Pharmacotherapy of respiratory tract diseases. Rational pharmacotherapy of respiratory diseases. “Pharmacotherapy of respiratory diseases”

Bronchial asthma, pneumonia and chronic obstructive pulmonary disease are the most common diseases today. About 5% of adults and 10% of children are diagnosed with bronchial asthma. Chronic obstructive disease has become a social problem because it is for this reason that the mortality rate of the population is increasing. Pneumonia still ranks first among the main causes of mortality. Tuberculosis, respiratory failure, upper respiratory tract diseases and many other diseases are no less important and attention should be paid to this. Treatment requires rational pharmacotherapy of respiratory diseases

Cough and sputum.

As a rule, cough and sputum are common symptoms of respiratory damage. The formation of sputum, bronchial secretion and its promotion is a protective reaction of the respiratory system. It is the bronchial secretion that protects the epithelium from damage by microbes. Bronchial secretions also have bacteriostatic properties. The inhaled air condenses into a layer of bronchial mucus. It settles and evacuates dust, while trapping germs and toxins.

The formation of tracheobronchial mucus occurs due to the bronchial glands, goblet cells, alveoli and bronchioles. The bronchial secretion contains components of serum origin, these are exudate and transudate, and there are also cell breakdown products. The human body secretes from 10-15 ml to 100-150 ml, or 0.1-0.75 ml of mucus per 1 kg of body weight per day. An absolutely healthy person does not feel excess mucus. Mucus is usually what causes coughing. This is due to the physiological mechanism of mucus secretion in the area of ​​the tracheobronchial tree. The main part of the secretion is mucins. They are divided into acidic and neutral. Acidic ones, in turn, are divided into glycoproteins, which contain carboxyl groups and sialic acid, as well as glycoproteins with sulfate groups, which make up the serous part of the secretion.

Normally, mucus consists of 89-95% water. Mucus contains ions such as Na+, C1-, P3+, Ca2+. The consistency of sputum depends on the water content. Water is required for normal mucocytic transport.

The accumulation of bronchial secretions contributes to the disruption of the mucociliary barrier and reduces immune processes. That is, the body’s defenses are reduced.

Rational pharmacotherapy of respiratory diseases will help cope with the problem.

To make sputum easily cleared, various drugs are used..

Firstly, these are enzyme preparations (ribonuclease and deoxyribonuclease). Enzymes help break down high molecular weight nucleic acids, as well as from nucleoproteins to soluble molecules. This reduces the viscosity of sputum.

Currently, there is great interest in the use of enzyme preparations in practice. Recombinant human deoxyribonuclease is used in pediatrics, in the treatment of purulent pleurisy, and in recurrent atelectasis in patients with spinal cord injury.

Ribonuclease depolymerizes RNA into acid-soluble mono- and oligonucleotides. This drug thins pus, mucus, as well as viscous sputum, and has anti-inflammatory properties. Delays the reproduction processes of RNA-containing viruses. It is used topically in the form of aerosols, as well as intrapleurally and intramuscularly. For inhalation, a fine aerosol is used. Dose - 0.025 mg per procedure. The drug is dissolved in 3-4 ml of isotonic sodium chloride solution, or use a 0.5% novocaine solution. The drug is administered endobronchially using a laryngeal syringe. A special catheter can be used. The solution contains 0.025-0.05 g of the drug.

For intramuscular injection, a single dose is 0.01 g. For intracavitary or local use, the dose is 0.05 g. Before use, a sensitivity test to the drug should be performed. To do this, 0.1 ml of solution is injected intradermally into the flexor surface of the forearm. If the reaction is negative, the patient can take the drug for treatment. Administration of the drug is stopped if the patient has normal body temperature.

Preparations for the treatment of respiratory organs.

Pharmacotherapy for respiratory diseases includes drugs such as Mesna and Acetylcysteine. These are thiol-containing drugs, which are M - a derivative of natural cysteine. This drug stimulates mucosal cells, the secretion of which is capable of lysing fibrin and blood clots.

Acetylcysteine

The drug Acetylcysteine ​​is well absorbed and is metabolized into cysteine ​​in the liver. Prescribed for bronchopulmonary diseases in the presence of viscous, thick, difficult to separate sputum in chronic bronchitis, bronchopneumonia, bronchial asthma and cystic fibrosis. Adults take the drug 200 mg 3 times a day for 5-10 days.

Mesna

Mesna thins the secretions in the trachea and bronchi, which greatly facilitates the discharge of sputum. Use in the form of inhalations 2-4 times a day for 2-24 days. 1-2 ampoules of the drug are diluted with distilled water 1:1. An intratracheal tube is used for drip infusion. Instill instillation every hour until the moment of liquefaction and sputum discharge.

Respiratory diseases are also treated with vasicinoids. These include bromhexine and ambroxol. These drugs have an expectorant effect. They have an antitussive effect.

Carbocisteine ​​and sodium bicarbonate are also pharmacological drugs for the treatment of respiratory organs. Carbocisteine ​​activates sialic transferase of goblet cells located in the bronchi. This leads to the normalization of acidic as well as neutral sialomucins in bronchial secretions. The elasticity and viscosity of mucus is restored, the structure of the bronchi is restored. Those. it is a mucoregulator. The drug is taken 750 mg 3 times a day orally.

Dudnikova Eleonora Vasilievna, Professor, Doctor of Medical Sciences, Head of the Department of Childhood Diseases No. 1

Simovanyan Emma Nikitichna, Professor, Doctor of Medical Sciences, Head of the Department of Children's Infectious Diseases, Rostov State Medical University

Chepurnaya Maria Mikhailovna, Professor, Doctor of Medical Sciences, Honored Doctor of the Russian Federation, Head of the Pulmonology Department

Karpov Vladimir Vladimirovich, Professor, pediatrician

Andriyashchenko Irina Ivanovna, Pediatrician of the highest qualification category

Page editor: Kryuchkova Oksana Aleksandrovna

In the treatment of respiratory diseases, etiotropic, pathogenetic and symptomatic drugs are used. Among etiotropic drugs, an important place is given to antibiotics.

Penicillin group drugs

Benzylpenicillin sodium salt is prescribed in doses:

children 1 year of life - 50,000-100,000-200,0000 units/kg body weight per day; from 1 year to 2 years - 250,000 units; 3-4 years - 400,000 units; 5-6 years -500,000 units; 7-9 years - 600,000 units; 10-14 years -750,000 units per day.

For children 1 year of age with severe pneumonia of staphylococcal etiology in intensive care, the daily dose of benzylpenicillin sodium salt is increased to 200,000-500,000 units/kg body weight.

The drug is administered intramuscularly, for pulmonary-pleural complications - intravenously (4-6 times a day), intrapleurally. Indicated for acute and exacerbation of chronic respiratory diseases.

For acute bronchitis, 7 days are used, for uncomplicated acute pneumonia - 7-10 days, severe pneumonia with purulent complications - 10-14 days, for exacerbation of chronic bronchitis, chronic pneumonia - 10-14 days.

Side effects: fever, headache, urticaria, angioedema, anaphylactic shock, fungal infections of the mucous membranes and general integument.

Benzylpenicillin is contraindicated in patients with hypersensitivity to the drug and persons with allergic diseases.

Methicillin sodium salt is prescribed in doses: children under 3 months - 50 mg/kg body weight per day; from 3 months to 12 years - 100 mg/kg; over 12 years old - adult dose (4-6 g per day). It is administered intramuscularly 4-6 times a day. The course of treatment is 10-14 days.

Indicated in the acute period of respiratory diseases caused by gram-positive pathogens resistant to benzylpenicillin sodium salt.

When using methicillin sodium salt, allergic reactions may occur. Contraindicated in patients with hypersensitivity to penicillin drugs and allergic diseases.

Oxacillin sodium salt is prescribed in doses: newborns - 20-40 mg/kg body weight per day; from 1 to 3 months - 60-80 mg/kg, from 3 months to 2 years - 1 g, from 2 to 6 years - 2 g, over 6 years - 1.5-3 g. Administered intramuscularly 4 times a day.

Give orally 4-6 times a day 1 hour before meals or 2-3 hours after meals in doses: children under 5 years old - 100 mg/kg body weight (I.N. Usov, 1976), over 5 years old - 2 g per day. The choice of route of administration of oxacillin sodium salt depends on the form and severity of the disease. In severe cases of acute pneumonia in children 1 year of age, pulmonary-pleural complications, exacerbation of chronic pneumonia in children over 1 year of age, intramuscular administration is indicated.

For acute bronchitis and uncomplicated pneumonia, the drug is given orally. If there is no effect, it is advisable to switch to intramuscular administration. The course of treatment is 10-14 days.

When using oxacillin sodium salt, allergic reactions are possible. Nausea, vomiting, and diarrhea are rarely observed. Intramuscular use is sometimes accompanied by a local reaction. Indicated for respiratory diseases caused by pathogens resistant to benzylpenicillin sodium salt, especially penicillinase-forming staphylococci.

Contraindicated in case of hypersensitivity to penicillin and allergic diseases.

Ampicillin sodium salt is prescribed in doses: for newborns - at the rate of 100 mg/kg body weight per day; up to 1 year - 75 mg/kg; from 1 year to 4 years - 50-75 mg/kg; over 4 years old - 50 mg/kg. In case of severe confluent (segmental) pneumonia with a protracted course, purulent pulmonary-pleural complications, the dose can be doubled.

It is administered intramuscularly and intravenously (microjet or drip), as well as into the pleural cavity. Indicated for severe forms of pneumonia with a protracted course in children of the 1st year of life, pulmonary-pleural complications, exacerbation of chronic pneumonia.

In case of severe focal, segmental pneumonia, or the development of purulent complications, ampicillin sodium salt is administered intravenously 4 times a day. If the patient's condition improves, intravenous and intramuscular use of the drug can be alternated with a gradual transition to the latter route of administration. The course of treatment is 10-14 days. Side effects: allergic reactions, dysbacteriosis. Contraindicated in case of hypersensitivity to the drug, does not affect strains of microorganisms resistant to penicillin.

Ampiox. The daily dose for newborns and children of the 1st year of life is 200 mg/kg, from 1 year to 6 years - 100 mg/kg, from 7 to 14 years - 50 mg/kg. It is administered intramuscularly 3-4 times a day. The course of treatment is 10-14 days.

Prescribed for severe pneumonia with a protracted course, pulmonary-pleural purulent complications, exacerbation of chronic pneumonia with bronchiectasis. Contraindicated if there is a history of allergic reactions that occur when using drugs of the penicillin group.

Dicloxacillin sodium salt is prescribed to children (up to 12 years old) at the rate of 12.5-25 mg/kg body weight per day in 4 doses orally 1 hour before meals or 1-11/2 hours after meals. The duration of treatment is from 5-7 days to 2 weeks or more. Indicated for acute pneumonia, bronchitis, and other acute purulent diseases of the respiratory tract in children over 1 year of age. The drug is active against pathogens resistant to penicillin. Allergic reactions and dyspeptic symptoms are possible.

Contraindicated in case of hypersensitivity to penicillin, gastric and duodenal ulcers.

Drugs of the cephalosporin group

Cephaloridine (syn. ceporin) is prescribed for respiratory diseases caused by gram-positive bacteria at a dose of 15-30 mg/kg body weight, gram-negative bacteria - 40-60 mg/kg per day. In severe forms of pneumonia with a protracted course, purulent-septic complications, exacerbation of chronic pneumonia, the daily dose of cephaloridine is 60-100 mg/kg body weight. Newborns are prescribed 30 mg/kg body weight per day.

Cephaloridine is administered mainly intramuscularly 2-3 times a day, 2 times for newborns. In case of severe disease and the need to quickly create a high concentration in the blood, it is infused intravenously (microstream for 3-5 minutes) or dropwise for 6 hours. For purulent pleurisy, it is injected into the pleural cavity. The course of treatment is 7-10 days.

Side effects: impaired renal excretory function (rare), allergic reactions, neutropenia, local irritation and transient pain along the vein. Indicated in the treatment of diseases caused by staphylococci resistant to other antibiotics. Can be used if you are allergic to penicillin.

Cephalexin (syn. ceporex) is similar in action to cephaloridine. It is prescribed orally in a daily dose of 15-30, 60-100 mg/kg body weight, depending on the severity of the process, in 4 doses. Indicated for acute bronchitis, acute and exacerbation of chronic pneumonia. The course of treatment is 5-10 days.

Dyspeptic symptoms and allergic reactions are possible (rare). Contraindications for use are the same as for cephaloridine.

Tetracycline group drugs

Tetracycline is prescribed in doses: children under 2 years old - 25-30 mg/kg body weight per day, 3-4 years old - 0.3 g, 5-6 years old - 0.4 g, 7-9 years old - 0.5 g , 10-14 years - 0.6 g per day. Take orally during or immediately after meals in 4 divided doses.

Children with acute, recurrent bronchitis and uncomplicated pneumonia are treated for 5-7 days.

Side effects: loss of appetite, nausea, vomiting, diarrhea, glossitis, stomatitis, gastritis, allergic reactions, Quincke's edema, etc. With long-term use of tetracycline, candidiasis may develop. To prevent it, antifungal drugs are used - nystatin, levorin. They also produce special Vitacycline tablets containing tetracycline along with vitamins. Tetracycline is contraindicated in case of hypersensitivity to it and fungal diseases. Requires careful use in diseases of the liver, kidneys, as well as in children under 5 years of age due to inhibition of chondrogenesis and bone growth (Ya. B. Maksimovich, 1974).

Morphocycline is prescribed in single doses: for children under 2 years old - 5000-7500 IU/kg body weight; from 2 to 6 years - 50,000 units; from 6 to 9 years - 75,000 units; from 9 to 14 years - 100,000 units. It is administered intravenously 2 times a day. Children 7-14 years old are prescribed 75,000 units orally; over 14 years old - 150,000 units 3 times a day.

For inhalation, morphocycline is used in the form of an aerosol. For this purpose, 150,000 units of the drug are dissolved in 3-5 ml of 20-30% glycerol solution. Doses for aerosol use: children under 1 year - 50,000 units; from 1 year to 3 years -75000 units; 3-7 years - 100,000 units; 7-12 years - 125,000 units; over 12 years old - 150,000 units.

Intravenous morphocycline is used for severe focal and polysegmental forms of pneumonia, protracted, recurrent course of the disease with insufficient effectiveness of other antibacterial agents. The course of treatment is 7-10 days. It is prescribed orally for children over 7 years of age with acute recurrent bronchitis and an uncomplicated form of pneumonia. The course of treatment is 7-10 days. In the form of an aerosol, the drug is prescribed to patients with focal, segmental pneumonia with a protracted course; chronic pneumonia in the presence of purulent endobronchitis, bronchiectasis. Inhalations lasting 15-20 minutes are carried out 1-3 times a day. The course of treatment is 5-10 days. If necessary, the course of treatment is repeated after 5-7 days.

Side effects: pain along the vein, dizziness, tachycardia, nausea and vomiting, decreased blood pressure at the time of administration. In some cases, phlebitis may develop. Inhalations may cause a sore throat, cough, and bitterness in the mouth.

Contraindicated in case of hypersensitivity to it, fungal diseases, thrombophlebitis.

It should be used with caution in cases of circulatory failure of II and III degrees. In the form of inhalations, the drug should not be used for atrophy of the mucous membranes of the respiratory tract or bronchospastic conditions.

Metacycline hydrochloride (syn. Rondomycin) is prescribed to children from 5 to 12 years old at the rate of 7.5-10 mg/kg body weight per day in 2-4 doses. In severe forms of the disease, the dose can be increased to 15 mg/kg body weight per day. Children over 12 years of age are prescribed 0.6 g per day (in 2 divided doses) during meals or immediately after meals.

Indicated for acute and exacerbation of chronic bronchopulmonary diseases in children over 5 years of age. Side effects are the same as with other tetracyclines.

The drug is contraindicated in cases of hypersensitivity to tetracyclines, as well as in children under 5 years of age. It should be prescribed with caution to patients with impaired liver function, kidney function and leukopenia.

Doxycycline (syn. Vibramycin) is prescribed orally for children over 5 years of age on the 1st day 4 mg/kg body weight (in 2 doses), on subsequent days - 2 mg/kg body weight 1 time per day.

Indicated for acute bronchitis, acute (uncomplicated form) and exacerbation of chronic pneumonia with symptoms of endobronchitis without the presence of ectasis. The course of treatment is 7-10 days.

Side effects and contraindications are the same as for treatment with other tetracyclines.

Preparations of the streptomycin group

Streptomycin sulfate is prescribed in doses: children from 1 to 2 years old - 20,000 units/kg body weight; 3-4 years - 300,000 units per day; 5-6 years - 350,000 units; 7-9 years - 400,000 units; 9-14 years old - 500,000 units per day. It is administered intramuscularly twice.

Indicated in combination with benzylpenicillin for patients with small focal pneumonia, acute bronchitis, as well as for exacerbation of chronic pneumonia with symptoms of purulent bronchitis. The course of treatment is 7-10 days.

Children 1 year of age with nonspecific respiratory diseases should not be prescribed streptomycin sulfate. In case of prolonged course and exacerbation of chronic pneumonia, recurrent endobronchitis, the drug can be used in the form of an aerosol (0.2-0.25 g dissolved in 3-5 ml of isotonic sodium chloride solution or distilled water). Inhalations (15-20) are carried out daily or every other day.

Side effects: drug fever, dermatitis and other allergic reactions, dizziness, headache, palpitations, albuminuria, hematuria, diarrhea. The most dangerous complication is damage to the VIII pair of cranial nerves and associated vestibular disorders and hearing impairment.

Streptomycin sulfate is contraindicated in children under 1 year of age, children who have suffered from acoustic neuritis, as well as those with liver disease and impaired renal excretory function.

Streptocillin is a combination drug containing a mixture of streptomycin and benzylpenicillin salts.

Daily doses: children from 1 year to 3 years - 200,000-250,000 units; 4-7 years - 250,000-300,000 units; 8-12 years - 300,000-500,000 units. It is administered intramuscularly 1-2 times a day.

Streptocillin is used for severe pneumonia with a protracted course, chronic pneumonia in the acute phase, lung abscess, exudative (purulent) pleurisy caused by mixed infections. The course of treatment is 2-3 weeks. When using streptocillin, pain at the injection site is possible, as well as side effects caused by penicillin and streptomycin.

Contraindicated if there is a history of hypersensitivity to penicillin and streptomycin, or with damage to the auditory nerve and vestibular system.

Preparations of the chloramphenicol group

Levomycetin sodium succinate. Daily dose: children under 1 year -25-30 mg/kg body weight; over 1 year - 50 mg/kg. It is administered intramuscularly in two doses (every 12 hours).

Indicated for acute and exacerbation of chronic pneumonia, bronchitis caused by pathogens resistant to penicillin and other antibiotics.

The course of treatment is 7 - 10 days. When using sodium chloramphenicol succinate, dyspepsia, irritation of the mucous membranes of the oral cavity, pharynx, skin, as well as changes in the blood - reticulo-, granulocytopenia, anemia may be observed. In infants, the toxic effect is manifested by “serous syndrome” in the form of bloating, cyanosis, and collapse. Contraindicated in case of suppression of hematopoiesis, psoriasis, eczema, fungal and other diseases of the general integument, or with hypersensitivity to the drug. Children under 3 years of age are not prescribed.

Macrolide drugs

Erythromycin is prescribed in single doses: for children under 2 years of age -0.005-0.008 g (5-8 mg) per 1 kg of body weight; at the age of 3-4 years - 0.125 g; 5-6 years - 0.15 g; 7-9 years - 0.2 g; 10-14 years - 0.25 g. Used orally 4 times a day 1 - 1.5 hours before meals. Indicated for acute and exacerbation of chronic pneumonia, acute bronchitis caused by pathogens sensitive to the antibiotic. The course of treatment is 7-10 days.

Side effects: relatively rarely nausea, vomiting, diarrhea; in some cases, with increased sensitivity to the drug, allergic reactions are observed.

There are no contraindications to the use of antibiotics. Caution should be prescribed in case of increased sensitivity to it, liver and kidney diseases, accompanied by a violation of their functions.

Erythromycin ascorbate is prescribed at the rate of 20 mg/kg body weight per day (20,000 units). It is administered intravenously slowly (over 3-5 minutes) 2-3 times a day. The drug can be administered dropwise in an isotonic sodium chloride solution and 5% glucose solution at a concentration of no more than 1 mg (1000 units) per 1 ml of solvent. Intravenous infusions are carried out for 3-5 days (until a clear therapeutic effect occurs), then they switch to taking the drug orally in the form of tablets or capsules.

Side effects and indications are the same as for treatment with erythromycin. Contraindicated in thrombophlebitis.

Erythromycin phosphate. Indications for use, doses, side effects are the same as for erythromycin ascorbate.

Oleandomycin phosphate is prescribed orally in doses: children under 3 years old - 0.02 g/kg body weight (20,000 units); 3-6 years - 0.25-0.5 g (250,000-500,000 units); 6-14 years - 0.5-1 g; over 14 years - 1 -1.5 g. The daily dose is divided into 4-6 doses. It is administered intramuscularly and intravenously in the following doses: children under 3 years of age - 0.03-0.05 g/kg body weight (30,000-50,000 units); 3-6 years - 0.25-0.5 g (250,000-500,000 units); 0 -10 years -0.5-0.75 g; 10-14 years - 0.75-1 g. Administered 3-4 times a day.

Indicated for acute bronchitis, acute and exacerbation of chronic pneumonia, purulent pulmonary-pleural complications caused by pathogens sensitive to this drug and resistant to other antibiotics. The course of treatment is 7-10 days.

Side effects: rarely nausea, vomiting, diarrhea; allergic reactions (skin itching, urticaria, angioedema). When administered intramuscularly, a pronounced local reaction is observed, so this method is used in exceptional cases.

Contraindicated in cases of increased individual sensitivity, intolerance, and diseases of the liver parenchyma.

Olethetrin (syn. tetraolean, sigmamycin). Prescribed in doses: for children under 1 year - 0.025 g/kg body weight; from 1 to 3 years - 0.25 g; 3-6 years - 0.4 g; 6-10 years - 0.5 g; 10-12 years - 0.75 g; over 12 years - 1 g. The daily dose is divided into 4-6 doses, taken orally.

Indicated for acute, recurrent bronchitis, prolonged pneumonia, exacerbation of chronic pneumonia of various ethnologies. The course of treatment is 7-14 days.

Side effects and contraindications are the same as for treatment with oleandomycin and tetracycline.

Tetraolean is prescribed to children in daily doses: for body weight up to 10 kg - 0.125 g, from 10 to 15 kg - 0.25 g, from 20 to 30 kg - 0.5 g, from 30 to 40 kg - 0.725 g, from 40 up to 50 kg - 1 g. Taken orally 4 times a day.

It is administered intramuscularly at the rate of 10-20 mg/kg per day in 2 divided doses (every 12 hours). It is administered intravenously slowly in a stream or drip at a dose of 15-25 mg/kg body weight per day (in 2-4 doses at intervals of 12 or 6 hours). Indicated internally for recurrent bronchitis, uncomplicated forms of acute pneumonia, as well as to consolidate the clinical effect after the use of penicillin antibiotics during prolonged treatment of acute and exacerbation of chronic pneumonia. The course of treatment is 5-7 days.

Intramuscular and intravenous administration is indicated for segmental, polysegmental pneumonia with the development of purulent complications (pleurisy, abscess), exacerbation of chronic pneumonia with purulent endobronchitis, ectasis.

Side effects are the same as with treatment with oleandomycin and tetracycline, as well as a local reaction when administered intramuscularly. Indications and contraindications are the same as for oletethrin.

Olemorphocycline is prescribed in doses: children under 2 years old - 8000 units/kg body weight; from 2 to 6 years - 75,000 units; 6-12 years - 150,000 units; 12-14 years - 150,000-200,000 units; over 14 years old - 250,000 units per day.

The drug is used intravenously 2 times (in severe cases 3 times) per day for 7-10 days.

For the inhalation method of administration, the following is prescribed: for children under 1 year of age - 75,000 units; from 1 to 3 years - 125,000 units; 3-7 years - 175,000 units; 7-12 years - 200,000 units; over 12 years old - 250,000 units.

Indicated for segmental, polysegmental forms of pneumonia with a protracted course, with the development of purulent pulmonary-pleural complications.

For acute and exacerbation of chronic pneumonia with bronchiectasis, bronchitis with a protracted course, olemorphocycline can be used in the form of inhalations. To do this, 250,000 units of the drug are dissolved in 5 ml of a 20-30% aqueous solution of glycerol or 5% glucose solution. Inhalations are performed 1 - 3 times a day for 5-14 days.

Side effects: pain along the vein with rapid intravenous administration, nausea, asthma attack in patients with bronchial asthma.

Contraindicated in cases of severe impairment of liver and kidney function, hypersensitivity to tetracycline and oleandomycin.

Aminoglycoside group drugs

Kanamycin monosulfate is prescribed to children at the rate of 0.015-0.02 g/kg (15-20 mg/kg) body weight per day (no more than 0.75 g per day). It is administered intramuscularly, in the form of an aerosol and into the cavity.

Indicated for severe pneumonia in children of the 1st year of life, with its segmental nature with a protracted course, segmental, focal acute pneumonia in older children, the development of purulent complications (pleurisy, pyopneumothorax), with exacerbation of chronic pneumonia with bronchiectasis, purulent bronchitis. In severe forms of pneumonia with a protracted course, the drug is administered intramuscularly in 2-3 doses. As a rule, for such forms of pneumonia, kamamycin monosulfate is combined with penicillin or other drugs from the group of semisynthetic penicillins. The course of treatment is 7-10 days.

With the development of purulent complications (pleurisy, pyopneumothorax), kanamycin monosulfate is injected into the pleural cavity in a daily dose not exceeding that for intramuscular administration. The course of treatment is 5-7 days or more (according to indications).

In case of prolonged course of confluent, segmental and exacerbation of chronic pneumonia with purulent bronchitis, bronchiectasis, kanamycin monosulfate can be administered in the form of an aerosol 1-2 times a day. To do this, 0.25-0.5-1 g of the drug is dissolved in 3-5-10 ml of isotonic sodium chloride solution, or distilled water, or 0.2-0.5% novocaine solution. Bronchodilators and antihistamines can be added to this solution if there are clinical signs of bronchospasm. The daily dose of kanamycin monosulfate is administered in 1-2 doses. The course of treatment for prolonged pneumonia is 10-15 days, for exacerbation of chronic pneumonia - 16-20 days.

With intramuscular administration of the drug, the development of auditory neuritis is possible. Therefore, the course of treatment is carried out briefly and carefully. It may also have a toxic effect on the kidneys (cylindruria, albuminuria, microhematuria). A urine test must be performed at least once every 5 days. In some cases, allergic reactions, paresthesia, and liver dysfunction are observed.

Contraindicated in case of neuritis of the auditory nerve, impaired liver and kidney function. It is unacceptable to prescribe kanamycin monosulfate simultaneously with other oto- and nephrotoxic antibiotics (streptomycin, monomycin, neomycin, etc.). Kanamycin monosulfate can be taken earlier than 10-12 days after the end of treatment with these antibiotics.

Gentamicin sulfate is prescribed at a dose of 0.6-2 mg/kg body weight per day. It is administered intramuscularly 2-3 times a day. Indicated for severe pneumonia with a protracted course. Due to the wide spectrum of action of gentamicin, sulfate is prescribed for mixed infections, as well as when the pathogen has not been identified. It is often effective when other antibiotics are insufficiently active. The course of treatment is 5-8 days (R. E. Mazo, 1977). Side effects and contraindications are the same as for other aminoglycosides.

Rifamycins

Rifampicin is prescribed in doses: for children under 6 years old at the rate of 10-30 mg/kg body weight per day, over 6 years old - 0.25 g (250 mg) 2-3 times a day at intervals of 12 or 8 hours. intramuscularly, intravenously, intrapleurally, intratracheally. It is administered intravenously in a slow stream or drip at the rate of 10-30 mg/kg per day. The daily dose is divided into 2-4 doses at equal intervals. Indicated for severe pneumonia with a protracted course in young children, pleurisy, empyema, exacerbation of chronic pneumonia with bronchiectasis, purulent endobronchitis. In case of acute pneumonia with a protracted course and exacerbation of chronic pneumonia, the drug is administered intramuscularly or intravenously in age-specific doses for 7-10 days; for empyema - 125-250 mg in 2 ml of distilled water into the pleural cavity for 3-5-7 days, based on the dynamics of the process.

In case of exacerbation of chronic pneumonia with bronchiectasis, purulent bronchitis, the drug (125 mg) is administered intratracheally in 2-3 ml of distilled water once every 2 days. The course of treatment is 10-15 injections.

Side effects: allergic skin rashes (rare). With prolonged intravenous administration, thrombophlebitis may develop. Sometimes jaundice is observed. Contraindicated in liver diseases that impair its functional ability.

Rifampicin is prescribed at a rate of 10-20 mg/kg body weight per day in 2 divided doses before meals (in the morning on an empty stomach and in the evening). Indicated for children over 5 years of age with acute bronchitis, acute pneumonia, with a prolonged course, especially caused by penicillinase-forming strains of staphylococci. The course of treatment is 7-10 days.

Side effects: allergic reactions (G.F. Gubanov, 1974), dyspepsia, leukopenia. The drug reduces the activity of indirect anticoagulants. Contraindicated for liver diseases.

Antibiotics of different groups

Lincomycin hydrochloride is administered intramuscularly at the rate of 15-30 mg/kg body weight per day (15,000-30,000 units) in two doses with an interval of 12 hours. Orally given at the rate of 30-60 mg/kg body weight per day (in 3- 4 doses).

Lincomycin hydrochloride is indicated for severe forms of pneumonia in children of the 1st year of life (focal, segmental) with a protracted course in the absence of a pronounced clinical effect from treatment with other antibiotics; for purulent complications of acute pneumonia, exacerbation of chronic pneumonia with bronchiectasis, purulent endobronchitis, if the pathogen is resistant to other antibiotics. Such patients are administered the drug intramuscularly for 10-14 days, and in severe forms - 3-4 weeks.

For children over 5 years of age with segmental, polysegmental pneumonia with a protracted course in the absence of full clinical effect from treatment with penicillin drugs and others, lincomycin hydrochloride is prescribed orally (in capsules) for 10-14 days. The drug can also be used internally in case of exacerbation of chronic pneumonia in the absence of severe complications.

Side effects: nausea, vomiting, rarely allergic reactions. Contraindicated for liver and kidney diseases.

Ristomycin sulfate is prescribed at a dose of 20,000-30,000 units/kg body weight per day. It is administered in 2 doses every 12 hours only intravenously. Indicated for children of different ages with severe segmental and lobar forms of pneumonia, with the development of purulent pulmonary-pleural complications, the etiological factor of which is staphylococcus, pneumococcus, streptococcus, resistant to other antibiotics.

For diseases caused by pneumococci and streptococci, ristomycin sulfate is used for 0-7 days; for staphylococcal pneumonia with the development of purulent complications - 10-14 days.

Side effects: chills, nausea, leukopenia, neutropenia, allergic reactions. Contraindicated in thrombocytopenia.

Fuzidin sodium is prescribed orally in doses: for newborns and children up to one year of age at the rate of 60-80 mg/kg of body weight, from 1 to 3 years - 40 mg/kg; from 4 to 14 years - 20-40 mg/kg body weight per day.

For newborns and children 1 year of age, sodium fusidine is given as a suspension in sugar syrup; over 1 year - in tablets.

Indicated for acute pneumonia with a protracted course, exacerbation of chronic pneumonia caused by staphylococci resistant to other antibiotics.

In severe (segmental) forms of pneumonia with a protracted course, the development of purulent pulmonary-pleural complications, to prevent the emergence of resistant pathogens, it is recommended to combine fusidine sodium with semi-synthetic penicillins or tetracycline. The course of treatment is 7-14 days, for severe forms of pneumonia - up to 3 weeks.

Side effects: abdominal pain, nausea, vomiting, diarrhea; rarely - allergic reactions.

Antifungal drugs

Nystatin is prescribed orally and rectally in doses: for children under 1 year of age - 100,000-125,000 units; from 1 to 3 years - 250,000 units 3-4 times a day; over 13 years old - from 1,000,000 to 1,500,000 units per day in 4 divided doses. Used for prophylactic purposes to prevent candidiasis in patients with respiratory diseases with long-term use of antibiotics. The course of treatment is 10-14 days. In case of prolonged course of severe forms of pneumonia, exacerbation of chronic pneumonia, repeated courses of treatment are carried out with breaks between them of 2-3 weeks.

Nystatin, as a rule, does not cause side effects. If you are hypersensitive to the drug, nausea, vomiting, diarrhea, fever, and chills are possible.

Levorin is prescribed for prophylactic purposes in case of candidiasis and candidiasis of the alimentary canal in doses: children under 2 years old - 25,000 units/kg body weight per day; from 2 to 6 years - 20,000 units/kg body weight; after 6 years - 200,000-250,000 units 3-4 times a day. It is used internally in the form of tablets or capsules. Children over 3 years old can use cheek tablets: 3-10 years old - ‘/4 tablets (125,000 units) 3-4 times a day; 10-15 years - 1/2 tablet (250,000 units) 2-4 times a day; over 15 years old - 1 tablet 2-4 times a day. The tablets dissolve in the mouth within 10-15 minutes.

Levorin can be given as a suspension (1 teaspoon contains 100,000 units) in the same doses as tablets or capsules. Treatment is carried out in courses of 7-10 days.

Side effects: nausea, general itching, dermatitis, diarrhea.

Contraindicated for liver diseases, acute diseases of the alimentary canal of a non-fungal nature, gastric and duodenal ulcers.

Levorin sodium salt is prescribed in the following daily doses: children under 1 year - 40,000 - 100,000 units; from 1 year to 3 years - 100,000-150,000 units; over 3 years - 150,000-100,000 units.

Indicated for candidiasis in patients with respiratory diseases treated with antibiotics.

Used in the form of inhalations. For this purpose, 100,000-200,000 units of levorine sodium salt are dissolved in 5 ml of distilled water. Inhalations are carried out for 15-20 minutes 1-2-3 times a day. The course of treatment is 7-10 days.

Side effects: during inhalation, cough, fever, bronchospasm are possible. Levorin sodium salt is contraindicated in case of hypersensitivity to the drug or bronchial asthma. Other contraindications are the same as for levorin.

Etiotropic drugs also include sulfonamide drugs.

Norsulfazole is prescribed orally in single doses: for children under 2 years old - 0.1-0.25 g; 2-5 years - 0.3-0.4 g; 6-12 years - 0.4-0.5 g. For the first dose, give a double dose. The optimal dose is 0.2 g/kg body weight per day in 6 divided doses.

Indicated for older children with acute bronchitis, an uncomplicated form of acute pneumonia. The course of treatment is 7 days. In children older than 1 year with a severe form of acute pneumonia, a protracted course of focal, segmental pneumonia, it is used in combination with antibiotics for 7 - 10 days or as an independent course after the end of antibiotic treatment (I. N. Usov, 1976; R. E. Mazo, 1.977). As a rule, the drug is not prescribed to children under the age of 1 year.

When using norsulfazole, it is recommended to drink plenty of alkaline liquids (Borjomi, sodium bicarbonate solution, etc.) in order to prevent the formation of crystals that block the urinary tract. Side effects: nausea, sometimes vomiting.

Contraindicated if there is a history of toxic-allergic reactions that occur when taking any sulfonamide drug.

Sulfazine is given at the rate of 0.1 g/kg body weight for the first dose, then 0.025 g/kg (25 mg/kg) every 4-6 hours. Prescribed orally for 5-7 days.

Indications for use are the same as for norsulfazole. Side effects: nausea, vomiting, leukopenia (rare). Possible hematuria, oliguria, anuria.

Sulfadimezin is prescribed orally in doses: 0.1 g/kg body weight for the first dose, then 0.025 g/kg body weight every 4-6-8 hours. The course of treatment is 7 days.

Indications, side effects, contraindications are the same as for other sulfonamide drugs.

Etazol sodium is prescribed as a 10% solution of 0.1 - 0.2 ml/kg body weight in 2-3 doses every 4-6 hours intramuscularly or intravenously for 5-7 days.

Indicated in combination with antibiotics for severe pneumonia in young children, for moderate and severe forms of acute pneumonia in older children, the development of purulent complications of pneumonia, exacerbation of chronic pneumonia with purulent endobronchitis, bronchiectasis.

Respiratory diseases are a serious problem due to their prevalence (especially among children) and the economic damage they cause to both individuals and society as a whole. At the same time, the rapidly expanding range of drugs used for these diseases creates objective difficulties in choosing adequate treatment tactics.

The mucous membrane of the respiratory tract is constantly exposed to the drying effect of inhaled air. Protection against it is carried out by tracheobronchial secretion, the formation of which is a prerequisite for the normal functioning of the respiratory system. It covers the surface of the mucous membrane of the respiratory tract, moisturizes and protects epithelial cells. Tracheobronchial secretion has a complex composition and is a mixture of secretion from goblet cells, Clark cells and submucosal glands, plasma transudate, locally secreted proteins, metabolic products of motile cells and vegetative microorganisms, pulmonary surfactant and cellular elements - alveolar macrophages and lymphocytes. Under physiological conditions, tracheobronchial secretion contains immunoglobulins and nonspecific protective factors (lysozyme, transferrin, opsonins, etc.) and therefore has a bactericidal effect.

According to the physicochemical structure, the tracheobronchial secretion is a multicomponent colloidal solution, which consists of two phases: liquid (sol) and gel-like, insoluble. The gel has a fibrillar structure and is formed mainly due to locally synthesized macromolecular glycoprotein complexes of mucins linked by disulfide bridges. The sol coats the apical surfaces of the mucociliary cells. In a liquid layer 5 microns thick, the cilia of the ciliated epithelium perform their constant oscillatory movements and transfer their kinetic energy to the outer layer of the gel. Thanks to the rhythmic “beating” of the cilia, a layer of thick mucus seems to “slide” in the bronchi and trachea along a more liquid layer in the proximal direction (towards the larynx, and in the nose - towards the pharynx). This process - mucociliary transport (clearance) - is the most important mechanism for cleansing the respiratory tract, which is one of the main mechanisms of the local defense system and provides the barrier, immune and cleansing functions of the respiratory system. Clearing the respiratory tract of foreign particles and microorganisms occurs due to their settling on the mucous membranes and subsequent removal along with tracheobronchial secretions. This mechanism is especially important in hyperproduction of mucus, as observed, for example, in most acute respiratory infections.

The speed of mucociliary transport in a healthy person ranges from 4 to 20 mm per minute. Normally, from 10 to 100 ml of tracheobronchial secretion is transported per day, which, when it enters the pharynx, is swallowed. The rate of removal of tracheobronchial secretions from the lower respiratory tract depends not only on the functional activity of the ciliated epithelium, but also on the rheological properties of the secretion itself. Under normal conditions, tracheobronchial secretions are characterized by low viscosity and good fluidity. These parameters depend on the proportion of water and its constituent glycoproteins, consisting of hydrophilic acid sialomucins (55%), hydrophobic neutral fucomucins (40%) and sulfomucins (5%). An increase in the viscosity of the secretion may be due to disturbances in the water-electrolyte flow through the mucous membrane (for example, with dehydration and cystic fibrosis), as well as inflammation accompanied by overproduction of sialomucin-poor thick mucus by goblet cells.

Disturbance of mucociliary transport is one of the main factors in the pathogenesis of inflammatory respiratory diseases. During inflammation, the qualitative composition of the secretion changes: the synthesis of neutral mucins increases and the production of acidic mucins decreases, and the water content decreases. The secretion becomes viscous, which significantly impairs its fluidity (the higher the viscosity of the mucus, the lower the speed of its movement along the respiratory tract). This is also facilitated by the formation of disulfide bridges and hydrogen, electrostatic bonds between mucin molecules. The effect of hydrophobicity increases with increasing adhesiveness. In chronic diseases, hyperplasia of goblet cells occurs, not only their number increases, but also the area of ​​distribution; hyperproduction of secretions is noted. In addition, as a result of inflammation, functional or structural disorders of the ciliated epithelium develop. All this causes a violation of mucociliary activity: the peristaltic movements of small bronchi and the “flickering” of the ciliated epithelium of large bronchi and trachea are not able to provide adequate drainage of the bronchial tree. Stagnation of bronchial contents leads to impaired lung function. The viscous secretion produced during acute and chronic respiratory diseases can cause bronchial obstruction due to the accumulation of mucus in the respiratory tract. In severe cases, ventilation disorders are accompanied by the development of atelectasis. Less commonly, with malformations of the bronchi or lungs or congenital pathology of the ciliated epithelium, the normal evacuation of tracheobronchial secretions is initially impaired.

An increase in the viscosity of tracheobronchial secretions contributes to increased adhesion of pathogenic microorganisms on the mucous membranes of the respiratory tract; a decrease in the concentration of secretory immunoglobulin A, interferon, lactoferrin, lysozyme (the main components of local protection) leads to a decrease in antiviral and antimicrobial protection, which together creates favorable conditions for the proliferation of infectious agents that have an adverse effect on the mucous membranes of the respiratory tract. Consequently, a violation of the drainage function of the bronchial tree can lead not only to ventilation disorders, but also to a decrease in the local immunological protection of the respiratory tract with a high risk of developing a protracted course of the inflammatory process and contribute to its chronicity.

When mucociliary clearance becomes ineffective, additional mechanisms for clearing the bronchi are activated.

The main reflex, protective-adaptive reaction of the body, intended to remove foreign substances (both infectious and non-infectious origin) and/or pathologically altered tracheobronchial secretions from the respiratory tract, is a cough. It is designed to restore airway patency. When the sensitive endings of n. are irritated. vagus located in the respiratory organs, nerve impulses are transmitted to the cough center of the medulla oblongata. As a result of its excitation, a response is formed - a deep breath, and then a synchronous contraction of the muscles of the larynx, bronchi, chest, abdomen and diaphragm with the glottis closed, followed by its opening and a short, forced, jerky exhalation.

Cough can perform a protective function only with certain rheological properties of tracheobronchial secretions. Under physiological conditions, it plays only an auxiliary role in the processes of cleansing the respiratory tract, since the main mechanisms of sanitation are mucociliary clearance and peristalsis of small bronchi. In inflammatory diseases, when the peristaltic movements of the small bronchi and the activity of the ciliated epithelium of the large bronchi and trachea do not provide the necessary drainage, cough becomes the only effective mechanism for the sanitation of the tracheobronchial tree. The appearance of a cough in a child should be considered as a manifestation failure of the physiological mechanisms of sanitation of the tracheobronchial tree.

The most common causes of cough are pathological changes in the respiratory organs (inflammation, foreign body, etc.). It is one of the first and most important symptoms for diseases of the respiratory system. The vast majority of cases of acute cough are caused by respiratory viral infections, and the infectious-inflammatory process can be localized in both the upper and lower respiratory tract.

However, in some cases, cough may be associated with diseases of other organs and systems (central nervous system - CNS, mediastinal organs, etc.). It can be observed during neurotic reactions, psycho-emotional tension and stress. For diseases of the heart, esophagus, ENT organs as a result of irritation of peripheral receptors n. vagus, a reflex cough may occur.

The intensity and nature of cough in children varies depending on the etiological factor, the period of the disease and the individual characteristics of the body. A detailed description of cough (frequency, intensity, timbre, periodicity, soreness, productivity, nature of sputum, time of appearance and duration, etc.), along with a clarification of the medical history and an adequate assessment of the results of a clinical examination, allows us to establish the correct diagnosis and prescribe adequate therapy.

Treatment of cough in children should, of course, begin with eliminating its cause. When establishing the cause of cough, etiotropic or pathogenetic treatment of the underlying disease should be carried out first. With effective treatment of the disease accompanied by cough, it also disappears. Antitussive therapy is indicated only in cases where the cough does not fulfill its protective function, i.e. does not help clear the airways.

The effectiveness of therapy primarily depends on the correct and timely diagnosis of the disease. To determine the possible cause of cough, when collecting anamnesis, you need to pay attention to:

• heredity: the presence of patients with allergic diseases in the family allows us to suspect a possible allergic nature of the cough;
• allergy history: the persistence of a prolonged cough may be caused by the presence of allergens in the child’s environment;
• chronic diseases of the nasopharynx, bronchopulmonary diseases in the family;
• gastroenterological diseases, especially esophagitis, gastritis, duodenitis, gastroesophageal reflux;
• tuberculosis history - it is necessary to examine the child for the possibility of infection;
• the presence of other children in the family attending child care institutions, which leads to more frequent respiratory diseases;
• smoking by parents and, possibly, the patient himself often leads to the development of cough, especially in the morning;
• effect of the therapy: it is important to find out which drugs were prescribed for cough treatment and for how long. The low effectiveness of treatment may be due to an incorrect diagnosis or an incorrectly selected dose of medication.

Pathological secretions from the respiratory tract released when coughing or expectorating are called sputum.

Productive cough associated with the formation of liquid sputum. Various moist rales indicate the presence of secretions in the lumen of the bronchi. Conductive wheezing occurs when secretions accumulate in the upper respiratory tract and disappear when the child coughs or changes the position of the child’s body.

Ineffective, non-productive dry cough, when a child cannot completely cough up sputum, it may be associated with bronchospasm, increased sputum viscosity or reduced mucociliary activity of the cilia of the bronchial tree, a weak cough reflex in infants, and weakness of the respiratory muscles.

At the onset of acute respiratory diseases, the cough is usually dry, unproductive or unproductive, does not lead to effective expectoration of sputum and is subjectively felt as painful, debilitating, and intrusive. Its peculiarity is that such a cough does not lead to the evacuation of secretions accumulated in the respiratory tract and does not relieve the receptors of the mucous membrane of the respiratory tract from irritating effects. In this case, complete cleansing of the respiratory tract does not occur, which significantly aggravates the course of the disease. An unproductive or unproductive cough worsens the child’s quality of life, leads to sleep disturbances and is difficult to tolerate both by the patient himself and those around him. Such symptoms during an acute respiratory infection usually occur in the first days of the illness, and the main task of the so-called antitussive therapy is to transform the cough from dry, unproductive, to wet, productive. This ultimately leads to the restoration of airway patency, elimination of irritation of the mucous membrane, and cessation of the cough reflex.

As a rule, on the 3-4th day of the disease, the cough becomes moist and the volume of bronchial secretions increases, but its evacuation during this period is already impaired due to damage to the mucociliary epithelium. Consequently, with an uncomplicated course of acute respiratory disease, the nature of the cough changes, which requires a differentiated approach to its treatment.

It must be emphasized that in children (especially young children), cough is most often caused by increased viscosity of bronchial secretions, impaired “sliding” of sputum along the bronchial tree, insufficient activity of the ciliated epithelium of the bronchi and contraction of bronchioles. Insufficient synthesis of surfactant, especially pronounced in the first months of life, plays a significant role. Therefore, the main goal of therapy is to liquefy sputum, reduce its adhesiveness and thereby increase the effectiveness of cough:. That is i.e. The effectiveness of antitussive therapy essentially lies in strengthening the cough, provided it is transferred from dry, non-productive to wet, productive.

Among the drugs that affect the frequency, intensity and nature of cough, depending on the pharmacodynamics, antitussive, expectorant and mucolytic drugs are distinguished (see table). Moreover, their rational use requires a strictly differentiated approach to each clinical situation. The choice of specific medications depends on the clinical and pathogenetic characteristics of the disease, the individual characteristics of the child, as well as on the pharmacological characteristics of the drugs themselves.

Antitussive drugs include drugs of central (narcotic and non-narcotic) and peripheral action. The mechanism of action of antitussive drugs is based on suppression of the cough reflex.

In this case, the effect is achieved either by reducing the sensitivity of the receptors of the sensitive endings n. vagus present in the respiratory organs, or as a result of inhibition of the cough center of the medulla oblongata. It is obvious that in children the need to suppress cough using true antitussive drugs occurs extremely rarely; their use, as a rule, is not justified. The doctor should not suppress the cough, but be able to manage it. The simultaneous administration of antitussive and mucolytic drugs is unacceptable due to the possible development of “swamped bronchi” syndrome.

Indications for the use of antitussive drugs are those clinical conditions in which there is a dry, frequent cough, leading to vomiting, sleep disturbances and appetite (“painful”, “debilitating” cough). Therefore, for influenza, acute laryngitis, tracheitis, bronchitis, cough, dry pleurisy and other respiratory diseases accompanied by a “debilitating” non-productive cough, the use of antitussive drugs may be advisable. At the same time, antitussive drugs, regardless of their mechanism of action, are contraindicated in pulmonary hemorrhages, broncho-obstructive conditions and in all cases of overproduction of tracheobronchial secretions.

Combination drugs contain two or more components or more, some of them include an antitussive drug (Stoptussin, etc.), a bronchodilator (Solutan), antipyretic and/or antibacterial agents. These drugs should be prescribed only for strict indications; they are often contraindicated in young children. In addition, some combination drugs contain medications that are opposite in their effects or suboptimal doses of active substances, which reduces their effectiveness. But, of course, there are also completely justified combinations of drugs.

Expectorants (secretomotor) agents For a long time they were the main drugs used for diseases accompanied by cough. Secretomotor drugs enhance the physiological activity of the ciliated epithelium and the peristaltic movements of the bronchioles, promoting the movement of mucus from the lower parts of the respiratory tract to the upper and its elimination. This effect is usually combined with increased secretion of the bronchial glands and a slight decrease in sputum viscosity. Conventionally, drugs in this group are divided into 2 subgroups: reflex and resorptive action.

Facilities reflex action(preparations of thermopsis, istoda, marshmallow and other medicinal plants, terpin hydrate, etc.) when taken orally, have a moderate irritant effect on the receptors of the gastric mucosa, which stimulates the vomiting and cough centers of the medulla oblongata with the development of the gastropulmonary reflex. As a result, the peristalsis of the bronchioles increases and the movement of sputum from the lower respiratory tract is activated. The active principle of expectorants of plant origin are alkaloids and saponins, which promote mucus rehydration by increasing plasma transudation, enhancing bronchial motor function and expectoration due to peristaltic contractions of the bronchial muscles, and increasing the activity of the ciliated epithelium. A number of drugs also have a resorptive effect: the substances they contain are released through the respiratory tract and cause increased secretion of the salivary and bronchial glands, which increases the liquid (lower) layer of secretion and, accordingly, indirectly increases the activity of the ciliated epithelium. The effect of some drugs is associated with a stimulating effect on the vomiting and respiratory centers (thermopsis). In young children, these drugs should be used with great caution, since excessive stimulation of the vomiting and cough centers can lead to aspiration, especially if the child has damage to the central nervous system. Reflex agents also include drugs with predominant emetic activity (apomorphine, lycorine), which have an expectorant effect in small doses. Many drugs in this group are included in combination medicines (herbal mixtures, mixtures, etc.).

Drugs resorptive action(sodium and potassium iodide, sodium bicarbonate, etc.), absorbed in the gastrointestinal tract, are then released by the bronchial mucosa, causing direct liquefaction (hydration) of sputum, increasing its quantity and facilitating expectoration. To a certain extent, they also stimulate the motor function of the ciliated epithelium and bronchioles. Iodine preparations have a particularly active effect on the viscosity of sputum, which also stimulate the breakdown of sputum proteins in the presence of leukocyte proteases. When using expectorants with resorptive action, the volume of sputum increases significantly. In addition, they (especially iodides) quite often cause allergic reactions and, as a rule, taste unpleasant. Therefore, in recent years, drugs in this group have been used less and less.

When prescribing expectorant drugs, the following conditions must be met:

• the patient should, in addition to the physiological norm, drink another 15-20% of fluid for pathological losses;
• the patient should not be prescribed drugs that dehydrate his body (for example, diuretics, laxatives, etc.);
• the patient should not be prescribed drugs that inhibit the cough reflex and accumulate bronchial secretions in the respiratory tract and first generation H1 blockers, which thicken sputum.

In addition, when using expectorants, it is necessary to take into account that, firstly, the effect of these drugs is short-lived, frequent doses of small doses are required (every 2-3 hours); secondly, increasing a single dose causes nausea and in some cases vomiting; thirdly, drugs in this group can significantly increase the volume of bronchial secretions, which young children are not able to cough up on their own, which leads to a significant disruption of the drainage function of the lungs and reinfection.

Since the mucolytic and expectorant effects of these drugs are insufficient, the search for new effective drugs that improve sputum discharge has led to the creation of a new class of drugs - mucolytics (secretolytics). The main therapeutic effect of mucolytic drugs is the effect on the gel phase of tracheobronchial secretions and the effective dilution of sputum without a significant increase in its quantity. Therefore, indications for their use are clinical conditions accompanied by a cough with thick, viscous, difficult to separate sputum. Mucolytic drugs in the vast majority of cases are optimal for the treatment of respiratory diseases in children. Mucolytic therapy is an important part of the complex treatment of various bronchopulmonary diseases, but it should be borne in mind that the use of mucolytic agents requires sufficient hydration of the patient, especially in combination with alkaline inhalations, and must be accompanied by the use of kinesitherapy methods (massage, postural drainage, breathing exercises).

The choice of mucolytic therapy is determined by the nature of the damage to the respiratory tract. Mucolytics are widely used in pediatrics in the treatment of diseases of the lower respiratory tract, both acute (tracheitis, bronchitis, pneumonia) and chronic (chronic bronchitis, bronchial asthma, congenital and hereditary bronchopulmonary diseases, including cystic fibrosis). The prescription of mucolytics is also indicated for diseases of the ENT organs, accompanied by the release of mucous and mucopurulent secretions (rhinitis, sinusitis).

Age-related characteristics of the respiratory tract response to an infectious-inflammatory or allergic process are of significant importance. In particular, in the neonatal period, the high frequency, protracted and complicated course of respiratory pathology is due to the anatomical and physiological characteristics of the newborn. One of the causative factors may be a deficiency in the formation and release of surfactant, including its qualitative deficiency. In addition, the absence of a cough reflex in children in the first days and weeks of life quite often requires forced suction of mucus from the upper and lower respiratory tract, which can lead to injury and infection of the mucous membranes. A feature of the physiological reactions of children in the first three years of life is a pronounced hyperproduction and increased viscosity of mucus in combination with swelling of the bronchial mucosa, which secondarily disrupts mucociliary transport, causes bronchial obstruction, and contributes to the development of infectious inflammation. Thus, when conducting complex therapy in children with respiratory pathology, it is necessary to take into account the child’s age. In children of the first three years of life, mucolytics, as a rule, are the drugs of choice.

Some of the drugs in this group have several dosage forms that provide different methods of drug delivery (oral, inhalation, endobronchial, etc.), which is extremely important in the complex treatment of respiratory diseases in children.

The first mucolytic drugs were proteolytic enzymes (trypsin, chymotrypsin, ribonuclease, deoxyribonuclease, etc.), which reduce both the viscosity and elasticity of sputum, and have anti-edematous and anti-inflammatory effects. These drugs are practically not used in pulmonology, which is associated not only with high cost, but also with the danger of developing bronchospasm, hemoptysis, allergic reactions, and destructive processes in the lung tissue. An exception is recombinant deoxyribonuclease alpha (dornase alpha), which is prescribed to patients with cystic fibrosis.

A definite breakthrough in the development of drugs that affect the viscosity of sputum and have a pronounced expectorant effect was the creation of synthetic mucolytics (acetylcysteine, carbocysteine, bromhexine, ambroxol).

Mucolytic drugs differ in their mechanism of action and, accordingly, in their effectiveness in different clinical situations.

Acetylcysteine - active mucolytic drug. The high efficiency is due to the unique triple action of the drug: mucolytic, antioxidant and antitoxic. The mechanism of its action is to break the disulfide bonds of acidic mucopolysaccharides of sputum, which leads to their depolarization and a decrease in the viscosity of mucus. The drug also helps to liquefy pus. In addition, by participating in the synthesis of glutathione, acetylcysteine ​​increases the protection of cells from the damaging effects of free radical oxidation products, which is characteristic of an intense inflammatory reaction and plays a key role in the pathogenesis of many diseases of the respiratory system (bronchial asthma, pneumonia, bronchitis, chronic obstructive pulmonary disease, etc.) .

At the same time, it was noted that with long-term use of acetylcysteine, the production of lysozyme and secretory IgA may decrease. With the simultaneous administration of acetylcysteine ​​with tetracycline, ampicillin and amphotericin B, they may interact and reduce therapeutic effectiveness.

The drug is effective when taken orally, when administered endobronchially, and when administered in combination. A 3% solution is used parenterally. The drug should be prescribed with caution to patients with broncho-obstructive syndrome, since in 30% of cases there is an increase in bronchospasm. Indications for the use of acetylcysteine ​​are acute, recurrent and chronic diseases of the respiratory tract, accompanied by the formation of viscous sputum, including in the presence of a purulent inflammatory process - acute and chronic bronchitis, pneumonia, bronchiectasis, cystic fibrosis, and other chronic diseases of the respiratory tract. It is possible to use the drug during bronchoscopy to remove viscous secretions from the respiratory tract during post-traumatic conditions and postoperative interventions. In otorhinolaryngology, the pronounced mucolytic effect of the drug is also widely used for purulent sinusitis for better outflow of contents from the sinuses.

Carbocysteine also destroys disulfide bonds of sputum mucopolysaccharides. In addition, an improvement in the rheological parameters of tracheobronchial secretion occurs due to the restoration of the activity of secretory cells, which leads to normalization of the quantitative ratios of acidic and neutral sialomucins in the secretion. The number of goblet cells is normalized (especially in the terminal bronchi) and, consequently, the production of bronchial mucus is reduced; the structure of the mucous membrane of the tracheobronchial tree is restored; the viscosity and elasticity of the secretion is normalized. All this leads to stimulation of the motor function of the ciliated epithelium and improves mucociliary transport. When taking carbocysteine, the level of secretory IgA and the number of sulfhydryl groups in mucus are restored. Consequently, the drug not only improves mucociliary clearance, but is also a mucoprotector and protects the ciliated epithelium of the respiratory tract. It is important to emphasize that carbocisteine ​​acts on all parts of the respiratory tract involved in the pathological process, both at the level of the bronchi and at the level of the nasopharynx, paranasal sinuses and middle ear. It must be taken into account that carbocisteine ​​potentiates the effectiveness of theophylline and antibacterial drugs (cefuroxime, josamycin). When used simultaneously with atropine-like drugs, the therapeutic effect may be weakened. When taken simultaneously with glucocorticoids, a synergistic effect on the respiratory tract is observed. The drug is available in dosage forms for oral administration (capsules, tablets, syrup). Indications for the use of carbocisteine ​​are acute and chronic bronchitis, bronchial asthma, whooping cough, bronchiectasis, sinusitis, otitis, preparing the patient for a bronchological examination.

Bromhexine - a derivative of the alkaloid visine, has a mucolytic and expectorant effect. The mucolytic effect is associated with the depolymerization of acidic polysaccharides of the discharge and stimulation of secretory cells of the bronchial mucosa, which produce secretions containing neutral polysaccharides. As a result of depolymerization of mucoprotein and mucopolysaccharide fibers, the viscosity of sputum decreases. The drug also has a weak antitussive effect. Almost all researchers note a weaker pharmacological effect of bromhexine compared to the new generation drug, which is an active metabolite of bromhexine, ambroxol. Bromhexine is used for acute and chronic bronchitis, acute pneumonia, and chronic broncho-obstructive diseases.

Ambroxol is a metabolite of bromhexine and has pronounced mucolytic and expectorant effects. It normalizes the functions of altered serous and mucosal glands of the bronchial mucosa, helps to reduce mucosal cysts and activates the production of the serous component. Improving the function of the mucous glands is especially important in patients with chronic lung diseases, which are characterized by hypertrophy of the bronchial glands with the formation of cysts and a decrease in the number of serous cells. Ambroxol stimulates the production of enzymes that break down the bonds between sputum mucopolysaccharides. Thus, the drug promotes the production of qualitatively changed secretions. Ambroxol also has a slight antitussive effect, which is of great importance in the treatment of a number of pathologies where it is undesirable to stimulate the cough reflex.

An important feature of ambroxol is its ability to increase the content of surfactant in the lungs, blocking its breakdown, enhancing the synthesis and secretion of surfactant in type 2 alveolar pneumocytes. This, in turn, normalizes the rheological parameters of sputum, reducing its viscosity and adhesive properties, and directly stimulates the movement of the cilia and prevents them from sticking together, facilitating the evacuation of sputum. Surfactant is the most important factor that maintains surface tension in the alveoli and improves lung compliance. It lines the inner surface of the alveoli in the form of a thin film and ensures the stability of the alveolar cells during respiration and protects them from unfavorable factors. Being a hydrophobic boundary layer, surfactant facilitates the exchange of non-polar gases and has an anti-edematous effect on the membranes of the alveoli. It helps regulate the rheological properties of bronchopulmonary secretion, improve its “sliding” along the epithelium, and is involved in ensuring the transport of foreign particles from the alveoli to the bronchial region, where mucociliary transport begins, thus promoting the release of sputum from the respiratory tract. Having a positive effect on surfactant, ambroxol indirectly increases mucociliary transport and, in combination with increased secretion of glycoproteins (mucokinetic effect), gives a pronounced expectorant effect. There are indications of stimulation of surfactant synthesis in the fetus if ambroxol is taken by the mother. Clinical studies have made it possible to prove the drug's activity in the prevention of respiratory distress syndrome and pulmonary shock.

Ambroxol is known to have anti-inflammatory and immunomodulatory effects. It has been established that the drug stimulates local immunity, promoting an increase in the activity of tissue macrophages and increasing the concentration of secretory IgA, as well as having a suppressive effect on the production of inflammatory mediators by mononuclear cells (interleukin-1 and tumor necrosis factor ɑ), and enhances the natural defense of the lungs, increasing macrophage activity. Ambroxol also has an anti-edematous effect, which is especially important in the treatment of inflammatory lung diseases.

In recent years, based on the results of experimental work, it has been shown that ambroxol suppresses the degradation of hyaluronic acid under the influence of hydroxy radicals, inhibits lipid peroxidation, suppresses the synthesis of superoxide anion by activated neutrophils and reduces the secretion of elastase and myeloperoxidase by these cells, providing an antioxidant effect. Ambroxol can reduce the proteolytic activity of oxidants and suppress their damaging effect on phagocytes. It was noted that ambroxol significantly reduces the synthesis of tumor necrosis factor ɑ, interleukin 1-β, interleukin-6 by alveolar macrophages stimulated by lipopolysaccharide. As a result, the synthesis of superoxide anion, hydrogen peroxide and nitric oxide is reduced. Similar data were found for bronchoalveolar lavage cells obtained from patients with chronic obstructive pulmonary disease (COPD). Thus, the use of ambroxol is justified not only as a mucolytic, but also as a drug with an antioxidant effect.

The possibility of using mucolytic agents, in particular ambroxol, in patients with COPD is of particular interest. Currently, expectorants and mucolytic drugs are not included in recommendations for the treatment of COPD. The exception is acetylcysteine, which is used not as an expectorant or mucolytic, but as an antioxidant. Nevertheless, these drugs are widely used in clinical practice. Ongoing research is likely to clarify this issue.

Unlike acetylcysteine, ambroxol does not provoke bronchial obstruction, which is especially important when using inhaled forms of the drug. Moreover, ambroxol has been shown to inhibit the release of histamine, leukotrienes and cytokines from leukocytes and mast cells, which appears to help reduce bronchial hyperresponsiveness. A statistically significant improvement in indicators of external respiration function in patients with broncho-obstruction and a decrease in hypoxemia while taking ambroxol were shown. This, as well as anti-inflammatory and immunomodulatory effects, make it possible to use it more widely in patients with airway hyperresponsiveness, primarily with bronchial asthma.

The fact that ambroxol potentiates the action of antibiotics deserves special attention. It is known that the success of antibacterial therapy depends not only on the sensitivity of the pathogenic microorganism, but also on the concentration of the drug at the site of infection. This pharmacological aspect is especially important in the treatment of bacterial infections of the respiratory system. The combination of ambroxol with antibiotics certainly has an advantage over the use of a single antibiotic. It has been shown that ambroxol helps to increase the concentration of antibiotics (amoxicillin, cefuroxime, erythromycin, doxycycline) in the alveoli, bronchial mucosa and tracheobronchial secretions, which improves the course of the disease in bacterial respiratory tract infections.

The ability of ambroxol to prevent the development of bronchopulmonary diseases during surgical interventions on the chest and upper gastrointestinal tract was also shown.

Ambroxol is used for acute and chronic respiratory diseases, including bronchial asthma, bronchiectasis, and respiratory distress syndrome in newborns. The drug can be used in children of any age, even premature ones. Possible use in pregnant women in the 2nd and 3rd trimester of pregnancy. In pediatric practice in recent years, when choosing mucolytic drugs, ambroxol is preferred, due to its high therapeutic efficacy and high safety indicators.

So, ambroxol has the following properties:

• dilutes stagnant viscous sputum, reduces the amount and viscosity of secretions; accelerates mucus transport due to an increase in the frequency of movements of the villi of the ciliated epithelium;
• increases the penetration of antibiotics into foci of infection in the respiratory tract;
• stimulates the formation of endogenous surfactant;
• prevents exacerbations of chronic lung diseases;
• has a preventive effect against the development of bronchopulmonary diseases during surgical interventions on the chest and upper gastrointestinal tract.

Ambroxol preparations most often used in pediatrics include Ambrobene® (Ratiopharm, Germany). This drug has a wide selection of dosage forms: syrup (does not contain thickeners or preservatives, can be used from birth, a measuring cup is included), tablets (used from 6 years old), retard capsules No. 10 and No. 20, 75 mg each (used from 12 years old) , solution for oral administration and inhalation, as well as for endobronchial administration (40 and 100 ml, can be used from birth), solution for injection. A variety of release forms allows you to choose the most convenient form depending on age and clinical situation. Thus, in young children the drug can be used in the form of syrup and solution; in children over 6 years of age, Ambrobene® can be used in tablets. The use of inhalations allows you to create high concentrations of the drug directly at the site of inflammation (in the absence of systemic action). The use of retard capsules is especially justified for chronic respiratory diseases and in forgetful adolescents, since this dosage form can be used in children from 12 years of age once a day. The drug is well tolerated by patients of any age; adverse drug reactions are rare, therefore the drug is approved for use in newborns, from the 4th month of pregnancy. Thus, Ambrobene® is an effective mucolytic drug with a pronounced expectorant effect, recommended for the treatment of children and adolescents with acute and chronic respiratory diseases.

The duration of treatment with mucolytics depends on the nature and course of the disease: for acute respiratory tract infections it is from 3 to 14 days, for chronic diseases - from 10 days to 2-3 weeks with repeated courses of treatment several times a year.

General contraindications for the prescription of mucolytic drugs are peptic ulcer of the stomach and duodenum in the acute phase, as well as conditions in which pulmonary bleeding is noted. As stated earlier, the simultaneous use of antitussive and mucolytic drugs is unacceptable.

Summarizing the information presented, for practical use we can propose the following algorithm for selecting drugs that affect cough (see figure).

Algorithm for choosing medications for cough.

Antitussive drugs are indicated only in cases where the disease is accompanied by an unproductive, frequent, painful, painful cough, leading to disturbances in sleep and appetite.

Expectorant drugs indicated in cases of acute and chronic inflammatory diseases of the respiratory system, when the cough is unproductive - not accompanied by the presence of thick, viscous, difficult to separate sputum.

Mucolytic drugs indicated for respiratory diseases accompanied by a productive cough with thick, viscous, difficult to separate sputum. The choice of drug depends on the specific clinical situation.

Thus, when choosing medications for the treatment of diseases accompanied by cough, it is necessary to take into account not only the etiology and pathogenesis of the disease, its clinical manifestations, the mechanisms of action of the drugs used and their possible undesirable effects, but also the individual characteristics of the patient (age, premorbid background, etc. .). Such rational use of modern pharmacological drugs and methods of their delivery can significantly increase the effectiveness of the treatment.

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Acute respiratory infections (ARI) still occupy a leading place in the structure of general morbidity among the population. However, ARIs most often occur in children. It should be noted that in children, ARIs significantly predominate not only among infectious diseases (almost 90%), but also in the structure of all newly registered pathologies (more than 60%). At the same time, the highest incidence of ARI is observed in children of the first years of life who began to attend preschool organized groups. In addition, in young children, severe forms of the disease are most common and there is a high risk of developing serious complications. Considering that the incidence of ARI causes enormous material damage to the state, it becomes clear that ARI are a serious problem not only for healthcare, but also for the country’s economy as a whole.

The main causative agents of ARI are various respiratory viruses, which account for up to 95% of all acute upper respiratory tract infections. In this case, ARIs of viral etiology are called acute respiratory viral infections (ARVI). Thus, ARVI is a group of acute viral diseases of the upper respiratory tract of an inflammatory nature. At the same time, the main etiological agents of ARVI are adenoviruses, rhinoviruses, MS viruses - infections, influenza and parainfluenza, coronaviruses, as well as ECHO and Coxsackie viruses. ARVI is characterized by a seasonal increase in incidence. The highest incidence rate is observed in the cold season. The wide spread of ARVI is facilitated by the transmission routes of infection - aerogenic (airborne) and contact (especially relevant for rhinoviruses) and a large number of pathogens themselves (more than 150!).

ARVI may be accompanied by additional colonization of the respiratory tract by bacteria and/or activation of opportunistic pneumotropic bacterial flora in their obligate habitats (respiratory mucosa). However, despite this, in the vast majority of cases, ARVI is not complicated by bacterial inflammation. At the same time, with ARVI in children with chronic diseases of the upper respiratory tract (chronic tonsillitis, sinusitis, recurrent otitis media, adenoiditis), it is possible to expand the spectrum of bacterial pathogens, their intensive reproduction and the development of inflammatory processes of a bacterial nature. A mixed viral-bacterial infection is also possible (up to 25% of ARI cases).

The clinical manifestations of ARVI are determined by the peculiarities of the pathogenesis of the disease. At the same time, the pathogenesis of ARVI is based on acute infectious inflammation of the mucous membranes of the respiratory tract. Having a specific affinity for the mucous membrane of the upper respiratory tract, ARVI pathogens, when penetrating into epithelial cells, cause the development of both a local inflammatory reaction and general toxic manifestations due to the entry of cellular decay products into the systemic bloodstream. As a result, a clinical symptom complex typical of ARVI occurs: a combination of general toxic (headache, general weakness, lethargy, malaise, myalgia, fever, etc.) and local (hyperemia and swelling of the palatine tonsils, cough, sore throat, runny nose, difficulty breathing and functions of the vocal apparatus) symptoms. The severity of clinical manifestations of ARVI, both local and general, is very variable and depends on the individual characteristics of the macroorganism and the characteristics of the pathogen. It should be remembered that certain viruses have a greater affinity for the mucous membranes of certain parts of the respiratory organs. As a result, viral respiratory infections of various etiologies may have certain clinical features. Thus, based on the characteristic clinical picture of the disease, in some cases it is possible suggest the probable etiology of ARVI. Thus, predominant damage to the larynx with the development of stenosing laryngitis is a characteristic sign of ARVI of influenza or parainfluenza etiology. Rhinoviruses and coronaviruses more often cause the “common cold” in the form of rhinitis and nasopharyngitis. Coxsackie viruses often cause acute diseases of the nasopharynx in the form of pharyngitis, herpangina, while the vast majority of cases of fever with pharyngoconjunctivitis are caused by adenovirus infection. ARVI with bronchial obstruction syndrome in young children is most often caused by respiratory syncytial virus (RS virus) and parainfluenza virus. Identification of clinical syndromes characteristic of ARVI of a certain etiology, in some cases, makes it possible to timely prescribe etiotropic therapy and thereby significantly increase the effectiveness of treatment.

Treatment of ARVI should be etiopathogenetic, complex, taking into account the individual characteristics of the body.

Bronchial asthma, pneumonia and chronic obstructive pulmonary disease are the most common diseases today. About 5% of adults and 10% of children are diagnosed with bronchial asthma. Chronic obstructive disease has become a social problem because it is for this reason that the mortality rate of the population is increasing. Pneumonia still ranks first among the main causes of mortality. Tuberculosis, respiratory failure, upper respiratory tract diseases and many other diseases are no less important and attention should be paid to this. Treatment requires rational pharmacotherapy of respiratory diseases

Cough and sputum.

As a rule, cough and sputum are common symptoms of respiratory damage. The formation of sputum, bronchial secretion and its promotion is a protective reaction of the respiratory system. It is the bronchial secretion that protects the epithelium from damage by microbes. Bronchial secretions also have bacteriostatic properties. The inhaled air condenses into a layer of bronchial mucus. It settles and evacuates dust, while trapping germs and toxins.

The formation of tracheobronchial mucus occurs due to the bronchial glands, goblet cells, alveoli and bronchioles. The bronchial secretion contains components of serum origin, these are exudate and transudate, and there are also cell breakdown products. The human body secretes from 10-15 ml to 100-150 ml, or 0.1-0.75 ml of mucus per 1 kg of body weight per day. An absolutely healthy person does not feel excess mucus. Mucus is usually what causes coughing. This is due to the physiological mechanism of mucus secretion in the area of ​​the tracheobronchial tree. The main part of the secretion is mucins. They are divided into acidic and neutral. Acidic ones, in turn, are divided into glycoproteins, which contain carboxyl groups and sialic acid, as well as glycoproteins with sulfate groups, which make up the serous part of the secretion.

Normally, mucus consists of 89-95% water. Mucus contains ions such as Na+, C1-, P3+, Ca2+. The consistency of sputum depends on the water content. Water is required for normal mucocytic transport.

The accumulation of bronchial secretions contributes to the disruption of the mucociliary barrier and reduces immune processes. That is, the body’s defenses are reduced.

Rational pharmacotherapy of respiratory diseases will help cope with the problem.

To make sputum easily cleared, various drugs are used..

Firstly, these are enzyme preparations (ribonuclease and deoxyribonuclease). Enzymes help break down high molecular weight nucleic acids, as well as from nucleoproteins to soluble molecules. This reduces the viscosity of sputum.

Currently, there is great interest in the use of enzyme preparations in practice. Recombinant human deoxyribonuclease is used in pediatrics, in the treatment of purulent pleurisy, and in recurrent atelectasis in patients with spinal cord injury.

Ribonuclease depolymerizes RNA into acid-soluble mono- and oligonucleotides. This drug thins pus, mucus, as well as viscous sputum, and has anti-inflammatory properties. Delays the reproduction processes of RNA-containing viruses. It is used topically in the form of aerosols, as well as intrapleurally and intramuscularly. For inhalation, a fine aerosol is used. Dose – 0.025 mg per procedure. The drug is dissolved in 3-4 ml of isotonic sodium chloride solution, or use a 0.5% novocaine solution. The drug is administered endobronchially using a laryngeal syringe. A special catheter can be used. The solution contains 0.025-0.05 g of the drug.

For intramuscular injection, a single dose is 0.01 g. For intracavitary or local use, the dose is 0.05 g. Before use, a sensitivity test to the drug should be performed. To do this, 0.1 ml of solution is injected intradermally into the flexor surface of the forearm. If the reaction is negative, the patient can take the drug for treatment. Administration of the drug is stopped if the patient has normal body temperature.

Preparations for the treatment of respiratory organs.

Pharmacotherapy for respiratory diseases includes drugs such as Mesna and Acetylcysteine. These are thiol-containing drugs, which are M - a derivative of the natural amino acid cysteine. This drug stimulates mucosal cells, the secretion of which is capable of lysing fibrin and blood clots.

Acetylcysteine

The drug Acetylcysteine ​​is well absorbed and is metabolized into cysteine ​​in the liver. Prescribed for bronchopulmonary diseases in the presence of viscous, thick, difficult to separate sputum in chronic bronchitis, bronchopneumonia, bronchial asthma and cystic fibrosis. Adults take the drug 200 mg 3 times a day for 5-10 days.

Mesna

Mesna thins the secretions in the trachea and bronchi, which greatly facilitates the discharge of sputum. Use in the form of inhalations 2-4 times a day for 2-24 days. 1-2 ampoules of the drug are diluted with distilled water 1:1. An intratracheal tube is used for drip infusion. Instill instillation every hour until the moment of liquefaction and sputum discharge.

Respiratory diseases are also treated with vasicinoids. These include bromhexine and ambroxol. These drugs have an expectorant effect. They have an antitussive effect.

Carbocisteine ​​and sodium bicarbonate are also pharmacological drugs for the treatment of respiratory organs. Carbocisteine ​​activates sialic transferase of goblet cells located in the bronchi. This leads to the normalization of acidic as well as neutral sialomucins in bronchial secretions. The elasticity and viscosity of mucus is restored, the structure of the bronchi is restored. Those. it is a mucoregulator. The drug is taken 750 mg 3 times a day orally.