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Is doxycycline good for pneumonia: Doxycycline is a cost-effective therapy for hospitalized patients with community-acquired pneumonia

Содержание

Doxycycline is a cost-effective therapy for hospitalized patients with community-acquired pneumonia


Background:

Doxycycline has a high degree of activity against many common respiratory pathogens and has been used in the outpatient management of lower respiratory tract infections, including pneumonia.


Objective:

To evaluate the efficacy of intravenous doxycycline as empirical treatment in hospitalized patients with mild to moderately severe community-acquired pneumonia.


Patients and methods:

We conducted a randomized prospective trial to compare the efficacy of intravenous doxycycline with other routinely used antibiotic regimens in 87 patients admitted with the diagnosis of community-acquired pneumonia. Forty-three patients were randomized to receive 100 mg of doxycycline intravenously every 12 hours while 44 patients received other antibiotic(s) (control group). The 2 patient groups were comparable in their clinical and laboratory profiles.


Results:

The mean+/-SD interval between starting an antibiotic and the clinical response was 2.21+/-2.61 days in the doxycycline group compared with 3.84+/-6.39 days in the control group (P = .001). The mean+/-SD length of hospitalization was 4.14+/-3.08 days in the doxycycline group compared with 6.14+/-6.65 days in the control group (P = .04). The median cost of hospitalization was $5126 in the doxycycline group compared with $6528 in the control group (P = .04). The median cost of antibiotic therapy in the doxycycline-treated patients ($33) was significantly lower than in the control group ($170.90) (P<.001). Doxycycline was as efficacious as the other regimens chosen for the treatment of community-acquired pneumonia.


Conclusion:

Doxycycline is an effective and inexpensive therapy for the empirical treatment of hospitalized patients with mild to moderately severe community-acquired pneumonia.

Doxycycline: MedlinePlus Drug Information

Doxycycline comes as a capsule, delayed-release capsule, tablet, delayed-release tablet, and suspension (liquid) to take by mouth. Doxycycline is usually taken once or twice a day. Drink a full glass of water with each dose. If your stomach becomes upset when you take doxycycline, you may take it with food or milk. However, taking doxycycline with milk or food may decrease the amount of medication absorbed from your stomach. Talk with your doctor or pharmacist about the best way to take doxycycline. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take doxycycline exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Swallow the delayed-release tablets and the Acticlate CAP capsules whole; do not split, chew, or crush them.

If you cannot swallow certain delayed-release tablets (Doryx; generics) whole, carefully break up the tablet and sprinkle the contents of the tablet on a spoonful of cold or room temperature (not hot) applesauce. Be careful not to crush or damage any of the pellets while you are breaking up the tablet. Eat the mixture right away and swallow without chewing. If the mixture cannot be eaten right away it should be discarded.

Shake the suspension well before each use to mix the medication evenly.

If you are taking doxycycline for the prevention of malaria, start taking it 1 or 2 days before traveling to an area where there is malaria. Continue taking doxycycline each day you are in the area, and for 4 weeks after leaving the area. You should not take doxycycline for the prevention of malaria for more than 4 months.

Continue to take doxycycline even if you feel well. Take all the medication until you are finished, unless your doctor tells you otherwise.

One doxycycline product may not be able to be substituted for another. Be sure that you receive only the type of doxycycline that was prescribed by your doctor. Ask your pharmacist if you have any questions about the type of doxycycline you were given.

Diagnosis and Treatment of Community-Acquired Pneumonia

1. Andrews J,
Nadjm B,
Gant V,
Shetty N.
Community-acquired pneumonia. Curr Opin Pulm Med.
2003;9:175–80….

2. Niederman MS.
Community-acquired pneumonia: management controversies, part 1; practical recommendations from the latest guidelines. J Respir Dis.
2002;23:10–7.

3. Arias E,
Anderson RN,
Kung HC,
Murphy SL,
Kochanek KD.
Deaths: final data for 2001. Natl Vital Stat Rep.
2003;52:1–115.

4. Hall MJ,
DeFrances CJ.
2001 National hospital discharge survey. Adv Data.
2004:1–20.

5. File TM.
Community-acquired pneumonia. Lancet.
2003;362:1991–2001.

6. Fish D. Pneumonia. In: Pharmacotherapy self-assessment program. 4th ed. Kansas City: American College of Clinical Pharmacy, 2002.

7. Beovic B,
Bonac B,
Kese D,
Avsic-Zupanc T,
Kreft S,
Lesnicar G,

et al.
Aetiology and clinical presentation of mild community-acquired bacterial pneumonia. Eur J Clin Microbiol Infect Dis.
2003;22:584–91.

8. Niederman MS,
Mandell LA,
Anzueto A,
Bass JB,
Broughton WA,
Campbell GD,

et al.
American Thoracic Society. Guidelines for the management of adults with community-acquired pneumonia. Diagnosis, assessment of severity, antimicrobial therapy, and prevention. Am J Respir Crit Care Med.
2001;163:1730–54.

9. Mandell LA,
Bartlett JG,
Dowell SF,
File TM Jr,
Musher DM,
Whitney C.
Infectious Diseases Society of America. Update of practice guidelines for the management of community-acquired pneumonia in immunocompetent adults. Clin Infect Dis.
2003;37:1405–33.

10. Sopena N,
Sabria M,
Pedro-Botet ML,
Manterola JM,
Matas L,
Dominguez J,

et al.
Prospective study of community-acquired pneumonia of bacterial etiology in adults. Eur J Clin Microbiol Infect Dis.
1999;18:852–8.

11. Campbell SG,
Marrie TJ,
Anstey R,
Dickinson G,
Ackroyd-Stolarz S.
The contribution of blood cultures to the clinical management of adult patients admitted to the hospital with community-acquired pneumonia: a prospective observational study. Chest.
2003;123:1142–50.

12. Feagan BG.
A controlled trial of a critical pathway for treating community-acquired pneumonia: the CAPITAL study. Community-Acquired Pneumonia Intervention Trial Assessing Levofloxacin. Pharmacotherapy.
2001;21(pt 2):S89–94.

13. Priebe DL,
Chambliss ML.
Blood cultures not helpful for community-acquired pneumonia. J Fam Pract.
2003;52:599–600.

14. Sopena N,
Sabria-Leal M,
Pedro-Botet ML,
Padilla E,
Dominguez J,
Morera J,

et al.
Comparative study of the clinical presentation of Legionella pneumonia and other community-acquired pneumonias. Chest.
1998;113:1195–200.

15. Fine MJ,
Auble TE,
Yealy DM,
Hanusa BH,
Weissfeld LA,
Singer DE,

et al.
A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med.
1997;336:243–50.

16. Fine MJ,
Hough LJ,
Medsger AR,
Li YH,
Ricci EM,
Singer DE,

et al.
The hospital admission decision for patients with community-acquired pneumonia. Results from the Pneumonia Patient Outcomes Research Team cohort study. Arch Intern Med.
1997;157:36–44.

17. Fine MJ,
Pratt HM,
Obrosky DS,
Lave JR,
McIntosh LJ,
Singer DE,

et al.
Relation between length of hospital stay and costs of care for patients with community-acquired pneumonia. Am J Med.
2000;109:378–85.

18. Goss CH,
Rubenfeld GD,
Park DR,
Sherbin VL,
Goodman MS,
Root RK.
Cost and incidence of social comorbidities in low-risk patients with community-acquired pneumonia admitted to a public hospital. Chest.
2003;124:2148–55.

19. Hoe LK,
Keang LT.
Hospitalized low-risk community-acquired pneumonia: outcome and potential for cost-savings. Respirology.
1999;4:307–9.

20. Ruiz M,
Ewig S,
Marcos MA,
Martinez JA,
Arancibia F,
Mensa J,

et al.
Etiology of community-acquired pneumonia: impact of age, comorbidity, and severity. Am J Respir Crit Care Med.
1999;160:397–405.

21. Arnold FW,
Ramirez JA,
McDonald LC,
Xia EL.
Hospitalization for community-acquired pneumonia: the pneumonia severity index vs clinical judgment. Chest.
2003;124:121–4.

22. Roson B,
Carratala J,
Dorca J,
Casanova A,
Manresa F,
Gudiol F.
Etiology, reasons for hospitalization, risk classes, and outcomes of community-acquired pneumonia in patients hospitalized on the basis of conventional admission criteria. Clin Infect Dis.
2001;33:158–65.

23. Mandell LA.
Community-acquired pneumonia. Etiology, epidemiology, and treatment. Chest.
1995;108(suppl):S35–42.

24. Mandell LA.
Antibiotic therapy for community-acquired pneumonia. Clin Chest Med.
1999;20:589–98.

25. Mandell LA.
Antimicrobial approaches to therapy for pneumonia. Curr Opin Pulm Med.
1996;2:218–27.

26. Mundy LM,
Oldach D,
Auwaerter PG,
Gaydos CA,
Moore RD,
Bartlett JG,

et al.
for the Hopkins CAP team. Implications for macrolide treatment in community-acquired pneumonia. Chest.
1998;113:1201–6.

27. Mandell LA.
Antibiotics for pneumonia therapy. Med Clin North Am.
1994;78:997–1014.

28. Mandell LA,
Marrie TJ,
Grossman RF,
Chow AW,
Hyland RH.
for the Canadian Community-Acquired Pneumonia Working Group. Canadian guidelines for the initial management of community-acquired pneumonia: an evidence-based update by the Canadian Infectious Diseases Society and the Canadian Thoracic Society. Clin Infect Dis.
2000;31:383–421.

29. Heffelfinger JD,
Dowell SF,
Jorgensen JH,
Klugman KP,
Mabry LR,
Musher DM,

et al.
Management of community-acquired pneumonia in the era of pneumococcal resistance: a report from the Drug-Resistant Streptococcus pneumoniae Working Group. Arch Intern Med.
2000;160:1399–408.

30. Mandell LA,
Bergeron MC,
Gribble MJ,

et al.
Sequential antibiotic therapy: effective cost management and patient care. Can J Infect Dis.
1995;6:306

31. Kuti JL,
Capitano B,
Nicolau DP.
Cost-effective approaches to the treatment of community-acquired pneumonia in the era of resistance. Pharmacoeconomics.
2002;20:513–28.

32. Jones RN,
Biedenbach DJ,
Beach ML.
Influence of patient age on the susceptibility patterns of Streptococcus pneumoniae isolates in North America (2000–2001): report from the SENTRY Antimicrobial Surveillance Program. Diagn Microbiol Infect Dis.
2003;46:77–80.

33. Begg EJ,
Barclay ML,
Kirkpatrick CM.
The therapeutic monitoring of antimicrobial agents. Br J Clin Pharmacol.
2001;52(suppl 1):S35–43.

34. Milkovich G.
Intravenous-to-oral transition therapy in community-acquired pneumonia: the INOVA Health System experience. Pharmacotherapy.
2001;21(pt 2):S83–8.

35. Weingarten SR,
Riedinger MS,
Varis G,
Noah MS,
Belman MJ,
Meyer RD,

et al.
Identification of low-risk hospitalized patients with pneumonia. Implications for early conversion to oral antimicrobial therapy. Chest.
1994;105:1109–15.

36. Siegel RE,
Halpern NA,
Almenoff PL,
Lee A,
Cashin R,
Greene JG.
A prospective randomized study of in-patient iv. antibiotics for community-acquired pneumonia. The optimal duration of therapy. Chest.
1996;110:965–71.

37. Ramirez JA,
Vargas S,
Ritter GW,
Brier ME,
Wright A,
Smith S,

et al.
Early switch from intravenous to oral antibiotics and early hospital discharge: a prospective observational study of 200 consecutive patients with community-acquired pneumonia. Arch Intern Med.
1999;159:2449–54.

38. Coffey RJ,
Richards JS,
Remmert CS,
LeRoy SS,
Schoville RR,
Baldwin PJ.
An introduction to critical paths. Qual Manag Health Care.
1992;1:45–54.

39. Marrie TJ,
Lau CY,
Wheeler SL,
Wong CJ,
Vanervoort MK,
Feagan BG.
A controlled trial of a critical pathway for treatment of community-acquired pneumonia. CAPITAL Study Investigators. Community-Acquired Pneumonia Intervention Trial Assessing Levofloxacin. JAMA.
2000;283:749–55.

Fluoroquinolones, Cephalosporins, Macrolides, Monobactams, Antibiotics, Lincosamide, Tetracyclines, Carbapenems, Oxazolidinones, Aminoglycosides, Penicillins, Amino, Penicillins, Extended-Spectrum, Penicillins, Natural, Sulfonamides, Glycopeptides, Pleuromutilin, Glucocorticoids, Vaccines

  • Hussain AN, Kumar V. The lung. In: Kumar V, Abbas AK, Fausto N, eds. Robbins and Cotran: Pathologic Basis of Disease. 7th ed. Philadelphia, Pa: Elsevier Saunders; 2005. 711-72.

  • [Guideline] Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007 Mar 1. 44 Suppl 2:S27-72. [Medline].

  • Stedman’s Medical Dictionary. 27th ed. Baltimore, Md: Lippincott, Williams and Wilkins; 2003.

  • Brundage JF, Shanks GD. Deaths from bacterial pneumonia during 1918-19 influenza pandemic. Emerg Infect Dis. 2008 Aug. 14(8):1193-9. [Medline]. [Full Text].

  • Anand N, Kollef MH. The alphabet soup of pneumonia: CAP, HAP, HCAP, NHAP, and VAP. Semin Respir Crit Care Med. 2009 Feb. 30(1):3-9. [Medline].

  • El Solh AA. Nursing home-acquired pneumonia. Semin Respir Crit Care Med. 2009 Feb. 30(1):16-25. [Medline].

  • Kuti JL, Shore E, Palter M, Nicolau DP. Tackling empirical antibiotic therapy for ventilator-associated pneumonia in your ICU: guidance for implementing the guidelines. Semin Respir Crit Care Med. 2009 Feb. 30(1):102-15. [Medline].

  • Chacko R, Rajan A, Lionel P, Thilagavathi M, Yadav B, Premkumar J. Oral decontamination techniques and ventilator-associated pneumonia. Br J Nurs. 2017 Jun 8. 26 (11):594-599. [Medline].

  • Bouglé A, Foucrier A, Dupont H, Montravers P, Ouattara A, Kalfon P, et al. Impact of the duration of antibiotics on clinical events in patients with Pseudomonas aeruginosa ventilator-associated pneumonia: study protocol for a randomized controlled study. Trials. 2017 Jan 23. 18 (1):37. [Medline]. [Full Text].

  • Kollef MH, Ricard JD, Roux D, et al. A Randomized Trial of the Amikacin Fosfomycin Inhalation System for the Adjunctive Therapy of Gram-Negative Ventilator-Associated Pneumonia: IASIS Trial. Chest. 2017 Jun. 151 (6):1239-1246. [Medline].

  • Kalil AC, Metersky ML, Klompas M, Muscedere J, Sweeney DA, Palmer LB, et al. Executive Summary: Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis. 2016 Sep 1. 63 (5):575-82. [Medline].

  • Chalmers JD, Rother C, Salih W, Ewig S. Healthcare-associated pneumonia does not accurately identify potentially resistant pathogens: a systematic review and meta-analysis. Clin Infect Dis. 2014 Feb. 58 (3):330-9. [Medline].

  • Eggimann P, Pittet D. Infection control in the ICU. Chest. 2001 Dec. 120(6):2059-93. [Medline].

  • Gaynes R, Edwards JR. Overview of nosocomial infections caused by gram-negative bacilli. Clin Infect Dis. 2005 Sep 15. 41(6):848-54. [Medline].

  • Peleg AY, Hooper DC. Hospital-acquired infections due to gram-negative bacteria. N Engl J Med. 2010 May 13. 362(19):1804-13. [Medline].

  • Marik PE. Aspiration pneumonitis and aspiration pneumonia. N Engl J Med. 2001 Mar 1. 344(9):665-71. [Medline].

  • Mizgerd JP. Acute lower respiratory tract infection. N Engl J Med. 2008 Feb 14. 358(7):716-27. [Medline]. [Full Text].

  • Rubins JB, Janoff EN. Pneumolysin: a multifunctional pneumococcal virulence factor. J Lab Clin Med. 1998 Jan. 131(1):21-7. [Medline].

  • Sadikot RT, Blackwell TS, Christman JW, Prince AS. Pathogen-host interactions in Pseudomonas aeruginosa pneumonia. Am J Respir Crit Care Med. 2005 Jun 1. 171(11):1209-23. [Medline]. [Full Text].

  • McCullers JA. Insights into the interaction between influenza virus and pneumococcus. Clin Microbiol Rev. 2006 Jul. 19(3):571-82. [Medline]. [Full Text].

  • Forgie S, Marrie TJ. Healthcare-associated atypical pneumonia. Semin Respir Crit Care Med. 2009 Feb. 30(1):67-85. [Medline].

  • Centers for Disease Control and Prevention. Pneumonia. Available at http://www.cdc.gov/Features/Pneumonia/. Accessed: January 13, 2011.

  • Restrepo MI, Anzueto A. The role of gram-negative bacteria in healthcare-associated pneumonia. Semin Respir Crit Care Med. 2009 Feb. 30(1):61-6. [Medline].

  • Bacterial coinfections in lung tissue specimens from fatal cases of 2009 pandemic influenza A (h2N1) – United States, May-August 2009. MMWR Morb Mortal Wkly Rep. 2009 Oct 2. 58(38):1071-4. [Medline].

  • 2009 pandemic influenza A (h2N1) in pregnant women requiring intensive care – New York City, 2009. MMWR Morb Mortal Wkly Rep. 2010 Mar 26. 59(11):321-6. [Medline].

  • Dennis DT, Inglesby TV, Henderson DA, Bartlett JG, Ascher MS, Eitzen E, et al. Tularemia as a biological weapon: medical and public health management. JAMA. 2001 Jun 6. 285(21):2763-73. [Medline].

  • Rello J, Ollendorf DA, Oster G, Vera-Llonch M, Bellm L, Redman R, et al. Epidemiology and outcomes of ventilator-associated pneumonia in a large US database. Chest. 2002 Dec. 122(6):2115-21. [Medline].

  • American Lung Association. Trends in pneumonia and influenza morbidity and mortality. September 2008. American Lung Association. Available at http://bit.ly/gwYJAE. Accessed: January 13, 2011.

  • Kung HC, Hoyert DL, Xu JQ, Murphy SL, and the Division of Vital Statistics. Deaths: final data for 2005. National Vital Statistics Reports. Hyattsville, Md: National Center for Health Statistics April 2008: 56(10). http://www.cdc.gov. Available at http://bit.ly/i3ATH5. Accessed: January 13, 2011.

  • Mufson MA, Stanek RJ. Bacteremic pneumococcal pneumonia in one American City: a 20-year longitudinal study, 1978-1997. Am J Med. 1999 Jul 26. 107(1A):34S-43S. [Medline].

  • Cillóniz C, Ewig S, Polverino E, Marcos MA, Esquinas C, Gabarrús A, et al. Microbial aetiology of community-acquired pneumonia and its relation to severity. Thorax. 2011 Apr. 66(4):340-6. [Medline].

  • Slovis BS, Brigham KL. Cecil Essentials of Medicine. : Andreoli T, Carpenter CCJ, Griggs RC, Loscalzo J. Approach to the patient with respiratory disease. 6th ed. WB Saunders Co: Philadelphia, Pa; 2004. 177-80.

  • Brown SM, Jones BE, Jephson AR, Dean NC. Validation of the Infectious Disease Society of America/American Thoracic Society 2007 guidelines for severe community-acquired pneumonia. Crit Care Med. 2009 Dec. 37(12):3010-6. [Medline]. [Full Text].

  • Fang WF, Yang KY, Wu CL, Yu CJ, Chen CW, Tu CY, et al. Application and comparison of scoring indices to predict outcomes in patients with healthcare-associated pneumonia. Crit Care. 2011 Jan 19. 15(1):R32. [Medline].

  • Lim WS, van der Eerden MM, Laing R, Boersma WG, Karalus N, Town GI, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax. 2003 May. 58(5):377-82. [Medline]. [Full Text].

  • Fine MJ, Auble TE, Yealy DM, Hanusa BH, Weissfeld LA, Singer DE, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med. 1997 Jan 23. 336(4):243-50. [Medline].

  • Agency for Healthcare Research and Quality. Pneumonia severity index calculator. Available at http://pda.ahrq.gov/clinic/psi/psicalc.asp. Accessed: January 13, 2011.

  • Sligl WI, Majumdar SR, Marrie TJ. Triaging severe pneumonia: what is the “score” on prediction rules?. Crit Care Med. 2009 Dec. 37(12):3166-8. [Medline].

  • Phua J, See KC, Chan YH, Widjaja LS, Aung NW, Ngerng WJ, et al. Validation and clinical implications of the IDSA/ATS minor criteria for severe community-acquired pneumonia. Thorax. 2009 Jul. 64(7):598-603. [Medline].

  • Bloos F, Marshall JC, Dellinger RP, et al. Multinational, observational study of procalcitonin in ICU patients with pneumonia requiring mechanical ventilation: a multicenter observational study. Crit Care. 2011 Mar 7. 15(2):R88. [Medline].

  • Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985 Oct. 13(10):818-29. [Medline].

  • Le Gall JR, Lemeshow S, Saulnier F. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA. 1993 Dec 22-29. 270(24):2957-63. [Medline].

  • Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996 Jul. 22(7):707-10. [Medline].

  • El-Solh AA, Alhajhusain A, Abou Jaoude P, Drinka P. Validity of severity scores in hospitalized patients with nursing home-acquired pneumonia. Chest. 2010 Dec. 138(6):1371-6. [Medline].

  • España PP, Capelastegui A, Gorordo I, Esteban C, Oribe M, Ortega M, et al. Development and validation of a clinical prediction rule for severe community-acquired pneumonia. Am J Respir Crit Care Med. 2006 Dec 1. 174(11):1249-56. [Medline].

  • Rello J, Rodriguez A, Lisboa T, Gallego M, Lujan M, Wunderink R. PIRO score for community-acquired pneumonia: a new prediction rule for assessment of severity in intensive care unit patients with community-acquired pneumonia. Crit Care Med. 2009 Feb. 37(2):456-62. [Medline].

  • Charles PG, Wolfe R, Whitby M, Fine MJ, Fuller AJ, Stirling R, et al. SMART-COP: a tool for predicting the need for intensive respiratory or vasopressor support in community-acquired pneumonia. Clin Infect Dis. 2008 Aug 1. 47(3):375-84. [Medline].

  • Light RW. Clinical practice. Pleural effusion. N Engl J Med. 2002 Jun 20. 346 (25):1971-7. [Medline].

  • Bafadhel M, Clark TW, Reid C, Medina MJ, Batham S, Barer MR, et al. Procalcitonin and C reactive protein in hospitalised adult patients with community acquired pneumonia, exacerbation of asthma and chronic obstructive pulmonary disease. Chest. 2010 Oct 28. [Medline].

  • Skerrett SJ. Diagnostic testing for community-acquired pneumonia. Clin Chest Med. 1999 Sep. 20(3):531-48. [Medline].

  • Smith PR. What diagnostic tests are needed for community-acquired pneumonia?. Med Clin North Am. 2001 Nov. 85(6):1381-96. [Medline].

  • Ketai L, Jordan K, Marom EM. Imaging infection. Clin Chest Med. 2008 Mar. 29(1):77-105, vi. [Medline].

  • Cooper MS, Stewart PM. Corticosteroid insufficiency in acutely ill patients. N Engl J Med. 2003 Feb 20. 348(8):727-34. [Medline].

  • Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001 Nov 8. 345(19):1368-77. [Medline].

  • Kang YA, Kwon SY, Yoon HI, Lee JH, Lee CT. Role of C-reactive protein and procalcitonin in differentiation of tuberculosis from bacterial community acquired pneumonia. Korean J Intern Med. 2009 Dec. 24(4):337-42. [Medline]. [Full Text].

  • Pirracchio R, Mateo J, Raskine L, Rigon MR, Lukaszewicz AC, Mebazaa A, et al. Can bacteriological upper airway samples obtained at intensive care unit admission guide empiric antibiotherapy for ventilator-associated pneumonia?. Crit Care Med. 2009 Sep. 37(9):2559-63. [Medline].

  • Gharib AM, Stern EJ. Radiology of pneumonia. Med Clin North Am. 2001 Nov. 85(6):1461-91, x. [Medline].

  • Tarver RD, Teague SD, Heitkamp DE, Conces DJ Jr. Radiology of community-acquired pneumonia. Radiol Clin North Am. 2005 May. 43(3):497-512, viii. [Medline].

  • Gotway MB, Reddy GP, Webb WR, Elicker BM, Leung JW. High-resolution CT of the lung: patterns of disease and differential diagnoses. Radiol Clin North Am. 2005 May. 43(3):513-42, viii. [Medline].

  • [Guideline] Dellinger RP, Levy MM, Carlet JM, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Intensive Care Med. 2008 Jan. 34(1):17-60. [Medline]. [Full Text].

  • Siemieniuk RA, Meade MO, Alonso-Coello P, Briel M, Evaniew N, Prasad M, et al. Corticosteroid Therapy for Patients Hospitalized With Community-Acquired Pneumonia: A Systematic Review and Meta-analysis. Ann Intern Med. 2015 Oct 6. 163 (7):519-28. [Medline].

  • McCabe C, Kirchner C, Zhang H, Daley J, Fisman DN. Guideline-concordant therapy and reduced mortality and length of stay in adults with community-acquired pneumonia: playing by the rules. Arch Intern Med. 2009 Sep 14. 169(16):1525-31. [Medline].

  • [Guideline] Centers for Medicare and Medicaid Services, Joint Commission. Specifications manual for national hospital inpatient quality measures. V. 2.6b. Manual download retrieved April 2009.

  • Kalil AC, Murthy MH, Hermsen ED, Neto FK, Sun J, Rupp ME. Linezolid versus vancomycin or teicoplanin for nosocomial pneumonia: a systematic review and meta-analysis. Crit Care Med. 2010 Sep. 38(9):1802-8. [Medline].

  • Lam AP, Wunderink RG. The role of MRSA in healthcare-associated pneumonia. Semin Respir Crit Care Med. 2009 Feb. 30(1):52-60. [Medline].

  • Centers for Disease Control and Prevention. h2N1 Flu: Updated CDC estimates of 2009 h2N1 influenza cases, hospitalizations and deaths in the United States April 2009 – April 10, 2010. Available at http://www.cdc.gov/h2n1flu/estimates_2009_h2n1.htm. Accessed: June 1, 2010.

  • Sullivan SJ, Jacobson RM, Dowdle WR, Poland GA. 2009 h2N1 influenza. Mayo Clin Proc. 2010 Jan. 85(1):64-76. [Medline]. [Full Text].

  • 1. Phillips D. ACIP changes pneumococcal vaccine interval in low-risk elderly. Medscape Medical News. WebMD Inc. Sept 4, 2015. Available at http://www.medscape.com/viewarticle/850564.

  • Kobayashi M, Bennett NM, Gierke R, Almendares O, Moore MR, Whitney CG, et al. Intervals Between PCV13 and PPSV23 Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. 2015 Sep 4. 64 (34):944-7. [Medline].

  • Centers for Disease Control and Prevention. Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine for Adults with Immunocompromising Conditions: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. 2012 Oct 12. 61:816-9. [Medline].

  • Tomczyk S, Bennett NM, Stoecker C, Gierke R, Moore MR, Whitney CG, et al. Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine Among Adults Aged =65 Years: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. 2014 Sep 19. 63(37):822-5. [Medline]. [Full Text].

  • Bonten M, Bolkenbaas M, Huijts S, et al. Community Acquired Pneumonia Immunization Trial in Adults (CAPiTA). Abstract no. 0541. Pneumonia 2014;3:95. Available at https://pneumonia.org.au/public/journals/22/PublicFolder/ABSTRACTBOOKMASTERforwebupdated20-3-14.pdf.

  • Tang KL, Eurich DT, Minhas-Sandhu JK, Marrie TJ, Majumdar SR. Incidence, correlates, and chest radiographic yield of new lung cancer diagnosis in 3398 patients with pneumonia. Arch Intern Med. 2011 Jul 11. 171(13):1193-8. [Medline].

  • FDA requests boxed warnings on fluoroquinolone antimicrobial drugs: seeks to strengthen warnings concerning increased risk of tendinitis and tendon rupture [press release]. Silver Spring, Md: US Food and Drug Administration; July 8, 2008. FDA. Available at http://bit.ly/fkBFeA. Accessed: January 14, 2011.

  • Kollef M, et al. ASPECT-NP: a randomized, double-blind, phase III trial comparing efficacy and safety of ceftolozane/ tazobactam versus meropenem in patients with ventilated nosocomial pneumonia (VNP). Presented at the 2019 European Congress of Clinical Microbiology & Infectious Diseases (ECCMID) (P1917). Amsterdam, Netherlands. 13-16 April 2019.

  • doxycycline treats a host of human plagues, but it won’t work forever

    Doxycycline is an antibiotic drug that kills a wide, weird and wonderful range of bugs that are often difficult to treat with other antibiotics. These include bacteria and parasites that take up residence inside our cells (called “intracellular organisms”), making them hard for most antibiotics to reach.

    Unlike many other antibiotics, doxycycline penetrates deep into our tissues and ends up inside our cells, where it can kill these bugs. Examples of intracellular organisms susceptible to doxycycline include numerous “zoonotic infections” (infections that are spread from animals to humans), chlamydia, legionella (the cause of legionnaire’s disease) and malaria.

    Other susceptible microorganisms include “spirochaetes” (that can cause syphilis and Lyme disease) and the bacteria that cause acne, anthrax and cholera.

    Mechanism

    Doxycycline interferes with a microorganism’s ability to manufacture proteins – the “building blocks” of life. Protein manufacture occurs in a part of the cell called the “ribosome” and is fundamental to any organism’s survival.

    The reason doxycycline kills bacteria and parasites, but not our own cells, is that ours have a different type of ribosome to these simpler organisms.

    Uses

    Because doxycycline kills a wide range of bacteria that can infect the respiratory system, it is commonly prescribed for pneumonia and bronchitis. It is also widely used for treating acne and infections of the urinary and genital systems.

    It is usually taken orally as tablets or capsules but can also very occasionally be given as an intravenous injection.

    Doxycycline interferes with a microorganism’s ability to manufacture proteins – which is essential for survival.
    Tim Proctor/Flickr, CC BY

    Doxycycline continues to exert its effects for some time after being taken. This means it can be used not only as treatment, but also for prevention or “prophylaxis”.

    Its most widespread use as prophylaxis is for tourists and other travellers (such as military personnel) going to tropical countries where it is used to protect primarily against malaria. It may also provide additional protection from common bacterial causes of diarrhoea.

    To be effective in preventing infection, it needs to be taken once a day during the time the person is at risk. Doxycycline is also active against a number of bacteria that could possibly be used as agents of “germ” warfare. This included, most notably, anthrax. So it could be used as prophylaxis in military or other populations thought to be at risk of bio-warfare or following release of anthrax into the environment by terrorists.

    Development

    The development of doxycycline followed the momentous discovery of penicillin, a natural compound produced by a certain type of mould.

    This lead many pharmaceutical companies to investigate the microbe-killing properties of a large number of other natural products, such as those produced by other microorganisms and plants, a process termed “bio-discovery”.

    This unearthed natural compounds with anti-microbial activity and further synthetic modification improved these natural compounds.

    Resistance

    Like all antibiotics, doxycycline is susceptible to bugs that develop resistance. There is evidence this has already occurred in settings where the drug is widely used, such as treatment of acne.

    This means its use may be curtailed or overtaken by alternative drugs for some conditions, now or in the future.

    Side effects and reactions

    The most commonly reported side effect is inflammation of the oesophagus (food pipe), causing heartburn. This can be quite unpleasant but is somewhat preventable by taking the medication with plenty of water, while standing and well before going to bed.

    “Photosensitivity” (heightened sensitivity to sunlight resulting in being easily sunburnt) is also common ( in up to 20% of people taking it). This is especially problematic for travellers using it as malaria prophylaxis in tropical countries.

    Doxycycline should not be used in children or in pregnant women where it can result in permanent brown staining of teeth and have other effects on foetal bone development.

    Doxycycline can increase the toxicity of the anti-inflammatory drug methotrexate.

    Controversies

    Recent high-profile controversies regarding side-effects from antimalarial drug mefloquine in defence-force personnel and refugees have highlighted the role of doxycycline as one of two main alternatives to mefloquine.

    It is now generally considered a preferable initial choice to mefloquine for malaria prophylaxis. Interestingly, previous studies suggest many people actually prefer taking mefloquine to doxycycline.

    This may reflect the nature of doxycycline’s side effects, but also its less convenient daily dosing (mefloquine is taken weekly).

    Possible future uses

    It has recently been found doxycycline affects processes in human cells, especially a group of enzymes important for the body’s inflammatory response. This property may be beneficial and could lead to applications for treating various non-infectious conditions.

    These include cancers (especially those involving bone), inflammatory and autoimmune conditions (including rheumatoid arthritis and multiple sclerosis) and atherosclerotic diseases (plaque build-up in your arteries that can cause heart disease). However, these applications are currently still mostly in the experimental stage.

    Bronchitis and Pneumonia Drugs

    Bronchitis and Pneumonia Drugs

    Many different types of drugs may be used in dogs and cats suffering from bronchitis and/or pneumonia. Generally four types of drugs are most commonly
    used, and include antibiotics (antimicrobials), corticosteroids, bronchodilators and antitussives. Depending on the problems, different drugs in different
    combinations may be prescribed.

    ANTIBIOTICS:

    Antibiotics (antimicrobials) are drugs that are used in patients suffering from bacterial infections. In patients with lung disease, they are typically
    used for those with bacterial pneumonia (infection of the lungs) or septic tracheitis/tracheobronchitis (infection of the airways). Some antibiotics
    are classified as bacteriostatic, which means they inhibit the growth of microorganisms, allowing the body’s natural defenses to take over. Some antibiotics
    are considered bactericidal, which means they are directly toxic to microorganisms. Some antibiotics have a relatively narrow spectrum of activity,
    which means they may be useful for only certain types of bacterial infections, while others may have broad-spectrum activity, and are effective for
    many types of bacterial infections. Your veterinarian may recommend a culture/sensitivity to help choose an appropriate antibiotic for a specific infection.
    Samples of the airway secretions or those obtained from bronchoalveolar lavage may be cultured.

    Doxycycline (VIBRAMYCIN®):

    This is an antibiotic that belongs to the tetracycline group of drugs. This antibiotic has broad-spectrum protection for a variety of bacterial organisms,
    including Mycoplasma species. It has good tissue penetration, and is useful for many respiratory infections. Side effects may include gastrointestinal
    upset, and doxycycline is best given with food. It is important that cats receiving doxycycline tablets be syringed water immediately after oral administration
    to help prevent esophageal problems.

    Azithromycin (ZITHROMAX®):

    This is an antibiotic that belongs to the class of drugs known as macrolides. This antibiotic has broad-spectrum protection for a variety of bacterial
    organisms. It has good tissue penetration and is useful for many respiratory infections. Side effects may include gastrointestinal upset.

    Amoxicillin (AMOXI-TABS®):

    Amoxicillin/clavulanic acid (CLAVAMOX®):

    Amoxicillin and amoxicillin/clavulanic acid are antibiotics that belongs to the penicillin group of drugs. These antibiotics have broad-spectrum protection
    for a variety of bacterial organisms. It has good tissue penetration and is useful for many respiratory infections. Side effects may include gastrointestinal
    upset.

    Enrofloxacin (BAYTRIL®):

    Marbofloxacin (ZENEQUIN®):

    Enrofloxacin and marbofloxacin are fluoroquinolone antibiotics. These antibiotics have broad-spectrum protection for a variety of bacterial organisms.
    They have good tissue penetration and are useful for many respiratory infections. Side effects may include gastrointestinal upset.

    CORTICOSTEROIDS:

    Corticosteroids are the most potent anti-inflammatory drugs. They are used to treat diseases associated with severe inflammation, and may be used in patients
    suffering from bronchitis and/or asthma, as well as patients with severe airway collapse (collapsing trachea). Generally, it is advised to use tapering
    courses, and every effort is made to wean off the drug entirely or at least reach the lowest effective dose. Periodic bloodwork is advised in patients
    taking corticosteroids on a long-term basis. Patients on high doses for extended periods may become at risk for secondary infections, as corticosteroids
    can be immunosuppressive. Your veterinarian can help guide appropriate therapy.

    Prednisone/Prednisolone:

    Prednisone is a corticosteroid used for anti-inflammatory purposes in feline asthma, or for immunosuppression in some illnesses (requiring a higher
    dose). Side-effects can be increased thirst, increased urination, increased appetite, and panting in dogs. Long-term use should be continued at the
    lowest effective dose possible due to the risk for steroid overdose. For many asthmatic cats this may be 2.5 mg every other or every third day. Prednisone
    must be used cautiously in cats with cardiac disease, or cats with chronic cough history that may have an infectious component to their lung disease.

    BRONCHODILATORS:

    Bronchodilators are drugs used in patients with bronchial (airway) disease, such as bronchitis and asthma. They are occasionally helpful in patients with
    airway collapse. These drugs help open the airways, which improves symptoms of labored breathing in patients with airway constriction, which may result
    from chronic inflammation.

    Theophylline (THEODUR®):
    Aminophylline (PHYLLOCONTIN®):
    Theophylline belongs to the
    class of drugs known as phospodiesterase inhibitors, which are smooth muscle relaxants. These drugs are airway dilators, opening the bronchial tubes.
    This results in widening of the tubes and can assist breathing in certain situations. Theophylline has been used as an adjunct treatment in heart failure,
    asthma, bronchitis, or other chronic lung diseases. It should be used with caution in animals with severe heart disease, abnormal heart rhythms, kidney
    or liver impairment, or high blood pressure. Theophylline has been shown to cause stomach irritation and nervous system stimulation. Anxiety and restlessness
    are common side effects of treatment in dogs. Other potential adverse effects include nausea, vomiting, and diarrhea. Seizures can occur if the animal
    receives a significant overdose. Side effects often resolve once the drug is discontinued. 

    Terbutaline (BRETHINE®):­­­­­­­­­­­­­­­­­­­­­­­­

    A beta -2 agonist, terbutaline functions as a bronchodilator in the cat with feline asthma. It works by relaxing the smooth muscle that lines the
    respiratory tract and reverses constriction of the lower airways that can occur with inflammatory diseases of the lung. Terbutaline can have a mild
    side-effect of elevating heart rate and can even be used for heart rate stimulation in the dog at higher doses. Side-effects may also include increased
    energy level, or rarely, restlessness.

    ANTITUSSIVES:

    Antitussive medications help control coughing. These drugs typically contain an opiod, and as such, they are often controlled substances. Some over-the-counter
    formulations are available, and typically include the drug dextromethorphan. The most commonly used prescription antitussives are hydrocodone and butorphanol.
    Side effects may include sedation and constipation.

    Hydrocodone (HYCODAN®, TUSSIGON®, HYDRO-MET®):Butorphanol (TORBUTROL®):Certain respiratory
    conditions in dogs are associated with severe or chronic coughing. These include tracheobronchitis (kennel cough), chronic bronchitis, tracheal collapse
    and bronchial compression. In many instances, the only effective therapy for these major airway irritations is a cough suppressant or antitussive drug.
    These drugs suppress the cough reflex within the brain and also can cause sedation. They should not be used in the setting of an active bacterial infection
    of the lungs since a cough is an essential reflex to rid the lung of infection. Cough suppressants should be avoided in animals with significant heart
    or lung disease, unless supervised by a veterinarian. The most common adverse effects include sedation and constipation. These are controlled drugs
    and are available only from a veterinarian with an active DEA license. Hycodan® or Tussigon® contains hydrocodone bitartrate 5mg and homatropine MBr
    1.5 mg per tablet (or per 5 ml). It is important that this drug is NOT confused with hydrocodone/APAP (VICODIN®), which contains 5 mg of hydrocodone and 500 mg of acetaminophen, which may be potentially toxic to dogs. If you are concerned you may have
    the incorrect medication, DISCONTINUE it and notify us immediately. 

     

    Pneumonia Information | Mount Sinai

    Diagnostic Challenges

    Diagnostic Difficulties in CAP

    It is important to determine whether the cause of CAP is a bacterium, atypical bacterium, or virus, because they require different treatments. In children, for example, S pneumoniae is the most common cause of pneumonia, but RSV may also cause the disease. Although symptoms may differ, they often overlap, which can make it difficult to identify the organism by symptoms alone. The cause of CAP is found in only about half of cases.

    Nevertheless, in many cases of mild-to-moderate CAP, the physician is able to diagnose and treat pneumonia based solely on a medical history and physical examination.

    Diagnostic Difficulties with Hospital-Acquired (Nosocomial) Pneumonia

    Diagnosing pneumonia is particularly difficult in hospitalized patients for a number of reasons:

    • Many hospitalized patients have similar symptoms, including fever or abnormal x-rays.
    • In hospitalized patients, sputum or blood tests often show bacteria or other organisms, but such agents do not necessarily indicate pneumonia.

    Medical and Personal History

    The person’s history is an important part of making a pneumonia diagnosis. People should report any of the following:

    • Alcohol or drug abuse
    • Exposure to people with pneumonia or other respiratory illnesses (such as TB)
    • History of smoking
    • Occupational risks
    • Recent or chronic respiratory infection
    • Recent antibiotic therapy
    • Recent outpatient wound care
    • Home infusion therapy or dialysis
    • Recent travel
    • Exposure to birds, bats, or other animals
    • Compromised immune system

    Physical Examination

    Auscultation (Use of the Stethoscope) and Percussion

    The stethoscope is the tool that the physician uses to listen to the body sounds, including chest sounds produced while breathing. Sounds that may indicate pneumonia include:

    • Rales, a bubbling or crackling sound. Rales often suggest pneumonia.
    • Rhonchi, abnormal rumblings indicating that there is sputum in the large airways.
    • A dull thud. The physician will use a test called percussion, in which the chest is tapped lightly. A dull thud, instead of a hollow drum-like sound, indicates certain conditions that suggest pneumonia. These conditions include consolidation (in which the lung becomes filled with fluid and pus) and pleural effusion (fluid build-up in the space between the lungs and the lining around it).

    Pulse Oximetry

    A pulse oximetry test can help determine if a person needs hospital care. A simple test using a device on the fingertip or earlobe, determines the amount of oxygen in the blood.

    Laboratory Tests

    Although current antibiotics can attack a wide spectrum of organisms, it is best to use an antibiotic that targets the specific one making a person sick. Unfortunately, people carry many bacteria, and sputum and blood tests are not always effective in distinguishing between harmless and harmful kinds. The Infectious Diseases Society of America/American Thoracic Society (IDSA/ATS) recommends diagnostic testing when it may impact the choice of antibiotic and in people with a high likelihood of accurate results (sicker patients). Many of these laboratory tests take 4 to 5 days or longer to complete, however, and therapy should be started before results are available.

    Although viral pneumonia accounts for more than a third of CAP cases, it can sometimes be difficult to determine if the pneumonia is viral or bacterial in origin.

    In severe cases, a doctor needs to use invasive diagnostic measures to identify the cause of the infection. These tests are not commonly performed in outpatients. Standard lab tests are used to help diagnose pneumonia.

    Sputum Tests

    A sputum sample may reveal the organism causing the infection.

    The person coughs as deeply as possible to bring up mucus from the lungs, since a shallow cough produces a sample that usually only contains normal mouth bacteria. Some people may need to inhale a saline spray to produce an adequate sample. In some cases, a tube will be inserted through the nose into the lower respiratory tract to trigger a deeper cough.

    The physician will check the sputum for:

    • Blood, which suggests an infection is present.
    • Color and consistency. If it is gray, green, or brown, an infection is likely.

    The sputum sample is sent to the laboratory, where it is analyzed for the presence of bacteria and to determine whether the bacteria are Gram-negative or Gram-positive.

    Blood Tests

    The following blood tests may be performed:

    • White blood cell count (WBC). High levels indicate infection.
    • Blood cultures. Cultures are done to determine the specific organism causing the pneumonia, but they are accurate in only 10% to 30% of cases. Their use is generally limited to severe cases.
    • Detection of antibodies. Antibodies are immune factors that target specific foreign invaders. Antibodies that react with mycoplasma or chlamydia are not present early enough in the course of pneumonia to allow for prompt diagnosis by this method.
    • C-reactive protein or procalcitonin. Not generally recommended but may help identify which people with respiratory symptoms have pneumonia and need to be hospitalized. Procalcitonin may also help guide the clinician in the appropriate use of antibiotics.
    • Polymerase chain reaction (PCR). In some difficult cases, PCR may be performed. The test makes multiple copies of the genetic material (DNA) of a virus or bacteria to make it detectable. PCR is useful for identifying certain atypical bacteria strains, including mycoplasma and Chlamydia pneumonia. While expensive, a real-time PCR test may help quickly diagnose Pneumocystis pneumonia in HIV-positive patients.

    Urine Tests

    Urine antigen tests for Legionella pneumophila (Legionnaires disease) and S pneumoniae may be helpful in some people with severe CAP.

    Invasive Tests

    In critically-ill people with VAP, doctors have tried sampling fluid taken from the lungs or trachea. These techniques enabled the physicians to identify the pneumonia-causing bacteria and start the appropriate antibiotics. However, this made no difference in the length of stay in the ICU or hospital, and there was no significant difference in outcome.

    Imaging Techniques

    X-rays

    A chest x-ray is nearly always taken on a patient admitted to the hospital to confirm a pneumonia diagnosis.

    X-rays are a form of electromagnetic radiation (like light). They are of higher energy, however, and can penetrate the body to form an image on film. Structures that are dense (such as bone) will appear white, air will be black, and other structures will be shades of gray depending on density. X-rays can provide information about obstructions, tumors, and other diseases, particularly when coupled with the use of barium and air contrast within the bowel.

    A chest x-ray may reveal the following:

    • Complications of pneumonia, including pleural effusions and abscesses
    • White areas in the lung called infiltrates, which often indicate infection

    Other Imaging Tests

    Computed tomography (CT) scans or magnetic resonance imaging (MRI) scans may be useful in some circumstances, such as when:

    • A lung tumor is suspected
    • Complications occur
    • People do not respond to antibiotics
    • People have other serious health problems
    • Pulmonary embolism is suspected
    • X-ray results are unclear

    Click the icon to see an image of a CT scan.

    CT and MRI can help detect tissue damage, abscesses, and enlarged lymph nodes. They can also detect some tumors that block bronchial tubes. No imaging technique can determine the actual organism causing the infection. However, features on the CT scan of people with certain forms of pneumonia — for example that are caused by Legionella pneumophila — are usually different from features produced by other bacteria in the lungs.

    Invasive Diagnostic Procedures

    Invasive diagnostic procedures may be necessary when:

    • People have AIDS or other immune problems
    • People have life-threatening complications
    • Standard treatments have failed for unknown reasons

    Thoracentesis

    If a doctor detects pleural effusion during the physical exam or from an imaging procedure, and suspects that pus (empyema) is present, a thoracentesis is performed.

    • Fluid in the pleura is withdrawn using a long thin needle inserted between the ribs.
    • The fluid is then sent to the lab for multiple tests.

    Complications of this procedure are rare, but they can include collapsed lung, bleeding, and infection.

    Bronchoscopy

    Bronchoscopy is an invasive test to examine respiratory secretions. It is not usually needed in people with CAP, but it may be appropriate for people with a severely compromised immune system who need immediate diagnosis, or in people whose condition has worsened during treatment. In patients who need a breathing machine to breathe (severely ill) this procedure can be done via the existing breathing tube.

    A bronchoscopy is done in the following way:

    • The person is given a local anesthetic, oxygen, and sedatives.
    • The physician inserts a fiber optic tube into the lower respiratory tract through the nose or mouth.
    • The tube acts like a telescope into the body, allowing the physician to view the windpipe and major airways and look for pus, abnormal mucus, or other problems.
    • The doctor removes specimens for analysis and can also treat the person by removing any foreign bodies or infected tissue encountered during the process.

    Click the icon to see an image of a bronchoscopy.

    Bronchoalveolar lavage (BAL) may be done at the same time as bronchoscopy. This involves injecting high amounts of saline through the bronchoscope into the lung and then immediately sucking the fluid out. The fluid is then analyzed in the laboratory. BAL is an effective method for detecting specific infection-causing organisms.

    The procedure is usually very safe, but complications can occur. They include:

    • Allergic reactions to the sedatives or anesthetics
    • Asthma attacks in susceptible people
    • Bleeding
    • Fever

    Lung Biopsy

    In very severe cases of pneumonia or when the diagnosis is unclear, particularly in people with a damaged immune system, a lung biopsy may be required. A lung biopsy involves taking some tissue from the lungs and examining it under a microscope.

    Lung Tap

    This procedure typically uses a needle inserted between the ribs to draw fluid out of the lung for analysis. It is known by a number of names, including:

    • Lung aspiration
    • Lung puncture
    • Thoracic puncture
    • Transthoracic needle aspiration
    • Percutaneous needle aspiration
    • Needle aspiration

    This is a very old procedure that is not done often anymore because it is invasive and poses a slight risk for collapsed lung. Some experts argue, however, that a lung tap is more accurate than other methods for identifying bacteria, and the risk it poses is slight. Given the increase in resistant bacteria, they believe its use should be reconsidered in young people.

    An infectious disease specialist may need to be consulted in severe or difficult cases.

    Differential Diagnosis

    Common Causes of Persistent Coughing

    The four most common causes of persistent coughing are:

    • Asthma
    • Long-term (chronic) bronchitis
    • Gastroesophageal reflux disease (GERD)
    • Postnasal drip

    Other common causes of long-term (chronic) cough include heavy smoking or the use of blood pressure drugs known as ACE inhibitors.

    Acute Bronchitis

    Acute bronchitis is an infection in the passages that carry air from the throat to the lung. The infection causes a cough that produces phlegm. Acute bronchitis is almost always caused by a virus and usually clears up on its own within a few days. In some cases, acute bronchitis caused by a cold can last for several weeks.

    Chronic Bronchitis

    Chronic bronchitis causes shortness of breath and is often accompanied by infection, mucus production, and coughing, but it is a long-term and irreversible condition. The same bacteria and viruses that cause pneumonia can cause an infection in people with chronic bronchitis. However, infections involve only the airways leading to the lungs, and not the lung tissue itself. The 2 disorders may share the same symptoms, such as:

    • Coughing
    • Fatigue
    • Fever
    • Sputum production

    There are significant differences between chronic bronchitis and pneumonia:

    • People with bronchitis are more likely to have wheezing, but less likely to have chills, very high fevers, and other signs of severe illness.
    • Those with pneumonia often cough up heavy sputum, which may contain blood.
    • X-rays of people with pneumonia show inflammation and other changes in the lung tissue that are not seen in people with chronic bronchitis.

    Asthma

    In asthma, the cough is usually accompanied by wheezing and occurs mostly at night or during activity. Fever is rarely present (unless the person also has an infection). Asthma symptoms from occupational causes can lead to persistent coughing, which is usually worse during the workweek. Tests, like the methacholine inhalation challenge and pulmonary function studies, may be effective in diagnosing asthma. Chest X-ray can also help in ruling out pneumonia.

    Other Disorders that Affect the Lung

    Many conditions mimic pneumonia, particularly in hospitalized patients. They include:

    • ARDS
    • Atelectasis, a partial collapse of lung tissue
    • Bronchiectasis, an irreversible widening of the airways that is usually associated with birth defects, chronic sinus or bronchial infection, or blockage
    • Heart failure (if it affects the left side of the heart, fluid build-up can occur in the lungs and cause persistent cough, shortness of breath, and wheezing)
    • Interstitial pulmonary fibrosis, a non-infectious inflammation of the lung that causes damage and scarring
    • Lung cancer
    • Severe allergic reactions, such as reactions to drugs
    • Tuberculosis

    Ruling Out Causes in Children

    Important causes of coughing in children at different ages include:

    • Asthma
    • Sinusitis in children 18 months to 6 years

    Antibiotic for pneumonia in tablets: treatment features

    In recent years, experts have called pneumonia one of the most dangerous diseases of the respiratory system. The only effective treatment is antibiotics. Only these drugs help to quickly eliminate the causes of pneumonia and get rid of symptoms. In order for the treatment to be effective, you need to know which medications are most effective.

    Reception and choice of antibiotics

    Pneumonia develops against the background of the vital activity of pathogenic microorganisms that have entered the human body.It is impossible to cope with them without the use of antibiotics in 85% of cases.

    Several groups of antibiotics have been developed: depending on the severity of the disease, they can be used individually or as part of a comprehensive treatment program. If the initially selected drug does not bring the desired result, the doctor prescribes medicines of a different group.

    Long-term use of antibiotics often leads to intestinal problems. In this regard, doctors recommend, after a course of therapy, to take drugs aimed at restoring the natural microflora in the intestine. In this case, treatment of pneumonia with antibiotics will not harm the patient’s health.

    Blood, urine and sputum tests can help you choose the right antibiotics for treating pneumonia in adults. With their help, the doctor determines which bacteria became the causative agent of the disease. Based on this, the selection of drugs is made.

    After the causative agent of pneumonia has been identified in the laboratory, an additional study is carried out for its sensitivity to medications. Such an analysis will help determine the group to which the antibiotic should belong.

    The method is accurate enough, but the result will have to wait. Typically, the study takes 2 to 5 days. In some cases, this delay can be dangerous.

    Which pulmonary antibiotic is effective also depends on the patient’s state of health. If the disease has passed into a severe stage, then the use of the latest generation drugs will be required. They have a broader spectrum of action.

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    Preparations of the penicillin group

    Penicillin is one of the first antibiotics used to treat pneumonia. But if earlier they were of natural origin, then the drugs used today are most often semi-synthetic.

    Benzylpenicillin belongs to natural medicines. It is effective for pneumococcal pneumonia.

    Among semi-synthetic drugs, Oxacillin and Cloxacillin are popular. The best result is shown in the fight against staphylococcus. The most advanced are drugs with a wide spectrum of action. These include Ampiox and Amoxicillin. They quickly penetrate the cells of the body and successfully fight against gram-negative bacteria.

    This antibiotic therapy is used for mild pneumonia. It is prescribed for infection with staphylococci and streptococci. Taking penicillin drugs can provoke an allergic reaction, diarrhea, colitis and dyspepsia.

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    Treatment of pneumonia with cephalosporins

    Antibiotics for pneumonia, belonging to the group of cephalosporins, are quite effective. They have a wide spectrum of activity and successfully fight pathogens. There are four generations of similar medicines:

    1. First generation. This includes Cefapirin and Cefazolin. This antibiotic therapy is effective for pneumonia caused by cocci.
    2. Second generation. This group includes Cefuroxime and Cefradine. They successfully fight against hemophilic and Escherichia coli, as well as gonococci and Klebsiella.
    3. Third generation. Its representatives were Cefotaxime and Ceftazidim. They cope well with all bacteria except cocci.These drugs are used to treat severe pneumonia.
    4. Fourth generation. This group includes Tsefpirom. Has a wide spectrum of action, but does not have the desired effect on enterococci.

    The only drawback of using such antibiotics for pneumonia is the likelihood of an allergic reaction. Allergy to cephalosporins occurs in 10% of patients.

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    Macrolides

    Pneumonia is successfully treated with macrolide antibiotics.Some time ago they were considered ineffective. This happened due to the inability of specialists to apply them correctly.

    Many physicians simply did not follow the grading program in therapy. In this regard, the bacteria began to develop resistance.

    But this omission was corrected later. Modern antibiotics for pneumonia show excellent results in the treatment of pneumonia. Best of all, they cope with legionella, chlamydia and cocci.

    The most popular drugs in this group are:

    1. Ziomycin.
    2. Ormax.
    3. Rovamycin.
    4. Sumamed.
    5. Clarithromycin.

    It is possible to cure the disease with these medicines quickly enough. They are rapidly absorbed into the tissues and cells of the body. Eating a little slows down this process.

    Allergic reactions to macrolides are extremely rare. They are not recommended for use in patients suffering from liver dysfunctions.

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    Fluoroquinolones

    Taking antibiotics of the fluoroquinolone group is recommended if you are allergic to all other drugs. The drugs are divided into 3 generations:

    1. Most effective for infections with Legionella or E. coli. Weakly affect cocci and chlamydia. Recommended if pneumonia is mild.
    2. Suitable for the treatment of pneumococcal pneumonia in adults.
    3. Eleflox and Tigeron. Copes well with anaerobic bacteria.

    Medicines of this group are rapidly absorbed into the cells of the body. Among the contraindications to their use are pregnancy and individual intolerance.

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    Tetracyclines

    With the use of antibiotics of the tetracyclines group, treatment of pneumonia in adults is started until the pathogen is identified. This is especially true if the disease is rapidly progressing and there is no time to wait for the test results. The attending physician can prescribe these medicines for infection with chlamydia and mycoplasma.

    Recently, it has been noted that tetracyclines have become less effective than drugs of other groups. This is due to the fact that microorganisms have developed immunity to them.

    This antibiotic for pneumonia has a significant drawback: the ability to accumulate in the bones and tissues of the body. This leads to slow intoxication. Teeth can decay over time. In this regard, taking such medications is contraindicated in children, women during pregnancy and lactation, as well as in patients with impaired renal function.

    Among the most popular drugs in this group are Tetracycline and Doxycycline.

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    List of the best antibiotics for pneumonia

    If you ask your doctor how to treat pneumonia, the answer is simple – take antibiotics. The key to successful therapy will be the choice of an effective drug and its correct use. All modern products are available in tablets or injections. Among them are the following:

    1. Amoxiclav. The course of therapy with this drug is 5 to 7 days.The exact dosage is determined by the attending physician. Most often it is recommended to take one tablet once a day.
    2. Clarithromycin. They drink it one tablet a day for 8 days.
    3. Sumamed is a good broad-spectrum antibiotic. The scheme for taking it: one tablet a day. The course of therapy is 5 days.
    4. Amoxicillin. With its help, even severe pneumonia is successfully treated. The dosage and duration of admission is chosen by the doctor, based on the patient’s state of health.
    5. Ciprofloxacin. Antibiotics for pneumonia, used to fight many types of bacteria. It is recommended to take it on an empty stomach. So the absorption of the drug is much faster. The duration of treatment can vary from 5 to 15 days, depending on the severity of the disease.
    6. Metronidazole. The use of this drug is recommended in case of complications. Most often, one tablet is prescribed twice a day.
    7. Cefepime. A strong antibiotic that quickly eliminates the inflammatory process in the lungs.Available as a solution for injection. The duration of therapy is 7 to 10 days.
    8. Azithromycin. It is prescribed for moderate pneumonia. It is recommended to take the tablets on an empty stomach.
    9. Doxycycline. Belongs to the group of semi-synthetic tetracyclines. With its help, pneumonia is treated, which is mild.

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    Contraindications and possible side effects

    Antibiotic treatment is an integral part of therapy for pneumonia.But taking certain medications can negatively affect the patient’s health.

    Among the main contraindications are the following:

    1. Allergic reactions.
    2. Liver failure.
    3. Kidney disease.
    4. Pregnancy.
    5. Children’s age.

    In these cases, the doctor selects the medication especially carefully. The patient’s state of health and the results of all analyzes are taken into account.

    Long-term use of antibiotics often provokes side effects.Diarrhea, bouts of nausea, dizziness, skin rash, swelling, insomnia, and panic attacks may occur.

    If you begin to notice such symptoms in yourself, immediately seek the advice of your doctor. Most likely, you will need to make adjustments to the chosen treatment regimen. What antibiotics for pneumonia are best to take, your doctor will tell you. The choice of a specific drug is carried out exclusively by the attending physician based on the patient’s analyzes.

    It is important to remember that uncontrolled use of antibiotics can lead to negative health consequences.The dosage prescribed by the specialist must be strictly observed.

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    Antibiotics in tablets for pneumonia, antibiotic therapy, drugs of the latest generation

    Medicines are primarily used to treat pneumonia. If the disease is caused by pathogenic microorganisms, special drugs are needed to kill them, mainly antibiotics.

    Antibiotics in tablets for pneumonia are potent drugs that have side effects, so you need to carefully read the instructions for use.

    Antibiotics

    Efficacy of antibiotic tablets

    Antibacterial drugs are prescribed to kill bacteria and stop their reproduction. If this is not done in time, the body will be seriously damaged, and the person may die with advanced pneumonia. The course of antibiotic treatment is calculated based on the stage and type of the disease, as well as the strain of the infectious agent.

    For example, a week is enough for the treatment of the extracellular form of the pathogen, and it takes about one and a half months to get rid of a lung abscess.

    As a rule, the first signs of the work of antibacterial agents are noticeable already 3 days after the start of therapy:

    • the patient’s temperature decreases and the chills stop;
    • shortness of breath and symptoms of respiratory failure disappear due to blood oxygen saturation;
    • the volume of sputum secreted decreases, pus disappears.

    Antibiotics help reduce the area of ​​inflammation by freeing breathing and relieving the patient of pain.

    Proper nutrition

    In case of pneumonia, complex treatment is required, therefore painkillers, antitussives, mucolytics and antispasmodics are added to antibacterial drugs.

    Traditional medicine methods are also often used, but only as support for basic antibiotic therapy.

    In addition, the patient should put his lifestyle in order: quit bad habits, start eating right and exercise.

    Varieties of preparations

    Antibacterial agents for pneumonia are divided into groups depending on the main active ingredient in the composition:

    • Penicillins. This type of antibiotic was the first to appear. Distinguish between semi-synthetic and natural species, but the efficiency does not change. The list of side effects is limited to allergic manifestations, diarrhea and hypersensitivity. It is used against staphylococci and streptococci.
    • Tetracyclines.These funds are used much less frequently, since microorganisms easily develop resistance to the active substance. In addition, tetracyclines accumulate in human bones and can cause tooth decay. Such funds are not allowed for pregnant and lactating women, young children and patients with kidney pathology. Doxycycline and tetracycline are the most common drugs. Cephalexin
    • Cephalosporins. Allocate 4 generations of this type of drugs.First: Cefalexin, Cefazolin. Effective against staphylococci and pneumococci. Second: Cefuroxime, Cefurabol. They are used to treat both gram-positive and gram-negative flora. Third: Cefoperazone, Cefotaxime. They are prescribed for complications in the last stages of pneumonia. Fourth: Cefepim. The most powerful agent from the group of cephalosporins.
    • Macrolides. Drugs in this group are prescribed for the treatment of pneumonia caused by legionella, cocci and chlamydia. They are taken on an empty stomach because food inhibits absorption.Allergies are rare. Erythromycin, Clarithromycin and Azithromycin are mainly prescribed. Patients diagnosed with liver disease should not take such drugs.
    • Aminoglycosides. Antibiotics of this pharmacological group are intended to neutralize aerobic gram-negative bacteria. Moreover, they are effective in case of infection with several strains of microorganisms, when combined means have to be used. Among the aminoglycosides, Gentamicin and Amikacin are distinguished.The dose of the drug is individual for each patient and is based on the indicators of his body (weight, age) and the severity of the disease. During the course of treatment, it is necessary to monitor the condition of the kidneys, especially glomerular filtration.
    • Quinols and fluoroquinols. They are used to treat pneumonia caused by E. coli and legionella. Active substances are excreted from the body in the urine, therefore, impaired renal function is a contraindication. Also, you can not use the remedy for liver diseases, in childhood, with allergies and pregnancy.Medicines are used under the names Ciprofloxacin, Levofloxacin. Levofloxacin

    Reception details

    The use of antibiotics in pills for pneumonia is more common, since not everyone knows how to give injections. The oral form of antibacterial agents has a number of rules for use:

    • Treatment for pneumonia should be started as soon as the required medications are prescribed by the doctor. It is impossible to hesitate in buying and taking antibiotics.
    • If the patient is not well tolerated, a more effective remedy may be prescribed.At the same time, if complications were identified immediately, then two antibiotics are prescribed from the very beginning of treatment. The following combinations are commonly used: Erythromycin and Penicillin; Streptomycin and Monomycin; Monomycin, Oleandomycin and Tetracycline.
    • First-line antibiotics are prescribed before a specific pathogen is identified. They are taken constantly to ensure the required concentration of active substances in the blood. They should have the widest possible spectrum of action to cover the majority of potential inflammatory pathogens.Inpatient treatment
    • It should be noted that taking more than 2 drugs at home is not encouraged, since the combination of drugs leads to the suppression of some body systems. The doctor prescribes combinations of antibiotics to prevent death due to pneumonia and its complications, therefore, during a serious deterioration in health, it is recommended to go to the hospital.
    • Do not increase or decrease the indicated dosage. Small doses lead to the development of resistance of pathogens to the active substance, and large doses have a negative effect on the body.
    • With long-term use of antibacterial tablets, it is necessary to additionally include probiotics in the course. The fact is that antibiotics destroy not only harmful pathogens, but also beneficial bacteria in the intestines. Their lack becomes the cause of dysbiosis and deterioration of digestion and assimilation of food.
    • If therapy with antibacterial agents lasts more than 3 weeks, a week break is required. After this, sulfonamides or nitrofurans are usually prescribed.
    • It is important to remember: the course must be drunk completely, even if the symptoms of the disease have disappeared.

    Drink the tablets only with clean water and, in most cases, on an empty stomach. When treating children, adults need to closely monitor their condition so that the doctor has an idea of ​​the course of therapy. If the child becomes ill during the course of treatment, it is necessary to see a doctor, and not to cancel the drug on your own. Pneumonia is a disease in which antibiotic therapy cannot be dispensed with. These drugs fulfill an important mission: they destroy pathogenic microorganisms, but they can also harm humans.For this reason, you cannot prescribe drugs on your own, you need to observe the dosage and do not forget about supportive therapy.

    Antibiotics for pneumonia – effective and safe medicines

    Inflammation of the lungs begins immediately with chest pain when breathing, severe coughing up phlegm, fever. The disease urgently requires hospitalization. The patient is shown bed rest, special vitamin nutrition, and the main component of the therapeutic process is antibiotic treatment.

    What is pneumonia

    Pneumonia is popularly called pneumonia. It is an infection of the lower respiratory tract with an incubation period of 2 to 10 days, in which the lung tissue is involved. There are several types of disease:

    1. Atypical. It is caused by chlamydia, legionella, mycoplasma, that is, atypical microflora.
    2. Aspiration. Occurs from the ingress of water, food or foreign objects into the respiratory tract.
    3. Hospital.The disease develops while the patient is in the hospital.
    4. Community-acquired. It arises as a complication after a viral infection. It is often the cause of death due to a strong decrease in immunity.

    New generation antibiotics help to avoid complications of pneumonia, which can develop lung abscess, pleural empyema, pneumothorax and other serious diseases.

    The most severe consequence of pneumonia is respiratory failure.

    This pathology develops in patients with other chronic diseases or in elderly patients who do not receive adequate antibiotic treatment. Failure is often the cause of death.

    Antibiotics for pneumonia

    Given the acute course of the disease, broad-spectrum antibacterial drugs are prescribed without waiting for laboratory tests. Doctors distinguish three degrees of severity of the course of pneumonia.

    At the mildest stage, intoxication of the body occurs (mild), the patient’s body temperature does not exceed 38 ° C, the heart beats in a normal rhythm.

    The patient’s consciousness remains clear, and an X-ray examination shows a small focus of inflammation located in the upper lobe of the lung.

    In a severe stage, the body temperature immediately increases to 39 ° C, tachycardia (moderate), intoxication is observed, infiltration is pronounced on the X-ray. The most severe degree of pneumonia (pleuropneumonia) is characterized by a body temperature of 40 ° C, the patient is delirious, suffers from shortness of breath, intoxication is pronounced. Antibiotics are prescribed for pneumonia, taking into account the following factors:

    • stage and severity of the disease;
    • drug toxicity;
    • contraindications;
    • possible manifestation of allergies;
    • spectrum of antibiotic action;
    • the speed of drug penetration into the body;
    • the rate of development of bacterial resistance to this drug.

    Penicillins

    The first antibacterial drugs that quickly penetrate tissues and fluids, therefore they are used for congestive pneumonia.

    If the causative agent of inflammation are staphylococci or streptococci, then treatment with drugs of this type is effective. When the pathology occurs for another reason, other antibiotics are prescribed.

    Penicillins are administered orally (tablets, suspensions) and through injections (injections). Penicillins include:

    • Amoxicillin;
    • Mesocillin;
    • Flemoxin.

    Tetracyclines

    A group of drugs used in the treatment of pneumonia less and less. Their instability to the action of microorganisms and the ability to accumulate in tissues is the reason for this. Tetracyclines have many contraindications: pregnancy, lactation, age up to 7 years, kidney disease. Known representatives of this group of antibiotics:

    • Tetracycline;
    • Doxycycline.

    Cephalosporins

    Actively affect all bacteria of the cocci group, have excellent antibacterial properties against gram-negative and gram-positive flora, affect microorganisms that are resistant to drugs of the penicillin group.Among the side reactions, the manifestation of allergy is distinguished. An intravenous or intramuscular route of drug administration is used. Antibiotics of this group include drugs:

    • Ceftriaxone;
    • Cefonicide;
    • Ceftizoxime.

    Macrolides

    This group of antibiotics for pneumonia is used to neutralize chlamydia, legionella, cocci. Macrolides are well absorbed, but food intake can slow down the process. Side effects and allergic manifestations are extremely rare.Contraindications include liver disease in patients. Representatives of this drug category:

    • Sumamed;
    • Erythromycin;
    • Clarithromycin.

    Aminoglycosides

    Acts on gram-negative aerobic microorganisms. They are used when pneumonia is caused by several types of bacteria, therefore, therapy is prescribed together with antibacterial or antiviral drugs. For example, the antibiotic Amikacin in SARS will enhance the antibacterial Metronidazole.When taken together, one should observe the rate of glomerular filtration in the kidneys (excretory capacity). Representatives of the group are:

    • Gentamicin;
    • Isepamycin;
    • Neomycin.

    Fluoroquinols

    Medicines actively affect Escherichia coli, Legionella. Today fluoroquinols occupy one of the leading places in the treatment of bacterial pneumonia.

    These are broad-spectrum preparations with the ability to penetrate deeply into tissues.

    Resistance of microorganisms to fluoroquinols rarely develops due to structural changes in DNA and the permeability of the bacterial wall. Known antibiotics in this group:

    • Ofloxacin;
    • Pefloxacin;
    • Cifroloxacin.

    How to treat pneumonia with antibiotics

    Only the doctor decides what antibacterial drugs to take. Self-treatment of pneumonia at home can be fatal.Antibiotic therapy is carried out for no more than 10 days, since many drugs are toxic.

    In case of bilateral pneumonia, treatment can be extended for a longer period. The specialist takes into account the general condition of the patient, his age and the dosage form of the drug.

    The dosage of the antibiotic in the blood is needed to be effective in the given degree of the disease.

    Adults

    After 18 years, antibiotics are prescribed for pneumonia in a dosage calculated individually.An adult doctor can prescribe the use of both one drug and antibacterial agents of several groups.

    Medicines in ampoules are mainly used, because some modern drugs, for example, Ceftriaxone, are not available in tablets.

    In addition, experts say that antibiotics are more effective if they are injected rather than drunk.

    If, after 3 days, there is no therapeutic effect, then the doctor must replace the medicine with another group of antibiotics.It is also not recommended to change drugs often, so as not to develop microorganism resistance to them. When the cause of inflammation is a virus, then immunomodulators are additionally prescribed:

    • Groprinosine;
    • Amiksin;
    • Arbidol.

    Find out more treatments for pneumonia in adults.

    For children

    Children’s pneumonia is especially dangerous, because it occurs latently after an acute respiratory viral infection, and not as an independent disease. The child becomes lethargic, loses appetite, coughs, wheezing, high fever appear.

    The basis of pediatric therapy is also antibiotics, which are administered parenterally. Babies are prescribed natural and semi-synthetic penicillins or macrolides, in which the duration of treatment lasts no more than 5 days.

    Previously, pediatricians make a test for sensitivity to the antibiotic prescribed by the child.

    Video: Antibiotic treatment of pneumonia

    Antibiotics for pneumonia – Doctor Komarovsky – Inter

    Attention! The information presented in the article is for informational purposes only.The materials of the article do not call for self-treatment. Only a qualified doctor can diagnose and give recommendations for treatment, based on the individual characteristics of a particular patient.

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    Antibiotics for pneumonia

    An antibiotic is a drug whose action is completely aimed at destroying a bacterial infection.

    Pneumonia is a disease in which the respiratory tract and bronchi become inflamed and is caused precisely by a bacterial infection.

    Accordingly, antibiotics are used to treat pneumonia. But which of them are prescribed? Are there any significant differences between them? What dosage and course should be followed?

    What are the best antibiotics?

    What medications are best for pneumonia? There is no such thing as a “better” or “worse” antibiotic. Their principle of action is always the same, but they affect different groups of bacteria. Therefore, they are selected individually.

    For example, Augmentin has a broad spectrum of action and is effective against both aerobic and anaerobic infections. But Amoxiclav copes much better with those bacteria that are resistant to Amoxicillin.

    Often combined drugs are prescribed for pneumonia. For example, Amoxicillin-Oxacillin is often prescribed in injections (the solution is prepared on the basis of Novocaine or Sodium Chloride). But they are used for no more than 5 days, and then, if necessary, an antibiotic with a prolonged (slowly excreted from the body) action is prescribed.

    Why are injections sometimes prescribed, and pills at other times? It all depends on the severity of the course of the disease.

    In most cases, pills can be dispensed with. In the form of a solution, an antibiotic is used only at an advanced stage of the disease, when the patient has a high temperature for several days and it is almost impossible to bring it down with Paracetamol.

    There is also such a thing as the “generation” of an antibiotic. But it does not in any way indicate the harmfulness of the medicine.

    Any antibacterial drug harms the body and, in particular, brings an imbalance of the intestinal microflora.Therefore, one cannot do without taking vitamins and probiotics in treatment. Such medical advice should not be ignored.

    What antibiotics are prescribed?

    In most cases, when confirming the diagnosis, patients are prescribed:

    • Amoxicillin;
    • Ceftazidime;
    • Ticarcillin;
    • Cefotaxime.

    In this case, Tikarcillin and Cefotaxime are prescribed last, if the first two do not bring the desired effect. Naturally, these drugs can be replaced by analogs or derivatives.For example, Suprax is a derivative of Ceftazidime.

    In some cases, antibiotics alone are indispensable and glucose is additionally administered to provide the body with energy.

    For children, hospitalization is mandatory, for adults – as directed by a doctor (as a rule, at temperatures above 38.5 – doctors insist on inpatient treatment)

    .

    The course and dosage for the treatment of pneumonia is prescribed individually. The only caveat is that antibiotics in general should not be taken for more than 10 days, as this can lead to immunodeficiency, when the body simply stops getting rid of bacteria on its own.

    Conventionally, all antibiotics for pneumonia can be divided into 2 categories:

    • bactericidal action;
    • bacteriostatic action.

    The former are effective against the bacteria themselves. They contribute to the destruction of their protective shell, after which the leukocytes easily remove the infection from the body.

    Medicines with bacteriostatic action work a little differently – they interrupt the life cycle of an infection and simply prevent it from multiplying.The final result will be the same.

    It is believed that bacteriostatic antibiotics are less effective, but there are significantly fewer negative consequences after them.

    Which antibiotic is better for an adult, and which is better for children? For adults, predominantly those are prescribed that act instantly of a wide spectrum. For children – prolonged action (with bacteriostatic effect). Although the final choice of medication always depends on the current condition of the patient.

    For non-stationary (outpatient) treatment, the following drugs are mainly used:

    • Fluoroquinol;
    • Oxacillin;
    • Cefotaxime.

    They are available in tablets, but also in injections (for intramuscular injection).

    The only drawback is that they have to be injected frequently, every 6-12 hours. And most importantly, you must definitely follow the schedule so that the antibiotic works and there are no side effects.

    Combination of antibiotics

    Treat pneumonia with combined antibiotics, which immediately suppress the growth of bacteria and destroy the infection itself. True, they are prescribed only in severe cases, when pneumonia worsens and there is a high probability of complications.

    Most often, a combination of Cefolarosporins and inhibitor-protected drugs is required. Their significant drawback is a significant suppression of the effectiveness of natural immunity. And due to the slow reaction of the body, there is a high probability of developing intestinal infections.

    But such treatment is compulsory, because otherwise there is a high probability of death.

    There is also the concept of “congestive pneumonia”. It is treated only with a combination of antibiotics, and they are taken for a long period (from 2 weeks).Naturally, drugs with prolonged action are used in order to minimize the likelihood of immunodeficiency.

    Treatment – only under strict medical supervision and every other day tests to determine the concentration of leukocytes must be taken (thus the stage of the disease is controlled).

    An exception is the combination of long-acting and conventional antibiotics. This combination can do more harm, and at the same time make the body vulnerable to a whole range of other infections (including viral ones, against which antibiotics are powerless).

    Total, pneumonia in adults is treated mainly with antibiotics, but it should be prescribed exclusively by the attending physician after examination. Until this period, drugs with a wide spectrum of action with a minimum dosage are used.

    After sputum analysis, the exact subspecies of bacterial infection is established and narrow-spectrum antibiotics can be prescribed.

    In extreme cases, adults are injected directly into a vein (in the form of droppers) in order to reduce the concentration of bacteria as quickly as possible.

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    Antibiotics for pneumonia in adults – names: what pills to take for pneumonia, medications, a list of the best than to treat

    Antibiotics are the primary treatment for pneumonia. This disease is characterized by an acute course, it is accompanied by an increase in body temperature, severe cough with phlegm, pain in the chest.

    The antibiotic regimen for adults usually takes place in the internal medicine or intensive care unit.It all depends on the severity of the patient’s condition.

    The effectiveness of antibiotics for pneumonia is established using laboratory tests. In this article, we will tell you how to choose the right drugs, how to select their dose, and also give recommendations for use.

    Definition of disease

    Pneumonia is an acute infectious disease of the respiratory system, which is accompanied by damage to the lung tissue.

    Let’s consider the main types of this disease:

    1. Croupous.It usually occurs after hypothermia of the body. This form of pneumonia is characterized by a rapid rise in temperature (forty degrees), weakness and headaches, severe shortness of breath and discomfort in the chest area, cough, profuse sputum. Such pneumonia is a serious danger, because without timely diagnosis and treatment, it can cause sepsis, lung abscess, heart damage. As a result, the patient may die.
    2. Focal. It develops against the background of bronchitis and other respiratory diseases.Focal pneumonia has a less acute course. The temperature rises gradually, the cough is weak at an early stage, and there may be no sputum. Some people mistakenly believe that focal pneumonia can be carried “on the legs.” But this opinion is wrong. When the disease progresses, there is a strong and obsessive cough, accompanied by the release of purulent sputum. Without treatment, an abscess or breakthrough of pus into the pleural cavity may develop.
    3. Atypical. The manifestations of this form of pneumonia depend on the pathogen (mycoplasma, legionella, chlamydia).If there is a suspicion of SARS, then an urgent need to consult a doctor. In the case when the diagnosis was confirmed, treatment should be started immediately, since the mortality rate from this disease ranges from sixteen to thirty percent.

    The incubation period of typical pneumonia lasts on average from one to three days, and atypical pneumonia – from two to three weeks. It all depends on the pathogen and the state of the immune system.

    The following procedures are carried out to diagnose pneumonia:

    • General examination: examination of the chest, skin, listening to the lungs for wheezing.
    • Collection of anamnesis and patient complaints.
    • General and biochemical blood test.
    • Sputum analysis.
    • X-ray of the chest cavity organs.
    • Computed tomography of the chest cavity and fibrobronchoscopy (with long-term ongoing pneumonia that does not respond to treatment).
    • Culture and blood tests (in critically ill patients to identify the pathogen).

    It should be noted that in most cases there is a complete recovery of patients.But, if you start the disease, then serious complications can develop. The consequences of pneumonia are divided into pulmonary and extrapulmonary.

    The first group includes complications such as pleurisy, abscess, gangrene, broncho-obstructive syndrome, acute respiratory failure.

    Extrapulmonary consequences include toxic shock, myocarditis, meningitis, mental disorder, anemia.

    Causes of occurrence

    Pneumonia occurs when a pathogenic microorganism enters the weakened human body, which causes an inflammatory process in the lungs.

    The main cause is a bacterial infection (streptococci). Viruses also often cause disease. People mostly get sick with viral pneumonia in winter.

    It happens that pneumonia is caused by microorganisms that have the properties of viruses and bacteria. They are called mycoplasmas.

    Fungi and parasites are less common pathogens.

    Pneumonia is most often transmitted by viral droplets. When a sick person sneezes or coughs, the secretions with pathogenic microorganisms enter the lungs of a healthy person and cause inflammation.

    Also, pneumonia can develop due to the increased activity of bacteria that are constantly in the nose and throat of a person. When the immune system weakens, the body cannot resist viruses, and they immediately begin to actively multiply, enter the lungs and cause an inflammatory process there.

    Risk factors for developing pneumonia:

    • Body hypothermia.
    • Viral infections.
    • The presence of concomitant diseases, for example, chronic lung disease, heart failure, diabetes mellitus, and so on.
    • Drinking alcoholic beverages.
    • Immunity disorders.
    • Prolonged bed rest.
    • Senile age.
    • Operational interventions.

    Symptoms

    The manifestation of pneumonia is quite diverse. Nowadays, the asymptomatic course of the disease is very common, when the temperature does not rise, there is no cough, and 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 rise to thirty-seven to thirty-nine and a half degrees.
    2. Shortness of breath.
    3. Runny nose.
    4. Persistent cough with sputum production.
    5. Chills.
    6. Colds that last more than a week, especially when improvement is followed by a sharp deterioration.
    7. There is no decrease in temperature after taking Paracetamol.

    Sometimes with pneumonia, there is a bloody discharge, which is a streak of blood in the sputum.

    Pneumonia is characterized by a symptom such as chest pain when inhaling deeply. It usually appears in the place where the main focus of inflammation is located.

    It should be noted that coughing is not a characteristic sign of pneumonia, as the infection may be located away from the main airways. Sometimes skin color changes, headache, fever appear.

    Treatment of the disease – antibiotic therapy

    For the treatment of pneumonia, macrolides and antibiotics of the fluoroquinolone series are most often prescribed.For more effective treatment, antibiotics must be taken according to a special scheme. At the first stage of treatment, the drug is administered parenterally (intramuscularly or intravenously), and then antibiotics are prescribed in the form of tablets.

    Criteria for the selection of antibiotics for pneumonia

    Antibiotics for the treatment of pneumonia in adults should be selected depending on the age of the patient and the severity of the condition.

    For the treatment of this disease, synthetic, semi-synthetic and natural antibiotics are used.Some of them have a selective effect (on one kind of bacteria), and some have a wide spectrum of action.

    It is with antibiotics of a wide spectrum until the result of bacteriological analysis of sputum is obtained that it is customary to begin antibacterial treatment of pneumonia.

    Broad-spectrum antibiotics are prescribed based on the course of the disease, the color of the sputum. For this you need:

    • Bacteriological analysis of sputum to determine the pathogen.
    • Test for the sensitivity of the pathogen to antibiotics.
    • Scheme of antibacterial treatment based on the result of the analysis.

    Selection of an antibiotic based on the pathogen

    In severe pneumonia, antibiotics are combined.

    It is not worth prescribing antibiotics on your own, as this can lead to the development of bacterial resistance to certain groups of drugs. As a result, the treatment will be ineffective.

    List of drugs and tablets for the treatment of pneumonia

    After pneumonia is diagnosed, broad-spectrum antibiotics are taken (Suprax, Ceftriaxone).Before identifying the pathogen, it is necessary to select the therapeutic dose of the drug that will maintain the active concentration of the active substance in the blood.

    If SARS is diagnosed, then specialized antibiotics are used (Sumamed, Clarithromycin). But you do not need to give up broad-spectrum antibiotics.

    A two or three drug combination, such as Ceftriaxone or Suprax plus Sumamed or Clarithromycin, is often used for pneumonia.

    If the inflammatory process has spread to more than one segment, then a combination of such drugs from the list as Ceftriaxone plus Amikacin or Suprax plus Augmentin is used.

    How to take medicines – dosages

    Antibiotics for adults are prescribed taking into account the age of the patient and the severity of his condition.

    Adults under sixty years of age with a mild form of pneumonia are prescribed the antibiotic Avelox, four hundred milligrams or Tavanik, five hundred milligrams per day for five days, together with Doxycycline (two tablets per day on the first day, the rest of the days, one tablet) for ten – fourteen days.

    In severe pneumonia, which is accompanied by other chronic diseases, patients under sixty years of age are prescribed Avelox, four hundred milligrams in combination with Ceftriaxone, one gram twice a day for ten or more days. The same scheme applies to people over sixty years of age.

    If pneumonia is difficult at any age, then you need to know how many days to inject Ceftriaxone. Treatment can take place with a combination of drugs such as Levofloxacin or Tavanic, which are administered intravenously, plus Ceftriaxone two grams twice a day, or Fortum, Cefepim at the same dosage intramuscularly or intravenously.

    In case of hospitalization in intensive care, combinations of Sumamed and Tavanik, Fortum and Tavanik, Targotsid and Meronem, Sumamed and Meronem are prescribed.

    Contraindications

    Antibiotics are contraindicated in cases where pneumonia is caused by a viral infection, as they will be ineffective or even dangerous. These drugs cannot destroy viruses and do not have any positive effect on the patient.

    Each group of antibiotics has its own specific contraindications that must be taken into account before starting treatment.

    Main contraindications for taking antibiotics:

    1. Allergic reactions.
    2. Diseases of the kidneys, liver. In chronic kidney and liver diseases, taking antibiotics can have a negative effect on their condition, since these organs are responsible for processing and removing antibiotics from the body.
    3. Children’s age.
    4. Pregnancy. During this period, the woman’s body is very sensitive to drugs. It is very dangerous to take antibiotics in the first trimester of pregnancy.

    Application Note

    Currently, antibiotics are taken according to a special scheme, which is selected by a doctor.

    With the predominance of gram-positive cocci, antibiotics are prescribed, which are administered intravenously and intramuscularly. These are drugs of penicillin or cephalosporin of the first and second generation (Cefazolin, Cefuroxime, Cefoxin).

    • With the predominance of gram-negative bacteria, third-generation cephalosporins (Cefotaxime, Ceftriaxone, Ceftazidime) are prescribed.
    • In the case of SARS, macrolides (Azithromycin, Midecamycin) and third-generation cephalosporins (Ceftriaxone, Ceftazidime) are used.
    • With the predominance of intracellular organisms, such as mycoplasmas, Legionella, macrolides are also prescribed (Azithromycin, Clarithromycin, Roxithromycin).

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    Conclusions

    Pneumonia is not accompanied by pronounced symptoms, but it has a severe course and can cause serious complications. Acute pneumonia is especially dangerous, which develops in three to four days and leads to irreversible changes in the body.

    Antibiotics are the mainstay of treatment. More often, macrolides and fluoroquinolone antibiotics are widely used to treat pneumonia.

    You cannot prescribe antibiotics on your own.You need to see a doctor who will select the drug based on the test results. Please note that antibacterial drugs have a number of contraindications, therefore, you must carefully read the instructions before using.

    90,000 Antibiotic therapy for respiratory infections in children. Clinical observations

    Lecturer’s speech Tatochenko V.K. at the symposium “Rational antibiotic therapy in pediatrics” within the framework of the All-Russian Internet Congress of Specialists in Internal Diseases .

    00:00

    Vladimir Trofimovich Ivashkin , Academician of the Russian Academy of Medical Sciences, Doctor of Medical Sciences :

    – Moving on to the last symposium: “Rational antibiotic therapy in pediatrics.” Now, at the request of many pediatricians, Vladimir Kirillovich Tatochenko will make a message: “Antibiotic therapy for respiratory infections in children.”

    Vladimir Kirillovich Tatochenko , Doctor of Medical Sciences, Professor :

    – Simple question: what is the rational use of antibiotics (AB).This is the use of an antibiotic only when there is a bacterial infection. The choice of only such AB, to which the suspected pathogen is sensitive. The use of dosages of AB, which are able to provide concentrations that suppress the pathogen in the focus of inflammation. Refusal to use AB preventively, with very few exceptions. There are several positions where this is recommended.

    AB is used most often when a child has a fever. We must always remember that fever is a protective, immune-mobilizing reaction.You don’t need to worry too much about a fever. This is not hyperthermia, not overheating. Nothing bad usually happens.

    Now the situation is such that we do not have diphtheria, measles. Now there are a dozen cases. There used to be a million cases a year. Whooping cough, tuberculosis, mumps, polio – all this is more or less in the past, but feverish children remain.

    The pediatrician has two difficult problems:

    1. “Catch” from the total mass of febrile children who have a bacterial infection (we can also treat influenza etiotropically), which we can treat etiotropically.

    2. Provide febrile children with viral infections for whom there are no etiotropic agents, justified pathogenetic and symptomatic therapy, avoiding polypharmacy.

    Despite the fact that there is a minister’s order that more than five means cannot be used at the same time, children with a runny nose regularly receive an infinite amount of drugs. Most of them, apart from advertising, have no serious supporting materials.

    Catching bacterial and leaving alone children with a runny nose, with a cough, with bronchitis that goes away on its own is a very difficult task.

    The current situation is very unfavorable. I will only refer to published data. In Vladivostok, 86% of children with acute respiratory infections and bronchitis receive macrolides. In our clinic, you will see that you get 1-3%.

    03:20

    Data published. 8 regions, 11 hospitals. AB for children diagnosed with rotavirus diarrhea, gastroenteritis, enteritis is prescribed in 85% of cases (aminoglycosides in 37%, which are not absorbed and do not give anything except disorders and intestinal biocenosis).

    Recently I came across a work published in the respected magazine “Pharmateke”.In Novgorod, at the children’s hospital, 85% of children with bronchitis receive AB. Cephalosporins 2-3 generations, “Azithromycin” (“Azithromycyn”) for seven or more days. It is written that 70% is monotherapy. This means that 30% receive not one, but two ABs.

    AB is selected empirically, taking into account the probable etiology, sensitivity of the alleged pathogen. Although it is well known that if bronchitis is caused by bacteria, it is extremely, extremely rare. Bronchitis is a viral disease.

    In America, the assessment of the quality of treatment work includes the percentage of patients with bronchitis treated with AD.The higher this percentage, the worse the quality.

    Our data on how often we use AB. With acute respiratory viral infections, with croup, with bronchitis, they are used very rarely. It is unreasonable. Sometimes there is otitis media in a child (usually with croup). Usually a few percent are received. Either the parents refuse to cancel AB.

    (Slide Show) .

    This gives us a sharp reduction in the length of hospital stay. The data that we took from the city hospital is shown in red.Our data is green. Usually it is 2-3, maximum 4 days in children with bronchiolitis. We are waiting for them to stop whistling. We don’t give them AB.

    This is the preamble to my lecture.

    If you take an acute febrile illness. We have taken 1800 children hospitalized in recent years. They can be divided into two unequal parts. These are children with fever and severe catarrhal symptoms and children with fever without catarrhal symptoms. This is a good division, because catarrhal phenomena can be seen from afar.

    06:21

    Distribution with catarrhal symptoms. 35% – damage to the upper respiratory tract only. 30% – damage to the lower respiratory tract. Forms for which it is not necessary to give AB are shown in yellow.

    If taken without catarrhal symptoms, children with diarrhea and vomiting …

    We now have a huge amount of rotavirus and other viral diarrhea. Bokovirus of the third type also causes diarrhea, the third after rotavirus and norovirus. Without a visible focus of infections, a relatively rare contingent – there are also viral infections that do not give signs of catarrhal phenomena in the first days.There is a bacterial infection – bacteremia – an infection of the urinary tract, which is very difficult.

    If you take the forms and look at the ratio, it turns out that children with fever and catarrh – 67% of cases do not need AB. This is the hospital. If you take in a polyclinic who are not hospitalized, the ratio will be even more contrasting.

    If we take children with fever and without catarrhal symptoms, then we have the opposite relationship. 60% of children require antibiotic therapy.Fever without catarrh occurs, but it is only 40%.

    When a pediatrician encounters a child, he is least interested in the level. I am interested in other signs of bacterial disease. Such as violation of the general condition, toxicity of the child, appetite, he drinks or does not drink. These are the symptoms. Eyes or not. A child with a severe bacterial disease does not make eye contact with the doctor. This is a good sign.

    These children need to be given very close attention. Unfortunately, in practice we are very much obsessed with fever.”Ah, the child has 39.5.”

    Yes, at least 40.5. Nothing wrong. Give him an antipyretic. There won’t be much harm from this. Only immunity will strengthen.

    What we are doing about bacterial diseases. One hand has enough fingers to list the bacterial pathogens. These are pneumococci, H. influenza, hemolytic streptococcus (GABHS), Mycoplasma and Moraxella. Staphylococcus aureus is more in case of skin infection. Chlamydophila occurs in pneumonia. We are also talking about E. coli in kidney infections.

    09:45

    We are dealing with four major pathogens that cause virtually the entire spectrum of respiratory bacterial diseases.

    If we talk about oral antibiotics of the first choice (oral drugs should be used more widely in children) …

    An article was published today that all kidney infections, including pyelonephritis, are perfectly treated with oral drugs and give the same percentage of scars on the parenchyma as the effect of intravenous drugs alone.You do not need to inject the child again.

    For small children (who are one, two, three months old) it can be more difficult to give the drug by mouth than to inject it into a vein. Now we put it, he lies calmly.

    We’re talking about oral medications. What oral medications do we have. “Amoxicillin” (“Amoxicilin”), “Amoxicillin / clavulanate”. The drug “Cefuroxime axetil” is simpler, only more expensive.

    In what forms to apply them. Otitis media, sinusitis, tonsillitis, typical pneumonia, urinary tract infections.

    Macrolides are irreplaceable drugs for atypical infections (mycoplasmosis and chlamydia). Or as a substitute for lactams, if the child has some kind of allergy to them.

    “Doxycycline” we rarely use, it is used after 8 years. “Cefalexin” – only tonsillitis and impetigo. It has no effect on Haemophilus.

    The drug that is now in vogue – “Cefixime” – is a very good drug for the treatment of gonorrhea. One 400 mg dose cures any gonorrhea.It is good for urinary and intestinal infections in children. With dysentery, in particular. But it is not very suitable for the treatment of respiratory diseases, since pneumococcus is often resistant to it.

    12:14

    Treatment of acute otitis media or sinusitis. Here, the main flora is pneumococcus or Haemophilus influenzae in previously treated children who have recently received AB. They may have a moraxella. Hemolytic streptococcus.

    What is being treated. “Amoxicillin”. The dosage is 50 or 100 mg.A dosage of 100 mg for otitis media is normal, because “Amoxicillin” does not penetrate well into the cavity (like all ABs). A dosage of 50 mg per day may not work, so you have to give that dose. Children tolerate it well. The drug is not toxic. There are no problems with this.

    Americans, who have more resistance to pneumococcal lactams, now recommend 100 mg for the treatment of pneumonia. Although 50 mg is enough for pneumonia, it concentrates well in the lungs, accumulates.

    For children recently treated with AB, give “Amoxicillin / clavulanate”.We must clearly imagine that the addition of clavulanate does not affect pneumococcus in any way. For pneumococcus, you need to increase the dosage, then it is treatable.

    “Amoxicillin / clavulanate” is needed to suppress if the child has a resistant hemophilus influenzae. It is observed in child care institutions and in treated children quite often.

    Poor choice. But we have enough. No fantasies, use the drug with the letter “C”. The letter “C” is very attractive.

    Fever or ear pain.Here are two examples. A child of the first year, ill for two days. Temperature 38.5. Sometimes he screams out. A cloudy eardrum, exudate is visible, 15 thousand leukocytes. It is clear that there is purulent otitis media.

    The child is small. Was not treated with anything. Doesn’t go to kindergarten. “Amoxicillin” 50 mg per kilogram of weight is enough here.

    The same child, but 2.5 years old, who fell ill in kindergarten. Received a dose of “Amoxicillin / clavulanate” 25 mg per kilogram of body weight per day. Unfortunately, such doses still exist.Some brand name drugs give between 25 mg and 40 mg. We are quite often ineffective in this, as was the case in this case.

    Increasing the dose to 100 mg. Paracentesis had to be done – it led to a rapid decrease in temperature. The choice, perhaps, is not so much a choice as the choice of the dosage of the drug. There is no difficulty here.

    15:36

    Fever with respiratory distress. If a child has catarrhal symptoms, it is clear that this is a viral croup. We do not assign any AB to him.According to the available worldwide consensus, it is possible to give orally or intramuscularly “Dexamethasone”, “Prednisolone”. Or “Budesonide” (“Budesonide”) in the form of inhalation.

    85% of children recover after the first dose. Their stenosis stops. Some require two doses. Very rarely, three doses.

    With the same clinical picture, but without catarrhal phenomena, with chills, signs of toxicity, without a change in voice (the voice is just stifled, but not hoarse) – this is epiglottitis (inflammation of the epiglottis).We do not have mass vaccination against hemophilis B yet.

    The treatment here must be intravenous. Very early incubation. The epiglottis sinks very easily. Incubation for a day is no longer needed.

    Pneumonia. Sometimes we hear that there are some other pathogens now, and they are all stable. Nothing like this. Pneumococcus was the main pathogen and remained. Of course, in children of the first months of life, most often it is food aspiration, cystic fibrosis – these are the causes of pneumonia.

    Approximately 10% are infected from older sips – pneumococcus or hemophilis. Sometimes there is chlamydia trachomatis. From six months to five years, almost 85 – 90% are pneumococcus and hemophilis. Atypical – mycoplasma and chlamydia – are rare at this age.

    After five years, it turns out to be 50/50. About half is typical pneumococcal pneumonia. The second half is mycoplasma. Much less often chlamydia.

    What is the difference between atypical pneumonia and typical pneumonia. SymptomsMycoplasma pneumonia occurs with an abundance of wheezing. With typical pneumonia, wheezing or not, or very few of them. This is the most common mistake. No wheezing – no pneumonia. On the contrary, when I do not hear wheezing, it seems to me that I need to look after this child.

    If I hear a lot of wheezing, it’s bronchitis or SARS. Mycoplasma pneumonia occurs with red conjunctiva.

    19:01

    Drug selection. Young children are often difficult to treat. We give “Amoxicillin / clavulanate” intravenously.There may be E. coli. Cephalosporins 2-3 generations. For children with afebrile normal temperature (C. erachomatis) we prefer “Josamycin”. It has less prokinetic effect and does not cause pyloric stenosis, which is described in the treatment with “Erythromycin” and “Azithromycin” (“Azithrtomycin”).

    Further with typical pneumonia “Amoxicillin” or “Amoxicillin / clavulanate”. Over five years old – you can start with “Amoxicillin”, you can with macrolide. Josamycin takes precedence as well as Midecamycin.To him, the resistance of pneumococcus is slightly less than to “Azithromycin” and “Erythromycin”.

    The difference is small – 5%. But if you treat 100 children and fail in five cases, it will be quite unpleasant. In pediatrics, the simultaneous administration of beta-lactam and macrolide is permissible. Although in adults it is considered standard practice to start treating (especially the elderly) for not very severe pneumonia, immediately give oral lactam and macrolide. We recommend if the doctor is unsure.

    (Slide Show).

    Let me illustrate with an example what I said. Chlamydial pneumonia. What is its difference. With her, there is a very high leukocytosis. This child had 37 thousand leukocytosis. Moderate eosinophilia. This is a very unusual situation. Multiple small lesions. Very similar to miliary tuberculosis. Most therapists have not seen miliary tuberculosis. The comparison is incorrect.

    We give “Josamycin”, “Wilprafen”, we get a very quick effect. No parenteral antibiotic acts on chlamydia.

    We had an anecdotal case when a child was admitted who had been treated with parenteral antibiotics for a week. The sister was from a different department. She gave him 60 mg of “Azithromycin” (one spoon, no longer given). The mother says: “We treated him for a week, and you gave one spoon of something and everything helped.”

    22:04

    If you suspect afebrile pneumonia, macrolide is suitable. You have a 4.5-year-old child who was admitted on the 4th day of fever with a cough. “Amoxiclav” (“Amoksiklav”) received two days (25 mg / kg).On radiographs, this is not so often the case in children. Typical croupous pneumonia.

    There, and the cheek was red – a classic picture. 31 thousand leukocytes during treatment with Amoxiclav, but the dose is too small. This small dose has no effect. We have increased the dose to 50 mg. They gave “Amoxicillin”. This is a typical pneumonia. This was actually the end of it.

    (Slide Show).

    Second case. Massive shade, 4-year-old child, 5 days febrile temperature.He received “Azithromycin” on an outpatient basis for three days. “Azithromycin” did not give any effect. Maybe a little reduced the number of leukocytes. The appointment of “Amoxicillin / clavulanate” led to a fairly rapid decrease in temperature and resorption of the shadow.

    According to the Smolensk Pegasus study, up to 10% of pneumococci are resistant to Azithromycin. Otitis media and pneumonia, which do not go on “Azithromycin”. If you have suspicions of pneumococcal infection, do not philosophize, you need to use “Amoxicillin”.This is a unique drug in which there is practically no (there is, but extremely rarely, 0.01%) pneumococci.

    “Ceftibuten”. The child received Ceftibuten for two days with no effect. Although 93% of pneumococci are sensitive to Ceftibuten. But some part turns out to be insensitive. 17-18 thousand leukocytes. There was a rather serious illness. The use of “Amoxicillin / clavulanate” gave a good effect.

    The dosage is prescribed, which is recommended everywhere (45mg / kg). Some Jesuit took that dosage.If the child weighs 17 kg, multiply how much we should give him. It seems to me that there is no need to split hair and be precise. 50 mg.

    Americans honestly multiplied by two and give 90 mg. 17 by 90 is also not very easy to multiply. 50, 100 are easy to multiply. Of course, the dose is tied to the size of the tablet, to the size of the spoon. But this excessive precision is not needed.

    25:46

    Another group of pneumonia caused by atypical flora. The temperature in mycoplasma pneumonia is high, but there is no toxicosis.In Belgium, they call it the “Eighth Day Disease.” Parents wait a week for the temperature to drop, it does not drop. The child is not scary, but in a week I should go to the doctor.

    The saddest thing here was that the child began to be treated with Cefazolin. Although he had red conjunctiva and an abundance of small bubbling rales on both sides. When he entered, there was not even a talk. “Vilprafen” (“Josamycin”) was appointed right in the emergency room. He was assigned more. It says 40 mg. It’s all gone.

    The same story happened with a child who was treated with “Zinnat”, despite the abundance of wheezing and very calm blood (there was no leukocytosis).You can treat these children, from the very beginning give them the AB that is suitable for typical and atypical pneumonia.

    Same story. Here we managed to catch immunoglobulin M. Usually, immunoglobulin M appears by the end of the second week. When you take a fresh baby and give him immunoglobulin M, he is negative. You think there is no mycoplasmosis here.

    Then he gets better. Two months later, he falls ill again. You take him again, he gets IgM, because he lasts 6 months.Mycoplasma is already over. It is much easier to diagnose clinically and treat. If it doesn’t work with macrolide, lactam. The child received Ceftibuten.

    Another child. On the sixth day of illness, IgM is negative. Although there was absolutely no doubt that this is mycoplasma pneumonia.

    Now I want to show one case. If you dig into the literature, no one describes what chlamydial pneumonia looks like. We also do not really believe in the gullibility that this is chlamydial pneumonia.I had to show it on a CT scan. The lesions on the roentgenogram were not very bright, some completely unusual on the right and on the left.

    The most important thing is that we received negative antibodies to mycoplasma. Chlamydia pneumoniae got IgM positive. IgG 1: 200 U / ml. The disease began in a very unusual way. It began with obstructive bronchitis, which was treated in the hospital with Budesonide. Only on the 8th day did the temperature rise. Pneumonia began. An x-ray was taken – everything was clean.

    This unusual onset with obstruction is described as chlamydial pneumonia.We managed to catch and prove this once. Let’s assume that nothing has been messed up here. True, the child has IgM of 1133 U / ml. The obstruction could be quite calm of asthmatic order.

    30:04

    Now a little about severe pneumonia. Bilateral pneumonia with pleurisy. Azithromycin was ineffective from the second day. A very difficult child who was treated with intravenous therapy. We got the effect. Then they switched to the oral drug “Amoxicillin / clavulanate”.

    On tomography pleurisy on the left, the changes were not very noticeable on the roentgenogram.Despite such treatment, on the 22nd day of illness there were still very big changes. ESR is very high. It is difficult with such patients.

    Destruction. We are not afraid of destruction. With pneumococcal pneumonia, this is a fairly common occurrence. A small child with pneumonia of the apex of the lower lobe on the left. He entered on September 29th. On October 3, he had enlightenments.

    He received intravenous “Amoxicillin / clavulanate” with a switch to oral medication. Everything ended well here.

    Complications of pleurisy.We have been doing this for a long time. Parapneumonic pleurisy or synpneumonic pleurisy is part of pneumonia. Indicates a severe infection. If you start to heal on time, it goes away without residues. It is not particularly difficult. In this case, “Cefazolin” gave a decrease in temperature very quickly.

    But you need to consider. Abroad, this has not yet been sorted out. A child with pleurisy was admitted on the fourth day of illness. Cytosis of 5000 cells. This is a fairly purulent fluid. After starting treatment with “Penicillin” (“Penicillium”), he had an increase in the size of pleurisy, the amount of exudate.But the liquid has already become only 700 cells. This is metapneumonic pleurisy. It is an immunoprophylactic response to the destruction of pneumococci under the influence of treatment.

    32:47

    Incisura is very characteristic of this child – the temperature drops, then goes off scale again. These are metapneumonic changes. Sometimes you have to give “Prednisolone”. This does not affect the temperature. Change AB. We have now begun to take it calmly.

    (Slide Show).

    Same story.There’s a huge pneumonia on the right and left. Under the influence of treatment with “Pentamitsin” (“Pentamitsin”), the infiltration sharply decreased, and pleurisy appeared. We have the effectiveness of the treatment of pneumonia and the appearance of metapneumonic with very low cytosis (less than 1000).

    We take this very calmly too. American guidelines came out recently. There they are still a little worried. Against this background, a section of a bullous destructive process developed. Everything resolved without surgery.

    (Slide Show).

    Blue indicates incisura, a new rise in temperature. Cope with the temperature “Prednisolone”. It soothes immunological things very quickly.

    A small child with seemingly minor pneumonia. After the start of treatment, it gives a prolonged fever. Metapneumonic pleurisy simultaneously occurs at the site of the focus. The left appears completely with the liquid level. But we do not consider them as real abscesses. We continue treatment.

    Against the background of fever, they quickly switched to oral medication.AB is here to reassure the parents. Most likely for treatment.

    Recently we have the same case. Destructive pneumonia. A drop in temperature and the formation of metapneumonic, apparently interlobar pleurisy. We did not punctuate it. We know that this will all resolve.

    The acceleration of ESR against the background of metapneumonic pleurisy is very characteristic. On admission the ESR was 12, it became 61 with a drop in the number of leukocytes. The cavity was emptied, swelled a little. The child was discharged.

    I want to show nosocomial pneumonia caused by Haemophilus influenzae.We rarely manage to identify it. Stable. Whatever AB was given, nothing helped. Until they gave “Rifampicin” (“Rifampicinum”) inside. Instantly. Such was the progressive pneumonia. Moreover, a child with a congenital heart defect.

    At this point I will allow myself to end.

    36:09

    Coronavirus – what antibiotics help: Azithromycin for coronavirus, fluoroquinolone – November 12, 2020

    The famous doctor Evgeny Komarovsky in his YouTube blog shared his opinion on a controversial and relevant topic: pneumonia and antibiotic treatment.As the doctor noted, in most cases, the use of the drug is not required.

    “The topic of pneumonia and antibiotics has escalated, and, given the coronavirus, it almost threatens the health of a huge number of people. Pneumonia or pneumonia is the presence of an inflammatory process in the lung tissue. The very word “pneumonia” does not say who is to blame. There is an inflammatory process in the lungs, the cause of which may be an infection or exposure to a chemical, toxic substance.

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    Most often, when we say the combination “pneumonia”, we mean some kind of infectious process. This inflammation of the lungs can be viral and bacterial. The main thing we need to understand is that antibiotics are used to treat bacterial pneumonia. The word “pneumonia” itself is not a diagnosis, and one must understand what kind of pneumonia it is.

    Types of pneumonia

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    There are three main types of pneumonia: bacterial, viral and another bacterial, which is complicated by a viral infection.We may come into contact with a bacterium called pneumococcus or staphylococcus. Pneumococcus will enter the lungs and cause inflammation – we will treat with antibiotics. We can get a viral infection: flu, adenovirus, coronavirus – and a viral inflammation will arise in the lungs. It cannot be treated with an antibiotic: antibiotics have no effect on the virus. Another situation is possible when a viral infection occurs. Against the background of a viral infection, air ventilation in the lungs changes, mucus accumulates, which becomes infected, and a complication arises – bacterial pneumonia, which is treated with antibiotics.

    Why antibiotics don’t cure pneumonia

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    If we give an antibiotic for a viral infection, there will be bacteria that will survive after this antibiotic is prescribed. Imagine a classic situation: there are three microbes living in the lungs, of which there are actually three hundred and thirty-three. For example, streptococcus, pneumococcus, staphylococcus not only live there, but compete with each other.

    Bacteria live in specific areas of the respiratory tract. Or imagine a body of water with stumps sticking out of, birds sitting on them, which can only sit on these stumps – in the respiratory tract, there is about the same situation: there are certain places where bacteria sit.We prescribe the well-known antibiotic penicillin, ampicillin or amoxicillin. Amoxicillin will kill streptococcus, pneumococcus, but will not work on staphylococcus. Half or 2/3 days are free – birds can breed. When we in the community of bacteria kill a part, the remaining get conditions for reproduction. Moreover, the remaining staphylococcus without antagonists begins to multiply – now we have not just pneumonia, but staphylococcal, which is difficult to treat, for which more expensive and toxic antibiotics are needed.

    Medical science has proven that the prophylactic use of antibiotics is a huge folly. This does not work, it is ineffective, moreover: according to some reports, prophylactic antibiotics for viral infections increase the development of bacterial pneumonia and the likelihood of complications by 6-9 times.

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    Antibiotics are persistently prescribed because:

    • a huge number of people are convinced that this is the right thing to do.

    Doctors who know that it is impossible to do this, know another thing: ordinary people are convinced that it is necessary to be treated this way.If the doctor did not prescribe an antibiotic, and then pneumonia developed, it allegedly arose because the muddler doctor did not prescribe the necessary medicine in time.

    • in insurance companies they also say: they did not prescribe an antibiotic on time – we will not pay for it, since you brought the person.

    It is the legal aspects, fears, ignorance that lead to the massive prescription of antibiotics. Now the situation has taken on a catastrophic scale: it reaches a huge number of people – tens of thousands.I encounter this at least five times a day, when my relatives call, patients who went for a CT scan and received a conclusion: inflammation is 20-30%. This is a coronavirus process, it has nothing to do with bacterial pneumonia. They wrote you “pneumonia” – an antibiotic. Asking a perfectly normal sane doctor – why prescribed two antibiotics? He will answer: “What can I do? If I don’t appoint him now, he will be hospitalized later, it will get worse, and I will be accused that I did not appoint him on time ”.

    I see how many problems this creates – it kills a lot of people. Moreover, when the doctor sees 30%, in one lung, 40% in the other, he prescribes the so-called reserve antibiotics, which are prescribed extremely rarely, almost at the resuscitation stage, when nothing helps, but with these antibiotics completely and start at home nearby. And when a person who was treated like this at home ends up in the hospital, he feels very bad, and there is nothing to prescribe. Pneumonia develops, bacteria on which practically nothing acts.We see: the more actively antibiotics are prescribed at the prehospital stage, the greater the likelihood of severe, deadly complications.

    How to be treated without antibiotics

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    It is important to understand the relationship between antibiotics and coronavirus. Today, it has been proven that there are actually two options for coronavirus infection: before you start choking, and after. If you feel normal – there is a fever, but there is no oxygen deficiency, the general condition is tolerable – in fact, any treatment other than antipyretic drugs worsens your prospects.We are being treated because we are scared not to be treated, everyone around us is being treated, we were terribly intimidated. Because the President of America shouts that it is necessary to be treated with azithromycin, although azithromycin is used when the patient is practically lost. There was an excellent antibiotic, non-toxic, convenient, you can drink it once a day or take it for three days – it works after that for another ten days. Now it is being eaten by everything, almost all bacteria will be resistant to it – we will soon forget about this drug. The trouble is that we eat reserve antibiotics, like the third generation fluoroquinolone, and other expensive drugs.

    Sane people, some even with higher medical education, call and say: “I have 25% of one lung on CT, 35% of the second – what antibiotic should I take? I see that the coronavirus clearly affects the brain: the rudiments of logic and common sense are turned off. Guys, if a bacterial infection is not proven, a bacterial complication – antibiotics are contraindicated at any stage: at least in the hospital, at least at home.

    Denmark or Belgium did a great study where they analyzed people who are hospitalized in hospitals: when a person is really sick, and not because of pull.More than 70% of those hospitalized – with a lung deficiency and there is no hint of a bacterial process – a pure viral coronavirus lung disease. That is, antibiotics are contraindicated.

    Another point not about coronavirus: a routine clinical blood test, which indicates leukocytes, blood count. You can study my program “Clinical blood test” – you will understand how to understand from a routine clinical blood test whether it is a viral infection or a bacterial one. A clinical blood test shows whether there is a dominance of a bacterial process or not – antibiotics are needed or not.This is more important than all the tests put together.

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    Another misconception: suspected pneumonia – you need to prescribe an antibiotic. This is also not the case. There are such bacterial infections as pneumococcus, which can cause croupous pneumonia, when there is a fever, respiratory failure – then it must be treated immediately. And, conversely, when a child has snot, temperature 39, and some kind of focus in the lungs, and it is not clear whether it is pneumonia or not, it is not necessary to prescribe antibiotics if there is no respiratory failure.You can watch for a day or two, do a blood test.

    It is easier for any doctor to prescribe an antibiotic, it is even easier to prescribe two. If there is a doctor next to you who said: “CT scan, defeat is a virus,” but did not prescribe antibiotics, you are in luck: you have met a doctor who understands what responsibility is, medical science; that it is impossible to prescribe an antibiotic because of human stupidity. If people are fools, a doctor has no right to follow their lead, he must remain a doctor and make responsible decisions.

    The main thing: do not beg for antibiotics. In the case of coronavirus, this is the last thing the infection is treated with. Think about it, make the right conclusions and learn. ”

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