From the Guidelines
Respiratory infections in adults should be managed with a focus on symptom relief and addressing the underlying cause, with antibiotics prescribed only when necessary and appropriate, as outlined in the high-value care advice from the American College of Physicians and the Centers for Disease Control and Prevention 1.
Key Principles for Management
- For viral respiratory infections like the common cold or flu, treatment primarily involves rest, adequate hydration, and over-the-counter medications such as acetaminophen (325-650mg every 4-6 hours, not exceeding 3000mg daily) or ibuprofen (400-600mg every 6-8 hours with food) for fever and pain, as supported by recent clinical guidelines 1.
- Nasal saline rinses and decongestants like pseudoephedrine (30-60mg every 4-6 hours) can help with congestion, but their use should be guided by the severity of symptoms and potential for adverse effects 1.
Antibiotic Use
- Antibiotics should not be prescribed for patients with the common cold or bronchitis unless pneumonia is suspected, as emphasized in the high-value care advice 1.
- For bacterial infections such as streptococcal pharyngitis, amoxicillin (500mg three times daily for 10 days) is typically the first-line antibiotic, but treatment should be guided by rapid antigen detection test and/or culture for group A Streptococcus 1.
- For community-acquired pneumonia in otherwise healthy adults, amoxicillin-clavulanate (875/125mg twice daily for 5-7 days) or, in cases of penicillin allergy, azithromycin (500mg on day one, then 250mg daily for 4 more days) may be prescribed, as recommended by recent clinical guidelines 1.
Prevention Strategies
- Regular handwashing, avoiding close contact with sick individuals, staying current with vaccinations including annual flu shots and pneumococcal vaccines for eligible adults, and maintaining good overall health through adequate sleep, nutrition, and exercise to support immune function are crucial for preventing respiratory infections 1.
Considerations for Antibiotic Resistance
- The overuse and misuse of antibiotics contribute to antibiotic resistance, which is a significant public health concern, as highlighted in the evidence from the Centers for Disease Control and Prevention 1.
- Clinicians should be aware of the potential for antibiotic resistance and prescribe antibiotics judiciously, following the principles of high-value care advice 1.
From the FDA Drug Label
1.1 Nosocomial Pneumonia
Levofloxacin tablets are indicated for the treatment of nosocomial pneumonia due to methicillin-susceptible Staphylococcus aureus, Pseudomonas aeruginosa, Serratia marcescens, Escherichia coli, Klebsiella pneumoniae, Haemophilus influenzae, or Streptococcus pneumoniae.
1.2 Community-Acquired Pneumonia: 7 to 14 Day Treatment Regimen
Levofloxacin tablets are indicated for the treatment of community-acquired pneumonia due to methicillin-susceptible Staphylococcus aureus, Streptococcus pneumoniae (including multi-drug-resistant Streptococcus pneumoniae [MDRSP]), Haemophilus influenzae, Haemophilus parainfluenzae, Klebsiella pneumoniae, Moraxella catarrhalis, Chlamydophila pneumoniae, Legionella pneumophila, or Mycoplasma pneumoniae
Levofloxacin is indicated for the treatment of nosocomial pneumonia and community-acquired pneumonia in adults due to various susceptible microorganisms, including Streptococcus pneumoniae, Haemophilus influenzae, and Pseudomonas aeruginosa 2.
- The clinical success rates for levofloxacin in the treatment of community-acquired pneumonia were 95% in one study and 93% in another study 2.
- Microbiological eradication rates were also documented for infections listed in the studies 2.
- It is essential to note that levofloxacin should only be used to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria 2.
From the Research
Treatment of Respiratory Infections in Adults
- Azithromycin is a macrolide antibiotic that has been used to treat lower respiratory tract infections, including community-acquired pneumonia and acute exacerbations of chronic bronchitis 3, 4.
- Studies have shown that azithromycin is effective in treating acute lower respiratory tract infections, with a lower incidence of treatment failure and adverse events compared to amoxicillin or amoxyclav 5, 6.
- A randomized, double-blinded, double-dummy, multicenter trial found that azithromycin was clinically and bacteriologically equivalent to levofloxacin in the treatment of patients with acute bacterial exacerbations of chronic bronchitis 4.
- A review of systematic reviews and cost-effectiveness studies found that early warning scores, such as the CRB-65 and CURB-65, may be useful in identifying adults with suspected acute respiratory infection who are at high risk of serious illness 7.
- The use of azithromycin in the treatment of acute lower respiratory tract infections has been associated with a reduction in adverse events, including gastrointestinal events 5, 6.
Azithromycin vs. Other Antibiotics
- Studies have compared the effectiveness of azithromycin to amoxicillin or amoxyclav in the treatment of acute lower respiratory tract infections, with mixed results 5, 6.
- A subgroup analysis found that azithromycin was more effective than amoxicillin or amoxyclav in treating acute bronchitis, with a significantly lower incidence of clinical failure 6.
- However, the evidence is unclear regarding the superiority of azithromycin over other antibiotics in treating acute lower respiratory tract infections, and further trials of high methodological quality are needed 5, 6.
Clinical Scores and Triage
- Early warning scores, such as the CRB-65 and CURB-65, may be useful in identifying adults with suspected acute respiratory infection who are at high risk of serious illness 7.
- A cost-effectiveness study found that the use of clinical scores may be a cost-effective approach to triage patients with suspected acute respiratory infection 7.
- However, further research is needed to validate the use of early warning scores in primary care and community settings 7.