RESUMO
Pneumococcal pneumonia and other diseases caused by pneumococci still remain the main factors of high morbidity and mortality rates throughout the world. Pneumococci as the leading pathogens of community-acquired pneumonia (CAP), acute otitis media and sinusitis also cause a number of other serious systemic disorders including invasive infections with high mortality in spite of the antimicrobial resistance status and adequate antimicrobials choice. Pneumococcal infections are responsible for 5-35% or more of community-acquired pneumonias. The burden of pneumonia (up to 100-200 per thousand) is recorded among military recruits in training centers. Since the specific environment of the soldiers could be carrected, their health protection requires medical surveillance. For these reasons, polysaccharide and more immunogenic conjugated pneumococcal vaccines were developed. There is now an urgent need to understand whether such vaccines are effective in military conscripts. Controversy about the effectiveness and value of the polysaccharide (PPV-23) vaccine as a CAP morbidity restriction measure still persists. There were implemented plenty of metaanalyses of pneumococcal vaccines in adults. Some of them showed that the vaccine was effective against bacteremic pneumococcal pneumonia in 'low risk' healthy adults and elders. There have been a number of poor quality observational studies in Russia where 'all pneumonia cases' were considered as an endpoint. It remains controversial whether these observational studies provide adequate evidence to justify the use of the polysaccharide vaccine in the groups of healthy young men for whom it is being advocated. In our analysis we found weak evidence supporting pneumococcal vaccination with PPV-23 for this group. Nevertheless, favorable tendency was found to immunize. It is the reason for a trail to find pharmacoepidemiological support for vaccination by novel conjugated vaccines with better immunogenicity.
Assuntos
Controle de Doenças Transmissíveis , Doenças Transmissíveis , Surtos de Doenças/prevenção & controle , Militares , Vacinas Pneumocócicas/uso terapêutico , Pneumonia Bacteriana , Adulto , Feminino , Humanos , Masculino , Medicina Militar/métodos , Pneumonia Bacteriana/epidemiologia , Pneumonia Bacteriana/prevenção & controleRESUMO
Community-acquired pneumonia (CAP) remains one of the major healthcare problems globally. Pneumococcal disease is the leading cause of deaths among vaccine preventable diseases in children and adults. Plain polysaccharide vaccine PPSV-23 and conjugated pneumnococcal polysaccharide vaccine PCV-13 are widely used to prevent pneumococcal disease and CAP in adults without immunosuppression. The review concerns the results of trials and meta-analysis of PPSV-23 and PCV-13 effectiveness in invasive pneumococcal disease (IPD) and CAP prevention in immunocompetent adults. More and more expert immunization committees in different countries are taking into consideration uncertain effectiveness of PPSV-23 in CAP prevention in immunocompetent adults, and recommend the PCV-13 priority use for mass immunization campaigns in high-risk groups and elder population. Since the Russian Federation has started the PCV-13 vaccination campaign for early childhood only at the end of 2014, the anticipated serotype replacement should not be taken into consideration at the moment across all the age groups, and therefore the risk and age based approach to adult vaccination should be used with the PCV-13 priority.
Assuntos
Imunidade Inata/efeitos dos fármacos , Vacinação em Massa/métodos , Vacinas Pneumocócicas/administração & dosagem , Pneumonia Pneumocócica/prevenção & controle , Streptococcus pneumoniae/efeitos dos fármacos , Adulto , Criança , Infecções Comunitárias Adquiridas , Humanos , Programas de Imunização/organização & administração , Imunocompetência , Pneumonia Pneumocócica/epidemiologia , Pneumonia Pneumocócica/imunologia , Pneumonia Pneumocócica/microbiologia , Federação Russa/epidemiologia , Streptococcus pneumoniae/crescimento & desenvolvimento , Streptococcus pneumoniae/imunologia , Vacinas Conjugadas , Vacinas de Subunidades AntigênicasAssuntos
Infecções Comunitárias Adquiridas/tratamento farmacológico , Levofloxacino , Ofloxacino , Pneumonia/tratamento farmacológico , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Bactérias Gram-Negativas/efeitos dos fármacos , Bactérias Gram-Positivas/efeitos dos fármacos , Humanos , Ofloxacino/economia , Ofloxacino/farmacocinética , Ofloxacino/uso terapêuticoAssuntos
Amoxicilina/uso terapêutico , Antibacterianos/uso terapêutico , Rinite/tratamento farmacológico , Sinusite/tratamento farmacológico , Adolescente , Adulto , Amoxicilina/administração & dosagem , Amoxicilina/efeitos adversos , Antibacterianos/administração & dosagem , Antibacterianos/efeitos adversos , Farmacorresistência Bacteriana , Humanos , Adulto JovemAssuntos
Ampicilina/uso terapêutico , Antibacterianos/uso terapêutico , Bactérias/efeitos dos fármacos , Infecções Comunitárias Adquiridas/tratamento farmacológico , Combinação Amoxicilina e Clavulanato de Potássio/efeitos adversos , Combinação Amoxicilina e Clavulanato de Potássio/farmacologia , Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Ampicilina/efeitos adversos , Ampicilina/farmacologia , Resistência a Ampicilina , Antibacterianos/efeitos adversos , Antibacterianos/farmacologia , Inibidores Enzimáticos/efeitos adversos , Inibidores Enzimáticos/farmacologia , Inibidores Enzimáticos/uso terapêutico , Humanos , Cooperação do Paciente , Inibidores de beta-LactamasesRESUMO
The purpose of investigation was to evaluate the efficiency and safety of dipyridamole (the inductor of endogenous interferon) in prevention of outbreaks of extrahospital pneumonia (EP) and acute respiratory diseases (ARD). 2226 servicemen arrived to the educational center were studied. In the control group (n = 1034) EP developed in 11.9%, clinically significant ARD cases were noted in 18.7% (in prophylaxis group 9.6 and 11.7% respectively). The efficiency and safety of dipyridamole used to prevent ARD was demonstrated.
Assuntos
Dipiridamol/uso terapêutico , Surtos de Doenças/prevenção & controle , Indutores de Interferon/uso terapêutico , Militares , Infecções Respiratórias/prevenção & controle , Adolescente , Adulto , Dipiridamol/administração & dosagem , Humanos , Indutores de Interferon/administração & dosagem , Masculino , Estudos Prospectivos , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/etiologia , Federação Russa , Estações do Ano , Viroses/complicações , Viroses/epidemiologiaRESUMO
The influence of azithromycin prophylaxis on clinical course of extra-hospitalpneumonia (EP) and efficiency of empirical antibiotic therapy was studied. During 5 months EP was diagnosed in 2 groups (prophylaxis and control) in 8.6% (47/548) and 20.2% (137/678) subjects respectively. Mild EP was diagnosed in all cases. No significant differences in EP clinical course between the groups were noted. The empirical therapy using benzylpenicillin was considered as effective in 90.5% [95% CI=84.3-94.9%] and in 89.4% [95% CI=76.9-96.5%] cases in the control group and group of prophylaxis respectively (P=0.84).
Assuntos
Antibacterianos/uso terapêutico , Azitromicina/uso terapêutico , Broncopneumonia/prevenção & controle , Militares , Infecções Respiratórias/prevenção & controle , Adolescente , Adulto , Amoxicilina/uso terapêutico , Broncopneumonia/tratamento farmacológico , Broncopneumonia/microbiologia , Humanos , Masculino , Infecções Respiratórias/tratamento farmacológicoRESUMO
The efficacy and safety of azithromycin prophylaxis of community-acquired pneumonia (CAP) in young adults in a military training centre of the Ministry of Defence of the Russian Federation located in the Central European Region of Russia were studied. Two prophylactic regimens with azithromycin vs. the control were evaluated: azithromycin, 500 mg/w for 8 weeks (R1), azithromycin, 1500 mg once upon the enrolment (R2) and no drugs (R3). Nasopharyngeal carriage of Streptococcuspneumoniae and its susceptibility to antibacterials were estimated thrice: before the exposure, after the exposure within the 9th week and after the exposure within the 20th week. The MLS(B) phenotype was suspected when the isolates were resistant to erythromycin and clindamycin. During the observation period of 22 weeks CAP was diagnosed in 20.2% of 678 subjects in group R3, 8.6% of 508 subjects in group R1 (Risk Ratio =0.4, 95% Cl = 0.3-0.6) and 10.3% of 507 subjects in group R2 (Risk Ratio = 0.5, 95% Cl = 0.4-0.7). The S.pneumoniae carriage rate at visit 0 was 34-35%, within the 9th week it was 75, 66 and 50% (p<0.05) in groups R1, R2 and R3 respectively, and within the 20th week it was 69, 57 and 36% in the same groups (p<0.05). At visit 0 no macrolide resistance was detected in any of the 40 isolates tested. The background level of intermediate penicillin resistance was revealed in 0-14% of the isolates. Dramatic growth of macrolide resistance was observed within the 9th week in group R1 (95.7%, 44 resistant strains, Azithro+Clinda resistance in 37% of them) and in group R2 (89.5%, 34 resistant strains, Azithro+Clinda resistance in 11.9% of them). By the 20th week the resistance rate decreased up to 40 % (16 resistant strains, Azithro+Clinda resistance in 10% of them) in group R1 and up to 22.6% (7 resistant strains, Azithro+Clinda resistance in 5.4% of them) in group R2. As for penicillin resistance, no unfavourable shifts were detected. The study demonstrated the effectiveness of the azithromycin prophylaxis of CAP in healthy young men at high transient risk of the disease, as well as the possible risk for selection of resistant endemic pathogens.
Assuntos
Antibacterianos/uso terapêutico , Antibioticoprofilaxia , Azitromicina/uso terapêutico , Portador Sadio/prevenção & controle , Infecções Comunitárias Adquiridas/prevenção & controle , Militares , Doenças Nasofaríngeas/prevenção & controle , Infecções Pneumocócicas/prevenção & controle , Infecções Respiratórias/prevenção & controle , Administração Oral , Adolescente , Adulto , Antibacterianos/administração & dosagem , Antibacterianos/farmacologia , Azitromicina/administração & dosagem , Azitromicina/farmacologia , Clindamicina/farmacologia , Infecções Comunitárias Adquiridas/epidemiologia , Farmacorresistência Bacteriana , Eritromicina/farmacologia , Humanos , Testes de Sensibilidade Microbiana , Penicilinas/farmacologia , Federação Russa , Streptococcus pneumoniae/efeitos dos fármacos , Streptococcus pneumoniae/isolamento & purificaçãoRESUMO
The purpose of the study was to evaluate the effectiveness and prevention of outbreaks of community-acquired pneumonia (CAP) and acute respiratory diseases (ARD). The study included conscripts arrived at a training center. An 8-week course of prevention (curantyl, 100 mg a week) was assessed. The end point of the study was a new case of CAP and ARD. The study covered 2333 persons, of them 2226 completed the study. In the control group (n = 1034), CAP developed in 11.9% of the examinees (95% confidence interval (CI), 10-14%), clinical cases of ARD were observed in 18.7% (95% CI, 16-21%. The same parameters in the prophylaxis group (n = 1192) were 9.6% (95% CI, 8-11%) and 11,7% (95 CI, 10-14%). The relative risk of the diseases for a prevention group was 0.8 (95% CI, 0.7-1.1) (p = 0.34) and 0.6% (95% CI, 0.5-0.8) (p < 0.0001), respectively. The study has demonstrated that dipyridamole is effective and safe as a drug for preventing ARD. The findings were slightly more scarce than those obtained by other authors, which may explain the performance of the study in summer when the role of respiratory viruses and related disease is not so significant.
Assuntos
Dipiridamol/uso terapêutico , Inibidores de Fosfodiesterase/uso terapêutico , Infecções Respiratórias/prevenção & controle , Doença Aguda , Adolescente , Adulto , Método Duplo-Cego , Humanos , Masculino , Vigilância da População/métodos , Estudos ProspectivosAssuntos
Antibacterianos/uso terapêutico , Eucariotos/efeitos dos fármacos , Fungos/efeitos dos fármacos , Bactérias Gram-Negativas/efeitos dos fármacos , Bactérias Gram-Positivas/efeitos dos fármacos , Sepse/tratamento farmacológico , Animais , Anti-Inflamatórios/uso terapêutico , Antiprotozoários/uso terapêutico , Eucariotos/isolamento & purificação , Eucariotos/patogenicidade , Fungos/isolamento & purificação , Fungos/patogenicidade , Bactérias Gram-Negativas/isolamento & purificação , Bactérias Gram-Negativas/patogenicidade , Bactérias Gram-Positivas/isolamento & purificação , Bactérias Gram-Positivas/patogenicidade , Humanos , Sepse/etiologiaAssuntos
Pneumonia Bacteriana/prevenção & controle , Pneumonia Pneumocócica/prevenção & controle , Antibacterianos/uso terapêutico , Azitromicina/uso terapêutico , Chlamydophila pneumoniae/efeitos dos fármacos , Chlamydophila pneumoniae/isolamento & purificação , Chlamydophila pneumoniae/patogenicidade , Farmacorresistência Bacteriana/genética , Humanos , Militares/estatística & dados numéricos , Neisseria meningitidis/efeitos dos fármacos , Neisseria meningitidis/isolamento & purificação , Neisseria meningitidis/patogenicidade , Pneumonia Bacteriana/epidemiologia , Pneumonia Pneumocócica/epidemiologia , Streptococcus pneumoniae/efeitos dos fármacos , Streptococcus pneumoniae/isolamento & purificação , Streptococcus pneumoniae/patogenicidade , Vacinas/uso terapêuticoAssuntos
Antibacterianos/uso terapêutico , Azitromicina/uso terapêutico , Pneumonia Bacteriana/tratamento farmacológico , Pneumonia Bacteriana/prevenção & controle , Adolescente , Adulto , Resistência Microbiana a Medicamentos/genética , Humanos , Incidência , Masculino , Militares , Pneumonia Bacteriana/epidemiologia , Federação RussaAssuntos
Antibacterianos/uso terapêutico , Pneumonia/tratamento farmacológico , Índice de Gravidade de Doença , Adolescente , Adulto , Chlamydophila pneumoniae/efeitos dos fármacos , Humanos , Masculino , Militares , Pneumonia por Mycoplasma/tratamento farmacológico , Pneumonia Pneumocócica/tratamento farmacológico , Resultado do TratamentoAssuntos
Antibacterianos/uso terapêutico , Dermatopatias Bacterianas/tratamento farmacológico , Infecções dos Tecidos Moles/tratamento farmacológico , Antibacterianos/administração & dosagem , Infecção Hospitalar/tratamento farmacológico , Quimioterapia Combinada , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Sepse/tratamento farmacológico , Dermatopatias Bacterianas/microbiologia , Infecções dos Tecidos Moles/microbiologiaRESUMO
The article outlines current approaches to empiric antibacterial therapy of patients who had exacerbation of chronic obstructive pulmonary disease (COPD). The choice of the antibiotics should be made basing on the frequency of exacerbations, COPD duration, severity of bronchial obstruction, age of the patient, concomitant visceral lesions. Common errors in antibacterial therapy are analysed: wrong choice of the antibiotic, mode of drug administration, dose, dose regimen, duration of treatment (too long); simultaneous intake of antibiotics and nistatine; frequent change of antibiotics throughout the treatment.
Assuntos
Antibacterianos/efeitos adversos , Pulmão/efeitos dos fármacos , Pulmão/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Antibacterianos/administração & dosagem , Esquema de Medicação , Humanos , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Índice de Gravidade de DoençaRESUMO
The results of the treatment of community-acquired pneumonia with clarithromycin (500 mg bid for 6-8 days) at 172 patients (military recruits aged 18-25) are presented. Diagnosis, infection performance, treatment efficacy were evaluated by complex of data (X-ray, sputum analysis by bacteriological and cultural tests and immunochromatography test Binax NOW for pneumococcal antigen identification). High efficacy of clarithromycin for the treatment of moderate and mild pneumonia (including pneumococcal pneumonia) was demonstrated. Side effects were registered at 6.2 per cent of patients (gastro-intestinal disorders at 5 patients) and 1 general urticaria at 1 patient whose treatment had to be changed).