er respiratory tract infection
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Upper respiratory tract infections (URI or URTI) are the illnesses caused by an acute infection which involves the upper respiratory tract: nose, sinuses, pharynx or larynx. This commonly includes: tonsillitis, pharyngitis, laryngitis, sinusitis, otitis media, and the common cold.[1]
[edit] Definitions
Common URI terms are defined as follows:
[edit] Signs and symptoms
Acute upper respiratory tract infections include rhinitis, pharyngitis/tonsillitis and laryngitis often referred to as a common cold, and their complications: sinusitis, ear infection and sometimes bronchitis (though bronchi are generally classified as part of the lower respiratory tract.) Symptoms of URI's commonly include cough, sore throat, runny nose, nasal congestion, headache, low grade fever, facial pressure and sneezing. Onset of the symptoms usually begins 1–3 days after the exposure to a microbial pathogen. The illness usually lasts 7–10 days.
Group A beta hemolytic streptococcal pharyngitis/tonsillitis(strep
throat) typically presents with a sudden onset of sore throat, pain with
swallowing and fever. Strep throat does not usually cause runny nose,
voice changes or cough.
Pain and pressure of the ear caused by a middle ear infection (Otitis media) and the reddening of the eye caused by viral Conjunctivitis are often associated with upper respiratory infections.
URI, seasonal allergies, influenza: symptom comparison
[edit] Cause
Over 200 different viruses have been isolated in patients with URIs. The most common virus is called the rhinovirus. Other viruses include the coronavirus, parainfluenza virus, adenovirus, enterovirus, and respiratory syncytial virus.[2]
Up to 15% of acute pharyngitis cases may be caused by bacteria, commonly Group A streptococcus in Streptococcal pharyngitis ("Strep Throat").[3]
Influenza
(the flu) is a more severe systemic illness which typically involves
the upper respiratory tract. Influenza is a relatively uncommon cause of
influenza-like illness.
[edit] Treatment
Treatment depends on the underlying cause. There are currently no
medications or herbal remedies which have been conclusively demonstrated
to shorten the duration of illness.[4] Treatment comprises symptomatic support usually via analgesics for headache, sore throat and muscle aches.[5]
There is no evidence to support the age-old advice to rest when you
are sick with an upper respiratory illness. Moderate exercise in
sedentary subjects with a URI has been shown to have no effect on the
overall severity and duration of the illness. Based on these findings,
it was concluded that previously sedentary people who have acquired a
URI and who have initiated an exercise program may continue to exercise.[6]
Getting plenty of sleep; however, is advisable since even mild sleep
deprivation has been shown to be associated with increased
susceptibility to infection.[7][8]
Increasing fluid intake, or "drinking plenty of fluids" during a cold
is not supported by medical evidence, according to a literature review
published in the British Medical Journal.[9]
[edit] Antibiotics
Judicious use of antibiotics can decrease unnecessary adverse effects
of antibiotics as well as out-of-pocket costs to the patient. But more
importantly, decreased antibiotic usage will prevent the rise of drug resistant bacteria,
which is now a growing problem in the world. Health authorities have
been strongly encouraging physicians to decrease the prescribing of
antibiotics to treat common upper respiratory tract infections because
antibiotic usage does not significantly reduce recovery time for these
viral illnesses.[10]
Some have advocated a delayed antibiotic approach to treating URIs
which seeks to reduce the consumption of antibiotics while attempting to
maintain patient satisfaction. Most studies show no difference in
improvement of symptoms between those treated with antibiotics right
away and those with delayed prescriptions.[11]
Most studies also show no difference in patient satisfaction, patient
complications, symptoms between delayed and no antibiotics. A strategy
of "no antibiotics" results in even less antibiotic use than a strategy
of "delayed antibiotics". However, in certain higher risk patients with
underlying lung disease, such as chronic obstructive pulmonary disease (COPD), evidence does exist to support the treatment of bronchitis with antibiotics to shorten the course of the illness and decrease treatment failure.[12]
[edit] Decongestants
According to a Cochrane review single oral dose of nasal decongestant
in the common cold is modestly effective for the short term relief of
congestion in adults; however, "there is insufficient data on the use of
decongestants in children." Therefore decongestants are not recommended
for use in children under 12 years of age with the common cold.[13]
Oral decongestants are, also, contraindicated in patients with
hypertension, coronary artery disease, and history of bleeding strokes.[14][15]
[edit] Alternative medicine
The use of Vitamin C
in the inhibition and treatment of upper respiratory infections has
been suggested since the initial isolation of vitamin C in the 1930s.
Some evidence exists to indicate that it could be justified in persons
exposed to brief periods of severe physical exercise and/or cold
environments.[16]
The benefits versus risk of nasal irrigation are currently unclear and therefore is not recommended.[17]
[edit] Epidemiology
[ندعوك للتسجيل في المنتدى أو التعريف بنفسك لمعاينة هذه الصورة]
Disability-adjusted life year for upper respiratory infections per 100,000 inhabitants in 2002.[18] no data
less than 10
10-30
30-60
60-90
90-120
120-150
150-180
180-210
210-240
240-270
270-300
more than 300
Transmission is via respiratory droplets or by virus-contaminated
hands. Upper respiratory tract (nose, throat, sinuses) mucosa
inflammation causes increased secretions, rhinorrhea and results in sneezing, and coughing facilitating the spread.
In United States URIs are the most common infectious illness in the
general population. URIs are the leading reasons for people missing work
and school. URI is the leading diagnosis in the office setting.[19]y tract infection
From Wikipedia, the free encyclopedia
Jump to: navigation,
search
The lower respiratory tract is the part of the respiratory tract below the vocal cords. While often used as a synonym for pneumonia, the rubric of lower respiratory tract infection can also be applied to other types of infection including lung abscess and acute bronchitis. Symptoms include shortness of breath, weakness, high fever, coughing and fatigue.
Lower respiratory tract infections place a considerable strain on the
health budget and are generally more serious than upper respiratory
infections. Since 1993 there has been a slight reduction in the total
number of deaths from lower respiratory tract infection. However in 2002
they were still the leading cause of deaths among all infectious diseases, and they accounted for 3.9 million deaths worldwide and 6.9% of all deaths that year.[1]
There are a number of acute and chronic infections that can affect
the lower respiratory tract. The two most common infections are bronchitis and pneumonia.[2] Influenza
affects both the upper and lower respiratory tracts. Antibiotics are
often thought to be the first line treatment in lower respiratory tract
infections; however, these are not indicated in viral infections. It is
important to use appropriate antibiotic selection based on the infecting
organism and to ensure this therapy changes with the evolving nature of
these infections and the emerging resistance to conventional therapies.[3] H. influenzae and M. catarrhalis
are of increasing importance in both community acquired pneumonia (CAP)
and acute exacerbation of chronic bronchitis (AECB) while the
importance of S. pneumoniae is declining. It has also become apparent the importance of atypical pathogens such as C. pneumoniae, M. pneumoniae and L. pneumophila, in CAP.[3]
[edit] Classification
[edit] Bronchitis
Main article: Bronchitis
Bronchitis
can be classified as either acute or chronic. Acute bronchitis can be
defined as acute bacterial or viral infection of the larger airways in
healthy patients with no history of recurrent disease.[2] It affects over 40 adults per 1000 each year and consists of transient inflammation of the major bronchi and trachea.[4] Most often it is caused by viral infection and hence antibiotic therapy is not indicated in immunocompetent individuals.[5][6] There are no effective therapies for viral bronchitis.[6][7]
Treatment of acute bronchitis with antibiotics is common but
controversial as their use has only moderate benefit weighted against
potential side effects (nausea and vomiting), increased resistance, and
cost of treatment in a self-limiting condition.[4][8]
Beta2 agonists are sometimes used to relieve the cough associated with
acute bronchitis. In a recent systematic review it was found there was
no evidence to support their use.[6]
Acute Exacerbations of Chronic Bronchitis (AECB) are frequently due
to non-infective causes along with viral ones. 50% of patients are
colonised with Haemophilus influenzae, Streptococcus pneumoniae or Moraxella catarrhalis.[2] Antibiotics have only been shown to be effective if all three of the following symptoms are present:- increased dyspnoea, increased sputum volume and purulence. In these cases 500 mg of Amoxycillin orally, every 8 hours for 5 days or 100 mg doxycycline orally for 5 days should be used.[2]
[edit] Pneumonia
Main article: Pneumonia
Pneumonia occurs in a variety of situations and treatment must vary according to the situation.[7]
It is classified as either community or hospital acquired depending on
where the patient contracted the infection. It is life-threatening in
the elderly or those who are immunocompromised.[9][10] The most common treatment is antibiotics and these vary in their adverse effects and their effectiveness.[9] Pneumonia is also the leading cause of death in children less than five years of age.[11] The most common cause of pneumonia is pneumococcal bacteria, Streptococcus pneumoniae accounts for 2/3 of bacteremic pneumonias.[12] This is a dangerous type of lung infection with a mortality rate of around 25%.[10]
For optimal management of a pneumonia patient the following must be
assessed;- pneumonia severity (including where to treat e.g. Home,
hospital or intensive care), identification of causative organism,
analgesia of chest pain, the need for supplemental oxygen,
physiotherapy, Hydration, bronchodilators and possible complications of
emphysema or lung abscess.[13]
For community acquired respiratory infections the appropriate use of
fluoroquinolones is a therapeutic option. These have been demonstrated
to have targeted in vitro activity against both the typical and atypical pathogens of interest.[14][15]
The newer fluoroquinolones (e.g., moxifloxacin or gatifloxacin) have
extended gram +ve activity and once daily dosing and hence are potential
first line in the treatment of lower respiratory tract infections.[3]
However it is clinical response that is the best indicators of efficacy
and moxifloxacin or gatifloxacin have been proven to be effective
against community acquired respiratory tract infections clinically.[16][17]
[edit] Treatment
[edit] Antibiotic Choice
With increased development of drug resistance, traditional empirical
treatments are becoming less effective, hence it is important to base
antibiotic choice on isolated bacteria and sensitivity tests. According
to the Cochrane review of antibiotic use in CAP in adults, the current
evidence from RCTs is insufficient in order to make evidenced based
decisions on the antibiotic of choice. Further studies are required to
make these decisions.[9]
For children they found amoxicillin or procaine penicillin to have
greater effect than co-trimoxazole for the treatment of CAP. In hospital
settings, penicillin and gentamicin was found to be more effective than chloramphenicol, with oral amoxicillin giving similar results to injectable penicillins.[11]
In another review of children with severe pneumonia, oral antibiotics
were found to be as effective as injectable ones without the side
effects of pain, risk of infection, or high cost.[18]
Also in a Cochrane review azithromycin has been shown to be no better
than Amoxycillin or Amoxycillin with clavulanic acid in the treatment of
lower respiratory infections.[19]
The AMH list Amoxycillin as first line of AECB and community acquired
pneumonia where as IV azithromycin is first line if high risk of death.
If severe hospital acquired pneumonia it recommends IV gentamicin and
ticarcillin with clavulanic acid.[20]
[edit] Non-Pharmacological Treatments
In 2003 a very high quality, published research was done about the
risk of hospitalization due to respiratory illness and type of infant
feeding in developed countries. It involved 3,201 breastfed babies and
1,324 non –breastfed babies. It showed an overall 72 % reduction in the
risk of hospitalization in infants who exclusively breastfed for 4 or
more months compared to those who were formula-fed. Therefore, exclusive
breastfeeding for 4 or more months is associated with a reduction in
the risk of hospitalization secondary to lower respiratory tract
diseases.[21]
The mainstay of non pharmacological treatment for many years has been
rest and increased fluid intake. Although it is common for doctors and
other health professionals to recommend extra fluid intake, a Cochrane
systematic review could find no evidence for or against increased fluid
intake. Although the idea of replacing fluids lost through fever and
rapid breathing was sound, some observational studies reported harmful
effects such as dilution of blood sodium concentration leading to
headache, confusion or possibly seizures.[22]
Rest will allow the body to conserve energy to fight off the infection.
Physiotherapy is indicated in some types of pneumonia and should be
encouraged where appropriate.
[edit] Complementary Therapies
Chickweed taken orally has been used for many years to reduce fever
and phlegm associated with bronchitis. It is believed to act as an
expectorant and although the pharmacological actions of several
constituents suggest it may be useful, controlled studies are not
available to confirm its effectiveness.[23]
A systematic review of Chinese herbs used in the treatment of acute
bronchitis found that there was weak evidence for their use, but there
were insufficient quality data to recommend them. The benefit found may
be due to study design or publication bias. Hence they should be used
carefully because their safety is largely unknown.[24]
Thyme is approved by commission E in the treatment of bronchitis and
there are encouraging data for its use in chronic bronchitis when used
in combination with other herbs, however there is no stand-alone data.[23]
The use of Vitamin C is commonly thought to act to prevent colds and
other respiratory infections. However according to a recent Cochrane
review the evidence is too weak to support its widespread use as a
prophylactic in preventing pneumonia in the general population. It may
be reasonable to use in high risk patients with low plasma levels of
vitamin C due to its low cost and risk associated with is use.[25] Vitamin C used as an orthomolecular antibiotic, is most effective when used in the same way; i.e., on timetable dosages.
Vitamin A has been successfully used to reduce the mortality and
severity of respiratory infection with measles. However in a review of
non-measles pneumonia it was not found to have any benefit or harmful
effects.[26]
Used by native healers for millennia, garlic contains allicin, a
powerful anti-fungal and antibiotic compound. Native American tribes
have used garlic to treat coughs and croup. British herbalists use
garlic for hoarseness and coughs. Louis Pasteur studied garlic's
antibacterial properties. During both World Wars, Allium sativum was used as an antiseptic.
For the treatment of pneumonia baical skullcap was shown to be as
effective as piperacillin after one treatment. The piperacillin group
resulted in 4 of 30 patients with fungal infections while there were
none in the baical skullcap group.[23]
[edit] Epidemiology
[ندعوك للتسجيل في المنتدى أو التعريف بنفسك لمعاينة هذه الصورة]
Disability-adjusted life year for lower respiratory infections per 100,000 inhabitants in 2002.[27] no data
less than 100
100-700
700-1400
1400-2100
2100-2800
2800-3500
3500-4200
4200-4900
4900-5600
5600-6300
6300-7000
more than 7000
[edit] Research
It is likely that the future treatment of lower respiratory tract
infections will consist of new antibiotics aimed at facing the problems
associated with the constant emergence of antibiotic resistance. With
resistance evolving so rapidly future treatments may include the use of
vaccines to prevent these infections. Although a Cochrane systematic
review of a polysaccharide pneumococcal vaccine didn’t reduce the
pneumonia or their related deaths in adults, but was able to reduce
incidence of more specific outcomes such as pneumococcal disease in the
elderly.[10] So it is hoped with further developments these will become more effective against pneumonia.
Vaccination of patients with AECB in the autumn months is thought to
have a positive effect in reducing the severity and number of
exacerbations over winter. The oral vaccine described in this review was
able to decrease the carriage or non-typeable Haemophilus influenzae
that is a common cause of exacerbations to chronic bronchitis.[28]
With good planning and further research these types of vaccines may
reduce the burden associated with lower respiratory diseases.
There are few treatments available for viral forms of bronchitis and
pneumonia. Respiratory syncytial virus (RSV), the main cause of these in
children, could be potentially treated using a new monoclonal antibody
(mAb) Motavizumab. In animal trials it reduced antibody titres 100 lower
than the only drug currently available to treat the condition.[29] This holds great promise for future treatments of LRTI.
From Wikipedia, the free encyclopedia
Jump to: navigation,
search
| Classification and external resources | |
| [ندعوك للتسجيل في المنتدى أو التعريف بنفسك لمعاينة هذه الصورة] Conducting passages. | |
| J00-06., J30-39. | |
| 465.9 | |
Contents [hide]
|
Common URI terms are defined as follows:
- Rhinitis - Inflammation of the nasal mucosa
- Rhinosinusitis or sinusitis - Inflammation of the nares and paranasal sinuses, including frontal, ethmoid, maxillary, and sphenoid
- Nasopharyngitis (rhinopharyngitis or the common cold) - Inflammation of the nares, pharynx,hypopharynx, uvula, and tonsils
- Pharyngitis - Inflammation of the pharynx, hypopharynx, uvula, and tonsils
- Epiglottitis (supraglottitis) - Inflammation of the superior portion of the larynx and supraglottic area
- Laryngitis - Inflammation of the larynx
- Laryngotracheitis - Inflammation of the larynx, trachea, and subglottic area
- Tracheitis - Inflammation of the trachea and subglottic area
[edit] Signs and symptoms
Acute upper respiratory tract infections include rhinitis, pharyngitis/tonsillitis and laryngitis often referred to as a common cold, and their complications: sinusitis, ear infection and sometimes bronchitis (though bronchi are generally classified as part of the lower respiratory tract.) Symptoms of URI's commonly include cough, sore throat, runny nose, nasal congestion, headache, low grade fever, facial pressure and sneezing. Onset of the symptoms usually begins 1–3 days after the exposure to a microbial pathogen. The illness usually lasts 7–10 days.
Group A beta hemolytic streptococcal pharyngitis/tonsillitis(strep
throat) typically presents with a sudden onset of sore throat, pain with
swallowing and fever. Strep throat does not usually cause runny nose,
voice changes or cough.
Pain and pressure of the ear caused by a middle ear infection (Otitis media) and the reddening of the eye caused by viral Conjunctivitis are often associated with upper respiratory infections.
| Itchy, watery eyes | Common | Rare (conjunctivitis may occur with adenovirus) | Soreness behind eyes, sometimes conjunctivitis |
| Nasal discharge | Common | Common | Common |
| Nasal congestion | Common | Common | Sometimes |
| Sneezing | Very common | Very common | Sometimes |
| Sore throat | Sometimes (postnasal drip) | Very common | Sometimes |
| Cough | Sometimes | Common (mild to moderate, hacking) | Common (dry cough, can be severe) |
| Headache | Uncommon | Rare | Common |
| Fever | Never | Rare in adults, possible in children | Very common (100-102°F (or higher in young children), lasting 3–4 days; may have chills) |
| Malaise | Sometimes | Sometimes | Very common |
| Fatigue, weakness | Sometimes | Sometimes | Very common, can last for weeks, extreme exhaustion early in course |
| Muscle pain | Never | Slight | Very common, often severe |
Over 200 different viruses have been isolated in patients with URIs. The most common virus is called the rhinovirus. Other viruses include the coronavirus, parainfluenza virus, adenovirus, enterovirus, and respiratory syncytial virus.[2]
Up to 15% of acute pharyngitis cases may be caused by bacteria, commonly Group A streptococcus in Streptococcal pharyngitis ("Strep Throat").[3]
Influenza
(the flu) is a more severe systemic illness which typically involves
the upper respiratory tract. Influenza is a relatively uncommon cause of
influenza-like illness.
[edit] Treatment
Treatment depends on the underlying cause. There are currently no
medications or herbal remedies which have been conclusively demonstrated
to shorten the duration of illness.[4] Treatment comprises symptomatic support usually via analgesics for headache, sore throat and muscle aches.[5]
There is no evidence to support the age-old advice to rest when you
are sick with an upper respiratory illness. Moderate exercise in
sedentary subjects with a URI has been shown to have no effect on the
overall severity and duration of the illness. Based on these findings,
it was concluded that previously sedentary people who have acquired a
URI and who have initiated an exercise program may continue to exercise.[6]
Getting plenty of sleep; however, is advisable since even mild sleep
deprivation has been shown to be associated with increased
susceptibility to infection.[7][8]
Increasing fluid intake, or "drinking plenty of fluids" during a cold
is not supported by medical evidence, according to a literature review
published in the British Medical Journal.[9]
[edit] Antibiotics
Judicious use of antibiotics can decrease unnecessary adverse effects
of antibiotics as well as out-of-pocket costs to the patient. But more
importantly, decreased antibiotic usage will prevent the rise of drug resistant bacteria,
which is now a growing problem in the world. Health authorities have
been strongly encouraging physicians to decrease the prescribing of
antibiotics to treat common upper respiratory tract infections because
antibiotic usage does not significantly reduce recovery time for these
viral illnesses.[10]
Some have advocated a delayed antibiotic approach to treating URIs
which seeks to reduce the consumption of antibiotics while attempting to
maintain patient satisfaction. Most studies show no difference in
improvement of symptoms between those treated with antibiotics right
away and those with delayed prescriptions.[11]
Most studies also show no difference in patient satisfaction, patient
complications, symptoms between delayed and no antibiotics. A strategy
of "no antibiotics" results in even less antibiotic use than a strategy
of "delayed antibiotics". However, in certain higher risk patients with
underlying lung disease, such as chronic obstructive pulmonary disease (COPD), evidence does exist to support the treatment of bronchitis with antibiotics to shorten the course of the illness and decrease treatment failure.[12]
[edit] Decongestants
According to a Cochrane review single oral dose of nasal decongestant
in the common cold is modestly effective for the short term relief of
congestion in adults; however, "there is insufficient data on the use of
decongestants in children." Therefore decongestants are not recommended
for use in children under 12 years of age with the common cold.[13]
Oral decongestants are, also, contraindicated in patients with
hypertension, coronary artery disease, and history of bleeding strokes.[14][15]
[edit] Alternative medicine
The use of Vitamin C
in the inhibition and treatment of upper respiratory infections has
been suggested since the initial isolation of vitamin C in the 1930s.
Some evidence exists to indicate that it could be justified in persons
exposed to brief periods of severe physical exercise and/or cold
environments.[16]
The benefits versus risk of nasal irrigation are currently unclear and therefore is not recommended.[17]
[edit] Epidemiology
[ندعوك للتسجيل في المنتدى أو التعريف بنفسك لمعاينة هذه الصورة]
Disability-adjusted life year for upper respiratory infections per 100,000 inhabitants in 2002.[18] no data
less than 10
10-30
30-60
60-90
90-120
120-150
150-180
180-210
210-240
240-270
270-300
more than 300
Transmission is via respiratory droplets or by virus-contaminated
hands. Upper respiratory tract (nose, throat, sinuses) mucosa
inflammation causes increased secretions, rhinorrhea and results in sneezing, and coughing facilitating the spread.
In United States URIs are the most common infectious illness in the
general population. URIs are the leading reasons for people missing work
and school. URI is the leading diagnosis in the office setting.[19]y tract infection
From Wikipedia, the free encyclopedia
Jump to: navigation,
search
| [ندعوك للتسجيل في المنتدى أو التعريف بنفسك لمعاينة هذه الصورة] | This article's citation style may be unclear. The references used may be made clearer with a different or consistent style of citation, footnoting, or external linking. (September 2009) |
| Classification and external resources | |
| [ندعوك للتسجيل في المنتدى أو التعريف بنفسك لمعاينة هذه الصورة] Conducting passages. | |
| J10-J22, J40-J47 | |
Lower respiratory tract infections place a considerable strain on the
health budget and are generally more serious than upper respiratory
infections. Since 1993 there has been a slight reduction in the total
number of deaths from lower respiratory tract infection. However in 2002
they were still the leading cause of deaths among all infectious diseases, and they accounted for 3.9 million deaths worldwide and 6.9% of all deaths that year.[1]
There are a number of acute and chronic infections that can affect
the lower respiratory tract. The two most common infections are bronchitis and pneumonia.[2] Influenza
affects both the upper and lower respiratory tracts. Antibiotics are
often thought to be the first line treatment in lower respiratory tract
infections; however, these are not indicated in viral infections. It is
important to use appropriate antibiotic selection based on the infecting
organism and to ensure this therapy changes with the evolving nature of
these infections and the emerging resistance to conventional therapies.[3] H. influenzae and M. catarrhalis
are of increasing importance in both community acquired pneumonia (CAP)
and acute exacerbation of chronic bronchitis (AECB) while the
importance of S. pneumoniae is declining. It has also become apparent the importance of atypical pathogens such as C. pneumoniae, M. pneumoniae and L. pneumophila, in CAP.[3]
Contents [hide]
|
[edit] Bronchitis
Main article: Bronchitis
Bronchitis
can be classified as either acute or chronic. Acute bronchitis can be
defined as acute bacterial or viral infection of the larger airways in
healthy patients with no history of recurrent disease.[2] It affects over 40 adults per 1000 each year and consists of transient inflammation of the major bronchi and trachea.[4] Most often it is caused by viral infection and hence antibiotic therapy is not indicated in immunocompetent individuals.[5][6] There are no effective therapies for viral bronchitis.[6][7]
Treatment of acute bronchitis with antibiotics is common but
controversial as their use has only moderate benefit weighted against
potential side effects (nausea and vomiting), increased resistance, and
cost of treatment in a self-limiting condition.[4][8]
Beta2 agonists are sometimes used to relieve the cough associated with
acute bronchitis. In a recent systematic review it was found there was
no evidence to support their use.[6]
Acute Exacerbations of Chronic Bronchitis (AECB) are frequently due
to non-infective causes along with viral ones. 50% of patients are
colonised with Haemophilus influenzae, Streptococcus pneumoniae or Moraxella catarrhalis.[2] Antibiotics have only been shown to be effective if all three of the following symptoms are present:- increased dyspnoea, increased sputum volume and purulence. In these cases 500 mg of Amoxycillin orally, every 8 hours for 5 days or 100 mg doxycycline orally for 5 days should be used.[2]
[edit] Pneumonia
Main article: Pneumonia
Pneumonia occurs in a variety of situations and treatment must vary according to the situation.[7]
It is classified as either community or hospital acquired depending on
where the patient contracted the infection. It is life-threatening in
the elderly or those who are immunocompromised.[9][10] The most common treatment is antibiotics and these vary in their adverse effects and their effectiveness.[9] Pneumonia is also the leading cause of death in children less than five years of age.[11] The most common cause of pneumonia is pneumococcal bacteria, Streptococcus pneumoniae accounts for 2/3 of bacteremic pneumonias.[12] This is a dangerous type of lung infection with a mortality rate of around 25%.[10]
For optimal management of a pneumonia patient the following must be
assessed;- pneumonia severity (including where to treat e.g. Home,
hospital or intensive care), identification of causative organism,
analgesia of chest pain, the need for supplemental oxygen,
physiotherapy, Hydration, bronchodilators and possible complications of
emphysema or lung abscess.[13]
For community acquired respiratory infections the appropriate use of
fluoroquinolones is a therapeutic option. These have been demonstrated
to have targeted in vitro activity against both the typical and atypical pathogens of interest.[14][15]
The newer fluoroquinolones (e.g., moxifloxacin or gatifloxacin) have
extended gram +ve activity and once daily dosing and hence are potential
first line in the treatment of lower respiratory tract infections.[3]
However it is clinical response that is the best indicators of efficacy
and moxifloxacin or gatifloxacin have been proven to be effective
against community acquired respiratory tract infections clinically.[16][17]
[edit] Treatment
[edit] Antibiotic Choice
With increased development of drug resistance, traditional empirical
treatments are becoming less effective, hence it is important to base
antibiotic choice on isolated bacteria and sensitivity tests. According
to the Cochrane review of antibiotic use in CAP in adults, the current
evidence from RCTs is insufficient in order to make evidenced based
decisions on the antibiotic of choice. Further studies are required to
make these decisions.[9]
For children they found amoxicillin or procaine penicillin to have
greater effect than co-trimoxazole for the treatment of CAP. In hospital
settings, penicillin and gentamicin was found to be more effective than chloramphenicol, with oral amoxicillin giving similar results to injectable penicillins.[11]
In another review of children with severe pneumonia, oral antibiotics
were found to be as effective as injectable ones without the side
effects of pain, risk of infection, or high cost.[18]
Also in a Cochrane review azithromycin has been shown to be no better
than Amoxycillin or Amoxycillin with clavulanic acid in the treatment of
lower respiratory infections.[19]
The AMH list Amoxycillin as first line of AECB and community acquired
pneumonia where as IV azithromycin is first line if high risk of death.
If severe hospital acquired pneumonia it recommends IV gentamicin and
ticarcillin with clavulanic acid.[20]
[edit] Non-Pharmacological Treatments
In 2003 a very high quality, published research was done about the
risk of hospitalization due to respiratory illness and type of infant
feeding in developed countries. It involved 3,201 breastfed babies and
1,324 non –breastfed babies. It showed an overall 72 % reduction in the
risk of hospitalization in infants who exclusively breastfed for 4 or
more months compared to those who were formula-fed. Therefore, exclusive
breastfeeding for 4 or more months is associated with a reduction in
the risk of hospitalization secondary to lower respiratory tract
diseases.[21]
The mainstay of non pharmacological treatment for many years has been
rest and increased fluid intake. Although it is common for doctors and
other health professionals to recommend extra fluid intake, a Cochrane
systematic review could find no evidence for or against increased fluid
intake. Although the idea of replacing fluids lost through fever and
rapid breathing was sound, some observational studies reported harmful
effects such as dilution of blood sodium concentration leading to
headache, confusion or possibly seizures.[22]
Rest will allow the body to conserve energy to fight off the infection.
Physiotherapy is indicated in some types of pneumonia and should be
encouraged where appropriate.
[edit] Complementary Therapies
Chickweed taken orally has been used for many years to reduce fever
and phlegm associated with bronchitis. It is believed to act as an
expectorant and although the pharmacological actions of several
constituents suggest it may be useful, controlled studies are not
available to confirm its effectiveness.[23]
A systematic review of Chinese herbs used in the treatment of acute
bronchitis found that there was weak evidence for their use, but there
were insufficient quality data to recommend them. The benefit found may
be due to study design or publication bias. Hence they should be used
carefully because their safety is largely unknown.[24]
Thyme is approved by commission E in the treatment of bronchitis and
there are encouraging data for its use in chronic bronchitis when used
in combination with other herbs, however there is no stand-alone data.[23]
The use of Vitamin C is commonly thought to act to prevent colds and
other respiratory infections. However according to a recent Cochrane
review the evidence is too weak to support its widespread use as a
prophylactic in preventing pneumonia in the general population. It may
be reasonable to use in high risk patients with low plasma levels of
vitamin C due to its low cost and risk associated with is use.[25] Vitamin C used as an orthomolecular antibiotic, is most effective when used in the same way; i.e., on timetable dosages.
Vitamin A has been successfully used to reduce the mortality and
severity of respiratory infection with measles. However in a review of
non-measles pneumonia it was not found to have any benefit or harmful
effects.[26]
Used by native healers for millennia, garlic contains allicin, a
powerful anti-fungal and antibiotic compound. Native American tribes
have used garlic to treat coughs and croup. British herbalists use
garlic for hoarseness and coughs. Louis Pasteur studied garlic's
antibacterial properties. During both World Wars, Allium sativum was used as an antiseptic.
For the treatment of pneumonia baical skullcap was shown to be as
effective as piperacillin after one treatment. The piperacillin group
resulted in 4 of 30 patients with fungal infections while there were
none in the baical skullcap group.[23]
[edit] Epidemiology
[ندعوك للتسجيل في المنتدى أو التعريف بنفسك لمعاينة هذه الصورة]
Disability-adjusted life year for lower respiratory infections per 100,000 inhabitants in 2002.[27] no data
less than 100
100-700
700-1400
1400-2100
2100-2800
2800-3500
3500-4200
4200-4900
4900-5600
5600-6300
6300-7000
more than 7000
[edit] Research
It is likely that the future treatment of lower respiratory tract
infections will consist of new antibiotics aimed at facing the problems
associated with the constant emergence of antibiotic resistance. With
resistance evolving so rapidly future treatments may include the use of
vaccines to prevent these infections. Although a Cochrane systematic
review of a polysaccharide pneumococcal vaccine didn’t reduce the
pneumonia or their related deaths in adults, but was able to reduce
incidence of more specific outcomes such as pneumococcal disease in the
elderly.[10] So it is hoped with further developments these will become more effective against pneumonia.
Vaccination of patients with AECB in the autumn months is thought to
have a positive effect in reducing the severity and number of
exacerbations over winter. The oral vaccine described in this review was
able to decrease the carriage or non-typeable Haemophilus influenzae
that is a common cause of exacerbations to chronic bronchitis.[28]
With good planning and further research these types of vaccines may
reduce the burden associated with lower respiratory diseases.
There are few treatments available for viral forms of bronchitis and
pneumonia. Respiratory syncytial virus (RSV), the main cause of these in
children, could be potentially treated using a new monoclonal antibody
(mAb) Motavizumab. In animal trials it reduced antibody titres 100 lower
than the only drug currently available to treat the condition.[29] This holds great promise for future treatments of LRTI.
