Table Of ContentDEVELOPMENTS IN ANTIBIOTIC TREATMENT OF RESPIRATORY
INFECTIONS
NEW PERSPECTIVES IN
4
CLINICAL MICROBIOLOGY
SERIES EDITOR: W. BRUMFITT
Other volumes in this series:
1. Brumfitt W, ed, Hamilton-Miller JMT, ass. ed: New perspectives in clinical microbi
ology. 1978. ISBN 90-247-2074-5
2. Tyrrell DAJ, ed: Aspects of slow and persistent virus infections. 1979. ISBN 90-247-
2281-0
3. Brumfitt W, Curcio L, Silvestri L, eds: Combined antimicrobial therapy. 1979. ISBN
90-247-2280-2
Series ISBN 90-247-2329-9
DEVELOPMENTS IN ANTIBIOTIC
TREATMENT OF RESPIRATORY
INFECTIONS
Proceedings of the Round Table Conference on Developments in
Antibiotic Treatment of Respiratory Infections in the Hospital
and General Practice, held in the Kurhaus, Scheveningen, The
Netherlands, June 15-16, 1980
edited by
RALPH VAN FURTH
Department of Infectious Diseases
University Hospital, Leiden
The Netherlands
1981
MART INUS NIJHOFF PUBLISHERS
THE HAGUE/BOSTON/LONDON
The organization of this round table conference and the publication of the proceedings were made
possible by the gratefully acknowledged financial support received from Abbott N.V., The
Netherlands
Distributors:
for the United States and Canada
Kluwer Boston, Inc.
190 Old Derby Street
Hingham, MA 02043
USA
for all other countries
Kluwer Academic Publishers Group
Distribution Center
P.O. Box 322
3300 AH Dordrecht
The Netherlands
Library of Congress Cataloging in Publication Data
Round Table Conference on Developments in Antibiotic Treatment of Respiratory Infections in the
Hospital and General Practice (1980: Scheveningen, Netherlands)
Developments in antibiotic treatment of respiratory infections.
(New perspectives in clinical microbiology; 4) Includes index.
1. Respiratory organs - Infections - Chemotherapy - Congresses. 2. Antibiotics - Con
gresses.
I. Furth, Ralph van. II. Title. III. Series.
RC735.A57R68 1980 616.2'00461 81-9533
ISBN -13 :978-94-009-8307-6 e-ISBN-13 :978-94-009-8305-2 AACR2
DOl: 10.1007/978-94-009-8305-2
Copyright © 1981 by Martinus Nijhoff Publishers, The Hague.
So/tcover reprint 0/ the hardcover 1st edition 1981
All rights resaved. No part of this publication may be reproduced, stored in a retrieval system, or
transmitted in any form or by any means, mechanical, photocopying, recording, or otherwise, without
the prior written permission of the publisher,
Martinus Nijhoff Publishers, P.O. Box 566,2501 CN The Hague, The Netherlands.
CONTENTS
List of contributors vii
1. Introduction
The role of host defence in respiratory infections
R. van Furth
MICROBIOLOGY
2. The current antibiotic sensitivity of Haemophilus influenzae 9
J.C. Gould
Discussion 15
3. Current pattern of antibiotic sensitivity of pneumococci 22
F.H. Kayser
Discussion 27
4. Antibiotic sensitivity of Staphylococcus aureus. Past and present 33
R.P. Mouton
Discussion 50
5. The colonization resistance of the digestive tract with special em-
phasis on the oropharynx 53
D. van der Waaij
Discussion 61
PHARMACOKINETICS
6. General review on pharmacokinetics of antimicrobial drugs in re-
lation to respiratory infections 71
H.Mattie
Discussion 78
7. Penetration ofmacrolides into the respiratory tract 79
F. Fraschini, M. Falchi and V. Copponi
Discussion 84
8. Penetration of various antibiotics into sputum 86
C. Simon
Discussion 95
VI
9. Penetration of various antibiotics into the middle ear 98
L. Sundberg and S. Ernstson
Discussion 112
10. Penetration of various antibiotics into sinus cavities 116
O. Kalm
Discussion 124
CLINICAL USE OF ANTIMICROBIAL AGENTS
11. Antibiotic treatment of sinusitis and otitis 131
P.B. van Cauwenberge
Discussion 141
12. Antibiotic treatment of chronic bronchitis 146
R.l. Davies and G.K. Knowles
Discussion 157
13. Treatment of respiratory infections in children 163
K.F. Kerrebijn
Discussion 170
14. Antibiotic treatment of Mycoplasma pneumoniae infections 175
M. Van der Straeten
Discussion 184
15. Developments in antibiotic treatment of respiratory infections ill
general practice towards better prescribing 188
P.R. Grob
Discussion 193
16. Antibiotic treatment during influenza virus infections 196
l.R. Dijkman
Discussion 204
17. Antimicrobial treatment of Legionella pneumonia 208
P.L. Meenhorst
Discussion 224
18. Pulmonary infections ill myelosuppressed or immunosuppressed
patients 226
J.W.M. van der Meer
Discussion 236
19. Prevention of respiratory infections by vaccination 238
R. van Furth
Discussion 245
Subject index 249
LIST OF CONTRIBUTORS
Cauwenberge van, P.B., Department of Otorhinolaryngology, Academisch
Ziekenhuis, De Pintelaan 135, B-9000 Ghent, Belgium
Davies, R.J., Academic Unit of Respiratory Medicine, St. Bartholomew's Hos
pital, West Smithfield, London ECIA 7BE, England
Dijkman, J.H., Department of Pulmonology, Academisch Ziekenhuis, Rijns
burgerweg 10,2333 AA Leiden, The Netherlands
Fraschini, F., Institute of Chemotherapy, Faculty of Medicine, University of
Milan, Via Vanvitelli 32, 20129 Milan, Italy
Furth van, R., Department of Infectious Diseases, Academisch Ziekenhuis,
Rijnsburgerweg 10, 2333 AA Leiden, The Netherlands
Gould, J.C., Central Microbiological Laboratories, Western General Hospital,
Grewe Road, Edinburgh EH4 2XU, Scotland
Grob, P.R., Devonshire House, Station Road, Addlestone, Surrey KTl5 2AG,
United Kingdom
Kalm, 0., Department of Otorhinolaryngology, University Hospital, Fack,
S-211 85 Lund, Sweden
Kayser, F.H., Institute of Medical Microbiology, University of Zurich,
Gloriastrasse 32, CH-8028 Zurich, Switzerland
Kerrebijn, K.F., Department of Pulmonary Diseases, Sophia Kinderziekenhuis,
Gordelweg 160, 3038 GE Rotterdam, The Netherlands
Mattie, H., Department of Infectious Diseases, Academisch Ziekenhuis, Rijns
burgerweg 10,2333 AA Leiden, The Netherlands
Meenhorst, P.L., Department of Infectious Diseases, Academisch Ziekenhuis,
Rijnsburgerweg 10, 2333 AA Leiden, The Netherlands
Meer van der, J.W.M., Department of Infectious Diseases, Academisch
Ziekenhuis, Rijnsburgerweg 10, 2333 AA Leiden, The Netherlands
Mouton, R.P., Department of Medical Microbiology, Academisch Ziekenhuis,
Rijnsburgerweg 10,2333 AA Leiden, The Netherlands
Simon, C., Abteilung fUr Allgemeine Paediatrie, UniversiHits-KinderkIinik,
Schwanenweg 20, 2300 Kiel 1, Germany
Straeten Van der, M., Department ofInternal Medicine, Section Chest Diseases,
Academisch Ziekenhuis, De Pintelaan 135, B-9000 Ghent, Belgium
VIII
Sundberg, L., Department of Otorhinolaryngology, Centrallasarettet, S-371 85
Karlskrona, Sweden
Waaij van der, D., Laboratory for Medical Microbiology, Academisch Zieken
huis, Oostersingel 59, 9713 EZ Groningen, The Netherlands
1. INTRODUCTION. THE ROLE OF HOST DEFENCE IN
RESPIRATORY INFECTIONS
R. VAN FURTH
In healthy individuals there is an equilibrium between the host and the micro
organisms in his environment, including those on the skin and mucous mem
branes. An infection occurs when the interaction between the host and these
micro-organisms is disturbed (Fig. I). This equilibrium can be disturbed because
the host comes into contact with potentially pathogenic micro-organisms to
which he has not yet been exposed and against which he does not yet have
sufficient resistance, or because the number of potentially pathogenic micro
organisms on the mucous membranes or in the air has increased, or because the
INFECTION
~
'"
HOST "" MICRO-
-----....~... ORGANISM
/
THERAPY
AND
PREVENTION
Fig. 1. Interaction between host and micro-organism.
host's resistance has decreased. It must be kept in mind, however, that there is a
difference between infection and contamination or colonization. An infection
can be defined as a combination of reactions of the host to micro-organisms that
have penetrated his body and multiply there. Here, the host plays an active role.
Contamination or colonization concerns the presence ofliving micro-organisms
on living tissue or dead material; thus, there is no reaction of the host to the
(local) presence of micro-organisms.
MICRO-ORGANISMS AND THE RESPIRATORY TRACT
The respiratory tract is usually divided into the upper respiratory tract, which
includes the nose, paranasal sinuses, middle ear, oral cavity, pharyngeal mucous
2
membranes, tonsils, epiglottis, and glottis, and the lower respiratory tract, which
comprises the larynx, trachea, in bronchi, bronchioli, and alveoli. This dis
tinction is useful, because under normal conditions the lower respiratory tract
below the glottis is sterile, whereas the mouth, nose, and oral cavity are colonized
by micro-organisms. If the mucous membranes of the lower respiratory tract
have undergone pathological changes (e.g., in chronic bronchitis) or the com
position of the mucus is abnormal (e.g., in mucoviscidosis) bacteria can be
present on the mucous membranes without inducing inflammatory phenomena.
Thus, colonization has occurred but not infection. This means that the presence
of only micro-organisms in the sputum is not always an indication of infection,
whereas when leukocytes are present as well, a (local) infection is probable if the
clinical picture is consistent with this diagnosis.
A wide variety of micro-organisms (viruses, bacteria, fungi, and protozoa) can
colonize the upper respiratory tract and are potential pathogens. Micro
organisms which can be involved in respiratory infections are listed in Table 1.
Table 1. Micro-organisms involved in respiratory infections.
Bacteria Viruses
Streptococcus pneumoniae Adenovirus
Haemophilus influenzae
Streptococcus pyogenes Coxsackie virus
Branhamella catarrhalis Echovirus
Staphylococcus aureus Rhinovirus
Legionella pneumophila
Mycoplasma pneumoniae Corona virus
Corynebacterium diphteriae
Bordetella pertussis Influenza virus
Para-influenza virus
Klebsiella pneumoniae Respiratory-synocytial virus
Escherichia coli Measles virus
Proteus species Mumps virus
Pseudomonas species
Cytomegalo virus
Mycobacterium tuberculosis Epstein-Barr virus
Nocardia asteroides Herpes simplex virus
Varicella-zoster virus
Bacteroides species
Fusobacterium species Reovirus
Peptostreptococcus species
Fungi
Chlamydia psittaci Candida albicans
Chlamydia trachomatis Aspergillus fumigatus
Protozoa
Pneumocystis carinii
