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Antibacterial therapy in treatment of chronic obstructive bronchitis

Hamitov R. F., Palmova of L.Yu. Kafedr of faculty therapy of KGMU, Pulmonary center, Kazan

Relevance of chronic obstructive pathology of respiratory tracts does not raise doubts both at scientists, and at practical doctors. Episodes of respiratory infections act as the leading reason both aggravations, and complications of the chronic obstructive bronchitis (COB). Therefore rational antibacterial therapy belongs to one of the key directions of complex therapy of aggravations of HOB.
What in this case it is necessary to understand as rational antibacterial therapy? First, the etiotropic orientation which is based on knowledge of etiological structure of actual activators. It is H. influenzae, S. pneumoniae, M. catarrhalis. Secondly, the maximum aspiration to monotherapy. Thirdly, the preference has to be given to drugs with more convenient mode of dosing. Fourthly, drug has to get into tissues of bronchial tubes and a phlegm well.
In the conditions of stationary department of a city hospital 25 patients with HOB in an aggravation phase were observed (18 men and 7 women, middle age — 48 years).
At receipt all patients showed complaints to productive cough with allocation of a purulent and mucopurulent phlegm (at 8 — strong, at 13 — moderately expressed), 80% of patients were disturbed by an asthma, 60% had subfebrile temperature, 20% showed complaints to the pains in a thorax amplifying at deep breath and cough.
Radiological pneumonia was excluded.

ЗИТРОЛИД® (azithromycin) it was appointed to all patients; 10 — as initial therapy, whereas to 15 patients — as continuation of earlier inefficient antimicrobic therapy. The mode of dosing consisted of single oral administration of 500 mg of drug in the 1st day and on 250 mg in the next 4 days. By the end of this period at all temperature was normalized; there were no patients at whom strong expressiveness of cough and asthma would remain. Frequency of moderately expressed cough decreased twice, poorly expressed cough remained with 17 patients. Reliable dynamics of character of a mokrotootdeleniye was noted: frequency of a mucopurulent phlegm decreased by 4,5 times, at the main part having transformed to mucous. The number of patients with a moderate asthma due to decrease in its expressiveness was twice reduced. Positive dynamics was reflected also in auskultativny symptomatology: significantly expressiveness of rigid breath and dry rattles decreased. If before an initiation of treatment of 60% of patients regarded the state as unsatisfactory, then after five days of treatment of Zitrolidom®, 18 patients reported about satisfactory health and 7 — about good.
The clinical picture was supplemented with favorable laboratory and tool dynamics: reduction of a leukocytosis, SOE. Cases of increase in eosinophils of peripheral blood and indicators of a cytolysis of functional trials of a liver were not noted. The OFV1 level increased from 60 to 73%.
Thus, the obtained data allow to draw the following conclusions: the drug Zitrolid® can effectively be used as antibacterial drug in the form of monotherapy at not heavy aggravations of chronic is purulent - obstructive bronchitis. Taking into account its mode of the dosing providing a high komplayentnost in comparison with other germicides, Zitrolid® is especially attractive to an out-patient and polyclinic network.

Literature:
1. Practical pulmonology of children's age under. edition of V. K. Tatochenko, M., 2001; c. 268.
2. Classification of clinical forms of bronchopulmonary diseases at children (Materials of the All-Russian meeting of pediatricians-pulmonologists, Moscow, on December 21 — 22, 1995). Russian messenger of perinatology and pediatrics, No. 2. 1996; 41: 52 — 55. 3. Tatochenko V. K., Volkov I.K., Rachinsky S.V., etc. Criteria of diagnosis and the principles of treatment of recurrent and chronic diseases of lungs at children. A grant for doctors, MZ Russian Federation and NTsZD Russian Academy of Medical Science, M, 2001; c. 23.

 
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