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  • AFD - Community Acquired Pneumonia

    CAP: Back To Basics



    # 2259





    With the recent discussions (see here, here, and here) over the need for more antibiotics to combat secondary bacterial pneumonias during a future pandemic, concerns over what antibiotics should be stockpiled and dispensed have been raised.


    After all, we constantly hear of new, exotic, and difficult to treat bacterias that are rapidly developing resistance to our front-line antibiotics.


    What then?


    How do we deal with these superbugs during a pandemic?


    The good news, at least according to this study by the University of Melbourne, is that 95% of community acquired pneumonias (CAPs) respond well to traditional antibiotics.



    That is, penicillins along with `atypical' antibiotics like Doxycycline or Erythromycin.


    Whether this trend would hold up during some future pandemic is unknown, but for now, I should think this has to be seen as relatively good news.


    Here is the media release from the University of Melbourne.

    Stick with simple antibiotics for pneumonia to avoid the spread of hospital super bugs, says University of Melbourne researcher


    Media Release, Wednesday 27 August 2008

    Australian hospitals should avoid prescribing expensive broad-spectrum antibiotics for pneumonia to avoid the development of more drug-resistant super bugs, according to a University of Melbourne study.

    The study, by PhD researcher and Austin Health Infectious Diseases consultant, Dr Patrick Charles, shows that only 5 per cent of people admitted to hospital with community-acquired pneumonia had infections caused by organisms that could not be successfully treated with penicillin combined with an “atypical” antibiotic such as doxycycline or erythromycin.


    In the world’s largest study of its kind, Dr Charles studied almost 900 people admitted to six Australian hospitals over 28 months from 2004 to 2006.


    Dr Charles’ research analysed samples of blood, urine, sputum and viral swabs of the nose and throat taken from 885 patients at the Austin, Alfred, Monash and West Gippsland hospitals in Victoria, the Royal Perth Hospital and Princess Alexandra Hospital, Brisbane.


    He found that most cases of pneumonia were caused by easy to treat bacteria such as the pneumococcus or Mycoplasma, or alternatively by respiratory viruses that do not require antibiotic therapy.


    Only five per cent of cases were caused by organisms that would require more expensive and broad-spectrum antibiotics, and these cases were nearly all in patients who’d had frequent hospital admissions or were residents of nursing homes.


    “The study results show that current Australian guidelines for prescribing antibiotics for pneumonia are appropriate,’’ Dr Charles said.


    “It shows that Australian doctors should resist the push which is occurring in some parts of the world – particularly the US - to prescribe broad spectrum antibiotics to treat essentially all possible causes.”


    Dr Charles said the trend towards broad-spectrum antibiotics was being driven by laboratory-based studies of resistance rates in bacteria sent to the labs, rather than clinical studies of patients with pneumonia.


    In the laboratory-based studies, the bacterial isolates often come from highly selected patients with more difficult to treat disease.


    In addition, the fear of litigation made some doctors unnecessarily opt for more aggressive treatments.


    However, the more frequently these broad-spectrum antibiotics were used, the more likely it was that bacteria would be become resistant to them.


    “The emergence of antibiotic-resistant bacterial pathogens is one of the biggest threats to Australian health care standards and is closely linked to the inappropriate use of antibiotics,’’ Dr Charles said.


    “By continuing to use more traditional antibiotics to treat most cases of pneumonia, Australian doctors can limit or delay the emergence of more resistant strains of bacteria.


    “By using the broad-spectrum antibiotics less often, we can also prolong the effective lifespan of these drugs.


    “Furthermore, in the US, Canada and some parts of Europe, they are seeing some serious complications which appear to be related to the overuse of some classes of broad-spectrum antibiotics that are frequently used there to treat respiratory infections.”


    Dr Charles is a physician in Infectious Disease and General Medicine at the Austin Hospital in Melbourne. He is also an Honorary Lecturer in the University of Melbourne’s Department of Medicine at the Hospital.


    His study was recently published in the journal Clinical Infectious Diseases and he will be conferred with a PhD for his research today at the University of Melbourne.


    He received funding from the independent 201CC Research Fund to complete the study.
    More information about this article:
    Janine Sim-Jones
    Media Officer
    janinesj@unimelb.edu.au
    Mob: 0400 893 378

    Posted by FLA_MEDIC at <a class="timestamp-link" href="http://afludiary.blogspot.com/2008/08/cap-back-to-basics.html" rel="bookmark" title="permanent link"><abbr class="published" title="2008-08-28T09:05:00-04:00">9:05 AM</abbr>

  • #2
    Re: AFD - Community Acquired Pneumonia

    Study: Pneumonia Vaccine Lowers Heart Attack Risk



    # 2366



    The study is called:
    Pneumococcal vaccination and risk of myocardial infarction

    Fran?ois Lamontagne, MD MSc, Marie-Pierre Garant, PhD, Jean-Christophe Carvalho, MD, Luc Lanthier, MD MSc, Marek Smieja, MD PhD and Danielle Pilon, MD MSc

    From the Department of Medicine (Lamontagne, Garant, Carvalho, Lanthier, Pilon), Universit? de Sherbrooke, Sherbrooke, Que.; and the Department of Clinical Epidemiology and Biostatistics (Lamontagne, Smieja), McMaster University, Hamilton, Ont.

    and its authors believe they've found a link between receiving the Pneumococcal vaccination and a reduction in the risk of a heart attack (Myocardial Infarction).

    Here is how the CBC is presenting the story. A Hat tip to Shiloh on Flutrackers for posting this story.


    Pneumonia vaccine halves heart attack risk: study


    Last Updated: Monday, October 6, 2008 | 5:04 PM ET


    Pneumonia vaccine not only prevents bacterial infection but the injection also seems to dramatically lower the risk of heart attacks in adults, a Canadian study suggests.

    Pneumococcal or pneumonia vaccination was associated with a decrease of more than 50 per cent in the rate of heart attacks after two years, Dr. Danielle Pilon of the University of Sherbrooke and her colleagues reported in Tuesday's issue of the Canadian Medical Association Journal.

    The researchers compared hospital records for about 1,000 people who had suffered a heart attack with about 4,000 who did not but were at high risk for one. Participants had a mean age of about 60.

    "We compared the vaccination rates of the two groups to find that the patients who did end up getting a heart attack were less likely to have been vaccinated," study author Dr. Fran?ois Lamontagne said.

    The researchers knew the vaccination could change one of the steps involved in atheroslerosis ? the buildup of cholesterol, fat, calcium from the blood on the inside of arteries that can harden and potentially lead to heart attacks or strokes.

    "The hypothesis was that if the vaccination can alter one of the steps in atherosclerosis formation, perhaps it could decrease the risk of heart attack," said Pilon. "And this is what we found."

    (Continue)


    From the study, an overview of what was done, and what the authors found.

    Methods: We conducted a hospital-based case?control study<sup> </sup>that included patients considered to be at risk of myocardial<sup> </sup>infarction. We used health databases to obtain hospital diagnoses<sup> </sup>and vaccination status. We compared patients who had been admitted<sup> </sup>for treatment of myocardial infarction with patients admitted<sup> </sup>to a surgical department in the same hospital for a reason other<sup> </sup>than myocardial infarction between 1997 and 2003.<sup> </sup>

    Results: We found a total of 43 209 patients who were at risk;<sup> </sup>of these, we matched 999 cases and 3996 controls according to<sup> </sup>age, sex and year of hospital admission. Cases were less likely<sup> </sup>than controls to have been vaccinated (adjusted odds ratio [OR]<sup> </sup>0.53, 95% confidence interval [CI] 0.40?0.70). This putative<sup> </sup>protective role of the vaccine was not observed for patients<sup> </sup>who had received the vaccine up to 1 year before myocardial<sup> </sup>infarction (adjusted OR 0.85, 95% CI 0.54?1.33). In contrast,<sup> </sup>if vaccination had occurred 2 years or more before the hospital<sup> </sup>admission, the association was stronger (adjusted OR 0.33, 95%<sup> </sup>CI 0.20?0.46).<sup> </sup>

    Interpretation: Pneumococcal vaccination was associated with<sup> </sup>a decrease of more than 50% in the rate myocardial infarction<sup> </sup>2 years after exposure. If confirmed, this association should<sup> </sup>generate interest in exploring the putative mechanisms and may<sup> </sup>offer another reason to promote pneumococcal vaccination.


    While a good deal more research will be needed before it can be stated that the Pneumococcal vaccination is significantly protective against a heart attack, given known benefits of vaccination, talking to your doctor about whether it is right for you makes a good deal of sense.

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