Early Markers of Infection and Sepsis
in Newborns and Children 
A szövegben kék nyomtatásban megjelenő szavak nem fordíthatók, így nem jelennek meg a szótárban. Viszont ezek kiejtését -legalábbis általam való kiejtését- illusztrálom a szavakra kattintva. A latin -ae (pneumoniae) kiejtése itt nagyon változó, úgy mint a "i" kiejtése is az ant-i-biotikumban!

Conclusion

There is a clear need for more accurate biochemical markers of infection and sepsis in children.

   To date, no biochemical markers are either robust or accurate enough to serve clinical requirements, particularly not for clinical trials and for determining therapeutic response.

Perhaps the best hope for the future of biomarkers for infection and sepsis lies in combining different classifications of current biomarkers or in the development of rapid antigen, PCR, or proteomicrofile tests.

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     Moxifloxacin in respiratory tract infections

Moxifloxacin is a fourth-generation fluoroquinolone that has been shown to be effective against respiratory pathogens, including Gram-positive (Streptococcus pneumoniae), Gram-negative (Haemophilus influenzae, and Moraxella catarrhalis).

   Also atypical strains (Chlamydia pneumoniae, Mycoplasma pneumoniae), as well as multi-drug resistant S. pneumoniae, including strains resistant to penicillin, macrolides, tetracyclines, trimethoprim/sulfamethoxazole and some fluoroquinolones.

Moxifloxacin is highly concentrated in lung tissue, and has demonstrated rapid eradication rates. The bioavailability and half-life of moxifloxacin provides potent bactericidal effects at a dose of 400mg/day.

    The ratio of the area under the concentration–time curve to MIC of moxifloxacin is the highest among the fluoroquinolones against S. pneumoniae.

The clinical efficacy of moxifloxacin has been shown in controlled studies of community-acquired pneumonia (CAP), exacerbations of chronic bronchitis (CB) and acute bacterial rhinosinusitis.

    Moxifloxacin has demonstrated a faster resolution of symptoms in community-acquired pneumonia  and exacerbations of chronic bronchitis patients compared with first-line therapy.

It has also demonstrated better eradication in exacerbations of chronic bronchitis compared with standard therapy, in particular the macrolides.

    Treatment guidelines should take into account the results of clinical trials with moxifloxacin in order to establish the role of this antimicrobial in the therapeutic arsenal against respiratory tract infections.

    Tigecyclin

Conclusion

Antibiotic development has slowed and only a few broadspectrum antibiotic agents are currently in development.

Hence, new classes of antibiotics are urgently needed to address the increasing antibiotic resistance among common pathogens.

For patients with serious infections, the initial choice for empirical therapy with broad spectrum antibiotics is crucial, and, if the choice is inappropriate, it may have adverse consequences for the patient.

    Tigecycline, a novel, broad-spectrum potential glycylcycline, has been shown to be active against many gram-positive, gram-negative, atypical and anaerobic organisms. These include highly resistant strains of clinical importance such as community and hospital acquired MRSA, VRE, penicillin resistant S. pneumoniae and ESBL expressing E. coli and K. pneumoniae. Tigecycline has come into clinical use at a critical time and will be a welcome asset to the current armamentarium. Unlike tetracyclines, tigecycline does not require dose adjustment in patients with impaired renal function and is conveniently administered every 12 h.

    Since it has proven activity against highly resistant organisms, it should be reserved only for life-threatening situations and/or when resistant pathogens are suspected. Rational antimicrobial use, coupled with awareness of infection control measures, is paramount to avert the emergence of multi-drug resistant organisms.

Oral formulation of the drug would further expand the potential role of tigecycline therapy in clinical practice.

   Antibiotherapy for acute CAP in adults

Abstract

Community acquired pneumonia is one of the most frequent infections. With time, bacterial epidemiology and bacterial resistance evolve and new antibiotics become available. So an up-date on adequate antibiotic use is necessary. We reviewed the epidemiology of pneumonia and the evolution of bacterial resistance. We also collected data on new antibiotics which can be used for this infection such as levofloxacin, moxifloxacin, telithromycin, and pristinamycin.

   All these drugs are effective on bacteria involved in pneumonia. At this time, only few Streptococcus pneumoniae strains have developed resistance to these drugs. However, resistance to fluoroquinolones is not easily detected with common laboratory techniques. There is no effectiveness difference between the 2 new fluoroquinolones (levofloxacin, moxifloxacin) in clinical studies.

   However, in bacteriological and pharmacological studies, moxifloxacin seems to be more effective than levofloxacin (500 mg/day). For the treatment of pneumonia due to Legionella pneumophila, fluoroquinolones are now widely recommended. For Streptococcus pneumonia, amoxicillin remains the drug of choice, even for bacteria with a decreased susceptibility to penicillin. The importance of treating atypical pathogens remains to be documented.

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