Kondratenko A. An efficacy of treatment of patients with community-acquired pneumonias with peptic ulcer in out-patient settings.

Object of the study: non-severe non-hospital pneumonia (NNP) in patients with ulcerative disease of the stomach and duodenum (UDSD). Purpose of the research: an improvement of treating outpatients, who have NNP with underlying UDSD and who underwent antihelicobacter therapy from 3 months to 2 years before the appearance of pneumonia. Methods of the research: general clinical, laboratory, instrumental, mathematical, and statistical ones. Theoretical and practical results: the work shows that the administration of Amoxycillin or Azithromycin for NNP in patients with UDSD, who underwent a course of antihelicobacter therapy more than 3 months before the appearance of pneumonia, makes it possible to achieve the positive clinical-laboratory and radiological dynamics, therewith enabling practical physicians to improve the outpatient treatment in such cases. The same efficacy and safety of Amoxycillin and Azithromycin, their satisfactory tolerance in treating NNP patients with accompanying UDSD were proved. The efficacy of the treatment did not depend upon a preliminary scheme of the antihelicobacter therapy. These facts make it possible to optimize the treatment of such patients. The proved efficacy of using the peroral antibiotics for treating patients with NNP will help the doctors and patients to overcome their stereotypes concerning a preferred parenteral administration of the antibiotics. The revealed comparative efficacy of short- and long-term courses of the antibacterial therapy for NNP makes it possible to improve the treatment of such cases in outpatient conditions. Novelty: it was found out that a preliminary use of Amoxycillin in combination with Clarithromycin, or any of them together with other antimicrobial preparations (Metronidazole, Doxycycline, Furazolidon) as components of the antihelicobacter therapy for ulcerative disease more than 3 months before the appearance of nonhospital pneumonia did not decrease the efficacy of Amoxycillin and Azithromycin in treating the above pneumonia. The commensurable clinical efficacy and tolerance of Amoxycillin and Azithromycin for the treatment of NNP accompanied by ulcerative disease in outpatient conditions was proved. The same clinical efficacy of short-term (3-5 days) courses of using Azithromycin and tradiotional (? 7 days) courses of taking Amoxycillin in the treatment of NNP was revealed. The presence of UDSD in the patients did not produce any effect on the results of treating nonhospital pneumonia with Azithromycin or Amoxycillin. It was revealed that the presence of UDSD did not influence the tolerance of Amoxycillin and Azithromycin in the outpatient treatment of nonhospital pneumonia cases: the rate of the development of side effects did not exceed 2.6 %. The necessity to replace the antibiotic because of the development of some unfavourable phenomena occurred in 0.7 % of patients. The safety of the outpatient treatment of NNP in UDSD cases was proved: no lethal outcomes among the patients were registered, and the necessity of hospitalization owing to an inefficacy of a course of the initial antibacterial therapy developed in 0.7 % of patients. Degree of introduction: results of the thesis were introduced into the clinical practice of therapeutics departments at: Murafa Rural Hospital, Feskov Rural Hospital, Dergachi District Hospital, Volchansk Central District Hospital, Kharkiv City Hospitals Nos 1, 13, 11, Kharkiv City Multi-Type Hospital No. 25, Kharkiv City Consultation Polyclinic, as it is confirmed by the corresponding acts on introduction. Materials of the thesis are used in the educational process at the Department of Therapy of Kharkiv Medical Academy of Postgraduate Education (the Ministry of Health of Ukraine). Sphere of application: medicine, cardiology.