米国における呼吸器感染症

Abstract

Overview

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

Report 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

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