Публикация посвящена роли «защищенных» аминопенициллинов в терапии внебольничных инфекций нижних дыхательных путей. Приводятся фармакологические характеристики амоксициллина/клавуланата, данные по эффективности и безопасности его применения при внебольничной пневмонии и обострении хронической обструктивной болезни легких. В статье освещаются современные российские данные по антибиотикорезистентности пневмококка к антибактериальным препаратам, обсуждается вопрос высокодозной терапии аминопенициллинами у больных с факторами риска инфицирования лекарственно устойчивым Streptococcus pneumoniae. Представлена тактика назначения эмпирической антимикробной терапии у больных внебольничной пневмонией с обострением хронической обструктивной болезни легких с учетом современных клинических рекомендаций.
The article concerns the role of "protected" aminopenicillins use in community-acquired low respiratory tract infections. The pharmacological characteristics of amoxicillin/clavulanate, effectiveness and safety of its use in community-acquired pneumonia and chronic obstructive pulmonary disease exacerbation treatment are discussed. The article also presents updated data on pneumococcus antibiotic resistance and discusses the high dose therapy with aminopenicillin in patients with risk factors of drug-resistant Streptococcus pneumoniae infection. The approach to empiric antibiotic therapy use in patients with community-acquired pneumonia and chronic obstructive pulmonary disease exacerbation in the context of present guidelines is presented.
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1. Abraham EP, Chain E. An enzyme from bacteria able to destroy penicillin. Nature 1940; 373: 837.
2. Du Bois SK, Marriott MS, Amyes SG. TEM- and SHV-derived extended-spectrum b-lactamases: relationship between selection, structure and function. J Antimicrob Chemother 1995; 35: 7–22.
3. Reading C, Cole M. Ctavulanic acid: a beta-lactamase-inhibiting beta-lactam from Streptomyces clavuligerus. Antimicrob Agents Chemother 1977; 11 (5): 852–7.
4. Chambers HF. Other beta-lactam antibiotics. In: Mandell GL, Bennet JE, Dolin R, editors. Principles and Practice of Infectious Diseases. Churchill Livingstone, 6th edition, 2004, p. 311–8.
5. Bush K. Other b-lactam antibiotics. In: Finch RG, Greenwood D, Norrby SR, Whitley RJ, editors. Antibiotic and Chemotherapy. Anti-infective agent and their use in therapy. Churchill Livingstone, 8th edition, 2003, p. 259–78.
6. Neu HC, Wilson, APR. Gruneberg RN. Amoxycillin/clavulanic acid: a review of its efficacy in over 38,500 patients from 1979 to 1992. J Chemother 1993; 5: 67–93.
7. Briggs CG, Freeman RK, Yaffe SJ, editors. Drugs in pregnancy and lactation. Williams & Wilkins, 1994.
8. Berkovitch M, Diav-Citrin O, Greenberg R et al. First-trimester exposure to amoxy-cillin/clavulanic acid: a prospective, controlled study. Br J Clin Pharmacol 2004; 58 (3): 298–302.
9. Belevskii A.S., Zaitsev A.A. Zashchishchennye» aminopenitsilliny: 35 let klinicheskogo primeneniia v terapii infektsii nizhnikh dykhatel'nykh putei. Prakticheskaia pul'monologiia. 2015; 3: 43–8. [in Russian]
10. Chuchalin A.G., Sinopal'nikov A.I., Kozlov R.S. i dr. Klinicheskie rekomendatsii po diagnostike, lecheniiu i profilaktike tiazheloi vnebol'nichnoi pnevmonii u vzroslykh. Pul'monologiia. 2014; 4: 13–48. [in Russian]
11. Otchet po proektu TSERBERUS. Smolensk: NIIAKh, 2014. Iz doklada S.A.Rachinoi, GVKG im. N.N.Burdenko, 09.10.2014. [in Russian]
12. Onlain-platforma analiza dannykh rezistentnosti k antimikrobnym preparatam v Rossii, kriterii EUCAST, MAKMAKh: http://map.antibiotic.ru/ [in Russian]
13. Chuchalin A.G., Sinopal'nikov A.I. i dr. Vnebol'nichnaia pnevmoniia u vzroslykh. Prakticheskie rekomendatsii po diagnostike, lecheniiu i profilaktike. M., 2010. [in Russian]
14. Mandell L, Richard G et al. Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults. http://www.thoracic.org/sections/publications/statements/pages/mtpi/idsaats-cap.html
15. Woodhead M, Blasi F, Ewig S et al. New guidelines for the management of adult lover respiratory tract infections. Clin Microbiol Infect 2011; 17 (6): 1–59.
16. Ovchinnikov Iu.V., Zaitsev A.A. i dr. Vnebol'nichnaia pnevmoniia u voennosluzhashchikh: taktika vedeniia i antimikrobnaia terapiia. Voenno-med. zhurn. 2016; 3: 4–14. [in Russian]
17. 20th WHO Model List of Essential Medicines (March 2017). http://www.who.int/medicines/publications/essentialmedicines/en/
18. Pneumonia in adults: diagnosis and management. BMJ 2014; 349. http://nice.org.uk/guidance/cg191
19. Chidiac C. Antibiothérapie par voie générale dans les infections respiratoires basses de l’adulte. Pneumonie aiguë communautaire. Exacerbations de bronchopneumopathie chronique obstructive. In Médecine et Maladies Infectieuses 2011; 41. Issue 5: 221–8. https://doi.org/10.1016/j.medmal.2010.10.001.(http://www.sciencedirect.com/science/article/pii/S0399...
20. Boyles T, Brink A, Calligaro G et al. South African guideline for the management of community-acquired pneumonia in adults. J Thorac Dis 2017; 9 (6): 1469–502.
21. Anthonisen N, Manfreda J, Warren C et al. Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease. Ann Intern Med 1987; 106: 196–204.
22. Avdeev S.N., Baimakanova G.E., Zubairova P.A. Vozmozhnosti S-reaktivnogo belka v diagnostike bakterial'noi infektsii i pnevmonii u bol'nykh s obostreniem khronicheskoi obstruktivnoi bolezni legkikh. Ural'skii med. zhurn. 2008; 13: 19–24. [in Russian]
23. Sinopal'nikov A.I., Zaitsev A.A. Antibakterial'naia terapiia obostrenii khronicheskogo bronkhita/khronicheskoi obstruktivnoi bolezni legkikh: kliuchevye polozheniia. Med. sovet. 2017; 18: 14–20. [in Russian]
24. Yanyan Li, Linlin Xie, Shuzhen Xin. Values of procalcitonin and C-reactive proteins in the diagnosis and treatment of chronic obstructive pulmonary disease having concomitant bacterial infection. Pak J Med Sci 2017; 33 (3): 566–9.
25. Chuchalin A.G., Aisanov Z.R., Avdeev S.N. i dr. Proekt – Federal'nye klinicheskie rekomendatsii po diagnostike i lecheniiu khronicheskoi obstruktivnoi bolezni legkikh. Rossiiskoe respiratornoe obshchestvo 2017. http://spulmo.ru/obrazovatelnye-resursy/federalnye-klinicheskie-rekomendatsii/ [in Russian]
Авторы
А.А.Зайцев
ФГКУ «Главный военный клинический госпиталь им. акад. Н.Н.Бурденко» Минобороны России. 105229, Россия, Москва, Госпитальная пл., д. 3 a-zaicev@yandex.ru
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A.A.Zaitsev
N.N.Burdenko Main Military Clinical Hospital of the Ministry of Defence of the Russian Federation. 105229, Russian Federation, Moscow, Gospital'naia pl., d. 3 a-zaicev@yandex.ru