Diagnostic accuracy of a clinical diagnosis of idiopathic pulmonary fibrosis: An international case-cohort study

We conducted an international study of idiopathic pulmonary fibrosis (IPF) diagnosis among a large group of physicians and compared their diagnostic performance to a panel of IPF experts. A total of 1141 respiratory physicians and 34 IPF experts participated. Participants evaluated 60 cases of interstitial lung disease (ILD) without interdisciplinary consultation. Diagnostic agreement was measured using the weighted kappa coefficient (\u3baw). Prognostic discrimination between IPF and other ILDs was used to validate diagnostic accuracy for first-choice diagnoses of IPF and were compared using the Cindex. A total of 404 physicians completed the study. Agreement for IPF diagnosis was higher among expert physicians (\u3baw=0.65, IQR 0.53-0.72, p20 years of experience (C-index=0.72, IQR 0.0-0.73, p=0.229) and non-university hospital physicians with more than 20 years of experience, attending weekly MDT meetings (C-index=0.72, IQR 0.70-0.72, p=0.052), did not differ significantly (p=0.229 and p=0.052 respectively) from the expert panel (C-index=0.74 IQR 0.72-0.75). Experienced respiratory physicians at university-based institutions diagnose IPF with similar prognostic accuracy to IPF experts. Regular MDT meeting attendance improves the prognostic accuracy of experienced non-university practitioners to levels achieved by IPF experts

Role of the Oral Beta-Lactams in the Treatment of Exacerbations of Chronic Bronchitis : Critical Analysis and Therapeutic Recommendations. CHAPTER 1

The GIARIR study group has made a critical analysis of the most recent scientific literature on acute bacterial exacerbations of chronic bronchitis (ABECB) with the aim of proposing therapeutic recommendations applicable to the current epidemiological situation in italy. The international literature has indicated the scarcity of studies on the treatment of ABECB compared to an abundance of information regarding chronic obstructive pulmonary disease (COPD), of which ABECB is often considered the initial ore predisposing stage, even though a precise evolutionary correlation between these pathologies has not yet been demonstrated. ABECB is the principle cause of doctor visits, hospitalization and death in COPD patients. The natural course of the disease is characterized by the appearance of exacerbation episodes (a mean of two yearly). For this reason it is indispensable to prevent exacerbations, to treat them as quickly as possible, in order to minimize their negative effects on the respiratory tract and the patient\u2019s general health. The routine use of antibiotic therapy is controversial because at least 20% of exacerbations do not have an infectious origin and about 30% are viral. in most cases the choice of antibiotic is empiric, in both ABECB patients without risk factors (mild form) and in those with risk factors such as cigarette smoking or constant exposure to air pollutants (moderate form). For these reasons it is necessary to keep up to date on the local and regional bacteria etiological situation and to be aware of antibiotic resistance patterns for the most commonly involved pathogens. An analysis of the most recent information in italy has confirmed the involvement of the terrible three bacterial species\u2014Haemophilus influenzae, Moraxella catarrhalis and Streptococcus pneumoniae\u2014as the cause of 85-95% of ABECB cases, as well as an increase in resistance to various classes of molecules by all the respiratory pathogens. On the basis of the known resistance patterns in italy, some antibiotics are no longer considered first choice for empiric therapy such as the unprotected betalactams, tetracycline, trimethoprim/sulfamethoxazole and the macrolides) which should be used only after antibiotic susceptibility testing indicates they are still active against the pathogens. The epidemiological picture of bacterial resistance in italy has greatly restricted the choice of antibiotics which can be used for this type of infection, justifying interest in the oral beta-lactams which have the highest therapeutic index and are first choice therapy against bacterial exacerbations of chronic bronchitis. included in this group are amoxicillin-clavulanate and the new cephem molecule, cefditoren, which has been available in italy since 2008. Thanks to its good pharmacokinetics and pharmacodynamics as well as clinical performance, cefditoren may be considered a drug of choice against exacerbations of chronic bronchitis

Conclusions. Role of the oral Beta-lactams in the treatment of exacerbations of chronic bronchitis: critical analysis and therapeutics recommendations.

NO ABSTRAC

Description of the disease and diagnostic and epidemiologic aspects.

NO ABSTRAC

Role of the Oral Beta-Lactams in the Treatment of Exacerbations of Chronic Bronchitis: Critical Analysis and Therapeutic Recommendations

The GIARIR study group has made a critical analysis of the most recent scientific literature on acute bacterial exacerbations of chronic bronchitis (ABECB) with the aim of proposing therapeutic recommendations applicable to the current epidemiological situation in Italy. The international literature has indicated the scarcity of studies on the treatment of ABECB compared to an abundance of information regarding chronic obstructive pulmonary disease (COPD), of which ABECB is often considered the initial ore predisposing stage, even though a precise evolutionary correlation between these pathologies has not yet been demonstrated. ABECB is the principle cause of doctor visits, hospitalization and death in COPD patients. The natural course of the disease is characterized by the appearance of exacerbation episodes (a mean of two yearly). For this reason it is indispensable to prevent exacerbations, to treat them as quickly as possible, in order to minimize their negative effects on the respiratory tract and the patient's general health. The routine use of antibiotic therapy is controversial because at least 20% of exacerbations do not have an infectious origin and about 30% are viral. In most cases the choice of antibiotic is empiric, in both ABECB patients without risk factors (mild form) and in those with risk factors such as cigarette smoking or constant exposure to air pollutants (moderate form). For these reasons it is necessary to keep up to date on the local and regional bacteria etiological situation and to be aware of antibiotic resistance patterns for the most commonly involved pathogens. An analysis of the most recent information in Italy has confirmed the involvement of the terrible three bacterial species Haemophilus influenzae, Moraxella catarrhalis and Streptococcus pneumoniae as the cause of 85-95% of ABECB cases, as well as an increase in resistance to various classes of molecules by all the respiratory pathogens. On the basis of the known resistance patterns in Italy, some antibiotics are no longer considered first choice for empiric therapy such as the unprotected beta-lactams, tetracycline, trimethoprim/sulfamethoxazole and the macrolides) which should be used only after antibiotic susceptibility testing indicates they are still active against the pathogens. The epidemiological picture of bacterial resistance in Italy has greatly restricted the choice of antibiotics which can be used for this type of infection, justifying interest in the oral beta-lactams which have the highest therapeutic index and are first choice therapy against bacterial exacerbations of chronic bronchitis. Included in this group are amoxicillin-clavulanate and the new cephem molecule, cefditoren, which has been available in Italy since 2008. Thanks to its good pharmacokinetics and pharmacodynamics as well as clinical performance, cefditoren may be considered a drug of choice against exacerbations of chronic bronchitis

Pharmacological and pharmaeconomic considerations.

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Etiology issues and problems of antibiotic resistance.

NO ABSTRAC