1993
1993-07
Journal Article or Conference Abstract Publication
n/a
Shorter Course Therapy Of Serious Respiratory Infections: New Data For New Approaches To Management
adults; antibiotic-therapy; carriage; Infectious Diseases; meningococcal disease; randomized-trial; resolution; ventilator-associated pneumonia
File T M
Current Opinion in Infectious Diseases
2004
2004-04
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1097/10.qco.0000124363.27345.46" target="_blank" rel="noreferrer noopener">10.1097/10.qco.0000124363.27345.46</a>
Fluoroquinolones And Respiratory Tract Infections: Do They Work?
acute; antibacterial activity; antibiotic-therapy; chronic-bronchitis; community-acquired pneumonia; exacerbations; hospitalization; Immunology; in-vitro; Infectious Diseases; obstructive pulmonary-disease; oral ciprofloxacin; requiring; streptococcus-pneumoniae
File T M
Infectious Diseases in Clinical Practice
1997
1997-11
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1097/00019048-199711002-00006" target="_blank" rel="noreferrer noopener">10.1097/00019048-199711002-00006</a>
Duration And Cessation Of Antimicrobial Treatment
acinetobacter-baumannii; antibiotic-therapy; antimicrobial resistance; case studies; catheter-related bloodstream; clinical-practice guidelines; clinical-practice guidelines; community-acquired pneumonia; complicated intra-abdominal; course; General & Internal Medicine; healthcare-associated pneumonia; hospital-acquired pneumonia; infection; infectious-diseases-society; intensive-care units; pseudomonas-aeruginosa; resistant; short-course therapy; staphylococcus-aureus bacteremia; streptococcus-pneumoniae; ventilator-acquired pneumonia; ventilator-associated pneumonia
File T M
Journal of Hospital Medicine
2012
2012-01
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1002/jhm.988" target="_blank" rel="noreferrer noopener">10.1002/jhm.988</a>
Ventilator-associated pneumonia: gearing towards shorter-course therapy
pneumonia; Infectious Diseases; trial; infection; antibiotic-therapy; resolution; Antimicrobial therapy; duration of therapy; pseudomonas-aeruginosa; ventilator-associated
Purpose of review The studies that are reviewed in this article have all concluded that a shorter duration of antibiotic therapy (7-8 days) may be adequate in the treatment of the majority of patients with ventilator-associated pneumonia, and does not confer an increased incidence of mortality. Recent findings Ventilator-associated pneumonia has traditionally been treated with at least 2 weeks of antimicrobial therapy. With the increasing emergence of multi-drug-resistant pathogens, however, efforts have been directed at minimizing the duration of therapy. Several studies have emerged over the last few years aiming to shorten the duration of antimicrobial therapy for ventilator-associated pneumonia. Summary The minimum effective duration of antibiotic therapy, however, remains unclear. Further studies geared towards determining this are needed.
Chua T D; File T M
Current Opinion in Infectious Diseases
2006
2006-04
Journal Article or Conference Abstract Publication
n/a
Serum procalcitonin in the diagnosis and management of intra-abdominal infections
acute; anti-thymocyte globulin; antibiotic-therapy; antibiotic-therapy; appendicitis; c-reactive protein; critically-ill patients; intensive-care units; international multicenter; liver-transplantation; liver-transplantation; major abdominal-surgery; pancreatitis; peritonitis; Pharmacology & Pharmacy; procalcitonin; sepsis; spontaneous bacterial
The biomarker procalcitonin (PCT) has been used to diagnose and monitor a number of clinically significant infections. Serum levels of PCT are often increased in the presence of bacterial and fungal infections but not viral infections or noninfectious inflammation. Intra-abdominal infections (IAIs) are serious conditions that pose difficult challenges to physicians and the healthcare system. Researchers have evaluated PCT in the management of IAIs, both for diagnosis and for guiding antibiotic therapy. The studies have produced mixed results, leading to controversy on the utility of PCT in IAIs. PCT appears to be most useful in diagnosing postoperative infections and necrotizing pancreatitis. This review aims to summarize these data, explore the pathophysiology of PCT in sepsis from IAIs, discuss the strengths and weaknesses of PCT monitoring in IAIs, and provide guidance for the interpretation of PCT levels.
Watkins R R; Lemonovich T L
Expert Review of Anti-Infective Therapy
2012
2012-02
Journal Article
<a href="http://doi.org/10.1586/eri.11.164" target="_blank" rel="noreferrer noopener">10.1586/eri.11.164</a>
How long should we treat community-acquired pneumonia?
antibacterial response; antibiotic-therapy; antimicrobial therapy; azithromycin; clinical-efficacy; community-acquired pneumonia; double-blind; duration of therapy; Infectious Diseases; practice guidelines; respiratory-tract infections; short-duration therapy; Streptococcus pneumoniae
Purpose of review: The studies, reviewed in this article suggest that a shorter duration of antibiotic therapy is comparable to standard therapy in the treatment of community-acquired pneumonia and promotes reduction of adverse events, microbial resistance, cost, and improved patient compliance. Recent findings: Community-acquired pneumonia has traditionally been treated with a 7-14-day course of antimicrobial therapy. Since there have been few well controlled trials regarding the optimal duration of therapy, however, there has been no consensus on length of therapy among different organizational guidelines. Several recent studies have demonstrated that shorter course antibiotic regimens are effective in the treatment of community-acquired pneumonia. Summary: Short-course antibiotic therapy is equivalent to standard length of therapy for clinical cure and bacterial eradication. Minimization of drug exposure, however, reduces selection pressure for resistant strains, strengthens patient compliance, and potentially reduces adverse events such as Clostridium difficile infections.
Scalera N M; File T M
Current Opinion in Infectious Diseases
2007
2007-04
Journal Article
<a href="http://doi.org/10.1097/QCO.0b013e3280555072" target="_blank" rel="noreferrer noopener">10.1097/QCO.0b013e3280555072</a>