Author/Editor		Mivšek-Mušič, Ema
Title		Osnove novih smernic za ambulantno zdravljenje okužb na spodrnjih dihalih
Translated title		Suggestions for new guidelines for outpatients management of lower respiratory tract infections
Type		članek
Source		Krka Med Farm
Vol. and No.		Letnik 24, št. 35
Publication year		2003
Volume		str. 49-58
Language		slo
Abstract		Up to 80% of respiratory tract infections (RTI) are treated on an out-patient basis or at home. In 1997, the Slovenian Respiratory Society accepted the Slovenian Guidelines for the management of community-acquired pneumonia (1), and also in 1998, the Recommendations for the treatment of acute infective exacerbations of COPD (2). Similar epidemiology and bacterial susceptibility for antimicrobials in Slovenia and in western European countries, were the reason for Slovenia to adopt parts o f BTS (British Thoracic Society) guidelines and also of ERS (European Respiratory Society) guidelines (3, 4). In the years to follow, the antibiotic resistance of respiratory microorganisms developed to a different extent in each individual country. Meanwhile, new antibiotics for the management of RTI were approved, particularly new quinolones, new macrolides and ketolides, that are primarily indicated for the treatment of respiratory tract infections. At the Tavčarjevi dnevi 2001 symposium, RTls in the elderly were discussed and practical recommendations for treatment were prepared (S). On the occasion of the 80th anniversary of the Clinic for Respiratory Diseases and Allergy in Golnik, where new quinolones were introduced, an upgrade of Slovenian guidelines was formed. The new antibiotics should be included in the guidelines for out-patient treatment, however, indications should be care fully selected in order to further prevent the development of bacterial resistance to antibiotics, and to provide success ful out-patient treatment of RTl in most patients. The key factor for treatment choice is determined by host factors, comorbidities and intensity classification of the infection. Such approach and suggested antibiotic use would also be positive from the pharmacoeconomic point of view.
Summary		Do 80% bakterijskih okužb na dihalih zdravimo ambulantno in na domu. V letu 1997 so bile oblikovane slovenske smernice za zdravljenje zunajbolnišničnih pljučnic (1), leto kasneje pa priporočila za zdravljenje infekcijskih eksacerbacij KOPB (2). Oboje je sprejelo Združenje pnevmologov Slovenije. Zgledovali smo se po našim razmeram podobnih epidemioloških okoljih in povzeli predvsem priporočila Britanskega torakalnega združenja (3) in Evropskega respiratornega združenja (4). V letih zatem so nastajale nove mikrobiološko-epidemiološke okoliščine, ki so svojske različnim državam. V prakso pa so prihajali tudi novi antibiotiki, zlasti novi kinoloni, novi makrolidi in ketolidi, ki so namenjeni predvsem zdravljenju okužb na dihalih. Leta 2001 so bile na Tavčarjevih dnevih obravnavane okužbe na dihalih pri starostnikih in pripravljena priporočila za prakso (5), spremembe slovenskih smernic za okužbe na dihalih pa so nastajale ob 80-letnici Klinike Golnik in predstavitvi novih respiratornih kinolonov. Nove antibiotike je treba umestiti v priporočila za ambulantno zdravljenje, presoditi indikacije zanje, da bomo še naprej zadrževali razvoj bakterijske odpornosti proti antibiotikom, hkrati pa okužbe na dihalih zdravili uspešno in večinoma doma. Osrednje vodilo pri izbiri zdravljenja so dejavniki, povezani s posameznim bolnikom, in ocena intenzivnosti okužbe. Ta dejstva in sodobni antibiotiki bodo pogojevali tudi pocenitev uspešnega zdravljenja.
Descriptors		RESPIRATORY TRACT INFECTIONS PNEUMONIA ANTIBIOTICS COMMUNITY-ACQUIRED INFECTIONS BRONCHITIS AMBULATORY CARE PRACTICE GUIDELINES