6.1 Results of application of an antibacterial preparation roksitromitsina ("roksigeksal") at children with OSL (croup)

To 90 % of all registered infectious pathology it is bound with ORZ. Many children are ill practically monthly. In most cases these diseases have the virus nature (a flu, a parainfluenza, an adenoviral infection, rinovirusnaja an infection, a RS-infection, etc.) Also appointment of antibacterial therapy do not demand, but it is frequent at ORVI in pathological process the bacteriemic flora is involved and there are bacteriemic complications in the form of an otitis, a lymphadenitis, a tonsillitis, a pharyngitis, etc. in which occasion many children often receive antibacterial preparations, that on the one hand it is possible to consider highly expedient, but with another, such therapy quite often leads to undesirable consequences - disbioticheskim to disturbances, an organism allergization, antibiotikorezistentnosti and other. As from the practical point of view to avoid application of anti-infectives at ORZ it is not obviously possible, acutely there is a question about mimizatsii undesirable consequences of system anti-infectives.

But, presence of a probable and-or obvious clinical sign of the bacteriemic infection, any laboratory sign of a bacteriemic infection (nejtrofilnyj a leukocytosis (> 15*10 (9)/l); more than 5 % of juvenile forms; an ESR (> 20 mm/ch); a procalcitonin (> 2 ng/ml); C-jet fiber (> 70 mg/l = 0,007 g/l); ИЛ-6 (> 200 pg/ml); the TNF-ALPHA (> 200 pg/ml); rising LII and-or JAII above normal value, and also data of microbiological inspection and-or mass spectrometry, and also detection of staphylococcal enterotoxins) is the indication to appointment of antibacterial therapy and the preparations strengthening action of a causal treatment which basic action is bound to excision of an infection from an organism with the subsequent curing of the damages put by an infection.

From this point of view high interest is involved with antibiotics of a selective orientation and especially in the event that they along with antimicrobial
Action possess also immunomodulirujushchimi and antiinflammatory properties. It is obvious, that in this case there are more than bases to count on high efficiency at the expense of influence on inflammation mechanisms (migration of neutrophils, processes of an oxidising metabolism in phagocytes, production of proinflammatory cytokines, etc.) . Taking into account literature data to these demands partially answers roksitromitsin (roksigeksal), being dzhenerikom roksitromitsina, representing semisynthetic 14-chlennyj a macrolead which possesses expressed immunomodulirujushchim and antiinflammatory action. roksigeksal the colony stimulating factor influences processes of immune reaction by change of synthesis by monocytes and macrophages of such important mediators of the immune answer, as the factor of a necrosis of a tumour, interlejkiny. According to literature roksigeksal influences processes of immune reaction by change of synthesis by monocytes and macrophages of such important mediators of the immune answer as the factor of a necrosis of a tumour, interlejkiny, the colony stimulating factor, that as a whole renders not only bacteriostatic action, but also promotes restoration of tissues. These preparations with sufficient effect are used at treatment of opportunistic infections at immunodeficiencies, gerpeticheskih infections, virus hepatitises, a candidiasis, respiratory infections and others of Research spent on our chair, also have shown their efficiency at complicated ORZ.

As objective criteria of an estimation of efficiency of spent therapy studying of therapeutic efficiency and safety of preparation roksigeksal served in our research (GEKSAL AG, Germany) at OSL (groats), proceeding with bacteriemic complications.

Under observation there were 50 patients with srednetjazhelymi forms OSL (croup) with clinical implications of a bacteriemic infection as a stenosing laryngotracheobronchitis (25 patients),
tonzillofaringita (14 children), an otitis (4 children), an obstructive bronchitis (7 children), a purulent rhinitis (36 children), at the age from 4 months till 15 years (30 children - preschool children, 20 - schoolboys). Presence testified To development of a bacteriemic infection is serous-purulent separated of a nose with an unpleasant smell, development of an otitis, the phenomena granuleznogo a pharyngitis with applyings of a mucopurulent secret on a back wall of a pharynx.

Patients showed complaints to a pharyngalgia, sensations of dryness, an alien body, discomfort, pershenie.

To a category it is frequent and it is long ill (ORZ 4-10 times a year) concerned 38 children (76 %), at 36 (72 %) patients the hypertrophy of tonsils of II degree, at 17 (34 %) - an adenoid disease, at 14 (28 %) - adenoides of II degree, at 3 (6 %) - adeno - and tonzilektomija, at 34 (68 %) - the phenomena granulematoznogo a pharyngitis, at 19 (38 %) - a chronic pharyngitis, at 4 (8 %) - a bronchial asthma, at 3 (6 %) - a vegeto-vascular dystonia, at 1 (2 %) - syndrome Alporta, at 1 (2 %) - a pseudorheumatism, at 2 (4 %) - mikoplazmennaja an infection became perceptible.

For an estimation of microbic flora, an establishment of possibility of its participation in occurrence of complications of current ORZ, investigated a stomatopharynx biocenosis. Defined not only a qualitative microbiological landscape, but also its quantitative maintenance on mucous taking into account the existing norms calculated in WHICH/TAMPON, by a technique stated in the order №535 from 22.04.1985г. According to methodical references following specifications have been accepted: Staph.aureus - 101 - 102; Str.haemolyticus 103-104; Enterococcus - 101-102; C.albicans-101-102; Bacillus-102; Klebsiella - 101-102; Streptococcus 103-104; Staph. Saprophyticus - 101; Candida sp. - 101.

All children received treatment in the first 1-2 days from the disease beginning. Besides antibacterial therapy prescribed the standard

Symptomatic agents: alkaline inhalations, mucolytic, desensitizing preparations, vasoconstrictive drops in a nose, a stomatopharynx irrigation.

The basic group was made by 35 patients, they received roksigeksal, other 15 patients have made comparison group, of them 8 patients received ampicillin parenteralno, 5 - Cefazolinum parenteralno, 1 - augmentin inside and 1 - macrofoams inside in age dosages.

Investigated groups of patients stole up to a casual alphabetic sign and aetiologies and gravities of disease were comparable for statistical processing on age.

roksigeksal prescribed to children 2 times a day according to weight of the child: 7-13 kg - 25 mg, 14-26 kg - 50 mg, 27-40 kg - 100 mg, more 40 kg - 150 mg. Course of treatment proceeded before reduction or full cupping of the basic symptoms of disease - on the average 5-7 days.

For revealing disbioza oral cavities and estimations of sanifying efficiency of preparation roksigeksal before appointment of therapy and later 5-7 days from the treatment beginning in ispytuemoj to group and comparison group estimated structure of a microflora of a stomatopharynx.

Disbiozom change of concentration of a microflora of a stomatopharynx is considered to be oral cavities. In norm the oral cavity microflora has a relative constancy and is characterised by following indicators: streptococcuses-106-7; laktobakterii-103; staphilococcuses - 103; mushrooms of sort Candida - 102. Bacteria of group of an intestinal rod are absent.

Changes of structure of a microflora at the surveyed patients conditionally divided into 4 categories: disbiotichesky shift, disbioz I-II degrees, disbioz III degrees and disbioz IV degrees.

At disbioticheskom shift insignificant quantitative excess of one kind of is conditional-pathogenic microorganisms became perceptible at conservation of normal specific structure of a microflora of an oral cavity.

At disbioze I-II degrees (the subcompensated form) 2-3 pathogenic kinds against some depression titra laktobakterii were taped.

Disbioz III degrees it was characterised by revealing of a pathogenic monoculture at sharp depression of quantity or full absence of representatives of a normal (physiological) microflora (not hemolitic streptococcus, laktobakterii).

disbioz IV degrees put the diagnosis in the presence of associations of pathogenic kinds of bacteria with yeast-like mushrooms].

Golden and saprophytic staphilococcuses (65 %) were found out in patients with complicated ORZ among the allocated microorganisms most often at children, Haemophilus spp. (62,5 %), streptococcuses of various kinds (an alpha, beta and scale) (60 %), are much more rare mushrooms of sort Candida and others are pathogenic.

On the basis of microbiological shifts at 29 (72,5 %) we diagnosed patients it became perceptible disbioz oral cavities of III degree, at 11 (27,5 %) - disbioz IV degrees.

On set clinico-datas of laboratory bacteriemic complications with a known share of probability have been deciphered as follows (a drawing 24).

Drawing 24. Etiological structure of bacteriemic complications at OSL (groats).

In dynamics of observation after the termination of treatment the structure of microbic flora has essentially changed: on 20 %, Haemophilus spp.на20 %, the quantity of staphilococcuses has decreased for 10 % - E.coli, the number of mushrooms of sort Candida was enlarged by 10 % in control group, in group of streptococcuses have ceased to be allocated beta hemolitic, however total of other streptococcuses-saprophytes at children, treated roksigeksalom, was enlarged by 28 %, and in control group - on 40 % (a drawing.25,25а).

Drawing 25. A microflora of a stomatopharynx at children, treated roksigeksalom to (I) and after the termination of treatment (II).

Drawing 25а. A microflora of a stomatopharynx at children, treated other antibiotics to (I) and after the termination of treatment (II).

It is important to notice, that among treated children preparation roksigeksal has come eradikatsija 24 % of the allocated microorganisms, and in control group - 20 % in the same terms of observation.

For more detailed studying of changes of the quantitative maintenance of microorganisms their level depending on augmentation or reduction WHICH/TAMPON as a result of spent treatments (table 4) was estimated.

Table 3

Changes of quantitative structure of a microflora of a stomatopharynx at

OSL (croup) with bacteriemic complications against treatment

roksigeksalom and other antibiotics.

Apparently from the table against reception of antibacterial therapy, both in the basic group, and in comparison group the quantitative maintenance of golden staphilococcuses, pneumococcuses has decreased, beta - hemolitic streptococcuses have ceased to be allocated, however total of other streptococcuses representing saprophytic flora, remains without changes, thus in group of children, treated roksigeksalom their quantity was enlarged by 28 %, and in control group - on 40 %, also in control group the quantity of mushrooms of sort Candida was enlarged.

It is necessary to notice, that to roksigeksalu along with Klaritromitsinom, makropenom and Amoksiklavom the highest sensitivity of the allocated microorganisms that it is impossible to tell about other antibacterial preparations as a whole becomes perceptible, and high sensitivity remains both before appointment of preparations, and after the termination of course of treatment (table 5).

Table 5

Definition of sensitivity of the allocated microorganisms to germicides