Выбор эффективной терапии при инфекционно-воспалительных заболеваниях глотки

Морозова С.В., Щенникова Е.С. Выбор эффективной терапии при инфекционно-воспалительных заболеваниях глотки. Consilium Medicum. 2020; 22 (11): 21–24. DOI: 10.26442/20751753.2020.11.200411

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Morozova S.V., Shchennikova E.S. The choice of effective treatment for infectious and inflammatory diseases of the pharynx. Consilium Medicum. 2020; 22 (11): 21–24. DOI: 10.26442/20751753.2020.11.200411

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Аннотация

Боль как характерный признак инфекционно-воспалительных заболеваний глотки относится к наиболее частым причинам амбулаторного обращения к врачам-оториноларингологам, терапевтам и педиатрам. При тонзиллофарингите боль обусловлена локальными факторами, поэтому особенное значение имеет местная терапия, как противовоспалительная, так и обезболивающая. Тем не менее по данным литературы в подавляющем большинстве случаев назначается системная антибактериальная терапия. Однако известно, что по современным представлениям системная антибактериальная терапия должна назначаться строго по показаниям, так как чаще всего встречается вирусная этиология. В связи с этим симптоматическое лечение является терапией первой линии для лечения боли в горле. Наиболее эффективными с этой точки зрения являются нестероидные противовоспалительные препараты. В свою очередь, по данным большого количества исследований, препарат ОКИ показал свою эффективность в купировании симптомов, не приводя при этом к развитию выраженных побочных эффектов.

Ключевые слова: боль в горле, тонзиллофарингит, кетопрофена лизиновая соль.

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Sore throat is one of the most common patients' complaints at outpatient appointments in otorhinolaryngologists, general practitioners', and pediatrics' practice. Pain in tonsillopharyngitis is due to local factors, so local treatment plays an overwhelming role either for anti-inflammatory or painkilling effects. Nevertheless systemic antibacterial treatment is widespread during this pathology. But since this condition is usually caused by the viral infection, systemic antibiotic therapy should be prescribed strictly according to indications. Thereby, symptomatic treatment is the first line treatment that should be used in the patients with sore throat. Non-steroidal anti-inflammatory drugs are considered to be the most effective in that condition. According to the results of the number of studies, OKI is shown to be safe and effective against the symptoms of sore throat.

Key words: sore throat, tonsillopharyngitis, ketoprofen lysine salt.

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Список литературы

1. Козлов С.Н., Страчунский Л.С., Рачина С.А. Фармакотерапия острого тонзиллофарингита в амбулаторной практике: результаты многоцентрового фармакоэпидемиологического исследования. Терапевтический архив. 2004; 76 (5): 45–51.
[Kozlov S.N., Strachunskii L.S., Rachina S.A. Pharmacotherapy of acute tonsillopharyngitis in outpatient practice: results of a multicenter pharmacoepidemiological study. Therapeutic Archive. 2004; 76 (5): 45–51 (in Russian).]
2. Kenealy T. Sore throat. BMJ Clin Evid 2011; 2011: 1509.
3. Бабияк В.И., Говорухин М.И., Митрофанов В.В. Некоторые психологические аспекты проблемы «качества жизни человека». Рос. оториноларингология. 2004; 1 (8): 3–6.
[Babiiak V.I., Govorukhin M.I., Mitrofanov V.V. Nekotorye psikhologicheskie aspekty problemy “kachestva zhizni cheloveka”. Ros. otorinolaringologiia. 2004; 1 (8): 3–6 (in Russian).]
4. Stephenson KN. Acute and chronic pharyngitis across the lifespan. Lippincotts Prim Care Pract 2000; 4 (5): 471–89.
5. Hsieh TH, Chen PY, Huang FL et al. Are empiric antibiotics for acute exudative tonsillitis needed in children? J Microbiol Immunol Infect 2011; 44: 328–32.
6. Kenealy T. Sore throat. BMJ Clin Evid 2014; 2014: 1509.
7. Palla AH, Khan RA, Gilani AH, Marra F. Over prescription of antibiotics for adult pharyngitis is prevalent in developing countries but can be reduced using McIsaac modification of Centor scores: a cross-sectional study. BMC Pulm Med 2012; 12: 70.
8. Sun L, Klein EY, Laxminarayan R. Seasonality and temporal correlation between community antibiotic use and resistance in the United States. Clin Infect Dis 2012; 55 (5): 687–94.
9. National Institute for Health and Clinical Excellence. Respiratory tract infections – antibiotic prescribing. Prescribing of antibiotics for self-limiting respiratory tract infections in adults and children in primary care. London: National Institute for Health and Clinical Excellence, 2008; 2008. http://www.nice.org.uk/nicemedia/pdf/CG69FullGuideline.pdf
10. González Fernández N, Herrero-Morín JD, Solís Sánchez G et. al. Variability of antibiotic treatment in paediatric acute pharyngotonsillitis in Asturias, Spain. Arch Argent Pediatr 2012; 110 (3): 207–13.
11. Pignatari АС. The inappropriate use of antibiotics in upper respiratory tract infections: It is time for action. Braz J Otorhinolaryngol 2016; 82 (2).
12. Giraldi G, Montesano М, Frati Р et al. Healthcare-Associated Infections Due to Multidrug-Resistant Organisms: a Surveillance Study on Extra Hospital Stay and Direct Costs. Curr Pharm Biotechnol 2019; 20 (8): 643–52.
13. ESCMID Sore Throat Guideline Group. Guideline for the management of acute sore throat. Clin Microbiol Infect 2012; 18 (1): 1–28.
14. Крюков А.И., Кунельская Н.Л., Туровский А.Б., Изотова Г.Н. Тонзиллофарингиты: диагностика и лечение. Справочник поликлинического врача. 2007; 5 (1): 38–42.
[Kriukov A.I., Kunel'skaia N.L., Turovskii A.B., Izotova G.N. Tonsillopharyngitis: diagnosis and treatment. Handbook for Practitioners Doctors. 2007; 5 (1): 38–42 (in Russian).]
15. Лучшева Ю.В., Изотова Г.Н. Местная терапия при фарингите. РМЖ. 2011; 19 (6): 20–23.
[Luchsheva Iu.V., Izotova G.N. Mestnaia terapiia pri faringite. RMZh. 2011; 19 (6): 20–23 (in Russian).]
16. Natale F, de’ Lorenzi C. Efficacy and tolerability of ketoprofen lysine salt in oropharyngeal solution in inflammatory pathologies of oral cavity. Minerva Stomatol 1997; 46 (5): 273–8.
17. García Rodríguez LA. Variability in risk of gastrointestinal complications with different nonsteroidal anti-inflammatory drugs. Am J Med 1998; 104 (3A): 30–4; 41–2.
18. Helin-Salmivaara A, Virtanen A, Vesalainen R et al. NSAID use and the risk of hospitalization for first myocardial infarction in the general population: a nationwide case-control study from Finland. Eur Heart J 2006; 27 (14): 1657–63.
19. Brandolini L, d'Angelo M, Antonosante A et. al. Differential protein modulation by ketoprofen and ibuprofen underlines different cellular response by gastric epithelium. J Cell Physiol 2018; 233 (3): 2304–12.
20. Ruperto N, Carozzino L et al. A randomized, double-blind, placebo-controlled trial of paracetamol and ketoprofren lysine salt for pain control in children with pharyngotonsillitis cared by family pediatricians. Ital J Pediatr 2011; 37: 48.
21. Карпова Е.П., Тулупов Д.А., Федотов Ф.А. Использование нестероидных противовоспалительных средств для купирования болевого синдрома после тонзиллотомии у детей. Вестник оториноларингологии. 2017; 82 (5): 48–51.
[Karpova E.P., Tulupov D.A., Fedotov F.A. Ispol'zovanie nesteroidnykh protivovospalitel'nykh sredstv dlia kupirovaniia bolevogo sindroma posle tonzillotomii u detei. Vestnik otorinolaringologii. 2017; 82 (5): 48–51 (in Russian).]
22. D’Arienzo et al. Ketoprofen lysine: ketoprofen serum levels and analgesic activity. Drugs Exp Clin Res 1984; 10: 863–6.

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1. Kozlov S.N., Strachunskii L.S., Rachina S.A. Pharmacotherapy of acute tonsillopharyngitis in outpatient practice: results of a multicenter pharmacoepidemiological study. Therapeutic Archive. 2004; 76 (5): 45–51 (in Russian).
2. Kenealy T. Sore throat. BMJ Clin Evid 2011; 2011: 1509.
3. Babiiak V.I., Govorukhin M.I., Mitrofanov V.V. Nekotorye psikhologicheskie aspekty problemy “kachestva zhizni cheloveka”. Ros. otorinolaringologiia. 2004; 1 (8): 3–6 (in Russian).
4. Stephenson KN. Acute and chronic pharyngitis across the lifespan. Lippincotts Prim Care Pract 2000; 4 (5): 471–89.
5. Hsieh TH, Chen PY, Huang FL et al. Are empiric antibiotics for acute exudative tonsillitis needed in children? J Microbiol Immunol Infect 2011; 44: 328–32.
6. Kenealy T. Sore throat. BMJ Clin Evid 2014; 2014: 1509.
7. Palla AH, Khan RA, Gilani AH, Marra F. Over prescription of antibiotics for adult pharyngitis is prevalent in developing countries but can be reduced using McIsaac modification of Centor scores: a cross-sectional study. BMC Pulm Med 2012; 12: 70.
8. Sun L, Klein EY, Laxminarayan R. Seasonality and temporal correlation between community antibiotic use and resistance in the United States. Clin Infect Dis 2012; 55 (5): 687–94.
9. National Institute for Health and Clinical Excellence. Respiratory tract infections – antibiotic prescribing. Prescribing of antibiotics for self-limiting respiratory tract infections in adults and children in primary care. London: National Institute for Health and Clinical Excellence, 2008; 2008. http://www.nice.org.uk/nicemedia/pdf/CG69FullGuideline.pdf
10. González Fernández N, Herrero-Morín JD, Solís Sánchez G et. al. Variability of antibiotic treatment in paediatric acute pharyngotonsillitis in Asturias, Spain. Arch Argent Pediatr 2012; 110 (3): 207–13.
11. Pignatari АС. The inappropriate use of antibiotics in upper respiratory tract infections: It is time for action. Braz J Otorhinolaryngol 2016; 82 (2).
12. Giraldi G, Montesano М, Frati Р et al. Healthcare-Associated Infections Due to Multidrug-Resistant Organisms: a Surveillance Study on Extra Hospital Stay and Direct Costs. Curr Pharm Biotechnol 2019; 20 (8): 643–52.
13. ESCMID Sore Throat Guideline Group. Guideline for the management of acute sore throat. Clin Microbiol Infect 2012; 18 (1): 1–28.
14. Kriukov A.I., Kunel'skaia N.L., Turovskii A.B., Izotova G.N. Tonsillopharyngitis: diagnosis and treatment. Handbook for Practitioners Doctors. 2007; 5 (1): 38–42 (in Russian).
15. Luchsheva Iu.V., Izotova G.N. Mestnaia terapiia pri faringite. RMZh. 2011; 19 (6): 20–23 (in Russian).
16. Natale F, de’ Lorenzi C. Efficacy and tolerability of ketoprofen lysine salt in oropharyngeal solution in inflammatory pathologies of oral cavity. Minerva Stomatol 1997; 46 (5): 273–8.
17. García Rodríguez LA. Variability in risk of gastrointestinal complications with different nonsteroidal anti-inflammatory drugs. Am J Med 1998; 104 (3A): 30–4; 41–2.
18. Helin-Salmivaara A, Virtanen A, Vesalainen R et al. NSAID use and the risk of hospitalization for first myocardial infarction in the general population: a nationwide case-control study from Finland. Eur Heart J 2006; 27 (14): 1657–63.
19. Brandolini L, d'Angelo M, Antonosante A et. al. Differential protein modulation by ketoprofen and ibuprofen underlines different cellular response by gastric epithelium. J Cell Physiol 2018; 233 (3): 2304–12.
20. Ruperto N, Carozzino L et al. A randomized, double-blind, placebo-controlled trial of paracetamol and ketoprofren lysine salt for pain control in children with pharyngotonsillitis cared by family pediatricians. Ital J Pediatr 2011; 37: 48.
21. Karpova E.P., Tulupov D.A., Fedotov F.A. Ispol'zovanie nesteroidnykh protivovospalitel'nykh sredstv dlia kupirovaniia bolevogo sindroma posle tonzillotomii u detei. Vestnik otorinolaringologii. 2017; 82 (5): 48–51 (in Russian).
22. D’Arienzo et al. Ketoprofen lysine: ketoprofen serum levels and analgesic activity. Drugs Exp Clin Res 1984; 10: 863–6.

Авторы

С.В. Морозова*, Е.С. Щенникова

ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия
*doctormorozova@mail.ru

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Svetlana V. Morozova*, Ekaterina S. Shchennikova

Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
*doctormorozova@mail.ru

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