Внебольничные инфекции нижних дыхательных путей: подходы к рациональной антибактериальной терапии

Синопальников А.И. Внебольничные инфекции нижних дыхательных путей: подходы к рациональной антибактериальной терапии. Consilium Medicum. 2017; 19 (11.1. Болезни органов дыхания): 45–51. DOI: 10.26442/2075-1753_19.11.1.45-51

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Sinopalnikov A.I. Community-acquired infections of the lower respiratory tract: approaches to rational antibiotic therapy. Consilium Medicum. 2017; 19 (11.1. Respiratory Organs Diseases): 45–51. DOI: 10.26442/2075-1753_19.11.1.45-51

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Аннотация

Внебольничные инфекции нижних дыхательных путей (ИНДП) – широко распространенные заболевания, нередко с серьезным прогнозом. В настоящее время ИНДП, в т.ч. острый бронхит, внебольничная пневмония, инфекционные обострения хронической обструктивной болезни легких – занимают одно из лидирующих мест в структуре инфекционной заболеваемости человека. Не менее актуальной проблемой является и разработка подходов к рациональной антибактериальной терапии ИНДП, поскольку ошибки при назначении антибиотиков данной категории пациентов относятся к едва ли не самым частым в перечне лечебных ошибок, совершаемых в терапевтической и пульмонологической практике. В данной статье представлены ключевые диагностические и дифференциально-диагностические признаки ИНДП, а также данные, обосновывающие отказ от применения антибиотиков при вирусных/предположительно вирусных респираторных инфекциях и назначение наиболее эффективных из них там, где антибактериальная терапия показана.

Ключевые слова: внебольничные инфекции нижних дыхательных путей, острый бронхит, внебольничная пневмония, обострение хронической обструктивной болезни легких, антибактериальная терапия.

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Community-acquired infections of the lower respiratory tract (ILRT) is a widespread disease, often with serious prognosis. Currently ILRT, including acute bronchitis, community acquired pneumonia, infectious exacerbations of chronic obstructive pulmonary disease – is one of the leading places in the structure of human morbidity. Not less important problem is the development of approaches to rational antibiotic therapy as AFS, since errors in the prescription of antibiotics in these patients are perhaps the most frequent in the list of medical errors committed in internal medicine and pulmonary practice. This article presents the key diagnostic and differential diagnostic signs of the ILRT and the data justifying the rejection of the use of antibiotics in viral/presumably viral respiratory infections and the purpose of the most effective of them where antibacterial therapy is indicated.

Key words: community-acquired infections of the lower respiratory tract, acute bronchitis, community acquired pneumonia, exacerbation of chronic obstructive pulmonary disease, antibiotic therapy.

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Список литературы

1. Macfarlane J. Lower respiratory tract infection and pneumonia in the community. Sem Respir Infect 1999; 14: 151–62.
2. Batty SA, Fry J. Acute infections of the chest in general practice. BMJ 1955; II: 1577–86.
3. Woodhead M, Blasi F, Ewig S, ERS/ESCMID Task Force. Guidelines for the management of adult lower respiratory tract infections. Clin Microbiol Infect 2011; 17 (Suppl. 6): 1–59.
4. Harris AM, Hicks LA, Qaseem A et al. Appropriate antibiotic use for acute respiratory tract infection in adults: advice for high-value care from the American College of Physicians and the Centers for Disease Control and prevention. Ann Intern Med 2016; 164: 425–34.
5. Fleming-Dutra KE, Hersh AL, Shapiro DJ et al. Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits, 2010–2011. JAMA 2016; 315: 1864–73.
6. Gerber JS. Improving outpatient antibiotic prescribing. Another nudge in the right direction. JAMA 2016; 315: 558–9.
7. Hicks LA, Chien YW, Taylor TH et al. Outpatient antibiotic prescribing and nonsusceptible Streptococcus pneumoniae in the United States. Clin Infect Dis 2011; 53: 631–9.
8. Shehab N, Patel PR, Srinivasan A, Budnitz DS. Emergency department visits for antibiotic-associated adverse events. Clin Infect Dis 2008; 47: 735–43.
9. Centers for Disease Control and Prevention. Antibiotic resistance threats in the United States, 2013. Atlanta, GA: Centers for Disease Control and Prevention; 2014. Accessed at www.cdc.gov/drugresistance/treat-report-2013 on 25 September 2015.
10. Gonzales R, Sande MA. Uncomplicated acute bronchitis. Ann Intern Med 2000; 133: 981–91.
11. Gonzales R, Bartlett JG, Besser RE et al. Principles of appropriate antibiotic use for treatment of uncomplicated acute bronchitis: background. Ann Intern Med 2001; 134: 521–9.
12. Boivin G, ABED y, Pelletier G et al. Virological features and clinical manifestations associated with human metapneumovirus: a new paramyxovirus responsible for acute respiratory tract infections in all age groups. J Infect Dis 2002; 186: 1330–4.
13. Mosser AG, Vrtis R, Burchell L et al. Quantitative and qualitative analysis of rhinovirus infection in bronchial tissues. Am J Respire Crit Care Med 2005; 171: 645–51.
14. Gonzales R, Steiner JF, Sande MA. Antibiotic prescribing for adults with colds, upper respiratory tract infections, and bronchitis by ambulatory care physicians. JAMA 1997; 278: 901–4.
15. Meili M, Muller B, Kulkarni P et al. Management of patients with respiratory infections in primary care: procalcitonin, C reactive protein or both? Expert rev Respir Med 2015; 9: 587–601.
16. Pneumonia: Diagnosis and Management of Community and Hospital-Acquired Pneumonia in Adults. London: National Institute for Health and Care Excellence (UK), 2014.
17. Fahney T, Stocks N, Thomas T. Quantitative systematic review of randomized controlled trials comparing antibiotic with placebo for acute cough in adults. BMJ 1998; 316: 906–10.
18. Smucny JJ, Becker IA, Glazier RH et al. Are antibiotics effective treatment for acute bronchitis? A meta-analysis. J Fam Pract 1998; 47: 453–60.
19. Bent S, Saint S, Vittinghoff E et al. Antibiotics in acute bronchitis: a meta-analysis. Am J Med 1999; 197: 62–7.
20. Smith SM, Fahey T, Smucny J, Becker LA. Antibiotics for acute bronchitis. Cochrane Database Syst Rev 2014; 3: CD000245.
21. Balter MS, La Forge J, Low DE, Mandell L. Canadian guidelines for the management of acute exacerbations of chronic bronchitis. Can Resp J 2003; Suppl. 3B: 3B–32B.
22. Viasus D, Vecino-Moreno M, De La Hoz JM et al. Antibiotic stewardship in community-acquired pneumonia. Expert Rev Anti Infect Ther 2016. DOI: 10.1080/14787210.2017. 1274232.
23. Carugati M, Franzetti F, Wiemken T et al. De-escalation therapy among bacteraemic patients with community-acquired pneumonia. Clin Microbiol Infect 2015; 21: e11–e18.
24. Cazzola M, Rogliani P, Aliberti S et al. An update on the pharmacotherapeutic management of lower respiratory tract. Expert Opin Rharmacother 2017; 18: 973–88.
25. Козлов Р.С., Сухорукова М.В., Сивая О.В., исследовательская группа ПеГАС. Чувствительность к антимикробным препаратам клинических штаммов Streptococcus pneumoniae, выделенных в различных регионах РФ в 2010–2013 гг. Клин. микробиология и антимикробная терапия. 2015; 2 (Прил. 1): 31. / Kozlov R.S., Sukhorukova M.V., Sivaia O.V., issledovatel'skaia gruppa PeGAS. Chuvstvitel'nost' k antimikrobnym preparatam klinicheskikh shtammov Streptococcus pneumoniae, vydelennykh v razlichnykh regionakh RF v 2010–2013 gg. Klin. mikrobiologiia i antimikrobnaia terapiia. 2015; 2 (Pril. 1): 31. [in Russian]
26. Чучалин А.Г., Синопальников А.И., Козлов Р.С. и др. Внебольничная пневмония у взрослых: Практические рекомендации по диагностике, лечению и профилактике. Клин. микробиология и антимикробная терапия. 2010; 12: 186–226. / Chuchalin A.G., Sinopal'nikov A.I., Kozlov R.S. i dr. Vnebol'nichnaia pnevmoniia u vzroslykh: Prakticheskie rekomendatsii po diagnostike, lecheniiu i profilaktike. Klin. mikrobiologiia i antimikrobnaia terapiia. 2010; 12: 186–226. [in Russian]
27. McCabe C, Kirchner C, Zhang H et al. Guideline-concordant therapy and reduced mortality and length of stay in adults with community-acquired pneumonia: playing by the rules. Arch Intern Med 2009; 169: 1525–31.
28. Hurst JR, Wedzicha JA. Management and prevention of chronic obstructive pulmonary disease exacerbations: a state of the art review. BMC Med 2009; 7: 40–5.
29. Global Strategy for Diagnosis, Management and prevention of COPD. December 2017. http://www.goldcopd.org
30. Anthonisen NR, Manfreda J, Warren CP et al. Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease. Ann Intern Med 1987; 106: 196–204.
31. Puhan MA, Vollenweider D, Latshang T et al. Exacerbations of chronic obstructive pulmonary disease: when are antibiotic indicated? A systematic review. Respir Res 2007; 8: 30–40.
32. Stockley RA, O’Brien C, Pye A, Hill SL. Relationship of sputum color to nature and outpatient management of acute exacerbations of COPD. Chest 2000; 117: 1638–45.
33. Gompertz S, O’Brien C, Bayley DL et al. Changes in bronchial inflammation during acute exacerbations of chronic bronchitis. Eur respire J 2001; 17: 1112–9.
34. Hurst JR, Donaldson GC, Perera WR et al. Use of plasma biomarkers at exacerbation of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2006; 174: 867–74.
35. Синопальников А.И., Романовских А.Г. Инфекционное обострение хронической обструктивной болезни легких. В кн.: А.И.Синопальников, Р.С.Козлов. Внебольничные инфекции дыхательных путей. Руководство для врачей. М.: Премьер МТ; Наш Город, 2007. / Sinopal'nikov A.I., Romanovskikh A.G. Infektsionnoe obostrenie khronicheskoi obstruktivnoi bolezni legkikh. V kn.: A.I.Sinopal'nikov, R.S.Kozlov. Vnebol'nichnye infektsii dykhatel'nykh putei. Rukovodstvo dlia vrachei. M.: Prem'er MT; Nash Gorod, 2007. [in Russian]
36. Miravitlles M, Murio C, Guerrero T, Gisbert R. Cost of chronic bronchitis and COPD: a 1-year follow-up study. Chest 2003; 123: 784–91.
37. Dimopoulos G, Siempos II, Korbilla IP et al. Comparison of first-line with second-line antibiotics for acute exacerbations of chronic bronchitis: a meta-analysis of randomized controlled trails. Chest 2007; 132: 447–55.
38. Vogel F, Scholz H, al-Nawas B et al. Rational use of oral antibiotics. Findings of an expert commission of the Paul Ehrlich Society for Chemotherapy. Med Mongtssch Pharm 2002; 6: 193–204.
39. O’Donnell DE, Hernandez P, Kaplan A et al. Canadian Thoracic Society recommendations fr management of chronic obstructive pulmonary disease – 2008 update – highlights for primary care. Can Respir J 2008; 15 (Suppl. A): 1A–8A.
40. Miravitlles M, Anzueto A. Antibiotics for acute and chronic respiratory infection in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2013; 188: 1052–7.

________________________________________________

1. Macfarlane J. Lower respiratory tract infection and pneumonia in the community. Sem Respir Infect 1999; 14: 151–62.
2. Batty SA, Fry J. Acute infections of the chest in general practice. BMJ 1955; II: 1577–86.
3. Woodhead M, Blasi F, Ewig S, ERS/ESCMID Task Force. Guidelines for the management of adult lower respiratory tract infections. Clin Microbiol Infect 2011; 17 (Suppl. 6): 1–59.
4. Harris AM, Hicks LA, Qaseem A et al. Appropriate antibiotic use for acute respiratory tract infection in adults: advice for high-value care from the American College of Physicians and the Centers for Disease Control and prevention. Ann Intern Med 2016; 164: 425–34.
5. Fleming-Dutra KE, Hersh AL, Shapiro DJ et al. Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits, 2010–2011. JAMA 2016; 315: 1864–73.
6. Gerber JS. Improving outpatient antibiotic prescribing. Another nudge in the right direction. JAMA 2016; 315: 558–9.
7. Hicks LA, Chien YW, Taylor TH et al. Outpatient antibiotic prescribing and nonsusceptible Streptococcus pneumoniae in the United States. Clin Infect Dis 2011; 53: 631–9.
8. Shehab N, Patel PR, Srinivasan A, Budnitz DS. Emergency department visits for antibiotic-associated adverse events. Clin Infect Dis 2008; 47: 735–43.
9. Centers for Disease Control and Prevention. Antibiotic resistance threats in the United States, 2013. Atlanta, GA: Centers for Disease Control and Prevention; 2014. Accessed at www.cdc.gov/drugresistance/treat-report-2013 on 25 September 2015.
10. Gonzales R, Sande MA. Uncomplicated acute bronchitis. Ann Intern Med 2000; 133: 981–91.
11. Gonzales R, Bartlett JG, Besser RE et al. Principles of appropriate antibiotic use for treatment of uncomplicated acute bronchitis: background. Ann Intern Med 2001; 134: 521–9.
12. Boivin G, ABED y, Pelletier G et al. Virological features and clinical manifestations associated with human metapneumovirus: a new paramyxovirus responsible for acute respiratory tract infections in all age groups. J Infect Dis 2002; 186: 1330–4.
13. Mosser AG, Vrtis R, Burchell L et al. Quantitative and qualitative analysis of rhinovirus infection in bronchial tissues. Am J Respire Crit Care Med 2005; 171: 645–51.
14. Gonzales R, Steiner JF, Sande MA. Antibiotic prescribing for adults with colds, upper respiratory tract infections, and bronchitis by ambulatory care physicians. JAMA 1997; 278: 901–4.
15. Meili M, Muller B, Kulkarni P et al. Management of patients with respiratory infections in primary care: procalcitonin, C reactive protein or both? Expert rev Respir Med 2015; 9: 587–601.
16. Pneumonia: Diagnosis and Management of Community and Hospital-Acquired Pneumonia in Adults. London: National Institute for Health and Care Excellence (UK), 2014.
17. Fahney T, Stocks N, Thomas T. Quantitative systematic review of randomized controlled trials comparing antibiotic with placebo for acute cough in adults. BMJ 1998; 316: 906–10.
18. Smucny JJ, Becker IA, Glazier RH et al. Are antibiotics effective treatment for acute bronchitis? A meta-analysis. J Fam Pract 1998; 47: 453–60.
19. Bent S, Saint S, Vittinghoff E et al. Antibiotics in acute bronchitis: a meta-analysis. Am J Med 1999; 197: 62–7.
20. Smith SM, Fahey T, Smucny J, Becker LA. Antibiotics for acute bronchitis. Cochrane Database Syst Rev 2014; 3: CD000245.
21. Balter MS, La Forge J, Low DE, Mandell L. Canadian guidelines for the management of acute exacerbations of chronic bronchitis. Can Resp J 2003; Suppl. 3B: 3B–32B.
22. Viasus D, Vecino-Moreno M, De La Hoz JM et al. Antibiotic stewardship in community-acquired pneumonia. Expert Rev Anti Infect Ther 2016. DOI: 10.1080/14787210.2017. 1274232.
23. Carugati M, Franzetti F, Wiemken T et al. De-escalation therapy among bacteraemic patients with community-acquired pneumonia. Clin Microbiol Infect 2015; 21: e11–e18.
24. Cazzola M, Rogliani P, Aliberti S et al. An update on the pharmacotherapeutic management of lower respiratory tract. Expert Opin Rharmacother 2017; 18: 973–88.
25. Kozlov R.S., Sukhorukova M.V., Sivaia O.V., issledovatel'skaia gruppa PeGAS. Chuvstvitel'nost' k antimikrobnym preparatam klinicheskikh shtammov Streptococcus pneumoniae, vydelennykh v razlichnykh regionakh RF v 2010–2013 gg. Klin. mikrobiologiia i antimikrobnaia terapiia. 2015; 2 (Pril. 1): 31. [in Russian]
26. Chuchalin A.G., Sinopal'nikov A.I., Kozlov R.S. i dr. Vnebol'nichnaia pnevmoniia u vzroslykh: Prakticheskie rekomendatsii po diagnostike, lecheniiu i profilaktike. Klin. mikrobiologiia i antimikrobnaia terapiia. 2010; 12: 186–226. [in Russian]
27. McCabe C, Kirchner C, Zhang H et al. Guideline-concordant therapy and reduced mortality and length of stay in adults with community-acquired pneumonia: playing by the rules. Arch Intern Med 2009; 169: 1525–31.
28. Hurst JR, Wedzicha JA. Management and prevention of chronic obstructive pulmonary disease exacerbations: a state of the art review. BMC Med 2009; 7: 40–5.
29. Global Strategy for Diagnosis, Management and prevention of COPD. December 2017. http://www.goldcopd.org
30. Anthonisen NR, Manfreda J, Warren CP et al. Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease. Ann Intern Med 1987; 106: 196–204.
31. Puhan MA, Vollenweider D, Latshang T et al. Exacerbations of chronic obstructive pulmonary disease: when are antibiotic indicated? A systematic review. Respir Res 2007; 8: 30–40.
32. Stockley RA, O’Brien C, Pye A, Hill SL. Relationship of sputum color to nature and outpatient management of acute exacerbations of COPD. Chest 2000; 117: 1638–45.
33. Gompertz S, O’Brien C, Bayley DL et al. Changes in bronchial inflammation during acute exacerbations of chronic bronchitis. Eur respire J 2001; 17: 1112–9.
34. Hurst JR, Donaldson GC, Perera WR et al. Use of plasma biomarkers at exacerbation of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2006; 174: 867–74.
35. Sinopal'nikov A.I., Romanovskikh A.G. Infektsionnoe obostrenie khronicheskoi obstruktivnoi bolezni legkikh. V kn.: A.I.Sinopal'nikov, R.S.Kozlov. Vnebol'nichnye infektsii dykhatel'nykh putei. Rukovodstvo dlia vrachei. M.: Prem'er MT; Nash Gorod, 2007. [in Russian]
36. Miravitlles M, Murio C, Guerrero T, Gisbert R. Cost of chronic bronchitis and COPD: a 1-year follow-up study. Chest 2003; 123: 784–91.
37. Dimopoulos G, Siempos II, Korbilla IP et al. Comparison of first-line with second-line antibiotics for acute exacerbations of chronic bronchitis: a meta-analysis of randomized controlled trails. Chest 2007; 132: 447–55.
38. Vogel F, Scholz H, al-Nawas B et al. Rational use of oral antibiotics. Findings of an expert commission of the Paul Ehrlich Society for Chemotherapy. Med Mongtssch Pharm 2002; 6: 193–204.
39. O’Donnell DE, Hernandez P, Kaplan A et al. Canadian Thoracic Society recommendations fr management of chronic obstructive pulmonary disease – 2008 update – highlights for primary care. Can Respir J 2008; 15 (Suppl. A): 1A–8A.
40. Miravitlles M, Anzueto A. Antibiotics for acute and chronic respiratory infection in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2013; 188: 1052–7.

Авторы

А.И.Синопальников*

ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России. 125993, Россия, Москва, ул. Баррикадная, д. 2/1
*aisyn@list.ru

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A.I.Sinopalnikov*

Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation. 125993, Russian Federation, Moscow, ul. Barrikadnaia, d. 2/1
*aisyn@list.ru

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