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Drug treatment ineffective for acute bronchitis

A study published in the BMJ indicates that neither oral antibiotics nor nonsteroidal anti-inflammatory drugs (NSAIDs) are more effective than placebo for the treatment of acute bronchitis.

“Most of these infections are self limiting, and several studies have suggested that the benefit of antimicrobial treatment is marginal. However, most patients with acute bronchitis receive antibiotics, even in countries with low rates of antibiotic prescribing,” say authors Carl Llor (Cardiff University, UK) and colleagues.

“This over-prescription constitutes a global problem and is an important factor in increasing the levels of antibiotic resistance.”

The study involved 416 patients presenting to their general practitioner with cough, discolored sputum, and at least one other criterion for lower respiratory tract infection: dyspnea, wheezing, chest discomfort, or chest pain.

They were randomly assigned to receive an NSAID (n=136), an antibiotic (n=137) or placebo (n=143) for 10 days, and completed a symptom diary assessing disease severity, daytime cough, nighttime cough, limitation in daily activities, and febrile sensation for a maximum of 30 days.

The researchers found that there was no significant difference in the median number of days with frequent cough between the groups, at 9, 11, and 11 days, respectively. And neither active treatment was associated with an increased likelihood for cough resolution compared with placebo, including after adjustment for confounders.

Furthermore, patients in the antibiotic group were significantly more likely to report adverse events than patients in the ibuprofen or placebo groups (12 vs 5 and 3%, respectively).

Llor et al say that while previous research supports the efficacy of antibiotic treatment for purulent exacerbations of chronic obstructive pulmonary disease, their findings show that this “cannot be extrapolated to people with milder acute bronchitis without underlying pulmonary disease, even if they produce discoloured sputum.”

They add that the results support previous negative findings into the impact of antibiotics on acute cough duration, and add to scant data on a role for NSAIDs in acute respiratory tract infection.

“These findings have important implications for the daily clinical practice of doctors,” the team concludes.

Pseudomonas aeruginosa infection in patients with cystic fibrosis: scientific evidence regarding clinical impact, diagnosis, and treatment

The objective of this review was to address current concepts related to the clinical impact, diagnosis, and treatment of Pseudomonas aeruginosa infections in patients with cystic fibrosis.

For the preparation of this review, the authors defined a group of questions that would be answered in accordance with the principles of PICO–an acronym based on questions regarding the Patients of interest, Intervention being studied, Comparison of the intervention, and Outcome of interest. For each question, a structured review of the literature was performed using the Medline database in order to identify the studies with the methodological design most appropriate to answering the question.

The questions were designed so that each of the authors could write a response. A first draft was prepared and...

Clinical profile of recurrent community-acquired pneumonia in children.

The aim of this case--control study was to analyse the clinical characteristics of children with recurrent community-acquired pneumonia (rCAP) affecting different lung areas (DLAs) and compare them with those of children who have never experienced CAP in order to contribute to identifying the best approach to such patients.

METHODS: The study involved 146 children with >=2 episodes of radiographically confirmed CAP in DLA in a single year (or >=3 episodes in any time frame) with radiographic clearing of densities between occurrences, and 145 age- and gender-matched controls enrolled in Milan, Italy, between January 2009 and December 2012. The demographic and clinical characteristics of the cases and controls were compared, and a comparison was also made between the cases with rCAP (i.e. <=3 episodes) and those with highly recurrent CAP (hrCAP: i.e. >3 episodes).

RESULTS: Gestational age at birth (p = 0.003), birth weight (p = 0.006), respiratory distress at birth (p < 0.001), and age when starting day care attendance (p < 0.001) were significantly different between the cases and controls, and recurrent infectious wheezing (p < 0.001), chronic rhinosinusitis with post-nasal drip (p < 0.001), recurrent upper respiratory tract infections (p < 0.001), atopy/allergy (p < 0.001) and asthma (p < 0.001) were significantly more frequent. Significant risk factors for hrCAP were gastroesophageal reflux disease (GERD; p = 0.04), a history of atopy and/or allergy (p = 0.005), and a diagnosis of asthma (p = 0.0001) or middle lobe syndrome (p = 0.001). Multivariate logistic regression analysis, adjusted for age and gender, showed that all of the risk factors other than GERD and wheezing were associated with hrCAP.

CONCLUSIONS: The diagnostic approach to children with rCAP in DLAs is relatively easy in the developed world, where the severe chronic underlying diseases favouring rCAP are usually identified early, and patients with chronic underlying disease are diagnosed before the occurrence of rCAP in DLAs. When rCAP in DLAs does occur, an evaluation of the patients' history and clinical findings make it possible to limit diagnostic investigations.

Exogenous surfactant therapy in 2013: what is next? who, when and how should we treat newborn infants in the future?

Surfactant therapy is one of the few treatments that have dramatically changed clinical practice in neonatology. In addition to respiratory distress syndrome (RDS), surfactant deficiency is observed in many other clinical situations in term and preterm infants, raising several questions regarding the use of surfactant therapy.

Objectives: This review focuses on several points of interest, including some controversial or confusing topics being faced by clinicians together with emerging or innovative concepts and techniques, according to the state of the art and the published literature as of 2013. Surfactant therapy has primarily focused on RDS in the preterm newborn. However, whether this treatment would be of benefit to a more heterogeneous population of infants with lung diseases other than RDS needs to be determined.

Early trials have highlighted the benefits of prophylactic surfactant administration to newborns judged to be at risk of developing RDS. In preterm newborns that have undergone prenatal lung maturation with steroids and early treatment with continuous positive airway pressure (CPAP), the criteria for surfactant administration, including the optimal time and the severity of RDS, are still under discussion. Tracheal intubation is no longer systematically done for surfactant administration to newborns. Alternative modes of surfactant administration, including minimally-invasive and aerosolized delivery, could thus allow this treatment to be used in cases of RDS in unstable preterm newborns, in whom the tracheal intubation procedure still poses an ethical and medical challenge.

CONCLUSION: The optimization of the uses and methods of surfactant administration will be one of the most important challenges in neonatal intensive care in the years to come.

Incidence and risk of lung cancer in HIV-infected patients

Lung cancer is one of the most common non-AIDS-defining malignancies among HIV-infected patients. The incidence of lung cancer has significantly increased in the HIV-positive population in recent years. The purpose of this study was to summarize the incidence and risk of lung cancer in published population-based studies of people with HIV/AIDS.

Methods : Published literature from PubMed, Embase, the Web of Science, and Google Scholar was retrieved. Sixty-five publications were selected and assessed for the following parameters: research coverage and location; continent; study period; duration of follow-up; lung cancer cases; HIV cases; incidence rate; and overall SIR or adjusted IRR. In addition, the risk of lung cancer was compared based on age, gender, HIV exposure category, CD4 count, and periods with highly active antiretroviral therapy (HAART).

Conclusion : Our study suggests an increase in the incidence and risk of lung cancer in HIV/AIDS population is worldwide. The effect of HAART on the incidence and risk of lung cancer is in dispute. The risk of lung cancer based on gender differences, especially among females, as well as IDUs, requires further investigation.

 

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