Sustainable Antibacterial Management of Respiratory Infections in Actual Practice

Bibliography link: Fesenko O.V., Sinopalnikov A.I., Yanina А.А., Tokmulina G.M. Sustainable Antibacterial Management of Respiratory Infections in Actual Practice. Doctor.Ru. 2020; 19(5): 67–73. (in Russian) DOI: 10.31550/1727-2378-2020-19-5-67-73
22 July 19:45

Objective of the Review: to describe the principles of sustainable antibacterial therapy of respiratory infections in actual practice.

Key Points. Continuous increase in infectious agents’ resistance and dramatic reduction in the number of novel antibiotics make sustainable antibiotics therapy one of the burning issues of the contemporary medicine. Analysis of the current federal recommendations on management of respiratory infections and case studies are used in the article to discuss the principles of antibacterial therapy of respiratory infections.

Conclusion. The key principles of a successful antimicrobial therapy are accurate diagnosis, selection of a starting antibiotic agent depending on the causative agent, the rate of resistivity in the country and region, and individual risk factors for infection with resistant agents; accurate drug dosing; adequate efficiency and antimicrobial therapy duration assessment.

Contributions: Fesenko, O.V. — manuscript preparation; Sinopalnikov, A.I. — selection of sources; Yanina, A.A. — patient examination; Tokmulina, G.M. — patient examination and management.

Conflict of interest: The authors declare that they do not have any conflict of interests

O.V. Fesenko (Corresponding author) — Russian Medical Academy of Continuous Professional Education at the Ministry of Health of the Russian Federation; Bld. 1, 2/1 Barrikadnaya Str., Moscow, Russian Federation 125993. Е-mail:

A.I. Sinopalnikov — Russian Medical Academy of Continuous Professional Education at the Ministry of Health of the Russian Federation; Bld. 1, 2/1 Barrikadnaya Str., Moscow, Russian Federation 125993. Е-mail:

А.А. Yanina — S.P. Botkin Municipal Clinical Hospital of Moscow Department of Public Health; 5 2-Y Botkinskiy Proyezd, Moscow, Russian Federation 125284. Е-mail:

G.M. Tokmulina — N.V. Sklifosovskiy Clinical Medicine Institute, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation; 8/2 Trubetskaya Str., Moscow, Russian Federation 119435. Е-mail:


Table 1 Amoxicillin/ clavulanate (Amoxiclav) is highly potent against major causative agents of respiratory infections [28]


Note: +++ — high potency, ++ — moderate potency, 0 — no clinical potency, PRP — penicillin-resistant pneumococci, PSP — penicillin-susceptible pneumococci, MSSA — methicillin-susceptible Staphylococcus aureus.

 Fig. 1. Patient Т. X-ray image at first visit: frontal and lateral view. Illustrations by A. A. Yanina


Table 2
Antibacterial therapy of community-acquired pneumonia in adults [22]


1 Chronic obstructive pulmonary disease, diabetes mellitus, chronic cardiac failure, chronic renal disease, hepatic cirrhosis, alcoholism, drug addiction, exhaustion.
2 Administration: ≥ 2 days.
3 Not feasible for regions with resistivity of over 25% (Moscow, St. Petersburg).

Fig. 2. Patient Т. X-ray image at first visit (frontal and lateral view) after therapy. Illustrations by A. A. Yanina


Table 3
Antibacterial therapy of infectious complications of chronic obstructive pulmonary disease (COPD) [23]


Received: 15.06.2020
Accepted: 06.07.2020

22 July 19:45
  1. Luyt C.-E., Bréchot N., Trouillet J.-L., Chastre J. Antibiotic stewardship in the intensive care unit. Crit. Care. 2014; 18(5): 480. DOI: 10.1186/s13054-014-0480-6
  2. World Health Organization. Global action plan on antimicrobial resistance. WHO Library Cataloguing-in-Publication Data. 2015. URL: (Access date: 15.06.2020).
  3. Machowska A., Stålsby Lundborg C. Drivers of irrational use of antibiotics in Europe. Int. J. Environ Res. Public Health. 2018; 16(1): 27. DOI: 10.3390/ijerph16010027
  4. Dolin R. Common viral respiratory infections. In: Kasper D., Fauci A., Hauser S., Longo D., Jameson J.L., Loscalzo J. Harrison's principles of internal medicine. New York: McGraw-Hill Education; 2014.
  5. Yuschuk N.D., Vengerov Yu.Ya., eds. Infectious diseases. National manual. M.: GEOTAR-Media; 2010. 1047 p. (in Russian)
  6. Fendrick A.M., Monto A.S., Nightengale B., Sarnes M. The economic burden of non-influenzarelated viral respiratory tract infection in the United States. Arch. Intern. Med. 2003; 163(4): 487–94. DOI: 10.1001/archinte.163.4.487
  7. Kozlov R.S., Golub A.V. To stop the progress of antimicrobial resistance today means to give a chance of mankind surviving tomorrow. Clinical Microbiology and Antimicrobial Chemotherapy. 2019; 4: 310–13. (in Russian)
  8. O’Brien K.L., Wolfson L.J., Watt J.P., Henkle E., Deloria-Knoll M., McCall N. et al. Burden of disease caused by Streptococcus pneumoniae in children younger than 5 years: global estimates. Lancet. 2009; 374(9693): 893–902. DOI: 10.1016/S0140- 6736(09)61204-6
  9. Kolditz M., Tesch F., Mocke L., Höffken G., Ewig S., Schmitt J. Burden and risk factors of ambulatory or hospitalized CAP: a population based cohort study. Respir. Med. 2016; 121: 32–8. DOI: 10.1016/j.rmed.2016.10.015
  10. Zhang Z., Chen M., Yu Y., Pan S., Liu Y. Antimicrobial susceptibility among Streptococcus pneumoniae and Haemophilus influenzae collected globally between 2015 and 2017 as part of the Tigecycline Evaluation and Surveillance Trial (TEST). Infect. Drug Resist. 2019; 12: 1209–20. DOI: 10.2147/IDR.S203121
  11. Giufrè M., Fabiani M., Cardines R., Riccardo F., Caporali M.G., D’Ancona F. et al. Increasing trend in invasive non-typeable Haemophilus influenzae disease and molecular characterization of the isolates, Italy, 2012–2016. Vaccine. 2018; 36(45): 6615–22. DOI: 10.1016/j.vaccine.2018.09.060
  12. Liapikou A., Torres A. The clinical management of lower respiratory tract infections. Expert. Rev. Respir. Med. 2016; 10(4): 441–52. DOI: 10.1586/17476348.2016.1156537
  13. Atlas R.M. Handbook of microbiological media. CRC Press; 1997. 1946 p.
  14. Harbarth S., Balkhy H.H., Goossens H., Jarlier V., Kluytmans J., Laxminarayan R. et al. Antimicrobial resistance: one world, one fight! Antimicrob. Resist. Infect. Control. 2015; 4: 49. DOI: 10.1186/s13756-015-0091-2
  15. Zumla A., Memish Z.A., Maeurer M., Bates M., Mwaba P., A Al-Tawfiq J. et al. Emerging novel and antimicrobial-resistant respiratory tract infections: new drug development and therapeutic options. Lancet Infect. Dis. 2014; 14(11): 1136–49. DOI: 10.1016/S1473-3099(14)70828-X
  16. Kuzmenkov A.Yu, Trushin I.V, Avramenko A.A., Edelstein M.V., Dekhnich A.V., Kozlov R.S. AMRmap: an online platform for monitoring antibiotic resistance. Clinical Microbiology and Antimicrobial Chemotherapy. 2017; 19(2): 84–90. (in Russian)
  17. Torumkuney D., Mayanskiy N., Edelstein M., Sidorenko S., Kozhevin R., Morrissey I. Results from the Survey of Antibiotic Resistance (SOAR) 2014–16 in Russia. J. Antimicrob. Chemother. 2018; 73 (suppl.5): v14–v21. DOI: 10.1093/jac/dky065
  18. Dabernat H., Delmas C. Epidemiology and evolution of antibiotic resistance of Heamophilus influenzae in children 5 years of age or less in France, 2001–2008: a retrospective database analysis. Eur. J. Clin. Microb. Infect. Dis. 2012; 31(10): 2745–53. DOI: 10.1007/s10096-012-1623-9
  19. Kozlov R.S., Zyryanov S.K., Sinopalnikov A.I., Ryazantsev S.V., Styrt E.A. Empiric antibacterial therapy of respiratory infections depending on risks of resistivity. Expert resolution. Ambulatory Guidance. 2018; 1: 28–32. (in Russian)
  20. Chuchalin A.G., ed. Respiratory medicine: manual. M.: Litterra; 2017. V. 2. 544 p. (in Russian)
  21. Harris A.M., Hicks L.A., Qaseem A.; High Value Care Task Force of the American College of Physicians and for the Centers for Disease Control and Prevention. Appropriate antibiotic use for acute respiratory tract infection in adults: advice for high-value care from the American College of Physicians and the Centers for Disease Control and Prevention. Ann. Intern. Med. 2016; 164(6): 425–34. DOI: 10.7326/ M15-1840
  22. Clinical recommendations rubricator. URL: (Access date: 15/06/2020). (in Russian)
  23. Karneeva O.V., Polyakov D.P., Gurov A.V., Ryazantsev S.V., Maksimova E.A., Kazanova A.V. Clinical recommendations. Acute otitis media. М.; 2016. 24 p. (in Russian)
  24. Ryazantsev S.V., Karneeva O.V., Garaschenko T.I., Gurov A.V., Svistushkin V.M., Sapova K.I. et al. Clinical recommendations. Acute sinusitis. М.; 2016. 30 p. (in Russian)
  25. Polyakov D.P., Karneeva O.V., Ryazantsev S.V., Garaschenko T.I., Gurov A.V., Kazanova A.V. et al. Clinical recommendations. Acute tonsillopharyngitis. М.; 2016. 24 p. (in Russian)
  26. Chuchalin A.G., Sinopalnikov A.I., Kozlov R.S., Avdeev S.N., Tyurin I.E., Rudnov V.A. et al. Clinical recommendations. Community-acquired pneumonia. М.; 2018. 88 p. (in Russian)
  27. Chuchalin A.G., Avdeev S.N., Aysanov Z.R., Belevskiy A.S., Leschenko I.V., Ovcharenko S.I. et al. Federal clinical recommendations. Chronic obstructive pulmonary disease. М.; 2016. 68 p. (in Russian)
  28. Kozlov R.S., Dekhnich A.V., eds. Antimicrobial therapy guide. Issue 2. Smolensk: MAKMAX; 2010. 416 p. (in Russian)
  29. Veselov A.V. Amoxicillin/clavulanate: pharmacokinetics and pharmacodynamics in acute respiratory infections. Practical Pulmonology. 2008; 33–6. (in Russian)
Новости мировой медицины! Свежие статьи из журнала! Будьте в курсе!

Похожие статьи

Similar article
19 April 00:00, Paediatrics
A.V. Aksenov, E.A. Ivanovskaya
Successful Use of Tocilizumab in a Child with Systemic Juvenile Idiopathic Arthritis
Doctor.Ru Pediatrics. Vol. 20, No. 3 (2021)
19 April 00:00, Paediatrics
N.G. Bagdasaryan, G.S. Ayvazyan, L.A. Avetisyan, N.R. Mnatsakanyan, L.T. Aleksanyan
Hemophagocytic Lymphohistiocytosis in Children
Doctor.Ru Pediatrics. Vol. 20, No. 3 (2021)