ABSTRACT
ABSTRACT Community-acquired pneumonia (CAP) is the leading cause of death worldwide. Despite the vast diversity of respiratory microbiota, Streptococcus pneumoniae remains the most prevalent pathogen among etiologic agents. Despite the significant decrease in the mortality rates for lower respiratory tract infections in recent decades, CAP ranks third as a cause of death in Brazil. Since the latest Guidelines on CAP from the Sociedade Brasileira de Pneumologia e Tisiologia (SBPT, Brazilian Thoracic Association) were published (2009), there have been major advances in the application of imaging tests, in etiologic investigation, in risk stratification at admission and prognostic score stratification, in the use of biomarkers, and in the recommendations for antibiotic therapy (and its duration) and prevention through vaccination. To review these topics, the SBPT Committee on Respiratory Infections summoned 13 members with recognized experience in CAP in Brazil who identified issues relevant to clinical practice that require updates given the publication of new epidemiological and scientific evidence. Twelve topics concerning diagnostic, prognostic, therapeutic, and preventive issues were developed. The topics were divided among the authors, who conducted a nonsystematic review of the literature, but giving priority to major publications in the specific areas, including original articles, review articles, and systematic reviews. All authors had the opportunity to review and comment on all questions, producing a single final document that was approved by consensus.
RESUMO A pneumonia adquirida na comunidade (PAC) constitui a principal causa de morte no mundo. Apesar da vasta microbiota respiratória, o Streptococcus pneumoniae permanece como a bactéria de maior prevalência dentre os agentes etiológicos. Apesar da redução significativa das taxas de mortalidade por infecções do trato respiratório inferior nas últimas décadas, a PAC ocupa o terceiro lugar como causa de mortalidade em nosso meio. Desde a última publicação das Diretrizes Brasileiras sobre PAC da Sociedade Brasileira de Pneumologia e Tisiologia (SBPT; 2009), houve importantes avanços na aplicação dos exames de imagem, na investigação etiológica, na estratificação de risco à admissão e de escores prognósticos evolutivos, no uso de biomarcadores e nas recomendações de antibioticoterapia (e sua duração) e da prevenção por vacinas. Para revisar esses tópicos, a Comissão de Infecções Respiratórias da SBPT reuniu 13 membros com reconhecida experiência em PAC no Brasil que identificaram aspectos relevantes à prática clínica que demandam atualizações frente às novas evidências epidemiológicas e científicas publicadas. Foram determinados doze tópicos envolvendo aspectos diagnósticos, prognósticos, terapêuticos e preventivos. Os tópicos foram divididos entre os autores, que realizaram uma revisão de forma não sistemática da literatura, porém priorizando as principais publicações nas áreas específicas, incluindo artigos originais, artigos de revisão e revisões sistemáticas. Todos os autores tiveram a oportunidade de revisar e opinar sobre todas as questões, criando um documento único final que foi aprovado por consenso.
Subject(s)
Humans , Pneumonia, Viral/diagnostic imaging , Pneumonia, Bacterial/diagnostic imaging , Pneumonia, Viral/drug therapy , Societies, Medical , Brazil , Consensus Development Conferences as Topic , Community-Acquired Infections/drug therapy , Community-Acquired Infections/diagnostic imaging , Pneumonia, Bacterial/drug therapy , Evidence-Based Medicine , Anti-Bacterial Agents/therapeutic useABSTRACT
Community acquired pneumonia (CAP) is an important cause of morbidity and mortality around the world, with high treatment costs due to hospitalization and complications (adverse events due to medications, antibiotic resistance, healthcare associated infections, etc.). It has been proposed administration of short courses and early switch of intravenous administration to oral therapy to avoid costs and complications. There are recommendations about these topics in national and intemational guidelines, based on clinical trials which do not demónstrate diffe-rences in mortality and complications when there is an early change from intravenous administration to the oral route. There are no statistically significant differences in safety and resolution of the disease when short and long treatment schemes were compared. In this review we present the most important guidelines and clinical studies, taking into account the pharmacological differences between different medications. It is considered that early switch from intravenous to oral administration route and use of short cycles in CAP is safe and brings benefits to patients and institutions.
La neumonía adquirida en la comunidad (NAC) es una causa importante de morbilidad y mortalidad en el mundo, con costos elevados por cuenta de las hospitalizaciones y las complicaciones (infección asociada al cuidado de la salud, efectos adversos de medicamentos, resistencia antimicrobiana, etc.). Ante este panorama se ha propuesto administrar ciclos cortos y el cambio temprano de la vía administración de antimicrobianos de endovenosa a oral. Existen recomendaciones acerca de los puntos anteriores en guías locales e internacionales, así como ensayos clínicos que no demuestran diferencias en cuanto a mortalidad y complicaciones cuando se realiza un cambio temprano de vía de administración de endovenosa a oral en NAC. Tampoco hay diferencias estadísticamente significativas en seguridad y resolución de enfermedad cuando se compararon esquemas cortos y prolongados. En esta revisión se presentan las guías y estudios más importantes, considerando las diferencias farmacológicas de los diferentes medicamentos. Se considera que el cambio temprano de vía de administración y el uso de ciclos cortos en NAC es seguro y presenta beneficios para pacientes e instituciones.
Subject(s)
Humans , Adult , Pneumonia, Bacterial/drug therapy , Anti-Bacterial Agents/administration & dosage , Time Factors , Drug Administration Schedule , Administration, Oral , Treatment Outcome , Practice Guidelines as Topic , Community-Acquired Infections/drug therapy , Dose-Response Relationship, Drug , Anti-Bacterial Agents/economics , Anti-Bacterial Agents/adverse effectsABSTRACT
Objective To investigate the clinical effect,safety,and value of bronchofibroscopeguided bronchoalveolar lavage and topical antibiotics in the treatment of pediatric patients with severe pneumonia.Methods A total of 60 patients with severe pneumonia was randomly divided into two groups with 30 cases in each group.Patients in the control group were treated with conventional anti-infection therapy,while patients in the treatment group were treated with bronchofibroscope-guided bronchoalveolar lavage and topical antibiotics on the basis of conventional therapy.The sputum positive rate,clinical effect,hospital stays,treatment costs,and adverse reactions were compared to analyze its value.Results The total effective rate of treatment group was 93.3％,which was significantly higher than that (60.0％) in the control group (P ＜0.01).The sputum positive rate of treatment group was 80.0％,which was significantly higher than that (43.3％) in the control group (P ＜0.01).The hospital stays and the treatment costs of the treatment group were both significantly less than those in control group (P ＜0.01 orP ＜0.05).No serious complications were found in patients of the treatment group.Conclusions Bronchofibroscope-guided bronchoalveolar lavage and topical antibiotics in the treatment of pediatric patients with severe pneumonia show exactly clinical effects and significant improvement in dyspnea,which shortens the hospital stays,reduces the treatment costs,and has no seriously adverse reactions.Therefore,it is worthy of clinical promotion and application.