Common Viruses, Pronounced Impact
On a year-to-year basis, viral infections such as Middle East respiratory syndrome, severe acute respiratory syndrome, pandemic H1N1 "swine flu," and H7N9 "avian influenza" garner considerable attention from the general public and infection control specialists.
However, most people are at much greater risk of developing illnesses, which can be severe, from less exotic respiratory viruses, such as influenza, parainfluenza virus (PIV), and respiratory syncytial virus (RSV). When time lost from work or school, direct healthcare costs, and unnecessary use of antibiotics are considered, the societal and healthcare burdens of these more mundane viral infections become even more pronounced.
Although management of lower respiratory tract viral infections, especially in immunocompromised patients, can prove challenging, such advances as rapid multiplex polymerase chain reaction (PCR) panels that test for multiple viral and bacterial pathogens and the development of new antiviral approaches are changing the field.
Table 1. Snapshot of Consequences of Inappropriate Antibiotic Use in Treating Respiratory Viral Infections
An estimated 25%-50% of antibiotic use may be inappropriate.[7,8] Antibiotics are prescribed in over 100 million ambulatory visits annually, with respiratory conditions being the most common (41%) prescribing indication. Older age and emergency department settings are associated with greater use of broad-spectrum antibiotics.
Diagnostic uncertainty is a major driver of antimicrobial overuse. The widespread use of rapid respiratory virus detection has improved diagnostic accuracy, but has not yet been unequivocally linked to more focused use of antimicrobials. However, with increased urgency to control antibiotic use, this situation may improve.
Earlier this year, the American College of Physicians (ACP) and the Centers for Disease Control and Prevention (CDC) released best practices for appropriate use of antibiotics in respiratory tract infection in adults. These practices comprise four high-value care points (Table 2).
Table 2. ACP and CDC's Advice on Appropriate Antibiotic Use for Acute Respiratory Tract Infection in Adults
One cannot be dogmatic about equating the presence of a respiratory viral infection with the absolute absence of another process. Respiratory viral infections can also be associated with bacterial coinfections and superinfections. In addition, in highly immunocompromised patients, resolution of viral infections can sometimes be followed by development of invasive filamentous fungal infection (eg, aspergillosis).
Medscape Infectious Diseases © 2016 WebMD, LLC
Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: Commonly Encountered Respiratory Virus Infections: Update and New Treatments - Medscape - Nov 08, 2016.