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

The aim of the work was the comparative evaluation of the clinical efficacy of the drug Amoxil in the complex treatment of chronic tonsillitis in children. Monitoring the effectiveness of therapy was based on the dynamics of local and general clinical data (increase and the friability of the tonsils, the presence of purulent cheesy plugs in the gaps, increase in regional lymph nodes, flushing handles, the frequency of acute respiratory viral infections and sore throats, signs tonsillogenic intoxication), total blood analysis, bacteriological method.

Clinical studies have proven the effectiveness of weighty and high safety profile of the modern semi-synthetic antibiotic Amoxil compared with ampicillin. This allows us to recommend Amoxil as the drug of choice in the treatment of chronic tonsillitis in children.

Chronic tonsillitis is one of the biggest 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 suffering from chronic diseases of upper respiratory tract, chronic tonsillitis is from 54 to 79%. Among the complications of recurrent tonsillitis - such formidable as the lateral and retropharyngeal abscesses, and systemic complications of the threat is rheumatic fever, glomerulonephritis, vasculitis.

Chronic tonsillitis causes the development of the body's chain of pathogenetic factors leading to significant health disorders up to a disability, has an immunosuppressive effect, contributes to the development of severe complications, autoimmune processes. At the same time the tonsils play an important role in the body, as a secondary immunocompetent bodies involved in the creation of non-specific immune barrier and mucous membranes of the oropharynx, participate in the functioning of the immune and endocrine systems, anti-tumor protection. This makes the need to preserve the tonsils, especially in young children, conservative treatment of chronic tonsillitis.

Conservative treatment of chronic tonsillitis should be comprehensive, aimed at the reorganization of the infection in the tonsils, eradication of the pathogen, creating the risk of developing rheumatism, and to improve the non-specific and specific resistance of the organism, its security forces.

Currently, many suggested various methods of conservative treatment of chronic tonsillitis, but this problem is not completely solved. It is important to emphasize not only medical and biological, but also socio-economic importance of the problem. Proved a significant reduction in the quality of life of children with tonsillar disease, worsening of the psychological condition of the patients and their parents, the increase in the costs of treatment in cases of recurrence and transformation into other serious diseases (rheumatic fever, glomerulonephritis).

Since 1951 the gold standard etiotrop treat tonsillitis caused by b-hemolytic streptococcus group A, a course of oral penicillin (penicillin), duration 10 days or a single intramuscular dose of benzathine benzyl penicillin. Both courses of penicillin at the time allowed to successfully reduce the incidence of potentially dangerous complications of the disease.

However, the growing resistance of pathogens and as a result - increasing the 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 empirical treatment of ENT infections. In addition to the stability of the etiological agents in the treatment of exacerbations of chronic tonsillitis there is a new problem: kopatogeny, ie microorganisms inhabiting the normal upper respiratory tract and alone does not cause disease, but actively producing beta-lactamase antibiotics destroy the traditional range (penicillin, phenoxymethyl penicillin, ampicillin, cephalosporins many). It specifies whether the group as aminopenicillins selection drugs.

At the present stage Amoxil is effective and safe antibiotic semisynthetic penicillin group of broad-spectrum for the treatment of infectious and inflammatory diseases of different localization, including the pathology of upper respiratory tract. The active substance is amoxicillin - ampicillin active metabolite, close to it for antibacterial spectrum, effective against all strains of hemolytic streptococci, pneumococci and enterococci, staphylococci, gram-negative bacteria, anaerobic series, etc. In action on sensitive strains to ampicillin it exceeds 7.5 times.

Materials and methods

A comprehensive survey was carried out to achieve this goal and treatment of 70 children with chronic tonsillitis in age from 10 to 14 years. Patients included in the study suffered from chronic tonsillitis over from one year to seven years and were followed up by a otolaryngologist. 45% had comorbid conditions, among which the most common were chronic gastroduodenitis, reactive pancreatitis, biliary dyskinesia, allergic dermatitis and asthma. The diagnosis was established on the basis of complaints of frequent acute respiratory viral infection (4-6 times per year), a history of angina, time to time - in the low-grade temperature, tonsillogenic manifestation of intoxication with weakness, malaise, fatigue, recurrent pain in the joints, the heart during an exacerbation; physical examination data (enlarged tonsils, their looseness, the presence of liquid or pus purulent cheesy plugs in the gaps, flushing handles, purulent subepithelial follicles signs Zak, Giza, Transfiguration, fusion with arches and a triangular fold increase in regional lymph nodes); general analysis of blood; bacteriological survey data.

Bacteriological examination was carried out 3-fold: to treat, for 7-10 minutes a day and in 2,5-3 months. The material for bacteriological study were discharge from the surface of the tonsils.

Two groups of patients were formed with observance of the principle of randomization. 1st group of children as a starting antibiotic received oral antibiotic Amoxil. A single dose of an antibiotic for children over 10 years (with a body weight over 40 kg) was 500 mg with an interval between doses of 8 hours (1 tablet (500 mg) three times a day). Babies who prepared the 2nd group was appointed ampicillin trihydrate in tablet form at a daily dose of 100 mg / kg in 4 divided doses after meals. Duration of assignment of both antibiotics was determined according to the state of gravity (average 10.7 days). In the treatment of children surveyed also received local antibiotic therapy, vitamin therapy, probiotics.

Evaluation of efficacy was conducted on the basis of the dynamics of local and general clinical data (increase and the friability of the tonsils, the presence of liquid pus or purulent cheesy plugs in the gaps, increase in regional lymph nodes, flushing handles, the frequency of acute respiratory viral infections and sore throats, signs tonsillogenic intoxication), blood count (leukocytosis, stab shift, increased ESR), bacteriological method to assess the relative efficacy of the treatment in the target groups.

Evaluation of clinical parameters was performed on a 5-point visual scale on the 3rd and 7th day of treatment. Long-term results were evaluated after 5-6 months. For 0 took the absence of the symptom, 5 points - its maximum manifestation 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 to 5 - 0 points; 5-8 - 1 point 8-10 - 2 points, more than 10 - 3 points.

Bacteriological efficacy of treatment regarded as excellent (eradication of the pathogen), good (persistence of the pathogen within the opportunistic values) and satisfactory (colonization of the pathogen). Evaluation of antibiotic tolerance was carried out on the basis of accounting side effects: 1 point - very good, 2 points - good, 3 points - satisfactory, 4 points - unsatisfactory, 5 points - very unsatisfactory.

Results and discussion

Analysis of the dynamics of subjective symptoms of the disease during treatment showed that the positive dynamics in the group of children treated with Amoxil, observed already with 2-3-day administration of the drug: the temperature was normalized, headaches disappeared, reduced the number of purulent cheesy plugs in the gaps or not It was. With 3-5-day congestion dropped arches, and to the 7-10 th day was a decrease in regional lymph nodes, and from cleaning gaps exudate, blood count closer to normal.

In the group of children who received ampicillin, dynamics of clinical data has been less pronounced, and in 6 children subjective complaints were held to five days, which gave reason to replace ampicillin to another antibiotic. In 7 children who received ampicillin until the end of treatment (10 days), traced transient diarrhea with 3-5-th day of the disease. appointed multiprobiotics (under bacteriological control) - They corrective therapy has been carried out. In 4 patients had abdominal pain in 5 patients had an allergic rash, which disappeared after the abolition of the antibiotic, and the appointment of antihistamines, while a group of children treated with Amoxil, observed only 1 case of allergic reactions.

After 7 days of treatment there was a significant positive dynamics of the disease, while others quickly regressed headache, the longest preserved enlarged lymph nodes. The most pronounced was the dynamics of these parameters in children of group 1 - 27 persons (77.1%) and group 2 - 22 (62.8%). Lacunas cleansed in the 1st group, 26 (74.2%) in the 2nd group - 20 persons (65.7%).

Already on day 7 in the two groups of children were normalized indicators in the analysis of peripheral blood, more significantly - in children treated with Amoxil (p <0.05).

The majority of patients in both groups received excellent and good results. Excellent results were achieved in the 1st group - in 29 (82.8%), in the 2nd - in 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 ordinary colds, or SARS, in the case of illness, it proceeded with marked temperature reaction (without hyperthermia), it reduces the duration of the disease.

In the future, parents noted the increase child resistance to the cooling action. Objectively reduction tonsils and adenoids mentioned in 1.5-2 months after a course of antibiotics.

Achieved treatment effect was quite robust. 29 people treated with Amoxil, in the next winter season hurt occasionally (up to 3 times during the cold period of the year) or rarely (3-4 times a year), a disease characterized by an acute course of moderate severity, rapid recovery without complications.

Most of the children in Group 1 (57.1%) by the end of treatment was observed eradication of pathogens, while in Group 2 this result was achieved in only 34.2%.

Conclusions

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

This trend is due to the fact that Amoxil characterized significantly more pronounced than ampicillin bioavailability, better absorption from the gastrointestinal tract. There is a good permeability Amoxil in the tonsils and lymphoid tissue. It should be emphasized that if other antibiotics penicillin have approximately equal ratio in plasma and tissue concentrations, the concentration Amoxil tissues exceeds that in the blood plasma. Moreover, exposure of the drug in the tissues of more than 8 hours, whereas in other penicillins it is 2 hours. The study has revealed a significantly lower frequency of allergic reactions, side effects from the digestive tract.

When using Amoxil less frequently observed dyspeptic disorders and disbiotic. Amoxil take 3 times a day regardless of the meal, which improves komplayentnost treatment, whereas ampicillin should be taken 4 times a day for 1 hour before or 2 hours after eating (eating 2 times reduces the absorption of the antibiotic). Of all penicillins oral Amoxil most active against penicillin-resistant pathogens, and 4 times higher than this indicator ampicillin.

The conclusions indicate that Amoxil is a highly effective antibacterial drug for the treatment of chronic tonsillitis, has good portability, ease of use and minimum side effects that can be recommended as a drug of first choice in the causal treatment of chronic inflammatory diseases of the upper respiratory tract in pediatric practice.