ro13-9904 and Influenza--Human

In chronic persistent asthma and severe acute exacerbations of bronchial asthma, infectious agents are the predominant triggers that drive disease and airway pathobiology. In acute exacerbations of bronchial asthma (AEBA) including near fatal and fatal asthma, viral agents, particularly human rhinovirus-C, respiratory syncytial virus and influenza A appear to be the more prevalent and recurring threats. Both viral, and to a lesser extent bacterial agents, can play a role, and co-infection may also be present and worsen prognosis in hospitalized patients, placing a portion at risk for critical asthma syndrome. During severe acute exacerbations, infectious agents must be treated empirically, but the initial treatment regimens can vary and viral coverage may also vary based on seasonality and patient age. Early treatment with ceftriaxone and azithromycin, along with oseltamivir in winter months, should be initiated with all cases of severe exacerbations where infection is suspected, and definitely in critical asthma syndrome until infection is excluded by appropriate diagnostic testing. In this manuscript we will outline the impact of the major viral agents on severe asthma including the data from the 2009 H1N1 influenza pandemic. The role of bacterial infections in acute exacerbations of asthma will also be reviewed as well as the benefit of empiric antibiotics and the role of macrolides in both acute and chronic asthma.

Topics: Animals; Asthma; Azithromycin; Bacterial Infections; Ceftriaxone; Coinfection; Critical Illness; Disease Progression; Humans; Influenza A Virus, H1N1 Subtype; Influenza, Human; Oseltamivir; Seasons; Syndrome

Topics: Anti-Bacterial Agents; Ceftriaxone; Diagnosis, Differential; Epiglottitis; Female; Haemophilus Infections; Haemophilus influenzae; Humans; Influenza A virus; Influenza, Human; Microbiological Techniques; Middle Aged; Nasal Cavity; Pharynx; Streptococcal Infections; Streptococcus pyogenes; Treatment Outcome

Topics: Adolescent; Anti-Bacterial Agents; Ceftriaxone; Child; Cystitis; Diagnosis, Differential; Female; Hematuria; Humans; Influenza A Virus, H1N1 Subtype; Influenza, Human; Injections, Intravenous; Kidney; Male; RNA, Viral; Treatment Outcome; Urinalysis

Evidence shows that the rapid detection of influenza using an enzyme-linked immunosorbent assay decreases antibiotic use in the treatment of pediatric patients. To our knowledge, the effect on other diagnostic testing in an emergency department (ED) has not been examined.. To determine the effect of rapid diagnosis of influenza virus type A on the clinical management of febrile infants and toddlers in a pediatric ED at an urban children's hospital.. A retrospective review of ED records from an electronic database was performed. All children 2 to 24 months of age, with a temperature higher than 39 degrees C who had a positive influenza virus type A test result using an enzyme-linked immunosorbent assay from November 1, 1998, through April 30, 2000 (n = 72), were included in this study. Two groups were compared-those who had positive test results reported before discharge from the ED (early diagnosis) and those who had positive test results after discharge (late diagnosis).. Forty-seven patients (65%) were in the early diagnosis group and 25 (35%) in the late diagnosis group. The groups were similar for age, temperature, and triage category. Fewer patients in the early diagnosis group received ceftriaxone sodium compared with those in the late diagnosis group (2% vs 24%, P =.006); there were fewer urinalyses (2% vs 24%, P =.006) and complete blood cell counts performed (17% vs 44%, P =.02).. Rapid confirmation of influenza virus type A infection seems to decrease ancillary tests and antibiotic use in febrile infants and toddlers in the ED. A prospective study with a larger group is needed to confirm these findings.

Topics: Ceftriaxone; Cephalosporins; Child, Preschool; Drug Utilization; Emergency Service, Hospital; Enzyme-Linked Immunosorbent Assay; Fever; Health Services Research; Hospitals, Pediatric; Hospitals, Urban; Humans; Infant; Influenza A virus; Influenza, Human; Pediatrics; Practice Patterns, Physicians'; Retrospective Studies; Sensitivity and Specificity; Time Factors

Topics: Acute Disease; Aged; Ceftriaxone; Cephalosporins; Coronary Disease; Diabetes Complications; Exanthema; Extremities; Female; Humans; Influenza, Human