(9R)-9-chloro-11-17-dihydroxy-17-(2-hydroxy-1-oxoethyl)-10-13-16-trimethyl-6-7-8-11-12-14-15-16-octahydrocyclopenta[a]phenanthren-3-one and Bacterial-Infections

The article is a short review of some aspects of the surface structure of the human nose. It deals with the morphology of the surface epithelium in nasal allergy, viral and bacterial infection. Kartagener's triad and in rhinitis patients continuously treated with topically active steroids.

Topics: Bacterial Infections; Basement Membrane; Beclomethasone; Cilia; Common Cold; Humans; Kartagener Syndrome; Nasal Mucosa; Nasal Polyps; Nose Diseases; Rhinitis; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal

Topics: Aerosols; Airway Obstruction; Anti-Bacterial Agents; Asthma; Bacteria; Bacterial Infections; Beclomethasone; Carbenicillin; Child; Clinical Trials as Topic; Colistin; Corticosterone; Dexamethasone; Gentamicins; Humans; Hydrocortisone; Kanamycin; Lung Diseases, Fungal; Placebos; Polymyxins; Respiratory Therapy; Triamcinolone Acetonide

Beclomethasone dipropionate administered by metered-dose inhaler to ventilated infants with early chronic lung disease was evaluated in a double-blind, placebo-controlled study to determine the feasibility and safety of administration. Patients selected for study were less than 1500 g birthweight, had previous radiographic evidence of respiratory distress syndrome with early changes of bronchopulmonary dysplasia (BPD), were greater than 2 weeks of age, and had failed attempts at extubation. The metered-dose inhaler was connected to the respirator circuit by an in-line spacer device and either saline placebo or beclomethasone was delivered for 7 days or until extubated. Beclomethasone was delivered in a dose calculated to be approximately 1 mg/kg/day in three divided doses. Nineteen infants were enrolled. Nine received placebo and 10 received beclomethasone. No adverse effects on blood pressure, heart rate, respiratory rate, ventilator settings, concentration or duration of oxygen therapy, incidence of retinopathy of prematurity (ROP) or infections, blood glucose, daily weight, or serum cortisol levels before and after adrenal stimulation tests were observed in the beclomethasone group compared with the placebo group. One infant in the placebo and six infants in the steroid group were extubated during the study period (p = 0.03). These data indicate that beclomethasone dipropionate may be administered safely to intubated neonates without adverse effects of hypertension, hyperglycemia, diminished weight gain, or adrenal suppression frequently seen with systemic steroid administration. Beclomethasone may enhance extubation in infants with early BPD, however, further data are required to substantiate this preliminary observation.

Topics: Anti-Inflammatory Agents; Bacterial Infections; Beclomethasone; Blood Glucose; Blood Pressure; Body Weight; Bronchopulmonary Dysplasia; Double-Blind Method; Feasibility Studies; Female; Glucocorticoids; Heart Rate; Humans; Hydrocortisone; Infant, Low Birth Weight; Infant, Newborn; Male; Nebulizers and Vaporizers; Oxygen Inhalation Therapy; Placebos; Respiration; Respiratory Distress Syndrome, Newborn; Retinopathy of Prematurity; Safety; Sodium Chloride; Ventilators, Mechanical

Chronic middle ear disease is common in Aboriginal children, and may be linked to nasal inflammation and Eustachian tube dysfunction. The pattern of nasal inflammation is unknown. The study reported here was performed to define the role of allergy and infection in causing nasal inflammation in Aboriginal children with chronic middle ear disease.. Thirty-one Aboriginal children aged between 3 and 7 years underwent clinical assessment, audiometry and allergy skin tests. Nasal swabs for bacterial culture and cytology were performed during the winter and again in spring to identify any seasonal variation. A randomized trial of nasal beclomethasone for 8 weeks was conducted in children with abnormal tympanometry to identify the effect of therapy upon nasal cytology.. Twenty-six of the 31 children had abnormal tympanograms. Average hearing levels were reduced in nine children. Pathogenic organisms were isolated from most children: Streptococcus pneumoniae (82%), Haemophilus influenzae (79%), Moraxella catarrhalis (39%) and Staphylococcus aureus (29%). Eight of the 31 children (26%) were atopic. Nasal cytology disclosed a marked neutrophil infiltrate (80% of cells) during the winter, which fell significantly in spring to 52% of cells. Only two subjects had nasal eosinophilia of >10%. There was no effect of beclomethasone on nasal cytology.. Chronic ear disease in Aboriginal children is associated with nasal inflammation, neutrophil infiltration and the presence of bacteria. These features suggest respiratory infection as the main cause of chronic nasal inflammation in Aboriginal children with middle ear disease. There is a seasonal variation in the severity of the nasal infiltrate, consistent with increased infections during winter. Despite a high prevalence of atopy, allergic nasal disease was uncommon.

Topics: Anti-Inflammatory Agents; Bacterial Infections; Beclomethasone; Child; Child, Preschool; Chronic Disease; Double-Blind Method; Female; Humans; Male; Native Hawaiian or Other Pacific Islander; New South Wales; Otitis Media with Effusion; Rhinitis; Seasons

Parenteral glucocorticoids have been shown to be effective in the treatment of oxygen- and ventilator-dependent bronchopulmonary dysplasia. We conducted a randomized, prospective study using a nebulized, water-soluble form of beclomethasone dipropionate for the treatment of infants with oxygen- and ventilator-dependent lung disease. Newborn infants with chest x-ray changes consistent with bronchopulmonary dysplasia at 14 days of age were randomly assigned, in a paired sequential fashion by birth weight, to treatment (beclomethasone) or placebo (saline solution) groups. Treatment included three nebulized doses of beclomethasone (50 micrograms) or saline solution per day for 28 days. Measured variables included tidal volume, total dynamic compliance, and airway resistance. Weight gain, gender, and incidence of infection during therapy were also recorded. Pulmonary functions were measured before initiation of therapy and weekly thereafter. Thirteen infants, seven in the saline solution group and six in the beclomethasone group, met study criteria and completed treatment. Infants treated with beclomethasone had reductions in airway resistance that were significant in weeks 2, 3, and 4 (p < 0.05, p < 0.02, and p < 0.001, respectively). Dynamic lung compliance increased at weeks 3 and 4 (p < 0.01 and p < 0.05, respectively). As expected, tidal volume increased with weight and time, but there were no significant differences between groups. There were no differences between the groups in weight gain, gender, or infection. This study demonstrates that beclomethasone by nebulization (1) reduced airway resistance in oxygen-dependent neonates with bronchopulmonary dysplasia, (2) improved dynamic lung compliance, as reported with parenterally administered glucocorticoids, and (3) produced no apparent increase in the incidence of infection.

Topics: Administration, Inhalation; Airway Resistance; Bacterial Infections; Beclomethasone; Bronchopulmonary Dysplasia; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Lung Compliance; Nebulizers and Vaporizers; Oxygenators; Placebos; Prospective Studies; Tidal Volume; Time Factors; Ventilators, Mechanical

Topics: Aerosols; Airway Obstruction; Anti-Bacterial Agents; Asthma; Bacteria; Bacterial Infections; Beclomethasone; Carbenicillin; Child; Clinical Trials as Topic; Colistin; Corticosterone; Dexamethasone; Gentamicins; Humans; Hydrocortisone; Kanamycin; Lung Diseases, Fungal; Placebos; Polymyxins; Respiratory Therapy; Triamcinolone Acetonide

Patients with more severe chronic obstructive pulmonary disease frequently experience exacerbations and it is estimated that up to 50% of these exacerbations are associated with bacterial infections. The mainstay treatment for these infection-related exacerbations constitutes the administration of glucocorticoids, alone or in combination with antibiotics. A recent line of evidence demonstrates that many hormones including the steroid beclomethasone can also directly affect bacterial growth, virulence, and antibiotic resistance. The effect of these regimens on the release of potentially virulent and toxic membrane vesicles (MVs) is at present unclear. In this study, we determined the effect of several pharmacological agents on MVs release by and bacterial growth of common respiratory pathogens. We found that neither the release of MVs nor the bacterial growth was affected by the glucocorticoids budesonide and fluticasone. The macrolide antibiotic azithromycin only inhibited the growth of Moraxella catarrhalis but no effects were observed on bacterial MV release at a concentration that is achieved locally in the epithelial lining on administration. The macrophage pro-inflammatory response to MVs was significantly reduced after treatment with budesonide and fluticasone but not by azithromycin treatment. Our findings suggest that these glucocorticoids may have a positive effect on infection-related inflammation although the bacterial growth and MV release remained unaffected.

Topics: Anti-Bacterial Agents; Azithromycin; Bacteria; Bacterial Infections; Beclomethasone; Budesonide; Cell Line; Cell-Derived Microparticles; Fluticasone; Glucocorticoids; Humans; Inflammation; Macrophages

Despite advances in vaccination and antimicrobial therapy, community-acquired pneumonia (CAP) remains as a leading cause of morbidity and mortality worldwide. As the severity of CAP has been linked to the extent of inflammation in the body, adjunctive therapeutic measures aimed at modulating the immune response have therefore become increasingly attractive in recent years. In particular, for CAP patients with underlying medical conditions such as chronic obstructive pulmonary disease (COPD), a steroid-antibiotic combination will no doubt be a useful and timely therapeutic intervention. Unfortunately, no combined steroid-antibiotic dry powder formulation is available commercially or has been reported in the academic literature. The aim of this work was hence to develop a novel steroid-antibiotic dry powder inhaler formulation [ciprofloxacin hydrochloride (CIP) and beclomethasone dipropionate (BP)] for inhaled anti-infective therapy. The spray-dried powder was of respirable size (d50 of ∼2.3 μm), partially crystalline and had BP preferentially deposited on the particle surface. Favorably, when formulated as a binary mix, both CIP and BP showed much higher drug release and fine particle fractions (of the loaded dose) over their singly delivered counterparts, and had robust activity against the respiratory tract infection-causing bacteria Klebsiella pneumoniae, Pseudomonas aeruginosa, and Staphylococcus aureus.

Topics: Administration, Inhalation; Anti-Bacterial Agents; Bacterial Infections; Beclomethasone; Ciprofloxacin; Dry Powder Inhalers; Glucocorticoids; Humans; Klebsiella pneumoniae; Pneumonia; Powders; Pseudomonas aeruginosa; Pulmonary Disease, Chronic Obstructive; Staphylococcus aureus

The aim of this clinical study was to investigate the influence of beclomethasone dipropionate (BDP) inhalation therapy on respiratory bacterial infections in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). We studied 30 patients who had been admitted twice, (before and after the beginning BDP inhalation therapy) to our hospital because of an exacerbation of COPD by respiratory tract infection. No differences were observed before and after BDP inhalation therapy in values for PaO2, PaCO2, body temperature, CRP, WBC count, number of admission days, and bacterial culture of sputum on admission. These results suggest that BDP inhalation therapy has little influence on respiratory bacterial infection during exacerbation of COPD.

Topics: Administration, Inhalation; Aged; Anti-Asthmatic Agents; Anti-Inflammatory Agents; Bacterial Infections; Beclomethasone; Female; Humans; Lung Diseases, Obstructive; Male; Middle Aged; Respiratory Tract Infections; Retrospective Studies

The aim of this clinical study was to investigate the influence of beclomethasone dipropionate (BDP) inhalation therapy on respiratory bacterial infection in patient with an asthmatic attack. We studied 267 asthmatic attack episodes of 241 patients with/without BDP inhalation therapy. There was no difference between two groups in %peak flow, body temperature, CRP, WBC count, bacterial culture of sputum on admission. BDP inhalation therapy has little influence on respiratory bacterial infection at an asthmatic attack.

Topics: Adult; Anti-Asthmatic Agents; Asthma; Bacterial Infections; Beclomethasone; Female; Humans; Male; Respiratory Tract Infections

Forty patients with skin diseases were treated by the simultaneous application of three creams, the respective bases of which were beclomethasone dipropionate, sodium fusidate and ketoconazole. The treatment yielded positive results in 92.5% of the treated cases with good relief of symptoms, arrest of growth of pathogenic agents, and good local and systemic tolerance. No adverse reactions of any kind were observed.

Topics: Administration, Topical; Adolescent; Adult; Aged; Bacterial Infections; Beclomethasone; Child; Dermatitis, Contact; Dermatomycoses; Drug Combinations; Female; Fusidic Acid; Humans; Ketoconazole; Male; Middle Aged; Skin Diseases; Skin Diseases, Infectious

Forty-two infants and young children with skin diseases of various kinds were treated by the simultaneous application of a combination of three creams, the respective ingredients of which were beclomethasone dipropionate, sodium fusidate and ketoconazole. The treatment produced good results in 97.6% of cases, with eradication of pathogenic agents and satisfactory relief of symptoms. The combination was well tolerated in almost all cases, both locally and systemically, and no adverse reactions were reported.

Topics: Administration, Topical; Bacterial Infections; Beclomethasone; Child; Child, Preschool; Dermatomycoses; Diaper Rash; Drug Therapy, Combination; Female; Fusidic Acid; Humans; Infant; Ketoconazole; Male; Skin Diseases