Sunday, November 27, 2022

Broad Spectrum Antibiotics For Pneumonia

Offset The Damage To Your Microbiome

What is Doxycycline?

One of the rules of the Plant Paradox Program is take care of your gut microbes and theyll take care of you. Your microbes are key to keeping you healthy they help you digest and get nutrients from food, they assist your immune system, they help control hormones and appetite, and they keep bad microbes at bay. To allow them to do their jobs, you need to eliminate the broad-spectrum antibiotics, antacids, NSAIDs, and processed foods that kill off your ecosystem of microbes.

Controlling Resistance By Proper Duration Of Therapy

Clinical pulmonary infection score for patients treated with antimicrobials for ventilator-associated pneumonia . *P< .001, vs. 3 days before onset of VAP P = .0083 P = .0051.

For patients with VAP who are at a high risk of infection due to multidrug-resistant pathogens, initial therapy with aerosolized antimicrobial agents, combined with systemically administered agents, may result in good clinical outcomes and permit shortening the duration of treatment . This finding is in contrast to those of previous experiences with aerosol administration of antimicrobials for the prevention of pneumonia in seriously ill patients . Given the poor distribution of aminoglycosides from serum into respiratory secretions and the high risk of toxicity, targeted adjunctive therapy with aerosolized aminoglycosides, used with parenteral administration of either the same or another class of antimicrobial agents, may facilitate successful treatment of multidrug-resistant strains. Aerosolized delivery of aminoglycosides provides local concentrations that exceed by several fold those achieved with parenteral administration without systemic toxicity .

What Did The Research Team Do

The research team did two studies. In both studies, children were ages 6 months to 12 years.

In the first, the research team looked at health records for 30,159 children who used broad- or narrow-spectrum antibiotics to treat ear, sinus, or throat infections. Of the children, 63 percent were white, 16 percent were mixed or another race, 12 percent were black, and 8 percent were Hispanic. The average age was 5, and 52 percent were boys. The team looked at how often treatment worked and whether patients had side effects in the month after diagnosis.

The second study included 2,472 children. All children had an ear, sinus, or throat infection. The research team interviewed parents and children about quality of life, how long symptoms lasted, and side effects after the children got antibiotics. Of the children, 59 percent were white, 23 percent were black, 8 percent were another race, and 9 percent were Hispanic. The average age was 5, and 52 percent were boys. All were patients at one of 31 childrens clinics in Pennsylvania or New Jersey.

Children, parents, and physicians helped plan and conduct the study.

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Rethinking The ‘more Is Better’ Mantra

For Michael Klompas, MD, MPH, a professor of population medicine at Harvard Medical School and author of an editorial that accompanies the study, the data from this analysis and other studies make a compelling argument that broad-spectrum antibiotics for pneumonia should be avoided until it’s clear they are needed.

“The messages are clear: empirical coverage with broad-spectrum agents is not indicated in most patients being treated for pneumonia, and if the diagnosis of pneumonia is uncertain, there is no harm and likely some benefit in taking some time to acquire more diagnostic clarity before treating , so long as the patient is clinically stable,” he writes.

Valerie Vaughn, MD, a hospitalist at the University of Michigan’s academic medical center who was not involved in the study, says the findings are significant because there’s long been a concern among clinicians that CAP patients are being overtreated, given the fact that MRSA is still a very rare cause of pneumonia.

“There was this growing sense that we’d swung the pendulum too far, and were very focused on trying to make sure that we didn’t miss any patients with MRSA, so anybody that had a risk for MRSA we treated with vancomycin,” Vaughn said. “We really focused on the risk of missing patients that might have MRSA, and less about the potential harms of overtreating what is a much larger number of patients who don’t have MRSA pneumonia.”

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Impact Of Resistance On Outcomes

Guiding Broad

Nosocomial infections increase mortality rates among critically ill patients, with nosocomial pneumonia being no exception. In a case-control study, Fagon et al. showed that half of deaths occurring among patients undergoing ventilation were attributable to nosocomial pneumonia. Identity of the causative pathogens, use of inappropriate antimicrobial therapy, and severity of illness were identified as risk factors for the attributable mortality .

Mortality rate associated with ventilator-associated pneumonia, by appropriateness and time of initiation of antimicrobial therapy. Post result denotes results obtained after culture data were known. BAL, bronchoalveolar lavage. *P< .001. Adapted from Luna et al. .

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Stick With Simple Antibiotics For Pneumonia To Avoid Super Bugs Says Researcher

Date:
University of Melbourne
Summary:
Australian hospitals should avoid prescribing expensive broad-spectrum antibiotics for pneumonia to avoid the development of more drug-resistant super bugs, according to a new study.

Australian hospitals should avoid prescribing expensive broad-spectrum antibiotics for pneumonia to avoid the development of more drug-resistant super bugs, according to a University of Melbourne study.

The study, by PhD researcher and Austin Health Infectious Diseases consultant, Dr Patrick Charles, shows that only 5 per cent of people admitted to hospital with community-acquired pneumonia had infections caused by organisms that could not be successfully treated with penicillin combined with an “atypical” antibiotic such as doxycycline or erythromycin.

In the world’s largest study of its kind, Dr Charles studied almost 900 people admitted to six Australian hospitals over 28 months from 2004 to 2006.

Dr Charles’ research analysed samples of blood, urine, sputum and viral swabs of the nose and throat taken from 885 patients at the Austin, Alfred, Monash and West Gippsland hospitals in Victoria, the Royal Perth Hospital and Princess Alexandra Hospital, Brisbane.

He found that most cases of pneumonia were caused by easy to treat bacteria such as the pneumococcus or Mycoplasma, or alternatively by respiratory viruses that do not require antibiotic therapy.

In addition, the fear of litigation made some doctors unnecessarily opt for more aggressive treatments.

Data Source And Patient Population

We used data from the Pediatric Health Information System database . The PHIS administrative database contains clinical and billing data from 43 freestanding, tertiary care childrens hospitals and accounts for 20% of all US pediatric hospitalizations. Data quality is ensured through a joint effort between the Childrens Hospital Association and participating hospitals as described previously.15 In accordance with the Common Rule ), and the policies of the Cincinnati Childrens Hospital Medical Center Institutional Review Board, this research, using a deidentified data set, was not considered human subjects research.

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Epidemiology Of Pneumonia In Internal Medicine

The burden of Gram-positive in pneumonia is central , and Streptococcus pneumoniae is the most common bacteria causing CAP. Furthermore, approximately 16% of nosocomial types of pneumonia are a consequence of S. aureus infection . There is a close connection between influenza A virus disease and the subsequent or concurrent S. aureus infection: influenza A virus may increase the adhesion of S. aureus to respiratory tract cells boosts its proteases and simultaneously enhancing viral replication . For the above reasons, nasal carriers of S. aureus, which include from 20% to 83.7% of the general population, are at high-risk for secondary staphylococcal-pneumonia following influenza A .

Length Of Stay In Hospital Clinical Failure 30 Day Mortality

What is meant by the term broad spectrum antibiotics ? Explain….

In the intention-to-treat and evaluable study population, no significant difference in LOS was detected between the two treatment groups. In the intention-to-treat population, patients in the PDT group remained in hospital for an average of 14.3 days compared with 13.2 days for the EAT group . In the evaluable patient population, LOS in the PDT and EAT groups was 13.7 days and 12.8 days, respectively .

Table 4

Clinical efficacy of treatment in the two treatment groups

In neither the intention-to-treat population nor the evaluable patient population was any significant difference found in clinical failures between the two treatment groups . In the evaluable population, 26 in the PDT group and 27 in the EAT group suffered a clinical failure on antibiotic treatment . In the PDT group, clinical failure occurred in 15 of 62 patients who were treated according to rapidly obtained microbial results, and in 11 of 72 patients who were treated according to a syndromic approach . In the EAT group, mortality after inadequate treatment occurred in two patients infected with S aureus and in two other patients no pathogen could be identified .

Patients in both groups were treated for a mean period of 5 days with IV antibiotics and completed their treatment course after 10.8 days in the PDT group and 9.9 days in the EAT group. Patients were afebrile by day 3 of treatment .

Secondary outcome parameters

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How Your Doctor Chooses

Your doctor will select the right antibiotic for you based on multiple factors, including:

  • Your age: People 65 and older have a greater risk of serious complications from pneumonia infections.
  • Your health history: A history of smoking, lung diseases, or other conditions may influence a person’s ability to fight off infections.
  • The exact infection you have: Your doctor may take a sample and test it for bacteria. They can then pick an antibiotic based on your specific infection.
  • Your previous experiences with antibiotics: Make sure to tell your doctor if you are allergic to any medications, had bad reactions to antibiotics in the past, or have developed an antibacterial-resistant infection.
  • The antibiotic sensitivity of the bacteria: The lab will test the bacteria causing your pneumonia to determine which antibiotics it is sensitive or resistant to.

Doctors typically choose your antibiotics prescription based on what medicines they think will be most effective and cause the fewest side effects.

What Is The Role Of Broad

Broad-spectrum antibiotics may be added to treat bacterial superinfection in cases of fulminant amebic colitis and suspected perforation. Bacterial coinfection of amebic liver abscess has occasionally been observed , and adding antibiotics to the treatment regimen is reasonable in the absence of a prompt response to nitroimidazole therapy.

Loperamide should be avoided in the treatment of amebic colitis.

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Whats Known On This Subject:

Recent guidelines for the management of childhood pneumonia recommend narrow-spectrum antimicrobial agents for most children however, few studies have directly compared the effectiveness of narrow-spectrum agents to the broader spectrum third-generation cephalosporins commonly used among children hospitalized with pneumonia.

When Not To Use Antibiotics

Overuse of broad

Antibiotics are not the correct choice for all infections. For example, most sore throats, cough and colds, flu, COVID or acute sinusitis are viral in origin and do not need an antibiotic. These viral infections are self-limiting, meaning that your own immune system will usually kick in and fight the virus off.

Using antibiotics for viral infections can increase the risk for antibiotic resistance. Antibiotic-resistant bacteria cannot be fully inhibited or killed by an antibiotic, even though the antibiotic may have worked effectively before the resistance occurred. This can also lower your options for effective treatments if an antibiotic is needed eventually due to a secondary infection. Using unnecessary antibiotics also puts you at risk for side effects and adds extra cost.

Its important not to share your antibiotic or take medicine that was prescribed for someone else, and dont save an antibiotic to use the next time you get sick. It may not be the right drug for your illness.

To better understand antibiotics, its best to break them down into common infections, common antibiotics, and the top antibiotic classes as listed in Drugs.com.

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Case Reports Of Antibacterial Therapy In Covid

These clinical reports provide insights into the complications and challenges faced in treating SARS-CoV-2 infected patients. Patients with pneumonia caused by other respiratory viruses or SARS-CoV-2 pneumonia patients were often prophylactically treated with broad-spectrum antibiotics, in an attempt to reduce the risk of bacterial superinfections. Complications were observed in patients that were not treated with antibiotics. Antibiotic-resistant infections, in particular, nosocomial – hospital-acquired – infections were common for more than one third of ICU patients, posing a threat to disease progression, often resulting in the death of the affected individual .

Perioperative Considerations And Postoperative Care

Broad-spectrum antibiotics are recommended to prevent infection after any stage. In the first stage of phalloplasty, a special dressing and fixation of the neophallus in an elevated position are used to prevent pedicle kinking. After each stage of urethral reconstruction, a suprapubic catheter is placed for a period of 3 weeks to allow for a satisfactory healing of the neourethra. When the urethral plate is being reconstructed using the buccal mucosa graft, the buccal mucosa graft should undergo a special treatment that includes wetting of the graft every 3 hours during the first 72 hours, and then treatment with antibiotic ointment and moisturizing cream with gentle massage for a period of at least 6 months to prepare the urethral plate for tubularization. After penile prosthesis implantation, special care should be taken to prevent infection and rejection, together with antibiotic prophylaxis.66 Patients are advised to refrain from physical activity for a period of 2 months after phalloplasty, and sexual intercourse should be avoided after penile prosthesis implantation for a period of 8 weeks postoperatively.

Robert P. Marini, James G. Fox, in, 2002

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  • macrolides
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When buying antibiotics online at discounted prices, you may reduce the cost of each antimicrobial agent dose, and reduce the overall cost of an infectious disease treatment.

Before you place your order, you may ask questions about the antibiotics to an online pharmacy pharmacist. When applying for a confidential advice of the pharmacist, you may get information about the different dosage forms, therapeutic properties, producers and delivery options of the antibiotics.

Antibiotic Route Of Administration

Broad spectrum antibiotics.
  • Intravenous antibiotics switching to oral antibiotics after 2 to 4 days if there was clinical improvement was not significantly different to continuous intravenous antibiotics for mortality, treatment success or recurrence of infection in adults with moderate to high severity community-acquired pneumonia. However, there were significantly fewer days in hospital and adverse events with the switch to oral antibiotics .

  • Oral antibiotics were not significantly different to intravenous or intermuscular penicillins for clinical failure rate in children and young people with non-severe community-acquired pneumonia .

  • Oral antibiotics were significantly better than intravenous or intramuscular penicillins for mortality , in children and young people with severe community-acquired pneumonia. However, there were no significant differences in the rates of cure, clinical failure, hospitalisation or relapse, including when oral amoxicillin was analysed separately .

Committee discussions on antibiotic route of administration

In line with the NICE guideline on antimicrobial stewardship and Public Health England’s Start smart then focus, the committee agreed that if intravenous antibiotics are used initially, this should be reviewed by 48 hours and switched to oral treatment where possible.

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Intensive Care Admission And 14

One hundred and fifty six children receiving broad-spectrum therapy and 13 children receiving narrow-spectrum therapy were admitted to intensive care after the first 2 days of hospitalization . Readmissions within 14 days of discharge did not differ between those receiving broad-spectrum therapy and narrow-spectrum therapy . In multivariable analyses, the odds of admission to intensive care and 14-day readmission did not significantly differ between children treated with broad- versus narrow-spectrum antimicrobial therapy .

Inappropriate Antibiotic Use In Children With Community

Macrolides and broad-spectrum antibiotics are the most commonly prescribed antibiotics for ambulatory children with community acquired pneumonia , despite guidelines recommending the use of narrow-spectrum aminopenicillins, according to data published in The Journal of Pediatrics.

Among 252,177 Medicaid-enrolled children discharged from an ambulatory care setting with a diagnosis of CAP, the median patient age was 4 years , 57,565 children had a history of asthma, and 34,104 children had an asthma co-diagnosis at the initial visit.

Macrolide monotherapy was prescribed in 43.2% of cases. Narrow- and broad-spectrum antibiotics were prescribed to 26.1% of children and 24.7% of children, respectively. A combination of a macrolide and narrow- or broad-spectrum antibiotic was used in 11,719 children , and macrolide use increased with increasing age . Investigators also observed an increase in narrow-spectrum antibiotic use from 20.1% to 31.8%, decrease in broad-spectrum antibiotic use from 28.8% to 21.2%, and decrease in macrolide monotherapy use from 45.8% to 40.5% from 2010 to 2016 .

Limitations of the study includes inability to generalize to all US children, use of administrative claims database that limits the analysis of clinically relevant variables, and the inability to rule out residual confounding from severity.

Reference

This article originally appeared on Infectious Disease Advisor

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No Benefit Increased Risk Of Harm

The strategy goes back to the 2005 guidelines from the American Thoracic Society and the Infectious Diseases Society of America for treatment of adults who have community-acquired pneumonia . Those guidelines recommended that pneumonia patients who lived in nursing homes or had been in the hospital in the previous 90 days should be labeled as having healthcare-associated pneumonia and treated empirically with broad-spectrum antibiotics like vancomycin or piperacillin-tazobactam to cover for the possibility that the pneumonia was caused by MRSA or Pseudomonas.

Subsequently, a 2015 study of patients in the Department of Veterans Affairs healthcare system found that, after those guidelines were published, a substantial shift in treatment of CAP patients occurred, with the proportion of vancomycin prescribing rising from 16% in 2006 to 31% in 2010 and piperacillin-tazobactam prescribing jumping from 16% to 27%. This shift occurred even though less than 5% of patients in the study had resistant bacteria detected.

But it’s unclear which patients, and how many, are benefitting from the use of more potent antibiotics.

To get a better sense of how empiric broad-spectrum therapy is affecting clinical outcomes in CAP patients, a team led by investigators from the VA Salt Lake City Health Care System and the University of Utah conducted a retrospective cohort study of all CAP hospitalizations in the VA health care system from 2008 through 2013.

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