antibioticsАнтибиотики и ХимиотерапияAntibiot Khimioter = Antibiotics and Chemotherapy0235-2990ООО «Издательство ОКИ»antibiotics-183Research ArticleВ ПОМОЩЬ ПРАКТИКУЮЩЕМУ ВРАЧУGUIDELINES FOR PRACTITIONERSРациональная этиотропная терапия инфекций верхних дыхательных путей. Проблемы резистентности внебольничных микроорганизмовRational Etiotropic Treatment of Upper Respiratory Tract Infections. Problems of Antibiotic Resistance of Community-Acquired InfectionsКарповИ. А.KarpovI. A.СоловейН. В.SoloveyN. V.Белорусский государственный медицинский университетБеларусьBelarusian State Medical UniversityBelarus201808052020639-101925Copyright © ООО «Издательство ОКИ», 20202020ООО «Издательство ОКИ»ООО «Издательство ОКИ»https://www.antibiotics-chemotherapy.ru/jour/about/submissions#copyrightNoticehttps://www.antibiotics-chemotherapy.ru/jour/article/view/183

В статье представлены современные данные по антибиотикорезистентности и этиологии острых инфекций верхних дыхательных путей (тонзиллофарингита, риносинусита, среднего отита), рассмотрены возможности клинической дифференциации между бактериальным и вирусным генезом данных заболеваний, приведены рекомендации по обследованию пациентов и выбору рациональной антимикробной терапии.

The article presents current data on antibiotic resistance and etiology of acute upper respiratory tract infections (tonsillopharyngitis, rhinosinusitis, otitis media); it discusses the possibilities of clinical differentiation between the bacterial and viral etiology of these diseases, provides recommendations on diagnosis and antimicrobial therapy.

тонзиллофарингитриносинуситсредний отитамоксициллинамоксициллин/клавуланатмакролидыцефалоспориныtonsillopharyngitisrhinosinusitisotitis mediaamoxicillinamoxicillin/clavulanatemacrolidescephalosporinsReferencesHong C.-Y. et at. Acute respiratory symptoms in adults in general practice. Family Practice 2004; 21: 3: 317—323.Hong C.-Y. et at. Acute respiratory symptoms in adults in general practice. Family Practice 2004; 21: 3: 317—323.Teng C.L. Antibiotic prescribing for upper respiratory tract infections in the Asia-Pacific region: A brief review. Malaysian Family Physician: The Official Journal of the Academy of Family Physicians of Malaysia 2014; 9: 2: 18-25.Teng C.L. Antibiotic prescribing for upper respiratory tract infections in the Asia-Pacific region: A brief review. Malaysian Family Physician: The Official Journal of the Academy of Family Physicians of Malaysia 2014; 9: 2: 18-25.Cantrell R., Young A.F., Martin В. С Antibiotic prescribing in ambulatory care settings for adults with colds, upper respiratory tract infections, and bronchitis. Clinical Therapeutics 2002; 24:1:170—182.Cantrell R., Young A.F., Martin В. С Antibiotic prescribing in ambulatory care settings for adults with colds, upper respiratory tract infections, and bronchitis. Clinical Therapeutics 2002; 24:1:170—182.Shapiro D.J. et at. Antibiotic prescribing for adults in ambulatory care in the USA 2007-09. Antimicrob Chemother 2014; 69:1: 234-240.Shapiro D.J. et at. Antibiotic prescribing for adults in ambulatory care in the USA 2007-09. Antimicrob Chemother 2014; 69:1: 234-240.Keneaty Т., Arroll B. Antibiotics for the common cold and acute purulent rhinitis. The Cochrane Database of Systematic Reviews 2013; 6: CD000247.Keneaty Т., Arroll B. Antibiotics for the common cold and acute purulent rhinitis. The Cochrane Database of Systematic Reviews 2013; 6: CD000247.Coenen S. etal. Appropriate international measures for outpatient antibiotic prescribing and consumption: recommendations from a national data comparison of different measures.. J Antimicrob Chemother 2014; 69: 2: 529-534.Coenen S. etal. Appropriate international measures for outpatient antibiotic prescribing and consumption: recommendations from a national data comparison of different measures.. J Antimicrob Chemother 2014; 69: 2: 529-534.Zoorob R. et at. Antibiotic use in acute upper respiratory tract infections. //American Family Physician 2012; 86: 9: 817—822.Zoorob R. et at. Antibiotic use in acute upper respiratory tract infections. //American Family Physician 2012; 86: 9: 817—822.KociolekL.K, Shuiman S. T. In the clinic. Pharyngitis. Annal Intern Med 2012; 157: 5: ITC3-1-ITC3-16.KociolekL.K, Shuiman S. T. In the clinic. Pharyngitis. Annal Intern Med 2012; 157: 5: ITC3-1-ITC3-16.Ebell M.H. et at. The rational clinical examination. Does this patient have strep throat? JAMA 2000; 284: 22: 2912-2918.Ebell M.H. et at. The rational clinical examination. Does this patient have strep throat? JAMA 2000; 284: 22: 2912-2918.Shuiman S. T. et at. Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clin Infect Dis 2012; 55:10: E86-102.Shuiman S. T. et at. Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clin Infect Dis 2012; 55:10: E86-102.Amess J.A. et at. A six-month audit of the isolation of Fusobacterium necrophorum from patients with sore throat in a district general hospital. Brit J Biomed Science 2007; 64: 2-63-65.Amess J.A. et at. A six-month audit of the isolation of Fusobacterium necrophorum from patients with sore throat in a district general hospital. Brit J Biomed Science 2007; 64: 2-63-65.Jensen A., Hagelskjaer Kristensen L., PragJ. Detection of Fusobacterium necrophorum subsp. funduliforme in tonsillitis in young adults by realtime PCR. Clin Microbiol Infect 2007; 13: 7: 695-701.Jensen A., Hagelskjaer Kristensen L., PragJ. Detection of Fusobacterium necrophorum subsp. funduliforme in tonsillitis in young adults by realtime PCR. Clin Microbiol Infect 2007; 13: 7: 695-701.Hedin K. et at. The aetiology of pharyngotonsillitis in adolescents and adults — Fusobacterium necrophorum is commonly found. Clin Microbiol Infect 2015; 21: 3: 263:1-7.Hedin K. et at. The aetiology of pharyngotonsillitis in adolescents and adults — Fusobacterium necrophorum is commonly found. Clin Microbiol Infect 2015; 21: 3: 263:1-7.Center R.M. et at. The clinical presentation of Fusobacterium-positive and streptococcal-positive pharyngitis in a university health clinic: a cross-sectional study. Annal Intern Med 2015; 162: 4: 241—247.Center R.M. et at. The clinical presentation of Fusobacterium-positive and streptococcal-positive pharyngitis in a university health clinic: a cross-sectional study. Annal Intern Med 2015; 162: 4: 241—247.Klug Т.Е. etal. A systematic review of Fusobacterium necrophorum-positive acute tonsillitis: prevalence, methods of detection, patient characteristics, and the usefulness of the Centor score. Eur J Clinical Microbiol Infect Dis 2016; 35:12:1903-1912.Klug Т.Е. etal. A systematic review of Fusobacterium necrophorum-positive acute tonsillitis: prevalence, methods of detection, patient characteristics, and the usefulness of the Centor score. Eur J Clinical Microbiol Infect Dis 2016; 35:12:1903-1912.Bjork H. et at. Tonsillar colonisation of Fusobacterium necrophorum in patients subjected to tonsillectomy. BMC Infect Dis 2015; 15: 264.Bjork H. et at. Tonsillar colonisation of Fusobacterium necrophorum in patients subjected to tonsillectomy. BMC Infect Dis 2015; 15: 264.Riordan T. Human infection with Fusobacterium necrophorum (Necrobacillosis), with a focus on Lemierre's syndrome. Clin Microbiol Rev 2007; 20: 4: 622-659.Riordan T. Human infection with Fusobacterium necrophorum (Necrobacillosis), with a focus on Lemierre's syndrome. Clin Microbiol Rev 2007; 20: 4: 622-659.Centor RM. etal. The diagnosis of strep throat in adults in the emergency room. Medical Decision Making: An Intern J Soc Med Dec Making 1981; 1:3: 239-246.Centor RM. etal. The diagnosis of strep throat in adults in the emergency room. Medical Decision Making: An Intern J Soc Med Dec Making 1981; 1:3: 239-246.Mclsaac W.J. et al Empirical validation of guidelines for the management of pharyngitis in children and adults. JAMA 2004; 291:13:1587—1595.Mclsaac W.J. et al Empirical validation of guidelines for the management of pharyngitis in children and adults. JAMA 2004; 291:13:1587—1595.ESCMID Sore Throat Guideline Group et al. Guideline for the management of acute sore throat. ESCMID Sore Throat Guideline Group et al. Clin Microbiol Infect 2012; 18 Suppl 1:1-28.ESCMID Sore Throat Guideline Group et al. Guideline for the management of acute sore throat. ESCMID Sore Throat Guideline Group et al. Clin Microbiol Infect 2012; 18 Suppl 1:1-28.Fine A.M., Nizet V., Mandl K.D. Improved diagnostic accuracy of group A streptococcal pharyngitis with use of real-time biosurveillance. Ann Intern Med 2011; 155: 6: 345-352.Fine A.M., Nizet V., Mandl K.D. Improved diagnostic accuracy of group A streptococcal pharyngitis with use of real-time biosurveillance. Ann Intern Med 2011; 155: 6: 345-352.Snow V.etal Principles of appropriate antibiotic use for acute pharyngitis in adults. Ann Intern Med 2001; 134: 6: 506-508.Snow V.etal Principles of appropriate antibiotic use for acute pharyngitis in adults. Ann Intern Med 2001; 134: 6: 506-508.Kolukirik M. et al. Development of a fast and low-cost qPCR assay for diagnosis of acute gas pharyngitis. Ann Clin Microbiol Antimicrob 2016; 15:1:46.Kolukirik M. et al. Development of a fast and low-cost qPCR assay for diagnosis of acute gas pharyngitis. Ann Clin Microbiol Antimicrob 2016; 15:1:46.Pritt B.S. et al Point-Counterpoint: A Nucleic Acid Amplification Test for Streptococcus pyogenes Should Replace Antigen Detection and Culture for Detection of Bacterial Pharyngitis. J Clin Microbiol 2016; 54: 10: 2413-2419.Pritt B.S. et al Point-Counterpoint: A Nucleic Acid Amplification Test for Streptococcus pyogenes Should Replace Antigen Detection and Culture for Detection of Bacterial Pharyngitis. J Clin Microbiol 2016; 54: 10: 2413-2419.Holm K. et al. The role of Fusobacterium necrophorum in pharyngotonsillitis — A review / K. Holm et al. Anaerobe 2016; 42: 89—97.Holm K. et al. The role of Fusobacterium necrophorum in pharyngotonsillitis — A review / K. Holm et al. Anaerobe 2016; 42: 89—97.Tanz RR. et al. Community-based surveillance in the united states of macrolide-resistant pediatric pharyngeal group A streptococci during 3 respiratory disease seasons. Clin Infect Dis 2004; 39: 12: 1794—1801.Tanz RR. et al. Community-based surveillance in the united states of macrolide-resistant pediatric pharyngeal group A streptococci during 3 respiratory disease seasons. Clin Infect Dis 2004; 39: 12: 1794—1801.Syrogiannopoulos G.A. et al. Seven-year surveillance of emm types of pediatric Group A streptococcal pharyngitis isolates in Western Greece. PloSOne2013;8:8:E71558.Syrogiannopoulos G.A. et al. Seven-year surveillance of emm types of pediatric Group A streptococcal pharyngitis isolates in Western Greece. PloSOne2013;8:8:E71558.Pichichero M.E. et al. Penicillin failure in streptococcal tonsillopharyngitis: causes and remedies. Pediatr Infect Dis J 2000; 19: 9: 917—923.Pichichero M.E. et al. Penicillin failure in streptococcal tonsillopharyngitis: causes and remedies. Pediatr Infect Dis J 2000; 19: 9: 917—923.Pichichero M.E., Casey JR. Systematic review of factors contributing to penicillin treatment failure in Streptococcus pyogenes pharyngitis Otolaryngology. Head and Neck Surgery 2007; 137: 6: 851—857.Pichichero M.E., Casey JR. Systematic review of factors contributing to penicillin treatment failure in Streptococcus pyogenes pharyngitis Otolaryngology. Head and Neck Surgery 2007; 137: 6: 851—857.Adam D. Hostalek V., Troster K. 5-day cefrxime therapy for bacterial pharyngitis and/or tonsillitis: comparison with 10-day penicillin V therapy. Cefixime Study Group. Infection 1995; 23: Suppl 2: S83-86.Adam D. Hostalek V., Troster K. 5-day cefrxime therapy for bacterial pharyngitis and/or tonsillitis: comparison with 10-day penicillin V therapy. Cefixime Study Group. Infection 1995; 23: Suppl 2: S83-86.Pichichero M.E., Casey J.R. Bacterial eradication rates with shortened courses of 2nd- and 3rd-generation cephalosporins versus 10 days of penicillin for treatment of group A streptococcal tonsillopharyngitis in adults. Diagnostic Microbiol Infect Dis 2007; 59: 2:127—130.Pichichero M.E., Casey J.R. Bacterial eradication rates with shortened courses of 2nd- and 3rd-generation cephalosporins versus 10 days of penicillin for treatment of group A streptococcal tonsillopharyngitis in adults. Diagnostic Microbiol Infect Dis 2007; 59: 2:127—130.Fokkens W.J. etal. EPOS 2012: European position paper on rhinosinusitis and nasal polyps 2012. A summary for otorhinolaryngologists. Rhinology 2012; 50: 1:1-12.Fokkens W.J. etal. EPOS 2012: European position paper on rhinosinusitis and nasal polyps 2012. A summary for otorhinolaryngologists. Rhinology 2012; 50: 1:1-12.Gonzales R et al. Principles of appropriate antibiotic use for treatment of nonspecific upper respiratory tract infections in adults: background. Ann Intern Med 2001; 134: 6: 490-494.Gonzales R et al. Principles of appropriate antibiotic use for treatment of nonspecific upper respiratory tract infections in adults: background. Ann Intern Med 2001; 134: 6: 490-494.Chow A. W etal. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. Clin Infect Dis 2012; 54: 8: E72-ell2.Chow A. W etal. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. Clin Infect Dis 2012; 54: 8: E72-ell2.Страчуиский Л. С, Тарасов АА., Крюков АН. и др. Возбудители острого бактериального риносинусита. Результаты многоцентрового микробиологического исследования SSSR. Клин микробиол антимикроб химиотер. — 2005. — №4. — С. 337—349. / Strachunskiy L.S., Tarasov АА, Kryukov AL i dr. Vozbuditeli ostrogo bakteriafnogo rinosinusita. Rezuftaty mnogotsentrovogo mikrobiologicheskogo issledovaniya SSSR. Klin mikrobiol antimikrob khimioter 2005; 4:337—349. [in Russian]Страчуиский Л. С, Тарасов АА., Крюков АН. и др. Возбудители острого бактериального риносинусита. Результаты многоцентрового микробиологического исследования SSSR. Клин микробиол антимикроб химиотер. — 2005. — №4. — С. 337—349. / Strachunskiy L.S., Tarasov АА, Kryukov AL i dr. Vozbuditeli ostrogo bakteriafnogo rinosinusita. Rezuftaty mnogotsentrovogo mikrobiologicheskogo issledovaniya SSSR. Klin mikrobiol antimikrob khimioter 2005; 4:337—349. [in Russian]Козлов P. С. Пневмококки: уроки прошлого — взгляд в будущее. Смоленск: МАКМАХ, 2010. - 128 с. / Kozlov R. S. Pnevmokokki: uroki proshlogo — vzglyad v budushchee. Smolensk: MAKMAKH, 2010; 128. [in Russian]Козлов P. С. Пневмококки: уроки прошлого — взгляд в будущее. Смоленск: МАКМАХ, 2010. - 128 с. / Kozlov R. S. Pnevmokokki: uroki proshlogo — vzglyad v budushchee. Smolensk: MAKMAKH, 2010; 128. [in Russian]KozlovR. etal. ECCMID 2016,Amsterdam, 9—12April,Abstract #4319.KozlovR. etal. ECCMID 2016,Amsterdam, 9—12April,Abstract #4319.Kaplan A. Canadian guidelines for acute bacterial rhinosinusitis: clinical summary. Canad Family Physic Med De Famille Canadien 2014; 60: 3: 227-234.Kaplan A. Canadian guidelines for acute bacterial rhinosinusitis: clinical summary. Canad Family Physic Med De Famille Canadien 2014; 60: 3: 227-234.Falagas M.E. et al. Effectiveness and safety of short vs. long duration of antibiotic therapy for acute bacterial sinusitis: a meta-analysis of randomized trials. Brit J Clin Pharmacol 2009; 67: 2:161—171.Falagas M.E. et al. Effectiveness and safety of short vs. long duration of antibiotic therapy for acute bacterial sinusitis: a meta-analysis of randomized trials. Brit J Clin Pharmacol 2009; 67: 2:161—171.Atkinson H, Walks S., Coatesworth A.P. Acute otitis media. Postgrad Med 2015; 127: 4: 386-90.Atkinson H, Walks S., Coatesworth A.P. Acute otitis media. Postgrad Med 2015; 127: 4: 386-90.Dickson G. Acute otitis media. Primary Care 2014; 41:1:11—18.Dickson G. Acute otitis media. Primary Care 2014; 41:1:11—18.Lieberthal AS. et al. The diagnosis and management of acute otitis media. Pediatrics 2013; 131: 3: E964—999.Lieberthal AS. et al. The diagnosis and management of acute otitis media. Pediatrics 2013; 131: 3: E964—999.Ngo С. С. et al. Predominant Bacteria Detected from the Middle Ear Fluid of Children Experiencing Otitis Media: A Systematic Review. PloS One2016;ll:3:E0150949.Ngo С. С. et al. Predominant Bacteria Detected from the Middle Ear Fluid of Children Experiencing Otitis Media: A Systematic Review. PloS One2016;ll:3:E0150949.Dagan R. et al. Evidence to support the rationale that bacterial eradication in respiratory tract infection is an important aim of antimicrobial therapy. J Antimicrob Chemother 2001; 47: 2:129—140.Dagan R. et al. Evidence to support the rationale that bacterial eradication in respiratory tract infection is an important aim of antimicrobial therapy. J Antimicrob Chemother 2001; 47: 2:129—140.Courier J.D. et al Increased clinical failures when treating acute otitis media with macrolides: a meta-analysis. Ann Pharmacother 2010; 44:3:471—478.Courier J.D. et al Increased clinical failures when treating acute otitis media with macrolides: a meta-analysis. Ann Pharmacother 2010; 44:3:471—478.Муравьев А.А., Чагарян A.H., Братусь Е.В., Нерцева ТА., Карпов И.А., Качанко Е. Ф. Серологическая характеристика и чувствительность к антибиотикам серотипов Streptococcus pneumoniae, циркулирующих в различных регионах Беларуси и Украины, выделенных у детей до 5 лет и пациентов старше 65 лет. Клин микробиол антимикроб химиотер. - 2013. - Т. 1 5 . - № 2 . - С . 147-158./ Murav'ev A.A., CHagaryan A.N., Bratus' E.V., Pertseva T.A., Karpov I.A., Kachanko E.F. Serologicheskaya kharakteristika i chuvstvitel'nost' k antibiotikam serotipov Streptococcus pneumoniae,tsirkuliruyushchikh v razlichnykh regionakh Belarusi i Ukrainy, vydelennykh u detey do 5 let i patsientov starshe 65 let. Klin mikrobiol antimikrob khimioter 2013; 15: 2: 147—158. [in Russian]Муравьев А.А., Чагарян A.H., Братусь Е.В., Нерцева ТА., Карпов И.А., Качанко Е. Ф. Серологическая характеристика и чувствительность к антибиотикам серотипов Streptococcus pneumoniae, циркулирующих в различных регионах Беларуси и Украины, выделенных у детей до 5 лет и пациентов старше 65 лет. Клин микробиол антимикроб химиотер. - 2013. - Т. 1 5 . - № 2 . - С . 147-158./ Murav'ev A.A., CHagaryan A.N., Bratus' E.V., Pertseva T.A., Karpov I.A., Kachanko E.F. Serologicheskaya kharakteristika i chuvstvitel'nost' k antibiotikam serotipov Streptococcus pneumoniae,tsirkuliruyushchikh v razlichnykh regionakh Belarusi i Ukrainy, vydelennykh u detey do 5 let i patsientov starshe 65 let. Klin mikrobiol antimikrob khimioter 2013; 15: 2: 147—158. [in Russian]Качанко E. Ф. Внебольничная пневмония: современные подходы к диагностике и антибактериальной терапии. Клин инфектол паразитол. - 2018. - № 1. - С. 126-139. / Kachanko E.F. Vnebol'nichnaya pnevmoniya: sovremennye podkhody k diagnostike i antibakterial'noy terapii. Klin infektol parazitol 2018; 1:126—139. [in Russian]Качанко E. Ф. Внебольничная пневмония: современные подходы к диагностике и антибактериальной терапии. Клин инфектол паразитол. - 2018. - № 1. - С. 126-139. / Kachanko E.F. Vnebol'nichnaya pnevmoniya: sovremennye podkhody k diagnostike i antibakterial'noy terapii. Klin infektol parazitol 2018; 1:126—139. [in Russian]

The authors declare that there are no conflicts of interest present.