Respiratory infections attack us no matter where we live. This is the reality of our life. And, compared to other infectious diseases, both adults and children are equally ill, according to the online publication for girls and women from 14 to 35 years old Pannochka. net Why doctors often use antibiotics for such a common infection?

What is behind this:.

necessity or fear - no matter what happens? And what are the consequences of such appointments for the further development of the child?

This is discussed at one of the professional conferences by the professor of the Department of Children's Diseases of the First Moscow State Medical University named after. Sechenov Alexander Gorelov:.

Respiratory diseases tend not to always run smoothly, they develop complications, although I am aware that prescribing an antibiotic is not the same as preventing the development of complications, but anyway, again, this is the straw that we traditionally grasp at in this situation..

Are antibiotics needed? Are antibiotics needed I will just give official data. No matter what they say - about antipyretics, about immunotropic drugs, we involuntarily return to the problem of using antibacterial drugs in acute respiratory viral infections. I believe that the unreasonable prescription of antibacterial drugs (regardless of what kind of education people have received, Western or Russian), in relation to Russian reality, is primarily due to the social vulnerability of doctors in our country. It's always the doctor's fault. And therefore, no one filmed the Russian thesis that we work not for the patient, but for the prosecutor, and therefore the realities of our life are as follows, I will demonstrate this, that antibiotics, unfortunately, no matter what mass diseases we are talking about - respiratory, intestinal infections. Therefore, I would like to dwell on certain aspects of this problem..

The number of infections is growing And the number of such respiratory infections is growing every year, and we must remember that the situation when you really need to prescribe an antibacterial drug is a change in the clinical picture of SARS. Not a banal runny nose, which should last a week, whether we treat it or not, but a change in the clinical picture of the disease or the presence of certain criteria makes it possible to give an antibacterial drug 100%. And in this situation, you see a lot of different recommendations when it is not necessary to give antibacterial drugs.. And there's no time to talk about it. The Union of Pediatricians in 2003 developed a program according to which antibacterial drugs should be given.. I will not voice them in detail, but, according to this program, I will focus on those positions in which, regardless of our desire, antibiotics are indicated. This is primarily acute purulent sinusitis (or an exacerbation of a chronic one), this is streptococcal tonsillitis or tonsillitis, this is acute otitis media and, mind you, in children under six months of age. In children under two years of age, other indications discussed for prescribing antibiotics are absolute, I'm talking about absolute indications.. Paratonsillitis, life-threatening epiglotitis, and undoubtedly pneumonia.

I would like to draw attention to the WHO criteria. So, we believe that we are acting absolutely according to the program of the Union of Pediatricians. There is another program of the Union of Pediatricians, which gives relief. And in this situation, when prescribing antibiotics, I always say: we must collect a history of antibiotic use in the family, that is, what antibiotics the parents were treated with before prescribing this or that antibacterial drug, and what are the consequences in this situation. And a certain backlash, relaxation can be in that situation, if the child had a history of recurrent otitis as such. If an acute respiratory infection has developed in a child with an unfavorable background, with malformations or with a gross pathology of the central nervous system, or due to certain circumstances, a chained, sedentary patient and in the presence of clinical signs of an immunodeficiency state according to the classic manifestations, which are the presence of pus - recurrent suppuration and other signs. That is, a disease that occurs with pus.

The problem does not end The problem of prescribing antibiotics ends not only with the problem of antibiotic resistance - this is our misfortune, and I would like to draw your attention to the fact that we are changing our view, from planktonic forms, from the classical teaching of Koch, when there was one microbe, we come to; and microbes have their means of communication, " So, undoubtedly, the era of antibiotics is at a certain stage the era of euphoria. I understand that from 28 to 41 or 42, when penicillin was used in an English hospital, a certain era of data accumulation passed, but after three years the euphoria began to disappear: there was information, described by the same Fleming, about side effects, about.

Traveler's Diarrhea It is hard to imagine, if you look at the statistical reports, that of all the diarrheas we officially had in the reports, the last position was antibiotic-associated diarrhea.. The whole world divides diarrhea into domestic, hospital, traveler's diarrhea and antibiotic-associated diarrhea.. But, if we have any idea about travelers’ diarrhea, at least from our own experience (for those who don’t know, world statistics say that if you go on vacation for 10 days, it doesn’t matter where you go, in Yugo. Because a change of water, a change in diet, invariably accompanies the development of infection). But for antibiotic-associated diarrhea, these data differ: 3-29% in this situation, when antibiotics are prescribed, antibiotic-associated diarrhea (ACD) develops.. Yes, we live with you in a dirty country. Yes, we often have diarrheal diseases, but this diagnosis, at least in recent years, does not appear in official statistics at all.. And the manifestations are completely different - from mild self-limiting diarrhea up to pseudomembranous or fulminant colitis, which is most often diagnosed by a pathologist.. And therefore, in this situation, Russia, as well as some countries, has a certain predisposition to antibiotic-associated diarrhea..

How food is preserved Here is the position I would like to draw attention to. These are the conditions for preserving food for residents of the metropolis. Therefore, there is no need to go for a distant example, it is well known that 30% of our meat industry, dairy, etc.. contain antibacterial drugs, therefore..., given the cycle of antibiotics in nature, a certain metabolism... But milk is therefore not without reason a product of baby food, especially up to the age of three, with the instability of the microflora, if we offer what is called milk, we still have all this. Here is the data for Moscow on the example of one hospital. Already 74% of children in the first year of life in Moscow have tried what an antibiotic is. At three years - this is 80% according to the anamnesis. And only immunomodulators are inferior to them, this is the next " So, we have already said that the development of antibiotic-associated diarrhea is not an inevitable condition.. There are non-infectious mechanisms in which you do not need to go to your grandmother, just read the annotation of the drug. The use of tetracycline or chloramphenicol in pediatric practice slows down the repair of the gastrointestinal mucosa and prolongs bacteriolysis, no matter whether this intestinal infection is caused by a bacterial pathogen or another situation. And as before, certain drugs that are toxic to children are still present in our routine practice.. We forget that toxic colitis, for example, with meningcococemia, the prescribed dose of penicillin is 500 thousand. per kg. , led to the fact that the development of segmental colitis was noted. Fortunately, these doses are now gone.. Although a special breakthrough in the treatment of meningococcal infection, meningococcemia, did not occur in this situation, but segmental colitis is the reality of our life..

One more problem. Nosocomial circulation associated with antibiotic resistance. And here in the USA you can not grow Clostridium difficile in your own gastrointestinal tract, but this hospital effect of diarrhea when prescribing antibiotics can build up. We don’t talk about this much, because there are no nosocomial infections in Russia, well, there aren’t any and there won’t be, until a certain moment.

But Americans suffer from situations that are inexplicable to us. And I draw your attention to the fact that to start the development of this condition, it doesn’t matter if you had a course of treatment, combined treatment, even after the first prescription of the drug, regardless of the method of administration, AAD may develop. Look at another very interesting point: 2-5% of children, unfortunately, have a recurrent course of AAD, and children with persistence worthy of better use are treated or examined for non-existent infections..

What is the basis Therefore, what is the basis? It is hard to imagine an antibacterial drug, although we are assured that some are gentle on the normal intestinal microflora, others are super gentle, but you know, there is no such antibiotic that would not selectively mow down certain representatives (not all, but certain) of the gastrointestinal tract. Therefore, a priori, the appointment of an antibiotic is equal to another concept - the development of dysbacteriosis, no matter how we call it. And in this situation, not only the food that we talked about so much is so poisonous, but you and I still somehow survive, especially in large cities, and we don’t have natural milk, but also environmental troubles, and stress (and for; undeniably, age - young children - are all factors that contribute to the development of AAD. I am for the balance of views when prescribing antibacterial drugs. And in this situation, no matter what develops, diarrhea or colitis, it is important to remember one thing that we talk about very little.. And, above all, the most vulnerable, no doubt, are children of the first year of life - due to certain circumstances, due to unformed microflora. And therefore, in this situation, we practically do not talk about this form, which is not diagnosed.. The patient goes into another world before, when he, in fact, falls into the field of view of doctors.

But, one way or another, fulminant colitis as a result of the use of antibiotics is also the reality of our lives.. It needs to be talked about. And therefore, in this situation, a very simple truth suggests itself: gave an antibiotic - think about the normal microflora. Give a probiotic in this situation. Or suggest such conditions that will not allow the same pseudomembranous colitis to develop.

Elizaveta Vasilyeva nedug. en.

e-news. com. ua.