Jude Children's Research Hospital have demonstrated a more effective treatment for bacterial pneumonia following influenza. They found that the antibiotics clindamycin and azithromycin, which kill bacteria by inhibiting their protein synthesis, are more effective than a standard first-line treatment with the "beta-lactam" antibiotic ampicillin, which causes the bacteria to lyse, or burst. The finding is important because pneumonia, rather than the influenza itself, is a principal cause of death from influenza in children and the elderly. During pandemics--such as the one that may arise from avian influenza--up to 95 percent of influenza deaths are due to pneumonia. Jude Infectious Diseases department, expect the new findings, currently demonstrated in mice, to be incorporated into standard clinical practice guidelines during the next few years. A bioterrorism attack using the influenza virus would likely result in the same high percentage of pneumonia deaths, according to the researchers. Mc Cullers and his colleagues published their findings in the advanced, online issue of the Journal of Infectious Diseases. The researchers based the new treatment on growing evidence that beta-lactams are relatively ineffective against secondary pneumonia because the drugs exacerbate inflammation caused by influenza. "With severe secondary pneumonia, it has seemed that physicians do almost everything they can, and it doesn't work," Mc Cullers said. Winter is almost here, and a typical phone call to the pharmacy will likely involve questions about antibiotics to treat pneumonia. When doctors call, it is usually because the patient has multiple drug allergies and/or drug interactions that make antibiotic selection difficult. Based on Infectious Disease Society of America/American Thoracic Society guidelines, I have organized the information in a chart that makes sense to me. This chart is my sole creation, and I encourage others to formulate their own charts if they do not understand or like mine. I organized my chart from the least-aggressive drug regimen to the most aggressive. Once a bacterium is identified in the cultures, de-escalation occurs to avoid unnecessary adverse effects, costs, and possible drug resistance. What is significant for retail pharmacists is that the guidelines are for doxy or a macrolide but never both at the same time. If a prescription comes across for a z-pack and doxy, that would be a red flag to call the doctor.
The impact of azithromycin on mortality in SP pneumonia remains unclear. Recent safety concerns regarding azithromycin have raised alarm about this agent's role with pneumonia. We sought to clarify the relationship between survival and azithromycin use in SP pneumonia. Primary and secondary outcome measures Hospital mortality served as the primary endpoint, and we compared patients given azithromycin with those not treated with this. Covariates of interest included demographics, severity of illness, comorbidities and infection-related characteristics (eg, appropriateness of initial treatment, bacteraemia). We employed logistic regression to assess the independent impact of azithromycin on hospital mortality. Results The cohort included 187 patients (mean age: 67.0±8.2 years, 50.3% men, 5.9% admitted to the intensive care unit). Community-acquired pneumonia is one of the most common serious infections in children, with an annual incidence of 34 to 40 cases per 1,000 children in Europe and North America. When diagnosing community-acquired pneumonia, physicians should rely mainly on the patient’s history and physical examination, supplemented by judicious use of chest radiographs and laboratory tests as needed. The child’s age is important in making the diagnosis. Pneumonia in neonates younger than three weeks of age most often is caused by an infection obtained from the mother at birth. often are the etiologic agents in children older than five years and in adolescents. In very young children who appear toxic, hospitalization and intravenous antibiotics are needed. The symptoms in outpatients who present with community-acquired pneumonia can help determine the treatment.
[Posted 08/03/2018]AUDIENCE: Patient, Health Professional, Oncology ISSUE: The antibiotic azithromycin (Zithromax, Zmax) should not be given long-term to prevent a certain inflammatory lung condition in patients with cancers of the blood or lymph nodes who undergo a donor stem cell transplant. Results of a clinical trial found an increased rate of relapse in cancers affecting the blood and lymph nodes, including death, in these patients. We are reviewing additional data and will communicate our conclusions and recommendations when our review is complete. BACKGROUND: The serious lung condition for which long-term azithromycin was being studied called bronchiolitis obliterans syndrome is caused by inflammation and scarring in the airways of the lungs, resulting in severe shortness of breath and dry cough. Cancer patients who undergo stem cell transplants from donors are at risk for bronchiolitis obliterans syndrome. The manufacturer of brand name azithromycin is providing a Dear Healthcare Provider letter on this safety issue to health care professionals who care for patients undergoing donor stem cell transplants. Azithromycin is not approved for preventing bronchiolitis obliterans syndrome. Combination antibiotic treatment for community-acquired pneumonia in children is common, but a new study suggests that using just one of the two drugs is just as effective in most cases and can go a long way toward curbing the use of azithromycin, one of the most commonly used antibiotics in pediatric settings. A research team based at Vanderbilt University Medical Center (VUMC) reported their findings in a recent issue of . For most pneumonia infections, the causative agent is difficult to identify, and clinicians often prescribe empiric treatment. Amoxicillin, a beta lactam drug, treats the most common bacteria that cause pneumonia and according to national guidelines is the treatment of choice for most children with the disease. Azithromycin, a macrolide antibiotic, is often used to treat "atypical pneumonia," which can be more common in older children and adolescents, though the benefits of the drug aren't clear. The prospective observational study, part of a larger pneumonia etiology study, included 1,418 children hospitalized at three centers in Tennessee and Utah from January 2010 to June 2012 for radiologically confirmed pneumonia; 72% received just amoxicillin, while 28% were treated with both amoxicillin and azithromycin. Nearly 74% of the kids had a virus detected, with or without bacterial coinfection.
Objective Streptococcus pneumoniae SP represents a major pathogen in pneumonia. The impact of azithromycin on mortality in SP pneumonia remains. They found that the antibiotics clindamycin and azithromycin, which. a more effective treatment for bacterial pneumonia following influenza.