Antibiotics for pneumonia in adults: a listefficiency

Update: November 2018

Pneumonia is an acute inflammatory lung disease.
origin. The causative agents of pneumonia can be many
microorganisms, but more often it is bacteria (streptococcus, staphylococcus,
enterobacteria, hemophilus bacillus, legionella, etc.).

The role of atypical microflora (mycoplasma, chlamydia) is not excluded.
Given this, antibiotics are used in the treatment of pneumonia. it
the basis of successful etiological therapy is to eliminate the cause
pulmonary inflammation.

General principles of antibiotic therapy

To achieve the maximum positive effect from the reception
antibiotics for pneumonia in adults, doctors adhere to the rules
their destination. First of all, when establishing radiologically
confirmed diagnosis of “Pneumonia” and before the identification of the exact
microbial pathogen in the patient’s sputum are prescribed antibiotics
wide spectrum of activity. it значит, что препарат будет
to cover with its therapeutic effect a whole range of microbes. After
If a specific pathogen becomes known, an antibiotic can be
change (if the spectrum of activity does not include this microbe).

In addition, there is a list of clinical and laboratory signs
testifying to the effectiveness of the antibiotic for pneumonia. They
evaluated after 3 days from the start of treatment:

  1. Lowering the temperature
  2. Reduction of dyspnea, symptoms of intoxication and respiratory
    deficiency (increased oxygen saturation).
  3. Reducing the amount of pus and sputum.

Moreover, if persistence is observed persistent subfebrile
temperature after taking antibiotics (in the range of 37-37.5 ° C),
wheezing in the lungs, dry cough, sweating and weakness, residual
traces on radiographs, it is not regarded as a reason
continue treatment or change antibacterial agent.

Severity of pneumonia

To understand what kind of antibiotics for pneumonia will be
most effective and in what conditions to treat
for a particular patient, it is necessary to determine the criteria for severity
diseases. Selected severity of pneumonia:

  1. not heavy
  2. heavy;
  3. extremely heavy.

For the first, least dangerous pneumonia, characteristic symptoms
perform:

Criterion Value
Breathing rate <24/мин
Heart rate ≤90 / min
Temperature <38°С
Blood leukocytes 4,0-12,0 х 109
Hemoglobin (g / l) >90
Oxygen saturation (%) >95
The level of serum creatitine (µmol / l) Norm (men – 74-110; women – 60-100)
Lung damage Within the segment
Concomitant pathology Not

Severe pneumonia is characterized by the following symptoms:

Criterion Value
Breathing rate >24/мин
Heart rate >90/мин
Temperature >38,5°С
Blood leukocytes <4,0 х 109/л или >12,0 х 109
Hemoglobin (g / l) <90
Oxygen saturation (%) <90
The level of serum creatitine (µmol / l) >176,7
Lung damage In several segments, but within one share
Concomitant pathology
  • Immune deficiency in infections, cancer and
    systemic diseases, congenital defects of the immune system.
  • COPD (chronic obstructive pulmonary disease).
  • CHF (chronic heart failure).
  • Chronic renal failure (chronic renal failure).
  • Bronchial asthma.

Extreme severe pneumonia is most unfavorable in its
course, it is possible to suspect the symptoms:

Criterion Value
Breathing rate ≥30 / min
Heart rate >120/мин
Temperature ≥40°С или <35°С
Blood leukocytes <4,0 х 109/л или >25,5 х 109
Hemoglobin (g / l) <90
Oxygen saturation (%) <90
The level of serum creatitine (µmol / l) >176,7
Lung damage Captures several lobes, there may be foci of tissue breakdown,
fluid in the pleural cavity
Concomitant pathology
  • Multiple organ failure.
  • Sepsis.

In emergency hospitalization in the therapeutic department (in
individual cases in the intensive care unit and intensive care)
нуждаются пациенты тяжелого и крайне тяжелого течения diseases.
You can use the CRB-65 scale, which reflects the risk of death in
patient and recommends certain conditions of his reference. In scale
evaluate:

  • consciousness;
  • частота дыхания (≥30 / min);
  • артериальное давление (<90/60 мм рт. ст.);
  • age over 65 years.

For each of the points total 1 point. According to the results
there are three groups of patients:

  1. Outpatient treatment (0 points).
  2. Inpatient therapy (1-2 points).
  3. Emergency hospitalization (3-4 points).

Treatment of patients with mild pneumonia

Usually with bronchitis and pneumonia of a given severity of the patient.
is on sick leave and fulfills the doctor’s recommendations in
home conditions. Cure pneumonia is usually possible by oral
drugs without the use of injectable forms, that is, tablets,
capsules, suspensions.

Patients over 60 receive one treatment.
from β-lactam antibiotics:

Active substance Method of use, price
Penicillins:

  • Amoxicillin
Amoxicillin (таблетки): по
0.5 gr. x 2 times a day inside for 14 days. 39-70
rub.
Флемоксин Солютаб (таблетки): по 0,5
gr. x 2 times a day inside for 14 days. 390-530
rub.
Амосин:

  • Capsules: dosing regimen is similar. 75-115
    rub.
  • Powder for suspension: pour into a glass of warm clear water
    the contents of the bag, mixed, consumed inside. 40-90
    rub.
Macrolides:

  • Azithromycin
Азитрал (капсулы): 0,25/0.5 gr.
once a day before or 2 hours after a meal.
280-330 rub.
Сумамед:

  • Таблетки: 0.5 gr. once a day 60 minutes before or after 2
    hours after meals. 200-580 rub.
  • Капсулы: 0.5 gr. once a day 60 minutes before or after 2
    hours after eating. 450-500 rub.
  • Powder for suspension: take 1 time per day 60 minutes before
    or 2 hours after meals, adding 11 ml of clean in advance
    water into a vial and shake the mixture. 200-570 rub.
Азитрокс:

  • Капсулы: по 0,25/0.5 gr. once a day. 280-330
    rub.
  • Powder for suspension in vials: use 2 times a day
    after adding 9.5 ml of water to the vial. 120-370
    rub.
  • Clarithromycin
Клацид:

  • Granules for suspension: take 2 times a day after a slow
    add water to the vial and shake. 350-450
    rub.
  • Таблетки: 0.5 gr. twice a day, take 14 days.
    500-800 rub.
Clarithromycin Тева (таблетки): 0,25 gr.
twice a day course of 1 week. 380-530 rub.
Фромилид (таблетки): 0.5 gr. twice in
day course 2 weeks. 290-680 rub.

For patients 60 years and older in combination with concomitant
pathology (or without it) are suitable protected penicillins and
fluoroquinolones:

Active substance Method of use, price
Protected penicillins:

  • Amoxicillin + клавулановая кислота
Амоксиклав:

  • Tablets: 1 tablet (250 + 125 mg, respectively) x 3 times a
    день или по 1 таблетке (500+125 мг соответственно) x 2 раза в день
    together with the beginning of the meal, the course of 14 days. 220-380
    rub.
  • Powder for suspension: dosage is determined per 1 kg of mass
    bodies on the tables attached to the bottles. 130-280
    rub.
Аугментин:

  • Tablets: 1 tablet (250 + 125 mg, respectively) three times a
    day, course of 14 days. 260-380 rub.
  • Powder for suspension: cooled to room temperature
    water in a volume of 60 ml add to the vial, shake, give it
    brew for 5 minutes, then add water to the mark and again
    shake several times. 150-470 rub.
Флемоклав Солютаб (таблетки): по 1
a tablet (500 + 125 mg, respectively) three times a day or 1 each
таблетке (875+125 мг соответственно) twice in день, не разжевывая в
the beginning of the meal, the course 2 weeks. 300-450 rub.
Респираторные fluoroquinolones:

  • Levofloxacin
Таваник (таблетки): по 0,25 gr. x 2
таблетки x 2 раза в день либо по 0.5 gr. x 1 tablet x 1 time a
a day, drinking water, course 2 weeks. 460-1000
rub.
Флорацид (таблетки): по 0.5 gr. twice
per day, without chewing, between meals. 300-800
rub.
  • Moxifloxacin
Авелокс (таблетки): 0,4 gr. x 1 time
day, without chewing, course 2 weeks. 220-380
rub.
Мофлаксия (таблетки): режим дозирования
similar. 320-350 rub.

Respiratory fluoroquinolones remain the best antibiotics for
pneumonia at stage 2 of its treatment. They are connected in the absence of
signs of the effectiveness of the first drug used.
Representatives of this group have a large spectrum of action and
less resistant microbes. However every case
is individual.

Treatment of patients with severe and extremely severe pneumonia

Key drugs in the treatment of these patient groups in
hospital are cephalosporins – another representatives
β-lactam strong antibiotics. Apply drugs III and IV
generations with a bactericidal effect (complete destruction
pathogen cells).

Among the representatives of cephalosporins III generation can be found
oral and parenteral forms. In the first subgroup
common:

  • Цефиксим (Супракс в капсулах – по 0,4
    gr. x 1 time сутки, 700-780 rub.)
  • Цефтибутен (Цедекс в капсулах – по 0,4
    gr. x 1 time сутки, 800-1100 rub.)
  • Цефдиторен (Спектрацеф в таблетках – по
    0,2/0,4 gr. x 2 раза в день, 1300-1400 rub.)

The effective antibiotic from the second subgroup is ceftriaxone:

  • Цефтриаксон в виде порошка for
    приготовления инъекционного раствора – по 1,0-2,0 gr. once in
    day intramuscularly or intravenously. 30-900
    rub.
  • Азаран в виде порошка for приготовления
    инъекционного раствора – по 1,0 gr. x 1 time сутки внутримышечно,
    dissolved in 3.5 ml of 1% lidocaine hydrochloride solution.
    2300-2700 rub.

Additional activity against Pseudomonas aeruginosa have
parenteral:

  • Цефтазидим (Фортум в виде порошка for
    приготовления инъекционного раствора – по 1,0-6,0 gr. per day in 2-3
    intravenouslyго или внутримышечного введения, 450-520
    rub.
    )
  • Цефоперазон (Цефобид в виде порошка for
    приготовления инъекционного раствора – по 2,0-4,0 gr. per day
    внутримышечно, разделенные на 2 приема, 250-300
    rub.
    )

Carbapenems are another of the “spare” groups in stationary
treatment of pneumonia. However, these drugs are not active for atypical
flora. Among antibiotics, note the names:

  • Имипенем + циластатин (Тиенам в виде
    powder for the preparation of injection solution – the average daily
    дозировка 2,0 gr., т.е. 4 intravenous / intramuscular injections,
    4500-4800 rub.).
  • Меропенем (Меронем в виде порошка for
    приготовления инъекционного раствора – по 0,5-1,0 gr. intravenously
    каждые 8 часов, 5000-11100 rub.).

For the destruction of mycoplasmas with pneumonia are suitable
antibiotics:

  • Macrolides active against atypical flora (see above
    tab.)
  • Tetracyclines – reserve drugs. Doxycycline
    (Юнидокс Солютаб в таблетках – по 0,2 gr. в
    1-2 приема, не разжевывая во время приема пищи, 300-350
    rub.
    )

The cure for pneumonia certainly also indicates a decrease in
temperature when taking antibiotics. It is wrong to think that the most
antibiotics will be effective drugs, since their
the spectrum is wider. The purpose of such drugs should be forced
because otherwise the resistance of bacteria will only
grow, and medicine will lose its “siding”.

Adequate therapy for pneumonia cannot do without antibiotics.
it единственная современная и эффективная мера for устранения
the causes of the disease are microorganisms. All drug prescriptions must
be controlled by a doctor, self-treatment is fraught with aggravation of the flow
diseases and the development of bacterial cell immunity to
antibiotic effects.

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