Pneumonia
Some selected abstract: |
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1 |
Alvarez-Lerma F, Grau S, Alvarez-Beltran M. Levofloxacin in the treatment of ventilator-associated pneumonia. Clin Microbiol Infect. 2006 May;12 Suppl 3:81-92. Review. Service of Intensive Care Medicine, Hospital del Mar, Universitat Autonoma de Barcelona, Spain. Falvarez@imas.imim.es
The use of levofloxacin
in critically ill patients has progressively increased since commercial
marketing of the drug in 1999, despite the fact that few studies have been
designed to assess the use of levofloxacin in this population.
Pharmacological characteristics, broad spectrum of activity, and
tolerability account for the high interest in the drug for the treatment of
different infectious diseases, including ventilator-associated pneumonia (VAP),
and the recommendation of levofloxacin in guidelines developed by a number
of scientific societies. According to pharmacokinetic-pharmacodynamic data,
it seems reasonable to assume that an increase in activity follows from a
larger dose, so that 500 mg/12 h is adequate in patients with VAP. In
critically ill patients with VAP, levofloxacin monotherapy is indicated for
empirical treatment of patients with early onset pneumonia without risk
factors for multiresistant pathogens, and in combination therapy for late
onset VAP or for patients at risk for multiresistant pathogens. The use of
levofloxacin in combination therapy is supported by multiple reasons,
including: increased empirical coverage in infections with suspected
intracellular pathogens; substitution for more toxic antimicrobial agents
(e.g., aminoglycosides) in patients with renal dysfunction and in those at
risk for renal insufficiency; and severity of systemic response to infection
(septic shock) that justifies multiple treatment with better tolerated
antibiotics. The availability of the oral formulation allows sequential
therapy, switching from the intravenous route to the oral route.
Levofloxacin is well tolerated by critically ill patients, with few adverse
events of mild to moderate severity. |
2 |
Artinian V, Krayem H, DiGiovine B. Effects of early enteral feeding on the outcome of critically ill mechanically ventilated medical patients. Chest. 2006 Apr;129(4):960-7. Henry Ford Hospital, Division of Pulmonary and Critical Care, 2799 W Grand Blvd, K-17, Detroit, MI 48202, USA.
STUDY OBJECTIVES: To
determine the impact of early enteral feeding on the outcome of critically
ill medical patients. DESIGN: Retrospective analysis of a prospectively
collected large multi-institutional ICU database. PATIENTS: A total of 4,049
patients requiring mechanical ventilation for > 2 days. MEASUREMENTS AND
RESULTS: Patients were classified according to whether or not they received
enteral feeding within 48 h of mechanical ventilation onset. The 2,537
patients (63%) who did receive enteral feeding were labeled as the "early
feeding group," and the remaining 1,512 patients (37%) were labeled as the
"late feeding group." The overall ICU and hospital mortality were lower in
the early feeding group (18.1% vs 21.4%, p = 0.01; and 28.7% vs 33.5%, p =
0.001, respectively). The lower mortality rates in the early feeding group
were most evident in the sickest group as defined by quartiles of severity
of illness scores. Three separate models were done using each of the
different scores (acute physiology and chronic health evaluation II,
simplified acute physiology score II, and mortality prediction model at time
0). In all models, early enteral feeding was associated with an
approximately 20% decrease in ICU mortality and a 25% decrease in hospital
mortality. We also analyzed the data after controlling for confounding by
matching for propensity score. In this analysis, early feeding was again
associated with decreased ICU and hospital mortality. In all adjusted
analysis, early feeding was found to be independently associated with an
increased risk of ventilator-associated pneumonia (VAP) developing.
CONCLUSION: Early feeding significantly reduces ICU and hospital mortality
based mainly on improvements in the sickest patients, despite being
associated with an increased risk of VAP developing. Routine administration
of such therapy in medical patients receiving mechanical ventilation is
suggested, especially in patients at high risk of death. |
3 |
Bose A, Coles CL, Gunavathi, John H, Moses P, Raghupathy P, Kirubakaran C, Black RE, Brooks WA, Santosham M. Efficacy of zinc in the treatment of severe pneumonia in hospitalized children <2 y old. Am J Clin Nutr. 2006May;83(5):1089-96; quiz 1207. Departments of Community Medicine and Child Health, Christian Medical College, Vellore, India.
BACKGROUND: Severe
pneumonia remains a leading cause of morbidity and mortality in
undernourished young children in developing countries. OBJECTIVE: This study
evaluated the effect of adjuvant zinc therapy on recovery from severe
pneumonia by hospitalized children in southern India who were receiving
standard antibiotic therapy. DESIGN: This randomized, double-blind,
placebo-controlled clinical trial was conducted at the Christian Medical
College Hospital, an 1800-bed teaching hospital in Tamilnadu, India.
Enrollment and follow-up occurred between September 2003 and August 2004.
Children aged 2-23 mo (n = 299) who were hospitalized with severe pneumonia
were randomly assigned to receive 10-mg tablets of zinc sulfate or placebo
twice a day during hospitalization, along with standard therapy for severe
pneumonia. All clinical signs and symptoms of pneumonia were assessed and
recorded at 8-h intervals. RESULTS: There were no clinical or statistically
significant differences in the duration of tachypnea, hypoxia, chest
indrawing, inability to feed, lethargy, severe illness, or hospitalization.
Zinc supplementation was associated with a significantly longer duration of
pneumonia in the hot season (P = 0.015). CONCLUSIONS: Zinc supplementation
had no overall effect on the duration of hospitalization or of clinical
signs associated with severe infection in young children hospitalized for
severe pneumonia in southern India. This finding differs from the results of
2 previously reported trials wherein zinc supplementation was associated
with a shorter period of recovery from severe pneumonia. Given the
conflicting results, further research in representative settings is required
to help clarify the role of zinc in the treatment of severe pneumonia. |
4 |
Carey TS, Hanson L, Garrett JM, Lewis C, Phifer N, Cox CE, Jackman A. Expectations and outcomes of gastric feeding tubes. Am J Med. 2006 Jun;119(6):527.e11-6. The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, NC 27599-7590, USA. tim_carey@unc.edu
PURPOSE: To compare
expected outcomes with actual outcomes from tube feeding in adult patients.
SUBJECTS AND METHODS: This prospective cohort study was conducted in two North Carolina
hospitals. Surrogates were interviewed shortly after feeding tube insertion
and at 3- and 6-month follow-up; chart abstraction and death certificate
review also were carried out. Participants were surrogate decision-makers
for consecutive adult patients who received new feeding tubes. RESULTS:
There were 288 patients with surrogate decision-makers enrolled. Mean age
was 65 years; 30% had a primary diagnosis of stroke, 16% neurodegenerative
disorder, 20% head and neck cancer, and 30% other diagnoses. At 3 months,
21% of patients had died, and 6-month mortality was 30%. At 3 months, 38% of
survivors were residing in a nursing home, and 27% had the feeding tube
removed. Patients were impaired in most activities of daily living (ADLs)
with little change over time. Medical complications were common: 25% of
patients had decubitus ulcers at 3 months, and 24% had at least one episode
of pneumonia. Perceived global quality of life was poor at 4.6 (on a 0-10
scale) at baseline, and surrogates anticipated this would improve to 8.0
with tube feeding. Family surrogates' expectations for improvement from the
feeding tube were very high at baseline and remained so at 3 and 6 months.
CONCLUSIONS: Families' high expectations of benefit from tube feeding are in
contrast to clinical outcomes. Providers and families need better
information about the outcomes of this common procedure. |
5 |
Demirkaya E, Atay AA, Musabak U, Sengul A, Gok F. Ceftriaxone-related hemolysis and acute renal failure. Pediatr Nephrol. 2006 May;21(5):733-6. Department of Pediatric Nephrology, Gulhane Military Medical Academy, 06018, Etlik, Ankara, Turkey. dottore_erkan@yahoo.com
A 5-year-old girl with
no underlying immune deficiency or hematologic disease was treated with a
combination of ceftriaxone and ampicilline-sulbactam for pneumonia. On the
ninth day of the therapy, she developed oliguria, paleness, malaise, immune
hemolytic anemia (IHA) and acute renal failure (ARF). Laboratory studies
showed the presence of antibodies against ceftriaxone. Acute interstitial
nephritis (AIN) was diagnosed by renal biopsy. The patient's renal
insufficiency was successfully treated with peritoneal dialysis without any
complications. The patient recovered without any treatment using steroids or
other immunosuppressive agents. |
6 |
Depuydt P, Myny D, Blot S. Nosocomial pneumonia: aetiology, diagnosis and treatment. Curr Opin Pulm Med. 2006 May;12(3):192-7. review. Department of Intensive Care, Ghent University, De Pintelaan, Belgium. pieter.depuydt@ugent.be
PURPOSE OF REVIEW: This
review highlights recent advances in the aetiology of nosocomial pneumonia,
and in strategies to increase accuracy of diagnosis and antibiotic
prescription while limiting unnecessary antibiotic consumption. RECENT
FINDINGS: Bacterial pathogens still cause the bulk of nosocomial pneumonia
and are of concern because of ever-rising antimicrobial resistance. Yet, the
pathogenic role of fungal and viral organisms is increasingly recognized.
Since early appropriate antimicrobial therapy is the cornerstone of an
effective treatment, further studies have been conducted to improve
appropriateness of early antibiotic therapy. De-escalation strategies
combine initial broad-spectrum antibiotics to maximize early antibiotic
coverage with a subsequent focusing of the antibiotic spectrum when the
cause is identified. Invasive techniques probably do not alter the immediate
outcome but have the potential to reduce unnecessary antibiotic exposure.
Decisions to stop or change antibiotic therapy are hampered due to a lack of
reliable parameters to assess the resolution of pneumonia. SUMMARY:
Increasing antimicrobial resistance in nosocomial pneumonia both challenges
treatment and mandates limitation of selection pressure by reducing
antibiotic burden. Treating physicians should be both aggressive in
initiating antimicrobials when suspecting nosocomial pneumonia but willing
to discontinue antimicrobials when diagnostic results point to an
alternative diagnosis. Efforts should be made to limit duration of
antibiotic therapy when possible. |
7 |
El Moussaoui R, de Borgie CA, van den Broek P, Hustinx WN, Bresser P, van den Berk GE, Poley JW, van den Berg B, Krouwels FH, Bonten MJ, Weenink C, Bossuyt PM, Speelman P, Opmeer BC, Prins JM. Effectiveness of discontinuing antibiotic treatment after three days versus eight days in mild to moderate-severe community acquired pneumonia: randomised, double blind study. BMJ. 2006 Jun 10;332(7554):1355. Department of Internal Medicine, Division of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands.
OBJECTIVE: To compare
the effectiveness of discontinuing treatment with amoxicillin after three
days or eight days in adults admitted to hospital with mild to
moderate-severe community acquired pneumonia who substantially improved
after an initial three days' treatment. DESIGN: Randomised, double blind,
placebo controlled non-inferiority trial. SETTING: Nine secondary and
tertiary care hospitals in the Netherlands.
PARTICIPANTS: Adults with mild to moderate-severe community acquired
pneumonia (pneumonia severity index score < or = 110). INTERVENTIONS:
Patients who had substantially improved after three days' treatment with
intravenous amoxicillin were randomly assigned to oral amoxicillin (n = 63)
or placebo (n = 56) three times daily for five days. MAIN OUTCOME MEASURES:
The primary outcome measure was the clinical success rate at day 10.
Secondary outcome measures were the clinical success rate at day 28, symptom
resolution, radiological success rates at days 10 and 28, and adverse
events. RESULTS: Baseline characteristics were comparable, with the
exception of symptom severity, which was worse in the three day treatment
group. In the three day and eight day treatment groups the clinical success
rate at day 10 was 93% for both (difference 0.1%, 95% confidence
interval--9% to 10%) and at day 28 was 90% compared with 88% (difference
2.0%,--9% to 15%). Both groups had similar resolution of symptoms.
Radiological success rates were 86% compared with 83% at day 10 (difference
3%,--10% to 16%) and 86% compared with 79% at day 28 (difference 6%,--7% to
20%). Six patients (11%) in the placebo group and 13 patients (21%) in the
active treatment group reported adverse events (P = 0.1). CONCLUSIONS:
Discontinuing amoxicillin treatment after three days is not inferior to
discontinuing it after eight days in adults admitted to hospital with mild
to moderate-severe community acquired pneumonia who substantially improved
after an initial three days' treatment. |
8 |
Glikman D, Matushek SM, Kahana MD, Daum RS. Pneumonia and empyema caused by penicillin-resistant Neisseria meningitidis: a case report and literature review. Pediatrics. 2006 May;117(5):e1061-6. Department of Pediatrics, University of Chicago, Chicago, Illinois, USA. dglikman@peds.bsd.uchicago.edu
Pneumonia is an uncommon
manifestation of Neisseria meningitidis infection, and empyema is rarely
reported. Uniform penicillin susceptibility has been assumed for
meningococcal infections for many years, but decreased penicillin
susceptibility has been recognized recently with increasing frequency.
Breakpoints to define different categories of susceptibility were published
recently by the Clinical and Laboratory Standards Institute. We report the
case of a teenage girl with sepsis and extensive bilateral pneumonia with
empyema caused by an N meningitidis isolate that was resistant to
penicillin. Her protracted clinical course suggested that penicillin
resistance contributed to her delayed recovery. Our experience with this
patient suggests that susceptibility testing should be performed in every
case of N meningitidis isolation, and treatment with a third-generation
cephalosporin should be provided until the susceptibility results are known.
Clinical suspicion of N meningitidis as a possible cause of respiratory
symptoms accompanied by hypotension, even in the absence of a rash, may aid
in diagnosis and therefore in the treatment and provision of prophylaxis to
contacts of patients with meningococcal disease. |
9 |
Nathan RV, Rhew DC, Murray C, Bratzler DW, Houck PM, Weingarten SR. In-hospital observation after antibiotic switch in pneumonia: a national evaluation. Am J Med. 2006 Jun;119(6):512.e1-7. Division of Infectious Diseases, Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, Calif, USA.
PURPOSE: To evaluate the
clinical benefit of in-hospital observation after the switch from
intravenous (IV) to oral antibiotics in a large Medicare population.
Retrospective studies of relatively small size indicate that the practice of
in-hospital observation after the switch from IV to oral antibiotics for
patients hospitalized with community-acquired pneumonia (CAP) is
unnecessary. METHODS: We performed a retrospective examination of the US
Medicare National Pneumonia Project database. Eligible patients were
discharged with an ICD-9-CM diagnosis consistent with community-acquired
pneumonia and divided into 2 groups: 1) a "not observed" cohort, in which
patients were discharged on the same day as the switch from IV to oral
antibiotics and 2) an "observed for 1 day" cohort, in which patients
remained hospitalized for 1 day after the switch from IV to oral
antibiotics. We compared clinical outcomes between these 2 cohorts. RESULTS:
A total of 39,242 cases were sampled, representing 4341 hospitals in all 50
states and the District of Columbia. There were 5248 elderly patients who
fulfilled eligibility criteria involving a length of stay of no more than 7
hospital days (2536 "not observed" and 2712 "observed for 1 day" patients).
Mean length of stay was 3.8 days for the "not observed" cohort and 4.5 days
for the "observed for 1 day" cohort (P <.0001). There was no significant
difference in 14-day hospital readmission rate (7.8% in the "not observed"
cohort vs 7.2% "observed for 1 day" cohort, odds ratio 0.91; 95% confidence
interval [CI] 0.74-1.12; P =.367) and 30-day mortality rate (5.1% "not
observed" cohort vs 4.4% in the "observed for 1 day" cohort, odds ratio
0.86; 95% CI, 0.67-1.11; P =.258) between the "not observed" and "observed
for 1 day" cohorts. CONCLUSIONS: Our analysis of the US Medicare Pneumonia
Project database provides further evidence that the routine practice of
in-hospital observation after the switch from IV to oral antibiotics for
patients with CAP may be avoided in patients who are clinically stable
although these findings should be verified in a large randomized controlled
trial. |
10 |
Sharma A, Ohri S, Bambery P, Singh S. Idiopathic endogenous lipoid pneumonia. Indian J Chest Dis Allied Sci. 2006 Apr-Jun;48(2):143-5. Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Lipoid pneumonia is a
rare pulmonary disorder having no classical radiological appearance. We
report a 33-year-old male, ex-smoker who was referred to us with history of
cough, mild mucoid expectoration and progressively increasing dyspnoea since
one year. He was investigated at local hospital and was treated with 30 mg
prednisolone per day for 6 months for sarcoidosis without any response. On
examination, he was normal except for fine basal crepitations in chest.
Pulmonary function test (PFT) revealed mild airway obstruction. High
resolution computerised tomographic scan (HRCT scan) revealed bilateral
reticulonodular shadows and bronchiectasis in lower zones. Open lung biopsy
revealed lipoid pneumonia. As there was no history of nasal distillation of
oils, it was diagnosed to be idiopathic. The relevant literature is
reviewed. |
11 |
Shiber JR, Santana J. Dyspnea. Med Clin North Am. 2006 May;90(3):453-79. Review. Department of Medicine, East Carolina University, Greenville, NC 27834, USA. shiberj@mail.ecu.edu
When evaluating a dyspneic
patient in the office, a quick initial assessment of the airway, breathing,
and circulation, while gathering a brief history and focused physical
examination are necessary. Most often, an acute cardiopulmonary disorder,
such as CHF, cardiac ischemia, pneumonia, asthma, or COPD exacerbation, can
be identified and treated. Stable patients who improve can be sent home, but
those in acute distress with unstable or impending unstable conditions need
to be transferred emergently to definitive care. Because of the difficult
logistics involved in attempting to work up an outpatient for new onset of
SOB, some patients will need to be transferred to the nearest ED for a
definitive diagnosis. |
12 |
Rojas MX, Granados C. Oral antibiotics versus parenteral antibiotics for severe pneumonia in children. Cochrane Database Syst Rev. 2006 Apr 19;(2):CD004979. Review. Pontificia Universidad Javeriana, Epidemiology Unit, Faculty of Medicine, Hospital Universitario de San Ignacio, Cr. 7 #40-62, 2nd floor, Bogota, DC, Colombia. mxrojas@gmail.com
BACKGROUND: Acute
respiratory infection (ARI) is one of the leading causes of morbidity and
mortality in children under five years of age in developing countries. When
hospitalisation is required, the usual practice includes administering
parenteral antibiotics if a bacterial infection is suspected. This has
disadvantages as it causes pain and discomfort to the children, which may
lead to treatment refusal or reduced compliance. It is also associated with
needle-related complications. In some settings this equipment is in short
supply or unavailable necessitating transfer of the child, which increases
risks and healthcare costs. OBJECTIVES: To determine the equivalence in
effectiveness and safety of oral antibiotic compared to parenteral
antibiotic therapies in the treatment of severe pneumonia in children
between three months and five years of age. SEARCH STRATEGY: We searched the
Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane
Library Issue 2, 2005); MEDLINE (January 1966 to July 2005); EMBASE (January
1990 to July 2005) and LILACS (February 2005). SELECTION CRITERIA: The
review included published or unpublished randomised controlled trials (RCTs)
and quasi-RCTs comparing any oral antibiotic therapy with any parenteral
antibiotic therapy for the treatment of severe pneumonia in children from
three months to five years of age. DATA COLLECTION AND ANALYSIS: The search
yielded more than 1300 titles. Only three studies met all criteria for
eligibility. One of the identified trials is yet to publish its results. We
did not perform a meta-analysis because of clinical heterogeneity of
therapies compared in the included trials. MAIN RESULTS: Campbell 1988
compared oral co-trimoxazole versus intramuscular procaine penicillin
followed by oral ampicillin in 134 children. At the seventh day of follow
up, treatment failure occurred in 6/66 (9.1%) in the oral co-trimoxazole
group and 7/68 (10.2%) in the combined-treatment group. The risk difference
was -0.01% (95% confidence interval (CI) -0.11 to 0.09). The APPIS Group
2004 evaluated 1702 patients comparing oral amoxicillin versus intravenous
penicillin for two days followed by oral amoxicillin. After 48 hours,
treatment failure occurred in 161/845 (19%) in the amoxicillin group and
167/857 (19%) in the parenteral penicillin group. The risk difference was
-0.4% (95% CI -4.2 to 3.3). The authors reported similar recovery in both
groups at 5 and 14 days. AUTHORS' CONCLUSIONS: Oral therapy appears to be an
effective and safe alternative to parenteral antibiotics in hospitalised
children with severe pneumonia who do not have any serious signs or
symptoms. |
13 |
Tan MP, Koren G. Chickenpox in pregnancy: revisited. Reprod Toxicol. 2006 May;21(4):410-20.Review. The Motherisk Program, Division of Clinical Pharmacology and Toxicology, The Hospital for Sick Children, University of Toronto, Ont., Canada.
Varicella infection during
the first and second trimester of pregnancy may increase the risk for
congenital varicella syndrome 0.5-1.5% above the baseline risk for major
malformation. Third trimester infection may lead to maternal pneumonia which
can be life threatening if not treated appropriately. Varicella-zoster
immune globulin (VZIG) should be administered as soon as possible preferably
within 96 h from exposure to prevent maternal infection or subsequent
complications. Later than 96 h, the effectiveness of VZIG has not been
evaluated. Neonatal varicella is more severe if maternal rash appears 5 days
prior to or 2 days after delivery. The newborn should be given VZIG
immediately. Intravenous acyclovir is recommended for maternal pneumonia and
severely affected neonate. No controlled study has yet evaluated the
effectiveness of acyclovir or valacyclovir for postexposure prophylaxis to
pregnant women or neonates. Unlike primary varicella infection in pregnancy,
herpes zoster has not been documented to cause complications unless in the
disseminated form. The advent of advanced imaging techniques and molecular
biotechniques has improved prenatal diagnosis. With increase use of
vaccination, the incidence of chickenpox in pregnancy is expected to decline
in the future. |
Diagnosis, Diagnostics, Immunodiagnosis & Immunodiagnostics: 14813. Bratzler DW. Blood cultures in pneumonia patients. Ann Emerg Med. 2006 Jun;47(6):580; author reply 581. 14814. Broom MA, Wang LL, Otta SK, Knutsen AP, Siegfried E, Batanian JR, Kelly ME, Shah M. Successful umbilical cord blood stem cell transplantation in a patient with Rothmund-Thomson syndrome and combined immunodeficiency. Clin Genet. 2006 Apr;69(4):337-43. 14815. Chu WC, Li AM, Ng AW, So HK, Lam WW, Lo KL, Yeung MC, Yau YS, Chiu K, Leung CW, Ng PC, Hon KL, Mo KW, Fok TF, Ahuja AT. Thin-Section CT 12 Months After the Diagnosis of Severe Acute Respiratory Syndrome in Pediatric Patients. AJR Am J Roentgenol. 2006 Jun;186(6):1707-14. 14816. Gibbons FK, Branda JA, Shepard JA. Case records of the Massachusetts General Hospital. Case 12-2006. A 37-year-old man with hemoptysis and a pulmonary infiltrate. N Engl J Med. 2006 Apr 20;354(16):1729-37. 14817. Goossens H, Little P. Community acquired pneumonia in primary care. BMJ. 2006 May 6;332(7549):1045-6. 14818. Hoare Z, Lim WS. Pneumonia: update on diagnosis and management. BMJ. 2006 May 6;332(7549):1077-9. Review. 14819. Hoque KM, Binder HJ. Zinc in the treatment of acute diarrhea: current status and assessment. Gastroenterology. 2006 Jun;130(7):2201-5. Review. 14820. Kamath AV, Myint PK. Recognizing and managing severe community-acquired pneumonia. Br J Hosp Med (Lond). 2006 Apr;67(4):M76-8. Review. 14821. Koga T, Aizawa H. Pneumonia: ... and to tuberculosis as differential diagnosis in community acquired pneumonia. BMJ. 2006 May 20;332(7551):1214. 14822. Kuzucu A. Parasitic diseases of the respiratory tract. Curr Opin Pulm Med. 2006 May;12(3):212-21. Review. 14823. Lednicky JA, Rayner JO. Uncommon respiratory pathogens. Curr Opin Pulm Med. 2006 May;12(3):235-9. Review. 14824. Lomas DA. The selective advantage of alpha1-antitrypsin deficiency. Am J Respir Crit Care Med. 2006 May 15;173(10):1072-7. Review. 14825. Peralta G, Rodriguez-Lera MJ, Garrido JC, Ansorena L, Roiz MP. Time to positivity in blood cultures of adults with Streptococcus pneumoniae bacteremia. BMC Infect Dis. 2006 Apr 27;6:79. 14826. Porcel JM, Light RW. Diagnostic approach to pleural effusion in adults. Am Fam Physician. 2006 Apr 1;73(7):1211-20. Review. 14827. Ranganathan LN, Ramaratnam S. Rapid versus slow withdrawal of antiepileptic drugs. Cochrane Database Syst Rev. 2006 Apr 19;(2):CD005003. Review. 14828. Romero-Gomez M, Otero MA, Sanchez-Munoz D, Ramirez-Arcos M, Larraona JL, Suarez Garcia E, Vargas-Romero J. Acute hepatitis due to Mycoplasma pneumoniae infection without lung involvement in adult patients. J Hepatol. 2006 Apr;44(4):827-8. 14829. Rice LB. Antimicrobial resistance in gram-positive bacteria. Am J Med. 2006 Jun;119(6 Suppl 1):S11-9; discussion S62-70. Review. 14830. Wazni OM, Fahmy TS, Natale A. Circumferential pulmonary-vein ablation for atrial fibrillation. N Engl J Med. 2006 May 25;354(21):2289-91; author reply 2289-91. Therapy: 14831. Cals J, Hopstaken R. Lower respiratory tract infections: treating patients or diagnoses? J Fam Pract. 2006 Jun;55(6):545-6; author reply 546-7. 14832. Carratala J, Martin-Herrero JE, Mykietiuk A, Garcia-Rey C. Clinical experience in the management of community-acquired pneumonia: lessons from the use of fluoroquinolones. Clin Microbiol Infect. 2006 May;12 Suppl 3:2-11. Review. 14833. Challen K, Walter D, Bright J, Bentley A. More on pneumonia: clinical judgment is also needed with CURB score. BMJ. 2006 Jun 3;332(7553):1333. 14834. Chua Tde J, File TM Jr. Ventilator-associated pneumonia: gearing towards shorter-course therapy. Curr Opin Infect Dis. 2006 Apr;19(2):185-8. Review. 14835. Craven DE. What is healthcare-associated pneumonia, and how should it be treated? Curr Opin Infect Dis. 2006 Apr;19(2):153-60. Review. 14836. Dean NC, Sperry P, Wikler M, Suchyta MS, Hadlock C. Comparing gatifloxacin and clarithromycin in pneumonia symptom resolution and process of care. Antimicrob Agents Chemother. 2006 Apr;50(4):1164-9. 14837. Hambidge KM. Zinc and pneumonia. Am J Clin Nutr. 2006 May;83(5):991-2. 14838. Jeena P, Thea DM, MacLeod WB, Chisaka N, Fox MP, Coovadia HM, Qazi S; Amoxicillin Penicillin Pneumonia International Study (APPIS Group). Failure of standard antimicrobial therapy in children aged 3-59 months with mild or asymptomatic HIV infection and severe pneumonia. Bull World Health Organ. 2006 Apr;84(4):269-75. Jereb M, Kotar T. Usefulness of procalcitonin to differentiate typical from atypical community-acquired pneumonia. Wien Klin Wochenschr. 2006 Apr;118(5-6):170-4. 14839. Laifer G, Frei R, Adler H, Fluckiger U. Necrotising pneumonia complicating a nasal furuncle. Lancet. 2006 May 13;367(9522):1628. 14840. Lim WS, Hoare Z. Pneumonia: let's avoid confusion of secondary and primary care issues in pneumonia. BMJ. 2006 May 20;332(7551):1214. 14841. Marchetti F, Berti I. Pneumonia: macrolides or amoxicillin for community acquired pneumonia? BMJ. 2006 May 20;332(7551):1213-4. 14842. Maroun V, Cochrane D, Allegra J. Delays in antibiotic administration associated with chest X-ray negative and computed tomographic scan positive for pneumonia. Am J Emerg Med. 2006 May;24(3):390-1. 14843. Owen D, Shiner T, Sivakumar R, Dent R, Hilton C. Pneumonia: are we putting the CURB score into practice? BMJ. 2006 May 20;332(7551):1213. 14844. Ramphal R, Ambrose PG. Extended-spectrum beta-lactamases and clinical outcomes: current data. Clin Infect Dis. 2006 Apr 15;42 Suppl 4:S164-72. Review. 14845. Ranganathan LN, Ramaratnam S. Rapid versus slow withdrawal of antiepileptic drugs. Cochrane Database Syst Rev. 2006 Apr 19;(2):CD005003. Review.
14846.
Tan MP, Koren G. Chickenpox in pregnancy:
revisited. Reprod Toxicol. 2006 May;21(4):410-20.Review. |