Table of Contents
- ABOUT HEALTHCARE
- About the infectious diseases pharmaceutical analysis team
- CHAPTER 1 EXECUTIVE SUMMARY
- Scope of the analysis
- Datamonitor insight into the respiratory tract infections (RTIs) market
- CHAPTER 2 INTRODUCTION AND SCOPE
- Coverage of the Stakeholder Insight Survey
- Disease definition and epidemiology
- Diagnosis
- Treatment
- Key prescribing influences
- CHAPTER 3 TREATMENT TREES ABS, AECB, CAP
- Treatment trees for ABS
- Treatment trees for AECB
- Treatment trees for CAP
- CHAPTER 4 EPIDEMIOLOGY AND PATIENT SEGMENTATION DISEASE DEFINITION
- The respiratory tract
- Infections of the respiratory tract
- Acute bacterial sinusitis (ABS)
- Disease prevalence
- Disease mechanism
- Symptoms
- Diagnosis
- Classification of disease
- Acute exacerbations of chronic bronchitis (AECB)
- Disease prevalence
- Diagnosis
- Community acquired pneumonia
- Disease prevalence
- Symptoms
- Diagnosis
- CHAPTER 5 DIAGNOSIS AND TREATMENT OPTIONS
- Presentation and diagnosis
- Physician types responsible for diagnosis
- Role of primary care physicians and internists
- Role of other specialists
- Diagnostic tools
- Diagnosis of ABS is based on clinical prediction rules
- AECB is diagnosed primarily on self-reported symptoms and clinical
assessment
- Chest radiography is critical for accurate CAP diagnosis
- Evaluation of diagnostic tests
- Treatment
- Physician types responsible for treatment
- First-line treatment for ABS, AECB, and CAP is given empirically
- Treatment failures are the principal reason for switching to second
line therapy
- Treatment options
- Duration of therapy: trend to shorter treatment
- Guideline endorsed antibiotics
- Amoxicillin
- Amoxicillin plus clavulanate
- Cephalosporins (cefpodoxime [Vantin], cefuroxime, cefdinir
[Omnicef], ceftriaxone [Rocephin])
- Macrolides (Azithromycin, clarithromycin)
- Fluoroquinolones (Levofloxacin, moxifloxacin)
- Telithromycin (Ketek)
- Treatment guidelines
- Treatment guidelines for ABS
- Treatment guidelines for AECB
- Treatment guidelines for CAP
- Overuse of antibacterials has led to the emergence of resistant strains
- Referral patterns
- CHAPTER 6 PRESCRIBING TRENDS AND INFLUENCING FACTORS PRESCRIBING TRENDS
- Drug classes most commonly prescribed
- Antibacterials most commonly prescribed
- Brand versus generic
- Pathogen-specific therapies
- Streptococcus pneumoniae
- Haemophilus influenzae
- Moraxella catarrhalis
- Other pathogens
- Atypical pathogens
- Changes in therapy
- Factors influencing physician decision making
- CHAPTER 7 IMPROVING TREATMENT OUTCOMES
- Challenges in choosing appropriate antibacterial treatment
- Impact of treatment failure
- Unmet needs
- Diagnostic unmet needs
- Therapeutic unmet needs
- Measures to improve treatment outcomes
- Treatment guidelines
- Controlling antibiotic resistance
- National campaigns
- Surveillance systems
- Future trends
- New product development
- Faropenem daloxate
- Garenoxacin
- CHAPTER 8 BIBLIOGRAPHY
- Websites
- Company press releases
- APPENDIX A
- Physician research methodology
- Physician sample breakdown
- APPENDIX B
- The study questionnaire for the physician survey
- The opinion leader discussion guide
- Disclaimer
- List of Tables
- Table 1: Percentage of patients prescribed each class of antibiotic,
2006
- Table 2: US physician sample breakdown, 2006
- List of Figures
- Figure 1: Diagrammatic overview of the Stakeholder Insight:
Respiratory tract infections in the US survey
- Figure 2: Total number of patients diagnosed with an RTI each year
- Figure 3: Treatment tree for ABS in the US (first line)
- Figure 4: Treatment tree for ABS in the US (second line)
- Figure 5: Treatment tree for AECB in the US (first line)
- Figure 6: Treatment tree for AECB in the US (second line)
- Figure 7: Treatment tree for CAP in the US (first line)
- Figure 8: Treatment tree for CAP in the US (second line)
- Figure 9: Treatment tree for CAP in the US (second line therapy for
atypical pathogens)
- Figure 10: Infections of the respiratory tract
- Figure 11: Four types of sinuses and locations
- Figure 12: Comparison of a normal sinus with an infected sinus
- Figure 13: Pathogens implicated in acute bacterial sinusitis infections
- Figure 14: Management of acute bacterial sinusitis, 2006
- Figure 15: Classification of acute bacterial sinusitis
- Figure 16: Rates of emergency department visits for patients with
chronic bronchitis, 1992 and 2000
- Figure 17: Anatomy of the lung, effects of bronchitis on normal bronchi
- Figure 18: Etiology of acute exacerbations of chronic bronchitis
- Figure 19: Classification of acute exacerbations of chronic bronchitis
- Figure 20: Percentage breakdown of physicians involved in the
diagnosis of ABS, AECB and CAP in the US, 2006
- Figure 21: Percentage of physicians using each diagnostic tool, 2006
- Figure 22: Percentage of patients on whom each diagnostic tool is
used, 2006
- Figure 23: The Williams Rule for diagnosis of acute bacterial sinusitis
- Figure 24: The Berg Rule for diagnosis of acute bacterial sinusitis
- Figure 25: FEV1 and FVC in normal pulmonary function and in COPD
- Figure 26: Pneumonia severity index
- Figure 27: Rating of each test according to accuracy for ABS, AECB and
CAP diagnosis, 2006
- Figure 28: Level of influence of different factors on use of
laboratory-based microbiological techniques, 2006
- Figure 29: Level of satisfaction with current laboratory-based
microbiological assays, 2006
- Figure 30: Percentage breakdown of physicians involved in treatment of
ABS, AECB and CAP
- Figure 31: Distribution of first-line therapy for ABS, AECB and CAP by
disease, 2006
- Figure 32: Percentage of patients switched onto second-line therapy
after initial treatment with empiric therapy for ABS, AECB and CAP, 2006
- Figure 33: Reasons for changing from empiric first-line therapy to
second-line therapy
- Figure 34: Percentage of patients failing first-line treatment by
cause, 2006
- Figure 35: Percentage breakdown of patients failing first-line
treatment by physician type, 2006
- Figure 36: Reasons for lack of coverage of empiric first-line therapy,
2006
- Figure 37: Choice of therapy following identification of resistant
strain of pathogen in patients with ABS, AECB and CAP, 2006
- Figure 38: Overview of antibiotic classes
- Figure 39: Summary of US antibiotic treatment recommendations for ABS
- Figure 40: Treatment algorithm for ABS
- Figure 41: Stratification of patients with AECB
- Figure 42: Antibiotics commonly used to treat patients with AECB
- Figure 43: Treatment algorithm for AECB patients
- Figure 44: Stratification of patients recommended by ATS guidelines
- Figure 45: Treatment guidelines from the IDSA
- Figure 46: Treatment guidelines from ATS
- Figure 47: Treatment algorithm for CAP patients
- Figure 48: Primary care office visits and antibiotic prescriptions for
acute respiratory illnesses in the United States (National Ambulatory
Medical Care Survey, 1998)
- Figure 49: Increase in macrolide resistance , 1993-99
- Figure 50: Growth in penicillin and TMP-SMX resistance, 1994/95-2002/03
- Figure 51: Susceptibility of key pathogens in AECB results from TRUST
6 study
- Figure 52: S. pneumoniae resistance trends, 1998/99-2004/05
- Figure 53: Susceptibility to common antibacterials among 2,901 S.
pneumoniae isolates from US adults, 2006
- Figure 54: Patient referral for ABS, AECB and CAP by specialty, 2006
- Figure 55: Percentage of patients being consulted directly by each
specialist, 2006
- Figure 56: Reasons for referral on to a different specialist, 2006
- Figure 57: Percentage of patients prescribed each type of
antibacterial for ABS, 2006
- Figure 58: Percentage of patients prescribed each type of
antibacterial for AECB, 2006
- Figure 59: Percentage of patients prescribed each type of
antibacterial for CAP, 2006
- Figure 60: Percentages of physicians prescribing branded products and
generics, 2006
- Figure 61: Percentages of physicians prescribing generics, 2006
- Figure 62: Percentage of physicians prescribing selected
antibacterials against strains of S. pneumoniae, 2006
- Figure 63: Percentage of physicians prescribing selected therapies
against H. influenzae strains, 2006
- Figure 64: Percentage of physicians prescribing selected therapies
against M. catarrhalis strains, 2006
- Figure 65: Other pathogens implicated in ABS, AECB and CAP infections,
2006
- Figure 66: Atypical pathogens implicated in ABS, AECB and CAP
infections, 2006
- Figure 67: Percentage of patients on monotherapy, combination therapy
of two drugs and combination therapy of more than two drugs, 2006
- Figure 68: Factors influencing physicians' choice of empiric therapy,
2006
- Figure 69: Factors influencing choice of treatment ranked by
importance, 2006
- Figure 70: Factors influencing choice of prescription in RTI
treatment, 2006
- Figure 71: Bar chart representing the factors influencing choice of
prescription in RTI treatment, 2006
- Figure 72: Performance ratings for selected antibacterials in RTI
treatment, 2006
- Figure 73: Performance ratings of selected antibacterials in treatment
of RTIs, 2006
- Figure 74: Sum of ratings given to each drug
- Figure 75: Level of satisfaction with current laboratory based
microbiological assays, 2006
- Figure 76: Therapeutic unmet needs in the treatment of ABS, AECB and
CAP, 2006
- Figure 77: Other unmet needs in the treatment of ABS, AECB and CAP,
2006
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