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https://www.readbyqxmd.com/read/29098998/the-emergence-of-multidrug-resistant-pseudomonas-aeruginosa-in-cystic-fibrosis-patients-on-inhaled-antibiotics
#1
Atqah AbdulWahab, Khalid Zahraldin, Mazen A Sid Ahmed, Sulieman Abu Jarir, Mohammed Muneer, Shehab F Mohamed, Jemal M Hamid, Abubaker A I Hassan, Emad Bashir Ibrahim
INTRODUCTION: Multidrug-resistant Pseudomonas aeruginosa (MDR-PA) is an important and growing issue in the care of patients with cystic fibrosis (CF), and a major cause of morbidity and mortality. OBJECTIVE: The objective of the study was to describe the frequency of MDR-PA recovered from the lower respiratory samples of pediatric and adult CF patients, and its antibiotic resistance pattern to commonly used antimicrobial agents including β-lactams, aminoglycosides, and fluoroquinolones...
November 2017: Lung India: Official Organ of Indian Chest Society
https://www.readbyqxmd.com/read/29080051/reducing-unnecessary-chest-x-rays-antibiotics-and-bronchodilators-through-implementation-of-the-nice-bronchiolitis-guideline
#2
Richard Breakell, Benjamin Thorndyke, Julie Clennett, Christian Harkensee
Chest X-rays (CXR), antibiotics and inhaled/nebulized therapy are overused in bronchiolitis, despite evidence-based guidelines suggesting supportive management only. This study investigates the effect of the implementation of the NICE bronchiolitis guideline in a secondary paediatric unit in England. We present a quality improvement project with a completed audit cycle (winter 2014-2015 and 2015-2016) pre- and post-implementation of the NICE bronchiolitis guideline. The educational intervention included sessions for raising awareness of appropriate and inappropriate management of bronchiolitis for both clinicians and nursing staff...
October 28, 2017: European Journal of Pediatrics
https://www.readbyqxmd.com/read/29058607/aerosol-delivery-during-invasive-mechanical-ventilation-a-systematic-review
#3
Jonathan Dugernier, Stephan Ehrmann, Thierry Sottiaux, Jean Roeseler, Xavier Wittebole, Thierry Dugernier, François Jamar, Pierre-François Laterre, Gregory Reychler
BACKGROUND: This systematic review aimed to assess inhaled drug delivery in mechanically ventilated patients or in animal models. Whole lung and regional deposition and the impact of the ventilator circuit, the artificial airways and the administration technique for aerosol delivery were analyzed. METHODS: In vivo studies assessing lung deposition during invasive mechanical ventilation were selected based on a systematic search among four databases. Two investigators independently assessed the eligibility and the risk of bias...
October 21, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28942198/effect-of-antibiotics-administered-via-the-respiratory-tract-in-the-prevention-of-ventilator-associated-pneumonia-a-systematic-review-and-meta-analysis
#4
Frederico Castro Costa Póvoa, Pablo Cardinal-Fernandez, Israel Silva Maia, Maycon Moura Reboredo, Bruno Valle Pinheiro
PURPOSE: We evaluated the effect of antibiotics administered via the respiratory tract to prevent the ventilator-associated pneumonia (VAP) in mechanically ventilated (MV) patients. METHODS: We searched relevant articles for trials that evaluated the impact of prophylactic antibiotics administered through the respiratory tract on the occurrence of VAP. The end-point was the occurrence of VAP in MV patients. RESULTS: We included 6 comparative trials involving 1158 patients (632 received prophylactic antibiotic)...
September 18, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28874611/how-should-aerosols-be-delivered-during-invasive-mechanical-ventilation
#5
Rajiv Dhand
The delivery of aerosols to mechanically ventilated patients presents unique challenges and differs from inhaled drug delivery in spontaneously breathing patients in several respects. Successful aerosol delivery during invasive mechanical ventilation requires careful consideration of a host of factors that influence the amount of drug inhaled by the patient. Pressurized metered-dose inhalers and nebulizers (jet, ultrasonic, and vibrating mesh) are the most commonly used aerosol delivery devices in these patients, although other delivery devices, such as dry powder inhalers, soft mist inhalers, and intratracheal nebulizing catheters, could also be adapted for in-line use...
October 2017: Respiratory Care
https://www.readbyqxmd.com/read/28862210/pulmonary-toxicity-following-bleomycin-use-a-single-center-experience
#6
Irappa Madabhavi, Gaurang Modi, Apurva Patel, Asha Anand, Harsha Panchal, Sonia Parikh
BACKGROUND: Bleomycin-induced pulmonary (BIP) toxicity is a notorious entity and cropped up in roughly 10% of cases. The aim of the study is to evaluate BIP at our tertiary care cancer center. PATIENTS AND METHODS: This is a retrospective, analytical study conducted at a tertiary care center from January 1998 to December 2012. Records of all the patients who were offered bleomycin chemotherapy as an integral part of adriamycin, bleomycin, vinblastine, and dacarbazine or bleomycin, etoposide, and cisplatin regimen in Hodgkin disease (HD) or germ cell tumor (GCT) were studied for the study inclusion criteria...
July 2017: Journal of Cancer Research and Therapeutics
https://www.readbyqxmd.com/read/28857848/nebulized-versus-iv-amikacin-as-adjunctive-antibiotic-for-hospital-and-ventilator-acquired-pneumonia-postcardiac-surgeries-a-randomized-controlled-trial
#7
Nehal A Hassan, Faten Farid Awdallah, Maggie M Abbassi, Nirmeen A Sabry
OBJECTIVE: Nebulized antibiotics offer high efficacy due to significant local concentrations and safety with minimal blood levels. This study evaluates the efficacy and nephrotoxicity of nebulized versus IV amikacin in postcardiothoracic surgical patients with nosocomial pneumonia caused by multidrug-resistant Gram--negative bacilli. DESIGN: Prospective, randomized, controlled study on surgical patients divided into two groups. SETTING: Postcardiac surgery ICU...
August 28, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28814254/bronchiolitis-care-in-the-hospital
#8
Jennifer Orr Vincent, Huay-Ying Lo, Susan Wu
BACKGROUND: Viral bronchiolitis is a common cause of hospitalization in young children, but despite a variety of therapeutic options, the mainstay of treatment remains supportive care. OBJECTIVE: To examine the most recent evidence for supportive care measures and pharmacologic options in the treatment of bronchiolitis in the hospital setting Methods: MEDLINE search with expert medical librarian for publications on management and therapies for bronchiolitis Results: Evidence does not support the use of bronchodilators, racemic epinephrine, deep suctioning, systemic corticosteroids, or antibiotics in the absence of a concomitant bacterial infection, as these treatments do not change the course of illness or shorten length of stay (LOS)...
August 16, 2017: Reviews on Recent Clinical Trials
https://www.readbyqxmd.com/read/28766281/nebulized-antibiotics-in-mechanically-ventilated-patients-a-challenge-for-translational-research-from-technology-to-clinical-care
#9
REVIEW
Stephan Ehrmann, Jean Chastre, Patrice Diot, Qin Lu
Nebulized antibiotic therapy directly targets airways and lung parenchyma resulting in high local concentrations and potentially lower systemic toxicities. Experimental and clinical studies have provided evidence for elevated lung concentrations and rapid bacterial killing following the administration of nebulized antibiotics during mechanical ventilation. Delivery of high concentrations of antibiotics to infected lung regions is the key to achieving efficient nebulized antibiotic therapy. However, current non-standardized clinical practice, the difficulties with implementing optimal nebulization techniques and the lack of robust clinical data have limited its widespread adoption...
December 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/28741229/inhaled-antimicrobials-for-ventilator-associated-pneumonia-practical-aspects
#10
Garyphallia Poulakou, Dimitrios K Matthaiou, David P Nicolau, Georgios Siakallis, George Dimopoulos
Positive experience with inhaled antibiotics in pulmonary infections of patients with cystic fibrosis has paved the way for their utilization in mechanically ventilated, critically ill patients with lower respiratory tract infections. A successful antibiotic delivery depends upon the size of the generated particle and the elimination of drug impaction in the large airways and the ventilator circuit. Generated droplet size is mainly affected by the type of the nebulizer employed. Currently, jet, ultrasonic, and vibrating mesh nebulizers are marketed; the latter can deliver optimal antibiotic particle size...
September 2017: Drugs
https://www.readbyqxmd.com/read/28649564/primary-ciliary-dyskinesia-an-update-on-clinical-aspects-genetics-diagnosis-and-future-treatment-strategies
#11
REVIEW
Virginia Mirra, Claudius Werner, Francesca Santamaria
Primary ciliary dyskinesia (PCD) is an orphan disease (MIM 244400), autosomal recessive inherited, characterized by motile ciliary dysfunction. The estimated prevalence of PCD is 1:10,000 to 1:20,000 live-born children, but true prevalence could be even higher. PCD is characterized by chronic upper and lower respiratory tract disease, infertility/ectopic pregnancy, and situs anomalies, that occur in ≈50% of PCD patients (Kartagener syndrome), and these may be associated with congenital heart abnormalities...
2017: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/28644389/chronic-respiratory-infection-in-patients-with-chronic-obstructive-pulmonary-disease-what-is-the-role-of-antibiotics
#12
REVIEW
Marc Miravitlles, Antonio Anzueto
Chronic infections are associated with exacerbation in patients with chronic obstructive pulmonary disease (COPD). The major objective of the management of these patients is the prevention and effective treatment of exacerbations. Patients that have increased sputum production, associated with purulence and worsening shortness of breath, are the ones that will benefit from antibiotic therapy. It is important to give the appropriate antibiotic therapy to prevent treatment failure, relapse, and the emergence of resistant pathogens...
June 23, 2017: International Journal of Molecular Sciences
https://www.readbyqxmd.com/read/28627354/-principle-and-influence-factors-of-aerosolized-antibiotics-in-the-treatment-of-ventilator-associated-pneumonia
#13
Chang Liu, Yuting Zhang, Jianguo Li
Ventilator associated pneumonia (VAP) is a challenging complication of critical illness. Aerosolized antibiotic is an option for the management of VAP currently, as it is reported that it could increase levels of drug in alveolar without increasing systemic toxicity. The articles that focused on the aerosolized antibiotics in the treatment of VAP and its influence factors were reviewed, and it was found that to achieve maximum drug delivery efficiency and reduce the influence of nebulization method, some factors, such as ventilation modes, tidal volume, nebulizer type, should be adjusted and monitored during the treatment...
March 2017: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/28509852/inhaled-antibiotic-therapy-in-chronic-respiratory-diseases
#14
REVIEW
Diego J Maselli, Holly Keyt, Marcos I Restrepo
The management of patients with chronic respiratory diseases affected by difficult to treat infections has become a challenge in clinical practice. Conditions such as cystic fibrosis (CF) and non-CF bronchiectasis require extensive treatment strategies to deal with multidrug resistant pathogens that include Pseudomonas aeruginosa, Methicillin-resistant Staphylococcus aureus, Burkholderia species and non-tuberculous Mycobacteria (NTM). These challenges prompted scientists to deliver antimicrobial agents through the pulmonary system by using inhaled, aerosolized or nebulized antibiotics...
May 16, 2017: International Journal of Molecular Sciences
https://www.readbyqxmd.com/read/28478753/antibiotic-prescription-patterns-in-spanish-cystic-fibrosis-patients-results-from-a-national-multicenter-study
#15
Juan de Dios Caballero, Rosa Girón, Rosa Del Campo, Concepción Prados, María-Isabel Barrio, Antonio Salcedo, Rafael Cantón
OBJECTIVE: Information about antibiotic prescription patterns for cystic fibrosis (CF) patients and, specifically, about inhaled treatment strategies for their management is lacking in Spain due to the absence of a national patient registry. In this study we present data about antibiotic prescription in the Spanish CF context that were obtained in a multicenter study, being inhaled treatment strategies the special focus of this work. METHODS: Twenty-four specialized CF units (12 adult, 12 pediatric) from 17 tertiary-care hospitals covering all Spanish Autonomous Communities provided sputa and clinical data from 15 consecutive patients...
May 1, 2017: Farmacia Hospitalaria
https://www.readbyqxmd.com/read/28476135/the-effects-of-inhaled-aztreonam-on-the-cystic-fibrosis-lung-microbiome
#16
Alya A Heirali, Matthew L Workentine, Nicole Acosta, Ali Poonja, Douglas G Storey, Ranjani Somayaji, Harvey R Rabin, Fiona J Whelan, Michael G Surette, Michael D Parkins
BACKGROUND: Aztreonam lysine for inhalation (AZLI) is an inhaled antibiotic used to treat chronic Pseudomonas aeruginosa infection in CF. AZLI improves lung function and quality of life, and reduces exacerbations-improvements attributed to its antipseudomonal activity. Given the extremely high aztreonam concentrations achieved in the lower airways by nebulization, we speculate this may extend its spectrum of activity to other organisms. As such, we sought to determine if AZLI affects the CF lung microbiome and whether community constituents can be used to predict treatment responsiveness...
May 5, 2017: Microbiome
https://www.readbyqxmd.com/read/28412382/use-of-nebulized-antimicrobials-for-the-treatment-of-respiratory-infections-in-invasively-mechanically-ventilated-adults-a-position-paper-from-the-european-society-of-clinical-microbiology-and-infectious-diseases
#17
J Rello, C Solé-Lleonart, J-J Rouby, J Chastre, S Blot, G Poulakou, C-E Luyt, J Riera, L B Palmer, J M Pereira, T Felton, J Dhanani, M Bassetti, T Welte, J A Roberts
With an established role in cystic fibrosis and bronchiectasis, nebulized antibiotics are increasingly being used to treat respiratory infections in critically ill invasively mechanically ventilated adult patients. Although there is limited evidence describing their efficacy and safety, in an era when there is a need for new strategies to enhance antibiotic effectiveness because of a shortage of new agents and increases in antibiotic resistance, the potential of nebulization of antibiotics to optimize therapy is considered of high interest, particularly in patients infected with multidrug-resistant pathogens...
September 2017: Clinical Microbiology and Infection
https://www.readbyqxmd.com/read/28367654/a-review-of-co-milling-techniques-for-the-production-of-high-dose-dry-powder-inhaler-formulation
#18
Michael Lau, Paul M Young, Daniela Traini
Drug delivery by inhalation offers several advantages compared to other dosage forms, including rapid clinical onset, high bioavailability, and minimal systemic side effects. Drug delivery to the lung can be achieved as liquid suspensions or solutions in nebulizers and pressurized metered-dose inhalers (pMDI), or as dry powders in dry powder inhalers (DPIs). Compared to other delivery systems, DPIs are, in many cases, considered the most convenient as they are breath actuated and do not require the use of propellants...
August 2017: Drug Development and Industrial Pharmacy
https://www.readbyqxmd.com/read/28347790/key-considerations-on-nebulization-of-antimicrobial-agents-to-mechanically-ventilated-patients
#19
J Rello, J J Rouby, C Sole-Lleonart, J Chastre, S Blot, C E Luyt, J Riera, M C Vos, A Monsel, J Dhanani, J A Roberts
Nebulized antibiotics have an established role in patients with cystic fibrosis or bronchiectasis. Their potential benefit to treat respiratory infections in mechanically ventilated patients is receiving increasing interest. In this consensus statement of the European Society of Clinical Microbiology and Infectious Diseases, the body of evidence of the therapeutic utility of aerosolized antibiotics in mechanically ventilated patients was reviewed and resulted in the following recommendations: Vibrating-mesh nebulizers should be preferred to jet or ultrasonic nebulizers...
September 2017: Clinical Microbiology and Infection
https://www.readbyqxmd.com/read/28270028/designing-and-evaluating-a-health-education-session-on-respiratory-infections-addressed-to-caregivers-of-children-under-three-years-of-age-attending-day-care-centres-in-porto-portugal-a-community-based-intervention
#20
RANDOMIZED CONTROLLED TRIAL
Ana Manuela Ferreira da Silva Alexandrino, Rita Isabel Garrido Vieira Dos Santos, Maria Cristina Damas Argel de Melo, José Adelino Mesquita Bastos
BACKGROUND: Acute respiratory infections (ARI) are common in children, increasing the pressure on clinicians to prescribe antibiotics and affecting public health Objectives: This study aimed to design a health education session (HES) for caregivers of children, and to evaluate its effects on caregivers' needs, as well as on their knowledge and attitudes concerning ARI. METHODS: A generalized model of developing, implementing and evaluating a community-based intervention was followed, including caregivers of children under three years of age...
December 2017: European Journal of General Practice
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