scholarly journals Role and place of levofloxacin in the treatment of community-acquired pneumonia

2021 ◽  
Vol 3 (2) ◽  
pp. 41-48
Author(s):  
D V Dmytriiev ◽  
O A Nazarchuk ◽  
Yu M Babina
Keyword(s):  
Low Income ◽  
Alternative Therapy ◽  
Treatment Method ◽  
Community Acquired Pneumonia ◽  
Low Income Countries ◽  
Development Of Resistance ◽  
Antibiotics Use ◽  
Potential Alternative ◽  
Tract Infections ◽  
Short Courses

Lower respiratory tract infections are the third mortality cause in the world and the first mortality cause in low-income countries. Community-acquired pneumonia (CAP) is a dangerous infectious pathology, especially in children younger than 5 years, elderly people and patients with compromised immunity. Antibiotic therapy is a standard treatment method for CAP. But an increase in antibiotics use caused a development of resistance in bacteria and onset of adverse events in humans. A new class of fluorchinolones is widely used nowadays in clinical practice. They have good activity against Gram-negative bacteria, as early chinolones, as well as against Gram-positive bacteria, such as pneumococci and atypical bacteria. An increasing amount of penicillin-resistant streptococcal pneumonia leads to more intensive studies of the use of new chinolones. In this review the data of 750 mg levofloxacin is presented. It is used in short courses for the treatment of severe and moderate CAP. Taking into account the broad spectrum of activity of levofloxacin ad bactericidal activity of this antibiotic, it can be a potential alternative therapy for the treatment of children and adults with CAP, especially with a tendency of an increase in antibiotic resistance of pneumococcus.

#61: Antibiotic Use for Community-Acquired Pneumonia Among Hospitalized Children in Japan

2021 ◽  
Vol 10 (Supplement_1) ◽  
pp. S13-S13
Author(s):  
Chiaki Tao-Kidoguchi ◽  
Eiki Ogawa ◽  
Kensuke Shoji ◽  
Isao Miyairi
Keyword(s):  
Physician Behavior ◽  
Point Of Care ◽  
Descriptive Analysis ◽  
Antibiotic Use ◽  
Community Acquired Pneumonia ◽  
Clinical Criteria ◽  
Focus Of Infection ◽  
Tract Infections ◽  
Short Courses ◽  
Viral Etiologies

Abstract Background Judicious use of antimicrobials is the cornerstone of action against antimicrobial resistance. Respiratory tract infections account for over 80% of pediatric antibiotic use in Japan. Antibiotics are generally used empirically for most hospitalized patients with pneumonia although it is becoming clearer that viral etiologies account for approximately 70% of these cases. Defining the characteristics of patients who are managed with a short course of antibiotics and subsequently do well, may lead to setting clinical criteria for early termination of antibiotics. Methods We performed a retrospective descriptive analysis. Medical charts of patients aged 3 months to 18 years, who were admitted with a diagnosis of pneumonia, bronchitis, bronchiolitis, or asthma to the Department of Interdisciplinary medicine at the National Center for Child Health and Development from March 2018 through February 2019 were reviewed. Those who had respiratory symptoms and were started on antibiotics within 48 hours of hospitalization were included. Those who had a focus of infection elsewhere or were immunocompromised were excluded. Results Of the 556 candidates, 80 patients met the criteria. The median age was 1.5 years which included 42.5% (34/80) with comorbidities. Underlying conditions included 9 with trisomy 21, and 8 with perinatal issues. Rapid antigen testing was performed and 7 patients with RSV, 5 patients with influenza, 1 patient with human metapneumovirus were identified. The average duration of antibiotic therapy was 7.2 days (range 2–14 days). There were no statistical differences in the characteristics of patients who received antibiotics for more or less than 5 days. The positivity of the rapid antigen test tended to be higher in those who received antibiotics for a shorter period (25% vs. 15%). There were no differences in the rate of readmission or complications between the two groups. Conclusion We were unable to identify a clear characteristic of patients who received short courses of antibiotics for pneumonia. The trend observed for those who had a point of care testing may suggest that the use of a multiplex PCR testing covering a greater number of pathogens would influence physician behavior in antibiotic use.

scholarly journals Antiretroviral Therapy for HIV-2 Infection: Recommendations for Management in Low-Resource Settings

2011 ◽  
Vol 2011 ◽  
pp. 1-11 ◽  
Author(s):  
Kevin Peterson ◽  
Sabelle Jallow ◽  
Sarah L. Rowland-Jones ◽  
Thushan I. de Silva
Keyword(s):  
Antiretroviral Therapy ◽  
West Africa ◽  
Low Income ◽  
Low Income Countries ◽  
Hiv Diagnosis ◽  
Nonnucleoside Reverse Transcriptase Inhibitors ◽  
Development Of Resistance ◽  
Virologic Control ◽  
Testing Algorithms ◽  
Hiv 1

HIV-2 contributes approximately a third to the prevalence of HIV in West Africa and is present in significant amounts in several low-income countries outside of West Africa with historical ties to Portugal. It complicates HIV diagnosis, requiring more expensive and technically demanding testing algorithms. Natural polymorphisms and patterns in the development of resistance to antiretrovirals are reviewed, along with their implications for antiretroviral therapy. Nonnucleoside reverse transcriptase inhibitors, crucial in standard first-line regimens for HIV-1 in many low-income settings, have no effect on HIV-2. Nucleoside analogues alone are not sufficiently potent enough to achieve durable virologic control. Some protease inhibitors, in particular those without ritonavir boosting, are not sufficiently effective against HIV-2. Following review of the available evidence and taking the structure and challenges of antiretroviral care in West Africa into consideration, the authors make recommendations and highlight the needs of special populations.

scholarly journals Mental Wellbeing and Self-reported Symptoms of Reproductive Tract Infections among Girls

2017 ◽  
Vol 52 ◽  
pp. 29-41
Author(s):  
Sushama A. Khopkar ◽  
Sangita Kulathinal ◽  
Suvi M. Virtanen ◽  
Minna Säävälä
Keyword(s):  
Reproductive Health ◽  
Low Income ◽  
Reproductive Tract ◽  
Mental Wellbeing ◽  
Low Income Countries ◽  
Service Development ◽  
Western India ◽  
Reproductive Health Services ◽  
Reproductive Tract Infections ◽  
Tract Infections

This study examined the self-reported mental wellbeing among slum-dwelling adolescents in Western India and asked whether adolescent postmenarcheal girls’ mental wellbeing and self-reported symptoms suggestive of reproductive tract infections (RTIs) were associated. A sub-section of a cross-sectional personal interview survey among unmarried 10–18-year-old adolescents (n= 85) in a slum in the city of Nashik was analyzed. Logistic regression models were used to assess the associations between sociodemographic variables, physical health indicators, and adolescent postmenarcheal girls’ mental wellbeing. Nearly every other postmenarcheal girl reported having experienced symptoms suggestive of RTIs during the last twelve months. Adolescent postmenarcheal girls’ mental health and some aspects of somatic health appear to be closely interrelated. Understanding the relationship between adolescent mental wellbeing and reproductive health in low-income countries requires further investigation. Health service development in growing informal urban agglomerations in India and beyond should provide combined mental and reproductive health services for adolescents.  

scholarly journals 1425. Revisiting β-Lactams for Treatment of Uncomplicated Urinary Tract Infections: Evaluation of Twice-daily Cephalexin for Empiric Treatment of UTIs

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S795-S796
Author(s):  
Molly Benning ◽  
Dominic Acosta ◽  
Preeyaporn Sarangarm ◽  
Carla Walraven
Keyword(s):  
Antibiotic Therapy ◽  
Clinical Success ◽  
Retrospective Chart Review ◽  
Clinical Failure ◽  
University Of New Mexico ◽  
Empiric Treatment ◽  
Development Of Resistance ◽  
Future Utility ◽  
Tract Infections ◽  
Short Courses

Abstract Background Current IDSA guidelines for the treatment of UTIs discourage oral β-lactams based on lack of adequately powered studies to assess efficacy compared to fluoroquinolones or TMP-SMX. However, increasing E. coli and Klebsiella spp. resistance to first-line antibiotics has necessitated the need for alternative agents. Methods This was a single-center retrospective chart review of adult patients discharged from the University of New Mexico ED with twice-daily cephalexin for the treatment of uncomplicated UTIs from January 1, 2019 to December 31, 2019. Patients were excluded if < 18 years of age, received ≥ 10 days of cephalexin, received antibiotics for other indications, received antibiotics within 60 days prior to ED visit, or had structural abnormalities. The primary outcome of this study was the proportion of patients with clinical success 30 days after discharge from the ED. Patients not meeting criteria for clinical failure were classified as clinical success. Clinical failure was defined as return of patient within 30 days due to non-resolving or worsening UTI symptoms or change in antibiotic therapy after discharge based on urine culture and susceptibilities. Results A total of 264 patients were included for evaluation. The average age was 56.0 ± 20.2 years and 82.6% were female. Patients received an average 5.6 ± 0.9 days of antibiotic therapy including IV therapy. Of the 264 patients included for evaluation, 81.1% met criteria for clinical success. Of the patients with clinical failure, 29 (13.6%) required a change in antibiotics based on cultures and sensitivities, 17 (6.4%) returned for non-resolving or worsening symptoms, and 4 (1.5%) required both a change in antibiotics and returned for non-resolving or worsening symptoms. Conclusion Short courses of twice-daily cephalexin appear to be safe and effective for empiric treatment of uncomplicated UTIs. Adding β -lactams back to the antibiotic armamentarium for UTI treatment may delay the development of resistance to non- β -lactam antibiotics, ensuring their future utility. Disclosures All Authors: No reported disclosures

A review on Development and Characterization of a Cost-Effective Targeted Quality-Driven Antimalarial Product with an Emphasis on Phytosomes

2021 ◽  
Vol 22 ◽  
Author(s):  
E. Bhargav ◽  
Y. Padmanabha Reddy ◽  
K.B. Koteshwara
Keyword(s):  
Low Income ◽  
Cost Effective ◽  
Low Income Countries ◽  
Development Of Resistance ◽  
Infected Rbcs ◽  
Resistant Strains ◽  
The One ◽  
The Cost ◽  
Neural Network Technology

Abstract : Malaria, a protozoan disease led to numerous deaths and several new million cases raised due to the development of resistance as per the WHO malaria report 2019. This can be overcome by the development of an effective targeted plant-based delivery system through phytosomes that are effective in permeation and bioavailability to treat infected RBCs (parasitic cells). This review article explained the development of targeted Nanophytosomes to overcome resistance, to improve efficacy. This review paper also emphasized various quality-driven developmental approaches in developing an antimalarial product at a reasonable cost. By implementing molecular modeling techniques in development, a significant phytoconstituent with the capability of acting at the target (receptor or enzymes) of the parasite and the one with the capability to overcome drug resistance against resistant strains of parasites can be identified. Absorption Distribution Metabolism Excretion and Toxicity (ADMET) studies information provide a route to the design and formulation of a potent antimalarial agent. Efficient targeted Nanophytosomal formulations can be formulated by functionalizing or conjugating with suitable targets to direct the phytoconstituent to the infected RBCs thereby achieving complete parasitic eradication. Artificial Neural Network technology (ANN), Quality by Design (QbD), molecular dynamics, and simulation studies implementation improves quality and reduces the cost of the product, as these malarial products are much utilized in low-income countries. Hence it can be concluded that targeted developmental quality-driven approaches implementation is essential for effective malarial treatment.

scholarly journals Antibiotic Prescribing Patterns for Childhood infections in Ambulatory Settings

2021 ◽  
Author(s):  
Samah Al-Shatnawi ◽  
Sanabel Alhusban ◽  
Shoroq Altawalbeh ◽  
Rawand Khasawneh
Keyword(s):  
Antimicrobial Resistance ◽  
Low Income ◽  
Action Plan ◽  
Prescribing Patterns ◽  
World Health ◽  
Low Income Countries ◽  
Antibiotic Prescribing ◽  
Cross Sectional ◽  
Tract Infections ◽  
The Impact

Background: Antibiotics’ rational prescribing is a major goal of the World Health Organization’s (WHO) global action-plan to tackle antimicrobial resistance. Evaluation of antibiotic prescribing patterns is necessary to guide simple, globally applicable stewardship interventions. The impact of antimicrobial resistance is devastating, especially in low-income countries. We aimed to introduce ambulatory data on patterns of pediatric antibiotic prescribing in Jordan, which could be used to guide local stewardship interventions. Methods: A cross-sectional retrospective study was conducted by selecting a random sample of pediatric patients, who attended ambulatory settings in 2018. Records of outpatients (age 18 years) receiving at least one antibiotic were included. The WHO’s model of drug utilization was applied, and all prescribing indicators were included. Multiple linear regression was performed to examine factors influencing the ratio of prescribed antibiotics to overall medications per encounter. Results: A total of 20,494 prescriptions, containing 45,241 prescribed drugs, were obtained. Average number of prescribed drugs per prescription was (2.21  0.98). 77.5% of overall ambulatory prescriptions accounted for antimicrobials. Only 0.6% of total prescriptions were for injectables. All antimicrobials (100%) were prescribed by generic-names and from essential drug list. Antibiotics were most commonly prescribed for respiratory tract infections. Age, gender, season, and facility type were significant predictors of prescribed antibiotics to overall medications ratio. Conclusions: This is the first study of antibiotic prescribing patterns among outpatient pediatrics that covers wide regions in Jordan. Results indicate high rates of antibiotics use among outpatient pediatrics. Such findings necessitate more focused efforts and regulations that support rational utilization of drugs.

scholarly journals Atypical pathogens in hospitalized patients with community-acquired pneumonia: a worldwide perspective

2018 ◽  
Vol 18 (1) ◽  
Author(s):  
Andrea Gramegna ◽  
◽  
Giovanni Sotgiu ◽  
Marta Di Pasquale ◽  
Dejan Radovanovic ◽  
...  
Keyword(s):  
Low Income ◽  
Univariate Analysis ◽  
Real Life ◽  
Community Acquired Pneumonia ◽  
Hospitalized Patients ◽  
Adult Patients ◽  
Low Income Countries ◽  
Atypical Pathogen ◽  
Atypical Pathogens ◽  
The Impact

Abstract Background Empirical antibiotic coverage for atypical pathogens in community-acquired pneumonia (CAP) has long been debated, mainly because of a lack of epidemiological data. We aimed to assess both testing for atypical pathogens and their prevalence in hospitalized patients with CAP worldwide, especially in relation with disease severity. Methods A secondary analysis of the GLIMP database, an international, multicentre, point-prevalence study of adult patients admitted for CAP in 222 hospitals across 6 continents in 2015, was performed. The study evaluated frequency of testing for atypical pathogens, including L. pneumophila, M. pneumoniae, C. pneumoniae, and their prevalence. Risk factors for testing and prevalence for atypical pathogens were assessed through univariate analysis. Results Among 3702 CAP patients 1250 (33.8%) underwent at least one test for atypical pathogens. Testing varies greatly among countries and its frequency was higher in Europe than elsewhere (46.0% vs. 12.7%, respectively, p < 0.0001). Detection of L. pneumophila urinary antigen was the most common test performed worldwide (32.0%). Patients with severe CAP were less likely to be tested for both atypical pathogens considered together (30.5% vs. 35.0%, p = 0.009) and specifically for legionellosis (28.3% vs. 33.5%, p = 0.003) than the rest of the population. Similarly, L. pneumophila testing was lower in ICU patients. At least one atypical pathogen was isolated in 62 patients (4.7%), including M. pneumoniae (26/251 patients, 10.3%), L. pneumophila (30/1186 patients, 2.5%), and C. pneumoniae (8/228 patients, 3.5%). Patients with CAP due to atypical pathogens were significantly younger, showed less cardiovascular, renal, and metabolic comorbidities in comparison to adult patients hospitalized due to non-atypical pathogen CAP. Conclusions Testing for atypical pathogens in patients admitted for CAP in poorly standardized in real life and does not mirror atypical prevalence in different settings. Further evidence on the impact of atypical pathogens, expecially in the low-income countries, is needed to guidelines implementation.

Parental manual ventilation in resource-limited settings: an ethical controversy

2020 ◽  
Vol 46 (7) ◽  
pp. 459-464 ◽  
Author(s):  
Emily Barsky ◽  
Sadath Sayeed
Keyword(s):  
Mechanical Ventilation ◽  
Low Income ◽  
Best Interests ◽  
Low Income Countries ◽  
Careful Examination ◽  
Ethical Challenges ◽  
Manual Ventilation ◽  
Resource Limited ◽  
Life Saving ◽  
Tract Infections

Lower respiratory tract infections are a leading cause of paediatric morbidity and mortality worldwide. Children in low-income countries are disproportionately affected. This is in large part due to limitations in healthcare resources and medical technologies. Mechanical ventilation can be a life-saving therapy for many children with acute respiratory failure. The scarcity of functioning ventilators in low-income countries results in countless preventable deaths. Some hospitals have attempted to adapt to this scarcity by using hand-bag ventilation, as either a bridge to a mechanical ventilator, or until clinical improvement occurs rendering mechanical ventilation no longer necessary. In instances of hand-bag ventilation, an endotracheal tube is first placed. Family members are then asked to play the role of a ventilator, manually compressing a bag repeatedly to inflate the child’s lungs. This approach is fraught with numerous ethical challenges. A careful examination of the data and a nuanced approach to the ethical considerations are imperative. Ethical arguments in support of and in opposition to allowing parental hand-bag ventilation are explored, including the best interests of the child, the child’s right to an open future, beneficence and parental protection, legitimising substandard care, and finally, contextual concerns. An algorithmic, potentially ethically permissible approach to parental participation in manual ventilation is proposed.

scholarly journals Antibiotic-Resistant Acinetobacter baumannii in Low-Income Countries (2000–2020): Twenty-One Years and Still below the Radar, Is It Not There or Can They Not Afford to Look for It?

Antibiotics ◽  
2021 ◽  
Vol 10 (7) ◽  
pp. 764
Author(s):  
Soha S. Rizk ◽  
Wafaa H. Elwakil ◽  
Ahmed S. Attia
Keyword(s):  
Acinetobacter Baumannii ◽  
Low Income ◽  
Antimicrobial Agents ◽  
Genetic Resistance ◽  
Infectious Agent ◽  
Carbapenem Resistance ◽  
Healthcare Services ◽  
Low Income Countries ◽  
Surveillance Systems ◽  
Development Of Resistance

Acinetobacter baumannii is an emerging pathogen, and over the last three decades it has proven to be particularly difficult to treat by healthcare services. It is now regarded as a formidable infectious agent with a genetic setup for prompt development of resistance to most of the available antimicrobial agents. Yet, it is noticed that there is a gap in the literature covering this pathogen especially in countries with limited resources. In this review, we provide a comprehensive updated overview of the available data about A. baumannii, the multi-drug resistant (MDR) phenotype spread, carbapenem-resistance, and the associated genetic resistance determinants in low-income countries (LIICs) since the beginning of the 21st century. The coverage included three major databases; PubMed, Scopus, and Web of Science. Only 52 studies were found to be relevant covering only 18 out of the 29 countries included in the LIC group. Studies about two countries, Syria and Ethiopia, contributed ~40% of the studies. Overall, the survey revealed a wide spread of MDR and alarming carbapenem-resistance profiles. Yet, the total number of studies is still very low compared to those reported about countries with larger economies. Accordingly, a discussion about possible reasons and recommendations to address the issue is presented. In conclusion, our analyses indicated that the reported studies of A. baumannii in the LICs is far below the expected numbers based on the prevailing circumstances in these countries. Lack of proper surveillance systems due to inadequate financial resources could be a major contributor to these findings.

scholarly journals Detection of Chlamydia pneumonia and Mycoplasma pneumonia in hospitalised children with community acquired pneumonia

2018 ◽  
Vol 5 (4) ◽  
pp. 1310
Author(s):  
Kannan Ramamoorthy ◽  
Agora Shivan Shanmuga Sundaram
Keyword(s):  
Low Income ◽  
Chlamydia Pneumoniae ◽  
Radiological Feature ◽  
Community Acquired Pneumonia ◽  
Low Income Countries ◽  
Study Objective ◽  
Igm Elisa ◽  
Atypical Pathogens ◽  
Mycoplasma Pneumonia ◽  
Chest X Ray

Background: Mycoplasma pneumoniae and Chlamydia pneumoniae are atypical pathogens responsible for community acquired pneumonia (CAP) and are a leading cause of morbidity and mortality in low income countries. The study objective was to determine the prevalence of C. pneumoniae and M. pneumonia in hospitalized children with CAP.Methods: This study was performed on ninety-four children admitted with radiologically confirmed diagnosis of pneumonia in Government Rajah Mirasudar Hospital, Thanjavur, during the period of July 2005 to April 2006. The diagnosis of infections with C. pneumonia and M. pneumonia was determined by detection of IgM antibody by using ELISA method. In this study clinical and radiological feature of these infections were also looked for.Results: Among 94 children, 9 children (9.6%) were detected positive for M. pneumonia and 8 children (8.5%) were detected positive for C. pneumonia. Infection rate was highest among 5-12 years and least among 1 month to 24 months age group. The most common symptoms observed in patients with these pathogens are cough, fever, crepitations and rhonchi. Pulmonary infiltrates were the most common chest X-ray features of both C. pneumoniae pneumonia and M. pneumoniae pneumonia.Conclusions: This study has shown that C. pneumonia and M. pneumonia play a significant role in paediatric CAP. Identification and confirmation of these organisms by IgM ELISA helps in better management that would decrease the need for hospitalization and IV antibiotics.

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