pulmoПульмонологияPULMONOLOGIYA0869-01892541-9617Scientific and Practical Journal “PULMONOLOGIYA” LLC10.18093/0869-0189-2014-0-4-105-111pulmo-446Research ArticleОБЗОРЫREVIEWАнтибактериальная терапия обострений нетяжелой хронической обструктивной болезни легкихAntibacterial treatment of moderate chronic obstructive pulmonary disease exacerbationКазанцевВ. А.KazantsevV. A.

д. м. н., профессор, кафедра терапии усовершенствования врачей ФГБВОУ ВПО "ВМА им. С.М.Кирова" Министерства обороны РФ; тел.: (921) 9463803

victor.kazantsev@mail.ruГучевИ. А.GuchevI. A.

к. м. н., начальник терапевтического отделения филиала № 4 ФГКУ "1586 Военный клинический госпиталь Западного военного округа" Министерства обороны РФ; тел.: (4812) 686728

iguchev@gmail.comФГБВОУ ВПО "Военно-медицинская академия им. С.М.Кирова" Министерства обороны РФРоссияFederal Military Institution S.M.Kirov's Military Academy, Defense Ministry of Russian FederationRussian FederationФГКУ "1586 Военный клинический госпиталь Западного военного округа" Министерства обороны РФРоссияFederal Institution "Military Clinical Hospital 1586 of the Western military district", Defense Ministry of Russian FederationRussian Federation20142808201404105111Copyright © Казанцев В.А., Гучев И.А., 20142014Казанцев В.А., Гучев И.А.Kazantsev V.A., Guchev I.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.pulmonology.ru/pulm/article/view/446

Хроническая обструктивная болезнь легких (ХОБЛ) – основная причина заболеваемости и смертности в мире. Периодически естественное прогрессирующее течение ХОБЛ прерывается обострениями, обусловливающими дальнейшее ухудшение функциональной способности легких. При гнойном обострении (1й и 2й тип по N.Anthonisen) в случае своевременно начатой антимикробной терапии ограничивается неблагоприятное влияние воспаления и увеличивается интервал между обострениями. Учитывая ключевую роль Haemophilus influenzae и Streptococcus pneumoniae, в качестве препарата выбора при обострении нетяжелой ХОБЛ в группе пациентов низкого риска рекомендуется амоксициллин, активность которого направлена против 97 % выделенных в России штаммов гемофильной палочки. При непереносимости пенициллинов, не связанной с иммуноглобулином E, целесообразно применение цефиксима – высокоактивного антигемофильного препарата с умеренной антипневмококковой активностью. Применение 14 и 15членных макролидов в связи с низкой антигемофильной и снижающейся антипневмококковой активностью не рекомендуется. В случае непереносимости βлактамов альтернативным препаратом является респираторный фторхинолон.

Chronic obstructive pulmonary disease (COPD) is one of the main causes of morbidity and mortality worldwide. Time to time, the natural progres sive course of COPD is interfered by exacerbations which lead to further lung function worsening. Adequate antibacterial therapy could diminish unfavorable inflammation effects and prolong time to the next exacerbation in patients with Anthonisen's type 1 and type 2 exacerbations. Given the leading role of Haemophilus influenzae and Streptococcus pneumonia as causative agents in COPD exacerbations, amoxicillin is recommended as the first choice drug in lowrisk patients with nonsevere COPD exacerbation. Amoxicillin is also active against 97% of H. influenzae strains in Russia. In patients with poor tolerance of penicillins, if not related to IgE, administration of cefixime, which is highly active against H. influenza and moderately active against S. pneumonia, is reasonable. In case of βlactam intolerance respiratory fluoroquinolones could be considered as alternative drugs.

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The authors declare that there are no conflicts of interest present.