title: The most appropriate therapeutic strategy for acute lower respiratory tract infections: a Delphi-based approach.
abstract: Lower respiratory tract infections (LRTIs) cause high morbidity and mortality worldwide. Empiric therapy often base the choice of antibiotic treatment on antibacterial spectrum of the agent rather than on its pharmacological properties or the pathogen resistance profile. Inappropriate prescribing leads to therapeutic failure and antibiotic resistance, with increasing direct and indirect health costs. A consensus on appropriate prescribing in LRTI therapy was appraised by this Delphi exercise, based on a panel of 70 pulmonologists, coordinated by a Scientific Committee of nine experts in respiratory medical care. Full or very high consensus was reached on several issues, including the role of oral cephalosporins in first-line treatments of LRTIs and the appropriateness of cefditoren, with balanced spectrum and high intrinsic activity, in LRTI treatment. Evidence-based medicine approach and a comprehensive process of disease management, from diagnosis to therapy and follow-up, should guide antibiotic prescribing.
authors.affiliation: a Department of Pathophysiology and Transplantation , Università degli Studi di Milano, Cardio-Thoracic Unit and Adult Cystic Fibrosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico , Milan , Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Blasi
authors.affiliation: b Section of Infectious Diseases, Department of Pathology and Diagnostics , Azienda Ospedaliera Universitaria Integrata , Policlinico G B Rossi, Verona , Italy.
authors.forename: Ercole
authors.initials: E
authors.lastname: Concia
authors.affiliation: c Unit of Interventional Pulmonology, High Speciality "A. Cardarelli" Hospital , Naples , Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Del Prato
authors.affiliation: d Internal Medicine, Hospital San Giovanni Bosco Hospital , Turin , Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Giusti
authors.affiliation: e Department of Health Sciences , Section of Clinical Pharmacology and Oncology, University of Florence , Firenze , Italy.
authors.forename: Teresita
authors.initials: T
authors.lastname: Mazzei
authors.affiliation: f C.R.E.A. Sanità. University of Rome Tor Vergata , Rome , Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Polistena
authors.affiliation: g Responsabile Nazionale Area Progettuale SIMG Malattie Infettive , Terni , Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Rossi
authors.affiliation: h Dipartimento di Scienze Biomediche e Biotecnologiche, School of Medicine , University of Catania , Catania , Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Stefani
authors.affiliation: e Department of Health Sciences , Section of Clinical Pharmacology and Oncology, University of Florence , Firenze , Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Novelli
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002511:Cephalosporins / Q000627:therapeutic use; D024881:Drug Resistance, Bacterial / Q000187:drug effects; D019317:Evidence-Based Medicine / Q000379:methods; D006801:Humans; D057970:Inappropriate Prescribing / Q000009:adverse effects; D012141:Respiratory Tract Infections / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; C073460:cefditoren
keywords: Antibiotic resistance; Cefditoren; Cephalosporins; Delphi-based consensus; LRTIs; Prescribing appropriateness