Modern Methods of Pneumonia Therapy

Posted by Jared S on March 17th, 2021

An integrated approach to treating a disease is a fundamental aspect of therapy. Its volume depends on the severity of the patient's condition. Treatment includes the appointment of medicines, both antibacterial and other drugs, aimed at eliminating the cause of pneumonia and preventing complications. Non-drug treatment means a regimen, nutrition, physiotherapy. The severe pneumonia course is accompanied by detoxification, hormonal anti-inflammatory and hospital therapy, resuscitation measures.

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There are many options to treat pneumonia and we will describe them below.

Medicamentous therapy

In the treatment of pneumonia, antimicrobial drug is chosen first after diagnosis. At the initial disease's stage, it is impossible to use etiotropic therapy. This means that it is not possible to prescribe a medicine that will act directly 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 patient's age and complaints, medical history, 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 can kill most of the bacteria that cause community-acquired pneumonia. Empiric therapy, based on the severity of the disease's course, can be carried out at home or in a hospital. When appointing a list of medicines at home, the following means are chosen:

• in patients without concomitant pathologies who have not taken antibacterial therapy for the last 3 months - amoxicillins or macrolides (medicines based on azithromycin, clarithromycin);
• in patients with intercurrent diseases, aggravated by the course of inflammation, who have taken such a therapy for the last 3 months, protected amoxicillins with clavulanic acid) or macrolides (azithromycin, clarithromycin), or fluoroquinolones (levofloxacin, moxisifloxacin, hemifloxacin).

Antimicrobial drugs for pneumonia

β-lactam antibiotics:

• Unprotected amoxicillins (Amoxicillin, Amoxicar, Flemoxin Solutab);
• Protected amoxicillins (Amoxiclav, Augmentin);
• Cefuroxime Axetil (Zinnat, Zinacef).

Macrolides:

• Clarithromycin (Fromilid, Klacid, Klabax);
• Roxithromycin (Rulicin, Rulid);
• Azithromycin (Azibiot, Sumamed, Azimycin).

Fluoroquinolones (for pulmonary pathology):

• Levofloxacin (Tavanic, Levoximed);
• Moxifloxacin (Moxifur, Avelox, Simoflox);
• Hemifloxacin (Factive).

The effectiveness of therapy is assessed after 48-72 hours. If there is a positive trend, the treatment is continued. When the condition worsens, the doctor changes the main antibacterial therapy.

Important! Changing antibiotics frequently during treatment can lead to 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 drugs' action.

Etiotropic therapy

If the proper effect of the treatment is not found, the pathogen is known, a more accurate etiotropic therapy is used.

The structure of causative agents of pneumonia 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 chlamydiae initiate 20-30% of pneumonia and have an atypical course.
• Haemophilus influenzae (H. influenzae), Klebsiella pneumoniae, Legionella pneumoniae in adults cause pneumonia in 5% of cases.

In the absence of resistance, 3-generation cephalosporins are used (cefotaxime, ceftriaxone, cefixime, ceftibuten). Alternative auxiliary drugs are also used: macrolides (clarithromycin, azithromycin), fluoroquinolones for the treatment of pulmonary pathology (levofloxacin, moxifloxacin, gemifloxacin). In severe cases, reserve antibacterial therapy is prescribed: vancomycin, linezolid.

The use of non-respiratory fluoroquinolones (pefloxacin, ciprofloxacin, norfloxacin, etc.) is considered irrational.

Similar principles of treatment and in community-acquired pneumonia caused by Haemophilus influenzae 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 aureus). For methicillin-sensitive MSSA, standard therapy is used and choosen one of the following:
amoxicillin / clavulanate (Augmentin, Amoxiclav),
amoxicillin / sulbactam (Unazin, Sulacillin), 3rd generation cephalosporins (cefotaxime, ceftriaxone, cefixime, ceftibuten), lincosamides (lincomycin, clindamycin).

Pathogenetic therapy

Specific pathogenetic therapy is relevant in identifying severe and protracted forms of community-acquired pneumonia in adults. Pathogenetic therapy involves:

• immunosubstitution 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 the community-acquired pneumonia course, it is advisable to strengthen the protective forces. For this purpose, it can be cured by using immunomodulatory drugs (Interferons, Levamisole, Zimozan, Diucifon, Timalin, Polyoxidonium, Isoprinosin).

Immunosubstitution and immunomodulatory therapy is prescribed only on the doctor's recommendation, since with a strong weakening of the patient's body, this type of drug can worsen the overal condition.

Detoxification therapy

This type of therapy is carried out in order to eliminate the toxic effect on the body of the decomposition products of bacteria. Specific procedures, such as intravenous drip infusion of saline, glucose, are carried out in a complicated state. Drinking plenty of fluids is effective in most cases.

Non-drug therapy

Along with antibacterial drugs therapy, non-drug support for the body is relevant. First of all, patients are recommended to drink plenty of alkaline drink. Warm milk or mineral water can be used.

Breathing exercises are effective. They improve the respiratory mobility of the chest wall, strengthen the respiratory muscles.

Exercise therapy is carried out using 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 has returned to normal.

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 using special vibration massagers with a given amplitude. For vacuum massage, cups are used, which, due to the creation of negative pressure, improve local blood circulation and cause reflex irritation, vasodilation. Such procedures facilitate lung drainage and reduce inflammation in the alveolar tissue.