Antibiotic regimens utilization in treating community acquired pneumonia of a government practice setting: a prospective observational study in medical inpatients

Background: Pneumonia is a lower respiratory tract infection characterized by inflammation of lung tissue accompanied by infiltration of alveoli and bronchioles. Most common type is community acquired pneumonia (CAP). Initial therapy is usually empirical that is designed to treat various pathogens. In CAP cases, antibiotic therapy should begin at the earliest. The objectives of the study include to identify most common causative micro-organisms, to assess risk of developing CAP in patients having co-morbidities, to identify most commonly prescribed antibiotic regimen.Methods: A prospective observational study was conducted for period of 6 months at RIMS, Kadapa. 120 patients were recruited based on inclusion criteria. Treatment was given according to Infectious Diseases Society of America and American Thoracic Society guidelines.Results: In a total of 120 patients, 77 were males and 43 were females. 69 patients belong to 46-55 & above age groups. 84 patients had social habits and 36 patients are without social habits. Patients with single lobe infiltrations are 105 and patients with multiple lobe infiltrations are 15. In our study, streptococcus pneumoniae and pseudomonas aeruginosa were the most common isolated organisms. Monotherapy was given for 7 patients, dual therapy for 97 patients and triple therapy for 16 patients. 33 patients received ceftriaxone (CEF) and augmentin (AUG), 29 patients received CEF and azithromycin (AZI), 7 patients received levofloxacin (LEV), 25 patients received CEF and LEV, 10 patients received CEF and ciprofloxacin (CIP) and 16 patients received CEF, AUG and AZI. 100 patients had less than 8 days of hospital stay.Conclusions: Research study concluded that ? lactum antibiotics were the most commonly prescribed class. CEF and AUG was highly recommended drug regimen.

Observation of clinical effect of montelukast sodium in the treatment of chronic cough with small airway disease / 中国基层医药

Objective To explore the clinical efficacy of montelukast sodium in the treatment of chronic cough with small airway disease.Methods 50 chronic cough patients with small airway disease were selected,and they were randomly divided into montelukast sodium group and control group according to the digital table,25 cases in each group.The control group was given conventional treatment,the montelukast sodium group was treated with montelukast sodium on the basis of routine treatment.At the end of treatment,the clinical effect of the two groups was compared.Results The total effective rate of the montelukast sodium group was 92.0％,which of the control group was 84.0％,the difference was not statistically significant between the two groups (x2 =1.05,P ＞ 0.05).After 3 months of treatment,the pulmonary function of the two groups was significantly improved.Compared with the control group,the FEV1,FVC and FEV1/FVC％ of the montelukast sodium group showed no statistically significant differences(t =0.71,0.64,1.46,all P ＞ 0.05),but the FEF25 ％-75 ％,FEF50％,FEF75 ％ improved significantly with significant differences (t =7.07,2.62,3.83,all P ＜ 0.01).After 6 months of treatment,the difference of FEF75 ％ was statistically significant between the two groups (t =1.92,P ＜ 0.05).Compared with the control group,the level of serum IgE was significantlylower in the montelukast sodium group(t =4.02,P ＜0.01).There were no serious adverse reactions in the two groups,the difference was not statistically significant (x2 =1.42,P ＞ 0.05).Conclusion Montelukast sodium in the treatment of chronic cough with small airway disease has significant effcet,it is conducive to improve small airway disease and reduce serum IgE level,it is safe,effective and worthy of clinical application.

Toxic Inhalational Injury-Associated Interstitial Lung Disease in Children

Interstitial lung disease in children (chILD) is a group of disorders characterized by lung inflammation and interstitial fibrosis. In the past recent years, we noted an outbreak of child in Korea, which is possibly associated with inhalation toxicity. Here, we report a series of cases involving toxic inhalational injury-associated chILD with bronchiolitis obliterans pattern in Korean children. This study included 16 pediatric patients confirmed by lung biopsy and chest computed tomography, between February 2006 and May 2011 at Asan Medical Center Children's Hospital. The most common presenting symptoms were cough and dyspnea. The median age at presentation was 26 months (range: 12-47 months), with high mortality (44%). Histopathological analysis showed bronchiolar destruction and centrilobular distribution of alveolar destruction by inflammatory and fibroproliferative process with subpleural sparing. Chest computed tomography showed ground-glass opacities and consolidation in the early phase and diffuse centrilobular nodular opacity in the late phase. Air leak with severe respiratory difficulty was associated with poor prognosis. Although respiratory chemicals such as humidifier disinfectants were strongly considered as a cause of this disease, further studies are needed to understand the etiology and pathophysiology of the disease to improve the prognosis and allow early diagnosis and treatment.

The Middle Lobe Cancer Treated with Bronchovascular Resection and Reconstruction / 中国医师杂志

Objective In order to research the operative method for preservation of healthy lung in the middle lobe carcinoma.Methods From June,1994 to August,1999,16 cases lobectomy of middle lobe cancer were performed.12 of 16 cases were received middle lobectomy with bronchial wedge-shaped resection,6 of which were followed by partial pulmonary artery resection,2 of which,with pulmonary artery sleeve resection,3 of 16 were cured by the middle lobe sleeve lobectomy,one of which was done with combined partial pulmonary artery resection.One of 16 received both middle and lower lobectomy,simultaneously,completed upper pulmonary vein and lower pulmonary vein reconstruction.Results 16 cases operation were all successful.The survival rate in 1 and 3 years were 88% and 50%,respectively.Conclusion Bronchovascular resection and reconstruction applied to treat the middle lobe cancer not only could maximal remove the focal lesion,but also reserve the healthy lung fully,and expanded the surgical indication.