Современные подходы к выбору антибиотика для терапии внебольничной пневмонии у различных категорий пациентов

Abstract

Community-acquired pneumonia (CAP) is the leader among respiratory tract infections. The severity of CAP varies from mild forms (outpatient treatment) to severe, requiring hospitalization. A signifi cant number of negative clinical outcomes, including lethal, actualize regular analysis of patient’s management strategies with a focus on a rational antibiotic therapy. The purpose of the review is to evaluate a rational approach to the choice of an empirical drug for antibiotic therapy of CAP in diff erent patient populations. This review includes an analysis of modern clinical guidelines for CAP antibiotic therapy in pediatric patients and adults, considering current data on the resistance of the main pathogens and the results of clinical effi cacy trials involving antimicrobials listed in the given guidelines. Analysis of the prevalence of causative agents of CAP reveals leading positions of Streptococcus pneumoniae and atypical microfl ora with a tendency to increase of the role of potentially resistant microorganisms — Staphylococcus aureus and Gram-negatives (Pseudomonas aeruginosa, Haemophilus infl uenzae, family of Enterobacteriaceae). The schemes of CAP empiric antibiotic therapy in adults and children according to the clinical guidelines in Europe, USA, and Russia include β-lactams, macrolides, respiratory fl uoroquinolones and doxycycline. In Russian Federation, a suffi ciently high level of sensitivity of major CAP pathogens is detected for β-lactams (inhibitorprotected aminopenicillins, third-generation cephalosporins), respiratory fl uoroquinolones and macrolides (azithromycin, clarithromycin). Analysis of clinical effi cacy trials of empiric antibiotic therapy revealed benefi ts of aminopenicillins in treatment of outpatients, except in cases caused by atypical microfl ora macrolides are the drug of choice. The combination of β-lactam antibiotic plus macrolide is indicated for patients with increased CAP severity rates and risks of atypical microfl ora. Inhibitor-protected β-lactams, cephalosporins II and III generations, and respiratory fl uoroquinolones are essential to treat severe CAP.