zithromax and Respiratory-Insufficiency

Despite a high disease burden, there is no effective treatment for respiratory syncytial virus (RSV) infection.. To determine whether administration of azithromycin (AZM) to children with RSV-induced respiratory failure is safe and to define the effect of AZM therapy on nasal matrix metalloproteinase 9 (MMP-9) levels.. This randomized, double-blind, placebo-controlled phase 2 trial was conducted at a single tertiary pediatric intensive care unit from February 2016 to February 2019. The study included children with RSV infection who were admitted to the pediatric intensive care unit and required respiratory support via positive pressure ventilation (invasive and noninvasive). A total of 147 children were screened; 90 were excluded for not meeting inclusion criteria, having an absent legal guardian, lacking pharmacy support, or having a language barrier and 9 declined participation, resulting in 48 patients enrolled in the study.. Receipt of standard dose AZM (10 mg/kg/d), high-dose AZM (20 mg/kg/d), or a matching placebo of normal saline intravenously for 3 days.. Nasal and endotracheal samples were collected at baseline as well as at 24 hours and 48 hours after start of treatment. The secondary outcome was to determine treatment effect on clinical outcome measures, including days of positive pressure ventilation and length of hospital stay.. A total of 48 patients were enrolled in the trial, with a median (range) age at randomization of 12 (1 to 125) months; 36 participants (75.0%) were younger than 2 years. Overall, 26 participants (54.2%) were boys, and 29 (60.4%) had a comorbidity. A total of 16 patients were randomized into each trial group (ie, placebo, standard-dose AZM, and high-dose AZM). Baseline demographic characteristics were comparable among the 3 groups. Both doses of AZM were safe, with no adverse events observed. No difference in nasal MMP-9 levels were observed between treatment groups. Among those who required mechanical ventilation and received high-dose AZM, endotracheal active and total MMP-9 levels were lower on day 3. Compared with baseline, active and total MMP-9 levels in endotracheal aspirates were 1.0 log lower in the high-dose AZM group (active MMP-9: 99.8% CI, -1.28 to -0.64; P < .001; total MMP-9: 99.8% CI, -1.37 to -0.57; P < .001). Patients who received high-dose AZM had fewer median (interquartile range) hospital days compared with those receiving the placebo (8 [6-14] days vs 11 [8-20] days; mean ratio estimate, 0.57; 95% CI, 0.38-0.87; P = .01).. In this phase 2 randomized clinical trial, both doses of AZM were safe. While nasal MMP-9 levels were unchanged among treatment groups, endotracheal MMP-9 levels were lower among those who received high-dose AZM. The positive secondary clinical outcome, while exploratory, provides insight for end points in a multicenter randomized trial.. ClinicalTrials.gov Identifier: NCT02707523.

Topics: Administration, Intravenous; Anti-Bacterial Agents; Azithromycin; Child; Child, Preschool; Dose-Response Relationship, Drug; Double-Blind Method; Female; Humans; Infant; Intensive Care Units, Pediatric; Male; Matrix Metalloproteinase 9; Positive-Pressure Respiration; Respiratory Insufficiency; Respiratory Syncytial Virus Infections; Viral Load

The potential antimicrobial and anti-inflammatory effectiveness of azithromycin against severe influenza is yet unclear. We retrospectively investigated the effect of intravenous azithromycin administration within 7 days of hospitalization in patients with influenza virus pneumonia and respiratory failure. Using Japan's national administrative database, we enrolled and classified 5066 patients with influenza virus pneumonia into severe, moderate, and mild groups based on their respiratory status within 7 days of hospitalization. The primary endpoints were total, 30-day, and 90-day mortality rates. The secondary endpoints were the duration of intensive-care unit management, invasive mechanical ventilation, and hospital stay. The inverse probability of the treatment weighting method with estimated propensity scores was used to minimize data collection bias. Use of intravenous azithromycin was proportional to the severity of respiratory failure (mild: 1.0%, moderate: 3.1%, severe: 14.8%). In the severe group, the 30-day mortality rate was significantly lower with azithromycin (26.49% vs. 36.65%,

Topics: Azithromycin; Hospitalization; Humans; Influenza, Human; Orthomyxoviridae; Pneumonia; Propensity Score; Respiratory Insufficiency; Retrospective Studies

As the COVID-19 pandemic continues to claim lives across the globe, insufficient data exists regarding the optimal treatment. It is well known that patients 55 years of age or older and patients with certain chronic diseases are at higher risk of severe illness, including acute respiratory distress syndrome and death. A potentially fatal pulmonary complication of sickle cell disease, acute chest syndrome, can be precipitated by acute infections, including respiratory viruses. We report the case of a patient with sickle cell disease (HbSC) who developed COVID-19 pneumonia and acute chest syndrome who was treated with emergent red blood cell exchange in order to avoid endotracheal intubation.

Topics: Acute Chest Syndrome; Adult; Analgesics; Anemia, Sickle Cell; Antiviral Agents; Azithromycin; Betacoronavirus; Combined Modality Therapy; Contraindications, Procedure; Coronavirus Infections; COVID-19; Erythrocyte Transfusion; Humans; Hydroxychloroquine; Intubation, Intratracheal; Male; Methylprednisolone; Oxygen Inhalation Therapy; Pandemics; Pneumonia, Viral; Respiration, Artificial; Respiratory Insufficiency; SARS-CoV-2

A patient with COVID-19-related severe respiratory failure, with insufficient response to an antiretroviral therapy, hydroxychloroquine and Interleukin-6 (IL-6) antagonist therapy, presented a prompt resolution of the respiratory function and improvement in the radiological picture after baricitinib at an oral dose of 4 mg per day for 2 weeks.

Topics: Acute Disease; Aged; Antibodies, Monoclonal, Humanized; Antiviral Agents; Azetidines; Azithromycin; Betacoronavirus; Coronavirus Infections; COVID-19; Drug Combinations; Drug Repositioning; Humans; Hydroxychloroquine; Lopinavir; Male; Pandemics; Pneumonia, Viral; Purines; Pyrazoles; Respiratory Insufficiency; Ritonavir; SARS-CoV-2; Sulfonamides; Treatment Outcome

The evolving pandemic of Coronavirus Disease 2019 has posed a substantial health risk worldwide. However, there is a paucity of data regarding the clinical course and the therapeutic management of patients with chronic kidney disease and COVID-19 infection. To date, most evidence has come from renal transplantation, with about 45 patients reported thus far, and the current data from the ERA-EDTA (ERACODA) registry for transplanted patients and patients on Renal Replacement Therapy (RRT); as for those with glomerular diseases, data are lacking. Herein, we report the case of a 62-year-old patient with severe membranoproliferative glomerulonephritis who had been receiving a high burden of immunosuppression until four months before the COVID-19 infection. He developed severe disease with acute respiratory failure requiring mechanical ventilation. After treatment with hydroxychloroquine and azithromycin, despite his low chances, he gradually recovered and survived. To the best of our knowledge, this is one of the few reported patients with glomerulonephritis who had COVID-19 Besides our single case with glomerulonephritis early during the disease outbreak, the very low prevalence of COVID-19 infection in the country's transplant recipients (0.038%) and dialysis patients (0.24%) reflects the impact of the rapid implementation of social distancing rules as well as of preventive measures for disease control in the hospitals and dialysis units in our country.

Topics: Anti-Bacterial Agents; Azithromycin; Betacoronavirus; Ceftriaxone; Coronavirus Infections; COVID-19; Creatinine; Cryoglobulinemia; Cyclophosphamide; Enzyme Inhibitors; Glomerulonephritis, Membranoproliferative; Glucocorticoids; Greece; Humans; Hydroxychloroquine; Immunocompromised Host; Immunologic Factors; Kidney Failure, Chronic; Kidney Transplantation; Leukemia, Lymphocytic, Chronic, B-Cell; Lung; Male; Methylprednisolone; Middle Aged; Pandemics; Pneumonia, Viral; Renal Dialysis; Respiration, Artificial; Respiratory Insufficiency; Reverse Transcriptase Polymerase Chain Reaction; Rituximab; SARS-CoV-2; Tomography, X-Ray Computed

Coronavirus disease 2019 (COVID-19) is a potentially fatal disease that is of great global public health concern.. We explored the clinical management of inpatients with COVID-19 in Italy.. A self-administered survey was sent by email to Italian physicians caring for adult patients with COVID-19. A panel of experts was selected according to their clinical curricula and their responses were analyzed.. A total of 1,215 physicians completed the survey questionnaire (17.4% response rate). Of these, 188 (15.5%) were COVID-19 experts. Chest computed tomography was the most used method to detect and monitor COVID-19 pneumonia. Most of the experts managed acute respiratory failure with CPAP (56.4%), high flow nasal cannula (18.6%), and non-invasive mechanical ventilation (8%), while an intensivist referral for early intubation was requested in 17% of the cases. Hydroxychloroquine was prescribed as an antiviral in 90% of cases, both as monotherapy (11.7%), and combined with protease inhibitors (43.6%) or azithromycin (36.2%). The experts unanimously prescribed low-molecular-weight heparin to patients with severe COVID-19 pneumonia, and half of them (51.6%) used a dose higher than standard. The respiratory burden in patients who survived the acute phase was estimated as relevant in 28.2% of the cases, modest in 39.4%, and negligible in 9%.. In our survey some major topics, such as the role of non-invasive respiratory support and drug treatments, show disagreement between experts, likely reflecting the absence of high-quality evidence studies. Considering the significant respiratory sequelae reported following COVID-19, proper respiratory and physical therapy programs should be promptly made available.

Topics: Adult; Aged; Anti-Bacterial Agents; Anticoagulants; Antiviral Agents; Azithromycin; Betacoronavirus; Cannula; Cardiology; Continuous Positive Airway Pressure; Coronavirus Infections; COVID-19; COVID-19 Drug Treatment; Critical Care; Heparin, Low-Molecular-Weight; Hospitalization; Humans; Hydroxychloroquine; Intensive Care Units; Internal Medicine; Italy; Lung; Middle Aged; Noninvasive Ventilation; Pandemics; Physicians; Pneumonia, Viral; Practice Patterns, Physicians'; Protease Inhibitors; Pulmonary Medicine; Referral and Consultation; Respiration, Artificial; Respiratory Insufficiency; SARS-CoV-2; Surveys and Questionnaires; Tomography, X-Ray Computed

Invasive mechanical has been associated with high mortality in COVID-19. Alternative therapy of high flow nasal therapy (HFNT) has been greatly debated around the world for use in COVID-19 pandemic due to concern for increased healthcare worker transmission.This was a retrospective analysis of consecutive patients admitted to Temple University Hospital in Philadelphia, Pennsylvania, from 10 March 2020 to 24 April 2020 with moderate-to-severe respiratory failure treated with HFNT. Primary outcome was prevention of intubation. Of the 445 patients with COVID-19, 104 met our inclusion criteria. The average age was 60.66 (+13.50) years, 49 (47.12 %) were female, 53 (50.96%) were African-American, 23 (22.12%) Hispanic. Forty-three patients (43.43%) were smokers. Saturation to fraction ratio and chest X-ray scores had a statistically significant improvement from day 1 to day 7. 67 of 104 (64.42%) were able to avoid invasive mechanical ventilation in our cohort. Incidence of hospital-associated/ventilator-associated pneumonia was 2.9%. Overall, mortality was 14.44% (n=15) in our cohort with 13 (34.4%) in the progressed to intubation group and 2 (2.9%) in the non-intubation group. Mortality and incidence of pneumonia was statistically higher in the progressed to intubation group. CONCLUSION: HFNT use is associated with a reduction in the rate of invasive mechanical ventilation and overall mortality in patients with COVID-19 infection.

Topics: Adrenal Cortex Hormones; Aged; Anti-Bacterial Agents; Antibodies, Monoclonal, Humanized; Antirheumatic Agents; Azithromycin; Betacoronavirus; Black or African American; Cannula; Comorbidity; Coronavirus Infections; COVID-19; Diabetes Mellitus; Female; Healthcare-Associated Pneumonia; Heart Diseases; Hispanic or Latino; Humans; Hydroxychloroquine; Hypertension; Hypoxia; Immunoglobulins, Intravenous; Immunologic Factors; Intubation, Intratracheal; Lung Diseases; Male; Middle Aged; Oxygen Inhalation Therapy; Pandemics; Philadelphia; Pneumonia, Ventilator-Associated; Pneumonia, Viral; Pulse Therapy, Drug; Renal Insufficiency, Chronic; Respiratory Insufficiency; Retrospective Studies; SARS-CoV-2; Severity of Illness Index; Smoking; White People

Topics: Anti-Bacterial Agents; Azithromycin; Bordetella pertussis; Cough; Drainage; Female; Humans; Infant; Pneumothorax; Radiography, Thoracic; Respiratory Insufficiency; Treatment Outcome; Whooping Cough

Psittacosis is a rare disease particularly in children with usual presentation of respiratory and constitutional symptoms. The cases may remain undiagnosed or diagnosis may be delayed because of lack of awareness among the paediatricians and physicians. Early diagnosis is very important as this is potentially curable and preventable disease. An interesting case of psittacosis is being reported here, which has been treated successfully with azithromycin.

Topics: Anti-Bacterial Agents; Azithromycin; Child; Cough; Humans; Psittacosis; Radiography, Thoracic; Respiratory Insufficiency; Treatment Outcome

The authors report a case of Q fever infection that caused acute exacerbation of chronic respiratory failure, which had developed as a sequela of pulmonary tuberculosis. This case was found on wide-ranging serological screening for respiratory infection performed in order to investigate the prevalence of Q fever in Japan. A 73-year-old man who had been treated for hypertension and sequelae of pulmonary tuberculosis was admitted to our hospital because of fever, productive cough, and dyspnea on effort. Hypoxia and right heart failure were detected on arterial blood analysis and ultrasonography. The acute exacerbation was triggered by respiratory infection and although the infection improved on azithromycin treatment after admission, respiratory failure continued for the period of admission. Home oxygen therapy was required for the management of chronic respiratory failure on discharge. Paired serum samples were tested for antibodies against Coxiella burnetii by indirect immunofluorescence, showing an elevated antibody titer in the convalescent phase. We believe that Q fever infection caused acute exacerbation of chronic respiratory failure, and that C. burnetii is an agent that might influence the clinical course of chronic respiratory failure.

Topics: Acute Disease; Aged; Anti-Bacterial Agents; Antibodies, Bacterial; Azithromycin; Chronic Disease; Coxiella burnetii; Fluorescent Antibody Technique, Indirect; Humans; Male; Oxygen Inhalation Therapy; Q Fever; Respiratory Insufficiency; Serologic Tests

We report the case of a 25-year-old female patient with severe aggravation of myasthenia gravis due to azithromycin which was prescribed for an influenza syndrome. One hour after the intake of 500 mg azithromycin the patient developed weakness of the legs and respiratory distress due to respiratory muscle failure. She was hospitalized in a comatose state and required intubation and mechanical ventilation for six days. Acute worsening of myasthenia gravis was observed in this patient in 1986 after parenteral administration of erythromycin. Erythromycin causing aggravation of myasthenia gravis by interfering with neuromuscular transmission is reported in the literature. The close temporal relationship between the intake of azithromycin and severe worsening of myasthenia gravis in our patient suggests that azithromycin, a new azalid-antibiotic of the macrolid group, can exacerbate myasthenia gravis. We conclude that azithromycin should be added to the list of drugs to be used with caution in patients with myasthenia gravis.

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Female; Humans; Myasthenia Gravis; Paralysis; Respiratory Insufficiency