The problem of a rational antibiotic therapy of pneumonia is among the most actual in modern medicine. Despite of a powerful arsenal of antibacterial means, growth of incidence of pneumonia and deterioration of its outcomes is registered everywhere.
Key words: pneumonia, antimicrobial therapy, side effects, age, value.
Inflammatory diseases of upper air passages and respiratory passage are still one of the most frequent abnormality of both adult and children's population. Primary care doctors, pediatricians and general practice doctors come across with these diseases in ambulance situation. Irrational prescription of antibiotics leads to ineffective treatment and heavy complications.
Key words: upper air passages diseases, antibiotic therapy, antibiotic resistance, Streptococcus pneumonia, treatment.
Situation with respiratory diseases in the Republic of Kazakhstan corresponds to world statistics - prevalence rate of respiratory system diseases in our country is 29-30 thousands per 100 thousands of population. The number of patients increases in autumn and winter period .
Acute respiratory tract infectious agents can be both viruses and bacteria. The most frequent bacteritic respiratory infectious agents are Streptococcus pneumoniae, gram-negative Haemophilus influenzae, Streptococcus pyogenes, Mycoplasma pneumoniae. Recently the rapid growth of mycoplasmal ethiology diseases, the most intensive in the large cities and industrial centers, is registered.
The main virus infectious agents are rhinoviruses (25-40% of all viruses), coronaviruses, influenza viruses and Picornaviruses. Respiratory syncitial virus, Adenoviruses, enteroviruses, Reoviruses and Picornaviruses happen less frequently. The presence of virus component in etiological structure of upper air passages diseases should be taken in account when therapy prescription because generally perceptible system antibiotics don't have an effect on viruses .
According to different pharmacoepidemiological researches the system antibiotic prescription in Acute Respiratory Infections is determined undue practically in 50% cases [13, 4, 5].
The overestimation by general practice doctors the effect of system antibiotic in Acute Respiratory Infections of upper air passages is explained by high frequency of patients' spontaneous recovery when these infections and mistaken opinions that the system antibiotics prevent the development of bacteritic superinfections in case of virus diseases [3,4,6].
In placebo-controlled studies the essential advantages of system antibiotics are not detected not only in recovery occurrence but in the time of disease symptom disappearance in patient with Acute Infections of upper air passages [3, 7, 8, 9]. The fair evidence is procured that the system antibacterial therapy of upper air passages virus infection doesn't prevent bacterial complications such as pneumoniae or Acute otitis media. Some major complications of acute rhinotracheitis such as meningitis and cephalopyosis are rare, and at the present time the data confirming the efficiency of the system antibiotics in preventive measures of these complications are not available [8,10].
It is difficult to overestimate potential harm from undue prescription of the antibacterial therapy. It is necessary to point out the most dangerous: they are allergic reactions (including life-threatening, for example, Stevens-Johnson syndrome); culture of microorganism resistant strain especially among the major respiratory antigens (Streptococcus pneumoniae, Streptococcus pyogenes) ; the development of serious side effects, such as prolongation of Q-T interval, which is under observation when applying of macrolides and some fluoruquinolones.
The major is the S. pneumoniae resistance to penicillin, macrolides, co-trimoxazole, S. pyogenes - to macrolides, tetracycline. S. pneumoniae resistance to penicillin and macrolides in some European countries comes up to 40-50%, S. pyogenes resistance to macrolides comes up to 40-50%, that limits the possibilities of the effective therapy of upper air passages infections. In particular, decrease in clinical and bacteriological efficiency of macrolides at the respiratory infections caused by resistant strains of S. pneumoniae or S. pyogenes is shown . S. pneumoniae resistance level (high and moderate) to penicillin in Kazakhstan makes about 20%, the similar level of resistance (within 20%) is registered among S. pyogenes to makrolidny antibiotics .
The state level active restrictive policy of using the system antibiotics promotes the reduction of resistant strains prevalence. A number of non-governmental organizations, including WHO, have formulated restriction strategy in out-patient practice of antibacterial preparations application if patients have a respiratory infection.
However, it should be remembered that dysbiotic disorders are possible in patients with chronic conditions of ENT organs, in sickly children as a result of which pathogenic flora constantly persists on the mucous membrane. There is a possibility of pathogenic bacterial flora activation in acute respiratory viral infection, and the main causative factor is not just viruses but virous and bacterial associations.
In cases when there is a high probability of virus and bacterial etiology of upper air passages infections or high risk of complications, the application of antibiotics is indicated.
- http://healthkz.com/arhiv/4_iyun_2013/razvitie_respiratornoj_mediciny_v_kazahstane_lish_vopros_vrem eni/
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- http://www.kazpravda.kz/rubric/tehnologii/uchenii-ustoichivost-bakterii-k-antibiotikam-razvivaetsya- bistree-sozdaniya-novi/