Антибактериальная терапия обострений нетяжелой хронической обструктивной болезни легких


https://doi.org/10.18093/0869-0189-2014-0-4-105-111

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Аннотация

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.


Об авторах

В. А. Казанцев
ФГБВОУ ВПО "Военно-медицинская академия им. С.М.Кирова" Министерства обороны РФ
Россия

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



И. А. Гучев
ФГКУ "1586 Военный клинический госпиталь Западного военного округа" Министерства обороны РФ
Россия

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



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Для цитирования: Казанцев В.А., Гучев И.А. Антибактериальная терапия обострений нетяжелой хронической обструктивной болезни легких.  Пульмонология. 2014;(4):105-111. https://doi.org/10.18093/0869-0189-2014-0-4-105-111

For citation: Kazantsev V.A., Guchev I.A. Antibacterial treatment of moderate chronic obstructive pulmonary disease exacerbation. Russian Pulmonology. 2014;(4):105-111. (In Russ.) https://doi.org/10.18093/0869-0189-2014-0-4-105-111

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