Modern and effective treatment regimens for pneumonia in adults: strength in an integrated approach! Treatment of pneumonia in adults with antibiotics scheme Modern treatment of pneumonia in adults.

Reading time: 44 minutes. Published 01/03/2020

How to choose an antibiotic?

The main symptoms of pneumonia are high fever, cough with yellow or brown sputum, shortness of breath, and general malaise. The doctor listens to the patient’s lungs and, if an inflammatory process is suspected, sends him for x-rays and relevant tests. Depending on their results and the characteristics of the patient’s body, therapy is prescribed.

In approximately 60% of cases, pneumonia is caused by microorganisms called pneumococci, but in addition, the following agents can trigger the disease:

• streptococci;
• staphylococci;
• hemophilus influenzae;
• chlamydia;
• mycoplasma;
• legionella;
• enterobacteria;
• Klebsiella;
• Escherichia;
• fungi of the genus Candida.

Each of the above types of bacteria has sensitivity to a certain substance, that is, for maximum effectiveness of therapy, it is very important to determine the root cause of the disease. On average, treatment lasts from 7 to 10 days, depending on the age and condition of the person, as well as the characteristics of the course of the disease.

The main symptoms of pneumonia are high fever, cough with yellow or brown sputum, shortness of breath, and general malaise. The doctor listens to the patient’s lungs and, if an inflammatory process is suspected, sends him for x-rays and relevant tests.

Depending on their results and the characteristics of the patient’s body, therapy is prescribed.

As first aid, antibiotics are prescribed experimentally (the so-called first-line medications), so the patient should undergo all tests as quickly as possible, in particular, take a sputum test, which will determine the causative agent of the disease.

Each of the above types of bacteria has sensitivity to a certain substance, that is, for maximum effectiveness of therapy, it is very important to determine the root cause of the disease.

On average, treatment lasts from 7 to 10 days, depending on the age and condition of the person, as well as the characteristics of the course of the disease.

Taking antibiotics on your own is strictly not recommended, as they not only will not give the desired effect, but can also cause serious harm to the body.

As with any other medications, antibiotic therapy must be carried out in accordance with a number of rules.

1. For pneumonia, a combination of several drugs (2-3 items) is usually used.
2. First-line antibiotics, that is, those that were prescribed before the causative agent of the disease was identified, must be taken regularly so that the appropriate dosage of the active substance is maintained in the blood.
3. After conducting the necessary research, you should start taking the latest generation drugs.
4. For symptoms of atypical pneumonia caused by chlamydia, legionella, mycoplasma, etc. the use of antibacterial drugs is necessary.
5. The severe stage of pneumonia, in addition to drug therapy, requires oxygen inhalation and other similar measures.
6. Antibiotics for pneumonia are usually administered to patients intramuscularly or orally (most new generation drugs are available in tablet form), and in complex forms of the disease and to achieve a quick effect, drugs can be administered intravenously.

For pneumonia, it is possible to use folk remedies, but you should not abandon traditional medicine. In addition, it is necessary to strictly monitor the patient's condition and monitor for possible allergic reactions.

Today, simple penicillins and other similar drugs are not used to treat pneumonia, since there are more effective and safe drugs of the latest generation. They have a wide spectrum of action, a small number of contraindications, can be used in small doses and have virtually no toxic effect on the liver, kidneys and other organs.

Cephalosporins	"Ceftriaxone", "Cefotaxime"		Prescribed for uncomplicated pneumonia caused by pneumococci, streptococci, enterobacteria. The substance has no effect on Klebsiella and Escherichia coli. Prescribed in case of proven sensitivity of microorganisms to the drug, as well as contraindications to macrolides
Macrolides	"Azithromycin", "Midecamycin", "Clarithromycin", "Erythromycin"		Prescribed as a first-line drug in the presence of contraindications to drugs of the penicillin group. Effective for atypical pneumonia, pneumonia due to acute respiratory infections. It has a good effect on chlamydia, mycoplasma, legionella, and hemophilus influenzae. Worse effect on staphylococci and streptococci
Semi-synthetic penicillins	"Amoxiclav", "Flemoclav", "Ampicillin", "Oxacillin"		It is prescribed experimentally or with proven sensitivity of microorganisms. Used for diseases caused by Haemophilus influenzae, pneumococci, as well as mild pneumonia of viral-bacterial etiology
Carbapenems	"Imipenem", "Meropenem"		They affect bacteria that are resistant to the cephalosporin series. They have a wide spectrum of action and are prescribed for complex forms of the disease and sepsis.
Fluoroquinolones	"Sparfloxacin", "Moxifloxacin", "Levofloxacin"		The drugs have a good effect on pneumococci
Monobactams	"Aztreonam"		Drugs that are similar in action to penicillins and cephalosporins. Good effect on gram-negative microorganisms

When prescribing antibiotics for the treatment of pneumonia, it is very important to pay attention to the compatibility of specific drugs. It is not recommended to take drugs from the same group at the same time, or to combine certain drugs (“Neomycin” with “Monomycin” and “Streptomycin”, etc.).

As mentioned above, antibiotics are potent medications, and therefore require compliance with certain conditions of administration.

1. Follow the instructions and recommendations of the doctor. Some antibiotics are more effective if taken with food, while others need to be taken before or after meals.
2. Maintain equal intervals between doses. It is necessary to take medications at the same time of day at regular intervals.
3. Follow the recommended dosage. The dosage when taking antibiotics must be observed very strictly, since exceeding it can lead to serious side effects, and decreasing it can lead to the formation of drug-resistant strains of microorganisms.
4. Do not interrupt the course of treatment. In order for therapy to produce the desired effect, a certain concentration of the active substance in the patient’s blood is required. That is why you should take antibiotics exactly as prescribed by your doctor. You cannot interrupt the course even after relief occurs.
5. Take the tablets only with clean water. It is recommended to drink any antibiotics with exclusively clean, still water. Tea, coffee, milk or fermented milk products cannot be used for these purposes.
6. Take probiotics. Since antibiotics destroy not only pathogenic, but also beneficial bacteria. To avoid problems with the gastrointestinal tract, when taking such drugs you need to drink probiotics (Linex, Narine, etc.), which restore the natural intestinal microflora.

All of the above rules not only contribute to a quick recovery, but also minimize the side effects of taking antibiotics and their toxic effects on the body.

Intramuscular infusions are considered a more effective therapeutic method than oral medication, since in this case the drugs are absorbed into the blood faster and begin to act. Antibiotic injections can be done at home, but it is very important to follow certain norms and standards.

1. Dosage forms sold in powder form must be diluted immediately before injection. For this, sterile water for injection is used, and sometimes lidocaine or novocaine to reduce pain (in the absence of allergic reactions to these drugs).
2. Before giving an antibiotic injection, you need to do a skin test. Make a small scratch on the inner surface of the forearm with a sterile needle and apply the prepared solution of the drug to it. Wait 15 minutes and watch the body’s reaction - if redness and itching appear at the site of the scratch, the drug should not be administered. In this case, it should be replaced with another drug. If this condition is not followed, the patient may experience anaphylactic shock.
3. For each injection, a sterile syringe is used, and when administering the medicine, you must adhere to the rules of antiseptic treatment of the injection site.
4. After the administration of antibiotics, painful infiltrates often remain in the tissues. To avoid this unpleasant phenomenon, you need to insert the needle strictly perpendicularly, and draw an iodine grid at the injection site.

Where to give the injection in the buttock

If the doctor has prescribed intravenous infusions of antibiotics to the patient, it is better to invite a person with medical education to carry out the procedure, since it is strictly not recommended to install IVs without the appropriate knowledge.

Since therapy for pneumonia must be comprehensive, in addition to antibiotics, it involves taking other drugs, in particular antiviral and mucolytic agents.

1. If pneumonia is of viral origin, it is necessary to take appropriate antiviral drugs. These include “Acyclovir”, “Arbidol”, “Valacyclovir”, etc.
2. To thin sputum and facilitate coughing, it is recommended to use mucolytic and expectorant agents, including Ambroxol, Bromhexine, Acetylcysteine ​​(“ACC”) and their analogues. For the same purposes, you can use herbal preparations - for example, “Gedelix” and “Sinupret”.
3. If there is difficulty breathing, it is recommended to use bronchodilators in the form of inhalations. The most common of them are b-2-agonists (Berotec, Serevent), anticholinergic drugs (Itrop, Spiriva), methylxanthines (Euphylline, Theophylline).

Antibiotics for pneumonia. Treatment of pneumonia with antibiotics in adults and children

The manifestations of pneumonia are quite varied. Nowadays, the asymptomatic course of the disease is very common, when the temperature does not rise, there is no cough, there is no sputum. Therefore, such pneumonia begins to be treated late, and this is fraught with the development of serious complications.

Main symptoms of pneumonia:

1. Temperature rises to thirty-seven to thirty-nine and a half degrees.
2. Dyspnea.
3. Runny nose.
4. Constant cough with sputum production.
5. Chills.
6. Colds that last more than a week, especially when improvement is followed by a sharp deterioration in condition.
7. There is no decrease in temperature after taking Paracetamol.

Pneumonia is characterized by chest pain when taking a deep breath. Usually it appears in the place where the main focus of inflammation is located.

It is worth noting that coughing is not a characteristic sign of pneumonia, since the infection may be located away from the main respiratory tract. Sometimes skin color may change, headache, or fever may appear.

Treatment of pneumonia at home can be carried out only after examination by a doctor and the appointment of appropriate therapy, if there are no indications for hospital treatment.

It should be noted that about 80% of patients (including older children) with community-acquired pneumonia can be treated at home, as well as in a day hospital.

Indications for treatment in a hospital are:

• the patient’s age is less than six months or older than 65 years (this category of patients has too high a risk of developing DN and other complications, so treatment should be carried out only in a hospital setting);
• severe pneumonia;
• presence of pregnancy;
• suspicion of atypical pneumonia;
• the patient has underlying diseases that can aggravate the course of pneumonia and cause complications. Patients with congenital heart defects, cystic fibrosis, bronchopulmonary dysplasia, bronchiectasis, immunodeficiency conditions, diabetes mellitus, etc. are subject to hospitalization;
• patients who have recently completed or are currently receiving immunosuppressive therapy;
• pneumonia is treated with antibiotics within 48 hours to no avail, with clinical symptoms progressing.i.e. in an adult patient, fever persists, respiratory failure increases, etc.;
• lack of conditions for treatment at home (children from disadvantaged families, boarding schools, patients living in hostels, etc.) are hospitalized.

Pneumonia in adults is manifested by general intoxication symptoms (fever, chills, weakness, muscle pain, joint aches). As well as a sharp, significant increase in temperature, dry (possible at the onset of the disease) or wet cough (characterized by purulent, viscous sputum; with a strong cough, streaks of blood may appear). Cyanosis of the nasolabial triangles and swelling of the wings of the nose may occur.

There may be noisy breathing and wheezing audible from a distance.

Pneumonia presents basic symptoms similar to those in adults. Symptoms of respiratory failure in children tend to be more severe. Infants typically experience noisy, grunting breathing. Coughing attacks are often accompanied by vomiting (this is especially typical for children in the first years of life). There is also tearfulness, lethargy, the baby refuses to eat, and is capricious. With a strong cough, complaints of abdominal pain may occur.

Mycoplasma pneumonia in children (as well as chlamydial or legionella pneumonia) is characterized by a dry, sonorous, often with a metallic tint, obsessive cough, headaches, myalgia, sore and dry throat, nasal congestion, enlarged tonsils and lymph nodes, hoarseness, abdominal pain . The darkening on the radiograph is minimal, there is an increase in the pulmonary pattern, and, as a rule, interstitial changes are characteristic.

All antibiotics for pneumonia must be prescribed by your doctor. Self-medication is unacceptable.

Aminopenicillins:

• Amoxicillin (Amosin, Ecobol, Amoxisar, Ospamox);
• Ampicillin.

Amoxicillin 10 capsules 500 mg photo

Inhibitor-protected penicillins:

• Amoxicillin clavulanic acid (Flemoklav, Augmentin, Amoxiclav).

Amoxiclav

Macrolides:

• Azithromycin (Sumamed, Zitrolide, AzitRUS, Azitral, Azitrox);
• Clarithromycin (Fromilid, Klabax, Klacid, Ecositrin);
• Spiramycin (Rovamycin).

Cephalosporins:

• Cefixime (Pancef, Suprax, Tsemidexor, Cefspan, Sorcef, Ixim Lupin);
• Cefuroxime (Zinnat, Axef).

Doxycycline 100 mg

Fluoroquinolones:

• Levofloxacin (Glevo, Levolet, Tavanic);
• Ciproflosacin (Tsiprolet, Tsiprobay, Tsifran).

Ciprolet 500 mg

If necessary, inhibitor-protected penicillins and macrolides (azithromycin, erythromycin), fluoroquinolones (ciprofloxacin, levofloxacin) can be administered intramuscularly or intravenously.

Highly effective cephalosporins:

• Cefuroxime (Zinacef);
• Ceftriaxone (Medakson, Lendatsin, Rofecin);
• Ceftazidime (Vicef, Fortum, Tazicef);
• Cefoperazone (Cephobid);
• Cefotaxime (Cefosin, Cephabol).

Ceftriaxone

Carbapenems are also prescribed intravenously:

• Imipenem (Tienam);
• Meropenem (Meronem);
• Ertapenem (Invanz).

Lincosamides:

• Lincomycin;
• Clindamycin (Dalacin D).

With the development of such a dangerous pathology, characteristic symptoms begin to appear quite quickly in people:

1. A cough appears, during which moist and copious sputum begins to come out. Some patients may have a dry cough.
2. Even with minor physical exertion, shortness of breath occurs.
3. Discomfort and pain occur at the location of the inflammatory focus.
4. Breathing becomes rapid.
5. If the source of inflammation is localized in the lower part of the lung, then the patient may experience pain in the peritoneum and subcostal areas.
6. When coughing, taking a deep breath or moving, the intensity of the pain increases.
7. Hemodynamic disturbances are observed.
8. Blueness appears in the area of ​​the nasolabial triangle.
9. Signs of intoxication may be observed.
10. Headaches occur.
11. Discomfort and pain appear in joint and muscle tissues.
12. The temperature is rising.

PNEUMONIA

Pneumonia- an acute infectious disease of predominantly bacterial etiology, affecting the respiratory parts of the lungs with intra-alveolar exudation, infiltration by inflammatory cells and saturation of the parenchyma with exudate, the presence of previously absent clinical and radiological signs of local inflammation not associated with other causes.

According to ICD-10:
J12 Viral pneumonia, not elsewhere classified;
J13 Pneumonia (bronchopneumonia) caused by Streptococcus;
J14 Pneumonia (bronchopneumonia) caused by Haemophilus influenza;
J15 Bacterial pneumonia, not elsewhere classified Includes: Legionnaires' disease (A48.1);
J16 Pneumonia caused by other infectious agents;
J17 Pneumonia in diseases classified elsewhere;
J18 Pneumonia without specifying the pathogen.

Classification.
According to international consensus, there are:
- community-acquired pneumonia (primary);
- nosocomial (hospital) pneumonia;
- pneumonia in patients with immunodeficiencies.

The following classifications are saved:
- by etiology - pneumococcal, staphylococcal, etc.;
- by localization - share, segment;
- by complications - complicated (indicating complications: pleurisy, pericarditis, infectious-toxic shock, etc.), uncomplicated.

Based on severity, pneumonia is divided into mild, moderate and severe.
The severity criteria are given in the indications for hospitalization and intensive care.

Etiology. In community-acquired pneumonia (CAP), the most common pathogens are: Streptococcus pneumoniae, Mycoplasma pneumoniae, Haemophilus influenzae, Influenza virus, Chlamidia pneumoniae, Legionella spp., Staphylococcus aureus and gram-negative flora - rarely.
In 20-30%, the etiology of pneumonia is not established; in hospital cases - gram-positive flora (Staphylococcus aureus, Streptococcus pneumoniae), gram-negative flora (Pseudomonas aeruginoza, Klebsiella pneumoniae, Echerichia coli, Proteus mirabilis, Legionella pneumophila, Hemophilus influenzae), anaerobes, viruses, Aspergillus, Candida, Pneumocystis carini.
However, these pathogens cause pneumonia only in immunocompromised individuals.
Pneumonia can be caused by various bacteria, viruses, chlamydia, mycoplasma, rickettsia, fungi, and protozoa.

Among primary pneumonias as independent diseases according to etiology, the following are distinguished:
1) bacterial pneumonia (pneumococcal, Friedlander - caused by Klebsiella pneumoniae, Pseudomonas aeruginosa; Haemophilus influenzae; streptococcal; staphylococcal; pneumonia caused by E.coli and Proteus);
2) viral pneumonia (adenovirus, respiratory syncytial, parainfluenza, rhinovirus);
3) mycoplasma. Other pneumonias, including influenza and legionnaires' pneumonia, are considered manifestations of the underlying disease (influenza, Legionnaires' disease, etc.).

Pathogenesis. Infection of lung tissue is most often bronchogenic, extremely rarely - hemato- or lymphogenous; it is possible with insufficiency of local factors protecting the lungs, which develops during acute respiratory viral infections and cooling, or with extremely high aggressiveness of the pathogen, contributing to the development of primary (in previously healthy individuals) pneumonia.
A variety of factors can lead to the occurrence of secondary pneumonia: hypostatic, contact, aspiration, traumatic, postoperative, infectious diseases, toxic, thermal.
With primary bacterial pneumonia, the factors of systemic immunity are activated, and its tension constantly increases, right up to the beginning of the stage of anatomical recovery.

In pneumonia caused by endotoxin-forming pathogens (pneumococcus, Klebsiella, Haemophilus influenzae, etc.) > the process begins with toxic damage to the alveolar capillary membrane, leading to progressive bacterial edema.

In pneumonia caused by exotoxin-forming bacteria (staphylococcus, streptococcus), the process begins with the development of focal purulent inflammation with the obligatory purulent melting of lung tissue in its center.

Mycoplasma, ornithosis and some viral pneumonias begin with inflammatory damage to the interstitial tissue of the lungs.
Influenza pneumonia due to the cytopathogenic effect of the virus on the epithelial cells of the respiratory tract begins with hemorrhagic tracheobronchitis with rapid progression of the disease with the addition of bacterial flora, often staphylococcal.

With pneumonia of any etiology, fixation and reproduction of the infectious agent occurs in the epithelium of the respiratory bronchioles - acute bronchitis or bronchiolitis of various types develops (from mild catarrhal to necrotic).
Due to disruption of bronchial obstruction, foci of atelectasis and emphysema occur. Reflexively, with the help of coughing and sneezing, the body tries to restore the patency of the bronchi, but as a result, the infection spreads to healthy tissues and new foci of pneumonia are formed.

Clinical manifestations.
Pneumococcal pneumonia, caused by serotypes I-III of pneumococcus (“lobar” in the terminology of old authors), begins suddenly with chills, dry cough, with the appearance of rusty sputum on the 2-4th day, pain when breathing on the affected side, shortness of breath.

At stage I (bacterial edema), a tympanic percussion tone, a slight increase in vocal tremor, and sharply weakened breathing are detected in the projection of the affected lobe, as it spares the diseased half of the chest.
When relieving pain, harsh breathing, crepitus, or pleural friction noise are heard.

At stage II (hepatization), dullness of percussion tone, increased vocal tremors and bronchial breathing appear in the affected area, and when the bronchi are involved in the process, moist rales appear.

At stage III (resolution), the severity of these symptoms gradually decreases until they disappear, and crepitus appears for a short time.

Bacterial pneumonia of other etiologies are also characterized by an acute onset and various combinations of symptoms of bacterial infection, compaction of lung tissue and damage to the bronchi.
Colibacillary pneumonia is more common in people suffering from diabetes mellitus, immunodeficiency, alcoholism, and the elderly.
The same contingent is also affected by Klebsiella (Friedlander's bacillus), which stimulates the formation of a viscous sticky exudate, often bloody, with the smell of burnt meat.
With Friedlander's pneumonia, early, on the 2-5th day of the disease, collapse of the lung tissue often occurs.

Haemophilus influenzae is the main causative agent of pneumonia in smokers; it also causes severe pneumonia in children, and in adults (more often against the background of COPD) it can lead to sepsis or purulent metastatic lesions.
Pseudomonas aeruginosa usually occurs in inpatients (after operations), against the background of debilitating diseases.
Staphylococcal pneumonia is common after influenza A.
Mycoplasma pneumonia begins with symptoms of acute respiratory viral infection and severe asthenia, after a few days from the onset of which persistent fever and symptoms of focal, segmental or lobar lesions of the lung parenchyma appear.

Viral pneumonia debuts with respiratory symptoms gradually and acquires a detailed clinical picture with the addition of secondary bacterial flora.
Influenza pneumonia begins with symptoms of toxicosis (fever, headache, meningismus), which are joined on days 1-2 by hemorrhagic tracheobronchitis, and then pneumonia, progressing independently or as a result of staphylococcal superinfection.
Laboratory tests make it possible to identify acute-phase blood reactions, the severity of which is proportional to the severity of the disease.
The exception is mycoplasma and viral pneumonia, in which leukopenia and lymphopenia are common.

Sputum examination (bacterioscopy, culture) identifies the causative agent of pneumonia.
With toxic damage to internal organs, in addition to the corresponding clinical symptoms, pathological changes appear in biochemical and instrumental indicators of assessing their functions.

Radiologically, pneumonia is characterized by the appearance of shading in the lung fields of varying density and distribution.

Diagnostics.
There is a concept of a “gold standard” when diagnosing pneumonia; it consists of six signs.
1. Fever and fever.
2. Cough and purulent sputum.
3. Compaction of the pulmonary parenchyma (shortening of the lung sound, auscultatory phenomena over the affected area of ​​the lung).
4. Leukocytosis or leukopenia (less often) with a neutrophilic shift.
5. X-ray infiltration in the lungs, which was not previously determined.
6. Microbiological verification of sputum and examination of pleural effusion.

A detailed clinical diagnosis implies etiological verification of the pathogen, determination of the localization of pneumonia, establishment of the severity and complications.

Additional research:
- X-ray tomography, computed tomography (in case of damage to the upper lobes, lymph nodes, mediastinum, a decrease in the volume of the lobe, suspected abscess formation, if adequate antibacterial therapy is ineffective);
- microbiological examination of urine and blood, including mycological examination (including sputum and pleural contents) in case of ongoing febrile condition, suspicion of sepsis, tuberculosis, superinfection, AIDS;
- serological testing (determination of antibodies to fungi, mycoplasma, chlamcdia and legionella, cytomegalovirus) for atypical pneumonia in the risk group of alcoholics, drug addicts, immunodeficiency (including AIDS), and the elderly;
- biochemical blood test in severe cases of pneumonia with manifestations of renal and liver failure, in patients with chronic diseases, decompensation of diabetes mellitus;
- cyto- and histological examination in the risk group for lung cancer in smokers over 40 years of age, with chronic bronchitis and a family history of cancer;
- bronchoscopic examination: diagnostic bronchoscopy in the absence of effect from adequate therapy for pneumonia, if lung cancer is suspected in a risk group, foreign body, including during aspiration in patients with loss of consciousness, biopsy. Therapeutic bronchoscopy for abscess formation to ensure drainage;
- ultrasound examination of the heart and abdominal organs if sepsis or bacterial endocarditis is suspected;
- isotope scanning of the lungs and angiopulmonography for suspected pulmonary embolism.

Criteria for hospitalization.
Age over 70 years; concomitant chronic diseases (COPD, CHF, CG, CGN, diabetes, alcoholism or substance abuse, immunodeficiencies); ineffective outpatient treatment within 3 days; confusion or decreased consciousness; possible aspiration; the number of respirations is more than 30 per minute; unstable hemodynamics; septic shock; infectious metastases; multilobar lesion; exudative pleurisy; abscess formation; leukopenia less than 4x10*9/l or leukocytosis more than 20x10*9/l; anemia - hemoglobin less than 90 g/l; PN - creatinine more than 0.12 mmol/l: social indications.

Criteria for intensive care.
Respiratory failure: P02/Fi02< 250 (F < 200 при ХОБЛ); признаки утомления диафрагмы; необходимость в механической вентиляции.
Circulatory failure: shock - systolic blood pressure< 90 мм рт. ст., диастолическое АД < 60 мм рт. ст.; необходимость введения вазоконстрикторов чаще, чем через 4 ч; уменьшение диуреза (СКФ < 20 мл/ч); острая почечная недостаточность и необходимость диализа; синдром диссеминированного внутрисосудистого свертывания; менингит; кома.

Treatment.
Goals: 1) complete elimination of the pathogen;
2) ensuring an abortive course of the disease with limiting the area of ​​inflammation and a rapid decrease in intoxication;
3) prevention of protracted course and complications of the disease.

Principles:
1) take into account the etiology of pneumonia;
2) initial antibacterial therapy should be focused on the clinical and radiological features of the course of the disease and the specific epidemiological situation;
3) start treatment as early as possible, without waiting for the isolation and identification of the causative agent of pneumonia;
4) use antibacterial agents in such doses and at such intervals that a therapeutic concentration of the drug is created and maintained in the blood and lung tissue;
5) monitor the effectiveness of treatment by clinical observation and, if possible, bacteriologically;
6) combine antibacterial therapy with pathogenetic treatments aimed at improving the drainage function of the bronchi;
7) at the stage of resolving the infectious process, use non-drug therapy aimed at strengthening the body’s nonspecific resistance.

General remarks
In the treatment of mild (outpatient) forms of CAP, preference should be given to oral antibiotics.
In severe cases, antibiotics must be administered intravenously.
In the latter case, stepwise therapy is also highly effective, which involves switching from parenteral to oral administration. The transition should be made when the course of the disease stabilizes or the clinical picture of the disease improves (on average 2-3 days after the start of treatment).

In uncomplicated CAP, antibacterial therapy can be completed once stable normalization of body temperature is achieved.
The duration of treatment is usually 7-10 days.
The duration of antibiotic use for complicated CAP and nosocomial pneumonia is determined individually.
The persistence of certain clinical, laboratory and/or radiological signs is not an absolute indication for continuation of antibacterial therapy or its modification.
In most cases, resolution of these symptoms occurs spontaneously or under the influence of symptomatic therapy.

In practical work, treatment has to begin before the flora is verified. The current trend towards changing the etiology of CAP is to expand the range of potential infectious agents, which determines the need to revise approaches to the treatment of this disease.
If in the 70s gt. Empirical antibiotic therapy regimens for CAP were directed against three key pathogens: S. pneumoniae, M. pneumoniae, S. aureus (and anaerobes in aspiration pneumonia), then at present the possible role of H. influenzae, M. catarrhalis, gram-negative bacteria, chlamydia, legionella, viruses and fungi in the etiology of CAP in adult patients.

Additionally, trends in the development of antibiotic resistance of the leading etiological agents of CAP should be taken into account.
However, in outpatients without concomitant pathology who have not received systemic antibacterial drugs in the previous 3 months, the administration of aminopenicillins and modern macrolides (erythromycin, azithromycin, clarithromycin) as monotherapy is considered adequate therapy; An alternative drug to them is doxycycline.

In the presence of concomitant diseases (COPD, diabetes mellitus, chronic renal failure, heart failure, malignancy), it is advisable to either combine protected aminopenicillins with macrolides, or pephalosporins with macrolides, or respiratory fluoroquinolones (moxifloxacin, gatifloxacin, levofloxacin or gemifloxacin).

In case of severe pneumonia (it is mandatory to prescribe 2 antibiotics at the same time (benzylpenicillin IV, IM; ampicillin IV, IM; amoxicillin/clavulanate IV; cefuroxime IV, IM; cefotaxime IV /v, i/m; ceftriaxone i/v, i/m).
For hospital-acquired pneumonia, the drugs of choice are penicillins with clavulanic acid, third-generation cephalosporins, fluoroquinolones, modern aminoglycosides (not gentamicin!), and carbapenems (it should be noted that aminoglycosides are not effective against pneumococcus).
Combination therapy is carried out for unknown etiology and most often consists of 2 or 3 antibiotics; penicillin + aminoglycoside antibiotic; cephalosporin 1 + aminoglycoside antibiotic; cephalosporin 3 + macrolide antibiotic; penicillin (cephalosporin) + aminoglycoside + clindamycin.

Comprehensive treatment of severe pneumonia
Immunoreplacement therapy:
native and/or fresh frozen plasma 1000-2000 ml per 3 days, immunoglobulin 6-10 g/day once intravenously.

Correction of microcirculatory disorders: heparin 20,000 units/day, rheopolyglucin 400 ml/day.
Correction of dysproteinemia: albumin 100-500 ml/day (depending on blood parameters), retabolil 1 ml once every 3 days No. 3.
Detoxification therapy: saline solutions (physiological, Ringer's, etc.) 1000-3000 ml, glucose 5% - 400-800 ml/day, hemodez 400 ml/day.

Solutions are administered under the control of central venous pressure and diuresis.
Oxygen therapy: oxygen through a mask, catheters, IVL and mechanical ventilation depending on the degree of respiratory failure. Corticosteroid therapy: prednisolone 60-90 mg IV or equivalent doses of other drugs as appropriate.
The frequency and duration are determined by the severity of the condition (infectious-toxic shock, infectious-toxic damage to the kidneys, liver, bronchial obstruction, etc.).

Antioxidant therapy: ascorbic acid - 2 g/day per os, rutin - 2 g/day per os.
Antienzyme drugs: contrical, etc. 100,000 units/day for 1-3 days if there is a threat of abscess formation.

Broncholytic therapy: aminophylline 2.4% - 5-10 ml 2 times a day intravenously, Atrovent 2-4 breaths 4 times a day, Berodual 2 breaths 4 times a day, expectorants (lazolvan - 100 mg/day, acetylcysteine 600 mg/day). Expectorants and bronchodilators during intensive care are administered through a nebulizer.

Duration of treatment
Determined by the initial severity of the disease, complications, concomitant diseases, etc.
The approximate timing of antibacterial therapy may be for pneumococcal pneumonia - 3 days after normalization of temperature (minimum 5 days); for pneumonia caused by enterobacteria and Pseudomonas aeruginosa - 1-4 days; staphylococci, - 1 day.

The most reliable guidelines for discontinuing antibiotics are positive clinical dynamics and normalization of blood and sputum parameters, which make it possible to objectify the indications for continuing, changing or canceling antibacterial therapy in a specific clinical case, which does not necessarily fit into the standard, albeit modern, treatment regimen.

Treatment tactics. During the period of fever, strict bed rest and a diet with limited carbohydrates (suppliers of the largest amount of CO2) with sufficient fluid and vitamins are prescribed.

If there are no signs indicating a specific pathogen, then antibiotic therapy is started based on the assumption of the most common flora (pneumococcus, Haemophilus influenzae) with amoxicillin (amoxiclav) or macrolides (erythromycin, clarithromycin) orally in standard dosages.

If there is no effect, they move on to parenteral administration of drugs specifically targeted at the pathogen, which by this time it is desirable to identify.
Haemophilus influenzae pneumonia - ampicillin (2-3 g/day), cefuroxime (IM or IV 0.75-1.5 g every 8 hours) and ceftriaxone (IM 1-2 g 1 time per day ).

Reserve drugs can be sparfloxacin (Sparflo), fluoroquinolones, macrolides (azithromycin, clarithromycin, spiramycin).

Mycoplasma pneumonia - doxycycline (per os or intravenously - 0.2 g on the first day, 0.1 g each in the next 5 days).

The ineffectiveness of previous therapy with penicillins, aminoglycosides and cephalosporins with the high effectiveness of tetracyclines or erythromycin is indirect evidence of the mycoplasma etiology of pneumonia.

Reserve drugs may include fluoroquinolones (ciprofloxacin, ofloxacin), azithromycin and clarithromycin.

Legionella pneumonia - erythromycin 1 g IV every 6 hours; with a clear clinical improvement, subsequent administration of the drug per os no 500 mg 4 times a day is possible; A 21-day course of treatment is optimal.

Patients with immunodeficiency are additionally prescribed the synergistically acting rifampicin.

Friedlander pneumonia - 2nd or 3rd generation cephalosporins.
Reserve drugs are considered imipenem (0.5-0.75 g every 12 hours IM with lidocaine - for moderate infections; for severe infections - 0.5-1 g every 6 hours IV drip slowly, for 30 min, per 100 ml of isotonic solution of glucose or sodium chloride), ciprofloxacin (tsiprolet) 0.5-0.75 g IV infusion every 12 hours, aztreonam (IM or IV 1-2 g every 6-8 hours) or biseptol. If the listed drugs are unavailable, chloramphenicol can be used (up to 2 g/day per os or intramuscularly). streptomycin (1 g/day IM) or a combination thereof.

Colibacillary pneumonia - ampicillin or cefuroxime. Ampicillin is effective for infection with b-lactamase-negative strains.
Reserve drugs can be biseptol, ciprofloxacin, aztreonam or imipenem. If the listed drugs are unavailable, chloramphenicol (1-2 g/day) and aminoglycosides (gentamicin or brulamycin 160-320 mg/day) or mefoxine may be recommended.

Pseudomonas aeruginosa and Proteus - carbenicillin (4-8 g/day i.v. infusion in 2-3 injections), piperacillin or ceftazidime (i.v./po 1-2 g every 8-12 hours) in combination with anti-pseudomonas aminoglycosides (tobramycin , sisomicin 3-5 mg/(kt/day) in 2-3 injections). For strains resistant to piperacillin and ceftazidime, use imipenem 0.5-0.75 g 2 times a day intramuscularly with lidocaine in combination with aminoglycosides. Alternative drugs are ciprofloxacin (0.5-0.75 g 2 times a day per os or intravenous infusion 0.2-0.4 g 2 times a day per 100 ml of 0.9% sodium chloride solution) and aztreonam (1-2 g IM or IV 3-4 times a day).

Streptococcal pneumonia - penicillin, dosed in proportion to the severity of the disease, up to intravenous administration of huge doses (30-50 million units/day) of the drug. In life-threatening situations, penicillin (or ampicillin) must be combined with aminoglycosides. 3rd generation cefadosporins or imipenem can also be used. If you are allergic to penicillins, erythromycin, clindamycin or vancomipin are prescribed.
If the empirically selected penicillin gave a good effect against staphylococcal pneumonia, it means that the pathogenic strain did not produce b-lactamase.
Alternative drugs for pneumonia caused by staphylococci producing b-lactamase can be clindamycin, imipenem, b-lactamase-resistant cephalosporins (mefoxin 3-6 g/day) or rifampicin - 0.3 g 3 times a day per os.
If there is a threat or development of abscess formation, passive immunization with antistaphylococcal γ-globulin is carried out, 3-7 ml daily IM or IV.

For pneumonia caused by chlamydia, doxycycline or tetracycline per os is prescribed for 14 to 21 days.
Alternative drugs are erythromycin 500 mg 4 times a day, fluoroquinolones and azalides.

For viral pneumonia, the same treatment is prescribed as for pneumonia, which is supplemented with antibiotic therapy, initially empirical, and subsequently depending on the nature of the pathogens isolated from the patient’s sputum.
If the etiology of severe pneumonia is unclear, antibacterial treatment with drugs that suppress the maximum number of microflora species from the bacterial “landscape” is necessary.

Clindamycin (Dalacin C) 600 mg IM 3-4 times a day (in combination with aminoglycosides) is advertised as the “gold standard” for the treatment of patients with anaerobic and aerobic infections, in particular bronchopulmonary.

Correction of antibacterial therapy if it is ineffective should be made no later than 2 days of treatment, taking into account the characteristics of the clinical picture and the results of sputum bacterioscopy.
If the correction carried out does not bring the expected results, then drugs that can act reliably can be selected only after an immunofluorescence study with antisera of sputum discharged from the nose and obtaining the results of sputum culture.

In uncomplicated pneumonia, the administration of antibiotics is stopped on the 3-4th day after stable normalization of body temperature.

The exceptions are legionella, mycoplasma and chlamydial pneumonia, in which the duration of treatment with an effective drug can be extended to 3 weeks if the resorption of the infiltrate is slow.

The treatment complex for pneumonia includes expectorants (see) and bronchospasmolytics (see “Treatment of COPD”) drugs.

Antitussives are indicated only for painful, hacking or painful coughs.

In case of infectious-toxic shock or orthostatic hypotension, which is the initial sign of threatening shock, glucocorticosteroid hormones are necessarily prescribed - prednisolone 60-120 mg/day or hydrocortisone 100-200 mg/day IV infusion in combination with hemodez, rheopolyglucin or polyionic mixtures , daily until the complication resolves.

In acute respiratory failure, administration of corticosteroids in the same or higher dose is indicated, in combination with bronchospasmolytic drugs and oxygen inhalation.
If drug therapy does not provide sufficient effect, then auxiliary ventilation is necessary.

Bacterial pneumonia is usually accompanied by severe disseminated intravascular coagulation syndrome.
At the height of pneumonia, with the development of hyperfibrinogenemia and consumption thrombocytopenia, especially if the patient has hemoptysis (against the background of severe hypercoagulation), heparin is indicated at a dose of up to 40,000 units/day or antiplatelet agents.

In pneumococcal pneumonia, heparin not only neutralizes hypercoagulation, but also, most importantly, blocks the pathogenic effect of complement activated by the pneumococcal phosphocholine-CRP complex, which determines the main features of the clinical picture of pneumonia, reminiscent of anaphylactic reactions.

Hemostatic therapy is indicated only for influenza pneumonia and when pneumonia is complicated by acute gastric bleeding; in other cases, it can aggravate the patient's condition.

Summarizing the above, we can recommend as an initial empirical drug therapy for severe, with hyperpyrexia, acute pulmonary failure or infectious-toxic shock, primary household typical pneumonia not previously treated with antibiotics, intravenous infusions of benzylpenicillin sodium salt twice a day, 10- 20 million units (after taking blood for culture) in combination with GCS (prednisolone 90-150 mg or other drugs) and heparin 10,000 units in isotonic sodium chloride solution.

In the intervals between infusions, penicillin can be administered intramuscularly, taking into account that excretion of penicillin by the kidneys does not exceed 3 million units/hour, i.e., after intravenous administration of 20 million units of penicillin, its high concentration in the blood will remain for 6-7 h.

If such treatment does not produce a noticeable effect within 24 hours, and the probable pathogen is not yet known, then it is necessary to intensify treatment by adding a second antibiotic, the choice of which should be based on an analysis of the clinical picture of the disease and the results of sputum bacterioscopy, Gram-stained.
If the analysis does not suggest the probable etiology of pneumonia, then it is advisable to intensify treatment with any antibiotic from the aminoglycoside groups (brulamycin, gentamicin, etc.) or cephalosporins at the maximum permissible dose, or, in case of very severe pneumonia, one of the combinations recommended above for the treatment of pneumonia of unknown etiology.

With a prolonged course of pneumonia, insufficiency of systemic immunity factors and latent DIC of the blood may be detected.
To accelerate repair and activate immune and non-immune defense factors, methyluracil is prescribed 1 g 4 times a day for 2 weeks. Prescription for a short period of time, for 5-7 days, of prednisolone at a dose of 15-20 mg/day or any other corticosteroids, which, with short-term use, cause an acceleration of neutrophil differentiation and do not have time to suppress humoral immunity.

The administration of anabolic steroid hormones is also useful.
The latent syndrome of blood intravascular coagulation is inferior to the effect of acetylsalicylic acid (0.5 g/day for 1-2 weeks).
Those recovered from pneumonia are in most cases able to work.

Pneumonia has claimed many lives as a disease over the long history of human existence. Until there were antibiotics, pneumonia and death were synonymous.

Terminology

Classifications of this disease are quite variable. Even at the dawn of Russian medicine, attempts were made to divide pneumonia by etiology, morphology and course, by localization and complications. In addition, there are a huge number of definitions of pneumonia.

One of the definitions is as follows: Pneumonia is a group of acute infectious diseases differing in etiological, morphological, pathogenetic origin, characterized by lesions of the respiratory tract of a focal nature with the presence of exudate in the alveoli. It is also worth adding that pneumonia is an acute infectious disease and it is unnecessary to define acute pneumonia in the interpretation of the diagnosis. The term “chronic pneumonia” is practically no longer used.

From the above it follows that there may be different causes of pneumonia.

Pathogenesis

The most common view today is the following point of view. The respiratory tract is protected by mechanical factors (branching of the bronchi, epiglottis, coughing and sneezing, aerodynamic filtration, ciliated epithelium of the bronchial mucosa) and immune defense mechanisms (cellular and humoral).

The inflammatory process can occur both as a result of a decrease in protective properties, and as a result of massive contamination by pathogenic microorganisms.

Of all the mechanisms, four are distinguished:

1. Aspiration of secretions from the oropharynx. This mechanism is the most common. Colonization of the oropharynx by pneumococcus can occur without infection of the lower respiratory tract. Aspiration of the contents of the oropharynx into the respiratory tract occurs due to the physiological functioning of the body. This is the norm in most cases. Most often, aspirate is ingested during sleep. But people don’t get pneumonia all the time, because all their defense systems work well. Disease occurs only when one of the protectors experiences difficulty and is in a state of imbalance and dysfunction. If the aspirate contains a large number of virulent microorganisms, even normal defense systems may not work - pathogens penetrate into the lower respiratory tract with the formation of pneumonia;
2. Inhalation of aerosol containing microbes. This route of development of community-acquired pneumonia is much less common. It contributes to the development of pneumonia in certain cases, for example, with Legionella contamination;
3. Spread of bacteria and viruses by hematogenous route from any pathological focus. This path is even less noticeable than the previous one;
4. Spread of infection from neighboring infectious foci.

The use of fiberoptic bronchoscopy for the diagnosis of pneumonia is considered by many to be an additional research method and is prescribed only when therapy for pneumonia does not produce positive results, if the formation of lung cancer is suspected, the presence of a foreign body, or if aspiration is possible in patients with neurological disorders.

At the moment, the reason for the occurrence of pneumonia in this segment or in this lobe is unclear. When examining patients using bronchoscopy, it was found that in the presence of pneumonia, the mouth of the bronchus of the part of the lung tissue that is affected by the inflammatory process is always closed.

It is not possible to detect this bronchial occlusion only in the case of a deeper location.

Symptoms of pneumonia

Pneumonia is preceded by a cough with varying degrees of productivity. The cough occurs in paroxysmal bursts, consisting of several cough bursts that last from 3 to 5 seconds. The longer the cough, the higher the speed of air movement.

Many infectious diseases, be it whooping cough, measles, influenza or rubella, are characterized by coughing attacks of varying duration and intensity. As a result of these actions, the bronchus becomes clogged with phlegm, like a bottle with a cork.

Debilitated patients may have pneumonia without cough.

Occlusion also occurs due to the anatomical structure of the bronchi. The bronchi have the shape of a wedge or cone. Right-sided pneumonia occurs much more often than left-sided pneumonia. Why is this happening? In fact, the right bronchus is wider and shorter than the left and is a direct continuation of the trachea, so it is easier for a foreign agent to enter to the right than to the left.

When the bronchus closes, a closed cavity is formed where the air pressure is lower than in the atmosphere. Plasma effusion occurs from the vessels with the formation of exudate in the alveoli. Exudate is an excellent breeding ground for pathogenic microorganisms. The most common uninvited guests are pneumococci.

It is in connection with the occurrence of such pathological mechanisms that all the symptoms of pneumonia develop, which are confirmed both x-ray and physical methods.

In the resulting chamber, microbes multiply against the background of reduced protective properties. This explains the increased mortality from pneumonia without the use of antibacterial drugs. When an antibiotic is prescribed, it penetrates the pathological alveolar chamber and exerts its therapeutic effect.

Pathological processes that take place in closed body cavities proceed in the same way:

• Occlusion;
• Vacuum air mixture;
• Plasma exudation;
• The onset of bacterial inflammation in the cavity.

All this leads not only to pneumonia, but also to otitis, if the pathological process is located in the middle ear, and to frontal sinusitis, if the inflammation began in the frontal sinuses, etc.

During bronchoscopy, you can notice a piece of sputum that has blocked the bronchus. It can be removed, after which the disease will stop much faster, of course, against the background of properly selected antibiotic therapy.

Nosocomial pneumonia

With this type of pneumonia, which occurs after endotracheal anesthesia, the sputum is very viscous. The endotracheal tube irritates the mucous membrane and after its removal a dry cough appears.

The function of the ciliated epithelium is significantly impaired and it is not able to adequately perform its main function - removing excess mucus and foreign substances and microbes dissolved in it. These moments undoubtedly predispose to blockage of the bronchi - focal and lower lobe pneumonia.

Bronchoscopy with lavage with antiseptic solutions after prolonged intubation may help reduce the risk of pneumonia.

At the moment, there is a great underestimation of the capabilities of fibrobronchoscopy. In case of radiographically confirmed pneumonia, bronchoscopy should become a mandatory examination.

Of course, this procedure must be related to the patient’s condition.

If severe respiratory failure is present, it is obvious that bronchoscopy should not be performed or is performed only if necessary.

It's worth summing up. Focal pneumonia occurs due to blockage of the bronchus by sputum. This happens during a cough. After occlusion, the pathological process described above starts.

The pathogenesis of community-acquired and nosocomial pneumonia is no different. Fiberoptic bronchoscopy should become the main therapeutic and diagnostic instrumental method after it is radiologically confirmed diagnosis of pneumonia, as it can reduce the number of complications and significantly speed up the patient’s recovery.

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Source: https://sovdok.ru/?p=2777

Modern and effective treatment regimens for pneumonia in adults: strength in an integrated approach!

Pneumonia is one of the most common infectious pathologies, which, with timely consultation with a specialist and a complete diagnosis, can be successfully treated.

At the same time, therapy is not limited to the selection of one antibacterial drug, but implies an integrated approach, which allows you to effectively fight the disease and restore the body's defenses.

Modern methods of treating pneumonia

An integrated approach to treating the disease is a fundamental aspect of therapy. Its volume depends on the severity of the patient's condition.

Treatment includes the prescription of medications, both antibacterial and other drugs aimed at eliminating the cause of pneumonia and preventing complications. Non-drug treatment involves regimen, nutrition, and physical procedures.

Severe pneumonia is accompanied by detoxification, hormonal anti-inflammatory and hospital therapy, and resuscitation measures.

Medication

When treating pneumonia, the first choice after diagnosis is an antimicrobial drug (AMP). At the initial stage of the disease, it is impossible to use etiotropic therapy. This means that it is not possible to prescribe a medicine that will act directly as planned on the pathogen, due to the need to identify the microorganism within at least 18-24 hours.

Additionally, it is necessary to determine the sensitivity of the pathogen to antibacterial drugs. This analysis will take 5-6 days.

Based on the patient’s age and complaints, medical history, severity of inflammation and the presence of complications, concomitant pathologies, the doctor selects one of the recommended regimens (according to clinical protocols).

Groups of choice for antibiotic therapy are macrolides, fluoroquinolones and some β-lactams. These drugs can neutralize most bacteria that cause community-acquired pneumonia. Empirical therapy, based on the severity of the disease, can be carried out at home or in a hospital. When prescribing a list of medications at home, choose the following remedies:

• in patients without concomitant pathologies who have not taken AMPs in the last 3 months,– amoxicillins or macrolides (medicines based on azithromycin, clarithromycin);
• in patients with intercurrent diseases, aggravated by inflammation, who have been taking AMPs for the last 3 months, protected amoxicillins (with clavulanic acid) or macrolides (azithromycin, clarithromycin), or fluoroquinolones (levofloxacin, moxifloxacin, gemifloxacin).

Antimicrobial drugs for the treatment of pneumonia:

β-lactam antibiotics

• Unprotected amoxicillins (Amoxicillin, Amoxicar, Flemoxin solutab)
• Protected amoxicillins (Amoxiclav, Augmentin, Amoclav)
• Cefuroxime axetil (Zinnat, Zinacef, Axef, Cefoctam)

Macrolides

• Clarithromycin (Fromilid, Klacid, Klabax)
• Roxithromycin (Rulitsin, Rulid, Romik)
• Azithromycin (Azibiot, Sumamed, Azimicin)

Fluoroquinolones (for pulmonary pathology)

• Levofloxacin (Tavanic, Lebel, Levoximed)
• Moxifloxacin (Moxifur, Avelox, Simoflox)
• Gemifloxacin (Faktiv)

The effectiveness of therapy is assessed after 48-72 hours. If positive dynamics are observed, treatment is continued. If the condition worsens, the doctor changes the main AMP.

Important! Frequently changing antibiotics during treatment may cause the development of resistance and reduce the effect of antibiotics in the future.

Complicated and severe types of pneumonia are treated only in a hospital setting, and include the injection of drugs into a muscle or into a vein in order to speed up the action of the drugs.

Etiotropic

If the desired effect of treatment is not observed, and the causative agent is known, more precise etiotropic therapy is used.

The structure of the causative agents of pneumonia is diverse; microorganisms are classified as follows:

1. Pneumococci(St. pneumoniae), Staphylococcus aureus (MRSA, MSSA), Pseudomonas aeruginosa (Ps. aeruginosa) - account for up to 60% of all cases of the disease.
2. Intracellular microorganisms(M. pneumoniae, C. pneumoniae). Mycoplasmas and chlamydia initiate 20-30% of pneumonia and have an atypical course.
3. Haemophilus influenzae(H. influenzae), Klebsiella pneumoniae, Legionella pneumoniae in adults cause pneumonia in 5% of cases.

In the structure of pathogens of community-acquired pneumonia, pneumococcus is the leader. Treatment involves the appointment of protected β-lactams, for example, Augmentin, Amoxiclav, Unazin, Sulacillin. The spectrum of their activity includes staphylo- and streptococci, intestinal bacteria, Haemophilus influenzae, and anaerobes.

In the absence of resistance, 3rd generation cephalosporins (cefotaxime, ceftriaxone, cefixime, ceftibuten) are used. Alternative auxiliary drugs are also used: macrolides (clarithromycin, azithromycin), fluoroquinolones for the treatment of pulmonary pathology (levofloxacin, moxifloxacin, gemifloxacin). In severe cases, reserve APMs are prescribed: vancomycin, linezolid.

Important! The use of non-respiratory fluoroquinolones (pefloxacin, ciprofloxacin, norfloxacin, etc.) is considered irrational.

Similar principles of treatment apply to community-acquired pneumonia caused by Haemophilus influenzae or intestinal bacteria.

In cases where the causative agent is Staphylococcus aureus, special attention is paid to such a factor as MRSA/MSSA (methicillin-resistant/sensitive staphylococcus).

For methicillin-sensitive varieties of MSSA, standard therapy is used, and one of the following drugs is selected: amoxicillin/clavulanate (Augmentin, Amoxiclav), amoxicillin/sulbactam (Unazin, Sulacillin), 3rd generation cephalosporins (cefotaxime, ceftriaxone, cefixime, ceftibuten), lincosamides ( lincomycin, clindamycin).

If the form of pneumonia is severe and MRSA is detected, then reserve drugs are used: linezolid, vancomycin. Atypical forms of pneumonia are treated with medications from the group of macrolides or tetracyclines (doxycycline), or respiratory fluoroquinolones.

Pathogenetic

Specific pathogenetic therapy is relevant when identifying severe and protracted forms of community-acquired pneumonia in adults. Pathogenetic therapy involves:

• immunoreplacement therapy;
• detoxification therapy;
• treatment of vascular insufficiency;
• treatment of hypoxia or effective respiratory support;
• correction of perfusion disorders;
• treatment of bronchial obstruction;
• anti-inflammatory therapy.

In severe cases of community-acquired pneumonia, it is advisable to strengthen protective forces. For this purpose, it can be cured using immunomodulatory drugs (interferons, Levamisole, Zymosan, Diucifon, T-activin, Timalin, Polyoxidonium, Isoprinosine).

Important! Immuno-replacement and immunomodulatory therapy is prescribed only on the recommendation of a doctor, since if the patient’s body is severely weakened, this type of drug can worsen the condition.

If there is an association of bacteria and virus in the patient’s body, it is advisable to prescribe anti-influenza γ-globulin and antiviral agents (Ribavirin, interferons). Viral influenza pneumonia is treated with Tamiflu.

In case of severe staphylococcal inflammation, passive immunization is carried out with serum (hyperimmune antistaphylococcal) or staphylococcal antitoxin.

Among other methods of pathogenetic therapy, correction of bronchial obstruction is important.

The causative agents of pneumonia contribute to the fact that the patency of the bronchi is significantly reduced due to the narrowing of their lumen, especially in atypical forms of inflammation.

Berodual, Pulmicort, Berotec, Salbutamol, Atrovent are prescribed. Drugs with bronchodilator action, i.e. aimed at dilating the bronchi, it is better to administer by inhalation. This increases their efficiency. Of the tablet preparations, Teopek and Theotard are effective.

They use sputum thinners: ambroxol, ACC, bromhexine. The combined action agent Joset allows you to dilate the bronchi and facilitate the removal of sputum. Warm alkaline drinks also have a beneficial effect: milk, mineral water.

Nonspecific therapy includes vitamins A, C, E, and group B. Adaptogens also have a beneficial effect on the restoration of the body: eleutherococcus, tinctures of lemongrass and ginseng.

Detoxification

This type of therapy is carried out to eliminate the toxic effects of bacterial breakdown products on the body. Specific procedures, such as intravenous drip infusions of saline and glucose, are carried out in severe cases. In most cases, drinking plenty of fluids is effective.

Non-drug

Along with treatment with antibacterial drugs, non-drug support for the body is relevant. First of all, patients are recommended to drink plenty of alkaline fluids. You can use warm milk or mineral water.

Breathing exercises are effective. They improve respiratory mobility of the chest wall and strengthen the respiratory muscles. Exercise therapy is carried out using various special devices or directly through gymnastics. Exercises, as well as other auxiliary activities, begin no earlier than 3 days after the temperature normalizes.

It is possible to use massage (vibration or vacuum). These procedures are also carried out after stable improvement of the condition. Vibration massage is performed using special vibration massagers with a given amplitude.

For vacuum massage, cups are used, which, by creating negative pressure, improve local blood circulation and cause reflex irritation and vasodilation.

Such procedures facilitate lung drainage and reduce the inflammatory process in the alveolar tissue.

Physiotherapy

Physiotherapy is used as measures whose goal is to restore the drainage capacity of the bronchi, improve sputum discharge and normalize the body's resistance. This auxiliary treatment is prescribed only after the temperature reaches 37˚C. Among the procedures considered the most effective:

• inhalation of bronchodilators through a nebulizer or ultrasonic inhaler;
• local UHF therapy;
• local UFO;
• electrophoresis of an antimicrobial drug.

How to treat at home?

Often, uncomplicated forms of the disease are treated at home. However, the nature of the course of pneumonia should only be assessed by a doctor. Find out what will help you recover faster at home in this article.

How to use medications for severe cases in adults?

Severe pneumonia can only be treated in a hospital setting. This form has specific features:

1. Febrile fever (body temperature 40˚C or higher).
2. Signs of respiratory failure.
3. Blood pressure is below 90/60 mm Hg, pulse is over 100 beats. per minute
4. Bilateral course of pneumonia, spread of the pathological process into several lobes and segments.
5. In patients over 65 years of age, the disease is more severe.

The severity of pneumonia also differs during the treatment process. Antibiotics are administered intravenously. Most often, one antimicrobial drug is not enough, so they resort to various combinations. For example, β-lactam + macrolide or fluoroquinolone. When the condition stabilizes, intravenous administration of the drug is replaced by taking tablet forms.

Regime and balanced diet

At the same time, the diet includes a large number of dishes rich in vitamins A, C, E, group B: dairy products, lean meat, vegetables. Salty, spicy, pickled foods are excluded during treatment.

The amount of fluid consumed is at least 2 liters per day in the form of plain, mineral water, compotes.

Prognosis and recovery criteria

If treatment is started in a timely manner and all therapeutic measures are carried out in the proper amount, the prognosis is favorable. The following criteria will help assess the improvement of your condition:

1. The temperature drops to 37.0-37.5˚C and is stably maintained at this level.
2. The pulse is less than 100 beats. in a minute. A few days after treatment, the indicator stabilizes to normal values: 60-80 beats. in a minute.
3. Shortness of breath decreases.
4. Blood pressure rises, but does not exceed normal values.

How long does the course last?

Even after the condition improves, the course of antibiotics cannot be canceled immediately. The duration of treatment of pneumonia with antimicrobial drugs is:

• mild – 7-10 days;
• severe – 10-12 days;
• atypical – 14 days;
• staphylococcal, legionella pneumonia or caused by enterobacteria – 14-21 days.

You can stop taking medications only as prescribed by your doctor. Other restorative measures and physical therapy continue for about 7 days or more.

Prevention

The onset of the disease can be prevented through preventive measures.

One of the effective specific methods is vaccination of persons predisposed to pneumonia.

Vaccinations against influenza, pneumococcus, and Haemophilus influenzae are used. Vaccination is best done from October to the first half of November.

Vaccinations are administered to a healthy person in the absence of exacerbation of infectious and non-infectious diseases.

Conclusion

Pneumonia is a fairly serious infectious disease, the treatment of which requires an integrated approach. All treatment methods given must be timely and complete. Canceling treatment due to apparent ineffectiveness can erase the overall understanding of the course of the disease and complicate diagnosis. Pneumonia treatment is carried out as prescribed by a specialist and under his supervision.

Source: http://bronhus.com/zabolevaniya/legkie/pnevmoniya/vzroslye/lechenie-pn

Features of the treatment of pneumonia

Pneumonia is a life-threatening and health-threatening disease caused by pathogenic microflora. These can be bacteria of the staphylococcal, streptococcal and pneumococcal groups, including influenza viruses. It often occurs against the background of herpes infections, mycoplasmosis, chlamydia due to decreased immunity.

For pneumonia, treatment is carried out both in hospital and at home. How long it takes to be treated directly depends on the severity of the lung damage. Including how diagnostic, treatment and preventive procedures are selected correctly.

If pneumonia is diagnosed, treatment is always complex, consisting of several components.

Symptoms and approaches to diagnosis

Pneumonia is an acute condition in which a pathogenic or viral infection affects the structure of the lung tissue. The first symptoms are often similar to acute respiratory diseases (ARI, ARVI). Treatment of pneumonia is an area of ​​general therapy. In some cases, the disease is difficult to distinguish from them without special diagnostic methods and tools. Main symptomatic picture:

• temperature reaching high values ​​(up to 38-39⁰С);
• general weakness, malaise, headache;
• painful cough, dry in the initial stages, turning into “wet”, with a discharge of yellow-green exudate;
• shortness of breath, inability to take a deep breath;
• pain in the chest area;

Diagnosis of the disease

At the first symptoms, especially if the temperature persists, the cough brings unbearable suffering, you should immediately contact a general practitioner. Effective treatment for pneumonia depends on examination based on:

• percussion (tapping the chest to test its ability to transmit sound, which decreases with pneumonia);
• auscultation (using a phonendoscope to determine areas of obstructed air conduction in the lungs);
• X-ray data;
• general and biochemical blood analysis.

If there is active sputum production, then bacterial culture of the contents is prescribed, which will help identify the pathogen and prescribe appropriate treatment for pneumonia, excluding tuberculosis.

All diagnostic procedures help determine the type of pneumonia, treatment and directions of therapy. There are 4 types in total, they differ in location and can be:

• focal and segmental - with lesions in the alveoli;
• lobar, when the entire lobe of the lung becomes inflamed;
• lobar - damage on both sides.

The classification includes atypical pneumonia, congestive and basal. The latter is the most difficult to treat due to the difficulty of diagnosing it.

Features of treatment procedures

Treatment for pneumonia, especially in children and the elderly, is carried out only in a hospital. When treating pneumonia, a general practitioner relies on a specific algorithm.

1. Diagnostics.
2. Elimination of causes.
3. Elimination of the source of inflammation.
4. Prescription of symptomatic therapy.

Depending on the source of inflammation and manifestations, treatment for pneumonia is prescribed. The basis of therapy is the use of antibiotics, antiviral drugs, agents that reduce temperature and affect respiratory functions. How much antibiotics to use, what spectrum - only a doctor decides. Treatment excludes independence in the selection of means and methods. This is life-threatening.

Antibiotic group

In modern medical practice, antiviral drugs and antibiotics with a wide range of effects on pathogenic microflora are used in the treatment of pneumonia. They can be in the form of injections or tablets.

The selection and dosage of medications is prescribed by a specialist based on the diagnostics performed. Every year, the pathogenic flora expands, species mutate, which leads to the adaptability of viruses and bacteria and affects the treatment of pneumonia.

Therefore, the more modern the drug, the faster the cure for the disease. Groups of such drugs include: cephalosparins (broad spectrum), fluoroquinolones, aminopenicillins, macrolides.

How much to use, what dose is up to the doctor, since based on the diagnosis, he can use two-stage therapy, when pneumonia is first treated with one group of antibiotics, and after a few days - with another.

Symptomatic treatment

The inflammatory process is treated by increasing the blood supply to the bronchi and lungs, to facilitate breathing and expectoration.

It also involves the use of antipyretic, painkillers, antiallergic medications: Ibuprofen and Paracetamol, Aspirin, Analgin, Diphenhydramine, Suprastin, Tavegil, and others like that.

In addition to antibiotics or antiviral drugs, mucolytics are prescribed to help thin mucus and effectively clear it when coughing: ACC, Bromhexine, Lazolvan, tinctures and herbal decoctions.

Against the background of the disease, problems with cardiac activity may occur. If necessary, additional treatment for pneumonia is prescribed.

Mandatory for pneumonia - treatment with general strengthening agents in the form of vitamins, microelements, herbal tinctures for immunity (Eleutherococcus, ginseng).

Diet food

The disease is treated with a carbohydrate-free, low-calorie diet, excluding fatty foods. Food should be maximally enriched with vitamins A, C, E and proteins. The therapist will tell you how, how much, and what foods to exclude.

Use of traditional medicine

Treatment of pneumonia with folk remedies is one of the additional measures that helps in successfully eliminating the disease. An integrated approach includes the use of both medicines and folk remedies. If there is no elevated temperature, then you can use:

• cups and mustard plasters on the affected area of ​​the lungs, such procedures alternate with each other;
• inhalations using aroma oils: eucalyptus, mint, lavender, orange;
• compresses and rubdowns.

For pneumonia, treatment can be prescribed by a herbalist. Some products can be purchased at the pharmacy, for example, a breast mixture consisting of string herbs, yarrow, plantain, licorice root, chamomile, and linden blossom. You can prepare some of the decoctions yourself, using herbs such as coltsfoot, plantain, marshmallow, and sage. In the treatment of pneumonia, these herbs are active helpers.

Milk-based decoctions are also used. Treatment for pneumonia based on dairy products guarantees a speedy recovery. To make it, take 200-300 ml of cow's milk and boil it with figs, butter and honey, sugar and onions.

For a patient with pneumonia, treatment with goat's milk, which is rich in fats and protein, has long proven itself. It is consumed warm.

Among traditional medicine, rubbing is excellent. So, badger fat is mixed with vegetable oil and the entire chest area is rubbed with it.

Treatment for pneumonia is based on the use of melted butter or lard, which is mixed in equal proportions with honey, applied to parchment and applied as a compress to the back and chest.

Pneumonia is treated with plenty of fluids. This will help avoid disruption of the water-energy balance, which occurs with effusion. To do this, the patient is offered:

• warm milk with butter, especially at night;
• rich chicken broth that restores strength and immunity;
• berry juices, fruit drinks, jelly, decoctions, compotes;
• warm mineral water without gas containing alkali;
• tea based on herbs: mint, lemon balm, with lemon.

Inhaling the vapors of boiled potatoes, oils, drinking plenty of fluids - this is the modest arsenal of remedies. This treatment for pneumonia can be used by anyone without spending a lot of money in search of an effective treatment.

To summarize, it should be noted that pneumonia is a disease that must be treated only with the participation of a physician. Only he can prescribe the right approaches, various methods, medications in combination with physiotherapy and traditional medicine. It is important not only to know how much, how and when to start taking medications, but also in what dosages.

Any deviation from the norm can lead to disruption of the gastrointestinal tract. Therefore, if you have any problems, you should definitely tell your therapist.

After suffering from pneumonia, it is necessary to undergo a set of rehabilitation measures to prevent the disease: strengthen the immune system, perform physical exercises and breathing exercises, try to avoid colds.

Pneumonia (pneumonia) is an acute pathological condition leading to infectious and inflammatory processes in the lower respiratory tract (alveoli, bronchioles). The disease can develop at any age and most often affects patients with weakened immune systems. It is necessary to treat pneumonia in adults under the supervision of a specialist, using effective drugs. Independent choice of medications is unacceptable - ill-conducted therapy is fraught with the development of severe complications and even death of the patient.

Causes of the disease

The main reason for the development of pneumonia is the activation of bacteria in the human body:

1. Pneumococci (in 40-60% of cases).
2. Haemophilus influenzae (5-7%).
3. Enterobacteria, mycoplasma (6%).
4. Staphylococci (up to 5%).
5. Streptococci (2.5-5%).
6. Escherichia coli, Legionella, Proteus (from 1.5 to 4%).

Less commonly, pathology is caused by chlamydia, influenza viruses, papainfluenza, herpes, adenoviruses, and fungal infections.

Factors that increase the risk of developing pneumonia in adults are weakened immunity, frequent stress, poor nutrition associated with insufficient consumption of fruits, vegetables, fresh fish, and lean meat. Frequent colds, which create a source of chronic infection, and bad habits (smoking, alcoholism) can provoke the disease.

Types of pneumonia

Depending on the etiology, pneumonia can be:

• viral;
• fungal;
• bacterial;
• mycoplasma;
• mixed.

The most common type of disease is community-acquired pneumonia. Hospital (nosocomial) develops within 3 days of the patient being in the hospital. Aspiration can occur as a result of the contents of the oral cavity, nasopharynx, and stomach entering the lower respiratory tract.

Depending on the nature of the pathology, it is classified as acute, chronic, or atypical. According to localization, pneumonia can be left-, right-, unilateral, or bilateral. By severity – mild, moderate, severe.

Common symptoms for various types of pneumonia are dry cough, fever, weakness, and chest pain. As the disease progresses, the patient begins to experience anxiety associated with lack of air, feels muscle pain, and increased fatigue. In some cases, cyanotic (blue) discoloration of the lips and nails is observed.

Diagnosis of pneumonia

To make a diagnosis, a detailed examination of the patient is performed. The specialist must resort to the following methods:

1. Listening to breathing with a stethoscope.
2. Measuring body temperature.
3. X-rays of the chest organs.
4. Sputum analysis.
5. General and biochemical blood tests.

The basis of diagnosis for pneumonia is the patient undergoing radiography. This type of examination is carried out mainly in a direct projection, sometimes in a lateral one. The method allows not only to establish a diagnosis and identify possible complications, but also to evaluate the effectiveness of the therapy. It is for this reason that x-rays should be taken several times during the treatment process.

In addition to the listed diagnostic measures, it may be necessary to perform computed tomography and bronchoscopy. In order to exclude the presence of lung cancer or tuberculosis, a study of pleural fluid is performed.

Treatment of pneumonia with antibiotics

The basis of treatment for pneumonia is antibiotic therapy. The choice of a specific drug depends on the type of pathogen. Traditionally, pulmonologists prescribe the following types of medications:

• natural and synthetic penicillins (in cases where the disease is caused by pneumococci, staphylococci);
• cephalosporins (against E. coli, gram-negative bacteria);
• tetracyclines, which act in the development of any infectious processes;
• macrolides that help quickly cure pneumonia caused by mycoplasma;
• fluoroquinolones aimed at combating bacterial pneumonia.

Antibiotics for pneumonia can only be prescribed by a doctor. They are taken at the same time of day, after an equal number of hours, strictly observing the dosage and duration of the course. In the first days of treatment, patients are mainly prescribed bed rest.

Carbapenems are effective in treating severe forms of pneumonia. Patients may be prescribed drugs with names such as Tienam, Invanz, Aquapenem.

Penicillin drugs

The most commonly prescribed penicillins are:

1. Ampicillin.
2. Amoxicillin.
3. Amoxiclav.

Ampicillin is a medicine for pneumonia, mainly prescribed intramuscularly or intravenously. This method of administration allows for accelerated penetration of the active substance into the tissues and fluids of the body. Intramuscular injections are carried out every 4-6 hours, in a dosage prescribed by the doctor. For adults, a single dose is 0.25–0.5 g, a daily dose is 1–3 g. In severe cases of the disease, it is increased to 10 g per day (maximum – no more than 14 g). The duration of the course is determined individually by a specialist.

Amoxicillin can be given as tablets or injections. The medicine is taken orally three times a day. Most often, adults are prescribed 500 mg of the drug per dose. In case of complicated infection, it is recommended to drink 0.75-1 g of Amoxicillin 3 times every 24 hours. 1 g of antibiotic is administered intramuscularly twice a day, intravenously - 2-13 g daily.

Amoxiclav contains 2 active components - semisynthetic penicillin amoxicillin and clavulanic acid. Depending on the severity of the pathological process, adults are prescribed 250 (+125)-875 (+125) mg of the drug orally twice or thrice a day. 1.2 g (+200 mg) is administered intravenously at 6-8 hour intervals.

Intramuscular or intravenous administration of drugs to patients with pneumonia should be carried out under sterile conditions by a competent healthcare professional.

Drug treatment with cephalosporins

Among the cephalosporins, therapy is often carried out using:

• Cephalexin;
• Ceftriaxone;
• Cefepime

Cephalexin is taken in tablets or capsules. The drug is drunk half an hour before meals, 0.25-0.5 g, taking 6-hour breaks. For pneumonia, the medicine is taken four times a day.

Ceftriaxone is used in various ways - intramuscular, by drip, intravenous. The daily dosage for adults is 1-2 g. In case of severe disease, it is increased to 4 g. Therapy with this antibiotic lasts from 5 to 14 days.

Cefepime is prescribed for intramuscular injections in the development of mild or moderate pneumonia. In this case, adults are advised to administer 0.5-1 g of antibiotic at 12-hour intervals. If pneumonia is classified as severe, the dosage increases to 2 g twice a day.

Tetracyclines and macrolides

Tetracyclines for pneumonia are used less frequently than penicillins and cephalosporins. This is due to their ability to accumulate in body tissues and also cause a considerable number of side effects.

Tetracycline or Doxycycline is used to treat pneumonia in adults. Tetracycline tablets are taken four times a day, 0.5 g each. Therapy with this drug takes at least 7 days. Doxycycline can be given orally or intravenously. The maximum daily dosage of tablets (capsules) is 300-600 mg. No more than 300 mg of antibiotic can be administered intravenously per day. The duration of therapy depends on the intensity of the inflammatory process.

Macrolides used in the treatment of pneumonia include:

1. Erythromycin.
2. Clarithromycin.
3. Sumamed.

Erythromycin is prescribed intravenously, 1-4 g per day, divided into 4 doses. The drug in tablets is taken 250 mg 4 times a day, with 6-hour breaks.

Clarithromycin is taken 250 mg-1 g twice every 24 hours. If the doctor considers it necessary to use the medicine intravenously, 500 mg of antibiotic is administered twice a day.

Sumamed – tablets for pneumonia, taken once a day. The average dose is 500 mg (1 tablet). For uncomplicated pneumonia, therapy with this drug lasts 3-5 days.

Principle of treatment with fluoroquinolones

The use of fluoroquinolones can effectively treat pneumonia caused by Escherichia coli or Legionella. This type of antibiotic is distinguished by its ability to penetrate deep into the affected tissues and does not cause resistance in pathogenic microorganisms.

Therapy for bacterial pneumonia in adults is often carried out with the following:

• Ciprofloxacin (orally – 250-500 mg twice a day, intravenously – 200-400 mg twice within 24 hours);
• Ofloxacin (200-800 mg 2 times a day).

The duration of the treatment course is determined in each specific case individually. On average, therapy lasts 1-2 weeks.

Side effects of antibiotics and common contraindications

Treatment with antibiotics can provoke side effects in the form of digestive disorders, neurotoxic reactions, vaginal candidiasis, allergic reactions, and anaphylactic shock. The lowest degree of toxicity is exhibited by penicillin drugs, macrolides and cephalosporins, due to which in the treatment of pneumonia the choice is made primarily in favor of these medications.

A direct contraindication to the use of a particular antibiotic is individual intolerance to its composition. In addition, most antibacterial agents are contraindicated during the period of pregnancy and breastfeeding. In pregnant and lactating patients diagnosed with pneumonia who require antibiotic therapy, treatment can be carried out using the most gentle drugs. These include antibacterial agents that are included in the group B category according to the level of danger.

Auxiliary drugs for pneumonia

In addition to antibiotics, it is recommended to treat pneumonia using auxiliary agents. Among the additional drugs often used are:

1. Expectorants and bronchodilators (Gerbion, Pertussin syrups, Salbutamol spray).
2. Antipyretic medications (Paracetamol, Aspirin, Ibuprofen).
3. Vitamin complexes with a high content of vitamins A, C, group B (Supradin, Duovit, Complivit).

For patients who have a hard time tolerating synthetic drugs, homeopathy becomes relevant. Among such remedies, the most effective are Aconite, Bryonia, Belladonna, Sanguinaria, Arsenicum Yodatum. The patient should be treated with such drugs in accordance with his constitutional type.