Medical notes 8. Pneumonia. Completed 11/02/14

Continues the theme of acute respiratory diseases.

Suggest an article about pneumonia (inflammation of the lungs).

Thus, pneumonia, or more complex formulation, — inflammation of the lower airways. Why two diagnoses? Because it is not always possible to determine the field — is a question of bacterial bronchitis or pneumonia. Easier to talk about «lower airway inflammation», then VNDP.

What causes VNDP? In the case of bronchitis, we talked about viral agents usually do not require antibiotic therapy. When overhead or VNDP pathogen most often — a bacterium. But, we must pay tribute, except bacteria there are several other, equally dangerous pathogens.
The article will only talk about bacterial VNDP adults in the field, in an outpatient (non-hospital) environment.

What is the pathogen most often vyzyvet VNDP?
Quote Russian sites:
http://www.03digest.ru/pnevmoniya.html
Approximately 50% of the cause of bacterial pneumonia is virus.

http://ru.wikipedia.org/wiki/% CF% ED% E5% E2% EC% EE% ED% E8% FF
Pneumococcus is responsible for up to 76% of community-acquired pneumonia in adults Russians.

http://pulmonolog.com/content/vnebolnichnaya-pnevmoniya
The most common causative agents of CAP are:
S.pneumoniae (pneumococcus) — 20-60%
Mycoplasma pneumoniae — 5-50% …

Clear — this Russian statistics or data literatry world. Statistics somewhat strange — and viruses, and pneumococci. But … it is logical.

What is written in foreign medical literature — the type of agent VNDP option depends by region, season, demographic and epidemiological factors.
In the U.S., the UK, Spain and Germany often the causative agent pneumococcus.
Has this information only medical value or there is some practical interest to know strange names and numbers? Undoubtedly «yes», explain why later.

All the people at their level, heard about the development of stability (resistance) pathogen to antibiotics. Yes, it is true, but not always resistance determines treatment. In German literature, write directly about what resistance, such as drugs, penicillin derivatives, does not really matter.

Briefly about diagnosing inflammation of the lower dyhatenyh ways.
Perhaps readers will be surprised, but there are no absolutely convincing, typical symptoms.
The most frequent, perhaps typical complaints of patients with pneumonia or lower respiratory tract infection:
— Sudden onset of a sharp rise in temperature (fever)
— Cough (dry or with moderate sputum)
— Chest pain (often on the affected side) may be aggravated by inhalation
— A sudden drop in temperature of the patient!,
— The feeling of lack of air during inhalation,
I can add a couple of symptoms: fatigue (literally from the first day of the disease), the participation of accessory muscles in breathing — that is, the patient breathes deeply through the help of the abdominal muscles, and the wings of the nose is actively moving when inhaling (imagine a man who very quickly ascended the stairs — he breathes so that you can see the movement of the wings of the nose), sweating, loss of appetite, thirst. The patient may be lethargic and not always adequate — as they say «raves.»

How to examine a patient?
Inspection — pale skin, sometimes on the lips herpes rash,
shortness of breath, sometimes a person says that sitting or half breathe easier than lying. Furthermore,
cough, complaints of chest pain, weakness.
Verify — whether contacts with unhealthy people, potential sources of TB, for example.
More important — was sick for the last three or four months of inpatient treatment at the hospital, he took antibiotics or other drugs, whether the day before yesterday, vomiting, swimming in the water … whether there was previously an allergy?
I do not think that a layman in the field has a stethoscope and a backpack, even if it is, whether it can correctly interpret the results of auscultation.
In this case, the overdiagnosis (increased diagnosis) is better than passive observation.

The consequence is a diagnostic treatment.

Pneumonia or lower respiratory tract infection is treated with antibiotics.
Administration of antibiotics occurs Empirically, that is — on the basis of experience, based on observations and experiments (see explanation of the term here).

Important information — the use of any drug can cause Unexpected side effects and complications! Before you advise or prescribe treatment, verify features — allergies to medicines, liver, kidney, heart, results of previous therapy with antibiotics Be prepared for a possible deterioration due to the development of shock (septic or allergic). Despite some inaccuracy terms, they show specifically, the relationship between the clinical treatment and complications.

All patients with suspected pneumonia in the community, just divide the (relatively) into two groups.

The first group. People aged 14-15 years, with no risk factors.
These include — chronic diseases (high blood pressure or arterial hyper-Tonia, chronic respiratory disease (asthma, bronchitis, tuberculosis ….), diseases of other organs and systems. Moreover, risk factors can be added — hospital treatment and antibiotics over the last few weeks.

In this group, in the preliminary diagnosis of «pneumonia» therapy begins immediately.
1. Heavy drinking (it is easier to cough up phlegm).
2. Calm — no exercise.
3. Reception lowering drugs temperature — aspirin, paracetamol, cooling the temporal region of the head with wet compresses … Consider the possibility of allergy!
4. Antibiotics.

Start with the drugs of choice (once appointed)
Amoxicillin. Recommendations of German literature — 1 gram taken irrespective of meals, three times a day.
Russian sources say the admission of 500 mg three times a day.
Possible unwanted effects — urticaria (skin rash), nausea, vomiting, development of shock.

The second group of antibiotics. In the absence of ampicillin or its intolerance / inefficiency can use the second group of drugs:

Azithromycin. German 1 times the dosage of 500 mg per day.
Russian sources indicate a similar dose.
Possible complications or side effects: nausea, vomiting, abdominal pain, weakness, headache.

Clarithromycin. Recommendations reception of German literature 500 mg 2 times a day,
Russian recommendations — 500 mg 2 times a day.
Possible complications or side effects: nausea, vomiting, abdominal pain, weakness, headache, agitation, panic attacks and panic.

Roxithromycin.
Recommendations of the German and Russian literature match — once daily 300 mg, regardless of the meal.
Possible complications or side effects: nausea, vomiting, abdominal pain, weakness, headache, allergic reactions.

Doxycycline. Again recommendations Russian and German literature the same — on the first day to take two 100 mg, then 100 mg once.
Possible complications or side effects: nausea, vomiting, abdominal pain, weakness, headache, allergic reactions.

We talked about the division of patients into two groups.
The above described steps in the absence of risk factors. Below are described the treatment in the presence of risk factors.

Risk factors include — chronic disease — high blood pressure or hypertension, chronic respiratory disease (asthma, bronchitis, tuberculosis ….) and other organs and systems. In addition, risk factors can be added — hospital treatment and antibiotics for the past few weeks.

The first group of drugs — amoxicillin in combination with klavuronovoy acid.
In tablet form in Yandex I did not find the drug.
German recommendation — receiving a combined preparation «Amoxicillin / Klavuronovaya acid» 1500/375 mg three times a day during meals with water.
Possible complications or side effects: nausea, vomiting, abdominal pain, weakness, headache, allergic skin reactions (often occur 5-7 days after discontinuation of the drug).
The Russian internet I found the drug only for intravenous administration.

Supplement. User Korvet found this preparation in the Russian Internet.
Link www.rlsnet.ru/tn_index_id_219.htm

Option sultamicillin.
Take 750 mg twice a day.
Possible complications or side effects: nausea, vomiting, abdominal pain, weakness, headache, diarrhea (often).

The second group of drugs (used in case of intolerance and / or ineffectiveness of the above means).

Moxifloxacin
Russian and German recommendations — 400 mg 1 time a day.
Possible complications — nausea, vomiting, abdominal pain, weakness, headache, insomnia, anxiety, palpitations.

Levofloxacin
Again we see a consensus — 500 mg once a day, regardless of the meal.
Possible complications — see above.

German literature points to a very important complication during and after treatment with moxifloxacin and / or levofloxacin — the tendency to inflammation and spontaneous rupture of the Achilles tendon!
I think that under certain conditions it is very dangerous.

Duration of treatment — at least 7-10 days upon receipt of a constant dose of antibiotic.
How to assess the course of the disease?
Recommended 48-72 hours compare the current and the initial state of the patient.

Criteria for improvement: Temperature decrease, dyspnea (patient breathes not as common as it was in the beginning of the disease), a decrease of cough and chest pain, increase efficiency.

Criteria deterioration: increased heart rate, consistently high or unexpectedly low temperature, persistent cough with increasing amounts of sputum, persistent shortness of breath, light blue lips, strange behavior — the patient does not always correctly understand others.

What if I have experienced a worsening?
Cause of the deterioration is most often resistant pathogen or multiple pathogens or low dosage of the drug.
In principle, the first group of patients (see above) recommends formulations can combine the various groups — amoxicillin, for example, atsitromitsin. Chance shock and other complications will be higher! It is possible that the second group can combine two raznogruppnyh drug.
You should think about consulting a doctor …

A few tips.
If ill survivalist single, it will be very difficult, may be advisable to perform all the advice to take medication at least 7-10 days.
If the sick person in the group, the collective survivalist, I consider it necessary to advise the following:
1. Try to isolate the person, at least, reduce contact with other people. If the group is sick is bad, if sick all at once, it’s just a disaster.
2. Treatment of a patient control over it should hold one person. It is easier to assess the dynamics of the disease.
3. Helping others and do not forget about yourself — improvised face mask (exotic viral pneumonia, tuberculosis?), Hand washing, etc.

Questions and answers.

Q. Why do we have German guideline? We ourselves with a mustache.
A. It is more international recommendations. Rationally know the experiences of others and use it instead of the way in the darkness, instead of mistakes and tragedies. Level of Western medicine is somewhat different from the Russian, all recommendations (prior to publication) repeatedly checked and analyzed. If you do not like the advice, I tried to indicate more and Russian sites for comparison.

Q. Why divide patients into two groups?
A. This article is written based on the recommendations of the German. When creating such
recommendations take into account the huge kind of statistical material. It is based on an analysis of statistics in the major countries, the doctors concluded that patients with chronic illnesses, or after treatment with antibiotics, the disease differs from that of pneumonia in young, healthy person. So — the sooner appropriate treatment is started, the greater the effect, and fewer complications. The division into two groups is a forced measure.

Q. Why drugs are divided into two groups?
A. Because there are different pathogens (see above). The preparation of the first group, for example, amoxicillin differs that acts primarily on the pneumococcus. The second group of drugs act on some others, the most common pathogens. Also they need to be taken in case of intolerance to penicillin group of drugs.

Q. Why are so many tips, so many medications? Why not one or two drugs in all cases of pneumonia or infection of some sort of ways? Why is it so difficult?
O.
First, I pointed out above, there are several options for the pathogen, ie each bacterium — your antibiotic.
Second, how to be in the case of failure or allergy to the «universal» antibiotic? Change it to another? What? The article indicated drugs selected on the basis of studying large statistical material in different countries, that is, in part it is «universal» antibiotics.
Third, it is unknown what drugs will be in the hands of the sick at the time of emergency, BP etc. The article contains a minimum of five drugs.
Fourth, imagine the situation. In the auto parts store person comes and says «I need new tires on the car.» Seller interested model car tire size, season of operation, etc. Buyer it clearly does not understand and says irritably, «What do I hang noodles? I Need To Pts P W K & N! Round and Black!!! Understand or not? »
Look like the search for a universal antibiotic.

Q. Do you believe that you can cure pneumonia in the field?
A. Yes and no. Success depends on the patient’s condition, adequacy of treatment (choice of drug, dosage, duration of admission), the type of pathogen. For reference, according to the German recommendations, well-fed Europe, under a peaceful sky, at an affordable medical care after treatment in an outpatient setting from 30 to 50 percent of patients require hospitalization!
Think about this fact — to half of the patients received medication at home, get to the hospital! The reason for this is 1.osobennosti exciter 2. Particular age, 3. Previous disease (it is most of the patients of the second group).
Pneumonia, one of the most ubiquitous cause of death in developed countries-industialno! Thus, in Germany overhead is in third place in the list of diseases caused by the death of the patient.

Q. How long does it take these drugs?
A. Again, referring to German literature (it is mandatory for doctors advice!) — Duration of treatment for at least 7-10 days.

Q. How do I determine intolerance amoxicillin or other drugs?
O. Skin rash of red, pink, itchy skin, swelling of the lips, face, tongue — is enough to stop the drug and go to the second group. Constant abdominal pain, diarrhea, agitation — neperonosimosti frequent symptoms.

Q. Do I need to take with allergy medications?
A. I think that is necessary. Itchy skin is very unpleasant. Swelling of face and tongue can be extremely life threatening.

Q. How do I determine the effectiveness of treatment?
A. See above.

Q. How do I determine treatment failure?
A. See above.

B. These «septic and allergic» shock are life-threatening?
A. Yes. Patient death can occur.

Q. If so, why take these drugs, whether there analogs?
O. Analogs any antibiotic can cause exactly the same reaction.

Q. Can I take other drugs from other groups, unspecified in the article?
O. Article written based on the German «Guidelines» for physicians. It is with these drugs begin treatment in the community. Other antibiotics of other groups, are intended for the hospital. Theoretically can be used in field conditions, the dosage to the manufacturer’s instructions.

Q. What is better — to take drugs in the form of pills or injections?
A. If vnutivennom or vnutimyshechnom medicines administered high concentration is achieved faster. Under field conditions, the probability of septic shock or allergic to, I think, above. In addition, you should be able to get shots and have all this.

For writing used the following references:

1. S3-Leitlinie: Tiefe Atemwegsinfektionen / Pneumonie 2009 — 2012.

«Epidemiologie, Diagnostik, antimikrobielle Therapieund Management von erwachsenen Patienten mit ambulant erworbenen tiefen Atemwegsinfektionen (akute Bronchitis, akute Exazerbation einer
chronischen Bronchitis, Influenza und andere respiratorische Virusinfektionen) sowie ambulant erworbener Pneumonie »

2. S-3 Leitlinie der Deutschen Gesellschaft fur Anasthesiologie und Intensivmedizin eV, der Deutschen Gesellschaft fur Infektiologie eV, der Deutschen Gesellschaft fur Hygiene und Mikrobiologie eV, der Deutschen Gesellschaft fur Pneumologie und Beatmungsmedizin eV und der Paul-Ehrlich-Gesellschaft fur Chemotherapie eV

«Epidemiologie, Diagnostik und Therapie erwachsener Patienten mit nosokomialer Pneumonie»
As I mentioned, these «Guidelines» are often in Russian called «guideline.» These recommendations were prepared by the German scientific societies of anesthesiologists, pulmonologists, and infectious disease specialists in respiratory medicine.

3. Innere Medizin Gerd Harold und Mitarbeiter. 2014

Thank you for your attention, waiting for criticism and comments.

Добавить комментарий

Tags: , , , ,

Site "Survival in the wild nature", glad to see you. If you come to us, it means you want to get complete information about survival in a variety of extreme conditions, in emergency situations. Man, throughout the development, sought to preserve and protect themselves from the various negative factors surrounding it - cold, heat, hunger, dangerous animals and insects.

Site structure "Survival in the wild nature" is simple and logical, selecting a specific section, you will find information. You will find on our website recommendations and practical advice on survival, unique descriptions and pictures of animals and plants, turn-based scheme to trap wild animals, tests and reviews of travel gear, rare books on survival and wildlife. The site also has a large section devoted to video on survival survivalist-known professionals around the world.

The main theme of the site, "Survival in the wild nature" - is to be ready to be in the wild, and the ability to survive in extreme conditions.

The Survival in the wild nature - how correctly to behave, it having appeared in an emergency situation. Ability to find a way out from any situation: to kindle a fire, to put traps, to prepare food, to arrange dwelling and a lodging for the night; to learn to knit knots, to clear water, to be guided by districts, correctly to choose equipment, a knife. Also you can download directories to tourists, encyclopedias survivals, video Bear Grills to Survive at any cost (Man vs. Wild).