Stakeholder Insight: Respiratory Tract Infections in the USA - The demise of narrow-spectrum antibiotics

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