Community-acquired pneumonia in Ugandan adults: short-term parenteral ampicillin therapy for bacterial pneumonia.

Yoshimine, Hiroyuki; Oishi, Kazunori; Mubiru, Francis; Nalwoga, Hawa; Takahashi, Hidehiko; Amano, Hideaki; Ombasi, Philip; Watanabe, Kiwao; Joloba, Moses; Aisu, T.; Ahmed, Kamruddin; Shimada, M.; Mugerwa, Roy D.; Nagatake, Tsuyoshi

doi:10.4269/ajtmh.2001.64.172

Cited by 34 publications

(29 citation statements)

References 30 publications

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“…11 The effects on morbidity and mortality are similar to those found in other studies in Africa. [3][4][5][6][7] Some of the beneficial effect of co-trimoxazole could be the result of a stabilisation of immune status.…”

Section: Discussionsupporting

confidence: 78%

“…19 The effect of co-trimoxazole on preventing opportunistic infections and maintaining CD4-cell counts and viral loads might explain why the drug combination has been effective in reducing morbidity and mortality in disparate parts of the world. Antimicrobial resistance of specific pathogens varies by geographical region in Africa, 11,24,25 but in all areas some pathogens are sensitive, which could lead to a general retention of immune response, maintenance of CD4-cell count, and improved survival.…”

Section: Discussionmentioning

confidence: 99%

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Effect of co-trimoxazole prophylaxis on morbidity, mortality, CD4-cell count, and viral load in HIV infection in rural Uganda

et al. 2004

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SummaryBackground Prophylaxis with co-trimoxazole (trimethoprim-sulphamethoxazole) is recommended for people with HIV infection or AIDS but is rarely used in Africa. We assessed the effect of such prophylaxis on morbidity, mortality, CD4-cell count, and viral load among people with HIV infection living in rural Uganda, an area with high rates of bacterial resistance to co-trimoxazole.Methods Between April, 2001, and March, 2003, we enrolled, and followed up with weekly home visits, 509 individuals with HIV-1 infection and their 1522 HIV-negative household members. After 5 months of follow-up, HIV-positive participants were offered daily co-trimoxazole prophylaxis (800 mg trimethoprim, 160 mg sulphamethoxazole) and followed up for a further 1·5 years. We assessed rates of malaria, diarrhoea, hospital admission, and death. Findings Co-trimoxazole was well tolerated with rare (<2% per person-year) adverse reactions. Even though rates of resistance in diarrhoeal pathogens were high (76%), co-trimoxazole prophylaxis was associated with a 46% reduction in mortality (hazard ratio 0·54 [95% CI 0·35-0·84], p=0·006) and lower rates of malaria (multivariate incidence rate ratio 0·28 [0·19-0·40], p<0·0001), diarrhoea (0·65 [0·53-0·81], p<0·0001), and hospital admission (0·69 [0·48-0·98], p=0·04). The annual rate of decline in CD4-cell count was less during prophylaxis than before (77 vs 203 cells per µL, p<0·0001), and the annual rate of increase in viral load was lower (0·08 vs 0·90 log 10 copies per mL, p=0·01).Interpretation Daily co-trimoxazole prophylaxis was associated with reduced morbidity and mortality and had beneficial effects on CD4-cell count and viral load. Co-trimoxazole prophylaxis is a readily available, effective intervention for people with HIV infection in Africa.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Effect of co-trimoxazole prophylaxis on morbidity, mortality, CD4-cell count, and viral load in HIV infection in rural Uganda

et al. 2004

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“…A pneumonia diagnosis was based on either clinical symptoms (cough, sputum or fever) plus increased white blood cell counts or serum C-reactive protein, and the appearance of a new infiltration on a chest radiograph [21]. Acute exacerbation in CLD was defined by criteria as previously described [22]: 1) increased dyspnea, 2) increased sputum volume, and 3) increased sputum purulence, and 4) absence of newly appeared infiltration on a chest radiograph.…”

Section: Outcome Measuresmentioning

confidence: 99%

Additive effect of pneumococcal vaccine and influenza vaccine on acute exacerbation in patients with chronic lung disease

Furumoto

Ohkusa

Chen

et al. 2008

Vaccine

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To determine the clinical efficacy of combined vaccination with 23-valent pneumococcal vaccine (PV) and influenza vaccine (IV) against pneumonia and acute exacerbation of chronic lung diseases (CLD), we conducted an open-label, randomized, controlled study among 167 adults with CLD over a 2 year period. Subjects were randomly assigned to a PV+IV group (n=87) or an IV group (n=80), respectively. The number of patients with CLD experiencing infectious acute exacerbation (P=0.022), but not pneumonia (P=0.284), was significantly lower in the PV+IV group compared with the IV group. When these subjects were divided into subgroups, an additive effect of PV with IV in preventing infectious acute exacerbation was significant only in patients with chronic obstructive pulmonary diseases (P=0.037). In patients with CLD, the Kaplan-Meier survival curves demonstrated a significant difference for infectious acute exacerbation (P=0.016) between the two groups. An additive effect of PV with IV on infectious acute exacerbation was found during the first year after vaccination (P=0.019), but not during the second year (P=0.342), and was associated with serotype-specific immune response in sera of these patients who used PV during the same period.

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“…The combination of a beta lactam and a macrolide has been associated with better outcomes in HIV sero negative patients, but not in all studies 163 , and is recommended by the Infectious Disease Society of America and the American Thoracic Society 164 . Pneumococcal penicillin resistance may be more common in HIV infected persons 165 but outcomes of treatment appear not to be influenced by the presence of intermediate levels of penicillin resistance 166 , 167 . In patients with Rhodococcus infection at least two antimicrobial agents should be given simultaneously to treat this infection for a period of up to several months.…”

Section: Treatment Of Community Acquired Bacterial Pneumonia In Hiv Imentioning

confidence: 99%

Pulmonary Manifestations of HIV Disease

Chakaya¹

2011

HIV Infection in the Era of Highly Active Antiretroviral Treatment and Some of Its Associated Complications

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Community-acquired pneumonia in Ugandan adults: short-term parenteral ampicillin therapy for bacterial pneumonia.

Cited by 34 publications

References 30 publications

Effect of co-trimoxazole prophylaxis on morbidity, mortality, CD4-cell count, and viral load in HIV infection in rural Uganda

Effect of co-trimoxazole prophylaxis on morbidity, mortality, CD4-cell count, and viral load in HIV infection in rural Uganda

Additive effect of pneumococcal vaccine and influenza vaccine on acute exacerbation in patients with chronic lung disease

Pulmonary Manifestations of HIV Disease

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