pulmoПульмонологияPULMONOLOGIYA0869-01892541-9617Scientific and Practical Journal “PULMONOLOGIYA” LLC10.18093/0869-0189-2014-0-6-65-72pulmo-495Research ArticleОБЗОРЫREVIEWОбострения хронической обструктивной болезни легких: выбор антибактериальной терапииExacerbation of chronic obstructive pulmonary disease: a choice of antibacterial treatmentАвдеевС. Н.AvdeevS. N.

д. м. н., профессор, зав. клиническим отделом ФГБУ "НИИ пульмонологии" ФМБА России; тел. / факс: (495) 465-52-64

MD. Professor, Head of Clinical Department, Federal State Budget Institution "Pulmonology Research Institute", Federal Medical and Biological Agency of Russia; tel. / fax: (495) 465-52-64

serg_avdeev@list.ruФГБУ "НИИ пульмонологии" ФМБА России: 105077, Москва, ул. 11-я Парковая, 32, корп. 4РоссияFederal Institution "Pulmonology Research Institute", Federal Medical and Biological Agency of Russia: 32, build. 4, 11th Parkovaya ul., Moscow, 105077, Russia SummaryRussian Federation201428122014066572Copyright © Авдеев С.Н., 20142014Авдеев С.Н.Avdeev S.N.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/495

Развитие обострений характерно для течения хронической обструктивной болезни легких (ХОБЛ). Ведущая роль бактериального фактора в генезе развития обострения ХОБЛ является основанием для назначения антибактериальных препаратов. Доказано, что при антибактериальной терапии (АБТ) в случае обострения ХОБЛ ускоряется разрешение обострения и улучшаются функциональные показатели и прогноз. При неосложненных обострениях ХОБЛ (легкого и среднетяжелого течения, без факторов риска) рекомендуется назначение амоксициллина, современных макролидов или цефалоспоринов III поколения (цефиксим и т. п.). При осложненных обострениях ХОБЛ (тяжелое течение заболевания или наличие факторов риска) рекомендовано назначение либо амоксициллина / клавуланата (АМК), либо респираторных фторхинолонов (левофлоксацин или моксифлоксацин). Лечение обострений ХОБЛ с помощью АМК является высокоэффективной терапией, при которой значительно увеличивается время до следующего обострения по сравнению с плацебо. При использовании АМК в виде диспергируемых таблеток значительно уменьшается число побочных эффектов АБТ у пациентов с обострением ХОБЛ. 

Exacerbation is a typical feature of the natural history of chronic obstructive pulmonary disease (COPD). The leading role of bacteria substantiates use of antibacterial therapy in this disease. Antibacterial therapy of COPD exacerbation has been shown to shorten the length of exacerbation, to improve lung function and prognosis. Amoxicilline, newer macrolides, such as azithromycin, clarithromycin, or the 3rd generation of cephalosporins, such as cefixime, etc., are recommended for patients with uncomplicated exacerbation of mild to moderate COPD without risk factors. Amoxicilline / clavulanate or newer quinolones (levofloxacin or moxifloxacin) are recommended for patients with severe COPD and complicated exacerbation or with risk factors. Amoxicilline / clavulanate is highly effective in COPD exacerbations and significantly increases time to the first exacerbation compared to placebo. Dispersible tablets of amoxicilline / clavulanate could reduce a rate of adverse events in patients with exacerbation of COPD. 

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