Tags: Pertussis

Important Anaerobes

Anaerobic bacteria are the predominant component of the normal microbial flora of the human body. The following sites harbor the vast majority of them:

Haemophilus, Bordetella, & Branhamella Species

Before 1990, strains of Haemophilus influenzae type b were found in the upper respiratory tract of 3-5% of children and a small percentage of adults. Colonization rates with type-b strains are even lower now, reflecting routine immunization of infants against H influenzae type b. Non-type-b encapsulated H influenzae are present in the nasopharynx of < 2% of individuals, whereas nonencapsulated (nontypable [see below]) strains colonize the respiratory tract of 40-80% of children and adults.

Bordetella Species: Clinical Syndrome

The catarrhal stage is characterized by nonspecific upper respiratory symptoms, including rhinorrhea, mild cough, and low-grade fever. During this stage, which typically lasts 1-2 weeks, the disease is highly communicable. The paroxysmal stage is marked by sudden attacks or paroxysms of severe, repetitive coughing, often culminating with the characteristic whoop and frequently followed by vomiting.

Haemophilus Influenzae: Clinical Syndromes

H influenzae was first isolated during the 1892 influenza pandemic and was originally believed to be the causative agent of influenza. Although subsequent studies revealed the fallacy of this idea, H influenzae has proved to be a common cause of localized respiratory tract and systemic disease, including meningitis, epiglottitis, pneumonia, pyogenic arthritis, cellulitis, otitis media, and sinusitis, among others (Box 1). Meningitis is the most common and serious form of invasive H influenzae type-b disease. In the mid-1980s, before the introduction of effective vaccines, ~ 10,000-12,000 cases of H influenzae type-b meningitis occurred in the United States each year, and 95% of cases involved children < 5 years old.

Adenoviruses

Adenoviruses were first isolated in 1953 in human adenoid cell culture. Since then approximately 100 serotypes, at least 47 of which infect humans, have been recognized. All human serotypes are included in a single genus within the family Adenoviridae. Based on homology studies and hemagglutination patterns, each of the 47 serotypes belongs to one of six subgroups.

Adenoviruses: Clinical Syndromes

Adenoviruses cause primary infection in children and, less commonly, adults. Reactivation of virus occurs in immunocompromised children and adults. Several distinct clinical syndromes are associated with adenovirus infection (Box 1). Acute pharyngitis is usually nonexudative but is associated with fever.

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In a direct comparison of clarithromycin with erythromycin stearate, the rate of adverse events was 19% in 96 patients taking clarithromycin and 35% in 112 patients taking erythromycin . Most of the adverse events associated with clarithromycin affect the gastrointestinal tract (7%). In a prospective, single-blind, randomized study of a 7-day course of clarithromycin (7.5 mg/kg bd) and a 14-day course of erythromycin (13.3 mg/kg tds) in 153 children with pertussis, the incidence of treatment-emergent drug-related adverse events was significantly higher with erythromycin than with clarithromycin (62 versus 45%). Three subjects given erythromycin withdrew prematurely because of adverse events: one because of a rash; one with vomiting and diarrhea; and one with vomiting, abdominal pain, and rash.

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Erythromycin has antidysrhythmic properties similar to those of Class IA antidysrhythmic drugs, and causes an increase in atrial and ventricular refractory periods. This is only likely to be a problem in patients with heart disease or in those who are receiving drugs that delay ventricular repolarization. High-doses intravenously have caused ventricular fibrillation and torsade de pointes.

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See also Macrolide antibiotics Clarithromycin is a commonly used macrolide antibiotic and is a regular part of regimens for the eradication of Helicobacter pylori, often in combination with a nitromidazole antibiotic as well, in addition to a proton pump inhibitor. Variable rates of adverse events (4-30%) have been reported with clarithromycin.

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Preclinical and clinical trial data and data from phase IV studies have suggested that levofloxacin causes prolongation of the QT interval. There were cardiovascular problems in 1 in 15 million prescriptions compared with 1-3% of patients taking sparfloxacin, who had QTC prolongation to over 500 ms.