Prospective study of lower respiratory tract infections in an extended-care nursing home program: Potential role of oral ciprofloxacin

Peterson, Phillip K.; Stein, Daniel J.; Guay, David R.P.; Logan, George B.; Obaid, S R; Gruninger, Robert P.; Davies, Scott F.; Breitenbucher, Robert B.

doi:10.1016/s0002-9343(88)80336-x

Cited by 98 publications

(50 citation statements)

References 32 publications

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“…This figure is very similar to that obtained in other trials where elderly patients with lower-respiratory-tract infections were treated with oral antibiotics [15,[24][25][26], even though the sample size was rather small in our study. Bacteriological response in the present study was still modest, and a longer duration of antibiotic treatment might have led to a bet ter response.…”

Section: Discussionsupporting

confidence: 91%

Efficacy and Tolerance of Erythromycin Acistrate in the Treatment of Acute Exacerbations of Chronic Bronchitis in the Elderly

Forsén¹,

Wikberg

Lehtonen

1993

Chemotherapy

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This randomized, investigator-blind, parallel-group trial compared erythromycin acistrate (EA) and erythromycin base (EB) in the treatment of elderly patients with acute exacerbations of chronic bronchitis. In total, 57 hospitalized patients were included, of whom 28 received EA 400 mg three times daily, and 29 EB 500 mg three times daily for 10-21 days. The mean age of the patients was 70 and 68 years in the EA and EB groups, respectively. The patients underwent medical examination before the onset of the study, at the 7th day during the treatment and 3-5 days after termination of the treatment. The efficacy assessment was based on clinical signs and symptoms of infection as well as on bacteriological culture from sputum samples. 55% of the patients in the EA group and 61% in the EB group were totally cured, 23 and 29%, respectively, had only mild symptoms at the end of the therapy and 14 versus 11% of the patients did not respond at all. The predominant pathogens isolated from sputum were Haemophilus influenzae, Bran-hamella catarrhalis and Streptococcus pneumoniae. 60% of the patients in the EA group and 46% in the EB group from whom a sample was taken had normal flora in the posttreatment culture. In the EA group, 8 patients and in the EB group 7 patients complained of gastrointestinal side effects and 4 and 1, respectively, discontinued the treatment prematurely. Slight, reversible elevations of one or more liver parenchymal enzyme activities during and after treatment were seen at the same frequency in both treatment groups. The results show that EA is as effective and well tolerated as EB in the treatment of exacerbations of chronic bronchitis in elderly patients.

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Section: Discussionsupporting

confidence: 91%

Efficacy and Tolerance of Erythromycin Acistrate in the Treatment of Acute Exacerbations of Chronic Bronchitis in the Elderly

Forsén¹,

Wikberg

Lehtonen

1993

Chemotherapy

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“…Lack of a febrile response, being "off legs" and confusion are all common modes of presentation in these older patients [16]. Studies of CAP in the elderly report the presence of mental confusion on admission in 17-45% of patients [6,[17][18][19][20]], similar to that described for patients in longterm care facilities with pneumonia (21-50%) [4,21,22]. MARRIE and BLANCHARD [4] noted a nonsignificant trend towards more patients with NHAP displaying confusion compared to patients with CAP (50% versus 35%) [4].…”

Section: Presenting Clinical Featuresmentioning

confidence: 64%

A prospective comparison of nursing home acquired pneumonia with community acquired pneumonia

2001

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Nursing home acquired pneumonia (NHAP) is thought to be clinically distinct from community acquired pneumonia (CAP). This observation, based on studies conducted mainly in North America, may not be relevant in countries with a different healthcare system.The authors describe an 18-month prospective cohort study of 437 patients admitted to hospital with CAP, 40 (9%) of whom came from nursing homes. Detailed microbiological tests were performed in a subset of patients over 12 months.Patients with NHAP were less likely to have a productive cough (odds ratio (OR) 0.4, p=0.02) or pleuritic pain (OR 0.1, p=0.03), but they were more likely to be confused (OR 2.6, p<0.001). They had poorer functional status (p<0.001) and more severe disease (p=0.03). Mortality was higher compared to CAP (53%versus13%), but this was mainly explained by prior functional status (OR 0.5, after adjustment for functional status). Pathogens were identified in 68% of 22 NHAP and 80% of 44 matched CAP patients.Streptococcus pneumoniaewas the most common (55% NHAP, 43% CAP). Atypical pathogens, enteric Gram negative bacilli andStaphylococcus aureuswere uncommon.In conclusion, differences in functional status accounted for the increased mortality in nursing home acquired pneumonia compared to community acquired pneumonia. The pathogens implicated were similar. No grounds for a difference in choice of empirical antibiotics were apparent.

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“…There have been six studies comparing quinolones with other agents for treatment of community-acquired lower respiratory tract infections (26,190,279,577,601,868 In comparative studies that included patients with pneumonia, oral ciprofloxacin (250 to 750 mg twice daily) was comparable to doxycycline (100 mg twice daily) (26), amoxicillin (250 mg three times daily) (279), or cefamandole (1 g every 6 h) (577) and ciprofloxacin (100 mg intravenously every 8 to 12 h or 500 mg orally twice daily) was comparable to imipenem-cilastatin (500 mg imipenem given intravenously every 6 h) (465). Because these studies included patients with bronchitis and pneumonia, however, it was not possible to determine the organisms causing pneumonia.…”

Section: Respiratory Tract Infectionsmentioning

confidence: 99%

Fluoroquinolone antimicrobial agents

1989

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The fluoroquinolones, a new class of potent orally absorbed antimicrobial agents, are reviewed, considering structure, mechanisms of action and resistance, spectrum, variables affecting activity in vitro, pharmacokinetic properties, clinical efficacy, emergence of resistance, and tolerability. The primary bacterial target is the enzyme deoxyribonucleic acid gyrase. Bacterial resistance occurs by chromosomal mutations altering deoxyribonucleic acid gyrase and decreasing drug permeation. The drugs are bactericidal and potent in vitro against members of the family Enterobacteriaceae, Haemophilus spp., and Neisseria spp., have good activity against Pseudomonas aeruginosa and staphylococci, and (with several exceptions) are less potent against streptococci and have fair to poor activity against anaerobic species. Potency in vitro decreases in the presence of low pH, magnesium ions, or urine but is little affected by different media, increased inoculum, or serum. The effects of the drugs in combination with a beta-lactam or aminoglycoside are often additive, occasionally synergistic, and rarely antagonistic. The agents are orally absorbed, require at most twice-daily dosing, and achieve high concentrations in urine, feces, and kidney and good concentrations in lung, bone, prostate, and other tissues. The drugs are efficacious in treatment of a variety of bacterial infections, including uncomplicated and complicated urinary tract infections, bacterial gastroenteritis, and gonorrhea, and show promise for therapy of prostatitis, respiratory tract infections, osteomyelitis, and cutaneous infections, particularly when caused by aerobic gram-negative bacilli. Fluoroquinolones have also proved to be efficacious for prophylaxis against travelers' diarrhea and infection with gram-negative bacilli in neutropenic patients. The drugs are effective in eliminating carriage of Neisseria meningitidis. Patient tolerability appears acceptable, with gastrointestinal or central nervous system toxicities occurring most commonly, but only rarely necessitating discontinuance of therapy. In 17 of 18 prospective, randomized, double-blind comparisons with another agent or placebo, fluoroquinolones were tolerated as well as or better than the comparison regimen. Bacterial resistance has been uncommonly documented but occurs, most notably with P. aeruginosa and Staphylococcus aureus and occasionally other species for which the therapeutic ratio is less favorable. Fluoroquinolones offer an efficacious, well-tolerated, and cost-effective alternative to parenteral therapies of selected infections.

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Prospective study of lower respiratory tract infections in an extended-care nursing home program: Potential role of oral ciprofloxacin

Cited by 98 publications

References 32 publications

Efficacy and Tolerance of Erythromycin Acistrate in the Treatment of Acute Exacerbations of Chronic Bronchitis in the Elderly

Efficacy and Tolerance of Erythromycin Acistrate in the Treatment of Acute Exacerbations of Chronic Bronchitis in the Elderly

A prospective comparison of nursing home acquired pneumonia with community acquired pneumonia

Fluoroquinolone antimicrobial agents

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