Experience of using azikara in treating children with respiratory tract and upper respiratory tract in the day hospital

Antibiotic therapy in pediatric patients remains an urgent and difficult problem, often solved by using macrolides.

Macrolide class has more than ten different drugs, which, depending on the number of carbon atoms in the lactone ring is divided into 3 groups - 14, 15 and 16-membered. The most popular macrolide antibiotics - erythromycin and clarithromycin - a 14-membered and 15-membered azithromycin (azalides is because the ring is a nitrogen atom). Structural features primarily determine the differences in the pharmacokinetics of drugs. In addition, they are responsible for some of the nuances of their antibacterial activity, tolerability and drug interactions. At the same time, all macrolides have the same mechanism of action and are generally similar antimicrobial spectra. Mechanisms of resistance to them microflora are also similar.

Macrolides possess antibacterial activity against gram-positive cocci, such as hemolytic group A streptococcus, pneumococcus, staphylococcus aureus, excluding metitsillinrezistentnye strains of the latter. Good acting on pertussis, diphtheria bacillus, the causative agent erythrasma, moraksellu, Legionella, Campylobacter, Listeria, Chlamydia, mycoplasma, ureaplasma.

The advantage is the ability of macrolides to create very high and stable tissue concentrations exceeding the level of drugs in serum. High tissue levels of 10 - 100 times the concentration in the blood are characteristic of azithromycin.

Macrolides accumulate in the tonsils, middle ear, sinuses, lungs, bronchopulmonary secretions, pleural and peritoneal fluid, lymph nodes, pelvic, and in inflammation of the permeability of drugs to the appropriate center increases. In contrast to many other antibiotics, macrolides penetrate cells well, and create high intracellular concentration, which is important in the treatment of infections caused by intracellular pathogens (Mycoplasma spp., Chlamydia spp., Legionella spp. And so on). It is also essential that macrolides (mostly clarithromycin and azithromycin) are able to penetrate phagocytic cells such as macrophages, fibroblasts, polymorphonuclear granulocytes, and transported them to the inflammatory focus.

Macrolides are considered to be one of the safest groups of antibiotics are very rarely cause serious adverse reactions. The most typical of the macrolides are reactions of the upper gastrointestinal tract as pain, nausea and vomiting. The development of dyspeptic disorders is most characteristic of erythromycin and oleandomitsina, due to their stimulating effect on the motility of the gastrointestinal tract. Other macrolides, less likely to cause dyspepsia. Adverse reactions from the lower intestine are rare, although cases of diarrhea are described. Hypersensitivity to macrolide antibiotics has very rarely.

The most commonly used macrolides for respiratory tract infections. They are effective in 80 - 70% of patients with bronchitis, acute otitis media, sinusitis, and pneumonia tonzillofaringitami. Macrolides are traditionally considered as an alternative to penicillin in tonzillofaringite caused by S. pyogenes. Clinical and bacteriological studies have shown that they are equally effective in the eradication of streptococci from the tonsils (70%), as well as dentists, therefore, provide a completely reliable prevention of serious complications tonzillofaringita - rheumatic fever and glomerulonephritis. When otitis media macrolide antibiotics can be used as an alternative to aminopenicillins and co-trimoxazole. Azithromycin is effective in patients with sinusitis and otitis in the appointment of a short 3-day course.

Macrolides are more common than beta-lactam antibiotics offer treatment effect in those cases when it can not identify a pathogen. In comparative controlled clinical studies have shown that macrolides are not inferior and sometimes superior to oral antibiotics some of the other classes (ampicillin, amoxicillin, co-amoksiklav, cefixime, ciprofloxacin, doxycycline) in patients with community-acquired pneumonia. The high efficiency of macrolides for respiratory tract infections related to, firstly, the fact that their spectrum of antimicrobial activity includes most major respiratory pathogens such as S. pneumoniae, M. catarrhalis, H. , с активностью против атипичных возбудителей. influenzae, and secondly, with the ability to create high concentrations of the respective foci of inflammation and, thirdly, with activity against atypical pathogens. Given the characteristics of the spectrum of antimicrobial activity and a good pharmacokinetic profile macrolides are the drugs of choice for "atypical" pneumonia, according to the results of numerous controlled studies are highly effective in patients with this pathology.

The main pathogens, against which antibiotics should be directed lower respiratory infections in outpatient settings, are pneumococci, Haemophilus influenzae, and intracellular pathogens. The most common are pneumococci, their share may reach 60 - 70%, followed by Haemophilus influenzae (10 to 20% according to different authors) among intracellular pathogens in community-acquired pneumonia and bronchitis dominated by mycoplasma. The prevalence of the latter agent cyclically varies from year to year. The activity of azithromycin against Haemophilus influenzae in the hundreds if not thousands of times greater than the activity of erythromycin and azithromycin, currently is the only antibiotic that is active against all three major "unsafe" pathogens in lower respiratory tract infections.

It is important that azithromycin for several days stored in the tissues after the last dose. This allows not only to enter it once a day, but generally limit the use of the drug three days. Naturally, pneumonia or 3 days or 5 days to cure is not possible. It is just that, at the expense of long-term preservation of therapeutic concentrations of azithromycin in the tissues 3 days taking the antibiotic provided complete 10 days of treatment.

Thus, a wide range of community-acquired strains of microorganisms in causing disease of the upper and lower respiratory tract, the small number of side effects, the possibility of taking the drug 1-2 times a day short course, no age restrictions and the need to introduce the drug parenterally, as well as a low risk of dysbiotic disorders caused the popularity of the use of new macrolides, particularly azithromycin, in outpatient pediatric practice.

In the 10 day hospital outpatient clinics for children's clinical treatment of preschool children with various respiratory diseases and ENT used a suspension form of azithromycin - Azikar. Box after dilution is 22.5 ml of the suspension (5 ml - 200 mg), which is sufficient for 3 - 5-day course of treatment at a dose of 10 mg / kg of the child from 3 to 7 years.

Treated 16 children aged 3 to 8 years: 7 - with an acute pneumonia, 5 - with acute bronchitis, when prolonged (more than 3 days) period and the presence of febrile neutrophilic shift in the blood have suggested a bacterial etiology of the disease, 2 - with acute middle otitis, 1 - with acute maxillary sinusitis, and 1 - with acute tonsillitis. In 5 children a history of food and 4 - drug allergy to penicillin semisynthetic. Examination at diagnosis consisted of the inspection, the implementation of common blood and urine, according to testimony - radiography of the chest and ENT examination. In acute tonsillitis it streptococcal etiology was confirmed by taking a swab from the throat. Children were observed daily for 7 - 10 days from the conduct of audit trail of blood to the end of the observation and re-radiography of the chest through a 10 - 12 days of starting treatment. During the observations take into account the dynamics of the main clinical manifestations of disease and temperature, as well as the presence of allergic or dyspeptic disorders.

The dynamics of the temperature curve in the observed patients was as follows: the first day of treatment, the average temperature was 37.7, the second - 36.9 on the third day marked by persistent normalization of temperature in all patients. By the 7th day of observation the main symptoms were cropped in 15 children (93.8%). One child with right-sided bronchopneumonia kept local auscultatory changes in the lungs and cough, stoped to 10 day. The lack of infiltration in the lungs during X-ray control was observed in all patients with pneumonia.

Analysis of changes in blood before and after 7 days of treatment showed reliable normalization of the level of white blood cells, the disappearance of inflammatory neutrophilic left shift and accelerated erythrocyte sedimentation rate. Registered a decline gemogolobina (in any case lower than 115 g / l), probably due to the toxicity against the illness.

Tolerability was good, the adverse effects of one child (6.2%) were reported more frequent stools up to 2 - 3 times a day, and do not require correction since the discontinuation of the drug.

Allergic reactions to receiving a suspension Azikara, though weighed down allergoanamnez (food and drug allergies), half of the patients have been recorded.

The data obtained allow to recommend a short course for Azikara primary choice in the treatment of bacterial respiratory tract infections and upper respiratory tract in children.