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the modern approach to therapy of an acute stenosing laryngitis (croup) at children of a bacteriemic aetiology

Basic indicator of efficiency of spent therapy is lethality reduction. The lethality at a croup of not diphtheritic aetiology before introduction in practice sulfanilamidnyh preparations and antibiotics according to J.Brenemann (1938г) made to 88 %, H.Z.Leicher (1929г) - 80 %.

After introduction in practice of Sulfanilamidums according to F.Escher (1944г) - 25-27 %; A.Windorfer (1949г) - 4,6 %, and after introduction of antibiotics (1959-1960гг) - 2 %, D.B.Hawkins (1963г) - 1 %

As a whole with 1949г. The lethality at a croup has decreased in 19 times. Now within last decade lethal outcomes at an acute stenosing laryngitis (croup) at children it did not become perceptible. It is bound first of all by that now razrabotaty and various schemes of treatment of immediately stenosis the larynxes rendering expressed clinical effect in the form of cupping of an edema are widely applied in pediatrics that quite often is the indication for the further treatment of the child domiciliary for the purpose of avoidance of a superbecoming infected and-or an aggravation of symptoms for the account kontaminatsii with "hospital" flora [30, 191, 185, 201].

However, in therapy osrogo an obstructive laryngitis (croup) paramount value has also causal treatment appointment, in particular antiviral and-or antibacterial, immediately acute respiratory infection referred on treatment. According to N.A.Geppe (2005г), G.A.Samsyginoj (1997г.), V.F.Uchajkina (2008г.), F.S.Harlamovoj (2011г.), R.I.Haitova (2011г.), O.V.Kladovoj (2011г.) the reasons of development ORZ are virusno-bacteriemic associations, bacteria, mushrooms, the elementary. The Virusno-bacteriemic and bacteriemic nature of respiratory diseases is more characteristic for newborns,
Thoracal children and children of early age. Acute bacteriemic diseases of respiratory tracts can arise as an independent pathology. However in 60 % of cases they are complication of virus infections VirusnoYObakterialnye of a lesion are bound to activization microbic autoflory in connection with disturbance of barrier function of a respiratory tract and depression of protective properties of an organism, and also a superbecoming infected bacteriemic agents. Joining of a bacteriemic infection leads to increase of gravity of disease and can be a failure principal cause. At the same time there are also initially bacteriemic infections of respiratory tracts. The most frequent originators are pneumococcuses (Str.pneumonie), hemolitic streptococcuses of group And (Str. pyogenes, viridans, etc.) A hemophilic rod, a pneumonia mycoplasma, moraksella katarralis. Usually in the bacteriemic nature of acute respiratory disease specifies long (more than 3 days) a febrile fever, occurrence of purulent scurf and slizistoyognojnogo or purulent separated of a nose, the expressed intoxication, and also fixing character of a respiratory infection [119, 25, 172, 54, 153, 74, 112, 75, 128, 126, 60, 111, 154, 125].

At a choice of antibacterial therapy in practical work it is necessary to combine the decision of tactical problems which the rational choice of an antibacterial preparation with the greatest therapeutic and least toxic influence concerns, with the decision of a strategic problem which define as reduction of selection and diffusion of refractory strains of microorganisms to populations.

Now at bacteriemic infections of a respiratory tract at children antibiotics of a penicillinic number (preparations of 1st choice), cephalosporins I are used, II and macroleads and other groups of preparations (reserve) are more rare than III generations (preparations of 2nd number).

Preparations of 1st choice use in cases, when there is no the basis to think
About medicinal fastness, first of all at vnebolnichnoj infections. There, where fastness is probable (the intrahospital infection, previous therapy by antibiotics), treatment should be begun with preparations of 2nd number. For each localisation of bacteriemic process there are a few probable originators that allows to make a rational choice of an antibiotic for starting therapy and to provide replacement in case of its inefficiency. Agents of 3rd choice apply (reserve) only in cases of the expressed polyresistance in hospitals [130, 71].

By data mnogotsentrovyh researches (Alexander Project, 1998-2000, 26 countries; PROJECT-1, 1999-2000, 25 countries; ПеГАС-I, 2000-2001, Russia, 15 centres;.McCaig LF, 1995г.; Ball P, 2002г. On a share of acute respiratory infections it is necessary about 75 % of prescriptions of antibiotics in medical practice [173] Thus not all acute infections of the top respiratory tracts have a bacteriemic aetiology. A part of infections cause viruses, on which system antibiotics do not operate. In 20-50 % of cases of acute respiratory infections appointment of system antibiotics is recognised by unjustified [173, 217, 195].

Besides, last 10 years resistance of respiratories patogenov becomes more and more actual problem. Resistance S. pneumoniae to Penicillinum and macroleads in some countries of Europe reaches 40-50 %, resistance S. pyogenes to macroleads makes 30­40 %, in Russia within 20 % that limits possibilities of effective therapy of infections of the top respiratory tracts. [16,121,181].

The most important factor promoting occurrence and selection of resistance in population, use of system antibiotics is wide, often unjustified. So, in some farmakoepidemiologicheskih researches direct dependence between previous application b-laktamnyh has been shown
Antibiotics and frequency of colonisation of the top respiratory tracts Penicillinum-refractory strains S.pneumoniae [205, 176].

Besides, practically all antibiotics, especially active in the relation anaerobov, are capable to cause ntibiotik aasotsiirovannye diarrheas (AAD). Risk AAD increases at clindamycin application, linkomitsina, aminopenitsillinov, cephalosporins II and III generations. According to L. McFarland (1993) and other authors, AAD meets in 5-10 % of cases at ampicillin application, in 10-25 % — cephalosporins of II generation, and only in 2-5 % of cases at use of other antibiotics, such as Tetracyclinum, macroleads (erythromycin), a nitrofurantoin, to - trimoksazol, ftorhinolony, aminoglycosides (Kanamycinum, gentamycin) [9,211].

However, AAD at children and adults easily enough korrigiruetsja application probiotikov, enzimov therefore do not arise now any menacing situations bound to application AB of therapy at children [9, 39]. So, for the purpose of correction disbioticheskih changes it is possible to use the preparation of system enzymotherapy possessing

Antiinflammatory, immunomodulirujushchim, antiagregatsionnym, fibrino - thrombolytic and potentsirujushchim action. Effketivnost applications of the given therapy it is shown in a number of works [31,99,125].

Thus, presence of a virusno-bacteriemic or bacteriemic aetiology of disease demands appointment in early terms of disease AB of therapy, especially from children of younger age groups. Taped resistance to AB and their by-effects in the form of AAD should not promote prolongation of terms of appointment AB of therapy as only at in due time begun complex therapy it is possible to avoid an aggravation of symptoms of the child and, quite often, lethal an outcome during disease.

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Scientific source FELDFIKS LARISSA IZEVNA. ROLE of the BACTERIEMIC INFECTION AT the ACUTE STENOSING LARYNGITIS (CROUP) At CHILDREN. The dissertation on competition of a scientific degree of the candidate of medical sciences. Moscow - 2014. 2014

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