Antibiotic treatment of pneumonia
Pneumonia, including hospital-acquired pneumonia (HAP) and hospital acquired
pneumonia (CAP) of the fungus are not identical. For drugs in the treatment of HAP, you need to be able to confront some difficult to consider the governance of multi-drug-
resistant strains of antibiotics, especially in face of MPSA, Pseudomonas aeruginosa, Acinetobacter, resistance of Enterobacter cloacae and Serratia serious s bacteria should be timely use of the new generation of β-lactam antibiotics or β-lactamase
inhibitors and β-lactam antibiotic compound preparation; for CAP due to multi-drug
resistant strains of the rare, Application old Some of the β-lactam antibiotics and
macrolides antibiotics are often ineffective. Pneumonia, antibiotic therapy in general
can be divided into two situations: First experience in treatment; 2 is based on pathogen susceptibility test results of drug use.
An experience of treatment
1.1 The community-acquired pneumonia (CAP)
60 years of age without underlying diseases in patients infected with the pathogen mainly Streptococcus pneumoniae, Haemophilus influenzae out, Chlamydia pneumoniae, Mycoplasma pneumoniae and respiratory viruses. Pathogen and therefore are not clear with mild to moderate CAP, experience, penicillin therapy
should be the preferred class or first-generation cephalosporins. Sodium penicillin,
potassium penicillin can choose, penicillin V potassium tablets or ammonia amoxicillin, amoxicillin; first-generation cephalosporins can choose cefazolin sodium or
cephradine; can also be used macrolides, or cotrimoxazole , minocycline and so on. Second choice second-generation cephalosporins or β-lactam / β-lactamase inhibitors or
fluoroquinolones. The third generation of ceftriaxone and cefotaxime CAP also has a
good treatment. Fluoroquinolones ciprofloxacin and ofloxacin in to the most commonly used antibacterial effect of levofloxacin compared with ofloxacin strong tosufloxacin (Tosu-floxacin), and SPLX (Sparfloacin) against Gram-positive bacteria, Legionella,
Mycoplasma, and the enhanced role of Chlamydia.
Over 60 years of age and underlying diseases, pneumonia and more serious conditions other than the addition to the above pathogens, but also have aerobic gram-
negative bacilli, Staphylococcus aureus, and anaerobic bacteria such as Legionella. For severe CAP addition to the use of such antibacterial drugs, can be added with the amino sugar rickets drugs. CAP pathogens could include Legionella, Mycoplasma and Chlamydia, while the β-lactam class medicine with a large cyclopropane lactone class medicine combination therapy. King suspected staphylococcus infection, the choice of A oxacillin or cloxacillin. Such as suspicious for MRSA, then the use of vancomycin or
to vancomycin. If suspected Pseudomonas infections, can be used with anti-
Pseudomonas activity of penicillins, third-generation cephalosporin class, as well as β-
lactam / β-lactamase inhibitors; can also be used imipenem or ciprofloxacin and the new quinolones.
1.2 hospital-acquired pneumonia (HAP or NP)
The causal organism is non-existence of common risk factors with mild to moderate infections are common aerobic gram-negative bacilli and methicillin-sensitive
staphylococcus aureus (MSSA). The former includes Enterobacter spp, Klebsiella spp, variable opening bacteria, Serratia marcescens, and Haemophilus influenzae. Treatment can use second-generation cephalosporins or third generation cephalosporins in the ceftriaxone and cefotaxime and so on. Or β-lactam / β-lactamase
inhibitors, such as ampicillin / sulbactam, amoxicillin / clavulanic acid. Can not be
excluded, such as Pseudomonas infection, you can use anti-pseudomonas β-lactams,
including penicillins, third-generation cephalosporins, β-lactam / β-lactamase
inhibitory agents, and imipenem. Are allergic to penicillin can be used, such as fluoroquinolones or clindamycin plus aztreonam. If suspected anaerobic infection,
antibiotics can be the basis of the above major add clindamycin, can also be used with
metronidazole or β-lactam / β-lactamase inhibitors. If the suspected Legionella infections, mainly used macrolide plus rifampin.
Severe infections, in addition to the above-mentioned bacteria, this may appear highly resistant Gram-negative bacteria, such as the green pus A single-cell bacteria,
Acinetobacter spp and methicillin-resistant strains of micrantha (MRSA). Impaired immune function or neutropenia, or even suspected to have HIV infection or AIDS patient, there may be fungus, Pneumocystis carinii and cytomegalovirus infections. For severe HAP alone in the above anti-pseudomonas drugs based on the amino sugar rickets with class or in conjunction with ciprofloxacin. If the suspected MR-SA, or
vancomycin can be used to vancomycin plus amino sugar rickets class or ciprofloxacin, suspected fungal infection, can be added with ketoconazole or fluconazole.
The initial antibiotic therapy in HAP The basic principle is that: ? timely, adequate
volume, broad-spectrum, joint; ? punch; ? use of antibiotics should try to cover the possible pathogens; ? application of antibiotics prior to the bacterial culture.
Two pathogens are defined, the treatment
Principle is based on selection of appropriate antimicrobial susceptibility test drug
2.1 Streptococcus pneumoniae
Still penicillin therapy. For the moderately resistant strains, penicillin-type drugs
still available, but the need for greater dose, intravenous drip. In case of highly drug-
resistant strains of who should be added with vancomycin or rifampin; or application of ceftriaxone, cefotaxime, a new thiophene Snow ketone, or imipenem.
2.2 Staphylococcus aureus
? MSSA: oxacillin or chlorine preferred yl Syringa rifampicin or gentamicin, may be an alternative to wall neomycin, fluoroquinolones and so on. ? MRSA: treatment
should be preferred to vancomycin or vancomycin plus rifampicin, or amino rickets type of alternative medicine wall neomycin, fluoroquinolones and so on.
2.3 Haemophilus influenzae
First, second and third generation STZ, the new macrolides (such as clarithromycin and azithromycin) and fluoroquinolones such as cotrimoxazole. Alternative drugs
doxycycline, β-lactam / β-lactamase inhibitors. Reposted elsewhere in the paper for free download http://
2.4 Pseudomonas aeruginosa
Preferred anti-pseudomonas β-lactam plus aminoglycoside; or piperacillin /
tazobactam, ticarcillin / clavulanic acid, cefoperazone / sulbactam, imipenem can also be used , ciprofloxacin and aztreonam alternative.
2.5 pneumonia bacillus Reber
For the lower respiratory tract infection in common pathogens, is to produce ultra-
broad-spectrum β-lactamase (ESBL), one of the most common bacteria. Preferred first and second-generation cephalosporin plus amino rickets class medicine; alternative medicine for the fluoroquinolones, imipenem, aztreonam, β-lactam / β-lactamase
2.6 E. coli
Is a common bacteria of nosocomial infection is a common ESBL bacteria produce one of its treatment with Klebsiella pneumoniae.
Foundation of the existence of its multi-infection diseases and other risk factors,
which enhance the role of other bacterial virulence, mixed infection and drug resistance rates were high. Treatment of first choice to adapt to imipenem or fluoroquinolones
plus amikacin; alternative medicine has ceftazidime.
Preferred: erythromycin plus rifampicin, ciprofloxacin, levofloxacin. Alternative drugs are clarithromycin, azithromycin, doxycycline or a new fluoroquinolone.
Preferred metronidazole 500mg infusion, bid, or oral tid; or clindamycin 0.6g, intravenous infusion q 6 ~ 8h, fever or clinical symptoms improved was later changed to oral administration of 0.3g, tid; or penicillin plus metronidazole , or β-lactam / β-
lactamase inhibitors. If the use of penicillin, the dose should be large, 10 million units / day, sub-second intravenous infusion.
Candida can be selected oral ketoconazole (with liver disease were used with caution
or disabled); can also be used fluconazole oral, severe cases can first administered intravenously, the condition improved later changed to oral. Amphotericin B treatment is better, but major adverse reactions, should start small dose and gradually increasing
doses. Aspergillus infection in the treatment of choice amphotericin B, itraconazole has some effect, 200mg, oral, 1 ~ 2 times a day, with an average course of treatment 2 to 5 months.
2.11 Pneumocystis carinii infection in insects
Preferred cotrimoxazole, which SMZ75 ~ 100mg/kg/d, TMP15 ~ 20mg/kg/d, oral or intravenous, sub-sub-grant. Alternative Medicine: pentane Amidines, dapsone.
3 ESBLs principle of treatment
? severe infections, the preferred carbapenem (imipenem, meropenem); ? in a
stable condition after the change drugs, according to the results of selected amino sugar rickets susceptibility classes (amikacin, gentamicin), quinolones class (ciprofloxacin); ? the choice of antibiotic-containing enzyme inhibitor compound preparation (but
high-yielding enzyme strains, while strains with AmpC enzymes, enzyme inhibitors bad); ? available cephalosporin (cephalosporin West Ding, cefmetazole), but only to solve 2 / 3; ? avoid the use of penicillin and third generation cephalosporins.
4 continued to yield AcpC β-lactam treatment options mold
? carbapenems: imipenem, meropenem; ? fluoroquinolones: amikacin; ? four-
generation cephalosporins: cefepime, cefpirome; ? avoid the use of third-generation
cephalosporins Abamectin with the enzyme inhibitor complex preparation. Reposted elsewhere in the paper for free download http://