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Penicillins in ENT practice

The problem of diagnosis and treatment of acute and chronic infectious diseases of upper respiratory tract (rhinosinusitis, tonzillofaringit, bacterial tonsillitis, adenoids, epiglottid, acute otitis media and external, a maze) has not lost its relevance, as evidenced by a high incidence and referral of patients to general practitioners and otorhinolaryngology. Options often remain a chronic, protracted course of the disease, cases of a syndrome of systemic inflammation, development of severe, life-threatening complications. This issue is important not only in the ENT, but also for medicine in general. Suffice it to say that most patients with acute inflammatory diseases of upper respiratory tract often in the first place come to the attention of general practitioners, chronic inflammatory disease of the mucous membrane of the nasal cavity and paranasal sinuses are the most abundant and hard-occurring pathological conditions of the upper respiratory tract and acute otitis media is a leader in a number of non-invasive bacterial infections, especially in childhood. In addition, after the diagnostic and therapeutic manipulations in oropharynx in 18-58% of cases detected bacteremia, which is the causative agent of hemolytic streptococcus.

Years of experience gained by clinicians significantly proves: the effectiveness of the treatment of acute infectious and inflammatory diseases of upper respiratory tract is largely caused by how promptly and efficiently carried out systemic antibiotic therapy because antibiotics are etiotropic medicines selectively inhibit the vital activity of the microbial flora and possess specificity for infectious diseases in humans.

Adequate use of active, high-speed, secure and easy to use antibiotics can reduce the number of acute and as a consequence of chronic infectious and inflammatory diseases of upper respiratory tract, to conduct an effective intraoperative and perioperative antibiotic prophylaxis of possible postoperative complications. In some cases, this allows you to refuse invasive traumatic diagnostic method - a puncture of the maxillary sinus puncture and tactics of treatment of sinusitis. These provisions were convincing evidence of a sufficiently large number of scientific and clinical research in recent years. The effectiveness of systemic antibiotic therapy significantly increases when correctly selected the complex of therapeutic measures. For example, in combination with purulent inflammation in the paranasal sinuses in allergic or polypous process of conducting systemic antibiotics alone can not achieve lasting remission or complete recovery. Clinically effective in this case, combination therapy with broad-spectrum antibiotics, mucolytics and drugs used to treat allergic rhinosinusitis - topical corticosteroids and H1-receptor blockers. The need for such a treatment policy increases when combined polypous-purulent rhinosinusitis and bronchial asthma, since the successful treatment of diseases of the nose and paranasal sinuses provides improvement of the bronchopulmonary system. Combined therapy of patients with bacterial tonsillitis should reasonably include a local immunocorrecting drugs and adaptogens. In acute otitis media, in addition to local therapy, it is appropriate appointment mucolytics, antihistamines, analgesics.

The basis for successful management of etiopathogenetic-sound application of antimicrobial drugs - a detailed analysis of the "patient factors" and "factors of infectious agents. Firm rule-purpose antibiotic: assessment of the interaction "patient (macro-) - pathogen (microorganism) - medicine, which involves:

  • Compliance with antimicrobial nature of the microbial flora and the range of sensitivity (the growth of sensitive organisms is terminated upon reaching the therapeutic concentration of drug in the patient's blood);
  • Compliance with the necessary requirements under the fence of the pathological material that provides the reliability of the results of bacteriological research;
  • Proper selection of the mode of administration of the drug and its single, daily dose and the exchange rate;
  • Analysis of the severity of the disease, the immune status, allergy history, state excretory, cardiovascular system, gastrointestinal tract, physiological and individual characteristics, taking into account the patient's age, tolerance to previous antimicrobial therapy. Mandatory reporting physician and patient about possible side effects of therapy.

Serious aspect of antibiotic therapy - prevention of development of resistance of pathogenic microorganisms. Need to prescribe antibiotics in the optimal dosage and strictly regulate the duration of the therapeutic course, since excessively short course, only "to the disappearance of marked clinical manifestations" can lead to relapse of the disease or the development of complications, and overly long course - the development of resistance to the pathogen, the emergence of undesirable "side "reactions. When non-invasive ear infections, throat, nose, sinuses and throat should be mindful of the need to correct antibiotic therapy, taking into account the possible formation of superinfection.

The beginning of the treatment of acute infectious and inflammatory diseases of upper respiratory tract, as a rule, empirical, but it should be regarded not as a rule, but as an emergency measure. Of course, it is shown holding a preliminary bacteriological study, which largely determine not only the usefulness of the antibiotic therapy, but also the choice of drug. The answer to the question: "Which antibiotic to appoint a patient?" Should be based on the principles of evidence-based medicine. With respect to antimicrobial therapy, this provision requires the holding in our country monitoring and multicenter randomized studies to obtain reliable information about current local rezistentonsti and sensitivity of microbial agents, volatility which leads to continued expansion and frequent updates of antibacterial drugs market.

From this point of view of interest penicillins, whose implementation in medical practice for over 60 years ago was the final stage. The first report on the discovery of penicillin by Alexander Fleming refers to 1929. In 1937 saw the publication of the first publication dedicated to the successful experience with penicillin treatment of infected wounds, and in 1943 started a mass industrial production of penicillin. In accordance with the classification of antibacterial agents on the mechanism of action of penicillins are specific inhibitors of cell wall biosynthesis. According to the definition of antibiotics on the bactericidal and bacteriostatic agent penicillins are a group of bactericidal drugs that should be taken into account in combination antibiotic therapy, which involves the joint appointment of agents of one group. "Early penicillin became the basis for creating more sophisticated arsenal of antibiotics, penicillins, which have a wide spectrum of antimicrobial activity and is better absorbed, which is why they are widely used in modern ENT practice.

The results of numerous scientific and clinical studies performed in our country in recent years, can draw the following picture of the nature and sensitivity of pathogens (microorganisms isolated from a clinically significant degree of contamination of more than 104 CFU / ml), the most common infectious and inflammatory diseases of upper respiratory tract. The main causative agent of acute infectious and inflammatory diseases of the throat - Streptococcus pyogenes, inoculation of which patients with bacterial tonsillitis is 80-100%, less isolated streptococci group C and G, Streptococcus pneumoniae, Corynebacterium diphtheria, Neisseria gonorrhoeae, Arcanobacterium haemolyticum. In otology more than 50% isolated pathogens of acute otitis media accounted for Streptococcus pneumoniae and Haemophilus influenzae, Moraxella rarely find catarrhalis, Streptococcus pyogenes, Staphylococcus aureus. The main bacterial pathogens of acute sinusitis, which account for about 50% of pathogenic organisms in this disease - Haemophilus influenzae, Streptococcus pyogenes and Staphylococcus aureus. The remaining 50% is a large group of microorganisms, including Streptococcus pneumoniae, Chlamidia pneumoniae, Pseudomonas aerogenozae. To determine the antibacterial drug of first choice for empiric antimicrobial therapy in the phase of these diseases is important to highlight the major pathogens.

Be sure to take into account data on the local microbial resistance. Comparative analysis of these data in the literature about the resistance shown in Table 2 the main bacterial pathogens to different antimicrobial agents showed that resistance to penicillins with extended spectrum of activity and protected penicillins is low. Thus, the drug amoxicillin exhibits almost 100% of th activity against strains of Streptococcus pyogenes and Streptococcus pneumoniae. Considering also that amoxicillin good penetrating into the tissues when administered as a drug of first choice as an empirical point of antimicrobial therapy, and when causal antibacterial treatment of acute infectious and inflammatory diseases of upper respiratory tract can be viewed semi-Spector aminopenicillins with extended activity (amoxicillin) and inhibitor penicillins.

Amoxicillin tablets is a semisynthetic antibiotic of penicillin third generation. Has a bactericidal effect by inhibiting transpeptidase, disrupting the synthesis of peptidoglycan in the peridium of division and growth of microorganisms, causing their lysis. If ingestion is absorbed up to 93% within 1-2 hours. Resistant to acidic conditions, therefore the adsorption of the drug does not depend on food intake. Easily penetrates into the middle ear. Effect of the drug begins in 15-30 minutes. since its introduction and continues for 8 hours. Refers to broad-spectrum antibiotics, active against most strains of Streptococcus, Staphylococcus, Neisseria, as well as Escerichia coli, Proteus mirabilis, individual strains of Salmonella, Shigella, Klebsiella, Haemophilus influenzae. The drug is indicated for infectious diseases of the pharynx, paranasal sinuses and the nose, outer and middle ear. Included in the combined antibacterial therapy and otogennyh rhinogenous intracranial and orbital complications. Antibacterial activity increases during the interaction with aminoglycosides and metronidazole is reduced by concomitant administration of antacids and bacteriostatic chemotherapeutic agents. Possible side effects: most common - the gastro-intestinal disturbances, allergic reactions, as well as shortness of breath, tachycardia, changes in the hemogram. The drug is effective in oral administration: Adults and children over 10 years of 500-750 mg 2 times a day (or at 375 - 500 mg 3 times daily, taking into account the maximum daily dose - 6 g), young children - a rate of 30 mg kg body weight 2-3 times a day. The course of treatment averages 5-7, less often - 10 days.

Amoxicillin is a member of the combined broad-spectrum antibiotic - amoxicillin / clavulanate. The effectiveness of this drug is due to the activity of amoxicillin and inhibitory action on the most clinically relevant b-lactamases, provided the potassium salt of clavulanic acid. Such a successful combination ensures high activity of the drug to a wider spectrum of microorganisms, including the strains resistant to amoxicillin. Prescribe amoxicillin / clavulanate for adults and children older than 14 years 3 times a day to 375 mg or 625 mg, depending on the severity of the disease. In pediatric practice, either form of release of the drug in the form of dry matter for suspension or drops for oral administration (in the age dosage). The advantage is the availability of the drug dosage form as a solution for intravenous (bolus or infusion), which allows its use in severe infectious diseases, with life-threatening conditions, including the intracranial and otogennyh rhinogenous complications.

Thus, the evolution of "early" antibiotics penicillin allowed to create modern drugs amoxicillin, amoxicillin / clavulanate, regarded as first choice for treatment of bacterial infections of upper respiratory tract that is caused by:

  • High degree of microbiological activity;
  • A unique mechanism of action and pharmacokinetic properties;
  • Broad spectrum antimicrobial activity, primarily against major pathogens of rhinosinusitis, tonzillofaringitov, otitis media (including complicated forms);
  • High degree of tissue penetration;
  • The possibility of using the stage empirichekoy antimicrobial therapy;
  • Well tolerated, relatively low frequency of side effects, convenient dosing regime.
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