Introduction. The problem of efficient antibiotic therapy for pneumonia is one of the most urgent in modern medicine. The article presents some approaches to efficient antibiotic therapy of community-acquired pneumonia, taking into account some individual specifics of a patient and health economics.
Key words: pneumonia, antibiotic therapy, side effects, age, price.
Discussion. Antibacterial therapy for pneumonia as one of the most efficient forms of treatment belongs to the category of causal therapy. Antibiotic treatment should be initiated immediately after diagnosis pneumonia. Two main tendencies of a choice of antibiotics were defined by:
1) selection of the most efficient and economical preparations, minimization of an impact on saprophile flora of a patient, reduction in a risk of a superinfection and avoidance of an undesirable immunosuppressive effect;
2) empirical prescription of broad spectrum antibiotics.
Etiotropic therapy is considered as a basic one; however, adequate antibacterial therapy cannot be prescribed because of complexity of early disclosure of causative microorganisms.
Today a doctor deals with a huge set of different antibacterial drugs, which are highly effective at a variety of etiologies of pneumonia. It is very important to choose an initial antibiotic, focusing on the fact that the most of non-pneumococcal pneumonias caused by opportunistic microorganisms are characterized by the specific clinical course of a disease. Drug alternatives depends on some patient’s features such as age, allergy in the anamnesis, functions of the liver and kidneys, and pregnancy.
The severity of pneumonia is also one of the clinical guidelines in the initial choice of antibacterial drugs and ways of administration. While prescribing an antibacterial therapy, it is necessary to take into account the possible side effects of drugs and to avoid prescription of drugs that may cause adverse effects and worsen a prior disease as well as intercurrent diseases. It is necessary to take into account the increased sensitivity to the previously used antibacterial drugs.
When selecting antibiotic, it is required to take into consideration the age of a patient. The treatment in elderly and senile ages is associated with considerable difficulties. At the same time apart from drug therapy for pneumonia, people older than 60 years often require medications for some intercurrent diseases, that is why people over 60 years old often use broad-spectrum antibiotics to eliminate both gram-positive and gramnegative microorganisms.
Numerous studies in the field of health economics have shown that the cost of treatment of a patient is determined not only by the price of the antibiotic, but also by the duration of recovery process and medical expenses of the complications from the disease. Health economics enables us to find new approaches to the most rational use of funds. It is recommended that a local passport of antibiotic resistance and formulary of bactericide drugs should be available in a hospital. It is also essential to use antibiotics per os and to implement a step therapy. Another advantage of the formulary of antibiotic therapy is to schedule and to replenish drugs at the pharmacy in time to avoid stressful situations related to the lack of an antibiotic for a particular patient, and to reduce dramatically the list of required drug preparations for a hospital.
Conclusion. Bronchopulmonary diseases among infections are at the top of the total volume of prescribed medications and financial expenses of their purchases. Thus, more than 30% of antibiotics are used during the treatment for lower respiratory tract diseases. It is required to take into account the medical expenses and to give preference to economically justifiable schemes of antibacterial therapy.