Community-acquired pneumonia in outpatients: topical issues of antibacterial therapy

Abstract

Community-acquired pneumonia (CAP) is one of the leading causes of morbidity and mortality worldwide. Successful treatment of patients with CAP is mainly determined by the correct choice of the place of treatment (outpatient or inpatient) and the correct initial empirical therapy, considering the predictable spectrum of potential pathogens of CAP. The article provides up-to-date data on the etiological structure of non-severe CAP. Most patients with CAP receive outpatient medical care, which is determined by their clinical status and a limited number of laboratory data for minimizing the risk of adverse outcomes in CAP. The absence of a microbiological diagnosis in a mild course of CAP does not lead to a decrease in the effectiveness of empirical antibacterial therapy in outpatient settings. The article highlights current clinical recommendations on the choice of empirical antibiotic therapy for CAP in outpatients. Amoxicillin is a semi-synthetic penicillin, which, including in combination with the beta-lactamase inhibitor clavulanic acid, is the most affordable and widely used penicillin in various countries. According to clinical recommendations, amoxicillin, including in combination with a β-lactamase inhibitor, is the drug of choice for the initial empirical therapy of most outpatients with CAP. The oral route is the most common and preferred for antibiotic delivery in mild CAP. Dispersible forms of tablets have certain advantages, including easier intake in patients with difficulty swallowing, such as the elderly, stroke patients, and children. The assessment of biological equivalence showed similar pharmacokinetic parameters of Amoxicillin and Amoxicillin in combination with clavulanic acid in the form of dispersible tablets and in the original form of film-coated tablets.