Antibiotic therapy in children with ent diseases

Upper respiratory tract infections and ENT (ear, nose, throat) diseases account for a significant proportion of outpatient pediatric visits. At the same time, 40—60% of patients with acute respiratory infections (ARIs) receive antibacterial drugs, despite the fact that 80% of such diseases are of viral etiology and do not require antimicrobial therapy. The main risks of overprescribing antibiotics include the progressive growth of resistance among pathogenic microorganisms, long-term microbiota dysbiosis and increased incidence of adverse drug reactions. Objective. To systematize and analyze data on modern principles of antibiotic therapy in the treatment of ENT diseases in children. Material and methods. Materials from publications presented in the Medline, Embas, and PubMed databases are used in the review. Results. Modern studies demonstrate that strict adherence to clinical criteria of bacterial etiology is the basis of rational antibiotic therapy. Amoxicillin in high doses (80—90 mg/kg/day), effective against S. pneumoniae and H. influenzae, remains the first-line drug. Shortened courses of antibiotic therapy (5—7 days) are effective in uncomplicated infections in children over 2 years old, with the exception of tonsillopharyngitis caused by group A beta-hemolytic streptococcus. Such courses reduce the antimicrobial load and the frequency of side effects, while being non-inferior in clinical effectiveness to standard regimens. Conclusion. The current strategy requires a comprehensive approach including: accurate diagnosis of bacterial infection, a balanced choice of drug and dosage, individualization of treatment duration, systematic prescription monitoring, as well as consideration of the impact on the patient’s microbiome and population resistance.