Topical antibiotics in the therapy of infectious-inflammatory diseases of the upper respiratory tract

Despite the high prevalence of acute infectious and inflammatory diseases of the upper respiratory tract (rhinitis, sinusitis, nasopharyngitis, adenoiditis) among children and adults, the effectiveness of systemic antibacterial therapy for these diseases remains at 40–60%, which is associated with limited penetration of antibiotics through histohematic barriers into the area of the inflamed mucous membrane and the formation of microbial biofilms. This article summarizes the mechanism of action, pharmacokinetics, clinical efficacy, safety profile, and practical applications of topical aminoglycosides, with particular emphasis on framycetin during the period 2007–2024. Scientific literature was retrieved from eLIBRARY, PubMed, CyberLeninka databases, as well as from official websites of peer-reviewed scientific journals. A total of 42 relevant studies were identified; 26 sources were included in this analysis, comprising: 1 clinical practice guideline (Russian national standards for acute rhinosinusitis management), 5 randomized controlled trials of framycetin (including comparative studies of original and generic formulations), 8 prospective cohort studies, and 4 systematic reviews and meta-analyses on topical antimicrobial therapy. Acute infectious-inflammatory diseases of the upper respiratory tract, including rhinitis, nasopharyngitis, and sinusitis, remain among the most prevalent infectious pathologies requiring antimicrobial therapy. The conventional approach utilizing systemic antibiotic therapy is limited by inadequate penetration into the inflammatory focus, an elevated risk of antibiotic resistance development, rapid formation of pathogenic bacterial biofilms, and the potential for chronicity of the inflammatory process. Topical antibiotics represent an effective alternative, providing high local antibiotic concentrations with minimal systemic absorption. Original clinical observations of framycetin application in pediatric practice are presented, confirming the high efficacy and safety of topical antimicrobial therapy for infectious-inflammatory upper respiratory tract diseases.

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