Acute bacterial infections of the upper respiratory tract: principles of starting etiotropic therapy (agreed position of pediatricians and otorhinolaryngologists)

In some cases, with acute respiratory infection of viral etiology, children may develop bacterial complications (acute purulent otitis media, acute bacterial sinusitis), which determines the need to prescribe antibiotics as etiotropic drugs. In addition, the mandatory need for the appointment of antibiotics for streptococcal tonsillitis/pharyngitis has been established. However, the analysis of the frequency of antibiotic use in children with acute respiratory infection indicates that the use of antibiotics still often remains unreasonable and stereotyped and is not limited to the indicated nosological forms, which leads to a significant acceleration in the development of antibiotic resistance of pathogens. Given the rapid and widespread formation of bacterial resistance to antibiotics, their rational use is one of the most urgent problems of modern healthcare. At the same time, one of the effective tools for introducing the principles of rational antibiotic therapy into domestic medical practice will be the mandatory use of clinical guidelines approved by the Ministry of Health of the Russian Federation from January 1, 2022.The article presents the principles of antibacterial therapy for such infectious and inflammatory diseases of the upper respiratory tract as acute streptococcal tonsillitis and acute streptococcal pharyngitis, as well as acute sinusitis, acute purulent otitis media and acute otitis media in children. The need for antibiotic therapy in acute tonsillitis/pharyngitis of streptococcal etiology is due to the high risk of complications in the acute period of the disease (peritonsillar and retropharyngeal abscess, purulent cervical lymphadenitis), as well as such streptococcal-associated diseases in the future, such as rheumatism and glomerulonephritis. The introduction into practice of the main provisions of the presented clinical recommendations will make it possible to promptly make an adequate decision on the need to prescribe antibiotic therapy and on the choice of a rational starting etiotropic therapy for these nosological forms of acute upper respiratory tract infections.

1. On the state of sanitary and epidemiological well-being of the population in the Russian Federation in 2020: State report. M.: Federal'naya sluzhba po nadzoru v sfere zashchity prav potrebiteley i blagopoluchiya cheloveka, 2021. p 256 https://www.rospotrebnadzor.ru/upload/iblock/5fa/gd-seb_02.06-_s-podpisyu_.pdf.

2. Lobzin Yu. V., Skripchenko N. V., Volzhanin V. M. State and achievements in diagnostics, therapy, rehabilitation and prevention of infectious diseases in children // Zhurnal infektologii. 2019; 11(4), prilozheniye 1. P. 5-28.

3. Acute respiratory tract infections in children. Diagnosis, treatment, prevention: clinical guidelines / Pod red. Geppe N. A. M.: MedKom-Pro, 2018. Р. 200.

4. RedBook: 2018. Report of the Committee on Infection Diseases. 31th ed. / Ed. D. W. Kimberlin, Brady M. T., Jackson M. A., Long S. S. Itasca, IL: American Academy of Pediatrics, 2018.

5. Yakovlev S. V., Rafal'skiy V. V., Sidorenko S. V., Spichak T. V. i dr. Strategy and tactics of rational use of antimicrobial agents in outpatient practice. Eurasian clinical guidelines. 2016 // Spravochnik poliklinicheskogo vracha. 2017; 01: 6-53.

6. Zaplatnikov A. L., Girina A. A., Lepiseva I. V. i dr. On the rational therapy of acute respiratory infections in children under conditions of growing antibiotic resistance // Consilium medicum. Pediatriya. 2018; 4: 37-41.

7. Roca I., Akova M., Baquero F. et al. The global threat of antimicrobial resistance: science for intervention // New Microbesand New nfections. 2015; 6: 22-29.

8. WHO Global Strategy for Containing Antimicrobial Resistance. WHO/ CDS/CSR/DRS/2001.2a.

9. Federal Law No. 489-FZ of December 25, 2018 «On Amendments to Article 40 of the Federal Law» On Compulsory Health Insurance in the Russian Federation" and the Federal Law «On the Basics of Health Protection of Citizens in the Russian Federation» on Clinical Recommendations.» http://publication.pravo.gov.ru/Document/View/0001201812250098?index=0〉eSize=1.

10. Decree of the Government of the Russian Federation of November 17, 2021 No. 1968 «On approval of the Rules for the gradual transition of medical organizations to the provision of medical care based on clinical guidelines developed and approved in accordance with parts 3, 4, 6-9 and 11 of Article 37 of the Federal Law «On the basics of protecting the health of citizens in the Russian Federation.» http://publication.pravo.gov.ru/Document/View/0001202111190015.

11. Acute tonsillitis and pharyngitis (Acute tonsillopharyngitis). Clinical guidelines. Approved by the Scientific and Practical Council of the Ministry of Health of the Russian Federation. KP306-2. M., 2021. https://cr.minzdrav.gov.ru/.

12. Acute otitis media. Clinical guidelines. Approved by the Scientific and Practical Council of the Ministry of Health of the Russian Federation. KP314-2. M., 2021. https://cr.minzdrav.gov.ru/.

13. Acute sinusitis. Clinical guidelines. Approved by the Scientific and Practical Council of the Ministry of Health of the Russian Federation.. КР313-2. М., 2021. https://cr.minzdrav.gov.ru/.

14. Diseases of the ear, nose and throat in childhood: National guidelines / Pod red. M. R. Bogomil'skogo, V. R. Chistyakovoy. M.: GEOTAR-Media, 2008. Р. 736.

15. Andreyeva I. V., Stetsyuk O. U., Yegorova O. A. Respiratory tract infections in pediatric practice: complex answers to simple questions // RMJ. Mat' i ditya. 2020; 3 (2): 105–111. https://doi.org/10.32364/2618-8430-2020-3-2-105-111.

16. Tulupov D. A., Karpova Ye. P. Antibacterial therapy of acute infections of the upper respiratory tract in children // Meditsinskiy Sovet. 2018; (11): 58-62. https://doi.org/10.21518/2079-701X-2018-11-58-62.