Antibiotics for inflammation of the lymph nodes - which are the most effective?

Features of the disease

Lymphadenitis is a very common pathology, during which inflammation develops in the lymph nodes.
To understand the etiology of the disease, it is necessary to understand in more detail the physiological processes occurring in the human body. Lymph nodes represent a kind of barrier that restrains the spread of pathogenic microflora from the nearest focus of the inflammatory process throughout the system. However, there are cases when the lymph node itself becomes a source of infection in the event of suppuration. As a result, patients often require hospitalization and possibly surgery. It is quite difficult to obtain statistical data regarding the prevalence of pathology. The fact is that the disease often becomes a complication of other pathologies, for example, tonsillitis or purulent wounds, and its course is not very difficult. In such situations, therapy is aimed at the underlying disease, and lymphadenitis disappears without specific treatment. Therefore, patients with a very serious degree of pathology, which already requires serious medical and often surgical intervention, turn to a specialist.

Causes of pathology

As already indicated, in the vast majority of cases, inflammation occurs as a complication after an infectious process that has already been suffered.
This occurs for physiological reasons, when pathogens are carried by the lymph current to the nearest lymph node. If the body functions correctly and appropriate therapy is carried out, then the bacteria arrive there already in a weakened or killed state, or die directly in it. In this case, inflammation does not develop further. However, if the process is not stopped and the pathogen is very active, then inflammation is already developing in the node itself. In such a situation, lymphadenitis is secondary. However, there are cases when the pathology is primary.
This can occur as a result of trauma to the lymph node area, during which the strain penetrates through the site of injury. It should be noted that such pathologies are very rare and occur against the background of reduced immune defense. The cause of nonspecific lymphadenitis in most cases is staphylococcal and streptococcal infections .
The nodes enter through the flow of blood or lymph. The most common foci of primary inflammation include: carbuncles, boils, infected wounds, thrombophlebitis, osteomyelitis and others. A specific type of pathology is caused by a special type of pathogen that provokes the appearance of specific diseases, for example, gonorrhea, syphilis, tuberculosis, plague, anthrax and others. In such situations, the localization of the inflammatory process occurs in the node closest to the site of infection. So, in case of a sexually transmitted disease, the inguinal nodes are the first to react.

Ear congestion

Fungus

Allergy

28607 04 February

IMPORTANT!

The information in this section cannot be used for self-diagnosis and self-treatment.
In case of pain or other exacerbation of the disease, diagnostic tests should be prescribed only by the attending physician. To make a diagnosis and properly prescribe treatment, you should contact your doctor. Ear congestion: causes, diagnosis and treatment methods.

Definition

Congestion in the ear or ears occurs as a result of a violation of sound perception and is characterized by various sensations, which may include deafness, a feeling of squeezing and heaviness, and the sound of one’s own voice being too strong. Ear congestion, regardless of the causes of its occurrence, is difficult for the patient to tolerate and, as a rule, requires the help of a specialist.

Types of ear congestion

Blockage in one or both ears may be accompanied by pain, tingling, noise or ringing in the ears, and dizziness. In some cases, congestion disappears after swallowing.

A dangerous symptom is ear congestion accompanied by fever, headache, discharge from the ear (purulent or bloody), and foreign body sensation.

Ear congestion does not always indicate a pathological process.
This condition can be caused by water getting into the ear, pressure changes
during air travel or diving to depth.
Sometimes too strong and incorrect blowing of the
nose from two nasal passages at the same time leads to a blocked ear (ears), which is associated with an increase in pressure in the middle chamber of the ear due to a sharp intake of air from the Eustachian tube.
Taking certain medications
(antibiotics, psychotropic substances) has a toxic effect on the ear, causing the development of congestion and hearing loss.

Diseases that can cause ear congestion.
Earwax
blocking the ear canal. Attempting to remove earwax yourself using improvised objects significantly increases the likelihood of pushing the plug deeper into the ear and sticking to the eardrum (this increases the risk of injury to the eardrum, which leads to complete or partial hearing loss). In these cases, the condition of congestion in the ears is accompanied by excruciating pain, noise, dizziness and nausea.

Mycotic, or fungal, infection of the external auditory canal

. Infection with fungi can be complicated by narrowing or blockage of the ear canal with a feeling of fullness in the ears. The spread of fungi in the ear is aggravated by hearing aids, in-ear headphones, and inflammatory diseases of the ear. The main signs of the disease are itching, ear congestion and resulting hearing loss, and increased sound of one’s own voice in the affected ear.

Damage to the external auditory canal and middle ear structures

may be accompanied by hearing loss and congestion. Bleeding and the formation of a blood clot that blocks the ear canal lead to deterioration in sound transmission. In addition, injury to the eardrum is possible during cleaning of the ear canal, a sudden change in pressure, or a strong blow to the outer ear. In this case, sharp pain occurs, which is replaced by congestion, ringing, noise and hearing loss.

Acute inflammatory diseases

accompanied by swelling and sometimes the formation of purulent contents.
They can lead to ear congestion and hearing loss. In particular, with otitis media of the middle ear (tympanitis),
the tympanic cavity and auditory tube are involved in the inflammatory process. Swelling, which narrows the lumen of the auditory tube, and suppuration of the soft tissues cause ear congestion and hearing impairment. As a rule, the infection enters this sterile cavity from the Eustachian tube, which is directly connected to the nasopharynx.

In children of the first and second year of life, acute otitis may occur when breast milk or formula enters the nasopharynx during regurgitation.

In older children, otitis media and congestion can be caused by
inflammation of the adenoids
, the lymphoid tissue responsible for the local immunity of the nasopharynx and closing the openings of the auditory tubes in the nasopharynx. The anatomical proximity of the adenoids and the auditory tube ensures the rapid transition of infection from the nasopharynx to the ears. In addition, enlarged adenoids can block the openings of the auditory tube, which causes a feeling of stuffiness.

Allergic reactions

can also lead to acute inflammation and swelling of the middle ear.

Otitis externa

characterized by inflammation of the external auditory canal. Congestion in the ear in this case occurs due to swelling of the tissues of the ear canal.

If the disease is caused by a foreign body entering the ear canal

, then swelling and congestion are complemented by a picture of severe irritation. The patient complains of severe itching, pain, a feeling of fullness, and heat in the ear area. The pain intensifies with chewing movements.

For furunculosis

In the external auditory canal, the picture of the disease is aggravated by a closed space where the inflammatory process develops. Increasing pain in the ear is complemented by its irradiation to the corresponding half of the head. The patient cannot lie on the painful side. Due to severe swelling of the tissues of the external auditory canal, sound transmission into the affected ear is disrupted, and a feeling of stuffiness occurs.

Among the anatomical and postoperative defects

that cause ear congestion include deviated nasal septum, narrowing of the nasal passage due to hypoplasia of the nasal wings, and stenosis of the external nasal valve.

Impaired nasal breathing leads to frequent runny nose, infection of the nasal sinuses and, as a consequence, to the transition of the inflammatory process to the auditory tube.

Ear congestion in these cases appears on the side of the narrow nasal passage. The same consequences occur after operations in the nose area.

Sensorineural hearing loss

occurs due to damage to any part of the auditory nerve. Most often, this is an irreversible phenomenon, the symptoms of which include imbalance, dizziness, nausea, fullness and noise in the ear, and poor perception of low sounds. The causes of sensorineural hearing loss can be previous infectious and vascular diseases, tumor processes, injuries, and toxic effects of various substances.

Meniere's disease

is a non-purulent disease of the inner ear, which is accompanied by congestion. An increase in the volume of lymph in the labyrinth of the ear leads to increased pressure and attacks of progressive deafness, tinnitus, and sudden dizziness. In most cases, one ear is affected first. The disease begins either with attacks of dizziness or with deterioration of hearing, which is completely restored between attacks. However, after a few years, hearing loss becomes irreversible.

Myofascial pain syndrome, temporomandibular joint diseases

. Patients with myofascial pain syndrome, which is associated with disruption of the masticatory muscles and limited mobility of the lower jaw, may also complain of ear congestion. In addition, the disease is accompanied by headaches and facial pain, difficulty opening the mouth, and clicking in the temporomandibular joint.

The root cause of the syndrome is spasm of the masticatory muscles.
A similar clinical picture is also given by diseases of the joint itself caused by malocclusion. Atherosclerosis of cerebral vessels, increased blood pressure
. Congestion in the ears due to damage or narrowing of blood vessels is explained by a deterioration in the blood supply to all tissues, as well as impaired circulation in the area of ​​the inner and middle ear.

Vasomotor rhinitis, or runny nose during pregnancy

occurs under the influence of hormonal changes and is characterized by impaired vascular tone and the release of mucous secretion. With allergic rhinitis, the clinical picture of the disease is almost the same, but the provoking factor is not hormones, but a specific allergen. Swelling of the mucous membrane and narrowing of the nasal passages lead to obstruction of the auditory tube and cause ear congestion.

Tumors in the area of ​​the auditory canal, auditory tube and inner ear

– the most serious cause of ear congestion. Among them should be called cholesteatoma - a tumor-like formation that consists of epidermal cells impregnated with cholesterol. Cholesteatoma is characterized by slow but steady growth. Forming in the middle ear, it can spread to the outer and inner ear, causing congestion and a feeling of heaviness in the ear, purulent discharge, swelling and redness of the auricle.

Which doctors should I contact if I have ear congestion?

If ear congestion occurs, you should contact an otolaryngologist. In the future, you may need to consult a neurologist, cardiologist, or allergist.

Diagnosis and examinations for ear congestion

To diagnose the disease that caused ear congestion, a careful questioning of the patient, examination of the outer ear and ear canal to the eardrum, and an audiometric examination are necessary. The infectious nature of the disease is determined on the basis of the clinical picture, otoscopy data and culture of the discharge.

Antibiotics for inflammation of the lymph nodes

To understand which antibiotics should be used for a particular pathology, it is necessary to pay attention to certain factors. There is clinical evidence that in most cases, nonspecific lymphadenitis is caused by streptococcal and staphylococcal microorganisms. That is why it is customary to prescribe antimicrobial agents that are most effective against them.

In addition, it is necessary to take into account the severity of the disease, the patient’s age and the presence of concomitant pathologies. Despite the fact that lymphadenitis has a very clear clinical picture, its features vary somewhat from patient to patient. Elderly people, young children and patients with chronic decompensated conditions are very prone to the formation of sepsis, which may well be fatal. Therefore, in such situations, a more powerful medication, or a combination of both, is often prescribed.

A characteristic feature of each type of antibiotic is the place where they accumulate. Due to the characteristics of the disease, it is preferable to use a product with a concentration in the human lymphatic system. For the best effect, it is also recommended to take into account the patient’s medical history and medication history. If a few months ago the patient already underwent antimicrobial therapy, then it is necessary to select a drug from a different group.

Modern tactics for treating pathology involve dividing drugs into first and second lines. Initially, safer drugs with a broad spectrum of action are prescribed. However, if they turn out to be ineffective or cause an allergic reaction, then you have to move on to second-line drugs.

For lymphadenitis use:

• penicillins;
• cephalosporins;
• macrolides;
• fluoroquinolones;
• lincosamides;
• aminoglycosides.

Penicillins

This class of antimicrobial agents was found earlier than others and has been widely used in medical practice for many decades. They have a very wide spectrum of bactericidal effects. However, due to long-term use, many pathogens have developed resistance to these medications.

Antibacterial therapy for acute infections of the ENT organs

AND

Infectious diseases of the ENT organs are a very large group of inflammatory diseases, each of which a person experiences several times in life.
This group includes inflammatory diseases of the paranasal sinuses (rhinosinusitis), pharynx and tonsils (tonsillopharyngitis, tonsillitis) and middle ear (otitis). The significance of these diseases is determined by their extreme prevalence, especially in childhood. Thus, in the United States, 31 million cases of acute rhinosinusitis (ARS) are registered annually. According to estimates, in Russia 10 million people suffer from ARS annually
, but this figure also looks underestimated, since it takes into account only severe manifest forms. According to the National Center for Disease Statistics in the United States, costs associated with the diagnosis and treatment of ARS in 1996 amounted to $5.8 billion.

Acute otitis media (AOM) is one of the most common childhood diseases

. By the age of three, 71% of children experience AOM, and in the first 7 years of life, up to 95% of children have a history of at least one episode of this disease [10,11]. According to the HMO (Health Maintenance Organization), 48% of children have single episodes of acute perforated or non-perforated otitis media in the first 6 months of life or more than 2 episodes in 12 months of life.

There is no exact information about the prevalence of sore throats and acute tonsillopharyngitis (ATP), but it is clear that these are also one of the most common human infectious diseases. In adults, damage to the palatine tonsils is typical; in children, adenoiditis, an inflammation of the pharyngeal tonsil, is more common. In early childhood (up to 3 years) and in old age (after 50 years) the incidence of sore throats is lower, which is associated, respectively, with age-related imperfections or age-related involution of the lymphoid tissue of the pharynx.

The pathogenesis of ARS, AOM and ATP is based on an inflammatory reaction, which usually develops against the background of an acute respiratory viral infection (ARVI). Viral infection of the mucous membrane is the first phase of the disease. Studies using computed tomography and magnetic resonance imaging have shown that 90% of patients with ARVI develop catarrhal inflammation of the mucous membrane in the paranasal sinuses and there is stagnation of secretions [6]. This actually means that catarrhal sinusitis of viral etiology, along with rhinitis, laryngitis and laryngotracheitis, is one of the typical manifestations of ARVI. However, only 2% of patients develop secondary purulent inflammation caused by the addition of a bacterial infection, the conditions for which arise in the mucous membrane damaged by the virus. Under conditions of normally functioning mucociliary transport, bacteria are not able to contact the epithelial cells of the nasal cavity for a long enough time. When affected by a virus, the cilia of the mucous membrane cannot work at full strength, and the speed of mucociliary transport is significantly reduced. In conditions of stagnation of secretions and a decrease in the partial pressure of oxygen in the paranasal sinuses, optimal conditions are created for the development of bacterial infection.

Streptococcus pneumoniae is considered the main causative agent of ARS.

and
Haemophilus influenzae
: they are cultured from the sinuses in approximately 70–75% of patients [2,6].
Other pathogens include Moraxella catarrhalis, Staphilococcus aureus, Streptococcus pyogenes, Streptococcus viridans,
etc. Anaerobic bacteria are detected in MS in 4–11% of cases, and the main ones are anaerobic streptococci. However, the spectrum of ARS pathogens can vary significantly depending on geographic, socioeconomic and other conditions.

A similar mechanism underlies the pathogenesis of AOM, with disruption of the patency of the auditory tube playing a leading role in the development of the disease. It leads to the creation of negative pressure in the tympanic cavity and extravasation of fluid. The resulting exudate is initially sterile, but after pathogenic bacteria enter the tympanic cavity, it becomes inflammatory in nature. The results of a microbiological study of punctate tympanic cavity indicate that, as with ARS, the main causative agents of AOM are Streptococcus pneumoniae and Haemophilus influenzae

- precisely those microorganisms, various strains of which populate the nasopharynx in most children.
These two microorganisms together account for approximately 60% of bacterial pathogens [7,11]. Less commonly sown are Moraxella catarrhalis
(3–10%),
Streptococcus pyogenes
(2–10%), and
Staphylococcus aureus
(1–5%).
About 20% of cultures from the tympanic cavity turn out to be sterile. A significant proportion of AOM have a viral etiology. Mycoplasma pneumoniae
, which, in particular, can cause bullous hemorrhagic myringitis,
Chlamydia trachomatis
and
Chlamydophila pneumoniae
, may have a certain role in the etiology of AOM .

Approximately 70% of ATF are caused by viruses (rhinoviruses, coronaviruses, respiratory syncytial virus, adenovirus, influenza and parainfluenza viruses), of which rhinoviruses are the most common pathogen. The main bacterial causative agent of sore throats and ATF is considered to be group A b-hemolytic streptococcus (GABHS), the presence of which is confirmed in approximately 31% of patients [9]. Among other possible pathogens, hemolytic streptococci of other groups, Staphylococcus aureus, Enterobacteriaceae, and Haemophilus influenzae are mentioned.

There are several specific forms of OFT, among which the following are important. Acute epiglottitis is an inflammation of the lymphoid tissue of the epiglottis. The causative agent of the disease is often Haemophilus influenzae

type B, less often -
S. pneumoniae, S. aureus
and a number of other pathogens. The disease is manifested by high fever, severe sore throat, and sometimes difficulty breathing. When examined with a laryngeal mirror or endoscope, a sharply enlarged edematous epiglottis is visible; foci of abscess formation are often visible under the mucous membrane. In severe cases, a sharply enlarged epiglottis occupies the entire lumen of the laryngopharynx and leads to the development of laryngeal stenosis, which may require tracheostomy.

Sore throat of the lateral (tubopharyngeal) ridges of the pharynx

develops more often in people who have previously undergone tonsillectomy. In this case, there is compensatory hyperplasia of the tubopharyngeal ridges, which combine the tubal tonsils and accumulations of lymphoid tissue in the lateral walls of the pharynx, which, when inflamed, are brightly hyperemic, swollen, and contain small abscesses visible through the mucous membrane. The clinical picture is almost no different from ordinary tonsillitis, with the exception of the characteristic irradiation of pain in the ears due to the involvement of the tubal tonsils.

Adenoiditis

– inflammation of the pharyngeal tonsil usually occurs in children and is manifested by difficulty in nasal breathing, drainage of mucopurulent discharge along the back wall of the pharynx, and cervical lymphadenitis. Posterior rhinoscopy or, more precisely, endoscopy of the nasopharynx allows us to establish the correct diagnosis.

Main goals of treatment

for infections of the ENT organs are:

• reducing the duration and severity of symptoms of the disease;
• prevention of the development of complications (orbital, intracranial, rheumatic fever, phlegmon and abscesses);
• eradication of the pathogen.

From this point of view, the main method of treating infections of the ENT organs is systemic antibiotic therapy

, which is based on knowledge of typical pathogens or on culture sensitivity testing of specific microorganisms isolated from the affected sinus, pharynx or middle ear cavity. Although microbiological testing plays a role in selecting the optimal antibiotic, in most cases this choice is empirical. The choice of an antibiotic aimed at a specific pathogen identified during a bacteriological study does not at all guarantee success due to the high probability of “traveling” microflora entering the test material during sampling [2]. In addition, the clinical picture of moderate and severe infections dictates the need for systemic administration of antibiotics, without waiting for the results of a microbiological study, which takes several days.

Direct bacterioscopy can to some extent suggest the type of pathogen. The presence of chains or pairs of small gram-positive cocci in the preparation indicates that the probable causative agent is streptococcus (pneumococcus), large gram-positive cocci - staphylococcus. The detection of gram-negative bacteria usually indicates the presence of Haemophilus influenzae, and various microorganisms - a mixed aerobic-anaerobic infection. When choosing an antibacterial drug, the sensitivity of typical pathogens to it is of paramount importance: S. pneumonia

and
H. influenzae
.
The growing resistance of these microorganisms to many major antibiotics in recent years is a major problem in the rational antibiotic therapy of bacterial infections. Already, almost 5% of H. influenzae
in Russia are not sensitive to unprotected penicillins [3].

Acute rhinosinusitis

. The effectiveness and appropriateness of antibiotic therapy for ARS is often critically debated, and placebo-controlled studies often yield conflicting results. This is due to two main factors:

• predominantly viral etiology of the disease;
• a pronounced tendency towards spontaneous recovery.

Two recent studies found no statistically significant differences at all between doxycycline and placebo and amoxicillin and placebo in the treatment of ARS. In the last mentioned study, the clinical effectiveness of amoxicillin was 83%, and placebo was 77% [8]. In this regard, it is believed that not all ORS are subject to antibiotic treatment, but only their moderate and severe forms.

. Since additional research methods (RG, CT, ultrasound and diaphanoscopy) do not allow differentiating viral and bacterial damage to the SNP and are not indicators of the severity of the disease, the main criteria when deciding whether to prescribe an antibiotic are the patient’s general condition and complaints, medical history and the presence of purulent discharge in nasal passages.

From a clinical point of view, signs of ARS caused by typical pathogens ( S. pneumoniae

and
H. influenzae
), are the presence of fluid level on the x-ray, decreased sense of smell and good response to traditional therapy. Distinctive features of ARS caused by other microorganisms are the presence of foul-smelling nasal discharge, a total decrease in pneumatization of the SNP on an x-ray, and a slower positive dynamics of the x-ray picture during treatment [5].

Microbiological examination of the contents of the paranasal sinuses does not always reveal the true causative agent of ARS, and the results of an in vitro

do not always correlate with the clinical effectiveness of specific antibiotics.
The reasons for this may be a significant increase in antibacterial activity as a result of the unidirectional effect of the antibiotic and its metabolite and the ability of the drug to specifically achieve bactericidal concentrations at the site of infection. These qualities are characteristic of macrolide antibiotics
, in particular clarithromycin, the clinical effectiveness of which significantly exceeds the results of laboratory sensitivity testing.

Taking into account the range of typical pathogens and Russian data on their antibiotic resistance, the drug of first choice for ARS is amoxicillin

. An adequate dose for adults is 3–3.5 g/day, for children – 80–90 mg/kg/day; The daily dose is divided into three doses, regardless of food. The effect of empirical antibiotic therapy should be monitored, and the criterion of effectiveness is, first of all, the dynamics of the main clinical manifestations of the disease (headache, discharge, nasal congestion) and the general condition of the patient. If there is no noticeable clinical effect after three days, amoxicillin should be replaced with an antibiotic active against penicillin-resistant pneumococci and b-lactamase-producing strains of Haemophilus influenzae. In this case, if treatment is carried out on an outpatient basis, amoxicillin-clavulanate is prescribed orally. For young children, the drug is prescribed in powder form for the preparation of a suspension. Another treatment option is cephalosporins, particularly cefuroxime axetil.

In addition to amoxicillin and cephalosporins, modern macrolides, for example, clarithromycin (Fromilid)

, which is the drug of choice for intolerance to penicillin drugs, when cephalosporins cannot be prescribed due to the possibility of cross-allergy. Research in recent years shows that in terms of clinical effectiveness and eradication of bacterial pathogens, clarithromycin is in no way inferior to protected penicillins and cephalosporins. In addition, clarithromycin has been found to have immunostimulating properties. In particular, it increases the phagocytic activity of neutrophils and macrophages, increases the degranulation of phagocytes, the bactericidal activity of leukocytes, and also increases the activity of T-killers.

Clarithromycin has a local anti-inflammatory effect, which is due to inhibition of cytokine production, reduction of hypersecretion of mucus and sputum in the respiratory tract and sputum viscosity. These properties of clarithromycin may have an additional effect (in addition to antibacterial) in the treatment of chronic infections of the ENT organs, such as otitis media, sinusitis.

Most studies report that clarithromycin is well tolerated. According to summary data from controlled studies, when treated with clarithromycin, adverse events were observed in 19.6% of patients, among whom nausea (3%), diarrhea (3%), dyspepsia (2%), abdominal pain (2%), headache pain (1%). Comparative studies showed that the frequency of side effects when using clarithromycin was the same as azithromycin, roxithromycin, amoxicillin and lower than erythromycin.

Fromilid (clarithromycin) is available in tablets for oral administration (250 and 500 mg). In adults with acute tonsillopharyngitis, clarithromycin is prescribed orally at a dose of 250 mg every 12 hours; The duration of treatment is 10 days. For more severe sinusitis and suspected or documented H. influenzae

, it is advisable to increase the dose of clarithromycin to 500 mg every 12 hours. In children, clarithromycin is prescribed at the rate of 7.5 mg/kg 2 times a day.

If the patient is hospitalized and the intramuscular route of administration is preferable, it is possible to prescribe an inhibitor-protected antibiotic of the penicillin group - ampicillin-sulbactam or cephalosporins: cefotaxime or ceftriaxone. The optimal drugs for intravenous administration are amoxicillin-clavulanate, clarithromycin and cephalosporins.

The drugs of second choice, which are prescribed in case of ineffectiveness of the first course of anibiotic therapy, are currently fluoroquinolones of the III–IV generations: levofloxacin, moxifloxacin, sparfloxacin. The spectrum of antimicrobial action of this group of drugs is maximally adapted to pathogens of upper respiratory tract infections, and their calculated bacteriological effectiveness approaches 100%, which is confirmed by studies conducted in Russia. When developing new fluoroquinolones, the disadvantage of drugs of the 1st–2nd generation was eliminated - low effectiveness against S. pneumonia

, characteristic, in particular, of ciprofloxacin. The main side effect of fluoroquinolones of the III–IV generation is their negative effect on growing connective and cartilage tissue, therefore these drugs are contraindicated in children and adolescents. In this situation, modern macrolide antibiotics again become second-line drugs in patients under 16 years of age.

Acute otitis media

. Not all forms of AOM require the prescription of antibiotics, since with an uncomplicated course of this disease, 80–90% of children recover without antibiotic therapy. In these cases, it is sufficient to prescribe analgesics, topical drugs, thermal procedures, toileting and anemia of the nasal mucosa. With a decrease in temperature, a decrease in ear pain and symptoms of intoxication, you can limit yourself to symptomatic therapy. Patients with AOM who are not receiving systemic antibiotic therapy should be monitored by a physician so that if there is no clinical improvement within the first 24–48 hours, there is an opportunity to re-evaluate and adjust treatment accordingly. It is considered mandatory to prescribe antibiotics in all cases of AOM in children less than two years old (with an otoscopically confirmed diagnosis!), as well as in patients with immunodeficiency conditions [1]. Treatment with antibiotics reduces the risk of developing mastoiditis and intracranial complications of AOM.

As with ARS, the initial choice of antibiotic for AOM is usually empirical. The standard protocol for antimicrobial therapy outlined in many clinical guidelines differs little from what has been said about the treatment of ARS. Taking into account typical pathogens and Russian data on antibiotic resistance, the drug of first choice for AOM is amoxicillin. An adequate dose for children is 80–90 mg/kg/day, for adults – 3–3.5 g/day, divided into three doses, regardless of food. If there is no sufficient clinical effect after three days, amoxicillin should be replaced with an antibiotic active against pneumococci with a high level of penicillin resistance and b-lactamase-producing strains of Haemophilus influenzae: either amoxicillin-clavulanate or cephalosporins (cefuroxime axetil orally or ceftriaxone intramuscularly once a day in three days).

Acute tonsillopharyngitis/tonsillitis

. Antibacterial therapy for these diseases has the following goals:

• reducing the severity of symptoms of the disease and its duration;
• reducing the risk of developing rheumatic fever;
• reduction in the frequency of purulent complications (peritonsillitis, neck phlegmon);
• prevention of the spread of streptococcal infection.

Patients with a sore throat, runny nose, cough, pharyngeal congestion and no fever usually have a viral infection, for which there is no need to prescribe antibiotics. The decision to prescribe systemic empirical antibiotic therapy for ATF is based on the presence of four main clinical criteria of the disease:

plaque on the tonsils, soreness of the cervical lymph nodes, fever and lack of cough. In patients with exudative ATP, fever and cervical lymphadenitis in the absence of cough (3–4 mentioned signs), systemic antibiotic administration is indicated due to the high probability of GABHS infection. If 1 or 2 of the mentioned signs are present, antibacterial therapy is prescribed only if the culture result is positive or the rapid analysis is positive. The latest method for diagnosing GABHS infection is based on the identification of streptococcal antigen in throat swabs by enzymatic or acid extraction of the antigen followed by its agglutination, demonstrating the formation of an antigen-antibody complex.

Antibacterial therapy for ATF is aimed at eradicating the main causative agent of sore throats and metatonsillar complications - GABHS. The drug of choice is phenoxymethylpenicillin [4,12], the advantages of which are a narrow and targeted spectrum of action, good tolerability, minimal impact on the normal microflora of the gastrointestinal tract and low price. For recurrent tonsillitis/OPT, treatment is recommended to begin with amoxicillin-clavulanate or macrolide antibiotics (azithromycin, clarithromycin, midecamycin), which provide at least an equal percentage of eradication of the pathogen. Eradication of GABHS is usually achieved by oral administration of cephalosporins, however, their wider spectrum of action and stronger effect on the normal intestinal microflora place them in the category of alternative drugs. In case of clinical ineffectiveness of the first course of empirical antibiotic therapy, microbiological examination of throat swabs and determination of the sensitivity of the identified pathogen is necessary. In case of severe clinical symptoms and symptoms of intoxication, parenteral administration of antibiotics is indicated.

It is known that GABHS causes no more than a third of ATF and its presence in the pharynx does not always correlate with the severity of the clinical picture. In only 30–50% of people, microbiological identification of GABHS in the pharynx is confirmed by clinical manifestations

. In this regard, the American Academy of Pediatric Infections does not recommend repeated courses of antibiotic therapy for patients in whom GABHS is cultured from the throat. The only exceptions are children with a family history of rheumatism [12]. The variety of forms of inflammatory diseases of the pharynx and their causative agents makes it justified to prescribe drugs with a wider spectrum of antimicrobial action than penicillin - primarily modern macrolides (clarithromycin).

Treatment of laryngeal sore throat (epiglottitis) requires special attention.
To prevent the development of laryngeal stenosis, urgent hospitalization and parenteral administration of cephalosporins (cefotaxime, ceftriaxone) or amoxicillin-clavulanate are required. If there is obvious abscessation of the epiglottis (it is confirmed by indirect laryngoscopy), it is necessary to open the abscess with a laryngeal knife. Literature:
1. Kosyakov S.Ya., Lopatin A.S. Modern principles of treatment of acute otitis media, prolonged and recurrent acute otitis media. RMJ 2002; 10, No. 20: 903–909.

2. Lopatin A.S. Acute inflammatory diseases of the paranasal sinuses. Clinician's Handbook 2002; No. 1: 29–32.

3. Strachunsky L.S., Kamanin E.I., Tarasov A.A. The influence of antibiotic resistance on the choice of antimicrobial drugs in otorhinolaryngology. Consilium Medicum 2002: 3, no. 8: 352–357.

4. Strachunsky L.S., Kozlov S.N. Modern antimicrobial therapy. Guide for doctors. CD. – 2002.

5. Tarasov A.A. Features of the clinical picture and rationale for the choice of antibiotics for acute bacterial sinusitis of various etiologies. Author's abstract. dis. Ph.D. honey. Sci. Smolensk, 2003.

6. Antimicrobial Treatment Guidelines for Acute Bacterial Rhinosinusitis / Sinus and Allergy Partnership. Otolaryngol. Head Neck Surg 2000; 123, N1, Part 2: S1–S32.

7. Bergeron MG, Ahroheim C, Richard JE et al. Comparative efficacies of erythromycin–sulfisoxazole and cefaclor in acute otitis media: a double blind randomized trial. Pediatr Infect Dis J 1987; 6:654–660.

8. van Buchem FL, Knottnerus JA, Schrijnemaekers VJ, Peeters MF. Primary–care–based randomized placebo–controlled trial of antibiotic treatment in acute maxillary sinusitis. Lancet 1997; 349:683–687.

9. Dagnelie CF. Sore Throat in General Practice. A Diagnostic and Therapeutic Study. Thesis. Rotterdam, 1994.

10. Daly KA, Brown JE, Lindgren BR et al. Epidemiology of otitis media onset by six months of age. Pediatrics 1999; 103:1158–66.

11. Healy GB. Otitis media and middle ear effusions. In: Ballenger JJ, Snow JB, Ed. Otorhinolaryngology: Head and Neck Surgery. 15th edition. Baltimore: Williams & Wilkins, 1996: 1003–1009.

12. Principles of appropriate antibiotic use for acute pharyngitis in adults: Background. Ann Emerg Med 2001; 37: 711–719.

Rules for taking antibacterial drugs

Antibiotics are among a number of drugs, the use of which is strictly prohibited without a doctor’s prescription, as they can lead to the development of serious side effects. In addition, the choice of antibacterial agent depends on the pathogen, so the patient cannot choose it independently.

Antimicrobial drugs are prescribed for lymphadenitis in a course. The minimum duration of therapy is five days, the maximum is four weeks. It is prohibited to discontinue the drug before completing the full course, because this can lead to a worsening of the condition and the development of sepsis.

It is advisable to take the antibiotic at the same time, so that equal intervals are maintained between doses. If for any reason the time was missed, then the tablet must be taken as soon as possible and then continue the course as usual. You can take the drug only with clean water; any other liquid can affect the absorption of the active substance.

What antibiotics can you take during pregnancy?

The period of waiting for the birth of a child is very important in the life of every mother, and the main task of the therapist when prescribing treatment is the safety of the fetus and the woman. Therefore, it is necessary to clearly understand what is prescribed for inflammation of the lymph nodes during pregnancy and lactation.

In most cases, penicillins are used for antimicrobial therapy. They are allowed to be used at any stage of pregnancy, including the first trimester. However, the prescription must have clearly defined indications.

For infections of the respiratory tract, urinary system and ENT organs, beta-lactam antibiotics and cephalosporins are used in most cases. In some cases, the use of Erythromycin is permitted.

What antibiotics are prescribed for children?

Lymphadenitis in children develops in childhood in most cases as a result of infectious lesions of the respiratory tract, and they, in turn, are accompanied by respiratory viruses.
Uncontrolled use of antimicrobial agents for respiratory infections in children often leads to the emergence of antibiotic resistance. Due to the improper use of antibiotics, children may experience dyspeptic symptoms. In severe cases, it can lead to acute liver failure, enterocolitis or erythema multiforme.

Prescription of antibiotics is necessary for:

• bacterial pneumonia;
• meningitis;
• infections of the genitourinary system;
• purulent tonsillitis.

In childhood, the use of Cefuroxime and Amoxicillin is permitted. The first is used to destroy streptococcus, pneumococcus and staphylococcus, which often cause inflammation of the throat and mouth. The second belongs to the class of penicillins and is widely used in the treatment of tonsillitis, infections of the ears, nose and throat, as well as inflammation in bone tissue and the bloodstream.

Lymphadenitis - a lump in the groin area

11.11.2021

There are many unusual inflammatory tumors, malignant and benign neoplasms on the human body. Neutralizing each of them requires its own special approach. A lump in the groin area can be represented by either a small swelling or a massive formation.

In any case, such an anomaly should be shown to an experienced doctor . During the examination, the latter will probably prescribe a number of medical procedures. Well, then everything will depend on the type of growth that appears. Most likely, the formation will disappear on its own after a few days, but there are situations when surgical removal is clearly unavoidable.

Lump in the groin in men - causes and treatment

A lump in the groin in men is the very first symptom of inflammatory processes in the lymph nodes. And in this case, it clearly smells like hernia Diagnosis of such a disease is carried out through self-examination or medical examination. This will only give a superficial idea of ​​the severity of the disease. Next you need to undergo a more serious examination.

This type of formation appears in men in the upper part of the inguinal fold. The size of their healthy lymph nodes can be compared to a bean, but when it becomes inflamed, the size increases, literally, to a walnut. When a lump appears in the groin, males feel a sharp or dull pain in this area. In addition to the above symptoms of the inflammatory process, there is also a significant increase in body temperature.

Lymphadenitis in the groin area can occur due to infection with a variety of genital infections. Among the latter, viruses are often observed. In this case, treatment will be more predictable than in the presence of malignant or benign tumors. Lymph nodes can become inflamed during prostatitis . And during the course of various types testicular A male lump in the groin is more rarely observed as a consequence of swelling of the scrotum. But for children (boys), this disease is explained by the fact that the testicle does not descend from the abdominal cavity.

Lymphadenitis (inflammation of the male inguinal lymph nodes), which appears between the groin and also the leg, can be removed by modern doctors not only through surgery. There are many medications on sale, the use of which promotes complete resorption of inflammatory formations.

A lump on the pubis in representatives of the stronger sex may also appear after a sudden weakening of the muscles that are located in the wall of the abdominal cavity. Moreover, such a nuisance can provoke not only enormous physical exertion, but even a severe cough. Because of all this, intestinal loops often protrude directly under the skin. Thus, a hernial sac is literally instantly formed and unprecedented pain appears in the groin, which is unbearable. When a hernia is subjected to excessive stress under the influence of physical stress, the skin that is located above it swells very quickly, acquiring a red tint. If a hernia is strangulated, you obviously cannot avoid surgical medical intervention.

Lump in the groin in women - causes and treatment

A lump in the groin in women can also occur due to a variety of factors. There are a lot of variations in the process of treating a lump near the groin. Most often, representatives of the fairer sex discover such formations on their own. Well, then, it’s up to the doctors . Most likely, they will diagnose you with harmful enlarged lymph nodes. In this case, it is necessary to identify the causes of damage to these natural protective barriers of the body. Viral infections are considered the most common of them.

In case of inflammatory processes in the organs of the female reproductive system, a lump under the skin in the groin can be treated faster and more productively than in the case of cancer. The most trouble awaits you when malignant processes appear in the body. Even the use of high-precision instrumental examination, including computed tomography or biopsy, does not always help to identify all the nuances regarding tumors.

And finally, remember that it is better to show the above abnormal formations that appear on the body to a doctor , since only medical professionals can promptly save you from the serious consequences of illnesses. And it doesn’t matter whether the lump is in the groin on the right, left or in the center - the main thing is that such an anomaly needs to be eliminated.

Published in Lymphology Premium Clinic