Lower respiratory tract infections

Description:

Lower respiratory tract infections are a damage of a mucous membrane of a respiratory path, including terminal bronchioles and alveoluses.

Symptoms of Lower respiratory tract infections:

Diseases of a respiratory organs are diagnosed for 60% of children. Frequent pathology is acute and chronic bronchitis (an inflammation of bronchial tubes with preferential defeat their mucous). Acute bronchitis complicates a current of ORZ. Children can have primary chronic bronchitis and secondary. At children development of primary chronic bronchitis is promoted: exudative diathesis, rickets, the postponed measles or whooping cough, immunodeficiency recuring ORZ, chronic diseases of a nasopharynx (rhinitises, sinusitis, adenoidites, tonsillitis), respiratory allergoses, an adverse effect of environmental factors (smoking of parents, air pollution).

Secondary chronic bronchitis accompanies a number of chronic pulmonary diseases (to malformations of bronchial tubes and lungs, a mucoviscidosis, syndromes of tsiliarny dyskinesia, chronic aspiration of food, etc.).

The important place in structure of incidence of lower respiratory tract infections at children is taken by pneumonia (acute infectious diseases of a pulmonary parenchyma) in 80% of cases having the virus and bacterial nature. They most often are registered at children of the first year of life (20:1000 children) and preschool age (40:1000 children), being the reason of high mortality of the children's population even in economically developed countries.

Clinical symptoms of acute and chronic infectious diseases of the lower respiratory tracts at children depend on a type of the activator, localization of inflammatory process, age of the child, weight of a course of pathological process. However their main manifestation is cough.

Reasons of Lower respiratory tract infections:

Various gram-positive, gram-negative, atypical and anaerobic microorganisms can be causative agents of lower respiratory tract infections. One of the most widespread respiratory pathogens remain a pneumococcus (S. рneumoniae) so far. The hemophilic stick (H. influenzae) is also considered one of the most widespread causative agents of respiratory infections, in particular community-acquired pneumonia and aggravations of HOZL.

Treatment of Lower respiratory tract infections:

At nonspecific extra hospital lower respiratory tract infections the choice of antibacterial drug in most cases is based on statistical data on their most frequent activators, and also data on the efficiency of these or those antibiotics confirmed in controlled clinical trials at infections of the known etiology. By force empirical approach to treatment is connected with lack of a possibility of a microbiological research in out-patient medical institutions, duration of bacteriological identification of the activator and definition of its sensitivity to antibiotics (3–5 days, and in case of "atypical" pathogens more), impossibility in some cases to receive biological material for crops or a bacterioscopy (for example, about 30% of patients with pneumonia have unproductive cough that does not allow to investigate a phlegm), difficulties in differentiation of true activators and saprophytes (usually the microorganisms of a stomatopharynx getting to the studied material). Difficulties of the choice of medicine in out-patient conditions are defined also by lack of full observation of the course of a disease and, therefore, timely correction of treatment at its inefficiency. Antibiotics differently get into various fabrics and biological liquids. Only some of them well get into a cell (macroleads, tetracyclines, ftorkhinolona, to a lesser extent — clindamycin and streptocides). Therefore even if the drug in vitro shows high activity concerning this activator, but does not reach in the place of its localization of the level exceeding the minimum overwhelming concentration (MOC) for this microorganism, clinical effect it will not render though microbic resistance to it will be developed. Not less important aspect of antibacterial therapy is its safety, especially for the ambulatory deprived of daily medical observation. It is necessary to give preference in out-patient conditions to oral administration of antibiotics. In pediatric practice organoleptic properties of drug matter. For increase in an ispolnyaemost by the patient of medical appointments the mode of dosing of an antibiotic has to be the simplest, t.   е. more preferable drugs with the minimum frequency rate of reception and a short course of treatment.