Bacterial corneal ulcers in pediatric patients. Algorithms of pharmacotherapy. Part II

Part I of the article presents a review of publications highlighting current exogenous and endogenous risk factors contributing to the occurrence of bacterial corneal ulcers, laboratory diagnostic methods, clinical differential diagnostic features of bacterial corneal ulcers. A wide variety of objective symptoms characterizes the clinical picture of bacterial corneal ulcers. Still, objective differential diagnostic signs make it possible with a high degree of probability to assume the etiology of the disease during the first biomicroscopy and immediately begin etiotropic therapy, on the timing of which the outcome of the disease depends. Standard laboratory examination of patients with bacterial corneal ulcers includes the bacterioscopic and cultural examination of the contents of the conjunctival sac. However, the absence of etiotropic therapy while waiting for the results of microbiological research methods, which takes from 3 to 7 days, contributes to the rapid progression of the disease, the development of endophthalmitis, and corneal perforation, up to the loss of an eye in children. In this regard, treatment must be started immediately. Therefore, the choice of a drug is determined not only by the causative agent, proven laboratory but, first of all, based on clinical differential diagnostic signs of the disease. The traditional, undeniable approach to the conservative treatment of bacterial corneal ulcers is conventional etiotropic therapy using local and systemic antibacterial drugs. In addition, timely intensive specific drug therapy prevents the destruction of all layers of the cornea, and the use of metabolic drugs that improve regeneration and trophism promotes epithelialization of corneal ulcers. Attention should be given to the necessity and validity of the choice of antibacterial drugs for various etiological forms of bacterial corneal ulcers in children. An individual approach is a basis for effective antibiotic therapy in pediatric ophthalmology. The article presents an up-to-date review of publications and modern algorithms for treating bacterial corneal ulcers in children, the main causative agents of which are: Staphylococcus aureus, Streptococcus pneumoniae, Pseudomonas aeruginosa, Neisseria gonorrhoeae.

PYOTRAUMATIC DERMATITIS IN DOGS

Resume The most informative methods of diagnosing dermatological diseases in dogs are a clinical study of the skin and its derivatives, and to identify the main etiological factor, dermatological tests are used to identify signs of ectoparasitosis. In the treatment of pyotraumatic dermatitis in dogs, after eliminating the effects of the main etiological factor, the most effective is the use of janus kinase inhibitors against the background of local and systemic antibacterial therapy.

The choice of antibacterial drugs in dentistry taking into account the oral microbiome

The article presents modern data on the features of the oral microbiome and its medical significance when prescribing systemic antibacterial therapy for infectious and inflammatory processes in the oral cavity. The main microbial associations in normal conditions, as well as in diseases of periodontal tissues and apical periodontitis are presented. The use of antibacterial drugs in dentistry is aimed at eliminating the etiological factor of the pathogenic microflora of the oral cavity. The effectiveness of the treatment depends on how well the doctor aware of the main pathogens and microbial associations in generalized periodontitis, periodontitis, a choice of optimal antibacterial agent, compliance with indications and contraindications upon treatment.

Biomimetic nanomedicine-triggered in situ vaccination for innate and adaptive immunity activations for bacterial osteomyelitis treatment

The development of bacterial vaccines for inducing immunoresponse against infectious diseases such as osteomyelitis is of great significance and importance. However, the responsiveness of bacterial immunotherapy remains far from being satisfactory largely due to the erratic antigen epitopes of bacteria. Herein, we report an in situ vaccination strategy for the immunotherapy of bacterial infection based on an osteomyelitis model using a biomimetic nanomedicine named as HMMP, which was constructed by engineering PpIX-encapsulated hollow MnOx with a hybrid membrane exfoliated from both macrophage and tumor cell lines. The as-established HMMP features a burst bacterial antigen release as the in situ vaccine by the augmented sonodynamic treatment, and the resultant priming of antigen presenting cells for the following activations of both cellular and humoral adaptive immunities against bacterial infections. This treatment regimen not only triggers initial bacterial regression in established osteomyelitis model, also simultaneously generate robust systemic antibacterial immunity against poorly immunogenic secondary osteomyelitis in the contralateral knee as well, and additionally, confers long-lasting bacteria-specific immune memory responses to prevent infection relapse. Thus, our study provides a proof of concept of in situ vaccination for the activation of both innate and adaptive antibacterial immune responses, providing an individual-independent bacterial immunotherapy.

Cervicitis: potentialities of alternative treatment

Aim: to assess the efficacy of the alternative treatment for cervicitis in women of reproductive age and premenopausal women. Patients and Methods: this pilot comparative study included 60 women of reproductive age and premenopausal women (25–45 years) with cervicitis who were divided into two groups. Group 1 women (n=30) received multi-component herbal preparation (Tukofitol cream) once daily for 20 days. Group 1 women were subdivided into two subgroups. In women of subgroup 1A (n=14), opportunistic flora in relevant titers was identified, and these women were prescribed systemic antibacterial treatment. In women of subgroup 1B, no opportunistic flora in relevant titers was identified, and these women were prescribed with multi-component herbal preparation only. Group 2 women (controls, n=30) were also subdivided into two subgroups. In subgroup 2A (n=16), women received systemic antibacterial treatment and Povidone Iodine vaginal to manage opportunistic flora. In subgroup 2B (n=14), no opportunistic flora in relevant titers was identified, and a watchand- wait approach was applied. Before treatment and 30 days, subjective symptoms typical for cervicitis were evaluated, laboratory tests and colposcopy were performed. Results: two women from each group have withdrawn from the study. In group 1, more rapid improvement of cervicitis symptoms vs. group 2 (p<0.05) was reported. Moreover, no growth of opportunistic flora was more commonly seen in group 1 (100%) compared to group 2 (92.85%, p>0.05). Conclusion: the improvement of subjective criteria and laboratory test results has demonstrated that treatment was effective in both groups. In the lack of opportunistic flora in relevant titers, multi-component herbal preparation as monotherapy can be prescribed to reduce symptoms of inflammation. KEYWORDS: cervicitis, inflammation of the cervix, Tukofitol, reproductive age, premenopausal age, treatment, diagnostics, colposcopy, opportunistic microbes, sexually transmitted infections, monotherapy. FOR CITATION: Saprykina L.V., Ibragimova D.M., Narimanova M.R. Cervicitis: potentialities of alternative treatment. Russian Journal of Woman and Child Health. 2021;4(3):225–228 (in Russ.). DOI: 10.32364/2618-8430-2021-4-3-225-228.

Porphyromonas gingivalis: where do we stand in our battle against this oral pathogen?

Local and/or systemic antibacterial therapy has been extensively studied and suggested to control periodontopathogens like P. gingivalis. However, more effective and specific antibacterial agents against oral pathobionts remain to be developed.

Evaluation of the clinical efficacy of local antibacterial therapy in the treatment of acute bacterial rhinosinusitis

Aim.To evaluate the clinical efficacy of Polydexa with phenylephrinum in the complex treatment of moderate acute bacterial rhinosinusitis. Materials and methods.The article presents the results of a clinical study of 100 patients with moderate acute bacterial rhinosinusitis 37 (37%) men, 63 (63%) women aged 15 to 53 years. The patients were randomized into 2 groups of 50 people each. In the study group, patients received systemic antibiotic therapy and a topical nasal spray of Polydexa with phenylephrinum. The control group received systemic antibacterial therapy and long-acting local decongestants. The evaluation criteria were statistically significant differences in clinical and laboratory parameters of the control and main groups. Results and conclusion.The pronounced anti-inflammatory, antimicrobial effects of the drug were confirmed; conclusions were drawn about the clinical efficacy, tolerability, safety of Polydexa with phenylephrinum and allows to achieve complete resolution of the pathological process in more cases.

Topical antibiotics for acute rhinosinusitis in children

In this article, the authors provide an overview of existing data on the use of topical antibacterial drugs in acute rhinosinusitis in children. General information on the etiology of acute rhinosinusitis is given. Indications for systemic and topical antibiotic therapy in acute rhinosinusitis are noted, indicated in Russian and international consensus documents. The advantages of using the combined preparation of thiamphenicol and N-acetylcysteine in acute rhinosinusitis in children and adults are considered separately. It is concluded that the topical antibacterial therapy of acute rhinosinusitis, despite all its advantages, is not an equivalent substitute for systemic antibacterial therapy in the treatment of severe and, especially, complicated forms of acute rhinosinusitis. The practitioner should be guided by the indications for systemic and topical antibacterial therapy adopted in Russian consensus documents. If there are indications for systemic antibiotic therapy, local remedies are only ancillary treatment, the action of which is aimed at enhancing the effect of systemic antibiotics. In the case of monotherapy with local drugs containing antibacterial components, it is mandatory to re-evaluate the patient’s condition and the dynamics of the symptoms of the disease for 2–3 days of treatment, and in the absence of positive changes, reconsider the need for systemic antibacterial therapy. More promising is the use of combined drugs that, in addition to affecting the causative agent of the disease, achieve anti-inflammatory, decongestion or mucolytic effects. It is convenient and rational to use nasal sprays, however, in order to improve the delivery of the active substance to the site of inflammation in acute rhinosinusitis, the use of nebulizer is justified.

On the role of topical drugs in the treatment of acute otitis media in children

The article presents an overview of modern approaches to diagnosis and treatment of acute otitis media in children. On the basis of the existing clinical recommendations the indications for systemic antibacterial therapy and tympanocentesis are listed, the algorithm of antibacterial therapy accepted in Russia is described. The role of various drugs in the form of ear drops for local treatment of acute otitis media in children is considered separately. One clinical case is presented, illustrating the capabilities of local anesthetics in the treatment of acute otitis media.