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Impact of safety warnings for fluoroquinolones on prescribing behaviour. Results of a cohort study with outpatient routine data. Infection 2020; 49:447-455. [PMID: 33258075 PMCID: PMC8159769 DOI: 10.1007/s15010-020-01549-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 10/28/2020] [Indexed: 01/01/2023]
Abstract
Purpose The need for drug-related safety warnings is undisputed, but their impact on prescribing behaviour is not always clear. Safety warnings usually do not contain therapeutic alternatives. Based on German outpatient routine healthcare data, our cohort study investigated the impact of three warnings for fluoroquinolones on prescribing behaviour. Methods Structural breaks were estimated in a time-series analysis (2005–2014) of 184,134 first antibiotic prescriptions for patients (≥ 18 years) diagnosed with community-acquired pneumonia (CAP), acute bacterial sinusitis (ABS), or acute exacerbation of chronic bronchitis (AECB). Subsequently, risk factors for patients’ before/after safety warnings presented as risk ratios (RR) were estimated by Poisson regression. Results Following the 2008 warning for moxifloxacin, the RR of being prescribed moxifloxacin was reduced by 56% (95% CI 0.41–0.47; p < 0.001) for CAP, by 65% (95% CI 0.32–0.39; p < 0.001) for ABS, by 57% (95% CI 0.41–0.45; p < 0.001) for AECB. After the 2012 warning for levofloxacin, the RR of being prescribed levofloxacin was reduced by 31% (95% CI 0.64–0.74; p < 0.001) for CAP, by 14% (95% CI 0.77–0.96; p = 0.007) for ABS, by 27% (95% CI 0.69–0.77; p < 0.001) for AECB. We noticed a prescription-switch to other antibiotics which was not in line with the national guideline recommendations. The warning for moxifloxacin 2009 had no impact on prescribing behaviour. Conclusion This study observed an impact on prescribing behaviour in response to regulatory safety warnings for two out of three warnings. Information on therapeutic alternatives should be a part of any safety warning to encourage the intended changes in prescribing behaviour. Electronic supplementary material The online version of this article (10.1007/s15010-020-01549-7) contains supplementary material, which is available to authorized users.
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[Guideline for "rhinosinusitis"-long version : S2k guideline of the German College of General Practitioners and Family Physicians and the German Society for Oto-Rhino-Laryngology, Head and Neck Surgery]. HNO 2019; 66:38-74. [PMID: 28861645 DOI: 10.1007/s00106-017-0401-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Abstract
Chronic rhinosinusitis is a heterogeneous group of inflammatory diseases with significant annual costs for the health care system. To date, there is no distinct signaling pathway known that explains the entire process from the beginning to tissue transformation. Due to the diversity of chronic rhinosinusitis, no uniform treatment has yet been developed. With a focus on chronic rhinosinusitis with nasal polyps (CRSwNP), molecular biologic gene expression studies have been performed to identify specific characteristics of nasal polyps that might allow the development of new therapeutic procedures. Microarray analysis revealed alterations in cell adhesion and differentiation as well as blood vessels. Further examinations identified two mechanisms that could play an important role in the pathogenesis of nasal polyps. In the context of the underlying disease, i.e., Th2-mediated chronic inflammation with predominantly eosinophilic cell infiltration, these findings might explain the pathogenesis of nasal polyps and allow development of new therapeutic strategies.
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Affiliation(s)
- M Koennecke
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland.
| | - R Pries
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - B Wollenberg
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
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Könnecke M, Klimek L, Mullol J, Gevaert P, Wollenberg B. Subtypisierung der Polyposis nasi: Phänotypen, Endotypen und Komorbiditäten. ALLERGO JOURNAL 2018. [DOI: 10.1007/s15007-018-1542-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Koennecke M, Klimek L, Mullol J, Gevaert P, Wollenberg B. Subtyping of polyposis nasi: phenotypes, endotypes and comorbidities. ALLERGO JOURNAL INTERNATIONAL 2018; 27:56-65. [PMID: 29564208 PMCID: PMC5842507 DOI: 10.1007/s40629-017-0048-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 10/12/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is a heterogeneous, multifactorial inflammatory disease of the nasal and paranasal mucosa. It has not been possible to date to develop an internationally standardized, uniform classification for this disorder. A phenotype classification according to CRS with (CRSwNP) and without polyposis (CRSsNP) is usually made. However, a large number of studies have shown that there are also different endotypes of CRS within these phenotypes, with different pathophysiologies of chronic inflammation of the nasal mucosa. This review describes the central immunological processes in nasal polyps, as well as the impact of related diseases on the inflammatory profile of nasal polyps. MATERIALS AND METHODS The current knowledge on the immunological and molecular processes of CRS, in particular CRSwNP and its classification into specific endotypes, was put together by means of a structured literature search in Medline, PubMed, the national and international guideline registers, and the Cochrane Library. RESULTS Based on the current literature, the different immunological processes in CRS and nasal polyps were elaborated and a graphical representation in the form of an immunological network developed. In addition, different inflammatory profiles can be found in CRSwNP depending on related diseases, such as bronchial asthma, cystic fibrosis (CF), or NASID-Exacerbated Respiratory Disease (N‑ERD). CONCLUSION The identification of different endotypes of CRSwNP may help to improve diagnostics and develop novel individual treatment approaches in CRSwNP.
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Affiliation(s)
- Michael Koennecke
- Lübeck Campus, Department of Otorhinolaryngology, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Ludger Klimek
- Center for Rhinology and Allergology, Wiesbaden, Germany
| | - Joaquim Mullol
- Rhinology Unit and Smell Clinic, Department of Otorhinolaryngology, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, CIBERES Spain
| | - Philippe Gevaert
- Department of Otorhinolaryngology, Ghent University, Ghent, Belgium
| | - Barbara Wollenberg
- Lübeck Campus, Department of Otorhinolaryngology, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538 Lübeck, Germany
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Ickrath P, Kleinsasser N, Ding X, Ginzkey C, Beyersdorf N, Hagen R, Kerkau T, Hackenberg S. Characterization of T-cell subpopulations in patients with chronic rhinosinusitis with nasal polyposis. ALLERGY & RHINOLOGY 2017; 8:139-147. [PMID: 29070271 PMCID: PMC5662539 DOI: 10.2500/ar.2017.8.0214] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: There is an ongoing discussion concerning the potential origins of chronic rhinosinusitis with nasal polyposis (CRSwNP). Objective: The aim of this study was to quantify subpopulations of T cells in peripheral blood and nasal polyps in CRSwNP to examine their influence on the etiology of this disease. Methods: Tissue and blood samples were collected from 11 patients who underwent nasal sinus surgery, and these samples were analyzed by multicolor flow cytometry. Results: There was a significantly lower frequency of CD4+ T-helper (Th) cells and a significantly higher frequency of CD8+ T cells among lymphocytes isolated from nasal polyps compared with peripheral blood mononuclear cells (PBMC). In both T-cell subpopulations, a shift mainly from naive T cells among peripheral blood lymphocytes toward an effector memory and terminally differentiated subtype predominance in nasal polyps was observed. Among CD4+ T cells, the frequencies of cluster of differentiation (CD) 45RA- Forkhead-Box-Protein P3high (FoxP3high) cytotoxic T-lymphocyte-associated Protein 4high (CTLA-4high) activated regulatory T (Treg) cells, and CD45RA- Forkhead-Box-Protein P3low (FoxP3low) memory T cells were significantly increased in nasal polyps compared with PBMC. Conclusion: In this study, we presented a detailed characterization of CD4+ and CD8+ T-cell subpopulations in patients with CRSwNP. CD8+ T cells were more prominent in nasal polyps than in CD4+ T cells. Both nasal CD8+ T cells and CD4+ T cells predominantly had an effector memory phenotype. Among CD4+ T cells, activated Treg cells were increased in nasal polyps compared with PBMC. The data point toward a local regulation of T-cell composition within the microenvironment of nasal polyps, which might be further exploited in the future to develop novel immunotherapeutic strategies.
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Affiliation(s)
- Pascal Ickrath
- From the Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University of Wuerzburg, Würzburg, Germany
| | - Norbert Kleinsasser
- From the Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University of Wuerzburg, Würzburg, Germany
| | - Xin Ding
- Institute for Virology and Immunobiology, University of Wuerzburg, Würzburg, Germany
| | - Christian Ginzkey
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery "Otto Körner," University Medical Center Rostock, Rostock, Germany
| | - Niklas Beyersdorf
- Institute for Virology and Immunobiology, University of Wuerzburg, Würzburg, Germany
| | - Rudolf Hagen
- From the Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University of Wuerzburg, Würzburg, Germany
| | - Thomas Kerkau
- Institute for Virology and Immunobiology, University of Wuerzburg, Würzburg, Germany
| | - Stephan Hackenberg
- From the Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University of Wuerzburg, Würzburg, Germany
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Klimek L, Pfaar O, Bousquet J, Senti G, Kündig T. Allergen immunotherapy in allergic rhinitis: current use and future trends. Expert Rev Clin Immunol 2017; 13:897-906. [DOI: 10.1080/1744666x.2017.1333423] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Ludger Klimek
- Department of Otorhinolaryngology, Allergy Center, Wiesbaden, Germany
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Allergy Center, Wiesbaden, Germany
- Department of Otorhinolaryngology, Head and Neck Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Jean Bousquet
- MACVIA-France, Contre les MAladies Chroniques pour un VIeillissement Actif en France European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France
- INSERM U 1168, VIMA: Ageing and chronic diseases Epidemiological and public health approaches, Villejuif, Université Versailles St-Quentin-en-Yvelines, Montigny le Bretonneux, France
| | - Gabriela Senti
- Center for Clinical Trials, Zurich University Hospital, Zurich, Switzerland
| | - Thomas Kündig
- Dept. of Dermatology, Zurich University Hospital, Zurich, Switzerland
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Li YY, Liu J, Li CW, Subramaniam S, Chao SS, Yu FG, Cohen NA, Li S, Wang DY. Myrtol standardized affects mucociliary clearance. Int Forum Allergy Rhinol 2016; 7:304-311. [PMID: 27888644 DOI: 10.1002/alr.21878] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 10/11/2016] [Accepted: 10/18/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Myrtol standardized (Gelomyrtol forte) has been shown to be effective in controlling nasal symptoms of rhinosinusitis by promoting mucociliary clearance. Our aim was to evaluate the short- and long-term effects of myrtol on ciliated columnar cells and goblet cells in an in-vitro setting. METHODS Nasal epithelial cells were harvested (42 days) from an air-liquid interface (ALI) culture of human nasal epithelial stem/progenitor cells (hNESPCs), which was derived from biopsies of nasal inferior turbinate mucosa. Myrtol 0.1% was applied to the ALI culture system at 2 different time-points (day 0 and day 35) on progenitor and differentiated cells. Ciliary beat frequency (CBF), supernatant fluid, and ciliated and goblet cell markers were evaluated after short- (7 days) and long-term (42 days) treatment. RESULTS In the long-term treatment with myrtol, there was an increase in cilia area (type IV β-tubulin+ , 1.53-fold, p = 0.031) and ciliogenesis-related markers (Foxj1 and CP110) with no change in CBF, as compared with control. In addition, the short-term myrtol treatment group exhibited greater mucin secretion compared with control. CONCLUSION This study demonstrates, through cellular and molecular mechanisms, that myrtol standardized enhances the mucus production from goblet cells in the short term, and promotes ciliated cell differentiation in the long term.
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Affiliation(s)
- Ying Ying Li
- Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jing Liu
- Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chun Wei Li
- Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Siew Shuen Chao
- Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Feng Gang Yu
- Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Noam A Cohen
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA
| | - Shi Li
- Department of Otolaryngology, The Second Hospital of Shandong University, Jinan, China
| | - De Yun Wang
- Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Kirsche H, Klimek L. [ASA-intolerance syndrome and persistent rhinosinusitis : Differential diagnosis and treatment]. HNO 2016; 63:357-63. [PMID: 25929893 DOI: 10.1007/s00106-015-0008-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND A differential diagnosis of persistent chronic rhinosinusitis is ASA-intolerance syndrome (AIS), also known as Aspirin®‑exacerbated respiratory disease (AERD), Samter-Trias (Samter's disease, Morbus Widal). Particularly in cases of frequent recurrency of nasal polyps in combination with bronchial asthma and hypersensitivity reactions to acetylsalicylic acid (ASA) and other nonsteroidal anti-inflammatory drugs (NSAR) can often be referred to an underlying AIS. The pathogenesis of this syndrome is attributed to a misallocation of the arachidonic acid metabolism, resulting in an increased leukotriene production. METHODS The diagnosis may be difficult in the early stages of the disease with incomplete triad of symptoms. RESULTS Therapy may consist of paranasal sinuses surgery, drug therapy and adaptive deactivation as the only causal treatment option for patients with AIS. CONCLUSION For adaptive desactivation, positive effects were actually shown even in patients with long-term recurrent or persistent complaints of chronic rhinosinusitis.
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Affiliation(s)
- H Kirsche
- Universitätsklinikum Münster, Klinik für Hals-Nasen-Ohrenheilkunde, Kardinal-von-Galen-Ring 10, 48149, Münster, Deutschland,
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[Rhinosinusitis guidelines--unabridged version: S2 guidelines from the German Society of Otorhinolaryngology, Head and Neck Surgery]. HNO 2012; 60:141-62. [PMID: 22139025 DOI: 10.1007/s00106-011-2396-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Steffen A. Botulinumtoxin für die Behandlung sekretorischer Störungen im Kopf-Hals-Bereich. HNO 2012; 60:484-9. [DOI: 10.1007/s00106-012-2498-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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13
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The problem of placebo-controlled trials allowing rescue medication: how to assess efficacy in rhinosinusitis and allergic rhinoconjunctivitis when both groups receive active rescue treatment. Curr Opin Allergy Clin Immunol 2009; 9:222-7. [DOI: 10.1097/aci.0b013e32832aa5cf] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Falagas ME, Giannopoulou KP, Vardakas KZ, Dimopoulos G, Karageorgopoulos DE. Comparison of antibiotics with placebo for treatment of acute sinusitis: a meta-analysis of randomised controlled trials. THE LANCET. INFECTIOUS DISEASES 2008; 8:543-52. [DOI: 10.1016/s1473-3099(08)70202-0] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Current World Literature. Curr Opin Otolaryngol Head Neck Surg 2008; 16:292-5. [DOI: 10.1097/moo.0b013e3283041256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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[Analgesic intolerance (AI). Key position of ENT physicians for early detection of this condition]. HNO 2008; 56:443-50; quiz 451. [PMID: 18389300 DOI: 10.1007/s00106-008-1701-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The clinical manifestation of analgesic intolerance (AI) is frequently associated with symptoms examined by ear-nose-throat (ENT) specialists. The prevalence of AI is reported in the literature to be 0.6-2.5%. Even though there are no concluding results concerning its pathogenesis, an altered arachidonic acid metabolism is most likely the underlying pathomechanism. The symptoms include chronic rhinosinusitis with nasal polyps, asthma, gastrointestinal ulcers, angioedema, and urticaria. Clinical reactions after ingestion of nonsteroidal anti-inflammatory-drugs (NSAIDs) are often obvious in the progress of disease. In order to initiate early therapy and therefore prevent the progress of disease, the diagnosis of AI should occur before the complete picture of AI is obvious. Adaptive desensitization is currently the single causal therapy. Frequency of endonasal revision surgery is reduced after desensitization; severe asthma and reactions after ingestion of NSAIDs are avoided. ENT specialists are particularly in a key position for early detection of AI.
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