Antibacterial therapy for patients with chronic bronchitis
Etiology and pathogenesis
The main cause of chronic bronchitis is prolonged exposure of the bronchial mucosa to harmful impurities in the inhaled air, primarily tobacco smoke. Production factors (dust and gas contamination of workplaces), as well as general air pollution, are of significant importance. A major role in the development of chronic bronchitis is played by the pathology of the ENT organs, possibly being a manifestation of general damage to the respiratory tract, and a violation of the conditioning function of nasal breathing. The above factors lead to a restructuring of the mucous membrane, consisting in hypertrophy of the mucous glands and an increase in the number of mucus-producing cells of the bronchial epithelium, gradually replacing ciliated cells responsible for the evacuation of mucus and mechanical cleansing of the bronchi from dust and microbial contamination. Simultaneously with hypersecretion of mucus (hypercrinia), a violation of physicochemical (viscosity, elasticity) and antimicrobial properties (discrinia) occurs. This leads to stagnation of mucus along with the contaminants it contains, necessitating its evacuation through a pathological process - coughing and contributes to the secondary development of intrabronchial infection, the main causative agents of which are pneumotropic microorganisms - streptococcus and Haemophilus influenzae. Intrabronchial infection usually occurs with periodic exacerbations, the causes of which are unfavorable weather conditions, cooling, or viral infection. Violation of the protective and cleansing functions of the bronchi and the persistence of infection in them determine an increased likelihood of the development of infectious processes in the lung tissue (acute pneumonia, destructive pneumonia), which in patients with chronic bronchitis are observed several times more often than in persons without previous bronchial pathology, and are often characterized by protracted and complicated course. In some patients with chronic bronchitis, there is a progressive obstruction of the patency of predominantly small bronchi. An important role in this is played by expiratory collapse of the small airways, spasm of the bronchial muscles, swelling of the mucous membrane and other factors. As a result of obstruction, the ventilation-perfusion relationship is disrupted and hypoxemia develops. This, in turn, causes spasm of the pulmonary arterioles, increased pulmonary vascular resistance, hypertension and the formation of “pulmonary heart”. Thus, obstruction of the small bronchi leads to respiratory and heart failure, which causes disability and death in patients. In most cases, obstructive bronchitis is accompanied by emphysema, which aggravates functional disorders.
Classification
It is fundamentally important to divide chronic bronchitis into obstructive
and
non-obstructive
.
The diagnosis also reflects the presence of a mucopurulent inflammatory process. There are 4 forms of chronic bronchitis:
simple, purulent, obstructive and purulent-obstructive. Important characteristics of the disease are its course (latent, with rare exacerbations, with frequent exacerbations, continuously relapsing) and phase (exacerbation or remission). In recent years, according to the recommendations of the European Respiratory Society, it has been proposed to assess the severity of COPD or chronic obstructive bronchitis depending on the FEV1 value, expressed as a percentage of the proper value: mild FEV1 70%, moderate - ranging from 50-69% and severe - FEV1 is less than 50%.
Clinical picture, course
Chronic bronchitis is characterized by the absence of an acute onset of the disease and its slow progression. The first symptom of the disease is usually a morning cough, which intensifies in the cold and damp seasons, weakens or completely stops in the summer. Subsequently, the cough gradually increases and is observed throughout the day and at night. The amount of sputum in chronic bronchitis is small. Exacerbations of chronic bronchitis are characterized as sluggish, manifested by malaise, sweating, especially at night, increased cough, tachycardia, normal or subfebrile body temperature, and the appearance or intensification of shortness of breath. The duration of an exacerbation of chronic bronchitis can be 3–4 weeks or more. Along with the relapsing course of chronic bronchitis, a latent or asymptomatic course is often observed for a long time, without pronounced exacerbations. With chronic obstructive bronchitis, persistent symptoms of chronic bronchial obstruction appear:
– shortness of breath on exertion; – increased shortness of breath under the influence of nonspecific stimuli; – an annoying, unproductive cough, in which the release of a small amount of sputum requires significant effort from the patient, but the cough impulse is weak due to the weakness of the respiratory muscles and the collapse of the respiratory tract with increased intrathoracic pressure; – prolongation of the expiratory phase during quiet and especially forced breathing; – scattered dry wheezing of predominantly high tones on exhalation; – symptoms of increased air filling of the lungs. The results of long-term observations of patients have made it possible to establish that chronic obstructive bronchitis is a slowly progressive disease that begins many years before the onset of clinical symptoms of respiratory failure, and the prognosis depends on the rate of progression of the process. The main causes of death in patients with chronic bronchitis are acute respiratory failure, which occurs against the background of chronic breathing disorders, an active inflammatory process in the bronchopulmonary system and circulatory failure. There are also indications of pulmonary embolism and spontaneous pneumothorax.
Treatment
Particular importance in chronic bronchitis is given to etiotropic treatment
which gives the greatest effect.
All other types of therapy are essentially symptomatic. Smoking cessation is the basis for starting therapy. Already a few months after stopping smoking, cough and sputum production usually significantly decrease or completely stop, but previously formed irreversible changes in the respiratory tract and lungs do not disappear. Sanitation of foci of infection is also of paramount importance in connection with the removal of places where pathogenic microorganisms accumulate. In this regard, great importance is attached to prescribing antibiotic therapy to patients. The main indications for prescribing antibiotics for chronic bronchitis are active bacterial inflammatory processes in the bronchial tree. The use of an antibiotic that is specifically active against a significant infectious agent is considered optimal. The use of broad-spectrum drugs that suppress normal microflora contributes to the growth of resistant gram-negative microorganisms in the nasopharynx and further progression of the chronic inflammatory process. The method of administration of the drug (oral, parenteral or aerosol) is determined by the severity of the exacerbation and the ability of the antibiotic to create a high concentration in the bronchial tissues and bronchial mucus. The clinical result (and not the antibiogram data) is the basis for judging the correctness of the choice of drug. It should be noted that in chronic bronchitis, effective antibacterial therapy can cause a deterioration in sputum production, since a decrease in its infection is accompanied by a decrease in the mucolytic effect of bacterial enzymes. As mentioned above, the most common causative agents of the infectious process in the bronchi are H. Influenzae and S. Aureus, the main mechanism for the development of resistance to antibiotics is the production of broad-spectrum β-lactamases (up to 10% of H. Influenzae strains and 70–80% of S. Aureus), respectively, these microorganisms are capable of destroying natural and semi-synthetic penicillins, first generation cephalosporins. Therefore, the drugs of choice for the treatment of bronchitis of this etiology are protected aminopenicillins (for example, amoxicillin/clavulanate) and second-generation cephalosporins (III-IV generation cephalosporins and carbapenems have no advantages). The combination of amoxicillin/clavulanate (Panklav) provides high bactericidal activity of the drug
. The main pharmacokinetic parameters of amoxicillin and clavulanic acid are similar. After oral administration, both components of the drug are quickly absorbed from the gastrointestinal tract. Concomitant food intake does not affect absorption. Cmax in blood plasma is reached approximately 1 hour after administration. Both components are found in high concentrations in body fluids and tissues, including bronchial secretions. The drug is prescribed orally for adults and children over 12 years of age (or weighing more than 40 kg) 1 tablet. 250 mg 3 times/day. for mild to moderate cases and 2 tablets. 250 mg or 1 tablet. 500 mg 3 times/day. In case of severe infection, the maximum daily dose of clavulanic acid (in the form of potassium salt) is 600 mg for adults, 10 mg/kg body weight for children. The maximum daily dose of amoxicillin is 6 g for adults and 45 mg/kg body weight for children. Most drugs from the group of second and third generation cephalosporins are administered parenterally and can be used for severe exacerbation of chronic bronchitis in a hospital setting. For the treatment of uncomplicated forms of chronic bronchitis, macrolides can be recommended, which have the ability to create a high local concentration of the drug in tissues and penetrate into cells, suppressing the growth of obligate parasites (mycoplasma, legionella, chlamydia), which can cause exacerbations of chronic bronchitis. These drugs (azithromycin, spiramycin, clarithromycin) rarely cause allergic reactions and do not interact with theophylline. Tetracyclines (in particular, doxycycline) retain their value in chronic bronchitis only as second-line drugs. Most fluoroquinolines (ciprofloxacin, sparfloxacin, trovafloxacin) have little effect on streptococci, but a fairly wide spectrum of action, especially with legionella, mycoplasma, chlamydia infections, the ability to create a high concentration in the tissues of the bronchi and bronchial mucus makes them in demand in patients with a high risk of developing dysbacteriosis and in weakened patients. Thus, a fairly large list of antibacterial drugs allows the doctor, taking into account the patient’s condition, the severity of his disease, the microorganism that caused the pathological process, to make the right choice of the drug and the method of its administration.
Antibiotics for bronchitis
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What does the word "antibiotic" mean? Translated from Greek, “anti” means “against”, and the word “bios” means “life”. So the word “antibiotic” can be literally translated as “against life.” Despite such a menacing name, antibiotics only threaten the life of bacteria. But still, they can seriously affect the metabolism in the human body and therefore can lead to numerous side effects. These medications are considered potentially dangerous and most are prohibited for pregnant women and young children.
Bronchitis is a very common disease, which in recent years has become chronic among the population of our country, and the signs of bronchitis in adults are varied and depend on many factors. Before treating bronchitis, it is necessary to find out the cause of the disease.
Unfortunately, today antibiotics for bronchitis in adults are prescribed at random, and in some conditions the prescription of antibiotics is completely inappropriate.
It is known that bronchitis without antibiotics is easily treated if the inflammation is of viral origin, since the virus is not treated with antiseptics. If you treat viral bronchitis, antibiotics only interfere with the body's defense mechanisms to fight the virus, suppress the immune system, lead to the development of dysbacteriosis, allergies, and develop resistance of microorganisms to the drug.
Sometimes antibiotics are simply necessary. For example, in the treatment of bronchitis in elderly people over 60 years of age. At this time, a person’s immune system is not strong enough to quickly overcome the infection, and as a result, even banal bronchitis can result in unpleasant complications.
If symptoms of bronchitis persist for quite a long period, your doctor may recommend antibiotics. After all, if the body cannot cope with the infection on its own, it needs help.
There is such a disease as bronchial asthma. It is based on an allergic reaction, which manifests itself in response to various causes. With so-called infection-dependent asthma, allergies occur as a reaction to the presence of pathogenic microbes in the body. Therefore, each episode of bronchitis entails an increase in asthma attacks. To avoid this, patients are prescribed antibacterial drugs from the very beginning of the disease.
If you suffer from chronic obstructive bronchitis (smoker's bronchitis, chronic obstructive pulmonary disease), then during an exacerbation, when you have a cough with yellow or green sputum, you should also take a course of antibiotics.
Sometimes these drugs are prescribed for chemical bronchitis, which occurs when inhaling aggressive volatile substances (vapors of acids and alkalis). It would seem that if there are no manifestations of infection, then antibiotics are not needed. However, with chemical bronchitis there is a high risk of bacterial complications. Any injury is always easily accompanied by infection, so such patients also need antibiotics.
About half of cases of acute bronchitis are caused by viruses, and the effect of antibacterial drugs, as is known, applies only to bacteria. Therefore, only a doctor can decide on prescribing a course of antibiotics after a thorough examination. Never make this decision on your own!
Contact the Pulmonology Center, they will definitely help you, conduct the necessary examination and tell you whether you should take antibiotics and in what quantity.
Trust your health only to professionals, contact us at the Pulmonology Center!
