"Difficult" pneumonia

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Abstract

The article considers the issues of therapeutic management of patients with so-called “difficult” pneumonia, particularly, patients with diagnosed syndrome slowly resolving / nonresolving pneumonia, who do not respond to the treatment. The reasons and significant risk factors potentially affecting the effectiveness of therapy are analyzed, the therapeutic tactics of managing patients with no “response to treatment” are considered, the list of necessary diagnostic methods and directions of antibiotic therapy is updated. The article analyses the tactics of managing patients with pneumonia during a pandemic caused by SARS-CoV-2 coronavirus. It also provides directions of diagnostics with priority discussion of biological markers of the inflammatory response as well as antimicrobial therapy strategy.

About the authors

Andrey A. Zaicev

Burdenko Main Military Clinical Hospital

Author for correspondence.
Email: zaicev@yandex.ru
ORCID iD: 0000-0002-0934-7313

д.м.н., проф., гл. пульмонолог Минобороны России, гл. пульмонолог ФГБУ «ГВКГ им. акад. Н.Н. Бурденко», президент Межрегиональной ассоциации специалистов респираторной медицины

Russian Federation, Moscow

Alexander I. Sinopalnikov

Russian Medical Academy of Continuous Professional Education

Email: zaicev@yandex.ru
ORCID iD: 0000-0002-1990-2042

д.м.н., проф., зав. каф. пульмонологии ФГБОУ ДПО РМАНПО, вице-президент Межрегиональной ассоциации по клинической микробиологии и антимикробной химиотерапии

Russian Federation, Moscow

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Supplementary files

Supplementary Files
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1. JATS XML
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2. Fig. 1. Variants of the EP flow [4].

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3. Fig. 2. The reasons for the ineffectiveness of the treatment of patients with CAP [4].

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4. Fig. 3. Use of the CRB-65 scale for choosing the site of treatment for CAP [21].

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5. Fig. 4. Risk factors for the detection of antibiotic-resistant microorganisms [4].

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6. Fig. 5. Algorithms for empirical antibiotic therapy of CAP in adults.

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