MURMAN KIKVIDZE – Doctor of Medical Sciences, Alergologist of Central University Clinic named Academician N. Khipshidze
Respiratory diseases represent the most widespread pathology of human. Increasing of its incidence in many countries do not depend either on climate or on social and economical development. Globalization process aggravates risk of spreading of these diseases and causes development of new infections, which spread faster and hardly is cured with traditional treatment methods. New causatives and new strains easily overlap all social and biological barriers and lead to unfavorable results.
Respiratory infections also commonly aggravate allergic diseases. Exacerbation of bronchial asthma is caused from this reason in 70-80% of cases. The high prevalence of bronchial asthma and allergic rhinitis and problems in treatment and prophylaxis of respiratory infections deserve the great attention from the side of scientists and physicians.
Antibiotics are not the usual component in the treatment regimen of exacerbated bronchial asthma, but they are indicated for the patients with concomitant pneumonia or fever and cough with purulent (containing polymorphonuclear cells and not eosinophils) sputum, which indicate its bacterial origin. Antibiotic therapy is especially important, if patient has bronchial asthma combined with bacterial sinusitis.
For the rational usage of antimicrobial treatment, it is important to identify the causative organisms and test their sensitivity to particular antibiotics. Also should be foreseen localization of the infection. Attention should be paid to patient’s individual characteristics (age, sex, allergic predisposition, pregnancy etc). Cost effectiveness of the particular antibiotic preparations should also be taken under consideration.
Ideally, antibiotic should be prescribed after identification of the bacteria and its sensitivity to the antibiotics. This takes time and may lead to fatal outcome for critically ill patient. That’s why physicians frequently have to begin antibiotic treatment empirically.
Viral and combined viral and bacterial infections are most meaningful from the causatives of respiratory tract infections. In the etiology of pneumonia and bronchitis the main is bacterial microflora and less frequently fungi and protozoa.
Nowadays, pneumonias are classified according its origin into ambulatory, so called non-hospital pneumonias and hospital pneumonias. The etiologic structures of them are basically different.
From the variety of microorganisms, only some of them have raised virulence. They can cause inflammatory reactions of the lower respiratory tract. Such typical causatives are S.pneumoniae (30-50% of cases). Infrequent causatives are: Haemophylus influenzae, Staphylococcus aureus, Klebsiella pneumoniae (3-5% of cases). Important role in the etiology of pneumonias play so called atypical microorganisms: Clamydophyla pneumoniae, Mycoplasmae pneumoniae, Legionella pneumoniae, and they cause 8-10 % of all cases of pneumonias. Randomly pneumonia may be caused by Pseudomonae. Quite often, Mycoplasmae or Chlamydiae may be isolated in adults with Pneumococcal pneumoniae.
Pneumonia, not infrequently, may be caused by respiratory viruses (influenzae A and B, Parainflunzae etc.), but they randomly cause sever lesions and are considered as the main risk factors in the development of bacterial pneumonias. It is important to carefully differentiate viral and bacterial pneumonias, as their treatment methods differ.
Also, it should be take in considerations, that acute progressive pneumonias may be caused by unknown causatives. Nowadays these may be avian flu virus, Coronaviruses.
Pneumonias in hospitalized patients are caused by Pneumococci, Mycoplasmae and Chlamydiae in 25 % of cases. The frequency of infections caused by Legionella spp, S.aureus, gram negative Enterobacteriae, K.pneumoniae is increasing in this group.
The main etiologic factors of acute bacterial sinusitis are:
Streptococcus pneumoniae – 20-35%
Haemohpylus influenzae – 6-25%
Moraxella catarralis – 2-10%
Anaerobes – 0-8%
Staphylococcus aureus – 0-8%
In case of chronic bacterial sinusitis :
Coagulase negative staphylococci – 24-80%
Anaerobes – 0-8%
Staphylococcus aureus – 9-33%
Streptococcus pneumoniae – 0-7%
Microorganisms have damaging effect on respiratory tract and cause serous-purulent or purulent exudation with disturbance of mucocilliary clearance, which leads to destruction of lung epithelia. During inflammatory reaction cytokines and ferments are released, which destructs elastin and leads to sever lesion of bronchial mucosa.
All mentioned above show that antibiotic therapy is important in the treatment of bronchial asthma with concomitant pneumonia, acute or exacerbated chronic sinusitis, fever and purulent sputum.
Nowadays, main antibiotics used for the treatment of respiratory infections are beta-lactam antibiotics, aminopenicillins, III-IV generations of cephalosporins and macrolids.
It is quite difficult to choose the correct antibiotic for the physician. He should predict which microorganism is the causative, take into consideration type of the infection, severity of the disease, patient age, tolerance of the antimicrobial preparation, its side effects etc.
Frequently, in the case of allergic reactions to penicillins, aminopenicillins and cephalosporins, macrolids are the only drug of choice for the treatment of respiratory infections.
Spiramycin (Doramycin), the macrolid of new generation have been used successfully in allergology for already many years. Its advantage is its high effectiveness against S.pneumoniae and atypical microorganisms. It is effective against H.influenzae. Easily penetrates in lung tissue and bronchial secrets, is safe and non-allergic. In contrast to other macrolids it reaches the highest concentration in infected lung tissue and alveolar macrophages. It is very important to mention spiramycin’s (Doramycin) suppressing effect on T lymphocytes, which hamper autoimmune damage of tissues.
The treatment duration with Doramycin is 5 to 10-14 days and depends on disease course. Treatment of exacerbation of bronchial asthma with coexisting infectious pneumonia, bronchitis, sinusitis, is aimed to regression of the inflammation process and shorten the course of exacerbation of bronchial asthma. The lengthening of the time of achieved remission is then accomplished with medications controlling asthma.