Эффективность растительных лекарственных препаратов при лечении острых респираторных инфекций в реальной клинической практике

Свистушкин В.М., Никифорова Г.Н., Шевчик Е.А., Золотова А.Н., Никифорова А.Н., Сивохин Д.А. Эффективность растительных лекарственных препаратов при лечении острых респираторных инфекций в реальной клинической практике. Consilium Medicum. 2022;24(9):579–587.
DOI: 10.26442/20751753.2022.9.201944

© ООО «КОНСИЛИУМ МЕДИКУМ», 2022 г.

________________________________________________

Svistushkin VM, Nikiforova GN, Shevchik EA, Zolotova AN, Nikiforova AN, Sivokhin DA. Efficacy of herbal medicines in the treatment of acute respiratory infections in real clinical practice. Consilium Medicum. 2022;24(9):579–587. DOI: 10.26442/20751753.2022.9.201944

Читать PDF

Аннотация

Обоснование. Необоснованное назначение антибиотиков пациентам с острыми заболеваниями верхних и нижних отделов дыхательных путей является значимой проблемой современной медицины, так как сопряжено с высоким риском развития побочных эффектов, ростом антибиотикорезистентности и большими экономическими затратами. Фитопрепараты могут способствовать снижению частоты неадекватного назначения антибиотиков.
Цель. Изучить влияние использования лекарственных средств растительного происхождения на изменение частоты назначения антибиотических препаратов больным инфекционной респираторной патологией, а также определить наличие взаимосвязи между назначением фитопрепаратов и продолжительностью течения инфекционно-воспалительного процесса.
Материалы и методы. Проведен анализ материалов из базы данных IMS® Disease Analyze. Для участия в исследовании отбирались пациенты, которым в период между январем 2015 и мартом 2019 г. поставлен диагноз «острая респираторная инфекция». Соответственно назначаемому лечению пациенты распределены на 2 группы: основная, пациентам которой назначались фитопрепараты в качестве терапии, и контрольная группа без назначения аналогичного лечения. Пациенты, которым в день постановки диагноза назначены антибиотики, исключались из исследования. Для оценки взаимосвязи между назначением фитопрепаратов, антибиотиков и длительностью периода временной нетрудоспособности использовался метод логической регрессии.
Результаты. В 1-ю группу включены 117 182 пациента, которые применяли лекарственные средства растительного происхождения. В контрольную – такое же число пациентов без назначения фитопрепаратов.
Заключение. Полученные результаты позволяют сделать вывод, что рациональное назначение определенных фитопрепаратов для лечения острых респираторных вирусных инфекций может значительно снизить потребность в назначении антибиотиков при дальнейшем течении заболевания, а также сократить длительность временной нетрудоспособности пациентов.

Ключевые слова: респираторные инфекции, фитопрепараты, антибиотики, временная нетрудоспособность

________________________________________________

Background. Unreasonable prescription of antibiotics to patients with acute diseases of the upper and lower respiratory tract is a significant problem of modern medicine, as it is associated with a high risk of side effects, an increase in antibiotic resistance and high economic costs. Phytopreparations can help reduce the frequency of inadequate antibiotic prescribing.
Aim. To study the effect of the use of herbal medicines on changing the frequency of prescribing antibiotic drugs to patients with infectious respiratory pathology. In addition, the presence of a relationship between the appointment of phytopreparations and the duration of the course of the infectious and inflammatory process was determined.
Materials and methods. Materials from the IMS® Disease Analyze database were analyzed. The study included patients who were diagnosed with acute respiratory infection between January 2015 and March 2019. According to the prescribed treatment, patients were divided into two groups: the main one, whose patients were prescribed phytopreparations as therapy, and the control group without the appointment of similar treatment. Patients who were prescribed antibiotics on the day of diagnosis were excluded from the study. To assess the relationship between the prescription of phytopreparations, antibiotics and the duration of the period of temporary disability, the logical regression method was used.
Results. The first group included 117 182 patients who used herbal medicines. In the control – the same number of patients without the appointment of phytopreparations. The following results were obtained: the use of phytopreparations was accompanied by a rarer additional prescription of antibiotics in the process of treatment, the duration of the period of temporary disability in the main group was shorter.
Conclusion. The use of phytopreparations in acute respiratory infections statistically significantly causes a decrease in the frequency of prescribing systemic antibiotics and a decrease in the duration of the period of temporary disability.

Keywords: respiratory infection, herbal remedies, antibiotics, temporary disability

Полный текст

Материалы доступны только для специалистов сферы здравоохранения. Авторизуйтесь или зарегистрируйтесь.

Список литературы

1. Jain N, Lodha R, Kabra SK. Upper respiratory tract infections. Indian J Pediatr. 2001;68:1135-8.
2. Carroll KC, Adams LL. Lower Respiratory Tract Infections. Eds RT Hayden, DM Wolk, KC Carroll, Y-W Tang. Microbiol Spectr. 2016;4.
3. Grief SN. Upper respiratory infections. Prim Care. 2013;40:757-70.
4. Linde K, Atmann O, Meissner K, et al. How often do general practitioners use placebos and non-specific interventions? Systematic review and meta-analysis of surveys. PLoS One. 2018;13:e0202211.
5. Kraus EM, Pelzl S, Szecsenyi J, Laux G. Antibiotic prescribing for acute lower respiratory tract infections (LRTI) – guideline adherence in the German primary care setting: An analysis of routine data. PLoS One. 2017;12:e0174584.
6. Ostermaier A, Barth N, Schneider A, Linde K. On the edges of medicine – A qualitative study on the function of complementary, alternative, and non-specific therapies in handling therapeutically indeterminate situations. BMC Fam Pract. 2019;20:1-10.
7. Zweigner J, Meyer E, Gastmeier P, Schwab F. Rate of antibiotic prescriptions in German outpatient care – are the guidelines followed or are they still exceeded? GMS Hyg Infect Control. 2018;13:Doc04.
8. Mcdonagh MS, Peterson K, Winthrop K, et al. Interventions to reduce inappropriate prescribing of antibiotics for acute respiratory tract infections: summary and update of a systematic review. J Int Med Res. 2018;46:3337-57.
9. Guitor AK, Wright GD. Antimicrobial Resistance and Respiratory Infections. Chest. 2018;154:1202-12.
10. Griffin AS, Cabot P, Wallwork B, Panizza B. Alternative therapies for chronic rhinosinusitis: A review. Ear Nose Throat J. 2020;145561320939415.
11. Anheyer D, Cramer H, Lauche R, et al. Herbal Medicine in Children With Respiratory Tract Infection: Systematic Review and Meta-Analysis. Acad Pediatr. 2018;18:8-19.
12. Jund R, Mondigler M, Stammer H, et al. Herbal drug BNO 1016 is safe and effective in the treatment of acute viral rhinosinusitis. Acta Otolaryngol. 2015;135:42.
13. Mousa HA. Prevention, Treatment of Influenza, Influenza-Like Illness, and Common Cold by Herbal, Complementary, and Natural Therapies. J Evid Based Complementary Altern Med. 2017;22(1):166-74.
14. Matthys H, Lehmacher W, Zimmermann A, et al. EPs 7630 in acute respiratory tract infections – a systematic review and meta-analysis of randomized clinical trials. J Lung Pulm Respir Res. 2016;3.
15. Taylor JA, Weber W, Standish L, et al. Efficacy and safety of echinacea in treating upper respiratory tract infections in children: a randomized controlled trial. JAMA. 2003;290:2824-30.
16. Ogal M, Johnston SL, Klein P, Schoop R. Echinacea reduces antibiotic usage in children through respiratory tract infection prevention: a randomized, blinded, controlled clinical trial. Eur J Med Res. 2021;26.
17. Jaume F, Valls-Mateus M, Mullol J. Common Cold and Acute Rhinosinusitis: Up-to-Date Management. Curr Allergy Asthma Rep. 2020;20(7):28.
18. Lum EPM, Page K, Whitty JA, et al. Antibiotic prescribing in primary healthcare: Dominant factors and trade-offs in decision-making. Infect Dis Health. 2018;23:74-86.
19. Martin D, Konrad M, Adarkwah CC, Kostev K. Reduced antibiotic use after initial treatment of acute respiratory infections with phytopharmaceuticals- a retrospective cohort study. Postgrad Med. 2020;132:412-8.
20. Rathmann W, Bongaerts B, Carius HJ, et al. Basic characteristics and representativeness of the German Disease Analyzer database. Int J Clin Pharmacol Ther. 2018;56:459-66.
21. Becher H, Kostev K, Schröder-Bernhardi D. Validity and representativeness of the “Disease Analyzer” patient database for use in pharmacoepidemiological and pharmacoeconomic studies. Int J Clin Pharmacol Ther. 2009;47:617-26.
22. Quan H, Sundararajan V, Halfon P, et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care. 2005:43:1130-9.
23. Клинические рекомендации Министерства здравоохранения Российской Федерации по лечению острого синусита (взрослые, дети). КР313. 2021 г. Режим доступа: https://cr.minzdrav.gov.ru/recomend/313_2. Ссылка активна на 23.10.2022 [Clinical recommendations of the Ministry of Health of the Russian Federation for the treatment of acute sinusitis (adults, children). KR313. 2021. Available at: https://cr.minzdrav.gov.ru/recomend/313_2. Accessed: 23.10.2022 (in Russian)].
24. Fokkens WJ, Lund VJ, Hopkins C, et al. European Position Paper on Rhinosinusitis and Nasal Polyps. Rhinology. 2020(29):1-464.
25. Seibel J, Kryshen K, Pongrácz JE, Lehner MD. In vivo and in vitro investigation of anti-inflammatory and mucus-regulatory activities of a fixed combination of thyme and primula extracts. Pulm Pharmacol Ther. 2018;51:10-7.
26. Glatthaar-Saalmüller B, Rauchhaus U, Rode S, et al. Antiviral activity in vitro of two preparations of the herbal medicinal product Sinupret® against viruses causing respiratory infections. Phytomedicine. 2011;19:1-7.
27. Roth M, Fang L, Stolz D, Tamm M. Pelargonium sidoides radix extract EPs 7630 reduces rhinovirus infection through modulation of viral binding proteins on human bronchial epithelial cells. PLoS One. 2019;14:e0210702.
28. Tariq S, Wani S, Rasool W, et al. A comprehensive review of the antibacterial, antifungal and antiviral potential of essential oils and their chemical constituents against drug-resistant microbial pathogens. Microb Pathog. 2019;134 :103580.
29. Moore M, Stuart B, Little P, et al. Predictors of pneumonia in lower respiratory tract infections: 3C prospective cough complication cohort study. Eur Respir J. 2017;50(5):1700434.
30. Cars T, Eriksson I, Granath A, et al. Antibiotic use and bacterial complications following upper respiratory tract infections: a population-based study. BMJ Open. 2017;7:e016221.
31. Bachert C. Evidence-based management of acute rhinosinusitis with herbal products. Clinical Phytoscience. 2020;6:85. DOI:10.1186/s40816-020-00231-7
32. Kemmerich B. Evaluation of efficacy and tolerability of a fixed combination of dry extracts of thyme herb and primrose root in adults suffering from acute bronchitis with productive cough. A prospective, double-blind, placebo-controlled, multicentre clinical trial. Arzneimittelforschung. 2007;57:607-15. DOI:10.1055/s-0031-1296656
33. Kemmerich B, Eberhardt R, Stammer H. Efficacy and tolerability of a fluid extract combination of thyme herb and ivy leaves and matched placebo in adults suffering from acute bronchitis with productive cough. A prospective, double-blind, placebo-controlled clinical trial. Arzneimittelforschung. 2006;56:652-60. DOI:10.1055/s-0031-1296767
34. Petursson P. GPs’ reasons for “non-pharmacological” prescribing of antibiotics A phenomenological study. Scand J Prim Health Care. 2005;23(2):120-5.
35. Lemiengre MB, van Driel ML, Merenstein D, et al. Antibiotics for acute rhinosinusitis in adults. Cochrane Database Syst Rev. 2018;9:CD006089. DOI:10.1002/14651858.CD006089.pub5
36. Smith SM, Fahey T, Smucny J, Becker LA. Antibiotics for acute bronchitis. Cochrane Database Syst Rev. 2017;6:CD000245. DOI:10.1002/14651858.CD000245.pub4
37. Мартынов А.И., Горелов А.В., Малявин А.Г., и др. Резолюция Совета экспертов «Растительные лекарственные препараты с доказанной клинической эффективностью в клинической практике врача». Терапия. 2022;5:101-18 [Martynov AI, Gorelov AV, Maliavin AG, et al. Rezoliutsiia Soveta ekspertov “Rastitel'nye lekarstvennye preparaty s dokazannoi klinicheskoi effektivnost'iu v klinicheskoi praktike vracha”. Terapiia. 2022;5:101-18 (in Russian)].

________________________________________________

1. Jain N, Lodha R, Kabra SK. Upper respiratory tract infections. Indian J Pediatr. 2001;68:1135-8.
2. Carroll KC, Adams LL. Lower Respiratory Tract Infections. Eds RT Hayden, DM Wolk, KC Carroll, Y-W Tang. Microbiol Spectr. 2016;4.
3. Grief SN. Upper respiratory infections. Prim Care. 2013;40:757-70.
4. Linde K, Atmann O, Meissner K, et al. How often do general practitioners use placebos and non-specific interventions? Systematic review and meta-analysis of surveys. PLoS One. 2018;13:e0202211.
5. Kraus EM, Pelzl S, Szecsenyi J, Laux G. Antibiotic prescribing for acute lower respiratory tract infections (LRTI) – guideline adherence in the German primary care setting: An analysis of routine data. PLoS One. 2017;12:e0174584.
6. Ostermaier A, Barth N, Schneider A, Linde K. On the edges of medicine – A qualitative study on the function of complementary, alternative, and non-specific therapies in handling therapeutically indeterminate situations. BMC Fam Pract. 2019;20:1-10.
7. Zweigner J, Meyer E, Gastmeier P, Schwab F. Rate of antibiotic prescriptions in German outpatient care – are the guidelines followed or are they still exceeded? GMS Hyg Infect Control. 2018;13:Doc04.
8. Mcdonagh MS, Peterson K, Winthrop K, et al. Interventions to reduce inappropriate prescribing of antibiotics for acute respiratory tract infections: summary and update of a systematic review. J Int Med Res. 2018;46:3337-57.
9. Guitor AK, Wright GD. Antimicrobial Resistance and Respiratory Infections. Chest. 2018;154:1202-12.
10. Griffin AS, Cabot P, Wallwork B, Panizza B. Alternative therapies for chronic rhinosinusitis: A review. Ear Nose Throat J. 2020;145561320939415.
11. Anheyer D, Cramer H, Lauche R, et al. Herbal Medicine in Children With Respiratory Tract Infection: Systematic Review and Meta-Analysis. Acad Pediatr. 2018;18:8-19.
12. Jund R, Mondigler M, Stammer H, et al. Herbal drug BNO 1016 is safe and effective in the treatment of acute viral rhinosinusitis. Acta Otolaryngol. 2015;135:42.
13. Mousa HA. Prevention, Treatment of Influenza, Influenza-Like Illness, and Common Cold by Herbal, Complementary, and Natural Therapies. J Evid Based Complementary Altern Med. 2017;22(1):166-74.
14. Matthys H, Lehmacher W, Zimmermann A, et al. EPs 7630 in acute respiratory tract infections – a systematic review and meta-analysis of randomized clinical trials. J Lung Pulm Respir Res. 2016;3.
15. Taylor JA, Weber W, Standish L, et al. Efficacy and safety of echinacea in treating upper respiratory tract infections in children: a randomized controlled trial. JAMA. 2003;290:2824-30.
16. Ogal M, Johnston SL, Klein P, Schoop R. Echinacea reduces antibiotic usage in children through respiratory tract infection prevention: a randomized, blinded, controlled clinical trial. Eur J Med Res. 2021;26.
17. Jaume F, Valls-Mateus M, Mullol J. Common Cold and Acute Rhinosinusitis: Up-to-Date Management. Curr Allergy Asthma Rep. 2020;20(7):28.
18. Lum EPM, Page K, Whitty JA, et al. Antibiotic prescribing in primary healthcare: Dominant factors and trade-offs in decision-making. Infect Dis Health. 2018;23:74-86.
19. Martin D, Konrad M, Adarkwah CC, Kostev K. Reduced antibiotic use after initial treatment of acute respiratory infections with phytopharmaceuticals- a retrospective cohort study. Postgrad Med. 2020;132:412-8.
20. Rathmann W, Bongaerts B, Carius HJ, et al. Basic characteristics and representativeness of the German Disease Analyzer database. Int J Clin Pharmacol Ther. 2018;56:459-66.
21. Becher H, Kostev K, Schröder-Bernhardi D. Validity and representativeness of the “Disease Analyzer” patient database for use in pharmacoepidemiological and pharmacoeconomic studies. Int J Clin Pharmacol Ther. 2009;47:617-26.
22. Quan H, Sundararajan V, Halfon P, et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care. 2005:43:1130-9.
23. Clinical recommendations of the Ministry of Health of the Russian Federation for the treatment of acute sinusitis (adults, children). KR313. 2021. Available at: https://cr.minzdrav.gov.ru/recomend/313_2. Accessed: 23.10.2022 (in Russian).
24. Fokkens WJ, Lund VJ, Hopkins C, et al. European Position Paper on Rhinosinusitis and Nasal Polyps. Rhinology. 2020(29):1-464.
25. Seibel J, Kryshen K, Pongrácz JE, Lehner MD. In vivo and in vitro investigation of anti-inflammatory and mucus-regulatory activities of a fixed combination of thyme and primula extracts. Pulm Pharmacol Ther. 2018;51:10-7.
26. Glatthaar-Saalmüller B, Rauchhaus U, Rode S, et al. Antiviral activity in vitro of two preparations of the herbal medicinal product Sinupret® against viruses causing respiratory infections. Phytomedicine. 2011;19:1-7.
27. Roth M, Fang L, Stolz D, Tamm M. Pelargonium sidoides radix extract EPs 7630 reduces rhinovirus infection through modulation of viral binding proteins on human bronchial epithelial cells. PLoS One. 2019;14:e0210702.
28. Tariq S, Wani S, Rasool W, et al. A comprehensive review of the antibacterial, antifungal and antiviral potential of essential oils and their chemical constituents against drug-resistant microbial pathogens. Microb Pathog. 2019;134 :103580.
29. Moore M, Stuart B, Little P, et al. Predictors of pneumonia in lower respiratory tract infections: 3C prospective cough complication cohort study. Eur Respir J. 2017;50(5):1700434.
30. Cars T, Eriksson I, Granath A, et al. Antibiotic use and bacterial complications following upper respiratory tract infections: a population-based study. BMJ Open. 2017;7:e016221.
31. Bachert C. Evidence-based management of acute rhinosinusitis with herbal products. Clinical Phytoscience. 2020;6:85. DOI:10.1186/s40816-020-00231-7
32. Kemmerich B. Evaluation of efficacy and tolerability of a fixed combination of dry extracts of thyme herb and primrose root in adults suffering from acute bronchitis with productive cough. A prospective, double-blind, placebo-controlled, multicentre clinical trial. Arzneimittelforschung. 2007;57:607-15. DOI:10.1055/s-0031-1296656
33. Kemmerich B, Eberhardt R, Stammer H. Efficacy and tolerability of a fluid extract combination of thyme herb and ivy leaves and matched placebo in adults suffering from acute bronchitis with productive cough. A prospective, double-blind, placebo-controlled clinical trial. Arzneimittelforschung. 2006;56:652-60. DOI:10.1055/s-0031-1296767
34. Petursson P. GPs’ reasons for “non-pharmacological” prescribing of antibiotics A phenomenological study. Scand J Prim Health Care. 2005;23(2):120-5.
35. Lemiengre MB, van Driel ML, Merenstein D, et al. Antibiotics for acute rhinosinusitis in adults. Cochrane Database Syst Rev. 2018;9:CD006089. DOI:10.1002/14651858.CD006089.pub5
36. Smith SM, Fahey T, Smucny J, Becker LA. Antibiotics for acute bronchitis. Cochrane Database Syst Rev. 2017;6:CD000245. DOI:10.1002/14651858.CD000245.pub4
37. Martynov AI, Gorelov AV, Maliavin AG, et al. Rezoliutsiia Soveta ekspertov “Rastitel'nye lekarstvennye preparaty s dokazannoi klinicheskoi effektivnost'iu v klinicheskoi praktike vracha”. Terapiia. 2022;5:101-18 (in Russian).

Авторы

В.М. Свистушкин, Г.Н. Никифорова*, Е.А. Шевчик, А.Н. Золотова, А.Н. Никифорова, Д.А. Сивохин

ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия
*gn_nik_63@mail.ru

________________________________________________

Valery M. Svistushkin, Galina N. Nikiforova*, Elena A. Shevchik, Anna N. Zolotova, Anna N. Nikiforova, Dmitrii A. Sivokhin

Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
*gn_nik_63@mail.ru

Назад к списку

Цель портала OmniDoctor – предоставление профессиональной информации врачам, провизорам и фармацевтам.