Pharmacotherapy of specific and unspecific respiratory infections

Irrational administration of antimicrobials, incorrect regimens and dosing provide occurrence of adverse effects with minimal therapeutic results and development of drug resistance including anti-tuberculosis drugs.
The study was designed to detect information sources on drug therapy used by general practitioners and TB specialists, to establish stereotypical models of antibacterial drug administration in prevalent upper and lower airway diseases at the Samara region and to substantiate the supposition about unreasonable empiric administration of anti-tuberculosis drugs in a respiratory patient without microbiological confirmation as a probable cause of drug resistant tuberculosis. A cross-sectional study based on a special questionnaire was performed in 425 general practitioners in primary care facilities, hospitals and in TB specialists at the Samara region. The questionnaire contained several clinical situations and their solving and the respondents should choose the most suitable ones.
Results demonstrated that majority of the practitioners (80 %, or 340 / 425 cases) widely use advertising information regarding antimicrobials. Several doctors (1.7 %) chose antibacterial drugs to treat acute respiratory viral infection, 0.8 to 1.6 % of doctors certainly decided to administer anti-tuberculotics in non-TB respiratory diseases such as acute bronchitis, chronic obstructive pulmonary disease, communityacquired pneumonia and acute tonsillitis, and approximately one fifth of the practitioners thought to administer antituberculotics in these diseases (18.4 % (78 / 425) – rifampicin, 21.2 % (90 / 425) – isoniasid).

1. Павин M., Нургожин T., Хафнер Г. и др. Практика предписаний лекарств у сельских врачей первичной помощи в Узбекистане. Trop. Med. Int. Hlth 2003; 8 (2): 182—190.

2. Cars H., Hakansson A. To prescribe-or not to prescribe antibiotics. District physicians’ habits vary greatly, and are difficult to change. Scand. J. Prima Hlth Care 1995; 13 (1): 3—7.

3. Standing Medical Advisory Committee report. House of Lords; 1998.

4. Pechere J.C. Patients’ interviews and misuse of antibiotics. Clin. Infect. Dis. 2001; 33 (suppl. 3): S170—S173, PMID: 11524715

5. Macfarlane J., Holmes W., Macfarlane R., Britten N. Influence of patients’ expectations on antibiotic management of acute lower respiratory tract illness in general practice: questionnaire study. Br. Med. J. 1997; 315 (7117): 1211—1214.

6. Stone S., Gonzales R., Maselli J., Lowenstein S.R. Antibiotic prescribing for patients with colds, upper respiratory tract infections, and bronchitis: A national study of hospital-based emergency departments. Ann. Emerg. Med. 2000; 36 (4): 320—327.

7. Дробневский Ф., Балабанова Я., Радди М. и др. Туберкулез с множественной лекарственной устойчивостью и устойчивый к рифампину туберкулез в Российском гражданском и тюремном секторе: доминирование семьи Пекинского штамма. Emerg. Infect. Dis. 2002; 8 (11):1320—1326.

8. Smith R. Medical journals and pharmaceutical companies: uneasy bedfellows. Br. Med. J. 2003; 326: 1202—1208.

9. American Thoracic Society. Guidelines for the initial management of adults with community-acquired pneumonia: Diagnosis, assessment of severity, and initial antimicrobial therapy. Am. Rev. Respir. Dis. 1993; 148: 1418—1426.

10. BTS. Guidelines for the management of chronic obstructive pulmonary disease. Thorax 1997; 52 (suppl. 5): S1—S28.

11. BTS. Guidelines for the management of community acquired pneumonia in adults. Thorax 2001; 56 (suppl. 4): IV1—IV64.

12. European Respiratory Society Task Force report. Guidelines for management of adult community-acquired lower respiratory tract infections. Eur. Respir. J. 1998; 11: 986—991.

13. Крюков Н.Н. Диагностика и лечение внутренних болезней (стандарты). Самара: Изд-во Самар. мед. унта; 2000. 43—56.

14. Окороков А.Н. Лечение внутренних болезней. Руководство для врачей. М.: Мед. литература; 2000. 1—66; 176—208.

15. Чучалин А.Г., Синопальников А.И., Чернеховская Н.Е. Пневмония. М.; 2002.

16. Olivier C. Rheumatic fever — is it still a problem? J. Antimicrob. Chemother. 2000; 45 (suppl.): 13—21.

17. Mandell G.L., Bennet J.E., Dolin R. Principles and practice of infectious diseases. 4-ed. 1995. 606—608.

18. Jain N., Lodha R., Kabra S.K. Upper respiratory tract infections. Indian J. Pediatr. 2001; 68 (12): 1135—1138.

19. Плужников М.С., Лавренкова Г.В., Никитин К.А. Ангина и хронический тонзиллит: Руководство для врачей. СПб.; 2002. 15-18.

20. Солдатов И.Б. Лекции по оториноларингологии: Учеб. пособие. М.: Медицина; 1994. 168—190.