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Corticosteroid for community acquired pneumonia

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https://www.readbyqxmd.com/read/28756034/efficacy-of-corticosteroid-treatment-for-severe-community-acquired-pneumonia-a-meta-analysis
#1
Wei-Fang Wu, Qiang Fang, Guo-Jun He
BACKGROUND: The benefits and adverse effects of corticosteroids in the treatment of severe community-acquired pneumonia (CAP) have not been well assessed. The aim of this systematic review of the literature and meta-analysis was to evaluate the clinical efficacy of adjuvant corticosteroid therapy in patients with severe CAP. METHODS: The following databases were searched: PubMed, the Cochrane database, Embase, Wanfang, the China National Knowledge Infrastructure (CNKI), and the WeiPu (VIP) database in Chinese...
July 15, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28694698/maintenance-therapy-in-copd-time-to-phase-out-ics-and-switch-to-the-new-lama-laba-inhalers
#2
REVIEW
Syed Mohammad Tariq, Enson C Thomas
Long-term maintenance therapy for COPD is evolving rapidly. Dual bronchodilation with new long-acting muscarinic antagonist and long-acting beta-agonist (LAMA/LABA) fixed dose combination inhalers were introduced over the past 2 years. In clinical trials, these inhalers significantly improved lung function (trough forced expiratory volume in 1 second), patient-reported outcomes, and quality of life measures compared with placebo, their respective monocomponents, and tiotropium. The recorded adverse events of these new inhalers were also similar to those of their monocomponents or placebo...
2017: International Journal of Chronic Obstructive Pulmonary Disease
https://www.readbyqxmd.com/read/28694251/advances-in-the-causes-and-management-of-community-acquired-pneumonia-in-adults
#3
REVIEW
Richard G Wunderink, Grant Waterer
Community acquired pneumonia remains a common cause of morbidity and mortality. Usually, the causal organism is not identified and treatment remains empiric. Recent computed tomography and magnetic resonance imaging studies have challenged the accuracy of the clinical diagnosis of pneumonia, and epidemiologic studies are changing our perspective of what causes community acquired pneumonia, especially the role of viral pathogens and the frequent finding of multiple pathogens. The past decade has seen increasing overuse of empiric coverage of meticillin resistant Staphylococcus aureus and antibiotic resistant Gram negative pathogens owing to inappropriate application of guidelines for healthcare associated pneumonia...
July 10, 2017: BMJ: British Medical Journal
https://www.readbyqxmd.com/read/28690980/crh-affects-the-phenotypic-expression-of-sepsis-associated-virulence-factors-by-streptococcus-pneumoniae-serotype-1-in-vitro
#4
Colette G Ngo Ndjom, Lindsay V Kantor, Harlan P Jones
Sepsis is a life-threatening health condition caused by infectious pathogens of the respiratory tract, and accounts for 28-50% of annual deaths in the US alone. Current treatment regimen advocates the use of corticosteroids as adjunct treatment with antibiotics, for their broad inhibitory effect on the activity and production of pro-inflammatory mediators. However, despite their use, corticosteroids have not proven to be able to reverse the death incidence among septic patients. We have previously demonstrated the potential for neuroendocrine factors to directly influence Streptococcus pneumoniae virulence, which may in turn mediate disease outcome leading to sepsis and septic shock...
2017: Frontiers in Cellular and Infection Microbiology
https://www.readbyqxmd.com/read/28690643/mechanism-of-resistance-acquisition-and-treatment-of-macrolide-resistant-mycoplasma-pneumoniae-pneumonia-in-children
#5
REVIEW
Hyeon-Jong Yang, Dae Jin Song, Jung Yeon Shim
Mycoplasma pneumoniae pneumonia (MPP) is one of the most common forms of community-acquired pneumonia in children and adolescents. Outbreaks of MPP occur in 3- to 7-year cycles worldwide; recent epidemics in Korea occurred in 2006-2007, 2011, and 2015-2016. Although MPP is known to be a mild, self-limiting disease with a good response to macrolides, it can also progress into a severe and fulminant disease. Notably, since 2000, the prevalence of macrolide-resistant MPP has rapidly increased, especially in Asian countries, recently reaching up to 80%-90%...
June 2017: Korean Journal of Pediatrics
https://www.readbyqxmd.com/read/28634021/mycoplasma-pneumoniae-and-health-outcomes-in-children-with-asthma
#6
Pamela R Wood, Jordan C Kampschmidt, Peter H Dube, Marianna P Cagle, Paola Chaparro, Norma S Ketchum, Thirumalai R Kannan, Harjinder Singh, Jay I Peters, Joel B Baseman, Edward G Brooks
BACKGROUND: Acute infections with Mycoplasma pneumoniae (Mp) have been associated with worsening asthma in children. Mp can be present in the respiratory tract for extended periods; it is unknown whether the long-term persistence of Mp in the respiratory tract affects long-term asthma control. OBJECTIVE: To determine the effect of Mp on asthma control. METHODS: We enrolled 31 pediatric subjects 3 to 10 years of age with persistent asthma who completed up to 8 visits over a 24-month period...
August 2017: Annals of Allergy, Asthma & Immunology
https://www.readbyqxmd.com/read/28617807/treatment-with-macrolides-and-glucocorticosteroids-in-severe-community-acquired-pneumonia-a-post-hoc-exploratory-analysis-of-a-randomized-controlled-trial
#7
RANDOMIZED CONTROLLED TRIAL
Adrian Ceccato, Catia Cilloniz, Otavio T Ranzani, Rosario Menendez, Carles Agusti, Albert Gabarrus, Miquel Ferrer, Oriol Sibila, Michael S Niederman, Antoni Torres
BACKGROUND: Systemic corticosteroids have anti-inflammatory effects, whereas macrolides also have immunomodulatory activity in addition to their primary antimicrobial actions. We aimed to evaluate the potential interaction effect between corticosteroids and macrolides on the systemic inflammatory response in patients with severe community-acquired pneumonia to determine if combining these two immunomodulating agents was harmful, or possibly beneficial. METHODS: We performed a post-hoc exploratory analysis of a randomized clinical trial conducted in three tertiary hospitals in Spain...
2017: PloS One
https://www.readbyqxmd.com/read/28403766/controversies-in-diagnosis-and-management-of-community-acquired-pneumonia
#8
REVIEW
Sarah Sparham, Patrick Gp Charles
Community-acquired pneumonia (CAP) is a common condition; however, it appears to be overdiagnosed. Diagnosing CAP too frequently may be adding to the problems of overuse of antibiotics, such as bacterial resistance in the community and greater costs and complications in individuals. Data support that most patients with non-severe CAP can be treated for 3-5 days; however, most patients with CAP are receiving much longer courses of therapy. Macrolides such as azithromycin have the potential to prolong the QT interval, although large population studies show that this does not appear to result in excess cardiac mortality...
April 17, 2017: Medical Journal of Australia
https://www.readbyqxmd.com/read/28335807/time-dependent-association-of-glucocorticoids-with-adverse-outcome-in-community-acquired-pneumonia-a-6-year-prospective-cohort-study
#9
Manuela Nickler, Manuel Ottiger, Christian Steuer, Alexander Kutz, Mirjam Christ-Crain, Werner Zimmerli, Robert Thomann, Claus Hoess, Christoph Henzen, Luca Bernasconi, Andreas Huber, Beat Mueller, Philipp Schuetz
BACKGROUND: The hypothalamic-pituitary-adrenal stress axis plays a crucial role in community-acquired pneumonia (CAP), with high cortisol being associated with disease severity and corticosteroid treatment resulting in earlier time to recovery. Our aim in the present study was to compare different glucocorticoid hormones, including cortisol, 11-deoxycortisol, cortisone, and corticosterone, regarding their association with short- and long-term adverse outcomes in a well-defined CAP cohort...
March 24, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28302543/immunomodulatory-effects-of-pidotimod-in-adults-with-community-acquired-pneumonia-undergoing-standard-antibiotic-therapy
#10
D Trabattoni, M Clerici, S Centanni, M Mantero, M Garziano, F Blasi
The morbidity and mortality of community-acquired pneumonia (CAP) are still elevated and two aspects seem to contribute to a worse outcome: an uncontrolled inflammatory reaction and an inadequate immune response. Adjuvants, including corticosteroids and intravenous immunoglobulins, have been proposed to counterbalance these effects but their efficacy is only partial. We examined the immunomodulatory activity of Pidotimod (PDT), a synthetic dipeptide molecule in adult patients hospitalized for CAP. Sixteen patients with a diagnosis of CAP and a PSI score III or IV and/or a CURB-65 0-2 were randomized to receive either levofloxacin 500 mg b...
June 2017: Pulmonary Pharmacology & Therapeutics
https://www.readbyqxmd.com/read/28176888/seasonality-risk-factors-and-burden-of-community-acquired-pneumonia-in-copd-patients-a-population-database-study-using-linked-health-care-records
#11
Nicholas P Williams, Ngaire A Coombs, Matthew J Johnson, Lynn K Josephs, Lucy A Rigge, Karl J Staples, Mike Thomas, Tom Ma Wilkinson
BACKGROUND: Community-acquired pneumonia (CAP) is more common in patients with COPD than in the adult general population, with studies of hospitalized CAP patients consistently reporting COPD as a frequent comorbidity. However, despite an increasing recognition of its importance, large studies evaluating the incidence patterns over time, risk factors and burden of CAP in COPD are currently lacking. METHODS: A retrospective observational study using a large UK-based database of linked primary and secondary care records was conducted...
2017: International Journal of Chronic Obstructive Pulmonary Disease
https://www.readbyqxmd.com/read/28118166/update-on-low-dose-corticosteroids
#12
REVIEW
Josef Briegel, Thomas Bein, Patrick Möhnle
PURPOSE OF REVIEW: Low-dose hydrocortisone is recommended in patients with septic shock unresponsive to fluid and vasopressor therapy. Recent research added new data for patients with septic shock and other target groups such as patients with severe sepsis, acute respiratory distress syndrome (ARDS), community-acquired pneumonia, and burns. The objective of this review is to summarize and comment recent findings on low-dose corticosteroids (LDC) in critically ill patients. RECENT FINDINGS: In the last 2 years, a series of clinical trials and retrospective analyses investigated LDC therapy in critically ill patients with severe systemic inflammation of various origins...
April 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/27960215/nonantibiotic-adjunctive-therapies-for-community-acquired-pneumonia-corticosteroids-and-beyond-where-are-we-with-them
#13
Oriol Sibila, Ana Rodrigo-Troyano, Antoni Torres
Community-acquired pneumonia (CAP) is a leading cause of hospitalization, morbidity, and mortality. Despite advances in antibiotic treatments, mortality among patients with CAP is still high. For this reason, interest has been focused on nonantibiotic therapeutic measures directed to the host response rather than the microorganism. The development of an efficacious adjunctive treatment has important implications for reducing mortality in CAP. Some clinical studies performed in the last decade have shown a clinically beneficial effect of corticosteroids, possibly by diminishing local and systemic inflammatory host response...
December 2016: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/27929242/community-acquired-pneumonia-in-adults-diagnosis-and-management
#14
Alexander Kaysin, Anthony J Viera
Community-acquired pneumonia is a leading cause of death. Risk factors include older age and medical comorbidities. Diagnosis is suggested by a history of cough, dyspnea, pleuritic pain, or acute functional or cognitive decline, with abnormal vital signs (e.g., fever, tachycardia) and lung examination findings. Diagnosis should be confirmed by chest radiography or ultrasonography. Validated prediction scores for pneumonia severity can guide the decision between outpatient and inpatient therapy. Using procalcitonin as a biomarker for severe infection may further assist with risk stratification...
November 1, 2016: American Family Physician
https://www.readbyqxmd.com/read/27846240/efficacy-and-safety-of-adjunctive-corticosteroids-therapy-for-severe-community-acquired-pneumonia-in-adults-an-updated-systematic-review-and-meta-analysis
#15
REVIEW
Jirui Bi, Jin Yang, Ying Wang, Cijiang Yao, Jing Mei, Ying Liu, Jiyu Cao, Youjin Lu
BACKGROUND: Adjunctive corticosteroids therapy is an attractive option for community-acquired pneumonia (CAP) treatment. However, the effectiveness of adjunctive corticosteroids on mortality of CAP remains inconsistent, especially in severe CAP. We performed a meta-analysis to evaluate the efficacy and safety of adjunctive corticosteroids in severe CAP patients. METHODS: Three databases of PubMed, EMBASE and Cochrane Library were searched for related studies published in English up to December, 2015...
2016: PloS One
https://www.readbyqxmd.com/read/27694410/corticosteroids-for-community-acquired-pneumonia-a-critical-view-of-the-evidence
#16
EDITORIAL
James D Chalmers
No abstract text is available yet for this article.
October 2016: European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology
https://www.readbyqxmd.com/read/27614658/benefit-of-adjunct-corticosteroids-for-community-acquired-pneumonia-in-diabetic-patients
#17
RANDOMIZED CONTROLLED TRIAL
Milica Popovic, Claudine A Blum, Nicole Nigro, Beat Mueller, Philipp Schuetz, Mirjam Christ-Crain
AIMS/HYPOTHESIS: We have recently shown that adjunct prednisone shortens the time taken to reach clinical stability (time to clinical stability, TTCS) in patients with community-acquired pneumonia (CAP). Considering the hyperglycaemic effects of prednisone, there are concerns about the efficacy and safety of this therapy for diabetic patients with CAP. Our objective was to evaluate whether diabetes and/or hyperglycaemia on admission to hospital has an influence on the effect of corticosteroids on outcome in a well-defined cohort of patients with CAP...
December 2016: Diabetologia
https://www.readbyqxmd.com/read/27583588/community-acquired-pneumonia-still-a-major-burden-of-disease
#18
Charles Feldman, Ronald Anderson
PURPOSE OF REVIEW: Describe recent studies that may impact on the management of community-acquired pneumonia (CAP). RECENT FINDINGS: CAP continues to be associated with a considerable burden of disease. Diagnosis remains problematic, and various biomarkers are neither accurate in the diagnosis of the presence of CAP nor superior to standard severity of illness scores in predicting outcome. Current evidence indicates that patients with nonsevere CAP can be effectively treated with antibiotic monotherapy, whereas those with severe infection, particularly ICU cases, do best with early initiation of combination antibiotic therapy...
October 2016: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/27471201/pathogen-and-antibiotic-specific-effects-of-prednisone-in-community-acquired-pneumonia
#19
Sebastian A Wirz, Claudine A Blum, Philipp Schuetz, Werner C Albrich, Christoph Noppen, Beat Mueller, Mirjam Christ-Crain, Philip E Tarr
In a double-blind, randomised, placebo-controlled trial of hospitalised patients with community-acquired pneumonia (CAP), we demonstrated shorter time to clinical stability (TTCS) with adjunct corticosteroid therapy compared with placebo.We did a pre-planned, exploratory analysis of any association between microbiological diagnosis, antibiotic treatment and procalcitonin level and effect of prednisone on TTCS, mortality, and CAP complications (n=726 participants, enrolled between December 2009 and May 2014)...
October 2016: European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology
https://www.readbyqxmd.com/read/27404370/betamethasone-and-dexamethasone-in-adult-community-acquired-bacterial-meningitis-a-quality-registry-study-from-1995-to-2014
#20
M Glimåker, M Brink, P Naucler, J Sjölin
Acute bacterial meningitis (ABM) is a highly lethal disease. Available data support the use of corticosteroids in high-income countries, but the effect on mortality is still controversial. The effects of corticosteroids on mortality and sequelae were evaluated in the national Swedish quality registry. In total, during 1995-2014 1746 adults with ABM were included, of whom 989 were treated with corticosteroids (betamethasone, n = 766; dexamethasone, n = 248; methylprednisolone, n = 2), 498 were not given corticosteroids and in 259 patients data for corticosteroids were missing...
September 2016: Clinical Microbiology and Infection
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