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THE MICROORGANISMS CAUSING A PNEUMONIA AT CHILDREN AND TREATMENT OF ANTIBIOTICS IN REPUBLIC KAZAKHSTAN

Post date: 31-10-2014
Author(s): R.E. Kulubekov, N.E. Aukenov, K.S. Amrenova State Medical University of Semey, of Republic Kazakhstan

Abstract

The offered scheme therapy of antibiotics for treatment a pneumonia:

Choice preparations: cefalosporines 2 generations, amoksiclave, ampicillin/sulbaktam.

Alternative preparations: New macroleads.

Reserve preparations: Ampicillin + gentamycin; cephazoline or cephamandol + Gentamycin.

 

Key words: unhospital pneumonia, microflora, transport function, resistance, empirical therapy, antibiotics, rational treatment.

 

 

The microflora most often causing a unhospital pneumonia at children in Semipalatinsk (table 1): Str. spp.-58,7 ± 3,8%, Str. Pneumoniae - 29,3 ± 2,2% (n=315). For an example: of Almaty: Str. Pneumoniae - 41,3 ± 2,2 %, Streptococcus spp. - 11,7 ± 0,6% (n=400). However, unlike of Almaty, the majority штаммов, both streptococcus of saprophitics and streptococcus pneumoniae has been revealed, that, possess stability to any penicillin (71,7 ± 4,4%) at the expense of development penicilline – aze the expanded spectrum of action and their hyperproduction (74,2±3,7%), damage of structure of DNA - ferments antibacterial preparations (10,2 ± 0,7%), presence of the structures coding enzyme of antibiotics (4,9 ± 0,3%). Besides, infringement of transport function of molecules of antibiotics of a penicillinic number in the presence of a streptococcal infection is revealed. The carried out researches have shown, that in Semipalatinsk region are present macrolide resistance (only to erythromycin) streptococci - 91,3 ± 4,1% (Р <0,05).

 

 

Table 1.

The comparative characteristic *

City

Str. Pneumoniae

Streptococcus spp.

H.

Influenzae

St.aureus

Other

(mycoplazma, moraxella,

citobacter, proteus)

Semipalatinsk

29,3 ± 2,2%

58,7 ± 1,8%

2,6 ± 0,4%

1,1 ± 0,08%

0,4 ± 0,02%

Almaty

41,3 ± 2,2%,

11,7 ± 3,6%

9,6 ± 1,3

6,8 ± 1,2%

2,5 ± 0,7%

*- Р < 0,05

 

 

The carried out analysis has shown, that efficiency empirical therapy of antibiotics reached more than 70 % (76,2 ± 5,6 %) (Р <0,05) at duration of course of treatment 6-11 (8,2 ± 1,9 %) days those antibiotics, in whose spectrum entered grampossitive streptococci and H. influenzae. They had appeared cefalosporines 2 generations, and also amoksiclave. Besides, combinations cefalosporines 2 generations or ampicillin with gentamycin had similar efficiency.

At appointment of macroleads efficiency of therapy has made about 60 % (52,7 ± 4,9 %) (Р <0,05). It has appeared is connected by that macroleads have appeared are ineffective concerning streptococci and H.influenze. However it has not affected efficiency azitromycine which has made at treatment a unhospital pneumonia more than 90 % (88,3 ± 3,21 %) (Р <0,05). The preparation has appeared is active in the relation as streptococci and H. influenzae, so concerning Мoraxella.

Concerning safety of spent therapy, appointments ampicillin in injections, cefalosporines 2 generations, cefalosporines 2 generations by per os and azitromycine have appeared the most safe.

If to estimate profitability therapy of antibiotics the most preferable had appeared per os forms cefalosporines 2 generations and new macroleads. At treatment estimation of cost it has appeared, that replacement of a combination of ampicillin with gentamycin on per os a preparation cefalosporines 2 generations or the same azitromycine, treatment cost is reduced in 1,5-1,8 times.

The offered scheme therapy of antibiotics for treatment a pneumonia:

Choice preparations: cefalosporines 2 generations, amoksiclave, ampicillin/sulbaktam.

Alternative preparations: New macroleads.

Reserve preparations: Ampicillin + gentamycin; cephazoline or cephamandol + Gentamycin.

 

 

Резюме

МИКРООРГАНИЗМЫ, ВЫЗЫВАЮЩИЕ ПНЕВМОНИЮ У ДЕТЕЙ

В РЕСПУБЛИКЕ КАЗАХСТАН И АНТИБАКТЕРИАЛЬНАЯ ТЕРАПИЯ

Р.Е. Кулубеков, Н.Е. Аукенов, К.Ш. Амренова

Государственный медицинский университет города Семей

Схема антибактериальной терапии при пневмонии у детей:

Препарат выбора: цефалоспорины 2 поколения, амоксиклав, ампициллин/сульбактам.

Альтернатива: новые макролиды.

Резерв: Ампициллин+ гентамицин, цефазолин  или цефамандол+ гентамицин.

 

Тұжырым

ҚАЗАҚСТАН РЕСПУБЛИКАСЫНДА ӨКПЕ ҚАБЫНУЫН ШАҚЫРАТЫН МИКРООРГАНИЗМДЕР

ЖӘНЕ АНТИБАКТЕРИАЛЬДЫ ТЕРАПИЯ

Р.Е. Кулубеков, Н.Е. Аукенов, Қ.Ш. Амренова

Семей қаласының мемлекеттік медициналық университеті

Балаларда өкпе қабынуын емдеу схемасы.

Таңдау препараттары: 2 қатардағы цефалоспориндер, амоксиклав, ампициллин/сульбактам.

Альтернативасы: жаңа макролидтер.

Қордағы дәрілер: Ампициллин+ гентамицин, цефазолин немесе цефамандол+ гентамицин.

год: 2012 выпуск №4