bronchitis

Description: Antimicrobial overuse is a major health care issue that contributes to antibiotic resistance. Such overuse includes unnecessarily long durations of antibiotic therapy in patients with common bacterial infections, such as acute bronchitis with chronic obstructive pulmonary disease (COPD) exacerbation, community-acquired pneumonia (CAP), urinary tract infections (UTIs), and cellulitis. This article describes best practices for prescribing appropriate and short-duration antibiotic therapy for patients presenting with these infections.

Methods: The authors conducted a narrative literature review of published clinical guidelines, systematic reviews, and individual studies that addressed bronchitis with COPD exacerbations, CAP, UTIs, and cellulitis. This article is based on the best available evidence but was not a formal systematic review. Guidance was prioritized to the highest available level of synthesized evidence.

Best practice advice 1: Clinicians should limit antibiotic treatment duration to 5 days when managing patients with COPD exacerbations and acute uncomplicated bronchitis who have clinical signs of a bacterial infection (presence of increased sputum purulence in addition to increased dyspnea, and/or increased sputum volume).

Best practice advice 2: Clinicians should prescribe antibiotics for community-acquired pneumonia for a minimum of 5 days. Extension of therapy after 5 days of antibiotics should be guided by validated measures of clinical stability, which include resolution of vital sign abnormalities, ability to eat, and normal mentation.

Best practice advice 3: In women with uncomplicated bacterial cystitis, clinicians should prescribe short-course antibiotics with either nitrofurantoin for 5 days, trimethoprim-sulfamethoxazole (TMP-SMZ) for 3 days, or fosfomycin as a single dose. In men and women with uncomplicated pyelonephritis, clinicians should prescribe short-course therapy either with fluoroquinolones (5 to 7 days) or TMP-SMZ (14 days) based on antibiotic susceptibility.

Best practice advice 4: In patients with nonpurulent cellulitis, clinicians should use a 5- to 6-day course of antibiotics active against streptococci, particularly for patients able to self-monitor and who have close follow-up with primary care.

Author/s:

Lee, Rachael A., Centor, Robert M., Humphrey, Linda L., Jokela, Janet A., Andrews, Rebecca, Qaseem, Amir

Association Between E-Cigarette Use and Chronic Obstructive Pulmonary Disease by Smoking Status: Behavioral Risk Factor Surveillance System 2016 and 2017

Brian Desmarais — Fri, 03 Jan 2020 20:33:58 +0000

Date Added:

January 3, 2020

Journal/Publication:

American Journal of Preventative Medicine

Publication Date:

January 1, 2020

URL:

Association Between E-Cigarette Use and Chronic Obstructive Pulmonary Disease by Smoking Status: Behavioral Risk Factor Surveillance System 2016 and 2017

Type:

Community-Based Research Results

Format:

Article

DOI (1):

https://doi.org/10.1016/j.amepre.2019.10.014

Keywords

MeSH

Behavioral Risk Factor Surveillance System

bronchitis

Chronic Traumatic Encephalopathy

self report

Smokers

Cigarette Smoking

electronic nicotine delivery systems

Vaping

More evidence that e-cigarette smoking is hazardous to lungs apart from the adverse effects of regular cigarette smoking. James W. Mold, MD, MPH

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Introduction: The association between e-cigarette use and chronic bronchitis, emphysema, and
chronic obstructive pulmonary disease has not been studied thoroughly, particularly in populations
defined by concomitant combustible smoking status.

Methods: Using pooled 2016 and 2017 data from the Behavioral Risk Factor Surveillance System,
investigators studied 705,159 participants with complete self-reported information on e-cigarette use,
combustible cigarette use, key covariates, and chronic bronchitis, emphysema, or chronic obstructive
pulmonary disease. Current e-cigarette use was the main exposure, with current use further classified
as daily or occasional use. The main outcome was defined as reported ever having a diagnosis of

chronic bronchitis, emphysema, or chronic obstructive pulmonary disease. For all the analyses, multi-
variable adjusted logistic regression was used, with the study population stratified by combustible ciga-
rette use status (never, former, or current). All the analyses were conducted in 2019.

Results: Of 705,159 participants, 25,175 (3.6%) were current e-cigarette users, 64,792 (9.2%) current
combustible cigarette smokers, 207,905 (29.5%) former combustible cigarette smokers, 432,462

(61.3%) never combustible cigarette smokers, and 14,036 (2.0%) dual users of e-cigarettes and combus-
tible cigarettes. A total of 53,702 (7.6%) participants self-reported chronic bronchitis, emphysema, or

chronic obstructive pulmonary disease. Among never combustible cigarette smokers, current e-ciga-
rette use was associated with 75% higher odds of chronic bronchitis, emphysema, or chronic obstruc-
tive pulmonary disease compared with never e-cigarette users (OR=1.75, 95% CI=1.25, 2.45), with

daily users of e-cigarettes having the highest odds (OR=2.64, 95% CI=1.43, 4.89). Similar associations
between e-cigarette use and chronic bronchitis, emphysema, or chronic obstructive pulmonary disease
were noted among both former and current combustible cigarette smokers.
Conclusions: The results suggest possible e-cigarette−related pulmonary toxicity across all thecategories of combustible cigarette smoking status, including those who had never smoked combus-
tible cigarettes.

Author/s:

Osei , A.D., Mirbolouk, M., Orimoloye, O.A., Dzaye, O.

Association of E-Cigarette Use With Respiratory Disease Among Adults: A Longitudinal Analysis

John Bayhi — Thu, 02 Jan 2020 20:08:03 +0000

Date Added:

January 2, 2020

Journal/Publication:

American Journal of Preventive Medicine

Publisher:

Elsevier Inc.

Publication Date:

December 11, 2019

URL:

Association of E-Cigarette Use With Respiratory Disease Among Adults: A Longitudinal Analysis

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1016/j.amepre.2019.07.028

Keywords

e-cigarette or vaping product use-associated lung injury

PMID (1):

31859175

MeSH

Adult

electronic nicotine delivery systems

This longitudinal study documents an increase in respiratory problems associated with e-cigarette use and supports a mechanism distinct from those associated with respiratory problems associated with standard cigarettes. The combination of e-cigarettes and standard cigarettes appears to be particularly hazardous. James W. Mold, MD, MPH.

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INTRODUCTION:

E-cigarettes deliver an aerosol of nicotine by heating a liquid and are promoted as an alternative to combustible tobacco. This study determines the longitudinal associations between e-cigarette use and respiratory disease controlling for combustible tobacco use.

METHODS:

This was a longitudinal analysis of the adult Population Assessment of Tobacco and Health Waves 1, 2, and 3. Multivariable logistic regression was performed to determine the associations between e-cigarette use and respiratory disease, controlling for combustible tobacco smoking, demographic, and clinical variables. Data were collected in 2013-2016 and analyzed in 2018-2019.

RESULTS:

Among people who did not report respiratory disease (chronic obstructive pulmonary disease, chronic bronchitis, emphysema, or asthma) at Wave 1, the longitudinal analysis revealed statistically significant associations between former e-cigarette use (AOR=1.31, 95% CI=1.07, 1.60) and current e-cigarette use (AOR=1.29, 95% CI=1.03, 1.61) at Wave 1 and having incident respiratory disease at Waves 2 or 3, controlling for combustible tobacco smoking, demographic, and clinical variables. Current combustible tobacco smoking (AOR=2.56, 95% CI=1.92, 3.41) was also significantly associated with having respiratory disease at Waves 2 or 3. Odds of developing respiratory disease for a current dual user (e-cigarette and all combustible tobacco) were 3.30 compared with a never smoker who never used e-cigarettes. Analysis controlling for cigarette smoking alone yielded similar results.

CONCLUSIONS:

Use of e-cigarettes is an independent risk factor for respiratory disease in addition to combustible tobacco smoking. Dual use, the most common use pattern, is riskier than using either product alone.

Author/s:

Bhatta, DN, Glantz, SA

FDA updates warnings for fluoroquinolone antibiotics on risks of mental health and low blood sugar adverse reactions

Jeffrey Wilson — Mon, 10 Dec 2018 14:18:59 +0000

Date Added:

December 10, 2018

Journal/Publication:

FDA News Release

Publisher:

U.S. Food and Drug Administration

Publication Date:

July 10, 2018

URL:

FDA updates warnings for fluoroquinolone antibiotics on risks of mental health and low blood sugar adverse reactions

Type:

Notifications and Opportunities

Format:

Web Page

Keywords

MeSH

The more we learn about the potential adverse effects of fluoroquinolones, the more we should try to avoid their use, particularly for self-limited conditions like sinusitis and bronchitis.

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The U.S. Food and Drug Administration today is requiring safety labeling changes for a class of antibiotics called fluoroquinolones to strengthen the warnings about the risks of mental health side effects and serious blood sugar disturbances, and make these warnings more consistent across the labeling for all fluoroquinolones taken by mouth or given by injection.