Expert consensus on treatment of pneumonia in patients with circulatory decompensation

Chuchalin, Alexander; Arutyunov, G. P.; Sinopalnikov, A. I.; Avdeev, S. N.; Zyryanov, S. K.; Arutyunov, A G; Kozlov, R. S.; Belevsky, A. S.; Rachina, S. A.; Dragunov, D. O.; Simbirtseva, A. S.; Gendlin, G. E.; Козиолова, Н. А.; Tarlovskaya, E. I.; Korsunskaya, M. I.; Rylova, A. K.; Чесникова, А. И.; Orlova, Ya. A.; Проценко, Д. Н.

doi:10.18087/rhfj.2016.3.2202

Cited by 4 publications

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“…According to the current clinical guidelines, the presence of individual clinical, laboratory symptoms and signs of the disease is not an absolute indication for continuing the therapy. As a rule, their disappearance occurs independently or against the background of a symptomatic therapy (Chuchalin et al 2010(Chuchalin et al , 2019. Of the proposed answers -prevalence of subfebrile condition, prevalence of increased ESR (the erythrocyte sedimentation rate), prevalence of residual infiltration on radiography of the thoracic region 2 weeks after the start of a pneumonia treatment, in none of the indicated situations (correct answer) -32.8% of the specialists made the right choice, and fewer than 1.0% answered partially correctly.…”

Section: Resultsmentioning

confidence: 99%

“…To varying degrees, 95.1% of the specialists successfully coped with this task, 89.8% of the respondents answered partially correctly, and only 5.3% of the doctors indicated all the correct answers. Among the partially correct answers, doxycycline has the highest specific weight among the proposed options -60.3% but its use in our country is irrational due to the high resistance of S. pneumoniae to tetracyclines; the second most frequent choice is ciprofloxacin -46.8%, it is ineffective against S. pneumoniae; next came the group of respiratory fluoroquino-lones -40.9%, the appointment of which to patients with non-severe CAP without risk factors is inappropriate; then came ampicillin for oral administration -24.1%, which has low bioavailability with this route of drug administration (40.0%) compared with amoxicillin (75-93.0%), and, finally, cefazolin -23.2%, characterized by a low activity against pneumococci and the lack of clinically significant activity against H. influenzae (Russian Respiratory Society 2018, Chuchalin et al 2010) (Fig. 4).…”

Section: Resultsmentioning

confidence: 99%

“…When determining the drug for empirical treatment of mild CAP, first of all, it was necessary to assess the available parameters of the patient, basing on which he could be to referred to the group of outpatients without risk factors and concomitant diseases. The drugs of choice for this category of patients are amoxicillin, which is highly active against the main causative agent of infection -S. pneumoniae, and/or a group of macrolides with improved pharmacokinetic properties (azithromycin, clarithromycin, spiramycin) (Chuchalin et al 2010(Chuchalin et al , 2018Gavrilova 2020). Despite a wide spectrum of action of doxycycline in relation to these pathogens, its use for empirical therapy in Russia is not contemplated due to the high occurrence of tetracycline-resistant strains of the pathogen, while in the USA, according to the updated recommendations of the American Thoracic Society and the International Society for Infectious Diseases, doxycycline may be used as a first-line drug for CAP treatment (Metlay et al 2019).…”

Section: Resultsmentioning

confidence: 99%

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Rational antimicrobial chemotherapy: assessment of the level of basic knowledge of general practitioners. Final results of the KANT project

Bontsevich¹,

Adonina²,

Gavrilova³

et al. 2020

RRP

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Introduction: The irrational use of medicines leads to a decrease in the quality of care, an increase in treatment costs and side effects. In the case of antibacterial drugs, in addition to all the above-mentioned consequences, their improper use can lead to an aggravation of the existing and quite challenging problem of our time – the growth of antibiotic resistance among pathogenic microorganisms. The aim of the study: to determine the level of basic knowledge of medical specialists in the field of a rational use of antimicrobial drugs (AMD). Materials and methods: The study was based on an analysis of an anonymous multicenter survey in the framework of the KANT project (the full name of the project is “Physicians’ (Students’) Knowledge of Antimicrobials Usage”). It was conducted in 2018–2019 in 10 major centers of Russia. Results and iscussion: According to the results of the study, the respondents showed a low level of knowledge of the rational use of antibacterial drugs. The best results are obtained for questions No.1 (time interval for evaluating the effectiveness of the initial antimicrobial therapy (AMT)), No.2 (rationality and period of AMD change with a positive clinical effect), and No.9 (determining the mode of using the proposed drugs), whereas the worst results were obtained for questions No.3 (determining irrational combinations of AMD), No.4 (determining a situation requiring a long course of AMT), and No.7 (choosing auxiliary drugs for bacterial respiratory infections). Conclusion: The results obtained in the study indicate the need for additional educational activities among health professionals.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Rational antimicrobial chemotherapy: assessment of the level of basic knowledge of general practitioners. Final results of the KANT project

Bontsevich¹,

Adonina²,

Gavrilova³

et al. 2020

RRP

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“…Сердечно-сосудистая коморбидность практически с одинаковой частотой встречается при различной тяжести ХОБЛ, но часто не диагностируется и не лечится. Ранее было показано, что около 40 % больных с легкой и среднетяжелой ХОБЛ умирали из-за сердечно-сосудистой патологии, что в 8-10 раз чаще смертельных исходов в этой же группе вследствие дыхательной недостаточности [40,[42][43][44][45][46][47]. В течение 5 лет последующего наблюдения у больных ХОБЛ отмечался более высокий уровень госпитализаций и смертельных исходов, причиной которых были ИБС, инсульт и СН.…”

Section: роль бронхиальной обструкцииunclassified

Chronic obstructive pulmonary disease and cardiovascular comorbidity

2019

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In recent years, a greater understanding of the heterogeneity and complexity of chronic obstructive pulmonary disease (COPD) has come from the point of view of an integrated clinical assessment of severity, pathophysiology, and the relationship with other pathologies. A typical COPD patient suffers on average 4 or more concomitant diseases and every day about a third of patients take from 5 to 10 different drugs. The mechanisms of the interaction of COPD and cardiovascular disease (CVD) include the effects of systemic inflammation, hyperinflation (hyperinflation) of the lungs and bronchial obstruction. The risk of developing CVD in patients with COPD is on average 2–3 times higher than in people of a comparable age in the general population, even taking into account the risk of smoking. The prevalence of coronary heart disease, heart failure, and rhythm disturbances among COPD patients is significantly higher than in the general population. The article discusses in detail the safety of prescribing various groups of drugs for the treatment of CVD in patients with COPD. Achieving success in understanding and managing patients with COPD and CVD is possible using an integrated multidisciplinary approach.

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“…The total mortality of patients with a chronic heart failure (CHF) with pneumonia development increases by 1.8-4.6 times, and the risk of death increases by 49.5%. It was established that in this category of patients, pneumonia contributes to the progression of circulatory failure by 17.7%, increases the risk of acute coronary syndrome by 14.1% and any rhythm disturbance by 5.3% [11][12][13]. A significant increase in economic losses due to direct and indirect costs up to 61.6 billion rubles is a negative contribution due to progressive COPD [14].…”

Section: Introductionmentioning

confidence: 99%

Pharmacoeconomic Evaluation of Anti-Pneumococcal Vaccination in Risk Groups for the Prevention of Community-Acquired Pneumonia Among Adults in the Astrakhan Region

Орлова

Дорфман

Орлов

et al. 2021

Farm. farmakol. (Pâtigorsk)

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The aim. To evaluate the economic efficiency and the choice of the vaccination strategy in the respiratory pneumococcal infection risk groups among the adult population of the Astrakhan region.Materials and methods. The data for the period of 2015 - 2018 were analyzed on the number of registered diseases in the patients living in the service area of the medical organizations (Form No. 12, Federal State Statistics Service Orders No. 591, dated 27 November, 2015; No. 679, dated 22 November, 2019). The following working directives were studied: the base medical examination documentation submitted by medical institutions (Form No. 030/y “Dispensary Monitoring Checklist”; lists of the persons subjected to medical observation in the reporting year; Orders of the Ministry of Health of the Russian Federation: No. 1344, dated 12 December, 2012; No. 173n, dated 29 March, 2019). Statistical materials of the territorial fund for compulsory medical insurance of the Astrakhan region on the payment of medical care to 12,970 patients who had had pneumonia in 2015-2018, were analyzed. The financial support of vaccination based on the results of tenders for the procurement of pneumococcal vaccines organized by the regional Ministry of Health, was considered. The calculations were carried out in accordance with the guidelines of “Cost-effectiveness of vaccine prophylaxis” (Methodological guidelines 3.3.1878-04, dated 04.03.2004).Results. The prospective calculation of the vaccination cost showed that the benefits of vaccination with pneumococcal conjugate vaccine Prevenar13 (PCV13) and pneumococcal polyvalent vaccine Pneumovax 23 (PPV23) with a 95% vaccination coverage, are recorded after 2 years. The economic benefit of vaccination by reducing the possible number of pneumonias at the end of 2028 will be 968.2 million rubles.Conclusion. The economic feasibility of vaccine prophylaxis of the adult contingent with an increased risk of developing pneumococcal infection has been established. The sequential strategy of PCV13 and PPV23 application provides the most effective localization of pneumococcal infection. The research results should be widely introduced into the long-term plans for vaccination and healthcare practice in the Astrakhan region.

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Expert consensus on treatment of pneumonia in patients with circulatory decompensation

Cited by 4 publications

References 0 publications

Rational antimicrobial chemotherapy: assessment of the level of basic knowledge of general practitioners. Final results of the KANT project

Rational antimicrobial chemotherapy: assessment of the level of basic knowledge of general practitioners. Final results of the KANT project

Chronic obstructive pulmonary disease and cardiovascular comorbidity

Pharmacoeconomic Evaluation of Anti-Pneumococcal Vaccination in Risk Groups for the Prevention of Community-Acquired Pneumonia Among Adults in the Astrakhan Region

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