• Methods of approach for the treatment of bacterial infections of the upper and lower respiratory tract

    October 23, 2014

    The bacterial infections of the upper and lower respiratory tract acquired in the community are some of the most common reasons for seeking medical care in the developed countries. The acute bacterial rhinosinusitis, exacerbation of chronic bronchitis and pneumonia cause high morbidity. And the infections of the lower respiratory tract, especially after a viral infection, cause for poor prognosis.

    Like other respiratory infections, the community-acquired pneumonia (CAP) is more frequent in autumn and winter. To a large extent, this is due to the increase of the viral infection of the upper and lower respiratory tract, complications of which are pneumoniae. For the prognosis of this infection very important is the severity of the pneumonia and microbiological monitoring of the patient. 19.6% of the patients with bacteremia during pneumonia die.

    The death of every fifth patient with bacteremia is a serious reason for the study of blood cultures – a rule that is often neglected in our country. The assessment of the general condition and comorbidities are especially necessary for decision-making for hospitalization, for the intensity of diagnostic and therapeutic procedures. We should not forget that the etiological agents of the infections of the upper respiratory tract and pneumoniae acquired in the community often depend on premorbid condition of the patient. Also, it is very likely the pneumonia, occurring in outpatients, who were hospitalized in the past 15 days, to be hospital-acquired pneumonia. In these the microbial agents are fundamentally different, drug resistance is very high and the therapeutic approach should be entirely different.

    The etiotropic therapy depends on the general condition of the patient, and on the accompanying diseases and last but not least – on the previous antibiotic therapy. The acute bacterial rhinosinusitis is only about 2% percent of rhinitis during the autumn-winter season, which in majority have viral etiology /Blondeau, JM 2006/. The bacterial rhinosinusitis is usually a secondary infection that occurs ten days after the virus infection. Usually indicative of the diagnosis, which requires also microbiological testing, is the lack of improvement within ten days of viral rhinitis and the deterioration of its clinical picture after 5-6 days of infection. Pathognomonic are symptoms associated with the onset of pain, deterioration of the general condition and changes in secretion. The most common causes are Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis. According to the ABRS Guidelines, it is very important for the approach in the antimicrobial therapy whether the patient has been treated in the past 4-6 weeks with antibiotics. When the infection is mild and the patient has taken antibiotics in the last 4-6 weeks, treatment with Amoxicillin (up to 4000 mg/day), Amoxicillin/Clavulanate, Cefuroxim is recommended. For the patients with moderate infection and those treated with antibiotics in recent weeks, the therapy is Amoxicillin/Slavulanate, Levofloxacin, or a combination of macrolides (Claritromycin) with Amoxicillin. The exacerbation of chronic bronchitis is most commonly caused by pneumococci, haemophilus and moraxella, but etiologically significant microbes are also Staphylococcua aureus, Pseudomonas, Enterobacteriaceae. This requires not only microbiological testing for pneumonia, but also a different approach to antibiotic therapy.

    Along with the symptoms of exacerbation such as: increasing dyspnea, increase in the volume of expectoration and pus like expectoration, attention must be paid to predisposing factors and comorbidities of the patient. In Bulgaria the higher incidence of staphylococcus exacerbations is due largely to non etiological treatment of influenza.

    The high frequency of infections caused by pseudomonas and enterobacteriaceae is due to alcohol abuse and neglect of oral hygiene. For exacerbation of chronic bronchitis without risk factors the treatment with Claritromycin, Amoxicillin, Doxycyclin, Trimetoprim/ Sulfamethoxazole are recommended. For chronic bronchitis, combined with risk factors the quinolones – Levofloxacin or Amoxicillin/Clavulanate are recommended.

    Tchaikapharma High Quality Medicines provides on the Bulgarian market antibiotics with the following trade names:

    JF 491 Climox (Amoxicillin/Clavulanic acid ) 875mg/125mg x 14 tabl.
    JF 509 Lifurox (Cefuroxime) 500 mg x 10 tabl.
    JF 499 Levor (Levofloxacin) 500 mg x 10 tabl.
    JF 400 Klacar (Clarithromycin) 500 mg x 14 tabl.
    JF 515 Klacar XL (Clarithromycin) 500 mg x 7 tabl.

    The price of all these antibiotics is BGN 14.99.