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Lu J, Zhang J, Wang G, Zhang X, Li Z. Effects of bronchoalveolar lavage on Mycoplasma Pneumoniae pneumonia: A propensity score matched-cohort study. Front Pediatr 2022; 10:1066640. [PMID: 36683805 PMCID: PMC9846808 DOI: 10.3389/fped.2022.1066640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 12/12/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the efficacy and safety of BAL in treating MPP. METHODS From January 2013 to January 2019, 1,689 pediatric patients with MPP were analyzed retrospectively. Patients were subdivided into BAL group and non-BAL group according to whether they received BAL treatment within seven days after admission. The propensity score matching method matched patients' baseline characteristics (1:1). The primary outcomes were hospital stays and the cure rate. Secondary outcomes included mortality, co-infection, repeat hospitalization within 30 days, and total cost of treatment. RESULTS After matching, 524 patients (BAL: 262; control: 262) were recorded. The BAL group had significantly shorter hospital stays (OR: 0.5, 95% CI: 0.4-0.7). Meanwhile, BAL did not significantly modify the cost, co-infection rate, and mortality. In subgroup analyses, the group with BAL intervention within three days had a significantly shorter hospital stay (OR: 0.4, 95% CI: 0.3-0.5) compared with the group with BAL intervention three days after admission. CONCLUSIONS Early BAL intervention is a better treatment than conventional drug therapy alone, and no significant complications were seen in this study. BAL intervention has an excellent clinical benefit. The earlier the intervention, the better the effect.
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Affiliation(s)
- Jinmiao Lu
- Department of Pharmacy, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China
| | - Junqi Zhang
- Department of Pharmacy, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China
| | - Guangfei Wang
- Department of Pharmacy, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China
| | - Xiaobo Zhang
- Department of Respiratory Disease, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China
| | - Zhiping Li
- Department of Pharmacy, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China
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2
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Desai S, Hall M, Lipsett SC, Shah SS, Brogan TV, Hersh AL, Williams DJ, Grijalva CG, Gerber JS, Blaschke AJ, Neuman MI, Ambroggio L. Mycoplasma Pneumoniae Testing and Treatment Among Children With Community-Acquired Pneumonia. Hosp Pediatr 2021; 11:760-763. [PMID: 34583319 DOI: 10.1542/hpeds.2020-005215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To describe testing and treatment practices for Mycoplasma pneumoniae (Mp) among children hospitalized with community-acquired pneumonia (CAP). METHODS We conducted a retrospective cohort study using the Pediatric Health Information Systems database. We included children 3 months to 18 years old hospitalized with CAP between 2012 and 2018 and excluded children who were transferred from another hospital and those with complex chronic conditions. We examined the proportion of patients receiving Mp testing and macrolide therapy at the hospital level and trends in Mp testing and macrolide prescription over time. At the patient level, we examined differences in demographics, illness severity (eg, blood gas, chest tube placement), and outcomes (eg, ICU admission, length of stay, readmission) among patients with and without Mp testing. RESULTS Among 103 977 children hospitalized with CAP, 17.3% underwent Mp testing and 31.1% received macrolides. We found no correlation between Mp testing and macrolide treatment at the hospital level (R 2 = 0.05; P = .11). Patients tested for Mp were more likely to have blood gas analysis (15.8% vs 12.8%; P < .1), chest tube placement (1.4% vs 0.8%; P < .1), and ICU admission (3.1% vs 1.4%; P < .1). Mp testing increased (from 15.8% to 18.6%; P < .001), and macrolide prescription decreased (from 40.9% to 20.6%; P < .001) between 2012 and 2018. CONCLUSIONS Nearly one-third of hospitalized children with CAP received macrolide antibiotics, although macrolide prescription decreased over time. Clinicians were more likely to perform Mp testing in children with severe illness, and Mp testing and macrolide treatment were not correlated at the hospital level.
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Affiliation(s)
- Sanyukta Desai
- Divisions of Hospital Medicine .,Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington
| | | | - Susan C Lipsett
- Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts.,Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Samir S Shah
- Divisions of Hospital Medicine and.,Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Thomas V Brogan
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington.,Critical Care, Seattle Children's Hospital, Seattle, Washington
| | - Adam L Hersh
- Division of Pediatric Infectious Diseases, Department of Pediatrics, School of Medicine, The University of Utah, Salt Lake City, Utah
| | | | - Carlos G Grijalva
- Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jeffrey S Gerber
- Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anne J Blaschke
- Division of Pediatric Infectious Diseases, Department of Pediatrics, School of Medicine, The University of Utah, Salt Lake City, Utah
| | - Mark I Neuman
- Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts.,Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Lilliam Ambroggio
- Sections of Emergency Medicine and Hospital Medicine, Children's Hospital Colorado and Department of Pediatrics, University of Colorado, Aurora, Colorado
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Rose MA, Barker M, Liese J, Adams O, Ankermann T, Baumann U, Brinkmann F, Bruns R, Dahlheim M, Ewig S, Forster J, Hofmann G, Kemen C, Lück C, Nadal D, Nüßlein T, Regamey N, Riedler J, Schmidt S, Schwerk N, Seidenberg J, Tenenbaum T, Trapp S, van der Linden M. [Guidelines for the Management of Community Acquired Pneumonia in Children and Adolescents (Pediatric Community Acquired Pneumonia, pCAP) - Issued under the Responsibility of the German Society for Pediatric Infectious Diseases (DGPI) and the German Society for Pediatric Pulmonology (GPP)]. Pneumologie 2020; 74:515-544. [PMID: 32823360 DOI: 10.1055/a-1139-5132] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The present guideline aims to improve the evidence-based management of children and adolescents with pediatric community-acquired pneumonia (pCAP). Despite a prevalence of approx. 300 cases per 100 000 children per year in Central Europe, mortality is very low. Prevention includes infection control measures and comprehensive immunization. The diagnosis can and should be established clinically by history, physical examination and pulse oximetry, with fever and tachypnea as cardinal features. Additional signs or symptoms such as severely compromised general condition, poor feeding, dehydration, altered consciousness or seizures discriminate subjects with severe pCAP from those with non-severe pCAP. Within an age-dependent spectrum of infectious agents, bacterial etiology cannot be reliably differentiated from viral or mixed infections by currently available biomarkers. Most children and adolescents with non-severe pCAP and oxygen saturation > 92 % can be managed as outpatients without laboratory/microbiology workup or imaging. Anti-infective agents are not generally indicated and can be safely withheld especially in children of young age, with wheeze or other indices suggesting a viral origin. For calculated antibiotic therapy, aminopenicillins are the preferred drug class with comparable efficacy of oral (amoxicillin) and intravenous administration (ampicillin). Follow-up evaluation after 48 - 72 hours is mandatory for the assessment of clinical course, treatment success and potential complications such as parapneumonic pleural effusion or empyema, which may necessitate alternative or add-on therapy.
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Affiliation(s)
- M A Rose
- Fachbereich Medizin, Johann-Wolfgang-Goethe-Universität Frankfurt/Main und Zentrum für Kinder- und Jugendmedizin, Klinikum St. Georg Leipzig
| | - M Barker
- Klinik für Kinder- und Jugendmedizin, Helios Klinikum Emil von Behring, Berlin
| | - J Liese
- Kinderklinik und Poliklinik, Universitätsklinikum an der Julius-Maximilians-Universität Würzburg, Würzburg
| | - O Adams
- Institut für Virologie, Universitätsklinikum Düsseldorf
| | - T Ankermann
- Klinik für Kinder- und Jugendmedizin 1, Universitätsklinikum Schleswig-Holstein, Campus Kiel
| | - U Baumann
- Pädiatrische Pneumologie, Allergologie und Neonatologie, Medizinische Hochschule Hannover
| | - F Brinkmann
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Ruhr-Universität Bochum
| | - R Bruns
- Zentrum für Kinder- und Jugendmedizin, Ernst-Moritz-Arndt-Universität Greifswald
| | - M Dahlheim
- Praxis für Kinderpneumologie und Allergologie, Mannheim
| | - S Ewig
- Kliniken für Pneumologie und Infektiologie, Thoraxzentrum Ruhrgebiet, Bochum/Herne
| | - J Forster
- Kinderabteilung St. Hedwig, St. Josefskrankenhaus , Freiburg und Merzhausen
| | | | - C Kemen
- Katholisches Kinderkrankenhaus Wilhelmstift, Hamburg
| | - C Lück
- Institut für Medizinische Mikrobiologie und Hygiene, Technische Universität Dresden
| | - D Nadal
- Kinderspital Zürich, Schweiz
| | - T Nüßlein
- Klinik für Kinder- und Jugendmedizin, Gemeinschaftsklinikum Mittelrhein, Koblenz
| | - N Regamey
- Pädiatrische Pneumologie, Kinderspital Luzern, Schweiz
| | - J Riedler
- Kinder- und Jugendmedizin, Kardinal Schwarzenberg'sches Krankenhaus, Schwarzach, Österreich
| | - S Schmidt
- Zentrum für Kinder- und Jugendmedizin, Ernst-Moritz-Arndt-Universität Greifswald
| | - N Schwerk
- Pädiatrische Pneumologie, Allergologie und Neonatologie, Medizinische Hochschule Hannover
| | - J Seidenberg
- Klinik für pädiatrische Pneumologie und Allergologie, Neonatologie, Intensivmedizin und Kinderkardiologie, Klinikum Oldenburg
| | - T Tenenbaum
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Mannheim
| | | | - M van der Linden
- Institut für Medizinische Mikrobiologie, Universitätsklinikum Aachen
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Esposito S, Bianchini S, Argentiero A, Neglia C, Principi N. How does one choose the appropriate pharmacotherapy for children with lower respiratory tract infections? Expert Opin Pharmacother 2020; 21:1739-1747. [PMID: 32567405 DOI: 10.1080/14656566.2020.1781091] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The definition of acute lower respiratory tract infection (LRTI) includes any infection involving the respiratory tract below the level of the larynx. In children, the most common acute LRTIs, and those with the greatest clinical relevance, are community-acquired pneumonia (CAP), bronchiolitis, bronchitis and tuberculosis (TB). The clinical relevance of LRTIs implies that they must be addressed with the most effective therapy. Antibiotics and antivirals play an essential role in this regard. AREAS COVERED In this paper, the most recent advances in the drug treatment of LRTIs in children are discussed. EXPERT OPINION Although LRTIs are extremely common and one of the most important causes of hospitalization and death in children, anti-infective therapy for these diseases remains unsatisfactory. For CAP and BR, the most important problem is the overuse and misuse of antibiotics; for BCL, the lack of drugs with demonstrated efficacy, safety and tolerability; for TB, the poor knowledge on the true efficacy and safety of the new drugs specifically planned to overcome the problem of MDR M. tuberculosis strains. There is still a long way to go for the therapy of pediatric LRTIs to be considered satisfactory.
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Affiliation(s)
- Susanna Esposito
- Pediatric Clinic, Pietro Barilla Children's Hospital, Department of Medicine and Surgery, University of Parma , Parma, Italy
| | - Sonia Bianchini
- Pediatric Clinic, Pietro Barilla Children's Hospital, Department of Medicine and Surgery, University of Parma , Parma, Italy
| | - Alberto Argentiero
- Pediatric Clinic, Pietro Barilla Children's Hospital, Department of Medicine and Surgery, University of Parma , Parma, Italy
| | - Cosimo Neglia
- Pediatric Clinic, Pietro Barilla Children's Hospital, Department of Medicine and Surgery, University of Parma , Parma, Italy
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Yang D, Chen L, Chen Z. The timing of azithromycin treatment is not associated with the clinical prognosis of childhood Mycoplasma pneumoniae pneumonia in high macrolide-resistant prevalence settings. PLoS One 2018; 13:e0191951. [PMID: 29377957 PMCID: PMC5788379 DOI: 10.1371/journal.pone.0191951] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 01/15/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Mycoplasma pneumoniae infection is a major cause of community-acquired pneumonia in children. We performed a retrospective study to evaluate the clinical impact of the timing of azithromycin treatment in children with Mycoplasma pneumoniae pneumonia in high macrolide-resistant prevalence settings. METHODS AND FINDINGS A total of 623 patients were enrolled in this study and were divided into 2 groups according to the timing of azithromycin therapy. Children who received azithromycin within 3 days (72 hours) after the onset of Mycoplasma pneumoniae pneumonia were classified into the early azithromycin treatment group (n = 174), whereas the late azithromycin treatment group (n = 449) comprised children treated with azithromycin more than 72 hours after symptom onset. We evaluated clinical prognosis according to demographic, clinical and laboratory characteristics. Although the early azithromycin treatment group exhibited a longer fever duration after azithromycin administration (7.17±4.12 versus 4.82±3.99 days, P<0.01), the total fever duration exhibited no significant difference (9.02±4.58 versus 9.57±4.91 days, P = 0.212). After azithromycin therapy, the two groups exhibited no significant differences with respect to improvements in the laboratory and radiological findings (all P>0.05). CONCLUSION The timing of azithromycin treatment is not associated with the clinical prognosis of Mycoplasma pneumoniae pneumonia in children in high macrolide-resistant Mycoplasma pneumoniae prevalence settings.
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Affiliation(s)
- Dehua Yang
- Zhejiang University School of Medicine, Hangzhou, Zhejiang, P.R. China
| | - Linghong Chen
- Zhejiang University School of Medicine, Hangzhou, Zhejiang, P.R. China
- The First People’s Hospital of Wenling, Wenling, Zhejiang, P.R. China
| | - Zhimin Chen
- Zhejiang University School of Medicine, Hangzhou, Zhejiang, P.R. China
- * E-mail:
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Wang L, Lu S, Feng Z, Li L, Niu B, Shuai J, Cao L, Li G, Liu J. The early examination of combined serum and imaging data under flexible fiberoptic bronchoscopy as a novel predictor for refractory Mycoplasma pneumoniae pneumonia diagnosis. Medicine (Baltimore) 2017; 96:e9364. [PMID: 29390413 PMCID: PMC5815825 DOI: 10.1097/md.0000000000009364] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The treatment role of flexible bronchoscopy (FOB) for pediatric refractory Mycoplasma pneumoniae pneumonia (RMPP) has been well documented. Besides, the application indication of FOB is also studied in patients with general MPP (GMPP), especially in those with large pulmonary lesions. This study was designed to examine the diagnostic value of bronchoscopic features for RMPP.The FOB and bronchoalveolar lavage (BAL) were adopted for pediatric patients who showed clinical and radiograph indications. On the basis of the final diagnosis on discharge, patients were divided into general and refractory MPP groups. The clinical, laboratory, and bronchoscopic imaging features were retrospectively investigated between these 2 groups.From June 2012 to May 2014, a total of 62 RMPP and 101 GMPP patients were treated with therapeutic bronchoscopy. The comparison analysis showed that the CRP, HBDH, LDH were significantly different between RMPP and GMPP groups (all P < .001). In the bronchoscopic imaging, the mucus plug was significantly more commonly seen in the RMPP group (P < .001). Receiver operating characteristic (ROC) analysis revealed that the combined serum, clinical, and FOB imaging data possessed greater specificity and sensitivity than serum and clinical data alone.Our data suggest that the combined serum, clinical, and bronchoscopic imaging data might serve as a promising predictor for early RMPP diagnosis for pediatric patients with large pulmonary lesions.
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Affiliation(s)
- Le Wang
- Institute of Pediatric Research
| | | | | | - Lanfeng Li
- Department of Nursing, Children's Hospital of Hebei Province, Shijiazhuang, China
| | - Bo Niu
- No.2 Department of Respiratory
| | | | | | - Guixia Li
- Institute of Pediatric Research
- Department of Laboratory Medicine
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7
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Li F, Huang J, Ji D, Meng Q, Wang C, Chen S, Wang X, Zhu Z, Jiang C, Shi Y, Liu S, Li C. Azithromycin effectively inhibits tumor angiogenesis by suppressing vascular endothelial growth factor receptor 2-mediated signaling pathways in lung cancer. Oncol Lett 2017; 14:89-96. [PMID: 28693139 PMCID: PMC5494938 DOI: 10.3892/ol.2017.6103] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 03/03/2017] [Indexed: 02/02/2023] Open
Abstract
Tumor angiogenesis is essential during lung cancer development and targeting angiogenesis may possess a potential therapeutic value. The present study demonstrates that azithromycin, a Food and Drug Administration-approved antibiotic drug, is a novel tumor angiogenesis inhibitor. Azithromycin inhibits capillary network formation of human lung tumor associated-endothelial cells (HLT-ECs) in vitro and in vivo. It significantly inhibits HLT-EC adhesion and vascular endothelial growth factor (VEGF)-induced proliferation of HLT-ECs in a dose-dependent manner without affecting migration. In addition, azithromycin induces apoptosis of HLT-ECs even in the presence of VEGF. Notably, azithromycin inhibits proliferation and induces apoptosis in multiple lung cancer cell lines to a significantly reduced extent compared with in HLT-ECs, suggesting that HLT-ECs are more susceptible to azithromycin treatment. In a lung tumor xenograft model, azithromycin significantly inhibits tumor growth and its anti-tumor activities are achieved by suppressing angiogenesis. Notably, the inhibitory effects of azithromycin on angiogenesis are associated with its ability to suppress VEGF-induced activation of VEGF receptor 2 (VEGFR2), phosphoinositide 3-kinase (PI3K)/protein kinase B (Akt), focal adhesion kinase, and disruption of focal adhesion assembly and actin stress fiber formation in HLT-ECs. The present study identifies that azithromycin targets VEGFR2-mediated focal adhesion and PI3K/Akt signaling pathways in HLT-ECs, leading to the suppression of angiogenesis and lung tumor growth.
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Affiliation(s)
- Fajiu Li
- Department of Respiratory Medicine, Wuhan No. 6 Hospital, Affiliated Hospital to Jianghan University, Wuhan, Hubei 430072, P.R. China
| | - Jie Huang
- Department of Respiratory Medicine, Wuhan No. 6 Hospital, Affiliated Hospital to Jianghan University, Wuhan, Hubei 430072, P.R. China
| | - Dongyuan Ji
- Department of Respiratory Medicine, Wuhan No. 6 Hospital, Affiliated Hospital to Jianghan University, Wuhan, Hubei 430072, P.R. China
| | - Qinghua Meng
- Department of Respiratory Medicine, Wuhan No. 6 Hospital, Affiliated Hospital to Jianghan University, Wuhan, Hubei 430072, P.R. China
| | - Chuanhai Wang
- Department of Respiratory Medicine, Wuhan No. 6 Hospital, Affiliated Hospital to Jianghan University, Wuhan, Hubei 430072, P.R. China
| | - Shi Chen
- Department of Respiratory Medicine, Wuhan No. 6 Hospital, Affiliated Hospital to Jianghan University, Wuhan, Hubei 430072, P.R. China
| | - Xiaojiang Wang
- Department of Respiratory Medicine, Wuhan No. 6 Hospital, Affiliated Hospital to Jianghan University, Wuhan, Hubei 430072, P.R. China
| | - Zhiyang Zhu
- Department of Respiratory Medicine, Wuhan No. 6 Hospital, Affiliated Hospital to Jianghan University, Wuhan, Hubei 430072, P.R. China
| | - Cheng Jiang
- Department of Respiratory Medicine, Wuhan No. 6 Hospital, Affiliated Hospital to Jianghan University, Wuhan, Hubei 430072, P.R. China
| | - Yi Shi
- Department of Respiratory Medicine, Wuhan No. 6 Hospital, Affiliated Hospital to Jianghan University, Wuhan, Hubei 430072, P.R. China
| | - Shuang Liu
- Department of Respiratory Medicine, Wuhan No. 6 Hospital, Affiliated Hospital to Jianghan University, Wuhan, Hubei 430072, P.R. China
| | - Chenghong Li
- Department of Respiratory Medicine, Wuhan No. 6 Hospital, Affiliated Hospital to Jianghan University, Wuhan, Hubei 430072, P.R. China
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Rodrigues CM. Challenges of Empirical Antibiotic Therapy for Community-Acquired Pneumonia in Children. CURRENT THERAPEUTIC RESEARCH 2017; 84:e7-e11. [PMID: 28761583 PMCID: PMC5522971 DOI: 10.1016/j.curtheres.2017.01.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 01/03/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality globally, responsible for more than 14% of deaths in children younger than 5 years of age. Due to difficulties with pathogen identification and diagnostics of CAP in children, targeted antimicrobial therapy is not possible, hence the widespread use of empirical antibiotics, in particular penicillins, cephalosporin, and macrolides. OBJECTIVES This review aimed to address medical, societal, and political issues associated with the widespread use of empirical antibiotics for CAP in the United Kingdom, India, and Nigeria. METHODS A literature review was performed identifying the challenges pertaining to the use of widespread empirical antibiotics for CAP in children. A qualitative analysis of included studies identified relevant themes. Empirical guidance was based on guidelines from the World Health Organization, British Thoracic Society, and Infectious Diseases Society of America, used in both industrialized and resource-poor settings. RESULTS In the United Kingdom there was poor adherence to antibiotics guidelines. There was developing antibiotic resistance to penicillins and macrolides in both developing and industrialized regions. There were difficulties accessing the care and treatment when needed in Nigeria. Prevention strategies with vaccination against Streptococcus pneumonia, Haemophilus influenza, and measles are particularly important in these regions. CONCLUSIONS Effective and timely treatment is required for CAP and empirical antibiotics are evidence-based and appropriate in most settings. However, better diagnostics and education to target treatment may help to prevent antibiotic resistance. Ensuring the secure financing of clean food and water, sanitation, and public health infrastructure are also required to reduce the burden of disease in children in developing countries.
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Affiliation(s)
- Charlene M.C. Rodrigues
- Department of Zoology, University of Oxford, Oxford, United Kingdom
- Department of Paediatric Immunology and Infectious Diseases, Newcastle upon Tyne Hospitals Foundation Trust, Great North Children’s Hospital, Newcastle upon Tyne, United Kingdom
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9
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Meyer Sauteur PM, Unger WWJ, Nadal D, Berger C, Vink C, van Rossum AMC. Infection with and Carriage of Mycoplasma pneumoniae in Children. Front Microbiol 2016; 7:329. [PMID: 27047456 PMCID: PMC4803743 DOI: 10.3389/fmicb.2016.00329] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 03/02/2016] [Indexed: 12/18/2022] Open
Abstract
“Atypical” pneumonia was described as a distinct and mild form of community-acquired pneumonia (CAP) already before Mycoplasma pneumoniae had been discovered and recognized as its cause. M. pneumoniae is detected in CAP patients most frequently among school-aged children from 5 to 15 years of age, with a decline after adolescence and tapering off in adulthood. Detection rates by polymerase chain reaction (PCR) or serology in children with CAP admitted to the hospital amount 4–39%. Although the infection is generally mild and self-limiting, patients of every age can develop severe or extrapulmonary disease. Recent studies indicate that high rates of healthy children carry M. pneumoniae in the upper respiratory tract and that current diagnostic PCR or serology cannot discriminate between M. pneumoniae infection and carriage. Further, symptoms and radiologic features are not specific for M. pneumoniae infection. Thus, patients may be unnecessarily treated with antimicrobials against M. pneumoniae. Macrolides are the first-line antibiotics for this entity in children younger than 8 years of age. Overall macrolides are extensively used worldwide, and this has led to the emergence of macrolide-resistant M. pneumoniae, which may be associated with severe clinical features and more extrapulmonary complications. This review focuses on the characteristics of M. pneumoniae infections in children, and exemplifies that simple clinical decision rules may help identifying children at high risk for CAP due to M. pneumoniae. This may aid physicians in prescribing appropriate first-line antibiotics, since current diagnostic tests for M. pneumoniae infection are not reliably predictive.
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Affiliation(s)
- Patrick M Meyer Sauteur
- Department of Pediatrics, Division of Pediatric Infectious Diseases and Immunology, Erasmus MC-Sophia Children's Hospital, University Medical CenterRotterdam, Netherlands; Laboratory of Pediatrics, Division of Pediatric Infectious Diseases and Immunology, Erasmus MC-Sophia Children's Hospital, University Medical CenterRotterdam, Netherlands; Division of Infectious Diseases and Hospital Epidemiology, and Children's Research Center, University Children's Hospital of ZurichZurich, Switzerland
| | - Wendy W J Unger
- Laboratory of Pediatrics, Division of Pediatric Infectious Diseases and Immunology, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Netherlands
| | - David Nadal
- Division of Infectious Diseases and Hospital Epidemiology, and Children's Research Center, University Children's Hospital of Zurich Zurich, Switzerland
| | - Christoph Berger
- Division of Infectious Diseases and Hospital Epidemiology, and Children's Research Center, University Children's Hospital of Zurich Zurich, Switzerland
| | - Cornelis Vink
- Erasmus University College, Erasmus University Rotterdam, Netherlands
| | - Annemarie M C van Rossum
- Department of Pediatrics, Division of Pediatric Infectious Diseases and Immunology, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Netherlands
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10
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Gardiner SJ, Gavranich JB, Chang AB. Antibiotics for community-acquired lower respiratory tract infections secondary to Mycoplasma pneumoniae in children. Cochrane Database Syst Rev 2015; 1:CD004875. [PMID: 25566754 PMCID: PMC10585423 DOI: 10.1002/14651858.cd004875.pub5] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Background. Mycoplasma pneumoniae (M. pneumoniae) is widely recognised as an important cause of community-acquired lower respiratory tract infection (LRTI) in children. Pulmonary manifestations are typically tracheobronchitis or pneumonia but M. pneumoniae is also implicated in wheezing episodes in both asthmatic and non-asthmatic individuals. Although antibiotics are used to treat LRTIs, are view of several major textbooks offers conflicting advice for using antibiotics in the management of M. pneumoniae LRTI in children.Objectives To determine whether antibiotics are effective in the treatment of childhood LRTI secondary to M. pneumoniae infections acquired in the community.Search methods We searched CENTRAL (2014, Issue 3), MEDLINE (1966 to July week 4, 2014), EMBASE (1980 to July, 2014), and both WHOICTRP and ClinicalTrials.gov (13 August 2014).Selection criteria Randomised controlled trials (RCTs) comparing antibiotics commonly used for treating M. pneumoniae (i.e. macrolide, tetracycline or quinolone classes) versus placebo, or antibiotics from any other class in the treatment of children under 18 years of age with community acquired LRTI secondary to M. pneumoniae.Data collection and analysis The review authors independently selected trials for inclusion and assessed methodological quality. We extracted and analysed relevant data separately and resolved disagreements by consensus.Main results A total of 1912 children were enrolled from seven studies. Data interpretation was limited by the inability to extract data that referred to children with M. pneumoniae. In most studies, clinical response did not differ between children randomised to a macrolide antibiotic and children randomised to a non-macrolide antibiotic. In one controlled study (of children with recurrent respiratory infections, whose acute LRTI was associated with Mycoplasma, Chlamydia or both, by polymerase chain reaction and/or paired sera) 100% of children treated with azithromycin had clinical resolution of their illness compared to 77% not treated with azithromycin at one month. Authors' conclusions There is insufficient evidence to draw any specific conclusions about the efficacy of antibiotics for this condition in children (although one trial suggests macrolides may be efficacious in some children with LRTI secondary to Mycoplasma). The use of antibiotics has to be balanced with possible adverse events. There is still a need for high quality, double-blinded RCTs to assess the efficacy and safety of antibiotics for LRTI secondary to M. pneumoniae in children.
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Affiliation(s)
- Samantha J Gardiner
- Queensland Children's Medical Research InstituteDepartment of Respiratory MedicineLevel 3 Woolworths BuildingRoyal Children's HospitalBrisbaneQueenslandAustralia4006
| | - John B Gavranich
- Ipswich HospitalDepartment of PaediatricsPO Box 73IpswichQueenslandAustralia4305
| | - Anne B Chang
- Menzies School of Health Research, Charles Darwin UniversityChild Health DivisionPO Box 41096DarwinNorthern TerritoriesAustralia0811
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11
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Biondi E, McCulloh R, Alverson B, Klein A, Dixon A, Ralston S. Treatment of mycoplasma pneumonia: a systematic review. Pediatrics 2014; 133:1081-90. [PMID: 24864174 DOI: 10.1542/peds.2013-3729] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Children with community-acquired lower respiratory tract infection (CA-LRTI) commonly receive antibiotics for Mycoplasma pneumoniae. The objective was to evaluate the effect of treating M. pneumoniae in children with CA-LRTI. METHODS PubMed, Cochrane Central Register of Controlled Trials, and bibliography review. A search was conducted by using Medical Subject Headings terms related to CA-LRTI and M. pneumoniae and was not restricted by language. Eligible studies included randomized controlled trials (RCTs) and observational studies of children #17 years old with confirmed M. pneumoniae and a diagnosis of CA-LRTI; each must have also compared treatment regimens with and without spectrum of activity against M. pneumoniae. Data extraction and quality assessment were completed independently by multiple reviewers before arriving at a consensus. Data were pooled using a random effects model. RESULTS Sixteen articles detailing 17 studies were included. The most commonly selected primary outcome was symptomatic improvement. Nine studies examined M. pneumoniae treatment in CA-LRTI secondary to M. pneumoniae, and 5 RCTs met criteria for meta-analysis. The suggested pooled risk difference of 0.12 (95% confidence interval, 20.04 to 0.20) favoring treatment was not significantly different and demonstrated significant heterogeneity. Limitations included substantial bias and subjective outcomes within the individual studies, difficulty interpreting testing modalities, and the inability to correct for mixed infections or timing of intervention. CONCLUSIONS We identified insufficient evidence to support or refute treatment of M. pneumoniae in CA-LRTI. These data highlight the need for well-designed, prospective RCTs assessing the effect of treating M. pneumoniae in CA-LRTI.
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Affiliation(s)
- Eric Biondi
- Department of Pediatrics, University of Rochester, Rochester, New York
| | - Russell McCulloh
- Department of Pediatrics, Children’s Mercy Hospitals & Clinics, Kansas City, Missouri
| | - Brian Alverson
- Department of Pediatrics, Hasbro Children’s Hospital, Providence, Rhode Island; and
| | - Andrew Klein
- Department of Pediatrics, University of Rochester, Rochester, New York
| | - Angela Dixon
- Department of Pediatrics, University of Rochester, Rochester, New York
| | - Shawn Ralston
- Department of Pediatrics, Children’s Hospital at Dartmouth–Hitchcock, Hanover, New Hampshire
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Parnham MJ, Erakovic Haber V, Giamarellos-Bourboulis EJ, Perletti G, Verleden GM, Vos R. Azithromycin: mechanisms of action and their relevance for clinical applications. Pharmacol Ther 2014; 143:225-45. [PMID: 24631273 DOI: 10.1016/j.pharmthera.2014.03.003] [Citation(s) in RCA: 371] [Impact Index Per Article: 37.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 03/04/2014] [Indexed: 01/02/2023]
Abstract
Azithromycin is a macrolide antibiotic which inhibits bacterial protein synthesis, quorum-sensing and reduces the formation of biofilm. Accumulating effectively in cells, particularly phagocytes, it is delivered in high concentrations to sites of infection, as reflected in rapid plasma clearance and extensive tissue distribution. Azithromycin is indicated for respiratory, urogenital, dermal and other bacterial infections, and exerts immunomodulatory effects in chronic inflammatory disorders, including diffuse panbronchiolitis, post-transplant bronchiolitis and rosacea. Modulation of host responses facilitates its long-term therapeutic benefit in cystic fibrosis, non-cystic fibrosis bronchiectasis, exacerbations of chronic obstructive pulmonary disease (COPD) and non-eosinophilic asthma. Initial, stimulatory effects of azithromycin on immune and epithelial cells, involving interactions with phospholipids and Erk1/2, are followed by later modulation of transcription factors AP-1, NFκB, inflammatory cytokine and mucin release. Delayed inhibitory effects on cell function and high lysosomal accumulation accompany disruption of protein and intracellular lipid transport, regulation of surface receptor expression, of macrophage phenotype and autophagy. These later changes underlie many immunomodulatory effects of azithromycin, contributing to resolution of acute infections and reduction of exacerbations in chronic airway diseases. A sub-group of post-transplant bronchiolitis patients appears to be sensitive to azithromycin, as may be patients with severe sepsis. Other promising indications include chronic prostatitis and periodontitis, but weak activity in malaria is unlikely to prove crucial. Long-term administration of azithromycin must be balanced against the potential for increased bacterial resistance. Azithromycin has a very good record of safety, but recent reports indicate rare cases of cardiac torsades des pointes in patients at risk.
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Affiliation(s)
- Michael J Parnham
- Fraunhofer Institute for Molecular Biology and Applied Ecology, Project Group Translational Medicine and Pharmacology, Frankfurt am Main, Germany; Institute of Pharmacology for Life Scientists, Goethe University Frankfurt, Frankfurt am Main, Germany; Institute of Clinical Pharmacology, Goethe University Frankfurt, Frankfurt am Main, Germany.
| | | | - Evangelos J Giamarellos-Bourboulis
- 4th Department of Internal Medicine, University of Athens, Medical School, Athens, Greece; Integrated Research and Treatment Center, Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany.
| | - Gianpaolo Perletti
- Biomedical Research Division, Department of Theoretical and Applied Sciences, University of Insubria, Busto A., Varese, Italy; Department of Basic Medical Sciences, Ghent University, Ghent, Belgium.
| | - Geert M Verleden
- Respiratory Division, Lung Transplantation Unit, University Hospitals Leuven and Department of Clinical and Experimental Medicine, KU Leuven, Belgium.
| | - Robin Vos
- Respiratory Division, Lung Transplantation Unit, University Hospitals Leuven and Department of Clinical and Experimental Medicine, KU Leuven, Belgium.
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Abstract
BACKGROUND Pneumonia caused by bacterial pathogens is the leading cause of mortality in children in low-income countries. Early administration of antibiotics improves outcomes. OBJECTIVES To identify effective antibiotic drug therapies for community-acquired pneumonia (CAP) of varying severity in children by comparing various antibiotics. SEARCH METHODS We searched CENTRAL 2012, Issue 10; MEDLINE (1966 to October week 4, 2012); EMBASE (1990 to November 2012); CINAHL (2009 to November 2012); Web of Science (2009 to November 2012) and LILACS (2009 to November 2012). SELECTION CRITERIA Randomised controlled trials (RCTs) in children of either sex, comparing at least two antibiotics for CAP within hospital or ambulatory (outpatient) settings. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data from the full articles of selected studies. MAIN RESULTS We included 29 trials, which enrolled 14,188 children, comparing multiple antibiotics. None compared antibiotics with placebo.Assessment of quality of study revealed that 5 out of 29 studies were double-blind and allocation concealment was adequate. Another 12 studies were unblinded but had adequate allocation concealment, classifying them as good quality studies. There was more than one study comparing co-trimoxazole with amoxycillin, oral amoxycillin with injectable penicillin/ampicillin and chloramphenicol with ampicillin/penicillin and studies were of good quality, suggesting the evidence for these comparisons was of high quality compared to other comparisons.In ambulatory settings, for treatment of World Health Organization (WHO) defined non-severe CAP, amoxycillin compared with co-trimoxazole had similar failure rates (odds ratio (OR) 1.18, 95% confidence interval (CI) 0.91 to 1.51) and cure rates (OR 1.03, 95% CI 0.56 to 1.89). Three studies involved 3952 children.In children with severe pneumonia without hypoxaemia, oral antibiotics (amoxycillin/co-trimoxazole) compared with injectable penicillin had similar failure rates (OR 0.84, 95% CI 0.56 to 1.24), hospitalisation rates (OR 1.13, 95% CI 0.38 to 3.34) and relapse rates (OR 1.28, 95% CI 0.34 to 4.82). Six studies involved 4331 children below 18 years of age.In very severe CAP, death rates were higher in children receiving chloramphenicol compared to those receiving penicillin/ampicillin plus gentamicin (OR 1.25, 95% CI 0.76 to 2.07). One study involved 1116 children. AUTHORS' CONCLUSIONS For treatment of patients with CAP in ambulatory settings, amoxycillin is an alternative to co-trimoxazole. With limited data on other antibiotics, co-amoxyclavulanic acid and cefpodoxime may be alternative second-line drugs. Children with severe pneumonia without hypoxaemia can be treated with oral amoxycillin in an ambulatory setting. For children hospitalised with severe and very severe CAP, penicillin/ampicillin plus gentamycin is superior to chloramphenicol. The other alternative drugs for such patients are co-amoxyclavulanic acid and cefuroxime. Until more studies are available, these can be used as second-line therapies.There is a need for more studies with radiographically confirmed pneumonia in larger patient populations and similar methodologies to compare newer antibiotics. Recommendations in this review are applicable to countries with high case fatalities due to pneumonia in children without underlying morbidities and where point of care tests for identification of aetiological agents for pneumonia are not available.
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Affiliation(s)
- Rakesh Lodha
- All India Institute of Medical SciencesDepartment of PediatricsAnsari NagarNew DelhiIndia110029
| | - Sushil K Kabra
- All India Institute of Medical SciencesPediatric Pulmonology Division, Department of PediatricsAnsari NagarNew DelhiIndia110029
| | - Ravindra M Pandey
- All India Institute of Medical Sciences (AIIMS)Department of BiostatisticsAnsari NagarNew DelhiIndia110029
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14
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Mulholland S, Gavranich JB, Gillies MB, Chang AB. Antibiotics for community-acquired lower respiratory tract infections secondary to Mycoplasma pneumoniae in children. Cochrane Database Syst Rev 2012:CD004875. [PMID: 22972079 DOI: 10.1002/14651858.cd004875.pub4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Mycoplasma pneumoniae (M. pneumoniae) is widely recognised as an important cause of community-acquired lower respiratory tract infection (LRTI) in children. Pulmonary manifestations are typically tracheobronchitis or pneumonia but M. pneumoniae is also implicated in wheezing episodes in both asthmatic and non-asthmatic individuals. Although antibiotics are used to treat LRTIs, a review of several major textbooks offers conflicting advice for using antibiotics in the management of M. pneumoniae LRTI in children. OBJECTIVES To determine whether antibiotics are effective in the treatment of childhood LRTI secondary to M. pneumoniae infections acquired in the community. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 2), which contains the Cochrane Acute Respiratory Infections Group's Specialised Register, MEDLINE (1966 to February week 5, 2012) and EMBASE (1980 to March 2012). SELECTION CRITERIA Randomised controlled trials (RCTs) comparing antibiotics commonly used for treating M. pneumoniae (i.e. macrolide, tetracycline or quinolone classes) versus placebo, or antibiotics from any other class in the treatment of children under 18 years of age with community-acquired LRTI secondary to M. pneumoniae. DATA COLLECTION AND ANALYSIS The review authors independently selected trials for inclusion and assessed methodological quality. We extracted and analysed relevant data separately. We resolved disagreements by consensus. MAIN RESULTS A total of 1912 children were enrolled from seven studies. Data interpretation was limited by the inability to extract data that referred to children with M. pneumoniae. In most studies, clinical response did not differ between children randomised to a macrolide antibiotic and children randomised to a non-macrolide antibiotic. In one controlled study (of children with recurrent respiratory infections, whose acute LRTI was associated with Mycoplasma, Chlamydia or both by polymerase chain reaction, and/or paired sera) 100% of children treated with azithromycin had clinical resolution of their illness compared to 77% not treated with azithromycin at one month. AUTHORS' CONCLUSIONS There is insufficient evidence to draw any specific conclusions about the efficacy of antibiotics for this condition in children (although one trial suggests macrolides may be efficacious in some children with LRTI secondary to Mycoplasma). The use of antibiotics has to be balanced with possible adverse events. There is still a need for high quality, double-blinded RCTs to assess the efficacy and safety of antibiotics for LRTI secondary to M. pneumoniae in children.
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Affiliation(s)
- Selamawit Mulholland
- Queensland Respiratory Centre, Royal Children's Hospital, Herston Road, Herston, Brisbane, Queensland, Australia
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15
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Strachan RE, Cornelius A, Gilbert GL, Gulliver T, Martin A, McDonald T, Nixon GM, Roseby R, Ranganathan S, Selvadurai H, Smith G, Soto-Martinez M, Suresh S, Teoh L, Thapa K, Wainwright CE, Jaffe A. Bacterial causes of empyema in children, Australia, 2007-2009. Emerg Infect Dis 2011; 17:1839-45. [PMID: 22000353 PMCID: PMC3310657 DOI: 10.3201/eid1710.101825] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
An increase in the incidence of empyema worldwide could be related to invasive pneumococcal disease caused by emergent nonvaccine replacement serotypes. To determine bacterial pathogens and pneumococcal serotypes that cause empyema in children in Australia, we conducted a 2-year study of 174 children with empyema. Blood and pleural fluid samples were cultured, and pleural fluid was tested by PCR. Thirty-two (21.0%) of 152 blood and 53 (33.1%) of 160 pleural fluid cultures were positive for bacteria; Streptococcus pneumoniae was the most common organism identified. PCR identified S. pneumoniae in 74 (51.7%) and other bacteria in 19 (13.1%) of 145 pleural fluid specimens. Of 53 samples in which S. pneumoniae serotypes were identified, 2 (3.8%) had vaccine-related and 51 (96.2%) had nonvaccine serotypes; 19A (n = 20; 36.4%), 3 (n = 18; 32.7%), and 1 (n = 8; 14.5%) were the most common. High proportions of nonvaccine serotypes suggest the need to broaden vaccine coverage.
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16
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Abstract
Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis seem to have no role in asthma in children. Mycoplasma pneumoniae and Chlamydophila pneumoniae can induce wheezing and cause asthma exacerbations in children, and chronic Chlamydophila infections may even participate in asthma pathogenesis. However, studies have failed to show any benefits from antibiotics for incipient or stable pediatric asthma, as well as for asthma exacerbations in children. Exposure to antibiotics in infancy has been an independent risk factor of later asthma in many studies. A recent study applying molecular biology methods to lower airway samples provided preliminary evidence that lower airways are not sterile but have their own protective microbiota, which can be disturbed in lung diseases like asthma.
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Affiliation(s)
- Matti Korppi
- Pediatric Research Center, Tampere University and University Hospital, Finmed-3 building, Tampere University 33014, Finland.
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17
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Mulholland S, Gavranich JB, Chang AB. Antibiotics for community-acquired lower respiratory tract infections secondary to Mycoplasma pneumoniae in children. Cochrane Database Syst Rev 2010:CD004875. [PMID: 20614439 DOI: 10.1002/14651858.cd004875.pub3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Mycoplasma pneumoniae (M. pneumoniae) is widely recognised as an important cause of community-acquired lower respiratory tract infection (LRTI) in children. Pulmonary manifestations are typically tracheobronchitis or pneumonia but M. pneumoniae is also implicated in wheezing episodes in both asthmatic and non-asthmatic individuals. Although antibiotics are used to treat LRTI, a review of several major textbooks offers conflicting advice for using antibiotics in the management of M. pneumoniae LRTI in children. OBJECTIVES To determine whether antibiotics are effective in the treatment of childhood LRTI secondary to M. pneumoniae infections acquired in the community. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, issue 1), which contains the Acute Respiratory Infections Group's Specialised Register, MEDLINE (1966 to February 2010) and EMBASE (1980 to February 2010). SELECTION CRITERIA Randomised controlled trials (RCTs) comparing antibiotics commonly used for treating M. pneumoniae (i.e. macrolide, tetracycline or quinolone classes) versus placebo, or antibiotics from any other class in the treatment of children under 18 years of age with community-acquired LRTI secondary to M. pneumoniae. DATA COLLECTION AND ANALYSIS The review authors independently selected trials for inclusion and assessed methodological quality. We extracted and analysed relevant data separately. Disagreements were resolved by consensus. MAIN RESULTS A total of 1912 children were enrolled from seven studies. Data interpretation was limited by the inability to extract data that referred to children with M. pneumoniae. In most studies, clinical response did not differ between children randomised to a macrolide antibiotic and children randomised to a non-macrolide antibiotic. In one controlled study (of children with recurrent respiratory infections, whose acute LRTI was associated with Mycoplasma, Chlamydia or both by polymerase chain reaction, and/or paired sera) 100% of children treated with azithromycin had clinical resolution of their illness compared to 77% not treated with azithromycin at one month. AUTHORS' CONCLUSIONS There is insufficient evidence to draw any specific conclusions about the efficacy of antibiotics for this condition in children (although one trial suggests macrolides may be efficacious in some children with LRTI secondary to Mycoplasma). The use of antibiotics has to be balanced with possible adverse events. There is still a need for high quality, double-blinded RCTs to assess the efficacy and safety of antibiotics for LRTI secondary to M. pneumoniae in children.
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Affiliation(s)
- Selamawit Mulholland
- Queensland Respiratory Centre, Royal Children's Hospital, Herston Road, Herston, Brisbane, Queensland, Australia
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18
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Abstract
BACKGROUND Pneumonia caused by bacterial pathogens is the leading cause of mortality in children in low-income countries. Early administration of antibiotics improves outcomes. OBJECTIVES To identify effective antibiotics for community acquired pneumonia (CAP) in children by comparing various antibiotics. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2009, issue 2) which contains the Cochrane Acute Respiratory Infections Group's Specialised Register; MEDLINE (1966 to September 2009); and EMBASE (1990 to September 2009). SELECTION CRITERIA Randomised controlled trials (RCTs) in children of either sex, comparing at least two antibiotics for CAP within hospital or ambulatory (outpatient) settings. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data from full articles of selected studies. MAIN RESULTS There were 27 studies, which enroled 11,928 children, comparing multiple antibiotics. None compared antibiotic with placebo.For ambulatory treatment of non-severe CAP, amoxycillin compared with co-trimoxazole had similar failure rates (OR 0.92; 95% CI 0.58 to 1.47) and cure rates (OR 1.12; 95% CI 0.61 to 2.03). (Three studies involved 3952 children).In children hospitalised with severe CAP, oral amoxycillin compared with injectable penicillin or ampicillin had similar failure rates (OR 0.95; 95% CI 0.78 to 1.15). (Three studies involved 3942 children). Relapse rates were similar in the two groups (OR 1.28; 95% CI 0.34 to 4.82).In very severe CAP, death rates were higher in children receiving chloramphenicol compared to those receiving penicillin/ampicillin plus gentamycin (OR 1.25; 95% CI 0.76 to 2.07). (One study involved 1116 children). AUTHORS' CONCLUSIONS There were many studies with different methodologies investigating multiple antibiotics. For treatment of ambulatory patients with CAP, amoxycillin is an alternative to co-trimoxazole. With limited data on other antibiotics, co-amoxyclavulanic acid and cefpodoxime may be alternative second-line drugs. For severe pneumonia without hypoxia, oral amoxycillin may be an alternative to injectable penicillin in hospitalised children; however, for ambulatory treatment of such patients with oral antibiotics, more studies in community settings are required. For children hospitalised with severe and very severe CAP, penicillin/ampicillin plus gentamycin is superior to chloramphenicol. The other alternative drugs for such patients are ceftrioxone, levofloxacin, co-amoxyclavulanic acid and cefuroxime. Until more studies are available, these can be used as a second-line therapy.There is a need for more studies with larger patient populations and similar methodologies to compare newer antibiotics.
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Affiliation(s)
- Sushil K Kabra
- Pediatric Pulmonology Division, Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India, 110029
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[When and how to modify the management of asthma in children over the age of 4]. Rev Mal Respir 2010; 26:827-35. [PMID: 19953027 DOI: 10.1016/s0761-8425(09)73678-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The treatment of asthma in children should not be fixed but rather must be regularly adapted to keep the condition under control defined according to clinical and functional criteria. In a child whose asthma is controlled, a step down in therapy should be carried out every 3 to 6 months to achieve the minimal effective level of treatment. In a child whose asthma appears not to be controlled, it is necessary initially to evaluate compliance with therapy and to seek aggravating factors which may include allergic rhinitis, multiple sensitisation, tobacco exposure, psychological factors, obesity, gastro- oesophageal reflux and infection. Where control of asthma is poor the main therapeutic strategy rests on an increase in the dose of inhaled corticosteroid and on the addition of other anti-asthmatic treatments--inhaled long--acting beta 2 agonists and oral leukotriene antagonists.
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20
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Korppi M. Management of bacterial infections in children with asthma. Expert Rev Anti Infect Ther 2009; 7:869-77. [PMID: 19735226 DOI: 10.1586/eri.09.58] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Respiratory viruses are the single most common causes of asthma exacerbations in children. Rhinovirus-induced wheezing is a risk factor for chronic asthma, but its mechanism has remained unknown. Human bocavirus is a common finding in wheezing children, but its role as a respiratory pathogen is still unclear. Mycoplasma pneumoniae may, like viruses, induce wheezing and asthma exacerbation. Chlamydia pneumoniae and, in recent studies, Chlamydia trachomatis, may not only induce asthma exacerbations but may also be involved in the pathogenesis of chronic asthma. Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis are often involved in respiratory infections associated with wheezing, but there is no evidence for their active role in asthma pathogenesis or exacerbation. This review summarizes current knowledge on the association between respiratory infections and asthma in children, with a special focus on the role of antibiotics in incipient asthma, asthma exacerbation and chronic stable asthma.
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Affiliation(s)
- Matti Korppi
- Paediatric Research Centre, Tampere University and University Hospital, Tampere, Finland.
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21
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Kurz H, Göpfrich H, Wabnegger L, Apfalter P. Role of Chlamydophila pneumoniae in children hospitalized for community-acquired pneumonia in Vienna, Austria. Pediatr Pulmonol 2009; 44:873-6. [PMID: 19670403 DOI: 10.1002/ppul.21059] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND No recent Austrian data are available on the epidemiology and morbidity of Chlamydophila pneumoniae (C. pneumoniae) as causative agent in youths and children hospitalized with community-acquired pneumonia (CAP). These data would serve as a rationale for empiric antimicrobial therapy. METHODS During winter months 2006/7 112 immunocompetent youths and children between 2 months and 18 years hospitalized consecutively with CAP were prospectively enrolled. Microbiological detection of conventional bacteria, Mycoplasma pneumoniae as well as respiratory viruses was performed, and clinical signs as well as indices of inflammation were documented. Diagnosis of C. pneumoniae was performed by means of species-specific real-time PCR as well as cell culture from respiratory secretions. RESULTS PCR for C. pneumoniae was performed in 60 patients. In 4 cases (6.7%) C. pneumoniae was found as causative agent. In 1 case C. pneumoniae could be confirmed by cell-culture. All children with C. pneumonia were > or =5 years of age. All but 1 child received clarithromycin together with cefuroxime. The number of days with fever >38,5 degrees C was between 1 and 7, the number of days in hospital was between 4 and 7, all children recovered completely. CONCLUSION C. pneumoniae was found in 6.7% of children and youths hospitalized with CAP in a community hospital during the winter months 2006/07. Children and youths with lower respiratory infections should further be tested for C. pneumoniae to elucidate the actual epidemiological situation and to guide empiric antimicrobiotic therapy.
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Affiliation(s)
- Herbert Kurz
- Department of Pediatrics, Danube Hospital, Vienna, Austria.
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22
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Palusińska-Szysz M, Cendrowska-Pinkosz M. Pathogenicity of the family Legionellaceae. Arch Immunol Ther Exp (Warsz) 2009; 57:279-90. [DOI: 10.1007/s00005-009-0035-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2008] [Accepted: 01/30/2009] [Indexed: 10/20/2022]
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Tigecycline therapy significantly reduces the concentrations of inflammatory pulmonary cytokines and chemokines in a murine model of Mycoplasma pneumoniae pneumonia. Antimicrob Agents Chemother 2009; 53:1546-51. [PMID: 19139287 DOI: 10.1128/aac.00979-08] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Mycoplasma pneumoniae is one of the causative agents of atypical community-acquired pneumonia. Tigecycline belongs to a new class of glycylcycline antimicrobials that have activity against a wide range of microorganisms, including in vitro activity against M. pneumoniae. We investigated the effect of tigecycline on microbiologic, histologic, and immunologic indices in a murine model of M. pneumoniae pneumonia. BALB/c mice were inoculated intranasally with M. pneumoniae and treated subcutaneously with tigecycline or placebo for 6 days. Outcome variables included quantitative bronchoalveolar lavage (BAL) M. pneumoniae culture, lung histopathologic score (HPS), BAL cytokine and chemokine concentrations (tumor necrosis factor alpha [TNF-alpha], gamma interferon [IFN-gamma], interleukin 1beta [IL-1beta], IL-2, IL-4, IL-5, IL-6, IL-10, IL-12 [p40/p70], granulocyte-macrophage colony-stimulating factor, MIP-1alpha, MIG, KC, MCP-1, and IP-10). BAL M. pneumoniae concentrations in mice treated with tigecycline (MpTige) tended to be reduced compared with mice treated with placebo (MpPl); however this did not reach statistical significance. The lung HPS was significantly lower, as well as the parenchymal-pneumonia subscore, in the MpTige mice than in the MpPl mice. MpTige mice had significantly lower BAL cytokine concentrations of IL-1beta, IL-12 (p40/p70), IFN-gamma, and TNF-alpha; of the chemokines, MIG, MIP-1alpha, and IP-10 were statistically lower in MpTige mice. While tigecycline treatment demonstrated a modest microbiologic effect, it significantly improved lung histologic inflammation and reduced pulmonary cytokines and chemokines.
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Bosis S, Esposito S, Niesters HGM, Zuccotti GV, Marseglia G, Lanari M, Zuin G, Pelucchi C, Osterhaus ADME, Principi N. Role of respiratory pathogens in infants hospitalized for a first episode of wheezing and their impact on recurrences. Clin Microbiol Infect 2008; 14:677-84. [PMID: 18558940 PMCID: PMC7130007 DOI: 10.1111/j.1469-0691.2008.02016.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In order to evaluate the infectious agents associated with the first episode of severe acute wheezing in otherwise healthy infants and to define the role of each of them in recurrences, 85 patients in Italy, aged <12 months, hospitalized because of a first acute episode of wheezing, were prospectively enrolled between 1 October 2005 and 31 March 2006. Upon enrollment, nasopharyngeal swabs were collected for the real-time PCR detection of respiratory syncytial virus (RSV) types A and B, influenza virus types A and B, adenovirus, parainfluenza viruses types 1, 2, 3 and 4, rhinovirus, human metapneumovirus, human coronavirus types 229E, OC43, NL63, and HKU1, bocavirus, enterovirus, and paraechovirus; nasopharyngeal aspirates were also obtained to detect atypical bacteria. At least one infectious agent was identified in 76 children (89.4%). RSV was the most frequently detected pathogen and its prevalence was significantly higher than that of the other pathogens in both age groups, and significantly higher in the children aged 3-12 months than in those aged <3 months. Only the children with RSV infection experienced recurrent wheezing. Viral load was significantly higher in children with than in those without recurrent wheezing. This study shows that RSV is the main reason for hospitalization during the first wheezing episode in infants, and that it appears to be the only pathogen associated with a high frequency of recurrences. A high viral load seems to be strictly related to the likelihood of recurrence.
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Affiliation(s)
- S Bosis
- Institute of Paediatrics, University of Milan, Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milan, Italy
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Esposito S, Marchisio P, Capaccio P, Bellasio M, Corti F, Dusi E, Blasi F, Pignataro L, Principi N. Role of atypical bacteria in children undergoing tonsillectomy because of severely recurrent acute tonsillopharyngitis. Eur J Clin Microbiol Infect Dis 2008; 27:1233-7. [PMID: 18566843 DOI: 10.1007/s10096-008-0560-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2008] [Accepted: 05/14/2008] [Indexed: 11/24/2022]
Abstract
The aim of this study was to verify the frequency of atypical bacterial infections in children undergoing tonsillectomy because of severely recurrent acute tonsillopharyngitis (AT) and the possible benefit of surgery in cases in which Mycoplasma pneumoniae and Chlamydophila pneumoniae seem to play a role in causing the recurrences. A total of 118 patients (76 males; mean age +/- standard deviation, 6.67 +/- 3.31 years) were enrolled: 59 underwent tonsillectomy because of severely recurrent AT and 59 underwent adenotonsillectomy because of obstructive sleep apnea syndrome (OSAS). The results show, for the first time, that the great majority of children with a history of severely recurrent AT (and, therefore, considered to be eligible for elective tonsillectomy) are infected by atypical bacteria, mainly M. pneumoniae, and that tonsillectomy seems to be effective in reducing the recurrence of both AT and acute respiratory disease during 12 months follow-up postsurgery.
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Affiliation(s)
- S Esposito
- Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Institute of Pediatrics, University of Milan, Via Commenda 9, 20122, Milano, Italy
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27
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Abstract
Acute bronchitis is one of the most common infections reported in children under 5 years of age, and is a leading cause of hospitalisation. In general practice, confusion surrounds the clinical diagnosis of acute bronchitis, especially when distinguishing it from asthma. The microbiological causes are mostly known, but the contribution of each is much less clear, and they are non-specific in their clinical expression in individual cases. Viral pathogens, particularly respiratory syncytial virus and rhinoviruses are cited as the leading agents in the development of serious episodes, but other pathogens may also be important. This article covers a range of issues surrounding acute bronchitis, including epidemiology and pathogenesis, as well as the management, prevention and treatment of disease in children.
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Affiliation(s)
- Douglas M Fleming
- Birmingham Research Unit of the Royal College of General Practitioners, Lordswood House, 54 Lordswood Road, Harborne, Birmingham B17 9DB, UK.
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28
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Blasi F, Johnston SL. The role of antibiotics in asthma. Int J Antimicrob Agents 2007; 29:485-93. [PMID: 17353114 PMCID: PMC7126415 DOI: 10.1016/j.ijantimicag.2006.11.029] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2006] [Accepted: 11/21/2006] [Indexed: 11/04/2022]
Abstract
There is increasing evidence that atypical respiratory pathogens such as Chlamydophila pneumoniae and Mycoplasma pneumoniae may contribute to the pathogenesis of both stable asthma and asthma exacerbations. It is postulated that these organisms may contribute to inflammation in the airways possibly by activating inflammatory mechanisms in the respiratory tract. The macrolide class of antibiotics may have a part to play in the management of asthma by exerting anti-inflammatory effects on the chronically inflamed airways in addition to their anti-infective action. The ketolide antibiotics may also have similar properties. This paper discusses the role of these antibiotics in the management of asthma.
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Affiliation(s)
- Francesco Blasi
- Institute of Respiratory Diseases, University of Milan, IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milan, Italy
| | - Sebastian L. Johnston
- Department of Respiratory Medicine, National Heart and Lung Institute, Imperial College London, London W2 IPG, UK
- Corresponding author. Tel.: +44 20 7594 3764; fax: +44 20 7262 8913.
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Abstract
BACKGROUND Pneumonia is the leading cause of mortality in children. In developing countries, pneumonia is usually caused by bacterial pathogens. The early administration of empirical antibiotics improves the patients' clinical outcomes. There are currently no systematic reviews of clinical trials on this subject. OBJECTIVES To identify effective antibiotic drug therapy for community acquired pneumonia (CAP) in children by comparing various antibiotics. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 4, 2005), MEDLINE (OVID) (1966 to January 2006) and EMBASE (WebSPIRS) (1990 to September 2005). There were no language restrictions. SELECTION CRITERIA Randomized controlled trials (RCTs) in children of either sex, which compared at least two antibiotics for CAP in hospital or ambulatory settings. DATA COLLECTION AND ANALYSIS Data from full articles of selected studies were independently extracted by two authors. MAIN RESULTS The review of these studies suggests that for treatment of pneumonia, co-trimoxazole is inferior in efficacy to both amoxycillin (failure rates odds ratio (OR) 1.33; 95% CI 1.05 to 1.67) and procaine penicillin (cure rates OR 2.64; 95% CI 1.57 to 4.45). Penicillin in conjunction with gentamycin was better than chloramphenicol alone (re-hospitalization rates OR 1.61; 95% CI 1.02 to 2.55). Co-amoxyclavulanic acid was better than amoxycillin alone (cure rates OR 10.44; 95% CI 2.85 to 38.21). There was no differences between injectable penicillin and oral amoxycillin (failure rates OR 1.03; 95% CI 0.81 to 1.31); azithromycin and erythromycin (cure rates OR 1.17; 95% CI 0.70 to 1.95); cefpodoxime and amoxycillin (cure rates OR 0.69; 95% CI 0.18 to 2.60); or azithromycin and co-amoxyclavulanic acid (cure rates OR 1.02; 95% CI 0.54 to 1.95, failure rates OR 1.42; 95% CI 0.43 to 4.66). AUTHORS' CONCLUSIONS There were many studies each investigating multiple antibiotics with different methodologies. For treatment of ambulatory patients with CAP, amoxycillin was better than co-trimoxazole; there was no difference between azithromycin and erythromycin, or between cefpodoxime and co-amoxyclavulanic acid. For hospitalized patients, procaine penicillin was better than co-trimoxazole; and the combination of penicillin and gentamycin was better than chloramphenicol alone. Injectable penicillin and oral amoxycillin had similar failure rates. For the rest of the antibiotics there were only single studies available. There is a need for more studies with large patient populations and similar methodologies in order to compare newer antibiotics.
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Affiliation(s)
- S K Kabra
- All India Institute of Medical Sciences, Department of Pediatrics, Ansari Nagar, New Delhi, India 110 029.
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Esposito S, Bosis S, Begliatti E, Droghetti R, Tremolati E, Tagliabue C, Bellasio M, Blasi F, Principi N. Acute Tonsillopharyngitis Associated with Atypical Bacterial Infection in Children: Natural History and Impact of Macrolide Therapy. Clin Infect Dis 2006; 43:206-9. [PMID: 16779748 DOI: 10.1086/505120] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2006] [Accepted: 04/11/2006] [Indexed: 11/04/2022] Open
Abstract
This study evaluated the natural history of acute tonsillopharyngitis associated with atypical bacterial infections, showing that Mycoplasma pneumoniae and Chlamydia pneumoniae organisms are frequently found in children with acute tonsillopharyngitis. The study also demonstrated, for what we believe to be the first time, that, unless adequately treated, acute tonsillopharyngitis associated with infection with M. pneumoniae and C. pneumoniae may have a negative outcome with a high risk of recurrence of respiratory illness.
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31
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Chu HW, Breed R, Rino JG, Harbeck RJ, Sills MR, Martin RJ. Repeated respiratory Mycoplasma pneumoniae infections in mice: effect of host genetic background. Microbes Infect 2006; 8:1764-72. [PMID: 16713727 DOI: 10.1016/j.micinf.2006.02.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2005] [Revised: 12/28/2005] [Accepted: 02/08/2006] [Indexed: 11/20/2022]
Abstract
Respiratory Mycoplasma pneumoniae (Mp) infection is involved in several acute and chronic lung diseases including community-acquired pneumonia, asthma and chronic obstructive pulmonary disease. In the chronic disease process, recurrent respiratory bacterial infections could occur, which may result in varying degrees of symptoms and lung inflammation among patients. However, the lung immunologic differences of host responses to repeated bacterial (i.e., Mp) infections remain to be determined. In the present study, we examined cellular and humoral responses to multiple (up to 3) Mp infections in two genetically different strains of mice (BALB/c and C57BL/6). Mice were intranasally inoculated with one Mp infection, two or three Mp infections (4 weeks apart), and sacrificed on days 3, 7 and 14 after the last Mp infection. Overall, compared to C57BL/6 mice, BALB/c mice demonstrated a significantly higher degree of lung tissue inflammatory cell infiltrate, BAL cellularity, and release of pro-inflammatory cytokines (TNF-alpha, keratinocyte-derived chemokine (KC, a mouse homolog of human chemokine Gro-alpha [CXCL1], and IFN-gamma). In addition, BALB/c mice presented higher levels of serum Mp-specific IgG and IgM, but not IgA. Consistently with lung and serum data, Mp load in BAL and lung specimens was significantly higher in BALB/c mice than C57BL/6 mice. Moreover, repeated Mp infections in BALB/c, but not C57BL/6 mice, produced a greater inflammatory response than did a single Mp infection. Our results suggest that hosts with different genetic background may have different susceptibility to repeated respiratory Mp infections along with inflammatory responses.
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Affiliation(s)
- Hong Wei Chu
- Department of Medicine, National Jewish Medical and Research Center and the University of Colorado Health Sciences Center, Denver, CO 80206, USA.
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32
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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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Abstract
There is an increasing number of viral and bacterial pathogens suspected of contributing to asthma pathogenesis in childhood, making it more difficult for the practitioner to make specific therapy decisions. This review discusses the role of viruses, e.g. respiratory syncytial virus, human metapneumovirus, influenza viruses and rhinoviruses, as well as the role of the atypical bacteria Chlamydophila pneumoniae and Mycoplasma pneumoniae, as contributors to childhood asthma. Diagnosis, prevention, and therapy are discussed, including a summary of drugs, i.e. macrolide antibacterials, antivirals, and vaccine regimens already available, or at least in clinical trials. For the practitioner dealing with patients every day, drug regimens are assigned to the individual pathogens and an algorithm for the management of atypical infections in patients with asthma or recurrent wheezing is presented.
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Affiliation(s)
- Arne Simon
- Children’s Hospital, Medical Centre, University of Bonn, Bonn, Germany
| | - Oliver Schildgen
- Department of Virology, Institute for Medical Microbiology, Immunology, and Parasitology, Medical Centre, University of Bonn, Sigmund-Freud-Strasse 25, Bonn, 53105 Germany
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Banerjee R, Hersh A, Newman TB. Azithromycin treatment of recurrent respiratory tract infections in children. Pediatr Infect Dis J 2005; 24:1030; author reply 1030. [PMID: 16282955 DOI: 10.1097/01.inf.0000186290.79412.da] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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