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Treatment - Chronic bronchitis

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Chronic bronchitis
Treatment

General principles of treatment of chronic bronchitis

Treatment purposes:
• elimination of symptoms of an exacerbation of a disease;
• reduction in the rate of progressing of a disease;
• prevention of repeated aggravations;
• improvement of quality of life.
At the choice of pharmacological and not medicinal methods of treatment much attention is paid to their safety.
For treatment of chronic bronchitis use medicines of 4 groups, including antimicrobic and mucolytic medicines, bronchodilators and immunomodulators is proved.

Effects of antimicrobic medicines

Proved

Expected

Faster disappearance of symptoms of an aggravation

Prevention of development of pneumonia

Faster disappearance of signs of bronchial obstruction (increase in OFV1)

Reduction of bacterial colonization of a mucous membrane of bronchial tubes

Reduction of duration of stay in a hospital

Reduction of expressiveness of inflammatory process in bronchial tubes

Reduction of the period of disability

Lengthening of remissions

Pharmacotherapy of the exacerbations of chronic bronchitis caused by a bacterial infection

At the exacerbation of chronic bronchitis caused by a bacterial infection, empirical antibacterial therapy remains by the main method of treatment.
At the choice of medicines it is necessary to consider:
• weight of an aggravation;
• activity of medicines concerning the most often found causative agents (see. "An etiology and a pathogeny of a disease") taking into account a possible antibiotikorezistentnost;
• optimum pharmacokinetic properties (ability to penetration into a phlegm and slime, action duration);
• range of side effects;
• economic aspects.
In the period of an aggravation apply antimicrobic medicines of the following groups to treatment of chronic bronchitis:
• macroleads;
• penicillin;
• tetracyclines;
• ftorkhinolona;
• cephalosporins.
It is preferred as peroral antimicrobic medicines. Indications for purpose of parenteral forms are:
• a serious condition of patients (the expressed exacerbation of chronic bronchitis);
• the digestive tract diseases breaking absorption medicines;
• low bioavailability of peroral forms of medicines;
• lack of a peroral form of medicines (in case of need purposes of a certain medicine, the phlegm determined by results of bacteriological research and BALZh);
• inability of the patient to follow recommendations of the doctor.
In the absence of effect of use of medicines of the choice bacteriological research of a phlegm or BALZh is conducted and alternative medicines taking into account sensitivity of the revealed activator are appointed.

Antibacterial therapy of simple uncomplicated chronic bronchitis

Choice medicines:
Azithromycin in 500 mg 1 r / days — the 1st days, further 250 mg 1 r / days of 4 days (adult); 10 mg/kg 1 r / days — the 1st days, further 5 mg/kg 1 r / days of 4 days (to children 1 years are more senior) or Amoxicillin inside on 500 mg 3 r / days of 7 — 10 days (to adults and children
10 years are more senior); on 100 — 250 mg 3 r / days of 7 — 10 days (to children till 10 flyings) or Amoxicillin/clavulanate inside on 625 mg 3 r / days of 7 — 10 days (adult); on 20 — 45 mg/kg/days (calculate on amoxicillin) in 3 receptions to 7 — 10 days (children) or Ampicillin inside on 500 mg 4 r / days of 7 — 10 days (adult); 100 — 200 mg/kg/days in 4 — 6 receptions to 7 — 10 days (children) or Klaritromitsin inside on 500 mg 2 r / days of 7 — 10 days (adult);
on 7,5 mg/kg 2 r / days to 7 — 10 days (children) or Levofloxacin in 500 mg 1 r / days of 7 — 10 days (adult) or Moxifloxacin in 400 mg 1 r / days 7 — 10 days (adult) or Sparfloksatsin in 400 mg 1 r / days in the 1st days, then 200 mg 1 r / days of 4 — 6 days (adult)

Alternative medicines:
Doxycycline inside on 100 mg 2 r / days of 7 — 10 days (adult); on 2 mg/kg 2 r / days of 7 — 10 days (children of 9 — 14 years)

Antibacterial therapy of obstructive chronic bronchitis

Choice medicines:
Amoxicillin/clavulanate inside on 625 mg 3 r / days of 7 — 10 days (adult); in oil or in/in on 1,2 g
3 r / days of 7 — 10 days (adult) or
Levofloxacin in 500 mg
1 r / days of 7 — 10 days (adult) or
Moxifloxacin in 400 mg
1 r / days of 7 — 10 days (adult) or
Oxacillinum inside on 250 — 500 mg
4 r / days of 7 — 10 days (adult) or
Sparfloksatsin in 400 mg
1 r / days in the 1st days, then 200 mg 1 r / days of 4 — 6 days (adult) or
Cefazolin in oil or in/in on 2 g
3 r / days of 7 — 10 days (adult) or
Tsefaklor inside on 500 mg 3 r / days of 7 — 10 days (adult) or
Tsefuroksim inside on 250 — 500 mg
2 r / days of 7 — 10 days; in oil or in/in on 750 mg 3 r / days of 7 — 10 days (adult)

Alternative medicines:
Sultamitsillin in/in or in oil on
1,5 g 4 r / days of 7 — 10 days
(adult) or Tsefotaksy in/in or in oil on 2 g
3 r / days of 7 — 10 days (adult)
or
Tseftriakson in/in or in oil on 2 g 1 r / days of 7 — 10 days (adult)

Antibacterial therapy of purulent chronic bronchitis

Choice medicines:
Amoxicillin/clavulanate inside on 625 mg 3 r / days of 7 — 10 days
(adult); 20 — 45 mg/kg/days (calculate on amoxicillin)
in 3 receptions to 7 — 10 days (children) or Levofloxacin in 500 mg 1 r / days of 7 — 10 days (adult) or Moxifloxacin in 400 mg 1 r / days of 7 — 10 days (adult) or Oxacillinum inside on 500 mg 4 r / days of 7 — 10 days (to adults and children
6 years) or Sparfloksatsin in 400 mg 1 r / days in the 1st days, then 200 mg are more senior
1 r / days of 4 — 6 days (adult) or Tsefaklor inside on 500 mg 3 r / days of 7 — 10 days (adult); 20 —
40 mg/kg/days in 3 receptions to 7 — 10 days (children) or Tsefepy in oil or in/in on 2 g 2 r / days of 7 — 10 days (adult);
50 mg/kg/days in 2 introductions to 7 — 10 days (children) or Tsefiksim inside on 400 mg 1 — 2 r / days of 7 — 10 days (adult);
8 mg/kg 1 r / days to 7 — 10 days (children) or Tsefotaksy in oil or in/in on 2 g 3 r / days of 7 — 10 days (adult); in oil
or in/in 50 — 200 mg/kg/days in 2 — 4 introductions to 7 — 10 days (children) or the Ceftazidime in oil or in/in on 2 g 2 — 3 r / days of 7 — 10 days (adult);

Alternative medicines:
Piperatsillin/tazobaktat
in/in on 2,25 g 4 r / days of 7 — 10 days (to adults and children 12 years are more senior) or
Tikartsillin / clavulanate in/in on 3,2 g 3 — 4 r / days (adult); on 80 mg/kg 3 — 4 r / to days (children) or
Ciprofloxacin inside on 500 — 750 mg 2 r / days of 7 — 10 days (adult); in/in on 400 mg 2 r / days of 7 — 10 days (adult)

Best of all azithromycin and ftorkhinolona get into a phlegm.
Insufficient efficiency of the carried-out antibacterial therapy can be caused:
• advanced age of the patient;
• the expressed disturbance of bronchial passability;
• development of acute respiratory insufficiency;
• serious associated diseases;
• antibiotikorezistentny causative agents, virus etiology of a disease.

Mucolytic medicines

Efficiency of this group of medicines is small. Their use can be justified only at patients with the knitting which is hardly separated by a phlegm. However thanks to antioxidant properties of an atsetiltsiltsistein at patients with chronic bronchitis the frequency and weight of aggravations as a result of prolonged course use decreases. Use of the combined medicines with mucolytic and expectorant effect is more proved that allows to influence various pathogenetic mechanisms, to minimize quantity and frequency rate of reception of each of medicines and at the same time to reduce risk of side effects. As alternative medicines use vegetable drugs.

Choice medicines:
Ambroxol inside on 30 mg
3 r / days during 2 days, further on 30 mg 2 r / days of 8 — 12 days (adult); on 7,5 mg 2 r / days of 10 — 14 days (to children till 2 flyings); on 7,5 mg 3 r / days of 10 — 14 days (children of 2 — 5 years); on 15 mg 2 — 3 r / days of 10 — 14 days (children of 5 — 12 years); solution, in inhalations on 2 — 3 ml 1 — 2 r / days of 10 — 14 days or
Acetylcysteinum inside on 200 mg 3 — 4 r / days of 10 — 14 days (adult); on 50 mg 2 — 3 r / days of 10 — 14 days (to children till 2 flyings); on 100 mg 2 — 3 r / days of 10 — 14 days (children of 2 — 6 years); on 200 mg 2 — 3 r/sut10 — 14 days (children of 6 — 14 years); 20% solution,
in oil or in/in 50 — 100 mg/kg/days in 2 introductions to 7 — 10 days (children) or Tseftibuten in 400 mg 1 r / days of 7 — 10 days (to adults and children 10 years are more senior); 9 mg/kg/days (to children till 10 flyings) or Tseftriakson in oil or in/in on 2 g 1 r / days of 7 — 10 days (to adult children
12 years are more senior); 50 — 80 mg/kg/days of 7 — 10 days (to children till 12 flyings); or Tsefuroksim inside on 500 mg 2 r / days of 7 — 10 days (adult); on 250 mg 2 r / to days (children) in inhalations on 2 ml 2 — 4 r / days of 10 — 14 days or
Bromhexine inside on 8 — 16 mg 3 r / days of 10 — 14 days (to adults and children 14 years are more senior); on 4 mg 3 r / days (to children till 6 flyings) 10 — 14 days; on 8 mg 3 r / days of 10 — 14 days (children of 6 — 14 years); in oil or in/in on 16 mg 2 — 3 r / days of 10 — 14 days (adult) or
Karbotsistein inside on 750 mg 3 r / days of 10 — 14 days (adult); 2,5% syrup, on 2,5 — 5 ml 4 r / days of 10 — 14 days (children of 2 — 5 years); 2,5% syrup, on 10 ml 4 r / days of 10 — 14 days (children of 5 — 12 years) or
Tiamfenikol glitsinat atsetiltsi-steinat in inhalations on 250 mg 1 — 2 r / days of 7 — 10 days

The combined medicines having broncholitic effect

For the purpose of stopping of attacks of bronchial obstruction appoint fenspirid — drug with antiinflammatory action:

Fenspirid inside, tablets, on 80 mg 2 r / days of 10 — 14 days (adult); syrup, on 15 — 30 ml 3 r / days of 10 — 14 days (adult); syrup, on 10 — 60 ml/days in 3 receptions to 10 — 14 days (children)

Pharmacotherapy of noninfectious exacerbations of chronic bronchitis

Treatment of noninfectious exacerbations of chronic bronchitis consists in stopping of cardiac arrhythmias, displays of heart failure, purpose of anticoagulants at a tromboemoliya of a pulmonary artery, the medicines increasing motility of a digestive tract, and anti-secretory medicines at a gastroesophagal reflux, etc.

Maintaining patients with chronic bronchitis during remission

The main objective of maintaining patients with chronic bronchitis during remission consists in prevention of exacerbations of a disease and ensuring optimum quality of life.
Are necessary for achievement of the specified purposes:

• refusal of smoking;
• elimination of influence of adverse physical and chemical factors;
• improvement of an otkhozhdeniye of a phlegm for ensuring optimum bronchial passability;
• treatment of associated diseases;
• purpose  of immunomodulators of a plant or bacterial origin;
• vaccination against flu.

Assessment of efficiency of treatment

Clinical performance of antibacterial therapy at an exacerbation of chronic bronchitis is estimated on the basis:

• the next  clinical  outcomes (expressiveness and speed of regression of clinical manifestations, loudspeaker of indicators of disturbance of bronchial passability (OFV, prevention and reduction of duration of hospitalization, prevention of progressing of process and development of pneumonia);

• remote clinical outcomes (remission period duration, frequency of aggravations).
Bacteriological efficiency of treatment is estimated taking into account achievement and terms of an eradikation etiologically of a significant microorganism.

Side effects of treatment

Ftorkhinolona increase concentration of theophylline (which can be applied at obstructive bronchitis) in blood, increasing its toxic action.

Mistakes and unreasonable appointments

As mucolytic medicines patients with chronic bronchitis should not appoint fermental medicines (trypsin, chymotrypsin, etc.) as they activate proteolytic activity of elastase and a collagenase that strengthens and aggravates destruction of elastic fibers of alveoluses and progressing of emphysema of lungs. Besides, proteolytic enzymes can cause a pneumorrhagia, a bronchospasm, allergic reactions.

Forecast

Patients with the expressed symptoms of bronchial obstruction, the progressing respiratory insufficiency and pulmonary hypertensia have an adverse forecast.