Moraxella catarrhalis infections

A combination of trimethoprim-sulfamethoxazole is effective treatment for a wide variety of infections including P jiroveci pneumonia, shigellosis, systemic salmonella infections, urinary tract infections, prostatitis, and some nontuberculous mycobacterial infections. It is active against most Staphylococcus aureus strains, both methicillin-susceptible and methicillin-resistant, and against respiratory tract pathogens such as the pneumococcus, Haemophilus sp, Moraxella catarrhalis, and Klebsiella pneumoniae (but not Mycoplasma pneumoniae). However, the increasing prevalence of strains of E coli (up to 30% or more) and pneumococci that are resistant to trimethoprim-sulfamethoxazole must be considered before using this combination for empirical therapy of upper urinary tract infections or pneumonia. 

Azithromycin, though less active against streptococci and staphylococci than erythromycin, is far more active against respiratory infections due to Haemophilus influenzae and Moraxella catarrhalis. Except for its cost, it is now the preferred therapy for urethritis caused by Chlamydia trachomatis. Its activity against Mycobacterium avium intracellulare complex has not proven to be clinically important, except in AIDS patients with disseminated infections. 

Due to its powerful specific activity against commonly isolated community-acquired respiratory tract pathogens [33,149-158], including penicillin-sensitive and -resistant Streptococcus pneumoniae, methicillin-sensitive Staphylococcus aureus, Haemophilus spp., Moraxella catarrhalis and atypical pathogens such as Mycoplasma pneumoniae, Chlamydia pneumoniae and Legionella pneumophila and Klebsiella pneumoniae and anaerobic bacteria [159-162], moxifloxacin was developed as a respiratory tract anti-infective [163-168]. 

Jones ME, et al. In vitro susceptibility of Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis a European multicenter study during 2000-2001. Clin. Microbiol. Infect., 2003, 9, 590-599. 

Starting in the 1920s, very many different mixed bacterial vaccine products (including inactivated bacteria such as Staphylococcus aureus. Streptococcus species. Streptococcus pneumoniae, Moraxella catarrhalis, Klebsiella pneumoniae, H. influenzae) were marketed worldwide. Currently, there are still several products available in European countries, and one product in the USA. Most vaccines have been used for treatment of recurrent and chronic infections of the respiratory tract. The efficacy of these products is doubtful. Delayed hypersensitivity to bacterial products is common. Delayed reactions, sometimes associated with vague malaise or myalgia, can occur after the administration of maintenance doses for months. If delayed skin reactions are accompanied by any systemic symptoms, administration of the mixed vaccine should be drastically reduced or stopped (87). 

Thomsberry C, Sahm DF, Kelly LJ, et al. Regional trends in antimicrobial resistance among clinical isolates of Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis in the United States Results from the TRUST surveillance program, 1999—2000. Qin Infect Dis 2002 34(suppl 1) S4-16. 

Among these fluorinated derivatives, 21 showed the most promising features of antimicrobial activity in vivo, pharmacokinetics, and clinical efficacy [51-54], The in vitro activity of 21 against pathogens of respiratory tract infections was compared with that of 1. The activity of 21 and 1 were tested against S. aureus (16 strains). Streptococcus pneumoniae (24), Streptococcus pyogenes (24), Moraxella catarrhalis (22), and H. influenzae (22), and the observed MIC50 values (pg/ml) were 0.5 and 0.25,0.03 and 0.03,0.125 and 0.03,0.125 and 0.06, and 2 and 4, respectively. 

Biedenbach, D. J., Barrett, M. S., and Jones, R. N. (1998). Comparative antimicrobial activity and kill-curve investigations of novel ketolide antimicrobial agents (HMR 3004 and HMR 3647) tested against Haemophilus influenzae and Moraxella catarrhalis strains. Diagn. Microbiol. Infect. Dis. 31, 349 —353. 

S. pyogenes, H. influenzae, H. parainfluenzae, and Moraxella catarrhali. Cefditoren pivoxil is only indicated for the treatment of mild-to-moderate pharyngitis, tonsillitis, uncomplicated skin and skin structure infections, and acute exacerbations of chronic bronchitis. 

Trimethoprim and sulfamethoxazole (TMP-SMZ) This important drug combination is currently accepted treatment for complicated urinary tract infections and for respiratory, ear, and sinus infections due to H influenzae and Moraxella catarrhalis. In the immunocompromised patient, TMP-SMZ is used for infections due to Aeromonas hydrophila and is the drug of choice for prevention and treatment of pneumocystis pneumonia. TMP-SMZ is a possible backup drug for typhoid fever and shigellosis and has been used in the treatment of infections caused by methicillin-resistant staphylococci and Listeria monocytogenes. 

Morgan, M.G., McKenzie, H., Enright, M.C., Bain, M., and Emmanuel, F.X. 1992, Use of molecular methods to characterize Moraxella catarrhalis strains in a suspected outbreak of nosocomial infection. Eur J Clin Microbiol Infect Dis 11 305-312. 

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. 

Mild cases, characterised by pinkness or infection of the eardrum, often resolve spontaneously and need only analgesia emd observation. They are normally viral. A bulging, inflamed eardrum indicates bacterial otitis media usually due to Streptococcus pneumoniae, Haemophilus influenzae, Moraxella (Bran-hamella) catarrhalis. Streptococcus pyogenes (Group A) or Staphylococcus aureus. Amoxicillin or co-amoxiclav is satisfactory, but the clinical benefit of antibiotic therapy is very small when tested in controlled trials. Chemotherapy has not removed the need for myringotomy when pain is very severe, and also for later cases, as sterilised pus may not be completely absorbed and may leave adhesions that impair hearing. Chronic infection presents a similar problem to that of chronic sinus infection, above. 

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. 

Lomefloxacin, a fluoroquinolone broad-spectrum antibiotic (400 mg p.o. daily for 10 to 14 days), is used in acute bacterial exacerbations of chronic bronchitis caused by Haemophilis influenzae or Moraxella (Branhamella) catarrhalis in uncomphcated urinary tract infections (cystitis) caused by Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, or Staphylococcus saprophyticus, in complicated urinary tract infections caused by E. coli, K. pneumoniae, P. mirabilis, and Pseudomonas aeruginosa and it is possibly effective against infections caused by Citrobacter diversus or Enterobacter cloacae and for the prophylaxis of infections after transurethral surgical procedures (see also Figure 85). 

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