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Levofloxacin, like other fluroquinolones, acts as a antibacterial agent on bacterial topoisomerases. A broad range of Gram-positive and Gram-negative of levofloxacin was confirmed in clinical trials in patients with respiratory tract infections. In therapy of chronic diseases exacerbations of the respiratory tract, including community-acquired pneumonia, a high oral bioavailability allows to switch from intravenous to oral way of treatment. Although a high penetration degree of levofloxacin into serum and tissues gives possibility to control bacterial biofilm. For this reasons levofloxacin is recommended for therapy of respiratory tract infections as a second-line antibacterial agent, but in severe exacerbations may be considered as additional therapy, rarely as monotherapy. Source

Inhaled particles or compacted secretions in the respiratory tract cause irritation of mechanoreceptors, subsequent stimulation of afferent fibers of the vagus nerve, triggering the cough reflex. Distribution of drugs used in the treatment of cough takes into account the pharmacokinetic activity, and this mainly affect on bronchial secretions-drugs that act directly, which destroy disulfide bonds mucous glucoproteins using free sulfhydryl groups and digesting enzymes, extracellular DNA, acting indirectly, that modify the secretion of mucus in the way of other mechanisms, as well as acting on the cough reflex (effects on receptors in the bronchial tree). Mucolytics reduce the viscosity of bronchial secretions by interrupting the sulfide bonds in the mucoprotein chain. Mucokinetic drugs are designed to reduce the adhesion of secretions and facilitate the process of mucociliary clearance by enhancing the potency of cilia. One o' the ways of the increasing process is the stimulation of secretion by human neutrophil elastase gene and protein expression regulating this process. The pharmacokinetic properties of these drugs show their high clinical utility and effectiveness in the treatment of respiratory secretions dense clutter. This is possible to reduce the viscosity of mucus by bromhexine. This is obtained by acid depolymerization of the polysaccharide fibers in the bronchial secretions. Synergistic effect with antibiotics of these preparations indicates their permanent place in the treatment of patients with respiratory pathology. Source

Plusa T.,Military Institute of Medicine in Warsaw
Polski Merkuriusz Lekarski

Respiratory tract infections are caused by biological pathogens, which are found in the environment around us. They cause inflammation of varying severity, threatening the health and lives. For this reason they can be used as a biological weapon. Dealing with victims requires special diagnostic and therapeutic procedures. In some cases, it is necessary to quarantine patients and apply an intensive treatment in specialized centers. Source

Hospital-acquired pneumonia (HAP) is recognized when the clinical and radiological symptoms appear in the 48-72 hours from the admission to the hospital or in the case of pneumonia during the mechanical respiration after 72 hours of the patient's intubation. The frequency of HAP placed between 5 to 15 per 1000 patients undergoing hospital treatment. The appearance of clinical symptoms: high fever, cough with expelling of purulent sputum, an increased number of breaths or dyspnoe and the occurrence of inflammation's morphological markers and the presence of new changes in the radiography (or severity seen earlier) confirms the diagnosis. Difficulties arise during the treatment of pneumonia caused by several strains of bacteria or flora which are resistant to available antibiotics. This is the reasons of high mortality among patients with HAP, reaching above 35%. Source

Respiratory diseases and particularly those linked to pneumonia and influenza infections are a leading cause of serious illness. Streptococcus pneumoniae is responsible for 30 to 50% of all community- acquired pneumonia. It is also a common bacterial complication of influenza, especially in the frail populations, such as the elderly. There are scarce data reporting the medical and economic burden of these infections in Poland. Polish authorities recommend influenza and pneumococcal vaccinations for subjects aged 65 years and over but there is not public vaccination program in place for covering immunization. Elderly vaccination rates against influenza and pneumonia in Poland remain far below the World Health Organization's recommendations. The aims of the study was to assess the mean economic costs of influenza and pneumococcal diseases in the Polish elderly population, treated in outpatient and inpatient settings. Costs were estimated from the public payer and societal perspectives. Material and methods. Data were collected retrospectively from 2007 to 2009 in three different sites: a general practitioner Family clinic for outpatient data and two hospitals in Warsaw for inpatient data. Resource use linked to pneumonia or influenza treatments were collected from each site. Microcosting calculation method was used to estimate the outpatient costs. Inpatient costs were measured using the Ministry of Health patient's payment for each diagnosis group (DRG) but also using each subject's treatment inpatient costs added to the cost of hospital stay. Results. Mean outpatient cost for treating an outpatient was 101 PLN for influenza (1 euro = 4 PLN) and 186 PLN for community- acquired pneumonia. Mean total hospitalization cost including treatment cost and cost of stay was 7633 PLN among P&l patients whereas the DRG cost for this diagnosis was 1885 PLN. Similarly, the mean total inpatient cost was estimated to be 7162 PLN for Streptococcal bacteremia (DRG payment: 7140 PLN) and 4104 PLN for meningitis (DRG payment: 3804 PLN). Conclusions. This study highlights the significant economic impact of influenza and pneumococcal diseases in the Polish population aged 65 years and over. Complications of influenza and pneumonia diseases contribute to weight down this burden as they often lead to hospitalizations in these frail populations. This first economic assessment is a 1st step in the measurement of the value of preventing these diseases through vaccination. Source

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