New Concept of Rational Use of Antibiotics in Outpatient Practice

Abstract

In recent years, there has been a significant increase in the frequency of antibiotic-resistant pathogens of community-acquired respiratory infections, especially pneumococcus, in most regions of the world, including Russia. This requires a review of recommendations on the use of antibiotics in the treatment of infections in outpatient practice. In 2017, two fundamental documents on the rational use of antibiotics in outpatient practice were issued: Eurasian Clinical Guidelines (document available at www.antimi-crob.net) and the 20^th WHO Essential Medicines List with recommendations on the choice of antibiotics for community-acquired infections. The opinions of the experts in these two documents almost completely coincided with the main provisions of rational antibiotic therapy. 5 key provisions of these documents are as follows. 1. In the recommendations for antibiotic therapy, antibiotics are divided into three lines or groups by administration priority. 2. Amoxicillin is an antibiotic of the 1st line of therapy in the treatment of all acute infections of the upper and lower respiratory tract. 3. Macrolides should be considered as antibiotics of the 2nd line of therapy (or the second group) for respiratory infections; their use is justified only when it is impossible to use penicillins; Azithromycin is not recommended for the treatment of respiratory infections due to environmental hazards and the risk of car-diotoxicity. 4. Fluoroquinolones are reserve antibiotics and are not recommended for the treatment of acute uncomplicated infections in outpatient practice. 5. The antibiotic must be of adequate quality and in optimal dosage form; WHO and UNICEF experts recommend the use of antibiotics in the most optimal form - in the form of dispersible tablets, which increases the safety of treatment and patient adherence to medical recommendations.