Антибактериальная терапия обострений нетяжелой хронической обструктивной болезни легких

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.

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