Effect of Antibiotic Exposure on Upper Respiratory Tract Bacterial Flora

AbstractBackground:Several trials found procalcitonin (PCT) helpful for guiding antibiotic treatment in patients with lower respiratory tract infections and sepsis. We aimed to perform an individual patient data meta-analysis on the effects of PCT guided antibiotic therapy in upper respiratory tract infections (URTI).Methods:A comprehensive search of the literature was conducted using PubMed (MEDLINE) and Cochrane Library to identify relevant studies published until September 2016. We reanalysed individual data of adult URTI patients with a clinical diagnosis of URTI. Data of two trials were used based on PRISMA-IPD guidelines. Safety outcomes were (1) treatment failure defined as death, hospitalization, ARI-specific complications, recurrent or worsening infection at 28 days follow-up; and (2) restricted activity within a 14-day follow-up. Secondary endpoints were initiation of antibiotic therapy, and total days of antibiotic exposure.Results:In total, 644 patients with a follow up of 28 days had a final diagnosis of URTI and were thus included in this analysis. There was no difference in treatment failure (33.1% vs. 34.0%, OR 1.0, 95% CI 0.7–1.4; p=0.896) and days with restricted activity between groups (8.0 vs. 8.0 days, regression coefficient 0.2 (95% CI –0.4 to 0.9), p=0.465). However, PCT guided antibiotic therapy resulted in lower antibiotic prescription (17.8% vs. 51.0%, OR 0.2, 95% CI 0.1–0.3; p<0.001) and in a 2.4 day (95% CI –2.9 to –1.9; p<0.001) shorter antibiotic exposure compared to control patients.Conclusions:PCT guided antibiotic therapy in the primary care setting was associated with reduced antibiotic exposure in URTI patients without compromising outcomes.

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The effects of age, environmental temperature and relative humidity on the bacterial flora of the upper respiratory tract in calves

British Veterinary Journal ◽

10.1016/s0007-1935(11)80004-7 ◽

1990 ◽

Vol 146 (3) ◽

pp. 211-218 ◽

Cited By ~ 5

Author(s):

Z. Woldehiwet ◽

B. Mamache ◽

T.G. Rowan

Keyword(s):

Relative Humidity ◽

Respiratory Tract ◽

Environmental Temperature ◽

Bacterial Flora ◽

Upper Respiratory Tract ◽

Upper Respiratory

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The Haemophilic Bacteria of the Upper Respiratory Tract, the Appearance of Virulent forms in Relation to Upper Respiratory Infections

Journal of Hygiene ◽

10.1017/s0022172400034525 ◽

1934 ◽

Vol 34 (2) ◽

pp. 195-202 ◽

Cited By ~ 3

Author(s):

L. Hoyle

Keyword(s):

Respiratory Tract ◽

Respiratory Infections ◽

Bacterial Flora ◽

The Other ◽

Upper Respiratory Tract ◽

Upper Respiratory Infections ◽

Acute Infections ◽

Other Hand ◽

Upper Respiratory ◽

Normal Health

In previous studies of the bacterial flora of the upper respiratory tract and its variations during attacks of acute coryza (Hoyle, 1932), it was found that there was in many cases a striking relationship between the appearance of certain organisms with definite pathogenic properties towards the lower animals, in the upper respiratory tract, and the occurrence of acute infections. This relationship was especially marked in the case of the influenza bacillus, and it was suggested that this organism played a prominent part in the aetiology of upper respiratory infections. The significance of the influenza bacillus in acute coryza has been noted by various workers (Noble, Fisher and Brainard, 1928; Burky and Smillie, 1929; Webster and Clow, 1932; Kneeland and Dawes, 1932), but on the other hand various observers have found the incidence of influenza bacilli in the respiratory tract to be the same in normal health and in acute coryza, and Fleming (1929) and Fleming and Maclean (1930) have devised a technique by means of which they claim to have isolated influenza bacilli in 100 per cent, of normal throats. One possible explanation of these conflicting results may be found in the absence of any very exact criterion of what constitutes a typical influenza bacillus.

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Assessment of Postvaccine Immunity against Streptococcus pneumoniae in Patients with Asplenia, including an Analysis of Its Impact on Bacterial Flora of the Upper Respiratory Tract and Incidence of Infections

Journal of Immunology Research ◽

10.1155/2018/1691347 ◽

2018 ◽

Vol 2018 ◽

pp. 1-9 ◽

Cited By ~ 1

Author(s):

Alina Olender ◽

Katarzyna Małkińska ◽

Jacek Roliński ◽

Ewelina Grywalska ◽

Elżbieta Pels ◽

...

Keyword(s):

Respiratory Tract ◽

Bacterial Flora ◽

Carrier State ◽

Control Group ◽

Pathogenic Microorganisms ◽

Upper Respiratory Tract ◽

Specific Antibodies ◽

Positive Effects ◽

Upper Respiratory ◽

Potentially Pathogenic Microorganisms

S. pneumoniae is a microorganism that may cause a serious threat in postsplenectomy patients due to a potentially invasive course of infection. In order to assess a protective activity after vaccination with the 23-valent vaccine, we made an analysis of the level of antibodies in patients with asplenia compared to a control group of healthy donors. Additionally, colonization by potentially pathogenic microorganisms of the upper respiratory tract was analyzed to determine the carrier state by strains with vaccine serotype. No such strains were found in the research, yet three non-vaccine-serotype strains were found. Colonization of the upper respiratory tract by potentially pathogenic microorganisms may be connected with increased susceptibility observed and incidence of infections in patients with asplenia. However, colonization by S. pneumoniae may not have an effect on the level of specific antibodies with the 23-valent vaccine against S. pneumoniae (PPV23) in postsplenectomy patients and healthy people. The response to vaccination against S. pneumoniae showed a lower level of specific antibodies in patients with splenectomy performed more than 2 years before the test than in patients with a recently removed spleen, i.e., from 1 month to 2 years before the test. Vaccination against pneumococci also has positive effects on incidence of other etiology infections, which is of high significance in the prophylaxis of infectious diseases in this group of patients.

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The Role of Bacterial Interference in Otitis, Sinusitis and Tonsillitis

Otolaryngology ◽

10.1016/j.otohns.2005.03.012 ◽

2005 ◽

Vol 133 (1) ◽

pp. 139-146 ◽

Cited By ~ 57

Author(s):

Itzhak Brook

Keyword(s):

Respiratory Tract ◽

Respiratory Tract Infections ◽

Antimicrobial Agents ◽

Bacterial Flora ◽

Upper Respiratory Tract ◽

Bacterial Strains ◽

Upper Respiratory ◽

Tract Infections ◽

Bacterial Interference

Bacterial interactions that include antagonism (interference) and synergism help maintain balance between the members of the normal endogenous flora. Alpha-streptococci that predominate in the normal respiratory tract flora attracted most attention in studies of bacterial interference. Other organisms that possess interfering characteristics in upper respiratory tract infections (URTIs) are nonhemolytic streptococci, and Prevotella and Peptostreptococcus spp. The production of bacteriocins by some microorganisms is one of the important mechanisms of interference. The role of bacterial interference in the development of URTI and its effect on the eradication of these infections is discussed. These infections include pharyngo-tonsillitis, otitis media, and sinusitis. Treatment with various antimicrobial agents can affect the balance between members of the oro-pharyngeal bacterial flora and interfering organisms. Implantation into the indigenous microflora of low virulence bacterial strains that are potentially capable of interfering with colonization and infection with other more virulent organisms has been used in preliminary studies as a means of coping with the failure of antimicrobials in the treatment of several URTI.

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