Rational strategy of pharmacotherapy of patients with community-acquired pneumonia at elderly and senil eage

Abstract

Introduction. Nonhospital pneumonia is the most common acute infectious infections disease of the lower respiratory tract.  The incidence of the community-acquired pneumonia in Ukraine is 3 - 11 cases per 1,000 in adults per year and is the highest among the elderly and old patients. According to the foreign epidemiological studies, the incidence of nonhospital pneumonia in persons of young and middle-aged adults (> 18 years) is 1 - 11,6 %; in the older age groups - 25 - 44 %. Mortality from nonhospital pneumonia without concomitant diseases is also the lowest (1-3 %) in those young and middle age. In patients over 60 years of age, if there is a serious comorbidity and in cases of severe nonhospital pneumonia, this figure reaches 15-30 %. To improve treatment outcome in nonhospital pneumonia and cost optimization in recent years a number of international and national recommendations were proposed.  This help doctor to choose the most rational strategy for the management of patients in a specific clinical situation.

The aim of the study. Retrospective analysis of case histories of patients older than 60 years with nonhospital pneumonia treated in the therapeutic department during the period from September 2010 to May 2013. Assessment of the quality of medical care and the practice of the appointment systemic antibacterial therapy in accordance with modern standards and quality indicators.

Material and methods.  Were selected 66 case histories of patients with nonhospital pneumonia, men were 41 people (62.1%), and women - 25 (37,9%), the average age was 69,5 ± 8.1 years. Based on the goal of the research objectives were: to assess the quality of medical aid for patients with nonhospital pneumonia and frequency of antibacterial therapy for patients with nonhospital pneumonia in a particular situation.; explore the features of administration of antibiotics at the start of therapy of the community-acquired pneumonia and compliance choice of antibiotic therapy to the national guidelines. Statistical data processing was carried out in the system of the SPT Statistica, version 8.0.

Results and discussion. All hospitalized patients received systemic antibiotic therapy. Frequency assignments AMP patients at the outpatient stage was 21 %. Quick antibacterial therapy was in 15.1 % (n=10) cases, mainly in patients from 60 to 68 years, with no complications. Starting antibiotic therapy in most cases was chosen according to the national treatment guidelines. High efficiency of the combined antibacterial therapy compared with mono - antibacterial therapy was noted.

Conclusions:

The most effective antibacterial treatment was expected from the triple combination of antibacterial drugs: cephalosporins 3rd generation + fluoroquinolones + macrolides.

The study has also noted the high relevance of the ongoing antibiotic therapy with existing national guidelines for management of patients with nonhospital pneumonia (89,9 %), which is comparable with the commitment to comply with the recommendations in the clinics of Europe and the USA.