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Symptoms of a disease. Pneumonia is a group various on an etiology, a pathogeny and the morphological characteristic of the acute infectious diseases which are characterized by preferential defeat of respiratory departments of lungs and existence of intra alveolar exudation.
The term a pneumonitis is applied to inflammatory processes in lungs of the noninfectious nature (allergic, eosinophilic, toxic, beam, etc.).
Distinguish the following types of pneumonia.
1. Community-acquired pneumonia (house, out-patient).
2. Intrahospital pneumonia (hospital, nozokomialny).
3. Aspiration pneumonia (at epilepsy, alcoholism, swallowing disturbances, vomiting etc.).
4. Pneumonia at persons with heavy defects of immunity (at a congenital immunodeficiency disorder, HIV infection, drug addiction, alcoholism, tumoral diseases, an agranulocytosis, use of immunosuppressive therapy).
The main clinical symptoms of pneumonia are cough, expectoration (mucous, mucopurulent, "rusty", with blood streaks), short wind, pains at breath on the party of defeat. At physical inspection syndromes of focal or share consolidation of lungs, a syndrome of a pleural exudate, the accompanying bronchitis come to light. From extra pulmonary displays of pneumonia are characteristic: fever, oznoba and perspiration, cyanosis. Herpes labialis, confusion of consciousness, diarrhea, jaundice.
At X-ray inspection segmented or share shading of lungs is defined. In peripheral blood — a neutrocytosis with shift to young forms, toksogenny granularity of neutrophils, acceleration of SOE.
Risk factors of pneumonia.
• age (children and elderly people);
• chronic diseases of lungs, hearts, kidneys, digestive tract;
• contact with birds, rodents and other animals;
• travel (trains, airplanes, stations, hotels);
One of aggressive risk factors of development of pulmonary diseases is smoking in connection with decrease in mechanisms of protection of a respiratory organs under the influence of a tobacco smoke. In developing of atypical pneumonia contact with birds, rodents, travel matters (water in air conditioning systems of hotels can be a habital legionell). Cooling promotes damage of a mucous barrier of respiratory tracts. Risk factors of development of intrahospital pneumonia are stay in intensive care units and an intensive care, septic states, the postoperative period, artificial ventilation of the lungs, a bronkhoskopiya, etc. There is a high risk of development of pneumonia in patients with primary and secondary immunodeficience.
Treatment of pneumonia.
At community-acquired pneumonia drugs of the choice are:
• penicillin — benzylpenicillin on 1 — 2 mln units intramusculary equal doses each 4-6 h at the easy course of pneumonia and on 2-4 mln units intravenously, intramusculary 6 times a day at a heavy current; ampicillin in a dosage of 0,5 g in each 4 — 6 h, a daily dose — 2-3 g;
• amoxicillin of 0,25-0,5 g 3 times a day for intake or 0,25 — 1 g each 8 h intravenously at the heavy course of pneumonia;
• ingibitorozashchishchenny penicillin — amoxicillin + clavulanic acid (augmentin, Amoxiclav) 0,375-0,625 3 times a day inside, at a heavy current on 1,2 g in 6 — 8 h intravenously;
• macroleads — erythromycin on 0,25-0,5 g in each 4 — 6 h or on 0,2 g 2-3 times a day intravenously in hard cases within several days with the subsequent transition to oral administration; roksitromitsin on 150-300 mg of 1 — 2 time a day inside; azithromycin on 500 mg/days once a day within 3 — 5 days;
• I—IV cephalosporins of generations — Cefaloridinum (tseporin) 1 — 4 g/days intravenously, intramusculary; cefazolin (Cefamezinum, Kefzolum) of 2 — 4 r/days intravenously, intramusculary; tsefuroksy (ketotsef) 3-6 g/days intravenously, intramusculary; tsefotaksy (klaforan) to 6 g/days intramusculary, intravenously; tseftriakson (rotsefin), tsefepy (maksipy) on 1 — 2 g each 8 h intravenously; the tsefaklor (tseklor) and tsefuroksy aksetit (zinnat) 0,5 — 1 g 3-4 times a day inside, the maximum daily dose to 4 g;
• early ftorkhinolona — ofloxacin on 0,4 — 0,8 g in 12-24 h inside, intravenously, intramusculary; ciprofloxacin in the same dose;
• respiratory ftorkhinolona — levofloxacin (tavanik) on 500 mg of 1 times a day inside, intravenously; moxifloxacin (aveloks) on 400 mg of 1 times a day inside, intravenously; pefloksatsin (abaktat) 400 mg 2 times a day inside, intravenously.
Tsefotaksim, tseftriakson, tsefepy, the protected aminopenicillin, respiratory ftorkhinolona are choice drugs at empirical treatment of pneumonia of a heavy current, both in the form of monotherapy, and in a combination: augmentin + macrolead, tsefotaksy or tseftriakson + macrolead intravenously.
At intrahospital pneumonia use the following antibacterial drugs:
• ingibitorozashchishchenny penicillin — amoxicillin + clavulanic acid (augmentin, Amoxiclav) on 1,2 g in 6 — 8 h intravenously;
• generation cephalosporins II, III and IV — tsefotaksy, a ceftazidime (Fortum), tseftriakson (rotsefin), tsefepy (maksipy) on 1-2 g each 8 h intravenously, intramusculary;
• aminoglycosides — gentamycin of 240 — 320 mg/days intramusculary, intravenously equal doses each 8 h; Tobramycinum or sisomicin in the same dose, amikacin (Amikinum) on 10 — 15 mg/kg of body weight a day equal doses each 8 — 12 h intravenously, intramusculary;
• respiratory ftorkhinolona — levofloxacin, moxifloxacin, pefloksatsin intravenously;
• karbapenema — to tiyena (imipenem/tselastin) on 1-2 g intravenously, intramusculary in 6-8 h.
At an unknown etiology therapy is carried out by two antibiotics: the protected aminopenicillin + aminoglycosides, cephalosporins + aminoglycosides, cephalosporins + macroleads. Means of the choice of treatment of the pneumonia caused by a pyocyanic stick is antipsevdomonadny penicillin — azlotsillin, tikartsillin, piperatsillin, tikartsillin / clavulanic acid in combination with aminoglycosides. From cephalosporins possess activity concerning a pyocyanic stick tsefotaksy, tsefoperazon (tsefobid), tseftriakson (longatsef) and tsefepy.
At aspiration pneumonia in connection with high probability of anaerobe bacterias the scheme of treatment includes anti-anaerobic drugs of a broad spectrum of activity — the protected aminopenicillin, tsefotetan, tsefoksitin, karbapenema or metronidazole, Tinidazolum in combination with other antibiotics.
Along with antibacterial therapy at pneumonia apply various anti-inflammatory drugs (an ibuprofen, diclofenac, indometacin), cardiovascular means, vitamins, means to improvement of a bronchial drainage — Mucolyticums, bronchodilators.
At development of shock, hypotension, allergic reactions, the bronkhoobstruktivny syndrome, an agranulocytosis appoint glucocorticoids.
Complex treatment of heavy pneumonia includes disintoxication therapy — Haemodesum of 400 ml/days, saline solutions (normal saline solution, Ringer's solution), glucose of 5% — 400-800 ml/days; immuno-replacement therapy — freshly frozen plasma, immunoglobulin; correction of microcirculator disturbances — heparin to 20 000 PIECES/days, reopoliglyukin 400 ml/days; oxygen oterapiya.
Physiotherapeutic treatment is usually appointed in a permission phase, includes: UVCh, an inductothermy, amplipulsetherapy, with the resorptional purpose — an electrophoresis of medicines (heparin, calcium chloride, a lidaza); laser therapy.
See also. Criteria of severity of pneumonia, Medical foods at pneumonia