Community-acquired pneumonia. Diagnosis, treatment approaches

Abstract

The article presents current data on the prevalence and etiology of community-acquired pneumonia, shows the contribution of each of the possible pathogens to the structure of the disease. The diagnostic criteria for pneumonia are given. The main algorithms for assessing the severity of pneumonia and the prognosis of the disease using different scales: CURB-65 / CRB-65, PORT (PSI), are described. The purpose of the test is to determine the place of treatment: outpatient or in the in-patient department, in the general department or in the intensive care unit. The criteria for IDSA / ATS (American Thoracic Society / American Society of Infectious Diseases), as well as the SMART-COP / SMRCO scale to determine the need for hospitalized patients in the intensive care unit, are reviewed. The Aliberti and PES scales are given, assessing the risk of the presence of resistant pathogens in community-acquired pneumonia. Modern recommendations on the empirical choice of antibacterial drugs depending on individual patient factors are presented: anamnestic indications for treatment with antimicrobials during the preceding three months, hospitalization within six months before the onset of pneumonia, the presence of comorbidities, the severity of the disease, the risk of resistant pathogens. The average therapeutic doses of antibacterial drugs for the treatment of community-acquired pneumonia in patients with normal renal function are indicated. The questions of the optimal duration of treatment of pneumonia depending on the etiology are considered, the criteria of sufficiency of antibacterial therapy are presented. The reasons for the possible ineffectiveness of the empirical antibiotic therapy of community-acquired pneumonia are described. The importance of identifying a particular form of community-acquired pneumonia – severe community-acquired pneumonia is emphasized. Described drugs for the treatment of severe community-acquired pneumonia. The issues of prevention of pneumonia were discussed, its importance in the strategy of reducing mortality according to the World Health Organization was emphasized.