Previous respiratory tract infections and antibiotic consumption in children with long- and short-term carriage of penicillin-resistant Streptococcus pneumoniae.
Previous respiratory tract infections (RTI) and antibiotics consumption as possible risk factors for extended duration of PRP carriage were investigated in 24 children (cases) with previous carriage of penicillin-resistant pneumococci (PRP) for a duration exceeding 120 days (median 168 days) and a control group of 53 children with a duration of PRP carriage less than 90 days (median 21 days). The cases had experienced 0.99 episodes of acute otitis media (AOM) per life-year compared to 0.79 episodes in the controls (P = 0.32). For antibiotic-treated RTI other than AOM, the corresponding numbers were 0.49 and 0.29 episodes per life-year, respectively (P = 0.01). No differences in antibiotic consumption in the 3 months preceding the carriage, nor during the carriage period were noted. Other factors than impaired host defence to respiratory tract pathogens or antibiotics consumption seem to be more important in determining the duration of PRP carriage. (+info)
Comparative activity of quinupristin/dalfopristin and RPR 106972 and the effect of medium on in-vitro test results.
Quinupristin/dalfopristin and RPR 106972 were active in vitro against a wide range of aerobic Gram-positive organisms including Enterococcus faecium. However, most isolates of Enterococcus faecalis were resistant or of intermediate sensitivity. Against Staphylococcus aureus quinupristin/dalfopristin was more active but for all other species the range of activity of the two drugs was the same or RPR 106972 was more active. RPR 106972 was also more active against the respiratory pathogens Haemophilus influenzae and Moraxella catarrhalis. Quinupristin/dalfopristin MICs for isolates of H. influenzae (1-8 mg/L) clustered around the breakpoint. There were differences in the quality of growth, but little difference in MICs or zone diameters was obtained on three different media: Mueller-Hinton (MHA), Iso-Sensitest (ISA), and Diagnostic Sensitivity Test (DST) agars. The addition of blood to the medium increased MICs 2- to 4-fold, with MHA showing the greatest increase, and reduced zone diameters around quinupristin/dalfopristin discs by 3-4 mm, with the greatest effect on ISA. (+info)
Respiratory tract infections as a public health challenge.
Acute respiratory infections have everywhere become the province of clinicians and the pharmaceutical industry. A public health approach is needed with systematic efforts to minimize transmission, maximize prevention, and harness the research and surveillance effort to decrease their incidence and severity. These infections have a huge incidence, morbidity burden, and economic impact in all societies. Several factors now demand renewed attention to prevention. They include the growing costs and potentially limited benefits of an expanded pharmacotherapeutic approach; the serious change in antibiotic susceptibility of the common respiratory pathogens; the advances made in vaccinology in recent years; and the need to promote equity and share limited health resources across the world's population. Care should not be restricted to those in affluent countries who can afford increasingly expensive treatment. (+info)
A national program for control of acute respiratory tract infections: the Philippine experience.
Maturing programs on child immunization and diarrheal diseases, a community-based research project, and a rational drug-use program facilitated the launching in 1989 of a nationwide Philippine Control of Acute Respiratory Infections program (Phil-CARI). From 1990 to 1991 the Phil-CARI expanded rapidly, training >80% of its middle managers and frontline health care providers on the case-management protocols of the World Health Organization for acute respiratory infection. Multiple donors and good collaboration with various societies and medical schools assisted the program. However, by 1992, there were difficulties in maintaining training quality, follow-up, and supervision. Donor assistance dwindled and the health care delivery system decentralized. Government procurement systems were unable to meet the logistics demands of the program. The monitoring and evaluation system was inadequate to measure impact. The Phil-CARI provides lessons in searching for more sustainable approaches and systems to meet the various demands of a nationwide ARI control program and to create the desired impact. (+info)
Interrupting the transmission of respiratory tract infections: theory and practice.
Interruption of transmission has always been one of the most attractive approaches for infection control. The technologies available were severely limited before the development of appropriate vaccines. Mathematically, the proportion of those who need to be immune to interrupt transmission can be derived from the Ro, which represents the number of new cases infected by a single case when all contacts are susceptible. Purely respiratory infections have critical characteristics affecting transmission that are different from key childhood vaccine-preventable diseases spread by the respiratory route. They include frequent reinfections and antigenic changes of the agents. Pragmatic approaches to understanding their potential effect can be found in experimental and programmatic use of vaccines such as those for Haemophilus influenzae type b and influenza virus infections. Results of these experiences can in turn strengthen the development of transmission theory. (+info)
Epidemiology and prevention of group A streptococcal infections: acute respiratory tract infections, skin infections, and their sequelae at the close of the twentieth century.
Infections of the upper respiratory tract and skin due to group A Streptococcus are common, and the organism is highly transmissible. In industrialized countries and to some extent in developing countries, control efforts continue to emphasize that group A streptococcal pharyngitis should be properly diagnosed and appropriately treated. In developing countries and in indigenous populations where the burden of group A streptococcal diseases appears greatest, the epidemiology is less completely defined and may differ from that in industrialized countries. There is a need for accurately collected epidemiological data from developing countries, which may also further clarify the pathogenesis of group A streptococcal infections and their sequelae. While proper treatment of group A streptococcal pharyngitis continues to be essential in all populations, it may be appropriate in developing countries to consider additional strategies to reduce rates of pyoderma. (+info)
Antibiotic strategies for developing countries: experience with acute respiratory tract infections in Pakistan.
The Pakistan program for control of acute respiratory tract infections (ARIs) adopted the standard ARI-case-management strategy of the World Health Organization and recommended co-trimoxazole for the management of nonsevere pneumonia. Reports in that country of high in vitro antimicrobial resistance of Streptococcus pneumoniae and Haemophilus influenzae to co-trimoxazole prompted the program to reevaluate its treatment policy. Two community-based studies during 1991-1993 showed in vivo efficacy of co-trimoxazole in 92% and 91% of children with nonsevere pneumonia. A third double-blind trial showed co-trimoxazole and oral amoxicillin to be equally effective in vivo in cases of nonsevere pneumonia, despite high in vitro resistance. Country-wide surveillance from 1991 to 1994 revealed 78.3%-79.9% in vitro resistance to co-trimoxazole among S. pneumoniae isolates and 59.5%-61.0% among H. influenzae isolates. Co-trimoxazole is still recommended by the Pakistan ARI control program. The fact that amoxicillin is three times more expensive and must be administered more frequently is a big impediment to recommending it as a first-line drug for nonsevere pneumonia. (+info)
The future role of international agencies in control of acute respiratory tract infections.
Achievements in the control of acute respiratory infection (ARI) owe much to international collaboration in research, education, and delivery of services. This article highlights some of the current activities of the many international agencies involved and summarizes thoughts on their future roles. Key recent scientific advances include better surveillance, new and improved vaccines, refinement of standard clinical management plans and behavioral change techniques, and demonstration of the effectiveness of their application. Agencies involved include the World Health Organization, the International Union Against Tuberculosis and Lung Disease, national government agencies for overseas aid, many academic departments, and professional lung health associations. However, much remains to be done, especially in collaborative research, in the devising, implementing, and evaluating of health care delivery systems in low-income countries, and in mobilizing political will and resources. These are tasks beyond the capacity of any lone agency. Success will depend on how effectively we collaborate. (+info)