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Bruce Arrol - One of the best experts on this subject based on the ideXlab platform.

  • Effectiveness of β lactam antibiotics compared with antibiotics active against atypical pathogens in non-severe community acquired Pneumonia: Meta-analysis
    British Medical Journal, 2005
    Co-Authors: Graham D. Mills, Michael R. Oehley, Bruce Arrol
    Abstract:

    OBJECTIVE: To systematically compare beta lactam antibiotics with antibiotics active against atypical pathogens in the management of community acquired Pneumonia.\n\nDATA SOURCES: Medline, Embase, Cochrane register of controlled trials, international conference proceedings, drug registration authorities, and pharmaceutical companies. Review methods Double blind randomised controlled monotherapy trials comparing beta lactam antibiotics with antibiotics active against atypical pathogens in adults with community acquired Pneumonia. Primary outcome was failure to achieve clinical cure or improvement.\n\nRESULTS: 18 trials totalling 6749 participants were identified, with most patients having mild to moderate community acquired Pneumonia. The summary relative risk for treatment failure in all cause community acquired Pneumonia showed no advantage of antibiotics active against atypical pathogens over beta lactam antibiotics (0.97, 95% confidence interval 0.87 to 1.07). Subgroup analysis was undertaken in those with a specific diagnosis involving atypical pathogens. We found a significantly lower failure rate in patients with Legionella species who were treated with antibiotics active against atypical pathogens (0.40, 0.19 to 0.85). Equivalence was seen for Mycoplasma Pneumoniae (0.60, 0.31 to 1.17) and Chlamydia Pneumoniae (2.32, 0.67 to 8.03).\n\nCONCLUSIONS: Evidence is lacking that clinical outcomes are improved by using antibiotics active against atypical pathogens in all cause non-severe community acquired Pneumonia. Although such antibiotics were superior in the management of patients later shown to have legionella related Pneumonia, this pathogen was rarely responsible for Pneumonia within the included trials. beta lactam agents should remain the antibiotics of initial choice in adults with non-severe community acquired Pneumonia.

Graham D. Mills - One of the best experts on this subject based on the ideXlab platform.

  • Severe community acquired Pneumonia
    BMJ, 2006
    Co-Authors: Graham D. Mills, Richard Laing
    Abstract:

    Research into community acquired Pneumonia over the past two decades has focused on developing tools to measure the severity of illness and which antibiotics to choose. Several tools can now help clinicians identify patients with severe community acquired Pneumonia in clinical settings.1 In people with severe disease, international guidelines recommend early treatment with broad spectrum antibiotics, which provide cover for atypical pathogens.2

  • Effectiveness of β lactam antibiotics compared with antibiotics active against atypical pathogens in non-severe community acquired Pneumonia: Meta-analysis
    British Medical Journal, 2005
    Co-Authors: Graham D. Mills, Michael R. Oehley, Bruce Arrol
    Abstract:

    OBJECTIVE: To systematically compare beta lactam antibiotics with antibiotics active against atypical pathogens in the management of community acquired Pneumonia.\n\nDATA SOURCES: Medline, Embase, Cochrane register of controlled trials, international conference proceedings, drug registration authorities, and pharmaceutical companies. Review methods Double blind randomised controlled monotherapy trials comparing beta lactam antibiotics with antibiotics active against atypical pathogens in adults with community acquired Pneumonia. Primary outcome was failure to achieve clinical cure or improvement.\n\nRESULTS: 18 trials totalling 6749 participants were identified, with most patients having mild to moderate community acquired Pneumonia. The summary relative risk for treatment failure in all cause community acquired Pneumonia showed no advantage of antibiotics active against atypical pathogens over beta lactam antibiotics (0.97, 95% confidence interval 0.87 to 1.07). Subgroup analysis was undertaken in those with a specific diagnosis involving atypical pathogens. We found a significantly lower failure rate in patients with Legionella species who were treated with antibiotics active against atypical pathogens (0.40, 0.19 to 0.85). Equivalence was seen for Mycoplasma Pneumoniae (0.60, 0.31 to 1.17) and Chlamydia Pneumoniae (2.32, 0.67 to 8.03).\n\nCONCLUSIONS: Evidence is lacking that clinical outcomes are improved by using antibiotics active against atypical pathogens in all cause non-severe community acquired Pneumonia. Although such antibiotics were superior in the management of patients later shown to have legionella related Pneumonia, this pathogen was rarely responsible for Pneumonia within the included trials. beta lactam agents should remain the antibiotics of initial choice in adults with non-severe community acquired Pneumonia.

Michael R. Oehley - One of the best experts on this subject based on the ideXlab platform.

  • Effectiveness of β lactam antibiotics compared with antibiotics active against atypical pathogens in non-severe community acquired Pneumonia: Meta-analysis
    British Medical Journal, 2005
    Co-Authors: Graham D. Mills, Michael R. Oehley, Bruce Arrol
    Abstract:

    OBJECTIVE: To systematically compare beta lactam antibiotics with antibiotics active against atypical pathogens in the management of community acquired Pneumonia.\n\nDATA SOURCES: Medline, Embase, Cochrane register of controlled trials, international conference proceedings, drug registration authorities, and pharmaceutical companies. Review methods Double blind randomised controlled monotherapy trials comparing beta lactam antibiotics with antibiotics active against atypical pathogens in adults with community acquired Pneumonia. Primary outcome was failure to achieve clinical cure or improvement.\n\nRESULTS: 18 trials totalling 6749 participants were identified, with most patients having mild to moderate community acquired Pneumonia. The summary relative risk for treatment failure in all cause community acquired Pneumonia showed no advantage of antibiotics active against atypical pathogens over beta lactam antibiotics (0.97, 95% confidence interval 0.87 to 1.07). Subgroup analysis was undertaken in those with a specific diagnosis involving atypical pathogens. We found a significantly lower failure rate in patients with Legionella species who were treated with antibiotics active against atypical pathogens (0.40, 0.19 to 0.85). Equivalence was seen for Mycoplasma Pneumoniae (0.60, 0.31 to 1.17) and Chlamydia Pneumoniae (2.32, 0.67 to 8.03).\n\nCONCLUSIONS: Evidence is lacking that clinical outcomes are improved by using antibiotics active against atypical pathogens in all cause non-severe community acquired Pneumonia. Although such antibiotics were superior in the management of patients later shown to have legionella related Pneumonia, this pathogen was rarely responsible for Pneumonia within the included trials. beta lactam agents should remain the antibiotics of initial choice in adults with non-severe community acquired Pneumonia.

Mark Loeb - One of the best experts on this subject based on the ideXlab platform.

  • Meta-analysis: proton pump inhibitor use and the risk of Community-Acquired Pneumonia: META-ANALYSIS: PPI USE AND Community-Acquired Pneumonia
    Alimentary Pharmacology & Therapeutics, 2010
    Co-Authors: Jennie Johnstone, K. Nerenberg, Mark Loeb
    Abstract:

    Aliment Pharmacol Ther 31, 1165–1177 Summary Background  Observational studies examining the association between proton pump inhibitor (PPI) use and risk of Community-Acquired Pneumonia are conflicting. Aim  To assess systematically the association between risk of Community-Acquired Pneumonia and PPI use in adults. Methods  We searched MEDLINE, EMBASE and CINAHL databases between 1988 and January 2010. Two reviewers independently selected studies based on eligibility criteria and extracted data. Included studies evaluated adults (≥18 years) who took PPIs as an out-patient. The primary outcome was Community-Acquired Pneumonia. Only observational studies with a comparison arm were included. Results  Over 2600 citations were reviewed. Six studies were included. All were nested case-control studies. Meta-analysis found an increased risk of Community-Acquired Pneumonia associated with PPI use [OR 1.36 (95% CI 1.12–1.65)]; significant heterogeneity remained (I2 92%, P 

  • Community‐acquired Pneumonia in older adults
    Geriatrics & Gerontology International, 2005
    Co-Authors: Mark Loeb
    Abstract:

    Community-Acquired Pneumonia is an important cause of morbidity and mortality in older adults. Residents of long-term care facilities, a distinct subpopulation of elderly people, are at particularly high risk for developing nursing-home acquired Pneumonia. In this review, the best evidence for etiology, risk factors, clinical presentation, management and prevention of community acquired Pneumonia in persons 65 years and older are summarized. The emphasis is on the clinical characteristics unique to Community-Acquired Pneumonia in the elderly as well as nursing home acquired Pneumonia.

R D Moore - One of the best experts on this subject based on the ideXlab platform.

  • Community-Acquired Pneumonia: impact of immune status.
    American Journal of Respiratory and Critical Care Medicine, 1995
    Co-Authors: Mundy Lm, P G Auwaerter, D Oldach, M L Warner, E Vance, C A Gaydos, J M Joseph, R Gopalan, Albert A. Burton, R D Moore
    Abstract:

    This cross-sectional and prospective one year study evaluated adults admitted to an inner city hospital with Community-Acquired Pneumonia. The study used extensive diagnostic methods to evaluate the etiologies of Community-Acquired Pneumonia in hospitalized patients with differing immunologic status. Of 385 study patients, concurrent problems associated with immunosuppression were noted in 221 (57%) patients, 180 of whom were human immunodeficiency virus (HIV)-infected. The five most common causes of Community-Acquired Pneumonia were: Streptococcus Pneumoniae, Pneumocystis carinii, aspiration, Hemophilus influenzae, and gram-negative bacilli. Only 8.3% of patients had either Legionella, Chlamydia Pneumoniae or Mycoplasma Pneumoniae. Despite use of state-of-the-art diagnostic techniques, no diagnosis was made in 46 of 180 (25.6%) HIV-infected patients, 56 of 164 (34.1%) immunocompetent patients, and 20 of 41 (48.8%) non-HIV-infected immunosuppressed patients. The diagnostic yield of pre-antibiotic sputum c...

  • Community-Acquired Pneumonia: impact of immune status.
    American journal of respiratory and critical care medicine, 1995
    Co-Authors: L M Mundy, P G Auwaerter, D Oldach, M L Warner, A Burton, E Vance, C A Gaydos, J M Joseph, R Gopalan, R D Moore
    Abstract:

    This cross-sectional and prospective one year study evaluated adults admitted to an inner city hospital with Community-Acquired Pneumonia. The study used extensive diagnostic methods to evaluate the etiologies of Community-Acquired Pneumonia in hospitalized patients with differing immunologic status. Of 385 study patients, concurrent problems associated with immunosuppression were noted in 221 (57%) patients, 180 of whom were human immunodeficiency virus (HIV)-infected. The five most common causes of Community-Acquired Pneumonia were: Streptococcus Pneumoniae, Pneumocystis carinii, aspiration, Hemophilus influenzae, and gram-negative bacilli. Only 8.3% of patients had either Legionella, Chlamydia Pneumoniae or Mycoplasma Pneumoniae. Despite use of state-of-the-art diagnostic techniques, no diagnosis was made in 46 of 180 (25.6%) HIV-infected patients, 56 of 164 (34.1%) immunocompetent patients, and 20 of 41 (48.8%) non-HIV-infected immunosuppressed patients. The diagnostic yield of pre-antibiotic sputum culture for conventional bacteria was 99/155 (63.9%) compared to 52 of 169 patients (32.7%) with adequate post-antibiotic sputum culture (p < 0.0001). Although S. Pneumonia continues to be the most commonly identified etiologic agent of Community-Acquired Pneumonia, it is surpassed by P. carinii in the HIV-infected patient population. The apparent decline in the frequency of S. Pneumoniae in our series presumably reflects administration of antibiotics prior to procurement of sputum culture. The paucity of atypical agents in this study support the current American Thoracic Society guidelines for selective use of macrolide therapy in immunocompetent adults hospitalized with Community-Acquired Pneumonia.(ABSTRACT TRUNCATED AT 250 WORDS)