amoxicillin-potassium-clavulanate-combination and Pneumonia--Viral

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Community-Acquired Infections; Dose-Response Relationship, Drug; Drug Resistance, Microbial; Drug Therapy, Combination; Guidelines as Topic; Humans; Macrolides; Penicillins; Pneumonia, Bacterial; Pneumonia, Viral; Prognosis; Treatment Outcome

To determine the etiology of community-acquired pneumonia in ambulatory children and to compare responses to treatment with azithromycin, amoxicillin-clavulanate or erythromycin estolate.. Ambulatory patients with pneumonia were identified at the Children's Medical Center of Dallas, TX. Children age 6 months to 16 years with radiographic and clinical evidence of pneumonia were enrolled and randomized to receive either azithromycin suspension for 5 days or a 10-day course of amoxicillin-clavulanate for those <5 years or erythromycin estolate suspension for those > or = 5 years. Blood culture was obtained in all patients and we obtained nasopharyngeal and pharyngeal swabs for culture and polymerase chain reaction (PCR) testing for Chlamydia pneumoniae and Mycoplasma pneumoniae and nasopharyngeal swabs for viral direct fluorescent antibody and culture. Acute and convalescent serum specimens were tested for antibodies to C. pneumoniae, M. pneumoniae and Streptococcus pneumoniae. Patients were evaluated 10 to 37 days later when repeat specimens for serology, PCR and culture were obtained. For comparative purposes healthy children attending the well-child clinic had nasopharyngeal and pharyngeal swabs obtained for PCR and culture for C. pneumoniae and M. pneumoniae.. Between February, 1996, and December, 1997, we enrolled 174 patients, 168 of whom fulfilled protocol criteria for evaluation. There were 55% males and 63% were <5 years of age. All blood cultures were sterile and there was no correlation between the white blood cell and differential counts and etiology of pneumonia. Etiologic agents were identified in 73 (43%) of 168 patients. Infection was attributed to M. pneumoniae in 7% (12 of 168), C. pneumoniae in 6% (10 of 168), S. pneumoniae in 27% (35 of 129) and viruses in 20% (31 of 157). None of the swab specimens from 75 healthy control children was positive for C. pneumoniae or M. pneumoniae. Clinical response to therapy was similar for the three antibiotic regimens evaluated, including those with infection attributed to bacterial agents.. Although a possible microbial etiology was identified in 43% of the evaluable patients, clinical findings and results of blood cultures, chest radiographs and white blood cell and differential counts did not distinguish patients with a defined etiology from those without a known cause for pneumonia. There were no differences in the clinical responses of patients to the antimicrobial regimens studied.

Topics: Adolescent; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Antibodies, Bacterial; Antibodies, Viral; Azithromycin; Child; Child, Preschool; Community-Acquired Infections; Drug Therapy, Combination; Erythromycin; Humans; Infant; Nasopharynx; Outpatient Clinics, Hospital; Pneumonia, Bacterial; Pneumonia, Viral; Prospective Studies

Topics: Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Azithromycin; Betacoronavirus; Chloroquine; Combined Modality Therapy; Coronavirus Infections; COVID-19; Fatal Outcome; Female; Humans; Infant; Morocco; Multiple Organ Failure; Nasopharynx; Pandemics; Pneumonia, Viral; Respiration, Artificial; Respiratory Distress Syndrome; SARS-CoV-2; Tomography, X-Ray Computed

Despite dramatic reductions in the rates of bacteremia and meningitis since the 1980s, febrile illness in children younger than 36 months continues to be a concern with potentially serious consequences. Factors that suggest serious infection include age younger than one month, poor arousability, petechial rash, delayed capillary refill, increased respiratory effort, and overall physician assessment. Urinary tract infections are the most common serious bacterial infection in children younger than three years, so evaluation for such infections should be performed in those with unexplained fever. Abnormal white blood cell counts have poor sensitivity for invasive bacterial infections; procalcitonin and C-reactive protein levels, when available, are more informative. Chest radiography is rarely recommended for children older than 28 days in the absence of localizing signs. Lumbar puncture is not recommended for children older than three months without localizing signs; it may also be considered for those from one to three months of age with abnormal laboratory test results. Protocols such as Step-by-Step, Laboratory Score, or the Rochester algorithms may be helpful in identifying low-risk patients. Rapid influenza testing and tests for coronavirus disease 2019 (COVID-19) may be of value when those diseases are circulating. When empiric treatment is appropriate, suggested antibiotics include ceftriaxone or cefotaxime for infants one to three months of age and ampicillin with gentamicin or with cefotaxime for neonates. For children three months to three years of age, azithromycin or amoxicillin is recommended if pneumonia is suspected; for urinary infections, suggested antibiotics are cefixime, amoxicillin/clavulanate, or trimethoprim/sulfamethoxazole. Choice of antibiotics should reflect local patterns of microbial resistance.

Topics: Algorithms; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Betacoronavirus; Blood Culture; C-Reactive Protein; Child, Preschool; Clinical Decision-Making; Clinical Laboratory Techniques; Coronavirus Infections; COVID-19; COVID-19 Testing; Culture Techniques; Fever; Humans; Infant; Infant, Newborn; Influenza, Human; Leukocyte Count; Pandemics; Pneumonia, Bacterial; Pneumonia, Viral; Procalcitonin; Radiography, Thoracic; SARS-CoV-2; Spinal Puncture; Trimethoprim, Sulfamethoxazole Drug Combination; Urinalysis; Urinary Tract Infections

Topics: Acetates; Adrenergic beta-2 Receptor Antagonists; Amoxicillin-Potassium Clavulanate Combination; Anti-Asthmatic Agents; Antibodies, Monoclonal, Humanized; Asthma; Azithromycin; Betacoronavirus; Budesonide; Convalescence; Coronavirus Infections; COVID-19; Cyclopropanes; Eosinophils; Female; Humans; Hydroxychloroquine; Ipratropium; Male; Middle Aged; Pandemics; Pneumonia, Viral; Quinolines; SARS-CoV-2; Sulfides; Treatment Outcome

Cowpox virus infection in cats is rare and usually leads to cutaneous lesions alone. Pulmonary infection and pneumonia have been documented occasionally but all such cases described to date have been fatal. Although usually affecting the upper respiratory tract, feline herpesvirus can also induce pneumonia. The present report describes the case of a cat that recovered from a pneumonia in which both poxvirus and feline herpesvirus were demonstrated.

Topics: Amoxicillin-Potassium Clavulanate Combination; Animals; Anti-Bacterial Agents; Bronchopneumonia; Cat Diseases; Cats; Cowpox; Cowpox virus; Herpesviridae Infections; Pneumonia, Viral; Radiography; Treatment Outcome; Varicellovirus

Topics: Adult; Aged; Ambulatory Care; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Ceftriaxone; Female; Humans; Male; Middle Aged; Patient Admission; Pneumonia, Bacterial; Pneumonia, Pneumococcal; Pneumonia, Viral; Risk Factors; Systemic Inflammatory Response Syndrome