scholarly journals Risks Related to the Use of Non-Steroidal Anti-Inflammatory Drugs in Community-Acquired Pneumonia in Adult and Pediatric Patients

2019 ◽  
Vol 8 (6) ◽  
pp. 786 ◽  
Author(s):  
Guillaume Voiriot ◽  
Quentin Philippot ◽  
Alexandre Elabbadi ◽  
Carole Elbim ◽  
Martin Chalumeau ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Strong Association ◽  
Community Acquired Pneumonia ◽  
Current Data ◽  
Hospital Length Of Stay ◽  
Hospital Referral ◽  
Complicated Course ◽  
Inflammatory Drugs ◽  
Anti Inflammatory ◽  
Tract Infections

Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to alleviate symptoms during community-acquired pneumonia (CAP), while neither clinical data nor guidelines encourage this use. Experimental data suggest that NSAIDs impair neutrophil intrinsic functions, their recruitment to the inflammatory site, and the resolution of inflammatory processes after acute pulmonary bacterial challenge. During CAP, numerous observational data collected in hospitalized children, hospitalized adults, and adults admitted to intensive care units (ICUs) support a strong association between pre-hospital NSAID exposure and a delayed hospital referral, a delayed administration of antibiotic therapy, and the occurrence of pleuropulmonary complications, even in the only study that has accounted for a protopathic bias. Other endpoints have been described including a longer duration of antibiotic therapy and a greater hospital length of stay. In all adult series, patients exposed to NSAIDs were younger and had fewer comorbidities. The mechanisms by which NSAID use would entail a complicated course in pneumonia still remain uncertain. The temporal hypothesis and the immunological hypothesis are the two main emerging hypotheses. Current data strongly support an association between NSAID intake during the outpatient treatment of CAP and a complicated course. This should encourage experts and scientific societies to strongly advise against the use of NSAIDs in the management of lower respiratory tract infections.

Non-steroidal Anti-inflammatory Drugs may Worsen the Course of Community-Acquired Pneumonia: A Cohort Study

Lung ◽  
2016 ◽  
Vol 195 (2) ◽  
pp. 201-208 ◽  
Author(s):  
Damien Basille ◽  
Nathalie Plouvier ◽  
Charlotte Trouve ◽  
Pierre Duhaut ◽  
Claire Andrejak ◽  
...  
Keyword(s):  
Cohort Study ◽  
Community Acquired Pneumonia ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

ANTI-INFLAMMATORY THERAPY OF THROAT DISEASES

2019 ◽  
Vol 25 (3) ◽  
pp. 53-59
Author(s):  
O.M. Kolesnikova ◽  
◽  
S.A. Karpishchenko ◽  
Y.V. Legkova ◽  
◽  
...  
Keyword(s):  
Quality Of Life ◽  
Respiratory Tract ◽  
Antibiotic Therapy ◽  
Symptomatic Treatment ◽  
Diagnostic Methods ◽  
Active Life ◽  
Systemic Antibiotic Therapy ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

Sore throat is one of the most common complaints faced by doctors of various specialties. This symptom accompanies many diseases of the pharynx and larynx, and may be a manifestation of certain diseases that are not associated with the respiratory tract. When choosing therapy, it is necessary by doctors to rationally use the criteria for the appointment of systemic antibiotic therapy. However, local anti-inflammatory therapy as a symptomatic treatment should be selected before accurate confirmation of the etiology of the disease. This provides patients with a quick return to an active life and an improvement in the quality of life in general. The article discusses the etiology and pathogenesis of pain in diseases of the pharynx, modern diagnostic methods and optimal tactics for treating patients. As a symptomatic treatment, to reduce inflammation in the pharynx, the drug Vertum LOR, which belongs to the group of non-steroidal anti-inflammatory drugs of local action, may contain benzidamine as an active substance.

Purple urine bag syndrome: When the urine turns purple – An under diagnosed spot diagnosis

2021 ◽  
Vol 2 (3) ◽  
Author(s):  
Cathrin Kodde ◽  
◽  
Till Othmer ◽  
David Krieger ◽  
Silke Polsfuss ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Antibiotic Therapy ◽  
Urinary Catheter ◽  
Rare Condition ◽  
Community Acquired Pneumonia ◽  
Purple Urine Bag Syndrome ◽  
Indigo Blue ◽  
Tract Infections ◽  
Purple Urine

The Purple Urine Bag Syndrome (PUBS) is a rare condition in which the urine turns purple. It may occur in Urinary Tract Infections (UTIs) when bacteria metabolize dietary tryptophan to indole resulting in indigo (blue) and indirubin (red). This condition is mostly seen in elderly female patients with permanent urinary bladder catheterization. Patients, relatives and health professionals may be concerned about this discolouration, which is usually harmless. Medical management of PUBS involves frequent urinary bag change, antibiotic therapy and most importantly reassurance. We report an 89-years-old long-term catheterized female nursing home resident who was admitted to the emergency room because of a Community Acquired Pneumonia (CAP). After a few days of inpatient treatment her urine bag turned purple. Antibiotic therapy continued and the indwelling urinary catheter was changed resulting in clear urine. Keywords: Purple urine bag syndrome (PUBS); purple discolouration; urinary tract infection (UTI); long-term catheterization.

Non-steroidal anti-inflammatory drugs may worsen the course of community-acquired pneumonia : A cohort study

2016 ◽  
Author(s):  
Damien Basille ◽  
Charlotte Trouve ◽  
Nathalie Plouvier ◽  
Claire Andrejak ◽  
Vincent Jounieaux
Keyword(s):  
Cohort Study ◽  
Community Acquired Pneumonia ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

scholarly journals POS1151 IMMUNOGENICITY AND SAFETY OF 23-VALENT PNEUMOCOCCAL POLYSACCHARIDE VACCINE IN PATIENTS WITH SPONDYLOARTHRITIS.

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 854.2-855
Author(s):  
N. Muravyeva ◽  
B. Belov ◽  
M. Baranova ◽  
M. Cherkasova
Keyword(s):  
Respiratory Tract ◽  
Lower Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Capsular Polysaccharide ◽  
Polysaccharide Vaccine ◽  
Pneumococcal Polysaccharide Vaccine ◽  
Lower Respiratory Tract Infections ◽  
Inflammatory Drugs ◽  
Anti Inflammatory ◽  
Tract Infections

Background:Currently, for the treatment of patients with spondyloarthritis (SpA), basic anti-inflammatory drugs and biological drugs are widely used to effectively control the activity of the disease. At the same time, the use of these drugs is associated with an increased risk of developing infections, some of which can be prevented by vaccination.Objectives:The aim of the study was to evaluate the immunogenicity and safety of the 23-valent pneumococcal polysaccharide vaccine (PPV-23) in patients with SpA.Methods:The study included 42 patients with SpA: 30 men, 12 women, age 22-60 years, disease duration 14.8±10.6 years. Ankylosing spondylitis was diagnosed in 30 patients, psoriatic spondyloarthritis – in 12 patients. Activity of diseases was assessed as high in 78% of patients (median BASDAI index was 5.3 [4.1; 6.8]). At the time of inclusion in the study, all patients received nonsteroidal anti-inflammatory drugs, 14 patients - methotrexate, 10 - sulfasalazine, 6 - glucocorticoids, 2 - leflunomide, 2 - etanercept, 2 - secukinumab. 15 patients were planned to be prescribed secukinumab, 3 – etanercept, 3 - adalimumab, 1 – golimumab. 7 patients had a history of more than 2 cases of lower respiratory tract infections, 2 patients reported a monthly exacerbation of chronic sinusitis, 1 patient – the development of otitis every 2-3 months, requiring the use of antibacterial drugs. PPV-23 was administered in the amount of 1 dose (0.5 ml) subcutaneously into the deltoid muscle against the background of anti-rheumatic therapy. The level of antibodies to pneumococcal capsular polysaccharide was determined using the EIA PCP IgG kit (TestLine Clinical Diagnostics s.r.o., Czech Republic) before vaccination, 1, 3 and 12 months after vaccination.Results:The dynamics of the concentration of antibodies to pneumococcal capsular polysaccharide in patients with SpA is presented in the Table 1.Table 1.Concentration of pneumococcal antibodies, U/ml, Me [25; 75 percentile]1 visit (initial)2 visit (after 1 month)3 visit (after 3 month)4 visit (after 12 month)80.0 [35.2; 154.0]160.1 [73.5; 245.7] *214.5 [103.2; 255.0] **175.0 [120.1; 260.1] **p=0.01 **p=0.005At 1, 3 and 12 months after vaccination, the concentration of antibodies to pneumococcal capsule polysaccharide was significantly higher compared to the baseline values. In 81% of patients, vaccination tolerance was good. Reactions at the injection site (pain, swelling and hyperemia of the skin up to 2 cm in diameter), resolved independently after 1-5 days, were observed in 6 patients. In 2 patients, a severe local reaction was registered in the form of pain in the arm, infiltration and hyperemia of the skin up to 8 and 15 cm in diameter, respectively, accompanied by low-grade fever in one patient for 2 days, and febrile fever in the other for 3 days. In both cases, these symptoms were completely stopped after administration of paracetamol and antihistamines. Exacerbation of SpA and the emergence of new autoimmune disorders were not detected. During the follow-up period, no patients developed lower respiratory tract infections. Patients suffering from frequent sinusitis and otitis reported the absence of these infections after vaccination.Conclusion:The obtained data indicate satisfactory immunogenicity and good tolerability of PPV-23 in patients with SpA. Further studies are needed to better assess the immunogenicity and safety of vaccine, as well as to study of the influence of anti-rheumatic therapy on the effectiveness of immunization.Disclosure of Interests:None declared.

scholarly journals Treatment with anti-inflammatory drugs in community-acquired pneumonia

2012 ◽  
Vol 272 (1) ◽  
pp. 25-35 ◽  
Author(s):  
S. C. A. Meijvis ◽  
E. M. W. van de Garde ◽  
G. T. Rijkers ◽  
W. J. W. Bos
Keyword(s):  
Community Acquired Pneumonia ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

scholarly journals Cyclooxygenase inhibitor use is associated with increased COVID-19 severity

2021 ◽  
Author(s):  
Justin Reese ◽  
Ben Coleman ◽  
Lauren Chan ◽  
Tiffany J Callahan ◽  
Luca Cappelletti ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Smoking Status ◽  
Community Acquired Pneumonia ◽  
Cox Proportional Hazards ◽  
Electronic Health Record Data ◽  
Cox Inhibitors ◽  
Inflammatory Drugs ◽  
Race Ethnicity ◽  
Tract Infections ◽  
Conclusive Data

BACKGROUND Cyclooxygenase (COX) inhibitors including non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to reduce pain, fever, and inflammation but have been associated with complications in community acquired pneumonia and other respiratory tract infections (RTIs). Conclusive data are not available about potential beneficial or adverse effects of COX inhibitors on COVID-19 patients. METHODS We conducted a retrospective, multi-center observational study by leveraging the harmonized, high-granularity electronic health record data of the National COVID Cohort Collaborative (N3C). Potential associations of eight COX inhibitors with COVID-19 severity were assessed using ordinal logistic regression (OLR) on treatment with the medication in question after matching by treatment propensity as predicted by age, race, ethnicity, gender, smoking status, comorbidities, and BMI. Cox proportional hazards analysis was used to estimate the correlation of medication use with morbidity for eight subcohorts defined by common indications for COX inhibitors. RESULTS OLR revealed statistically significant associations between use of any of five COX inhibitors and increased severity of COVID-19. For instance, the odds ratio of aspirin use in the osteoarthritis cohort (n=2266 patients) was 3.25 (95% CI 2.76 - 3.83). Aspirin and acetaminophen were associated with increased mortality. CONCLUSIONS The association between use of COX inhibitors and COVID-19 severity was consistent across five COX inhibitors and multiple indication subcohorts. Our results align with earlier reports associating NSAID use with complications in RTI patients. Further research is needed to characterize the precise risk of individual COX inhibitors in COVID-19 patients.

scholarly journals Multistep antimicrobial stewardship intervention on antibiotic prescriptions and treatment duration in children with pneumonia

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0257993
Author(s):  
Sara Rossin ◽  
Elisa Barbieri ◽  
Anna Cantarutti ◽  
Francesco Martinolli ◽  
Carlo Giaquinto ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Broad Spectrum ◽  
Antibiotic Stewardship ◽  
Clinical Pathways ◽  
Community Acquired Pneumonia ◽  
Broad Spectrum Antibiotics ◽  
Outpatient Group ◽  
Before And After ◽  
Tract Infections ◽  
The Impact

Introduction The Italian antimicrobial prescription rate is one of the highest in Europe, and antibiotic resistance has become a serious problem with high costs and severe consequences, including prolonged illnesses, the increased period of hospitalization and mortality. Inadequate antibiotic prescriptions have been frequently reported, especially for lower respiratory tract infections (LRTI); many patients receive antibiotics for viral pneumonia or bronchiolitis or broad-spectrum antibiotics for not complicated community-acquired pneumonia. For this reason, healthcare organizations need to implement strategies to raise physicians’ awareness about this kind of drug and their overall effect on the population. The implementation of antibiotic stewardship programs and the use of Clinical Pathways (CPs) are excellent solutions because they have proven to be effective tools at diagnostic and therapeutic levels. Aims This study evaluates the impact of CPs implementation in a Pediatric Emergency Department (PED), analyzing antibiotic prescriptions before and after the publication in 2015 and 2019. The CP developed in 2019 represents an update of the previous one with the introduction of serum procalcitonin. The study aims to evaluate the antibiotic prescriptions in patients with community-acquired pneumonia (CAP) before and after both CPs (2015 and 2019). Methods The periods analyzed are seven semesters (one before CP-2015 called PRE period, five post CP-2015 called POST 1–5 and 1 post CP-2019 called POST6). The patients have been split into two groups: (i) children admitted to the Pediatric Acute Care Unit (INPATIENTS), and (ii) patients evaluated in the PED and sent back home (OUTPATIENTS). We have analyzed all descriptive diagnosis of CAP (the assessment of episodes with a descriptive diagnosis were conducted independently by two pediatricians) and CAP with ICD9 classification. All antibiotic prescriptions for pediatric patients with CAP were analyzed. Results A drastic reduction of broad-spectrum antibiotics prescription for inpatients has been noticed; from 100.0% in the PRE-period to 66.7% in POST1, and up to 38.5% in POST6. Simultaneously, an increase in amoxicillin use from 33.3% in the PRE-period to 76.1% in POST1 (p-value 0.078 and 0.018) has been seen. The outpatients’ group’s broad-spectrum antibiotics prescriptions decreased from 54.6% PRE to 17.4% in POST6. Both for outpatients and inpatients, there was a decrease of macrolides. The inpatient group’s antibiotic therapy duration decreased from 13.5 days (PRE-period) to 7.0 days in the POST6. Antibiotic therapy duration in the outpatient group decreased from 9.0 days (PRE) to 7.0 days (POST1), maintaining the same value in subsequent periods. Overlapping results were seen in the ICD9 group for both inpatients and outpatients. Conclusions This study shows that CPs are effective tools for an antibiotic stewardship program. Indeed, broad-spectrum antibiotics usage has dropped and amoxicillin prescriptions have increased after implementing the CAP CP-2015 and the 2019 update.

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