lower respiratory tract infection (LRI)
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Laboratory
- procalcitonin in serum & may help guide treatment decisions, reduce antibiotic use & improve survival[7][9]
- point of care testing for procalcitonin & CRP may reduce antibiotic use in nursing homes
- see ARUP consult[4]
Diagnostic procedures
- lung ultrasonography may not add additional information to serum procalcitonin[9]
Differential diagnosis
- asthma
- exacerbation of chronic obstructive pulmonary disease
- pulmonary embolism
- neoplasm
- allergic aspergillosis
- congestive heart failure
- pulmonary aspiration
- cystic fibrosis
- cough secondary to medications
Management
- see specific etiology
- vitamin E NOT helpful for prevention in nursing home residents[2]
- patients without pneumonia do well without antibiotics[5]
- oral glucocorticoids of no benefit to adults without chronic obstructive pulmonary disease[6]
More general terms
More specific terms
Additional terms
References
- ↑ Ferri's Clinical Advisor, Instant Diagnosis and Treatment, Ferri FF (ed), Mosby, Philadelphia, 2003
- ↑ 2.0 2.1 Journal Watch 24(18):124, 2004 Meydani SN, Leka LS, Fine BC, Dallal GE, Keusch GT, Singh MF, Hamer DH. Vitamin E and respiratory tract infections in elderly nursing home residents: a randomized controlled trial. JAMA. 2004 Aug 18;292(7):828-36. Erratum in: JAMA. 2004 Sep 15;292(11):1305. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15315997
- ↑ Journal Watch 24(19):153, 2004 Welschen I, Kuyvenhoven MM, Hoes AW, Verheij TJ. Effectiveness of a multiple intervention to reduce antibiotic prescribing for respiratory tract symptoms in primary care: randomised controlled trial. BMJ. 2004 Aug 21;329(7463):431. Epub 2004 Aug 05. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/15297305 <Internet> http://bmj.bmjjournals.com/cgi/content/full/329/7463/431
- ↑ 4.0 4.1 ARUP Consult: Respiratory Viruses The Physician's Guide to Laboratory Test Selection & Interpretation https://arupconsult.com/content/respiratory-viruses
ARUP Consult: Respiratory Pathogen Molecular Panel Testing https://arupconsult.com/ati/respiratory-pathogen-molecular-panel-testing - ↑ 5.0 5.1 Little P, Stuart B, Smith S et al. Antibiotic prescription strategies and adverse outcome for uncomplicated lower respiratory tract infections: Prospective cough complication cohort (3C) study. BMJ 2017 May 22; 357:j2148. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28533265 Free PMC Article <Internet> http://www.bmj.com/content/357/bmj.j2148
Scott AM, Del Mar C. Controlling antibiotic prescribing for lower respiratory tract infections: Prescribing less is safe for patients and better for all of us. BMJ 2017 May 22; 357:j2398 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28533355 <Internet> http://www.bmj.com/content/357/bmj.j2398 - ↑ 6.0 6.1 Hay AD, Little P, Harnden A et al Effect of Oral Prednisolone on Symptom Duration and Severity in Nonasthmatic Adults With Acute Lower Respiratory Tract Infection. A Randomized Clinical Trial. JAMA. 2017;318(8):721-730 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28829884 <Internet> http://jamanetwork.com/journals/jama/article-abstract/2649201
- ↑ 7.0 7.1 Schuetz P, Wirz Y, Sager R et al Effect of procalcitonin-guided antibiotic treatment on mortality in acute respiratory infections: a patient level meta-analysis. The Lancet Infectious Diseases. Oct 13, 2017 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29037960 <Internet> http://thelancet.com/journals/laninf/article/PIIS1473-3099(17)30592-3/fulltext
Fontela PS, Papenburg J Procalcitonin and antibiotic use: imperfect, yet effective. The Lancet Infectious Diseases. Oct 13, 2017 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29037959 <Internet> http://thelancet.com/journals/laninf/article/PIIS1473-3099(17)30593-5/fulltext - ↑ Schuetz P, Wirz Y, Sager R et al Procalcitonin to initiate or discontinue antibiotics in acute respiratory tract infections. Cochrane Database Syst Rev. 2017 Oct 13;10:CD007498 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29025194
- ↑ 9.0 9.1 9.2 Lhopitallier L, Kronenberg A, Meuwly JY et al. Procalcitonin and lung ultrasonography point-of-care testing to determine antibiotic prescription in patients with lower respiratory tract infection in primary care: Pragmatic cluster randomised trial. BMJ 2021 Sep 21; 374:n2132 PMID: https://www.ncbi.nlm.nih.gov/pubmed/34548312 Free article https://www.bmj.com/content/374/bmj.n2132
- ↑ Boere TM, van Buul LW, Hopstaken RM et al. Effect of C reactive protein point-of-care testing on antibiotic prescribing for lower respiratory tract infections in nursing home residents: Cluster randomised controlled trial. BMJ 2021 Sep 21; 374:n2198. PMID: https://www.ncbi.nlm.nih.gov/pubmed/34548288 PMCID: PMC8453309 Free PMC article