Principles of rational antibiotic therapy�
Why is this important?
According to some forecasts, the losses associated with antibiotic resistance will amount to about 100 trillion US dollars by 2050.
Even more terrible are the losses of human lives - up to 10 million a year.
PRINCIPLES OF RATIONAL ANTIBIOTIC THERAPY
Principles of rational antibiotic therapy
The main indication for prescribing antibiotics is bacterial inflammation.
The problem of treating upper and lower respiratory tract infections is the unreasonably frequent prescription of antimicrobials without appropriate indications, primarily their use in viral infections.
An adult patient suffers up to 2-3 episodes a year of so-called common colds.
The development of diseases is facilitated by:�-stress �- decreased immunity�- unfavorable epidemiological situation (especially in the cold season)�- chronic background pathology.
1. MAKING AN ACCURATE DIAGNOSIS
Most acute diseases are of viral origin, are tolerated by the patient quite easily and, with adequate therapy, end safely. Causes of diagnostic errors: �- misinterpretation of symptoms (the doctor takes SARS for a bacterial infection)�- the desire to prevent bacterial complications of viral infection.� Antibiotics do not prevent bacterial superinfection, moreover, they promote the selection of more aggressive pathogens and the development of undesirable side effects. Irrational use of antibiotic therapy has serious consequences.
Principles of rational antibiotic therapy
2. KNOWLEDGE OF THE ETIOLOGY OF DISEASES
With a high probability of bacterial etiology of the disease, the choice of a drug that is active against a potential causative agent of an infectious disease.
In the vast majority of cases, antimicrobial therapy is prescribed empirically, that is, the pathogen and its sensitivity to antibiotics are not established.
2. KNOWLEDGE OF THE ETIOLOGY OF DISEASES
Pneumococcus (S. pneumoniae) is the most common bacterial causative agent of respiratory infections. Worldwide, diseases caused by pneumococci represent one of the most serious public health problems. To date, more than 90 different serotypes (immunological variants) of pneumococci have been identified. All of them are potentially pathogenic, severe infections are caused by about two dozen of them. According to statistics, up to 70% of all pneumonias, about 25% of otitis media, 5-15% of purulent meningitis, and about 3% of endocarditis are caused by pneumococcus.
Haemophilus influenzae (H. influenzae) has long been considered the causative agent of influenza, since the infection caused by this pathogen most often occurs in the form of rhinopharyngitis or SARS without specific features, which led to the name of the microorganism. But H. influenzae can also cause serious diseases (pneumonia, exacerbation of COPD, sinusitis, meningitis, sepsis).
M. catarrhalis is involved in the development of respiratory infections, especially in children. The causative agent is often present in combination with Haemophilus influenzae and pneumococcus. It is the second most common causative agent of bacterial exacerbations of COPD.
β-hemolytic group A streptococcus (pyogenic streptococcus, S. pyogenes) causes many diseases, such as sore throat, pharyngitis, scarlet fever, erysipelas, paratonsillar abscess, phlegmon of the neck, sepsis, otitis, meningitis, streptoderma, rheumatism, glomerulonephritis.
3. ADEQUATE DOSAGE
Dose-dependent A.:
the antibacterial activity of an antimicrobial drug depends on its concentration in the site of inflammation, �The best effect can be achieved when using high doses of the drug, close to toxic. At the same time, the higher the ratio of the maximum (peak) concentration of the antibiotic in plasma to the value of the minimum inhibitory concentration (MIC) of the causative agent of the disease, the better. Representatives: Fluoroquinolones, aminoglycosides, amphotericin B, metronidazole
Time-dependent A.:�efficacy depends not so much on the maximum concentration in the blood plasma as on the period of time during which the concentration of the drug in the blood exceeds the MIC for the causative agent of the disease. Example: in order to realize the antibacterial effect of β-lactams, it is necessary that their concentration in the blood exceeds the BMD of the pathogen for at least 40% of the time interval between the administration of the next doses of the antibiotic. Representatives: β-lactams, glycopeptides, macrolides (except azithromycin and possibly clarithromycin), clindamycin.
Principles of rational antibiotic therapy
4. TAKING INTO ACCOUNT THE LEVEL OF RESISTANCE OF THE PATHOGEN IN THE COUNTRY AND REGION
The main limitation of the effectiveness of antimicrobials is the ability of microorganisms to form resistance to their action.
A natural process is greatly accelerated by the unreasonable and excessive use of antibiotics as a means of prevention and self-treatment.
The threat of the formation and spread of antibacterial resistance was realized by the scientific community almost immediately after the appearance of the first antibiotics, but for many years the problem was solved through the development and introduction of new drugs that overcome resistance.
Risk factors for infection with drug-resistant pathogens
Principles of rational antibiotic therapy
5. EVALUATION OF THE EFFICACY AND DURATION OF ANTIMICROBIAL THERAPY
Initial evaluation of the efficacy of therapy should be carried out 48 to 72 hours after initiation of treatment. Telephone contact with the patient the day after the start of therapy is advisable.
Performance criteria:�- lowering the temperature, �- reduction of symptoms of intoxication and other manifestations (for example, shortness of breath).
If the patient has a high fever and intoxication or symptoms progress, treatment should be considered ineffective. In this case, it is necessary to review the tactics of antibiotic therapy and re-assess the feasibility of hospitalizing the patient.
5. EVALUATION OF THE EFFICACY AND DURATION OF ANTIMICROBIAL THERAPY
To date, the optimal duration of treatment for patients with respiratory infections remains a matter of debate. �Mild pneumonia: the key criterion for discontinuation of antibiotic therapy is considered to be stable normalization of body temperature within 48-72 hours with a positive trend of other symptoms and the absence of signs of clinical instability. �With this approach, the duration of treatment usually does not exceed 7 days. �Criteria for adequacy of antibiotic therapy:�a steady decrease in body temperature ≤ 37.2 ° C, �absence of symptoms of intoxication, respiratory failure (respiratory rate (RRR) less than 20 / min), �absence of purulent sputum; �positive dynamics of peripheral blood parameters (the number of leukocytes in the blood <10 × 109 / l, neutrophils <80%, young forms <6%), �absence of negative dynamics on the radiograph.
Principles of rational antibiotic therapy