The Management of Respiratory Tract Infections: A Focus on Appropriate Antibiotic Utilization

Streptococcus pneumoniae.

The American Journal of Managed Care

Community-acquired respiratory tractinfections (CARTIs) account for morethan 100 million office visits eachyear, and impart tremendous health andeconomic consequences to managed careorganizations and their members. In additionto the typical and atypical pathogens thataccount for most CARTI cases, increases inthe resistance of these pathogens to traditionalempiric therapies continue to be reportedthroughout the world, including increases inmultidrug-resistant A new class of antibiotics, the ketolides,possesses many attributes that comparefavorably to existing empiric CARTI therapies,and offers managed care decision makersand physicians a new choice for themanagement of CARTIs. This supplement to willreview emerging strategies for antibioticselection and highlight the available clinicaland economic data for the ketolide class.

The supplement begins with an articlewhich reviews the epidemiology andcausative pathogens associated with community-acquired pneumonia (CAP), acuteexacerbation of chronic bronchitis (AECB),and acute rhinosinusitis (AS). The articleintroduces the concept of "collateral damage"caused by inappropriate antibiotic therapyand reviews the components of a usefulframework for selecting antibiotic agents forthe treatment of CARTIs.

An article by John A. Sbarbaro, MD, MPH,FCCP, follows with a review of the chemicalstructure and mechanism of action of theketolide class of antibiotics. The articlereviews the in vitro activity and the pharmacokineticand pharmacodynamic propertiesof telithromycin, the first ketolideantibiotic available in the United States. Areview of the safety and clinical efficacy oftelithromycin in CAP, AECB, and AS trials ispresented.

The supplement concludes with an articleby Diana I. Brixner, RPh, PhD, whichreviews the disease burden and economiclandscape of CAP and AECB, including areview of CAP hospitalization costs amongthe elderly. The article presents severaltreatment guidelines for the management ofCAP, and reviews the results of several trialsthat both support and contradict these recommendations.The article also presents theresults of the 4 telithromycin studies thatincluded a post-trial comparative analysisof health outcomes for telithromycin andthe comparator therapy, including resourceutilization, hospitalization rates, and economiccosts.

Together, these articles provide valuableinformation that can be used by managedcare decision makers and physicians as theyevaluate and compare the clinical and economicattributes of various antibiotic therapiesfor the treatment of CARTIs.

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