Resistance of bacterial flora and recommendations on the use of antibiotics in respiratory infections

The widespread unreasonable use of antibiotics (ABs) in viral infections is one of the most important sources of increasing the drug resistance of the bacterial flora. This practice leads to a stereotyped prescription of ABs without taking into account the sensitivity of pathogens, which drastically reduces the effectiveness of therapy. The purpose of the review is information on the drug sensitivity of the main pathogens of community-acquired bacterial acute respiratory infections (ARIs) «here and now» and on current recommendations for their antibacterial therapy. The main respiratory pathogen, pneumococcus, has acquired a high level of resistance to macrolides and oral third generation cephalosporins, which makes these drugs unsuitable for the treatment of community-acquired typical pneumonia, otitis, and sinusitis. The growth of resistance to macrolides is also observed for hemolytic streptococcus, the causative agent of acute tonsillitis. Under these conditions, the main antibiotics for the treatment of all bacterial ARIs are amoxicillin and amoxicillin clavulanate, to which more than 90% of pneumococci are susceptible; Haemophilus influenzae also retains a high sensitivity to amoxicillin, moraxella -to amoxicillin/clavulanate. Their doses should not be less than 50 mg/kg/day, and in case of a risk of resistance - 80-100 mg/kg/day. Macrolides are indicated for the treatment of atypical pneumonia caused by mycoplasma and chlamydia. The article contains a translation of the section «Antimicrobial agents» of the new list of WHO vital medicines published in March 2017.

acute respiratory diseases, bacterial pathogens, drug resistance, empirical choice of antibiotics