Treatment Of Community-acquired Pneumonia Research Articles

Develop adult extrapolation to pediatrics and pediatric dose optimization based on the physiological pharmacokinetic model of azithromycin.

Physiologically-based pharmacokinetic (PBPK) models are more frequently used for supporting pediatric dose selection in small-molecule drugs. Through literature research, drug parameters of azithromycin and clinical data from different studies were obtained. Through parameter optimization of the absorption and dissolution process, the adult intravenous model was extended to the adult oral model. The adult intravenous and oral PBPK models are precise to meet the AAFE<2 standard, and the pharmacokinetic parameters of the predicted values of the model are all within the mean standard deviation of the clinical observations. The values of plasma protein unbound fraction, renal clearance, and gastric juice pH between adults and pediatrics were changed by using the age-dependent pediatric organ maturity formula, and the adult model was extrapolated to the pediatric model. The final developed pediatric PBPK model was used to evaluate optimal dosing for children of different developmental ages. The relationship between the frist dose and age was as follows: 8.8mg/kg/day from 0.5 to 2years old, 9.2mg/kg/day from 3 to 6years old, 9.4mg/kg/day from 7 to 12years old, and 8.2mg/kg/day from 13 to 18years old, taken in half for 2-5days. Simultaneously, the simulated exposures achieved with the dosing regimen proposed were comparable to adult plasma exposures for treatment of community-acquired pneumonia. A reasonable azithromycin pharmacokinetic-pharmacodynamic model for adults and pediatrics has been established, which can be demonstrated by the use of literature pediatric data to develop pediatric PBPK models, expanding the scope of this powerful modeling tool.

Evaluation of a Pediatric Community-Acquired Pneumonia Antimicrobial Stewardship Intervention at an Academic Medical Center.

(1) Background: Pneumonia is the leading diagnosis associated with antibiotic use in hospitalized children. The Infectious Diseases Society of America published pediatric community-acquired pneumonia (CAP) guidelines in 2011, but adherence to recommendations varies across institutions. The purpose of this study was to evaluate the impact of an antimicrobial stewardship intervention on antibiotic prescribing in pediatric patients admitted to an academic medical center. (2) Methods: This single-center pre/post-intervention evaluation included children admitted for CAP during three time periods (pre-intervention and post-intervention groups 1 and 2). The primary outcomes were changes in inpatient antibiotic selection and duration following the interventions. Secondary outcomes included discharge antibiotic regimens, length of stay, and 30-day readmission rates. (3) Results: A total of 540 patients were included in this study. Most patients were under five years of age (69%). Antibiotic selection significantly improved, with prescriptions for ceftriaxone decreasing (p < 0.001) and ampicillin increasing (p < 0.001) following the interventions. Antibiotic duration decreased from a median of ten days in the pre-intervention group and post-intervention group 1 to eight days in post-intervention group 2. (4) Conclusions: Our antibiotic stewardship intervention directed at pediatric CAP treatment resulted in improved antibiotic prescriptions and provides data that can be used to further educate providers at our institution.

Safety and Efficacy of Nemonoxacin vs Levofloxacin in Patients With Community-Acquired Pneumonia: A Systematic Review and Meta-Analysis of Randomized Control Trials.

Community-acquired pneumonia is a leading cause of morbidity and mortality throughout the world, which incurs significant healthcare costs. The aim of his meta-analysis is to assess the clinical efficacy and safety of a novel non-fluorinated quinolone, nemonoxacin, compared with levofloxacin in treating community-acquired pneumonia (CAP). A recursive literature search was conducted using PubMed, Google Scholar, andScopusup to August 2022. All randomized clinical trials comparing nemonoxacin to levofloxacin for community-acquired pneumonia were included.The patients selected for this study had mild to moderate CAP. Each individual received treatment with either nemonoxacin (500 mg or 750 mg) or levofloxacin (500 mg) for a duration of 3-10 days. Four randomized control trials with a total of 1955 patients were included. Nemonoxacin and levofloxacin were found to have similar clinical cure rates in the treatment of CAP. There were no significant differences reported in the treatment-emergent adverse events between the two drugs (RR=0.95, 95% CI: 0.86, 1.08, I2=0%). However, the most frequent symptoms exhibited were gastrointestinal system-related. Both the dosages (500 mg and 750 mg) of nemonoxacin were found to have similar efficacy as that of levofloxacin.Our meta-analysis indicates that nemonoxacin is a well-tolerated and effective antibiotic therapy for the treatment of community-acquired pneumonia (CAP), with clinical success rates comparable to those of levofloxacin. Furthermore, the adverse effects associated with nemonoxacin are generally mild. Therefore, both the 500 mg and 750 mg dosages of nemonoxacin can be recommended as appropriate antibiotic therapy regimens for the treatment of CAP.

CEFTO-CURE study: CEFTObiprole Clinical Use in Real-lifE – a multi-centre experience in Italy

Ceftobiprole is approved in Europe for treatment of community-acquired pneumonia and non-ventilator-associated hospital-acquired pneumonia (HAP) in adults. Real-world data are limited. This multi-centre, observational, ambispective investigator-initiated study was undertaken in Italy from January 2018 to December 2019 in order to evaluate the use of ceftobiprole in a real-world setting. Overall, 195 patients from 10 centres were evaluated (68% retrospectively). Male sex was prevalent (n=121, 62%). Median age was 67 [interquartile range (IQR) 53-75] years. Median Charlson Comorbidity Index score was 5 (IQR 3-7). The most common indication was pneumonia (151/195, 77%), especially HAP. Other uses were skin and soft tissue infections (5%), endocarditis (4%) and bone infections (4%). Ceftobiprole was usually an empiric choice (65%), in combination with other drugs (66%) and as second-line therapy (58%). A causative agent was found in 39% of cases. A diagnosis of sepsis was made in 59 cases (30%). Success in the clinically evaluable population (excluding 12 cases due to isolation of pathogens outside ceftobiprole's spectrum of activity) was obtained in 79% of cases, with all-cause mortality of 20%. On multi-level analysis, three predictors were positively associated with clinical success: male gender, pneumonia and detection of causal agent. Sepsis was a negative predictor. Nine factors were independently associated, favourably or unfavourably, with fatal outcome. Ceftobiprole is a safe and effective therapeutic choice, even in a real-world setting. More data are needed to establish its efficacy in patients with sepsis.

Changes in the pathogen spectrum of hospitalized adults with community-acquired pneumonia in Fujian Province: A multicenter, retrospective study from 2012 to 2018.

Changes in the pathogen spectrum of hospitalized adults with community-acquired pneumonia in Fujian Province: A multicenter, retrospective study from 2012 to 2018.

Features of the course, clinic and approaches to treatment of community-acquired pneumonia

This article covers the work devoted to the study of the features of the course, clinic and treatment of CAP

ESTIMATION OF MATERIAL LOSSES DURING THE REGISTRATION OF THE DRUG «AMOXICILLIN + CLAVULANIC ACID» IN INFUSION THERAPY OF COMMUNIT Y-ACQUIRED PNEUMONIA IN CHILDREN

Patients diagnosed with community-acquired pneumonia are recommended to receive anti- biotic therapy. In case of severe pneumonia in hospital, infusion of Amoxicillin preparations is used. In the Russian pharmaceutical market during the study period, there are no solutions for parenteral administration in pediatric dosages, which leads to high financial losses of medical organization and environmental risks in the disposal of antibiotics. Objective of the study evaluation of losses of drug weight and financial losses when using «adult» doses of anti- bacterial agents for infusion therapy of community-acquired pneumonia in children (on the example of the drug «Amoxicillin+clavulanic acid, powder for preparation of solution for intravenous injection»). Materials and methods the objects of the study were clinical guidelines on treatment of community-acquired pneu- monia in children, information from the State Register of Medicines, instructions for medical use. The source of data on prices was the information from the State Register of maximum selling prices. Analytical, statistical, logical, and computational-constructive methods of re- search were used in the work. Results: the study calculated the material losses of the drug in mg per vial and 12 vials (treat- ment course of 4 days). With a single therapeutic dose of 300 mg, the material losses of the drug, using a dosage of 1200 mg, were: 1200 - 300 = 900 mg (75% of the dosage form). Fi- nancial losses in rubles calculated for the course of treatment with the drug Amoxicillin + clavulanic acid 1200 mg amounted to 756.00 rubles (79.05%) per 1 child, and for treatment with the dosage of 600 mg - 252.00 rubles (52.70% of the cost of the drug). The development of the dosage forms for intravenous administration of Amoxicillin + clavu- lanic acid in the doses of 180 and 240 mg would allow decreasing considerably the losses of the drug during preparation of infusion solutions in pediatric practice. Conclusion 1. When administering antibacterial therapy for community-acquired pneumonia in chil- dren, the drug Amoxicillin + clavulanic acid, powder for preparation of solution for intrave- nous injection, manufactured in doses of 1200 mg and 600 mg, is used. 2. Modeling of weight losses of Amoxicillin + clavulanic acid powder for intravenous solu- tion preparation for treatment of community-acquired pneumonia in children aged 1 year showed that when 1200 mg dosage was used, losses were 900 mg/ vial (10800 mg per treat- ment course), and in 600 mg dosage - 300 mg/ vial (3600 mg per course); 75 and 50% of drug weight respectively. 3. Calculations have been made and significant financial losses have been established in treatment of community-acquired pneumonia in children under 5 years old with the drug «Amoxicillin + clavulanic acid, powder for preparation of solution for intravenous injection» 1200 mg and 600 mg, due to incomplete use of the package. The financial loss for the course of treatment with the drug Amoxicillin + clavulanic acid in the dosage of 1200 mg amounted to 756.00 rubles (79.05%) for 1 child aged 1 year, and for treatment with the dosage of 600 mg - 252.00 rubles (52.70% of the cost of the drug for the course of treatment). 4. For treatment of community-acquired pneumonia in children aged 5-11 years it is reason- able to use Amoxicillin + clavulanic acid 600 mg dosage. 5. For treatment of community-acquired pneumonia in children under 5 years old it is advis- able to commercially release the medicinal product «Amoxicillin + clavulanic acid, powder for preparation of solution for intravenous injection» in doses of 180 mg (150+30 mg) and 240 mg (200+40 mg).

Which trial do we need? Doxycycline in combination with ceftriaxone for the treatment of community-acquired pneumonia

Which trial do we need? Doxycycline in combination with ceftriaxone for the treatment of community-acquired pneumonia

Optimal duration of antibiotic treatment for community-acquired pneumonia in adults: a systematic review and duration-effect meta-analysis

ObjectivesTo find the optimal treatment duration with antibiotics for community-acquired pneumonia (CAP) in adults.DesignSystematic review and duration-effect meta-analysis.Data sourcesMEDLINE, Embase and CENTRAL through 25 August 2021.Eligibility criteriaAll randomised controlled trials...

Integrative population pharmacokinetic/pharmacodynamic analysis of nemonoxacin capsule in Chinese patients with community-acquired pneumonia.

Introduction: Nemonoxacin is an innovative quinolone antibiotic for treatment of community-acquired pneumonia (CAP). As more data are available from clinical studies, it is necessary to perform an integrative pharmacokinetic/pharmacodynamic (PK/PD) analysis to support and justify the optimal dosing regimen of nemonoxacin in clinical practice. Methods and Results: We developed a population PK model using non-linear mixed effect model based on the data of 195 Chinese subjects receiving nemonoxacin in phase I to III clinical trials. The base model was a standard two-compartment PK model defined by clearance (12L/h) and central volume of distribution (86L). Covariates included creatinine clearance (CLcr), body weight (BW), sex, disease status and food. Compared to the subject with BW 60kg, Cmax and reduced by 24% and 19% in the subject with BW 80kg, respectively. Compared to the subject with CLcr 150ml/min, and T1/2 increased by 28% and 24%, respectively in the subject with CLcr 30ml/min. Compared to the fasted status, Tmax of nemonoxacin increased by 1.2h in the subject with fed status. Effects of sex and disease status on PK parameters were small (change of PK parameters ≤19%). AUC0-24/MIC and %T > MIC were identified as the optimal PK/PD indices for predicting clinical efficacy. The AUC0-24/MIC target was 63.3, 97.8, and 115.7 against Streptococcus pneumoniae, Staphylococcus aureus, and Haemophilus influenzae, respectively. The %T > MIC target was 7.96% against Klebsiella pneumoniae. Monte Carlo simulation showed that treatment with nemonoxacin 500mg q24h could attain a PK/PD cutoff value higher than the MIC90 against S. pneumoniae and S. aureus. The corresponding cumulative fraction of response (CFR) was greater than 93%, while nemonoxacin 750mg q24h would provide higher PK/PD cutoff value against Haemophilus parainfluenzae, and higher CFR (83%) than 500mg q24h. Conclusion: Integrative PK/PD analysis justifies the reliable clinical and microbiological efficacy of nemonoxacin 500mg q24h in treating CAP caused by S. pneumoniae, S. aureus, and K. pneumoniae, irrespective of patient sex, mild renal impairment, empty stomach or not. However, nemonoxacin 750mg q24h would provide better efficacy than 500mg q24h for the CAP caused by H. parainfluenzae in terms of CFR.

Outpatient treatment of pneumonia in a setting with and without an infectious disease doctor

To compare the outpatient treatment of community acquired pneumonia (CAP) by infectious disease doctors (IDDs) and doctors of other specialties (nIDDs). We retrospectively identified 600 outpatients with CAP: 300 treated by IDDs and 300 by nIDDs in two tertiary hospitals during 2019. The two groups were compared in terms of adherence to guidelines, antibiotic group prescription, frequency of combined treatment, and treatment duration. IDDs prescribed significantly more first-line treatment (P<0.001) and alternative treatment (P=0.008). NIDDs prescribed more reasonable (P<0.001) and unnecessary (P=0.002) second-line treatment, and inadequate treatment (P=0.004). IDDs significantly more frequently prescribed amoxicillin (P<0.001) for typical and doxycycline (P=0.045) for atypical CAP, while nIDDs significantly more frequently prescribed amoxicillin-clavulanate (P<0.001) for typical and fluoroquinolones for both typical (P<0.001) and atypical (P<0.001) CAP. No significant differences were found in the frequency of combined treatment, which exceeded 50% in both groups, or in treatment duration. Outpatient treatment of CAP in the absence of IDDs meant more broad-spectrum antibiotic prescription and more disregard for national guidelines. Our results highlight the need for antibiotic stewardship, especially in settings with no IDDs.

Possibilities of physical therapy and electrophysical modalities in the complex therapy of pneumonia

Pneumonia is one of the most common infectious diseases and the leading infectious cause of death worldwide. High rates of morbidity, frequency of complications, mortality, the emergence of new highly virulent strains of pneumonia pathogens, antibiotic resistance determine the global medical and social problem of community-acquired pneumonia. The economic consequences of pneumonia are represented not only by direct medical costs (the cost of maintaining a patient in a medical institution, the cost of medical services, the cost of medicines, laboratory and instrumental studies, other medical procedures, etc.), but also include non-material costs from pneumonia, which include pain, psycho-emotional experiences of the patient due to a decrease in the quality of life during the illness. One of the directions of increasing the effectiveness of pneumonia therapy is the widespread introduction of physical therapy (PT) and electrophysical modalities (EM) into complex treatment, which are an important part of the medical rehabilitation for pneumonia, aimed at the speedy restoration of the health and working capacity of patients. The effectiveness of EM in the treatment of pneumonia is due to the versatile therapeutic effect of physical factors that have anti-inflammatory, desensitizing, bacteriostatic, broncholytic, mucolytic, immunostimulant effects, improve blood supply to the lungs. PT contributes to the normalization of pulmonary ventilation, has an expectorant effect, strengthens the respiratory muscles, accelerates the resorption of the inflammatory focus, prevents the formation of pleural adhesions, activates blood and lymph circulation. PT and EM are relevant in the comprehensive treatment of community-acquired pneumonia since they accelerate the regression of clinical symptoms, decrease the drug load, reduce the duration of inpatient treatment, that is confirmed by the results of clinical studies. We assume that the inclusion of PT and EM in the comprehensive treatment of pneumonia can lead to minimizing the total cost of the disease while reducing the duration and volume of drug treatment.

Guideline-Concordant Antibiotic Therapy for the Hospital Treatment of Community-Acquired Pneumonia and 1-Year All-Cause and Cardiovascular Mortality in Older Adult Patients Surviving to Discharge

Selection of empiric antibiotic treatment for community-acquired pneumonia (CAP) that is concordant with clinical practice guidelines has been associated with improved short-term outcomes of this infection, but whether it is also associated with longer-term outcomes is unknown. Is guideline-concordance of the initial antibiotic treatment given to older adult patients hospitalized with CAP associated with the 1-year all-cause and cardiovascular mortality risk of those patients who survive hospitalization for this infection? A total of 1,909 older (> 65 years of age) patients were identified who survived hospitalization for CAP at The Ottawa Hospital (Ontario, Canada) between 2004 and 2015. Linking patients' information to hospital and provincial data sets, this study analyzed whether the selection of the initial antibiotic therapy for their CAP was concordant with current clinical practice guidelines, and whether guideline-concordance was associated with 1-year all-cause and cardiovascular mortality following their index CAP hospitalization. Adjustments were made forthe patients' overall 1-year expected death risk; CAP severity; and history of previous pneumonia admissions, myocardial infarction, heart failure, or cerebrovascular disease. Selection of guideline-concordant antibiotic therapy was associated with a trend towards lower all-cause mortality at 1 year post-CAP (hazard ratio, 0.82; 95%CI, 0.65-1.04; P= .099). Furthermore, the use of guideline-concordant antibiotic therapy was associated with a significant almost 50%reduction in cardiovascular death risk 1 year following CAP admission (hazard ratio, 0.53; 95%CI, 0.34-0.80; P= .003). Use of guideline-concordant antibiotic therapy for CAP treatment in older hospitalized patients is associated with a significant reduction in the risk of cardiovascular death at 1 year post-CAP. This finding further supports current clinical practice guideline recommendations for CAP treatment.

Efficacy of corticosteroids as an adjunctive therapy in the treatment of community-acquired pneumonia: a systematic review and meta-analysis

The objective of this study was to systematically evaluate the clinical efficacy of the complementary use of corticosteroids in the treatment of community-acquired pneumonia (CAP). We searched all relevant documents in five scientific databases from inception to June 2022 to collect clinical trials (randomized controlled trials and controlled trials) reporting on the adjunctive use of corticosteroids in CAP treatment. The primary outcome was mortality, and secondary outcomes included the time to clinical stability, therapeutic efficacy, duration of antibiotic treatment and length of hospital/ICU stay. Therapeutic efficacy was defined as the rate of achieving clinical recovery with no fever, improvement or disappearance of cough. Clinical stability was defined by improvements in laboratory values. Two researchers independently screened the literature according to the inclusion and exclusion criteria, extracted data and evaluated the quality of literature. Statistical analysis and meta-analysis of intervention measures and indicators were performed with IBM SPSS and RevMan 5.4 software. Nine randomized controlled trials comprising 2673 participants with CAP (1335 in the corticosteroid group and 1338 in the control group) were identified and included in this study. The mean cumulative corticosteroid dose and treatment duration were 298.00±287.140 mg and 5.22±1.787 days, respectively. Corticosteroid treatment was not associated with a significant decrease in mortality (RR; 95% CI, 0.96 [0.67–1.38], P=0.83). Because of the low number of included patients in our study, more studies with larger sample sizes and high-quality randomized, double-blind controlled trials are needed to confirm the results.

Duration of antibiotic therapy for common respiratory infections in adults

Antibiotic therapy is not recommended for the majority of adult outpatients with a respiratory tract infection. When antibiotic therapy is mandatory, its duration should be as short as possible in order to avoid side effects and reduce costs. This literature review summarises the recommendations for new, shorter courses of antibiotics. The recommended duration of antibiotic treatment for community-acquired pneumonia, chronic obstructive pulmonary disease exacerbation and acute otitis media is now 5 days, 6 days for pharyngitis and between 5 and 7 days for sinusitis. These recommendations do not apply to severe or complicated infections, infections with resistant agents or in immunosuppressed patients.

Naso-pharyngeal carriage and antimicrobial susceptibility of Streptococcus pneumoniae in community-acquired pneumonia in children

Streptococcus pneumoniae is the most common cause of community-acquired pneumonia (CAP) in children. Recently, the rapid emergence of antibiotic-resistant pneumococci has posed enormous challenges for CAP treatment and public health. This study aims to provide clinicians with updated data about the antimicrobial susceptibility of S. pneumoniae and improve the treatment guidelines in CAP in children. This cross-sectional and in-vitro study was conducted at three hospitals in Quang Nam province and Da Nang city in Vietnam. Pneumococcal strains were isolated from nasopharyngeal aspirate samples of 360 CAP in-patients under five years of age. The susceptibility of clinically used antibiotics was investigated using the disk diffusion test and the E-test for identifying the MIC. Multi-drug resistant (MDR) S. pneumoniae isolates were also determined. 21.9% of CAP children patients were pneumococcal carriage. The susceptibility testing demonstrated that all 56 tested pneumococcal isolates were resistant to erythromycin and azithromycin, whereas none of the isolates developed the resistance to levofloxacin, vancomycin, and linezolid. The clindamycin- and cotrimoxazole-resistant pneumococci rates were 96.4% and 87.5%, respectively. For β-lactam antibiotics, the resistance proportions of pneumococcal isolates to penicillin G, co-amoxiclav, amoxicillin, cefotaxime, and ceftriaxone were 3.6%,1.8%, 1.8%, 1.8%, and 3.6%, respectively. 83.9% of the tested isolates were MDR S. pneumoniae. Our data support using penicillin G, amoxicillin, co-amoxiclav, or cefotaxime as the first-line therapy for uncomplicated-pneumococci-induced CAP in Quang Nam – Da Nang, while vancomycin, linezolid, and levofloxacin should be used as alternatives or in MDR cases.

A Review on Ceftaroline in the Treatment of Community Acquired Bacterial Pneumonia

Ceftaroline fosamil (ceftaroline) is approved by the United States Food and Drug Administration (FDA) for the treatment of community-acquired pneumonia (CAP). It is a fifth-generation cephalosporin having broad-spectrum efficacy against gram-positive bacteria such as Methicillin-resistant Staphylococcus aureus (MRSA) and penicillin-resistant Streptococcus pneumoniae (PRSP), as well as a variety of common gram-negative pathogens. Ceftaroline can bind to penicillin-binding protein (PBP)2a, an MRSA-specific PBP with minimal affinity for the majority of other β-lactam antibiotics. The drug is often given intravenously in doses of 600 mg every 12 hours for 5-7 days. Only a parenteral formulation of ceftaroline is commercially available, and the prodrug, ceftaroline fosamil, is rapidly and completely hydrolysed after intravenous administration. Ceftaroline was found to be noninferior to comparator agents in Phase II and Phase III clinical studies, with good clinical cure rates in the treatment of CAP. Ceftaroline is well tolerated, which is consistent with the cephalosporin class's safety and tolerability profile. In this review, we will evaluate the microbiological properties, pharmacological features, efficacy, safety, and tolerability of ceftaroline in the treatment of CAP. Keywords: Ceftaroline, MRSA, CAP, efficacy.

Analysis of antibacterials for systemic use recommended for the treatment of patients with community-acquired pneumonia in Ukraine according to the modern approach to preventing the development of antimicrobial resistance

BACKGROUND. According to a 2019 epidemiological study, antibiotic resistance (AR) caused about 1.27 million deaths worldwide, with lower respiratory tract infections (particularly pneumonia) dominating the global disease burden caused by resistant microorganisms.&#x0D; OBJECTIVE. To determine the compliance of antibiotics (J01), which are recommended by the guidelines of the National Academy of Medical Sciences of Ukraine for the empiric therapy of community-acquired pneumonia (CAP) in adults, with World Health Organization (WHO) recommendations based on the prevention of the development of AR.&#x0D; MATERIALS AND METHODS. Objects – antibiotics (J01) recommended by the guideline and their belonging to the access, watch and reserve groups according to the WHO AWaRe classification of antibiotics. Methods: system overview, analytical, comparison and generalization.&#x0D; RESULTS AND DISCUSSION. In the guidelines for empiric therapy of CAP in adults, antibiotics of 7 groups are recommended, from which 36 international non-proprietary names (INNs) were selected and analyzed. Of these, 7 INNs belong to the access group, of which only 4 antibiotics (amoxicillin, amoxicillin / clavulanic acid, gentamicin, doxycycline) are recommended by WHO experts for empiric treatment of CAP in adults; 26 INNs belong to the watch group, but only 3 antibiotics (cefotaxime, ceftriaxone, clarithromycin) according to the WHO database are recommended as empiric therapy for the severe CAP in adults. Ceftaroline, according to the WHO AWaRe antibiotic classification, belongs to the reserve group and should be used to fight multiresistant microorganisms. No antibiotic of the reserve group is recommended by WHO for empiric therapy of CAP.&#x0D; CONCLUSIONS. The results of the analysis can be used in updating the recommendations for rational empiric antibiotic therapy of CAP, taking into account the mechanisms of resistance to the development and spread of AR.

Doxycycline vs. macrolides in combination with a β-lactam antibiotic for the treatment of community-acquired pneumonia in inpatients.

Hospitalized patients with non-severe community-acquired pneumonia (CAP) are treated with a β-lactam plus either a macrolide or doxycycline. Limited data exist on the effectiveness of the latter combination. Therefore, we aimed to compare the combination of doxycycline vs. macrolide when either is combined with a β-lactam from effectiveness and safety perspectives. This was a retrospective cohort study in CAP inpatients between December 2013 and November 2020. Patients were divided into BL-D (β-lactam plus doxycycline) and BL-M (β-lactam plus a macrolide [azithromycin or clarithromycin]) groups. The primary endpoint was time to clinical stability. Secondary endpoints included length of stay (LOS) and in-hospital mortality. Of 197 patients included, 57 were in the BL-D arm and 140 were in the BL-M arm. Patients were similar at baseline, except for the presence of leukocytosis, risk factors for drug resistance, and duration of therapy (P < 0.05 for all comparisons). No difference in clinical cure rate was observed (94.7% vs. 91.4%; P = 0.43). Time to clinical stability and LOS were similar in both groups at 4 (P = 0.82) and 7days (P = 0.62), respectively. While only three patients died, only one (from the BL-M group) was due to sepsis. Liver enzymes elevation was more prominent in the BL-M group (21.4% vs. 5.3%; P = 0.01). A subgroup analysis showed shorter time to clinical stability with clarithromycin but higher cure rates with azithromycin. Data on doxycycline use with a β-lactam are scarce. Our study showed that such regimen was comparable in effectiveness to regimens involving macrolides with a better safety profile.

КЛИНИЧЕСКИЙ СЛУЧАЙ ТЯЖЕЛОЙ ВНЕБОЛЬНИЧНОЙ ПНЕВМОНИИ, ПРОТЕКАЮЩЕЙ С ДЕСТРУКЦИЕЙ ЛЕГОЧНОЙ ТКАНИ

The сommunity-acquired pneumonia is a widespread pathology of the respiratory organs, which occupies a leading place in the structure of morbidity and mortality from infectious diseases in developed countries. The patients with severe community-acquired pneumonia present the greatest problem for physicians. Despite the available diagnostic and treatment methods, including modern antibacterial medicine, mortality in this category of patients remains high, and treatment is complex and expensive. The purpose of the analysis of this clinical case was to study risk factors, features of clinical manifestations, differential diagnosis and therapy in patients with severe community-acquired pneumonia occurring with lung tissue destruction. In the clinical case, the patient had the background of such risk factors as a long smoking history with a smoker index of 60 pack/years with the formation of chronic obstructive pulmonary disease; alcohol abuse; toxic-alimentary damage to the liver; facts of aspiration on the background of vomiting; prolonged stay in a horizontal position, due to secondary toxic-metabolic polyneuropathy with severe motor disorders. The break in antibiotic therapy developed community-acquired bilateral polysegmental pneumonia, severe form with cavities, destruction of both lungs caused by multiresistant gram-negative microflora, complicated by the development of respiratory failure of degrees 2, polyserositis, and anemia. The patient underwent an extended examination in accordance with the Federal clinical guidelines for the diagnosis and treatment of community-acquired pneumonia. Differential diagnosis was carried out with pulmonary tuberculosis, lung cancer, new coronavirus infection. In the treatment, according to clinical recommendations, controlled oxygen therapy, combined antibiotic therapy taking into account the data of the antibiogram, mucolytic, antioxidant therapy, treatment of underlying diseases and symptomatic therapy were carried out. Against the background of the treatment, the patient showed positive clinical, laboratory and radiological dynamics, in the form of an improvement in general well-being, normalization of laboratory parameters and partial resorption and a decrease in the volume of decay cavities in the lungs.