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lower respiratory tract infection (LRI)

Differential diagnosis: 1) asthma 2) exacerbation of chronic obstructive pulmonary disease 3) pulmonary embolism 4) neoplasm 5) allergic aspergillosis 6) congestive heart failure 7) pulmonary aspiration 8) cystic fibrosis 9) cough secondary to medications 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] Special laboratory: - lung ultrasonography may not add additional information to serum procalcitonin [9] Management: 1) see specific etiology 2) vitamin E NOT helpful for prevention in nursing home residents [2] 3) patients without pneumonia do well without antibiotics [5] 4) oral glucocorticoids of no benefit to adults without chronic obstructive pulmonary disease [6]

Related

laryngitis pharyngitis

Specific

pulmonary infection

General

lower respiratory tract disease respiratory tract infection

References

  1. Ferri's Clinical Advisor, Instant Diagnosis and Treatment, Ferri FF (ed), Mosby, Philadelphia, 2003
  2. 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: 15315997
  3. 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. PMID: 15297305 http://bmj.bmjjournals.com/cgi/content/full/329/7463/431
  4. 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. 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. PMID: 28533265 Free PMC Article 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 PMID: 28533355 http://www.bmj.com/content/357/bmj.j2398
  6. 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 PMID: 28829884 http://jamanetwork.com/journals/jama/article-abstract/2649201
  7. 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 PMID: 29037960 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 PMID: 29037959 http://thelancet.com/journals/laninf/article/PIIS1473-3099(17)30593-5/fulltext
  8. 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: 29025194
  9. 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: 34548312 Free article https://www.bmj.com/content/374/bmj.n2132
  10. 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: 34548288 PMCID: PMC8453309 Free PMC article