Rational choice of antibiotic therapy in children with acute respiratory infections of the upper respiratory tract

Acute respiratory infections are leading in the structure of infectious pathology in children. Despite the high importance of viruses in the etiology of acute respiratory infections, the role of bacterial pathogens remains important. Features of the current course, high frequency of complications, unreasonable prescription of antibacterial drugs and the risk of developing drug-resistant forms of microorganisms require adherence to algorithms for the timely diagnosis of bacterial infections and the rational use of antibacterial drugs. In the article, on the example of the analysis of clinical cases, the main stages of diagnosis and algorithms for choosing the initial antibiotic therapy for acute respiratory infections of the upper respiratory tract in children in an outpatient setting are considered. In the first clinical case, the principles of differential diagnosis of viral and bacterial acute otitis media, the risks of adverse outcome are considered, the main indications for prescribing systemic antibiotic therapy in preschoolers are identified. The second clinical case demonstrates the algorithms for diagnosing bacterial sinusitis, the possible masks of the disease, and the selection of a starting antibacterial drug. The example of the third clinical case shows the etiological diversity of acute tonsillopharyngitis in children, defined indications for systemic antibacterial therapy. It has been noted that only streptococcal tonsillopharyngitis is the primary indication of antibacterial prescription. The features of initial therapy and the duration of the course of antibacterial drugs in children were determined.

1. Karneeva O.V., Gurov A.V., Polyakov D.P., Tulupov D.A., Ryazantsev S.V., Gagua A.K., Trukhin D.V. Otitis media acute: clinical guidelines. Moscow; 2021. 47 p. (In Russ.) Available at: https://cr.minzdrav.gov.ru/recomend/314_2.

2. Karneeva O.V., Gurov A.V., Karpova E.P., Tulupov D.A., Ryazantsev S.V., Garashchenko T.I. Acute sinusitis: clinical guidelines. Moscow; 2021. 51 p. (In Russ.) Available at: https://cr.minzdrav.gov.ru/recomend/313_2.

3. Daikhes N.A., Baranov A.A., Lobzin Yu.V., Namazova-Baranova L.S., Kozlov R.S., Polyakov D.P. et al. Acute tonsillitis and pharyngitis (Acute tonsillopharyngitis): clinical guidelines. Moscow; 2021. 51 p. (In Russ.) Available at: https://cr.minzdrav.gov.ru/recomend/306_2.

4. Group A Streptococcal Infections. Pertussis. In: Pickering L.K. (ed.). Red Book 2003: Report of the Committee on Infectious Diseases. 26th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2003, pp. 573–584.

5. Kozlov R.S., Muravyev A.A., Chagaryan A.N., Ivanchik N.V., Kurkova A.A., Kuzmenkov A.Yu. et al. The prevalence and antimicrobial susceptibility of circulating S. pneumoniae serotypes in adult population in Russia (epidemiological study «SPECTRUM»). Clinical Microbiology and Antimicrobial Chemotherapy. 2021;23(2):127–137. (In Russ.) https://doi.org/10.36488/cmac.2021.2.127-137.

6. Shi W., Du Q., Yuan L., Gao W., Wang Q., Yao K. Antibiotic Resistance and Molecular Biological Characteristics of Non-13-Valent-Pneumococcal Conjugate Vaccine Serogroup 15 Streptococcus pneumoniae Isolated From Children in China. Front Microbiol. 2022;12:778985. https://doi.org/10.3389/fmicb.2021.778985.

7. Resolution of the Expert Council “Principles of rational antibiotic therapy of respiratory infections in children. Let’s preserve antibiotics for future generations”. March 31, 2018, Moscow. Pediatrics. Consilium Medicum. 2018;(3):10–15. (In Russ.) Available at: https://omnidoctor.ru/library/izdaniya-dlya-vrachey/pediatriya-consilium-medicum/ped2018/ped2018_3/rezolyutsiya-ekspertnogo-soveta-printsipy-ratsionalnoy-antibiotikoterapii-respiratornykh-infektsiy-u/.

8. Karpova E.P., Tulupov D.A., Karneeva O.V., Polyakov D.P. Hypertrophy of the adenoids. Hypertrophy of the palatine tonsils: clinical guidelines. Moscow; 2021. 44 p. (In Russ.) Available at: https://cr.minzdrav.gov.ru/recomend/662_1.

9. Zyryanov S.K., Baibulatova E.A. The Use of New Dosage Forms of Antibiotics as a Way to Improve the Effectiveness and Safety of Antibiotic Therapy. Antibiotics and Chemotherapy. 2019;64(3-4):81–91. (In Russ.) https://doi.org/10.24411/0235-2990-2019-10020.

10. Fokkens W.J., Lund V.J., Hopkins C., Hellings P.W., Kern R., Reitsma S. et al. European Position Paper on Rhinosinusitis and Nasal Polyps 2020. Rhinology. 2020;58(Suppl. 29):1–464. https://doi.org/10.4193/Rhin20.600.

11. Kryukov A.I. (ed.). Pharmacotherapy of purulent-inflammatory pathology of ENT organs. Moscow; 2018. 55 p. (In Russ.)

12. Zaitseva S.V., Zastrozhina A.К., Kulikova E.V. Acute tonsillitis in a pediatrician’s practice. Meditsinskiy Sovet. 2019;(2):113–119. (In Russ.) https://doi.org/10.21518/2079-701X-2019-2-113-119.

13. Kryukov A.I., Ivoylov A.Yu., Kulagina M.I. Acute tonsillit in children: diagnosis, predictive value, treatment. Meditsinskiy Sovet. 2015;(3):56–59. (In Russ.) https://www.med-sovet.pro/jour/article/view/138.