Bronchitis Causes and Treatments

Relieve Your Bronchitis Cure

When you begin to take the specific natural ingredients outlined in the program you will be amazed at how you will really begin to feel the Phlegm and Mucus clear up nearly immediately! Within minutes of the first step you will feel the natural ingredients in action, targeting the specific root cause of the bronchitis. These ingredients will come in direct contact with the bacteria causing your infection, and get rid of them quickly. You will discover all the secrets I have come across while I was researching how to get rid of my own Bronchitis, and how you will not only get rid of your bronchitis, but actually prevent it from ever coming back again! More here...

Relieve Your Bronchitis Cure Overview

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My Relieve Your Bronchitis Cure Review

Highly Recommended

The author presents a well detailed summery of the major headings. As a professional in this field, I must say that the points shared in this book are precise.

As a whole, this e-book contains everything you need to know about this subject. I would recommend it as a guide for beginners as well as experts and everyone in between.

Australian infectious bronchitis virus A

Strain of avian infectious bronchitis virus originally isolated by Cumming in 1962 from poultry in Australia suffering from a kidney disease known as uremia. Infectious bronchitis viruses isolated in Australia before 1980 induced nephritis with high mortality, whereas viruses isolated in the USA and elsewhere outside Australia showed little evidence of nephropathogenicity. Since 1980, most viruses isolated from Australia appear to be less nephrotropic, and no longer cause high mortality.

Bronchospasm and Severe Bronchitis A Real Chokehold on Ventilation

Bronchospasms often accompany both asthma attacks and bronchitis (brahng-KEYE-tis) or ''inflammation of the bronchial tubes.'' Asthma is literally a ''panting.'' In asthma, the affected person's immune system In bronchitis, the lining of the bronchi and bronchioles are all swollen and inflamed (perhaps from a bacterial or viral infection). This severe irritation often causes a hypersecretion (excessive secretion) of mucus, which also tends to block or occlude the extremely narrowed airways.

Acute Exacerbations of Chronic Bronchitis

Timely and accurate diagnosis and treatment of AECB remain challenges to clinicians because of the indefinite beginnings and uncertain treatment modalities of the condition. Because patients with AECB have chronic bronchitis as an underlying disease and because the definition of AECB is subjective, it is sometimes difficult to determine when an exacerbation has begun or ended.

Do We Want New Antibiotics for Mild Infections Is Bacterial Bronchitis in the Setting of Chronic Lung Disease a Mild

The FDA and Europe could make an enormous difference immediately. First, for mild, acute infections like otitis, sinusitis and bronchitis, they need to reconsider their entire approach. For example, for otitis, where most authorities agree that expectant therapy is a reasonable approach, placebo-controlled trials remain difficult to accomplish, especially in the US. Guidelines from the American Society of Pediatrics suggest that patients with severe symptoms, those age 2 or less and those where the diagnosis is certain that it is otitis media, be treated with antibiotics immediately. This leaves older children, those with milder disease and those where the diagnosis is less certain (the majority of patients) available for expectant therapy. Nevertheless, recent surveys have shown that only 15 of children in the US are treated expectantly. The most common reason is parental concern (85 of parents) about not using antibiotics. One solution is based on a recent study reviewing many...

Bronchitis Acute

Acute bronchitis is characterized by acute inflammation of the tracheobronchial tree. This condition may be part ot or preceded by, an upper respiratory tract infection such as influenza (the *flu) or the common cold. Most infections occur during the winter when acute respiratory tract infections are common. The pathogenesis of acute bronchitis has not been studied for all of the causative agents but appears to be a mixture of viral cytopathic events and the host-related inflammatory response. Regardless of the cause, the protective functions of the bronchial epithelium are disturbed and excessive fluid accumulates in the bronchi. Depending on the etiology, destruction of the bronchial epithelium is either extensive (e.g., influenza virus) or minimal (e.g., rhinovirus colds). Clinically, bronchitis is characterized by cough, variable fever and sputum production. Sputum (matter Table 53-1 Major Causes of Acute Bronchitis Table 53-1 Major Causes of Acute Bronchitis ejected from the...

Patient Knowledge and Behavior

The final paragraphs of the preceding section already alluded to the important role patients play in the prescribing process. A series of patient-related factors are implicated in determining the quality of antimicrobial prescribing (Table 2.2), First, the level of knowledge regarding the difference between viral and bacterial infections, regarding the antimicrobial resistance problem and the effectiveness of antibiotics is important.31,32 It has been found that 83 of Canadians were unfamiliar with the concept of antimicrobial resistance, and this was especially the case for poorly educated young people.22 An investigation carried out in the United States showed that 27 of patients with a cold thought that an antibiotic would help, 58 were unaware of the risks of antibiotic treatment, and 48 expected an antibiotic prescription.33 MacFarlane et al.16 in the United Kingdom showed that 87 of patients with bronchitis thought they had an infection, 72 wanted an antibiotic and expected a...

Sociocultural Environment

Patients and also healthy people within a society have about the health, causes of disease, labeling of illness, attributions, coping strategies, and treatment modalities may well be decisive. As an interesting example, differences observed between the Netherlands and Belgium may serve. Deschepper and Van der Stickele42 found that in the Netherlands, people label a bronchial infection as a cold for which they usually take an aspirin or just wait. In Belgium, people label this ailment as bronchitis, they do not decide how to deal with it themselves, but tend to consult a doctor. In the Netherlands, people do not look up to their general practitioner, whereas in Belgium they do they expect the doctor to make a decision. In Germany the situation is somewhat different patients tend to have a wait-and see attitude to bronchial infections, they will avoid antibiotics and prefer homeopathic medication.43 In France, patients commonly visit their doctor to receive an antibiotic prescription to...

Recent Developments in Antitussive Therapy

Introduction - Cough is a forceful defensive reflex maneuver that leads to expulsion of irritants, fluids, mucus or foreign material from the respiratory tract. Specifically, the reflex triggers a complex, multiphasic motor pattern characterized by sequential coordination of large increases in motor output to an array of inspiratory and expiratory skeletal muscles. This highly coordinated musculoskeletal activation process consists of three sequential phases, namely deep inspiration, compression (i.e. contraction against a closed glottis) and vigorous expulsion. The expulsion is ultimately attained through the combined forceful contraction of thoracic, abdominal and diaphragm muscles through the generation of rapid airflow (1, 2). While generally beneficial, cough is a prominent pathophysiological feature associated with many airway and lung diseases such as asthma, upper respiratory viral and bacterial infections, post-nasal drip syndrome, gastroesophageal reflux disease, pulmonary...

Regulating the Public Sector

Even though algorithms may be closely followed, what is uncertain is how much diagnosis creep occurs (Hsia et al., 1988 Carter et al., 1990). For instance, in response to patient pressure, or their own inclinations, is clinic staff more likely to diagnose a lower respiratory tract infection requiring antimicrobial therapy, rather than upper respiratory tract infection, which algor-ithmically does not require antimicrobials, even though the signs and symptoms might be characteristic of the latter Or diagnose dysentery (also requiring antimicrobial therapy) rather than watery diarrhea, which does not require antimicrobial therapy

Review obstructive airway diseases and their pulmonary function test abnormalities

Obstructive airway diseases, including asthma, chronic bronchitis, emphysema, cystic fibrosis, and bronchiolitis, exhibit diminished expiratory airflow and involve airways distal to the carina. The FEV1, FEV1 FVC ratio, and the forced expiratory flow at 25 to 75 of FVC (FEF25-75) are below predicted values. A decreased FEF25-75 reflects collapse of the small airways and is a sensitive indicator of early airway obstruction. The FVC may be normal or decreased as a result of respiratory muscle weakness or dynamic airway collapse with subsequent air trapping. Table 9-1 compares the alterations in measures of lung function in various obstructive lung diseases. Table 9-2 grades the severity of obstruction based on the FEV1 FVC ratio.

The Cultural Perspective

Cultural views of infectious conditions that require antibiotic treatment differ between countries.15 Deschepper and co-investigators have contrasted labeling of disease and patients' attitude toward upper respiratory tract infections (URTI) in a Dutch and a Belgian city.16 The Dutch participants labeled most URTI episodes as common cold or flu. The Flemish participants labeled most of their URTI episodes as bronchitis and used more antibiotics. In general, participants with a Protestant background were more skeptical about antibiotics than those with a Catholic background. Likewise, antibiotic consumption in countries with predominantly Protestant populations is generally lower than those with predominantly Catholic populations.2 However, this is not always true notably Austria has an antibiotic consumption comparable to that of Germany.5 This suggests that, although the main religious background is part of a country's culture, other factors may be better suited to describe the...

The Socioeconomic Perspective

Knowledge and education also influence auto-medication and compliance with antibiotic use, which vary tremendously between countries.33, 34 Grigo-ryan and colleagues recently published a survey in 19 European countries, demonstrating that prevalence of self-medication with antibiotics varied from 1 to 210 per 1000 rates were highest in eastern and southern Europe.34 In a global survey among 4088 participants,35 prevalence of noncompliance with antibiotic prescriptions was highest in China (44 ), Japan (34 ), Mexico (26 ), Philippines (26 ) and Turkey (26 ). According to this study, noncom-pliance not only depends on the country, but also on the age of the patient, antibiotic dosing and dispensing practice, and patient attitudes. Factors that had little influence on compliance were gender and educational level. Even well-educated patients may have a hard time complying. A respected U.S. physician revealed in an editorial36 To be honest, I have a hard time finishing a 10-day course of...

Bronchial Hyperresponsiveness

One of the absolute features of asthma is exaggerated nonspecific airway reactivity to a variety of irritating stimuli. Thus, asthmatics develop airway obstruction in response to natural exposures (cold air, exercise, irritating chemicals, laughing, and coughing) or to provocations in the laboratory (histamine, methacholine, cold air hyperventilation) (Table 9). Airway hyperresponsiveness is found universally in asthmatics, in a portion of subjects with chronic bronchitis, in some subjects with allergic rhinitis, and in 3-8 of otherwise normal subjects. There is a close correlation between the degree of increased responsiveness and disease severity patients with the most reactive airways often require oral CCSs for control, whereas milder degrees of abnormality predict the requirement for fewer medications. Hyperresponsiveness increases after allergen exposure, late-phase allergic reactions, viral infections (especially influenza-type infections), and ozone exposure. Conversely,...

Symptoms And Signs

After an incubation period of 2-4 days, the illness starts with symptoms of nasal congestion blockage and irritation, sneezing and a sore throat. Excess nasal secretion follows which is serous at first and later becomes purulent if secondary bacterial infection ensues. Cough is a frequent symptom, as is headache during the first days of illness. Fever occurs seldom, and if so, it is moderate. Rhinovirus infection causes the same symptoms in all age groups. The infection is limited to the respiratory tract. It has been suggested that rhinoviruses may cause a more serious infection of the lower respiratory tract in small children. Rhinovirus infection has also been shown to precipitate attacks of asthma in children and aggravate chronic bronchitis in adults. Asymptomatic infections are reported to occur in about 25 of individuals infected with rhinovirus.

Therapy And Prophylaxis

In addition to inhalation of droplets, spread of infection by contact is considered to play a significant role. Measures should be taken to avoid infection from virus-contaminated hands. Persons suffering from asthma and from chronic bronchitis should avoid close contact with common cold patients.

Missing not at random

It will sometimes be clear that the censoring mechanism is not acting at random. If a patient withdraws from the trial because of clinical deterioration, then to assume that subsequent observations were missing at random would be totally inappropriate. Under such circumstances a variety of methods are employed in an attempt to reduce the bias due to poor responders having missing values. None of the methods are universally applicable, but the most widely applied is the 'last value carried forward' approach. In this method, the last observed value of the response variable is substituted for every subsequent missing observation. If the anticipated pattern of response to the intervention is of improving measurements, then this may be an effective way to minimise bias, but in some circumstances unthinking application of 'last value carried forward' can worsen the bias from withdrawal of poor responders. This would be the case in trials of treatments for chronic bronchitis where the aim is...

Fluoroquinolone Resistance

Survival advantage over the wild-type during fluoroquinolone exposure occurs predictably in the preferred enzymatic target (i.e., gyrA or parC) for the particular fluoroquinolone providing the selection pressure. These first-step mutations are generally associated with a 4- to 8-fold elevation in the MIC for all fluoroquinolones that preferentially target the mutated enzyme, but have little impact on the activity of fluoroquinolones that prefer the other enzyme as a target. When a population of such first-step mutants again reaches a density of 106 to 109 organisms, it becomes probable that a second mutation in the other enzyme will occur. The double mutant will now display more complete resistance to any one fluoroquinolone and cross-resistance to all fluoroquinolones. If, as suggested by some investigators, more than 109 organisms may be present in the lungs of patients with acute exacerbations of chronic bronchitis or pneumonia, then there is ample opportunity to select for mutants...

Trends in Outpatient Antimicrobial Utilization

Inappropriate use of broad-spectrum antimicrobials continues to be a problem, generating additional selection pressure for antimicrobial resistance in community-acquired pathogens. From 1996 to 2000, pediatric use of second-generation macrolide drugs (azithromycin, clarithromycin) increased dramatically in 9 large health plans, although they accounted for less than 10 of all antimicrobials dispensed 33 . From 1995 to 2002, fluoroquinolone prescribing for adults increased more than 300 , and over 40 of fluoroquinolone prescriptions were for diagnoses such as acute bronchitis, otitis media and acute upper respiratory infections 34 . These results emphasize the continued need for education and behavior change despite modest improvements in overall antimicrobial prescribing rates.

Clinical Implications Of Resistance

Microbiologic failures and the selection of resistant organisms during therapy for CAP and acute exacerbations of chronic bronchitis (AECB) with ciprofloxacin and ofloxacin have been well described (72). Clinical failures have been reported for patients receiving levofloxacin for AECB or pneumonia in the setting of fluoroquinolone resistance (72-74). Most failures have occurred in older adults with underlying lung disease and recent exposure to fluoroquinolones. Failure has occurred despite intravenous administration and most patients reported have responded to agents of another antibiotic class, suggesting that failure was related to resistance.

Pulmonary Pathophysiology

3.8.1 Bronchitis Bronchitis is an inflammation of the airways resulting in excessive mucus production in the bronchial tree. Bronchitis occurs when the inner walls of the bronchi become inflamed. It often follows a cold or other respiratory infection and happens in virtually all people, just as the common cold. When the bronchitis does not go away quickly but persists, then it is termed chronic bronchitis. Chronic obstructive pulmonary disease (COPD) is a slowly progressive disease of the lung and airways. COPD can include asthma, chronic bronchitis, chronic emphysema, or some combination of these conditions. The disease is characterized by a gradual loss of lung function. The most significant risk factor for COPD is cigarette smoking. Other documented causes of COPD include occupational dusts and chemicals. Genetic factors can also play a significant role in some forms of this disease.

Disorders That Obstruct Air Flow245

The flow of air from the lungs can be limited or obstructed by a variety of structural changes in the lungs. Chronic obstructive pulmonary disease (COPD), a major cause of disability and death in men, refers to asthma, chronic bronchitis, and emphysema. With COPD the airway obstruction is generally irreversible. With asthma the obstruction is reversible with treatment, although the disease itself may not be cured. Chronic Bronchitis Bronchitis is inflammation of the lining of the bronchial tubes. The inflammation results in the production of extra mucus, which causes the person to cough regularly to clear the airways. Acute (short-term) bronchitis often occurs along with a severe cold (usually with a fever) and clears up completely on its own. Chronic (long-term) bronchitis lasts for months but often goes unnoticed because of its gradual development. With chronic bronchitis, a mucus-producing cough lasts weeks after a cold apparently has cleared up. The coughing episodes become longer...

New diagnostic approaches

Using sets of classifier genes obtained from the above analyses, the authors examined the gene expression profiles of PBMCs isolated from patients presenting with lower respiratory infections the same as those listed above or from healthy volunteers. From these analyses, the authors were able to classify the samples from these new patients into the correct disease categories. In addition, the authors tested a separate set of samples using a different array platform. These studies also demonstrated that patients presenting with these illnesses could be accurately classified into distinct groups based on gene expression profiles (Ramilo et al., 2007). Through these painstaking efforts, the authors convincingly used functional genomics to discriminate between patients with a variety of acute infections, including influenza.

Human parvovirus See B19 virus

Human respiratory syncytial virus (HRSV) The type species in the genus Pneumovirus. A common human respiratory virus first isolated from a chimpanzee. An important cause of lower respiratory tract infection in infants which may be more severe if they have a low level of antibody, because this may react with viral antigen in the tissues. The antibody is often maternal. For this reason immunization may have unfavorable consequences and no protective vaccine has been developed. Reinfection

Infectious bovine rhinotracheitis virus

Infectious bronchitis virus (IBV) The type species of the genus Coronavirus. The cause of a common, contagious, acute respiratory disease of chicks. Neutralization tests using chick embryos indicate multiple variant antigenic types. All strains show some antigenic relationships but are unrelated to other coronaviruses. Beaudette strain (IBV-42) is serologically similar to Massachusetts strain, although on egg passage it has become lethal for chick embryos but has lost infectivity for older birds. Chicks up to 4 weeks old are most susceptible. They show depression and gasping rales are heard. The disease lasts 6-18 days and the mortality is up to 90 . In laying birds there is a drop in egg production and eggs are defective. Pheasants may be infected. Mild endemic infection may result in poor egg production and predispose to bacterial respiratory disease. Avian nephrosis and visceral gout may be caused by the virus, possibly by certain strains (see Australian infectious bronchitis...

Progress in the Development of Inhaled Long Acting P2Adrenoceptor Agonists

Asthma is a chronic inflammatory disorder of the airways causing recurrent episodes of wheezing, breathlessness, chest tightness, and coughing 7 . These symptoms often occur at night or in the early morning, impacting sleep patterns and so reducing overall quality of life. COPD is the fourth leading cause of death in the US and is characterized by airflow obstruction due to chronic bronchitis or emphysema

What is inhalation injury

Inhalation injury occurs when hot gases, toxic substances, and reactive smoke particles reach the tracheobronchial tree. These substances result in wheezing, bronchospasm, corrosion, and airway edema and should be suspected if the burn was sustained in a closed space. The presence of carbonaceous sputum, perioral soot, burns to the face and neck, stridor, dyspnea, or wheezing are indications for complete respiratory tract evaluation. Inhalation injury can cause damage to the upper airway (i.e., airway compromise, nasal obstruction, and acute laryngitis with varying degrees of laryngeal edema), damage to the conducting airway (i.e., tracheitis and bronchitis), and injury to the lower respiratory tract (i.e., pneumonitis, pulmonary edema, and adult respiratory distress syndrome). Chest radiographs during the initial phase usually underestimate the severity of lung damage because the injury is usually confined to the airways. Fiber-optic bronchoscopy has been quite useful in diagnosis of...

Patientbased interventions

In several studies, patient-based interventions were evaluated in conjunction with other interventions. There were, however, five studies that examined the effect of a variety of patient-based interventions alone (Table 7). These studies evaluated the effect of patient educational materials (Mainous et al., 2000), a patient information leaflet regarding antibiotics for acute bronchitis (Macfarlane et al., 2002) and the use of delayed prescriptions for infections where patients desired antibiotics but physicians did not feel antibiotics were necessary (Arroll et al., 2002 Dowell et al., 2001 Little et al., 2001). In the one study examining the effect of patient educational materials alone (Mainous et al., 2000), there was a modest effect seen in the group with this intervention compared with the control group. This effect was similar to that seen in the other intervention groups (audit and feedback alone, or combined with patient educational materials). In a study of prescribing for...

Government Sponsored Research and Research Tools Are Required

Hands working on it makes sense. (3) The NIH should immediately address those clinical trials which industry is unlikely to carry out. The first priority would be placebo-controlled trials for exacerbations of chronic bronchitis. For a full explanation of this issue, see Chapter 4. Other trials that are needed include studies on infections of heart valves and bones and joints. Since these infections are rare, the NIH could establish consortia of centers with access to large patient populations with these difficult infections. This would make NIH sponsored trials easier to perform and might even tempt industry back into this difficult area.

Discussion Of Results And Implications For Practice

In the studies of the use of delayed antibiotic prescriptions for URIs and otitis media, significant patient morbidity was not observed (Arroll et al., 2002 Dowell et al., 2001 Little et al., 2001). As the outcome of viral respiratory tract infections is not altered by antibiotics, these are not unexpected results for the studies of URIs. It is important, however, to have data that demonstrates this lack of morbidity for illnesses such as acute bronchitis and purulent rhinitis where the etiologic agent, while usually viral, is often thought to be bacterial by many practitioners. The demonstration that there is no benefit to immediate use of antibiotics may serve to convince many physicians and patients that antibiotics are not needed for these conditions. Delayed prescriptions for acute otitis media in children are frequently used in many European countries but have not gained popularity in North America. This pragmatic study (Little et al., 2001) demonstrates that waiting a few days...

The Common Cold and the

The flu is a viral infection of the nose, throat, and lungs. It is usually mild in young and middle-aged adults but can be life-threatening in older people and people who have a chronic illness such as heart disease, emphysema, asthma, bronchitis, kidney disease, or diabetes. The flu also can lead to more serious, potentially life-threatening infections such as pneumonia (see page 250). Because pneumonia is one of the five leading causes of death among older people, it is important for older people to take steps to prevent the flu. The best preventive measure is a flu shot (see page 93), given each fall at the beginning of the flu season. A pneumonia shot (see page 252) is another preventive measure available for older people and people who have a chronic illness the pneumonia shot is given only once.

Epidemiology Etiologic Agents

Neonates may acquire lower respiratory tract infections with C trachomatis or P. jiroveci (which likely indicates an immature immune system or an underlying immune defect). Young Adults. The most common etiologic agent of lower respiratory tract infection among adults younger than 30 years of age is Mycoplasma pneumoniae, which is transmitted via dose contact. Contact with secretions seems to be more important than inhalation of aerosols for becoming infected. After contact with respiratory mucosa, Mycoplasma organisms are able to adhere to and colonize respiratory mucosal cells. Both a protein adherence factor and gliding motility may be virulence determinants. Once situated in their preferred site between the cilia of respiratory mucosal cells, Mycoplasma organisms multiply and somehow destroy ciliary function. Cytotoxins produced by Mycoplasma organisms may account for the cell damage they inflict. Chtarny-daphila pneumoniae (originally called...

Antibiotic Consumption

It is a very difficult task to explain or to speculate as to why antibiotic use in the French community is so high. Despite clear guidelines on antibiotic use for presumed viral respiratory tract infection (PVRTI) over the last 10 years, the proportion of patients with PVRTI for whom antibiotics were prescribed remained high. Furthermore, antibiotic use tended to increase between 1984 and 1995, to treat acute media otitis and bronchitis, but remained almost stable for rhinopharyngitis or tonsillitis (Observatoire National des Prescriptions et Consommations des M dicaments, 1998) In contrast to certain northern European countries, in France, acute otitis media is considered as a pathology requiring antibiotic therapy. No element explaining the increased prescription of antibiotics for bronchitis has been clearly identified. The frequency of antibiotic prescriptions in sore throats reached 90 in 1984. Obviously, no increase would be expected but no spontaneous decrease occurred despite...

Guidelines For Rti The Value of Guidelines

Behavior, such as promoting the appropriate use of antibiotics. Effective clinical guidelines should improve patient care while enhancing cost savings. However, cost savings should not be the primary motivating factor. A recent example reported by Beilby et al. described a government intervention in Australia intended to decrease costs by reducing the use of amoxicillin-clavulanate (38). As a result, costs increased through the occurrence of adverse outcomes in patients with acute otitis media (AOM), sinusitis, lower RTI, and acute exacerbations of chronic bronchitis (AECB).

Materials And Methods

A total of 4865 patients with arsenical dermatosis (ASD) were thoroughly examined for clinical features in 300 rural areas. The field survey was initiated in 1983. It included clinical investigation, collection of tube well water samples, nails, hairs and skin scales of patients. The cases of mild complications, such as asthmatic bronchitis, received treatment in the field. However, serious cases with complications, such as ascetic jaundice, were admitted to the hospital of the Calcutta School of Tropical Medicine (CSTM), India, between 1983 and 1987 (Saha, 1984 Saha, 1995). After 1994 a collaborative study was done with the School of Environmental Studies (SOES) of Jadavpur University. In this institution arsenic content has been measured by flow injection hydride generation, atomic absorption spectrometry (FIHGAAS) (Samanta et al., 1994). Even after working for 17 years, we feel we have only seen the tip of the ice-berg.

The FDA Has to Level the Playing Field with Generic Antibiotics

The FDA cannot continue to allow Americans to use generic drugs that would not meet FDA's modern standards. All drugs have to meet the same standard of efficacy and safety. Specifically, I'm speaking about all the antibiotics that have ever been approved by the FDA for otitis, sinusitis, bronchitis and pneumonia. If the FDA has decided that the trials that were previously carried out do not show benefit, than by definition the risk to benefit ratio for those drugs is zero. Their marketing approval for those indications should be withdrawn. This is especially important since the use of the older generic drugs tends to be much greater than the use of the new antibiotics which is so closely monitored for approval. With the greater use of the older drugs comes the potential for greater danger.

Antibiotic Use And Cost Trends

Most information available comes from industrialised countries with minimal data from the developing world. In the United States, antimicrobial prescription rates by office-based physicians remained unchanged from 1980 through 1992 however, prescriptions for children increased by 48 (McCaig and Hughes, 1995). A large portion of these prescriptions was for the treatment of colds, upper respiratory tract infections, and bronchitis conditions where there is no proven benefit of antibiotic therapy. Trends in antimicrobial prescribing at visits to office-based physicians, hospital outpatient departments, and hospital emergency departments from 1992 to 2000 in the United States declined by 25 (McCaig et al., 2003). Amoxicillin and the cephalosporins were most prescribed (annual drug prescription rate per 1,000 population) in outpatient settings between 1980 and 1992 (McCaig and Hughes, 1995 Steinman et al., 2003). Even though antibiotic use in ambulatory patients is decreasing, use of...

Community Interventions

Conducted a multifaceted intervention to improve antimicrobial prescribing for upper respiratory tract infections (URTIs) in a small rural community in Utah. The intervention involved patient education materials, a media campaign to increase public awareness, small group sessions involving physicians, and physician use of URTI algorithms. After 6 months, the percentage of patients in the community who received antibiotics for URTIs during the intervention period was 15.6 less than that for the baseline period. There was a decrease of 56 on antibiotic prescriptions for acute bronchitis and a 13.4 decrease on macro-lides prescriptions. Among hospitalized patients, there was no significant decrease in the number of patients with URTI who were prescribed an antibiotic, although there was also a decrease in macrolide use (11.2 ).

Scope Of Inappropriate Antibiotic

Many descriptive studies show that, while recent efforts to curtail unnecessary antibiotic use have met with some success, there is evidence that there is still a long-standing and continuing problem with unnecessary antibiotic use in the United States for both adults and children, and that use of broad-spectrum antibiotics has been increasing. During the 1990s, adult antibiotic use fell by 23 for upper respiratory infections, and by 22 for bronchitis, but broad-spectrum antibiotic use doubled. By 2001-2002, 49 of adult outpatient visits for respiratory tract infections (acute bronchitis, cough, upper respiratory tract infection, and laryngitis, all conditions for which an antibiotic is rarely indicated) still received an antibiotic prescription, and 77 of these were for a broad-spectrum antibiotic, an increase of 87 over 6 years (22). Among children during the 1990s, antibiotic use decreased by 49 for upper respiratory tract infections, and by 13 for bronchitis, but broad-spectrum...

Gemifloxacin Antibacterial [5157

Gemifloxacin is a new fluoroquinolone derivative that is active against both Grampositive and Gram-negative bacteria, and it was launched last year as an oral treatment for bacterial respiratory infections. Compared with other fluoroquinol-ones currently on the market, gemifloxacin possesses enhanced in vitro activity against Streptococcus pneumoniae, including isolates resistant to p-lactams, mac-rolides, and ciprofloxacin. Gemifloxacin is specifically indicated for treating community-acquired pneumonia (CAP) caused by multi-drug resistant S. pneumoniae and for treating acute bacterial exacerbations of chronic bronchitis (AECB). The recommended dose of gemifloxacin is 320 mg daily for 5 days for AECB and 320 mg daily for 7 days for CAP. Fluoroquinolones derive their antibacterial activity by inhibiting either DNA gyrase or DNA topoisomerase IV or both. In S. pneumoniae, gemifloxacin is about 10-fold more potent inhibitor of topoisomerase IV (IC5o 1.4 mg mL) than DNA gyrase (IC50 47.5...

Medical Provider Interventions

Centers for Disease Control and Prevention (CDC) has recently completed a series of practice guidelines regarding appropriate antibiotic use for adult acute respiratory infection, including bronchitis (71), exacerbations of chronic obstructive pulmonary disease (72), pharyngitis (73), sinusitis (74), and nonspecific upper respiratory tract infections (75), and publishes regular guideline updates for influenza (76). The Infectious Diseases Society of America (3) and the American Thoracic Society (77) published recommendations for the management of adult community-acquired pneumonia. The American Academy of Pediatrics published guidelines for the diagnosis and antibiotic treatment of pediatric acute otitis media, the most common outpatient diagnosis for which an antibiotic is prescribed for children (78,79), and pediatric sinusitis (79).

Examples Of Successful Interventions To Reduce Inappropriate Antibiotic

Gonzales et al. published the results of their multidimensional intervention on the treatment of adult acute bronchitis in 1999 (39). This was a nonrandomized quasi-experimental study involving four primary care practices in Denver, Colorado that were part of a nonprofit group-model health maintenance organization. The full intervention site received household- and office-based patient educational materials. Household materials were mailed to families and included magnets outlining preventive and self-care issues, what to expect for a visit for respiratory illness, a CDC pamphlet entitled Your Child and Antibiotics, an industry-sponsored pamphlet regarding handwashing, and a letter from their practice's medical director about the importance of reducing unnecessary antibiotic use. Office-based materials, directed at patients and family medicine and internal medicine clinicians, included posters regarding (i) the lack of effect of antibiotic treatment on duration of illness for...

Antibiotic Resistance And Bacterial Variation

Resistance to antibiotics is increasing rapidly among human pathogens as pointed out by many authors (e.g., refs. 65 and 66). The reasons center around one problem the failure to control the human use of antibiotics. Numerous studies have shown that in medicine antibiotics are frequently prescribed unnecessarily or inappropriately. For example, it was estimated that in 1992, 12 million adults who presented bronchitis or upper respiratory infections received prescriptions for antibiotics that offered little or no benefit (67). Similar studies of inappropriate antibiotics usage have focused on Canada, Europe, and Japan. In developing countries, antibiotics usage has been poorly regulated, patient compliance has been poorly monitored, and much of the supply of antibiotics is of low quality. The common use of antibiotics in veterinary medicine and in agriculture has contributed to the problem to an extent that is difficult to determine but likely to be considerable.

Section Ii Cardiovascular And Pulmonary Diseases

Pulmonary hypertension is a major complication of several pulmonary disorders including emphysema and chronic bronchitis and can have many potential causes (1,2). A rigorous diagnostic classification of the various forms of pulmonary hypertension based on common clinical features has been developed to standardize diagnosis and treatment (3). However, the disease is conveniently classified here as (a) primary pulmonary hypertension (PPH i.e., unexplained) or (b) secondary to various lung, cardiovascular and other diseases (e.g., chronic bronchitis, hypoxia, emphysema, cardiac and extrathoracic conditions). Secondary pulmonary hypertension, with modest increases in mean pulmonary arterial pressures (< 40 mm Hg), is more prevalent but under diagnosed. Reliable estimates of incidence of this condition are difficult to obtain because numerous underlying pathologies contribute to the disease. In both primary and secondary pulmonary hypertension, a decrease in lung diffusion capacity...

Guidol Ma English 1st Sem Result 2015

F., Lum, A., and Barrett, P. H. J., 1999, Decreasing antibiotic use in ambulatory practice Impact of a multidimensional intervention on the treatment of uncomplicated acute bronchitis in adults. JAMA, 281, 1512-1519. Gonzales, R., Steiner, J. F., and Sande, M., 1997, Antibiotic prescribing for adults with colds, upper respiratory tract infections, and bronchitis by ambulatory care physicians. JAMA, 278, 901-904. Macfarlane, J., Holmes, W., Gard, P. et al., 2002, Reducing antibiotic use for acute bronchitis in primary care Blinded, randomised controlled trial of patient information leaflet * Commentary More self reliance in patients and fewer antibiotics Still room for improvement. BMJ, 324, 91. Nyquist, A-C., Gonzales, R., Steiner, J. F., and Sande, M., 1998, Antibiotic prescribing for children with colds, upper respiratory tract infections, and bronchitis. JAMA, 279, 875-877.

Some Edible Vegetables Of Saponin Containing Indigenous To China

From the edible fruits many saponins have been isolated. Sapogenins obtained after hydrolysis of lucyosides were pentacyclic triterpene genins, such as oleanolic acid, hederagenin, gypsogenin, moslinic acidand arjunolic acid etc. The isolated tetracyclic triterpens were dammarane saponin such as gensinoside-Re, -Rgj and saponon I. It was used as durgs for clearing away heat to relieve cough, dissipating phlegm and detoxication in traditional medicine. Achievements from research in recent years demonstrated its anti-inflamatory, sedative, analgesic, promoting immunity, anti-infection, anticoagulant, abatment of obesity and cure beauty of skin effects, thus it was used for treatment of chronic bronchitis and to manufacture healthy foods and cosmetics for cure beauty.

Chemokines Targets for Novel Therapeutics

Arthritis (RA), multiple sclerosis (MS) (29-34), atherosclerosis (35), asthma (36, 37), chronic obstructive pulmonary disorder (COPD) (38), and allergic disease (39). Taken together, this information has provided a very strong rationale for the implementation of chemokine antagonist programs. In the remainder of this review we will focus on the progress made towards identifying low molecular weight antagonists for CCR1, one of the receptors for MIP-1a and RANTES, CXCR2, one of the IL-8 receptors, and CCR2, the MCP-1 receptor (CCR2).

Doripenem Antibiotic [2225

Doripenem is a parenteral carbapenem antibiotic launched last year in Japan for the treatment of bacterial respiratory and urinary tract infections. It is a 1p-methyl carbapenem derivative, and it is the fourth analog to be marketed in this series following the launch of meropenem, biapenem, and ertapenem in previous years. The introduction of a 1 p-methyl group to the carbapenem skeleton enhances metabolic stability to renal dehydropeptidase-1 (DHP-1) and leads to improved antibacterial potency. The mechanism of action is likely to involve covalent modification of peptidoglycan biosynthetic enzymes responsible for catalyzing the final transpeptidation step of cell wall biosynthesis. The chemical synthesis of doripenem involves the coupling of a commercially available 4-nitrobenzyl protected 1 p-me-thylcarbapenem enolphosphate intermediate with a protected version of as the key step. The requisite pyrrolidine intermediate is prepared in six steps starting from...

Contagious pustular stomatitis of sheep virus Synonym for Orf virus

Coronaviridae A family of single-stranded RNA viruses, belonging to the Order Nidovirales. There are two genera (1) Coronavirus, type species Infectious bronchitis virus and (2) Torovirus, type species Equine torovirus. The virions are pleomorphic, approximately spherical, 120-160nm in diameter, covered with petal-like projections (peplomers) 12-24nm long and arranged in a characteristic fringe giving the appearance of a crown (corona) from which the family name is derived. Virus is assembled in the cytoplasm and matures by budding through the endo-plasmic reticulum. Nucleic acid consists of one molecule of infectious single-stranded RNA about 30kb (coronavirus) or 20kb (torovirus) in length. Virion RNA has a 5' terminal cap and a 3' terminal poly A tract. There are at least five virus-specific polypeptides. All coronaviruses have spike (S), membrane (M) and nucle-ocapsid (N) proteins and some also have a hemagglutinin-esterase (HE) protein. The S and HE proteins are N-glycosy-lated....

Antibacterial Treatment of Community Acquired Respiratory Tract Infections

Introduction - Community-acquired respiratory tract infections (CARTIs) represent one of the most globally prevalent classes of infection. Acute RTIs account for approximately 75 of all antibiotic prescriptions and 20 of all medical consultations (1). Community-acquired upper respiratory tract infections (CAURTI) (pharyngitis tonsillitis, laryngitis, otitis media and sinusitis) and viral RTIs (rhinorrhea the common cold, influenza A B, adenovirus, parainfluenza and syncytial virus) are typically not life-threatening unless complicated by a coinfection or an immunocompromised host (e.g. meningitis, HIV, etc.). Generally, CAURTIs respond well to front-line antibiotics such as penicillins, erythromycin, azithromycin, amoxicillin clavulanate or cefpodoxime. Viral RTIs are usually self-limiting and only require symptomatic support (2,3). Of greater concern are lower respiratory tract infections (LRTI) which include community-acquired pneumonia (CAP) and acute exacerbations of chronic...

The FDA Increases Clinical Trial Design Stringency and Costs Companies Abandon Antibiotic Research

With their advisory committee and in public, the FDA began to examine the issue of antibiotics used for mild infections like sinusitis, bronchitis and otitis (middle ear infections). The issue for these infections is that they frequently are caused by viruses and not bacteria and therefore would not respond to antibiotics in any case. This leads to much of the unnecessary use of antibiotics which in turn probably leads to antibiotic resistance. The other question is that even when bacteria cause these types of infections, will they get better without treatment Will serious complications arise without antibiotic treatment How do we know that antibiotics even work The scientific literature is very conflicted on this subject. The area of mild infections is directly related to the agency's basic concern about comparative trials where a placebo is not used. How do we know that the standard or comparator antibiotic is better than no antibiotic

Conditions Associated With Exacerbations Of Asthma

The physician should consider diagnostic studies for sinusitis whenever symptoms of upper respiratory infection or rhinitis are more protracted than expected, the patient has dull to intense throbbing pain over the involved sinus area, the patient's asthma is not responding appropriately to medications, or the patient has prolonged or persistent bronchitis that has failed to respond to appropriate therapy. On physical examination, edema and discoloration below the eyes may occasionally be observed. The nasal mucosa is inflamed, and a purulent discharge frequently is seen on the floor of the nose, beneath the middle turbinate, or draining down the throat.

Treatment of Concomitant Diseases and Conditions

Many asthmatics will only respond once their concomitant sinusitis, GERD, thyroiditis, emotional stress, or pregnancy is under control. Moreover, the treatment of asthma requires close attention to concomitant colds, flu, bronchitis, environmental irritant or pollutant inhalation, recreational drug use, and emotional changes. Compliance is a significant problem, both with medication use and allergen avoidance and inhaler techniques. Thus, the physician who treats asthma needs to keep the whole patient in focus, as well as his work and family environment. On the other hand, proper treatment is nearly always effective and can be extraordinarily gratifying. It is common to convert pulmonary cripples into totally functioning humans in a matter of weeks. 1. Most useful in the asthmatic with bronchitis to help reduce mucus production 3. Combivent (a metered-dose inhaler combining albuterol with ipratropium) may be useful for asthma and bronchitis (DuoNeb is one nebulized form)

Inappropriate Antibiotic

In the United States, an office-based study suggested an increase of 48 in antibiotic prescribing for children between 1980 and 1992 (McCaig et al. 2003). The Centers for Disease Control and Prevention (CDC) estimates that more than 100 million courses of antibiotics are prescribed each year, and approximately 50 of those prescriptions are unnecessary (usually indicated for viral or spontaneously resolving bacterial infections) (Dowell et al. 1998). The National Hospital Ambulatory Medical Care Survey demonstrated that almost 50 of common cold and up to 80 of acute bronchitis consults are treated with antimicrobial drugs.

The Arbroath Multiple Disease Study

Due to concerns about the effects of this centrally located foundry on the health status of the surrounding community, it was decided to examine the spatial distribution of mortality arising for a range of diseases in the town area. Specifically the study aimed to test the hypothesis that deaths from bronchitis, gastric, oesophageal and lung cancer would be raised in areas affected by pollution from the foundry. For all residents in the town, information was extracted from the death certificates for the years 1966-76 on age, sex, address, occupation, and the causes of death. Certificates with any mention of lung cancer were used unless the cancers were secondary to a primary cancer in another tissue. The address of each death was plotted on a map. The addresses of deaths with non-respiratory cancers were also extracted from the death certificates and the locations mapped. Two categories of non-malignant disease were selected from the death certificates ischaemic heart disease where no...

Differential Diagnosis Of Asthma

Not all that wheezes is asthma Diseases in which wheezing is a component are listed in Table 7. Asthma, chronic bronchitis, and emphysema affect the airways diffusely, cause airway obstruction, and may coexist in the same patient. Generally, chronic bronchitis occurs in cigarette smokers who develop chronic cough that persists for years before airflow becomes symptomatically obstructed. The bronchorrhea may vary in intensity in relation to infectious or irritant exposure, for example. Chronic bronchitis involves hyperplasia and hypertrophy of the submucosal glands, inflammation of the small airways, and hypersecretion of mucus. Emphysema may also be heralded by longstanding cough and mucus production, but this is a diagnosis confirmed only histo-logically. Emphysema is suggested by the presence of a reduced diffusing capacity and obstructing airways disease. Most adults have some degree of emphysema at autopsy, but severe emphysema is seen only in about 10 . Emphysema is another...

Biotech Is Still a High Risk Proposition

For every biotech success story like Cubist, there are many less happy stories. Some experts estimate that only 10 of biotech companies will succeed. One example of the other 90 is Replidyne, of Louisville, Colorado. Replidyne started with technologies for finding new antibiotics, but then realized that it too needed a near term product to attract investor capital. They licensed an antibiotic from Glaxo Smith Kline that could only be developed as a topical product. This was not sufficient to attract investor dollars, so they then licensed in an oral antibiotic called faropenem from a Japanese pharmaceutical company, Daiichi-Suntory, now Asubio. Faropenem was like an oral version of the very active carbapenems like imipenem. It had already been tested in late stage trials by Bayer (who had licensed it previously from the Daiichi). (In fact, when I first joined Wyeth, we were just giving faropenem back to Daiichi. It is such a small world ) When Bayer abandoned antibiotics, they...

Educational outreachacademic detailing

Increase prescribing of first-line agents for UTI, bacterial tonsillitis, otitis media, bacterial bronchitis, mild pneumonia 1982), and antibiotics combined with symptomatic medications, oral and injectable cephalosporins, and an injectable combination of penicillin and streptomycin (Font et al., 1991). Another RCT used academic detailing to promote the use of certain first-line agents for a variety of community-acquired bacterial infections (UTI, bacterial tonsillitis, otitis media, bacterial bronchitis, and mild pneumonia) (Ilett et al., 2000).

Medical Professionals

A major factor is imperfect knowledge of the prescriber. This lack of knowledge has to do with insufficient knowledge of infectious diseases, the potential causative microorganisms and their susceptibility to antimicrobials, and expertise on antimicrobial drugs. With regard to the latter, there is probably too little emphasis in most medical curricula on the relevance of prudent antibiotic prescribing. Imperfect knowledge of infectious diseases leads to insecurity about the diagnosis and difficulties of distinguishing in the clinic between bacterial and viral infections. Apparently, many physicians do not know (or ignore) that antibiotics do not influence the outcome in most cases of common infections such as otitis media, sinusitis, acute bronchitis, and chronic obstructive pulmonary disease.5-9 In a series of elegant studies Holmes et al. showed that antibiotics do not alter the natural course of cough.10 Poor case definition also in the hospital setting will lead to indiscriminate...

Edward A Belongiaa Rita Mangione Smithb Mary Jo Knoblocha

Appropriate antimicrobial use is increasingly viewed as a quality improvement issue, and performance measures have been established for pediatric upper respiratory infection and adult bronchitis. There is growing interest in pay for performance, but little is known regarding the relationship between physician reimbursement and appropriate antimicrobial prescribing. Clinical decision support tools are also promising but require further investigation. Over the next decade, we must acquire a better understanding of macro-level factors that contribute to inappropriate antimicrobial use, including social cultural health beliefs and practices, physician reimbursement practices, pharmaceutical marketing, and organizational policies regarding return-to-work or child care following illness. Health care systems, pharmaceutical companies, medical schools, residency programs and managed care organizations must all take responsibility and work col-laboratively to produce lasting change in...

Quail adenovirus See fowl adenovirus

Quail bronchitis A disease of quail caused by Fowl adenovirus A, a species in the genus Aviadenovirus. An acute, highly contagious respiratory disease in captive and wild bobwhite quail, Colinus virgini-anus. In young birds less than 4 weeks old there may be 100 fatality. Identical to CELO virus, fowl adenovirus 1. See fowl adenovirus 1. Synonym quail adenovirus.

Mapping Differences In Rates

There are numerous examples of mapping in which the main purpose was to compare rates of disease between communities some of these were reviewed in Chapter 1 and all the atlases which have been published obviously fall into this category.6-11 Figure 7.3 shows the distribution of standardized mortality ratios for bronchitis, emphysema and asthma in Scotland between 1979 and 1983. It shows quite clearly that the highest mortality was found in the industrialized central belt of Scotland. The strength of this finding was somewhat surprising as it represented deaths 10 years after the passage of the second of the UK's Clean Air Acts. Figure 7.3. SMRs for bronchitis, emphysema and asthma in Scotland between 1979 and 1983. Redrawn from Williams et al. (1987)20 Figure 7.3. SMRs for bronchitis, emphysema and asthma in Scotland between 1979 and 1983. Redrawn from Williams et al. (1987)20

Evaluaton of Patients With Recurrent or Persistent Sinusitis

Fifty percent of children and 30-40 of adults with recurrent or chronic sinusitis are sensitized to common aeroallergens such as plant pollens, house dust mite, and animal danders. Assessment of IgE-mediated hypersensitivities by allergy skin testing or in vitro blood assays should therefore be performed in all patients because they may benefit from a comprehensive program of allergen avoidance, anti-allergic drug therapy, and, in selected cases, immunotherapy. Patients with severe, recurrent episodes of sinusitis associated with other infections (e.g., otitis, bronchitis, and pneumonia) may suffer from one of the antibody deficiency syndromes and should undergo a screening assessment of their immunoglobulin levels. If a deficiency is noted or still suspected after the initial testing, these patients should be referred to an allergist immunologist for further evaluation.

Mild Infections Require Placebo Controlled Trials Industry Balks

This is a really controversial area. Patients with chronic lung disease, specifically, chronic obstructive pulmonary disease or COPD, have ongoing breathing problems and other symptoms like productive cough that get worse (exacerbations) from time to time. They are chronically colonized with bacteria in many cases. That is, even when they are not experiencing worsening symptoms, they have bacteria living in their lungs. Their exacerbations seem to be associated with the acquisition of new strains of bacteria in their lungs. For many years, physicians have thought that treating the bacteria isolated from the sputum (bronchial and lung secretions these patients cough up) of patients at the time of an exacerbation would shorten the duration of the episode and help avoid more serious complications like respiratory failure and pneumonia. Like otitis and sinusitis, many antibiotics marketed today are indicated for the treatment of these exacerbations all based...

New Therapies Or Therapeutic Strategies

The newer fluoroquinolones, gemifloxacin and moxifloxacin, possess improved activity against S. pneumoniae. They have proven effective against penicillin-resistant, macrolide-resistant, and multidrug-resistant S. pneumoniae. High clinical cure and bacterial eradication rates have been observed in clinical trials using fluoroquinolones for the treatment of community-acquired respiratory infections (87). For patients in which fluoroquinolones have been used to treat CAP or acute exacerbation of chronic bronchitis, the clinical cure rates are typically 90 (88). Moreover, the new fluoroquinolones may be dosed once-daily, increasing patient compliance (87). However, fewer genetic barriers are likely to result in more rapid development of resistance in S. pneumoniae under conditions of expanded use. The newer fluoroquinolones moxifloxacin and gemifloxacin combine the highest in vitro potency and the best pharmacokinetic profiles. These drugs require two spontaneous mutations (typically, 1...

Pneumonia The New Frontier New Trial Requirements for Pneumonia Will Make Approval Much More Difficult and Costly and

Along the same lines as their inquiry on otitis, sinusitis and bronchitis, the FDA recently examined the role of antibiotics in pneumonia. Those of us in the infectious diseases community held our collective breath waiting to see if the FDA would decide that they did not understand whether antibiotics had an effect on bacterial pneumonia. To us clinicians, that antibiotics have a dramatic beneficial effect in the treatment of pneumonia was obvious and well proven by our own personal experiences as physicians and by clear historical precedent. Many of us could not understand what the FDA was thinking.

The FDA Can Change Its Requirements After Completion of a Trial and then Require New Trials for Approval

New policy requiring a different design. This is important. A company will pay about 30 million for a single Phase III antibiotic trial. To get approval, you need to run two such trials for each indication (skin infection, pneumonia, etc.). These trials usually take about 2 years to run and at least another 6-12 months for data analysis and submission of the dossier to regulatory agencies. Most companies plan on spending about 70 million on trials and other requirements to get approval for a single indication. Before putting that much money in play, companies like some reassurance that the trial design they are using will, if the study reaches its endpoints, lead to approval by the FDA. There is a process in place at the FDA (Special Protocoal Assessment or SPA) where sponsors can submit specific trial protocols and get written comments back from the FDA. This, in the past, was extremely valuable to all parties. The withdrawal of approval of Ketek for sinusitis and bronchitis because...

Infections

All patients with asthma may experience a worsening of their symptoms concurrent with upper respiratory tract infections, bronchitis, or influenza-type illnesses. Moreover, children may experience their initial asthma as a consequence of viral bronchiolitis, which commonly develops into chronic asthma. Finally, some patients have no clinical asthma except during concurrent respiratory infections. Some adult asthmatics trace their chronic asthma to a viral respiratory infection that led directly to chronic and often severe, nonallergic asthma. RSV-related bronchiolitis has a mortality risk of 1 . Several studies suggest that atopic children develop IgE antibodies directed at the RSV, which converts the infection into an allergic reaction. About 50 of children with bronchiolitis in whom a family history of either allergies or asthma exists develop recurring wheezing. In most instances, postbronchiolitis asthma is mild in nature and largely under control or in remission by the age of 8...

Occupational Asthma

Up to 30 of asthmatic patients, particularly those over 30 yr of age, have no apparent cause for their asthma. Often their disease begins with a severe upper or lower respiratory tract infection or sinusitis and progresses to asthma in short order. Such patients often have coexistent sinusitis and nasal polyposis, as well as vasomotor rhinitis. It has been thought that such patients have a worse prognosis than other types of asthmatics, but this is certainly not predictable. In such patients it is necessary to search for factors that might worsen asthma. Many patients with idiopathic asthma regularly produce mucus and have a history of tobacco smoking such patients may have an asthmatic form of bronchitis. In some patients a trial of antibiotics for low-grade infectious bronchitis might be appropriate.

Symbols

The size and shape of point symbols may be varied. Different disease distributions may be mapped on the same map by use of different shapes of symbol. For example, the geographical distribution of individual cases of bronchitis and respiratory cancer could be mapped together with the residential address of each case being represented by a (+) for bronchitis and a (X) for respiratory cancer. In addition, the size of symbols can be varied to depict different measurements. For example, if the centre (cen-troid) of the tract were used alone, instead of the complete tract, to display the cumulative numbers with disease, then different sized symbols may be plotted at the centre location and these can represent the different scale of the number in that tract. Any measure made in the tract can be represented similarly. It is common practice to standardize data by forming a ratio of the count to the expected count in that tract. This ratio, known as a standardized mortality morbidity ratio...

Murine models

A subset of genes was preferentially upregulated in mice infected with the A WSN 33 recombinant virus containing the 1918 HA and NA. Among this group were genes that are indicative of T cell activation, macrophage activation, and cell death (Kash et al., 2004). In support of these findings, Tumpey et al. demonstrated that mice infected with A Texas 36 91 containing the HA and NA from the 1918 virus or with A WSN 33 containing these genes developed severe lung pathology, including varying degrees of necrotizing bronchitis, alveolitis, and pulmonary edema. Strikingly, there was also an increase in neutrophils and alveolar macrophages in the lungs of these animals. To analyze the importance of these immune cells in the context of A Texas 36 91 recombinant virus, animals in which neutrophils and or alveolar macrophages had been depleted were infected with a sublethal dose of the virus. Infected neutrophil-depleted mice had a 60 survival rate.

Diagnosis

Most of the literature has focused on overuse of antibacterial agents in situations where antibacterial treatment may not provide benefit. Examples of these situations include upper respiratory infection syndromes, acute non-P-hemolytic streptococcal pharyngitis, and acute bronchitis. Data from the 1996 National Ambulatory Medical Care Survey revealed that 61 to 72 of patients diagnosed with a cold, upper respiratory infection, or acute bronchitis were prescribed an antibacterial drug. Such prescriptions accounted for 15 of the total prescriptions for antibacterial drugs (9). Colds, upper respiratory infection syndromes, and acute bronchitis (in adults) are almost always caused by viral infection, and antibacterial therapy does not improve the outcome (10). Although acute sinusitis is frequently managed with antibacterial drugs, most patients have spontaneous resolution of symptoms. A recent placebo-controlled trial of amoxicillin treatment of acute sinusitis did not show a...

Chronic

Chronic bronchitis is a common condition affecting about 10 to 25 of adults. This disease is defined by clinical symptoms in which excessive mucus production leads to coughing up sputum on most days during at least 3 consecutive months for more than 2 successive years.24 Cigarette smoking, infection, and inhalation of dust or fumes are important contributing factors. Patients with chronic bronchitis can suffer from acute flare-ups of infection, but determination of the cause of the infection is difficult. Potentially pathogenic bacteria, such as nonencapsulated strains of Haemophilus influenzae, Streptococcus pneumoniae, and Maraxella catarrhal, are frequently cultured from the bronchi of these patients. Because of chronic colonization, it is difficult to incriminate one of these organisms as the specific cause of an acute infection in patients with chronic bronchitis. Although the role of bacteria in acute infections in these patients is questionable, viruses are frequent causes.

Bronchiolitis

Bronchiolitis, the inflammation of the smaller diameter bronchiolar epithelial surfaces, is an acute viral lower respiratory tract infection that primarily occurs during the first 2 years of life.9 Characteristic clinical manifestations indude an acute onset of wheezing and hyperinflation as well as cough, rhinorrhea (runny nose), tachypnea (rapid breathing), and respiratory distress. The disease is primarily caused by viruses including a

Estimation

The parameters of the log-linear model, just described previously, may be estimated via maximum likelihood, through standard Generalized Linear Modelling (GLM) packages, such as GLIM or S-Plus. Using a GLM, the known log of the background hazard for the sub-regions, log( ,), i 1, , p are treated as 'offsets' (i.e. known constants). A multiplicative (log) link can be directly modelled in this way, while an additive link can be programmed via special procedures. Lawson15 gives examples of this type of analysis in an application to the analysis of bronchitis mortality around a waste product incinerator.

Europe

Non-specific lower respiratory tract infections and throat infections accounted for the main decreases in antibiotic prescribing. In Norway, the most commonly recorded diagnosis was urinary tract infections, followed by acute bronchitis, ear infections, and non-specific upper respiratory tract infections in 1989 (Straand, 1998). The most prescribed antibiotics were narrow-spectrum penicillins (29 ), followed by tetracyclines (24 ), trimethoprim-sulfamethoxazole (17 ), and erythromycin (12 ). Narrowspectrum penicillin was used in a majority of ear infections, tonsillitis, nonspecific upper respiratory tract infections and sinusitis. Tetracyclines were most often prescribed for acute bronchitis and pneumonia and trimethoprim-sulfamethoxazole for urinary tract infections. In Sweden, a 1-week survey on 7,700 visits for infectious diseases in five counties was conducted in the year 2000 (Stalsby et al., 2002). Respiratory tract infections accounted for 70 of the diagnoses, of which...

United States

In a sample survey 2,500-5,000 office-based physicians reported data on office visits, including information on antimicrobial drug prescribing between 1980 and 1992 (McCaig and Hughes, 1995). During the years, an increasing trend in the visit rate to office-based physicians for otitis media was observed, while the visit rate for sinusitis among adults was found to be higher in 1992 than in each of the other study years. The five leading diagnoses for which oral antibiotics were prescribed were otitis media, upper respiratory tract infection, bronchitis, pharyngitis, and sinusitis. In a sample survey, 2,500-3,500 office-based physicians reported data on 6,500-13,600 paediatric visits during 2-year periods from 1989 to 1990 through 1999 to 2000 (McCaig et al., 2002), population and visit-based antimicrobial prescribing rates were calculated for children and adolescents younger than 15 years. Respiratory tract infections (otitis media, pharyngitis, bronchitis, sinusitis, and upper...

Canada

Information on indications was retrieved from The Drug Information Network, a prescription database, which reflects drug use for the Manitoba population. For new cases of upper respiratory tract infection or pharyngitis, an antibiotic was recorded for 57 of urban patient encounters and for 73 of rural patient encounters (Carrie et al., 2000). For sinusitis the most prescribed antibiotics was doxycycline (21 ), amoxicillin-clavulanate (18 ), and cefaclor (15 ). For bronchitis, the most prescribed antibiotics was amoxicillin (18 ), followed closely by roxithromycin (16.5 ) and cefaclor. In urinary tract infections TMP-SMZ (28.5 ) was most commonly prescribed, followed by cephalexin (18.9 ), and amoxicillin-clavulanate (17.2 ).

Australia

Diagnoses for which patients were prescribed antibiotics were obtained from a survey, based on a sample of 420 general practitioners, stratified in line with the total population by age, location, and practice size (McManus et al., 1997). In 1995, for sinusitis, the most prescribed antibiotics were tetracycline (21 ), amoxicillin-clavulanate (18 ), and cefaclor (15 ). For otitis media, the most prescribed antibiotics were cefaclor (36 ), amoxicillin (21 ), and amoxicillin-clavulanate (21 ) and for bronchitis, amoxicillin (18 ) was followed by roxithromycin (17 ) and cefaclor (15 ). In urinary tract infections, trimethoprim-sulfamethoxazole (29 ) was most commonly prescribed followed by cephalexin (19 ), and amoxicillin-clavulanate (17 ).

Background

As reported in 1998-9, infectious diseases continue to be a leading cause of death, accounting for a quarter to a third of the estimated 54 million deaths annually worldwide. Lower respiratory infections, diarrhoeal disease, tuberculosis (TB), and malaria were the leading causes of global infectious disease burden. While a decrease in diarrhoeal disease is projected for 2020, malaria is increasing and TB and HIV are growing far faster than projected (Gordon et al., 2000). For the new millennium, HIV AIDS, TB, and malaria are the leading infectious disease killers (WHO, 1999). Along with bioterrorism and homeland security, antimicrobial resistance has become one of the most important public health issues faced by the industrialised world, particularly G8 country members. Antimicrobial resistance typically develops when antibiotics are prescribed in inadequate amounts and or for a condition that does not warrant their usage, such as for viral infections. It is estimated that annual cost...

Consumer awareness

Educational campaigns can effectively reduce antibiotic use and ultimately, antibiotic resistance rates. An intervention conducted in the United States resulted in a decrease in antibiotic prescribing for bronchitis, from 74 to 48 , compared to a 2 decrease at control limited intervention sites (Gonzales et al., 1999). Successful integrated approaches have been carried out in India, Indonesia, and Pakistan (Tawfik, 2000) combining a Verbal Case Review (VCR) and a tool called Information Sharing, Feedback, Contracting, and Ongoing Monitoring (INFECTOM). The approach successfully educated practitioners in those countries about standard protocols, and compared their knowledge with actual practices. The results indicate that ongoing monitoring helps to encourage consistent improvement in prescribing practices. To influence parents, another approach could be to field test an antibiotic use and resistance curriculum for elementary and high schools.

Intervention Studies

Since it might be difficult to distinguish between bacterial and viral infections, physicians must be aware of elements that might help them elaborate a presumptive diagnosis and decide which patients might benefit from antibiotic therapy. The knowledge of the natural history of some infectious diseases and whether antibiotics will affect the course of the illness must be reinforced since viral and many common bacterial infections are self-limited and there is no additional benefit from antimicrobial treatment. For example, antibiotic therapy has little effect on the course of acute bronchitis caused by Mycoplasma pneumoniae or Chlamydophila pneumoniae (Gonzales and Sande 2000). Due to the complexity of this problem, the medical community has adopted a number of interventions directed to physicians, nurses, pharmacist, and the public. In 1995, the CDC launched the Campaign for Appropriate Antibiotic Use in the Community (Emmer and Besser 2002). This campaign targeted the five...

The Ketek Scandal

As I noted earlier, there are lots of antibiotics, including penicillin, approved for otitis, sinusitis and bronchitis based on the old approach (comparative rather than placebo-controlled trials). Some of these older antibiotics even have some level of toxicity. According to the FDA's own calculus, these products have a risk benefit ratio of zero since their benefit has never been shown using superiority or placebo-controlled trials. Has the FDA moved to remove marketing approval for these indications from these older antibiotics No. This point was driven home recently by the scandal over the FDA handling of a new antibiotic, Ketek (telithromycin). Even Congress got involved. This is a story I have followed closely and I was present at the final FDA meeting dealing with this new antibiotic. The Ketek story illustrates the effect of political pressure on the FDA process, FDA's inconsistent treatment of branded compared to generic antibiotics, and, in my view, their lack of leadership...

Routine Culture

Most of the commonly sought etiologic agents of lower respiratory tract infection will be isolated on routinely used media 5 sheep blood agar, MacConkey agar for the isolation and differentiation of gram-negative bacilli, and chocolate agar for Haemophilus and Neisseria spp. Because of contaminating oral flora, sputum specimens, specimens obtained by bronchial washing and lavage, tracheal aspirates, and tracheostomy or endotracheal tube aspirates are not inoculated to enrichment broth or incubated anaerobically. Only specimens obtained by percutaneous aspiration (including transtracheal aspiration) and by protected bronchial brush are suitable for anaerobic culture the latter must be done quantitatively for proper interpretation (refer to prior discussion). Transtracheal and percutaneous lung aspiration material Numerous bacterial agents that cause lower respiratory tract infections are not detected by routine bac-teriologic culture. Mycobacteria, Chlamydia, Nocardia, Bordetella...

The Perfect Storm

Requirements may be based on good science, but they render the clinical trials at best impractical and at worst infeasible. Their trial requirements have essentially removed large portions of the antibiotic market from the US for the foreseeable future. As we will see later, introducing a new antibiotic for mild bacterial infections like sinusitis, bronchitis and ear infections to the US market has now become virtually impossible. Even for a more serious infection like pneumonia, the development of new antibiotics has become much more difficult and expensive if not impossible. There may be sound scientific reasons for questioning the benefit of antibiotics for some of these infections, but the industry just sees a black hole in their bottom line for antibiotics.

How To Win Your War Against Bronchitis

How To Win Your War Against Bronchitis

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