scholarly journals Effectiveness of antimicrobial therapy for community-acquired pneumonia in real clinical practice

2022 ◽  
Vol 20 (4) ◽  
pp. 79-85
Author(s):  
O. M. Uryasev ◽  
A. V. Shakhanov ◽  
L. V. Korshunova
Keyword(s):  
Clinical Practice ◽  
Antimicrobial Therapy ◽  
Treatment Effectiveness ◽  
Complete Blood Count ◽  
Community Acquired Pneumonia ◽  
Hospitalized Patients ◽  
Important Place ◽  
Therapy Regimen ◽  
Empiric Antimicrobial Therapy ◽  
Real Clinical Practice

Background. Community-acquired pneumonia (CAP) remains one of the most common infectious diseases, occupying an important place in the structure of mortality worldwide.Aim. To evaluate the effectiveness of antimicrobial therapy for community-acquired pneumonia in hospitalized patients in real clinical practice.Materials and methods. A retrospective, observational study was conducted, which included 236 patients hospitalized for community-acquired pneumonia at the Regional Clinical Hospital in Ryazan in 2019. Based on these case histories, an analysis of the effectiveness of the initial empiric antimicrobial therapy was performed.Results. The initial empiric antimicrobial therapy in 73% of cases included administration of ceftriaxone, in 45% of cases – levofloxacin, in 14% of cases – azithromycin. It was found that initial antimicrobial therapy was effective in 58% of patients who did not require replacement for the antibiotic. A need for a change in the treatment regimen was significantly associated with an increase in the length of hospitalization (p < 0.001), heart rate upon admission (p = 0.032), myelocyte count in the complete blood count (p < 0.001), and urea and blood creatinine levels (p = 0.004 and p = 0.044, respectively). The selected antimicrobial therapy regimen was significantly associated with the expected treatment effectiveness (p = 0.039). The choice of levofloxacin in monotherapy or in combination with ceftriaxone was accompanied by a decrease in the relative risk of replacing the antimicrobial, compared with other treatment regimens (odds ratio (OR) = 0.86 (95% confidence interval (CI): 0.55–1.34) and OR = 0.57 (95% CI: 0.37–0.87), respectively).Conclusion. Empiric antimicrobial therapy for community-acquired pneumonia in real clinical practice complies with current recommendations, however, at the same time, its ineffectiveness persists. Respiratory fluoroquinolones are most effective in treating pneumonia in hospitalized patients. 

Pharmacological drug interactions in the treatment of community-acquired pneumonia in hospital settings (based on electronic databases of reported drug interactions)

2021 ◽  
Vol 31 (1) ◽  
pp. 38-45
Author(s):  
O. V. Zhukova ◽  
E. S. Khoroshavina ◽  
O. V. Ruina ◽  
M. V. Khazov
Keyword(s):  
Clinical Practice ◽  
Drug Interactions ◽  
Antimicrobial Therapy ◽  
Community Acquired Pneumonia ◽  
Treatment Standards ◽  
Antibacterial Drugs ◽  
Treatment Standard ◽  
Clinically Significant ◽  
Potential Interactions ◽  
Real Clinical Practice

The article presents the results of a study of potential drug interactions in the treatment of moderate and severe community-acquired pneumonia (CAP) in hospital settings. The study was conducted by analysis of treatment standards and data from real clinical practice regarding antimicrobial therapy. Methods. The study used the lists of drug products for medical use for the treatment of CAP (according to the standards of specialized medical care for moderate and severe CAP with complications). Also, the medical records of patients (n = 165) with CAP, hospitalized in hospitals of medical organizations (Nizhny Novgorod) were used. The study period was 2 years (2015 - 2016). The study included all patients admitted to the hospital during the analyzed period. CAP was treated in accordance with treatment standards. Results. The analysis of potential interactions of drugs used for moderate and severe CAP according to the treatment standards, showed that 27 and 72 drugs can be used, respectively. 325 potential interactions are possible in hospital settings for moderate CAP and 2,485 for severe CAP. According to the treatment standard, the number of minimally clinically significant potential interactions during the pharmacotherapy of moderate CAP in hospital settings is 8, the number moderately clinically significant interactions - 19; undesirable interactions - 7. In case of severe CAP, the number of potential interactions increases and amounts to 27 minimally clinically significant, 105 moderately clinically significant, and 41 undesirable. The analysis of the results of antimicrobial therapy in real clinical practice showed 4 therapeutic duplications (prescribing 2 β-lactam antibacterial drugs simultaneously) and 2 moderately clinically significant interactions during antimicrobial therapy in hospital 1. Only 1 therapeutic duplication was noted during antimicrobial therapy in hospital 2. Therapeutic overlap has been found between β-lactam antibacterial drugs (ceftaroline fosamil and meropenem). It is advisable to prescribe no more than one в-lactam antibacterial drug and it is inappropriate to include > 3 antimicrobial drugs in an antimicrobial regimen. Conclusion. Electronic databases simplify the selection of medicines and thus ensure the safe and effective use of registered drug interactions.

scholarly journals Efficacy of azoximer bromide in the treatment of hospitalized patients with moderate to severe community-acquired pneumonia

2021 ◽  
pp. 106-117
Author(s):  
S. K. Zyryanov ◽  
O. I. Butranova ◽  
A. V. Ershov ◽  
Z. Sh. Manasova
Keyword(s):  
Combination Therapy ◽  
Community Acquired Pneumonia ◽  
Hospitalized Patients ◽  
Study Group ◽  
Therapy Regimen ◽  
Duration Of Hospital Stay ◽  
Comparator Group ◽  
Group 2 ◽  
Severe Community Acquired Pneumonia ◽  
Group 1

Introduction. The high incidence of community-acquired pneumonia and the high complication rates in the cases of severe pneumonia actualize the search for new pharmacotherapy tools to improve the effectiveness of standard patient management regimens. A high level of severe inflammatory response underlies the high risk for developing septic complications of pneumonia, along with impaired immune responses.The aim is to evaluate the efficacy of azoximer bromide introduction in the combination therapy regimen for hospitalized patients with moderate to severe community-acquired pneumonia.Materials and methods. A prospective, open label, parallel group, randomized study comparing the efficacy of azoximer bromide introduction in the combination therapy of hospitalized patients with moderate to severe community-acquired pneumonia was conducted at the premises of Federal Scientific and Clinical Center for Reanimatology and Rehabilitation. 30 patients were included in the study group and 37 patients in the comparator group. The baseline characteristics were comparable in both groups. Results. The azoximer bromide introduction in the combination therapy of patients with community-acquired pneumonia led to a statistically significant reduction in the duration of hospital stay (Me (LQ; HQ): 9 (8; 10) days for the study group and 13 (10; 14) days for the comparator group, (p = 0.000078), duration of ICU stay (Me (LQ; HQ) 2 days (1.5; 2.5) and 5 days (5.0; 6.0), respectively, (p = 0.00001), the duration of febrile fever 5 (± 0.6) days versus 10 (± 1.2) days (p = 0.0000), the incidence of acute respiratory failure (13.33% in group 1 versus 37.84% in group 2, p = 0.024) and septic shock (10% in group 1 versus 32.43% in group 2, p = 0.0285).Conclusions. The azoximer bromide introduction in the standard therapy regimen for patients with community-acquired pneumonia allowed to reduce the duration of hospital stay, the duration of ICU stay, the length of febrile fever, the incidence of septic shock and respiratory failure. The possible mechanisms of action may include a reduction of the severe inflammatory reactions and an optimization of the patient's immune response to the infectious process.

2336-PUB: Treatment Effectiveness of Glimepiride Alone and in Combination with Other Oral Hypoglycemic Agents: Outcomes from Real Clinical Practice

Diabetes ◽  
2019 ◽  
Vol 68 (Supplement 1) ◽  
pp. 2336-PUB
Author(s):  
KRISHNA G. SESHADRI ◽  
C.S. DWARAKANATH ◽  
R.M. MANIKANDAN ◽  
USHA AYYAGARI ◽  
T.S. BOOCHANDRAN ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Treatment Effectiveness ◽  
Hypoglycemic Agents ◽  
Oral Hypoglycemic Agents ◽  
Real Clinical Practice

scholarly journals Community-acquired pneumonia in hospitalized patients: clinical guidelines

2019 ◽  
pp. 79-88
Author(s):  
A. A. Zaytsev ◽  
A. I. Sinopal’nikov
Keyword(s):  
Risk Factors ◽  
Antimicrobial Therapy ◽  
Alternative Therapy ◽  
Community Acquired Pneumonia ◽  
Hospitalized Patients ◽  
Public Health Care ◽  
High Morbidity ◽  
Wide Range ◽  
Amoxicillin Clavulanate ◽  
Severe Community Acquired Pneumonia

Community-acquired pneumonia is still the cornerstone of practical public health care due to high morbidity and mortality. Streptococcus pneumoniae (30-50%), Haemophilus influenzae, Staphylococcus aureus and Klebsiella pneumoniae remain the main cause of community-acquired pneumonia (3-5%). In recent years, the spread of strains resistant to macrolide antibiotics (~30:) and isolates with reduced sensitivity to β-lactams among pneumococci has been a topical problem. On the pages of international recommendations, biological markers of inflammatory response are of great importance in the diagnosis of community-acquired pneumonia. Thus, in patients with an uncertain diagnosis of «community-acquired pneumonia» in case of concentration of C-reactive protein ≥ 100 mg/l its specificity in confirming the diagnosis exceeds 90%, at a concentration of < 20 mg/l the diagnosis of pneumonia is unlikely. All hospitalized patients with community-acquired pneumonia should use the IDSA/ATS criteria or SMART-COP scale to assess severity, predict and determine admission to intensive  care  unit. When planning antimicrobial therapy tactics in hospitalized patients, it is advisable to categorize patients taking into account risk factors for ineffective therapy. In the absence of such, choice of antibiotics are inhibitor-proof aminopenicillins (amoxicillin/clavulanate, etc.), ampicillin; the alternative therapy mode involves the use of respiratory fluoroquinolones.In patients with comorbidities and other risk factors for infection with resistant microorganisms, the drugs of choice are inhibitorproof aminopenicillins (amoxicillin/clavulanate, etc.), III generation cephalosporins (cefotaxime, ceftriaxone), respiratory fluoroquinolones, and ceftaroline and ertapenem may be used in certain categories of patients. With regard to ceftaroline, it is worth noting that its use is currently an attractive strategy due to its wide range of activities, including resistant strains of pneumococcus and S. aureus. Special attention in the publication is paid to antimicrobial therapy modes in case of severe community-acquired pneumonia, the criteria of efficacy assessment and duration of antibiotics application are reflected. 

Community-acquired pneumonia in Japan: a prospective ambulatory and hospitalized patient study

2005 ◽  
Vol 54 (4) ◽  
pp. 395-400 ◽  
Author(s):  
Naoyuki Miyashita ◽  
Hiroshi Fukano ◽  
Keiji Mouri ◽  
Minoru Fukuda ◽  
Koichiro Yoshida ◽  
...  
Keyword(s):  
Streptococcus Pneumoniae ◽  
Haemophilus Influenzae ◽  
Antibody Titre ◽  
Antimicrobial Therapy ◽  
Outpatient Clinic ◽  
Chlamydophila Pneumoniae ◽  
Community Acquired Pneumonia ◽  
Hospitalized Patients ◽  
Recent Infection ◽  
Patient Study

In this study the aetiology of community-acquired pneumonia (CAP) in Japan was investigated and the incidence of causative pathogens in ambulatory and hospitalized patients was compared. In addition, the roles of Chlamydophila felis and Chlamydophila pecorum as causes of CAP were investigated. Five hundred and six patients with CAP who visited an outpatient clinic or were admitted to one of three different hospitals were enrolled in this study; 106 of them were outpatients and 400 were hospitalized patients. Among the 506 CAP cases, Mycoplasma pneumoniae was the most common pathogen found in the outpatients and Streptococcus pneumoniae was the most common in the hospitalized patients. No cases of Chlamydophila pecorum pneumonia were observed and only one patient had an antibody titre suggestive of recent infection with the feline strain of Chlamydophila. The incidence of infection with M. pneumoniae and Chlamydophila pneumoniae was higher among the outpatients than among hospitalized patients, whereas the incidence of infection with S. pneumoniae and Haemophilus influenzae was higher among the hospitalized patients. Recognition of these results will allow prompt and appropriate antimicrobial therapy to be provided using Japanese CAP guidelines.

scholarly journals Experience of using a genetically engineered biological drug biosimilar in patients with rheumatoid arthritis in real clinical practice

2020 ◽  
Vol 4 (8) ◽  
pp. 492-497
Author(s):  
E.V. Zhilyaev ◽  
◽  
E.N. Koltsova ◽  
E.I. Shmidt ◽  
K.A. Lytkina ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Clinical Practice ◽  
Adverse Events ◽  
Treatment Efficacy ◽  
Genetically Engineered ◽  
Efficacy And Safety ◽  
Biological Drug ◽  
Therapy Regimen ◽  
Switching Therapy ◽  
Real Clinical Practice

The article presents the data of the Moscow Unified Arthritis Register (MUAR) and the results of rituximab therapy in patients with rheumatoid arthritis (RA).Aim: to evaluate the efficacy and safety of switching from the original rituximab (MabThera®) to its biosimilar (Acellbia®) in patients with RA in real clinical practice.Patients and Methods: patients with RA, included in MUAR register, were evaluated with an assessment of therapy efficacy and safety with the original rituximab (MabThera®), as well as after switching to the rituximab biosimilar (Acellbia®). A standard examination was performed to determine the number of swollen and tender joints, erythrocyte sedimentation rate, and C-reactive protein. Treatment efficacy was assessed using the DAS28 composite index, HAQ-DI (Health Assessment Questionnaire Disability Index) and RAPID-3 (Routine Assessment of Patient Index Data 3). In terms of safety, adverse events were recorded based on patient reports.Results: switching therapy regimen of 46 patients with RA from the original rituximab to the biosimilar was not accompanied by a decrease in the treatment efficacy. There was statistically significant increase in the proportion of the patients with low disease activity (DAS28<3.2) from 39.1% to 52.2% and remission (DAS28<2.6) from 17.4% to 23.9%, respectively. Further positive dynamics of HAQ-DI and RAPID-3 indices were noted. According to the authors, the increase in the frequency of a positive response to the treatment was associated with the duration of rituximab use in general. The frequency of adverse events during therapy with the original rituximab and its biosimilar was comparable: 9.22 and 10.9 per 100 patient years respectively.Conclusion: there were no significant differences between the original rituximab and its biosimilar. The results of switching therapy regimen of patients with RA from the original rituximab (MabThera®) to its biosimilar (Acellbia®), observed in real clinical practice, confirm their therapeutic equivalence.KEYWORDS: rheumatoid arthritis, rituximab, biosimilar, real clinical practice.FOR CITATION: Zhilyaev E.V., Koltsova E.N., Shmidt E.I. et al. Experience of using a genetically engineered biological drug biosimilar in patients with rheumatoid arthritis in real clinical practice. Russian Medical Inquiry. 2020;4(8):492–497. DOI: 10.32364/2587-6821-2020-4-8-492-497.

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