Treatment of community-acquired pneumonia

How is community-acquired pneumonia treated?

Often in therapeutic practice, a pathology such as community-acquired pneumonia is diagnosed, which can be treated at home. Most often the disease has an infectious etiology.

Pneumonia occurs in both adults and children. Often, it occurs against another serious pathology, for example, HIV infection. The risk of pneumonia is largely dependent on the level of social well-being, lifestyle, immunity, working conditions, contact with sick people. Every year, hundreds of thousands of new cases of this disease are diagnosed worldwide. In the absence of treatment, severe pneumonia, especially in young children, can lead to death. What are the etiology, clinic and treatment of community-acquired pneumonia?

Features of Community-acquired Pneumonia

Currently, pneumonia is called inflammation of the lung tissue or both lungs, in which the alveoli and interstitial tissue of the organ are involved in the process. Pneumonia can be community-acquired and nosocomial. In the first case, there is an acute infectious pathology that occurred outside the hospital or less than 48 hours after the hospitalization. Depending on the localization of the pathological process, the following types of pneumonia are distinguished: focal, segmental, lobar, total, draining. The most common is shared pneumonia. In this situation, we are talking about croupous pneumonia.

In adults and children, one lung can be affected, and immediately both. There are 3 types of inflammation: with a decrease in immunity, without it and aspiration. The following processes are based on the development of the infectious form of pneumonia of the lungs: aspiration of the secretion located in the oropharynx, inhalation polluted by air microorganisms, the entry of pathogenic microbes from other organs into the lungs and the spread of the infectious agent through blood.

Etiological factors

If the inflammation has developed outside the hospital, there may be several reasons. The most common causes of the disease are:

• presence of a viral infection;
• contact with sick people;
• hypothermia (general and local);
• violation of mucociliary clearance;
• presence of foci of chronic infection (septic thrombophlebitis, endocarditis, liver abscess);
• penetrating wounds of the chest;
• decreased immunity (against the background of HIV infection);
• exposure to ionizing radiation and toxins;
• exposure to allergens;
• weakening and exhaustion of the body against a background of severe somatic pathology.

Diseases that increase the risk of pneumonia are diseases of the kidneys, heart, lungs, tumors, epilepsy. The risk group includes people over 60 years of age and children. The causative agents of community-acquired pneumonia are different. Most often they are pneumococci, mycoplasmas, chlamydia, hemophilic rod, Staphylococcus aureus, Klebsiella, Legionella. Much less often the disease is provoked by viruses and fungi.

The risk factors for this pathology are chronic alcoholism, smoking, the presence of COPD, bronchitis, crowding of groups (in homes elderly, schools, kindergartens, boarding schools), unsanitary oral cavity, contact with the system of artificial ventilation (air conditioners). In a separate group, aspiration-type pneumonia should be isolated. In this situation, they occur when foreign objects enter the bronchi. It can be food, vomit. Less often the cause of inflammation is thromboembolism of small branches of the pulmonary artery.

Clinical manifestations

Symptoms of community-acquired pneumonia include:

• increased body temperature;
• productive cough;
• pain in the chest;
• shortness of breath during work or at rest;
• lack of appetite;
• weakness;
• malaise;
• increased sweating.

Sometimes pneumonia occurs imperceptibly for the patient and is detected accidentally (for radiographic examination). All of the above characteristics are typical of a typical form of the disease. Community-acquired pneumonia may occur atypically. In this case, the gradual development of the disease, the appearance of dry cough, head and muscle pain, and throat swelling are noted. Inflammation of the lungs can occur in mild, moderate and severe forms. For an easy degree, a slight intoxication of the body (temperature rise to 38 ° C), normal pressure, absence of dyspnea at rest, is characteristic. When studying the lungs, a small hearth is found.

At an average degree of severity sweating, weakness, swelling, the temperature rises to 39 ° C, the pressure is slightly reduced, and the respiratory rate is increased. High fever, confusion, cyanosis, dyspnea at rest - all these are signs of severe community-acquired pneumonia. Croupous pneumonia is diagnosed most often. It arises sharply after an increase in body temperature, chills. She is characterized by severe shortness of breath, cough. First it is dry, then sputum is released. It has a rusty hue. Symptoms may persist for more than a week. The course of focal community-acquired pneumonia is more gradual.

Diagnostic measures

Diagnosis of community-acquired pneumonia includes:

• a detailed survey of the patient or his relatives about the development of the disease;
• anamnesis of life;
• listening to the lungs;
• conducting ultrasound;
• echocardiography;
• X-ray examination.

Radiography is the most reliable method of diagnosis. In this case, focal or diffuse darkening (less common), expansion of the roots of the lungs are detected. Sputum examination is also being organized to clarify the pathogen. In the process of auscultation, dullness of pulmonary sound, crepitation, wheezing are revealed. Additional diagnostic methods include CT, MRI, bronchoscopy, biopsy, urinalysis, detection of antibodies in the blood. In the analysis of blood, you can find signs of inflammation.

Treatment of pneumonia

With community-acquired pneumonia, treatment should be comprehensive. In uncomplicated inflammation, treatment can be carried out at home. In severe cases, hospitalization is required. This applies to young children.

Treat pneumonia mainly with antibacterial drugs. Medicines are chosen by the doctor, based on the patient's condition, age and type of pathogen. Antibiotics will be effective only with a bacterial form of pneumonia.The drugs of choice for community-acquired pneumonia are protected penicillins (Amoxiclav, Amoxicillin, Ampicillin), cephalosporins (Cefazolinum), macrolides (Rovamycin).The drugs can be administered orally or injected (intramuscularly or intravenously).

Treatment is carried out immediately. Do not wait for the results of the microbiological study. In severe cases, a combination of cephalosporins with macrolides (Macroben, Sumamed, Azithromycin) and fluoroquinolones is possible. In severe pneumonia, it is preferable to use Cefotaxime or Ceftriaxone. The duration of therapy is 1-2 weeks. If drugs are ineffective, they are replaced by others. At the end of the therapy, an X-ray examination is performed.

Other therapies

For successful recovery in the treatment regimen, it is required to include immunity-stimulating drugs, expectorant drugs and mucolytics, antihistamines, antipyretic drugs, NSAIDs. Mucolytics and expectorants dilute sputum and improve its excretion. This helps improve breathing function. These drugs include Bromhexine, Ambroxol, Acetylcysteine. Of the NSAIDs, Indomethacin, Aspirin, Ibuprofen are used.

With severe respiratory failure, the doctor can prescribe bronchodilators, oxygen therapy.

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With obstruction of the respiratory tract, bronchoscopy is indicated. In the development of infectious-toxic shock, which is the most formidable complication of pneumonia, infusion therapy, normalization of pressure, the introduction of sodium bicarbonate (with acidosis), cardiac drugs and Heparin, antibiotics. The prognosis for life and health with adequate treatment is favorable. The most dangerous pneumonia in early childhood (up to 1 year).

respiratoria.ru

Community-acquired pneumonia: diagnosis, treatment. Prevention of community-acquired pneumonia

Community-acquired pneumonia is considered to be the most common infectious diseases of the respiratory tract. Most often, this ailment is the cause of death from various infections. This occurs as a result of a decrease in the immunity of people and the rapid adaptation of pathogens to antibiotics.

What is community acquired pneumonia?

This is an infectious disease of the lower respiratory tract. Community-acquired pneumonia in children and adults develops in most cases as a complication of a viral infection. The name of pneumonia characterizes the conditions of its occurrence. The person is ill at home, without any contact with the medical institution.

Pneumonia in an adult

Adults most often get pneumonia due to ingestion of bacteria, which are the causative agents of the disease. Community-acquired pneumonia in adults does not depend on geographical zones and socio-economic relations.

Throughout life on the airways and lungs of a person are constantly affected by pathogens: viruses and parasites. On the way to the lungs, bacteria encounter protective barriers, which are represented by the upper respiratory tract and the oropharynx. If these barriers are overcome by pathogenic organisms - bacteria, viruses and fungi, infection begins to develop.

What is pneumonia?

This disease is divided into three types:

1. Light pneumonia is the largest group. She is treated out-patiently, at home.
2. The disease is of medium severity. Such pneumonia is treated in the hospital. The peculiarity of this group is that most patients have chronic diseases.
3. Severe form of pneumonia. She is treated only in the hospital, in the intensive care unit.

Community-acquired pneumonia happens:

• Focal. A small area of ​​the lungs is inflamed.
• Segmental. Characteristic is the defeat of one or at once several parts of the organ.
• The equity. Some part of the body is damaged.
• The total. The defeat is all the lungs.

Community-acquired pneumonia is one-sided and two-sided, right-sided and left-sided.

Symptoms

• The body temperature rises.
• There is a chill and weakness.
• Decreased efficiency and appetite.
• Sweating appears, especially at night.
• The head, joints and muscles aches.
• The consciousness gets confused and the orientation is broken, if the disease is in severe form.
• Pain in the chest.
• Herpes can appear.

• Pain in the abdomen, diarrhea and vomiting.
• Shortness of breath, which occurs during exercise. When a person is at rest, this does not happen.

Causes

Community-acquired pneumonia develops when microbes enter the weakened human body and cause inflammation. The causes of the disease are as follows:

• Subcooling the body.
• Viral infections.
• Concomitant diseases: diabetes, heart, lungs and others.
• Weakened immunity.
• Excessive consumption of alcoholic beverages.
• Long stay on bed.
• Postponed operations.
• Elderly age.

Pathogens of the disease

• Pneumococci (most often the cause of the disease).
• Staphylococci.
• Atypical pathogens: mycoplasma and chlamydia.
• Klebsiella.
• Viruses.
• Pneumocystis.
• Intestinal bacillus.
• Haemophilus influenzae.

Diagnostics

During the examination, it is very important to identify and evaluate the clinical symptoms of the disease, such as fever, chest pain, cough with phlegm. Therefore, if a person has community-acquired pneumonia, the history of the disease is mandatory for every patient. In it, the doctor records all the patient's complaints and appointments. To confirm the diagnosis, a radiological examination is carried out: chest x-ray. Clinical manifestations of community-acquired pneumonia are:

• Cough with discharge of muco-purulent sputum, in which veins of blood are present.
• Pain in the chest during breathing and coughing.
• Fever and shortness of breath.
• Trembling of the voice.
• Chryps.

Sometimes the symptoms differ from those typical for this disease, which makes it difficult to establish the correct diagnosis and determine the method of treatment.

Radiation examination

The patient is assigned radiography if he has community-acquired pneumonia. Diagnosis by the radiation method involves the examination of the organs of the chest cavity in the anterior part of it. The image is taken in a straight and a side view. The patient underwent an X-ray examination as soon as he consulted a doctor, and then half a month after the treatment with antibacterial agents began. But this procedure can be carried out earlier, if the treatment has complications or the clinical picture of the disease has changed significantly.

The main sign of community-acquired pneumonia during X-ray examination is the compaction of lung tissue, a darkening is determined in the picture. If there are no signs of densification, then there is no pneumonia.

Lower-lobe right-sided pneumonia

Many patients go to the hospital when they are disturbed by such symptoms as dyspnoea, cough, accompanied by discharge of mucous sputum, an increase in temperature to 39 degrees, pain with a sensation of tingling on the right side under edge. After hearing complaints of the patient, the doctor examines it, listens and probes where necessary. If it is suspected that the patient has a community-acquired right-sided pneumonia, which, as a rule, occurs much more often (why we pay special attention to it), he is assigned a full examination:

• Laboratory tests: general, clinical and biochemical blood analysis, urine and sputum analysis.
• Instrumental studies, including chest radiography, fibroblochoscopy and electrocardiograms. The form of darkening on the radiographic image allows us to clarify the diagnosis, and fibroscopy - to reveal the involvement of bronchi and trachea in the process of inflammation.

If the results of all tests confirm that the patient has a right-side community-acquired pneumonia, the medical history is supplemented. Before starting therapy, the patient's chart records the results of studies on all indicators. This is necessary in order to carry out its adjustment as necessary.

Laboratory and instrumental studies can show inflammation of the lower right lobe of the lung. This is another story of the disease. Community-acquired lower-lobe pneumonia - this will be the diagnosis. When it is accurately established, the doctor prescribes a treatment that is individual for each patient.

How to treat community-acquired pneumonia?

Patients with this diagnosis can be treated both in a hospital and at home. If a patient has community-acquired pneumonia, the history of the disease is mandatory, regardless of the place of treatment. Patients in out-patient treatment are conventionally divided into two groups. The first refers to people under 60 years of age who do not have concomitant diseases. The second - over 60 or people with concomitant diseases (of any age). When a person has community-acquired pneumonia, treatment is performed with antibacterial drugs.

For patients of the first group, the following are appointed:

• "Amoxicillin" with a dosage of -1 g or "Amoxicillin / Clavulanate" 25 grams at a time. Accepted during the day 3 times.
• An alternative to these drugs may be: "Clarithromycin" or "Roxithromycin" in a dosage of, g, and 5 g, respectively. Take twice a day. Can be appointed "Azithromycin which is taken once a day in the amount of, g.
• If there is a suspicion that the disease is caused by an atypical pathogen, the doctor may prescribe "Levofloxacin" or "Moxifloxacin" in g, g, g, respectively. Both drugs are taken once a day.

If patients of the second group have community-acquired pneumonia, the treatment is performed using the following drugs:

• "Amoxicillin / clavulanate" is prescribed three times a day for, 25 g or twice a day for 1 g, "Cefuroxime" should be taken in an amount, g at one time twice a day.
• Alternative drugs may be prescribed: "Levofloxacin" or "Moxifloxacin" in g, g, g, respectively, once a day per day. "Ceftriaxone" is prescribed for 1-2 grams intramuscularly, too, once a day.

Treatment of the disease in children

Community-acquired pneumonia in children with uncomplicated form of the disease, depending on age, is treated with the following drugs:

• Children under 6 months are prescribed: "Josamycin" twice a day for a week in the calculation of 20 mg per one kilogram of body weight. Maybe "Azithromycin" - the daily norm should not exceed 5 mg per kilogram of body weight, the duration of treatment - 5 days.
• Children under the age of 5 years are prescribed "Amoxicillin" inside 25 mg / kg twice a day, the duration of treatment is 5 days. Can appoint "Amoxicillin / clavulanate" in recalculation per kilogram of body weight 40-50 mg or "Cefuroxin aksetil" dosage of 20-40 mg / kg, respectively. Both drugs are taken twice a day, the duration of treatment is 5 days.
• Children older than 5 years are prescribed "Amoxicillin" with a dosage of 25 mg / kg in the morning and in the evening. If there are suspicions of SARS, prescribe "Josamycin" inside, increasing the dosage to 40 mg / kg per day for a week or "Azithromycin" according to the scheme: 1 day - 10 mg / kg, then 5 mg / kg for 5 days. If there is no positive result in treatment, you can replace "Amoxicillin" at a rate of 50 mg / kg once a day.

Preventive measures for the prevention of disease

Preventive maintenance of community-acquired pneumonia is carried out using pneumococcal and influenza vaccines. If necessary, they are injected simultaneously, only in different hands. For this purpose, a 23-valent unconjugated vaccine is used. It is introduced:

• People who are over 50 years old.
• Persons living in nursing homes.
• Adults and children with chronic lung, heart and vascular disease or under constant medical supervision.
• Children and adolescents (from six months to adulthood) who have been taking aspirin for a long time.
• Pregnant women 2-3 rd term.
• Doctors, nurses and the rest of the hospital staff and outpatient clinics.
• Employees of nursing departments.
• To family members of those people who are at risk.
• Medical workers caring for the sick at home.

Prevention of community-acquired pneumonia is:

• The correct way of life, which involves exercise, regular long walks in the fresh air, active rest.
• A balanced healthy diet with a normal content of proteins, vitamins and trace elements.
• Annual vaccination of children and adults against influenza, which is done before the onset of the cold season. Very often, the flu gives a complication. A person gets pneumonia, which is difficult.
• Life without hypothermia and drafts.
• Daily cleaning and airing of the room.
• Frequent washing of hands and rinsing of nasal passages.
• Restriction of contacts with patients with ARI.
• In the period of massive spread of infection, the intake of honey and garlic. They are excellent immunostimulating agents.
• If you become infected with flu yourself or your child, do not self-medicate, but call a doctor.

syl.ru

To date, community-acquired pneumonia remains a widespread and potentially life-threatening disease.

The disease is common not only among adults, but also among children. For 1000 healthy persons, there are 3 to 15 cases of pneumonia. Such a spread of figures is due to the different prevalence of the disease in the regions of the Russian Federation. 90% of deaths after 64 years are due to community-acquired pneumonia.

If a patient finds pneumonia in 50% of cases, doctors will decide to hospitalize him, because the risk of complications and deaths from this disease is too great.

So, what is community acquired pneumonia?

Community-acquired pneumonia is defined as an acute infectious process in the lungs that occurs outside a medical institution or within 48 hours from the moment of hospitalization, or developed in people who were not in the departments of long-term medical observation for 14 days and more. The disease is accompanied by symptoms of infection in the lower respiratory tract (fever, cough, shortness of breath, sputum, chest pain. Radiologically it is characterized by "fresh" foci of changes in the lungs, provided that other possible diagnoses are excluded.

Symptoms

To diagnose pneumonia is difficult, because there is no specific symptom or combination of symptoms specific to this disease. Community-acquired pneumonia is put on a set of nonspecific symptoms and objective examination.

Symptoms of community-acquired pneumonia:

• fever;
• cough with or without phlegm;
• difficulty breathing;
• pain in the chest;
• headache;
• general weakness, malaise;
• hemoptysis;
• severe sweating at night.

Less common:

• pain in muscles and joints;
• nausea, vomiting;
• diarrhea;
• loss of consciousness.

In elderly people, symptoms from the bronchopulmonary system are not expressed, in the first place common signs appear: drowsiness, sleep disturbance, confusion, exacerbation of chronic diseases.

At children of early age at presence of a pneumonia there are following signs:

• temperature increase;
• cyanosis;
• dyspnea;
• general signs of intoxication (lethargy, tearfulness, violation of sleep, appetite, rejection of the breast);
• cough (may not be).

In older children, the symptoms are similar to those in adults: malaise, weakness, fever, chills, cough, chest pain, abdominal pain, increased respiratory rate. If the child is older than 6 months, there is no fever, then according to the latest clinical recommendations, community-acquired pneumonia can be excluded.

Absence of a fever in children under 6 months with pneumonia is possible if the causative agent is C.trachomatis.

Treatment in adults and children

The main method of treatment is antibacterial therapy. At the first stages of outpatient and inpatient treatment, it is carried out empirically, that is, the doctor prescribes the drug, based only on his assumptions about the causative agent of the disease. This takes into account the age of the patient, the concomitant pathology, the severity of the disease, the patient's independent use of antibiotics.

Treatment of community-acquired pneumonia of mild degree is carried out by tablet preparations.

In the treatment of pulmonary pneumonia with a typical course in an outpatient setting, in persons up to 60 years old without concomitant diseases, therapy can begin with amoxicillin and macrolides (azithromycin, clarithromycin).If there is an allergy to penicillin or an abnormal course of pneumonia is observed or there is no effect from penicillins, then macrolide antibiotics should be preferred.

Patients older than 60 years with the presence of concomitant diseases are treated with protected penicillins (amoxicillin / clavulanate, amoxicillin / sulbactam). Alternatively, antibiotics from the respiratory fluoroquinolones group (levofloxacuin, moxifloxacin, hemifloxacin) are used.

Severe community-acquired pneumonia requires the appointment of several antibiotics. Moreover, at least 1 of them should be administered parenterally. Treatment begins with cephalosporins of the third generation in combination with macrolides. Sometimes prescribed amoxicillin / clavulanate. Alternatively, respiratory fluoroquinolones are used in combination with third-generation cephalosporins.

Every patient with pneumonia is required to make bacteriological examination of sputum. Based on its results, select an antibiotic that is sensitive to the detected pathogen.

If suspected of pneumonia caused by legionella, rifampicin must be added parenterally.

If pneumonia is caused by Pseudomonas aeruginosa, combinations of cefipime or ceftazidime or carbopenems with ciprofloxacin or aminoglycosides are used.

In pneumonia caused by Mycoplasma pneumoniae, it is best to prescribe macrolides, or respiratory fluoroquinolones or doxycycline.

With Chlamydia pneumoniae, the disease is also treated with fluoroquinolones, macrolides and doxycycline.

Principles of antibacterial therapy in children differ in groups of antibiotics. Many drugs are contraindicated.

The selection of an antibiotic is also carried out presumably until the microorganism that caused the disease has been determined.

For mild and moderate pneumonia, children from 3 months to 5 years of age are prescribed protected penicillins (amoxicillin / clavulanate, amoxicillin / sulbactam, ampicillin / sulbactam) inside. In severe current in the same age category - they are the same, but parenterally for 2-3 days with the subsequent transition to tablet form. Antibiotics with the prefix "Solutab" are more effective.

If you suspect a hemophilic infection, amoxicillin / clavulanate is selected with a high content of amoxicillin (1: 3 months. up to 12 years and 1: from 12 years).

In children older than 5 years, in the absence of the effect of amoxiclav therapy, macrolides (josamycin, midecamycin, spiramycin) can be added to the treatment.

The use of fluoroquinolones in children is contraindicated up to 18 years.The possibility of their application should be approved only by a consultation of doctors in a life-threatening situation.

What other antibiotics can I use in children under 3 months? If pneumonia is caused by enterobacteria, aminoglycosides are added to the protected penicillins. In addition to amoxicillin in children of this age, ampicillin and benzylpenicillin can be used parenterally. In severe cases, in the presence of resistant bacteria, carbapenems, doxycycline, cefotaxime or ceftriaxone can be used.

Rules of antibacterial therapy

• the earlier antibiotic treatment is initiated, the better the patient's prognosis;
• The duration of antibiotics in adults and children should not be less than 5 days;
• with mild pneumonia and a prolonged normalization of temperature, treatment can be stopped ahead of schedule on day 3-4;
• the average duration of antibiotic treatment is 7-10 days;
• if pneumonia caused chlamydia or mycoplasma, the treatment is prolonged to 14 days;
• intramuscular injection of antibiotics is not advisable, because their availability is less than with iv introduction;
• evaluation of the effectiveness of treatment can be carried out only after 48-72 hours;
• efficiency criteria: decrease in temperature, decrease in intoxication;
• X-ray picture is not a criterion by which the duration of treatment is determined.

Among the child population, community-acquired pneumonia can be caused not by a bacterium, but by a virus. In such cases, the use of antibiotics will not produce any result, but only worsen the prognosis. If pneumonia developed 1-2 days after the initial manifestations of a viral disease (especially influenza), then treatment can be initiated with antiviral drugs: oseltamivir, zanamivir, umifenovir, inosine pranobex, rimantadine.

In severe cases, in addition to fighting the pathogen, infusion therapy is carried out to eliminate intoxication, high temperature, oxygen therapy, vitamin therapy, mucolytics.

The most common mucolytic among adults and children is ambroxol. It not only dilutes sputum and facilitates its excretion, but also promotes better penetration of antibiotics into the lung tissue. It is best to use it through a nebulizer. Children can also use bromhexine from birth. From the age of 2, ACC is allowed, and from the age of 1, Flumucil. Carbocysteine ​​is allowed for children from 1 month.

Forecast

The outlook for community-acquired pneumonia is mostly good. But severe pneumonia can end up lethal in 30-50% of cases. The forecast deteriorates if:

• people over 70;
• the patient is on artificial ventilation;
• there is a sepsis;
• pneumonia bilateral;
• there is arrhythmia with an increase or decrease in the pulse;
• causative agent - Pseudomonas aeruginosa;
• initial antibiotic treatment is ineffective.

If there is a high temperature on the background or after a cold, you should always consult a doctor and make an X-ray of the lungs.

ingalin.ru

Community-acquired pneumonia treatment and symptoms

This disease is one of the leading causes of death in the world. Community-acquired pneumonia is an acute infection of the lung parenchyma caused by viruses, fungi, bacteria outside the hospital walls. Hospital or hospital form of pneumonia, in contrast, develops in patients weakened by treatment or chronic illness, during inpatient therapy.

Symptoms of Community-acquired Pneumonia

Often in the spring many of us pick up the most different infections: something between colds, flu and bronchitis. As a result, there is often a serious inflammation of the lungs, which as a result causes such a disease as pneumonia. The fight against pneumonia occurs quickly with a correct and timely diagnosis of the disease and an effective course of therapeutic treatment. Typical symptoms of the disease in an adult include:

1. increase in body temperature, which lasts for three days;

2. malaise;

3. weakness;

4. Strong headache;

5. chills;

6. nausea, vomiting;

7. cough with pus or blood;

8. labored breathing;

9. dyspnea;

10. cardiovascular insufficiency.

The most minor symptoms of pneumonia, oblige each patient, will consult a doctor.

Diagnosis of community-acquired pneumonia

Diagnostic symptoms of the disease are:

1. febrile state,

2. dry cough,

3. finely bubbling rales,

4. leukocytosis,

5. and also revealed infiltration.

Radiographic diagnosis has low sensitivity and specificity. It is known that infiltrative changes for the first time the days of the disease are poorly defined, they are characterized by low intensity in the elderly. There is a high percentage of contradictions in the interpretation of images by radiologists. The diagnosis is established only on a background of a clinical picture and results of inspection.

Epidemiological studies show that in 25% of cases, which is associated with respiratory disease, infection diseases occur. Community-acquired pneumonia is 15 cases per thousand and is characterized by a certain cyclicity. Mortality is 5%, and in the elderly, up to 20%.

Peculiarities of treatment of community-acquired pneumonia

With a mild disease, it is preferable to observe the home regime, preferably bed rest. Carry out antibacterial treatment for 7-10 days, taking vitaminized liquids (cranberry, cranberry, lemon). For pneumonia of moderate and severe severity, immediate hospitalization with the use of vascular drugs, inhalations with moistened oxygen, the use of artificial ventilation. Empirical therapy is prescribed no later than 8 hours after the patient has entered the department.

The duration of treatment depends on the patient's condition. In uncomplicated pneumonia, adults are prescribed antibiotics only for the disappearance of temperature, with a complicated disease treatment depends on the severity of the disease and the presence of complications.

Treatment includes exposure to the pathogen, elimination of intoxication, expectorants, bronchodilators, vitamins, exercise therapy, physiotherapy. With the development of heart failure prescribed cardiac glycosides, and with vascular insufficiency - analeptics.

The goal of physiotherapy of pneumonia in adults is to reduce inflammation and restore disturbed perfusion-ventilation relationships in the lungs. The tasks of physiotherapy are:

1. acceleration of resorption of inflammatory infiltrate (anti-inflammatory and reparative-regenerative methods),

2. reduction of bronchial obstruction (bronchodilator methods),

3. reduction of manifestations of hyper- and discrinia (mucolytic methods of treatment of community-acquired pneumonia),

4. activation of alveolar-capillary transport (methods of strengthening alveolar-capillary transport),

5. increase in the level of nonspecific resistance of the body (immunostimulating methods).

Therapy of community-acquired pneumonia in hospital

Determine the location of the patient during treatment (hospital or home) will help laboratory analysis of blood, sputum, X-ray examination. In general, pneumonia is treated within the walls of the hospital and under the strict supervision of the attending physician. Use antibiotics of different groups (Penicillin, macrolides, antifungal drugs, tetracyclines). Pneumonia without complication can be treated at home only after an accurate diagnosis of the doctor.

Ordinary pneumonia in adults can be treated with tablets and cough syrups, and complex pneumonia is treated with a course of taking antibiotics. Along with antibiotics prescribe expectorants. During recovery and lowering of temperature, exercise therapy, massage, respiratory gymnastics, which fix the result of treatment of pneumonia in an adult, can be prescribed. Also, the folk medicine (decoctions, herbal teas) help well. Do not forget about the damp air in the room or room, constant airing, copious drinking, bed rest and vitamins (vegetables, fruits). After discharge from the hospital, it is recommended to rest in a sanatorium.

For treatment in a hospital it is necessary to take into account a number of reasons:

1. age of the patient (over 60 years);

2. in the presence of concomitant diseases;

3. inefficiency of antibiotic therapy;

4. desire of the patient.

For the hospitalization of the patient the following factors are taken into account:

• arterial pressure,
• heart rate,
• impaired consciousness,
• Body temperature,
• as well as inadequate care for the patient at home.

With the advent of antibacterial drugs with a wide spectrum of action, a high concentration pulmonary tissues with oral administration of drugs, and allows for the treatment of community-acquired pneumonia outpatient.

Causes of Community-acquired Pneumonia

There are five main ways of penetration of pathogens of community-acquired pneumonia into the bronchial tree and alveolar parts of the lungs:

1. aerosol (infected air);

2. Aspiration (secret of the oropharynx);

3. hematogenous (the spread of microorganisms from the extrapulmonary focus of infection along the vascular bed, occurs in sepsis, septic endocarditis, some infectious diseases);

4. lymphogenous (the spread of microorganisms from the extrapulmonary focus of infection through the lymphatic system);

5. direct spread of infection of community-acquired pneumonia from neighboring affected tissues (lung abscess, tumor, chest injury).

Normally, protective mechanisms (cough reflex, mucociliary clearance, antibacterial activity of alveolar macrophages and secretory immunoglobulins) provide elimination of the infected secret from the lower respiratory ways. With the weakening of the general and local resistance of the organism after the penetration of bacteria into the lower respiratory tract, their adhesion occurs on the surface of epithelial cells, penetration into the cytoplasm and reproduction. The factors of adhesion of bacterial agents are fibronectin, sialic acids, etc.

Damage to epithelial and endothelial cells, activation of alveolar macrophages, migration to the inflammatory focus of polymorphonuclear leukocytes and monocytes as a result of community-acquired pneumonia lead to the formation of a complementary cascade, which in turn enhances migration to the inflammatory focus of polymorphonuclear leukocytes and erythrocytes, promotes the transudation of immunoglobulins, albumin and other serum factors. This is accompanied by increased production of pro-inflammatory cytokines, enzymes, procoagulants, increased exudation of the liquid part of the plasma into the alveoli, and ends with the formation of a focus of inflammation.

AstroMeridian.ru

Community-acquired pneumonia

Pneumonia or pneumonia is a very complex and dangerous infectious disease. It's hard to believe, but even today, when medicine seems to be able to cure anything, humans continue to die from this disease. Community-acquired pneumonia is one of the varieties of the disease that requires urgent and intensive treatment.

Causes and symptoms of community-acquired pneumonia

Everyone knows that the main cause of pneumonia (regardless of the form of the disease) is harmful viruses and bacteria. These microorganisms are characterized by vitality and the ability to adapt to different living conditions. Viruses can easily live even in the human body, but at the same time not manifest themselves. The danger they represent only when the immune system for whatever reasons can no longer prevent their growth and reproduction.

Community-acquired pneumonia is one of the types of pneumonia that the patient picks up outside the hospital. That is, the main difference of the disease is in the environment, where the infection has started to develop, its causing. In addition to out-of-hospital, there are other forms of pneumonia:

1. Nosocominal pneumonia is diagnosed if the symptoms of pneumonia in the patient manifest only after hospitalization (after two or more days).
2. Aspiration pneumonia - a disease that occurs as a result of penetration into the lungs of foreign substances (chemicals, food particles and others).
3. Another type of disease, very similar to community-acquired left- or right-sided pneumonia, is pneumonia in patients with immune system defects.

The main symptoms of different forms of pneumonia with each other practically do not differ and look like this:

• heat;
• cough, difficult to treat;
• fever;
• pain in the chest;
• increased fatigue;
• sweating;
• pallor;
• wheezing in the lungs.

Treatment of community-acquired pneumonia

Diagnosis of the inflammation of the lungs is most likely helped by radiographic examination. The picture clearly shows the darkened infected areas of the lungs.

The principle of treatment of community-acquired pneumonia, whether it is a polysergmentary bilateral or a right-sided lower-lobe form of it, consists in the destruction of the infection that caused the disease. As practice has shown, the strongest drugs, antibiotics, are the best to cope with this task. It is necessary to be ready and to the fact that during the treatment is mandatory hospitalization.

The medication course for each patient is selected individually. Unfortunately, the first time to reliably identify the virus that caused pneumonia is very difficult. Therefore, the appointment of a suitable antibiotic from the first time is quite difficult.

The list of the most effective drugs for the treatment of pneumonia is quite large and includes such medicines:

• Azithromycin;
• Erythromycin;
• Ceftriaxone;
• Spiromycin;
• Rifampicin;
• Ampicillin;
• Amoxicillin;
• Cefaclor;
• Tetracycline;
• 
• Ofloxacin and many others.

Antibiotics for the treatment of one- or two-sided community-acquired pneumonia are most commonly prescribed in the form of injections for intramuscular or intravenous (in particularly difficult cases) administration. Although some patients are more like drugs in tablets. The standard course of treatment in any case should not exceed two weeks, but it is forbidden to finish it prematurely.

If the patient's condition does not improve after two to three days after the start of taking antibiotics, and the main symptoms of pneumonia do not disappear, it is necessary to select an alternative antibiotic.

WomanAdvice.ru

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