Modern Directions of Optimization of Empirical Antimicrobial Therapy of Community-Acquired Pneumonia (Review)

Abstract

Severe community-acquired pneumonia (CAP) remains a life-threatening disease, causing 78 % of infection-related deaths and is the most common cause of sepsis. Empirical antibiotic therapy is started before the results of bacteriological diagnosis are available. The diversity of pathogens often makes it difficult to choose a drug for etiotropic empirical therapy. Isolates of bacteria responsible for CAP sometimes show high resistance to several antibiotics, including cephalosporins and carbapenems. We analyzed scientific publications from the PubMed database for the last 5 years on the problem of empirical antimicrobial therapy of CAP. Currently, empirical therapy for pneumonia is determined by the site of infection (hospital or other settings), but may be conditioned by the presence of risk factors for multidrug-resistant pathogens, regardless of the site of infection. A rational approach to making decisions about prescribing broad-spectrum antibiotics is to use risk prediction models at the patient level. Recommendations for empirical therapy of CAP have been developed, taking into account individual risk factors for multidrug-resistant infection, and their use, according to the results of 30-day mortality, has proven to be more effective than the use of classification by site of pneumonia.Among the current directions of empirical antimicrobial therapy of CAP are use of drugs with a narrow spectrum of action based on the use of an algorithm for determining the risk of multidrug-resistant infection, as well as a procalcitonin test; use of an algorithm for choosing an alternative antimicrobial agent in case of a history of penicillin allergy; reduction of the total duration of antimicrobial therapy; widespread introduction of antimicrobial stewardship programs in the activities of not only hospitals but also primary care facilities.