Treatment of hospital pneumonia

The mode is prescribed taking into account the severity of pneumonia and the age of the child. It is necessary to maximally provide access to fresh air (aerotherapy). Frequent airing, walking rooms - in winter walks at an air temperature of at least -10 ° C. In wards and home conditions in the summer, windows almost always need to be kept open. The position in the crib of the child must be sublime, for which raise its head end. This position facilitates the function of breathing and circulation. Implementation of general hygiene measures. It is necessary to create a protective regime for the central nervous system: sufficient night and daytime sleep in a calm environment, the minimum amount of injections and manipulations required, and careful and gentle treatment. In the case of hospitalization, it is necessary that the mother is in hospital with the child and take care of him, this is of great importance for the CNS condition and maintaining the emotional tone of the child. Diet - the child's nutrition is performed taking into account the age and severity of the condition. The child should receive a sufficient amount of liquid, including fruit, berry and vegetable juices, decoctions of raisins, prunes, dried apricots, cranberries, cowberries, dogrose.

Etiological therapy. Antibiotics are prescribed taking into account the patient's anamnesis: what antibiotics he received earlier, whether there were allergic reactions to the administration of antibiotics.

With out-of-hospital ("ambulatory", "home") pneumonia caused mainly by pneumococcus, the drug of choice may be amoxiclav, co-amoxiclav, unazine, cefuroxime axetil (administered 2 times a day), cefaclor (3 times a day).

In children with a burdened allergic anamnesis, second-generation macrolides (azithromycin, roxithromycin, clarithromycin) or macrolides of the "intermediate" group (between old and "new") are used: midekamycin (prescribed from 2 months of age, 2 times a day), deecosamycin ( from 3 months to 3 times a day). A good effect is provided by "protected" aminopenicillins: co-amoxiclav (combination of amoxicillin with clavulanic acid), sultamycillin (chemical compound ampicillin and subactam). Children of the first 3 months of life co-amoxiclave are prescribed 2 times a day in a single dose of 30 mg / kg, over 3 months of life - in the same single dose 3 times a day (for severe infections - 4 times a day). For children of any age, there are special dosage forms of these antibiotics in the form of a powder for the preparation of a sweet suspension.

The course of treatment of pneumonia at home is 7-10 days.

In the absence of the effect of outpatient treatment of community-acquired pneumonia or in the case of moderate and severe (initially) treatment is carried out in a hospital. Antibiotics administered intravenously or intramuscularly are used, such as cephalosporins of the third generation - ceftriaxone, cefotaxime, affecting gram-positive and gram-negative microorganisms. To them macrolides inside (roxithromycin), clarithromycin, azithromycin (sumamed), midecamycin (macropen) are added.

Against the background of immunodeficiency; while the agent is determined in the smear, the treatment should be performed with aminoglycosides, effective against the Pseudomonas aeruginosa with carbenicillin or ticarcillin.

With hospital (hospital) pneumonia, which include pneumonia, manifested clinically and radiologically in 48-72 hours after hospitalization, the pathogens are much more resistant to antibiotic therapy and cause often severe infection that requires parenteral antibiotic administration in combinations. Currently, step-by-step antibiotic therapy is recommended, the essence of which is as follows: at the beginning of the course of treatment, the antibiotic is administered parenterally, and with a positive dynamics of the patient's condition (after 3-5 days) go to its oral application. Given that in the etiology of nosocomial pneumonia, the main role is played by staphylococcus, intestinal and pseudomonas aeruginosa, Klebsiella, parenterally used antibiotics "covering" the entire possible spectrum of pathogens: cephalosporins of the third generation (cefotaxime, ceftriaxone), ceftibutene (zedex) or acting as well on Pseudomonas aeruginosa - the best (ceftazidime) in combination with aminoglycoside (amikacin). As antibacterial monotherapy, carbapenems (thienam, meronem) or parenteral cephalosporin IV generation (cefepime) can be prescribed.

After receiving the result of bacteriological research, purposeful therapy is already prescribed.

Thus, in pneumococcus - amoxicillin, augmentin (clavulanic acid), co-amoxicillin (amoxicillin + clavulanic acid), cephalosporins III (ceftriaxone, cefataxime, zedex) and IV (cefepime) generations; macrolides (azithromycin, rovamycin, macropen, clarithromycin, fromilide).

With staphylococcus macrolides (azithromycin, clarithromycin, roxithromycin), carbopenems (thienal and meropenem), rifampicin, vancomycin.

When the hemophilic rod - amoxicillin, co-amoxicillin, augmentin, oral cephalosporins III (ceftriaxone, cefotaxime) and IV (cefepime) generations; macrolides (especially azithromycin, clarithromycin, roxithromycin, misekamycin, josamycin); as a reserve antibiotic monobactams (aztreonam iv / in and / m), carbapenems (thienes, meropenem).

With Pseudomonas aeruginosa - ceftazidime (no equal in influence on this microbe), cefepime, carbenicillin, especially ticarcillin, thienam amikacin; in severe cases, the use of antisignagic ureidopenicillins (piperacillin) in combination with beta-lactamase inhibitors is recommended.

Prichlamidia infection - the appointment of modern macrolides: azithromycin (sumamed), roxithromycin (rulid), clarithromycin, medikamycin (macropen), spiramycin (rovamycin), fromilid (form of clarithromycin).

In the treatment of pneumonia caused by gram-negative microorganisms, aminoglycosides (amikacin, gentamicin) and fluoroquinolones are commonly used. In the presence of fungal flora - diflucane, Nizoral, Avelox.

With respect to anaerobic flora, often responsible for aspiration pneumonia, metronidazole, clindamycin, cefepime, carbapenems are active.

Treatment of patients with pneumonia at home in addition to the appointment of a regimen, diet and antibiotics, provides for the oral use of vitamins C, B1, B2, B6, PP and B15 (improve oxygen consumption of tissues). It is prescribed vitamin E as an antioxidant. To normalize metabolism, metabolic therapy can be used (phosphaden, lipid, lipoic acid, carnitine chloride, calcium pantothenate). With difficulty in sputum discharge and to improve the drainage function of the bronchi are recommended: with a strong and unproductive cough apply means that do not reduce the separation of sputum - this is libexine, althea root, tusuprex; to reduce the viscosity of sputum, you can appoint ambroxol, lazolvan - bronchosecretolytic, which at the intracellular level regulates pathologically altered secretion, dissolves the thickened discharge, stimulates mucociliary clearance, and, important for young children, lazolvan stimulates the formation of surfactant. It is prescribed in syrup for children under 2 years 2.5 ml 2 times a day, from 2 to 5 years - the same dose 3 times a day. You can use bromhexine, which helps to reduce the viscosity of the secret due to the cleavage of acid mucopolysaccharides and the "softening" of secretion granules in goblet cells.

In the period of reparation, patients with asthenic syndrome and autonomic dysfunction are assigned adaptogens for 2-3 weeks - tinctures of Eleutherococcus, ginseng, biogenic stimulants - aloe, apilac. LFK and massage are conducted. Must stay in the fresh air for at least 3-4 hours, frequent ventilation of the premises where the child is.

A pediatrician visits a child in the acute period of pneumonia every day until the child's condition is permanently improved, then after 1 and 2 days, alternating visits with a nurse who assess the general condition of the child, adherence to prescribed therapy and procedures. In the early days of the disease, chest radiographs, blood and urine tests are taken. Analyzes of blood and urine are repeated after 2-3 weeks.

Treatment of a patient with pneumonia in a hospital. Pathogenetic therapy is aimed primarily at providing access to fresh air, oxygen. For this purpose, in addition to aerotherapy, with pronounced respiratory failure, oxygen therapy is prescribed.

At DN I-II degrees, oxygen tents are used, with DN II-III degree - the method of spontaneous breathing of an oxygen-enriched gas mixture with a positive inspiratory and exhalation pressure. Preventing the collapse of the alveoli of the lungs and the violation of alveolar ventilation, this method contributes to the elimination of hypoxia. To carry out oxygen therapy, a nasal catheter can be used, oxygen for humidification is passed through Bobrov's apparatus. Vitamin C, B1, B2, B6, PP, rutin (vitamin P), glutamic acid are prescribed for the child to improve vascular permeability. To correct the acidosis use cocarboxylase, dimphosphone, as a drink - oralite.

Indications for infusion therapy: severe toxicosis, a decrease in the volume of circulating blood (BCC), a violation of microcirculation, the threat of DIC syndrome, neurotoxicosis, purulent infection.

To improve the drainage function of the bronchi, inhalations with mineral alkaline water (Borzhomi, Essentuki No. 17), steam-oxygen inhalations of broths of herbs (chamomile, sage, coltsfoot, rosemary, eucalyptus leaf), aerosols of a 10% solution of N-acetylcysteine are used.

With energy-dynamic heart failure - tsanangin, kokarboksilaza, riboksin, Polarizing Labory mixture: 10% glucose solution - 10 mg / kg, insulin 2 units for every 100 ml of 10% glucose solution, panangin 5-10 ml, cocarboxylase - 0.1 -0.2 g, vitamins B6 and C in 2 ml. To reduce hypertension in a small circle of blood, pentamine or benzohexonium is prescribed to eliminate the centralization of blood circulation.

Since the first days, distraction therapy has been used in young children in the form of mustard wraps, physiotherapy - UHF, UHF; After the course of UHF or UHF, electrophoresis with calcium, ascorbic acid is prescribed. Of great importance is exercise therapy.

With prolonged pneumonia, antimicrobial therapy is carried out for 6-8 weeks with a change of drugs taking into account the sensitivity of the flora. Often used are oral medications: amoxiclav, cefuroxime axetil, cefaclor, zeidex, in children with a history of an allergy-azithromycin, clarithromycin or spiramycin, josamycin, macropen. Assign funds that improve the drainage function of the bronchi (see acute bronchitis). Recommended aerosol inhalation bronholiticheskih mixtures and mucolytic drugs: 2% solution of sodium bicarbonate and sodium chloride, 10% solution of N-acetylcysteine, proteolytic enzymes (chemopsin, trypsin, chemotripsin). LFK and chest massage.

Clinical follow- up of a child of an early age who has undergone pneumonia is performed for one year by a pediatrician and a pulmonary physician. Children of the first 3 years of life during the first half of the disease are observed twice a month, in the second half - once a month. Children from 3 months to 1 year and older - 1 time per month. An individual plan for dispensary observation of each child is made, taking into account the concomitant diseases, the state of reactivity of the organism. It is important to have maximum stay in the open air, full-fledged nutrition taking into account age with the introduction of a full-value protein of unsaturated fatty acids, seasonal use of vegetables and fruits. It is necessary to continue massage and exercise therapy. Taking into account the age of the child, hardening is carried out. Prescribe courses of multivitamins. In the presence of an allergy, Tavegil, Claritin, and Fenkarol are prescribed for 2-3 weeks with a change of drugs every 7 days.

A child who received long-term antibiotics or who had dyspeptic disorders during the period of the disease can be prescribed bifidumbacterin, lactobacterin, bifikol for a course of 3 to 6 weeks.

The criteria for removal from dispensary registration are satisfactory condition, good emotional tone, absence of clinical and radiological signs of the disease.