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yxfbbiedtj · Wysłany: Wto 4:51, 08 Mar 2011

Chronic obstructive pulmonary disease with acute bacterial exacerbation of the threshold hypothesis and antibacterial treatment

lt; 50%, the elderly, acute deterioration of ≥ 4 times per year, there are important complications, malnutrition, long-term oral corticosteroids. In addition to the external pathogens, G a bacteria may increase, and often on the l3. Lactam antibiotic resistance. Recommended quinolone drugs, p. Lactam lactamase inhibitor,[link widoczny dla zalogowanych], Ⅱ / Ⅲ generation cephalosporins,[link widoczny dla zalogowanych], new macrolides. Type the majority of chronic purulent bronchiectasis, clinical persistent cough, purulent sputum and frequent deterioration. In addition to complex outside of the common pathogens, Enterobacteriaceae and Pseudomonas bacteria increased. Recommend 3 drug intravenous ciprofloxacin or other antibiotics against Pseudomonas. Must be stressed,[link widoczny dla zalogowanych], AECOPD severity of clinical disease varies greatly,[link widoczny dla zalogowanych], the need for antibiotic treatment of clinical prognostic factors in its impact fully assessed. These factors include: ① the infection of G a possibility Enterobacteriaceae; ② the case of bacterial colonization; ③ past history of acute exacerbation and antibiotic efficacy; ④ antimicrobial treatment failure in patients with lung function level can bear; ⑤ Other clinical decision making needs factors. Additional risk factors under evaluation, the following indicators should be enhanced with any 2 of the antibiotic treatment (mainly directed against G-bacilli): ① the short term (less than 4 months) onset of more than 3 times; ② who received multiple antibiotic therapy ; ③ G has proved the existence of a respiratory tract bacteria (Enterobacteriaceae, Pseudomonas, Klebsiella),[link widoczny dla zalogowanych], and other colonization; ④ had previous ineffective antibiotic treatment history that required mechanical ventilation; ⑤ G bacilli lower respiratory tract infection of a past history of ; ⑥ long-term hormone treatment system; ⑦ 10d within the emergency medical treatment several times due to recurrence of symptoms; ⑧ need oxygen therapy; ⑨ smoking; ⑩ has proved popular location of penicillin-resistant Streptococcus pneumoniae; ⑨ G of chronic alcoholism and had a sp (Klebsiella) history of lower respiratory tract infections; ⑥ serious complications (immune suppression, H 【V infection, cancer, etc.).