La polmonite acquisita in comunità

2021 ◽  
Vol 40 (8) ◽  
pp. 515-518
Author(s):  
Alessandra Iacono ◽  
Angela Troisi ◽  
Federico Marchetti
Keyword(s):  
Clinical Practice ◽  
Practice Guidelines ◽  
Antimicrobial Therapy ◽  
Standard Care ◽  
Current Practice ◽  
Respiratory Infections ◽  
Community Acquired Pneumonia ◽  
Healthy Children ◽  
Short Course ◽  
Serious Infections

Community-acquired pneumonia (CAP) is one of the most common serious infections in children. The appropriate duration of antimicrobial therapy is unclear. In current practice antibiotic treatment courses of 10 days are prescribed in mild-moderate CAP, while up to 14-21-day courses in severe and complicated cases. The results of the SAFER (Short-Course Antimicrobial Therapy for Paediatric Respiratory Infections) study found that the “short therapy” appeared to be comparable to standard care for the treatment of previously healthy children with CAP not requiring hospitalization. Clinical practice guidelines should recommend 5 days of amoxicillin for paediatric pneumonia management in accordance with antimicrobial stewardship principles.

scholarly journals 171. Short-course Antimicrobial Therapy for Paediatric Respiratory Infections (SAFER): a multicentre, Randomized, Controlled, Blinded, Noninferiority Trial

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S214-S215
Author(s):  
Jeffrey Pernica ◽  
Stuart Harman ◽  
April J Kam ◽  
Redjana Carciumaru ◽  
Thuva Vanniyasingam ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Clinical Cure ◽  
Standard Care ◽  
Respiratory Infections ◽  
Risk Difference ◽  
High Dose ◽  
Healthy Children ◽  
Beta Lactam ◽  
Study Objective ◽  
Short Course

Abstract Background Community-acquired pneumonia (CAP) is a common occurrence in childhood; consequently, evidence-based recommendations for its treatment are required. The study objective was to determine if, in previously healthy children presenting to the emergency department (ED), 5 days of high-dose amoxicillin led to noninferior rates of clinical cure at 14–21 days post-enrolment compared with 10 days of high-dose amoxicillin. Methods The SAFER study was a multicentre, randomized, parallel-group, multiple-blinded, controlled, noninferiority study, enrolling between 2012–2014 (single centre pilot) and then 2016–2019 (follow-up main study). Children aged 6 months – 10 years with all of the following were eligible: fever within 48h; a respiratory symptom/sign; a chest radiograph consistent with pneumonia as per the emergency MD; and a primary diagnosis of CAP. Children were excluded if they required hospitalization, had any medical comorbidities, or if they were already receiving beta-lactam antibiotic therapy. The intervention of interest was 5 days of high-dose amoxicillin followed by 5 days placebo. The control (standard care) arm received 5 days of high-dose amoxicillin followed by a different formulation of 5 days of high-dose amoxicillin. The primary outcome was clinical cure at 14–21 days post-enrolment. The pre-set noninferiority margin was 0.075 less than the clinical cure risk difference (1-sided 97.5% CI). Results Of the 281 participants, 119 (42%) were female; the median age was 2.6 y (25–75%ile 1.6–4.9 y). There were 140 randomized to short-course treatment and 141 to standard care. Clinical cure at 14–21 days was observed in 108/126 (86%) in the short-course arm and in 106/126 (84%) in the standard-care arm (risk difference 0.023, lower limit of 1-sided 97.5%CI -0.061). There were no participants who, after finishing amoxicillin, later deteriorated and required hospitalization for progressive CAP. Conclusion Short-course antibiotic therapy was noninferior to standard care for the treatment of previously healthy children with non-severe CAP diagnosed in Canadian EDs. Clinical practice guidelines should recommend no more than 5 days of amoxicillin for paediatric pneumonia management, in accordance with antimicrobial stewardship principles. Disclosures All Authors: No reported disclosures

Current Issues of Empirical Therapy of Severe Bacterial Community-Acquired Pneumonia During the Season of Respiratory Viral Infections

2020 ◽  
Vol 65 (9-10) ◽  
pp. 64-70
Author(s):  
V. B. Beloborodov ◽  
I. A. Kovalev ◽  
G. V. Sapronov
Keyword(s):  
Antimicrobial Therapy ◽  
Influenza A ◽  
Bacterial Infections ◽  
Randomized Clinical Trials ◽  
Respiratory Infections ◽  
Molecular Genetic ◽  
Seasonal Fluctuation ◽  
Empirical Therapy ◽  
Community Acquired Pneumonia ◽  
Adverse Event Rate

Progredient growth of morbidity and mortality of patients with community-acquired pneumonia (CAP) requires optimization of treatment including antibacterial therapy. Implementation of molecular-genetic methods of diagnostics of viral and viral-bacterial infections in clinical practice has significantly augmented the conception of etiology of community-acquired pneumonia. Seasonal fluctuation of CAP prevalence corresponds with growth of morbidity of acute respiratory infections and influenza which contribute to the etiological structure of CAP by increasing the risk of infection caused by staphylococci. The synergy between influenza A virus and S.aureus has been shown; it is associated with an increase of virus replication in the presence of specific staphylococcal proteases and the ability of viruses to increase adhesion of S.aureusin the respiratory tract, to decrease phagocytosis of S.aureus by macrophages/neutrophils and production of antimicrobial peptides, as well as to increase the probability of secondary bacterial co-infection. Therefore, the most important requirement for the empiric therapy agents of CAP is high streptococcal and staphylococcal activity. According to the current guidelines on antimicrobial therapy of severe CAP, antipneumococcic cephalosporins, macrolides, and fluoroquinolones are the basic treatment agents, but none of them have the combined high antistaphylococcal and antipneumococcal activity inherent in ceftaroline. The advantages of ceftaroline over ceftriaxone and levofloxacin in terms of the probability of reaching target concentrations for clinically relevant pharmacokinetic/pharmacodynamic parameters are shown. Meta-analysis of randomized clinical trials showed the higher clinical efficacy of ceftaroline in comparison to ceftriaxone with similar adverse event rate. Summarized analysis of antibiotic susceptibility data, pharmacokinetic/pharmacodynamic and clinical data, as well as negative epidemiological trends confirms the necessity of optimization of antimicrobial therapy of CAP for implementation of ceftaroline advantages against pneumococci and staphylococci in comparison to other β-lactams. Therefore, empiric treatment with ceftaroline is the most rational option for the therapy of CAP in critically ill patients during the season of respiratory viral infection.

scholarly journals Executive Summary: 2015 Infectious Diseases Society of America (IDSA) Clinical Practice Guidelines for the Diagnosis and Treatment of Native Vertebral Osteomyelitis in Adultsa

2015 ◽  
Vol 61 (6) ◽  
pp. 859-863 ◽  
Author(s):  
Elie F. Berbari ◽  
Souha S. Kanj ◽  
Todd J. Kowalski ◽  
Rabih O. Darouiche ◽  
Andreas F. Widmer ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Clinical Practice ◽  
Practice Guidelines ◽  
Antimicrobial Therapy ◽  
Healthcare Professionals ◽  
Surgical Intervention ◽  
Vertebral Osteomyelitis ◽  
Executive Summary ◽  
Orthopedic Surgeons ◽  
Infectious Disease Specialists

Abstract These guidelines are intended for use by infectious disease specialists, orthopedic surgeons, neurosurgeons, radiologists, and other healthcare professionals who care for patients with native vertebral osteomyelitis (NVO). They include evidence and opinion-based recommendations for the diagnosis and management of patients with NVO treated with antimicrobial therapy, with or without surgical intervention.

Short-Course Antimicrobial Therapy for Pediatric Community-Acquired Pneumonia

2021 ◽  
Author(s):  
Jeffrey M. Pernica ◽  
Stuart Harman ◽  
April J. Kam ◽  
Redjana Carciumaru ◽  
Thuva Vanniyasingam ◽  
...  
Keyword(s):  
Antimicrobial Therapy ◽  
Community Acquired Pneumonia ◽  
Short Course

Short-Course Antimicrobial Therapy for Community-Acquired Pneumonia

2005 ◽  
Vol 4 (4) ◽  
pp. 231-239 ◽  
Author(s):  
Martin Kolditz ◽  
Michael Halank ◽  
Gert H??ffken
Keyword(s):  
Antimicrobial Therapy ◽  
Community Acquired Pneumonia ◽  
Short Course

scholarly journals Effectiveness of antimicrobial therapy for community-acquired pneumonia in real clinical practice

2022 ◽  
Vol 20 (4) ◽  
pp. 79-85
Author(s):  
O. M. Uryasev ◽  
A. V. Shakhanov ◽  
L. V. Korshunova
Keyword(s):  
Clinical Practice ◽  
Antimicrobial Therapy ◽  
Treatment Effectiveness ◽  
Complete Blood Count ◽  
Community Acquired Pneumonia ◽  
Hospitalized Patients ◽  
Important Place ◽  
Therapy Regimen ◽  
Empiric Antimicrobial Therapy ◽  
Real Clinical Practice

Background. Community-acquired pneumonia (CAP) remains one of the most common infectious diseases, occupying an important place in the structure of mortality worldwide.Aim. To evaluate the effectiveness of antimicrobial therapy for community-acquired pneumonia in hospitalized patients in real clinical practice.Materials and methods. A retrospective, observational study was conducted, which included 236 patients hospitalized for community-acquired pneumonia at the Regional Clinical Hospital in Ryazan in 2019. Based on these case histories, an analysis of the effectiveness of the initial empiric antimicrobial therapy was performed.Results. The initial empiric antimicrobial therapy in 73% of cases included administration of ceftriaxone, in 45% of cases – levofloxacin, in 14% of cases – azithromycin. It was found that initial antimicrobial therapy was effective in 58% of patients who did not require replacement for the antibiotic. A need for a change in the treatment regimen was significantly associated with an increase in the length of hospitalization (p < 0.001), heart rate upon admission (p = 0.032), myelocyte count in the complete blood count (p < 0.001), and urea and blood creatinine levels (p = 0.004 and p = 0.044, respectively). The selected antimicrobial therapy regimen was significantly associated with the expected treatment effectiveness (p = 0.039). The choice of levofloxacin in monotherapy or in combination with ceftriaxone was accompanied by a decrease in the relative risk of replacing the antimicrobial, compared with other treatment regimens (odds ratio (OR) = 0.86 (95% confidence interval (CI): 0.55–1.34) and OR = 0.57 (95% CI: 0.37–0.87), respectively).Conclusion. Empiric antimicrobial therapy for community-acquired pneumonia in real clinical practice complies with current recommendations, however, at the same time, its ineffectiveness persists. Respiratory fluoroquinolones are most effective in treating pneumonia in hospitalized patients. 

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