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Concept: Lower respiratory tract

169

BACKGROUND: The new combination of moxifloxacin HCl and cefixime trihydrate is approved for the treatments of lower respiratory tract infections in adults. At initial formulation development and screening stage a fast and reliable method for the dissolution and release testing of moxifloxacin and cefixime were highly desirable. The zero order overlaid UV spectra of moxifloxacin and cefixime showed >90% of spectra are overlapping. Hence, simple, accurate precise and validated two derivative spectrophotometric methods have been developed for the determination of moxifloxacin and cefixime. METHODS: In the first derivative spectrophotometric method varying concentration of moxifloxacin and cefixime were prepared and scanned in the range of 200 to 400 nm and first derivative spectra were calculated (n = 1). The zero crossing wavelengths 287 nm and 317.9 nm were selected for determination of moxifloxacin and cefixime, respectively. In the second method the first derivative of ratio spectra was calculated and used for the determination of moxifloxacin and cefixime by measuring the peak intensity at 359.3 nm and 269.6 nm respectively. RESULTS: Calibration graphs were established in the range of 1–16 mug /mL and 1–15 mug /mL for both the drugs by first and ratio first derivative spectroscopic methods respectively with good correlation coefficients. Average accuracy of assay of moxifloxacin and cefixime were found to be 100.68% and 98 93%, respectively. Relative standard deviations of both inter and intraday assays were less than 1.8%. Moreover, recovery of moxifloxacin and cefixime was more than 98.7% and 99.1%, respectively. CONCLUSIONS: The described derivative spectrophotometric methods are simple, rapid, accurate, precise and excellent alternative to sophisticated chromatographic techniques. Hence, the proposed methods can be used for the quality control of the cited drugs and can be extended for routine analysis of the drugs in formulations.

Concepts: Ultraviolet-visible spectroscopy, Lower respiratory tract, Accuracy and precision, Upper respiratory tract, Respiratory system, Spectroscopy, Ultraviolet, Spectrophotometry

81

The present study was initiated to investigate the effectiveness, safety and tolerability of complex homeopathic CalSuli-4-02 tablets on prevention of recurrent acute upper respiratory tract infections (URTIs) in children, in comparison to another complex homeopathic product.

Concepts: Clinical research, Pharmaceutical industry, Lower respiratory tract, Pharmacology, Upper respiratory tract, Upper respiratory tract infection, Clinical trial, Respiratory system

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Objective To assess the impact on adverse outcomes of different antibiotic prescribing strategies for lower respiratory tract infections in people aged 16 years or more.Design Prospective cohort study.Setting UK general practice.Participants 28 883 patients with lower respiratory tract infection; symptoms, signs, and antibiotic prescribing strategies were recorded at the index consultation.Main outcome measures The main outcomes were reconsultation with symptoms of lower respiratory tract infection in the 30 days after the index consultation, hospital admission, or death. Multivariable analysis controlled for an extensive list of variables related to the propensity to prescribe antibiotics and for clustering by doctor.Results Of the 28 883 participants, 104 (0.4%) were referred to hospital for radiographic investigation or admission, or both on the day of the index consultation, or were admitted with cancer. Of the remaining 28 779, subsequent hospital admission or death occurred in 26/7332 (0.3%) after no antibiotic prescription, 156/17 628 (0.9%) after prescription for immediate antibiotics, and 14/3819 (0.4%) after a prescription for delayed antibiotics. Multivariable analysis documented no reduction in hospital admission and death after immediate antibiotics (multivariable risk ratio 1.06, 95% confidence interval 0.63 to 1.81, P=0.84) and a non-significant reduction with delayed antibiotics (0.81, 0.41 to 1.64, P=0.61). Reconsultation for new, worsening, or non-resolving symptoms was common (1443/7332 (19.7%), 4455/17 628 (25.3%), and 538/3819 (14.1%), respectively) and was significantly reduced by delayed antibiotics (multivariable risk ratio 0.64, 0.57 to 0.72, P<0.001) but not by immediate antibiotics (0.98, 0.90 to 1.07, P=0.66).Conclusion Prescribing immediate antibiotics may not reduce subsequent hospital admission or death for young people and adults with uncomplicated lower respiratory tract infection, and such events are uncommon. If clinicians are considering antibiotics, a delayed prescription may be preferable since it is associated with a reduced number of reconsultations for worsening illness.

Concepts: Lower respiratory tract, Disease, Upper respiratory tract infection, Antibiotic, Medical prescription, Bacteria, Upper respiratory tract, Respiratory system

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To compare the effects of a single nocturnal dose of 3 honey products (eucalyptus honey, citrus honey, or labiatae honey) to placebo (silan date extract) on nocturnal cough and difficulty sleeping associated with childhood upper respiratory tract infections (URIs).

Concepts: Diurnality, Hypnotic, Circadian rhythm, Sleep disorder, Lower respiratory tract, Upper respiratory tract, Upper respiratory tract infection, Respiratory system

43

Human rhinoviruses are the most common respiratory viruses detected in patients after hematopoietic cell transplantation. Although rhinovirus appears to occasionally cause severe lower respiratory tract infection in immunocompromised patients, the clinical significance of rhinovirus detection in the lower respiratory tract remains unknown. We evaluated 697 recipients transplanted between 1993 and 2015 with rhinovirus in respiratory samples. As comparative cohorts, 273 recipients with lower respiratory tract infection caused by respiratory syncytial virus (N=117), parainfluenza virus (N=120), or influenza (N=36) were analyzed. Factors associated with mortality were analyzed using Cox proportional hazard models. Among 569 subjects with rhinovirus upper respiratory tract infection and 128 subjects with rhinovirus lower respiratory tract infection, probabilities of overall mortality at 90 days were 6% and 41%, respectively (p<0.001). The survival rate after lower respiratory tract infection was not affected by the presence of co-pathogens (55% in patients with co-pathogens, 64% in patients without, p=0.34). Low monocyte count (p=0.027), oxygen use (p=0.015), and steroid dose greater than 1 mg/kg/day (p=0.003) before diagnosis were significantly associated with mortality among patients with lower respiratory tract infection in multivariable analysis. Mortality after rhinovirus lower respiratory tract infection was similar to that after lower respiratory tract infection by respiratory syncytial virus, parainfluenza virus or influenza in an adjusted model. In summary, transplant recipients with rhinovirus detection in the lower respiratory tract had high mortality rates comparable to viral pneumonia associated with other well-established respiratory viruses. Our data suggest rhinovirus can contribute to severe pulmonary disease in immunocompromised hosts.

Concepts: Pneumonia, Upper respiratory tract infection, Pulmonology, Human respiratory syncytial virus, Common cold, Lower respiratory tract, Upper respiratory tract, Respiratory system

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Cough is a frequent symptom associated to upper respiratory tract infections (URTIs) and, although being self-limiting, it might deeply affect the quality of life. Homeopathic products are often employed by patients to treat cough, but the evidence on their efficacy is scarce. Thus, we tested the efficacy of an homeopathic syrup in treating cough arising from URTIs with a randomized, double blind, placebo controlled clinical trial. Patients were treated with either the homeopathic syrup or a placebo for a week, and recorded cough severity in a diary by means of a verbal category-descriptive score for two weeks. Sputum viscosity was assessed with a viscosimeter before and after 4 days of treatment; patients were also asked to provide a subjective evaluation of viscosity. Eighty patients were randomized to receive placebo (n=40) or the homeopathic syrup (n=40). All patients completed the study. In each group cough scores decreased over time, however, after 4 and 7 days of treatment, cough severity was significantly lower in the homeopathic group than in the placebo one (P<0.001 and P=0.023, respectively). Sputum was collected from 53 patients: in both groups its viscosity significantly decreased after 4 days of treatment (P<0.001); however, viscosity was significantly lower in the homeopathic group (P=0.018). Instead, the subjective evaluation did not significantly differ between the two groups (P=0.059). No adverse events related to any treatment were reported. We concluded that the homeopathic syrup employed in the study was able to effectively reduce cough severity and sputum viscosity, thereby representing a valid remedy for the management of acute cough induced by URTIs.

Concepts: Lower respiratory tract, Homeopathy, Randomized controlled trial, Upper respiratory tract, Upper respiratory tract infection, Respiratory system, Clinical trial, Placebo

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The cause and manner of death in submersion cases are a routine challenge for forensic pathologists as they present considerable diagnostic difficulties. The present study was undertaken with a view to determine the characteristic pattern in bodies retrieved from water. From a total of 6779 medicolegal deaths reported at an Apex Medical Centre, Yeotmal, a rural district of Maharashtra over a 10-year study period, only 110 cases (1.6%) were decomposed and 243 cases (3.6%) were non-decomposed bodies retrieved from water with a rate of 0.6 decomposed body as compared with 1.4 non-decomposed bodies per 100,000 population per year. However, out of total 353 bodies retrieved from water, 31.2% were decomposed and 68.8% non-decomposed. Male predominance was seen in both groups with peak at 31-40 years. The cause and manner of death were ascertained as 89.9% and 82.7%, respectively, in decomposed bodies as compared with 100% and 96.3%, respectively, in non-decomposed bodies. Drowning was the commonest cause of death in both groups with suicide as the commonest manner of death in decomposed bodies in contrast to accidental in non-decomposed bodies. Excessive amount of pleural fluid, aquatic animal activity and mud/vegetation in lower respiratory tract was more commonly encountered in decomposed bodies. However, fine white froth was not seen in any of the cases in contrast to 81% non-decomposed bodies. Bodies were commonly recovered from wells in both groups. Most of the bodies were retrieved in the rainy season followed by summer and winter seasons in both groups.

Concepts: Wet season, Demography, Lower respiratory tract, Death, Aquatic plant, Season, Upper respiratory tract, Respiratory system

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Although culture-independent techniques have refuted lung sterility in health, controversy about contamination during bronchoscope passage through the upper respiratory tract (URT) has impeded research progress. We sought to establish whether bronchoscopic sampling accurately reflects the lung microbiome in health and to distinguish between two proposed routes of authentic microbial immigration, (i) dispersion along contiguous respiratory mucosa and (ii) subclinical microaspiration. During bronchoscopy of eight adult volunteers without lung disease, we performed seven protected specimen brushings (PSB) and bilateral bronchoalveolar lavages (BALs) per subject. We amplified, sequenced, and analyzed the bacterial 16S rRNA gene V4 regions by using the Illumina MiSeq platform. Rigorous attention was paid to eliminate potential sources of error or contamination, including a randomized processing order and the inclusion and analysis of exhaustive procedural and sequencing control specimens. Indices of mouth-lung immigration (mouth-lung community similarity, bacterial burden, and community richness) were all significantly greater in airway and alveolar specimens than in bronchoscope contamination control specimens, indicating minimal evidence of pharyngeal contamination. Ecological indices of mouth-lung immigration peaked at or near the carina, as predicted for a primary immigration route of microaspiration. Bacterial burden, diversity, and mouth-lung similarity were greater in BAL than PSB samples, reflecting differences in the sampled surface areas. (This study has been registered at ClinicalTrials.gov under registration no. NCT02392182.)IMPORTANCE This study defines the bacterial topography of the healthy human respiratory tract and provides ecological evidence that bacteria enter the lungs in health primarily by microaspiration, with potential contribution in some subjects by direct dispersal along contiguous mucosa. By demonstrating that contamination contributes negligibly to microbial communities in bronchoscopically acquired specimens, we validate the use of bronchoscopy to investigate the lung microbiome.

Concepts: Biotechnology, Lung cancer, Ribosomal RNA, 16S ribosomal RNA, Pulmonology, Lower respiratory tract, Upper respiratory tract, Respiratory system

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Excessive prescribing of antibiotics in patients with lower respiratory tract infections (LRTIs) is common in the general population. Due to communication difficulties, it is hypothesised that prescriptions are even more commonplace in the primary care of individuals with intellectual disabilities. Point-of-care C-reactive protein (POC-CRP) testing might lead to more efficient prescribing of antibiotics.

Concepts: Bacteria, Virus, Lower respiratory tract, Upper respiratory tract, Respiratory system

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Aloe arborescens (Candelabra Aloe) has been used in the treatment of upper respiratory tract infections in Central and Eastern European countries for many decades. Originally introduced to support the healing and recovery in cornea transplant patients, aqueous A. arborescens extracts soon became popular in the treatment of upper respiratory tract infections with a focus on toddlers and children. Recent preclinical and clinical data show that immunomodulatory, antiinflammatory, and antiviral effects contribute to its therapeutic efficacy. Based on its well documented, longstanding traditional use and its excellent safety and tolerability, A. arborescens may be considered a valuable addition to the spectrum of herbal medicinal products for the treatment and prophylaxis of upper respiratory tract infections, in particular common cold, in adults and children.

Concepts: Common cold, Aloe, Lower respiratory tract, Eastern Europe, Upper respiratory tract, Aloe arborescens, Respiratory system, Upper respiratory tract infection