Treatment of pneumonia

In addition to bed rest, plenty of water, oxygen inhalation and active expectoration, the most important link in treating pneumonia is anti-infection. The treatment of bacterial pneumonia includes pathogen-specific treatment and empirical treatment. According to the results of sputum culture and drug sensitivity test, the former selects antibacterial drugs sensitive in vitro; The latter is mainly based on the epidemiological data of pneumonia pathogens in this area, and selects antibacterial drugs that may cover pathogens. In addition, according to the patient's age, basic disease, severity of illness, whether it is inhaled by mistake and other factors, antibacterial drugs and routes of administration are selected. If pneumonia is suspected, give the first dose of antibacterial drugs immediately. After the condition is stable, the intravenous route can be changed to oral treatment. The course of antibiotic treatment for pneumonia is at least 5 days, and most patients need 7 ~ 10 days or more. The body temperature is normal for 48 ~ 72 hours, and there is no sign of clinical instability of pneumonia. Antibiotics can be stopped. The clinical stability criteria of pneumonia are: ① body temperature ≤ 37.8℃; ② Heart rate ≤ 100 beats/min; ③ Respiratory frequency ≤24 beats/min; ④ Blood pressure: systolic blood pressure ≥ 90 mmHg; ⑤ Arterial oxygen saturation ≥9O% or PAO _ 2≥60 mmHg； under the condition of breathing indoor air; 6. Be able to eat with your mouth; All landowners mental state is normal. Effective clinical manifestations are hypothermia, improvement of symptoms, stable clinical state, gradual decrease or return to normal of white blood cells, while X-ray chest film absorbs the focus later. If the symptoms do not improve after 72 hours, the reasons may be as follows: ① the drug failed to cover the pathogenic bacteria, or the bacteria developed drug resistance. ② Infection by special pathogens such as Mycobacterium tuberculosis, fungi and viruses. ③ Complications or host factors (such as immunosuppression) affect the curative effect. ④ Non-infectious diseases were misdiagnosed as pneumonia. ⑤ Drug fever. It needs careful analysis, necessary inspection and corresponding treatment. 1. Penicillins, first-generation cephalosporins and other antibiotics are selected for community-acquired pneumonia in young adults and people without basic diseases. Because of the high resistance rate of Streptococcus pneumoniae to macrolides in China, macrolides are not used alone to treat pneumonia caused by this bacterium, but fluoroquinolones (moxifloxacin, gemmoxifloxacin and levofloxacin) with special effects on respiratory tract infection can be used for resistant Streptococcus pneumoniae. 2. The elderly, people with basic diseases or community-acquired pneumonia who need hospitalization should choose fluvastatin, second/third generation cephalosporins, β-lactams/β-lactamase inhibitors, or ertapenem, which can be used together with macrocyclic vinegar. 3. The second/third generation cephalosporins, β-lactamases/β-lactamase inhibitors, fluoroquinolones or carbapenems were selected for hospital-acquired pneumonia. 4. The first choice for severe pneumonia is broad-spectrum powerful antibacterial drugs, combined with sufficient drugs. The initial empirical treatment is insufficient or unreasonable, and then the mortality rate of antibacterial drugs is higher than that of the initial treatment. β -lactams combined with macrocyclic vinegar or fluoroquinolones were selected for severe community-acquired pneumonia; Fluoroquinolones and aztreonam are used for people who are allergic to penicillin. Hospital-acquired pneumonia can be treated with fluoroquinolones or aminoglycosides in combination with any one of Pseudomonas beta-lactams, broad-spectrum penicillin/beta-lactamase inhibitors and carbapenems, and vancomycin, teicoplanin or linezolid can be combined if necessary.