According to the Infectious Diseases Committee of the American Academy of Pediatrics (AAP), the rational use of antibiotics for the treatment of upper respiratory tract infections (UTIs) includes 3 main principles: establish an accurate diagnosis, determine the benefit / risk and highlight situations where the prescription of antibiotics may be contraindicated. This information was published in the December issue of Pediatrics.

In the United States, approximately 50 million prescriptions for antibiotics are prescribed annually in pediatric practice, including 10 million for respiratory infections, in which the use of antibiotics is unlikely to benefit patients. This often happens due to difficulties in the differential diagnosis between viral and bacterial infections.

This report separately highlights the importance of using precise and validated clinical criteria for the diagnosis of acute otitis media (OTO), acute bacterial rhinosinusitis (OBRS) and tonsillopharyngitis caused by S. pyogenes .

The first principle of judicious use of antibiotics is the prescription of ABP for bacterial infections. For example, in an OSA, an otoscopic examination is mandatory to establish inflammatory changes on the part of the tympanic membrane + swelling of the tympanic membrane or a newly appeared otorrhea, i.e. signs not characteristic of otitis. external. Symptoms of ACC may also be moderate swelling of the eardrum in combination with severe redness or the onset of acute pain. Acute bacterial rhinosinusitis is characterized by persistent symptoms of acute respiratory infections or worsening after the initial positive dynamics or an immediately severe course of the disease. Streptococcal tonsillopharyngitis should be diagnosed using culture studies to identify a responsible pathogen. Strict adherence to these diagnostic recommendations helps doctors rule out non-specific IVDP colds and acute bronchitis, which are viral in nature and in which the use of antibiotics is ineffective.

The second principle of rational use of antibiotics is to strike a balance between the advantages and disadvantages of using antibiotics. In the case of ACC, it has been noted that at least 50% of patients with acute otitis media recover without antibiotics. Antibiotics accelerate recovery and are particularly indicated for young children with bilateral OSO or in patients with severe course of the disease.

Evidence for the usefulness of antibiotics for the treatment of acute bacterial rhinosinusitis is limited and ambiguous, and the role of antibiotics in preventing complications, such as orbital or intracranial abscesses, is also not proven. However, the AAP recommends the use of antibiotics in children with clinical signs of OBRS, in particular in case of worsening of the course of the disease or the initially severe course.

With regard to GABA-tonsillopharyngitis, it is clearly shown that antibiotics reduce the duration of symptoms and the horizontal spread of the pathogen. Antibiotics can also prevent early purulent complications from GABA tonsillopharyngitis, such as paratonsillary abscess.

Panel experts point out that the harmful effects of using antibiotics may outweigh the benefits. Most of the clinical trials reviewed have used amoxicillin or amoxicillin / clavulanate, the use of which has been associated with a variety of adverse events ranging from mild (such as diarrhea or rash) to severe (e.g. , Stevens-Johnson syndrome) and life-threatening cardiovascular or anaphylactic shock.

In addition, there is mounting evidence that the use of antibiotics in infancy can upset the normal microbial balance in the intestines and other organs, possibly affecting the health problems of children. child in his near-life, including inflammatory bowel disease, obesity, eczema and bronchial asthma.

The third principle of the rational use of antibiotics is the implementation of a rational strategy of prescription of antibiotics, including the choice of an antibacterial drug which very probably eliminates a responsible pathogen, the use of an adequate dose and the shortest duration of treatment. The committee advises physicians to consider anticipation and observation tactics before prescribing antibiotics, especially for older children with mild or moderate acute otitis media or acute bacterial rhinosinusitis.