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Liu LQ, Wang ZH, Yao HY. Hepatocyte growth factor can guide treatment of Mycoplasma pneumoniae pneumonia in children. Exp Ther Med 2020; 19:3432-3438. [PMID: 32266043 DOI: 10.3892/etm.2020.8596] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 02/02/2020] [Indexed: 12/30/2022] Open
Abstract
The objective of the present study was to explore the role of hepatocyte growth factor (HGF) in directing treatment of Mycoplasma pneumoniae pneumonia (MP). Serum levels of HGF were assessed using ELISA in 65 pediatric patients with MP, 42 with bacterial pneumonia and 30 healthy controls. Serum levels of C-reactive protein (CRP), the standard guide for MP treatment, were also examined in severe and non-severe MP. The sensitivity and specificity of HGF and CRP in assessing the outcome of azithromycin treatment of MP were compared using receiver operating characteristic curves. HGF levels were elevated in MP and bacterial pneumonia patients compared with healthy controls. HGF levels were also significantly higher in severe MP than in non-severe MP. HGF showed higher sensitivity and specificity than CRP in assessing outcomes of azithromycin treatment of MP. The results of the present study indicated that HGF may be used to detect severe MP and to direct its management. Furthermore, HGF may be better predictive marker to assess the effectiveness of azithromycin treatment of MP than CRP.
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Affiliation(s)
- Lun Qin Liu
- Department of Inspection, Infectious Diseases Hospital of Jinan, Jinan, Shandong 250021, P.R. China
| | - Zhi Hua Wang
- Department of Pediatrics, Tianjin Nankai Hospital, Tianjin Medical University, Tianjin 300100, P.R. China
| | - Hai Yun Yao
- Department of Inspection, Jinan Blood Center, Jinan, Shandong 250001, P.R. China
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Athlin S, Lidman C, Lundqvist A, Naucler P, Nilsson AC, Spindler C, Strålin K, Hedlund J. Management of community-acquired pneumonia in immunocompetent adults: updated Swedish guidelines 2017. Infect Dis (Lond) 2017; 50:247-272. [PMID: 29119848 DOI: 10.1080/23744235.2017.1399316] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Based on expert group work, Swedish recommendations for the management of community-acquired pneumonia in adults are here updated. The management of sepsis-induced hypotension is addressed in detail, including monitoring and parenteral therapy. The importance of respiratory support in cases of acute respiratory failure is emphasized. Treatment with high-flow oxygen and non-invasive ventilation is recommended. The use of statins or steroids in general therapy is not found to be fully supported by evidence. In the management of pleural infection, new data show favourable effects of tissue plasminogen activator and deoxyribonuclease installation. Detailed recommendations for the vaccination of risk groups are afforded.
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Affiliation(s)
- Simon Athlin
- a Department of Infectious Diseases , Örebro University Hospital , Örebro , Sweden.,b Faculty of Medicin and Health , Örebro University , Örebro , Sweden
| | - Christer Lidman
- c Unit of Infectious Diseases, Department of Medicine Solna , Karolinska Institutet , Stockholm , Sweden.,d Department of Infectious Diseases , Karolinska University Hospital , Stockholm , Sweden
| | - Anders Lundqvist
- e Department of Infectious Diseases , Södra Älvsborgs Hospital , Borås , Sweden
| | - Pontus Naucler
- c Unit of Infectious Diseases, Department of Medicine Solna , Karolinska Institutet , Stockholm , Sweden.,d Department of Infectious Diseases , Karolinska University Hospital , Stockholm , Sweden
| | - Anna C Nilsson
- f Infectious Disease Research Unit, Department of Translational Medicine , Lund University , Malmö , Sweden
| | - Carl Spindler
- d Department of Infectious Diseases , Karolinska University Hospital , Stockholm , Sweden
| | - Kristoffer Strålin
- b Faculty of Medicin and Health , Örebro University , Örebro , Sweden.,d Department of Infectious Diseases , Karolinska University Hospital , Stockholm , Sweden.,g Unit of Infectious Diseases, Department of Medicine Huddinge , Karolinska Institutet , Stockholm , Sweden
| | - Jonas Hedlund
- c Unit of Infectious Diseases, Department of Medicine Solna , Karolinska Institutet , Stockholm , Sweden.,d Department of Infectious Diseases , Karolinska University Hospital , Stockholm , Sweden
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Engel MF, Velzen M, Hoepelman AIM, Thijsen S, Oosterheert JJ. Positive urinary antigen tests for Streptococcus pneumoniae in community-acquired pneumonia: a 7-year retrospective evaluation of health care cost and treatment consequences. Eur J Clin Microbiol Infect Dis 2012; 32:485-92. [DOI: 10.1007/s10096-012-1761-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Accepted: 10/08/2012] [Indexed: 11/29/2022]
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Spindler C, Strålin K, Eriksson L, Hjerdt-Goscinski G, Holmberg H, Lidman C, Nilsson A, Ortqvist A, Hedlund J. Swedish guidelines on the management of community-acquired pneumonia in immunocompetent adults--Swedish Society of Infectious Diseases 2012. ACTA ACUST UNITED AC 2012; 44:885-902. [PMID: 22830356 DOI: 10.3109/00365548.2012.700120] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This document presents the 2012 evidence based guidelines of the Swedish Society of Infectious Diseases for the in- hospital management of adult immunocompetent patients with community-acquired pneumonia (CAP). The prognostic score 'CRB-65' is recommended for the initial assessment of all CAP patients, and should be regarded as an aid for decision-making concerning the level of care required, microbiological investigation, and antibiotic treatment. Due to the favourable antibiotic resistance situation in Sweden, an initial narrow-spectrum antibiotic treatment primarily directed at Streptococcus pneumoniae is recommended in most situations. The recommended treatment for patients with severe CAP (CRB-65 score 2) is penicillin G in most situations. In critically ill patients (CRB-65 score 3-4), combination therapy with cefotaxime/macrolide or penicillin G/fluoroquinolone is recommended. A thorough microbiological investigation should be undertaken in all patients, including blood cultures, respiratory tract sampling, and urine antigens, with the addition of extensive sampling for more uncommon respiratory pathogens in the case of severe disease. Recommended measures for the prevention of CAP include vaccination for influenza and pneumococci, as well as smoking cessation.
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Affiliation(s)
- Carl Spindler
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm.
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Aspa J, Rajas O, de Castro FR. Pneumococcal antimicrobial resistance: therapeutic strategy and management in community-acquired pneumonia. Expert Opin Pharmacother 2008; 9:229-41. [PMID: 18201146 DOI: 10.1517/14656566.9.2.229] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Streptococcus pneumoniae has been consistently shown to represent the most frequent causative agent of community-acquired pneumonia (CAP) and pneumococcal antibiotic resistance towards different families of antibiotics continues to be a much-debated issue. Microbial resistance causes a great deal of confusion in choosing an empirical treatment for pneumonia and this makes it necessary to know which factors actually determine the real impact of antimicrobial resistance on the outcome of pneumococcal infections. Several different aspects have to be taken into account when analyzing this matter, such as the study design, the condition of the patient at the time of diagnosis, the choice of the initial antimicrobial regimen (combination or monotherapy) and the pharmacokinetic/pharmacodynamic variables of the chosen antibiotic. It is generally accepted that in the treatment of beta-lactam-resistant pneumococcal infections, the use of standard antipneumococcal beta-lactam agents is unlikely to impact negatively on the outcome of CAP when appropriate agents are given in sufficient doses. As a general rule, for infections with penicillin-sensitive strains, penicillin or an aminopenicillin in a standard dosage will be effective; in the cases of strains with intermediate resistance, beta-lactam agents are still considered appropriate treatment although higher dosages are recommended; finally, infections with isolates of high-level penicillin resistance should be treated with alternative agents such as the third-generation cephalosporins or the new antipneumococcal fluoroquinolones. In areas of high prevalence of high-level macrolide resistance, empirical monotherapy with a macrolide is not optimal for the treatment of hospitalised patients with moderate or moderately-severe CAP. Fluoroquinolones are considered to be excellent antibiotics in the treatment of pneumococcal CAP in adults, but their general recommendation has been withheld due to fears of a widespread development of resistance. Most international guidelines recommend combination therapy (beta-lactam plus a macrolide) for the treatment of hospitalised patients with CAP.
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Affiliation(s)
- Javier Aspa
- Universidad Autónoma de Madrid, Servicio de Neumología, Hospital Universitario de la Princesa, Madrid, Spain.
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File TM. The development of pharmacokinetically enhanced amoxicillin/clavulanate for the management of respiratory tract infections in adults. Int J Antimicrob Agents 2007; 30 Suppl 2:S131-4. [DOI: 10.1016/j.ijantimicag.2007.07.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2007] [Accepted: 07/25/2007] [Indexed: 10/22/2022]
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Feldman C, Anderson R. Controversies in the treatment of pneumococcal community-acquired pneumonia. Future Microbiol 2006; 1:271-81. [PMID: 17661640 DOI: 10.2217/17460913.1.3.271] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Community-acquired pneumonia remains an important cause of disease and death both in the developed and the developing worlds, despite the ready availability of potent antimicrobial agents to which the organisms remain susceptible. Furthermore, disease management is complicated by emerging resistance of the common pathogens to the various classes of commonly prescribed antimicrobial agents. Much recent research in the field of community-acquired pneumonia has focused attention on optimal treatment, evaluating the impact of antibiotic resistance, as well as of antimicrobial choices, on the outcome of these infections. In addition, efforts have been directed towards finding adjunctive therapies to antibiotics that may improve the prognosis of these patients. This article reviews some of these research areas, highlighting controversies that still exist with regard to final recommendations, and in particular with regard to infections with Streptococcus pneumoniae, the most common bacterial cause of community-acquired pneumonia.
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Affiliation(s)
- Charles Feldman
- University of the Witwatersrand Medical School, Division of Pulmonology, Department of Medicine, Parktown, Johannesburg, South Africa.
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Fernández Álvarez R, Suárez Toste I, Rubinos Cuadrado G, Medina Gonzálvez A, Gullón Blanco JA, González Martín I. Neumonía adquirida en la comunidad por gérmenes atípicos: tratamiento y evolución. Arch Bronconeumol 2006. [DOI: 10.1157/13092412] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Klig JE. Office pediatrics: current perspectives on the outpatient evaluation and management of lower respiratory infections in children. Curr Opin Pediatr 2006; 18:71-6. [PMID: 16470166 DOI: 10.1097/01.mpo.0000192520.48411.fa] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The outpatient evaluation and management of a child with lower respiratory infection (LRI) remain a challenge to clinicians worldwide. This update will discuss current problems and new developments in the outpatient evaluation and treatment of pediatric LRIs. RECENT FINDINGS The cause of pediatric LRIs remains partially defined. Mixed infections and 'unknown' organisms may be important sources of clinical illness. A wider incidence of atypical bacteria LRIs (notably Mycoplasma pneumoniae) in children is now recognized. Viral LRIs from rhinoviruses and human metapneumovirus are increasingly detected in children. Human metapneumovirus may compound the clinical severity of pediatric LRIs, specifically in combination with respiratory syncytial virus. Innovations in testing for viral LRIs offer a promising tool for the outpatient evaluation and management of pediatric LRIs. SUMMARY Neither clinical symptoms nor findings on chest radiographs can reliably distinguish children with bacterial LRIs from those with viral or atypical pathogens. The efficacy of outpatient antibiotic treatment of atypical bacteria LRIs remains unproven. Multiplex rapid viral testing may ultimately help to refine strategies for outpatient management. The outpatient treatment of viral LRIs remains limited to supportive care; the 'value' of bronchodilators, epinephrine, or corticosteroids for treatment of bronchiolitis is unconfirmed.
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Affiliation(s)
- Jean E Klig
- Long Island Jewish Medical Center, Schneider Children's Hospital, Department of Emergency Medicine, Albert Einstein College of Medicine, New Hyde Park, New York, USA.
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Hedlund J, Strålin K, Ortqvist A, Holmberg H. Swedish guidelines for the management of community-acquired pneumonia in immunocompetent adults. ACTA ACUST UNITED AC 2006; 37:791-805. [PMID: 16358446 DOI: 10.1080/00365540500264050] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This document presents the evidence-based guidelines of the Swedish Society of Infectious Diseases for the management of adult immunocompetent patients with community-acquired pneumonia (CAP), who are assessed at hospital. The prognostic score 'CURB-65' is recommended for all CAP patients in the emergency room. The score provides an assessment tool for the decision regarding outpatient treatment or level of hospital supervision, the choice of microbiological investigations, and empirical antibiotic treatment. In patients with non-severe CAP (CURB-65 score 0-2) we recommend initial narrow-spectrum antibiotic treatment, orally or intravenously, primarily directed at Streptococcus pneumoniae. In those with CURB-65 score 3, penicillin G or a cephalosporin intravenously is recommended. For CURB-65 score 0-3 atypical pathogens should be covered only when they are suspected on clinical or epidemiological grounds. In patients with CURB-65 score 4-5 intravenous combination therapy with either cephalosporin/macrolide or penicillin G/fluoroquinolone is recommended. Efforts should be made to identify the CAP aetiology in order to support the ongoing antibiotic treatment or to suggest treatment alterations. Recommended measures for prevention of CAP include influenza -- and pneumococcal -- vaccination to risk groups and efforts for smoking cessation.
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Affiliation(s)
- Jonas Hedlund
- Department of Infectious Diseases, Karolinska University Hospital, S-17176 Stockholm, Sweden.
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Barrett JF. Can biotech deliver new antibiotics? Curr Opin Microbiol 2006; 8:498-503. [PMID: 16125445 DOI: 10.1016/j.mib.2005.08.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2005] [Accepted: 08/15/2005] [Indexed: 10/25/2022]
Abstract
The evolution of support for the discovery and development of antibacterial (or antibiotic) agents from the larger pharmaceutical companies to the entrepreneur-like small biotechnology companies has been an experiment in the making for the past 15 years. The word 'experiment' is precisely chosen as the outcome is not certain. Many of the antibiotic biotech organizations that were most likely to undertake the task of picking up where large pharmaceutical companies left off have failed to survive, despite their use of outstanding science and their novel approaches to the development of discovery platforms. So this leaves one with the question of 'can biotech deliver the new antibiotics?'.
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Affiliation(s)
- John F Barrett
- Department of Infectious Diseases, Merck Research Laboratories, Rahway, NJ 07065, USA.
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Calbo E, Garau J. Application of Pharmacokinetics and Pharmacodynamics to Antimicrobial Therapy of Community-Acquired Respiratory Tract Infections. Respiration 2005; 72:561-71. [PMID: 16354997 DOI: 10.1159/000089567] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
To achieve bacteriologic and clinical success, sufficient concentrations of antimicrobial at the site of infection must be maintained for an adequate period of time. These dynamics are determined by combining drug pharmacokinetic and pharmacodynamic (PK/PD) data with minimum inhibitory concentrations. Bacteriologically confirmed failures have been reported in otitis media and, with a lesser degree of evidence, in pneumococcal pneumonia with a variety of agents that include beta-lactams, macrolides and fluoroquinolones. These failures have been shown to be due to infection by resistant pathogens or suboptimal therapy. However, no clinical failure has been reported during therapy for bacteremic pneumococcal pneumonia with adequate doses of beta-lactams. The failures reported with macrolides or fluoroquinolones have been due to either preexisting resistance to these agents that cannot be overcome by increasing the dose of the antimicrobial or, more rarely, the emergence of resistance during therapy. In this review, we offer an overview of the most important attributes of the main antimicrobials that are currently used in the treatment of community-acquired respiratory tract infections from a PK/PD perspective.
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Affiliation(s)
- Esther Calbo
- Department of Internal Medicine, Infectious Diseases Unit, Hospital Mútua de Terrassa, University of Barcelona, ES-08221 Barcelona, Spain
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