A total of 80 cases of acute exacerbation of chronic obstructive pulmonary disease admitted in pulmonary medicine ward in Siddhartha medical college, Vijayawada during the period of 18 months one & half year Jan 2008 to June 2009 of 55 years to 75 years of both males 81% to 19% were females. The three commonest organisms isolated were: 1. Pseudomonas aeruginosa in 23 cases, 2. Klebsiella pneumonia in 18 cases, and 3. Staphylococcus aureus in 14 cases. Antibiotics therapy either with levofloxacin or intravenous cefotaxime can be given if the exacerbation is not severe in case of gram negative infection. When the infection is severe, combination antibiotic therapy with cefotaxime and gentamicin or ciprofloxacin & gentamicin should be started. In cases where the infection is very severe or when the isolates are resistant to quinolones or aminoglycosides then newer antibiotics like pipericillin + Tazobactam and cefoperazone + sulbactam can be started

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Lower respiratory tract infections (LRTIs) are among the most common infectious disease of humans worldwide and continue to be a major cause of morbidity. The overuse and misuse of antibiotics have been related to the growing emergence of bacterial resistance, increased incidence of adverse effects and prolonged hospitalization. This article focuses on bacterial infections, which includes the larynx, trachea, bronchi, and lung parenchyma. The main objective of this study is Therapeutic evaluation of various antibiotics in LRTI, and to study the demographic profile of patients, co-morbid conditions and clinical presentation of patients diagnosed with LRT infections. We conducted a single centre, prospective observational study by selecting patients who are diagnosed to have LRTI, patient case sheets were reviewed for antibiotics, co-morbid conditions, chest x-ray reports and different lab parameters in adults who are above 18 years prescribed at Government Fever Hospital, Guntur. A total of 335 patient case sheets were reviewed in the present study during the study period. In this study we observe that the most frequently prescribed antibiotics are higher percentage of patients using Cephalosporins (51.14%) followed by Macrolides (17.09%), Metronidazole (12.58%), Penicillin's (7.66%), Aminoglycosides (3.41%), Doxycycline (3.41%), Fluoroquinolones (3.27%), Carbapenems (1.30%) and other classes of drugs. This study concludes that LRTI usually causes minor illness, but may result in significant morbidity and mortality. Better lay and professional awareness of the often prolonged course of LRTI may improve understanding and appropriate use of antibiotics. Health care professionals are increase the awareness for improving quality of life in critically ill LRT infectious patients and preventing further complications.

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A 60 year female, housewife, presented with recurrent cough, breathlessness, hemoptysis from the past 20 yrs. Hemoptysis turned severe since 6 yrs., along with expectaration. Her family history is not significant. Patient has typical clubbing of all digits. On examination of chest, there is B/L wasting of muscles and increased hollowness of apical chest, trachea in midline, apical impulse normal in 5 th left ICS. Vocal tactile fremitus decreased on B/L supra and infraclavicular areas, impaired note present. Fine mid inspiratory crepts, not altered with cough. No post tussive suction noted. Bronchial breath sounds present with decreased VR, due to a fungal ball occupying B/L apical fibrocavities. Patient maintaining normal oxygen saturation, but during bouts of Hemoptysis, there is a fall in oxygen saturation, along with breathlessness. Sputum for afb negative at RNTCP (1) culture of fungal elements positive. FOB BAL fluid sent for culture. Aspergillus fumigates is isolated. On Trendelenberg position, CXR revealed B/L apical fibrocavity with fungal ball. HRCT revealed B/L apical fibrocavity with fungal ball with air crescent sign positive on both sides.