According to the World Health Organization (WHO), respiratory tract infections, including pneumonia, are one of the leading causes of disability and death worldwide.
In turn, the irrational use of antibacterial drugs has led to the emergence of one of the most pressing problems of the 21st century − antibiotic resistance.
For more information about modern approaches to the treatment of infectious diseases of the respiratory tract, in particular pneumonia, as well as risk groups for this disease, read the article on estet-portal.com.
- Antibiotic resistance in the treatment of infectious diseases of the lower respiratory tract
- Risk groups for acute infectious diseases of the respiratory tract
- Empirical antibiotic therapy for community-acquired pneumonitisii
Antibiotic resistance in the treatment of infectious diseases of the lower respiratory tract
Recently, the results of the British study Review on Antimicrobial Resistance were published, according to which in 2050 the number of deaths caused by antibiotic resistance will exceed the death rates from cancer and diabetes combined.
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Thus, today, rational antibiotic therapy for infectious diseases of the respiratory tract is extremely important.
The results of a study by P. Daniel et al showed that early initiation of antibiotic therapy (up to 4 hours from the time of diagnosis) is associated with a low mortality rate from acute respiratory infections.
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Risk groups for acute infectious diseases of the respiratory tract
Depending on the presence of concomitant pathology, previous antibiotic therapy, the severity of the course of the disease and the assessment of adverse prognostic factors, there are three risk groups for patients with pneumonia.
1. The first group includes patients with non-severe pneumonia, who do not require hospitalization and do not have modifying factors.
modifying factors include:
- age> 65 years;
- chronic alcoholism;
- multiple comorbidities;
- immunodeficiency (including taking corticosteroids);
- smoking.
In about 50% of patients, it is not possible to identify the causative agent of pneumonia, and, therefore, routine microbiological diagnostics is impractical.
The causative agents that most often cause the development of pneumonia of the first group are:
- Streptococcus pneumoniae;
- Mycoplasma pneumoniae;
- Chlamydophila pneumoniae;
- Haemophilus influenza;
- respiratory viruses.
In the management of group 1 pneumonia, the antibiotic of choice is amoxicillin (oral), alternatively macrolides or doxycycline.
2. The second group includes patients with non-severe pneumonia who do not require hospitalization and who have comorbidities:
- chronic bronchitis;
- renal or heart failure;
- diabetes mellitus;
- liver diseases of various etiologies;
- chronic alcoholism.
The most common pneumonia pathogens in the second group are:
- Streptococcus pneumoniae;
- Haemophilus influenza;
- Staphylococcus aureus;
- Moraxella catarrhalis.
As in the first group, routine microbiological diagnostics is not very informative and practically does not affect the choice of antibiotics.
For treatment, the antibiotic of choice is amoxicillin/clavulanic acid, alternatively fluoroquinolones III-IV generation or cefditoren.
3. The third group includes patients with non-severe pneumonia requiring hospitalization in a therapeutic hospital.
Most often pneumonia pathogens in the third group of patients are:
- Streptococcus pneumoniae;
- Haemophilus influenza;
- atypical pathogens;
- gram-negative bacteria.
When conducting microbiological diagnostics, in 10-40% of cases, the presence of mixed flora.
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Management of group 3 pneumonia involves the use of a combination of protected aminopenicillins parenterally and an oral macrolide/III generation cephalosporins and an oral macrolide.
Alternatively, fluoroquinolones III-IV generation or a combination of antibiotics of the carbapenem groups and a macrolide can be used s.
Empirical antibiotic therapy for community-acquired pneumonia
Empirical antibiotic therapy for community-acquired pneumonia includes several items:
1. Outpatient treatment, without comorbidity, risk
- Azithromycin 500 mg once a day once, then 250 mg once a day for 4 days;
- Clarithromycin 500 mg twice a day for 7 days;
- Doxycycline 100 mg twice a day for 5-7 days.
pneumonia if there is comorbidity:
Amoxicillin/clavulanic acid 500/125 mg 3 times a day or 875/125 mg 2 times a day or cefuroxime 500 mg 2 times a day in combination with macrolides;- Levofloxacin 750 mg once a day for 5 days;
- Moxifloxacin 400 mg once a day for 5-7 days;
- Gemifloxacin 320 mg once a day for 5-7 days.
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The basis of rational antibiotic therapyis:
correct choice of antibacterial drug;- its optimal dosage;
- use duration.
- This allows to significantly reduce the burden of infectious diseases, as well as one of the main problems of modern medicine −
.