Антисептики как альтернатива системной антибактериальной терапии

Рязанцев С.В., Павлова С.С., Еремин С.А., Горпинич В.Д. Антисептики как альтернатива системной антибактериальной терапии. Consilium Medicum. 2021; 23 (3): 256–260. DOI: 10.26442/20751753.2021.3.200774

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Ryazantsev SV, Pavlova SS, Eremin SA, Gorpinich VD. Antiseptics as an alternative to systemic antibiotic therapy. Consilium Medicum. 2021; 23 (3): 256–260. DOI: 10.26442/20751753.2021.3.200774

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Аннотация

Боль в горле – один из наиболее частых поводов обращения к врачу и назначения нерациональной антибактериальной терапии. Причин этому множество – от трудностей этиологической диагностики и развития рецидивов и возможных тяжелых осложнений до личностного отношения врачей и пациентов к выбору лечения. Вместе с тем вопрос антибиотикорезистентности, побочных эффектов, связанных с назначением антибактериальной терапии, является одной из важнейших проблем современного здравоохранения во всем мире. Сложности в процессе клинического наблюдения пациентов, особенности течения инфекционно-воспалительных заболеваний глотки – факторы, требующие постоянного совершенствования методов оказания медицинской помощи. Существенную роль при лечении боли в горле играют антисептики. Так, один из антисептиков, применяемых местно, эффективность которого доказано в клинических исследованиях, – препарат Стрепсилс, в состав которого входят 2,4-дихлорбензиловый спирт и амилметакрезол. Результаты клинических исследований препарата свидетельствуют о его положительном эффекте у пациентов с острым фарингитом, что позволяет рекомендовать шире включать в комплекс лечения инфекционно-воспалительных заболеваний полости рта и глотки данный комплексный антисептический препарат.

Ключевые слова: боль в горле, антибиотики, антисептики, инфекционно-воспалительные заболевания глотки, микробиом глотки, топическая терапия, амилметакрезол, дихлорбензиловый спирт

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Sore throat is one of the most frequent reasons for going to the doctor and prescribing irrational antibacterial therapy. The reasons for this are many – from the difficulties of etiological diagnosis and the development of relapses and possible severe complications to the personal attitude of doctors and patients to the choice of treatment. At the same time, the issue of antibiotic resistance, side effects associated with the appointment of antibacterial therapy, is one of the most important problems of modern health care around the world. Difficulties in the process of clinical observation of patients, the peculiarities of the course of infectious and inflammatory diseases of the pharynx are factors requiring constant improvement of methods of providing medical care. Antiseptics play a significant role in the treatment of sore throat, exceeding the frequency of use of antibiotics. So, one of the antiseptics used topically, the effectiveness of which has been proven in clinical studies, is Strepsils, which includes 2,4-dichlorobenzyl alcohol and amylmetacresol. The results of clinical studies of the drug indicate its positive effect in patients with sore throat. All this things allow us to recommend that this complex antiseptic be more often included in the treatment of infectious and inflammatory diseases of the oral cavity and pharynx.

Keywords: sore throat, antibiotic, antiseptics, infectious and inflammatory diseases of the pharynx, throat microbiome, topical therapy, amylmetacresol, dichlorobenzyl alcohol

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Список литературы

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1. Choby BA. Diagnosis and treatment of streptococcal pharyngitis. Am Fam Physician 2009; 79 (5): 383–90. Erratum in: Am Fam Physician. 2013; 88 (4): 222. PMID: 19275067
2. Van der Velden AW, Sessa A, Altiner A, et al. Patients with Sore Throat: A Survey of Self-Management and Healthcare-Seeking Behavior in 13 Countries Worldwide. Pragmat Obs Res. 2020; 11: 91–102. DOI: 10.2147.POR.S255872
3. ESCMID Sore Throat Guideline Group, Pelucchi C, Grigoryan L, Galeone C, et al. Guideline for the management of acute sore throat. Clin Microbiol Infect. 2012; 18 (Suppl. 1): 1–28. DOI: 10.1111/j.1469-0691.2012.03766.x
4. Osipova VV. Pain: psychological aspects. Neurology, neuropsychiatry, psychosomatics. 2010; 2 (1): 4–9 (in Russian)
5. Dyachenko SV, Slobodenyuk EV, Dyachenko VG. Organization of antibacterial therapy of common diseases. Textbook. Ed. EV Slobodenyuk. Khabarovsk: Publishing house of the Center of the State Educational Institution of Higher Professional Education, DVSMU, 2010 (in Russian)
6. Spinks A, Glasziou PP, Del Mar CB. Antibiotics for sore throat. Cochrane Database Syst Rev. 2013; 11: CD000023. DOI: 10.1002/14651858.CD000023.pub4
7. Costerton JW, Stewart PS, Greenberg EP. Bacterial biofilms: a common cause of persistent infections. Science. 1999; 284 (5418): 1318–22. DOI: 10.1126/science.284.5418.1318
8. Guarner F, Malagelada J-R. Gut flora in health and disease. Lancet. 2003; 361: 512–19. DOI: 10.1016/S0140-6736(03)12489-0
9. Holmes E, Loo RL, Stamler J et al. Human metabolic phenotype diversity and its association with diet and blood pressure. Nature. 2008; 453: 396–400. DOI: 10.1038/nature06882
10. Essack S, Bell J, Burgoyne DS, et al. Topical (local) antibiotics for respiratory infections with sore throat: An antibiotic stewardship perspective. J Clin Pharm Ther. 2019; 44 (6): 829–37. DOI: 10.1111/jcpt.13012
11. McDonnell G, Russell AD. Antiseptics and disinfectants: Activity, action, and resistance. Clin Microbiol Rev. 1999; 12: 147–79.
12. Oxford JS, Lambkin R, Gibb I, et al. A throat lozenge containing amyl meta cresol and dichlorobenzyl alcohol has a direct virucidal effect on respiratory syncytial virus, influenza A and SARS-CoV. Antivir Chem Chemother. 2005; 16 (2): 129–34.
13. Watson N, Nimmo WS, Christian J, et al. Relief of sore throat with the anti-inflammatory throat lozenge flurbiprofen 8.75 mg: a randomised, double-blind, placebo-controlled study of efficacy and safety. Int J Clin Pract 2000; 54 (8): 490–6. Erratum in: Int J Clin Pract. 2000; 54 (10): 686. PMID: 11198725
14. Sheldon AT Jr. Antiseptic "resistance": real or perceived threat? Clin Infect Dis. 2005; 40 (11): 1650–6.
15. Wingate D. Martindale: The Extra Pharmacopoeia. Gut. 1984; 25. DOI: 10.1136/gut.25.4.432-a. page549-561
16. Weckmann G, Hauptmann-Voß A, Baumeister SE, et al. Efficacy of AMC/DCBA lozenges for sore throat: A systematic review and meta-analysis. Int J Clin Pract. 2017; 71 (10). DOI: 10.1111/ijcp.13002
17. Gupta D, Agrawal S, Sharma JP. Evaluation of preoperative Strepsils lozenges on incidence of postextubation cough and sore throat in smokers undergoing anesthesia with endotracheal intubation. Saudi J Anaesth. 2014; 8 (2): 244–8. DOI: 10.4103/1658-354X.130737
18. Ebneshahidi A, Mohseni M. Strepsils® tablets reduce sore throat and hoarseness after tracheal intubation. Anesth Analg. 2010; 111 (4): 892–4. DOI: 10.1213/ANE.0b013e3181d00c60
19. Morokutti-Kurz M, Graf C, Prieschl-Grassauer E. Amylmetacresol/2,4-dichlorobenzyl alcohol, hexylresorcinol, or carrageenan lozenges as active treatments for sore throat. Int J Gen Med. 2017; 10: 53–60. DOI: 10.2147/IJGM.S120665
20. Gáspár L, Szmrtyka A, Turi J, et al. Benzylalcohol- és amyl-m-cresol-tartalmú szájfertótlenító szer (Strepsils) alkalmazásával szerzett klinikai tapasztaltaink sztomatológiai kórképekben [Clinical experience with the use of benzylalcohol and amyl-m-cresol (Strepsils) in stomatological diseases]. Fogorv Sz. 2000; 93 (3): 83–90. Hungarian. PMID: 10769492
21. Berkovitch M, Greenberg R, Gendler L, et al. Sore Throat Treatment during Pregnancy: A Prospective, Controlled, Pilot Study. Clin Drug Investig. 2002; 22 (2): 135–9. DOI: 10.2165/00044011-200222020-00008
22. Ryazantsev SV, Pavlova SV. Modern possibilities of topical therapy of upper respiratory tract and throat infectious inflammatory diseases. Meditsinskiy sovet = Medical Council. 2020; 6: 14–20 (in Russian) DOI: 10.21518/2079-701X-2020-6-14-20

Авторы

С.В. Рязанцев, С.С. Павлова*, С.А. Еремин, В.Д. Горпинич

ФГБУ «Санкт-Петербургский научно-исследовательский институт уха, горла, носа и речи» Минздрава России, Санкт-Петербург, Россия
*s-ultraviolet@mail.ru

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Sergey V. Ryazantsev, Svetlana S. Pavlova, Sergey A. Eremin, Valery D. Gorpinich

Saint Petersburg Research Institute of Ear, Throat, Nose and Speech, Saint Petersburg, Russia
*s-ultraviolet@mail.ru

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