Cord Blood Vitamin D Deficiency Is Associated With Respiratory Syncytial Virus Bronchiolitis Five-year cohort study of hospitalization for respiratory syncytial virus associated lower respiratory tract infection in African children. Economic impact of community-acquired and nosocomial lower respiratory tract infections in young children in Germany High Human Bocavirus Viral Load Is Associated with Disease Severity in Children under Five Years of Age Early Administration of Azithromycin and Prevention of Severe Lower Respiratory Tract Illnesses in Preschool Children With a History of Such Illnesses: A Randomized Clinical Trial. Lower respiratory tract illness and RSV prophylaxis in very premature infants Respiratory Syncytial Virus and Other Viral Infections among Children under Two Years Old in Southern Vietnam 2009-2010: Clinical Characteristics and Disease Severity Respiratory syncytial virus (RSV) infection in preterm infants and the protective effects of RSV immune globulin (RSVIG). Respiratory Syncytial Virus Immune Globulin Study Group. Respiratory syncytial virus: co-infection and paediatric lower respiratory tract infections Palivizumab prophylaxis for respiratory syncytial virus in Canada: utilization and outcomes Efficacy, safety and tolerability of 3 day azithromycin versus 10 day co-amoxiclav in the treatment of children with acute lower respiratory tract infections. Procalcitonin Guidance to Reduce Antibiotic Treatment of Lower Respiratory Tract Infection in Children and Adolescents (ProPAED): A Randomized Controlled Trial Airflow limitation during respiratory syncytial virus lower respiratory tract infection predicts recurrent wheezing. Pathogens involved in lower respiratory tract infections in general practice. Impact of Wheezing After Respiratory Syncytial Virus Infection on Health-Related Quality of Life Simultaneous zinc and vitamin A supplementation in Bangladeshi children: randomised double blind controlled trial Palivizumab prophylaxis, respiratory syncytial virus, and subsequent recurrent wheezing. Clinical trial of vitamin A as adjuvant treatment for lower respiratory tract infections. High incidence of pulmonary bacterial co-infection in children with severe respiratory syncytial virus (RSV) bronchiolitis The optimal dosage of ceftazidime for severe lower respiratory tract infections. Impact of C-reactive protein testing on adherence to thrice-daily antibiotic regimens in patients with lower respiratory tract infection. Intravenous ribavirin for respiratory syncytial viral infections in pediatric hematopoietic SCT recipients A comparative study of cefepime and ceftazidime in the treatment of community-acquired lower respiratory tract infections.
BACKGROUND : Respiratory syncytial virus ( RSV ) is the most important pathogen causing severe lower respiratory tract infection ( LRTI ) in infants . Epidemiologic and basic studies suggest that vitamin D may protect against RSV LRTI . OBJECTIVE : To determine the association between plasma vitamin D concentrations at birth and the subsequent risk of RSV LRTI . DESIGN : A prospect i ve birth cohort study was performed in healthy term neonates . Concentrations of 25-hydroxyvitamin D ( 25-OHD ) in cord blood plasma were related to RSV LRTI in the first year of life , defined as parent-reported LRTI symptoms in a daily log and simultaneous presence of RSV RNA in a nose-throat specimen . RESULTS : The study population included 156 neonates . Eighteen ( 12 % ) developed RSV LRTI . The mean plasma 25-OHD concentration was 82 nmol/L. Overall , 27 % of neonates had 25-OHD concentrations < 50 nmol/L , 27 % had 50 - 74 nmol/L and only 46 % had 25-OHD 75 nmol/L. Cord blood 25-OHD concentrations were strongly associated with maternal vitamin D3 supplementation during pregnancy . Concentrations of 25-OHD were lower in neonates who subsequently developed RSV LRTI compared with those who did not ( 65 nmol/L versus 84 nmol/L , P = .009 ) . Neonates born with 25-OHD concentrations < 50 nmol/L had a sixfold ( 95 % confidence interval : 1.6 - 24.9 ; P = .01 ) increased risk of RSV LRTI in the first year of life compared with those with 25-OHD concentrations ≥75 nmol/L. CONCLUSIONS : Vitamin D deficiency in healthy neonates is associated with increased risk of RSV LRTI in the first year of life . Intensified routine vitamin D supplementation during pregnancy may be a useful strategy to prevent RSV LRTI during infancy OBJECTIVES To describe the epidemiology of respiratory syncytial virus ( RSV ) associated lower respiratory tract infection ( RSV-LRTI ) hospitalizations in South African children over a 5-year period , and determine the impact of gestational age ( GA ) on the incidence of RSV-LRTI hospitalization . STUDY DESIGN A cohort of 39,836 children , 6.47 % of whom were HIV infected , enrolled into a phase 3 trial were prospect ively studied for respiratory viruses when hospitalized for LRTI . RESULTS The incidence of hospitalization for RSV-LRTI was 19.4 per 1000 in HIV uninfected children and 2.5-fold ( 95 % CI 2.04 - 3.03 ) greater in HIV infected children ( 45.0 per 1000 ) . The incidence of RSV-LRTI was 4.9-fold greater ( 95 % CI 3.9 - 6.8 ) in children born at < 36 weeks of gestational age ( GA ) and repeat hospitalizations for RSV-LRTI was 3.7-fold ( 95 % CI 1.4 - 9.4 ) more likely in these children ( 7.3 % ) than children born at > or = 36 weeks of GA ( 1.9 % ) . The burden of RSV-LRTI was greater in children born at < 32 weeks of GA than those born at 32 - 35 weeks of GA between 6 - 12 months ( P=0.008 ) and 12 - 24 months of age ( P=0.001 ) . The RSV epidemic occurred at the end of the rainy season and peaked when the monthly temperatures were at its lowest each year Data on the economic burden of lower respiratory tract infections ( LRTI ) in young children are lacking in Germany . The objective of the cost-of-illness study was to estimate the economic impact of community-acquired LRTI and nosocomial LRTI as well as of infections due to respiratory syncytial virus ( RSV ) , parainfluenza viruses ( PIV ) and influenza viruses ( IV ) . The economic analysis is part of the PRI.DE study , a prospect i ve , multi-centre , population -based epidemiological study on the impact of LRTI in children aged 0 to 36 months in Germany . The analysis includes children with community-acquired infections ( 1329 cases treated as out patients , 2039 cases treated as in patients ) and nosocomial infections ( 90 cases ) .  Medical services consumed were generated by chart abstract ion and parental expenses data by telephone interviews within four weeks after physician visit or hospitalisation . Costs were evaluated from following perspectives : third party payer , parent and society . Total costs for outpatient treatment are € 123 per LRTI case . Stratified by virus type , total costs per case are € 163 ( RSV ) , € 100 ( PIV ) and € 223 ( IV ) . Total costs per hospitalised LRTI case amount to € 2579 . Stratified by virus type , total costs per case are € 2772 ( RSV ) , € 2374 ( PIV ) and € 2597 ( IV ) . Total costs per nosocomial case are € 2814 . Economic burden due to LRTI is € 213 million annually . It is concluded that treatment of LRTI in children up to age three causes a considerable economic burden in Germany . Presented results are the first data describing the economic burden of LRTI in young children assessed by means of the incidence data for Germany . This cost-of-illness study provides basic data for further decision-making , focusing on the economic assessment of preventive strategies for RSV , PIV and IV infections Human bocavirus ( HBoV ) is a parvovirus and detected worldwide in lower respiratory tract infections ( LRTIs ) , but its pathogenic role in respiratory illness is still debatable due to high incidence of co-infection with other respiratory viruses . To determine the prevalence of HBoV infection in patients with LRTI in Shanghai and its correlation with disease severity , we performed a 3-year prospect i ve study of HBoV in healthy controls , out patients and in patients under five years of age with X-ray diagnosed LRTIs .  Nasopharyngeal aspirates were tested by PCR for common respiratory viruses and by real time PCR for HBoV subtypes 1–4 . Nasopharyngeal swabs from healthy controls and serum sample s and stools from in patients were also tested for HBoV1 - 4 by real time PCR .  Viral loads were determined by quantitative real time PCR in all HBoV positive sample s. HBoV1 was detected in 7.0 % of in patients , with annual rates of 5.1 % , 8.0 % and 4.8 % in 2010 , 2011 and 2012 , respectively . Respiratory syncytial virus ( RSV ) subtype A was the most frequent co-infection detected ; HBoV1 and RSVA appeared to co-circulate with similar seasonal variations . High HBoV viral loads ( > 106 copies/ml ) were significantly more frequent in in patients and out patients than in healthy controls . There was a direct correlation of high viral load with increasing disease severity in patients co-infected with HBoV1 and at least one other respiratory virus . In summary , our data suggest that HBoV1 can cause LRTIs , but symptomatic HBoV infection is only observed in the context of high viral load IMPORTANCE Many preschool children develop recurrent , severe episodes of lower respiratory tract illness ( LRTI ) . Although viral infections are often present , bacteria may also contribute to illness pathogenesis . Strategies that effectively attenuate such episodes are needed . OBJECTIVE To evaluate if early administration of azithromycin , started prior to the onset of severe LRTI symptoms , in preschool children with recurrent severe LRTIs can prevent the progression of these episodes . DESIGN , SETTING , AND PARTICIPANTS A r and omized , double-blind , placebo-controlled , parallel-group trial conducted across 9 academic US medical centers in the National Heart , Lung , and Blood Institute 's AsthmaNet network , with enrollment starting in April 2011 and follow-up complete by December 2014 . Participants were 607 children aged 12 through 71 months with histories of recurrent , severe LRTIs and minimal day-to-day impairment . INTERVENTION Participants were r and omly assigned to receive azithromycin ( 12 mg/kg/d for 5 days ; n = 307 ) or matching placebo ( n = 300 ) , started early during each predefined RTI ( child 's signs or symptoms prior to development of LRTI ) , based on individualized action plans , over a 12- through 18-month period . MAIN OUTCOMES AND MEASURES The primary outcome measure was the number of RTIs not progressing to a severe LRTI , measured at the level of the RTI , that would in clinical practice trigger the prescription of oral corticosteroids . Presence of azithromycin-resistant organisms in oropharyngeal sample s , along with adverse events , were among the secondary outcome measures . RESULTS A total of 937 treated RTIs ( azithromycin group , 473 ; placebo group , 464 ) were experienced by 443 children  ( azithromycin group , 223 ; placebo group , 220 ) , including 92 severe LRTIs ( azithromycin group , 35 ; placebo group , 57 ) . Azithromycin significantly reduced the risk of progressing to severe LRTI relative to placebo ( hazard ratio , 0.64 [ 95 % CI , 0.41 - 0.98 ] , P = .04 ; absolute risk for first RTI : 0.05 for azithromycin , 0.08 for placebo ; risk difference , 0.03 [ 95 % CI , 0.00 - 0.06 ] ) . Induction of azithromycin-resistant organisms and adverse events were infrequently observed . CONCLUSIONS AND RELEVANCE Among young children with histories of recurrent severe LRTIs , the use of azithromycin early during an apparent RTI compared with placebo reduced the likelihood of severe LRTI . More information is needed on the development of antibiotic-resistant pathogens with this strategy . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01272635 Aims : To determine the frequency of and the risk factors for readmissions for any lower respiratory tract illness ( LRTI ) and for respiratory syncytial virus ( RSV ) documented LRTI in children born very prematurely who had or had not received RSV prophylaxis . Methods : Multicentre prospect i ve longitudinal cohort study of 2813 infants , born between April 2000 and December 2000 at less than 33 weeks of gestational age , and followed until the end of the epidemic season . Results : Among the 2256 children who had no bronchopulmonary dysplasia at 36 weeks of postmenstrual age and were not su bmi tted to RSV prophylaxis  , 27.4 % were readmitted at least once for any reason during the epidemic season ; 15.1 % and 7.2 % were readmitted at least once for any LRTI and RSV related LRTI , respectively . Children born at less than 31 weeks ’ gestation , having an intrauterine growth restriction , or living in a single mother family were at a significantly higher risk of readmission for LRTI in general as well as for RSV related LRTI . Of the 376 children su bmi tted to prophylaxis , 28.2 % were readmitted at least once for any LRTI and 6.1 % for RSV related LRTI . Conclusion : One out of four children who had received no prophylaxis , was born very prematurely , and was without bronchopulmonary dysplasia at 36 weeks of postmenstrual age , was readmitted at least once for any reason . Roughly 50 % and 20 % of these readmissions were related to a LRTI and an RSV infection , respectively . Further epidemiological studies are warranted to assess the aetiology and impact of other respiratory pathogens on post-discharge readmission and respiratory morbidity in this population Background Despite a high burden of respiratory syncytial virus ( RSV ) infections among children , data on demographic and clinical characteristics of RSV are scarce in low and middle income countries . This study aims to describe the viral etiologies , the demographic , epidemiological , and clinical characteristics of children under two years of age who were hospitalized with a lower respiratory tract infections ( LRTI ) , focusing on RSV ( prevalence , seasonality , subgroups , viral load ) and its association with disease severity . Methods A prospect i ve study among children under two years of age , hospitalized with LRTI was conducted in two referral pediatric hospitals in Ho Chi Minh City , Vietnam , from May 2009 to December 2010 . Socio-demographic , clinical data and nasopharyngeal swabs were collected on enrolment and discharge . Multiplex real-time RT-PCR ( 13 viruses ) and quantitative RSV RT-PCR were used to identify viral pathogens , RSV load and subgroups . Results Among 632 cases , 48 % were RSV positive . RSV infections occurred at younger age than three other leading viral infections i.e rhinovirus ( RV ) , metapneumovirus ( MPV ) , parainfluenza virus ( PIV-3 ) and were significantly more frequent in the first 6 months of life . Clinical severity score of RSV infection was significantly higher than PIV-3 but not for RV or MPV . In multivariate analysis , RV infection was significantly associated with severity while RSV infection was not . Among RSV infections , neither viral load nor viral co-infections were significantly associated with severity . Young age and having fever at admission were significantly associated with both RSV and LRTI severity . A shift in RSV subgroup predominance was observed during two consecutive rainy seasons but was not associated with severity . Conclusion We report etiologies , the epidemiological and clinical characteristics of LRTI among hospitalized children under two years of age and risk factors of RSV and LRTI severity OBJECTIVE To evaluate the safety and efficacy of respiratory syncytial virus immune globulin ( RSVIG ) in the prevention of severe respiratory syncytial virus ( RSV ) lower respiratory tract infection ( LRTI ) in infants born prematurely with or without bronchopulmonary dysplasia ( BPD ) . METHODS Data from a prospect i ve , blinded , r and omized , multicenter trial during three consecutive RSV seasons involving 249 children . This analysis comprises 162 preterm children , of whom 102 had BPD . The 87 children with congenital heart disease ( CHD ) were excluded from this analysis . Children were r and omized to receive monthly infusions of RSVIG 750 mg/kg ( high dose ) , RSVIG 150 mg/kg ( low dose ) , or no RSVIG : Results from the preterm infants with and without BPD who received RSVIG 750 mg/kg are contrasted with control infants who did not receive RSVIG : RESULTS As compared with controls , high-dose RSVIG administration significantly reduced the incidences of RSV LRTI ( P = .01 ) and moderate-to-severe LRTI ( P = .006 ) . RSV-associated hospitalization also was decreased ( P = .06 ) as well as were total RSV-associated days in the intensive care unit ( P = .05 ) . Significantly fewer preterm infants developed severe RSV LRTI in the RSVIG group compared with controls ( 4/58 [ 7 % ] vs 14/58 [ 24 % ] , respectively ; P = .01 ) . Adverse reactions occurred in 5 % of RSVIG infusions . These were generally mild and included reversible fluid overload , transient fever , and decreases in oxygen saturation . There was one death unrelated to either RSV or RSVIG administration . CONCLUSIONS Prophylaxis with RSVIG is safe and is currently the only effective means to prevent severe RSV LRTI in high-risk preterm infants Comprehensive population -based data on the role of respiratory viruses in the development of lower respiratory tract infections ( LRTIs ) remain unclear . We investigated the incidence and effect of single and multiple infections with respiratory viruses on the risk of  LRTIs in Vietnam .  Population -based prospect i ve surveillance and a case – control study of hospitalised paediatric patients with acute respiratory infection ( ARI ) were conducted from April 2007 through to March 2010 . Healthy controls were r and omly recruited from the same community .  Nasopharyngeal sample s were collected and tested for 13 respiratory viruses using multiplex PCRs .  1992 hospitalised ARI episodes , including 397 ( 19.9 % ) with LRTIs , were enrolled .  Incidence of hospitalised LRTIs among children aged < 24 months was 2171.9 per 100 000 ( 95 % CI 1947.9–2419.7 ) . The majority of ARI cases ( 60.9 % ) were positive for at least one virus . Human rhinovirus ( 24.2 % ) , respiratory syncytial virus ( 20.1 % ) and influenza A virus ( 12.0 % ) were the most common and 9.5 % had multiple-viral infections . Respiratory syncytial virus and human metapneumovirus infections independently increased the risk of LRTIs . Respiratory syncytial virus further increased the risk , when co-infected with human rhinovirus , human metapneumovirus and parainfluenza virus-3 but not with influenza A virus . The case – control analysis revealed that respiratory syncytial virus and influenza A virus increased the risk of ARI hospitalisation but not human rhinovirus . Respiratory syncytial virus is the leading pathogen associated with risk of ARI hospitalisation and LRTIs in Vietnam Objective . To provide information on the use and outcomes of palivizumab prophylaxis in children at high risk of serious respiratory syncytial virus ( RSV ) infection . Design . Observational , prospect i ve , longitudinal , multicenter study . Setting . Eighteen hospitals and pediatric clinics located in six provinces across Canada . Patients . Infants enrolled in the palivizumab Special Access Programme of Canada ’s Therapeutic Products Programme throughout the 1999 to 2000 RSV season . Most were premature infants born at ≤32 weeks of gestation and /or had bronchopulmonary dysplasia . Methods and main outcome measures . Neonatal and demographic data were recorded for each subject . The parent/caregiver was contacted on a monthly basis until the end of the RSV season to obtain information on palivizumab utilization and compliance as well as incidence and severity of respiratory infections . Results . There were 444 evaluable subjects who each received 1 to 7 injections of palivizumab for a total of 1702 doses from September 1999 to April 2000 . Most subjects received 5 injections with high compliance . Prophylaxis was discontinued in 2 % of children . There were 116 clinical events or hospitalizations involving respiratory tract infections reported in 91 children . Eighty-six of these were managed in an outpatient setting , and 30 required hospitalization . The estimated incidence of hospitalization for RSV-positive lower respiratory tract infections ( LRTIs ) was 2.4 % . Hospitalization for RSV LRTI occurred more often in children with bronchopulmonary dysplasia ( 6.0 % ) than in those with prematurity only ( 1.6 % ) . Conclusions . This study demonstrates that prophylaxis with palivizumab during the RSV season was associated with a low rate of hospitalization for RSV-positive LRTIs  . Palivizumab was well-tolerated , and compliance was high . The findings confirm the results of the major r and omized clinical trial of palivizumab and demonstrate the safety and effectiveness of RSV prophylaxis To compare the efficacy , safety and tolerability of a 3 day course of azithromycin with a 10 day course of co-amoxiclav in the treatment of children with acute lower respiratory tract infection ( LRTI ) , 118 patients with community-acquired LRTI were included in a multicentre r and omized double-blind , double-dummy study . The diagnosis of LRTI was based on the presence of respiratory signs and symptoms in combination with consolidation on a chest radiograph or clinical evidence of LRTI . Patients received oral azithromycin suspension ( 10 mg/kg/24 h ) or placebo in one dose for 3 days and co-amoxiclav ( 45/11.25 mg/kg/24 h ) or placebo in three doses for 10 days . Of 110 eligible patients , 56 and 54 patients , respectively , were treated with azithromycin or co-amoxiclav . The percentage of patients cured or clinical ly improved at days 10 - 13 ( primary endpoint ) was 91 % for azithromycin and 87 % for co-amoxiclav . This difference of 4 % ( 90 % confidence interval : -6 % , + 14 % ) was not statistically significant ( P= 0.55 ) . Significantly ( P = 0.01 ) more related adverse events were found in the co-amoxiclav group . This was largely due to a higher percentage ( 43 % versus 19 % ) of gastrointestinal complaints . A 3 day course of azithromycin ( three doses ) is as effective in the treatment of LRTI in children as a 10 day course of co-amoxiclav ( 30 doses ) . The azithromycin group had fewer adverse events . We conclude that azithromycin is an effective , safe and well-tolerated drug in the treatment of children with LRTI . An additional advantage is the easy administration and short duration of therapy Background Antibiotics are overused in children and adolescents with lower respiratory tract infection ( LRTI ) .  Serum-procalcitonin ( PCT ) can be used to guide treatment when bacterial infection is suspected . Its role in pediatric LRTI is unclear . Methods Between 01/2009 and 02/2010 we r and omized previously healthy patients 1 month to 18 years old presenting with LRTI to the emergency departments of two pediatric hospitals in Switzerl and to receive antibiotics either according to a PCT guidance algorithm established for adult LRTI or st and ard care clinical guidelines . In intention-to-treat analyses , antibiotic prescribing rate , duration of antibiotic treatment , and number of days with impairment of daily activities within 14 days of r and omization were compared between the two groups . Results In total 337 children , mean age 3.8 years ( range 0.1–18 ) , were included .  Antibiotic prescribing rates were not significantly different in PCT guided patients compared to controls ( OR 1.26 ; 95 % CI 0.81 , 1.95 ) . Mean duration of antibiotic exposure was reduced from 6.3 to 4.5 days under PCT guidance ( −1.8 days ; 95 % CI −3.1 , −0.5 ; P = 0.039 ) for all LRTI and from 9.1 to 5.7 days for pneumonia ( −3.4 days 95 % CI −4.9 , −1.7 ; P<0.001 ) . There was no apparent difference in impairment of daily activities between PCT guided and control patients . Conclusion PCT guidance reduced antibiotic exposure by reducing the duration of antibiotic treatment , while not affecting the antibiotic prescribing rate . The latter may be explained by the low baseline prescribing rate in Switzerl and for pediatric LRTI and the choice of an inappropriately low PCT cut-off level for this population . Trial Registration Controlled-Trials.com IS RCT N17057980 IS RCT BACKGROUND Respiratory syncytial virus ( RSV ) lower respiratory tract infection ( LRTI ) is frequently followed by recurrent wheezing . Thus far no clinical risk factors have been identified to predict which infants will have wheezing episodes subsequent to RSV LRTI . OBJECTIVE To determine clinical predictors for airway morbidity after RSV LRTI . METHODS In a 1-year follow-up study we investigated the predictive value of auscultatory findings characteristic of airflow limitation ( wheezing ) during RSV LRTI for subsequent airway morbidity . Clinical characteristics , including the presence or absence of signs of airflow limitation , of hospitalized infants with RSV LRTI were prospect ively recorded during 2 winter epidemics . During a 1-year follow-up period parents of 130 infants recorded daily airway symptoms . OUTCOME MEASURE Recurrent wheezing defined as > or = 2 episodes of wheezing . RESULTS Signs of airflow limitation during RSV LRTI were absent in 47 ( 36 % ) infants and present in 83 ( 64 % ) infants . Recurrent wheezing was recorded in 10 ( 21 % ) infants without signs of airflow limitation and in 51 ( 61 % ) with signs of airflow limitation during initial RSV LRTI ( relative risk , 0.29 , P < 0.001 ) . In a multiple logistic regression model , airflow limitation during initial RSV LRTI proved independent from other clinical parameters , including age , parental history of asthma and smoke exposure . CONCLUSIONS A sign of airflow limitation during RSV LRTI is the first useful clinical predictor for subsequent recurrent wheezing BACKGROUND There are few investigations into the aetiology of  lower respiratory tract infections ( LRTIs ) in general practice . AIM To describe the aetiology of  LRTI among adult patients in general practice in The Netherl and s. DESIGN OF STUDY Prospect i ve observational study . SETTING General practice s in the Leiden region , The Netherl and s. METHOD Adult patients with a defined LRTI were included . St and ard medical history and physical examination were performed .  Sputum , blood and throat swabs  were collected for diagnostic tests . Aetiological diagnosis , categorised as definite or possible , was based on the results of bacterial and viral cultures , serological techniques , and on polymerase chain reaction . Proportions of pathogens causing LRTI were assessed in relation to chest X-ray findings . RESULTS A bacterial cause was established in 43 ( 30 % ) , and a viral cause in 57 ( 39 % ) of the 145 patients with a LRTI . Influenza virus A was the most frequently diagnosed microorganism , followed by Haemophilus influenzae , and Mycoplasma pneumoniae . Streptococcus pneumoniae was found in 6 % of the patients . CONCLUSIONS Pathogens were found in two-thirds of the patients . In half of these patients there was a viral cause . Influenza virus A was the most frequently found pathogen . The treatment with antibiotics of at least one-third of the patients with LRTI was superfluous . This observation should result in changes in the prescription of antibiotics in LRTI Background : Respiratory syncytial virus ( RSV ) lower respiratory tract infection ( LRTI ) is often followed by recurrent wheezing episodes during childhood . The effect of postbronchiolitis wheezing on the well-being of the child is not known . This study aim ed to determine the impact of RSV LRTI hospitalization before age 13 months on health-related quality of life ( HRQoL ) at age 3 years . Methods : HRQoL was measured in a previously described cohort of children with a history of RSV infection and compared with control term children from the open population .  HRQoL was determined during the winter season in index and control children . We used a vali date d question naire , which measures the health status of children in 13 domains weighted by the impact of the health status problems on well-being . The lung domain was the focus of this study . In addition daily respiratory symptoms of the index children were recorded prospect ively up to age 3 years and correlated with HRQoL scores . Results : HRQoL was lower in index children ( n = 128 ) than in control children ( n = 340 ) for the lung , gastrointestinal tract and sleeping domains . HRQoL scores for social and developmental domains were similar for index and control children . As anticipated the largest difference between index and control children was found in the lung domain ( 77.6 ± 2.2 vs. 93.9 ± 0.8 , P < 0.01 ) . HRQoL in the lung domain was lower during the winter than during the summer season ( 77.6 ± 2.2 vs. 85.6 ± 1.9 , P < 0.01 ) , which was explained by increased airway morbidity during the winter season . We found a high correlation between lung HRQoL scores and total number of wheezing days during follow-up . Conclusions : Postbronchiolitis wheezing has broad implication s for long-term well-being of  children . Decreased HRQoL was attributed to postbronchiolitis wheezing , but not to preexistent risk factors , such as premature birth . This study underscores the importance of developing new strategies to prevent and treat long term airway morbidity after RSV LRTI Abstract Objective : To evaluate the effect of simultaneous zinc and vitamin A supplementation on  diarrhoea and acute lower respiratory infections in children . Study design : R and omised double blind placebo controlled trial . Setting : Urban slums of Dhaka , Bangladesh . Participants and methods : 800 children aged 12 - 35 months were r and omly assigned to one of four intervention groups : 20 mg zinc once daily for 14 days ; 200 000 IU vitamin A , single dose on day 14 ; both zinc and vitamin A ; placebo . The children were followed up once a week for six months , and morbidity information was collected . Results : The incidence and prevalence of diarrhoea were lower in the zinc and vitamin A groups than in the placebo group . Zinc and vitamin A interaction had a rate ratio ( 95 % confidence interval ) of 0.79 ( 0.66 to 0.94 ) for the prevalence of persistent diarrhoea and 0.80 ( 0.67 to 0.95 ) for dysentery . Incidence ( 1.62 ; 1.16 to 2.25 ) and prevalence ( 2.07 ; 1.76 to 2.44 ) of acute lower respiratory infection were significantly higher in the zinc group than in the placebo group . The interaction term had rate ratios of 0.75 ( 0.46 to 1.20 ) for incidence and 0.58 ( 0.46 to 0.73 ) for prevalence of acute lower respiratory infection . Conclusions : Combined zinc and vitamin A synergistically reduced the prevalence of persistent diarrhoea and dysentery . Zinc was associated with a significant increase in acute lower respiratory infection , but this adverse effect was reduced by the interaction between zinc and vitamin A. What is already known on this topic Trials of vitamin A supplementation have failed to show a beneficial effect on morbidity in children Experimental studies have shown that , in the presence of zinc deficiency , vitamin A supplementation fails to reverse vitamin A deficiency Coexistence of deficiencies of zinc and vitamin A could be a reason for the failure of vitamin A supplementation , but data in humans are limited What this paper adds Combined zinc and vitamin A supplementation is more effective in reducing persistent diarrhoea and dysentery than either vitamin A or zinc alone Zinc alone increased respiratory illnesses , but interaction between zinc and vitamin A reduced this adverse OBJECTIVE Children who experience respiratory syncytial virus ( RSV ) lower respiratory tract infections ( LRTIs ) early in life have high rates of subsequent recurrent wheezing .  Palivizumab , an anti-RSV monoclonal antibody , has 78 % to 80 % efficacy in preventing RSV hospitalization in premature infants without chronic lung disease . We hypothesized that palivizumab , by ameliorating or preventing early RSV LRTI in preterm infants , might decrease later recurrent wheezing . STUDY DESIGN A cohort of preterm infants who had received palivizumab and were not hospitalized for RSV ( n = 191 ) or who never received palivizumab ( n = 230 ; 76 who were hospitalized for RSV and 154 who were not ) , were prospect ively followed for 24 months beginning at a mean age of 19 months . The subjects were assessed for recurrent wheezing by caretaker or physician report . RESULTS The incidences of recurrent wheezing and physician-diagnosed recurrent wheezing were significantly lower in the 191 palivizumab-treated  subjects ( 13 % and 8 % , respectively ) compared with all 230 untreated subjects ( 26 % , P = .001 and 16 % , P = .011 , respectively ) and with the 154 patients in the subgroup not hospitalized for RSV LRTI ( 23 % , P = .022 and 16 % , P = .027 , respectively ) . The effect of palivizumab treatment remained significant after adjustment for potential confounding variables . CONCLUSIONS Our study suggests that preventing RSV LRTI with palivizumab may reduce subsequent recurrent wheezing in premature infants OBJECTIVE To test the efficacy of a high dose of vitamin A as adjuvant treatment for radiographically confirmed cases of acute lower respiratory tract infection ( ALRI ) . DESIGN R and omized , double-masked , placebo-controlled clinical trial . SETTING Two large urban hospitals in Guatemala City . PATIENTS Sequential sample of 263 children aged 3 to 48 months , identified in the emergency departments and admitted to the hospital . INTERVENTIONS Vitamin A ( 100,000 IU for children less than 1 year of age , and 200,000 IU for older children ) or placebo in addition to st and ard treatment for ALRI which included antibiotics , oxygen , bronchodilators , and intravenously administered solutions . MEASUREMENTS AND MAIN RESULTS The children were assessed every 8 hours . There were neither statistically nor clinical ly significant differences by treatment group in the rate of normalization in respiratory rate , oxygen saturation , temperature , or clinical score . Duration of hospitalization was not different by treatment group . Adverse outcomes ( mechanical ventilation , prolonged hospitalization , readmission or transfer , and death ) were equally distributed between the two groups . CONCLUSIONS Treatment with high doses of vitamin A over and above st and ard care for infants and children with non-measles-related ALRI is not efficacious for the current episode . Additional trials among population s in which vitamin A deficiency is more prevalent and severe should be considered Background : Respiratory syncytial virus ( RSV ) is the most common cause of viral lower respiratory tract infections ( LRTI ) . Viral LRTI is a risk factor for bacterial superinfection , having an escalating incidence with increasing severity of respiratory illness . A study was undertaken to determine the incidence of pulmonary bacterial co-infection in infants and children with severe RSV bronchiolitis , using paediatric intensive care unit ( PICU ) admission as a surrogate marker of severity , and to study the impact of the co-infection on morbidity and mortality . Methods : A prospect i ve microbiological analysis was made of lower airways secretions on all RSV positive bronchiolitis patients on admission to the PICU during three consecutive RSV seasons . Results : One hundred and sixty five children ( median age 1.6 months , IQR 0.5–4.6 ) admitted to the PICU with RSV bronchiolitis were enrolled in the study . Seventy ( 42.4 % ) had lower airway secretions positive for bacteria : 36 ( 21.8 % ) were co-infected and 34 ( 20.6 % ) had low bacterial growth/possible co-infection . All were mechanically ventilated ( median 5.0 days , IQR 3.0–7.3 ) . Those with bacterial co-infection required ventilatory support for longer than those with only RSV ( p<0.01 ) . White cell count , neutrophil count , and C-reactive protein did not differentiate between the groups . Seventy four children ( 45 % ) received antibiotics prior to intubation . Sex , co-morbidity , origin , prior antibiotics , time on preceding antibiotics , admission oxygen , and ventilation index were not predictive of positive bacterial cultures . There were 12 deaths ( 6.6 % ) , five of which were related to RSV . Conclusions : Up to 40 % of children with severe RSV bronchiolitis requiring admission to the PICU were infected with bacteria in their lower airways and were at increased risk for bacterial pneumonia The optimal dosage of antibiotics for the treatment of patients with severe lower respiratory tract infections ( LRTI ) has not been determined but may be lower than is commonly administered at present . We have compared the efficacy of a low dosage of ceftazidime ( 1 g tds ) with the more usual dosage ( 2 g tds ) in a prospect i ve , r and omized study of the treatment of LRTI in seriously ill patients . Fifty patients on an Intensive Care Unit received one or the other regimen for 5 days ; the demographic characteristics of the two groups were comparable . There was no significant difference in terms of clinical and microbiological response rates between the two regimens . Overall , clinical resolution was documented for 86 % of patients , there was no change in 8 % and 6 % deteriorated . Microbiological eradication was achieved in 52 % of patients from whom a pathogen was isolated ( 46 % of all patients ) . We conclude that ceftazidime 1 g tds is effective treatment for severe LRTI in hospitalized patients BACKGROUND Few studies have analysed adherence to antibiotic treatment in respiratory tract infections . OBJECTIVE To evaluate the impact of C-reactive protein ( CRP ) testing on treatment adherence among patients aged 18 or over with lower respiratory tract infection ( LRTI ) treated with thrice-daily antibiotic regimens .  DESIGN Prospect i ve study 2003 - 2008 . SETTING Office-based physician practice s. METHODS We compared patient adherence prior to the use of CRP testing ( no CRP test was available prior to 2007 ) with adherence following CRP rapid testing for suspected bacterial infection in LRTIs . Patient adherence was assessed by electronic monitoring . RESULTS 161 patients with LRTI were recruited . The percentage of container openings was 76.8 ± 17.4 % . Adherence was significantly better when the CRP test was performed ( 83.3 % vs. 74.4 % ; p < 0.01 ) , as was ' good timing ' adherence during at least 80 % of the antibiotic course ( 32.6 % vs. 16.9 % ; p < 0.05 ) . CONCLUSION Greater antibiotic treatment adherence is observed among patients with LRTI after CRP testing at the consultation prior to administration of antibiotic treatment Respiratory syncytial virus ( RSV ) is a potential cause of serious morbidity and even mortality among children undergoing hematopoietic SCT ( HSCT ) . Contrary to the available information regarding the aerosolized formulation of ribavirin , there is a paucity of published studies using i.v . ribavirin in adults , and very few single reports on pediatric patients . Aerosolized drug administration has been limited by potential toxicity and special air-flow requirements . In this regard , i.v . ribavirin could prevent these disadvantages , but its efficacy and safety remain controversial in the pediatric HSCT setting . The present study describes the outcome of six pediatric patients undergoing HSCT with nine episodes of proven RSV . Four episodes corresponded to lower respiratory tract infection ( LRTI ) and five presented with  upper respiratory tract infection ( URTI ) . All LRTI patients showed favorable clinical responses , with 100 % survival and no progression to LRTI in the remaining five URTI . No side effects were documented during ribavirin administration . We conclude that ribavirin was well tolerated intravenously , without associated side effects , and was effective in the treatment of RSV in this limited number of pediatric HSCT patients . The role and efficacy of i.v . ribavirin needs to be further clarified by prospect i ve controlled trials in pediatric population Antibiotic treatment for community-acquired pneumonia must target Gram-positive pathogens , especially frequently isolated organisms such as Streptococcus pneumoniae . The severity of community-acquired pneumonia is often related to underlying factors . Occasionally it may be complicated by staphylococcal or Gram-negative bacillary infection . We have compared the safety and efficacy of cefepime 1 g bd with ceftazidime 1 g tds as empirical treatment in adults with community-acquired lower respiratory tract infections ( LRTIs ) . One hundred and thirty-one patients with moderate to severe LRTIs were r and omized to two treatment groups : 87 received cefepime and 44 received ceftazidime . The treatment groups were comparable with regard to sex , age and treatment duration . Of the 116 pathogens isolated , 57 were Gram-positive ( 46 strains of S. pneumoniae ) and 59 were Gram-negative ( 33 strains of Haemophilus influenzae ) . Of the 111 patients evaluated , clinical cure rates were 87 % ( 65/75 ) in the cefepime group and 86 % ( 31/36 ) in the ceftazidime group . Pathogen eradication rates were 95 % ( 74/78 and 36/37 , respectively ) in both groups . Both drugs were well tolerated and the incidence of adverse events in each group was comparable . Cefepime 2 g per day ( 1 g bd ) was as safe and effective as ceftazidime 3 g per day ( 1 g tds ) in the treatment of community-acquired LRTIs
Children with LRTI were found to have significantly lower mean vitamin D levels as compared to controls There was likewise a correlation between vitamin D levels and incidence and severity of LRTI .
Studies related to vitamin D deficiency and lower respiratory tract infections ( LRTI ) in children have inconsistent findings .
The objective of this systematic review was to assess the prevalence of vitamin D deficiency in children with LRTI , and to evaluate the correlation between vitamin D levels and the incidence and severity of LRTI .