Chemotherapy
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Lower respiratory tract infections are the major cause of death due to infectious disease in the developed and developing world. Despite substantial progress in defining pathogens and in therapeutic options, there continues to be major controversies in the clinical management of these infections. This report reviews the guidelines for community-acquired pneumonia from the Infectious Diseases Society of America (IDSA), updated from the initial publication. ⋯ Clinical trials have shown equivalence or superiority compared to other standard agents. They are well tolerated, and can be administered intravenously or orally, once daily. A recent retrospective review has shown superior outcome with fluoroquinolone treatment compared to cephalosporins, including a 36% reduction in mortality.
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A multiple-antibiotic-resistant (MAR) strain of Klebsiella pneumoniae was introduced into a pediatric ward and subsequently colonized neonates of two wards with several cases of systemic infection. This strain produced an extended-spectrum beta-lactamase and was resistant to cefotaxime, ceftazidime, and, among others, all aminoglycosides including amikacin. ⋯ The strain was susceptible to the innate antibacterial systems operative in fresh defibrinated blood from two adults. Combined human blood/antimicrobial drug assays documented the in vitro bactericidal activity of carbapenems (meropenem was slightly more effective than imipenem), fluoroquinolones (ciprofloxacin and trovafloxacin), and polymyxin B against this MAR strain of K. pneumoniae.