ABSTRACT
Background: In outpatient management of respiratory tract infections, the clinicians’ preferences always have a broad spectrum of antibiotics as an empirical therapy. Clinical use of cephalosporins and fluoroquinolones has been recommended by various international guidelines as a monotherapy or as combination therapy to manage these. This survey was conducted to assess the in-clinic use and preference of cephalosporins or fluoroquinolones as monotherapy or as combination therapy in managing respiratory tract infections by Indian doctors. Methods: A survey questionnaire was drafted to capture the feedback from crossspecialty regarding the preference of using antibiotics in respiratory tract infection in real time clinical settings. Results: Data from 163 physicians were collected and evaluated across India. 79 (48%) clinicians reported pharyngitis/tonsillitis to be the most commonly encountered respiratory tract infection followed by community-acquired pneumonia (CAP) 62 (38%). 100 (61%) clinicians preferred use of cefpodoxime monotherapy as a primary line of treatment for the management of respiratory pharyngitis/ tonsillitis. Use of short course therapy (≤1 week) of cefpodoxime and levofloxacin as combination therapy is preferred by 94 (58%) clinicians, in cases of acute exacerbation of chronic bronchitis (AECB) 85 (52%), and CAP 83 (51%). The clinical preference of levofloxacin was observed with only 16 (10%) clinicians, in lower respiratory tract infections, i.e. AECB and CAP. Conclusion: In-clinic use of cefpodoxime as monotherapy is preferred in upper respiratory tract infections. However, clinicians recommend a combination therapy of cefpodoxime and levofloxacin in lower respiratory tract infections.
ABSTRACT
Pneumothorax appears to be a common clinical state. Iatrogenic pneumothorax occurs commonly after procedures such as transthoracic needle biopsy, pleural biopsy, positive pressure ventilation, etc. Diagnosis of iatrogenic pneumothorax is often delayed. Broad spectrum anti-infectives appear to be benefi cial in reducing the infections, especially when chest drains are inserted. Garenoxacin, a potent quinolone with its unique structural modifi cation appears to have an edge over other respiratory quinolones.
ABSTRACT
Community-acquired pneumonia (CAP) is a major cause of adult mortality in Asia. Empirical use of antibiotics depends on the pathogens that are commonly responsible. Evolution of resistant pathogens in CAP has added to the burden of treating physicians. Microbiological culture and antibiotic sensitivity testing are helpful for the treatment of such respiratory tract infections. Klebsiella pneumoniae though uncommon pathogen of CAP has been reported in many cases. Garenoxacin a newer fluoroquinolone has found its utility in the treatment of respiratory tract infections. Providing symptomatic relief to the patient with the use of analgesics, antipyretics and cough preparations are also an essential part of the management.
ABSTRACT
Background: Asthma management has been fraught with several challenges especially for partly or uncontrolled cases. Incremental dosage strategy with salmeterol, fluticasone propionate combination offers stable yet effective control of symptoms preventing further exacerbations. However, there is limited evidence available on the need and safety profile of this incremental dosage strategy with the combination especially in Indian settings. To examine the safety and adverse clinical outcomes of Airtec SF when prescribed in patients with well- or poorly controlled persistent asthma. Methods: Based on the principle of prescription event monitoring (PEM) for safety reporting, this study was conducted at 20 centers across India. PEM study booklets with study questionnaire were provided to capture information related to adverse “events” during the observation period of 30 days. Results: Data of 384 patients were analyzed, with a mean age 44.5 years. 39% (n=150) were newly diagnosed and 61% (n=234) being in poorly controlled asthma status (i.e., partly or uncontrolled asthma). Of them, 42% (161), 44% (n=169) and 14% (54) patients were diagnosed with mild, moderate or severe persistent asthma, respectively. These were prescribed with metered-dose inhaler (n=187) or dry powder inhaler (n=197) formulations. 56% (n=216) patients suffered from concomitant allergic rhinitis. Among newly diagnosed patients with moderate to severe asthma dosage were tapered in 5.5% (n=3) cases. Dosage consistency was well-maintained in 98.2% (n=155) among partial or uncontrolled asthmatics with moderate to severe asthma with exacerbation rate of 1.9% (n=3). Adverse events including infective pneumonitis and upper respiratory tract infection were transient with none requiring treatment withdrawal. Conclusion: Use of Airtec SF was safe and well-tolerated with a negligible rate of exacerbations in Indian population especially amongst poorly controlled asthma patients.