An integrated approach to the treatment of the disease is a fundamental aspect of therapy. Its volume depends on the severity of the patient’s condition. Treatment includes the appointment of medications, both antibacterial and other drugs, aimed at eliminating the cause of pneumonia and preventing complications. Non-drug treatment implies a regimen, nutrition, physiotherapy. Severe course of lung inflammation is accompanied by detoxification, hormonal anti-inflammatory and hospital therapy, resuscitation measures.
In the treatment of pneumonia, an antimicrobial drug (AMP) is chosen first of all after the diagnosis. At the initial stage of the disease, it is impossible to use etiotropic therapy. This means that it is not possible to prescribe a medicine that will act directly according to the plan for the pathogen, due to the need to identify the microorganism for at least 18-24 hours.
Additionally, it is necessary to determine the sensitivity of the pathogen to antibacterial drugs. This analysis will take 5-6 days.
Based on the age and complaints of the patient, the history of the disease, the severity of inflammation and the presence of complications, concomitant pathologies, the doctor chooses one of the recommended regimens (according to clinical protocols).
The groups of choice for antibiotic therapy are macrolides, fluoroquinolones and some β-lactams. These drugs are able to neutralize most of the bacteria that are the causes of community-acquired pneumonia. Empirical therapy, based on the severity of the disease, can be carried out at home or in a hospital. When prescribing a list of medicines at home, the following means are chosen:
- In patients without concomitant pathologies who have not taken AMP for the last 3 months, amoxicillins or macrolides (medications based on azithromycin, clarithromycin);
- In patients with intercurrent diseases, aggravated by the course of inflammation, who have taken AMP for the last 3 months, amoxicillins protected by clavulanic acid) or macrolides (azithromycin, clarithromycin), or fluoroquinolones (levofloxacin, moxisifloxacin, hemifloxacin).
Antimicrobial drugs for the treatment of pneumonia:
- Unprotected amoxicillins (Amoxicillin, Amoxicar, Flemoxin solutab)
- Protected Amoxicillins (Amoxiclav, Augmentin, Amoclav)
- Cefuroxime axetil (Zinnat, Zinacef, Axef, Cefoctam)
- Clarithromycin (Fromilide, Klacid, Klabax)
- Roxithromycin (Rulicin, Rulid, Romic)
- Azithromycin (Azibiot, Sumamed, Azimicin)
Fluoroquinolones (for pulmonary pathology)
- Levofloxacin (Tavanic, Lebel, Levoximed)
- Moxifloxacin (Moxifur, Avelox, Simoflox)
- Hemifloxacin (Factiv)
The effectiveness of therapy is evaluated after 48-72 hours. If there is a positive trend, the treatment is continued. If the condition worsens, the doctor changes the main AMP.
Important! Frequent changes of antibiotics during treatment can cause the development of resistance and reduce the effect of antibiotics in the future.
Complicated and severe types of pneumonia are stopped only in a hospital setting, and include the introduction of drugs into a muscle or vein in order to accelerate the action of the drugs.
If the proper effect of treatment is not observed, and the pathogen is known, a more accurate etiotropic therapy is used.
The structure of pathogens of lung inflammation is diverse, microorganisms are classified as follows:
- Pneumococci (St. pneumoniae), Staphylococcus aureus (MRSA, MSSA), Pseudomonas aeruginosa (Ps.aeruginosa) – account for up to 60% of all cases of the disease.
- Intracellular microorganisms (M. pneumoniae, C. pneumoniae). Mycoplasmas and chlamydia initiate 20-30% of pneumonia and have an atypical course.
- Hemophilic bacillus (H. influenzae), Klebsiella pneumoniae, Legionella pneumoniae in adults cause pneumonia in 5% of cases.
Pneumococcus is the leader in the structure of pathogens of community-acquired pneumonia. Treatment involves the appointment of protected beta-lactams, for example, Augmentin, Amoxiclav, Unazine, Sulacillin. The spectrum of their activity includes staphylococci and streptococci, intestinal group of bacteria, hemophilic bacillus, anaerobes.
In the absence of resistance, cephalosporins of the 3rd generation are used (cefotaxime, ceftriaxone, cefixime, ceftibutene). Alternative auxiliary drugs are also used: macrolides (clarithromycin, azithromycin), fluoroquinolones for the treatment of pulmonary pathology (levofloxacin, moxifloxacin, hemifloxacin). In severe cases, reserve APMs are prescribed: vancomycin, linezolid.
Important! The use of non-respiratory fluoroquinolones (pefloxacin, ciprofloxacin, norfloxacin, etc.) is considered irrational.
There are similar principles of treatment for community-acquired pneumonia caused by hemophilic bacillus or an intestinal group of bacteria.
In cases where the causative agent is staphylococcus aureus, special attention is paid to such a factor as MRSA/MSSA (methicillin-resistant/sensitive staphylococcus). With a methicillin-sensitive variety of MSSA, standard therapy is used, and one of the following drugs is chosen:
amoxicillin/clavulanate (Augmentin, Amoxiclav),
amoxicillin/sulbactam (Unazine, Sulacillin), cephalosporins of the 3rd generation (cefotaxime, ceftriaxone, cefixime, ceftibutene), lincosamides (lincomycin, clindamycin).
If the form of pneumonia is severe and MRSA is detected, then reserve drugs are used: linezolid, vancomycin. Atypical forms of pneumonia are treated with medications from the group of macrolides or tetracyclines (doxycycline), or respiratory fluoroquinolones.
Specific pathogenetic therapy is relevant for the detection of severe and prolonged forms of community-acquired pneumonia in adults. Pathogenetic therapy involves:
- Immunosuppression therapy;
- Detoxification therapy;
- Treatment of vascular insufficiency;
- Treatment of hypoxia or effective respiratory support;
- correction of perfusion disorders;
- Treatment of bronchial obstruction;
- Anti-inflammatory therapy.
In severe cases of community-acquired pneumonia, it is advisable to strengthen the protective forces. For this purpose, it can be cured by using immunomodulatory drugs (interferons, Levamizole, Zymosan, Diuciphon, T-activin, Thymalin, Polyoxidonium, Isoprinosine).
Immunosuppression and immunomodulatory therapy is prescribed only on the recommendation of a doctor, since with a strong weakening of the patient’s body, this type of drugs can worsen the condition.
When a bacterium and a virus are associated in the patient’s body, it is advisable to prescribe anti-influenza u-globulin, antiviral agents (Ribavirin, interferons). Viral influenza pneumonia is treated with Tamiflu.
In the case of severe staphylococcal inflammation, passive immunization with serum (hyperimmune antistaphylococcal) or staphylococcal antitoxin is performed.
Of the other methods of pathogenetic therapy, the correction of bronchial obstruction is important.
The causative agents of pneumonia contribute to the fact that the patency of the bronchi is significantly reduced due to the narrowing of their lumen, especially in atypical forms of inflammation.
Assign Berodual, Pulmicort, Berotek, Salbutamol, Atrovent. Funds with a bronchodilator effect, i.e. aimed at expanding the bronchi, it is better to enter by inhalation. This increases their efficiency. Of the tableted drugs, Teopek and Teotard are effective.
They use means that dilute sputum: Ambroxol, ACC, Bromhexine The combined action of Jocet allows you to expand the bronchi and facilitate the removal of sputum. A warm alkaline drink also has a positive effect: milk, mineral water.
The means of non-specific therapy include vitamins A, C, E, group B. Adaptogens also favorably affect the recovery of the body: eleutherococcus, tinctures of lemongrass and ginseng.
This type of therapy is carried out in order to eliminate the toxic effect of bacterial decay products on the body. Specific procedures, such as intravenous drip infusions of saline solution, glucose, are carried out in a serious condition. In most cases, copious drinking is effective.
Along with treatment with antibacterial drugs, non-drug support of the body is relevant. First of all, patients are recommended to drink plenty of alkaline water. You can use warm milk or mineral water.
Breathing exercises are effective. They improve the respiratory mobility of the chest wall, strengthen the respiratory muscles. Physical therapy is carried out with the help of various special devices or directly by gymnastics. Exercises, as well as other auxiliary activities, begin to be carried out no earlier than 3 days after the temperature normalizes.
It is possible to use massage (vibration or vacuum). These procedures are also carried out after a stable improvement in the condition. Vibration massage is performed with the help of special vibration massagers with a given amplitude. For vacuum massage, banks are used, which, due to the creation of negative pressure, improve local blood circulation and cause reflex irritation, vasodilation. Such procedures facilitate the drainage of the lungs, and reduce the inflammatory process in the alveolar tissue.
Physiotherapy is used as measures aimed at restoring the drainage ability of the bronchi, improving the discharge of sputum and normalizing the resistance of the body.
This auxiliary treatment is prescribed only after reaching a temperature of 37°C. Among the procedures, the most effective are:
- Inhalation of bronchodilators through a nebulizer or an ultrasonic inhaler;
- Local uhf therapy;
- Local Ufa;
- Electrophoresis of an antimicrobial drug.