Pneumonia evaluation

Brown J III, Burke B, Dajani AS. 1974. Experimental kerosene pneumonia Evaluation of some therapeutic regimens. J Pediatr 84(3) 396-401. 

Barlow GD, Lamping DL, Davey PG, et al. Evaluation of outcomes in community-acquired pneumonia A guide for patients, physicians, and policymakers. Lancet Infect Dis 2003 3 476-488. 

Luna CM, Blanzaco D, Niederman MS, et al. Resolution of ventilator-associated pneumonia Prospective evaluation of the clinical pulmonary infection score as an early clinical predictor of outcome. Crit Care Med 2003 31 676-682. 

The outcome from intraabdominal infection is not determined solely by what transpires in the abdomen. Unsatisfactory outcomes in patients with intraabdominal infections may result from complications that arise in other organ systems. A complication commonly associated with mortality after intraabdominal infection is pneumonia.26 A high APACHE (Acute Physiology And Chronic Health Evaluation) II score, a low serum albumin, and a high New York Heart Association cardiac function status were significantly and independently associated with increased mortality from intraabdominal infection.27... 

Neutropenia occurs when the percent of mature neutrophils plus the percent of bands (or immature neutrophils) times the WBC count is less than 500/mm3 (0.5 x 109/L). The risk of infection increases as the extent of neutropenia becomes severe and the duration increases. The assessment of infection is different in the neutropenic cancer patient. First, WBC counts may be profoundly low, so no left shift is available to evaluate. Second, there is no pus without WBCs. Some bacterial pneumonias may not be readily apparent by chest x-ray. Third, if patients are receiving steroids as part of the cancer treatment, fever curves may be blunted or absent. When a patient does have a fever and is neutropenic, prompt initiation of anti-infectives is necessary. 

AIDSTRIALS (AIDS Clinical Trials). The AIDSTRIALS database [80] provides information about AIDS-related studies of experimental treatments conducted under the FDA s investigational new drug (IND) regulations. AIDSTRIALS contains information about clinical trials of agents undergoing evaluation for use against AIDS, HIV infection, and AIDS-related opportunistic diseases such as Pneumocystis carinii pneumonia (PCP). Detailed information is supplied... 

The first priority on assessing the patient with pneumonia is to evaluate the adequacy of respiratory function and to determine whether there are signs of systemic illness, specifically dehydration or sepsis with resulting circulatory collapse. 

The treatment of bacterial pneumonia initially involves the empiric use of a relatively broad-spectrum antibiotic (or antibiotics) effective against probable pathogens after appropriate cultures and specimens for laboratory evaluation have been obtained. Therapy should be narrowed to cover specific pathogens once the results of cultures are known. 

An increased susceptibility to Streptococcus zooepidemicus aerosol was not observed in mice exposed to 5 ppm phenol for 3 hours, or for 5 daily 3-hour periods (Aranyi et al. 1986). Neither did the phenol exposures affect pulmonary bactericidal activity towards Klebsiella pneumonia. Although tests for vulnerability to infectious agents do not represent a comprehensive evaluation of immunological competence, the 5-ppm level can be considered a NOAEL for this specific immunological effect, and is recorded in Table 2-1 and plotted in Figure 2-1. 

Pulmonary conditions Thmetrexate has not been evaluated clinically for the treatment of concurrent pulmonary conditions such as bacterial, viral, or fungal pneumonia or mycobacterial diseases. 

Drummond MF, Becker DL, Hux M, Chancellor JV, Duprat-Lomon I, Kubin R et al. An economic evaluation of sequential i.v./po moxifloxacin therapy compared to i.v./po co-amoxiclav with or without clarithromycin in the treatment of community-acquired pneumonia. Chest 2003 124 526-35. 

Once a chemotherapy regimen has been selected, the next step in managing chemotherapy is to define the outcome measures that will define therapeutic success and those that will define unacceptable toxicity and necessitate discontinuation of the chosen drugs. For example, resolution of fever and purulent sputum production, normalization of the white blood cell count, reversal of tachypnea and hypoxia, and improvement of constitutional signs and symptoms may be selected as measures that will be used to evaluate whether treatment of pneumonia is successful. 

Many patients receive lengthy courses of antibiotics that probably should not have been started. More than half of courses of antimicrobial chemotherapy are inappropriate. Influenza pneumonia and viral upper respiratory infections, for example, are impervious to assault by antibiotics, although many patients with these illnesses receive such antibiotics. Of course, influenza may be complicated by postinfluenzal staphylococcal pneumonia, for which antibiotics are indicated. Careful sequential evaluation of seriously ill patients for whom antibiotics are deferred is as important as in patients for whom antibiotics are prescribed. 

Serious life-threatening infections, including sepsis and pneumonia, have been reported with the use of TNF inhibitors. Patients should be evaluated for tuberculosisrisk factors and tested for latent tuberculosis infection prior to starting therapy. Concurrent use with other immunosuppressive therapy should be avoided. In clinical trials of all TNF-blocking agents more cases of lymphoma were observed compared with control patients. Patients with a prior history of prolonged phototherapy treatment should be monitored for nonmelanoma skin cancers. 

In the mouse model described here, pneumonia is induced after the intranasal instillation of S. pneumoniae. When using this model for evaluation of antimicrobial agents, therapeutic treatment should start after the infection has already been established in the lungs (6-12 h after bacterial inoculation). 

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