1 / 39

MANAGEMENT OF LOWER RTI IN BULGARIA THE PROBEMS

MANAGEMENT OF LOWER RTI IN BULGARIA THE PROBEMS. Kosta Kostov Clinic of pulmonary diseases Military Medical Academy , Sofia, BG koro_55@mail.bg. Europe & the Balkan countries. RU. BY. UA. RO. SL. HR. BA. SB &MN. BG. TR. MC. AL. GR. Antalya, 2007. 3.5. > 5 y. 3.

jillian-adriano
Download Presentation

MANAGEMENT OF LOWER RTI IN BULGARIA THE PROBEMS

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. MANAGEMENT OF LOWER RTI IN BULGARIATHE PROBEMS Kosta Kostov Clinic of pulmonary diseases Military Medical Academy, Sofia, BG koro_55@mail.bg

  2. Europe & the Balkan countries RU BY UA RO SL HR BA SB &MN BG TR MC AL GR Antalya, 2007

  3. 3.5 > 5 y. 3 < 5 y. 2.5 Million deaths 2 1.5 1 0.5 0 ARTI Measles Diarrhoea AIDS TB Malaria ARTI: The KILLER Antalya, 2007 World Health Organization, 1999.

  4. THE PROBLEMS • Poverty of the bigger part of the population esp. elderly • The diagnosis of pneumonia is often incorrect (false positive) • Some of the GP’s are not familiar with the most probable causative agents (etiology data of RTI) and with the principals of empirical treatment • Frequent and unneeded use of antibiotics (esp. betalactams) and the Stoichkov syndrome. • Bacterial resistance • Many GP’s are not familiar with the risk groups of patients who need more precise treatment options • Low reimbursement of antibiotics Antalya, 2007

  5. Demografic / health indicators • Total population: 7.866.000 • GDP per capita ($): 5.021 • Total health expenditure per capita ($): 198 • Total health expenditure as % of GDP: 4.4 Antalya, 2007

  6. BULGARIAN CAP GUIDELINES2007

  7. Definition of CAP Acute infection of lung parenchyma, running with: • (а) minimum 2 of following symptoms:fever, shiver, acute coughwith or without sputum (not obligatory symptom) orchronic coughwith changed sputum colour, pleural pain, dyspnea; • (б) auscultatory signs of pneumonia (crepitations or cracles, bronchial breath); • (в) new infiltrateson chest XR, without any explanation (pulmonary oedemaor embolia). Guidelines of CAP, 2007 Antalya, 2007

  8. When CAP is sure? According the definition CAPis sure only when the clinical suspicion of CAPis radiologicaly confirmed! Woodhead M. et al. Guidelines for the management of adult lower respiratory tract infections. Eur Respir J, 2005; 26: 1138-1180 Antalya, 2007

  9. Pneumococcal pneumonia

  10. CAP AGENTS (1998-2001) • Str. Pneumoniae - 26,5% • Haemophhilus influenzae - 3,5% • Moraxella catarrhalis - 1,2% • Klebsiella pneumoniae - 6,1% • Staphylococcus aureus - 9,5% • Escherichia coli - 7,5% Chlamidia pneumoniae andMycoplasma pneumoniae are not involved

  11. EMPIRICAL APPROACH Too manyprescriptions of: BETALACTAM’S and CIPROFLOXACIN Antalya, 2007

  12. Таbl 5. Guidelines for initial empirical CAP treatment - 2007. • Макролид – clarithromycin, azithromycin или roxithromycin; ** с най-висока активност спрямо S. pneumoniae от флуорохинолоните; • *** монотерапията често води до развитие на резистентност и затова се предпочита комбинация на -лактам с флуорохинолон. • Аминогликозидите са свързани с по-висока токсичност. Орални цефалоспорини не са за препоръчване поради не особено добра фармакокинетика.

  13. STOICHKOV SYNDROME Everybody knows how to treat himself (great self-confidence) !

  14. Resistance ofS. pneumoniae/ penicillin use % ofpenicillin resistance Ton’s of penicilinspro year Baquero, et al. JAC. 1991.

  15. 60 54 52 50 46 49 50 44 36 40 30 (%) 23 15 20 9 6 10 0 Latvia Overall Poland Croatia Bulgaria Slovenia Hungary Lithuania Romania Czech Rep. Slovak Rep. Bozdogan et al. Clin Microbiol Infect 2003;9:653–661. Penicillin MICs 0.12 mg/L. Penicillin-nonsusceptibleS. pneumoniae(2000–2001) Penicillin-non-susceptible isolates

  16. PENICILLIN RESISTANCE NCIPD, 2001 S. pneumoniae 22%

  17. RESISTANCE European antibiotic resistance surveillance study project (EARSS,1999): Erythromycin resistance ofS. pneumoniaein BGis: • 16% (interview) and • 8 %(throughEARSSproject); Emma Keuleyan et al. Antimicrobial agents, 2004; 24: 199-204

  18. RESISTANCE NCIPD, 2001 Macrolide resistance ofS. pneumoniae - 15% !

  19. 35 30 25 % 20 15 10 5 0 1979-87 1988-89 1990-91 1994-95 1997-98 1999- 2000- 2002- 2000 2001 2003 Visible increase ofpenicillin - 1-4and macrolide - resistantS. pneumoniae3-6 Penicillin-resistant (MIC ≥ 2 mg/L) Macrolide-resistant 1. Spika JS, et al. J Infect Dis. 1991;163:1273-1278; 2. Jorgensen JH, et al. Antimicrob Agents Chemother. 1990;34:2075-2080; 3. Doern GV, et al. Antimicrob Agents Chemother. 2001;45:1721-1729; 4. Doern GV, Brown SD. J Infect. 2004;48:56-65; 5. DoernGV, et al. Antimicrob Agents Chemother. 1996;40:1208-1213; 6. Doern GV, et al. Emerg Infect Dis. 1999;5:757-765.

  20. RESISTANCE2001 Haemophilus influenzae(pen) 33% Gram stained sputum (AECB) Haemophilus influenzae

  21. ONE OF THE MOST FREQUENT PROBLEMS IS: COMORBIDITY, which needs more precise treatment options and it isn’t taken in consideration!

  22. RISK PATIENTS GROUPS FOR BACTERIAL RESISTANCE • frequent suffering • > 65 y. old. • antibiotic therapy during last 3 months • immunosuppressed • comorbidity • nursing homes residents Wise R. A review of the mechanisms of action and resistance of antimicrobial agents. Can Respir J1999;6(SupplA):A20-2.

  23. The influence of good clinical evaluation on the treatment successof CAP?

  24. How often АBisinappropriate? Inappropriate (%) 45 50 40 34 30 17 20 10 0 CAP HAP HAP following CAP therapy Kollef M. et al. Chest 1999;115:462–474

  25. Effectofinappropriate AB therapy in ICU Deaths (%) 60 52 50 40 30 20 12 10 0 Inappropriate empirical therapy appropriate empirical therapy Kollef M. et al. Chest 1999;115:462–474

  26. QUORUM SENSING What about the whisper among bacterias? Maybe, that they where before and will be after us and we are only a surmountable obstacle on their way!

  27. after years...

  28. THE BETTER ALTERNATIVE

  29. Thank you for the attention! koro_55@mail.bg Mobile: 0888231921

More Related