Antibiotic therapy of infections of the upper respiratory tract

nfektsii upper respiratory tract infections (URI) took first place in the structure of morbidity and account for 70%. According to WHO, each year ARI is sick, every third inhabitant of the planet. Among the complications of acute respiratory infections sinusitis leading place, followed by otitis and tonzillofaringity.

According to the National Statistics Centre diseases United States in 1994 sinusitis in this country have become the most rasprostranennm chronic illness. Almost one in eight people in the U.S. is ill or has ever suffered from sinusitis [2]. In Russia, acute sinusitis each year, it registers with 10 million people. Acute otitis media is the most common bacterial infection in young children. At least one episode of acute otitis media were 90% of children under 6 years. The share of 75-80% have URI antibiotic prescriptions [3]. The effectiveness of treatment depends on correct choice of antibiotic therapy. The choice of the drug in acute processes, in most cases is carried out empirically from data on the predominant pathogens and their resistance in the region and taking into account the severity of the patient. Studies in recent years show that the most common cause of acute URI were Streptococcus pneumoniae (25-30%), Haemophilus influenzae (15-20%), Moraxella catarrhalis (15-20%) [1].

The choice of antibiotic should be based on the principle of selective toxicity, ie, preparation should be as toxic to microorganisms and are safe for human body. At present there are no drugs with selective toxicity of the absolute and yet, among the many antibacterial drugs with similar effects on microorganisms need to choose the means of the least toxic effect on the human body.

Basic principles of choice of antibiotic for the treatment of acute URI as follows:

∙ Activity against S. pneumoniae and H. influenzae;
∙ The ability to overcome the resistance of pathogens to the antibiotic;
∙ good penetration into the mucous membrane with a concentration above the minimum inhibitory concentration (MIC) for a given pathogen;
∙ preservation of serum concentrations above the MIC for 40-50% of the time between taking the drug.

Given all the above, the drugs of choice for treatment of acute URI beta-lactam antibiotics should be among them should be the main drug of amoxicillin. Of all available oral penicillins and cephalosporins, including cephalosporins II-III generation, amoxicillin is the most active against penicillin-resistant pneumococci. It reaches high concentrations in serum in excess of the IPC main pathogens, low incidence of adverse reactions (mainly gastro-intestinal tract), easy to use (taken by mouth 3 times daily with or without food).

The disadvantages of amoxicillin can be attributed to the ability of b-lactamases break, which can produce and Haemophilus influenzae moraksella. Therefore, its alternative, especially if treatment failure or recurrent processes is amoxicillin / clavulanate (amoksiklav, Augmentin) - combination drug consisting of amoxicillin, and b-lactamase inhibitor clavulanic acid.

High efficiency in the treatment of acute URI have cephalosporins II (cefuroxime aksetil) and III (cefotaxime, ceftriaxone), cefoperazone and other) generations.

Macrolides are currently treated as second-line antibiotics, and basically use them if you are allergic to b-lactams. It should be noted that interest in these antibiotics is increasing, as common causative agents of URI, including pneumococci, began to show steadily growing resistance to antibiotics penicillin and cephalosporin. In some European countries (France, Italy, Spain), pneumococcal resistance to penicillin is 40% or more [5]. At the same time so much resistance to macrolides were observed. Because of this prolonged and frequent use of beta-lactam antibiotics, it is expedient to the appointment of macrolides. For example, the major problem is the rational therapy pathology limfoglotochnogo ring, which affects up to 80% of children in the group of sickly. In the present cases where the standard treatment for this disease is not effective rates (including antibiotics), up to 30%, and the persistence of beta-hemolytic streptococcus A in the lacunae of tonsils after repeated courses of conventional natural penicillins can be observed in 60% of patients. This is presumably due to the fact that in the nasopharynx, hypopharynx, deep gaps almonds (especially in patients with chronic tonsillitis) is often present H. influenzae, Staph. aureus, M. satarrhalis producing 44 - 100% of the beta-lactamase. This makes treatment less effective natural penicillins and encouraged to find more effective classes of modern drugs, including macrolides.

Of macrolides in acute URI justified the use of azithromycin and clarithromycin, although eradication of pneumococcal and Haemophilus influenzae in their use is lower than when taking amoxicillin. Erythromycin can not be recommended for the treatment of acute URI, as it does not have activity against Haemophilus influenzae, and, moreover, causes a large number of adverse events from the gastrointestinal tract.

In recent years the market has seen a fluoroquinolone with an expanded spectrum of activity, effective against S. pneumoniae and H. influenzae. In particular, these drugs include levofloxacin. However, it should be noted greater toxicity to the human body with a fluoroquinolone compared with beta-lactam antibiotics and macrolides, which prevents their use in children.

In chronic URI spectrum of pathogens is somewhat different, in addition to pathogens, play a major role in the development of an acute process, there are anaerobes and atypical micro-organisms. According to various authors, detection of atypical microorganisms by PCR analysis of chronic sinusitis varies from 9,5% (Chlamidia trahomatis) to 76,2% (Chlamidia trahomatis + Chlamidia pneumoniae) and 47,6% (Mycoplasma hominis + Mycoplasma pneumoniae). Especially often atypical flora detected in rhinosinusitis associated with diseases of the lower respiratory tract According to our records atypical organisms vstrechatsya 50% of patients with chronic sinusitis, associated with diseases of the lower respiratory tract, and this association is observed in 56% of cases of chronic sinusitis [4].

A wide range of macrolide antibiotics and their activity against atypical organisms can highlight them in first-line drugs for the treatment of chronic URI. Macrolides characterized by a unique ability to accumulate not just in the tissues and within cells at concentrations several times higher than their levels in the blood. This ability makes the antibiotics active against such actual time in nastochschee infections, like chlamydia, mycoplasmosis, listeriosis, borellioz etc. In addition, recent studies have shown that macrolide antibiotics increase the sensitivity of the bacteria for phagocytosis, including those of bacteria to which the macrolides exert direct antimicrobial no impact (eg, Pseudomonas aeruginosa). This reduces the aggressiveness of microbes and promotes the release of the infection. Studies in recent years have revealed a macrolide antibiotic for the most unusual, non-specific effect prtivovospalitelny, which is associated with antioxidant activity. It is noted that macrolides have mukoregulyatornym action. Under the influence of macrolides observed suppression of secretion of mucus in the bronchi. This mukoregulyatornoe effects of drugs, increases the clinical effectiveness of antibiotics for respiratory diseases with hypersecretion of mucus.

At the Department of Otorhinolaryngology BelMAPO, the Republican Clinical Hospital Pathology of Hearing, Voice and Speech macrolides are successfully used for treatment of acute otitis and sinusitis. In chronic sinusitis macrolides (mostly clarithromycin and azithromycin) are the main antibacterial agent and entered into treatment protocols. We have examined and treated 46 patients with chronic sinusitis in age from 3 to 55 years with disease duration of 1.5 to 10 years. All of these patients surveyed for the presence of atypical flora by PCR analysis. DNA-positive for Clamydia trachomatic 26.1% were analyzes, Mycoplasma pneumoniae - 26,1%, Mycoplasma hominis - 32,6%. A comprehensive treatment, including surgical intervention to restore the natural function of fistula and drug therapy, including macrolide antibiotics. (кларитромицин) по 500 мг два раза в день 7 дней. More often than prescribed Azikar (azithromycin) 500 mg once daily for 5 days or Klarikar (clarithromycin) 500 mg twice daily for 7 days. ) в связи с их более доступной, по сравнению с аналогами, ценой. Patients preferred to purchase products company Pharmacare (Azikar and Klarikar) due to their more affordable compared to similar, price.
All patients received a good result: an end runny nose, nasal breathing is restored. At follow-up of 1-3 years no recurrence of the disease. 21 patients performed a control PCR analysis of one month after treatment, showed the absence of atypical microorganisms.

для лечения хронических синуситов и других ИВДП. Our observations demonstrate the effectiveness of drugs and Azikar Klarikar for the treatment of chronic sinusitis and other URI.

Accumulated in recent years, data on anti-inflammatory and immunoregulatory action of macrolide antibiotics open up entirely new prospects for their use, together with a traditional use for the treatment of acute bacterial infections of the respiratory tract.

References:

1. Kryukov AI, Shubin M., Alexanian, TA Therapeutic and diagnostic tactics in acute bacterial sinusitis / / Metod.rekom.-Moscow, 2002.-12s.

2. Lopatin AS Antibiotic treatment of acute inflammatory diseases of the paranasal sinuses / / Consilium medikum.-2003.-Volume 05 .- № 4.-C.1-8.

3. Ryazantsev S. Acute sinusitis. Approaches to therapy / / Metod.rekom.-Moscow, 2003.-16s.

4. Sidorenko IV factors of local immunity and flora in the development of chronic sinusitis / / Vestn. Otorhinolaryngology (Matthew Russian Conf. otolaryngologists) .- 2003 .- p.264-266

5. SV Yakovlev Comparative evaluation of betalaktamov and macrolides in community-acquired respiratory infections / / Antibiotics and Chemotherapy .- 2001.-v.46, № 3 .- P.1-4