Рациональный подход к терапии инфекции мочевой системы у детей
Рациональный подход к терапии инфекции мочевой системы у детей
Чугунова О.Л. Рациональный подход к терапии инфекции мочевой системы у детей. Педиатрия. Consilium Medicum. 2021; 1: 63–71. DOI: 10.26442/26586630.2021.1.200632
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Сhugunova OL. A rational approach to the treatment of urinary tract infections in children. Pediatrics. Consilium Medicum. 2021; 1: 63–71. DOI: 10.26442/26586630.2021.1.200632
Рациональный подход к терапии инфекции мочевой системы у детей
Чугунова О.Л. Рациональный подход к терапии инфекции мочевой системы у детей. Педиатрия. Consilium Medicum. 2021; 1: 63–71. DOI: 10.26442/26586630.2021.1.200632
________________________________________________
Сhugunova OL. A rational approach to the treatment of urinary tract infections in children. Pediatrics. Consilium Medicum. 2021; 1: 63–71. DOI: 10.26442/26586630.2021.1.200632
В статье рассматриваются вопросы комплексной терапии инфекции мочевой системы (ИМС) у детей на основании обсуждения современных особенностей этиологии, патогенеза, клинических проявлений. Появление микробных биопленок и увеличивающаяся резистентность возбудителей, вызывающих развитие ИМС, диктует необходимость поиска новых методов лечения. Для преодоления персистенции бактерий и реинфекции необходимы рациональная антибиотикотерапия с учетом чувствительности высеваемой флоры к антибиотикам, отказ от использования длительной антибиотикопрофилактики, устранение органических и функциональных нарушений уродинамики, а также применение лекарственных средств растительного происхождения. Если у ребенка нет тяжелых аномалий или имеет место обструкция функционального характера, то в качестве профилактической противорецидивной меры следует рассматривать альтернативные методы. После курсов антибиотика и уросептика или одновременно с ними может быть назначен растительный лекарственный препарат Канефрон® Н, в состав которого входят части трех растений – корни любистока лекарственного, трава золототысячника и листья розмарина. Препарат оказывает противомикробное, противовоспалительное, спазмолитическое и диуретическое действие. Его применение может повысить эффективность комплексного лечения обострений и профилактической терапии рецидивов ИМС.
Ключевые слова: инфекция мочевой системы, пиелонефрит, Канефрон Н, дети
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The article discusses the issues of complex therapy of urinary tract infection (UTI) in children on the basis of a discussion of modern features of etiology, pathogenesis, and clinical manifestations. The emergence of microbial biofilms and the increasing resistance of pathogens that cause the development of UTI dictate the need to search for new methods of treatment. To overcome the persistence of bacteria and reinfection, rational antibiotic therapy is required, taking into account the sensitivity of the sown flora to antibiotics, the rejection of the use of long-term antibiotic prophylaxis, the elimination of organic and functional disorders of urodynamics, as well as the use of herbal medicines. If the child does not have severe abnormalities or there is a functional obstruction, then alternative methods should be considered as a preventive anti-relapse measure. After courses of antibiotic and uroseptic, or simultaneously with them, the herbal medicinal product Canephron® N can be prescribed, which contains parts of three plants – the roots of lovage, herb centaury and rosemary leaves. The drug has antimicrobial, anti-inflammatory, antispasmodic and diuretic effects. Its use can increase the effectiveness of complex treatment of exacerbations and preventive therapy for recurrent UTI.
Keywords: urinary tract infection, pyelonephritis, Canephron N, children
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1. Lellig E, Apfelbeck M, Straub J et al. Urinary tract infections in children. Urologe A 2017; 56 (2): 247–62.
2. Larcombe J. Urinary tract infection in children: recurrent infections. BMJ Clin Evid 2015; 2015.
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4. Clinical guidelines of the Russian Ministry of Health. Professional associations: Union of Pediatricians of Russia. Urinary tract infection in children. 2018 (in Russian).
5. Chugunova OL. Techenie infektsii mochevoi sistemy u detei rannego vozrasta na fone ostroi respiratornoi virusnoi infektsii. Effektivnaia farmakoterapiia. 2016; 44: 38–50 (in Russian).
6. Sorlózano-Puerto A, Gómez-Luque JM, Luna-Del-Castillo JD, et al. Etiological and Resistance Profile of Bacteria Involved in Urinary Tract Infections in Young Children. Biomed Res Int 2017; 2017: 4909452. DOI: 10.1155/2017/4909452
7. Korovina NA, Zakharova IN, Strachunskii LS, et al. Prakticheskie rekomendatsii po antibakterial'noi terapii infektsii mochevoi sistemy vnebol'nichnogo proiskhozhdeniia u detei (posobie dlia vrachei). Klin. mikrobiologiia i antimikrob. khimioterapiia 2002; 4 (4): 337–46 (in Russian).
8. Chugunova OL, Shumikhina MV, Dumova SV, Foktova AS. Osobennosti patogeneza, diagnostiki, techeniia infektsii organov mochevoi sistemy u novorozhdennykh i detei rannego vozrasta, vozmozhnosti terapevticheskoi korrektsii. Vestn. sovrem. klin. meditsiny. 2013; 6 (6): 119–28 (in Russian).
9. Chugunova OL, Shumikhina MV. Urinary tract infection in children: current issues. Effective pharmacotherapy. Pediatrics. 2015; 3: 10–21 (in Russian).
10. Shaikh N, Shope TR, Hoberman A, Vigliotti A еt al. Association Between Uropathogen and Pyuria. Pediatrics 2016; 138 (1). DOI: 10.1542/peds.2016-0087
11. Brubaker L, Wolfe A. The female uriniary microbiota, urinary health and common urinary disorders. Ann Transl Med 2017; 5 (2): 34.
12. Amarenco G. Microbiote urinaire et troubles mictionnels. Progrès en urologie 2015; 25: 615–27.
13. Dzhakipbekova ZK, Nesmeianova EP. Primenenie preparatov Tsitsibon i Kanefron n v profilakticheskom lechenii infektsii mochevyvodiashchikh putei. World science. 2016; 2 (1): 28–32 (in Russian).
14. Murugapoopathy V, McCusker C, Gupta IR. The pathogenesis and management of renal scarring in children with vesicoureteral reflux and pyelonephrotis. Ped Nephrol 2020; 35 (3): 349–57. DOI: 10.1007/s00467-018-4187-9
15. Mattoo TK, Chesney RW, Greenfield SP, et.al. RIVUR Trial Investigators (2016). Renal scarring in the randomized intervention for children with vesicoureteral reflux (RIVUR) Trial. Clin J Am Soc Nephrol 2016; 11: 54–61. DOI: 10.2215/CJN.05210515
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Авторы
О.Л. Чугунова*
ФГБОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России, Москва, Россия
*ol_chugunova@mail.ru
________________________________________________
Olga L. Chugunova
Pirogov Russian National Research Medical University, Moscow, Russia