Collection

zero Useful+1

zero

lower respiratory tract infection

Name of medical condition

respiratory tract infection Divided into upper respiratory tract infection And lower respiratory tract infection. upper respiratory tract infection Divided into Viruses Sexual (70-80%), bacterial (20-25%). ordinary cold (commonly known as catch cold ）Usually Rhinovirus 、 adenovirus 、 Respiratory syncytial virus Caused by sneezing rhinorrhea 、 Pharyngalgia A few are weak Low fever And other symptoms. and flu Influenza Viruses Cause, have a minor epidemic or outbreak, High fever , whole body Muscle soreness 、 conjunctivitis And other symptoms.

TCM disease name: lower respiratory tract infection

Category: Acute trachea - bronchitis, chronic bronchitis, pneumonia, bronchiectasis, etc

catalog

one Basic overview
two Type of lower respiratory tract infection
three prevention
four Quinolone antibiotics

Basic overview

Announce

edit

Lower respiratory tract infection is the most common Infectivity The disease that causes infection must be identified during treatment pathogen To select effective antibiotics. There are more and more antibiotics to choose from clinically, Drug resistant strains It also increased significantly due to the large dose cephalosporin Application of, resulting in Nosocomial infection In particular, Pseudomonas aeruginosa and Enterococcus infections are increasing. serology and molecular biology The progress of research has made people mycoplasma 、 chlamydia Infection or Legionella infection The awareness of. Fluoroquinolones and macrolides have attracted people's attention.

Type of lower respiratory tract infection

Announce

edit

Lower respiratory tract infections including acute trachea—— bronchitis , chronic bronchitis pneumonia , bronchiectasis, etc. Is created by Viruses , bacteria mycoplasma 、 chlamydia 、 Legionella And other microbial infections.

prevention

Announce

edit

Prevention and treatment of respiratory tract infection should follow Prevention first The principle of accurate diagnosis and timely treatment. The key points of prevention include: 1 Susceptible population Of Vaccination ； include Pneumonia vaccine 、 influenza vaccine Etc. 2 Application of antibiotics in susceptible population, chronic disease in the elderly bronchitis 、 bronchiectasia 、 diabetes 、 heart disease （ Heart failure ）Patients and children with low immunity cold Antibiotics can be properly used to prevent bacterial infection. 3 If it is not correct whether it is common cold or bacterial lower respiratory tract infection, the respiratory specialist should Medical guidance 。 Accurate diagnosis mainly refers to distinguishing common cold from bacterial lower respiratory tract infection. Timely treatment mainly refers to Bacterial infection We should pay attention to: taking sputum for bacterial culture before applying antibiotics; application Chinese Medical Association Recommended Community acquired pneumonia Experience antibiotic treatment; Generally, antibiotics should not be replaced frequently until they are ineffective for 3 days; The elderly can appropriately relax the conditions of antibiotic application; For teenagers Drug resistant bacteria Attention should be paid to pneumonia; Try to use less antipyretics, especially not frequently use hormones.

Quinolone antibiotics

Announce

edit

fluorine Quinolone Class A drugs are important drugs for the treatment of lower respiratory tract infections in recent years. The production of a new generation of fluoroquinolones derivatives has significantly broadened their pharmacological activities Verdant Bacillus has strong antibacterial activity. This kind of antibiotic has high tissue concentration, Minimum inhibitory concentration (mIC) is low and has been used clinically to treat hospital respiratory tract infections and ICU Infection in. Although it is generally recognized that quinolones such as ciprofloxacin are effective against community acquired lower respiratory tract infections not regard as First choice, only for resistance to common antibiotics and multiple antibiotics Drug allergy The main reason is that quinolone Streptococcus pneumoniae MIC is high. In Europe and North America It is mainly used to treat mild community lower respiratory tract infections.

New generation of quinolones

Announce

edit

Other new generation Quinolones Drugs such as fluro Mercury , romefloxacin and sparfloxacin Pneumococcus It has higher activity than ciprofloxacin It has high activity against pneumococcus and is 4-8 times more effective than ciprofloxacin. Most quinolones pass Active transshipment The mechanism is distributed in a bronchial tube The concentration in mucosa is 2 times higher than that in blood Alveolar epithelium It is 2~3 times higher than that in blood alveolar macrophage Medium as high as 9-15 times. Sparfloxacin concentration in different parts of lung tissue was significantly higher than that in blood. Therefore, it has been used clinically for treatment Drug resistance Mycobacterium tuberculosis and Non tuberculous Mycobacterium Infection and mycoplasma 、 chlamydia No caused by Typical pneumonia 。 Levofloxacin Its activity is more than 2 times higher than its precursor Pneumococcus Its efficacy is up to 4-8 times. his Drug resistance Is mainly due to Bacterial cell membrane For drugs permeability Changes, and other Drug action It plays an antibacterial role in bacterial dNA helicase by preventing double stranded dNA chains from transforming into helical dNA. Bacterial dNA helicase Subunit Mutation is also an important drug resistance mechanism. CFC-222 is a new Fluoroquinolone Antibiotics like, against gram-negative bacilli and Staphylococcus aureus The activity is very strong, and its in vitro activity is not affected by the amount of inoculated bacteria culture medium Composition and serum effects. If the drug resistance and side effects of the new generation of quinolones can be minimized clinically respiratory tract infection Will be more widely used.

β - lactam antibiotics

Announce

edit

β - lactam antibiotics It is widely used in the treatment of respiratory tract infection. Mainly including penicillin Class cephalosporin Class, other atypical β - lactam antibiotics as cephamicins , monoamides Carbapenems Etc. new generation Cephalosporins Compared with some antibiotics in the past, the pharmacokinetics is good, and it is effective for bacteria hydrolase as Beta lactamase Relatively stable, treatment of various Gram negative and positive Aerobic bacteria The resulting respiratory tract infection is effective. Lactam enzyme inhibitor as Clavulic acid 、 Sulbactam It is rarely used alone, and it is better than β - lactam antibiotics Combined use can significantly increase its antibacterial activity and reduce the production of drug-resistant strains, Amoxicillin And Ticarcillin Compound preparation of combined clavulanic acid, Augmentine and Temetin It has started to be applied in clinic. Taineng It is a new type of broad-spectrum β - lactam antibiotics , with strong inhibition Bacterial cell wall The effect of synthesis on most clinically important gram-positive and negative aerobic bacteria and Anaerobic bacteria All of them have strong bactericidal activity and are resistant to hospital infection caused by gram-negative bacilli septicemia And the severity caused by the deficiency of immune function Bacterial infection It has significant clinical effect. Meropenen and Imine The energy training structure is similar Carbapenems Drug, but different from its precursor Lactamase Highly stable, no need to interact with enzymes inhibitor Therefore, enzyme inhibitors can be used to treat some severe hospital infections. Oral cephalosporin The group A antibiotics are increasing day by day. Although they are more expensive than earlier compounds, they have strong antibacterial activity, good oral absorption Beta lactamase Strong stability. Cefaclor As the number one killer of Haemophilus influenzae, yes Pneumococcal pneumonia Of Effectiveness Has been clinical practice And animal tests confirmed that susceptibility There are also literature reports. 3rd generation oral Cephalosporins as Cephalosporin Kexime, cefoxitone, cefmetazide, etc. have been applied in many countries, and some early out of hospital infections pathogen Valid. Common for lower respiratory tract infection pathogenic bacteria alive penicillin 、 ampicillin Gradually resistant, mainly due to the production of lactamases Gene analysis It was found that this resistance originated from a single clone, most of which were serotype 6B. Severe in treatment pneumonia In patients, the third generation should be used once drug resistance occurs cephalosporin or Macrolide antibiotics Therefore, it is particularly important in clinical practice to detect the emergence of this drug resistance for early control.

Macrolide antibiotics

Announce

edit

with erythromycin Represented by Macrolides Most used to treat bacteria outside hospital pulmonary infection , Yes Pneumococcus 、 Staphylococcus aureus , Streptococcus and other gram-positive cocci have strong antibacterial activity; yes Haemophilus influenzae 、 Bordetella pertussis 、 Brucella And division Bacteroides fragilis Various anaerobic bacteria other than clostridium also have considerable antibacterial activity; Because it can enter the cell, right Typical pneumonia as chlamydia 、 mycoplasma 、 legionaires disease It has definite clinical effect. In recent years Acquirability Research on respiratory tract infection found that these are not typical pathogen It has obvious Invasiveness To make it Scope of application More and more widely.

In recent years, the drug resistance of erythromycin has increased significantly. At the same time, because of its gastrointestinal side effects, people began to look for some new drugs, such as the new generation of macrolide antibiotics roxithromycin id 、 Azithromycin 、 Clarithromycin It overcomes the problem of erythromycin at low pH due to its own molecular structure A series of side effects caused by disorderly stimulation of gastrointestinal tract peristalsis. Its main advantage is that gastric acid stable, Bioavailability High; Blood concentration 、 Histiocyte High concentration and lasting; half life Long, less side effects, complete oral absorption, short course of treatment, patient Tolerance It is obviously increased, so that its application prospect is broader.

Macrolide animal test

Announce

edit

Animal tests have confirmed that clarithromycin is highly concentrated in both serum and tissue, and has strong intracellular penetration. Therefore, clarithromycin Pneumococcus Pneumonia and Intractability Legionella infection 、 mycoplasma infection It has good curative effect; Azithromycin Single dose After 96h of administration, the concentration in the tissue increased significantly and the concentration in the serum was relatively low, so it was used for chronic bronchitis Severe attack and some pneumonia patients, while Severe pneumonia And the severity caused by it Bacteremia The curative effect is poor [7]. Other studies have confirmed that the new generation of macrolide antibiotics can change the immunity , right and wrong Tuberculosis Mycobacterium has a positive clinical effect Multidrug resistance The treatment of tuberculosis provides valuable clues.

Aminoglycoside antibiotics

Announce

edit

Aminoglycosides pair pneumonia Klebsiella 、 Enterobacteriaceae Isogram negative bacilli have strong antibacterial activity , Yes streptococcus Poor activity, Anaerobic bacteria Resistance to it. And penicillin Class or cephalosporin Combined use for some gram-positive cocci such as staphylococcus It also has good antibacterial activity. The main side effects are Nephrotoxicity And Ototoxicity 。 adopt Renal function test 、 Histology and Electrophysiology The study found that its toxicity is related to Blood concentration Closely related [9]. Continuous or multiple times Administration Compared with short course and large dose administration, drug accumulation in renal cortex of the former is significantly increased Lymph The concentration also increased significantly, while the otonephrotoxicity did not increase or even decrease when the dose was increased to shorten the course of treatment. stay Rat and mice Observed in Aminoglycoside antibiotics Of Pharmacokinetics And nephrotoxicity show circadian rhythm changes, and the fluctuation of circadian rhythm is attributed to Glomerular filtration rate The rhythmic change of gFR in humans and animals at rest is the lowest, so the chance of nephrotoxicity after administration at rest will increase significantly. According to the above research results, short course and large dose treatment schemes are currently recommended at home and abroad. The maximum peak concentration of aminoglycoside antibiotics is positively correlated with mIC, relevance The higher the curative effect, the better. A reasonable dosage that can reach the highest peak concentration can obtain satisfactory curative effect.

Aminoglycoside antibiotics have a long antibiotic follow-up effect (pAE) on gram-negative bacilli and staphylococcus. This phenomenon shows that the concentration of Time dependence It was decided that the cells would not continue to grow after a few hours of high-dose administration, and repeated administration would weaken the pAE of aminoglycoside antibiotics. Human beings were simulated in vitro Pharmacokinetic study It was found that Pseudomonas spp Pseudomonas aeruginosa yes gentamicin That is to say, drug resistance began, and its bactericidal activity still did not recover 24 hours after administration, while a large dose of drug once a day can eliminate this phenomenon.

Aminoglycoside antibiotics enter the cell mainly through cell uptake, and the speed is very slow Atomization inhalation And Cricothyroid puncture Gentamicin injection and high concentration inhalation Tobramycin Can maintain good sputum and tissue concentration Gram negative bacilli infection Bronchus of pneumonia The patient can produce very well Clinical efficacy 。 But yes respiratory tract The issue of local administration is still controversial. Opponents believe that local administration is easy to lead to drug resistance, and the pollution of inhalation treatment devices increases the chance of infection.

Change in focus of treatment

Announce

edit

The treatment of acute respiratory tract infection should consider both the antibacterial activity of antibiotics and pathogen Its own variation. Cassiere et al. suggested that for severe community acquired lower respiratory tract infection Combined treatment Protocol, the currently recommended medication is penicillin (or Amoxicillin ）Combined with macrolide and large dose aminoglycoside antibiotics. In recent years, the focus of researchers has shifted from specificity Pathogen Transfer to host pathogen interaction and bacterial production Pathogenic factor Come up. Therefore, change clinician The medication habits of inpatients can not only reduce the Hospitalization expenses And can significantly reduce Side effects of drugs and Adverse reactions 。

Novice on the road

Growth task Getting Started with Editing Edit Rule Edit by myself

I have questions

Content query Online Service Official post bar Feedback

Complaints and suggestions

Report bad information Failed to appeal through entries Complaint of infringement information Blocking query and unblocking

Jinggong Network Anbei No. 1100000200001