Rational antibiotic therapy according to the National Program for the Protection of Antibiotics – selected issues

Facing the patient with respiratory tract infections, the key decision is whether to take only symptomatic treatment, or also initiate antibiotics. However no less important is to choose the right antimicrobial agent. Consideration should be given to the Polish official guidelines – Rekomendacje postępowania w pozaszpitalnych zakażeniach układu oddechowego 2016 which were created as a part of the National Program for the Protection of Antibiotics. Our paper focuses on the chosen aspects of that document.

According to them, in most respiratory tract infections first line antibiotic is amoxicillin. As the frequency of pneumococcal strains with reduced susceptibility to penicillin is increasing, extremely important is sufficiently high dosage, ie. 90 mg/kg/day for children and 3-4 g/day for adults. In the case of ineffectiveness of such treatment amoxicillin with clavulanic acid may be initiated, also in high dose. This antibiotic is recommended as a first-line treatment of exacerbations of chronic obstructive pulmonary disease.

In Poland one of the most commonly prescribed antibiotics is azithromycin. According to Rekomendacje 2016 it should be used primarily for the treatment of community acquired pneumonia caused by atypical pathogens or as adjusted antibiotic therapy of streptococcal pharyngitis. Once again, particularly in the case of pharyngitis, high dose of antibiotic is reccomended (60 mg/kg up to 3 grams per treatment).