Acute respiratory infection on the ICD 10. Infectness Acute Respiratory Virals - Description, Causes, Symptoms (Signs), Diagnostics, Treatment
RCRZ (Republican Center for Health Development MD RK)
Version: Clinical Protocols MOR RK - 2013
Acute laryngoparingitis (J06.0)
general information
Short description
Approved by the minutes of the meeting
Expert Commission on Health Development Mort RK
№23 dated 12.12.2013
ORVI -a group of infectious diseases caused by respiratory viruses transmitting air-droplets flowing with the damage of the respiratory system, characterized by an increase in body temperature, intoxication and catarrhal syndrome.
I. Introductory part
Protocol name:ORVI in children
Protocol code:
The code (codes) by MKB-10:
J00- J06 sharp respiratory infections of the upper respiratory tract
J00-Estraged Naphorgitis (Rubber)
J02.8 - acute pharyngitis caused by other refined pathogens
J02.9 - acute pharyngitis not refined
J03.8 - acute tonsillitis caused by other refined pathogens
J03.9 - acute tonsillitis, not refined
J04-edged laryngitis and tracheitis
J04.0 - acute laryngitis
J04.1 - acute tracheitis
J04.2 - acute laryngotrachite
J06 - Top respiratory infections of the upper respiratory tract of multiple and unspecified localization
J06.0 - acute laryngoparing
J06.8 - Other acute infections of the upper respiratory tract of multiple localization
J06 - acute infection of the upper respiratory tract uncomfortable
J10- J18 - Influenza and Pneumonia
J10 - Influenza, caused by identified influenza virus
J11 - flu, virus is not identified
Protocol development date: year 2013.
Abbreviations used in the protocol:
With a general practice doctor
DVS - Disseminated intravascular coagulation
ELISA - immunoformal analysis
MN - international normalized attitude
ORVI - Acute respiratory viral infection
ORZ - acute respiratory disease
PV - prothrombin time
PMSP - primary health care
PCR - Polymeraznasta Reaction
RNGU - react indirect hemagglutination
RPGA - Passive hemagglutination reaction
RSK - Complement Binding Reaction
RTHA - hemagglutination braking reaction
ESO - Erythrocyte settlement speed
Torso - Heavy Acute Respiratory Syndrome
Ivbdv-integrated childcare disease
HIV virus immunodeficiency
Optical signs of danger
Protocol users: UP PMS, a PMSP pediatrician, a doctor - an infectiousnessist Children's IPP;
- Pediatric infectious disease physician / department, doctor - pediatrician of multi-public and specialized hospitals
Classification
Clinical classification of ARVI:
- Easy,
- moderate,
- Heavy.
With the flow:
- smooth without complications;
- with complications.
For example: ARVI, laryngitis, moderate severity. Complication of sand stenosis 1 degree. With the clarification of the etiology of ORVI, the disease is classified by nosological form.
Clinical classification of influenza and other sharp respiratory diseases (ORZ):
1.1. Etiology
1.1.1. Influenza type A.
1.1.2. Influenza type V.
1.1.3. Flu type S.
1.1.4. Paragrippace infection.
1.1.5. Adenoviral infection.
1.1.6. Respiratory and synthetic infection.
1.1.7. Rinovirus infection.
1.1.8. Coronavirus infection.
1.1.9. Mycoplasma infection.
1.1.10. Orz bacterial etiology
1.1.11. ARVI mixed etiology (viral-viral, viral-myoplasma, viral-bacterial, mycoplasmo-bacterial).
1.2. Form of clinical flow
1.2.1. Asymptomatic.
1.2.2. Easy.
1.2.3. Medium-heavy.
1.2.4. Heavy.
1.3. Complications
1.3.1. Pneumonia.
1.3.2. Bronchitis.
1.3.3. Schimorite.
1.3.4. Otitis.
1.3.5. Crup syndrome.
1.3.6. Defeat of the cardiovascular system (myocarditis, ITS, etc.).
1.3.7. Defeat of the nervous system (meningitis, encephalitis, etc.).
Diagnostics
Ιι. Methods, approaches and diagnostic and treatment procedures
List of diagnostic events
Main:
1) Collect complaints and anamnesis, including epidemiological (contact with patients and / or large number of people during the seasonal lifting period of ARVI and influenza, etc.);
2) an objective examination (visual inspection, palpation, percussion, auscultation, general thermometry, blood pressure measurement, pulse and respiratory rate determination, assessment of urinary function);
3) General blood test (hemoglobin, erythrocytes, leukocytes, leukocyte formula, ESO).
4) General urine analysis.
5) studies to establish the etiology of the disease are carried out necessarily by the method of immunofluorescence and serological reactions;
6) Cala microscopy to detect Helminth eggs.
Additional:
1) ELISA, virological research and PCR are carried out in the laboratories of the Department of Gossennepidadzor to determine the etiology of influenza and ARVI;
Methods of etiological diagnostics of ORVI and influenza
| Diagnosis | Immunofluoo-recreation |
Rland RTHA |
IFA | Sowing a human embryo cell culture, monkey kidney (virological study) | PCR |
| Flu | + | +++ | + | + | + |
| Paragripp. | + | RTHA | - | + | - |
| Adenoviral infection | + | RTHA | - | - | - |
| + | Rland | - | + | - | |
| Rinovirus infection | + | - | - | + | - |
| TORSO | - | - | + | - | + |
2) platelets, many PV - in the presence of hemorrhagic syndrome;
3) microscopy of thick drop of blood for the detection of malaria plasma (for fever more than 5 days);
4) a spinal point with the study of liquor;
5) lung radiography - with suspected pneumonia or bronchitis;
6) ECG - if there is complications from the cardiovascular system;
7) consultation of the neurologist in the presence of cramps and symptoms of meningoencephalitis;
8) consultation of the hematologist with severe hematological changes and hemorrhagic syndrome;
- surveys that need to be carried out to planned hospitalization (minimum list) is not conducted.
Diagnostic criteria
Complaints and history, including epidemiological
Flu
:
- acute start with the development of symptoms of intoxication in the 1st day, high fever with chills;
- the total duration of the feverish period is 4-5 days;
- Headache with typical localization in the forehead, abrasion arcs, eyeballs;
- Weakness, Adamina;
- pain in the bones, muscles, lethargy, "Breakness";
- hyperesthesia;
Paragripp.:
- the beginning of the disease can be gradual;
- intoxication is poorly expressed;
- pain and sore throat, nasal congestion, abundant discharge from the nose, dry cough cough cough, witness voices;
Adenovirus infection:
- the beginning of the disease is acute;
- runny nose and nasal congestion, then the abundant mucous membranes from the nose are joined;
- There may be a sense of dedication or pain in the throat, dry cough;
- Phenomena of conjunctivitis - pain in the eyes, tear.
Respiratory and Syncitial Infection
:
- gradual start;
- subfebrile temperature;
- thrust cough, first dry, then productive, often parole;
- Characteristic shortness of breath (astmoid breathing in children under 5 years old).
Rinovirus infection
:
- moderate intoxication
- Start sharp;
- sneezing, discharge from the nose, hindered nose breathing, shaking;
TORSO
:
- acute beginning with chills, headache, pain in muscles, total weakness, dizziness, increasing body temperature, discharge from the nose;
- throat pain, hyperemia of the mucous membrane of the sky and the rear wall of the pharynx, cough;
- Possible nausea, one-two-time vomiting, abdominal pain, liquid stool;
- After 3-7 days, it is possible to re-increase the body temperature and the appearance of a resistant unproductive cough, shortness of breath, difficulty breathing.
Epidemiological history:
- Contact with patients with influenza and ORVI
physical examination
Objective symptoms characteristic of influenza and ORVI:
- increase body temperature;
- nasal congestion, impairment of nasal respiration, sneezing, department of mucus from the nose (acute rhinitis);
- hyperemia of the mucous membrane, perfense and dryness in the throat, soreness when swallowing (acute pharyngitis);
- hyperemia and swelling of the almonds, skydly arms, tongue, the posterior wall of the pharynx (acute tonsillitis);
- Dry bakey cough, witness of voice (laryngitis);
- Sadness for the sternum, dry cough (tracheitis);
- Astmoid breathing (obstructive bronchitis)
- cough (at the beginning of the disease Dry, in a few days wet with an increasing number of sputum); The sputum more often has a mucous nature, at the 2nd week it can acquire a greenish tint; Cough can be maintained for 2 weeks and longer (up to 1 month with adenovirus and respiratory-syntial-viral infections).
| Pathogens | Basic respiratory lesion syndromes |
| Influenza viruses | Tracheitis, laryngitis, rinofaring, bronchitis |
| Viruses paragrippa | Larygitis, Rinofaring, false croup |
| Respiratory Syncitial Virus | Bronchitis, bronchiolit |
| Adenovirus | Pharyngitis, tonsillitis, rhinitis, conjunctivitis |
| Rinovirus | Rinith, Rinofaringitis |
| Coronavirus man | Rinofaring, Bronchit |
| Coronavirus Torso | Bronchitis, Bronchiolitis, Respiratory Distress Syndrome |
Objective symptoms characteristic of flu:
- temperature 38.5-39.5 0 s;
- the pulse rate corresponds to an increase in temperature;
- breathing is rapidly;
- moderately pronounced catarrhal phenomena (runny nose, dry cough);
- hyperemia of the face and neck, the injection of the spool vessels, increased sweating, small hemorrhagic rash on the skin, spilled hyperemia and the grain of the ozo mucous membrane;
- with severe form: high fever, violation of consciousness, phenomena of meningism, shortness of breath, hemorrhagic rash, tachycardia, deafness of cardiac tones, pulse weakness, arterial hypotension, acricyanosis and cyanosis, convulsive readiness or convulsions;
- nasal bleeding, hemorrhagic rash on the skin and mucous meal due to the development of the DVS syndrome;
- signs of acute respiratory failure in patients with severe (especially pandemic) flu: parlorous cough cough, whistling streaming breath, inspiratory shortness of breath, voices, central and acrocyanosis, tachycardia, weak pulse, weakening of heart tones, arterial hypotension;
- Signs of acute vascular failure in patients with heavy (especially pandemic) flu: decrease in body temperature, pallor skin, cold sticky sweat, adamina with loss of consciousness, cyanosis and acricyanosis, tachycardia, weak threaded pulse, deafness of heart tones, arterial hypotension, cessation of urination ;
- Signs of edema and swelling of the brain substance in patients with heavy (especially pandemic) flu: psychomotor arousal and violation of consciousness, pathological type of breathing, bradycardia, replacing tachycardia, hyperemia, vomiting, non-relief, convulsions, focal neurological signs, meningeal syndromes, lability blood pressure, hyperstability, hyperkausia;
- Signs of pulmonary edema in patients with severe (especially pandemic) flu: increments of shortness of breath and stroke, central and acrocianoz, the appearance of foam and bloodworm sputum, decrease in body temperature, weak frequent pulse, many dry and wet solid-caliber wheels in the lungs.
Criteria for the severity of influenza and ORVI (Estimated by the severity of symptoms of intoxication):
L. egger
- an increase in body temperature not more than 38 ° C; moderate headache;
Middle degree - body temperature in the range of 38.1-40 ° C; severe headache; hyperesthesia; tachycardia
Heavy degree - the most acute principle, high temperature (more than 40 °) with sharply pronounced symptoms of intoxication (strong headache, fragile in all body, insomnia, nonsense, anorexia, nausea, vomiting, meningeal symptoms, sometimes encephalitic syndrome); Pulse more than 120 wt / min, weak filling, often arrhythmic; systolic blood pressure less than 90 mm Hg; Heart tones deaf; Respiratory frequency more than 28 per 1 min.
Very severe degree - lightning flow with rapidly developing symptoms of intoxication, with the possible development of DVS-syndrome and neurotoxicosis.
laboratory research:
General blood analysis:
- normo leukopenia (normal indicators of blood leukocytes: 4-9 · 10 9 / l);
- lymphocytosis (normal indicators of blood lymphocytes: 20-37% in children over 5 years old, up to 5 years old, 60-65%);
- in the case of attaching bacterial superinfection - leukocytosis and / or "shift of the formula to the left"; ;
- Normal Erythrocyte rates (4.0-6.0.10 12 / l), hemoglobin (120-140 g / l), SE (boys 2-10 mm / h, girls 2-15 mm / h).
- positive results of immunofluorescence and increasing the titer of specific antibodies in 4 or more times in serological reactions (in paired serums).
Spinal puncture - Likvor transparent, cytosis is normal, (normal figure of liquor: transparent, colorless, cytosis 4-6 in ml, including lymphocytes 100%, neutrophils 0%; protein 0.1-0.3 g / l, glucose 2 , 2-3.3 mmol / l).
Tools:
Respiratory radiography:
- signs of bronchitis, pneumonia, lung edema.
Indications for consultation of specialists:
- neurologist in convulsions and phenomena of meningoencephalitis;
- hematologist with severe hematological changes and hemorrhagic syndrome;
- Okulist at the edema of the brain.
Differential diagnosis
Differential diagnosis
|
Diagnosis or Cause of the disease |
In favor of diagnosis |
| Pneumonia |
Cough and Student Breath: age< 2 месяцев ≥ 60/мин Age 2 - 12 months ≥ 50 / min Age 1 - 5 years ≥ 40 / min - retraction of the bottom of the chest - Fever - Auscultative signs - weakened breathing, Wet whears - Inflating the wings of the nose - melting breath (in early child babies) |
| Bronchiolit |
- the first case of astmoid breathing in a child in age<2 лет - Astmoid breathing during the period of seasonal increase in the incidence of bronchiolite - breast expansion - elongated exhalation - Auscultative - weakened breathing (if expressed very much - to eliminate the obstruction of the respiratory tract) - weak reaction or no reaction to Broncholitical means |
| Tuberculosis |
- chronic cough (\u003e 30 days); - bad development / backlog in weight or weight loss; - Positive Mantu reaction; - Contact with patients with tuberculosis in history - X-ray signs: primary complex or miliar tuberculosis - Detection of mycobacterium tuberculosis in the study sputum in older children |
| Whooping cough |
- Paroxysmal cough accompanied by characteristic convulsive whistling inhale, vomiting, cyanosis or apnea; - good health between cough attacks; - lack of fever; - Lack of vaccination of ADCs in history. |
| Foreign body |
- the sudden development of mechanical obstruction of the respiratory tract (the child "suppressed") or stridor - sometimes astmoid breathing or pathological expansion of the chest on one side; - Air delay in the respiratory tract with amplification of the percussion sound and the displacement of the mediastinum - Signs of lung collapse: weakened breathing and pointing percussion sound - lack of reaction to bronchology |
|
Shipping / Empirea pleura |
- "Stone" stupidity of a percussion sound; - no respiratory noise |
|
Pneumothorax |
- a sudden beginning; - tympanic sound with percussion on one side of the chest; - Displacement of mediastinum |
|
Pneumonic pneumonia |
- 2-6 month old child with central cyanosis; - graining of the chest; - rapid breathing; - fingers in the form of "drum sticks"; Changes on the radiograph in the absence of auscultative disorders; - increased dimensions of the liver, spleen, and lymph nodes; - Positive HIV test from mother or child |
Criteria for differential diagnosis of sharp respiratory viral infectious diseases
| Signs |
Pandemic cue flu |
Seasonal flu | TORSO | Paragripp. |
Respirator- but sycitial Naya infection |
Adenovirus Naya infection |
Rinovirus Naya infection |
| Pathogen | Flu Virus A (H5N1) | Influenza viruses: 3 serotype (A, B, C) | Coronavirus new group | Paragrippa viruses: 5 serotypes (1-5) |
Respirator- but syntial Virus: 1 Serotype |
Adenoviruses: 49 Serotypes (1-49) | Rinoviruses: 114 Serotypes (1-114) |
|
Incubation Period |
1-7 days, on average 3 days | From several hours to 1.5 days | 2-7 days, sometimes up to 10 days | 2-7 days, more often 3-4 days | 3-6 days | 4-14 days | 23 days |
| Start | Acute | Acute | Acute | Gradual | Gradual | Gradual | Acute |
| Flow | Acute | Acute | Acute | Subacute | Subacute, sometimes protracted |
Protracted, wave-like noye |
Acute |
| Leading clinical syndrome |
Intoxic tion |
Intoxic tion |
Breathing insufficient Nosta |
Catarial |
Catarial, respiratory failure Nosta |
Catarial | Catarial |
|
Expressed intoxicating tion |
pronounced | pronounced | Strongly pronounced | moderate | Moderate or absent | Moderate | Moderate or absent |
|
Length intoxicating tion |
7-12 Sut. | 2-5 days | 5-10 day | 1-3 days | 2-7 days | 8-10 days | 1-2 days |
| Body temperature | 390s and above |
More often than 39 0 s and above, but maybe subfebrile Naya |
380С and higher | 37-38 0 s and above |
Subfebrile naya, sometimes normal |
Febrile or subfebrile Naya |
Normal or subfebrile Naya |
| Catarial manifestations | Absent |
Moderately pronounced Late later |
Moderately expressed, exudation is weak | Specified from the first day of the course of the disease. Voting witness | Expressed, gradually grow | Strongly expressed from the first day of the disease | Specified from the first day of the course of the disease. |
| Rhinitis | Absent |
Nose. Serous, mucous or succulent discharge in 50% of cases |
Possible at the beginning of the disease |
The difficulty of nasal respiration is laid Nose property |
Laid nose, unreasual serous separated |
Abundant mucous serous discontinued, sharp difficulty of nasal breathing | Abundant serous discontinued, nasal breathing difficult or absent |
| Cough | Expressed | Dry, painful, adsatory, with pains for the sternum, 3 days. Wet, up to 7-10 days. Terms of the disease | Dry, moderately pronounced | Dry, the marine can be saved for a long time (sometimes up to 12-21 days) |
Dry bouts shaped (up to 3 weeks), accompanied giving pains for the sternum, astmoid breathing in children is more often up to 2 years |
Wet | Dry, merpure |
| Changes in mucous membranes | Absent |
The mucous membrane of the pharynx and almonds are blue, moderately hyperemic Vana; Vessel injection. |
Weak or moderate hyperemia mucous membranes | Weak or moderate zea hyperemia, soft sky, rear wall of the throat | Moderate hyperemia, swelling, hyperplasia follicle almonds and rear wall of pharynges | Weak hyperemia mucous membranes | |
|
Physicial signs of lung damage |
CO 2-3 days of the course of the disease | Absent, if there is bronchitis - dry scattered wheezes |
Since the 3-5 days of the course of the disease, signs of interstitis often detect Pneumonia |
Absent |
Scattered dry and rare wet average Chattered wheezing, signs of pneumonia |
No missing. If there is bronchitis - dry, scattered wheezes. | Absent |
|
Leading respiratory syndrome lesions |
Lower respiratory syndrome |
Tracheitis |
Bronchitis, acute respiratory Distress syndrome |
Laryngitis, false croup | Bronchitis, bronchiolitis, bronchospasm is possible |
Rinofarine- Gokeonunctible Wit or tonsillit |
Rhinitis |
|
Increased lymphatic kih nodes |
Absent | Absent | Absent |
Rear less often armpits lymphatic Kie lymph nodes are increased and moderately painful nye |
Absent | Maybe polyadenit | Absent |
| Enlargement of liver and spleen | maybe | Absent | Reveal | Absent | Absent | Expressed | Absent |
| Eye damage | Absent | Injection of Vessel Scler | Seldom | Absent | Absent |
Conjunctiv WIT, Kerato conjunctiv VIT |
Vessel injection Scler, |
| Defeat of other organs |
Diarrhea, possibly damage to the liver, kidneys, leuko-, lymph, thrombocy Carrying |
Absent | Often, diarrhea develops at the beginning of the disease | Absent | Absent | Maybe exanthema, sometimes diarrhea | Absent |
Examples of diagnosis wording:
J11.0. Influenza, typical, toxic form with hemorrhagic severe hemorrhagic syndrome. Complication: neurotoxicosis of 1 degree.
J06 ORVI, easy severity.
J04 ORVI. Acute laryngitis and tracheitis, moderate severity.
Treatment abroad
Treat treatment in Korea, Israel, Germany, USA
Get advice on medical examination
Treatment
Treats of treatment :
Saving intoxication, catarrhal syndrome and seizures.
Tactics of treatment
Aged 0 to 5 years - treatmentaccording to the order of the Ministry of Health of the Republic of Kazakhstan№ 172 of 03/31/2011
Non-drug treatment:
In the conditions of primary health care and hospital:
- a bed mode for a period of fever with subsequent expansion as the symptoms of intoxication relieves;
- Diet - easily friendly food and abundant drink.
Medicia treatment
Flu treatment in the conditions of primary conditions:
Antiviral drugs
- remantadine -
- Arbidol
Treatment of ARVI in the conditions of primitive(Assign in the first 2-3 days from the beginning of the disease):
Antiviral drugs:
- 0.25% oxolin ointment - lubrication of the nasal moves from the first days of the disease.
Interferon and inducers of interferon synthesis
(Assign in the first 2-3 days from the beginning of the disease):
- Interferon recombinant alpha 2B (Viferon) Suppositories Rectal 150,000 IU (up to year), 500,000 me (from year to 3 years), 1,000,000 me (over 3 years) 1 suppositories 2 times a day daily. Course of treatment 10 days;
- Arbidol children over 12 are prescribed 200 mg, children from 6 to 12 years at 100 mg 3 times a day for 5 days;
To mitigate dry cough - expectorant preparations (ambroxol); (For children under 5 years old, expectorant means are not prescribed)
At high temperatures more than 38.5 degrees once - paracetamol is 10-15 mg / kg;
It should not be prescribed antibiotics to children with ORVI and acute bronchitis, laryngotracy are effective only in the treatment of bacterial infection. Should not be assigned tools that overwhelming cough;
Do not assign drugs containing atropine, codeine and its derivatives or alcohol (may be dangerous to the health of the child);
Do not use medical drops into the nose;
Do not use aspirin containing drugs.
Treatment under an infectious hospital
Influenza treatment in hospital
Antiviral drugs
(Assign in the first 2-3 days from the beginning of the disease, one of the following):
- Zanamivir (powder for inhalation dosage 5 mg / dose) in the treatment of influenza A and in children older than 5 years it is recommended to assign 2 inhalations (2 × 5 mg) 2 times / day for 5 days. Daily dose - 20 mg;
- Seltamivir - Children over 12 are prescribed 75 mg 2 times a day inside within 5 days. Increasing the dose of more than 150 mg / day does not lead to increased effect.
Children more than 40 kg or older than 8 years old Who can swallow capsules, can also receive treatment, taking on one capsule 75 mg 2 times a day, as an alternative to the recommended dose of the Tamiflu of the suspension (see the junction).
Children over 1 year A suspension is recommended for receiving inside for 5 days:
children weighing less 15 kg prescribe 30 mg 2 times a day;
children weighing 15-23. kg - 45 mg 2 times a day;
children weighing 23-40 kg -
60 mg 2 times a day;
children more than 40 kg -
75 mg 2 times a day.
Daily dose of 150 mg (75 mg twice a day) within 5 days.
- remantadine - Children over 10 years old are prescribed 100 mg 2 times a day for 5 days, children 1- 9 years 5 mg / kg per day in two receptions;
- 0.25% oxolin ointment - lubrication of the nasal moves from the first days of the disease.
Interferon and inducers of interferon synthesis
(Assign in the first 2-3 days from the beginning of the disease):
- Interferon Recombinant Alpha-2V Suppositories Rectal 1000000 IU (over 3 years old) 1 suppositories 2 times a day daily. Course of treatment 10 days;
- Arbidol children over 12 are prescribed 200 mg, children from 6 to 12 years at 100 mg 3 times a day for 5 days;
ORVI treatment in hospital(Assign in the first 2-3 days from the beginning of the disease):
Interferon and inducers of interferon synthesis
(Assign in the first 2-3 days from the beginning of the disease):
- Interferon Recombinant Alpha-2V Suppositories Rectal 150,000 IU (up to year), 500,000 meters (from year to 3 years), 1,000,000 meters (over 3 years) 1 suppositories 2 times a day daily. Course of treatment 10 days;
- Arbidol children over 12 are prescribed 200 mg, children from 6 to 12 years at 100 mg 3 times a day for 5 days;
Pathogenetic and symptomatic treatment -
according to the testimony:
- Disinfecting therapy: with light and medium degrees of gravity of the process, abundant drinking in the form of fruit and vegetable juices, horses, drinking water is prescribed to patients. In severe cases and in cases where orally fails to stop the inxication phenomena, the use of infusion therapy is required from the calculation of 30-50ml / kg / day. For this purpose, crystaloids (saline, azesol, lactosol, di- and trisol, etc.) and colloids (refooliglucin, hydroxyethyl storage solutions, gelatin) are used.
- antipyretic drugs;
Children under 5 do not prescribe:
- vasoconductive nasal drops and sprays;
- antitussive and expectorant;
- drug preparations containing atropine, codeine and its derivatives or alcohol (may be dangerous to the health of the child);
- medical drops into the nose;
- Aspirin containing drugs.
When developing bacterial complications In patients with medium-heavy and heavy forms of influenza, antibacterial therapy is prescribed with the inclusion of semi-synthetic penicillins, cephalosporins II-IV generations, carbapenes, macrolides and azalides, with a high probability of staphylococcal etiology complications with an antibiotic choice is vancomycin;
For cramps:
- Anticonvulsant drugs: diazepam, GOM, ConValex, Droperidol, phenobarbital.
With neurotoxicosis:
- Dehydration therapy: Manit, Laziks, diakar;
- oxygen therapy primarily (mask), low-speed feed - up to 2 months-0.5-1 liter per minute, older and up to 5 years - 1-2 liters per minute.
With astmoid breathing: Inhalation of salbutamola.
With stenosis of the larynx: Inhalation of alkaline water.
List of basic medicines:
Antiviral drugs:
1. oseltamivir capsules 75 mg, powder for the preparation of oral suspension 12 mg / ml (level B).
2. Zanavir powder d / inhalation dosage 5 mg / 1 dose: Rotadi 4 doses (5 pcs. In the set with dischecher) (level B).
3. remantadine 100 mg, tablets;
4. Steroid anti-inflammatory drugs:
- paracetamol 200 mg, 500 mg, Table., 2.4% Suspension for intakes in bottles of 70, 100, 300 ml
List of additional medicines:
1. Multic drugs:
Ambroxol 30 mg, Table. , 0.3% syrup in bottles of 100, 120, 250 ml and 0.6% - 120 ml; 0.75% for inhalations and intakes in bottles of 40 and 100 ml.
Interferon and inducers of interferon synthesis:
1. Interferon Recombinant Alpha-2V Suppositories Rectal 150 000 IU, 500,000 IU, 1 000 000 IU.
2. Arbitol children over 12 years old are prescribed 200 mg, children from 6 to 12 years at 100 mg 3 times a day for 5 days;
Disinfect drugs:
1. Glucose solution for infusion 5%, 10%.
2. Sodium chloride 0.9% solution for infusion.
3. Ringer's solution
4. Hydroxyethyl stroke (reform, stabizol) solutions for infusion 6%, 10%.
5. Solution of Reopolyglyukina
With complications (pneumonia):
1. Amoxicillin 500 mg, tabular, oral suspension 250 mg / 5 ml;
2. amoxicillin + clavulanic acid, tablets coated with a shell of 500 mg / 125 mg, 875 mg / 125 mg;
3. Cefotaxim - powder for the preparation of the solution for injections in bottles of 0.5, 1.0 or 2.0 g.;
4. Ceftazidim - powder for the preparation of the solution for injections in bottles of 0.5, 1.0 or 2.0 g.;
5. Imipine + cilastatin - powder for preparing a solution for infusion 500 mg / 500 mg; Powder for the preparation of a solution for intramuscular injections in vials of 500 mg / 500 mg;
6. Cefepim - powder for the preparation of a solution for injection of 500 mg, 1000 mg, powder for the preparation of a solution for intramuscular injections in a bottle in a set with a solvent (lidocaine hydrochloride 1% solution for injection in ampule 3.5 ml) 500 mg, 1000 mg;
7. Ceftriaxone - powder for the preparation of the solution for injections of 0.25 g, 0.5 g, 1 g, 2 g; Powder for the preparation of a solution for injections in a set with solvent (water for injection in ampoules 10 ml) 1000 mg;
8. Azitromycin - capsules of 0.25 g; Tablets at 0.125 g and 0.5 g; Syrup 100 mg / 5 ml and 200 mg / 5 ml; Powder for the preparation of suspension.
For cramps:
- diazepam 0.5% rr 2 ml, GOM 20% rr in 5 and 10 ml, phenobarbital powder, tablets of 0.005; Tablets 0.05 and 0.01
- Dehydration therapy: Manit 15% - 200 and 400 ml, 20% R-R-500 ml, Laziks 1% - 2 ml, Tablet diakar of 0.25.
With astmoid breathing:
- Salbutamol.
Other types of treatment: not.
Surgical intervention: not.
Preventive actions:
Seasonal vaccination against influenza virus (level a)
.
Anti-epidemic activities:
- insulation of patients,
- ventilating the room where the patient is located
- Wet cleaning using 0.5% chlorine solution,
- in medical institutions, pharmacies, shops and other enterprises of service sector, staff should work in masks,
- In the wards of medical institutions, medical offices and corridors, the clinic must systematically include ultraviolet lamps and carry out, for patients with polyclinics, isolated compartments are organized with a separate entrance from the street and the wardrobe.
- Use of ascorbic acid, polyvitamins (Level C)
, natural phytoncides (Level C).
Further guiding, principles dispensarization
If the cough lasts more than 1 month or fever for 7 days or more, carry out an additional examination to identify other possible causes (tuberculosis, asthma, cough, foreign body. HIV, bronchiectase, lung abscess, etc.).
Indicators efficiency treatment:
- normalization of body temperature;
- disappearance of intoxication (recovery of appetite, improvement of well-being);
- relief of astmoid breathing;
- disappearance of cough;
- relief symptoms of complications (if available).
Hospitalization
Indications for hospitalization:
Emergency hospitalization: in infectious hospital -during the epidemic raising of morbidity up to 5 days from the beginning of the disease; in profile hospitals (depending on complications) - after 5 days from the beginning of the disease:
- the availability of the OPOO in children under 5 years old by IWBDV
- patients with heavy and complicated flu forms and ARVI;
- patients with severe concomitant pathology, regardless of the form of gravity of influenza and ARVI;
- children with stenosis of laryngeal II-IV degree;
- The first year of life;
-They from closed institutions and from families with adverse socio-living conditions.
Information
Sources and literature
- Protocols of meetings of the Expert Commission on Health Development Mort RK, 2013
- 1. Efficacy and Tolerability of Ambroxol Hydrochloride Lozenges in Sore Throat. Randomised, Double-Blind, Placebo-Controlled Trials Regarding The Local Anaesthetic Properties .. 2001 Jan 22; 161 (2): 212-7. 2. Zanamivir for the Treatment of Influenza A and B Infection in High-Risk Patients: A Pooled Analysis of Randomized Controlled Trials. 2010 Oct 15; 51 (8): 887-94. 3. Early OSELTAMIVIR TREATMENT OF INFLUENZA IN CHILDREN 1-3 YEARS OF AGE: A RANDOMIZED CONTROLLED TRIAL. University of Turku, Turku, Finland. 4. Fahey T, Stocks N, Thomas T. SystemAtic Review of the Treatment of Upper Respiratory Tract Infection. Archives of deseases in Childhood 1998; 79: 225-230 5. The Database Of Abstracts Of Reviews of Effectiveness (University of York), Database No.:Dare-981666. In: The Cochrane Library, Issue 3, 2000. Oxford: Update Software 6. Institute for Clinical Systems Improvement (ICSI). VIRAL UPPER RESPIRATORY INFECTION (VURI) IN ADULTS AND CHILDREN. Bloomington (MN): Institute For Clinical Systems Improvement (ICSI); 2004 May. 29 p. 7. HEALTHCARE GUIDELINE, Viral Upper Respiratory Infection in adults and children, 9th edition, may 2004, ICSI 8. Cough and cold remedies for the treatment of acute respiratory infections in young children, Department of child and adolescent health and development, world health organization , 2001 9. Maintaining a child with a serious infection or severe nutrition. Guidelines for the care of first-level hospitals in Kazakhstan. WHO, MOR RK, 2003 10. Evidence-based medicine. Annual brief reference book. Issue 3. Moscow, media sphere, 2004. 11. Clinical recommendations for practitioners, based on evidence-based medicine: Per with English / Ed. Yu.L. Shevchenko, I.N. Denisova, V.I. Kulakova, R.M. Khaitova.- 2nd ed., Act. - M.: Gootar-Med, 2003. - 1248c.
Information
III. Organizational aspects of the implementation of the Protocol
List of developers:
1. Kuttykozhanova G.G. - D.M., Professor, Head of the Department of Children's Infectious Diseases Kaz NMU. Asphendiyarova.
2. Efendiev I.M. - Ph.D., Associate Professor, Head of the Department of Children's Infectious Diseases and Phthisiology of the GMU G. Family.
3. ATKENOV S. B. - K.M.N., Associate Professor, Department of Children's Infectious Diseases JSC Medical University of Astana
Reviewers:
1. Bazeheva D.A. - D.N., Head of the Department of Children's Infectious Diseases JSC Medical University of Astana.
2. Kosherova B. N. - Vice-Rector for Clinical Work and Continuing Professional Development, D.M., Professor of Infectious Diseases Kargmu.
Indication for the lack of conflict of interest: not.
Note Protocol Review Conditions:
-
changes in the regulatory framework of the Republic of Kazakhstan;
- revision of WHO clinical recommendations;
- availability of publications with new data obtained as a result of proven randomized studies.
Attached files
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Approved
Union of Pediatricians of Russia
Clinical recommendations
Acute respiratory viral
iNFECTION (ARVI) in children
МКБ 10:
J00 / J02.9 / j04.0 / j04.1 / j04.2 / j06.0 / j06.9
Year of approval (revision frequency):
2016 (
revision every 3 years)
ID:
URL:
Professional associations:
Union of Pediatricians of Russia
Agreed
Scientific Council of the Ministry
Health of the Russian Federation
__ __________201_
2
Table of contents
Keywords................................................ .................................................. ...................... 3.
List of abbreviations ................................................ .................................................. ................ 4 1. Brief information ............................... .................................................. .............................. 6 1.1 Definition ................. .................................................. ................................................. 6. 1.2 etiology and pathogenesis .............................................. .................................................. ..... 6 1.3 Epidemiology .......................................... .................................................. .................... 6 1.4 coding on the ICD-10 ....................... .................................................. ............................ 7 1.5
Classification................................................. .................................................. ................. 7 1.6 Examples of diagnoses ............................. .................................................. .......................... 7 2.
Diagnostics................................................. .................................................. ....................... 8 2.1 Complaints, anamnesis ...................... .................................................. ..................................... 8 2.2 Physical examination ......... .................................................. .................................. 9 2.3 Lab diagnostics ............ .................................................. ................................ 9 2.4
Instrumental diagnostics .................................................. .................................... 10 3. Treatment .......... .................................................. .................................................. .................. 11 3.1 Conservative treatment ............................ .................................................. ................. 11 3.2 Surgical treatment ................................... .................................................. .................. 16 4. Rehabilitation ............................ .................................................. ......................................... 16 5. Prevention and dispensary observation .. .................................................. .................. 16 6. Additional information affecting the course of the course of the disease .................... . 18 6.1 Complications .............................................. .................................................. ................... 18 6.2 Maintenance children ............................................................. .................................................. ............. 18 6.3.
Outcomes and forecast ............................................... .................................................. ......... nineteen
Criteria for assessing the quality of medical care ............................................... ................... twenty
Bibliography................................................ .................................................. ............... 21.
Appendix A1. Composition of the working group ................................................. ............................ 25.
Appendix A2. Methodology for the development of clinical recommendations .......................... 26
Appendix A3. Related Documents ................................................ ............................. 28.
Appendix B. Algorithms of patient maintenance .............................................. ....................... 29
Appendix B. Information for patients ............................................ .......................... thirty
Appendix G. Decoding Notes ............................................. ........................... 33.
3
Keywords
acute infection of the upper respiratory tract uncomfortable;
acute respiratory infection;
acute infections of the upper respiratory tract of multiple and unspecified localization;
acute laryngitis and tracheitis;
acute laryngitis;
acute laryngotracheit;
acute laryngoparingitis;
acute nationopharygitis (runny nose);
acute tracheitis;
acute pharyngitis uncomfortable;
acute pharyngitis.
4
List of abbreviations
Il -interleukin
ORVI -acute respiratory viral infection
5
Terms and Definitions
The concept of "acute respiratory viral infection (ARVI)" - summarizes the following nosological forms: acute nationopharygitis, acute pharyngitis, acute laryngitis, acute tracheitis, acute laryngoparing, acute infection of the upper respiratory tract uncomfortable. New and narrow-proof professional terms in these clinical guidelines are not used.
6
1. Brief information
1.1
Definition
Acute respiratory viral infection (ORVI) - acute, in most cases, self-limiting respiratory tract infection, manifested by catarrhal inflammation of the upper respiratory tract and flowing with fever, rhinar, sneezing, cough, sore throat, violation of the overall state of different severity.
1.2
Etiology and pathogenesis
The causative agents of diseases of the respiratory tract are viruses.
The spread of viruses occurs most often by self-intoulation on the mucous membrane of the nose or the conjunctival from the hands contaminated during contact with the patient
Another path is the air-droplege - when inhaling the aerosol particles containing the virus, or when larger droplets on the mucous membranes in close contact with the patient.
Incubation period of most viral diseases - from 2 to 7 days.
Selection of viruses in patients maximally on the 3rd day after infection, dramatically decreases to the 5th day; Non-intensive selection of the virus can be maintained up to 2 weeks.
Viral infections are characterized by the development of catarrhal inflammation.
ORVI symptoms are the result not so much damaging influence of the virus, how much reaction system of congenital immunity. The affected epithelium cells are isolated cytokines, incl. Interleukin 8 (Il 8), the amount of which correlates both with the degree of attracting phagocytes to the submucosal layer and epithelium and the severity of symptoms. An increase in nasal secretion is associated with an increase in vessel permeability, the number of leukocytes in it can increase repeatedly, changing its color with transparent on white and yellow or greenish, i.e. Change the change in the color of the nasal mucus with a sign of bacterial infection is unfounded.
Installation that, in any viral infection, a bacterial flora is activated (the so-called "viral-bacterial etiology
Ori "on the basis of, for example, the presence of the patient leukocytosis) is not confirmed by the practice. Bacterial complications of ARVI arise relatively rarely.
1.3
Epidemiology
7
ARVI - the most common person infection: children under the age of 5 are transferred, on average, 6-8 Episodes of ARVI per year, in children's preschool institutions, the incidence of 1-2 months is especially high, 10-15% higher than Inorganized children, however, in school the latter are more often sick. The incidence of acute infections of the upper respiratory tract can differ significantly in different years. The incidence is highest in the period from September to April, the peak of morbidity falls on February-March. The recession of the incidence of acute infections of the upper respiratory tract is consistently registered in the summer months, when it is reduced by 3-5 times. According to the Ministry of Health of Russia and Rospotrebnadzor in 2015, it amounted to 20.6 thousand cases of diseases per 100 thousand people (against 19,5 thousand on
100 thousand population in 2014). The absolute number of diseases with acute infections of the upper respiratory tract in the Russian Federation amounted to 30.1 million cases in 2015.
Among children from 0 to 14 years, the incidence of sharp infections of the upper respiratory tract in 2014. amounted to 81.3 thousand. per 100 thousand or 19559.8 thousand registered cases.
1.4
Coding on the ICD-10
Acute Natural Facre (J00) (J00)
Acute pharyngitis (j02)
J02.9 -
A sharp pharyngitis is uncomfortable
Acute laryngitis and tracheitis (j04)
J04.0 -
Acute laryngit
J04.1 -
Acute tracheitis
J04.2 -
Acute laryngotrachiteitis
Acute infections of the upper respiratory tract multiple and
uncomfortable Localization (J06)
J06.0 -
Acute laryngoparing
J06.9 -
Acute infection of the upper respiratory tract uncomplicated
1.5
Classification
The division of ARVI (Naphorgitis, Farrygita, Laringhotragte without stenosis of larynx) by severity is not advisable.
1
.6 examples of diagnoses
Acute nationopharygitis, acute conjunctivitis.
Acute laryngitis.
If the etiological role of the viral agent is confirmed, the clarification is made to the diagnosis.
8
As a diagnosis, the term "ORVI" should be avoided using the terms
«
acute Noodopharyngitis"Or" acute laryngit ", or" acute pharyngitis ", since Larygitis (cd), tonsillitis, bronchitis, bronchiolitis, which should also be indicated in the diagnosis, also cause pathogens. Details These syndromes are considered separately
(See clinical recommendations for children with acute tonsillitis, acute bronchitis and stenzing laryngotracy).
2. Diagnostics
2.1
Complaints, anamnesis
Patient or parents (legal representatives) may complain about
arising rhinitis and / or cough and / or hyperemia conjunctiva (catarrhal
conjunctivitis) in combination with phenomena of rhinitis, pharyngitis.
The disease usually begins acutely, often accompanied by increasing
temperatures of the body to subfebrile numbers (37.5 ° C-38.0 ° C). Febrile fever
more peculiar to influenza, adenoviral infection, enterovirus infections.
Increased temperature in 82% of patients decreases on the 2-3rd day of the disease; more
for a long time (up to 5-7 days), the febrile is kept in flu and adenoviral infection.
Rising the level of fever during the disease, symptoms of bacterial
intoxication in the child must be alarmed with respect to joining
bacterial infection. Re-climbing temperature after short
improvements often happens when developing acute average otitis on the background
long runny nose.
For NazoFaringitis, the complaints are characterized by nasal congestion, allocations from
nasal moves, unpleasant sensations in the nasopharynx: burning, tingling, dryness,
often cluster of the mucous membrane discharge, which in children, staining along the rear wall
things, can cause a productive cough.
When spreading inflammation on the mucous membrane of auditory pipes
(
eustheitim) appears skulling, noise and pain in the ears, it may decrease the ear.
Age features of the course of Naphorgitis: in infants - fever,
separated from nasal moves, sometimes anxiety, difficulties in feeding and
fall asleep. Elder children typical manifestations are symptoms of rhinitis (peak
on the 3rd day, duration up to 6-7 days), in 1/3-1 / 2 patients - sneezing and / or cough (peak in 1-
y day, average duration - 6-8 days), less often - headache (20% in 1st and 15% - until the 4th
day).
Symptom, allowing to diagnose laryngitis, is instilling
9
vote. At the same time there is no difficulty breathing, other signs of stained stenosis.
With pharyngitis, hyperemia and the ethomation of the rear wall of the pharynx, its
the graininess caused by hyperplasia of lymphoid follicles. On the back wall of the throat
there may be a noticeable small amount of mucus (catarrhal pharyngitis),
faringitis is also characterized by an unproductive, often obsessive cough. This
the symptom causes the extreme concern of parents, delivers unpleasant feelings.
child because the cough can be very frequent. Such cough is not amenable
treatment
armored carriers
mukolithics
inhalation
glucocorticosteroids.
Larygitis, laryngotracy is characterized by a rough cough, witness voice. For
trachey cough can be obsessive, frequent, exhausting the patient. Unlike
from the cereal syndrome (obstructive laryngotracy), the phenomena of the stenosis of the larynx
notes, there is no respiratory failure.
On average, ORVI symptoms can last up to 10-14 days.
2.2 Physical examination
The general inspection involves assessing the general condition, physical development.
child, counting the frequency of breathing, heart cuts, inspection of the upper
respiratory tract and zea, inspection, palpation and peracutia of the chest,
auscultation of the lungs, palpation of the abdomen.
2.3
Laboratory diagnostics
Survey of the patient with ORVI intends to identify bacterial foci, not
determined by clinical methods.
Routine virological and / or bacteriological examination of all patients is not recommended, since This does not affect the choice of treatment, the exception is an express test for influenza in highly fevering children and an express test for Streptococcus in suspected acute streptococcal tonsillitis.
Clinical urine analysis (incl. Using test strips in outpatient conditions) It is recommended to carry out all fevering children without catarrhal phenomena.
(
Comments: 5-10% of breast and early children with urinary infection
the paths also have a viral co-infection with clinical signs of ARVI.
However, the study of urine in children with noodopalitis or laryngitis without
10
fever is carried out only if there are complaints or special recommendations in connection
with the accompanying pathology of the urinary system.
Clinical analysis of blood is recommended for conducting common symptoms in children with fever.
Comments: Increasing the level of markers of bacterial inflammation is
the reason for finding a bacterial focus, first of all, "dumb" pneumonia,
acute medium otitis, urinary tract infection. Repeated
clinical blood tests and urine are needed only in case of detection
deviations from the norm during the primary examination or the appearance of new
symptoms requiring diagnostic search. If symptoms are viral
infections were stopped, the child stopped fevering and has a good
well-being
repeated
study
clinical
analysis
blood
it is impractical.
Features of laboratory indicators for some virus infections
Leukopenia characteristic of flu and enterovirus infections usually
none with other ORVI.
For PC-viral infection, lymphocytic leukocytosis is characteristic, which
may exceed 15 x 10
9
/ l.
When adenovirus infection, leukocytosis can reach the level of 15-20 x ∙ 10
9
/ L.
and even higher, with neutropylis more than 10 x 10 are possible
9
/
l, raising
the level of C-jet protein is above 30 mg / l.
Determining the level of C - reactive protein is recommended for eliminating severe bacterial infection in children with febrile fever
(temperature rise above 38ºС), especially in the absence of visible focus of infection.
(
Comments:Increased above 30-40 mg / l more characteristic of
bacterial infections (probability above 85%).
2.4
Instrumental diagnostics
Recommended to all patients with ORVI symptoms to spend the opposite.
(
Power recommendation 2; The level of reliability of evidence is C).
Comments: The otoscopy should be part of the routine pediatric
examination of each patient, along with auscultation, percussion, etc.
11
Radiography of the chest organs is not recommended for each child with SMI symptoms
(
Power recommendation 1; The level of reliability of evidence is C).
Comments:
Indications for the radiography of the chest organs are:
-
the emergence of physical symptoms of pneumonia (see PKR on pneumonia
children)
-
reduced Spo.
2
less than 95% with smooth air
-
the presence of pronounced symptoms of bacterial intoxication: the child is sluggish and
salt, unavailable eye contact, sharply expressed anxiety, refusal
from drink, hyperesthesia
-
high level of markers of bacterial inflammation: promotion in general
leukocyte blood analysis of more than 15 x 10
9
/ l in combination with neutropilose more than 10 x
10
9
/ l, the level of C-jet protein is above 30 mg / l in the absence of a focus
bacterial infection.
It should be remembered that the detection of light enhancement on the radiograph
bronchomicious drawing, expansion of the shadow of the roots of the lungs, increase
airiness is not enough to establish the diagnosis of pneumonia and not
are an indication for antibacterial therapy.
Radiography of the incomplete sinuses are not recommended for patients with acute Natural Farnish in the first 10-12 days of the disease.
(Power of recommendation 2; The level of reliability of evidence is C).
Comments: conducting radiography of the incomplete sinuses in the early term
diseases often identifies inflammation of the apparel sinus due to the virus
the nose that is spontaneously resolved for 2 weeks.
3.
Treatment
3.1
Conservative treatment
ORVI - the most frequent cause of the use of various drugs and
procedures, most often unnecessary, with an unproved action, often causing
side effects. Therefore, it is very important to clarify the parents benign
the nature of the disease and report what the estimated duration of available
symptoms, as well as convince them of the adequacy of minimal interventions.
Etiotropic therapy is recommended for influenza A (including H1N1) and in the first 24-48 hours of the disease. Neuraminidase inhibitors are effective:
Oseltamivir ( aTH code: J05AH02) from age 1 year 4 mg / kg / day, 5 days or
12
Zanyvir ( aTH code: J05AH01) Children from 5 years in 2 inhalations (only 10 mg) 2 times a day, 5 days.
(
Power recommendation 1; The level of reliability of evidence is a).
Comments: to achieve optimal effect, treatment must be
started when the first symptoms of the disease appeared. Patients with bronchial
asthma in the treatment of zanamivir must have as an agent
aid short-range bronchodulators. To other viruses, not
containing neuraminidases, these drugs do not act. Evidence
the base of the antiviral efficiency of other drugs in children
it remains extremely limited.
Antiviral drugs with immunotropic effects do not have a significant clinical effect, their appointment is inappropriate.
(
Power recommendation 2; The level of reliability of evidence -a).
Comment: These drugs develop a minor effect.
Perhaps appointment no later than the 1st day of the Day of Interferon Alpha
well, VK
(ATH code:
L03AB05),
however, there is no reliable evidence of its effectiveness.
Comments: ORVI is sometimes recommended interferonogens, but follows
remember that children over 7 years old when applying the fever
reduces less than 1 day, i.e. their use with most ORVI with
a short febrile period is not justified. Research results
efficiency of using immunomodulators during respiratory
infections, as a rule, show a minor effect. Preparations
recommended for the treatment of more severe infections, for example, viral
hepatitis, with ORVI not used. For the treatment of ARVI in children not
recommended homeopathic remedies, since their effectiveness is not
proved.
It is not recommended to use antibiotics for the treatment of uncomplicated ARVI and influenza, incl. If the disease is accompanied in the first 10-14 days of disease with rhinosinusitis, conjunctivitis, laryngitis, crop, bronchitis, broncho-prestructive syndrome.
(Power of recommendation 1; level of reliability of evidence - a).
Comments:Antibacterial therapy in the case of uncomplicated viral
infections not only does not prevent bacterial superinfection, but
contribute to its development due to the suppression of a normal pneumatic flora,
"Restraining aggression" staphylococci and intestinal flora. Antibiotics
13
can be shown to children with chronic pathology affecting
bronchopulmonary system (for example, fibrosis), immunodeficiency in which
there is a risk of exacerbation of the bacterial process; The choice of antibiotics they usually
predefined in advance the character of the flora.
It is recommended to conduct symptomatic (supportive) therapy .
Adequate hydration contributes to the discharge of secrets and facilitates their destruction.
(Power of recommendation 2; The level of reliability of evidence is C).
It is recommended to carry out elimination therapy, because
effective and safe. Introduction to the nose of physiological solution 2-3 times a day ensures the removal of mucus and restoring the work of the fiscal epithelium.
(Power of recommendation 2; The level of reliability of evidence is C).
Comments:Introduce the saline solution better in the position lying on
back with back back head for irrigation of nasopharynx and adenoid or adenoids. W.
small children with abundant separated effectively aspiration of nose mucus
special manual suction followed by the introduction of physiological
solid. Position in the crib with raised head end contributes
disintegration of the mucus from the nose. Senior children are justified spray with salt
isotonic solution.
It is recommended to assign vasoconstricting drops in the nose (decongestants) with a short rate of no more than 5 days. These drugs do not shorten the duration of a cold, but can facilitate the symptoms of the nasal congestion, as well as restore the function of the hearing pipe. In children, 0-6 years old are used phenylephrine ( aTH code:
R01ab01
) 0.125%, oxymetazoline ( aTH code: r01ab07) 0,01-0.025%, xylomezoline
aTH code: r01ab06) 0.05% (from 2 years), in older - more concentrated solutions.
(Power of recommendation 2; The level of reliability of evidence is C).
Comments:
Using
systemic
preparations
containing
decongestants (for example, pseudoephedrine) is extremely not desirable, medicinal
the means of this group are allowed only from age 12 years.
To reduce the temperature of the television factory child, it is recommended to be disclosed, wrapped with water T ° 25-30 ° C.
(Power of recommendation 2; The level of reliability of evidence is C).
In order to reduce body temperature in children, it is recommended to use only
14 two preparations - paracetamol w, vk
aTH code: N02BE01) up to 60 mg / kg / day or ibuprofen w, vk
aTH code: M01AE01) up to 30 mg / kg / day.
Power of recommendation 1 (level of reliability of evidence - a)
Comments:Antipyretic drugs in healthy children ≥3 months
justified at temperatures above 39 - 39.5 ° C. With a less pronounced fever
(38-
38.5 ° C) Funds that reduce the temperature are shown to children up to 3 months,
patients with chronic pathology, as well as with temperatures associated with temperature
discomfort. Regular (coursework) receiving antipyretic unwanted,
repeated dose is administered only after a new temperature increase.
Paracetamol and ibuprofen can be used inside or in the form of rectal
suppositories, there is also paracetamol for intravenous administration.
Alternation of these two antipytics or the use of combined
preparations have no significant advantages over monotherapy one of
these medicines.
It must be remembered that the most important problem for fever - on time
recognize bacterial infection. Thus, the diagnosis of severe
bacterial infection is much more important than fighting fever. Application
antipyretic
together
from
antibiotics
fraught
maskirovka
ineffectiveness of the latter.
In children with an antipyretic purpose, it is not recommended to use acetylsalicylic acid and nimesulide.
(Power of recommendation 1; The level of reliability of evidence is C).
The use of metamizole in children due to the high risk of agranulocytosis is not recommended.
Comment: In many countries of the world, metamizole is prohibited for use already
more than 50 years ago.
(
Power recommendation 1; The level of reliability of evidence is C).
The nasal toilet is recommended as the most efficient cough relief method.
Because with Na Napargitis, the cough is most often due to the irritation of the larynx by flowing secret.
(Power of recommendation 1; The level of reliability of evidence - b).
It is recommended to warm drinking or, after 6 years, using lollipops or pastilips, containing antiseptics to eliminate cough with pharyngitis, which is associated with the "throat" due to the inflammation of the mucous membrane of the pharynx or dryness when the mouth is breathing.
15
(
Power recommendation 2; The level of reliability of evidence is C).
Anti-tech, expectorant, mucolyts, including numerous proprietary drugs with various plant means, are not recommended for use in ORVI due to inefficiency, which has been proven in randomized studies.
(
Power of recommendations 2 The level of reliability of evidence is C).
Comments: With a dry obsessive cough in a child with pharyngitis or
laringhotrachite sometimes it is possible to achieve a good clinical effect when
using butamirate, but the evidence base for use
there is no antifreeze.
Inhalation steam and aerosol are not recommended for use, because did not show the effect in randomized studies, and not recommended
World Health Organization (WHO) for the treatment of ARVI.
(
POWER OF RECOMMENDATION 2 The level of reliability of evidence - b).
Antihistamine preparations of the first-generation, possessing an atropine-like action, are not recommended for use in children: they have an adverse therapeutic profile, have pronounced sedative and anticholinergic side effects, violate cognitive functions
(Concentration of attention, memory and ability to learn). In randomized studies, drugs of this group have not shown efficiency in reducing the symptoms of rhinitis.
(Power of recommendation 2; The level of reliability of evidence is C).
It is not recommended to all children with ARVI to prescribe ascorbic acid (vitamin
C) Since this does not affect the course of the disease.
Must be hospitalized in the hospital:
- Children under 3 months with febrile fever due to the high risk of developing severe bacterial infection.
- Children of any age with any of the following symptoms (main dangerous signs): inability to drink / suck the chest; drowsiness or absence of consciousness; breathing frequency is less than 30 per minute or apnea; symptoms of respiratory distress; Central cyanosis; phenomena of heart failure; Heavy dehydration.
- children with complex febrile convulsions (duration of more than 15 minutes and / or repeated more than once every 24 hours) are hospitalized for the whole
16 Fever period.
- Children with febrile fever and suspicion of severe bacterial infection (but may be hypothermia!), having the following accompanying symptoms: lethargy, drowsiness; Failure to eat and drink; hemorrhagic rash on the skin; vomiting.
- children with respiratory failure phenomena having any of the following symptoms: melting breathing, inflating the wings of the nose with breathing, the milestones (head moving, synchronized with breath); The frequency of respiratory movements in a child up to 2 months\u003e 60 per minute, in a child aged 2-11 months\u003e 50 per minute, in a child older than 1 year\u003e 40 per minute; retraction of the bottom of the chest when breathing; Blood saturation with oxygen The average duration of finding in the hospital may amount to 5-10 days depending on the nosological form of complication and severity of the state.
Hospitalization of children with noodamagitis, laryngitis, tracheobronchit
concomitant hazardous signs are inexpedient.
Febrile fever in the absence of other pathological symptoms in children over 3 months is not an indication for hospitalization in the hospital.
Children with simple febrile convulsions (up to 15 minutes, once during the day), completed by the time of appeal to the hospital, do not need hospitalization, but the child should be examined by a doctor to eliminate neuroinfection and other causes of convulsion.
3.2
Surgery
Not required
4. Rehabilitation
Not required
5.
Prevention and dispensary observation
Preventive measures that prevent the spread of viruses are of paramount importance: careful washing of hands after contact with the patient.
Recommended O.
washing masks, o
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