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Stakeholder Insight: Respiratory Tract Infections in the USA - The Demise of Narrow-spectrum Antibiotics

Published by: Datamonitor

Published: Nov. 27, 2006 - 158 Pages


Table of Contents


ABOUT DATAMONITOR 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

Abstract

Introduction

In the US, approximately 88 million people are diagnosed with a respiratory tract infection in an average year. Of these, a total of 66 million patients suffer from one of the three major diagnoses: acute bacterial sinusitis (ABS), acute exacerbation of chronic bronchitis (AECB) and community-acquired pneumonia (CAP).

Scope
  • Diagnosis patterns of the three conditions: ABS, AECB and CAP, based on a survey of 90 physicians across the US
  • Analysis of treatment regimens and preferences for ABS, AECB and CAP, according to Datamonitor's primary research data
  • Ranking of the greatest areas of unmet need for diagnostics and therapeutics within the RTI market
  • Evaluation of the reasons underlying prescription choices; discussion of the differences between diagnoses
Highlights

According to Datamonitor research, 83-97% of patients diagnosed with RTIs receive antibiotic therapy regardless whether a bacterial pathogen could be identified or not. While beta lactams are preferred for ABS, newer macrolides and fluoroquinolones are routinely chosen to treat AECB and CAP.

The lack of quick and reliable laboratory tests to identify the underlying pathogen results in 68-80% of treatments to be initiated empirically. About 16% of patients across the three conditions fail first-line treatment and move on to second line, mostly due to a lack of coverage for and drug resistance of the causative organisms.

While physicians appear evenly divided between branded and generic drugs when prescribing for initially relatively benign conditions such as ABS and AECB, they strongly prefer newer, more expensive drugs both for more serious conditions such as CAP and when experiencing treatment failure of their initial drug choice.

Reasons to Purchase
  • Identify the key factors that influence prescribing patterns for US RTI pharmacotherapy
  • Examine the remaining and emerging unmet needs in the US RTI market and identify opportunities for new product development
  • Enhance your commercial positioning through an improved understanding of the US RTI market dynamics


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