Epidemiological aspects of antibiotic resistance in respiratory pathogens

Abstract

Respiratory infections are the most frequent reason for primary health care consultation. The main causes of respiratory tract infections in children are viruses and the most common types are upper respiratory tract infections: common cold, pharyngitis, otitis media and sinusitis. Pneumonia is much more serious. As well as viruses, bacteria are often involved in respiratory tract infections. Three bacterial species are most commonly isolated: Streptococcus pneumoniae, non-encapsulated Haemophilus influenzae and Moraxella (Branhamella) catarrhalis. The most common bacterial cause of pharyngitis is Streptococcus pyogenes. Bacteria isolated from community-acquired infection usually are sensitive to the majority of suitable drugs, but during the past two decades, significant antibiotic resistance has emerged. Resistance to penicillins has spread among H. influenzae and S. pneumoniae. The mechanism of penicillin resistance in H. influenzae is mainly by production of beta-lactamases TEM-1 and ROB-1, whereas in S. pneumoniae resistance is an effect of the changes in penicillin binding proteins. Among respiratory pathogens, resistance to tetracyclines, macrolides, trimethoprim-sulphamethoxazole and fluoroquinolones has also appeared. Several mechanisms depending on changes in target, active efflux and modifying enzymes are involved.

Efficacy and safety of a triple active sore throat lozenge in the treatment of patients with acute pharyngitis: Results of a multi-centre, randomised, placebo-controlled, double-blind, parallel-group trial (DoriPha)

“…16 hours),42 by protecting against acute rheumatic fever or secondary bacterial infections (eg, acute otitis media) 42, 43, 44. Risks are known adverse reactions (eg, nausea, rash, vaginitis, headache, gastrointestinal side effects), disturbance of the beneficial microbial community, especially in the gut microbiome with decreased microbial diversity,44, 45, 46 but also reported in throat microflora45 and their widespread use leads to bacterial resistance especially with broad‐spectrum antibiotics 43, 44, 46, 47, 48, 49. Penicillin resistance in Haemophilus influenzae is mainly due to the production of beta‐lactamases TEM‐1 and ROB‐1.…”

“…pneumoniae resistance is due to changes in penicillin‐binding proteins. Resistance to tetracyclines, macrolides, trimethoprim‐sulphamethoxazole and fluoroquinolones depends on changes in target, active efflux and modifying enzymes involved 47, 48…”

Tonsillectomy and its effect on ASO titre

“…About 34 to 80% of all cases of tonsillo-pharyngitis have been attributed to bacterial etiology. [14][15][16] The commonest pathogenic bacteria being the Group A Beta Haemolytic Streptococcus, accounting for 24 to 65% of the cases. 17 About one in four children with acute sore throat has serologically confirmed GABHS pharyngitis.…”

Achado de bactérias selecionadas em crianças de Trinidad com doença amigdaliana crônica

“…Upper respiratory tract infections (URTIs) are the most frequent cause for patient visits in general practice, and in children account for a substantial proportion of family doctor consultations 1 . Sore throat, a predominant symptom of pharyngotonsillitis is one of the most common complaints in paediatrics 2 , inviting considerable antibiotic prescriptions.…”

“…Tonsillectomy, alone or with adenoidectomy in selected children for symptoms of recurrent infection or for hypertrophy and snoring is one of the most frequent paediatric surgical procedures. At least 34-80% of patients with sore throat are estimated to have a 'possible' bacterial aetiology 4,5 and approximately 24-65%, are actually tested for ß-haemolytic Streptococcus (BHS) in the throat 1,6 .…”