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 MODERN MEDICAL PRODUCTS IN PULMONOLOGY 
KAKHA VACHARADZE, Doctor of Medicine, M.D.
TSMU phthisiatric department, Professor.
Georgian Respiratory Association, Vice-President.
European Respiratory Association, Real member.
Georgian Phthisiatric Association, Board Member.
Member of Georgian Surgery Association.
Founder of Georgian Bronchopulmonologists Association.
Pneumonia still remains the actual medico-biological problem in the XXI century. This is contributed to its high prevalence in population, high mortality rate and serious economical loses.
The most authoritative recommendations (consensuses) in the diagnosis and treatment   of non-hospital pneumonia are those provided by the leading specialists, based on the randomized, placebo controlled trials and corresponds to the requirements of evidence based medicine. 
Non-hospital pneumonia is relatively common disease and is considered to be one of the leading causes of mortality. The main goal of these recommendations is to improve quality of diagnosis and treatment of non-hospital pneumonia in ambulatory and hospitalized patients. 
Pneumonia is the group of infection diseases which are classified according their etiologic, pathogenic and morphological pictures and which are characterized by local injuries of the respiratory part of lungs and intraalveolar exudation.
Based on the epidemiologic studies, the incidence of non-hospital pneumonia in adults (≥18 years) were more then 3 000 000 cases per year in five European countries (United Kingdome, France, Italy, Germany, Spain). 
The etiology of non-hospital pneumonia is related to the normal microflora, colonized in the upper part of the respiratory system. Such typical cause is S.pneumonia (30%-50% of cases). The main parts in the etiology of this disease also take “atypical” microorganisms (8%-30%), such as:
 
Chlamydophila pneumoniae
Mycoplasma pneumoniae
         Legionella pneumophila
 
The rare cases may be:
 
Haemophilus influenzae
Staphylococcus aureus
Moraxella catarrhalis
Klebsiella pneumoniae
 
And the rarest causes are other enterobacteria.  
 
It is important that non-hospital pneumonias often are caused by co-infections and mixed infections.
 
 
 
The natural activities of antimicrobial preparations against the common causes of non-hospital pneumonia are represented in the following scheme:
 
Antimicrobial Preparations
S. pneumoniae
penicillinsensitive
S. pneumoniae
penicillinresistant
H. influenzae
M. pneumoniae,
C. pneumoniae
S. aureus
(MSSA)
Klebsiella
pneumoniae
benzilpenicillin
+++
0
+
0
0
0
ampicillin
++
+
++
0
0
0
amoxicillin
+++
+++
++
0
0
0
cefazolin
+
0
+
0
+++
0
cefuroxim
++
+
++
0
++
++
ceftriaxon
+++
++
+++
0
++
+++
ceftazidim
0
++
+++
0
0
+++
spiramycin
+++
++
+
+++
++
0
ciprofloxacin
+
+
+++
++
+
+++
 
 
Beta-lactam drugs are the main preparations in the treatment of non-hospital pneumonia. This is contributed to its high bactericidal effects against the main causatives (especially against S.pneumonia), low toxicity and effective and safe usage during the many years.
 
Despite the rise of resistance of S.pneumonia, penicillin-resistant pneumococci, Heamophilus influenzae, M.catarrhalis, several enterobacteria, methicillinsensitive S.aureus still preserve high sensitivity to Cefamed (ceftriaxon) and correspondingly Cefamed has the high clinical effectivity in the treatment of non-hospital pneumonia. 
The important pharmacokinetic advantage of Cefamed is its high half-life which permits once daily usage of the preparation. 
In the presence of “atypical” microorganism in the etiology of pneumonia, it is important to combine beta-lactam drugs (Cefamed) with macrolides – Doramycine (spiramycin), the dignity of which is high effectivity against “atypical” microorganisms (C. pneumoniae, M. pneumoniae, L. pneumophila) along with S.pneumonia. Doramycin also have clinically important effect against Haemophilus influenzae.
Doramycin is characterized by good permeability in pulmonary tissue and the bronchial secretion, creating the higher concentration in them compared to plasma. It has high profile of safety and does not express cross-reactive allergic reactions with cefalosporines (Cefamed).  
It must be mentioned that treatment of non-hospital pneumonia can be divided in empirical and specific treatments determined by antibiotic sensitivity test of causative microorganism. As there is not effective express diagnostic method of non-hospital pneumonia nowadays the initiative etiotropic therapy is always empirical. That’s because it is important to pay attention to the antibacterial preparations which are effective against all possible causative agents of pneumonia, which can create high concentration in the respiratory system, have high safety profile, low rate of side effects, optimum parity cost/efficiency and good compliance, which is mainly defined by frequency of usage during the day and the length of treatment.     
According to all mentioned above, the treatment regimen of choice in the treatment of severe outpatient pneumonia still remains combination of Cefamed (ceftriaxon) and Doramycin (macrolide)
 
References:
1.      Non-hospital adult pneumonia: practical recomendations in diagnosis, treatment and prophylaxis. A.G. Chuchalin, A.I. Sinopalnikov, L.S. Strachunsky,
      R.S. Kozlov, S.A. Rachina, S.V. Iakovlev.
2.      Modern medical products in pulmonology. M.Listrov
3.      ASCAP recommendations for the treatment of outpatient pneumonia, 2004 year. Georgian Respiration Journal.