Antibiotics for pneumonia : doctor's opinion
Medicine / / May 18, 2016
- basic rules of rational antibiotic therapy
- Features choice of antibiotic therapy depends on the age
- Monitoring the effectiveness of the therapy
- Problems antibiotic
- errors in the treatment of antibiotic
Pneumonia - an acutedisease infectious etiology, accompanied by the formation of inflammatory fluid in the lung tissue.Before the discovery of penicillin, the disease characterized by a high mortality rate.Currently, the use of antibacterial agents is the basis for the treatment of pneumonia.
customary to distinguish two kinds of antibiotic therapy:
- causal - if the pathogen is defined by means of bacteriological examination of sputum.Sowing is advantageously carried out before the use of antibiotics.
- empiric therapy - in a situation where the pathogen is unknown.Empirical treatment is applied early in the disease, since the identification of the agent as a result of planting only 3-4 days.
basic rules of rational antibiotic therapy
When empiric antimicrobial agents
- Which antibiotic use - usually used monotherapy.In some cases, required a combination of antibiotics: in case of severe pneumonia within, a high probability of mixed infections, the presence of severe immunodeficiency.
- daily dose - depending on the age, severity of disease and the presence of concomitant diseases (e.g. renal failure).
- method of administration - in case of severe pneumonia during the preferred parenteral (injectable) method in a light and average - used oral forms of antibiotics.It is also more convenient tablet form for use in the home for outpatient treatment.
- course of treatment - usually 7 to 10 days.If pneumonia caused by atypical flora (mycoplasma, chlamydia, legionellёznoy infection), treatment periods are 2-3 weeks.
antibiotics for pneumonia are appointed taking into account the following points:
- epidemiological situation in the region, the prevalence of certain pathogens.
- medical history - is taken into account previous therapy, including antibacterial agents (eg, bronchitis, pneumonia with previous).
- presence of allergic reactions.
- clinical features - so, pneumococcal pneumonia often develops on the background of the previous SARS and is characterized by the classic symptoms.For mycoplasma pneumonia is characterized by atypical clinic: the cough is dry, unproductive, no chest pain, muscle pain expressed.Nosocomial pneumonia caused mainly staphylococcal infection, Haemophilus influenzae.In patients with severe impairment of the immune status of pneumonia is often caused by a viral or fungal flora.
- Pharmaco-economic factors - the prescribed treatment should be available to the patient at a cost.
Features choice of antibiotic therapy depends on the age
- Patients younger age with community-acquired pneumonia mild or moderate choice of drugs will be aminopenicillin or macrolides.
- In elderly patients in this situation is optimal to use "protected" or aminopenicillins tselafosporinov II generation.Furthermore, in this group of patients with a high probability of having an atypical flora (Chlamydia or Legionella infection) so you can use a combination therapy with the use of macrolides.
- community-acquired pneumonia in children in the first six months of life is an indication for hospitalization.As the therapy is applied parenteral administration of protected penicillins or cephalosporins II-III generation.In older children used penicillins, cephalosporins, and macrolides.Fluoroquinolones have age restrictions.
Monitoring the effectiveness of the therapy
When appropriately-chosen antibacterial drugs are improving the patient's condition during the first two days of therapy.The signs of effective treatment include the following:
- normalization of temperature, or the tendency to reduce it;
- reduction of intoxication symptoms (headaches, aching bones and muscles, pain in the eyeballs);
- change in laboratory parameters: reduction in the number of white blood cells in the sputum, blood count;
- positive dynamics of X-ray examination.
Unfortunately, not always possible to achieve a successful treatment with antibiotics, which may be due to the following reasons:
- formation of antibiotic resistance of pathogenic flora;
- increase epidemiological significance in the etiology of the disease atypical pathogens;
- wrong choice of antibacterial agent as a result of an erroneous determination of the etiologic factors in the empirical treatment of stage destination.
errors in the treatment of antibiotic
Often patients do not comply with treatment recommendations given to the doctor, which can lead to an increase in the duration of illness.Such errors include the following:
- later initiation of therapy - to achieve effective treatment and improvement of prognosis is important as much as possible early start of antibiotic therapy;
- non-compliance with treatment - despite the temperature normalization and improvement of general well-being, you need to take the drug for a specified period of a doctor, otherwise there is a risk of recurrence of infection, as well as the development of resistance to the drug;
- untimely taking the drug, a pass reception - leads to a decrease in the concentration of the active substance in tissues and as a result - reduce the effectiveness of the treatment.
Thus, when correctly prescribed treatment conducted taking into account the epidemiological and clinical data, as well as in compliance with the scheme and the duration of taking the drug can reduce the time of treatment and improve the prognosis.