zithromax and Eosinophilia

The aim of this manuscript is to outline an approach to severe asthma, which is among the most challenging problems faced by paediatric pulmonologists. A logical, protocolised approach is essential. The first step is to rule out alternative diagnoses. The next step is a multidisciplinary assessment. Severe, therapy resistant asthma (STRA) is rare, and most of those referred will improve if basic management is corrected, especially adherence to treatment. However some are unable or unwilling to make necessary changes (refractory asthma plus or refractory difficult asthma). Some, especially asthma in the obese, and those thought to have STRA, progress to bronchoscopic airway phenotyping and a parenteral steroid trial to determine an individualised treatment plan. Those with persistent eosinophilc airway inflammation should be considered for omalizumab, and mepolizumab. Pauci-inflammatory asthma remains a therapeutic challenge, with a paucity of evidence; increasing steroid therapy seems neither logical nor efficacious, but options include tiotropium and azithromycin. However the most important message to the paediatrician looking after a child with apprently severe asthma is that the answer is not uncritically escalating treatment, but finding the answer to the question, what is it about this child, and his/her environment, which means there is no response to what should be easily treated airway pathology? The answer usually requires input from a skilled and experienced multi-disciplinary team, without which management is unlikely to be succesful. CONCLUSION: When managing a child with severe asthma, a detailed multi-disciplinary is essential to get the basic management right, before prescribing biologicals.

Topics: Algorithms; Allergens; Anti-Asthmatic Agents; Anti-Bacterial Agents; Antibodies, Monoclonal, Humanized; Asthma; Asthma, Exercise-Induced; Azithromycin; Bronchodilator Agents; Bronchoscopy; Child; Comorbidity; Environmental Exposure; Eosinophilia; Glucocorticoids; Humans; Medication Adherence; Obesity; Omalizumab; Patient Care Team; Severity of Illness Index; Smoking; Tiotropium Bromide; Tobacco Smoke Pollution

A clinical, retrospective and non-comparative study was undertaken to assess the clinical efficacy and tolerability of azithromycin in the treatment of community-acquired pneumonia caused by Legionella pneumophila. A total of 16 patients with a serologically confirmed diagnosis of Legionnaires' diseases were included. Azithromycin was administered orally at a total dose of 1.5 g for either 3 or 5 days. All patients were no side-effects requiring discontinuation of the treatment. Further increase of abnormal baseline liver function was recorded in 2 patients and in 1 patient mild, transient eosinophilia. Equal clinical efficacy and tolerability were observed with the 3- and 5-day dosage regimen. These results indicate that azithromycin given at a standard dose of 1.5 g is effective and well tolerated in the treatment of Legionnaires' disease.

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Community-Acquired Infections; Drug Tolerance; Eosinophilia; Humans; Legionnaires' Disease; Liver; Male; Middle Aged; Retrospective Studies

Allergies are frequently implicated in ophthalmologic practice. These typically benign allergies can be potentially severe for the ocular surface and have an impact in everyday life. We relate, through a case of keratoconjunctivitis involving 2 types of hypersensitivity, the various triggers and therapeutic choices to allow a more effective treatment.

Topics: Adult; Allergens; Animals; Azithromycin; Blepharitis; Cats; Dermatitis, Atopic; Desensitization, Immunologic; Dogs; Drug Therapy, Combination; Eosinophilia; Histamine Antagonists; Humans; Hypersensitivity, Immediate; Immunoglobulin E; Intradermal Tests; Keratoconjunctivitis; Lubricant Eye Drops; Male; Pyroglyphidae; Rhinitis, Allergic, Seasonal; Tacrolimus

Topics: Anti-Bacterial Agents; Azithromycin; Biopsy; Child; Diagnosis, Differential; Drug Eruptions; Eosinophilia; Humans; Infectious Mononucleosis; Male; Skin

Topics: Anti-Bacterial Agents; Anti-Inflammatory Agents, Non-Steroidal; Arthralgia; Azithromycin; Diagnosis, Differential; Drug Eruptions; Eosinophilia; Female; Hip Joint; Humans; Middle Aged; Phenylbutazone; Syndrome