Iatrogenic Events During Antibiotic Therapy (Pulmonary Disease)

Antibiotics occupy a leading position among drugs that cause adverse drug reaction (ADR), in Russia as well. Drug-induced pulmonary disease (DIPD), which is the least studied, takes a special place among ADR in antibiotic therapy. There are difficulties in diagnosing such complications of antibiotic therapy, especially in patients with chronic bronchopulmonary pathology and receiving antibiotics due to an infection of the respiratory tract. Antibiotics occupy the third place (4.4%), after antitumor (53%) and antirheumatic (15%) drugs, among other groups of drugs that cause lung damage. Clinical options for DIPD are diverse. Antibiotics, which cause DIPD, are represented (in order of descending risk) by nitrofurans, daptomycin, tetracyclines (minocycline), cephalosporins (ceftaroline, ceftriaxone, cefotaxime, cefepime), fluoroquinolones (ciprofloxacin, levofloxacin). The forms of DIPD are extremely diverse when using nitrofurans (mainly nitrofurantoin) - from acute eosinophilic pneumonia (EP) to chronic interstitial pneumonitis and fibrosis («nitrofuran lung»). DIPD during treatment with lipotetic antibiotic daptomycin are well studied and are clinically presented by EP with a favorable outcome after discontinuation of the drug and the appointment of glucocorticoids; the risk of DIPD development directly depends on the total dose of daptomycin. Numerous clinical variants of DIPD have been observed with the use of tetracyclines (mainly minocycline, to a lesser extent doxycycline): EP, obliterating bronchiolitis with organizing pneumonia, pleurisy, pericarditis. With the use of certain cephalosporin antibiotics (cefotaxime, ceftriaxone, cefepime, ceftarolin), development of EP and hypersensitive pneumonitis has been noted; the development of the latter is associated with a genetic predisposition, since it is found predominantly among the inhabitants of Japan. Extremely rare cases of DIPD due to fluoroquinolones (ciprofloxacin, levofloxacin) are represented by hypersensitive pneumonitis. According to the classification of ADR, most DIPD belong to type B reactions (unpredictable, dose-independent, unrelated to pharmacological action); at the same time, lung damage due to daptomycin can be attributed to type C reactions (association with cumulation and dose of the drug, but not related to pharmacological action). The following clinical data allow to suspect DIPD in a patient receiving antibiotics: antimicrobial treatment, for which the development of lung damage is possible; the appearance of pulmonary symptoms in a patient receiving antibiotics due to infection of other localization, or exacerbation of pulmonary symptoms, despite the conduct of adequate antibiotic therapy; bilateral and interstitial nature of pulmonary lesions and the presence of systemic manifestations; eosinophilia of blood and BAL fluid. For the diagnosis of DIPD, a high-resolution CT scan, a dynamic study of eosinophils in the blood, a cytology of BAL fluid, and, in particularly difficult situations, a targeted fine needle biopsy of the lung are recommended.

antibacterial therapy, adverse reactions, pulmonary disease

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