Rational antibiotic therapy in treatment of bacterial tonsillitis in children
On the part of tonsillitis every second child suffers, and chronization of the infectious process leads to a number of complications from the organs and systems. Peritonsillar abscesses, tonsillitis sepsis, arthritis, vasculitis, rheumatism and heart disease all of these are the consequence of defective tonsillitis. There fore, the approach to the treatment of inflammations of palatine tonsils should be comprehensive and based on the results of continuous monitoring of microbial flora with a clear definition of the spectrum of its sensitivity to antibacterial agents. Purpose — improvement of antibiotic therapy of acute bacterial tonsillitis in children, based on the results of antibioticograms. The bacteriological method was used for the study, the seeds were culled quantitatively on 5% blood meat peptone agar and dense Saburo agar. Determination of the sensitivity of isolated microorganisms' cultures to antibacterial preparations was carried out by disc diffusion method. The examined contingent was made up of 75 children aged 1 to 17 years old who were on treatment with a diagnosis of acute tonsillitis in VRCCIH. Gr. (+) bacterial microflora was represented by coca flora with a high density of colonization: S.pyogenes (in 100% of children) — (4.16±0.07) Ig CFU/ml, S.salivarius (at 24.0%) — (2.96±0.12) Ig CFU / ml, S.epidermidis (62.6%) — (2.27±0.09) Ig CFU / ml, S.aureus (91.0%) — (3.38±0.11) Ig CFU / ml and Enterococcus spp. (42.6%) — (4.17±0.32) Ig CFU / ml. Among the microbial flora of Gr. (–), K.pneumoniae (in 65.3% of patients) with colonization ability (4.61±0.43) Ig CFU /ml, P.aeruginosa (in 20.0%) — (5,53±0.13) Ig CFU/ml, Alcaligenes spp. (24.0%) — (4.71±0.25) Ig CFU/ml, E.coli (at 65.3%) — (5,13±0.22) Ig CFU/ml, E.coli (69.3%) — (4.35±0.15) Ig CFU/ml. The isolated microflora was characterized by a low spectrum of sensitivity to antibacterial agents. So, S.pyogenes and Enterococcus spp. were sensitive to ceftriaxone (83.5% and 89.9% respectively), and S.aureus to oxacillin (84.0%), whereas S.pyogenes was resistant to 92.3%. Resistant S.aureus and Enterococcus spp. to the reserve cefepime (96.2% and 58.6% respectively) to which P.aeruginosa and Alcaligenes spp. were sensitive (79.3% and 78.2% respectively). Resistant to the latter were up to azithromycin in 95.1% and 91.3% of cases. E.coli, E.coli and K.pneumoniae were almost equally resistant to clarithromycin, showing high susceptibility to reserve vancomycin. Thus, in a microbiological study all children in the smears showed β-hemolytic streptococcus represented by S.pyogenes with high colonization density (4.16±0.07) Ig CFC / ml and in 91.0% of children S.aureus was isolated from colonization capacity (3.38 ± 0.11) Ig CFU / ml. Bacteria of the genus Alkaligenes were sown in 18 diseased children (24.0%), and 15 children (20.0%) isolated Pseudomonas aeruginosa. Conditionally pathogenic E.coli, E.cloacae and K.pneumoniae cultivated in more than 60.0% of cases and were characterized by high pathogenic activity. According to the results of the antibioticograms S.pyogenes and Enterococcus spp. were sensitive to ceftriaxone and resistant to cefepime. Gr.( –) flora, on the contrary, reacted to the reserve cefepimum, while exhibiting high resistance to the macrolide.
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