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0USE OF POLYOXIDONIUM IN THE COMPLEX TREATMENT AND PREVENTION OF FREQUENTLY ILL CHILDREN
Muratkhodjaeva A.V.
Tashkent Pediatric Medical Institute, Department of Pediatrics. https://doi.org/10.5281/zenodo.14028270
Abstract. Acute respiratory infections in childhood account for more than 60% of all pediatric pathology. The most frequent morbidity is observed in children of early and preschool age. In frequently ill children, when respiratory infections recur 6 - 8 times a year and more, there is no adequate recovery of functional characteristics of the immune system, which contributes to recurrences of the disease, the formation of chronic foci of infection. Repeated illnesses in some cases are accompanied by a decrease in physical and neuropsychiatric status, contribute to the development of social maladaptation.
Keywords: respiratory infections, etiotropic agents, chronic foci of infection, acute bronchiolitis, adenoiditis, tonsillitis, sinusitis.
Purpose of the study. To determine the effectiveness of immunomodulatory therapy in the complex treatment of frequently ill children.
Materials and Methods of the Study. During 2 years, 88 children aged from 1 year to 6 years were under our observation. According to the data of anamnesis and clinical observation, these children were classified into the group of frequently ill children with the frequency of respiratory infections 7-8 times a year. Children under 3 years of age (45 people) had a history of prematurity (15 days -33%), neonatal sepsis (5 children - 11%) and acute pneumonia in the first year of life (5 children -11%), exudative-catarrhal diathesis (8 children - 18%), lymphatic-hypoplastic diathesis (6 children - 13.5%), protein-energy deficiency (6 children - 13.5%). In children 3-6 years old (43 people), frequent respiratory diseases began to be observed after attending preschool institutions; allergic reactions to food (13 people - 30%), medicines (5 people - 12%), chronic foci of infection - adenoiditis, tonsillitis, sinusitis (25 people - 58%) were noted in the anamnesis. In both age groups it was possible to reveal in the anamnesis of one or both parents a tendency to private respiratory diseases, the presence of chronic foci of infection.
Children were admitted for inpatient treatment with diagnoses of acute tonsillopharyngitis, acute bronchitis, and acute pneumonia. In infants, acute bronchiolitis and acute obstructive bronchitis were diagnosed in 20 cases (44%) and acute pneumonia in 25 cases (56%). In preschool children, acute pneumonia was diagnosed in 15 children (35%), acute bronchitis in 18 children (42%), and acute tonsillopharyngitis in 10 children (23%).
The drugs of choice during acute respiratory disease are etiotropic agents depending on the clinical situation using antibacterial and antiviral agents. Simultaneously, symptomatic pathogenetic therapy was prescribed, contributing to the relief of intoxication, normalization of functional disorders against the background of the underlying disease. Children with chronic ENT pathology received local therapy under the supervision of an otolaryngologist.
Taking into account the frequency of respiratory infections, the specificity of the immune system of the observed children, immunomodulatory therapy was carried out depending on the age of the child, clinical manifestations during the acute period of the disease, the course of the disease and the presence of chronic foci of infection.
According to the terms of inclusion in the complex therapy, immunomodulators can be conditionally divided:
- drugs intended for use in the acute period;
- drugs intended for use in the remission period;
- drugs intended for use both for prophylactic purposes and in the period of disease exacerbation.
Results of the study. Due to the severity of clinical manifestations in acute pneumonia, polyoxidonium was used in 10 cases in young children and in 5 children of preschool age. In the anamnesis of this group of children, the previous diseases were characterized by pronounced signs of inflammatory process of the respiratory system, with a long course and frequent recurrences of respiratory infection.
Polyoxidonium (Azoximera bromide) has immunomodulatory action, has a direct effect on phagocytic cells and natural killer cells, stimulates antibody formation, and also has detoxification and antioxidant activity. Polyoxidonium was administered at a dose of 100-150 mcg/kg intravenously every other day, for a course of treatment of 5 injections.
In the dynamics of observation in children who received Polioxidonium during the acute illness, despite the severity of the condition in the initial period, signs of inflammatory process, functional disorders of other organs and systems disappeared faster, indicating an adequate response of the immune system of the child's organism. In this group of children the beginning of the remission period was observed on the 12th-14th day of the disease, whereas in children who did not receive polyoxidonium, despite the positive dynamics of clinical manifestations, the remission period began on the 18th-20th day of the disease.
The observed children were divided into two groups: Group 1 (42 children, including 25 children under 3 years of age and 17 children 3-6 years of age), Group 2 (46 children, including 20 children under 3 years of age and 26 children 3-6 years of age). During the remission period, regardless of the clinical diagnosis, group 1 children were administered polyoxidonium intranasally or sublingually at the rate of 150 mcg/kg/day. Intranasally - at the rate of 150mcg/kg for 7-10 days, i.e. 10-0 drops per day in 3-4 doses. This course of treatment was started in the hospital and continued at home.
At discharge all were given recommendations:
- observance of a rational daily regimen (exclusion of overexertion and overexcitation, limitation of visiting crowded places, etc.);
- good nutrition;
- taking multivitamins according to age;
- therapeutic gymnastics, massage, exercise training, hardening activities;
- exclusion of passive tobacco smoking of the child in the family;
- sanitation of chronic foci of infection in relatives of the child's environment.
When observed in dynamics, children who received polyoxidonium during the acute period and in remission of the disease did not give a relapse of respiratory infections during 3 months. In the group of children who did not receive immunomodulating respiratory infections were noted 11.5 months after the previous disease.
Children of the 1st group were given prophylactic courses of polyoxidonium sublingually or intranasally for prophylactic purposes in autumn (October-November) and at the end of winter and beginning of spring (February-March), i.e. in 3-4 months, giving preference to sublingual
application in the presence of tonsillitis, in the same dose as in the period of remission, for 7-10 days. Sublingual intranasal administration of drugs is less traumatic for children and more accessible in outpatient settings. 100
90
Fig.1 Dynamics of the frequency of respiratory diseases in children over a year depending on
the methods of therapy
Observation during 2 years showed that in children who received polyoxidonium for prophylactic purposes, the frequency of respiratory infections decreased to 3-4 times a year, the diseases were mild and did not require hospital treatment. Group 2 children who followed the general recommendations and did not receive prophylactic immunomodulatory treatment (polyoxidonium) had a frequency of respiratory infections 6-7 times a year, the diseases were moderately severe, and in some cases required hospital treatment in 24 children (52%), including 15 children of early age and 9 children of preschool age.
Conclusion. Prenatal and postnatal factors (prematurity, sepsis and pneumonia in the first year of life, presence of background conditions: diathesis, protein-energy deficiency, etc.) contribute to the development of frequent infectious diseases of the respiratory system in children. In preschool children repeated respiratory diseases contribute to the development of chronic foci of infection, as well as the presence of allergic mood of the body are the causes of secondary immunodeficiency, frequent morbidity. The use of immunomodulatory drugs in frequently ill children should be differentiated depending on the group of frequently ill children and the severity of respiratory infection manifestations. The use of polyoxidonium parenterally in the acute period of the disease is indicated in case of severe form, severity of clinical symptoms of intoxication and inflammatory process, prolonged course, threat of complications. The use of polyoxidonium sublingually or intranasally during remission and for prophylactic purposes increase the immune capacity of the body and reduce the incidence of infectious diseases.
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