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      Guidelines for the management of adult lower respiratory tract infections - Full version

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          This document is an update of Guidelines published in 2005 and now includes scientific publications through to May 2010. It provides evidence-based recommendations for the most common management questions occurring in routine clinical practice in the management of adult patients with LRTI. Topics include management outside hospital, management inside hospital (including community-acquired pneumonia (CAP), acute exacerbations of COPD (AECOPD), acute exacerbations of bronchiectasis) and prevention. Background sections and graded evidence tables are also included. The target audience for the Guideline is thus all those whose routine practice includes the management of adult LRTI.

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          Most cited references 516

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          Avian influenza A (H5N1) infection in humans.

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            Respiratory viruses, symptoms, and inflammatory markers in acute exacerbations and stable chronic obstructive pulmonary disease.

            The effects of respiratory viral infection on the time course of chronic obstructive pulmonary disease (COPD) exacerbation were examined by monitoring changes in systemic inflammatory markers in stable COPD and at exacerbation. Eighty-three patients with COPD (mean [SD] age, 66.6 [7.1] yr, FEV(1), 1.06 [0.61] L) recorded daily peak expiratory flow rate and any increases in respiratory symptoms. Nasal samples and blood were taken for respiratory virus detection by culture, polymerase chain reaction, and serology, and plasma fibrinogen and serum interleukin-6 (IL-6) were determined at stable baseline and exacerbation. Sixty-four percent of exacerbations were associated with a cold occurring up to 18 d before exacerbation. Seventy-seven viruses (39 [58.2%] rhinoviruses) were detected in 66 (39.2%) of 168 COPD exacerbations in 53 (64%) patients. Viral exacerbations were associated with frequent exacerbators, colds with increased dyspnea, a higher total symptom count at presentation, a longer median symptom recovery period of 13 d, and a tendency toward higher plasma fibrinogen and serum IL-6 levels. Non-respiratory syncytial virus (RSV) respiratory viruses were detected in 11 (16%), and RSV in 16 (23.5%), of 68 stable COPD patients, with RSV detection associated with higher inflammatory marker levels. Respiratory virus infections are associated with more severe and frequent exacerbations, and may cause chronic infection in COPD. Prevention and early treatment of viral infections may lead to a decreased exacerbation frequency and morbidity associated with COPD.
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              Mycoplasma pneumoniae and its role as a human pathogen.

              Mycoplasma pneumoniae is a unique bacterium that does not always receive the attention it merits considering the number of illnesses it causes and the degree of morbidity associated with it in both children and adults. Serious infections requiring hospitalization, while rare, occur in both adults and children and may involve multiple organ systems. The severity of disease appears to be related to the degree to which the host immune response reacts to the infection. Extrapulmonary complications involving all of the major organ systems can occur in association with M. pneumoniae infection as a result of direct invasion and/or autoimmune response. The extrapulmonary manifestations are sometimes of greater severity and clinical importance than the primary respiratory infection. Evidence for this organism's contributory role in chronic lung conditions such as asthma is accumulating. Effective management of M. pneumoniae infections can usually be achieved with macrolides, tetracyclines, or fluoroquinolones. As more is learned about the pathogenesis and immune response elicited by M. pneumoniae, improvement in methods for diagnosis and prevention of disease due to this organism may occur.

                Author and article information

                Clin Microbiol Infect
                Clin. Microbiol. Infect
                Clinical Microbiology and Infection
                European Society of Clinical Infectious Diseases. Published by Elsevier Ltd.
                13 December 2014
                November 2011
                13 December 2014
                : 17
                : E1-E59
                [a ]Department of Respiratory Medicine, Manchester Royal Infirmary, Manchester, UK
                [b ]Dipartimento Toraco-Polmonare e Cardiocircolatorio, Università degli Studi di Milano, IRCCS Ospedale Maggiore di Milano, Milano, Italy
                [c ]Chefarzt der Kliniken für Pneumologie und Infektiologie, Ev. Krankenhaus Herne und Augusta-Kranken-Anstalt, Bergstrasse, Bochum, Germany
                [d ]Department of Medicine, Hospital Universitari Mutua de Terrassa, University of Barcelona, Barcelona, Spain
                [e ]Pneumologie et Reanimation, Hotel-Dieu de Paris, 1 Place Parvis Notre-Dame, Paris, France
                [f ]Microbiology Laboratory, University Hospital Antwerp, Edegem, Belgium
                [g ]Department of Communicable Diseases Control and Prevention, Stockholm County, Stockholm, Sweden
                [h ]Zentrum für Pneumologie, Diakoniekrankenhaus Rotenburg, Elise-Averdiek-Str. Rotenburg, Germany
                [i ]Pulmonary Department, Institut Clinic del Torax, Hospital Clinic de Barcelona, IDIBAPS, CIBERES (Ciber de Enfermedades Respiratorias), Facultad de Medicina. Universitat de Barcelona, Barcelona, Spain
                [j ]Clinical Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Julius Center, Utrecht, The Netherlands
                [k ]Infectious Diseases, Department of Infection and Immunity, Sheffield School of Medicine and Biomedical Science, University of Sheffield, Royal Hallamshire Hospital, Sheffield, UK
                [l ]General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
                Author notes
                [* ] Corresponding author: Prof. Mark Woodhead, Department of Respiratory Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK mark.woodhead@
                Copyright © 2011 European Society of Clinical Infectious Diseases. Published by Elsevier Ltd.

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