Zakażenia dróg oddechowych. Antybiotykoterapia - tak czy nie? Długo czy krótko?

New data on antibiotic susceptibility of common respiratory pathogens in Poland create an opportunity to modify the current guidelines for antibiotic therapy known as “Rekomendacje 2003”. The new guidelines should be prepared according to recent principles of preparation and presentation of diagnostic and therapeutic guidelines. In viral infections, i.e. the common cold, acute bronchitis, and bronchiolitis, principles of carefull care and symptomatic treatment such as analgesia and antypyrexia should be prepared and presented. In streptococcal tonsillitis shorter alternatives to 10-day penicillin therapy with amoxicillin or cephalosporins should be offered. In acute otitis media and acute rhinosinusis, which are initially viral nasopharyngeal infections with overimposed bacterial superinfections, the duration of the “watchfull waiting” strategy should be precisely defined. The increasing antibiotic resistance of Streptococcus pneumoniae requires increasing the single doses of betalactam antibiotics and of the daily dose to overcome resistance and simultaneously allows decreasing the frequency of antibiotic administration and shortening the duration of therapy. The increase in the percentage of betalactamase-producing Haemophilus influenzae requires administration of amoxicillin + clavulanate in a new proportion of 14:1-16:1. resulting from the high dose of amoxicillin. The principles of antibiotic substitution in case of allergy to betalactams should be modified. In non-immediate allergy for penicillins cephalosporins may be an alternative. In the case of immediate allergy to any betalactam or nonimmediate allergy to all betalactams, macrolides are an appriopriate subsitute.