Efficacy and Safety of Intravenous Moxifloxacin Versus Cefoperazone with Azithromycin in the Treatment of Community Acquired Pneumonia

Summary： To compare the efficacy, safety, and tolerability of intravenous moxifloxacin with those of a commonly used empirical antibiotic regimen, cefoperazone and azithromycin in the treatment of community acquired pneumonia （CAP） in adult patients requiring initial parenteral therapy, 40 patients with CAP were divided into two groups, a moxifloxacin group （n=20） and a control group （n=20）, which were treated for 7 to 14 days. The patients in the moxifloxacin group were intravenously given 400 mg of moxifloxacin （AveloxR） once a day. Patients in the control group were administered 2.0 g of cefoperazone twice a day and azithromycin 0.5 g once a day. Clinical, bacteriological, and laboratory examinations were performed before the treatment, and at the end of the treatment. Our results showed that there was no significant difference in the clinical efficacy rate between two treatment groups at end of therapy （90 % for moxifloxacin, 95 % for cefoperazone plus azithromycin） （P〉0.05）. The bacteriologic eradication rate at the end of treatment was 90 % in the moxifloxacin group and 80 % in the cefoperazone-plus-azithromycin group, whereas there was no significant difference between the two groups （P〉0.05）. In addition, both drugs were well-tolerated in this trial, with the number of drug-related adverse events being comparable. It is concluded that moxifloxacin is an effective and well-tolerated treatment for CAP and was equivalent to the com- monly used empirical treatment of cefoperazone plus azithromycin. Moxifloxacin is likely to offer clinicians an alternative for reliable empirical CAP treatment in the face of increasing antibiotic resistance.

Pseudomonas aeruginosa Community Acquired Pneumonia with Septicemia in a Previously Healthy Woman

A previously healthy 53-year-old woman was urgently hospitalized due to septic shock. She was diagnosed with bacterial pneumonia based on chest radiograph and computed tomography findings of right upper lobe consolidation. Sputum Gramstain at the time of admission showed gram-negative rods with phagocytosis. Intravenous meropenem was immediately initiated as empiric antibacterial therapy. Bacterial culture specimens from sputum and blood were positive for Pseudomonas aeruginosa. Following appropriate antibiotic therapies, the patient recovered from a shock state and gradually became well. There has been no evidence of recurrence at 6 months after discharge. P. aeruginosa community acquired pneumonia with septicemia is rapidly progressive and often fatal. The choice of initial empiric antibiotic treatment that is active against P. aeruginosa is critical in improving outcome.

Study on inflammatory factors and curative effect of Rhizoma Imperata on community acquired pneumonia based on TLR4/NF-κB signaling pathway

Objective:To investigate the curative effect of Rhizoma Imperata in the treatment of patients with community-acquired pneumonia and its influence on inflammatory factors related to TLR4/NF-κB signaling pathway,so as to seek new drugs for the treatment of community-acquired pneumonia.Methods:120 patients with community-acquired pneumonia who were treated in Department of respiratory medicine,the First Affiliated Hospital of Hainan Medical College from November 2019 to September 2020 were collected and randomly divided into control group and experimental group,with 60 patients in each group.The control group was given cefuroxime sodium injection,and the experimental group was given cefuroxime sodium injection+Baimao root decoction.The levels of high-sensitivity C-reactive protein(CRP)and the level of serum CRP in the two groups before and after treatment were compared Objective To observe the expression of procalcitonin(PCT),IL-6,IL-8,TNF-αand TLR4/NF-κB mRNA levels,and to observe the effect of Radix Imperata Rubra on community-acquired pneumonia.Results:The fever,cough,expectoration subsided time and chest CT inflammation absorption time of the experimental group were shorter than those of the control group,the difference was statistically significant(P<0.05);the total effective rate of the experimental group(96.67%)was higher than that of the control group(85%),the difference was statistically significant(P<0.05);after treatment,the serum CRP,PCT,IL-6,IL-8,TNF-αin the two groups were lower than before,and the experimental group was significantly lower than the control group,the difference was statistically significant(P<0.05),There was statistical significance(P<0.05);after treatment,TLR4/NF-κB mRNA of the two groups were decreased,and the experimental group was significantly lower than the control group,the difference was statistically significant(P<0.05).Conclusion:In the treatment of cap,Rhizoma Imperata can reduce the levels of CRP,PCT,IL-6,IL-8 and TNF-α.The mechanism is related to inhibiting the activation of TLR4/NF-κB signaling pathway,so as to reduce the release of inflammatory factors and improve clinical symptoms.

Effect of Elephantopus scaber Linn on community acquired pneumonia through TLR4/NF-κB signaling pathway

Objective:To observe the effect of Elephantopus scaber Linn on community-acquired pneumonia and its relationship with the expression of TLR4/NF-κB pathway and the downstream inflammatory cytokines IL-6,IL-8,TNF-α.and to explore its molecular mechanism for the treatment of community-acquired pneumonia,so as to provide new ideas and theoretical basis for the treatment of community-acquired pneumonia.Methods:140 patients with community-acquired pneumonia were randomly divided into observation group and control group,with 70 cases in each group.Observation group:Elephantopus scaber Linn+NS atomized inhalation+intravenous injection of ceftazidine;Control group:intravenous injection of ceftazidine;Meanwhile,70 healthy subjects were selected as the healthy control group.The expressions of TLR4,NF-kB,IL-6,IL-8 and TNF-αin serum of observation group,control group before and after treatment and healthy control group were detected by enzyme linked immunosorbent assay(ELISA),and the efficacy of Elephantopus scaber Linn in the treatment of community acquired pneumonia was observed.Results:Compared with the control group,the observation group was significantly better than the control group in recovery rate,total effective rate,number of days for the disappearance of symptoms such as fever,cough,expectoration,with statistical significance(P<0.05);Compared with the healthy control group,the serum TLR4,NF-κB,IL-6,IL-8,TNF-αwere significantly different(P<0.05)between the observation group and the control group;Serum TLR4,NF-κB,IL-6,IL-8,TNF-αwere significantly different(P<0.05)in the observation group before and after treatment with Elephantopus scaber Linn;Compared with the control group after treatment,there were significantly different(P<0.05)in serum TLR4,NF-κB,IL-6,IL-8 and TNF-αin the observation group after treatment.Conclusion:Serum TLR4,NF-κB,IL-6,IL-8,TNF-αwere highly expressed in patients with community-acquired pneumonia,Elephantopus scaber Linn can decreased the expression of TLR4 and NF-κB in blood,and its downstream inflammatory factors also decreased significantly.There were significantly different(P<0.05)in blood TLR4 and NF-κB between the observation group and the control group after treatment.It is suggested that Elephantopus scaber Linn may inhibit TLR4/NF-kB signal pathway to exert anti-inflammatory effect.Elephantopus scaber Linn has a definite effect and can significantly improve the clinical symptoms,and effectively shorten the treatment cycle.

Steroids in acute respiratory distress syndrome:A panacea or still a puzzle?

Acute respiratory distress syndrome(ARDS)is a unique entity marked by various etiologies and heterogenous pathophysiologies.There remain concerns regarding the efficacy of particular medications for each severity level apart from respiratory support.Among several pharmacotherapies which have been examined in the treatment of ARDS,corticosteroids,in particular,have demonstrated potential for improving the resolution of ARDS.Nevertheless,it is imperative to consider the potential adverse effects of hyperglycemia,susceptibility to hospital-acquired infections,and the development of intensive care unit acquired weakness when administering corticosteroids.Thus far,a multitude of trials spanning several decades have investigated the role of corticosteroids in ARDS.Further stringent trials are necessary to identify particular subgroups before implementing corticosteroids more widely in the treatment of ARDS.This review article provides a concise overview of the most recent evidence regarding the role and impact of corticosteroids in the management of ARDS.

Predictive factors for early clinical response in community-onset Escherichia coli urinary tract infection and effects of initial antibiotic treatment on early clinical response

BACKGROUND Urinary tract infection(UTI)is a common disease.It often requires hospitalization,and severe presentations,including sepsis and other complications,have a mortality rate of 6.7%-8.7%.AIM To evaluate the predictive factors for early clinical response and effects of initial antibiotic therapy on early clinical response in community-onset Escherichia coli(E.coli)urinary tract infections(UTIs).METHODS This retrospective study was conducted at Wonkwang University Hospital in South Korea between January 2011 and December 2017.Hospitalized patients(aged>18 years)who were diagnosed with community-onset E.coli UTI were enrolled in this study.RESULTS A total of 511 hospitalized patients were included.66.1%of the patients had an early clinical response.The mean length of hospital stay in patients with an early clinical response were each 4.3 d shorter than in patients without an early clinical response.In the multiple regression analysis,initial appropriate antibiotic therapy(OR=2.449,P=0.006),extended-spectrum(3-lactamase(ESBL)-producing E.coli(OR=2.112,P=0.044),improper use of broad-spectrum antimicrobials(OR=0.411,P=0.006),and a stay in a healthcare facility before admission(OR=0.562,P=0.033)were the factors associated with an early clinical response.Initial broadspectrum antibiotic therapy was not associated with an early clinical response.CONCLUSION ESBL producing E.coli,and the type of residence before hospital admission were the factors associated with an early clinical response.Appropriateness of initial antibiotic therapy was a predictive factor for an early clinical response,but broadspectrum of initial antibiotic therapy did not impact early clinical response.

Impact of the socioeconomic status on the severity and outcome of community-acquired pneumonia among Egyptian children: a cohort study

Background:Community-acquired pneumonia(CAP)is one of the five leading causes of death among children in developing countries,accounting for approximately three million deaths per year.Identification of the modifiable risk factors of CAP may help to reduce the burden of this disease.In this study,the impact of the socioeconomic status(SES)on the severity and outcome of CAP among Egyptian children was studied.Methods:This was a prospective longitudinal cohort study which included 1,470 children diagnosed with CAP,aged two to 15 years(median age 5.4 years).The diagnosis of CAP was based on clinical and radiological findings.A structured questionnaire and the patients’medical records were used for the data collection.The subjects were divided into two groups:mild and severe CAP.Social and demographic variables were compared,and a multivariate logistic regression analysis was performed.Results:The multivariate analysis showed that a low maternal education level(OR:3.8;95%CI:2.12-6.70;P=.0001),unavailability of adequate medical care(OR:3.1;95%CI:1.99-4.88;P=.0001),a low family income(OR:2.2;95%CI:0.99-4.78;P=.047),and parents’smoking habits(OR:2.0;95%CI:1.15-3.55;P=.014)were significant independent predictive risk factors for severe CAP among Egyptian children.Conclusion:Public health measures against these socio-demographic risk factors should be identified as priorities in order to help reduce the disease burden of deaths from severe CAP among Egyptian children.

Clinical Profile and Outcome of Acute Kidney Injury in Elderly Adults in a Tertiary Hospital in Cameroon

Background: Elderly patients have a high risk of acute Kidney Injury (AKI) due to aging, decreased renal function and the presence of comorbidities. There is limited data on AKI in elderly patients in low income regions, especially in Sub-Saharan Africa. We therefore sought to describe the clinical profile and outcome of AKI in elderly in a tertiary hospital in Cameroon. Methods and Materials: We reviewed the medical records of all patients admitted with the diagnosis of AKI in the internal medicine unit of the Yaounde University Teaching Hospital, from January 2015 to February 2018. Records of elderly patients (≥65 years) were retrieved and analysed. AKI was diagnosed and classified using the KDIGO (Kidney Disease Improving Global Outcomes) 2012 classification. The diagnosis, aetiologies and mechanisms of AKI were clinical. Renal outcomes were evaluated on day 7, 14, 28, 60 and 90 of hospital stay. Results: We included 76 elderly (66% males) patients with a median [interquartile rate—IQR] age of 69 [65 - 75] years. Hypertension (60.5%), diabetes mellitus (36.8%) and heart failure (26.3%) were the most common comorbidities. The median [IQR] Charlson index was 4 [3 - 5]. Infections (47.4%) and hypovolemia (69.7%) were the most frequent risk factors for AKI. AKI was mainly community acquired (89.5%) and most of the patients were in stage 2 (34.2%) or 3 (29%). Pre-renal AKI (58%) was the leading mechanism involved. Hypovolemia and sepsis were the most common aetiologies. Of the 14.5% with indication for dialysis, only 2.6% had access to it. The overall prognosis was good with a mortality rate of 2.6%, complete and partial renal recovery at 3 months of 70%, and 26.3% respectively. Conclusion: AKI in the elderly, in our setting was community-acquired and affected mainly those with comorbidities. Pre-renal AKI was the main mechanism;hypovolemia and sepsis were the major aetiologies. Most participants had complete renal recovery at 3 months.

E test for studying in vitro activity of seven antimicrobial agents against penicillin-susceptible and penicillin-resistant pneumococci

To evaluate the comparative activity of seven oral antimicrobial agents against 100 strains of Streptococcus pneumoniae (S pneumoniae) Methods Total 100 strains of S pneumoniae were collected from general hospitals in Beijing from June 1996 to June 1997 E test method was used to detect the minimum inhibitory concentration (MIC) values of the following seven drugs against S pneumoniae : penicillin, amoxicillin/clavulanate, cefaclor, cefuroxime, ceftriaxone, azithromycin and ofloxacin The breakpoint of susceptibility categories was defined according to NCCLS Results 74% of isolates were susceptible (S, MIC 0 06?mg/L) to penicillin, and 5% were penicillin resistant (R, MIC 2?mg/L). The intermediately resistant (I, MIC 0 1-1?mg/L) rate to penicillin was 21% The total rates of R or I were 26% for penicillin, 6% for both amoxicillin/clavulanate and ceftriaxone, 9% for cefuroxime, 66% and 68% for azithromycin and ofloxacin respectively Overall 94%, 94% and 91% of the pneumococcal isolates were susceptible to amoxicillin/clavulanate, ceftriaxone and cefuroxime respectively S pneumoniae was highly resistant to azithromycin tested as a representative of macrolides (MIC 50 and MIC 90 both >256?mg/L, R rate 66%), and had a highly intermediately resistant rate to ofloxacin (I rate 62%) Conclusions Our data suggest that in vitro activity of oral amoxicillin/clavulanate was as good as ceftriaxone and cefuroxime It can be considered as an alternative compound in the treatment of community acquired pneumoniae and other respiratory tract infections caused by multiresistant S pneumoniae