Exercise for acute respiratory infections

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Delayed antibiotic prescriptions for respiratory infections

Background: Concerns exist regarding antibiotic prescribing for respiratory tract infections (RTIs) owing to adverse reactions, cost, and antibacterial resistance. One proposed strategy to reduce antibiotic prescribing is to provide prescriptions, but to advise delay in antibiotic use with the expectation that symptoms will resolve first. This is an update of a Cochrane Review originally published in 2007, and updated in 2010 and 2013. Objectives: To evaluate the effects on clinical outcomes, antibiotic use, antibiotic resistance, and patient satisfaction of advising a delayed prescription of antibiotics in respiratory tract infections. Search methods: For this 2017 update we searched the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, Issue 4, 2017), which includes the Cochrane Acute Respiratory Infection Group's Specialised Register; Ovid MEDLINE (2013 to 25 May 2017); Ovid Embase (2013 to 2017 Week 21); EBSCO CINAHL Plus (1984 to 25 May 2017); Web of Science (2013 to 25 May 2017); WHO International Clinical Trials Registry Platform (1 September 2017); and ClinicalTrials.gov (1 September 2017). Selection criteria: Randomised controlled trials involving participants of all ages defined as having an RTI, where delayed antibiotics were compared to immediate antibiotics or no antibiotics. We defined a delayed antibiotic as advice to delay the filling of an antibiotic prescription by at least 48 hours. We considered all RTIs regardless of whether antibiotics were recommended or not. Data collection and analysis: We used standard Cochrane methodological procedures. Three review authors independently extracted and collated data. We assessed the risk of bias of all included trials. We contacted trial authors to obtain missing information. Main results: For this 2017 update we added one new trial involving 405 participants with uncomplicated acute respiratory infection. Overall, this review included 11 studies with a total of 3555 participants. These 11 studies involved acute respiratory infections including acute otitis media (three studies), streptococcal pharyngitis (three studies), cough (two studies), sore throat (one study), common cold (one study), and a variety of RTIs (one study). Five studies involved only children, two only adults, and four included both adults and children. Six studies were conducted in a primary care setting, three in paediatric clinics, and two in emergency departments. Studies were well reported, and appeared to be of moderate quality. Randomisation was not adequately described in two trials. Four trials blinded the outcomes assessor, and three included blinding of participants and doctors. We conducted meta-analysis for antibiotic use and patient satisfaction. We found no differences among delayed, immediate, and no prescribed antibiotics for clinical outcomes in the three studies that recruited participants with cough. For the outcome of fever with sore throat, three of the five studies favoured immediate antibiotics, and two found no difference. For the outcome of pain related to sore throat, two studies favoured immediate antibiotics, and three found no difference. One study compared delayed antibiotics with no antibiotic for sore throat, and found no difference in clinical outcomes. Three studies included participants with acute otitis media. Of the two studies with an immediate antibiotic arm, one study found no difference for fever, and the other study favoured immediate antibiotics for pain and malaise severity on Day 3. One study including participants with acute otitis media compared delayed antibiotics with no antibiotics and found no difference for pain and fever on Day 3. Two studies recruited participants with common cold. Neither study found differences for clinical outcomes between delayed and immediate antibiotic groups. One study favoured delayed antibiotics over no antibiotics for pain, fever, and cough duration (moderate quality evidence for all clinical outcomes - GRADE assessment). There were either no differences for adverse effects or results favoured delayed antibiotics over immediate antibiotics (low quality evidence - to GRADE assessment) with no significant differences in complication rates. Delayed antibiotics resulted in a significant reduction in antibiotic use compared to immediate antibiotics prescription (odds ratio (OR) 0.04, 95% confidence interval (CI) 0.03 to 0.05). However, a delayed antibiotic was more likely to result in reported antibiotic use than no antibiotics (OR 2.55, 95% CI 1.59 to 4.08) (moderate quality evidence - GRADE assessment). Patient satisfaction favoured delayed over no antibiotics (OR 1.49, 95% CI 1.08 to 2.06). There was no significant difference in patient satisfaction between delayed antibiotics and immediate antibiotics (OR 0.65, 95% CI 0.39 to 1.10) (moderate quality evidence - GRADE assessment). None of the included studies evaluated antibiotic resistance. Authors' conclusions: For many clinical outcomes, there were no differences between prescribing strategies. Symptoms for acute otitis media and sore throat were modestly improved by immediate antibiotics compared with delayed antibiotics. There were no differences in complication rates. Delaying prescribing did not result in significantly different levels of patient satisfaction compared with immediate provision of antibiotics (86% versus 91%) (moderate quality evidence). However, delay was favoured over no antibiotics (87% versus 82%). Delayed antibiotics achieved lower rates of antibiotic use compared to immediate antibiotics (31% versus 93%) (moderate quality evidence). The strategy of no antibiotics further reduced antibiotic use compared to delaying prescription for antibiotics (14% versus 28%). Delayed antibiotics for people with acute respiratory infection reduced antibiotic use compared to immediate antibiotics, but was not shown to be different to no antibiotics in terms of symptom control and disease complications. Where clinicians feel it is safe not to prescribe antibiotics immediately for people with respiratory infections, no antibiotics with advice to return if symptoms do not resolve is likely to result in the least antibiotic use while maintaining similar patient satisfaction and clinical outcomes to delaying prescription of antibiotics. Where clinicians are not confident in using a no antibiotic strategy, a delayed antibiotics strategy may be an acceptable compromise in place of immediate prescribing to significantly reduce unnecessary antibiotic use for RTIs, and thereby reduce antibiotic resistance, while maintaining patient safety and satisfaction levels. Editorial note: As a living systematic review, this review is continually updated, incorporating relevant new evidence as it becomes available. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review

Respiratory infections

A new European Respiratory Review series explores respiratory infections https://bit.ly/3A5eN3

Standard Index of Air Pollutant, Meteorology Factor and Acute Respiratory Infections Occurrence in Pekanbaru

This study aims to know the relationship between standard index of air pollutant and meteorology factor with acute respiratory infections occurrence in Pekanbaru city. This ecological study involved community with acute respiratory infections. There is a correlation between standard index of air pollutant and meteorology with acute respiratory infections occurrence statistically and graphically. Comparison of acute respiratory infections occurrences one month earlier, PM10 in the same month, SO2 one month before, CO in the same month, CO one month before, O3 one month before, NO2 in the same month, NO2 one month before, temperature in the same month, the previous month's moisture, the same month's wind velocity, moon radiation in the same month, and the same month of fire were the predictor variables that hadan effect on the incidence of acute respiratory infections. The pattern of events follows fluctuations and meteorology. PM10 in the same month, SO2 one month before, CO in the same month, CO one month before, O3 in the same month, NO2 in the same month, NO2 one month before, moisture one monthbefore, solar radiation on month the same has a positive relationship with the incidence of acute respiratory infections in the city of Pekanbaru. Pekanbaru health office needs to consider the quality and theoretology in the acute respiratory infections prevention program

Rhinovirus infections in young children: Clinical manifestations, susceptibility, and host response

Rhinoviruses are the most common cause of respiratory infections, but the burden of rhinovirus infections in young children has not been evaluated. A diagnostic marker of virus infections detecting also rhinovirus infections could be useful for avoiding the unnecessary use of antibiotics. In this prospective birth cohort study, we followed 1570 children for acute respiratory infections from birth to two years of age. We aimed to establish the burden of rhinovirus infections in young children and to study the genetic susceptibility and blood myxovirus resistance protein A (MxA) response to respiratory infections. Altogether 12 846 episodes of acute respiratory infection were documented with an annual rate of 5.9 per child. Rhinovirus was detected in 59% of acute respiratory infections that were analyzed for viruses. Rhinoviruses were associated with 50% of acute otitis media episodes, 41% of wheezing illnesses, 49% of antibiotic treatments, and 48% of outpatient office visits for acute respiratory infections. The estimated annual rate of rhinovirus infections was 3.5 per child. Children with recurrent respiratory infections were at an increased risk for asthma in early childhood. Genetic polymorphisms of mannose-binding lectin and toll-like receptors were associated with the risk of respiratory infections. Blood MxA protein levels were increased in children with symptomatic virus infections, including rhinovirus infections, as compared to asymptomatic virus-negative children. Rhinovirus infections impose a major burden of acute respiratory illness and antibiotic use on young children. Genetic polymorphisms may partly explain why some children are more prone to respiratory infections. Blood MxA protein is an informative marker of viral respiratory infections including rhinovirus infections.Siirretty Doriast

Respiratory Infections in Children Hospitalized at the University Hospital Mostar during War and Post-War Period

Our aim was to investigate the incidence of respiratory infections in children treated at the Pediatric Department of the University Hospital Mostar during war (1993 and 1994) and after the war (2003 and 2004). In order to collect data we used medical histories of children with respiratory infections. Incidence of respiratory infections in children in war period was 230/1000, while in post-war period it was 190/1000. There was no significant difference in the incidence of respiratory infections in children during war and after the war (p=0.051). We have not found increase in respiratory infections prevalence in children treated during war period at the Pediatric department of University Hospital Mostar, compared to the period after the war. However, we did report certain differences related to age, clinical parameters, seasonal pattern, diagnosis, therapy and mean hospitalization time

Management of acute bronchitis in healthy adults.

Acute respiratory infections (ARIs) are the most common infections in humans, accounting for half of all acute conditions each year in the United States. Acute bronchitis episodes represent a significant portion of these illnesses. This article focuses on acute bronchitis in otherwise healthy individuals