Antibiotics for pneumonia in adults: names of drugs, assessment of effectiveness
The content of the article:
- Diagnostics
- Choice of etiotropic therapy
-
How to treat pneumonia with antibiotics
- Semisynthetic penicillins
- Cephalosporins
- Macrolides
- What antibiotics do they drink for pneumonia
- Requirements for antibacterial drugs
- Evaluation of the effectiveness of antibiotic treatment for pneumonia in adults
- Video
Antibiotics for pneumonia, a common respiratory infection, form the basis of treatment. The outcome of the disease depends on the timeliness and adequacy of the therapy.
Antibiotics are the mainstay of treatment for pneumonia
Pneumonia remains one of the most common diseases, accounting for up to 10% of all hospitalizations. The mortality rate of adults and children averages 5%, but in patients requiring hospital treatment it reaches 21.9%, in elderly patients - up to 46%.
Diagnostics
In addition to physical examination and history taking, the diagnostic minimum should include:
- chest x-ray in two projections;
- general blood analysis.
These studies make it possible to establish a diagnosis and determine the question regarding the severity of the pathology and the need for hospitalization of the patient.
Choice of etiotropic therapy
Etiotropic therapy includes the use of antibacterial drugs, taking into account the severity of the disease and identification of the pathogen.
The choice of the drug is made by the doctor taking into account many factors
The choice of an antibiotic is due to the following factors:
- age;
- features of the clinical picture;
- concomitant diseases;
- epidemiological situation;
- radiological data;
- heart, hepatic, or renal impairment affecting the concentration of the antimicrobial agent in the blood;
- contraindications to the use of the drug or a history of indications of side effects (allergic reactions) with previous antibiotic therapy;
- the use of other drugs that may affect the pharmacokinetic processes of the antibiotic.
How to treat pneumonia with antibiotics
At the beginning of treatment, broad-spectrum drugs are empirically prescribed. The most commonly used antibacterial drugs of the following groups:
- antibiotics: β-lactams, macrolides (azalides and ketolides), streptogramins, lincosamides, aminoglycosides, tetracyclines, glycopeptides, oxazolidinones;
- synthetic antimicrobial agents: fluoroquinolones, nitroimidazoles.
Semisynthetic penicillins
An important role in the treatment of pneumonia is played by semi-synthetic penicillins (distributed over generations):
- Isoxazolylpenicillins (penicillinase-resistant) - oxacillin, cloxacillin; aminopenicillins (penicillinazone-resistant) - ampicillin (Pentrexil), amoxicillin (Flemoxin Solutab, Ospamox), bacampicillin, penamecillin (Maripen); combined - amoxicillin / clavulanic acid (Augmentin), ampicillin / sulbactam (Unazin).
- Carboxypenicillins: carbenicillin, ticarcillin, carphecillin; combined - ticarcillin / clavulanic acid (Tymentin).
- Ureidopenicillins: Azlocillin, Piperacillin (Pipracil); combined - piperacillin / tazobactam (Tazocin);
- Amidinopenicillins: amdinocillin, pivamdinocillin, bacamdinocillin, acidocillin.
Cephalosporins
Cephalosporins are among the β-lactams and are one of the most extensive classes of antimicrobial agents. They occupy the leading place in the frequency of clinical use among all antibiotics due to their low toxicity and high efficiency.
There are four generations of cephalosporins:
- Cefazolin, Cefalexin, Cefalexin (have a narrow spectrum of action).
- Cefuroxime, Cefuroxime axetil, Cefaclor (affect gram-positive and some gram-negative bacteria).
- Cefotaxime, Ceftriaxone, Ceftazidime, Cefoperazone, Cefoperazone / sulbactam, Cefixime (have a wide spectrum of action).
- Cefepim, Cefpir (have a wide spectrum of action).
The first three generations are represented by drugs that can be taken orally (in the form of tablets or capsules), used for injections (intramuscularly) and injected intravenously.
Macrolides
Macrolides belong to the class of antibiotics, the chemical structure of which is based on a macrocyclic lactone ring. Considered the least toxic antibacterial agents.
The main clinical significance is the activity of these drugs against gram-positive cocci and intracellular pathogens (including mycoplasma, campylobacter, chlamydia, legionella).
List of drugs that are usually prescribed: Erythromycin, Spiramycin, Midecamycin, Josamycin, Roxithromycin, Clarithromycin, Azithromycin.
What antibiotics do they drink for pneumonia
Since in practice, in the first days of the illness, the doctor almost always has to prescribe antibiotic therapy in the absence of verification of the pathogen, he focuses on the features of the clinical picture, X-ray data, and the epidemiological situation.
The use of antibiotics depending on the etiology of the disease
| Causative agent | Features of the course of pneumonia | Recommended antibiotics |
| Pneumococcus | It belongs to the most frequent variants among pneumonia that have arisen in closely interacting teams (from 30 to 70%). It often occurs during flu epidemics against the background of chronic lung diseases. The disease is characterized by an acute onset, rusty sputum, there are signs of lobe lesion |
Penicillins, including with clavulanic acid Cephalosporins I-II generation Macrolides |
| Streptococcus | The development of the disease is more often observed in children, occurs mainly as a complication of other respiratory diseases. It is characterized by fever, severe cough, chest pain, shortness of breath; often complicated by pericarditis, purulent pleurisy, abscess formation |
Semi-synthetic penicillins with clavulanic acid Cephalosporins I-II generation Macrolides |
| Staphylococcus | It accounts for approximately 5% of domestic pneumonia, most often observed during influenza epidemics. Risk factors: chronic alcoholism, old age. Characteristic features: acute onset of the disease, severe intoxication, polysegmental infiltration with multiple foci of decay on x-ray. In the case of a breakthrough into the pleural cavity, pyopneumothorax occurs. Possible complication: sepsis with foci of septicopyemia (affects joints, skin, brain) |
Semi-synthetic penicillins with clavulanic acid Cephalosporins I-II generation Aminoglycosides Fluoroquinolones Vancomycin (tricyclic glycopeptide) |
| Haemophilus influenzae | Pneumonia usually occurs against the background of chronic obstructive pulmonary disease, heart failure. At risk are smokers, elderly people, patients after uncomplicated operations. X-ray reveals focal spotty darkening |
Semi-synthetic penicillins with clavulanic acid Cephalosporins I-II generation Macrolides |
| Klebsiella (Friedlander's wand) | This pathogen is characterized by an acute onset, respiratory failure, and severe intoxication. Usually, the disease occurs in patients with chronic alcoholism, liver cirrhosis, diabetes mellitus. X-ray reveals a lesion of the upper lobe of the lung, which has a well-emphasized interlobar groove with a bulge downward |
Cephalosporins I-II generation Aminoglycosides Fluoroquinolones |
| Pseudomonas aeruginosa | This microorganism most often leads to the development of hospital pneumonia in critically ill patients (with malignant tumors, after surgery), usually in intensive care units and undergoing bronchoscopy and mechanical ventilation |
Generation III cephalosporins Aminoglycosides Fluoroquinolones |
| Colibacillus | Pneumonia often occurs in diabetic patients with chronic pyelonephritis, epicystoma, and also against the background of senile dementia with fecal and urinary incontinence. The pathogen is usually localized in the lower lobes of the lungs |
Cephalosporins II-III generation Aminoglycosides Fluoroquinolones Carbapenems |
| Legionella | It can lead to the development of both community-acquired and hospital-acquired pneumonia. Risk factors: living near open water bodies, immunodeficiency states. The disease is characterized by an acute onset and severe course, mainly with signs of extrapulmonary lesions (in the form of diarrhea, liver enlargement, jaundice) |
Macrolides Fluoroquinolones |
| Mycoplasma | Often leads to infection in closely interacting teams. At risk are adults during outbreaks of mycoplasma infections and school-age children. A characteristic sign is the gradual onset of the disease with catarrhal symptoms, a relatively insignificant severity of clinical and radiological pulmonary symptoms |
Macrolides Fluoroquinolones |
After receiving the results of studies confirming the pathogen, the drug can be replaced with a more effective one.
Requirements for antibacterial drugs
When prescribing treatment, the following antibiotic requirements should be taken into account:
- high activity in relation to the causative agent of the disease;
- good tolerance and high safety;
- the ability to penetrate well into bronchopulmonary tissue.
Evaluation of the effectiveness of antibiotic treatment for pneumonia in adults
The effectiveness of antibiotic therapy should be assessed within 48–72 hours from the start of treatment. The fact that the drug is selected correctly is evidenced by the normalization of body temperature, reduction / disappearance of sweating, chills and signs of intoxication.
Evaluation of the effectiveness of antibiotics for pneumonia should be 2–3 days after the start of their administration
When treating mild pneumonia without complications, antibiotic therapy can be completed 2–3 days after the temperature has returned to normal. In case of mycoplasma, legionella, staphylococcal pneumonia, proceeding with complications, decompensation of concomitant diseases, as well as in elderly patients, the duration of the course can be up to three weeks.
Due to the difficulty of diagnosis and the high risk of developing serious complications, the treatment of pneumonia at the present stage of development of clinical medicine remains an urgent problem. In addition to the use of antibacterial agents, detoxification, symptomatic therapy, and rehabilitation measures are indicated.
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Anna Kozlova Medical journalist About the author
Education: Rostov State Medical University, specialty "General Medicine".
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