Treatment of community-acquired lower respiratory tract infections in adults

Abstract

Community-acquired lower respiratory tract infection (LRTI) is a common cause of acute illness in adults. The spectrum of disease ranges from a mild mucosal colonisation or infection, acute bronchitis or acute exacerbation of chronic bronchitis/chronic obstructive pulmonary disease (AE-CB/COPD), to an overwhelming parenchymal infection with the patient presenting with severe community-acquired pneumonia (CAP).Although the great majority of LRTIs are self-limiting viral infections, CAP is most often a bacterial disease with a substantial mortality. Thus, antibiotic treatment is rarely indicated for acute bronchitis and is only indicated for the more severe cases of AE-CB/COPD, but it is nearly always indicated for CAP, for which a delay in treatment may increase the risk of a fatal outcome. It may be difficult to differentiate between a viral and a bacterial LRTI, or between bronchitis/AE-CB/COPD and CAP. This may be one reason why antibiotics are prescribed to more than two-thirds of patients with LRTIs in Europe and the USA. Considering the worldwide development of antibiotic resistance, this is not an acceptable situation.Since an empirical approach is nearly always necessary in the management of LRTI, greater emphasis must be placed on the decision of whether or not to prescribe an antibiotic at all. This decision should be based on an assessment of the severity of the disease, including underlying risk factors, and on markers for bacterial/parenchymal/invasive LRTI. The choice of empirical therapy must be based on the same data together with epidemiological information. The choice of antibiotic must always coverStreptococcus pneumoniae, which remains the main pathogen of morbidity and mortality in CAP. In hospital, attempts should be made to obtain an aetiological diagnosis in order to be able to switch to a specific treatment or to evaluate a failure of empirical therapy.Several guidelines for the management of community-acquired pneumonia have been published during the last 10 yrs. Some reports indicate that the implementation of such guidelines has resulted in lowered costs, length of stay in hospital and mortality. However, the results from these studies are not consistent and the evidence is still weak.

Antimicrobial Resistance among Respiratory Pathogens in Spain: Latest Data and Changes over 11 Years (1996-1997 to 2006-2007)

“…Continuing surveillance for the antibiotic resistance of respiratory pathogens is a recognized public health need, particularly in those countries with high resistance rates, since initial antimicrobial treatment for patients with bacterial communityacquired respiratory tract infections (CARTIs) is usually selected empirically and should provide appropriate coverage against the most common causative organisms (35).…”

Resource use and costs of treating acute cough/lower respiratory tract infections in 13 European countries: results and challenges

“…Depending on the seriousness of the symptoms and disease, patients may also be hospitalised. However, there is no clear standard used to determine whether a patient should be hospitalised or not [2]. In groups such as the elderly, prognostic models have been developed to determine whether patients should be referred to hospital or not [7].…”

“…Acute cough/lower respiratory tract infection (acute cough/LRTI) accounts for about 10% of all mortality and morbidity cases worldwide [1] and is the most common cause of lost working hours in adults [2]. Acute cough/ LRTI can be viral or bacterial.…”

Respiratory infections and tuberculosis

“…Finally, ORTQVIST [10] reviewed current treatment of community-acquired pneumonia. The second part of the symposium dealt with TB.…”