ARVI PREVENTION IN CHILDREN AND ADULTS: HOW TO AVOID CONTACT WITH THE VIRUS

Few people realize that humans are the source of infection.

Accordingly, the best prevention of influenza and ARVI is to reduce the number of contacts. But since children go to kindergarten and school, adults go to work, many attend sections, absolutely everyone uses public transport and goes to shops, it is impossible to completely exclude communication. Accordingly, the most effective prevention method that excludes contact with carriers of viruses is difficult to implement.

Therefore, there are measures to prevent ARVI that reduce the risk of infection. It is important to realize that viruses are transmitted by airborne droplets and by contact. Therefore, the sick must take measures not to infect the healthy, and the healthy must take care of themselves.

A person with ARVI should do only two things:

1. Stay at home. Better prevention ARI and ARVI on the part of an infected person - excluding oneself for the duration of the illness from all social circles. So we do not spray our viruses, recover and return completely healthy to our duties: work, study, extracurricular activities.

2. Wear a mask.

If it is not possible to stay at home, and a runny nose and sneezing are still with us, it is worth taking care of others and wearing a mask. Since it accumulates viruses over time, it needs to be changed every 4 hours. During the period of illness, you do not need to shake hands, hug, kiss and otherwise contact with others. By the way, wearing a mask is unnecessary for healthy people. It is not designed to be protective because it cannot prevent the virus from entering the body.

Healthy people should not rely on the conscientiousness of the sick, they are also obliged to take preventive measures.

When the period of ARVI diseases begins, prevention in kindergarten, schools, public institutions is normal. It is aimed at reducing the concentration of viruses in the air, at reducing their activity.

Here basic preventive measures to prevent ARVI:

• Airing. Intensive air exchange reduces the number of viruses in the air, and with it the likelihood of getting sick. If there is a sick person in the house, you need to ventilate more often.
• Quartzization. UV rays kill viruses.
• Frequent hand washing.
• Wet cleaning using disinfectants.
• Treatment of common items with disinfectants (especially toys).

ARVI PREVENTION AND IMPROVING RESISTANCE TO VIRAL INFECTIONS

Prevention and treatment of influenza and ARVI can be carried out by strengthening immunity in three ways:

1. Vaccinations against ARVI. You need to understand that there are hundreds of viruses and it is impossible to get vaccinated against all of them, but it is still worth doing it against the most dangerous ones.

2. Immunotropic drugs for the prevention of ARVI. There are a great many of them and everyone decides which ones to choose, but it is better if they are vitamins, homeopathic medicines, bee products, phytoimmunomodulators, interferon inducers. For effective prevention of ARVI and influenza to take place, the drugs must be taken daily for the recommended period. If prevention of acute respiratory viral infections in children is needed, appropriate drugs are selected. Prevention of ARVI during pregnancy should be carried out only by those means that are safe for the fetus and mother.

3. Maintaining local immunity:

1. Frequent walks.
2. Compliance with personal hygiene.
3. Maintaining the optimum level of humidity, temperature, cleanliness in the premises.
4. Moisturizing the mucous membrane with saline solutions.

The term "frequently ill children" is widely known both among pediatricians and among nurses working with children, teachers, and parents. Despite serious research on this problem carried out by the leading pediatricians of our country, there are still a number of discrepancies both in terminology and in issues of etiology, pathogenesis, treatment, prevention and dispensary observation of this category of children.

I would like to draw your attention once again to the fact that when speaking of "frequently ill children" (sometimes the term "frequently and long-term ill child" is used), firstly, they mean children who often suffer from acute respiratory diseases, while the "acceptable" frequency respiratory infections depends on the age of the child, and secondly, these children do not have hereditary, congenital or chronic diseases, contributing to the frequent development of respiratory infections in them.

According to the definition of the national scientific and practical program "Acute respiratory diseases (ARI) in children: treatment and prevention" (2002), "Frequently ill children" (CFD) is not a diagnosis, but a group of dispensary observation, including children with frequent respiratory infections, arising from transient corrected deviations in the protective systems of the body, and not having persistent organic disorders in them. The increased susceptibility to respiratory infections in BWD is not associated with persistent congenital and hereditary pathological conditions. "

Domestic pediatricians up to now include children in the CHBD group on the basis of the criteria proposed by A. A. Baranov and V. Yu. Albitsky (table).

At the same time, some clinicians are of the opinion that if children early age, especially during the period of adaptation to the children's collective, acute respiratory viral infections (ARVI) are easy, the permissible frequency of diseases can reach up to 8 times a year.

It is well known that acute respiratory infections are the most common illnesses in both children and adults. But the highest incidence of respiratory infections is observed in preschool children attending organized groups. Frequent acute respiratory infections in children are currently not only a medical, but also a socio-economic problem.

On the other hand, contact and interaction with respiratory infections are necessary conditions for the formation of the child's immune system, the acquisition of immunological experience necessary for an adequate response to microbial aggression. However, frequent respiratory illnesses, one after the other, certainly have a negative effect on the child.

Thus, the allocation of the dispensary group of BHD is timely and relevant, but in each specific case, it is necessary to conduct a comprehensive examination of the child to clarify the reasons for his high level of respiratory morbidity. Dispensary observation of children in whom repeated episodes of respiratory infections are caused by persistent changes in immunity, congenital or hereditary diseases, should be carried out in strict accordance with the underlying disease.

The main causative agents of acute respiratory infections are various viruses, tropic to the epithelium respiratory tract and promoting their secondary colonization by bacteria. Viral infections damage the epithelium of the respiratory tract and cause mucosal inflammation. Inflammation of the respiratory tract is characterized by an increase in the production of viscous mucus, which is manifested by a runny nose and cough. A viscous secret promotes adhesion (adhesion) of pathogens of respiratory infections to the mucous membranes of the respiratory tract, which creates favorable conditions for the development of bacterial superinfection. In turn, microorganisms and their toxins impair the movement of cilia of the epithelium, disrupt the drainage functions of the bronchial tree, reduce the bactericidal properties of bronchial secretions and local immunological protection of the respiratory tract with high risk development of a protracted and chronic course inflammatory process... The damaged epithelium of the bronchi has an increased sensitivity of receptors to external influences, which significantly increases the likelihood of developing bronchospasm and bacterial superinfection.

The main bacterial pathogens of acute respiratory infections are pneumotropic microorganisms, incl. pneumococcus and other gram-positive cocci, bacillus hemophilus influenza, moraxella catarrhalis, atypical pathogens (mycoplasma, chlamydophila pneumonia), etc. It is believed that the primary viral infection often leads to the activation of endogenous opportunistic flora. The reason for the easier transformation of this microflora into a pathogenic one in a number of children is associated with the individual characteristics of the immune response, a violation of the barrier function of the respiratory tract, a decrease in local immunity, as well as superinfection with bacterial agents. The addition of a bacterial infection leads to an increase in the severity of the disease and may be the main cause of an unfavorable outcome of the disease. The nature of the clinical picture of acute respiratory infections is largely due to the pathogenic properties of the pathogen. However, it is known that the younger the child, the fewer specific signs the disease has.

Thus, infectious inflammation is the main pathogenetic link. clinical manifestations acute respiratory infections. The development of inflammation of the mucous membrane of the upper and lower respiratory tract contributes to the hypersecretion of viscous mucus, the formation of edema of the mucous membrane of the respiratory tract, disruption of mucociliary transport and bronchial obstruction. This leads to nasal congestion, nasal secretions, throat hyperemia, sore throat, tonsil edema, hoarseness, coughing, and other symptoms of acute respiratory disease, including laryngotracheitis and acute bronchitis. Some patients develop obstructive bronchitis.

Treatment

It is built according to the basic principles of treatment of acute respiratory diseases... There is a misconception that ARI can be left untreated - the disease "will pass" on its own. However, respiratory infections without adequate treatment often take a protracted or complicated course, a mild runny nose can result in severe pneumonia or sinusitis. Increasing the effectiveness of therapy for respiratory disease is of particular importance in frequently ill children. Of course, the treatment of acute respiratory infections should be comprehensive and built individually in each case.

It is known that until now there are no universal and safe chemotherapy drugs that are effective against most respiratory viruses. Antiviral chemotherapy drugs (ribavirin, etc.) in children are used only in severe ARVI of an established etiology. The use of antiviral ointments such as Oxolinova can be considered only as a prophylactic agent, and the appointment of drugs such as Remantadine is contraindicated for children in the first years of life due to its high toxicity and insufficient effectiveness.

Interferon preparations have found quite wide application in viral respiratory infections, which, as protective factors and means of maintaining immunity, have the widest spectrum of preventive and therapeutic action. Interferons are natural defense factors, that is, they are produced by the body itself when it comes into contact with infections of various origins (viruses, bacteria, fungi, etc.). Therefore, the use of interferon preparations is absolutely natural for humans. In addition, due to their biological characteristics of the effect on infectious agents, interferons are universal defenders, they are effective against all respiratory viruses. In addition to the antiviral and antimicrobial effects, interferon preparations increase their own defenses and prevent the harmful effects of radiation on the human body.

It is obvious that interferon preparations are widely used in practical health care. At first, these were preparations of leukocyte interferon obtained from donated blood. Subsequently, the development of biotechnology made it possible to create recombinant (genetically engineered) preparations of human interferons, in many respects superior to those of the first generation. Currently, there are quite a few preparations of recombinant interferons of both domestic and foreign production: Viferon, Reaferon, Grippferon, Realdiron, Intron A, Roferon-A, etc.

The most effective and safe in children are recombinant interferon preparations in combination with antioxidants, for example, the domestic drug "Viferon". Dosage forms of Viferon in the form of rectal suppositories (suppositories), gel and ointment provide a simple, safe and painless way of administering the drug, which is especially important in pediatrics and in outpatient treatment. Viferon protects cells from damage, activates the immune system, has antioxidant activity and prevents aging of the body. Viferon has not only strictly directed immunosubstitutional, but also quite broad immunomodulatory and protective effects. Viferon can be taken by everyone, including patients with allergies, pregnant women and children, including newborns and premature babies.

Immunocorrective and immunomodulatory drugs for acute respiratory infections provide both prophylactic and healing effect... There is convincing evidence of a high therapeutic effect in the treatment of children with influenza and acute respiratory viral infections of endogenous interferon inducers (Amiksin, Arbidol, Cycloferon). At the same time, Arbidol can be used in children from 2 years of age, Cycloferon is approved for use in children over 4 years old, and Amiksin - only in children over 7 years old. Of course, synthetic immunostimulants, drugs of thymic origin and some others have pronounced effects on the immune system, however, the decision on the need for their use, especially in children, should be made only after a clinical and immunological examination, clarification of the type of immune system dysfunction and in the presence of clear clinical and immunological indications. In this case, the therapy itself should be carried out with mandatory clinical monitoring and immunological control.

At the same time, increased susceptibility to respiratory infections in frequently ill children is not associated with immunopathological conditions, but arises in the overwhelming majority of cases due to transient deviations in the body's defense systems of multifactorial origin. According to the well-known children's immunologist Professor MN Yartsev, "it should be admitted that the targeted selection of immunocorrective drugs based on clinical and immunological examination of frequently ill children today, as a rule, is not feasible." This group of patients is recommended to prescribe herbal adaptogens, for example, preparations from Echinacea purpurea (Immunal, Immunorm), a combination of aloe and chokeberry (Bioaron C), bacterial lysates and their synthetic analogs (Broncho-Munal, IRS 19, Imudon, Likopid, etc.) , Ribomunyl (which does not contain bacterial lysates, but their ribosomes and fragments of the cell wall, which increases its effectiveness and safety), the use of which does not require preliminary immunological examination and is characterized by good tolerance, which significantly expands the possibilities of pharmacological immunocorrection during the recovery of frequently ill children.

A very effective immunomodulator is an increase in body temperature, when the synthesis of natural immune defense - interferons - is enhanced. Many microorganisms cannot reproduce at 38 ° C. Therefore, it is not recommended to lower the temperature to 39 ° C in adults and 38.5 ° C in children (we are talking about otherwise healthy people), unless the rise in temperature is accompanied by severe headache, aching muscles and joints. As antipyretic drugs in children, you can use only paracetamol or ibuprofen drugs. Complex anti-cold medications, contrary to the impression created by the advertising, do not treat a respiratory infection, but only alleviate its symptoms.

Antibiotic therapy with systemic antibiotics for acute respiratory infections is ineffective and is shown extremely rarely, in no more than 10% of all cases of the disease. Prescribing a systemic antibiotic without proper reason, the doctor increases the risk of side effects, disrupts microbiocenosis, contributes to a decrease in immunity and the spread of drug resistance. Local antibiotic therapy provides a direct effect on the site of infection, creates an optimal concentration of the drug and has no systemic side effects... One of the best local antibacterial drugs for the treatment of acute respiratory infections in children and adults is fuzafunzhin (Bioparox), which is unique due to its dual action: antibacterial and anti-inflammatory.

Inflammatory diseases of the respiratory tract are characterized by a change in sputum viscosity and a decrease in mucociliary clearance. If the peristaltic movements of the small bronchi and the activity of the ciliated epithelium do not provide the necessary drainage, a cough develops. Therefore, coughing is a protective reflex to restore airway patency. It is obvious that the need to suppress cough in children using true antitussive drugs from a pathophysiological standpoint is not justified. The goal of rational therapy is to thin the sputum, reduce its adhesiveness (viscosity) and thereby increase the effectiveness of the cough. To do this, use drugs that stimulate expectoration (phytopreparations, alkaline solutions) and mucolytics (bromhexine, ambroxol, acetylcysteine, etc.). These drugs improve mucociliary clearance and thus help to reduce inflammation of the mucous membranes of the respiratory tract.

However, the use of mucolytic and expectorant drugs in children with respiratory infection cannot always eliminate the “vicious circle” of bronchial inflammation. In recent years, fenspiride (Erespal), which has a pronounced tropism for the respiratory organs, has been successfully used as a nonspecific anti-inflammatory agent for respiratory diseases in children. The anti-inflammatory effect of Erespal improves mucociliary clearance and resolution of cough, reduces the effect of the main pathogenetic factors of respiratory infections, which contribute to the development of inflammation, mucus hypersecretion, hyperreactivity and bronchial obstruction. The drug is well tolerated by children of various age groups, including newborns, and, as a rule, does not cause side effects.

Acute respiratory infections in frequently ill children can sometimes be very difficult, with severe toxicosis, hyperthermia, acetone vomiting syndrome, broncho-obstructive syndrome. Treatment in this case should be based on the necessary syndromic therapy. In case of severe and / or complicated course, the child needs hospitalization and treatment in a hospital setting.

Thus, the treatment of acute respiratory diseases in frequently ill children is an urgent, but not an easy task. Complex therapy should be based on the main etiological and pathogenetic factors of the disease, and the use of modern pharmacological drugs ensures the effectiveness of the treatment. At the same time, timely preventive measuresopium can significantly reduce the incidence of respiratory infections in children.

Prevention

The best system for the prevention of acute respiratory diseases in frequently ill children is, of course, the formation of their own adequate immune response. This is facilitated by a healthy lifestyle, a rational daily regimen, good nutrition, and a variety of hardening programs.

Prevention of respiratory infections in frequently ill children involves limiting the child's contacts with patients with influenza and ARVI, carrying out sanitary and hygienic measures, reducing the use of city transport and lengthening the time the child spends in the air. Frequent respiratory morbidity is closely related to secondhand smoke, so stopping it is an important condition for treatment and prevention. All children prone to frequent respiratory infections should be examined and, if necessary, treated by an ENT doctor.

The main methods of increasing the child's resistance to infectious agents are hardening. Systematic contrast air or water hardening is accompanied by an increase in the body's resistance to temperature fluctuations in the environment and an increase in the body's immunological reactivity. The child's adaptive capabilities lend themselves well to training. The use of any hardening methods improves the work of the thermoregulation apparatus and expands the body's ability to adapt to changed temperature conditions. Hardening does not require much low temperatures, the contrast of the impact and the systematic nature of the procedures are important. Effects on the soles of the feet and, gradually, on the entire skin of the trunk and limbs are well tempered. The maximum duration of hardening procedures should not exceed 10-20 minutes, its regularity and gradualness are much more important. It was shown that in frequently ill children, the combination of local hardening procedures of the feet and nasopharynx restored the cytological parameters of the nasal secretion after 3-4 months. It is good to combine hardening procedures with gymnastics and massage chest... Hardening after a mild ARI can be resumed (or started) after 7-10 days, in case of a disease with a temperature reaction duration of more than 4 days - after 2 weeks, and after a 10-day fever - after 3-4 weeks. The effectiveness of hardening can be assessed not earlier than after 3-4 months, and the maximum effect is observed one year after the start of regular procedures.

Considering the leading role of immunity dysfunctions in the development of increased susceptibility of the child's body to respiratory infections, in addition to a complex of general strengthening measures for the purpose of prevention, a number of immunomodulatory drugs are used. At the same time, most authors emphasize that the use of immunomodulatory drugs in order to prevent respiratory infections in frequently ill children should be carried out against the background of mandatory adherence to the general principles of prevention and recovery.

So, there are recommendations for the seasonal course (1-2 times a year) use of recombinant interferon preparations (Viferon, Grippferon) in order to increase the nonspecific resistance of frequently ill children to acute respiratory diseases.

Through the activation of innate and adaptive immunity, the integrity of the mucous membranes is maintained and the development of full-fledged protection of the respiratory tract occurs. Of the means of non-specific prophylaxis, plant adaptogens are well known: Chinese magnolia vine, Eleutherococcus, ginseng, echinacea, leuzea. The most commonly used drugs obtained from echinacea (Immunal, Immunorm, Echinacin liquidum). Bioaron S (a combination of aloe and chokeberry) has proven itself well.

Interest in immunomodulatory drugs has increased. bacterial origin, which also has a vaccinal effect, which not only increase the activity of nonspecific immune defense factors, but also contribute to the formation of a specific immune response to the most significant pneumotropic bacterial pathogens. Among modern immunomodulators of bacterial origin, highly purified bacteriolysates, membrane fractions and ribosomal immunomodulator Ribomunil are distinguished, which does not include bacterial lysates, but their ribosomes and cell wall fragments (proteoglycans), which determines the high clinical and immunological efficiency and minimal reactogenicity of this drug, which combines properties of the vaccine and non-specific immunomodulator.

Often the question arises about the possibility of simultaneous calendar vaccination or influenza vaccination for children receiving treatment with bacterial vaccines. Special studies have shown that such a combination is not only possible, but also desirable, since it may be accompanied by an increase in the immune response. The combination of preventive vaccination with the beginning of treatment with bacterial vaccines is also quite justified.

In general, vaccination of frequently ill children is one of the most important preventive measures. Frequent ARVIs do not appear in the list of contraindications for vaccinations. Since frequent acute respiratory viral infections in this group of children do not indicate the presence of immunodeficiency, they cannot be a reason for withdrawal from vaccinations. At the end of ARVI, like other acute diseases, vaccinations can be carried out 2-3 weeks after the temperature has returned to normal.

In conclusion, it is necessary to emphasize once again that “frequently ill children” are a group of dispensary observation, quite numerous among preschool children living in ecologically unfavorable regions and attending preschool institutions. These children need regular comprehensive preventive measures, and with the development of an acute respiratory infection - timely and adequate therapy.

For literature questions, please contact the editorial office.

Influnet has antipyretic, analgesic, anti-congestive and antioxidant properties

Prevention and treatment of acute respiratory viral infections

Published in the journal:
"MEDICAL ADVICE"; No. 15; 2014; pp. 6-11.

Place of combination drugs

THEM. Kosenko, PhD, St. Petersburg State Pediatric Medical University, Ministry of Health of Russia

Acute respiratory viral infections (ARVI) - group infectious diseases viral etiology, characterized by damage to the respiratory tract, mainly in the upper parts, and the generality of clinical symptoms. The advances achieved by medicine in the field of infectious pathology have contributed to the development and improvement of methods for the prevention and treatment of diseases, but ARVI continues to remain a serious public health problem for most countries of the world due to the extremely high incidence rate, usually of the nature of seasonal epidemics.
Keywords:acute respiratory viral infections, prevention, treatment, combination drugs

In Russia, 30-40 million cases of infectious diseases are annually registered, in the structure of which 70% (in some years 90%) are influenza and acute infections of the respiratory tract of viral and unspecified etiology. The reasons for such a high incidence are considered to be the overcrowding of the population in large cities, poor ecology, high mobility of the population, incomplete vaccination coverage, low hygienic culture of people, and malnutrition.

ARVI occupies one of the leading positions in terms of the appealability of medical care for children and adults, temporary disability, the amount of drugs consumed during the period of illness. The high incidence of ARVI is associated with significant economic losses, primarily due to the indirect costs associated with disability. Children, the elderly, persons with concomitant diseases (various immunodeficiency states, diseases of the lungs, cardiovascular system, liver, kidneys, diabetes mellitus, etc.) are most susceptible to seasonal morbidity.

ARVI - polyetiologic diseases. Currently, more than 200 pathogens are known, however, rhinoviruses (30-50%) and influenza viruses (5-15%) are predominant, causing a high outbreak incidence in the autumn-winter period, much less often diseases are caused by adenoviruses, parainfluenza viruses, respiratory syncytial virus.

Influenza A and B viruses are of the greatest epidemic significance, causing annual epidemics, the economic losses from which amount to billions of dollars. In Russia, the annual total economic damage from influenza is estimated by experts at 40 billion rubles. Every year around the world 250-500 thousand people die from influenza. Numerous studies have shown a consistent link between influenza and acute myocardial infarction.

In some cases, viral infection predisposes to the development of complications, the most common of which are: otitis media (most often in children), sinusitis (in adults), exacerbation of chronic bronchitis / COPD or bronchial asthma.

ARVI is more often characterized by a mild short course, the most formidable infection is influenza. This is due to the fact that rhinoviruses mainly affect the epithelium of the upper respiratory tract, while influenza viruses have a tropism for the epithelium of the lower respiratory tract and can cause the development of acute tracheobronchitis and bronchiolitis. Pneumonia is a rare complication of rhinovirus infection, but it develops in 5-30% of patients with influenza A and 10% with influenza B.

Prevention of influenza and ARVI
Of course, isolation of a sick person remains an effective method of preventing influenza and ARVI. The most important route of transmission of infection, in addition to airborne, is contact (through a handshake, doorknobs, etc.). Therefore, not only wearing a mask bandage, but also frequent hand washing is an effective barrier to the spread of viruses. During the seasonal peak of the incidence, other general hygienic rules are also important - rinsing the nasal cavity, gargling with antiseptic solutions, as well as ventilating the premises, and, first of all, reducing the number of contacts with sources of infection.

Vaccination remains the most effective way to control seasonal influenza morbidity so far. There is no vaccine effective against rhinovirus infection. Influenza vaccines, depending on the manufacturing technology, are divided into two classes: live and inactivated. Live vaccines are administered intranasally, the traditional route of administration for inactivated vaccines is subcutaneous or intramuscular injection. Despite the promising non-invasive route of administration and the low cost of live vaccines, their use is limited due to their high reactogenicity (the development of infection symptoms - headache, fever, malaise), allergenicity and a number of contraindications (age over 50, acute diseases, diseases of internal organs, immunosuppression, etc.). In this regard, inactivated vaccines are recommended for mass prevention of influenza. The most important requirement for the vaccines used is the compliance of the antigenic composition with the influenza virus strains relevant in the given epidemiological season. The optimal time for vaccination is the autumn period - from September to November.

Before the beginning of the epidemiological season, persons over the age of 50 must be vaccinated; patients of any age suffering from chronic bronchopulmonary and cardiovascular diseases, diabetes mellitus, kidney disease and any immunosuppressive conditions; persons in nursing homes; women in the II and III trimesters of pregnancy; family members of patients belonging to the above risk groups; medical staff of medical institutions.

Drugs with a direct effect on the influenza virus (M2 channel blockers amantadine and rimantadine and neuraminidase inhibitors oseltamivir and zanamivir) are used for emergency prevention of influenza.

M2 channel blockers are active against the influenza A virus. Due to the better tolerability in clinical practice, it is advisable to use rimantadine. Its preventive effectiveness during seasonal outbreaks of influenza reaches 70-90%. In addition, studies have shown that the use of rimantadine is also associated with a 25% reduction in the incidence of influenza-like infections. The disadvantage of this group is the rapidly developing resistance of the virus to them and a number of possible undesirable phenomena (nausea, loss of appetite, dizziness, insomnia; among the contraindications are acute liver and kidney diseases). In this regard, the use of rimantadine should not be long-term (for prevention, it is recommended to use 50 mg 1 time per day for 10-15 days). It is important that against the background of the rest antiviral agents rimantadine is the most beneficial economically.

Neuraminidase inhibitors (oseltamivir, zanamivir) act on both influenza A and B viruses. Oseltamivir is available in capsule form. Prophylactic intake is allowed from 12 years of age: 75 mg daily 1 time per day for at least 10 days. The drug has a good safety profile, the observed adverse events (headaches, nausea, diarrhea, etc.) most often do not require withdrawal. Zanamivir is available only in inhalation form, therefore it is not used for prophylaxis.

The widespread use of neuraminidase inhibitors is limited by their high cost. In addition, increasing resistance of influenza viruses to these drugs has been reported in various regions of the world.

The prophylactic effectiveness of antiviral agents during an outbreak is high and reaches 70-80%. Chemoprophylaxis can be administered to both immunized and unvaccinated individuals.

Antiviral prophylaxis is indicated in the following cases: 1) as an addition to late vaccination of at-risk individuals in the first 2 weeks. after vaccination (for the period of antibody production); 2) for children who are vaccinated for the first time: taking drugs is indicated for 6 weeks. after the first vaccination (the final production of antibodies ends by 2 weeks after the second vaccination); 3) for persons with immunodeficiency who may give an insufficient immune response to vaccination; 4) for persons for whom vaccination is contraindicated (allergic reactions to chicken protein); 5) in the elderly, for whom the effectiveness of vaccination decreases and reaches 50-70%, as an addition to vaccination; 6) for unvaccinated persons in contact with sick relatives and neighbors; 7) when there is a threat of a pandemic (administration of neuraminidase inhibitors is indicated); 8) if the antigenic composition of the vaccine used does not match the epidemic situation.

Rhinoviruses mainly affect the epithelium of the upper respiratory tract, while influenza viruses have a tropism for the epithelium of the lower respiratory tract and can cause the development of acute tracheobronchitis, bronchiolitis.

The main disadvantage of vaccination and specific antiviral prophylaxis - action limited only to influenza viruses, there is no protection against other pathogens of ARVI. A promising direction of prevention is the use of funds to activate the body's nonspecific resistance. At the same time, domestic health care is characterized by the frequent use of drugs with unproven clinical efficacy. Echinacea preparations have a weak interferonogenic effect, and no serious studies of various adaptogens (ginseng, eleutherococcus, aralia, etc.) have been carried out for the prevention of respiratory infections.

It is justified to believe that prophylactic intake of vitamins, in particular ascorbic acid, can reduce the likelihood of illness in people exposed to physical and mental stress.

At present, the use of interferons (IFN) preparations for the prevention of viral infections seems to be the most proven. It is known that the IFN system is a natural defense system of the body, the main role of which is inhibition of viral replication. There are three main types of interferons - IFN-α, IFN-β and IFN-γ. Each of them in varying degrees has antiviral, immunomodulatory, antitumor and antiproliferative effects, but the most pronounced antiviral effect is provided by INF-α. Previously, the practice of prophylactic intranasal use of human leukocyte interferon-α (IFN) was widespread. However, the high incidence of adverse events ( bloody discharge from the nose, flu-like symptoms, drowsiness, allergic reactions, etc.) reduced the value of this method. Now in the arsenal of the doctor there are recombinant forms of IFN, characterized by a good safety profile. The prophylactic efficacy of intranasal IFN has been proven in a number of studies and confirmed by the results of meta-analysis. Therefore, their use can be recommended for the prevention of ARVI.

Another promising method of prevention is the use of drugs that induce endogenous IFN, the potential of which is associated with the formation in the human body of its own IFN in concentrations that have antiviral activity and circulate for a long time. The use of inducers of endogenous IFN is more physiological than exogenous interferon, which inhibits the production of its own IFN. According to the data of individual Russian studies, IFN inducers have demonstrated high effectiveness in the prevention of ARVI. But to determine the practical value of this group of drugs in the prevention of acute respiratory viral infections, further placebo-controlled studies are required.

The use of interferon and its inducers is most relevant in the pre-epidemic period in unvaccinated patients with high risk factors for complications (immunosuppression, diabetes mellitus, cardiovascular and chronic pulmonary diseases); in persons who often suffer from respiratory viral infections; as an additional treatment along with the recommended specific antiviral agents of the above categories of patients.

Treatment of influenza and ARVI
Specific antiviral therapy (using the M2-channel blocker rimantadine and neuraminidase inhibitors oseltamivir, zanamivir) is possible only for influenza.

Rimantadine is used to treat influenza A during epidemics in adults and children from 2 years of age and older, and also has an antitoxic effect in influenza B. Experience of mass use over the past 20 years has shown its effectiveness, especially when administered early in the first days of the disease. A number of randomized and placebo-controlled studies have shown that the use of rimantadine leads to a reduction in the duration of influenza symptoms, a decrease in the severity of the disease and the incidence of complications. For the purpose of treatment, rimantadine is prescribed 100 mg 2 times a day. Due to the possibility of adverse events, the duration of treatment should not exceed 3-5 days. ...

Oseltamivir, according to clinical studies, reduces the duration of influenza symptoms, the severity of its course, the incidence of complications and even mortality. In this regard, its use is recommended primarily in elderly patients and in the presence of risk factors for the development of complications (cardiovascular and chronic pulmonary diseases, diabetes mellitus, renal failure, neurological disorders, immunosuppression). The scheme for the treatment of influenza in adults is 75 mg 2 times a day.

Zanamivir is used only in inhalation form. For the treatment of influenza, inhalation of the drug through the mouth is used, using a dischaler. Among the adverse events of the drug are headache, dizziness, nausea, diarrhea, sinusitis, sore throat, bronchospasm, but, as a rule, zanamivir is well tolerated by patients.

The use of neuraminidase inhibitors is most justified in elderly patients, as well as in patients with risk factors for the development of complications (cardiovascular and chronic pulmonary diseases, diabetes mellitus, renal failure, neurological disorders, immunosuppression), as well as in the case of suspected infection with influenza H5N1 and H1N1 viruses. Evidence is emerging that the H1N1 (swine flu) virus is highly resistant to oseltamivir, while most strains remain susceptible to zanamivir.

Certain prospects in the treatment of ARVI are associated with the use of agents to activate the nonspecific resistance of the organism. But if the evidence of the preventive action of recombinant interferons looks convincing, then the therapeutic effect of drugs of this group in ARVI looks unproven and requires further study.

An important problem is the use of antibacterial drugs for ARVI. Antibiotics are widely prescribed to prevent bacterial complicationsthat with ARVI is unjustified. At the same time, systemic antibiotic therapy can be accompanied by a number of undesirable phenomena, and its administration without indications leads to an increase in the antibiotic resistance of microorganisms.

The appointment of antibiotics for ARVI is indicated only with the development of bacterial complications (sinusitis, otitis media, pneumonia). It is advisable to use drugs from the aminopenicillin group, including inhibitor-protected, macrolides or respiratory fluoroquinolones.

Clinical manifestations of ARVI include a wide range of symptoms - general toxic (fever, headache, weakness, lethargy, pain in muscles, joints, etc.) and local (nasal congestion, runny nose, sore throat, cough, etc.), which suggests simultaneous use of drugs from different pharmacological groups - antipyretic algesics, decongestants, etc.

For the relief of fever, headache and myalgia in acute respiratory viral infections and influenza, paracetamol and ibuprofen are recommended as the safest remedies. In connection with the emergence of evidence of the hepatotoxic effect of paracetamol, especially in persons taking alcohol, there were recommendations to reduce the dose of the drug to 1-1.5 g / day. Application acetylsalicylic acid should be limited due to the high risk of gastrointestinal bleeding. This drug is also contraindicated in patients under 18 years of age with respiratory infection due to the possible development of Reye's syndrome (encephalopathy with hepatic failure and high mortality) and in patients with bronchial asthma. The use of metamizole (analgin) should also be limited due to the high risk of agranulocytosis.

The appointment of antibiotics for ARVI is indicated only with the development of bacterial complications (sinusitis, otitis media, pneumonia)

Indications for the appointment of antipyretics:

fever above 38.5 ° C (risk of damaging the nervous system);

fever above 38 ° C in patients with diseases of the cardiovascular system and respiratory system, the course of which may worsen as a result of an increase in oxygen demand;

fever above 38 ° C in children under 5 years of age (risk of developing febrile seizures);

poor tolerance to fever.

Antipyretics are prescribed only "on demand", course reception is not shown.

Influenza viruses have a toxic effect on the vascular system. Due to an increase in vascular permeability, fragility of their walls and impaired capillary circulation, hemorrhagic syndrome develops. In this regard, ARVI (influenza) therapy includes agents that strengthen the walls of blood vessels: rutin, ascorbic acid, calcium salts.

Decongestants (local for intranasal use or systemic) are used to relieve nasal congestion and rhinorrhea. Long-acting local drugs are recommended - xylometazoline, oxymetazoline for a short time (no more than 3-5 days). The only recommended oral systemic decongestant is phenylephrine (a selective α1-adrenergic agonist). Due to a number of side effects (agitation, anxiety, irritability, tremors; dizziness and headache; arterial hypertension, pain in the heart and arrhythmias), phenylephrine is inappropriate to prescribe to working patients, motorists and people with pathology of the cardiovascular system. For the development of serious adverse events, a dose of 40-60 mg is required.

Antihistamines of the 1st generation (pheniramine, chlorpheniramine) have a drying effect on the nasal mucosa, as well as an antitussive effect, but their use is associated with a pronounced sedative effect, which does not allow their use in socially active patients, motorists, etc. Loratadine is one of the most famous antihistamines of the second generation, has a higher antihistaminic activity than drugs of the first generation, due to the greater affinity with peripheral H 1 -receptors. The drug has no sedative effect and does not potentiate the effect of alcohol.

A cough that has developed against the background of a viral infection most often does not require the appointment of antitussive drugs, therefore the use of cough suppressants - codeine, dextromethorphan - is not recommended in the early stages of the disease. Their use is possible only in case of sleep disturbance as a result of an indomitable cough. The most physiological method is hydration - frequent drinking of warm solutions, air humidification. In the case of viscous sputum (smokers, patients with chronic obstructive pulmonary disease), therapy with mucolytic agents (acetylcysteine, ambroxol) is advisable.

In order to reduce dryness, soreness in the throat, rinsing with warm solutions is most effective, it is possible to use local antiseptics / anesthetics.

Such a variety of drugs for the treatment of acute respiratory viral infections is accompanied by frequent cases of uncontrolled use of drugs, especially non-steroidal anti-inflammatory drugs (NSAIDs), antitussives without the necessary indications, which ultimately is accompanied by a number of undesirable phenomena and complications of the disease. Due to the fact that the patient, as a rule, has several manifestations of respiratory tract damage, the problem of polypharmacy comes to the fore in ARVI therapy. Often, such patients receive up to 5-7 symptomatic drugs. The consequences of this tactic of pharmacotherapy are the development of adverse events, low adherence of patients to treatment due to the need to follow often complex drug regimens, lengthening the recovery time, complicating the course of the disease and increasing financial costs for patient treatment and economic losses in healthcare. Such an abundance of drugs from different pharmacological groups, the presence of many analogs seem inconvenient for any category of patients, both from the point of view of choosing the most optimal treatment method and from an economic standpoint.

Therefore, in recent years, combination drugs have become widespread. Their advantage is the presence of almost all the necessary active ingredients for the complex therapy of diseases in one form. The ability to simultaneously act on many symptoms of acute respiratory viral infections and influenza infection is convenient for the patient, beneficial from an economic point of view (costs are less than with therapy with several symptomatic agents), and is characterized by a lower risk of adverse events due to the formulation selected and tested in clinical trials. The combination agent should be used only if there are several symptoms at the same time, and the choice of such a drug is based on the correspondence of the symptoms of the disease and the active ingredients in the composition drug.

In the early stages of the disease, the strategy of using complex multicomponent drugs is determined by the need to influence the primary links of the pathogenesis of acute respiratory viral infections (i.e., the immune system and metabolic disorders), the subsequent further progression of clinical manifestations. Taking combined drugs against the background of a detailed clinical picture of the disease is aimed primarily at alleviating the patient's condition and eliminating or reducing the severity of symptoms of the infectious process that are different in the mechanisms of occurrence.

The main requirement for a combined agent is the presence of no more than three active ingredients from different pharmacological groups and no more than one active substance from each pharmacological group. Moreover, each active ingredient must be present in an effective and safe concentration.

The combined preparation Influnet® deserves attention. Each component in the carefully selected composition of this drug performs its function. Paracetamol - the safest analgesic-antipyretic - reduces fever and eliminates pain. In order to relieve rhinorrhea, the composition of the combined agent includes a selective α1-adrenergic agonist phenylephrine, which has a vasoconstrictor effect, due to which there is a decrease in edema and hyperemia of the nasal mucosa, the airways are released, the pressure in the middle ear and in the paranasal sinuses is normalized. At a dose of 10 mg (standard dosage in a combined agent), phenylephrine causes the release of blocked nasal passages in patients with rhinitis at 15, 30 and 60 minutes by 11, 21 and 38%, respectively. And in Influnet®, due to the presence of succinic acid, the dosage of phenylephrine was reduced by half to 5 mg without loss of effectiveness. Ascorbic acid is involved in the regulation of redox processes, promotes normal capillary permeability, blood clotting, tissue regeneration, plays a positive role in the development of the body's immune responses; rutoside is an angioprotector, reduces capillary permeability, swelling and inflammation, strengthens the vascular wall; inhibits aggregation and increases the degree of deformation of erythrocytes. Succinic acid in combination with ascorbic acid and rutoside forms a powerful antioxidant complex that serves as a regulator of the immune system; stimulates physiological and biochemical recovery processes; has a hepatoprotective effect; enhances the overall positive effect and reduces the toxic effects of drugs.

The drug is available in two dosage forms - capsules and powder for preparation of a solution for oral administration (different tastes) - and has antipyretic, analgesic, angioprotective and decongestant effects, i.e., it realizes pathogenetic and symptomatic effects.

The ability to simultaneously act on many symptoms of ARVI and influenza infection is convenient for the patient, beneficial from an economic point of view (costs are less than with therapy with several symptomatic agents), is characterized by a lower risk of adverse events

At the same time, the main method effective treatment influenza, which makes it possible to reduce the duration of the symptoms of infection, the severity of its course and the frequency of complications, as proven in a number of controlled studies, is the use of antiviral drugs. Recognition of the central role of the inflammatory response of the "host" in the formation of the clinical picture of ARVI makes it advisable to use antiviral and anti-inflammatory drugs in combination, preferably in the form of a ready-made combination, which will undoubtedly reduce treatment costs and increase compliance. On the Russian pharmaceutical market, there is currently a combined drug AnviMax®, which implements an integrated approach - both symptomatic and pathogenetic, and etiotropic treatment of influenza infection due to the presence of an antiviral component in the formulation - the M2 channel blocker rimantadine. Taking it at the first symptoms of a respiratory viral infection can shorten the duration of the disease and reduce the incidence of complications. The use of these funds is most effective in the first two days from the onset of the disease, so the implementation of this approach in a combined preparation looks attractive.

In the structure of the drug, in addition to paracetamol, ascorbic acid and rutozide, there is a modern II generation antihistamine loratadine, which prevents the development of tissue edema associated with the release of histamine, and calcium gluconate, which also prevents the development of increased permeability and fragility of blood vessels that cause hemorrhagic processes in influenza and ARVI. The components of the drug provide antiviral, interferonogenic, antipyretic, analgesic, angioprotective and antihistamine effects. AnviMax ® has two dosage forms - powder for oral solution preparation (different tastes) and capsules. Moreover, the dosage form in the form of capsules allows the use of the drug in patients with a respiratory infection that occurs without a pronounced febrile or pain syndrome, when the appointment of an antipyretic analgesic is not required. After all, even safe paracetamol has a number of side effects, and its use without indications is impractical. The idea of \u200b\u200bsafety was successfully implemented in the combined preparation AnviMax ®, in which paracetamol is isolated in a separate blue capsule, which allows it to be taken only if indicated. In addition, the dosage of paracetamol 360 mg (daily - 1,080 mg) in the formulation of this product meets modern safety requirements. It is recommended to take the drug for no more than 5 days.

Analyzing the results of the studies, it can be concluded that the drug AnviMax ® has shown its effectiveness in the treatment of acute respiratory viral infections, as evidenced by the dynamics of the healing process of patients, as well as a reduction in the duration of negative symptoms. Treatment of patients with COPD in the phase of exacerbation of the disease with AnviMax® prevents the development of severe exacerbation (purulent bronchitis) in most of them, reduces the need for antibiotics and helps to shorten the bed-day (it is advisable to use it in case of infection with a viral infection, which is common reason exacerbation of COPD, especially in the autumn-winter period of the year). The use of AnviMax ® was well tolerated. No side effects were reported in any case.

Studies have shown that AnviMax ® is a promising drug for the treatment of ARVI patients in comparison with symptomatic complex drugs that do not contain an antiviral component, since it promotes rapid relief of the main symptoms of the disease, increases nonspecific immunity, is safe, well tolerated, and convenient to use.

Thus, combined drugs are highly effective drugs for ARVI pharmacotherapy.

LITERATURE

1. Selkova E.P. Prevention and treatment of acute respiratory viral infections. Application of amiksin. A guide for doctors. M., 2004.
2. Zharkova N.E. Symptomatic treatment of ARVI: the future belongs to the combined drugs. Russian medical journal, 2007, 22: 1636.
3. Namazova LS, Botvinyeva VV, Torshkhoeva RM, et al. Immunomodulatory therapy for frequently ill children in megacities. M., 2005.
4. Kuzin V.B., Lovtsova L.V., Barsuk A.L. Study of the clinical efficacy and tolerability of Antigrippin-Maximum in the treatment of ARVI (influenza). Outpatient Handbook, 2010, 1: 3-7.
5. Kuznetsova O.Yu., Pleshanova Zh.V. The place of modern combined drugs in the treatment of acute respiratory viral infections in outpatient practice. Consilium medicum, 2012, 3: 74-83.
6. Zaitsev A.A. Areas of pharmacotherapy and prevention of acute respiratory viral infections. Rus. Honey. zhurn, 2009, 17 (23): 1525.
7. Jefferson T, Demicheli V, Rivetti D, Jones M, Di Pietrantonj C, Rivetti A. Antivirals for influenza in healthy adults: a systematic review. Lancet 2006, 367 (9507): 303-13.
8. Melchart D, Linde K, Fischer P, Kaesmayr J. Echinacea for the prevention and treatment of the common cold. Cochrane Review, latest version 16 November 1998, In: The Cochrane Library, Oxford: Update Software.
9. Simasek M, Blandino D. Treatment of the Common Cold.
10. Ershov F.I., Kiselev O.I. Interferons and their inducers (from molecules to drugs). M .: GEOTAR-Media, 2005.
11. Jefferson TO, Tyrrell D. Antivirals for the common cold. The Cochrane Database of Systematic Reviews 2005 Issue 3.
12. Shumilov V.I., Shuster A.M., Lobastov S.P. et al. The effectiveness of arbidol in the prevention and treatment of acute respiratory viral infections in military personnel. Military medical zh., 2002, 323 (9): 51-3.
13. Malyshev N.A., Kolobukhina L.V., Merkulova L.N., Ershov F.I. Modern approaches to increasing the effectiveness of therapy and prevention of influenza and other acute respiratory viral infections Consilium Medicum 2005, 10 (10).
14. Jefferson T, Demicheli V, Deeks JJ, Rivetti D Amantadine and rimantadine for preventing and treating influenza A in adults (Cochrane Review) From The Cochrane Library, Issue 2, 2004. Chichester, UK: John Wiley & Sons, Ltd. All rights reserved.
15. Calfee DP, Hayden FG. New approaches to influenza chemotherapy: neuraminidase inhibitors. Drugs 1998, 56: 537-553.
16. Belousov Yu.B., Gurevich K.G., Zyryanov S.K. The effectiveness and safety of modern analgesics.
17. Merlo J, Broms K, Lindblad U et al. Association of outpatient utilization of non-steroidal anti-inflammatory drugs and hospitalized heart failure in the entire Swedish population. Eur J Clin Pharmacol 2001,57: 71-5.
18. Gwaltney JM Jr, Druce HM. Efficacy of chlorpheniramine maleate treatment for rhinovirus colds. Clin Infect Dis 1997, 25: 1188-94.
19. Korppi M, Laurikainen K et al. Antitussives in the treatment of acute transient cough in children. Acta Paediatr Scand, 1991, 80: 969-71.
20. Zaitsev A.A. Analysis of combined drugs for the treatment of ARVI. Pharmateca, 2009, 12: 77-82.
21. Chuchalin A.G., Avdeev S.N., Arkhipov V.V. and other Rational pharmacotherapy of respiratory diseases. A guide for medical practitioners. M .: Litterra, 2004.
22. Lowenstein SR, Parrino TA. Management of the Common Cold. Adv Inter Med 1987,32: 207-34.
23. Rothberg M, Bonner A, Rajab M et al. Effects of Local Variation, Specialty, and Beliefs on Antiviral Prescribing for Influenza. Clin Infect Dis. 2006,42: 95-9.

Keywords: acute respiratory infections, viruses, antiviral drugs, vaccination, immunomodulators

Keywords: acute respiratory infections, viruses, antiviral preparations, vaccination, immunomodulators

The issues of prevention, diagnosis and treatment of acute infectious respiratory diseases in children have always been and remain in the focus of pediatricians.

Acute respiratory infections (ARI) are the most common infectious pathology in children, characterized by a seasonal fall-winter rise and the ability to cause disease outbreaks in organized groups. The term "acute respiratory infection" encompasses a wide variety of diseases caused by various respiratory pathogens. The predominant place of reproduction and pathogenic effects of respiratory pathogens is the mucous membrane of the upper respiratory tract, however, the infection covers the entire respiratory tract, from the nasal passages to the terminal bronchioles and alveoli, which ultimately determines the clinical manifestations of the disease. Depending on the topic of the lesion of the respiratory tract, it is customary to distinguish various variants of infection of the upper (rhinitis, nasopharyngitis, tonsillopharyngitis, etc.) and lower (laryngo-tracheitis, tracheitis, bronchitis, pneumonia) respiratory tract. In most (90%) cases in which it is possible to detect pathogens by cultural, serological or molecular genetic methods, respiratory viruses are the cause of the development of ARI, which justifies the use of the term "acute respiratory viral infection (ARVI)", in other cases, acute respiratory infections have bacterial or viral-bacterial nature (table).

Table. The main groups of pathogens of ARI in children

Group	Causative agents
Respiratory viruses	Influenza (A, B), parainfluenza, adenoviruses, respiratory syncytial virus (RS virus), rhinoviruses, coronaviruses
Intra- and extracellular pathogens	Chlamidophila pneumonia, Ch. trachomatis, Mycoplasma pneumoniae, M. hominis, Pneumocystis spp.
Herpesviruses	Herpes type 1, 2, Epstein-Barr virus (EBV) type 4, cytomegalovirus (CMV) type 5, herpes type 6
Representatives of endogenous microflora	Staphylococci, streptococci, enterococci, etc.
Bacterial pathogens of ENT organs and the respiratory tract	Pneumococcus, Haemophilus influenzae, Moraxella, Staphylococcus aureus, Escherichia coli, Klebsiella
Other pathogens	Legionella, bocavirus, metapneumovirus

The causative agents of acute respiratory infections of viral etiology are representatives of different viral families, many viruses are heterogeneous in their antigenic structure and have several serotypes, which can greatly complicate clinical diagnosis, since this, in turn, determines the variety of clinical manifestations of the same infection. One of the most common are rhinoviruses (more than 100 strains of the pathogen are known), which cause disease in more than a third of ARVI cases. Along with rhinoviruses, the causes of acute respiratory infections are adenoviruses, parainfluenza viruses, respiratory syncytial virus (RS virus), enteroviruses, and during epidemic outbreaks - influenza viruses.

Currently, according to domestic and foreign studies, there are features of the epidemiology and etiological structure. acute infections respiratory tract. In recent years, especially in the last 5 years, a unique epidemiological situation with influenza has developed in the world. It is due to the fact that the world's population is simultaneously threatened by circulating strains of seasonal influenza A (H1N1), A (H3N2). Moreover, in recent years, a situation has developed when two evolutionary lines of the influenza B virus are relevant, which, unfortunately, do not provide cross-uniform immunity and create a problem in terms of the possibility of mismatching the strain composition of seasonal vaccines. The pandemic influenza A (H1N1) pdm09 virus continues to remain relevant, with a real threat of widespread spread bird flu A (H5N1), A (H7N9) and reassortant influenza A (H3N2) swl. In addition, in recent years, many studies have been devoted to the role of such "new" infections as coronavirus, bocavirus and metapneumovirus, which in the structure of respiratory viral morbidity, according to various sources, range from 10 to 20% (especially in combination with other respiratory viruses) ...

Today it is already known that not only influenza viruses and the RS virus, but also rhinoviruses, adenoviruses, human metapneumovirus, as well as herpes viruses and atypical ones, are important etiological agents in the development of infections of the upper respiratory tract, as well as bronchiolitis and pneumonia, croup and exacerbation of bronchial asthma. pathogens. For example, the pathogens of community-acquired pneumonia, along with the most significant pathogen for this pathology, Streptococcus pneumoniae, can be both the RS virus and rhinoviruses. Moreover, if for adults with community-acquired pneumonia of viral etiology, influenza viruses, coronaviruses and adenoviruses are most often relevant, then in children the spectrum of etiologically significant viral pathogens of pneumonia is much wider and viral and viral-bacterial associations are more often found.

Acute respiratory infections due to the high risk of developing complications at any time from the onset of the disease are a serious health problem, especially in children. But the most serious illness along the course and the risk of developing complications of all ARIs is influenza. Every year, even during seasonal outbreaks of influenza alone, up to 5 million people fall ill in the world, mortality from influenza during epidemics in different age groups ranges from tens to hundreds of cases, and during a pandemic the figure can reach 1000 cases per 100 thousand population. The results of an 8-year epidemiological study conducted by the Centers for Disease Control and Prevention (CDC) between October 2004 and September 2012 in the United States showed that the risk of death from influenza is high for both chronically ill and healthy children. ... According to the study, more than a third of children with influenza died before hospitalization, within 3 days from the onset of the first symptoms of the disease, the average age of the patients who died was 7 years (probable deviation: 1-12 years). Of the 794 influenza-related deaths, 43% of children were not at increased risk of illness. At the same time, these studies confirmed an increased risk of complications, including a high mortality rate among children with concomitant diseases: 33% of children who died had neurological pathologies and 12% had genetic or chromosomal abnormalities. The authors emphasize that the timely administration of anti-influenza drugs could reduce the severity of the disease and complications, however, only less than half of the children who died had information on the appointment of anti-influenza chemotherapy.

Effective method prevention of infections is vaccination - active immunization, leading to the development of specific immunity to infectious agents. Currently, vaccination is carried out against such respiratory pathogens as influenza, pneumococcal and hemophilus influenza (Hib) infections. Due to persistent genetic and antigenic changes in influenza viruses, the World Health Organization (WHO) recommends annual vaccination before the start of the season.

Specific prophylaxis of influenza is carried out by vaccines, which are prepared from the actual strains of the virus recommended by WHO for the new epidemic season, the composition of the vaccines contains 3 strains: 2 - subtypes A / H1N1 /, A / H3N2 / and 1 - influenza B virus. In addition, in the season 2013-2014 in the USA, Canada and a number of European countries were approved for use, including in children, 4-component vaccines containing 4 strains: 2 of each subtype of influenza A and B.

Today, an important point in the prevention of respiratory infections in children is the possibility of vaccination against hemophilic and pneumococcal infections, which are the cause of acute infectious diseases in children, mainly under the age of 5 years, and also associated with severe bacterial complications of influenza and ARVI. The results of a recent study of the prevalence of community-acquired pneumonia and acute otitis media in children under 5 years of age in Russia, conducted as part of the PAPIRUS (Prospective Assessment of Pneumococcal Infection in Russia) program, confirmed the high incidence of these diseases and demonstrated the leading role of Streptococcus pneumoniae and Haemophilus influenzae in their development. Analysis of epidemiological studies on the prevalence of various serotypes of pneumococcal pathogen in Russia at present, identification of antibiotic-resistant strains in all age groups allowed the authors to conclude that the widespread use of modern conjugated pneumococcal vaccines as part of the immunization program will solve this serious problem of domestic health care and significantly reduce the incidence given nosological forms.

Passive immunoprophylaxis of MS viral infection with immunoglobulin palivizumab (Sinagis) in our country has recently been carried out for children from high risk groups for the development of severe lower respiratory tract infections. According to foreign publications, monthly administration of palivizumab during the period of circulation of the RS virus among the population leads to a 50% decrease in the number of severe infections in children of risk groups requiring hospitalization, compared with placebo.

For seasonal prevention of acute infectious diseases of the respiratory system, methods of nonspecific activation of the immune system are also used with the use of immunomodulatory pharmaceuticals, for example, bacterial vaccines and synthetic immunomodulators. Bacterial vaccines - immunomodulators of microbial origin: purified bacterial lysates (IRS19, Imudon, Bronchomunal, Bronchovaxom), combined immunocorrectors containing bacterial antigens and nonspecific immunomodulators LPS and proteoglycan (Ribomunil, Immunovac VP-4) and semisynthetic analogs : specific (vaccinating) and non-specific (immunostimulating). Of the synthetic immunomodulators used are azoxymer bromide (Polyoxidonium), pidotimod (Imunorix), inducers of interferon tilorone (Amiksin).

In addition to vaccination as the main strategy for combating influenza, WHO recommends the use of etiotropic chemotherapy drugs that block the functional activity of the virus at different stages of its replicative cycle. Drug prophylaxis of influenza and ARVI is prescribed as an addition to late vaccination for people at risk in the first 2 weeks after vaccination (during the period of antibody formation); children who are vaccinated for the first time (since the formation of antibodies ends by the 2nd week after the second vaccination); patients with chronic pathology, accompanied by immunodeficiency, in whom, as a result of vaccination, an insufficient immune response is formed; persons for whom influenza vaccination is contraindicated (for example, in case of an allergic reaction to previous vaccinations); unvaccinated persons after contact with a sick person. Drug prevention of influenza and SARS effectively complements vaccination and, when used during influenza epidemics, can significantly reduce morbidity and mortality from infection. The WHO recommendations are the same for seasonal and pandemic influenza, but require compliance with the conditions of frequency and duration of antiviral drug intake. It is not recommended to carry out chemoprophylaxis later than 48 hours from the moment of contact with the patient. Post-exposure chemoprophylaxis is effective only if taken daily in recommended dosages for at least 7 days after contact with the patient. For newly vaccinated people, the recommended duration of chemoprophylaxis is at least 2 weeks, that is, until the formation of specific immunity (for children, the period may increase depending on age and vaccination history).

The vast domestic pharmaceutical market requires a clear understanding of the criteria for choosing an etiotropic drug. Antiviral chemotherapy drugs have a direct effect on viral reproduction and are aimed at a specific virus-specific target in the cycle of viral reproduction. The use of exclusion criteria - and this is the absence of a proven mechanism of action, the absence of a direct effect on one of the viral replication links, the impossibility of achieving a therapeutic concentration of the drug in the blood plasma - makes it possible to clearly limit the range of effective antiviral agents. In pediatric practice, neuraminidase inhibitors - oseltamivir (Tamiflu) in children from 1 year old, zanamivir (Relenza) - from 5 years old, and an inhibitor of virus-cell fusion umifenovir (Arbidol) - from 3 years old are used for chemoprophylaxis and therapy of influenza. Preparations of rimantadine, which blocks the M2 channels of the virion of the influenza A virus and is not active against the influenza B virus, are currently not recommended by WHO for use due to the high prevalence of drug-resistant virus strains. Unlike neuraminidase inhibitors, umifenovir is active not only against influenza A and B viruses, but also against a number of other pathogens of ARVI, is used both as a means for seasonal prevention of ARVI, and as a means of emergency prevention of not only influenza, but also ARVI in children's groups, in family foci, including in pregnant women who have been in contact with patients, preventing the development of severe forms of the disease in them.

The complex of preventive measures, in addition to vaccination and pharmacoprophylaxis, includes general strengthening measures aimed at reducing the antigenic effect and increasing the resistance of the child's body as a whole - a rational daily regimen, optimal nutrition, hardening procedures, sanitation of local foci of chronic infection; the appointment of vitamin and mineral complexes. The use of a set of these measures makes it possible to reduce the frequency of acute infectious respiratory diseases and exacerbations of foci of chronic infection.

Bibliography:
1. Baranov A.A., Namazova-Baranova L.S., Ilyin A.G., Bulgakova V.A., Antonova E.V., Smirnov I.E. Scientific research in pediatrics: directions, achievements, prospects. Russian Pediatric Journal, 2013, No. 5, p. 4-14.
2. Acute respiratory diseases in children: treatment and prevention. A guide for doctors. Scientific and practical program / Ed. A.A. Baranova, B.S. Kaganova, A.V. Gorelova. M .: OOO "Publishing house" Dynasty "", 2004, 39 p.
3. Savenkova M.S. The many faces of acute respiratory infection: from the main pathogens to the choice of drugs. Attending physician, 2011, No. 3, p. 58-64.
4. Williams J.V., Harris P.A, Tollefson S.J. et al. Human metapneumovirus and lower respiratory tract disease in other-wise healthy infants and children. N. Engl. J. Med., 2004; 35 (5): 443-450.
5. Wenzel R.P., Fowler AA 3rd. Clinical practice: Acute bronchitis. N. Engl. J. Med. 2006; 355 (20): 2125-2130.
6. Kozulina I.S., Samsygina G.A., Isaeva E.I. Metapneumovirus is one of the leading viruses that cause respiratory illness in children. Pediatrics. Journal them. G.N. Speransky, 2011; 90 (2): 108-113.
7. Kondratyeva T.Yu. Human bocavirus is a recently discovered virus associated with acute respiratory infections. Epidemiology and Vaccine Prevention, 2008; 3: 31-40.
8. Bulgakova V.A., Balabolkin I.I., Cern ^ a T.B. Respiratory viral infection in children and adolescents with allergic pathology. Children's infections, 2005, vol. 4, no. 4, p. 17-24.
9. Pavia AT. Viral Infections of the Lower Respiratory Tract: Old Viruses, New Viruses, and the Role of Diagnosis. Clinical Infectious Diseases. 2011; 52 (4): S284-289.
10. Bulgakova B.A., Balabolkin I.I., Sentsova T.B. Herpetic infection I and II types in children with allergic diseases. Children's infections, 2006, vol. 5, no. 1, p. 18-21.
11. Bulgakova V.A., Zubkova I.V. Chlamydial and mycoplasma infections in children with atopic bronchial asthma. Infectious diseases, 2008, vol. 6, no. 3, p. 56-60.
12. Ruuskanen O., Lahti E., Jennings L.C., Murdoch D.R. Viral pneumonia. Lancet, 2011; 377 (9773): 1264-75.
13. Juven T., Mertsola J., Waris M., Leinonen M., Meurman O., Roivainen M., Eskola J., Saikku P., Ruuskanen O. Etiology of community- acquired pneumonia in 254 hospitalized children. Pediatr. Infect. Dis. J., 2000; 19 (4): 293-8.
14. Kim S.S., Spichak T.V., Yatsyshina S.B., Katosova L.K., Great-grandfather M.N., Zubkova I.V. The role of viruses in community-acquired pneumonia in children. Diagnostic issues in pediatrics, 2012; 4 (4): 21-25.
15. Kokoreva SP, Sakharova LA, Kuprina H. P. Etiological characteristics and complications of acute respiratory infections in children. Questions of modern pediatrics, 2008; 7 (1): 47-50.
16. Baranov A.A., Albitsky V.Yu., Ilyin A.G. On the reserves of reducing the mortality rate of the child population of Russia. Questions of modern pediatrics, 2006, vol. 5, no. 5, p. 5-7.
17. Karpova L.S., Ishkina E.R., Stolyarov K.A., Popovtseva N.M., Stolyarova T.P., Zabaykin A.V. Mortality from somatic and infectious diseases and its correlation with the incidence of influenza and ARVI in the population of St. Petersburg (2004-2010). Epidemiology and Vaccine Prevention, 2012; 4: 29-36.
18. Wong K.K., Jain S., Blanton L., Dhara D., Brammer L., Fry AM., Finell L. Influenza- Associated Pediatric Deaths in the United States, 2004-2012. Pediatrics. Published online October 28, 2013.doi: 10.1542 / peds.2013-1493.
19. Immunomodulators and vaccination / Ed. M.P. Kostinova, I. L. Solovieva. Moscow: 4Mpress, 2013, 272 p.
20. Kozlov R.S., Krechikova O.I., Muravyev A.A., Mironov K.O., Platonov A.E., Dunaeva E.A., Tatochenko V.K., Shcherbakov M.E., Rodnikova V.Yu., Romanenko V.V., Safyanov K.N. Results of a study of the prevalence of community-acquired pneumonia and acute otitis media in children under 5 years of age in Russia (PAPIRUS). The role of S. pneumoniae and H. influenzae in the etiology of these diseases. Clinical microbiology and antimicrobial chemotherapy, 2013, vol. 15, no. 4, p. 246-260.
21. Tatochenko V., Sidorenko S., Namazova-Baranova L., Mayanskiy N., Kulichenko T., Baranov A, Lobzin Yu., Kharit S., Kozlov R., Andreeva I., Muravjev A., Chagaryan A, Koroleva I., Beloshitskiy G., Mironov K., Degtyareva E., Reinert RR. Streptococcus pneumoniae serotype distribution in children in the Russian Federation before the introduction of pneumococcal conjugate vaccines into the National Immunization Program. Expert Review of Vaccines. 2014 Feb; 13 (2): 257-264. doi: 10.1586 / 14760584.2013.871205.
22. Kuznetsova A. V., Rusakova I. V., Sitdikova I. V., Khaertynova A. R., Pirogova F. S., Netfullova L. F., Zakirov K. Z. Experience of using the drug palivizumab (Sinagis) for passive immunoprophylaxis of RSV infection in bronchopulmonary dysplasia in young children. Practical Medicine, 2012, No. 7 (62), p. 187-188.
23. Carbonell-Estrany X., Simoes E.A, Dagan R., Hall C.B., Harris B., Hultquist M., Connor E.M., Losonsky G.A Motavizumab for prophylaxis of respiratory syncytial virus in high-risk children: a noninferiority trial. Pediatrics, 2010 Jan; 125 (1): e35-51. doi: 10.1542 / peds. 2008-1036.
24. Bulgakova V.A., Balabolkin I.I., Sentsova T.B., Katosova L.K., Ryleeva I.V., Yukhtina N.V., Bashilova N.V. The use of topical immunotropic drugs for intercurrent infections in children with allergic pathology. Pediatric Pharmacology, 2006, vol. 3, no. 4, p. 56-62.
25. Immunotherapy / Ed. R.M. Khaitova, R.I. Ataullakhanov. M .: GEOTAR-Media, 2011, 672 p.
26. Leneva I.A., Maksimov M.L. Etiotropic agents in the treatment of influenza: exclusion criteria. Outpatient Doctor's Handbook, 2009; 9: 3-5.
27. Bulgakova V.A., Khanova N.I., Antonova E.V., Molochkova O.V. Therapeutic and prophylactic efficacy of a domestic antiviral drug in pediatrics. Pediatrics. Journal them. G.N. Speransky, 2013, vol. 92, no. 3, p. 78-85.
28. Belokrinitskaya T.E., Liga V.F., Trubitsyna A.Yu., Tarbaeva D.A. Medical prevention of influenza in pregnant women. Issues of gynecology, obstetrics and perinatology, 2012; 11 (4): 31-36.

Oleg Nikolaevich Inozemtsev,

diagnostician, pediatrician

ARI - what is it?

ARI, or acute respiratory disease (ARI) is a huge group of diseases, the main route of transmission of which is airborne. All these diseases are caused by various microorganisms and viruses (respiratory viral: ARVI, influenza, enterovirus, coronavirus, bacterial (chlamydial and mycoplasma)), have a different clinical picture, but they all have the same pathogenesis (development mechanism) and epidemiology.

Clinical symptoms of the disease

The clinical signs of the disease depend on the pathogen under the influence of which the infection was caused. The baby's breathing may change, becoming heavier. Various rashes may appear on the child's body. The baby's eyes are watery and may fester. In addition, the general condition of the child changes: the baby loses appetite, he becomes lethargic and whiny, and anxiety may appear. Later, a cough joins, the body temperature rises, a runny nose appears, and the stool may change.

How to proceed?

When the above symptoms appear in the baby, it is necessary to take certain measures for the treatment and further prevention of acute respiratory diseases. The basic principles of prevention and treatment of acute respiratory diseases are contained in an integrated approach. They should include specific vaccine prophylaxis (for influenza), strengthening the body's defenses (immunity) (bacterial immunomodulators, interferons, herbal adaptogens) and the main therapy for these diseases (antibiotics according to indications, expectorants, antipyretic drugs).

It should not be forgotten that preventive measures for ARI are the main task in those risk groups, which include children.

They begin to “fight” acute respiratory diseases by reducing contacts between infants and young children. First of all, this should be done during the seasons of increasing respiratory morbidity. For these purposes, it is necessary to reduce the use of urban transport, walk in the fresh air as long as possible, wear masks and more often wash the hands of family members where there is a child with acute respiratory infections.

More easy flow ARI can be achieved using hardening.

For the purpose of immunoprophylaxis of acute respiratory infections, it is necessary to use vitamins or food additives containing vitamins, trace elements, adaptogens based on plant components. Vitamin preparations must be taken in accordance with the age dosage. Vitamins are given to children 2-3 times a day for 20-30 days, after meals. In preschool institutions, it is common to give out rosehip syrup to children, 1 teaspoon daily. It is especially advisable to give rosehip syrup in the cold seasons. It can be replaced by adding vitamin C (ascorbic acid) to tea, compote, 40-50 mg per 200 ml (glass).

Courantil is a good immunomodulatory drug. It can be used as a prophylaxis for acute respiratory infections and used once a week, one tablet 2 times a day. The prophylaxis course lasts 5–6 weeks. As a correction of immunity, agents with a tonic and fortifying effect are used: tincture of Manchurian aralia, extract of Eleutherococcus.

What about antibiotics?

You can often hear about the appointment of antibacterial drugs for acute respiratory infections, allegedly for the prevention of bacterial complications. Antibiotics are not effective in this regard. Besides, antibacterial drugs inhibit the growth of sensitive microflora, thereby opening the "gate" for the settlement of the airways with a stable microflora. This increases the frequency of complications by about 2.5 times, primarily otitis media (inflammation of the middle ear) and pneumonia.

Non-specific prophylaxis

As a non-specific prevention of acute respiratory infections, basic health-improving measures are used, which include hardening procedures, exercise, massage, sleeping with open windows, gargling with cool water. Bathing and, in general, water procedures contribute to general hardening and, accordingly, the prevention of acute respiratory infections.

If a child is in a medical and prophylactic or any health institution, special attention should be paid to the rational ventilation of the premises. In such a room, wet cleaning should be carried out using chlorine-containing preparations. You need to expose the room to ultraviolet radiation. In wards, staff should use four-layer gauze masks. These masks need to be changed every 3-4 hours.

The main directions in the prevention of acute respiratory infections in young children

Don't forget that breast-feeding the child helps to maintain specific and non-specific protective factors. Therefore, breastfeeding is one of the main measures for the prevention of acute respiratory infections.

Elimination (removal) of the causative agent of the disease should be ensured by using intranasal drops (sprays), for example, "Aqua Maris". Such nasal drops allow mechanically (washing) to remove pathogenic microflora from the mucous membrane of the upper respiratory tract.

The antiviral activity of the body will be improved by interferons, which help to increase the resistance of the child's body by activating macrophages and natural killer cells. As interferons, leukocyte interferon and recombinant alpha-interferon for intranasal use have proven themselves well; alpha2-interferon in the form of rectal suppositories. The use of interferons is a common treatment for the prevention of acute respiratory infections in newborns and infants.

Non-specific prevention of acute respiratory infections involves the use of herbal immunotropic drugs, or adaptogens. This includes the use of preparations based on echinacea, sea buckthorn leaves, tea tree oil, ginseng. But we must remember that these drugs can cause allergic reactions, so they must be used with caution. Also, immunotropic drugs cannot be used in premature newborns, since they have functional immaturity of the kidneys, and this is a contraindication to the appointment of adaptogens.

The question of the use of immunomodulators of bacterial origin and their synthetic analogues - such as "Broncho-Munal", "IRS19", "Likopid", which stimulate the activation of nonspecific defense cells of the body, is being considered. But it has not yet been proven that they contribute to the development of specific immunity, therefore, they have not found wide application in the treatment and prevention of acute respiratory infections in newborns.

In a severe course of acute respiratory disease, immunoglobulin preparations for intravenous administration can be used in complex therapy in young children. They contain active antibodies against common infectious agents. This group includes drugs such as intraglobin, octagam, endobulin, sandoglobulin, pentaglobin.

Antiviral chemotherapy drugs, such as arbidol, remantadine, ribavirin, amiksin, zanamivir, deyitiforin, oseltamivir, can be used with great age restrictions, since their effect on young children has not been sufficiently studied.

Specific prophylaxis of acute respiratory diseases, in particular influenza vaccination, can be carried out from six months of age. Vaccination against Haemophilusinfluenzae type b infection is possible from only three months, and vaccination against pneumococcal infection can be done from the age of two.

Applying timely measures to prevent acute respiratory infections in young children, it is possible to make the course of acute respiratory infections easy and reduce the likelihood of morbidity in the future.