The role of topical therapy in the complex treatment of tonsillopharyngitis in children

Acute tonsillopharyngitis is a common disease (2–5% of paediatric outpatient visits) for which systemic antimicrobials are often prescribed. However, streptococcal tonsillopharyngitis, infection caused by group A beta-hemolytic streptococci (GABHS), is one of the main indications for antibiotic therapy in acute tonsillopharyngitis in children. When developing a treatment regimen for the disease, preference is given to topical therapy (except in cases of streptococcal tonsillopharyngitis), and the topical antimicrobial therapy methodology recognises that laryngospasm may occur in young children, and the microbiome of the oral cavity and pharynx may need correction in frequently ill children after intensive antimicrobial therapy. Aerosol therapy in the form of inhalation of pharmacological agents that have higher chemical and physical activity than their liquid counterparts due to larger total surface area of the dispersed phase is the optimal method for delivering pharmacological agents into the oral cavity and pharynx. In recent years, a new generation antiseptic benzyldimethyl-myristoylamino-propylammonium chloride has become increasingly common. It showed pronounced activity against Gram-positive and Gram-negative bacteria, fungi, complex viruses, including the SARS-CoV-2 coronavirus, protozoa, aerobic, anaerobic flora in the form of monocultures and microbial associations, including strains with multiple antibiotic resistance. This antiseptic agent refers to drugs of low-toxicity, and does not have any local irritating, allergenic, mutagenic, carcinogenic or embryotoxic effect. It has been identified as having immunoadjuvant effect. The review of clinical observations showed that an aerosolized form of benzyldimethyl-myristoylaminopropylammonium chloride had a favourable clinical effect in patients with tonsillopharyngitis of both streptococcal and other, in particular viral, etiology. The aerosolized form of the drug provides a wide spray angle and finely dispersed diffusion, as opposed to a spraying device, due to which the drops of the drug cover the mucous membrane in a more accurate way. The findings of the analysis of systematic reviews on the etiology, clinical picture and diagnosis of acute tonsillopharyngitis, updates on the oropharynx microbiocenosis and methods for its correction, and clinical studies on the efficacy and safety of the aerosolized form of benzyldimethyl-myristoylamino-propylammonium chloride have led to the conclusion that its application as topical therapy is useful for the treatment of acute tonsillopharyngitis in children.