Influenza pneumonia following

Pneumonia following influenza is often caused by Staphylococcus aureus, and best guess therapy is usually achieved by adding flucloxacillin to one of the regimens above. When staphylococcal pneumonia is proven, sodium fusidate p.o. plus flucloxacillin i.v. should be used in combination. 

Normal commensals of the upper respiratory tract proliferate in damaged lungs especially following viral infections, pulmonary congestion or pulmonary infarction. Mixed infection is therefore common, and since Haemophilus influenzae and Streptococcus pneumoniae are often the pathogens, amoxicillin or trimethoprim are reasonable choices, but if... 

Nicotine and the other ingredients in tobacco have been cited as causing a variety of fatal illnesses. A study by the Centers for Disease Control and Prevention (CDC) in 1991 listed the causes of death related to smoking with annual death toll as follows (cardiovascular) heart disease, 150,000 stroke, 26,000 other, 24,000 (cancer) lung, 112,000 other, 31,000 (non-malignant pulmonary disease) chronic obstructive pulmonary disease, 62,000 other, including pneumonia and influenza, 21,000 for a total of 426,000 fatalities a year directly attributable to tobacco. Further, the CDC points out that tobacco is also responsible for an annual... 

In 1974 vaccines against Neisseria meningitidis [20] followed by Streptococcus pneumoniae [21,22] in 1977 and later Haemophilus influenzae type b [23] were licensed (see Table 1). 

Lomefloxacin has been approved for two primary indica-(ions. First, it is indicated for acute bacterial exacerbations of chronic bronchitis cau.sed by H. influenzae or Moraxella (Branimmella) caiatrhalis. but not if Streptococcus pneumoniae is the causative organism. Second, it is used for prophylaxis of infection following transurethral surgery. Lomefloxacin also finds application in the treatment of acute cys-this and chronic urinary tract infections caused by Gram-negative bacilli. 

The details depend, of course, very much on the age group 1-4,5-14,15-24,25-44,45-64,65-74, and 75-. .. 121 In the United States the age group of 25 to 44 (all races and both sexes combined) will most likely die of accidents (27,182 deaths—but including medical accidents see below), cancer (20,436 deaths), heart disease (16,139 deaths), suicide (11,354 deaths), HIV (8,356 deaths), homicide (7,383 deaths), chronic liver disease (3,786 deaths), cerebrovascular diseases (3,201 deaths), diabetes mellitus (2,549 deaths), and pneumonia and influenza (1,068 deaths). At 1 to 4 years old, accidents (1,826 deaths) still dominate, but this is followed by congenital defects (495), cancer (420), homicide (356), heart disease (181), pneumonia and influenza (103), septicemia (99), prenatal conditions (79), so-called Benign neoplasm (i.e., simply meaning that they don t spread) (53), and lower respiratory diseases (51). For age 75 and up, it will be heart disease (471,302), cancer (242,235), cerebrovascular diseases (124,396), lower respiratory diseases (75,218), pneumonia and influenza (51,368), Alzheimer s disease (45,462), diabetic mellitus (35,470), nephritis (24,235), accidents (23,353), and septicemia (19,082). 

The high mortality associated with this pandemic was primarily due to the pneumonia, which so often followed the initial infection. This was sometimes caused by the influenza virus itself, but was more often due to the bacterium Streptococcus pyogenes. This invaded the already damaged lungs and produced a fulminating inflammatory condition, which led to respiratory collapse and death. With the advent of the sulfonamides in 1935, and subsequently, the penicillins and other antibiotics from 1945, the likelihood of such a high mortality rate from bacterial pneumonia in future pandemics was much reduced. 

Azithromycin, an azalide macrolide antibiotic (500 mg p.o. as a single dose on day 1, followed by 250 mg daily on days 2 to 5 total accumulation dose is 1.5 g), is indicated in the treatment of acute bacterial exacerbations of chronic obstructive pulmonary disease caused by Haemophilus influenzae, Moraxella (Branhamella) catarrhalis, or Streptococcus pneumoniae mild community-acquired pneumonia caused by H. influenzae or S. pneumoniae uncomplicated skin and skin-structure infections caused by Staphylococcus aureus, Streptococcus pyogenes, or S. agalactiae second-line therapy of pharyngitis or tonsillitis caused by S. pyogenes and in nongonococcal urethritis or cervicitis caused by Chlamydia trachomatis. 

Polymyxin B may be indicated (when less toxic drugs are ineffective or contraindicated) in serious infections caused by susceptible strains of the following organisms Haemophilus influenzae (meningeal infections) Escherichia coli (urinary tract infections) Enterobacter aero-genes (bacteremia) Klebsiella pneumoniae (bacteremia). In meningeal infections, polymyxin B sulfate must be administered only intrathecally. 

Compound 69c was proved to maintain good activity in vitro but had a short half-life in vivo due to hydroxylation of the 4"-side chain by cytochome P-450 followed by conversion to CP-418,001 (69d), which was inactive. To avoid such metabolism, a methyl group was introduced to the a-side chain of 69c to obtain CP-416,890 (69e). It exhibited increased stability to metabolism and good in vivo activity. Finally, synthesized 69f, which bears a smaller side chain, demonstrated superior in vitro and in vivo activity, particularly against S. pneumoniae, including the MLS-i and mef type of resistant strains. Its pharmacokinetic profile is comparable to AZM (19) and telithromycin (TLM) (91i) [87-93]. However, the antibacterial activity of 69f seems to be insufficient against MLS-c resistant strains of S. pneumoniae and H. influenzae compared with 91i and ABT-773 (95) (Schemes 8 and 11). 

Viruses, also, can be an important and often unappreciated cause of nosocomial pneumonia, causing as many as 20% of endemic nosocomial pneumonia infections (1). Nosocomial respiratory viral infections have exogenous sources and usually follow community outbreaks occurring during particular times of the year (8-15). A number of viruses—adenoviruses, influenza virus. 

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