Respiratory Tract Infections in the USA
Scope
Report Highlights
Reasons to Purchase
Table of Contents
- ABOUT DATAMONITOR HEALTHCARE - page 2
- About the infectious diseases pharmaceutical analysis team - page 2
- CHAPTER 1 EXECUTIVE SUMMARY - page 3
- Scope of the analysis - page 3
- Datamonitor insight into the respiratory tract infections (RTIs) market - page 4
- CHAPTER 2 INTRODUCTION AND SCOPE - page 7
- Coverage of the Stakeholder Insight Survey - page 7
- Disease definition and epidemiology - page 7
- Diagnosis - page 7
- Treatment - page 7
- Key prescribing influences - page 7
- Coverage of the Stakeholder Insight Survey - page 7
- CHAPTER 3 TREATMENT TREES ABS, AECB, CAP - page 9
- Treatment trees for ABS - page 11
- Treatment trees for AECB - page 13
- Treatment trees for CAP - page 15
- CHAPTER 4 EPIDEMIOLOGY AND PATIENT SEGMENTATION DISEASE DEFINITION - page 18
- The respiratory tract - page 18
- Infections of the respiratory tract - page 19
- Acute bacterial sinusitis (ABS) - page 20
- Disease prevalence - page 20
- Disease mechanism - page 20
- Symptoms - page 23
- Diagnosis - page 24
- Classification of disease - page 27
- Acute exacerbations of chronic bronchitis (AECB) - page 29
- Disease prevalence - page 29
- Diagnosis - page 33
- Community acquired pneumonia - page 34
- Disease prevalence - page 34
- Symptoms - page 35
- Diagnosis - page 37
- The respiratory tract - page 18
- CHAPTER 5 DIAGNOSIS AND TREATMENT OPTIONS - page 38
- Presentation and diagnosis - page 38
- Physician types responsible for diagnosis - page 38
- Role of primary care physicians and internists - page 40
- Role of other specialists - page 40
- Diagnostic tools - page 41
- Diagnosis of ABS is based on clinical prediction rules - page 42
- AECB is diagnosed primarily on self-reported symptoms and clinical assessment - page 46
- Chest radiography is critical for accurate CAP diagnosis - page 47
- Evaluation of diagnostic tests - page 50
- Physician types responsible for diagnosis - page 38
- Treatment - page 55
- Physician types responsible for treatment - page 55
- First-line treatment for ABS, AECB, and CAP is given empirically - page 56
- Treatment failures are the principal reason for switching to second line therapy - page 59
- Treatment options - page 65
- Duration of therapy: trend to shorter treatment - page 66
- Guideline endorsed antibiotics - page 68
- Amoxicillin - page 68
- Amoxicillin plus clavulanate - page 68
- Cephalosporins (cefpodoxime [Vantin], cefuroxime, cefdinir [Omnicef], ceftriaxone [Rocephin]) - page 69
- Macrolides (Azithromycin, clarithromycin) - page 70
- Fluoroquinolones (Levofloxacin, moxifloxacin) - page 70
- Telithromycin (Ketek) - page 71
- Treatment guidelines - page 71
- Treatment guidelines for ABS - page 71
- Treatment guidelines for AECB - page 77
- Treatment guidelines for CAP - page 81
- Overuse of antibacterials has led to the emergence of resistant strains - page 87
- Referral patterns - page 94
- Presentation and diagnosis - page 38
- CHAPTER 6 PRESCRIBING TRENDS AND INFLUENCING FACTORS PRESCRIBING TRENDS - page 99
- Drug classes most commonly prescribed - page 99
- Antibacterials most commonly prescribed - page 100
- Brand versus generic - page 103
- Pathogen-specific therapies - page 105
- Streptococcus pneumoniae - page 106
- Haemophilus influenzae - page 108
- Moraxella catarrhalis - page 110
- Other pathogens - page 111
- Atypical pathogens - page 114
- Changes in therapy - page 115
- Factors influencing physician decision making - page 116
- Drug classes most commonly prescribed - page 99
- CHAPTER 7 IMPROVING TREATMENT OUTCOMES - page 127
- Challenges in choosing appropriate antibacterial treatment - page 127
- Impact of treatment failure - page 128
- Unmet needs - page 129
- Diagnostic unmet needs - page 129
- Therapeutic unmet needs - page 131
- Measures to improve treatment outcomes - page 133
- Treatment guidelines - page 134
- Controlling antibiotic resistance - page 134
- National campaigns - page 134
- Surveillance systems - page 135
- Future trends - page 137
- New product development - page 138
- Faropenem daloxate - page 138
- Garenoxacin - page 139
- New product development - page 138
- Challenges in choosing appropriate antibacterial treatment - page 127
- CHAPTER 8 BIBLIOGRAPHY - page 140
- Websites - page 144
- Company press releases - page 145
- APPENDIX A - page 146
- Physician research methodology - page 146
- Physician sample breakdown - page 146
- Physician research methodology - page 146
- APPENDIX B - page 148
- The study questionnaire for the physician survey - page 148
- The opinion leader discussion guide - page 148
- Disclaimer - page 154
- List of Tables
- Table 1: Percentage of patients prescribed each class of antibiotic, 2006 - page 99
- Table 2: US physician sample breakdown, 2006 - page 146
- List of Figures
- Figure 1: Diagrammatic overview of the Stakeholder Insight: Respiratory tract infections in the US survey - page 8
- Figure 2: Total number of patients diagnosed with an RTI each year - page 10
- Figure 3: Treatment tree for ABS in the US (first line) - page 11
- Figure 4: Treatment tree for ABS in the US (second line) - page 12
- Figure 5: Treatment tree for AECB in the US (first line) - page 13
- Figure 6: Treatment tree for AECB in the US (second line) - page 14
- Figure 7: Treatment tree for CAP in the US (first line) - page 15
- Figure 8: Treatment tree for CAP in the US (second line) - page 16
- Figure 9: Treatment tree for CAP in the US (second line therapy for atypical pathogens) - page 17
- Figure 10: Infections of the respiratory tract - page 19
- Figure 11: Four types of sinuses and locations - page 21
- Figure 12: Comparison of a normal sinus with an infected sinus - page 22
- Figure 13: Pathogens implicated in acute bacterial sinusitis infections - page 23
- Figure 14: Management of acute bacterial sinusitis, 2006 - page 26
- Figure 15: Classification of acute bacterial sinusitis - page 28
- Figure 16: Rates of emergency department visits for patients with chronic bronchitis, 1992 and 2000 - page 30
- Figure 17: Anatomy of the lung, effects of bronchitis on normal bronchi - page 31
- Figure 18: Etiology of acute exacerbations of chronic bronchitis - page 32
- Figure 19: Classification of acute exacerbations of chronic bronchitis - page 33
- Figure 20: Percentage breakdown of physicians involved in the diagnosis of ABS, AECB and CAP in the US, 2006 - page 39
- Figure 21: Percentage of physicians using each diagnostic tool, 2006 - page 42
- Figure 22: Percentage of patients on whom each diagnostic tool is used, 2006 - page 42
- Figure 23: The Williams Rule for diagnosis of acute bacterial sinusitis - page 44
- Figure 24: The Berg Rule for diagnosis of acute bacterial sinusitis - page 45
- Figure 25: FEV1 and FVC in normal pulmonary function and in COPD - page 46
- Figure 26: Pneumonia severity index - page 50
- Figure 27: Rating of each test according to accuracy for ABS, AECB and CAP diagnosis, 2006 - page 52
- Figure 28: Level of influence of different factors on use of laboratory-based microbiological techniques, 2006 - page 54
- Figure 29: Level of satisfaction with current laboratory-based microbiological assays, 2006 - page 55
- Figure 30: Percentage breakdown of physicians involved in treatment of ABS, AECB and CAP - page 56
- Figure 31: Distribution of first-line therapy for ABS, AECB and CAP by disease, 2006 - page 59
- Figure 32: Percentage of patients switched onto second-line therapy after initial treatment with empiric therapy for ABS, AECB and CAP, 2006 - page 60
- Figure 33: Reasons for changing from empiric first-line therapy to second-line therapy - page 61
- Figure 34: Percentage of patients failing first-line treatment by cause, 2006 - page 62
- Figure 35: Percentage breakdown of patients failing first-line treatment by physician type, 2006 - page 63
- Figure 36: Reasons for lack of coverage of empiric first-line therapy, 2006 - page 64
- Figure 37: Choice of therapy following identification of resistant strain of pathogen in patients with ABS, AECB and CAP, 2006 - page 65
- Figure 38: Overview of antibiotic classes - page 66
- Figure 39: Summary of US antibiotic treatment recommendations for ABS - page 74
- Figure 40: Treatment algorithm for ABS - page 76
- Figure 41: Stratification of patients with AECB - page 78
- Figure 42: Antibiotics commonly used to treat patients with AECB - page 80
- Figure 43: Treatment algorithm for AECB patients - page 81
- Figure 44: Stratification of patients recommended by ATS guidelines - page 82
- Figure 45: Treatment guidelines from the IDSA - page 84
- Figure 46: Treatment guidelines from ATS - page 86
- Figure 47: Treatment algorithm for CAP patients - page 87
- Figure 48: Primary care office visits and antibiotic prescriptions for acute respiratory illnesses in the United States (National Ambulatory Medical Care Survey, 1998) - page 89
- Figure 49: Increase in macrolide resistance , 1993-99 - page 91
- Figure 50: Growth in penicillin and TMP-SMX resistance, 1994/95-2002/03 - page 91
- Figure 51: Susceptibility of key pathogens in AECB results from TRUST 6 study - page 92
- Figure 52: S. pneumoniae resistance trends, 1998/99-2004/05 - page 93
- Figure 53: Susceptibility to common antibacterials among 2,901 S. pneumoniae isolates from US adults, 2006 - page 94
- Figure 54: Patient referral for ABS, AECB and CAP by specialty, 2006 - page 96
- Figure 55: Percentage of patients being consulted directly by each specialist, 2006 - page 97
- Figure 56: Reasons for referral on to a different specialist, 2006 - page 98
- Figure 57: Percentage of patients prescribed each type of antibacterial for ABS, 2006 - page 101
- Figure 58: Percentage of patients prescribed each type of antibacterial for AECB, 2006 - page 102
- Figure 59: Percentage of patients prescribed each type of antibacterial for CAP, 2006 - page 103
- Figure 60: Percentages of physicians prescribing branded products and generics, 2006 - page 104
- Figure 61: Percentages of physicians prescribing generics, 2006 - page 105
- Figure 62: Percentage of physicians prescribing selected antibacterials against strains of S. pneumoniae, 2006 - page 108
- Figure 63: Percentage of physicians prescribing selected therapies against H. influenzae strains, 2006 - page 110
- Figure 64: Percentage of physicians prescribing selected therapies against M. catarrhalis strains, 2006 - page 111
- Figure 65: Other pathogens implicated in ABS, AECB and CAP infections, 2006 - page 113
- Figure 66: Atypical pathogens implicated in ABS, AECB and CAP infections, 2006 - page 115
- Figure 67: Percentage of patients on monotherapy, combination therapy of two drugs and combination therapy of more than two drugs, 2006 - page 118
- Figure 68: Factors influencing physicians' choice of empiric therapy, 2006 - page 119
- Figure 69: Factors influencing choice of treatment ranked by importance, 2006 - page 120
- Figure 70: Factors influencing choice of prescription in RTI treatment, 2006 - page 122
- Figure 71: Bar chart representing the factors influencing choice of prescription in RTI treatment, 2006 - page 123
- Figure 72: Performance ratings for selected antibacterials in RTI treatment, 2006 - page 124
- Figure 73: Performance ratings of selected antibacterials in treatment of RTIs, 2006 - page 125
- Figure 74: Sum of ratings given to each drug - page 126
- Figure 75: Level of satisfaction with current laboratory based microbiological assays, 2006 - page 130
- Figure 76: Therapeutic unmet needs in the treatment of ABS, AECB and CAP, 2006 - page 131
- Figure 77: Other unmet needs in the treatment of ABS, AECB and CAP, 2006 - page 132
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