Use of the drug Amoxil in the treatment of children with chronic tonsillitis

Chronic tonsillitis is one of the weighty problems of modern pediatrics. It accounts for 4 to 9% of all diseases in children. In the group of sickly children, which include one in four children, chronic tonsillitis is 43%. In the group of children with chronic diseases of ENT organs, chronic tonsillitis is from 54 to 79%. Among the complications of recurrent tonsillitis - such formidable, as the lateral and retropharyngeal abscesses, and the threat of systemic complications are rheumatic fever, glomerulonephritis, vasculitis.

Chronic tonsillitis causes the development of the organism chain of pathogenetic factors leading to significant health problems, until the disability has an immunosuppressive effect, promotes the development of severe complications, autoimmune processes. At the same time, the amygdala play an important role in the body, as a secondary immunocompetent organ involved in the development of nonspecific and the immune barrier of mucous cover oropharynx, and participate in the functioning of the immune and endocrine systems, in tumor protection. This necessitates maintaining the tonsils, especially in infants, conservative treatment of chronic tonsillitis.

Conservative treatment of chronic tonsillitis should be comprehensive, designed to reorganize the infection in the tonsils, eradication of the causative agent, creating a risk of rheumatism, and to increase nonspecific and specific resistance of the organism, its defense capability.

At present there are many different methods of conservative treatment of chronic tonsillitis, but the problem is finally solved. It is important to emphasize not only biomedical, but also the socio-economic importance of this problem. The considerable reduction in quality of life of children with diseases of the tonsils, the deterioration in the psychological condition of patients and their parents, increasing the cost of treatment in cases of recurrence and transformation into other severe diseases (rheumatic fever, glomerulonephritis).

Since 1951 the gold standard of treatment etiotrop tonsillitis caused by b-haemolytic streptococcus group A is a course of oral penicillin (dentists) for 10 days or a single intramuscular dose benzatinbenzilpenitsillina. Both courses of penicillin therapy in that period have succeeded in reducing the frequency of potentially dangerous complications of the disease.

However, the growing resistance of pathogens and as a result - an increasing number of failures in the application of traditional antibiotics, many of which have been used for two or three decades, forcing doctors to review the recommendations for empiric therapy of ENT infections. In addition to the stability of the etiological agents in the treatment of exacerbations of chronic tonsillitis have a new problem: kopatogeny, ie microorganisms inhabiting the normal upper respiratory tract and not independently cause disease, but actively producing beta-lactamases, which destroy the traditional range of antibiotics (penicillin, fenoksimetil-penicillin, ampicillin, many cephalosporins). This determines the need for use as drugs of choice groups aminopenitsillinov.

At the present stage Amoxil pills is effective and safe semisynthetic antibiotic of broad-spectrum penicillins for the treatment of infectious and inflammatory diseases of different localization, including the pathology of the ENT organs. The active ingredient amoxicillin - the active metabolite of ampicillin, close to it in antimicrobial spectrum, effective against all strains of hemolytic streptococci, pneumococci and enterococci, staphylococci, Gram-negative bacteria, anaerobes, and several others on the activity on sensitive strains is superior ampicillin at 5-7 times . Effective bactericidal. The therapeutic effect of Amoxil defined specificity of molecular structure, which differs from the presence of ampicillin in the molecule of the hydroxyl group of amoxicillin. This molecular change increases the rate of absorption of antibiotics, due to what is less destruction of b-lactam ring and the creation of high concentrations in the blood over a shorter period of time. With this pill Amoxil appointed instead of injections of sodium ampicillin, which provides economic benefits and ease of use. Amoxil online kisloustoychiv, well absorbed from the gastrointestinal tract, which makes it suitable for oral administration. After oral administration the maximum concentration of drug in the blood serum there in 1-2 hours. Pharmacokinetics do not vary depending on the reception and the composition of food. Antibiotics are well distributed in organs and tissues, the degree of penetration into lung tissue, bronchial mucosa, sputum than ampicillin. Most of the administered dose excreted in the urine (50-70%), a significant part - of bile.

Currently, along with the efficacy and safety of drug therapy given to the value of its pharmaco-economic aspects. According to the definition of international experts, formulated at a conference on rational use of medicines in Nairobi (1985), "rational use of medicines requires that patients receive medications appropriate to their clinical needs, in doses that meet their individual needs, for an adequate period of time and lowest cost for them and for society. " It should be noted that Amoxil fully complies with this standard of pharmacoeconomics.

Among the penicillins amoxicillin, in particular Amoxil, used most often in pediatric practice.

The aim of our work was the comparative evaluation of clinical efficacy of ampicillin and Amoxil as antibiotic pill therapy in the treatment of chronic tonsillitis in children.

Materials and methods

To achieve this goal a comprehensive examination and treatment of 70 children with chronic tonsillitis at the age of 10 to 14 years. Patients included in the study had chronic tonsillitis and extending from one year to seven years and were at the dispensary in otorhinolaryngology. 45% of them had concomitant diseases, among which the most common were chronic gastro, pancreatitis, biliary dyskinesia, allergic dermatitis and bronchial asthma. Diagnosis is based on complaints of frequent acute respiratory viral infection (4-6 times per year), history of angina, time to time - in sub-febrile temperature tonzillogennoy manifestation of intoxication with weakness, malaise, rapid fatigue, recurrent pain in the joints, the heart in acute, objective data survey (an increase of tonsils, their looseness, the presence of liquid pus or purulent caseous plugs in the gaps, flushing handles, subepithelial abscesses follicles signs of Zach, Giza, Transfiguration, union with the temples and the triangular fold, increase in regional lymph nodes), general blood analysis; Data bacteriological examination.

The bacteriological study was carried out 3 times: before treatment, 7-day 10 and after 2,5-3 months. The material for bacteriological investigation were removed with the surface of the palatine tonsils.

In conformity with the principle of randomization was formed two groups of patients. 1 st group of children as a starter antibiotic received oral antibiotic Amoxil. Single dose antibiotic for children over 10 years of age (weighing over 40 kg) was 500 mg with an interval between doses of 8 hours (1 tablet (500 mg) 3 times a day). Children accounted for 2 nd group, was appointed as ampicillin trihydrate in tablet form in a daily dose of 100 mg / kg in 4 reception after the meal. The duration of the appointment of both antibiotics was determined according to the severity (average 7-10 days). The comprehensive treatment of the children surveyed also received local antibiotic therapy, vitamins, probiotics.

The effectiveness of the therapy was evaluated on the basis of the dynamics of local and general clinical data (increasing and looseness of the tonsils, the presence of liquid pus or purulent caseous plugs in the gaps, an increase in regional lymph nodes, flushing handles, signs of intoxication tonzillogennoy), total blood count (leukocytosis, stab shift ), bacteriological method for assessing the comparative effectiveness of treatment in the groups surveyed. Assessment of clinical parameters was performed on a 5-point visual scale for the third and 7-day treatment. Long term results were evaluated after 5-6 months. For 0 on the absence of this symptom for 5 points - its maximum expression. Laboratory data were assessed as follows: stab shift to 4 - 0 points, 5-8 - 1 point, 8-10 - 2 points, more than 10 - 3 points; ESR 5 - 0 points; 5-8 - 1 point, 8-10 - 2 points, more than 10 - 3 points. Bacteriological efficacy of treatment was regarded as excellent (eradication of the causative agent), good (persistence of the pathogen within opportunistic values) and satisfactory (colonization of the pathogen). Evaluation of antibiotic tolerance was carried out based on the accounting side effects: 1 point - very good, 2 points - well, 3 points - Satisfactory, 4 points - Poor, 5 stars - very unsatisfactorily.

Results and discussion

The analysis of subjective symptoms during treatment showed that the positive dynamics in the group of children receiving Amoxil, have been observed with 2-3-day administration of the drug: the temperature returned to normal, the headaches disappeared, fewer purulent caseous plugs in the gaps or not was. With 3-5-day reduced congestion arches, and the 7-10-th day there was a decrease of regional lymph nodes and purification of the gaps from the exudate, hemogram closer to the norm. In the group of children who received ampicillin, the dynamics of clinical data was less pronounced, and have 6 children, subjective complaints are kept up to five days, which gave grounds to be replaced by another antibiotic ampicillin. In 7 children, who until the end of treatment received ampicillin (10 days), there is a transient diarrhea with 3-5-day illness. They were carried out corrective therapy - appointed Multiprobiotic (under bacteriological control). In 4 patients experienced pain in the abdomen, in 5 patients had an allergic rash, which disappeared after discontinuation of the antibiotic pills and the appointment of antihistamines, whereas in the group of children who received Amoxil, there was only 1 case of allergic reaction.

After 7 days of treatment there was a significant positive dynamics of the disease, while others regressed faster headache, remains longer enlarged lymph nodes. The most pronounced was the dynamics of these indicators in children of Group 1 - 27 (77,1%) and 2-nd group - 22 (62,8%). Lacunas cleansed in group 1 in 26 (74,2%) in group 2 - in 20 people (65,7%).

Already on the 7 th day in both groups of children normalized indicators in the analysis of peripheral blood, more significantly - in children who received Amoxil (p < 0,05).

Most patients in both groups had excellent and good results. Excellent results were achieved in group 1 - in 29 (82,8%), in the 2 nd - 22 patients (62,8%).

Changes in the status of children were observed during the first month of treatment: improved mood, appetite, lengthened the period between successive cold or SARS, in the case of the disease, it proceeded with a pronounced temperature response (without hyperthermia), shortens the duration of the disease.

Later, the parents noted increased resistance of children to act cool. Objectively, the reduction of the tonsils and adenoids was noted in 1,5-2 months after completion of antibiotic.

Achieved the effect of treatment was fairly stable. 29 people who received Amoxil in the next winter season hurt occasionally (up to 3 times during the cold period of the year) or rarely (3-4 times per year), diseases characterized by an acute course of moderate severity, a rapid recovery without any complications.

Most of the children of Group 1 (57,1%) to the end of treatment were eradication of pathogens, whereas in group 2, this result was achieved only at 34,2%.

Findings

Thus, the use of modern antibiotic from the group of semi-synthetic penicillins in Amoxil etiotropic eradication treatment of children with tonsillitis showed high efficacy and good tolerability of study drug, surpassing those of the comparison of antibiotic (ampicillin).

This trend is related to the fact that Amoxil characterized by much more pronounced than that of ampicillin, bioavailability, a more efficient absorption from the gastrointestinal tract. There is a good Amoxil The transmission in the tonsils and lymphoid tissue. It must be stressed that if other antibiotics penicillins have approximately equal ratio of concentration in plasma and tissues, the concentration Amoxil in tissues exceeds that in blood plasma. In addition, exposure of the drug in the tissues of more than 8 h, whereas the other penicillins, it is 2 h. The study was found significantly lower frequency of allergic reactions, side effects from the gastrointestinal tract.

In applying Amoxil antibiotic rarely observed dyspeptic and dysbiotic violations. Amoxil take 3 times a day regardless of food intake, which improves komplayentnost treatment, whereas ampicillin should be taken 4 times a day for 1 hour before or 2 hours after eating (eating a factor of 2 reduces the absorption of the antibiotic). Of all penicillin for oral use Amoxil most active against pathogens penitsillinorezistentnyh and 4 times ahead of the ampicillin.

The conclusions suggest that Amoxil is a highly effective antibacterial agent for treatment of chronic tonsillitis, has good tolerability, ease of use and minimal side effects that can be recommended as the drug of first choice in etiotropic treatment of chronic inflammatory diseases of ENT organs in pediatric practice.