Management of lower respiratory tract infections (LRTI’s): clinical microbiologists’ perspective

K V Ramana


In the era of emergence and re-emergence of newer and existing microorganisms, clinical and laboratory diagnosis of LRTI’s requires regular evaluation. Elaborating on possible predisposing factors will be critical to health care workers in the better management of patients suffering with Lower Respiratory Tract Infections (LRTI’s). Microbiologist’s role becomes crucial in deciding the culture methods to be employed to isolate the suspected causative microorganism and identification of the probable pathogen among mixed growth of the isolated bacteria/fungi. Antimicrobial therapy should necessarily be guided by the susceptibility patterns of various antibiotics against different microorganisms from a given geographical region, which should be regularly updated.


Lower Respiratory Tract Infections (LRTI’s), Diagnosis of LRTI’s, Patient management

Full Text:



World Health Organization. Disease and injury country estimates. Available at Accessed 12 February 2012.

Anne B Chang, Christina C Chang, K O Grady, P J Torzillo. Lower respiratory tract infections. Pediatr Clin N Am 2009;56:1303-21.

M. Woodhead, F. Blasi ,S.Ewig, G. Huchon, M. Ieven, T. Schaberg, A. Torres, G. van der Heijden, A. Ortqvist and T.J.M. Verhlj. Guidelines for the management of adult lower respiratory tract infections Eur Respir J 2005;26:1138-80.

Sharma BB, Singh V. Indian Pneumonia guidelines. Lung India 2012;29(4):307-8.

Karen C Carroll. Laboratory Diagnosis of Lower Respiratory Tract Infections: Controversy and Conundrums. J Clin Microbiol 2002;40(9):3115-20.

Beck JM, Young VB, Huffnagle GB. The microbiome of the lung. Transl Res 2012;160(4):258-66.

Cheung MK, Lam WY, Fung WYW, Law PTW, Au CH, et al. Sputum Microbiota in Tuberculosis as Revealed by 16S rRNA Pyrosequencing. PLoS One 2013;8(1):e54574.

Sheldon Campbell and Betty a Forbes. The Clinical Microbiology Laboratory in the Diagnosis of Lower Respiratory Tract Infections. J Clin Microbiol 2011;49(9 supplement):S30.

Beena Philomina J. Role of respiratory samples in the diagnosis of lower respiratory tract infections. Pulmon 2009;11:12-14.

OL Moncayo-Nieto, P Reid, IF Laurenson, AJ Simpson. Improving the use of sputum cultures in lower respiratory tract infection. J R Coll Physcians Edinb 2013;43:108-13.

Boloursaz MR, Lotfian F, Aghahosseini F, Cheraghvandi A, Khalilzadeh S, Farjah A, Boloursaz M. Epidemiology of Lower Respiratory Tract Infections in Children. J Compr Ped. 2013;3(3):93-8.

Borradale D. Combating the rise of the superbugs: The health and scientific challenges of antibiotic resistance. Australian Science. Retrieved: Sep 08, 2013, from

Whaley et al. Visit complexity, diagnostic uncertainty, and antibiotic prescribing for acute cough in primary care: a retrospective study. BMC Family Practice 2013 14:120Antibiotic apt diag/reduce antibiotic improve diagnosis.

King et al. Bacteria in COPD; their potential role and treatment. Translational Respiratory Medicine 2013;1:13.

Garcha DS, Thurston SJ, Patel AR, et al. Changes in prevalence and load of airway bacteria using quantitative PCR in stable and exacerbated COPD. Thorax 2012;67:1075–80.

Anselm Wang-Hei Hui, Hon-Wai Lau, Tiffany Hoi-Tung Chan, and Stephen Kwok-Wing Tsui. The human microbiota: a new direction in the investigation of thoracic diseases. J Thorac Dis. 2013 August;5(Suppl 2):S127–S131.

Z. Matkovic, M. Miravitlles. Chronic bronchial infection in COPD. Is there an infective phenotype? Resp Med 2013;107:10-22.

M. Woodhead, F. Blasi ,S.Ewig, G. Huchon, M. Ieven, T. Schaberg, A. Torres, G. van der Heijden, A. Ortqvist and T.J.M. Verhlj. Guidelines for the management of adult lower respiratory tract infections Eur Respir J 2005;26:1138-80.

Giovanni Battista Migliori, Miranda W. Langendam, Lia D’Ambrosio, Rosella Centis, et al. Protecting the tuberculosis drug pipeline: stating the case for the rational use of fluoroquinolones. Eur Respir J 2012;40:814-22.

Little P, Stuart B, Moore M, Coenen S, Butler CC, Godycki-Cwirko M. Amoxicillin for acute lower-respiratory-tract infection in primary care when pneumonia is not suspected: a 12-country, a randomised placebo-controlled trial. The Lancet Infectious Diseases 2012;13(2):123-9.

Brookes-Howell L, Hood K, Cooper L, et al. Clinical influences on antibiotic prescribing decisions for lower respiratory tract infection: a nine country qualitative study of variation in care. BMJ Open 2012;2:e000795.