**8.4. Adjuvant therapy to treat secondary bacterial superinfections caused by influenza and other respiratory viruses**

Viral influenza is very common in community and is often mistreated with antibiotics. Antibacterial drugs are not meant for viral infections and misuse leads to creation of resistant bacterial species. Viral-bacterial co-infections in humans are well documented. Viral infections often lead to bacterial superinfections. Bacterial superinfections accompanied by influenza and other respiratory virus infections contribute to the significant morbidity and mortality particularly among elderly and young children.

Bacterial infection could be concomitant with influenza viral infection as a result of an enhanced pneumonic illness or may happen soon following influenza virus has been widely cleared from the lungs, when the host seems to be more susceptible to bacterial infection [57, 58].

Morbidity and mortality have been recognized to be greater in cases of influenza-associated bacterial infection in all age groups [59]. The increase in influenza infection during winter is often associated with a rise in cases of community-acquired pneumonia. The most common causes of CAP are *S. pneumoniae, S. aureus*, and *H. influenzae. S. pneumoniae* is the most frequently isolated pathogen associated with influenza [60], although deaths, especially in children, are also associated with *S. aureus* infection, as highlighted by the recent emergence of community-acquired methicillin-resistant *S. aureus* [61]. Besides influenza, other respiratory viruses, such as coronavirus, adenovirus, and respiratory syncytial virus, are also associated with pneumonia [62].

peroxidase), along with xanthine oxidase, lipid peroxidation, myeloperoxidase (MPO) levels, hepatic, and renal parameters were significantly improved in plasma and tissues of the AAE-

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Osteomyelitis is an infection and inflammation in bone which is primarily caused by *S. aureus* and *S. epidermidis* and the levels of cytokines (TNFα and IL-6) is increased in osteomyelitis [79]. Dwivedi et al. [80] demonstrated that the combination of antibiotic along with adjuvant significantly improved the inflammatory cytokines (TNFα and IL-6), malondialdehyde (MDA), and myeloperoxidase in animal osteomyelitis infection model. From the earlier explanation, it may be concluded that compounds or drugs along with adjuvant generating both antibacterial and anti-inflammatory effects are likely to be most effective at treating bacteria-

Venus Medicine Research Centre, Hill Top Industrial Estate, Jharmajri EPIP, Bhatoli Kalan, India

[1] American Thoracic Society, Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcareassociated pneumonia. American Journal of Respiratory and Critical Care Medicine.

[2] Sharma S, Maycher B, Eschun G. Radiological imaging in pneumonia: Recent innova-

[3] Dunn L. Pneumonia: Classification, diagnosis and nursing management. Nursing

[4] World Health Organization. Pocket Book of Hospital Care for Children: Guidelines for the Management of Common Illnesses with Limited Resources. Geneva: World Health

[5] Black RE, Cousens S, Johnson HL, Lawn JE, Rudan I, Bassani DG, et al. Global, regional, and national causes of child mortality in 2008: A systematic analysis. Lancet. 2010;

[6] Farooqui H, Jit M, Heymann D, Zodpey S. Burden of severe pneumonia, pneumococcal pneumonia and pneumonia deaths in Indian states: Modelling based estimates. PLoS

Standard (Royal College of Nursing (Great Britain). 1987, 2005;**19**(42):50-54

tions. Current Opinion in Pulmonary Medicine. 2007;**13**(3):159-169

treated group indicating antioxidant or free radical scavenging properties [50].

induced inflammatory syndromes.

Manu Chaudhary, Gazalla Ayub and Anurag Payasi\* \*Address all correspondence to: ccmb@vmrcindia.com

**Author details**

**References**

2005;**171**:388-416

Organization; 2005. p. 72

One. 2015;**10**(6):e0129191

**375**(9730):1969-1987

The mechanisms of superinfection are very complex process. Several reports indicate that changes due to virus in the respiratory tract prime the upper airway and lung make way for subsequent bacterial infection. Super bacterial infections are accompanied by virus-induced cytopathology, leading to immunological impairment, which could be caused in part by the overproduction of inflammatory cytokines [63]. Transformation of the immune response by curtailing the capacity of the host to clear bacteria may contribute to the severity of the resulting infection [64]. Earlier studies on animal model have demonstrated that influenza predisposes to bacterial pneumonia [63, 65, 66]. It has been reported with 7–21 days of lag time for the onset of bacterial infection following seasonal influenza. However, shorter times from onset to death have been noticed in pandemic periods [67–69].
