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A special issue of Antibiotics (ISSN 2079-6382). This special issue belongs to the section "Antibiotic Therapy in Infectious Diseases".

Deadline for manuscript submissions: closed (30 June 2024) | Viewed by 35147

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Special Issue Editors

Prof. Dr. Anastasia Kotanidou

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Guest Editor

First Department of Critical Care Medicine & Pulmonary Services, Medical School of National and Kapodistrian University of Athens, Evangelismos Hospital, 10676 Athens, Greece
Interests: inflammation; endothelial injury; ventilator associated pneumonia; critical care medicine; critical care infections; SARS-CoV-2

Prof. Dr. Sotirios Tsiodras

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Guest Editor

Fourth Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
Interests: infections; emerging pathogens; inflammation; immunology; public health; respiratory infections; MDR organisms; viral pathogens

Dr. Paraskevi C. Fragkou

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Guest Editor

Attikon University Hospital, Athens, Greece
Interests: viral infections; immunopathogenesis of viral disease
Special Issues, Collections and Topics in MDPI journals

Dr. Charalampos D. Moschopoulos

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Guest Editor Assistant

Fourth Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
Interests: HIV infection; viral infection; emerging pathogens; MDR organisms; respiratory infections; infections in immunocompromised; host immune responses
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

We are pleased to invite you to contribute to this Special Issue, entitled “Antimicrobial Treatment of Lower Respiratory Tract Infections”. Lower respiratory tract infections (LRTIs) are highly prevalent. However, severe LRTIs are associated with significant mortality and morbidity worldwide. Pneumonia remains among the main causes of morbidity and mortality in adults and represents the leading cause of death in children under the age of five. Pneumonia, and specifically severe community-acquired pneumonia and nosocomial pneumonia, as well as other severe LRTIs, are associated with huge socioeconomic and healthcare costs. Antimicrobials remain the mainstay of bacterial LRTI treatment, although their use in viral LRTIs may be associated with significant side effects. Prompt initiation of pathogen-specific antimicrobials is crucial for improving the prognosis and outcome of LRTIs and plays a pivotal role in reducing their global healthcare and socioeconomic burden.

This Special Issue aims to delineate the latest pre-clinical (experimental), animal and clinical research and clinic-epidemiological data on the role of old and newer antimicrobials in the progress, prognosis and the outcome of pneumonia. Ultimately, this issue aims to expand our understanding and generate in-depth knowledge on the management of community- and healthcare-associated bacterial LRTIs through gathering current evidence and addressing potential gaps in the literature.

Original research articles and reviews are welcome. Research areas may include (but are not limited to) the following: antimicrobial treatment in community-acquired pneumonia/lower respiratory tract infection; antimicrobial treatment in healthcare-associated pneumonia; epidemiology and mechanisms of antibiotic resistance of pneumonia pathogens; novel antibiotics for lower respiratory tract infections; use of antimicrobials for lower respiratory tract infections in specific populations, such as immunocompromised and critically ill patients, those with COVID-19 and other severe viral LRTIs and elderly, pediatric, cystic fibrosis, COPD and asthma patients.

We look forward to receiving your contributions.

Prof. Dr. Anastasia Kotanidou
Prof. Dr. Sotirios Tsiodras
Dr. Paraskevi C. Fragkou
Guest Editors

Dr. Charalampos D. Moschopoulos
Guest Editor Assistant

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Antibiotics is an international peer-reviewed open access monthly journal published by MDPI.

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Keywords

lower respiratory tract infection
community-acquired pneumonia
nosocomial pneumonia
ventilator-associated pneumonia
antibiotics
antimicrobial resistance

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Published Papers (12 papers)

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11 pages, 1066 KiB

Open AccessArticle

Association between Empirical Anti-Pseudomonal Antibiotics and Progression to Thoracic Surgery and Death in Empyema: Database Research

by Akihiro Shiroshita, Kentaro Tochitani, Yohei Maki, Takero Terayama and Yuki Kataoka

Antibiotics 2024, 13(5), 383; https://doi.org/10.3390/antibiotics13050383 - 24 Apr 2024

Viewed by 1229

Abstract

Evidence on the optimal antibiotic strategy for empyema is lacking. Our database study aimed to evaluate the effectiveness of empirical anti-pseudomonal antibiotics in patients with empyema. We utilised a Japanese real-world data database, focusing on patients aged ≥40 diagnosed with empyema, who underwent thoracostomy and received intravenous antibiotics either upon admission or the following day. Patients administered intravenous vasopressors were excluded. We compared thoracic surgery and death within 90 days after admission between patients treated with empirical anti-pseudomonal and non-anti-pseudomonal antibiotics. Cause-specific hazard ratios for thoracic surgery and death were estimated using Cox proportional hazards models, with adjustment for clinically important confounders. Subgroup analyses entailed the same procedures for patients exhibiting at least one risk factor for multidrug-resistant organisms. Between March 2014 and March 2023, 855 patients with empyema meeting the inclusion criteria were enrolled. Among them, 271 (31.7%) patients received anti-pseudomonal antibiotics. The Cox proportional hazards models indicated that compared to empirical non-anti-pseudomonal antibiotics, empirical anti-pseudomonal antibiotics were associated with higher HRs for thoracic surgery and death within 90 days, respectively. Thus, regardless of the risks of multidrug-resistant organisms, empirical anti-pseudomonal antibiotics did not extend the time to thoracic surgery or death within 90 days. Full article

(This article belongs to the Special Issue Antimicrobial Treatment of Lower Respiratory Tract Infections)

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9 pages, 1039 KiB

Open AccessArticle

Antibiotic Treatment for Lower Respiratory Tract Infections in Primary Care: A Register-Based Study Examining the Role of Radiographic Imaging

by Sara Carlsson, Katarina Hedin, Olof Cronberg and Anna Moberg

Antibiotics 2023, 12(7), 1165; https://doi.org/10.3390/antibiotics12071165 - 9 Jul 2023

Cited by 2 | Viewed by 1659

Abstract

When imaging (i.e., chest-x-ray or computed tomography) is used to differentiate between acute bronchitis and pneumonia, many patients are being prescribed antibiotics despite the absence of radiographic pneumonia signs. This study of lower respiratory tract infections (LRTIs) with negative chest imaging compares cases where antibiotics were prescribed and not prescribed to find characteristics that could explain the prescription. Data were extracted from the regional electronic medical record system in Kronoberg County, Sweden, for patients aged 18–79 years diagnosed with acute bronchitis or pneumonia and who had any chest radiologic imaging between 2007–2014. Of 696 cases without evidence of pneumonia on imaging, 55% were prescribed antibiotics. Age, sex, and co-morbidity did not differ between those with or without antibiotics. The median level of C-reactive protein was low in both groups but differed significantly (21 vs. 10 mg/L; p < 0.001). Resident physicians prescribed antibiotics more frequently than interns or specialists (p < 0.001). It is unclear what features prompted the antibiotic prescribing in those with negative imaging indicating overuse of antibiotics for LRTIs. Full article

(This article belongs to the Special Issue Antimicrobial Treatment of Lower Respiratory Tract Infections)

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10 pages, 255 KiB

Open AccessArticle

Evaluation of a Pediatric Community-Acquired Pneumonia Antimicrobial Stewardship Intervention at an Academic Medical Center

by Lauren Puzz, Emily A. Plauche, David A. Cretella, Virginia A. Harrison and Mary Joyce B. Wingler

Antibiotics 2023, 12(4), 780; https://doi.org/10.3390/antibiotics12040780 - 19 Apr 2023

Cited by 2 | Viewed by 2096

Abstract

(1) Background: Pneumonia is the leading diagnosis associated with antibiotic use in hospitalized children. The Infectious Diseases Society of America published pediatric community-acquired pneumonia (CAP) guidelines in 2011, but adherence to recommendations varies across institutions. The purpose of this study was to evaluate the impact of an antimicrobial stewardship intervention on antibiotic prescribing in pediatric patients admitted to an academic medical center. (2) Methods: This single-center pre/post-intervention evaluation included children admitted for CAP during three time periods (pre-intervention and post-intervention groups 1 and 2). The primary outcomes were changes in inpatient antibiotic selection and duration following the interventions. Secondary outcomes included discharge antibiotic regimens, length of stay, and 30-day readmission rates. (3) Results: A total of 540 patients were included in this study. Most patients were under five years of age (69%). Antibiotic selection significantly improved, with prescriptions for ceftriaxone decreasing (p < 0.001) and ampicillin increasing (p < 0.001) following the interventions. Antibiotic duration decreased from a median of ten days in the pre-intervention group and post-intervention group 1 to eight days in post-intervention group 2. (4) Conclusions: Our antibiotic stewardship intervention directed at pediatric CAP treatment resulted in improved antibiotic prescriptions and provides data that can be used to further educate providers at our institution. Full article

(This article belongs to the Special Issue Antimicrobial Treatment of Lower Respiratory Tract Infections)

12 pages, 290 KiB

Open AccessArticle

Pulse Oximetry as an Aid to Rule Out Pneumonia among Patients with a Lower Respiratory Tract Infection in Primary Care

by Chloé Fischer, José Knüsli, Loïc Lhopitallier, Estelle Tenisch, Marie-Garance Meuwly, Pauline Douek, Jean-Yves Meuwly, Valérie D’Acremont, Andreas Kronenberg, Isabella Locatelli, Yolanda Mueller, Nicolas Senn and Noémie Boillat-Blanco

Antibiotics 2023, 12(3), 496; https://doi.org/10.3390/antibiotics12030496 - 2 Mar 2023

Cited by 1 | Viewed by 2008

Abstract

Guidelines recommend chest X-rays (CXRs) to diagnose pneumonia and guide antibiotic treatment. This study aimed to identify clinical predictors of pneumonia that are visible on a chest X-ray (CXR+) which could support ruling out pneumonia and avoiding unnecessary CXRs, including oxygen saturation. A secondary analysis was performed in a clinical trial that included patients with suspected pneumonia in Swiss primary care. CXRs were reviewed by two radiologists. We evaluated the association between clinical signs (heart rate > 100/min, respiratory rate ≥ 24/min, temperature ≥ 37.8 °C, abnormal auscultation, and oxygen saturation < 95%) and CXR+ using multivariate analysis. We also calculated the diagnostic performance of the associated clinical signs combined in a clinical decision rule (CDR), as well as a CDR derived from a large meta-analysis (at least one of the following: heart rate > 100/min, respiratory rate ≥ 24/min, temperature ≥ 37.8 °C, or abnormal auscultation). Out of 469 patients from the initial trial, 107 had a CXR and were included in this study. Of these, 26 (24%) had a CXR+. We found that temperature and oxygen saturation were associated with CXR+. A CDR based on the presence of either temperature ≥ 37.8 °C and/or an oxygen saturation level < 95% had a sensitivity of 69% and a negative likelihood ratio (LR−) of 0.45. The CDR from the meta-analysis had a sensitivity of 92% and an LR− of 0.37. The addition of saturation < 95% to this CDR increased the sensitivity (96%) and decreased the LR− (0.21). In conclusion, this study suggests that pulse oximetry could be added to a simple CDR to decrease the probability of pneumonia to an acceptable level and avoid unnecessary CXRs. Full article

(This article belongs to the Special Issue Antimicrobial Treatment of Lower Respiratory Tract Infections)

10 pages, 870 KiB

Open AccessArticle

Overruling of Procalcitonin-Guided Antibiotics for Lower Respiratory Tract Infections in Primary Care: Ancillary Study of a Randomized Controlled Trial

by José Knüsli, Loïc Lhopitallier, Andreas Kronenberg, Jean-Yves Meuwly, Onya Opota, Marc-Antoine Perrenoud, Marie-Anne Page, Kevin C. Kain, Aline Mamin, Valérie D’Acremont, Nicolas Senn, Yolanda Mueller, Isabella Locatelli and Noémie Boillat-Blanco

Antibiotics 2023, 12(2), 377; https://doi.org/10.3390/antibiotics12020377 - 12 Feb 2023

Cited by 1 | Viewed by 2145

Abstract

Background: Lower respiratory tract infections (LRTIs) in primary care are a promising target for antibiotic stewardship. A clinical trial in Switzerland showed a large decrease in antibiotic prescriptions with procalcitonin guidance (cut-off < 0.25 µg/L) compared with usual care. However, one-third of patients with low procalcitonin at baseline received antibiotics by day 28. Aim: To explore the factors associated with the overruling of initial procalcitonin guidance. Design and Setting: Secondary analysis of a cluster randomized trial in which patients with an LRTI were included. Method: Using the characteristics of patients, their disease, and general practitioners (GPs), we conducted a multivariate logistic regression, adjusted for clustering. Results: Ninety-five out of 301 (32%) patients with low procalcitonin received antibiotics by day 28. Factors associated with an overruling of procalcitonin guidance were: a history of chest pain (adjusted OR [aOR] 1.81, 95% confidence interval 1.03–3.17); a prescription of chest X-ray by the GP (aOR 4.65, 2.32–9.34); a C-reactive protein measured retrospectively above 100 mg/L (aOR 7.48, 2.34–23.93, reference ≤ 20 mg/L); the location of the GP practice in an urban setting (aOR 2.27, 1.18–4.37); and the GP’s number of years of experience (aOR per year 1.05, 1.01–1.09). Conclusions: Overruling of procalcitonin guidance was associated with GPs’ socio-demographic characteristics, pointing to the general behavioral problem of overprescription by physicians. Continuous medical education and communication training might support the successful implementation of procalcitonin point-of-care tests aimed at antibiotic stewardship. Full article

(This article belongs to the Special Issue Antimicrobial Treatment of Lower Respiratory Tract Infections)

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15 pages, 1404 KiB

Open AccessArticle

Intravenous Polymyxin B as Adjunctive Therapy to High-Dose Tigecycline for the Treatment of Nosocomial Pneumonia Due to Carbapenem-Resistant Acinetobacter baumannii and Klebsiella pneumoniae: A Propensity Score-Matched Cohort Study

by Lei Zha, Xue Zhang, Yusheng Cheng, Qiancheng Xu, Lingxi Liu, Simin Chen, Zhiwei Lu, Jun Guo and Boris Tefsen

Antibiotics 2023, 12(2), 273; https://doi.org/10.3390/antibiotics12020273 - 30 Jan 2023

Cited by 5 | Viewed by 3107

Abstract

Although the combination of polymyxin and tigecycline is widely used in treating carbapenem-resistant bacterial infections, the benefit of this combination is still uncertain. To assess whether adding polymyxin B to the high-dose tigecycline regimen would result in better clinical outcomes than the high-dose tigecycline therapy in patients with pneumonia caused by carbapenem-resistant Klebsiella pneumoniae and Acinetobacter baumannii, we conducted a propensity score-matched cohort study in a single center between July 2019 and December 2021. Of the 162 eligible patients, 102 were included in the 1:1 matched cohort. The overall 14-day mortality in the matched cohort was 24.5%. Compared with high-dose tigecycline, the combination therapy was not associated with better clinical outcomes, and showed similar 14-day mortality (OR, 0.72, 95% CI 0.27–1.83, p = 0.486), clinical cure (OR, 1.09, 95% CI 0.48–2.54, p = 0.823), microbiological cure (OR, 0.96, 95% CI 0.39–2.53, p = 0.928) and rate of nephrotoxicity (OR 0.85, 95% CI 0.36–1.99, p = 0.712). Subgroup analyses also did not demonstrate any statistical differences. Based on these results, it is reasonable to recommend against adding polymyxin B to the high-dose tigecycline regimen in treating pneumonia caused by carbapenem-resistant K. pneumoniae and A. baumannii. Full article

(This article belongs to the Special Issue Antimicrobial Treatment of Lower Respiratory Tract Infections)

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14 pages, 1894 KiB

Open AccessArticle

Pragmatic Comparison of Piperacillin/Tazobactam versus Carbapenems in Treating Patients with Nosocomial Pneumonia Caused by Extended-Spectrum β-Lactamase-Producing Klebsiella pneumoniae

by Lei Zha, Xiang Li, Zhichu Ren, Dayan Zhang, Yi Zou, Lingling Pan, Shirong Li, Shanghua Chen and Boris Tefsen

Antibiotics 2022, 11(10), 1384; https://doi.org/10.3390/antibiotics11101384 - 10 Oct 2022

Cited by 6 | Viewed by 5281

Abstract

The effectiveness of piperacillin/tazobactam for managing nosocomial pneumonia caused by extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae is unknown. To answer this question, we conducted a retrospective cohort study in two tertiary teaching hospitals of patients admitted between January 2018 and July 2021 with a diagnosis of nosocomial pneumonia caused by ESBL-producing K. pneumoniae receiving either piperacillin/tazobactam or carbapenems within 24 h from the onset of pneumonia for at least 72 h. Clinical outcomes, including 28-day mortality and 14-day clinical and microbiological cure, were analyzed. Of the 136 total patients, 64 received piperacillin/tazobactam and 72 received carbapenems. The overall 28-day mortality was 19.1% (26/136). In the inverse probability of treatment weighted cohort, piperacillin/tazobactam therapy was not associated with worse clinical outcomes, as the 28-day mortality (OR, 0.82, 95% CI, 0.23–2.87, p = 0.748), clinical cure (OR, 0.94, 95% CI, 0.38–2.35, p = 0.894), and microbiological cure (OR, 1.10, 95% CI, 0.53–2.30, p = 0.798) were comparable to those of carbapenems. Subgroup analyses also did not demonstrate any statistical differences. In conclusion, piperacillin/tazobactam could be an effective alternative to carbapenems for treating nosocomial pneumonia due to ESBL-producing K. pneumoniae when the MICs are ≤8 mg/L. Full article

(This article belongs to the Special Issue Antimicrobial Treatment of Lower Respiratory Tract Infections)

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8 pages, 1618 KiB

Open AccessArticle

Comparison between Ceftriaxone and Sulbactam-Ampicillin as Initial Treatment of Community-Acquired Pneumonia: A Systematic Review and Meta-Analysis

by Hideo Kato, Mao Hagihara, Nobuhiro Asai, Jun Hirai, Yuka Yamagishi, Takuya Iwamoto and Hiroshige Mikamo

Antibiotics 2022, 11(10), 1291; https://doi.org/10.3390/antibiotics11101291 - 22 Sep 2022

Cited by 4 | Viewed by 6826

Abstract

Current guidelines recommend the use of ceftriaxone and sulbactam-ampicillin for the initial treatment of community-acquired pneumonia (CAP). However, there are no clear data on these guidelines. Therefore, this systematic review and meta-analysis aims to evaluate the effectiveness of ceftriaxone and sulbactam-ampicillin in the initial treatment of CAP. The Embase, Scopus, PubMed, Ichushi, and Cumulative Index to Nursing and Allied Health Literature databases were systematically searched from inception to July 2022. The studies included patients who received ceftriaxone or sulbactam-ampicillin as the initial antibiotic therapy for CAP. The mortality and clinical cure rates were evaluated. Of the 2152 citations identified for screening, four studies were included. Results of the pooled analysis indicated no significant differences in the mortality and clinical cure rates between patients treated with ceftriaxone and those treated with sulbactam-ampicillin (mortality, odds ratio [OR]: 1.85, 95% confidence interval [CI]: 0.57–5.96; clinical cure rate, OR: 1.08, 95% CI: 0.18–6.44). This study supports the guidelines for CAP treatment, though further studies are needed to obtain a deeper understanding. Full article

(This article belongs to the Special Issue Antimicrobial Treatment of Lower Respiratory Tract Infections)

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26 pages, 1655 KiB

Open AccessReview

Duration of Antimicrobial Treatment in Adult Patients with Pneumonia: A Narrative Review

by Dimitra Dimopoulou, Charalampos D. Moschopoulos, Konstantina Dimopoulou, Anastasia Dimopoulou, Maria M. Berikopoulou, Ilias Andrianakis, Sotirios Tsiodras, Anastasia Kotanidou and Paraskevi C. Fragkou

Antibiotics 2024, 13(11), 1078; https://doi.org/10.3390/antibiotics13111078 - 12 Nov 2024

Viewed by 903

Abstract

Pneumonia remains a major global health concern, causing significant morbidity and mortality among adults. This narrative review assesses the optimal duration of antimicrobial treatment in adults with community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP), and ventilator-associated pneumonia (VAP). Current evidence about the impact of treatment duration on clinical outcomes demonstrates that shorter antibiotic courses are non-inferior, regarding safety and efficacy, compared to longer courses, particularly in patients with mild to moderate CAP, which is in line with the recommendations of international guidelines. Data are limited regarding the optimal antimicrobial duration in HAP patients, and it should be individually tailored to each patient, taking into account the causative pathogen and the clinical response. Shorter courses are found to be as effective as longer courses in the management of VAP, except for pneumonia caused by non-fermenting Gram-negative bacteria; however, duration should be balanced between the possibility of higher recurrence rates and the documented benefits with shorter courses. Additionally, the validation of reliable biomarkers or clinical predictors that identify patients who would benefit from shorter therapy is crucial. Insights from this review may lead to future research on personalized antimicrobial therapies in pneumonia, in order to improve patient outcomes. Full article

(This article belongs to the Special Issue Antimicrobial Treatment of Lower Respiratory Tract Infections)

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30 pages, 1048 KiB

Open AccessReview

Novel Antibiotics for Gram-Negative Nosocomial Pneumonia

by Maria Panagiota Almyroudi, Aina Chang, Ioannis Andrianopoulos, Georgios Papathanakos, Reena Mehta, Elizabeth Paramythiotou and Despoina Koulenti

Antibiotics 2024, 13(7), 629; https://doi.org/10.3390/antibiotics13070629 - 5 Jul 2024

Viewed by 1731

Abstract

Nosocomial pneumonia, including hospital-acquired pneumonia and ventilator-associated pneumonia, is the leading cause of death related to hospital-acquired infections among critically ill patients. A growing proportion of these cases are attributed to multi-drug-resistant (MDR-) Gram-negative bacteria (GNB). MDR-GNB pneumonia often leads to delayed appropriate treatment, prolonged hospital stays, and increased morbidity and mortality. This issue is compounded by the increased toxicity profiles of the conventional antibiotics required to treat MDR-GNB infections. In recent years, several novel antibiotics have been licensed for the treatment of GNB nosocomial pneumonia. These novel antibiotics are promising therapeutic options for treatment of nosocomial pneumonia by MDR pathogens with certain mechanisms of resistance. Still, antibiotic resistance remains an evolving global crisis, and resistance to novel antibiotics has started emerging, making their judicious use crucial to prolong their shelf-life. This article presents an up-to-date review of these novel antibiotics and their current role in the antimicrobial armamentarium. We critically present data for the pharmacokinetics/pharmacodynamics, the in vitro spectrum of antimicrobial activity and resistance, and in vivo data for their clinical and microbiological efficacy in trials. Where possible, available data are summarized specifically in patients with nosocomial pneumonia, as this cohort may exhibit ‘critical illness’ physiology that affects drug efficacy. Full article

(This article belongs to the Special Issue Antimicrobial Treatment of Lower Respiratory Tract Infections)

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13 pages, 1032 KiB

Open AccessReview

The Role of the Respiratory Microbiome in the Pathogenesis of Aspiration Pneumonia: Implications for Diagnosis and Potential Therapeutic Choices

by Natalia G. Vallianou, Alexandros Skourtis, Dimitris Kounatidis, Evangelia Margellou, Fotis Panagopoulos, Eleni Geladari, Angelos Evangelopoulos and Edison Jahaj

Antibiotics 2023, 12(1), 140; https://doi.org/10.3390/antibiotics12010140 - 10 Jan 2023

Cited by 6 | Viewed by 2413

Abstract

Although the lungs were considered to be sterile until recently, the advent of molecular biology techniques, such as polymerase chain reaction, 16 S rRNA sequencing and metagenomics has led to our expanding knowledge of the lung microbiome. These methods may be particularly useful for the identification of the causative agent(s) in cases of aspiration pneumonia, in which there is usually prior administration of antibiotics. The most common empirical treatment of aspiration pneumonia is the administration of broad-spectrum antibiotics; however, this may result in negative cultures from specimens taken from the respiratory tract. Therefore, in such cases, polymerase chain reaction or metagenomic next-generation sequencing may be life-saving. Moreover, these modern molecular methods may assist with antimicrobial stewardship. Based upon factors such as age, altered mental consciousness and recent hospitalization, there is a shift towards the predominance of aerobes, especially Gram-negative bacteria, over anaerobes in aspiration pneumonia. Thus, the therapeutic choices should be expanded to cover multi-drug resistant Gram-negative bacteria in selected cases of aspiration pneumonia. Full article

(This article belongs to the Special Issue Antimicrobial Treatment of Lower Respiratory Tract Infections)

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29 pages, 17265 KiB

Open AccessSystematic Review

Echinacea Reduces Antibiotics by Preventing Respiratory Infections: A Meta-Analysis (ERA-PRIMA)

by Giuseppe Gancitano, Nicola Mucci, Rainer Stange, Mercedes Ogal, Selvarani Vimalanathan, Mahfuza Sreya, Anthony Booker, Bushra Hadj-Cherif, Werner C. Albrich, Karin Woelkart-Ardjomand, Samo Kreft, Wim Vanden Berghe, Godehard Hoexter, Andreas Schapowal and Sebastian L. Johnston

Antibiotics 2024, 13(4), 364; https://doi.org/10.3390/antibiotics13040364 - 16 Apr 2024

Cited by 3 | Viewed by 4528

Abstract

Respiratory tract infections (RTIs) are the leading cause of antibiotic prescriptions, primarily due to the risk for secondary bacterial infections. In this study, we examined whether Echinacea could reduce the need for antibiotics by preventing RTIs and their complications, and subsequently investigated its safety profile. A comprehensive search of EMBASE, PubMed, Google Scholar, Cochrane DARE and clinicaltrials.gov identified 30 clinical trials (39 comparisons) studying Echinacea for the prevention or treatment of RTIs in 5652 subjects. Echinacea significantly reduced the monthly RTI occurrence, risk ratio (RR) 0.68 (95% CI 0.61–0.77) and number of patients with ≥1 RTI, RR = 0.75 [95% CI 0.69–0.81] corresponding to an odds ratio 0.53 [95% CI 0.42–0.67]. Echinacea reduced the risk of recurrent infections (RR = 0.60; 95% CI 0.46–0.80), RTI complications (RR = 0.44; 95% CI 0.36–0.54) and the need for antibiotic therapy (RR = 0.60; 95% CI 0.39–0.93), with total antibiotic therapy days reduced by 70% (IRR = 0.29; 95% CI 0.11–0.74). Alcoholic extracts from freshly harvested Echinacea purpurea were the strongest, with an 80% reduction of antibiotic treatment days, IRR 0.21 [95% CI 0.15–0.28]. An equal number of adverse events occurred with Echinacea and control treatment. Echinacea can safely prevent RTIs and associated complications, thereby decreasing the demand for antibiotics. Relevant differences exist between Echinacea preparations. Full article

(This article belongs to the Special Issue Antimicrobial Treatment of Lower Respiratory Tract Infections)

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