medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2023-041medsovet-7433Research ArticleCOVID-19Антибактериальная терапия: вопросы, которые ставит COVID-19, и реальная клиническая практикаAntibacterial therapy: questions posed by COVID-19 and real clinical practicehttps://orcid.org/0000-0001-5028-5276ВизельА. А.VizelA. A.

Визель Александр Андреевич - доктор медицинских наук, профессор, заведующий кафедрой фтизиопульмонологии.

420012, Казань, ул. Бутлерова, д. 49

Scopus Author ID: 195447

Alexander A. Vizel - Dr. Sci. (Med.), Professor, Head of the Department of Phthisiopulmonology, Kazan State Medical University.

49, Butlerov St., Kazan, 420012

Scopus Author ID: 195447

lordara@inbox.ruhttps://orcid.org/0000-0002-8855-8177ВизельИ. Ю.VizelI. Yu.

Визель Ирина Юрьевна – доктор медицинских наук, профессор Российской академии естествознания, доцент кафедры фтизиопульмонологии.

420012, Казань, ул. Бутлерова, д. 49

Scopus Author ID: 246946

Irina Yu. Vizel - Dr. Sci. (Med.), Professor of the Russian Academy of Natural Sciences, Associate Professor of the Department of Phthisiopulmonology, Kazan State Medical University.

49, Butlerov St., Kazan, 420012

Scopus Author ID: 246946

tatpulmo@mail.ruКазанский государственный медицинский университетРоссияKazan State Medical UniversityRussian Federation202313042023044349Copyright © Визель А.А., Визель И.Ю., 20232023Визель А.А., Визель И.Ю.Vizel A.A., Vizel I.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/7433

Пандемия COVID-19 в разные периоды сопровождалась назначением различных лекарственных средств. Назначение антибактериальных препаратов расценивалось по-разному, и даже термин «пневмония» был предметом обсуждения. Частота применения антибиотиков в период пандемии широко варьировала в разных странах с общей тенденцией к избыточному назначению. По мнению большинства исследований, в ранний период этой вирусной инфекции показаний к антибактериальной терапии не было, тогда как позднее, при присоединении бактериального процесса, важен рациональный выбор препарата с учетом потенциальной резистентности возбудителя, включая выработку β-лактамаз. В актуальной версии методических рекомендаций по COVID-19 тема бактериальных инфекций тщательно отработана. Четко прописано, что антибактериальная терапия назначается только при наличии убедительных признаков присоединения бактериальной инфекции. С одной стороны, отмечено, что большинство пациентов с COVID-19 не нуждаются в антибактериальной терапии, а с другой – для пациентов с признаками бактериальной инфекции, не нуждающихся в госпитализации, препаратом выбора является амоксициллин или амоксициллин + клавулановая кислота, при этом данная комбинация одобрена и для госпитализированных пациентов. Анализ литературы показал, что амоксициллин/клавуланат остается высокоэффективным антибиотиком для стартовой терапии внебольничных инфекций дыхательных путей. В условиях импортозамещения создание эффективных, безопасных и доступных по цене отечественных дженериков, имеющих терапевтическую эквивалентность с оригинальными препаратами, является существенным достижением российской фармацевтической науки и индустрии. В данном обзоре дается оценка эффективности и безопасности применения антибиотиков в период пандемии, а также места амокисициллина/клавуланата в современной клинической практике.

The COVID-19 pandemic was accompanied at different times by the prescription of various drugs. The prescription of antibacterial drugs was regarded differently, and even the term “pneumonia” was the subject of discussion. The frequency of antibiotic use during the pandemic varied widely across countries, with a general trend towards overprescribing. According to most studies, in the early period of this viral infection, there were no indications for antibiotic therapy, while later, when a bacterial process is attached, a rational choice of the drug is important, taking into account the potential resistance of the pathogen, including the production of beta-lactamase. In the current version of the guidelines on COVID-19, the topic of bacterial infections has been carefully worked out. It is clearly stated that antibiotic therapy is prescribed only if there are convincing signs of a bacterial infection. On the one hand, it was noted that most patients with COVID-19 do not need antibiotic therapy, and on the other hand, for patients who do not need hospitalization with signs of a bacterial infection, amoxicillin and amoxicillin/clavulanate are the drugs of choice. The latter combination is also approved for hospitalized patients. Literature analysis has shown that amoxicillin/clavulanate remains a highly effective antibiotic for the initial treatment of community-acquired respiratory tract infections. In the conditions of import substitution, the creation of effective and safe, affordable domestic generics that have therapeutic equivalence with original drugs is a significant achievement of the Russian pharmaceutical science and industry. This review assesses the efficacy and safety of antibiotic use during a pandemic, as well as the place of amoxicillin/clavulanate in modern clinical practice.

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The authors declare that there are no conflicts of interest present.