PHARMACODYNAMIC SUBSTANTIATED APPROACHES TO THE CHOICE OF ANTIMICROBIAL THERAPY FOR NOSOCOMIAL AND NON-NOSOCOMIAL PNEUMONIA

Abstract

Background. The strategy of choosing antimicrobials has recently been complicated by the expansion and modification of the list of pneumonia pathogens and the growth of antibiotic resistance. This requires periodic review of existing approaches to the selection of antimicrobials since their irrational use is an independent risk factor for the development of death.

Material and methods. The article presents the materials of research that were carried out in two directions: the identification of the main causative agents of severe pneumonia with a fatal outcome and a retrospective analysis of antibiotic therapy of severe nosocomial and non-nosocomial pneumonia with a fatal outcome using pharmacological research.

Results. Considering the structure of pathogens and the profile of resistance to antimicrobial drugs, it is advisable to use 3-4 generation cephalosporins or amoxicillin/clavulanate, ertapenem or respiratory fluoroquinolones in empirical therapy regimens for severe non-nosocomial pneumonia. In empirical treatment regimens for severe nosocomial pneumonia, it is advisable to use Imipenem, Meropenem, Vancomycin, or Linezolid.

Conclusion. The need to include drugs active against MRSA (Vancomycin, Linezolid, etc.) in the regimens of initial therapy for non-nosocomial pneumonia requires additional study. Cephalosporins of 3-4 generations, fluoroquinolones and Amikacin can be recommended for the treatment of severe nosocomial pneumonia only based on the results of determining the sensitivity of the isolated pathogens.