Antimicrobial prescription practices for outpatients with acute respiratory tract infections: A retrospective, multicenter, medical record-based study

Antimicrobial stewardship for outpatients with acute respiratory tract infections (ARTIs) should be urgently promoted in this era of antimicrobial resistance. Previous large-sample studies were based on administrative data and had limited reliability. We aimed to identify current antimicrobial prescription practices for ARTIs by directly basing on medical records. This multicenter retrospective study was performed from January to December in 2018, at five medical institutes in Japan. We targeted outpatients aged ≥18 years whose medical records revealed International Classification of Diseases (ICD-10) codes suggesting ARTIs. We divided the eligible cases into three age groups (18–64 years, 65–74 years, and ≥75 years). We defined broad-spectrum antimicrobials as third-generation cephalosporins, macrolides, fluoroquinolones, and faropenem. Primary and secondary outcomes were defined as the proportion of antimicrobial prescriptions for the common cold and other respiratory tract infections, respectively. Totally, data of 3,940 patients were collected. Of 2,914 patients with the common cold, 369 (12.7%) were prescribed antimicrobials. Overall, compared to patients aged ≥75 years (8.5%), those aged 18–64 years (16.6%) and those aged 65–74 years (12.1%) were frequently prescribed antimicrobials for the common cold (odds ratio [95% confidential interval]; 2.15 [1.64–2.82] and 1.49 [1.06–2.09], respectively). However, when limited to cases with a valid diagnosis of the common cold by incorporating clinical data, no statistical difference was observed among the age groups. Broad-spectrum antimicrobials accounted for 90.2% of the antimicrobials used for the common cold. Of 1,026 patients with other respiratory infections, 1,018 (99.2%) were bronchitis, of which antimicrobials were prescribed in 49.9% of the cases. Broad-spectrum antimicrobials were the main agents prescribed, accounting for nearly 90% of prescriptions in all age groups. Our data suggested a favorable practice of antimicrobial prescription for outpatients with ARTIs in terms of prescribing proportions, or quantitative aspect. However, the prescriptions were biased towards broad-spectrum antimicrobials, highlighting the need for further antimicrobial stewardship in the outpatient setting from a qualitative perspective.

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Introducing Covid-19 as an Evolutionary Metabolic Infecious Disease (EMID): The Prime Cause and Representing Alternative Treatment for COVID-19 (SARS-CoV-2)

Open Access Journal of Mycology & Mycological Sciences ◽

10.23880/oajmms-16000127 ◽

2020 ◽

Vol 3 (2) ◽

Author(s):

Sorush Niknamian

Keyword(s):

Free Radicals ◽

Magnetic Fields ◽

Respiratory Tract ◽

Common Cold ◽

Respiratory Tract Infections ◽

Erythroid Cell ◽

Human Coronavirus ◽

The Common ◽

Human Coronaviruses ◽

Tract Infections

Background: Coronaviruses are a group of related viruses that cause diseases in mammals and birds. In humans, coronaviruses cause respiratory tract infections that can range from mild to lethal. Mild illnesses include some cases of the common cold, while more lethal varieties can cause SARS, MERS, and COVID-19. The outbreak was identified in Wuhan, China, in December 2019, declared to be a Public Health Emergency of International Concern on 30 January 2020, and recognized as a pandemic on 11 March 2020. Introduction: Coronaviruses are the subfamily Orthocoronavirinae, within the family of Coronaviridae; order Nidovirales, and realm Riboviria. They are enveloped viruses with a positive-sense single-stranded RNA genome and a nucleocapsid of helical symmetry. The genome size of coronaviruses is approximately from 26 to 32kilobases. Coronaviruses were first discovered in the 1930s and Human coronaviruses were discovered in the 1960s. The earliest ones studied were from human patients with the common cold, which were later named human coronavirus 229E and human coronavirus OC43. Other human coronaviruses have since been identified, including SARS-CoV in 2003, HCoV NL63 in 2004, HKU1 in 2005, MERS-CoV in 2012, and SARS-CoV-2 in 2019. Most of these have involved serious respiratory tract infections. Discussions & Results: Based on our multidisciplinary research, we have found the major cause and some treatments methods for fighting this powerful pathogen. The prime cause of COVID-19 is pushing the mitochondrial to lose MMP. A loss of the MMP by any mechanism leads to functional and structural collapse of the mitochondria and cell death. Mitophagy plays an important role in maintaining mitochondrial homeostasis, but can also eliminate healthy mitochondria in cases such as cell starvation, viral invasion, and erythroid cell differentiation. The mitochondrial fusion and fission are highly dynamic. Viruses specially COVID-19, interfere with these processes to distort mitochondrial dynamic to facilitate their proliferation. Thus, interfering with these processes promotes the interference of different cellular signaling pathways. The severe acute respiratory syndrome coronavirus (SARS-CoV) escapes the innate immune response by translocating its ORF-9b to mitochondria and promotes proteosomal degradation of dynamin-like protein (Drp1) leading to mitochondrial fission. We also researched on Ultrasonic Energy to destroy the virus which leads to positive results but it needs more future research. The most destructive way of viruses is to enhance Reactive Oxygen Species (ROS) and free radicals in human contaminated cell which cause inflammation in a host cell. ELF-EMF converts free radicals into less active molecules and eliminates them into two pathways which have been discussed in the discussion part. Using ELF-EMF affects the second pathway that relies on the activity of the catalase and superoxide dismutase enzymes which is the most effective pathway. For the best result of treatment, is the use of lowfrequency magnetic fields (LFMF) plus EMF-ELF which penetrate into deeper tissues, cells and mitochondria. We also have gone through many researches since 1920 and found if we emit the frequency as the same frequency of COVID-19, can cause resonance in the virus and destroy it. So we measured the SARS-CoV-2 frequency by Cyclotron and calculated the frequencyof the virus is 30 KHz-500 KHz. Conclusion: COVID-19 (SARS-CoV-2) is one of the most complex viruses which have been discovered since 2020. Until today, there has been no Antiviral Drug which can be useful in the treatment of this infectious disease has been discovered till today. COVID-19 genomic sequence containing SARS-CoV, MERS-CoV and Influenza A. Therefore; there is a high possibility of continuing COVID-19 even in summer. To gain the best result in treatment, we should use low-frequency magnetic fields (LFMF) plus EMF which penetrate into deeper tissues, cells and mitochondria in order to reduce ROS and Inflammation. In order to destroy SARS-CoV-2 virus in environment and also in infected individuals, we should use ELF-EMF plus LFMF. We also have gone through many researches since 1920 and found if we emit the frequency as the same frequency of COVID-19, it can cause resonance in the virus and destroy it. So we measured the SARS-CoV-2 frequency by Cyclotron and calculated the frequency of the virus that id is 30 KHz-500 KHz. The differences in the frequencies are due to the size of the virus which is from 26 to 32 Kilobases.

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INTRODUCING COVID-19 AS AN EVOLUTIONARY METABOLIC INFECIOUS DISEASE (EMID) The Prime Cause and Representing Alternative Treatment for COVID-19 (SARS-CoV-2)

10.31219/osf.io/fp7uw ◽

2021 ◽

Author(s):

Sorush Niknamian

Keyword(s):

Free Radicals ◽

Magnetic Fields ◽

Respiratory Tract ◽

Common Cold ◽

Respiratory Tract Infections ◽

Low Frequency ◽

Human Coronavirus ◽

The Common ◽

Human Coronaviruses ◽

Tract Infections

Background: Coronaviruses are a group of related viruses that cause diseases in mammals and birds. In humans, coronaviruses cause respiratory tract infections that can range from mild to lethal. Mild illnesses include some cases of the common cold, while more lethal varieties can cause SARS, MERS, and COVID-19. The outbreak was identified in Wuhan, China, in December 2019, declared to be a Public Health Emergency of International Concern on 30 January 2020, and recognized as a pandemic on 11 March 2020. Introduction: Coronaviruses are the subfamily Orthocoronavirinae, within the family of Coronaviridae, order Nidovirales, and realm Riboviria. They are enveloped viruses with a positive-sense single-stranded RNA genome and a nucleocapsid of helical symmetry. The genome size of coronaviruses is approximately from 26 to 32 kilobases. Coronaviruses were first discovered in the 1930s and Human coronaviruses were discovered in the 1960s. The earliest ones studied were from human patients with the common cold, which were later named human coronavirus 229E and human coronavirus OC43. Other human coronaviruses have since been identified, including SARS-CoV in 2003, HCoV NL63 in 2004, HKU1 in 2005, MERS-CoV in 2012, and SARS-CoV-2 in 2019. Most of these have involved serious respiratory tract infections. Discussions and Results: Based on our multidisciplinary research, we have found the major cause and some treatments methods for fighting this powerful pathogen. The prime cause of COVID-19 is pushing the mitochondrial to lose MMP. A loss of the MMP by any mechanism leads to functional and structural collapse of the mitochondria and cell death. Mitophagy plays an important role in maintaining mitochondrial homeostasis, but can also eliminate healthy mitochondria in cases such as cell starvation, viral invasion, and erythroid cell differentiation. The mitochondrial fusion and fission are highly dynamic. Viruses specially COVID-19, interfere with these processes to distort mitochondrial dynamic to facilitate their proliferation. Thus, interfering with these processes promotes the interference of different cellular signaling pathways. The severe acute respiratory syndrome coronavirus (SARS-CoV) escapes the innate immune response by translocating its ORF-9b to mitochondria and promotes proteosomal degradation of dynamin-like protein (Drp1) leading to mitochondrial fission. We also researched on Ultrasonic Energy to destroy the virus which lead to positive results but it needs more future research. The most destructive way of viruses is to enhance Reactive Oxygen Species (ROS) and free radicals in human contaminated cell which cause inflammation in a host cell. ELF-EMF convert free radicals 2 into less active molecules and eliminate them into two pathways which has been discussed in the discussion part. Using ELF-EMF affects the second pathway that relies on the activity of the catalase and superoxide dismutase enzymes which is the most effective pathway. For the best result of treatment, is the use of low-frequency magnetic fields (LFMF) plus EMF-ELF which penetrate into deeper tissues, cells and mitochondria. We also have gone through many researches since 1920 and found if we emit the frequency as the same frequency of COVID-19, can cause resonance in the virus and destroy it. So we measured the SARS-CoV-2 frequency by Cyclotron and calculated the frequency of the virus is 30 KHz-500 KHz. Conclusion: COVID-19 (SARS-CoV-2) is one of the most complex virus which has been discovered since 2020. Until today, there has been no Antiviral Drug which can be useful in the treatment of this infectious disease has been discovered till today. COVID-19 genomic sequence containing SARS-CoV, MERS-CoV and Influenza A. Therefore; there is a high possibility of continuing COVID-19 even in summer. To gain the best result in treatment, we should use low-frequency magnetic fields (LFMF) plus EMF which penetrate into deeper tissues, cells and mitochondria in order to reduce ROS and Inflammation. In order to destroy SARS-CoV-2 virus in environment and also in infected individuals, we should use ELF-EMF plus LFMF. We also have gone through many researches since 1920 and found if we emit the frequency as the same frequency of COVID-19, it can cause resonance in the virus and destroy it. So we measured the SARS-CoV-2 frequency by Cyclotron and calculated the frequency of the virus that id is 30 KHz-500 KHz. The differences in the frequencies is due to the size of the virus which is from 26 to 32 Kilobases.

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BRIEF FACTS ABOUT COVID-19 (SARS-CoV-2) and DETAILS

10.31219/osf.io/4mfwa ◽

2021 ◽

Author(s):

Sorush Niknamian

Keyword(s):

Respiratory Tract ◽

Common Cold ◽

Respiratory Tract Infections ◽

Human Coronavirus ◽

The Family ◽

The Common ◽

Human Coronaviruses ◽

The 1960S ◽

Tract Infections ◽

Human Coronavirus 229E

Coronaviruses are a group of related viruses that cause diseases in mammals and birds. In humans, coronaviruses cause respiratory tract infections that can range from mild to lethal. Mild illnesses include some cases of the common cold, while more lethal varieties can cause SARS, MERS, and COVID-19. The outbreak was identified in Wuhan, China, in December 2019, declared to be a Public Health Emergency of International Concern on 30 January 2020, and recognized as a pandemic on 11 March 2020. Coronaviruses are the subfamily Orthocoronavirinae, within the family of Coronaviridae, order Nidovirales, and realm Riboviria. They are enveloped viruses with a positive-sense single-stranded RNA genome and a nucleocapsid of helical symmetry. The genome size of coronaviruses is approximately from 26 to 32 kilobases. Coronaviruses were first discovered in the 1930s and Human coronaviruses were discovered in the 1960s. The earliest ones studied were from human patients with the common cold, which were later named human coronavirus 229E and human coronavirus OC43. Other human coronaviruses have since been identified, including SARS-CoV in 2003, HCoV NL63 in 2004, HKU1 in 2005, MERS-CoV in 2012, and SARS-CoV-2 in 2019. Most of these have involved serious respiratory tract infections

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Brief Facts about COVID-19 (SARS-CoV-2)

Asian Journal of Complementary and Alternative Medicine ◽

10.53043/2347-3894.acam90001 ◽

2021 ◽

Vol 9 (1) ◽

Author(s):

Sorush Niknamian

Keyword(s):

Respiratory Tract ◽

Common Cold ◽

Respiratory Tract Infections ◽

Human Coronavirus ◽

The Family ◽

The Common ◽

Human Coronaviruses ◽

The 1960S ◽

Tract Infections ◽

Human Coronavirus 229E

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Evaluation of the prevalence and seasonality of human parainfluenza virus over five year period in pediatric patients

Medical Science and Discovery ◽

10.36472/msd.v8i4.530 ◽

2021 ◽

Vol 8 (4) ◽

pp. 260-265

Author(s):

Meryem Colak ◽

Selin Yigit ◽

Anil Tapisiz ◽

Hager Muftah ◽

Kenan Yuce ◽

...

Keyword(s):

Respiratory Tract ◽

Respiratory Tract Infections ◽

Pediatric Patients ◽

Age Groups ◽

Treatment Decision ◽

Respiratory Illness ◽

Common Type ◽

Clinical Samples ◽

Syncytial Virus ◽

Tract Infections

Objective: Human Parainfluenza viruses (HPIVs) cause respiratory tract infections, and the second most common cause of acute respiratory illness-related hospitalizations after the respiratory syncytial virus in children <5 years of age. The aim of the study; determination of HPIVs positivity and common types in pediatric patients with respiratory tract infection; investigation the distribution of HPIV positivity by age groups, months and seasons, respectively. Material and Method: HPIV results of 1613 pediatric patients who were sent to the molecular virology laboratory from various pediatric clinics of Gazi Hospital between March 2016 and February 2021 (five years period) were investigated. Nucleic acid isolation was performed on the EZ1 Advanced (Qiagen, Germany) device using the EZ1 Virus Mini Kit by the manufacturer's protocol. Results: HPIV positivity was detected as 4.1% in clinical samples and, the most common HPIV type was found to be HPIV-3 (55%). The distribution of other HPIV types were; HPIV-2, HPIV-4 and HPIV-1 with 26%, 23% and 14%, respectively. HPIV-3 is the most common type in 2016, 2017, 2018 and 2019; however, HPIV-1 is the most common type in 2020. HPIVs co-infection was detected with other respiratory tract viruses in 51% of samples. The highest HPIV co-infection was detected in Rhinovirus. The highest HPIV positivity rate (45%) were determined in the 0-2 age group compared to other age groups (p<0.05). The highest positivity rate was in October in the autumn season (p<0.05), the lowest was in January and February in winter. The highest rate (8.1%) of HPIV positivity was found in 2016 and the lowest rate (0.7%) was in 2020. Conclusions: Since it is not possible to diagnose viral etiology of respiratory tract infections based on clinical findings, viral respiratory tract panel and Multiplex real-time PCR test are a fast and useful method in early diagnosis, treatment decision and prevention of unnecessary antibiotic use. HPIVs positivity is seen at higher rates in children aged 0-2 and in autumn months with seasonal differences.

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Evidence Update for Clinicians: Narrow- versus Broad-Spectrum Antibiotics for Common Infections in Children

10.25302/eu5.2018.10 ◽

2018 ◽

Author(s):

Keyword(s):

Respiratory Tract ◽

Broad Spectrum ◽

Respiratory Tract Infections ◽

Acute Otitis Media ◽

Streptococcal Pharyngitis ◽

Upper Respiratory Tract ◽

Broad Spectrum Antibiotics ◽

Group A ◽

Tract Infections ◽

Common Infections

Comparing Narrow- vs. Broad-Spectrum Antibiotics for Common Infections in Children. The choice of antibiotic to treat acute bacterial upper respiratory tract infections in children can affect both symptom resolution and the risk of side effects such as diarrhea and vomiting. The findings of a PCORI-funded study published in JAMA can help clinicians treating children for acute respiratory tract infections (ARTIs)—including acute otitis media, Group A streptococcal pharyngitis, and acute sinusitis—make decisions with parents about the medicine that is best for the child. The study, led by Jeffrey Gerber, a pediatrician and researcher at the Children’s Hospital of Philadelphia, included 30,086 children ages 6 months to 12 years taking narrow- and broad-spectrum antibiotics to treat ARTIs.

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Respiratory viruses

Revision Notes for MCEM Part A ◽

10.1093/med/9780199583836.003.0027 ◽

2011 ◽

pp. 208-211

Author(s):

Dr Mark Harrison

Keyword(s):

Respiratory Syncytial Virus ◽

Respiratory Tract ◽

Common Cold ◽

Respiratory Viruses ◽

Upper Respiratory Tract Infections ◽

Upper Respiratory Tract ◽

The Common ◽

Upper Respiratory ◽

Syncytial Virus ◽

Tract Infections

15.1 Rhinovirus, 209 15.2 Influenza, 210 15.3 Parainfluenza, 211 15.4 Respiratory syncytial virus (RSV), 211 • There are more than 100 different serotypes of rhinovirus. • Rhinovirus is chiefly limited to upper respiratory tract infections and is the major cause of the common cold....

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Hospital-Acquired Viral Respiratory Tract Infections in the Neonatal Unit: A Comparison with Other Inpatient Groups

Neonatology ◽

10.1159/000506427 ◽

2020 ◽

Vol 117 (4) ◽

pp. 513-516

Author(s):

Chiara Taylor ◽

Shin Tan ◽

Rebecca McClaughry ◽

Don Sharkey

Keyword(s):

Respiratory Tract ◽

Respiratory Tract Infections ◽

Viral Infections ◽

Age Groups ◽

Length Of Hospital Stay ◽

Fold Increase ◽

Hospital Inpatient ◽

Tract Infections ◽

Hospital Acquired ◽

Viral Respiratory

Background: Hospital-acquired viral respiratory tract infections (VRTIs) cause significant morbidity and mortality in neonatal patients. This includes escalation of respiratory support, increased length of hospital stay, and need for home oxygen, as well as higher healthcare costs. To date, no studies have compared population rates of VRTIs across age groups. Aim: Quantify the rates of hospital-acquired VRTIs in our neonatal population compared with other inpatient age groups in Nottinghamshire, UK. Methods: We compared all hospital inpatient PCR-positive viral respiratory samples between 2007 and 2013 and calculated age-stratified rates based on population estimates. Results: From a population of 4,707,217, we identified a previously unrecognised burden of VRTI in neonatal patients, only second to the 0–1-year-old group. Although only accounting for 1.3% of the population, half of the infections were in infants <1 year old and neonatal intensive care unit (NICU) patients. Human rhinovirus was the most dominant virus across the inpatient group, particularly in neonatal patients. Despite a two- to three-fold increase in the rate of positive samples in all groups during the colder months (1.1/1,000 October–March vs. 0.4/1,000 April–September), rates in the NICU did not change throughout the year at 4.3/1,000. Pandemic H1N1 influenza rates were 20 times higher in neonatal patients and infants <1 year old. Conclusion: Good epidemiological and interventional data are needed to help inform visiting and infection control policies to reduce transmission of hospital-acquired viral infections to this vulnerable population, particularly during pandemic seasons.

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Antimicrobial Prescription Practices for Outpatients with Cystitis: A Multicenter, Medical Record-Based Study

10.21203/rs.3.rs-1132930/v1 ◽

2021 ◽

Author(s):

Misa Takahashi ◽

Hideharu Hagiya ◽

Tsukasa Higashionna ◽

Yasuhiro Nakano ◽

Kota Sato ◽

...

Keyword(s):

Broad Spectrum ◽

Age Groups ◽

Antibiotic Use ◽

International Classification Of Diseases ◽

Prescription Practices ◽

Classification Of Diseases ◽

Icd 10 ◽

Prescription Rates ◽

Uncomplicated Cystitis ◽

Antimicrobial Prescription

Abstract To promote antimicrobial stewardship (AMS) and appropriate antibiotic use, we studied antimicrobial prescription rates for uncomplicated cystitis, a common outpatient disease requiring antibiotic treatment in Japan. This multicenter retrospective study was performed from January 1, 2018, to December 31, 2020, targeting outpatients aged ≥20 years whose medical records revealed International Classification of Diseases (ICD-10) codes suggesting uncomplicated cystitis (N300). We divided eligible cases into two age groups (20–49 years and ≥50 years) and defined broad-spectrum antimicrobials as fluoroquinolones, third-generation cephalosporins, and faropenem. Primary and secondary outcomes were defined as the prescription rates of broad-spectrum antimicrobials for the disease and the association of antimicrobial types with recurrence. The data of 1,445 patients were collected and that of 902 patients were analyzed. The overall proportion of broad-spectrum antimicrobial prescriptions was 69.1%. The broad-spectrum agents were prescribed frequently in the older group, male patients, and internal medicine. Recurrence was observed in 37 (4.1%) cases, and age, sex, or antimicrobial types were not associated with the recurrence. Hence, approximately two-thirds of antimicrobials prescribed for uncomplicated cystitis were broad-spectrum agents. Administration of broad-spectrum antimicrobials was not associated with the prevention of the recurrence of cystitis.

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An Overview: Coronaviruses in Recent Two Decades

Al-Nahrain Journal of Science ◽

10.22401/anjs.00.5.03 ◽

2021 ◽

Vol 0 (5) ◽

pp. 13-16

Author(s):

Mohammed H. Al-Mashhadan ◽

◽

Alaa Mohammed ◽

Rasha Raheem ◽

Emad Yousif ◽

...

Keyword(s):

Middle East ◽

Respiratory Tract ◽

Respiratory Tract Infections ◽

Middle East Respiratory Syndrome ◽

The Common ◽

Tract Infections

Coronaviruses are an association of viruses which lead sicknesses in mammals and birds. The Common symptoms that affect humans are respiratory tract infections, fever, headache, etc.In this review, we highlight the development in coronaviruses in recent two decade, which include simpleacute respiratory syndrome (2002-2003), middle east respiratory syndrome (2012) and coronavirus disease 2019 (2019-2020).

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