Acute exacerbations infective

Picornavimses are small, nonenveloped RNA vimses. Members of this family include rhino- and enteroviruses, which are responsible for a variety of human diseases (viral respiratory infection, viral meningitis, myocarditis, pericarditis, encephalitis, chronic meningoencephalitis, herpangina, otitis media, neonatal enteroviral disease, and acute exacerbations of asthma). 

Acute exacerbations usually result from an allergen or a viral infection... 

The role of bacterial infections in COPD exacerbations is controversial, and there are limited data on the efficacy of antibiotics in treating COPD exacerbations. Recent studies suggest that bacteria cause 40% to 50% of acute exacerbations.31 Antibiotics should be used in patients with COPD exacerbations who have either of the following characteristics (1) at least two of three cardinal symptoms increased dyspnea, sputum volume, or sputum purulence or (2) a severe exacerbation requiring mechanical ventilation.2... 

Sethi S, Murphy TF. Acute exacerbations of chronic bronchitis new developments concerning microbiology and pathophysiology— impact on approaches to risk stratification and therapy. Infect Dis Clin North Am 2004 18 861-882. 

Airway clearance therapy is a necessary routine for all CF patients to clear secretions and control infection. It is typically performed once or twice daily for maintenance care and three or four times per day for acute exacerbations. 

Clinical features Acute exacerbation of anemia due to sequestration of large blood volume by the spleen. More commonly seen in patients with functioning spleens (e.g., infants and adults with HbSC disease) onset often is associated with viral or bacterial infections recurrences are common and can be fatal. 

The use of the aerosol route for delivery of antibiotics for pulmonary infections remains controversial. The majority of pediatric studies have been conducted in children with cystic fibrosis. In these patients distribution of the antibiotic to the desired tissue site is impeded because of the viscosity of the sputum in patients with acute exacerbations of their pulmonary infections [91,92], Long-term studies have demonstrated preventive benefits of aerosolized antibiotics in children with cystic fibrosis who are colonizing Pseudomonas aeruginosa in their lungs but are not acutely ill [93,94], Cyclic administration of tobramycin administered by nebulizer has received FDA approval [95],... 

Dickinson et al. [27], in 1985, published a double-blind controlled trial on the use of oral vancomycin as an adjunctive therapy in acute exacerbations of idiopathic colitis. No significant difference was found between the two treatment groups with only a trend in favor of a superior efficacy of vancomycin. It is important to underline that 7 of the 40 patients enrolled had colonic CD and that none of them had C. difficile infection that could explain the action of vancomycin. Subsequently, intravenous metronidazole, in addition to steroids, was effective similar to placebo in inducing remission [28],... 

The goals of therapy for chronic bronchitis are to reduce the severity of symptoms, to ameliorate acute exacerbations, and to achieve prolonged infection-free intervals. 

Tenofovir is not indicated for the treatment of chronic hepatitis B virus (HBV) infection, and the safety and efficacy of tenofovir have not been established in patients coinfected with HBV and human immunodeficiency virus (HIV). Severe acute exacerbations of hepatitis B have been reported in patients who are coinfected with HBV and HIV and have discontinued tenofovir. Closely monitor hepatic function with both clinical and laboratory follow-up for at least several months in patients who discontinue tenofovir and are coinfected with HBV and HIV. If appropriate, initiation of anti-hepatitis B therapy may be warranted. 

The major precipitants of exacerbations of COPD are acute airways infections. The role of bacteria in precipitating exacerbations is controversial. Bacteria may have a primary role in the development of an exacerbation or represent a secondary superinfection of an initial viral process. The major bacterial organisms that have been associated with exacerbations are Haemophilus influenzae. Streptococcus pneumoniae, and Moraxella (Branhamella) catarrhalis. Mycoplasma pneumoniae and Chlamydia pneumoniae may play a part. In COPD patients with a FEVi < 35% predicted gram-negative bacteria, especially Enterobacteriaceae and Pseudomonas spp. play an important part in acute exacerbations. 

Lactic acidosis and hepatomegaly with steatosis. Severe acute exacerbations of hepatitis B have occurred in patients co-infected with HBV and HIV. 

Tenofovir is not indicated for chronic hepatitis B virus (HBV) infection. Safety and efficacy have not been established in patients with HBV and HIV. Severe acute exacerbation of HBV infection has been reported in co-infected patients. 

Lower respiratory tract infections e.g., pneumonia, acute bronchitis and acute exacerbations of chronic bronchitis. 

Several anti-HBV agents have anti-HIV activity as well, including lamivudine, adefovir dipivoxil, and tenofovir. Emtricitabine, an antiretroviral NRTI, is under clinical evaluation for HBV treatment. Because NRTI agents may be used in patients co-infected with HBV and HIV, it is important to note that acute exacerbation of hepatitis may occur upon discontinuation or interruption of these agents. 

Indications IV Infusion Prophylaxis and treatment of Pneumocystis car/n/ pneumonia Shigellosis Severe or complicated urinary tract infections Tablets Prophylaxis and treatment of Pneumocystis carinii pneumonia Acute exacerbation of chronic bronchitis Urinary tract infections Travelers diarrhea in adults Shigellosis Acute otitis media ... 

Oral bioavailability is 57%, and tissue and intracallular penetration is generally good. Telithromycin is metabolized in the liver and eliminated by a combination of biliary and urinary routes of excretion. It is administered as a once-daily dose of 800 mg, which results in peak serum concentrations of approximately 2 g/mL. Telithromycin is indicated for treatment of respiratory tract infections, including community-acquired bacterial pneumonia, acute exacerbations of chronic bronchitis, sinusitis, and streptococcal pharyngitis. Telithromycin is a reversible inhibitor of the CYP3A4 enzyme system. 

Qll Acute exacerbations of chronic bronchitis can be caused either by viral or bacterial infections. Production of thick, green sputum suggests Chandra has a bacterial infection. Common bacterial pathogens affecting the lung include Streptococcus pneumoniae and Haemophilus influenzae. It is recommended that COPD patients receive influenza vaccine each year pneumoccocal vaccine is also often recommended in chronic lung disease and may prevent recurrence of chest infection in the elderly. 

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