An antibiotic (antibacterial drug, antimicrobial agent) is a drug that is effective in treating bacterial infections. Its effect is to directly affect the bacterium, it kills it. Its effect may also be to slow down the proliferation of bacteria, which allows the immune system to cope with it. The high prevalence of infections, a large selection of antibiotics for children, and the unjustified prescription of these drugs for diseases in children and adults have led to threatening consequences for human life—antibiotic resistance. According to the Eurasian recommendations, 25,000 deaths annually in the EU are associated with antibiotic resistance. At the moment, antimicrobial agents are an irreplaceable resource for humanity. Antibacterial resistance can be considered a threat to national security.
Before moving on to the choice of a children's antibiotic, consideration of dosage, duration of use, it is necessary to analyze and explain the main points in the formation of resistance to antibacterial agents. Only after this can one adequately judge the choice and approach to prescribing these medications.
Antibiotic resistance
Antibiotic resistance is the term for resistance to antibiotics. Who is to blame for this? The main reason is the excessive and uncontrolled use of antimicrobial agents. This applies not only to medicine.
Prescribing antibiotics should always be justified.
Causes
- Application in medicine. Unjustified prescription on an outpatient basis, in a hospital, self-medication (over-the-counter). The main emphasis is on counteracting the unjustified prescription of antibiotics in primary care (at the outpatient stage). For this purpose, clinical recommendations and algorithms for prescribing antibiotics to children are specially developed and implemented in practical healthcare. Also, through the media, explanations are provided to the population about the need for the judicious use of antimicrobial agents and the dangers of their independent use.
- Use of antibiotics in veterinary medicine.
- Application in the agricultural industry.
How to recognize the flu
As a rule, influenza is characterized by sudden development and the absence of prodromal symptoms. In the first days after infection, there is no runny nose or nasal congestion.
The development of the pathogen occurs rapidly, so the incubation period is short, often not exceeding 2 days.
Obvious symptoms of pathology are:
- Severe fever, temperature reaches 38 C or more.
- Alternating fever with chills.
- Headache.
- Pain in the eyes, fear of bright light.
- Aches in joints and muscles.
In addition to signs of intoxication, influenza is accompanied by an intense dry cough innervating the chest area.
Influenza is more dangerous when complications develop on the respiratory system. This manifests itself in increased coughing and shortness of breath. In severe cases, the respiratory rate increases to 30 or more, respiratory failure and acrocyanosis occur. In this case, you must urgently call a doctor. It is acute pneumonia and respiratory dysfunction that are the main causes of death with influenza.
Basic rules for the correct use of antibacterial drugs
- An antimicrobial agent is taken only in the presence of a bacterial infection that is suspected or documented.
- When using the drug, you must adhere to the optimal regimen. The first is the correct choice of medicine. Otherwise, it is necessary to maintain an adequate dose and duration of use.
- When choosing a drug, it is necessary to take into account the regional situation regarding antibiotic resistance of the most common pathogens and take into account the likelihood of infection of the patient with these bacteria.
- Do not use low quality antibiotics with unproven effectiveness.
- Do not use antibiotics for prophylactic purposes.
- The effect of using an antibacterial agent is assessed 48-72 hours after the start of treatment.
- Explain the harm of non-compliance with the medication regimen, and also explain the dangers of self-medication.
- Promote the correct use of the drug by the patient.
- In each case, it is necessary to use methods to determine the cause of the infection.
- When prescribing an antibacterial drug, doctors must adhere to recommendations based on evidence-based medicine.
Spectrum of action
There are antibacterial agents:
Indications for antibiotics
A fairly common mistake is the use of antibiotics for diseases that develop as a result of a non-bacterial infection.
Antibiotics should not be used for viral infections.
Among these diseases:
- Acute pharyngitis.
- Acute laryngotracheitis.
- Rhinitis.
- SARS, only.
- Acute bronchitis. It is permissible to use antibiotics when bronchial constriction develops, as well as when fever lasts more than 5 days.
In these cases, the prescription of antibiotics is not justified, since the cause that led to these diseases is often viruses.
There are also controversial points when both viruses and bacteria can lead to the development of the disease. Such diseases include:
- Acute rhinosinusitis.
- Acute otitis media.
- Acute tonsillitis.
In such cases, an antibiotic is prescribed only after examination and observation by a doctor of the patient.
For viral infections (pharyngitis, rhinitis, laryngitis, tracheitis), the effectiveness of antibiotics is equal to the placebo effect. It is important to remember that the prescription of antibacterial agents does not prevent the development of bacterial superinfection (that is, the addition of a bacterial infection to an existing viral one). There are no effective remedies against ARVI. The use of antiviral immunostimulating agents common in pharmacy chains often does not have any effect. In this case, the antiviral agent can be considered as ascorbic acid or garlic. In such cases, adequate pathogenetic and symptomatic treatment is prescribed, which allows eliminating and eliminating the symptoms of ARVI. Used: paracetamol, ibuprofen, mucolytics (ambroxol, acetylcysteine, carbocysteine), vasoconstrictor nasal drops for a runny nose, nasal corticosteroid for rhinosinusitis. If there is a disease with a viral or bacterial cause (tonsillitis, sinusitis, otitis media), then in this case antibacterial therapy delayed by 2-3 days is recommended. Delayed antibiotic prescribing for upper respiratory tract infections has reduced the frequency of antibiotic prescriptions by 40%.
These statements are of an evidentiary nature and are described in more detail in the training manual “ Rational use of antimicrobial agents in the outpatient practice of doctors , written on the basis and evidence base of the 2021 Eurasian recommendations.
Risk factors
Almost every person knows first-hand what acute respiratory infections are. For the vast majority of adults, unpleasant symptoms of acute respiratory infections make themselves felt 2-3 times a year. As a rule, the peak incidence occurs in the damp and cold seasons, during a period of decreased protective function of the body and increased activity of viruses. For various reasons, acute respiratory infections and acute respiratory viral infections are particularly dangerous for people over 55 years of age, asthmatics, diabetics, with endocrinological and neurological problems, as well as for hypertensive patients. Pregnant women should be very careful.
The main types of antibiotics and their common representatives on the market
Below we consider the most popular and frequently used groups of antibacterial agents:
- Beta-lactams . Among them are penicillins, cephalosporins, and carbapenems. Among the penicillins, it is worth highlighting: amoxicillin, ampicillin, ticarcillin, carbenicillin, mezlocillin, mecillam. The most popular cephalosporins are: cefazolin, cephalexin, cefuroxime, cefotaxime, ceftriaxone, cefepime, ceftobiprole. Carbapenems are used much less frequently. Meropenem can be isolated.
- Macrolides . Macrolides include: clarithromycin, azithromycin (sumamed), josamycin.
- Tetracyclines . The most common: tetracycline, doxycycline, oxytetracycline.
- Aminoglycosides . Popular ones: gentamicin, amikacin, isepamycin.
- Levomycetins . Trade names: chloramphenicol, chloromycetin.
- Glycopeptide antibiotics . The most commonly used: vancomycin, bleomycin.
- Lincosamides . Used in medicine: lincomycin, clindamycin.
- Fluoroquinolones . Among them, the most commonly used are: ciprofloxacin, levofloxacin, gemifloxacin. They are a broad-spectrum antibiotic for children. These antibiotics are not contraindicated in pediatric practice, but their use in children is sharply limited.
It is important to remember that these drugs have their own indications and contraindications, and are also used against certain infections.
These drugs have their own indications and contraindications, and have a narrow or broad spectrum of activity against bacteria. Some of the listed drugs can be used by children under one year of age. Children's antibiotics are available in tablets, suspensions, and ampoules for intravenous and intramuscular administration. Calculation of the dose, dilution of antibiotics and administration of the required dose to the child should be carried out by medical personnel in order to avoid unwanted reactions, as well as complications during injections. They should be prescribed exclusively by a doctor.
Duration of use of antibacterial agents
Parents often ask questions: “How many days are antibiotics given to children? What is the best antibiotic for children? What should I give my child when taking antibiotics? In most cases, 5-7 days of use are sufficient. There are exceptions in which the duration of use may increase to 10–28 days. The second question cannot be answered unambiguously. Each drug has its own indications and contraindications, so the use of a particular drug depends on the situation (age, diagnosis, concomitant pathology, etc.). To the third question, many doctors will answer the same: “Probiotics.” A probiotic will restore normal intestinal microflora that has been affected by an antibacterial agent. As a rule, they are prescribed in a course of 2 weeks to 1 month.
You can always consult your doctor if you have any questions regarding treatment.
According to the Eurasian recommendations, in order to overcome antibiotic resistance, experts emphasize the need to draw the attention of patients to strict adherence to the drug use regimen. It is necessary to use optimal dosage forms of antibiotics with high bioavailability, in particular, Solutab dispersible tablets, which is consistent with the current position of WHO and UNICEF. Advantages of Solutab dispersible tablets:
- Completely absorbed in the intestines. As a result, the effect is equal to the intravenous effect.
- Create a high concentration at the site of infection.
- Better portability.
- Good organoleptic properties.
- The ability to dissolve tablets, which allows the use of this dosage form in children.
- A minimal amount of liquid is required for swallowing.
- They have an advantage over a suspension - errors in preparation are eliminated.
Dispersible tablets recommended by WHO and UNICEF:
- Flemoxin Solutab
- Flemoklav Solutab
- Suprax Solutab
- Vilprofen Solutab
- Unidox Solutab
Parents of children should remember that an incomplete course of prescribed antibiotic treatment leads to the formation of bacterial resistance and a prolonged presence of the microbe in the body.
Prevention of acute respiratory infections and acute respiratory viral infections
The only way to protect yourself from the flu is to get vaccinated. No medications provide a proven effect in preventing viral diseases. But the likelihood of catching ARVI can be reduced if you take preventive measures. Avoid crowds of people.
Viruses are transmitted by airborne droplets, so during epidemics it is worth protecting yourself as much as possible from contact with crowds.
This is the most reliable, albeit not always accessible, method. Strengthen general immunity.
To do this, it is enough to eat right, avoid lack of sleep and stress, and find time to play sports or at least take daily walks.
Strengthen local immunity.
When the mucous membranes dry out, the protective barrier that should protect us from viruses is reduced.
In this case, the risk of infection becomes higher. Therefore, it is important to avoid dry indoor air - frequently wash the floors or use a humidifier. Wash your hands regularly.
During epidemics, wash your hands or treat them with antibacterial gel every time after external contact.
Complications of antibiotic use
When using antibiotics, there is a risk of developing unwanted reactions. Such complications include:
- Hepatotoxicity – liver damage. Most often observed when taking moxifloxacin, macrolides, and clavulanate.
- Cardiotoxicity is damage to the heart. Such a reaction can occur when using fluoroquinolones, azithromycin, clarithromycin.
- Neurotoxicity is damage to the nervous system. Occurs with fluoroquinolones.
- Allergy . Characteristic of penicillins and cephalosporins.
In fact, the wider the spectrum of antimicrobial activity, the higher the risk of adverse reactions..
Choosing an antibiotic in a child
Previously, we reviewed the main diseases of the upper and lower respiratory tract, for which antimicrobial agents can be used. Now we will analyze the main drugs that can be used for this or that pathology, and also indicate the required dosage of the drug.
Do not take antibiotics without a doctor's prescription.
Do not use medications yourself! The medications and dosages listed below are for informational purposes only and are not equivalent to treatments prescribed by a physician.
Acute otitis media
The drug of choice is amoxicillin 40-90 mg/kg/day in 3 divided doses. Duration of therapy is 10 days in children <5 years old, 5-7 days in children >5 years old. The second-line drug is amoxicillin/clavulanate. The third-line drug is josamycin.
Acute rhinosinusitis
Similar to the use of antibacterial agents for acute otitis media.
Acute tonsillitis
The drug of choice is amoxicillin 45-60 mg/kg in 3 doses, phenoxymethylpenicillin 25-50 mg/kg 3-4 times a day. The second-line drug is cefixime. The third-line drug is josamycin. Duration of therapy is 10 days.
Community-acquired pneumonia
The therapy of choice is amoxicillin IV 45-90 mg/kg/day in 3 divided doses. The second line drug is amoxicillin/clavulanate, cefuroxime IM, ceftriaxone IM. The third line drug is josamycin 40-50 mg/kg/day in 2 doses.
Antibiotics are indispensable drugs in the fight against bacterial infection. These medications should be prescribed solely for medical reasons. It is very important to adhere to the prescribed regimen of using the antibacterial agent. Do not self-medicate. If signs of infection occur, contact your pediatrician, who will help establish the diagnosis, cause of the disease, and prescribe adequate treatment.
When should you see a doctor when the first symptoms of the disease appear?
Of course, you need to be careful and attentive to your health. This means that if your body temperature exceeds 39 degrees, rashes, vomiting and other signs appear, you must immediately consult a doctor! If the symptoms of the disease are mild and are expressed in the form of sneezing, runny nose and sore throat, then this can be treated independently by drinking plenty of fluids and other methods of treating colds. And, of course, you should not neglect the health of children. Consult a doctor immediately if a child under 2 years of age becomes ill, or if the symptoms of the disease become severe.
