trimethoprim--sulfamethoxazole-drug-combination and Bronchitis

Acute bronchitis affects over 40/1000 adults a year in the UK. The causes are usually considered to be infective, but only around half of people have identifiable pathogens. The role of smoking or of environmental tobacco smoke inhalation in predisposing to acute bronchitis is unclear. One third of people may have longer-term symptoms or recurrence.. We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for acute bronchitis in people without chronic respiratory disease? We searched: Medline, Embase, The Cochrane Library, and other important databases up to March 2010 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).. We found 21 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.. In this systematic review we present information relating to the effectiveness and safety of the following interventions: analgesics, antibiotics (macrolides, tetracyclines, cephalosporins, penicillins, or trimethoprim-sulfamethoxazole [co-trimoxazole]), antihistamines, antitussives, beta(2) agonists (inhaled or oral), and expectorants/mucolytics.

Topics: Acute Disease; Administration, Oral; Anti-Bacterial Agents; Antitussive Agents; Bronchitis; Humans; Penicillins; Trimethoprim, Sulfamethoxazole Drug Combination

Most patients with acute bronchitis who seek medical care are treated with antibiotics, although the effectiveness of this intervention is uncertain. We performed a meta-analysis of randomized, controlled trials to estimate the effectiveness of antibiotics in the treatment of acute bronchitis.. English-language studies published January 1966 to April 1998 were retrieved using MEDLINE, bibliographies, and consultation with experts. Only randomized trials that enrolled otherwise healthy patients with a diagnosis of acute bronchitis, used an antibiotic in the treatment group and a placebo in the control group, and provided sufficient data to calculate an effect size were included.. We identified eight randomized controlled trials that satisfied all inclusion criteria. These studies used one of three antibiotics (erythromycin, doxycycline, trimethoprim/sulfamethoxazole). The use of antibiotics decreased the duration of cough and sputum production by approximately one-half day (summary effect size 0.21; 95% CI, 0.05 to 0.36). For specific symptoms, there were nonsignificant trends favoring the use of antibiotics: a decrease of 0.4 days of purulent sputum (95% CI, -0.1 to 0.8), a decrease of 0.5 days of cough (95% CI, -0.1 to 1.1), and a decrease of 0.3 days lost from work (95% CI, -0.6 to 1.1).. This meta-analysis suggests a small benefit from the use of the antibiotics erythromycin, doxycycline, or trimethoprim/sulfamethoxazole in the treatment of acute bronchitis in otherwise healthy patients. As this small benefit must be weighed against the risk of side effects and the societal cost of increasing antibiotic resistance, we believe that the use of antibiotics is not justified in these patients.

Topics: Acute Disease; Anti-Bacterial Agents; Bronchitis; Doxycycline; Erythromycin; Humans; Randomized Controlled Trials as Topic; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Acute bronchitis is a common clinical problem that causes considerable morbidity and presents both diagnostic and treatment dilemmas for the physician. An evaluation of all published randomized controlled trials of antibiotics in the treatment of acute bronchitis was conducted to (1) quantitatively assess methodologic rigor, (2) determine if effectiveness of antimicrobial therapy is known, and (3) analyze strengths and weaknesses of randomized controlled trials in family practice settings.. A scoring system for the evaluation of randomized controlled trials was adapted for this study. Four raters, who were blinded to which journals published the studies and the type of antibiotic used in each study, assessed the six-randomized clinical trials for treatment of bronchitis identified through a literature search. The trials were rated according to criteria that measured internal validity.. Scores for internal validity ranged from 65.5 to 102.5 points with a maximum possible score of 120 points (54.6% to 85.4%). The two trials with the highest scores assessed doxycycline and showed no benefit from use of this antibiotic. Single trials that studied erythromycin and trimethoprim-sulfamethoxazole showed improvement in outcome from use of these drugs; however, of the six trials, these two studies ranked fourth and fifth for internal validity. Low scores resulted from small sample size, possible contamination with other treatment measures, and poor assessment of subjects' compliance with antibiotic regimen.. An evaluation of the current literature does not support antibiotic treatment for acute bronchitis. Further studies of this common illness are indicated. It is hoped that this critical review of randomized control trials will prove useful in the planning of future studies, in placing greater emphasis on methodologic rigor, and in giving greater consideration to the practical constraints of research in the family practice setting.

Topics: Acute Disease; Anti-Bacterial Agents; Bronchitis; Erythromycin; Family Practice; Humans; Placebos; Randomized Controlled Trials as Topic; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Expectoration of bronchial casts (plastic bronchitis) is an uncommon but ancient problem. Herein we describe a 40-year-old man, with no prior lung disease, who had dyspnea, cough, and expectoration of long branching bronchial casts. No specific cause was delineated, although special stains for eosinophilic granule major basic protein demonstrated occasional foci of eosinophils and small amounts of extracellular major basic protein in the bronchial casts. Various diseases, such as allergic bronchopulmonary aspergillosis, bronchiectasis, and cystic fibrosis, have been associated with the formation of bronchial casts and should be considered in the differential diagnosis. Although most previously reported cases have been associated with some type of pulmonary disease, our patient had no evidence of an underlying pulmonary disorder.

Topics: Acetylcysteine; Adult; Blood Proteins; Bronchitis; Cough; Diagnosis, Differential; Dyspnea; Eosinophil Granule Proteins; Eosinophils; Humans; Male; Mucus; Prednisone; Ribonucleases; Trimethoprim, Sulfamethoxazole Drug Combination

TREATMENT OF SINUSITIS: For both acute rhinosinusitis in patients with no past history where S. pneumoniae and H. influenzae are the main causal agents, or recurrent sinusitis in a chronic background where anaerobic bacteria are increasingly implicated, pristinamycin is one of the rare compounds which can be expected to be effective and is a treatment of choice for an empirical strategy. LOWER RESPIRATORY TRACT INFECTIONS: Besides high-risk subjects with non-microbiologically proven bronchial infection, where enterobacteriaceae could involve a pristinamycin is a useful alternative to the conventional strategy (i.e.: amoxicillin, macrolides and cotrimoxazole) in the treatment of LRT infection.

Topics: Acute Disease; Adult; Amoxicillin; Bronchial Diseases; Bronchitis; Female; Humans; Macrolides; Male; Respiratory Tract Infections; Rhinitis; Sinusitis; Trimethoprim, Sulfamethoxazole Drug Combination; Virginiamycin

In a double-blind study of 137 patients with exacerbation of chronic bronchitis and chronic obstructive lung disease, the efficacy and safety of ofloxacin was compared with that of trimethoprim-sulfamethoxazole (TMP/SMX). Both groups improved. The frequency of severe adverse reactions was highest in the TMP/SMX group, and 14.9% of the patients discontinued the treatment. In the ofloxacin group 6% had to stop the treatment. The failure rate was significantly lower in the ofloxacin-treated patients, 3.2% versus 13.8% in the TMP/SMX group. Ofloxacin was found to be an effective drug with few adverse reactions.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bronchitis; Chronic Disease; Double-Blind Method; Female; Humans; Lung Diseases, Obstructive; Male; Middle Aged; Ofloxacin; Trimethoprim, Sulfamethoxazole Drug Combination

A total of 60 patients with lower respiratory tract or urinary tract infections were enrolled in an open, randomized, controlled, parallel study comparing 300 mg ofloxacin (OFX) b.i.d. with trimethoprim + sulfamethoxazole (TMP 800 mg + SMX 160 mg), 1 tablet, b.i.d. The signs and symptoms of low respiratory tract infection were cured in 12 patients (80%) of the OFX group and improved in 2 other patients (13%); at the end of therapy, the 2 germs that persisted were Streptococcus pneumoniae and Branhamella catarrhalis. Clinical cure was achieved in 13 patients (86%) in the TMP-SMX group, while 2 patients were considered as failures (14%); after therapy, the 3 organisms that persisted were 2 S. pneumoniae and 1 Pseudomonas aeruginosa. As far as urinary tract infections are concerned clinical cure and complete eradication of bacteria were achieved in 14 patients in the OFX group (93%); the germ that persisted was Escherichia coli (100,000 CFU), but the patient was asymptomatic. In patients of the TMP-SMX group the urinary infections were cured in 11 subjects (73%); the germs that persisted were 2 E. coli and 1 Proteus mirabilis. Adverse effects were reported for 3 patients (10%) in the OFX group and 4 patients (13%) in the TMP-SMX group. The measurement of serum and intracellular (polymorphonuclear cells and lymphocytes) levels of OFX and TMP-SMX and the assessment of the host's immunocompetence ruled out the possibility of any immunotoxicological side effect.

Topics: Acute Disease; Aged; Bronchitis; Bronchopneumonia; Chronic Disease; Cystitis; Escherichia coli; Female; Haemophilus influenzae; Humans; Klebsiella pneumoniae; Male; Middle Aged; Ofloxacin; Pyelitis; Remission Induction; Streptococcus pneumoniae; Trimethoprim, Sulfamethoxazole Drug Combination

A single blind prospective study was undertaken with 74 patients suffering from acute bronchitis, taken from general practice and one geriatric ward. Half were randomly allocated to treatment with 200 mg trimethoprim twice a day and the other half with 160 mg trimethoprim plus 800 mg sulphamethoxazole twice a day; both therapies were used for 7 days. We found little difference in the clinical or bacteriological responses to the different regimens although the higher concentration of trimethoprim in the single therapy gave a slightly more successful eradication of Haemophilus spp. Resistant bacteria appeared during and after therapy in a few cases but this was a greater problem with the sulphamethoxazole-containing preparation.

Topics: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bronchitis; Drug Combinations; Drug Evaluation; Female; Humans; Male; Middle Aged; Prospective Studies; Random Allocation; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

A new chemotherapeutic drug oriprim was used for therapy of 36 patients with bronchopulmonary pathology. Its therapeutic efficacy was noted in 83.3% of the cases. In 6 patients oriprim therapy turned out to be ineffective as a result of early side-effects. The drug was effective in pneumococcal infection. In suspicion of anaerobic infection (B. fragilis, etc) oriprim was given in combination with metronidazole.

Topics: Administration, Oral; Bacterial Infections; Bronchitis; Clinical Trials as Topic; Drug Combinations; Enterobacteriaceae Infections; Haemophilus Infections; Haemophilus influenzae; Humans; Injections, Intramuscular; Pneumonia; Pneumonia, Pneumococcal; Pneumonia, Staphylococcal; Staphylococcus epidermidis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Seven-day courses of either 200 mg pivmecillinam plus 250 mg pivampicillin or co-trimoxazole (800 mg sulphamethoxazole plus 160 mg trimethoprim) given twice daily were compared in a multi-centre general practice study in 318 patients with signs and symptoms of upper or lower respiratory tract infection. Patients were stratified into four diagnostic groups (sinusitis, otitis media, throat infections, and acute bronchitis) and randomly allocated to treatment within these groups. Assessments at Day 7 showed that both treatments were equally effective clinically, 154 (91%) patients in the pivmecillinam plus pivampicillin group showing clinical cure or improvement and 142 (88%) patients in the co-trimoxazole group. Side-effects were reported by 19 (11.9%) patients in the pivmecillinam plus pivampicillin group and by 24 (15.8%) patients in the co-trimoxazole group. Two patients in the pivmecillinam plus pivampicillin group and 4 patients in the co-trimoxazole group stopped treatment.

Topics: Adolescent; Adult; Aged; Amdinocillin; Amdinocillin Pivoxil; Ampicillin; Anti-Infective Agents; Bronchitis; Child; Clinical Trials as Topic; Drug Combinations; Family Practice; Female; Humans; Male; Middle Aged; Otitis Media; Pharyngitis; Pivampicillin; Random Allocation; Respiratory Tract Infections; Sinusitis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Forty-nine hospitalized patients with acute exacerbations of chronic bronchitis were randomly allocated a ten-day course of either pivmecillinam/pivampicillin or co-trimoxazole. Both treatments were equally effective clinically (pivmecillinam/pivampicillin successful in 72% of cases; co-trimoxazole in 70%) and in their ability to eradicate pus from sputum (pivmecillinam/pivampicillin 84%; co-trimoxazole 74%). One patient taking co-trimoxazole ceased therapy because of persistent nausea and vomiting. No side-effects were observed in the pivmecillinam/pivampicillin group.

Topics: Acute Disease; Adult; Aged; Amdinocillin; Amdinocillin Pivoxil; Ampicillin; Bronchitis; Candida; Drug Combinations; Drug Therapy, Combination; Female; Haemophilus; Humans; Male; Middle Aged; Pivampicillin; Pseudomonas; Random Allocation; Sputum; Streptococcus pneumoniae; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Sixty-seven previously healthy patients with acute bronchitis were randomized and treated with either a fixed dose of trimethoprim and sulfamethoxazole or placebo for seven days. All outcomes examined showed a trend favoring the use of antibiotic, with statistically significant differences for cough, night cough, mean temperature, and use of antihistamines or decongestants. Night cough occurred on 84 percent of nights in the control group vs 56 percent in the antibiotic group (P = .003). Cough occurred on 99 percent of days for patients in the control group vs 93 percent of days for patients in the antibiotic group (P = .05). Mean temperature over the seven nights was 37.3 degrees C in the control group vs 36.9 degrees C in the antibiotic group (P = .004). The use of antihistamines and decongestants was reduced from 32 percent of days in the control group to 6 percent of days in the antibiotic group (P = .005). Patients in the antibiotic group worked 73 percent of days vs 55 percent of days for patients in the control group, which was significant when patients were stratified by the appearance of their sputum on Gram stain (P = .006). Smoking history was not found to help predict the response to antibiotic therapy.

Topics: Acute Disease; Adolescent; Adult; Bronchitis; Cough; Double-Blind Method; Drug Combinations; Drug Evaluation; Humans; Random Allocation; Sputum; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

In a controlled blind study sputum of 84 patients suffering from chronic bronchitis was bacteriologically examined prior to treatment. Hereby resistance against azidocillin was exhibited by six of the pathogenic agents or the suspected ones; the bacteria in 18 samples of sputum showed resistance against co-trimoxazol. Azidocillin demonstrated, as opposed to co-trimoxazol, slight yet not significant advantages in the elimination of the agents. Azidocillin was, however, significantly superior to co-trimoxazol in the physicians total assessment, which included the clinical process as well as the components of the sputum. According to the results of our investigations, the treatment of chronic bronchitis can be started without examining the sputum. However, in patients showing exacerbation of chronic bronchitis with life-threatening complications, the sputum should be examined before medication is conducted. In such cases we recommend the treatment to be started immediately with an appropriate bactericide like azidocillin and to be continued till the result of the antibiogram is finally established.

Topics: Adult; Aged; Bacterial Infections; Bronchitis; Chronic Disease; Drug Combinations; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Penicillin G; Penicillin Resistance; Penicillins; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Aged; Bronchitis; Cefaclor; Cephalexin; Drug Combinations; Female; Humans; Male; Middle Aged; Sputum; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Aged; Amoxicillin; Bronchitis; Chronic Disease; Drug Combinations; Erythromycin; Female; Hospitalization; Humans; Male; Middle Aged; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Fluoroquinolones are used for conditions including sinusitis, bronchitis, and urinary tract infections. It has been suggested that exposure to fluoroquinolones for these conditions is associated with disability resulting from adverse events in 2 or more organ systems. The objectives were to: describe: 1) fluoroquinolone, azithromycin, and sulfamethoxazole / trimethoprim utilization for these infections; 2) the rate of disability associated with exposure to each of these antibiotic classes and adverse events in 2 or more system organ classes, and 3) compare outcome rates for each of the antibiotic classes.. This study was conducted using administrative data to mitigate the limitations of spontaneous reports. The sampling frame was a U.S. population with both medical and disability insurance, including patients with the above uncomplicated infections who were prescribed the antibiotics of interest. The primary outcome was an incident short-term disability claim associated with adverse events in 2 different organ systems within 120 days of exposure. A matched analysis was used to compare the outcome for patients receiving each of the drug classes.. After propensity score matching, there were 119,653 individuals in each of the exposure groups. There were 264 fluoroquinolone associated disability events and 243 azithromycin/ sulfamethoxazole associated disability events (relative risk =1.09 (95% CI: 0.92-1.30; calibrated p = 0.84)). The results were not significantly different from the null hypothesis of no difference between groups.. Comparative assessments are difficult to conduct in spontaneous reports. This examination of disability associated with adverse events in different system organ classes showed no difference between fluoroquinolones and azithromycin or sulfamethoxazole in administrative data.

Topics: Adolescent; Adult; Adverse Drug Reaction Reporting Systems; Aged; Anti-Bacterial Agents; Azithromycin; Bronchitis; Drug Utilization; Female; Fluoroquinolones; Humans; Male; Middle Aged; Sinusitis; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Young Adult

Topics: Aged, 80 and over; Anti-Infective Agents; Antibodies, Monoclonal; Antibodies, Monoclonal, Murine-Derived; Antineoplastic Agents; Bronchitis; Humans; Leukemia, Lymphocytic, Chronic, B-Cell; Male; Pasteurella Infections; Pasteurella multocida; Rituximab; Tracheitis; Trimethoprim, Sulfamethoxazole Drug Combination

Toxic epidermal necrolysis (TEN) is a rare, potentially life-threatening bullous drug reaction. Rapid diagnosis of TEN can lower the mortality rate when the offending drug is withdrawn immediately. Simple diagnostic tools such as cytology of skin blisters may be useful if rapid diagnosis is needed, in particular if standard histopathology service fails. An even faster bedside test for TEN in patients with black skin is color evaluation of skin blister fluid.

Topics: Adult; Anti-Bacterial Agents; Black or African American; Body Fluids; Bronchitis; Color; Early Diagnosis; Female; Humans; Keratinocytes; Melanins; Mucositis; Point-of-Care Systems; Stevens-Johnson Syndrome; Stomatitis; Trimethoprim, Sulfamethoxazole Drug Combination

To evaluate the WHO (World Health Organization) algorithm for management of respiratory tract infection (RTI) in HIV-1-infected adults and determine risk factors associated with RTI, we enrolled a cohort of 380 HIV-1-seropositive adults prospectively followed for incident RTI at an outpatient clinic in Nairobi, Kenya. RTI was diagnosed when patients presented with history of worsening or persistent cough. Patients were treated with ampicillin, or antituberculosis therapy when clinically indicated, as first-line therapy and with trimethoprim/sulfamethoxazole as second-line therapy. Five hundred ninety-seven episodes of RTI were diagnosed: 177 of pneumonia and 420 of bronchitis. The WHO RTI algorithm was used for 401 (95%) episodes of bronchitis and 151 (85%) episodes of pneumonia (p <.001). Three percent of bronchitis cases versus 32% of pneumonia cases failed to respond to first-or second-line treatment (p <.0001). Being widowed (adjusted odds ratio [OR] = 2.1, 95% confidence interval [CI]: 1.0-4.4), less than 8 years of education (adjusted OR = 2.5, CI: 1.5 - 4.1), and CD4 count < 200 cells/microl (adjusted OR = 2.4, CI: 1.4-3.9) were risk factors for pneumonia. A high percentage of patients (32%) with pneumonia required a change in treatment from that recommended by the WHO guidelines. Randomized trials should be performed to determine more appropriate treatment strategies in HIV-1-infected individuals.

Topics: Adult; AIDS-Related Opportunistic Infections; Algorithms; Ampicillin; Bronchitis; Cohort Studies; Female; HIV-1; Humans; Kenya; Male; Odds Ratio; Pneumonia; Prospective Studies; Respiratory Tract Infections; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination; World Health Organization

In the case reported, serial evaluation of sputum inflammatory cell counts made it possible to identify an unusual series of events in a man with eosinophilic bronchitis. The patient initially presented with a productive cough, which did not respond to treatment with antibiotics or high-dose inhaled corticosteroids. A diagnosis of eosinophilic bronchitis was made after demonstration of intense sputum eosinophilia. When inhaled corticosteroids were stopped, symptoms and sputum eosinophilia became worse and airway hyperresponsiveness developed. Both abnormalities were reversed by a course of prednisone. When the prednisone was stopped the productive cough recurred but on this occasion sputum examination suggested a different disease process and the symptoms resolved after a course of co-trimoxazole. The patient has subsequently remained well on no treatment with little or no sputum eosinophilia.

Topics: Anti-Infective Agents; Anti-Inflammatory Agents; Asthma; Bronchial Hyperreactivity; Bronchitis; Budesonide; Cough; Diagnosis, Differential; Eosinophilia; Eosinophils; Glucocorticoids; Humans; Leukocyte Count; Male; Middle Aged; Neutrophils; Prednisone; Pregnenediones; Sputum; Trimethoprim, Sulfamethoxazole Drug Combination

The antibiotic susceptibility of pneumococci isolated from clinical specimens from 1991 through 1994 was investigated. Of 305 strains tested by the agar dilution method, 16 (5.2%) were resistant to penicillin (MICs > or = 0.12 mg/l). Of the resistant strains, 0.3% showed high-level resistance (MIC > or = 2 mg/l). The rate of resistance to erythromycin (MIC > or = 4 mg/l) was 2.3%, to tetracycline (MIC > or = 8 mg/l) 8.5%, to chloramphenicol (MIC > or = 8 mg/l) 1.0%, and to trimethoprim sulfamethoxazole (MIC > or = 3.2/64 mg/l) 3.3%. Penicillin-resistant strains showed significantly higher resistance to the other antibiotics tested. Resistance to penicillin was higher in isolates from the respiratory tract than in those from blood and cerebrospinal fluid (6.2% vs. 2.4%, respectively). There was no increase in penicillin resistance from 1991 through 1994 (5.3% vs. 4.9%, respectively).

Topics: Anti-Bacterial Agents; Austria; Bronchitis; Chloramphenicol Resistance; Erythromycin; Humans; Microbial Sensitivity Tests; Nasopharynx; Penicillin Resistance; Sinusitis; Sputum; Streptococcal Infections; Streptococcus pneumoniae; Tetracycline Resistance; Trimethoprim, Sulfamethoxazole Drug Combination

A case of adverse side effects of co-trimoxazole (Biseptol) was observed, with predominance of neurological changes in the clinical picture. Attention is called to the infrequent occurrence of such side effects of this drug and to the necessity of prompt diagnostic and therapeutic management of such cases.

Topics: Acute Disease; Adult; Bronchitis; Combined Modality Therapy; Disorders of Excessive Somnolence; Drug Hypersensitivity; Headache; Humans; Male; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Blood Glucose; Bronchitis; Cough; Humans; Hypoglycemia; Pharyngitis; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Aged; Aged, 80 and over; Anti-Infective Agents; Bronchitis; Drug Combinations; Humans; Male; Postoperative Complications; Stevens-Johnson Syndrome; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

Chronic bronchitis is characterized by chronic, productive cough present on most days for at least three months of the year. Differential diagnosis must exclude an endobronchial obstructive lesion, asthma, nocturnal aspiration, bronchiectasis, cystic fibrosis, and immotile cilia syndrome. The most characteristic finding in patients with chronic bronchitis is hypertrophy of the mucous glands and goblet cells.

Topics: Alcoholism; Amoxicillin; Ampicillin; Animals; Bronchitis; Bronchodilator Agents; Chronic Disease; Diagnosis, Differential; Dogs; Drug Combinations; Humans; Ipratropium; Klebsiella Infections; Metaproterenol; Respiratory Tract Infections; Sulfamethoxazole; Tetracycline; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Bronchitis; Clinical Trials as Topic; Drug Combinations; Humans; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Branhamella catarrhalis, formerly regarded as an oropharyngeal commensal, has more recently been implicated as an opportunistic pathogen in the respiratory tract. This report describes the isolation of B. catarrhalis from two consecutive samples of empyema fluid and also from sputum in thirteen cases of lower respiratory tract disease, where the isolate was considered to be etiologically significant. The antibiotic therapy required to treat such infections is discussed.

Topics: Adult; Aged; Bronchitis; Drug Combinations; Empyema; Female; Humans; Infant; Male; Middle Aged; Neisseria; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Once a Hemophilus influenzae isolate is identified as the cause of a respiratory tract infection in an adult, it should be tested for beta-lactamase production, ie, for ampicillin resistance. The incidence of ampicillin-resistant strains of H influenzae is increasing. The Centers for Disease Control in Atlanta estimates an average incidence nationwide of 18% to 22%; the rate varies considerably from community to community. Thus, practitioners should be aware of the ampicillin-resistance rate in their community and should keep this rate in mind especially when treating patients empirically. Patients with H influenzae infections who are acutely ill, who fail to respond to ampicillin, or who are known to have an ampicillin-resistant infection on the basis of laboratory findings should receive therapy designed to combat ampicillin-resistant strains.

Topics: Adult; Ampicillin; Anti-Bacterial Agents; beta-Lactamases; Bronchitis; Drug Combinations; Haemophilus Infections; Haemophilus influenzae; Humans; Penicillin Resistance; Pneumonia; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Acute exacerbations of bronchitis are probably best treated with erythromycin or cotrimoxazole. The rising incidence of ampicillin resistance is reducing its value. Oxytetracycline and cephalosporins are best avoided. Trimethroprim may prove a safer alternative to cotrimoxazole. However, all these conclusions are based on theoretical reasons rather than large comparative trials.

Topics: Anti-Bacterial Agents; Bronchitis; Drug Combinations; Drug Resistance, Microbial; Erythromycin; Humans; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination