Bacteria in the respiratory tract—how to treat? Or do not treat?. (October 2016)

• Record Type: Journal Article
• Authors: Prat, Cristina; Lacoma, Alicia
• Is Part Of: International journal of infectious diseases. Volume 51(2016:Oct.)
• Page Start: 113
• Page End: 122
• Publication Date: 2016-10
• Subjects: Lower respiratory tract infection -- Bacterial colonization -- Novel therapeutic approaches -- Alternatives to antibiotics -- Prudent use of antibiotics; Communicable diseases -- Periodicals; Communicable Diseases -- Periodicals; Communicable diseases; Periodicals; Electronic journals; 616.9
• DOI: 10.1016/j.ijid.2016.09.005
• Languages: English
• ISSNs: 1201-9712

Abstract

Highlights: The clinical and microbiological challenges for establishing the clinical role of bacteria in the respiratory tract are listed. The available diagnostic methods and studies needed to help in treatment decisions are highlighted. A review of novel therapeutic options is provided. Summary: Background: Acute and chronic respiratory tract infections are a common cause of inappropriate antimicrobial prescription. Antimicrobial therapy leads to the development of resistance and the emergence of opportunistic pathogens that substitute the indigenous microbiota. Methods: This review explores the major challenges and lines of research to adequately establish the clinical role of bacteria and the indications for antimicrobial treatment, and reviews novel therapeutic approaches. Results: In patients with chronic pulmonary diseases and structural disturbances of the bronchial tree or the lung parenchyma, clinical and radiographic signs and symptoms are almost constantly present, including a basal inflammatory response. Bacterial adaptative changes and differential phenotypes are described, depending on the clinical role and niche occupied. The respiratory tract has areas that are potentially inaccessible to antimicrobials. Novel therapeutic approaches include new ways of administering antimicrobials that may allow intracellular delivery or delivery across biofilms, targeting the functions essential for infection, such as regulatory systems, or the virulence factors required to cause host damage and disease. Alternatives to antibiotics and antimicrobial adjuvants are under development. Conclusions: Prudent treatment, novel targets, and improved drug delivery systems will contribute to reduce the emergence of antimicrobial resistance in lower respiratory tract infections.