Principles of antibiotic treatment of community-acquired pneumonia in the outpatient setting

Segreti, John; House, Hans; Siegel, Robert

doi:10.1016/j.amjmed.2005.05.010

Cited by 38 publications

(16 citation statements)

References 40 publications

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“…In addition, this is also the first study to indicate a possible role for ACE inhibition in preventing pneumonia in outpatients. Approximately 80% of all pneumonia is treated in an outpatient setting [29,30]. In the present study, the protective effect of ACE inhibition was primarily present for outpatient-treated pneumonia.…”

Section: Discussionmentioning

confidence: 55%

Angiotensin-converting enzyme inhibitor use and protection against pneumonia in patients with diabetes

Garde

Souverein

Hak

et al. 2007

Journal of Hypertension

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Section: Discussionmentioning

confidence: 55%

Angiotensin-converting enzyme inhibitor use and protection against pneumonia in patients with diabetes

Garde

Souverein

Hak

et al. 2007

Journal of Hypertension

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“…However, hospitalized patient data demonstrate that patients with VAP can have a shorter therapy duration, and data on nonhospitalized patients with CAP indicate that we can treat with shorter duration [109]. The benefits of a shorter course of antibiotic therapy include lower cost, fewer potential adverse drug events, and, most importantly, a lower likelihood of selecting resistant bacteria.…”

Section: Discussionmentioning

confidence: 94%

Health Care–Associated Pneumonia (HCAP): A Critical Appraisal to Improve Identification, Management, and Outcomes—Proceedings of the HCAP Summit

et al. 2008

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Increasingly, patients are receiving treatment at facilities other than hospitals, including long-term-health care facilities, assisted-living environments, rehabilitation facilities, and dialysis centers. As with hospital environments, nonhospital settings present their own unique risks of pneumonia. Traditionally, pneumonia in these facilities has been categorized as community-acquired pneumonia (CAP). However, the new designation for pneumonias acquired in these settings is health care-associated pneumonia (HCAP), which covers pneumonias acquired in health care environments outside of the traditional hospital setting and excludes hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP), and CAP. Although HCAP is currently treated with the same protocols as CAP, recent evidence indicates that HCAP differs from CAP with respect to pathogens and prognosis and, in fact, more closely resembles HAP and VAP. The HCAP Summit convened national infectious disease opinion leaders for the purpose of analyzing current literature, clinical trial data, diagnostic considerations, therapeutic options, and treatment guidelines related to HCAP. After an in-depth analysis of these areas, the infectious disease investigators participating in the summit were surveyed with regard to 10 clinical practice statements. The results were then compared with results of the same survey as completed by 744 Infectious Diseases Society of America members. The similarities and differences between those survey results are the basis of this publication.

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“…Compared to the 3-day IR regimen, the single-dose ER regimen is expected to achieve improved patient compliance. Although there is no strong evidence to prove that the high-dose, shortcourse therapy can reduce resistance, the low-dose, long-duration therapy has been shown to accelerate the emergence of resistance (8,14,18).…”

Section: Discussionmentioning

confidence: 99%

Comparative Pharmacokinetics of Azithromycin in Serum and White Blood Cells of Healthy Subjects Receiving a Single-Dose Extended-Release Regimen versus a 3-Day Immediate-Release Regimen

Liu¹,

Allaudeen

Chandra

et al. 2007

Antimicrob Agents Chemother

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The pharmacokinetic profiles of azithromycin given as a single-dose regimen (2.0-g extended-release microspheres) were characterized in serum and white blood cells (WBC) and compared with those of a 3-day regimen (a 500-mg immediate-release tablet once daily; total dose, 1.5 g) in an open-label, randomized, parallel-group study of 24 healthy adult subjects. Serial blood samples were collected up to 5 days after the start of dosing for both regimens. Safety assessments were conducted throughout the study. A single 2.0-g dose of azithromycin microspheres achieved significantly higher exposures in serum and WBC during the first 24 h after the start of dosing than a 3-day regimen: an approximately threefold higher area under the curve from time zero to 24 h postdose (AUC 0-24 ) and an approximately twofold higher mean peak concentration on day 1. The single-dose regimen provided total azithromycin exposures in serum and WBC similar to those of the 3-day regimen, as evidenced by the similar AUC 0-120 and trough azithromycin concentrations in serum and WBC (mononuclear leukocytes [MNL] and polymorphonuclear leukocytes [PMNL]). For both regimens, the average total azithromycin exposures in MNL and PMNL were approximately 300-and 600-fold higher than those in serum. Azithromycin concentrations in MNL and PMNL remained above 10 g/ml for at least 5 days after the start of dosing for both regimens. This "front-loading" of the dose on day 1 is safely achieved by the extended-release microsphere formulation, which maximizes the drug exposure at the time when the bacterial burden is likely to be highest.Azithromycin is an azalide, structurally related to the macrolide family of antibiotics. It acts by binding to the 50S ribosomal subunit of susceptible organisms, thereby interfering with protein synthesis. Azithromycin is approved worldwide as a broad-spectrum antibiotic to treat a variety of communityacquired infections. Azithromycin is distributed extensively to a variety of body tissues and fluids. Due to its dibasic structure, azithromycin is actively taken up by a wide variety of cells, including white blood cells (WBC) and fibroblasts, a pattern different from that of the classic macrolide agents (1, 12, 13). The unique pharmacokinetic (PK) properties of azithromycin make short-course therapy possible. For most adult indications, a total of 1.5 g of immediate-release (IR) azithromycin formulations (Zithromax; Pfizer) is administered in divided doses over a period of 3 or 5 days (500 mg once daily [QD] for 3 days, or 500 mg QD on day 1 and 250 mg QD on days 2 to 5) (Zithromax [azithromycin] package insert; Pfizer Inc., New York, NY). The highest approved single oral dose of an azithromycin IR formulation is 2.0 g for the treatment of gonococcal urethritis (Zithromax package insert). The most common adverse events (AEs) of azithromycin are gastrointestinal (GI) in nature and appear to be dose related. The actual use of the 2.0-g dose is limited due to the high incidence of GI AEs such as nausea (18%), diarrhea/loose stool...

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Principles of antibiotic treatment of community-acquired pneumonia in the outpatient setting

Cited by 38 publications

References 40 publications

Angiotensin-converting enzyme inhibitor use and protection against pneumonia in patients with diabetes

Angiotensin-converting enzyme inhibitor use and protection against pneumonia in patients with diabetes

Health Care–Associated Pneumonia (HCAP): A Critical Appraisal to Improve Identification, Management, and Outcomes—Proceedings of the HCAP Summit

Comparative Pharmacokinetics of Azithromycin in Serum and White Blood Cells of Healthy Subjects Receiving a Single-Dose Extended-Release Regimen versus a 3-Day Immediate-Release Regimen

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