TABLE 1 Bacterial distribution associated with RTIs Prevalence (%) Pathogen ABS ABECB
CAP Streptococcus pneumoniae 20-43 3-25 20-60 Haemophilus influenzae 22-35 14-36 3-10 Moraxella catarrhalis 2-10 7-21 -- Staphylococcus aureus 0-8 3-20 3-5 Streptococcus spp 3-9 -- -- Anaerobes 0-9 -- -- Pseudomonas spp -- 1-15 -- Haemophilus parainfluenzae -- 2-28 -- Enterobacteriaceae spp -- 5-33 -- Mycoplasma pneumoniae -- -- 1-6 Chlamydia pneumoniae -- -- 4-6 Legionella spp -- -- 2-8 Gram-negative bacteria -- -- 3-10 ABECB
, acute bacterial exacerbation of chronic bronchitis; ABS, acute bacterial rhinosinusitis; CAP, community-acquired pneumonia.
Taking into account the shorter 3- to 5-day course of therapy, high susceptibilities, and fast clinical cures, it is appropriate to consider respiratory fluoroquinolones your first choice for optimal treatment of ABECB.
Criteria for Optimized Therapy of ABECB (6) Evidence based Therapeutic Safe Cost effective Optimal dosage and duration
Similar to ABS, variables associated with treatment failure in ABECB include recent antibiotic use and significant comorbidities, such as cardiac disease, which can increase the risk of treatment failure more than 2-fold.
Treatment failure in ABECB has been shown to result in increased use of health care resources caused by additional physician visits, further diagnostic tests, and repeated antibiotic treatments, (5,6) Significant comorbidity, such as cardiac disease, chronic corticosteroid administration, severely impaired underlying lung function, use of supplemental oxygen, frequent purulent exacerbations of COPD, malnutrition, advanced age, generalized debility, and chronic mucous hypersecretion (TABLE 2) all increase the costs associated with treatment failure and hospitalization.
As seen in ABS and ABECB, one of the most important risk factors for infection with a resistant organism is recent antibiotic therapy, including [beta]-lactam therapy within the past 3 months.
Although ABS rarely leads to hospitalization, severe lower RTIs such as ABECB or CAP can become serious enough that the patient must be hospitalized, which in turn can introduce further challenges.
High-dose amoxicillin/clavulanate 2000/125 mg, twice daily, was shown to be effective in treating patients with ABS, ABECB, and CAP caused by S pneurnoniae, including penicillin-resistant S pneumoniae.
10) The first ketolide, telithromycin, is an alternative to macrolides for the treatment of patients with ABS, ABECB, and CAP.
All of the same considerations mentioned for the treatment of ABS also apply to the selection of therapy for patients with ABECB or CAP (TABLE 4).