Effect of lower respiratory tract infections on peak expiratory flow rate in children admitted to Rajarajeshwari medical college hospital, Bangalore, Karnataka, India

Background: Peak expiratory flow rate is the simplest , cost effective and easily available test to assess the respiratory function. PEFR is measured by a peak expiratory flow meter. Measurement of PEFR is most commonly used for asthmatic patients. To evaluate the effect of lower respiratory tract infection on peak expiratory flow rate in children.'Methods: PEFR were measured in eighty children suffering from LRTI by peak flow meter . Height and weight were measured. PEFR was compared with the normal charts. mean PEFR was calculated and predicted percentage of PEFR was calculated.Results: Mean PEFR in pneumonia , para pneumonic effusion, bronchiectasis, and bronchitis was 187.2 , 187.6, 171.85 and 173.1 respectively. Mean PEFR was maximally reduced in bronchiectasis and bronchitis. Mean' PEFR was reduced in female children in comparison to males with LRTI. PEFR was decreased' more in children with severe clinical presentation and with malnutrition.Conclusions: In this study , most common LRTI was pneumonia followed by parapneumonic effusion. PEFR was maximally reduced in bronchiectasis and bronchitis. Undernourished children were more affected.

Clinico–Bacteriological Profile Of Lower Respiratory Tract Infections In Patients Attending Tripura Medical College And Dr. Bram Teaching Hospital, Tripura.

Background:Lower Respiratory Tract Infection(LRTI) is one of the commonest health problem which is not a single disease but a group of specific infections with varying etiology and symptomatology. This study was undertaken to determine bacterial etiology of LRTI and associated risk factors 250 samples from patients with suspected LRTI were collected Methodology:and processed by standard microbiological procedure. Risk factors relating to LRTI were also further evaluated from clinical history of the patient. Total 100 isolates were recovered where Klebsiella pneumoniae(57%) was predominant followed by Pseudomonas Results:aeruginosa(19%), Acinetobacter spp.,(9%), Citrobacter freundii(7%), Staphylococcus aureus(3%), and Streptococcus pneumoniae(2%). Multiple co-morbidities are more associated with LRTI than single risk factor like Diabetes mellitus, Smoking, Alcohol, Hypertension and COPD. Knowledge of bacterial agents causing LRTI and prevalent risk factors in our geographical area is to be required for better Conclusion:treatment and prevention of the disease

Vitamin D Supplementation for Treatment and Prevention of Pneumonia in Under-five Children: A Randomized Double-blind Placebo Controlled Trial.

Objective: To evaluate the efficacy of single oral mega-dose of Vitamin D3 for treatment and prevention of pneumonia in under-five children. Design: Randomized, double blind, placebo-controlled trial. Setting: Tertiary-care hospital. Participants: 324 children (of 980 assessed) between 6 mo-5 y age (median (IQR): 12 (7,19.8) mo) with WHO-defined severe pneumonia. Of these, 126 (39%) were vitamin D deficient (serum 25(OH)D <12 ng/mL). Intervention: 100,000 IU of oral cholecalciferol (n= 162) or placebo (n= 162) in single dose, administered at enrolment. Outcome variables: Primary: Time to resolution of severe pneumonia and proportion of children having recurrence of pneumonia in next 6 months; Secondary: Change in serum levels of 25(OH)D; immunoglobulins IgA, IgG, IgM, and cathelicidin 2 weeks following supplementation; and time taken for overall resolution of illness. Results: Median (95% CI) time for resolution of severe pneumonia was 30 (29, 31) h in the vitamin D group as compared to 31 (29,33) h in the placebo group [adjusted hazard ratio (95% CI): 1·39 (1·11, 1·76); P=0·005]. The risk of recurrence of pneumonia in next 6 months was comparable in the two groups [placebo: 36/158 (22·8%); vitamin D: 39/156 (25%); RR (95% CI): 1·13 (0·67,1·90); P=0·69]. Proportion of vitamin D deficient children declined from 38% to 4% in the supplementation group, and from 41% to 33% in the placebo group, two weeks after supplementation. There was no significant effect of vitamin D supplementation on serum levels of cathelicidin, IgA and IgG. The time taken for complete recovery from pneumonia, duration of hospitalization, and fever clearance time were comparable for the two groups. No adverse event was noted related to the intervention. Conclusion: There is no robust evidence of a definite biological benefit, either for therapy or prevention, to suggest a routine megadose supplement of vitamin D3 for under-five children with severe pneumonia.

Management of lower respiratory tract infections (LRTI's): clinical microbiologists' perspective.

In the era of emergence and re-emergence of newer and existing microorganisms, clinical and laboratory diagnosis of LRTI’s requires regular evaluation. Elaborating on possible predisposing factors will be critical to health care workers in the better management of patients suffering with Lower Respiratory Tract Infections (LRTI’s). Microbiologist’s role becomes crucial in deciding the culture methods to be employed to isolate the suspected causative microorganism and identification of the probable pathogen among mixed growth of the isolated bacteria/fungi. Antimicrobial therapy should necessarily be guided by the susceptibility patterns of various antibiotics against different microorganisms from a given geographical region, which should be regularly updated.

Efficacy and Safety of Fixed Dose Combination of Cefpodoxime Proxetil and Potassium Clavulanate (Cefchamp) in Comparison with Cefuroxime Axetil in Patients with Lower Respiratory Tract Infections.

Objectives: To evaluate the efficacy and safety of Fixed Dose Combination of Cefpodoxime Proxetil and Potassium Clavulanate (Cefchamp) in comparison with Cefuroxime Axetil in patients with Lower Respiratory Tract Infections.Methods:In this open, randomized, and controlled, parallel-group study of 7 days, 57 patients of both gender above 18 years of age with diagnosis of lower respiratory tract infection were randomized to receive Fixed Dose Combination (FDC) of Cefpodoxime Proxetil plus Potassium Clavulanate (Cefchamp), or Cefuroxime Axetil (CA) for a period of 7 days. Efficacy was assessed by symptoms of cough, dyspnoea, wheezing, Rhonchi, and chest pain based on 4-point scale as 0=none,1=mild, 2=moderate, 3=severe. Fever was recorded as the patient’s actual temperature. Safety assessment included adverse events and adverse drug reactions during the study period.Results: Three patients lost to follow up with CA.The improvement in all symptoms except cough was greater with CC as compared to CA group(p, >0.05). Fever improved from 37.18°C at baseline to 37.01 on day 3 with CC, whereas with CA the fever improved from 37.l5 at baseline to 37.05 on day 3 with CA. Fever subsided in all the patients in both treatments by day 5 of study therapy. Clinical cure was seen in 57.14% (16/28) patients on CC, whereas 42.3% patients (11/26) on CA had clinical cure.Conclusions:The fixed dose combination of Cefpodoxime Proxetil 200 mg and Potassium Clavulanate 125mg (Cefchamp) in comparison with Cefuroxime Axetil 500 mg showed improvement in the cure of respiratory tract infections in terms of decreasing the patient’s LRTI symptoms, improving the patient’s general health and with few adverse events and adverse drug reactions. However, further studies of greater sample size and blinded nature are needed to further substantiate this effect.

Surveillance of Pathogens Distribution and Antibiotic Resistance in Lower Respiratory Tract Infection in ICU / 中华医院感染学杂志

OBJECTIVE To investigate the distribution of pathogens and their antibiotic resistance in lower respiratory tract infection(LRTI) from intensive care unit(ICU) in our hospital,and provide basis for rational selection of clinical drugs.METHODS Pathogens were detected from qualified sputum specimens in LRTI from ICU and identified by VITEK-AMS60 automatic microbial analyzing system.Drug susceptibility was determined by KB test.RESULTS From 320 sputum specimens 367 pathogens were detected between from Jan 2007 to Mar 2008,including 261 strains(71.1%) of Gram-negative bacilli,70 strains(19.1%) of fungi,and 36 strains(9.8%) of Gram-positive cocci.21.8% Of the isolated pathogens were Acinetobacter baumannii,with 16.7% of drug-resistant rate to cefoperazone/sulbactam and over 71% to other 13 antibiotic agents.The rate of extended spectrum ?-lactamases(ESBLs) producing Escherichia coli isolates and Klebsiella pneumoniae ones were 65.2% and 72.0%,respectively,comparing to 84.6% for meticillin-resistant Staphylococcus aureus(MRSA).CONCLUSIONS Gram-negative bacilli are the major pathogens of LRTI in ICU,in which A.baumannii shows with a high rate of drug-resistance,followed by fungi,which should attract the clinician′s more attention.