Hsiao CB, Hewitt RG, Davis D; Interscience Conference on Antimicrobial Agents and Chemotherapy.
Abstr Intersci Conf Antimicrob Agents Chemother Intersci Conf Antimicrob Agents Chemother. 1998 Sep 24-27; 38: 403 (abstract no. I-129).
State University of New York, Buffalo.
Background: Bacterial lower respiratory tract infection (BLRTI) is a major cause of morbidity and mortality in patients with underlying pulmonary and immunocomprising diseases. BLRTI occurs in HIV+ persons at a greater incidence than the general population. Empiric intervention for outpatients may reduce or avoid hospitalization. Objectives: 1. to determine the viral and bacterial pathogens of LRTI in HIV+ patients; 2. to evaluate the effectiveness of azithromycin as empiric therapy for LRTI in HIV+ patients. Methods: Prospective, open-label study of HIV+ outpatients with presumed LRTI. Patients with presumed sinusitis or Pneumocystis carinii pneumonia were excluded. All patients had sputum and nasopharyngeal cultures for bacteria and viruses. Patients received open-label azithromycin 500 mg the first day and 250mg daily for the next 4 days. Phone call follow-up occurred at 48 hours and 10 days post-therapy to monitor outcome and tolerance of therapy. Results: A total of 63 episodes were treated in 46 men and 17 women, median CD4 counts 371 cells/mm3 (22% had <200). Isolated pathogens: bacterial in 63.5%, viral in 4.8%, mixed bacterial/viral in 6.3%, undetermined in 25.4%. 16% of pts had S. aureus, 11% had H. influenzae, 9.5% had S. pneumoniae. Viral pathogens appeared to follow seasonality: Picornavirus/Rhinovirus (Jun.-Oct.), Parainfluenza (Nov.), and Influenza H3N2 (Jan.-Mar.). 84% pts improved at 48 hours and at 10 days. Of these, 82% were symptom free at 10 days. Of two patients without improvement at 48 hours, one had picornavirus and the other erythromycin-resistant S. pneumoniae. No patient was hospitalized, nor did any patient discontinue azithromycin because of intolerance. No patients developed Pneumocystis carinii pneumonia within the 2 months following treatment. Conclusions: Bacterial pathogens, including S. aureus, H. influenzae, S. pneumoniae, are common etiologic agents of LRTI in HIV+ patients. Viral pathogens could also be isolated in predictable seasonal patterns. Azithromycin was effective in the clinical resolution in 84% of patients after 10 days of follow-up.
Publication Types:
Keywords:
- AIDS Vaccines
- Acquired Immunodeficiency Syndrome
- Azithromycin
- Drug Therapy, Combination
- Erythromycin
- Female
- HIV Infections
- HIV Seropositivity
- Haemophilus influenzae
- Humans
- Incidence
- Male
- Pneumonia
- Pneumonia, Pneumocystis
- Prospective Studies
- Respiratory Tract Infections
- Sjogren's Syndrome
- Thoracic Diseases
- drug therapy
- therapy
Other ID:
UI: 102188278
From Meeting Abstracts