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Therapeutic solutions for patients with community-acquired pneumonia in Bulgaria. Yavor Ivanov, Pavlina Nikolova, Tsanya Popova, Plamen Pavlov University Pulmonary Clinic Pleven, Bulgaria. Incidence of CAP in Bulgaria. Incidence of CAP in Bulgaria 1995-2004 ( provided by NCHI ). - PowerPoint PPT Presentation
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Therapeutic solutions Therapeutic solutions for patients with for patients with community-acquired community-acquired pneumonia in Bulgariapneumonia in BulgariaYavor Ivanov, Pavlina Nikolova,Yavor Ivanov, Pavlina Nikolova,Tsanya Popova, Plamen PavlovTsanya Popova, Plamen PavlovUniversity Pulmonary ClinicUniversity Pulmonary ClinicPleven, BulgariaPleven, Bulgaria
Incidence of CAP in Incidence of CAP in BulgariaBulgaria
yearyear numbernumber perper 100 000 100 000 populationpopulation
19951995 31 08031 080 450.3450.3
19961996 32 85432 854 500.3500.3
19971997 23 94623 946 365.3365.3
19981998 24 64524 645 376.1376.1
19991999 22 84322 843 348.5348.5
20002000 24 37524 375 371.8371.8
20012001 21 86521 865 342.1342.1
20022002 35 71535 715 550.0550.0
20032003 40 54240 542 635.0635.0
20042004 38 27038 270 599.8599.8
0
100
200
300
400
500
600
700
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
Incidence of CAP in Bulgaria 1995-2004 (provided by NCHI)per 100 000
population
years
Mortality from CAP Mortality from CAP in Bulgariain Bulgaria
yearyear numbernumber perper 100 000 100 000 populationpopulation
19951995 26682668 38.638.6
19961996 28312831 41.041.0
19971997 27062706 39.239.2
19981998 22032203 32.032.0
19991999 19281928 28.028.0
20002000 19721972 28.728.7
20012001 14611461 21.821.8
20022002 13801380 20.620.6
20032003 14051405 21.021.0
20042004 12721272 19.019.0
0
5
10
15
20
25
30
35
40
45
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
Mortality from CAP in Bulgaria 1995-2004 (provided by NCHI)
years
per 100 000 population
40.1
16.915.7
14.5
10.5 2.3S. pneumoniae
H. influenzae
K. pneumoniae
M. catarrhalis
P. aeruginosa
Other
EtiologyEtiology
•4669 patients hospitalized for CAP4669 patients hospitalized for CAP•21,5% had positive sputum result21,5% had positive sputum result
24.7
16.4
6
9.6
19.4
8.5
6.3
Penicillin
Erytromycin
Azithromycin
Clindamycin
Doxycycline
Ceftriaxone
Rifampin
S. pneumoniae resistanceS. pneumoniae resistance
Clinical considerationsClinical considerations
Assess the patientAssess the patient– Clinical condition – CRB 65Clinical condition – CRB 65– As a host of a probable agentAs a host of a probable agent– As a social beingAs a social being
The key advice for the The key advice for the prescribing doctorprescribing doctor
MIC Concentration at the site of infection Power
Number of antibiotics Number of antibiotics till clinical curetill clinical cure
59,3%49,3%
31,3%37,3%
8,6%12,6%
0,6%
1AB 2 AB 3 AB 4 AB
Number of antibiotics
Outpatients
Hospitalised
Setting Severity Recommended Alternative
Out-patient All
beta-lactam and/or macrolide
levofloxacinmoxifloxacin
Hospital
mild/moderate penicillin ± macrolide levofloxacin, moxifloxacin
beta-lactam ± macrolide
co-amoxiclav ± macrolide
cephalosporin II-III ± macrolide
Hospital Severe cephalosporin II-III ± macrolide
cephalosporin II-III ± levofloxacin, moxifloxacin
Hospital
Severe and risk
Antipseudomonas cephalosporin +
acilureidopenicillin/beta-lactamase inhibitor +
for Ps.aeruginosa ciprofloxacin ciprofloxacin
or carbapenem + ciprofloxacin
Bulgarian CAP guidelinesBulgarian CAP guidelines
Setting Severity Recommended Alternative
Out-patient All beta-lactam and/or macrolide
levofloxacin, moxifloxacin
hospital mild/moderate penicillin ± macrolide levofloxacin,
beta-lactam ± macrolide
co-amoxiclav ± macrolide moxifloxacin
cephalosporin II-III ± macrolide
Hospital Severe cephalosporin II-III ± macrolide
cephalosporin II-III ± levofloxacin, moxifloxacin
Hospital Severe and risk Antipseudomonas cephalosporin +
acilureidopenicillin/beta-lactamase inhibitor +
for Ps.aeruginosa ciprofloxacin ciprofloxacin
or carbapenem + ciprofloxacin
Bulgarian CAP guidelinesBulgarian CAP guidelines
Setting Severity Recommended Alternative
Out-patient All beta-lactam and/or macrolide
levofloxacin, moxifloxacin
Hospitalmild/moderate penicillin ± macrolide
levofloxacin, moxifloxacin
beta-lactam ± macrolide
co-amoxiclav ± macrolide
cephalosporin II-III ± macrolide
hospital severe cephalosporin II-III ± macrolide
cephalosporin II-III ± levofloxacin or moxifloxacin
HospitalSevere and risk Antipseudomonas cephalosporin +
acilureidopenicillin/beta-lactamase inhibitor +
for Ps.aeruginosa ciprofloxacin ciprofloxacin
or carbapenem + ciprofloxacin
Bulgarian CAP guidelinesBulgarian CAP guidelines
Setting Severity Recommended Alternative
Out-patient All
beta-lactam and/or macrolide levofloxacin, moxifloxacin
Hospital mild/moderatepenicillin ± macrolide levofloxacin, moxifloxacin
beta-lactam ± macrolide
co-amoxiclav ± macrolide
cephalosporin II-III ± macrolide
Hospital Severecephalosporin II-III ± macrolide
cephalosporin II-III ± levofloxacin, moxifloxacin
Hospital Severe and risk
Antipseudomonal cephalosporin +
antipseudomonal beta-lactam/ beta-lactamase inhibitor + ciprofloxacin
for Ps.aeruginosa ciprofloxacin
or carbapenem + ciprofloxacin
Bulgarian CAP guidelinesBulgarian CAP guidelines
150 outpatients vs 150 hospitalized patients150 outpatients vs 150 hospitalized patients
0
10
20
30
40
50
60
70
Outpatients Hospitalised
Macrolides
Quinolones
Amoxicillin/clavulanate
Ceftriaxone
Doctors’ solutionsDoctors’ solutions
11,47days
10,17days
Outpatients Hospitalized
Duration of treatment
21,1 €
72,06 €
Outpatients Hospitalized
Average cost of antibiotic treatment per patient
Summary – practical Summary – practical solutionssolutions Simple and clear guidelinesSimple and clear guidelines Teach the doctorsTeach the doctors Inform the regulatorsInform the regulators Follow the tendenciesFollow the tendencies
– Health outcomesHealth outcomes– Drug prescriptionsDrug prescriptions– Microbiological dataMicrobiological data– ExpensesExpenses