Lower respiratory tract infection

Last updated

Lower respiratory tract infection
Depiction of a person with a lung or lower respiratory tract infection.png
Depiction of a person with LRTI
Specialty Pulmonology   OOjs UI icon edit-ltr-progressive.svg
Frequency291 million (2015) [1]
Deaths2.74 million (2015) [2]

Lower respiratory tract infection (LRTI) is a term often used as a synonym for pneumonia but can also be applied to other types of infection including lung abscess and acute bronchitis. Symptoms include shortness of breath, weakness, fever, coughing and fatigue. [3] A routine chest X-ray is not always necessary for people who have symptoms of a lower respiratory tract infection. [4]

Contents

Influenza affects both the upper and lower respiratory tracts.[ citation needed ]

Antibiotics are the first line treatment for pneumonia; however, they are neither effective nor indicated for parasitic or viral infections. Acute bronchitis typically resolves on its own with time.[ citation needed ]

In 2015 there were about 291 million cases. [1] These resulted in 2.74 million deaths down from 3.4 million deaths in 1990. [5] [2] This was 4.8% of all deaths in 2013. [5]

The World Health Organization has reported that, in 2021, "Lower respiratory infections remained the world’s most deadly communicable disease other than COVID-19, ranked as the fifth leading cause of death." However, the number of deaths caused has decreased by around 13% from 2000 to 2021. [6]

Bronchitis

Bronchitis describes the swelling or inflammation of the [7] bronchial tubes. Additionally, bronchitis is described as either acute or chronic depending on its presentation and is also further described by the causative agent. Acute bronchitis can be defined as acute bacterial or viral infection of the larger airways in healthy patients with no history of recurrent disease. [8] It affects over 40 adults per 1000 each year and consists of transient inflammation of the major bronchi and trachea. [9] Most often it is caused by viral infection and hence antibiotic therapy is not indicated in immunocompetent individuals. [10] [7] Viral bronchitis can sometimes be treated using antiviral medications depending on the virus causing the infection, and medications such as anti-inflammatory drugs and expectorants can help mitigate the symptoms. [11] [7] Treatment of acute bronchitis with antibiotics is common but controversial as their use has only moderate benefit weighted against potential side effects (nausea and vomiting), increased resistance, and cost of treatment in a self-limiting condition. [9] [12] Beta2 agonists are sometimes used to relieve the cough associated with acute bronchitis. In a recent systematic review it was found there was no evidence to support their use. [7]

Acute exacerbations of chronic bronchitis (AECB) are frequently due to non-infective causes along with viral ones. 50% of patients are colonised with Haemophilus influenzae, Streptococcus pneumoniae, or Moraxella catarrhalis. [8] Antibiotics have only been shown to be effective if all three of the following symptoms are present: increased dyspnea, increased sputum volume, and purulence. In these cases, 500 mg of amoxicillin orally, every 8 hours for 5 days or 100 mg doxycycline orally for 5 days should be used. [8]

Pneumonia

Pneumonia occurs in a variety of situations and treatment must vary according to the situation. [11] It is classified as either community or hospital acquired depending on where the patient contracted the infection. It is life-threatening in the elderly or those who are immunocompromised. [13] [14] The most common treatment is antibiotics and these vary in their adverse effects and their effectiveness. [13] [15] Pneumonia is also the leading cause of death in children less than five years of age in low income countries. [15] The most common cause of pneumonia is pneumococcal bacteria, Streptococcus pneumoniae accounts for 2/3 of bacteremic pneumonias. [16] Invasive pneumococcal pneumonia has a mortality rate of around 20%. [14] For optimal management of a pneumonia patient, the following must be assessed: pneumonia severity (including treatment location, e.g., home, hospital or intensive care), identification of causative organism, analgesia of chest pain, the need for supplemental oxygen, physiotherapy, hydration, bronchodilators and possible complications of emphysema or lung abscess. [17]

Causes

Deaths from lower respiratory infections per million persons in 2012: .mw-parser-output .div-col{margin-top:0.3em;column-width:30em}.mw-parser-output .div-col-small{font-size:90%}.mw-parser-output .div-col-rules{column-rule:1px solid #aaa}.mw-parser-output .div-col dl,.mw-parser-output .div-col ol,.mw-parser-output .div-col ul{margin-top:0}.mw-parser-output .div-col li,.mw-parser-output .div-col dd{page-break-inside:avoid;break-inside:avoid-column} .mw-parser-output .legend{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .legend-color{display:inline-block;min-width:1.25em;height:1.25em;line-height:1.25;margin:1px 0;text-align:center;border:1px solid black;background-color:transparent;color:black}.mw-parser-output .legend-text{} 24-120 121-151 152-200 201-241 242-345 346-436 437-673 674-864 865-1,209 1,210-2,085 Lower respiratory infections world map-Deaths per million persons-WHO2012.svg
Deaths from lower respiratory infections per million persons in 2012:
  24-120
  121-151
  152-200
  201-241
  242-345
  346-436
  437-673
  674-864
  865-1,209
  1,210-2,085
Disability-adjusted life year for lower respiratory infections per 100,000 inhabitants in 2004: no data less than 100 100-700 700-1,400 1,400-2,100 2,100-2,800 2,800-3,500 3,500-4,200 4,200-4,900 4,900-5,600 5,600-6,300 6,300-7,000 more than 7,000 Lower respiratory infections world map - DALY - WHO2004.svg
Disability-adjusted life year for lower respiratory infections per 100,000 inhabitants in 2004:
  no data
  less than 100
  100–700
  700–1,400
  1,400–2,100
  2,100–2,800
  2,800–3,500
  3,500–4,200
  4,200–4,900
  4,900–5,600
  5,600–6,300
  6,300–7,000
  more than 7,000

Typical bacterial Infections:

Atypical bacterial Infections:

Parasitic infections:

Viral infections:

Aspiration pneumonia

Prevention

Vaccination helps prevent bronchopneumonia, mostly against influenza viruses, adenoviruses, measles, rubella, streptococcus pneumoniae, haemophilus influenzae, diphtheria, bacillus anthracis, chickenpox, and bordetella pertussis. [19] Specifically for the children with low serum retinol or who are suffering from malnutrition, vitamin A supplements are recommended as a preventive measure against acute LRTI. [20]

Treatment

Antibiotics do not help the many lower respiratory infections which are caused by parasites or viruses. While acute bronchitis often does not require antibiotic therapy, antibiotics can be given to patients with acute exacerbations of chronic bronchitis. [21] The indications for treatment are increased dyspnoea, and an increase in the volume or purulence of the sputum. [22] The treatment of bacterial pneumonia is selected by considering the age of the patient, the severity of the illness and the presence of underlying disease. A systematic review of 32 randomised controlled trials with 6,078 participants with acute respiratory infections compared procalcitonin (a blood marker for bacterial infections) to guide the initiation and duration of antibiotic treatment, against no use of procalcitonin. Among 3,336 people receiving procalcitonin-guided antibiotic therapy, there were 236 deaths, compared to 336 deaths out 3,372 participants who did not. Procalcitonin-guided antibiotic therapy also reduced the antibiotic use duration by 2.4 days, and there were fewer antibiotic side effects. This means that procalcitonin is useful for guiding whether to use antibiotics for acute respiratory infections and the duration of the antibiotic. [23] Amoxicillin and doxycycline are suitable for many of the lower respiratory tract infections seen in general practice. [21] Another cochrane review suggests that new studies are needed to confirm that azithromycin may lead to less treatment failure and lower side effects than amoxycillin. [24] In the other hand, there is no sufficient evidence to consider the antibiotics as a prophylaxis for the high risk children under 12 years. [25]

Oxygen supplementation is often recommended for people with severe lower respiratory tract infections. [26] Oxygen can be provided in a non-invasive manner using nasal prongs, face masks, a head box or hood, a nasal catheter, or a nasopharyngeal catheter. [26] For children younger than 15 years old, nasopharyngel catheters or nasal prongs are recommended over a face mask or head box. [26] A Cochrane review in 2014 presented a summary to identify children complaining of severe LRTI, however; further research is required to determine the effectiveness of supplemental oxygen and the best delivery method. [26]

Epidemiology

Lower respiratory infectious disease is the fifth-leading cause of death and the combined leading infectious cause of death, being responsible for 2.74 million deaths worldwide. [27] This is generally similar to estimates in the 2010 Global Burden of Disease study. [28] This total only accounts for Streptococcus pneumoniae and Haemophilus influenzae infections and does not account for atypical or nosocomial causes of lower respiratory disease, therefore underestimating total disease burden.[ citation needed ]

Society and culture

Lower respiratory tract infections place a considerable strain on the health budget and are generally more serious than upper respiratory infections.[ citation needed ]

Workplace burdens arise from the acquisition of a lower respiratory tract infection, with factors such as total per person expenditures and total medical service utilisation demonstrated as greater among individuals experiencing a lower respiratory tract infection. [29]

Pan-national data collection indicates that childhood nutrition plays a significant role in determining the acquisition of a lower respiratory tract infection, with the promotion of the implementation of nutrition program, and policy guidelines in affected countries. [27]

Related Research Articles

<span class="mw-page-title-main">Sinusitis</span> Inflammation of the inner lining of the sinuses

Sinusitis, also known as rhinosinusitis, is an inflammation of the mucous membranes that line the sinuses resulting in symptoms that may include thick nasal mucus, a plugged nose, and facial pain.

<span class="mw-page-title-main">Asthma</span> Long-term inflammatory disease of the airways of the lungs

Asthma is a long-term inflammatory disease of the airways of the lungs. It is characterized by variable and recurring symptoms, reversible airflow obstruction, and easily triggered bronchospasms. Symptoms include episodes of wheezing, coughing, chest tightness, and shortness of breath. These may occur a few times a day or a few times per week. Depending on the person, asthma symptoms may become worse at night or with exercise.

<span class="mw-page-title-main">Pneumonia</span> Inflammation of the alveoli of the lungs

Pneumonia is an inflammatory condition of the lung primarily affecting the small air sacs known as alveoli. Symptoms typically include some combination of productive or dry cough, chest pain, fever, and difficulty breathing. The severity of the condition is variable.

<span class="mw-page-title-main">Common cold</span> Common viral infection of the upper respiratory tract

The common cold or the cold is a viral infectious disease of the upper respiratory tract that primarily affects the respiratory mucosa of the nose, throat, sinuses, and larynx. Signs and symptoms may appear in as little as two days after exposure to the virus. These may include coughing, sore throat, runny nose, sneezing, headache, and fever. People usually recover in seven to ten days, but some symptoms may last up to three weeks. Occasionally, those with other health problems may develop pneumonia.

<span class="mw-page-title-main">Cough</span> Sudden expulsion of air from the lungs as a reflex to clear irritants

A cough is a sudden expulsion of air through the large breathing passages which can help clear them of fluids, irritants, foreign particles and microbes. As a protective reflex, coughing can be repetitive with the cough reflex following three phases: an inhalation, a forced exhalation against a closed glottis, and a violent release of air from the lungs following opening of the glottis, usually accompanied by a distinctive sound.

<span class="mw-page-title-main">Otitis media</span> Inflammation of the middle ear

Otitis media is a group of inflammatory diseases of the middle ear. One of the two main types is acute otitis media (AOM), an infection of rapid onset that usually presents with ear pain. In young children this may result in pulling at the ear, increased crying, and poor sleep. Decreased eating and a fever may also be present. The other main type is otitis media with effusion (OME), typically not associated with symptoms, although occasionally a feeling of fullness is described; it is defined as the presence of non-infectious fluid in the middle ear which may persist for weeks or months often after an episode of acute otitis media. Chronic suppurative otitis media (CSOM) is middle ear inflammation that results in a perforated tympanic membrane with discharge from the ear for more than six weeks. It may be a complication of acute otitis media. Pain is rarely present. All three types of otitis media may be associated with hearing loss. If children with hearing loss due to OME do not learn sign language, it may affect their ability to learn.

<span class="mw-page-title-main">Pharyngitis</span> Inflammation of the back of the throat

Pharyngitis is inflammation of the back of the throat, known as the pharynx. It typically results in a sore throat and fever. Other symptoms may include a runny nose, cough, headache, difficulty swallowing, swollen lymph nodes, and a hoarse voice. Symptoms usually last 3–5 days, but can be longer depending on cause. Complications can include sinusitis and acute otitis media. Pharyngitis is a type of upper respiratory tract infection.

<span class="mw-page-title-main">Acute bronchitis</span> Medical condition

Acute bronchitis, also known as a chest cold, is short-term bronchitis – inflammation of the bronchi of the lungs. The most common symptom is a cough. Other symptoms include coughing up mucus, wheezing, shortness of breath, fever, and chest discomfort. The infection may last from a few to ten days. The cough may persist for several weeks afterward with the total duration of symptoms usually around three weeks. Some have symptoms for up to six weeks.

<span class="mw-page-title-main">Bronchiolitis</span> Inflammation of the small airways in the lungs

Bronchiolitis is inflammation of the small airways in the lungs. Acute bronchiolitis is due to a viral infection usually affecting children younger than two years of age. Symptoms may include fever, cough, runny nose, wheezing, and breathing problems. More severe cases may be associated with nasal flaring, grunting, or the skin between the ribs pulling in with breathing. If the child has not been able to feed properly, signs of dehydration may be present.

<i>Klebsiella pneumoniae</i> Species of bacterium

Klebsiella pneumoniae is a Gram-negative, non-motile, encapsulated, lactose-fermenting, facultative anaerobic, rod-shaped bacterium. It appears as a mucoid lactose fermenter on MacConkey agar.

<span class="mw-page-title-main">Upper respiratory tract infection</span> Infection of the nose, sinuses, pharynx, larynx or trachea

An upper respiratory tract infection (URTI) is an illness caused by an acute infection, which involves the upper respiratory tract, including the nose, sinuses, pharynx, larynx or trachea. This commonly includes nasal obstruction, sore throat, tonsillitis, pharyngitis, laryngitis, sinusitis, otitis media, and the common cold. Most infections are viral in nature, and in other instances, the cause is bacterial. URTIs can also be fungal or helminthic in origin, but these are less common.

<span class="mw-page-title-main">Procalcitonin</span> Precursor of the peptide hormone calcitonin

Procalcitonin (PCT) is a peptide precursor of the hormone calcitonin, the latter being involved with calcium homeostasis. It arises once preprocalcitonin is cleaved by endopeptidase. It was first identified by Leonard J. Deftos and Bernard A. Roos in the 1970s. It is composed of 116 amino acids and is produced by parafollicular cells of the thyroid and by the neuroendocrine cells of the lung and the intestine.

<i>Chlamydia pneumoniae</i> Species of bacterium

Chlamydia pneumoniae is a species of Chlamydia, an obligate intracellular bacterium that infects humans and is a major cause of pneumonia. It was known as the Taiwan acute respiratory agent (TWAR) from the names of the two original isolates – Taiwan (TW-183) and an acute respiratory isolate designated AR-39. Briefly, it was known as Chlamydophila pneumoniae, and that name is used as an alternate in some sources. In some cases, to avoid confusion, both names are given.

Ventilator-associated pneumonia (VAP) is a type of lung infection that occurs in people who are on mechanical ventilation breathing machines in hospitals. As such, VAP typically affects critically ill persons that are in an intensive care unit (ICU) and have been on a mechanical ventilator for at least 48 hours. VAP is a major source of increased illness and death. Persons with VAP have increased lengths of ICU hospitalization and have up to a 20–30% death rate. The diagnosis of VAP varies among hospitals and providers but usually requires a new infiltrate on chest x-ray plus two or more other factors. These factors include temperatures of >38 °C or <36 °C, a white blood cell count of >12 × 109/ml, purulent secretions from the airways in the lung, and/or reduction in gas exchange.

<span class="mw-page-title-main">Respiratory tract infection</span> Infectious disease affecting nose, throat and lungs

Respiratory tract infections (RTIs) are infectious diseases involving the lower or upper respiratory tract. An infection of this type usually is further classified as an upper respiratory tract infection or a lower respiratory tract infection. Lower respiratory infections, such as pneumonia, tend to be far more severe than upper respiratory infections, such as the common cold.

<span class="mw-page-title-main">Hospital-acquired pneumonia</span> Pneumonia contracted by a hospital patient

Hospital-acquired pneumonia (HAP) or nosocomial pneumonia refers to any pneumonia contracted by a patient in a hospital at least 48–72 hours after being admitted. It is thus distinguished from community-acquired pneumonia. It is usually caused by a bacterial infection, rather than a virus.

<span class="mw-page-title-main">Bronchitis</span> Inflammation of the large airways in the lungs

Bronchitis is inflammation of the bronchi in the lungs that causes coughing. Bronchitis usually begins as an infection in the nose, ears, throat, or sinuses. The infection then makes its way down to the bronchi. Symptoms include coughing up sputum, wheezing, shortness of breath, and chest pain. Bronchitis can be acute or chronic.

<span class="mw-page-title-main">Meningitis</span> Inflammation of the membranes around the brain and spinal cord

Meningitis is acute or chronic inflammation of the protective membranes covering the brain and spinal cord, collectively called the meninges. The most common symptoms are fever, intense headache, vomiting and neck stiffness and occasionally photophobia.

<span class="mw-page-title-main">Acute exacerbation of chronic obstructive pulmonary disease</span> Medical condition

An acute exacerbation of chronic obstructive pulmonary disease, or acute exacerbations of chronic bronchitis (AECB), is a sudden worsening of chronic obstructive pulmonary disease (COPD) symptoms including shortness of breath, quantity and color of phlegm that typically lasts for several days.

In clinical guidelines chronic cough is defined as a cough lasting more than 8 weeks in adults and more than 4 weeks in children. The prevalence of chronic cough is about 10% although the prevalence may differ depending on definition and geographic area. Chronic cough is a common symptom in several different respiratory diseases like COPD or pulmonary fibrosis but in non-smokers with a normal chest x-ray chronic cough are often associated with asthma, rhinosinusitis, and gastroesophageal reflux disease or could be idiopathic Generally, a cough, for example after an upper respiratory tract infection, lasts around one to two weeks; however, chronic cough can persist for an extended period of time, often several years. People with chronic cough often experience more than one cause present. The current theory about the cause of chronic cough, independent of associated condition, is that it is caused by a hypersensitivity in the cough sensory nerves, called cough hypersensitivity syndrome. There are a number of treatments available, depending on the associated disease but the clinical management of the patients remains a challenge. Risk factors include exposure to cigarette smoke, and exposure to pollution, especially particulates.

References

  1. 1 2 "Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1545–1602. October 2016. doi:10.1016/S0140-6736(16)31678-6. PMC   5055577 . PMID   27733282.
  2. 1 2 "Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1459–1544. October 2016. doi:10.1016/s0140-6736(16)31012-1. PMC   5388903 . PMID   27733281.
  3. ↑ Antibiotic Expert Group (2014). Therapeutic Guidelines: Antibiotic (15th ed.). Therapeutic Guidelines Limited. ISBN   978-0-9925272-1-1.
  4. ↑ Cao AM, Choy JP, Mohanakrishnan LN, Bain RF, van Driel ML (2013-12-26). "Chest radiographs for acute lower respiratory tract infections". Cochrane Database of Systematic Reviews. 2013 (12): CD009119. doi:10.1002/14651858.CD009119.pub2. ISSN   1469-493X. PMC   6464822 . PMID   24369343.
  5. 1 2 "Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013" (PDF). Lancet. 385 (9963): 117–71. January 2015. doi:10.1016/S0140-6736(14)61682-2. hdl:10379/13075. PMC   4340604 . PMID   25530442.
  6. ↑ "The top 10 causes of death". www.who.int. Retrieved 2024-08-12.
  7. 1 2 3 4 Becker LA, Hom J, Villasis-Keever M, van der Wouden JC (September 2015). "Beta2-agonists for acute cough or a clinical diagnosis of acute bronchitis". The Cochrane Database of Systematic Reviews. 2015 (9): CD001726. doi:10.1002/14651858.CD001726.pub5. PMC   7078572 . PMID   26333656.
  8. 1 2 3 Antibiotic Expert Group. Therapeutic guidelines: Antibiotic. 13th ed. North Melbourne: Therapeutic Guidelines; 2006.
  9. 1 2 Wark P (July 2015). "Bronchitis (acute)". BMJ Clinical Evidence. 2015. PMC   4505629 . PMID   26186368.
  10. ↑ Therapeutic guidelines : respiratory. 2nd ed: North Melbourne : Therapeutic Guidelines Limited, 2000.[ page needed ]
  11. 1 2 Integrated pharmacology / Clive Page ... [et al.]. 2nd ed: Edinburgh : Mosby, 2002.[ page needed ]
  12. ↑ Smith SM, Fahey T, Smucny J, Becker LA (19 June 2017). "Antibiotics for acute bronchitis". The Cochrane Database of Systematic Reviews. 2017 (6): CD000245. doi:10.1002/14651858.CD000245.pub4. PMC   6481481 . PMID   28626858.
  13. 1 2 Pakhale S, Mulpuru S, Verheij TJ, Kochen MM, Rohde GG, Bjerre LM (October 2014). "Antibiotics for community-acquired pneumonia in adult outpatients". The Cochrane Database of Systematic Reviews. 2014 (10): CD002109. doi:10.1002/14651858.CD002109.pub4. PMC   7078574 . PMID   25300166.
  14. 1 2 Moberley S, Holden J, Tatham DP, Andrews RM (January 2013). "Vaccines for preventing pneumococcal infection in adults". The Cochrane Database of Systematic Reviews. 2013 (1): CD000422. doi:10.1002/14651858.CD000422.pub3. PMC   7045867 . PMID   23440780.
  15. 1 2 Lodha R, Kabra SK, Pandey RM (June 2013). "Antibiotics for community-acquired pneumonia in children". The Cochrane Database of Systematic Reviews. 2013 (6): CD004874. doi:10.1002/14651858.CD004874.pub4. PMC   7017636 . PMID   23733365.
  16. ↑ The Merck manual of diagnosis and therapy. 17th ed / Mark H. Beers and Robert Berkow ed: Whitehouse Station, N.J. : Merck Research Laboratories, 1999.[ page needed ]
  17. ↑ Kumar Pius PS, Alexis A, P SK, Ganesan M (2017). "Diagnosis of Sputum Culture Positive Organisms and Their Antimicrobial Sensitivity Profile in a Tertiary Care Centre- Kanyakumari". Journal of Evidence Based Medicine and Healthcare. 4 (4): 168–171. doi: 10.18410/jebmh/2017/33 .
  18. ↑ "Mortality and Burden of Disease Estimates for WHO Member States in 2002" (xls). World Health Organization. 2002.
  19. ↑ Woodhead M, Blasi F, Ewig S, Garau J, Huchon G, Ieven M, Ortqvist A, Schaberg T, Torres A, van der Heijden G, Read R, Verheij TJ (November 2011). "Guidelines for the management of adult lower respiratory tract infections--full version". Clinical Microbiology and Infection. 17 (Suppl 6): E1–59. doi: 10.1111/j.1469-0691.2011.03672.x . PMC   7128977 . PMID   21951385.
  20. ↑ Chen H, Zhuo Q, Yuan W, Wang J, Wu T (23 January 2008). "Vitamin A for preventing acute lower respiratory tract infections in children up to seven years of age". Cochrane Database of Systematic Reviews (1): CD006090. doi:10.1002/14651858.CD006090.pub2. PMID   18254093.
  21. 1 2 Ball P, Baquero F, Cars O, File T, Garau J, Klugman K, Low DE, Rubinstein E, Wise R (January 2002). "Antibiotic therapy of community respiratory tract infections: strategies for optimal outcomes and minimized resistance emergence". The Journal of Antimicrobial Chemotherapy. 49 (1): 31–40. doi:10.1093/jac/49.1.31. PMID   11751764.
  22. ↑ Woodhead M, Blasi F, Ewig S, Huchon G, Ieven M, Leven M, Ortqvist A, Schaberg T, Torres A, van der Heijden G, Verheij TJ (December 2005). "Guidelines for the management of adult lower respiratory tract infections". The European Respiratory Journal. 26 (6): 1138–80. doi: 10.1183/09031936.05.00055705 . PMID   16319346.
  23. ↑ Schuetz P, Wirz Y, Sager R, Christ-Crain M, Stolz D, Tamm M, Bouadma L, Luyt CE, Wolff M, Chastre J, Tubach F, Kristoffersen KB, Burkhardt O, Welte T, Schroeder S, Nobre V, Wei L, Bucher HC, Bhatnagar N, Annane D, Reinhart K, Branche A, Damas P, Nijsten M, de Lange DW, Deliberato RO, Lima SS, Maravić-Stojković V, Verduri A, Cao B, Shehabi Y, Beishuizen A, Jensen JU, Corti C, Van Oers JA, Falsey AR, de Jong E, Oliveira CF, Beghe B, Briel M, Mueller B (12 October 2017). "Procalcitonin to initiate or discontinue antibiotics in acute respiratory tract infections". Cochrane Database of Systematic Reviews. 10 (5): CD007498. doi:10.1002/14651858.CD007498.pub3. PMC   6485408 . PMID   29025194.
  24. ↑ Laopaiboon M, Panpanich R, Swa Mya K (8 March 2015). "Azithromycin for acute lower respiratory tract infections". Cochrane Database of Systematic Reviews. 2015 (3): CD001954. doi:10.1002/14651858.CD001954.pub4. PMC   6956663 . PMID   25749735.
  25. ↑ Onakpoya IJ, Hayward G, Heneghan CJ (26 September 2015). "Antibiotics for preventing lower respiratory tract infections in high-risk children aged 12 years and under". Cochrane Database of Systematic Reviews. 2015 (9): CD011530. doi:10.1002/14651858.CD011530.pub2. PMC   10624245 . PMID   26408070.
  26. 1 2 3 4 Rojas-Reyes MX, Granados Rugeles C, Charry-Anzola LP (10 December 2014). "Oxygen therapy for lower respiratory tract infections in children between 3 months and 15 years of age". Cochrane Database of Systematic Reviews. 2014 (12): CD005975. doi:10.1002/14651858.CD005975.pub3. PMC   6464960 . PMID   25493690.
  27. 1 2 "Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory tract infections in 195 countries: a systematic analysis for the Global Burden of Disease Study 2015". The Lancet. Infectious Diseases. 17 (11): 1133–1161. November 2017. doi:10.1016/S1473-3099(17)30396-1. PMC   5666185 . PMID   28843578.
  28. ↑ Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, Abraham J, Adair T, Aggarwal R, Ahn SY, Alvarado M, Anderson HR, Anderson LM, Andrews KG, Atkinson C, Baddour LM, Barker-Collo S, Bartels DH, Bell ML, Benjamin EJ, Bennett D, Bhalla K, Bikbov B, Bin Abdulhak A, Birbeck G, Blyth F, Bolliger I, Boufous S, Bucello C, et al. (December 2012). "Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010". Lancet. 380 (9859): 2095–128. doi:10.1016/S0140-6736(12)61728-0. hdl: 10536/DRO/DU:30050819 . PMC   10790329 . PMID   23245604. S2CID   1541253.
  29. ↑ Chen Y, Shan X, Zhao J, Han X, Tian S, Chen F, Su X, Sun Y, Huang L, Grundmann H, Wang H, Han L (November 2017). "Predicting nosocomial lower respiratory tract infections by a risk index based system". Scientific Reports. 7 (1): 15933. Bibcode:2017NatSR...715933C. doi:10.1038/s41598-017-15765-z. PMC   5698311 . PMID   29162852.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.