Injections for bronchitis: list of antibiotics, how to give injections

Bronchitis is a complication of colds. The main symptom is a cough, which can be either dry or wet. The mucous membrane of the bronchi becomes inflamed. It swells, a large amount of mucus is released, which accumulates in the narrowed lumen of the bronchus. The mucus is thick and viscous and difficult to cough up.

The patient’s condition is complicated not only by a cough, which is debilitating at first, but also by general intoxication of the body. If treatment is started on time, the prognosis is good, recovery occurs within 7-10 days.

There is a complicated course of the disease, which may require intensive therapy and injections for bronchitis. They can be done on an outpatient basis or in a hospital setting.

Prescription of drugs

Injections for bronchitis in adults are prescribed in the following cases:

A severe form of the disease with severe symptoms of respiratory failure.
Presence of an obstructive or asthmatic component.
Ineffectiveness of treatment. If within 5 days after taking the drugs in tablet form there is no visible improvement, then the doctor prescribes parenteral administration of the drugs.
Exacerbation of the chronic form of the disease.
Risk of progression to pneumonia.
concomitant diseases that provoke a complicated course of bronchitis or the risk of complications from other body systems.
Inability to take medications orally (for example, gastrointestinal diseases).

The parenteral method of drug administration is intramuscular or intravenous injections of drugs.

It has a lot of advantages:

With this method of administration, the medicine quickly enters the bloodstream in greater concentration.
Fewer side effects on the gastrointestinal tract. This is the only way if the patient has diseases such as ulcers or gastritis. Taking pills can cause an exacerbation.
There is no need to associate taking medications with food intake. Sometimes there are special instructions, for example, some antibiotics should be taken with food, others on an empty stomach. Doing this is not always convenient, and violating the dosage regimen will not give the desired therapeutic effect.
When administered parenterally, the effect of the drug occurs faster and the absorption time is reduced. Injections for bronchitis are prescribed if urgent medical care is needed.
The drug, administered by injection, is not affected by digestive enzymes, and there is no risk of weakening its effectiveness due to contact with various substances in the digestive tract.

ANTIBIOTICS in the treatment of acute bronchitis in children

What is the main etiological cause of acute and recurrent bronchitis? What are the tactics for choosing antibacterial drugs?

Bronchitis is one of the most common infectious diseases of the respiratory tract in children and, it would seem, does not pose a particular problem for a pediatrician. However, this is a very misleading impression. There are many unresolved issues related to the terminology, etiology and pathogenesis of this disease, as well as the influence of environmental, allergic and other aggressive factors. All this creates a number of objective difficulties both in the interpretation of clinical data and in the choice of treatment tactics.

First of all, let's focus on the definition of concepts. Currently, it is customary to distinguish three clinical forms of bronchitis: acute, recurrent and chronic [5]. Acute bronchitis occurs at any age period of a person’s life and is an acute self-limited (i.e., self-healing) inflammation of the mucous membrane of the tracheobronchial tree, usually resulting in complete cure and restoration of function [6]. Most often, acute bronchitis is one of the manifestations of an acute respiratory disease of various etiologies - viral, bacterial, fungal, parasitic, mixed. There is also acute irritative bronchitis of chemical, allergic and other non-infectious nature.

Acute bronchitis, if it is not accompanied by clinically pronounced signs of obstruction, is usually referred to as acute simple bronchitis, or simply acute bronchitis.

In contrast, acute obstructive bronchitis is characterized by the fact that inflammation of the bronchial mucosa is accompanied by narrowing and/or blockage of the airways due to edema and hyperplasia of the mucous membrane, hypersecretion of mucus or the development of bronchospasm. A combined nature of bronchial obstruction is possible. Obstructive bronchitis is somewhat more often recorded in young children, i.e., in children under 3 years of age. Moreover, at this age, obstructive syndrome is predominantly caused by hypersecretion of viscous and thick mucus and hyperplasia of the mucous membrane. Bronchospasm is more common in children over 4 years of age [1].

One of the clinical forms of acute inflammation of the bronchial mucosa is bronchiolitis. It is, in fact, a clinical variant of acute obstructive bronchitis, but unlike the latter, it is characterized by inflammation of the mucous membranes of the small bronchi and bronchioles. This determines the clinical features of the disease, its severity and prognosis. Bronchiolitis occurs mainly in young children, and more often in infancy, i.e., up to one year [1, 5].

Recurrent bronchitis is understood as a form of the disease when at least three episodes of acute bronchitis are observed during the year. As a rule, such a tendency to develop repeated inflammation of the bronchial mucosa is not accidental, and it is based on a decrease in mucociliary clearance due to damage to the ciliated epithelium: increased mucus viscosity; changes in the diameter of the bronchi; increased resistance of the respiratory tract; violation of local or general anti-infective protection.

Recurrent bronchitis clinically occurs in the form of acute simple or obstructive bronchitis, less often in the form of episodes of repeated bronchiolitis. In children, recurrent bronchitis occurs at any age during childhood, but is most often recorded after 3 years.

Therapy of any infectious disease and, in particular, the choice of antibacterial therapy, as is known, are determined by the etiology of the process.

The causes of acute and recurrent bronchitis in the vast majority of cases are infectious agents: viruses, viral-bacterial associations and bacteria. Non-infectious factors are much less common: chemical, physical, allergic. The latter can act as independent causative factors or determine a predisposition to the development of an infectious inflammatory process or aggravate its course.

Among the viruses, the leading place is occupied by types 1 and 3 of parainfluenza, RS virus, and adenoviruses. Less common causes of bronchitis are rhinoviruses, influenza viruses, enteroviruses, measles virus, cytomegalovirus, etc. However, one should not forget about their etiological significance.

Age and epidemiological aspects play an important role in the development of bronchitis. Viruses such as parainfluenza, adenovirus, rhinovirus, and influenza virus cause bronchitis with almost equal frequency at any age. Here, the epidemiological situation is of greatest importance: the time of year (mainly the cold season), “crowding” (living in a hostel, frequent use of public transport, staying in a children’s group, etc.), epidemic, etc.

Rhinosyncytial virus as a cause of bronchitis is more common in young children, mainly from 6 months to 3 years, which is apparently due to a certain tropism of this pathogen. At the same time, seasonality and “crowding” play a much smaller role in the development of the disease.

The type of viral infection has a significant impact on the nature of the mucosal lesion. Thus, parainfluenza, influenza, and cytomegalovirus infection are characterized by dystrophy and destruction of the epithelium with rejection of entire layers. For RS viral infection - hyperplasia of the epithelium of the smallest bronchi and bronchioles, cushion-like proliferation of the epithelium with impaired bronchial conduction. This is precisely what is associated with the fact that bronchiolitis or acute obstructive bronchitis often develops with an RS viral infection. Adenoviral infection is accompanied by a pronounced exudative component, mucous deposits, loosening and rejection of the epithelium are often observed, and large cell infiltrates form in the bronchial wall. This contributes to the formation of atelectasis and airway obstruction.

As noted above, viruses can be an independent cause of illness. According to our data, in children over 4 years of age, viral bronchitis is recorded in approximately 20% of cases, but in children from 14 days to 4 years of age in less than 10% of cases. The role of viruses in general in the etiology of infections of the tracheobronchial tree in this age group was low - up to 15%. As a rule, they were found in associations, more often with bacteria, less often with other representatives of the microbial world: fungi, protozoa [7, 8].

Bacteria that can cause acute bronchitis are also very diverse. Moreover, the etiological structure of acute community-acquired and hospital-acquired diseases differs significantly. A fairly wide range of pathogens is involved in the etiology of community-acquired bronchitis, i.e. bronchitis that developed under normal conditions of a child’s life.

Currently, depending on the nature of the clinical manifestations, community-acquired bronchitis, as well as pneumonia, is usually divided into typical and atypical.

Typical bronchitis is characterized by an acute onset with a pronounced febrile reaction, intoxication, cough and quite pronounced physical manifestations. Typical bronchitis is usually caused by pneumococcus, Moraxella catarrhalis and Haemophilus influenzae.

Atypical diseases of the tracheobronchial tree are characterized by an oligosymptomatic subacute onset, with normal or subfebrile temperature, and the absence of intoxication. The most typical symptom is a dry, non-productive, obsessive cough. The causes of atypical community-acquired bronchitis are chlamydia pneumoniae and mycoplasma pneumoniae [6, 7, 8]. With mycoplasma etiology of the disease, respiratory syndrome at normal or subfebrile temperature may be observed at its debut. With chlamydia, especially in children in the first months of life, conjunctivitis occurs in half of the cases, and the cough is of a whooping cough-like nature.

Observations by foreign authors and our research conducted in 1996-1999 indicate that the etiological significance of chlamydia and mycoplasma, which are intracellular pathogens, is much higher than previously thought. Mycoplasma and chlamydial etiology of bronchitis and pneumonia in children can currently range from 25 to 40%, and it is highest in the first year of life and after 10 years [7, 8].

A feature of intracellular pathogens is their insensitivity to traditional antibacterial therapy, which, along with the insufficiency of the macrophage defense characteristic of this infection, contributes to the protracted and recurrent course of the inflammatory process in the bronchi. A certain role is also played by the fact that in the child’s environment, as a rule, there are carriers of this infectious agent, and this creates conditions for reinfection. Therefore, mycoplasma and chlamydial bronchitis often acquire a protracted (up to 4–8 weeks) or recurrent course.

Treatment of acute bronchitis during the febrile period of the disease includes bed rest, drinking plenty of fluids, and prescribing antipyretic and anti-inflammatory drugs. A separate area is the choice of antitussive therapy.

But the most difficult issue is the prescription and choice of antibacterial therapy.

The great importance of viruses in the etiology of the disease, the predominance of mild forms, and the self-limiting nature of the disease raise the question of the advisability of using antibiotics in the treatment of acute bronchitis. And this issue is widely discussed. A number of studies conducted on adult patients indicate that the use of antibacterial therapy does not have a significant effect on the outcome of bronchitis [4]. This calls into question the need for its use.

On the other hand, according to the data provided in the State Report on the State of Health of the Population of Russia [2], respiratory diseases remain the leading cause of death in children of the first year of life (21.8 per 10,000 births) and children from 1 to 4 years of age (55. 6 per 100,000 children of this age, compared to 2.6 per 100,000 children aged 5 to 9 years). The most common cause of death is pneumonia, the main complication of bronchitis in early childhood. Our analysis of the reasons for hospitalization of young children in the hospital showed that in almost 50% of cases the cause is acute respiratory pathology. Moreover, the immediate reasons for hospitalization were the serious condition of the child, caused by infectious toxicosis or severe broncho-obstructive syndrome, as well as the presence of an unfavorable premorbid background (congenital malformations, hereditary diseases, encephalopathy).

Thus, it should be recognized that the indication for prescribing antibacterial therapy for acute bronchitis in pediatrics is the presence of severe symptoms of intoxication and prolonged hyperthermia (more than 3 days), especially in the group of young children, as well as in children of all age groups with an unfavorable premorbid background that can create a real threat of development of the pneumonic process.

Indications for prescribing antibiotics should be considered clinical signs indicating the bacterial nature of the inflammatory process (mucopurulent and purulent sputum) in combination with severe intoxication.

A prolonged course of the disease, especially if the intracellular nature of the pathogen is suspected, is also an indication for antibacterial therapy.

Bronchiolitis, which has a mortality rate of 1–3%, is also considered an indication for antibiotics.

Three groups of drugs are currently most widely used in the treatment of bronchitis: penicillin and its derivatives from the aminopenicillin group, second-generation oral cephalosporins and macrolides [3].

Penicillin and aminopenicillins (ampicillin, amoxicillin) have a bactericidal effect on streptococci, including pneumococcus, some types of staphylococci and some types of gram-negative bacteria, including Haemophilus influenzae and Moraxella catarrhalis, but are easily destroyed by beta-lactamases of pneumococcus, Haemophilus influenzae and Moraxella. The so-called inhibitor-protected penicillins (ampicillin sulbactam and amoxicillin clavulanate), due to the introduction of beta-lactamase inhibitors sulbactam and clavulanic acid into their formula, are much more effective against pathogens such as Haemophilus influenzae and Moraxella catarrhalis. And they are also more active against pneumococcus. But all penicillin preparations have no effect on intracellular pathogens. In addition, they significantly affect the intestinal biocenosis and often cause allergic reactions.

Cephalosporins for oral use (mainly 1st and 2nd generations) - cephalexin, cefaclor, ceforuxime axetil - have the same strengths and weaknesses as penicillin derivatives. Cephalexin is destroyed by b-lactamases of bacteria, cefaclor and cefuroxime axetil have a fairly high resistance to bacterial enzymes and are effective against Haemophilus influenzae and Moraxella catarrhalis. But like penicillin derivatives, they do not act on mycoplasmas and chlamydia, and in addition, they often cause severe intestinal dysbiosis and allergic reactions. However, it should be noted that cephalosporins are highly effective against streptococcal (including pneumococcal), staphylococcal and gram-negative (Escherichia coli, etc.) etiology of the disease.

Macrolides, especially 2 and 3 generations, differ significantly from the antibiotics of the two previous groups. Erythromycin affects both streptococci and some types of staphylococcus, as well as mycoplasma and chlamydia. But this drug requires four doses, which sharply reduces the so-called. treatment compliance, i.e. actual implementation of treatment measures. Such frequent use of drugs presents particular difficulties in young children. Erythromycin itself has an extremely unpleasant taste and is characterized by a high frequency (up to 20-23%) of side effects from the gastrointestinal tract in the form of nausea, vomiting, diarrhea, and pain. But unlike penicillins and cephalosporins, the side effects of macrolides, and erythromycin in particular, are not caused by a violation of the intestinal biocenosis, but by the prokinetic, motilium-like effect of the drugs.

Macrolides of 2 (spiramycin) and 3 generations (roxithromycin, clarithromycin, azithromycin, josamycin) do not have the disadvantages inherent in erythromycin. They should be taken 2-3 times, and azithromycin - 1 time per day. They have satisfactory taste characteristics, especially children's dosage forms (suspensions and sachets). The frequency of side effects does not exceed 4-6% of cases. In addition, macrolides have antibacterial activity against a number of gram-negative bacteria that are relevant for pediatrics: diphtheria bacilli, whooping cough, and campylobacter.

The weakness of these drugs is their oral use, which limits the possibility of using macrolides in severe cases, and low effectiveness in hemophilic and enterobacterial etiologies of the disease. The exception is azithromycin, which has high antihemophilic activity.

Since antibiotics for bronchitis are prescribed empirically in all cases, when choosing them it is necessary to take into account a number of factors: the age of the child, individual tolerance, community-acquired or nosocomial nature of infection, features of the clinical picture of the disease (typical, atypical), the nature of the course (protracted, recurrent), the effectiveness of the previous therapy.

The most accepted practice [6] is to prescribe amoxicillin or, better yet, amoxicillin clavulanate as the drug of choice for a typical picture of acute bronchitis (high fever, intoxication, cough, severe physical changes in the lungs). Alternative drugs (if ineffective within 48-72 hours of therapy, intolerance) can be cephalosporins and macrolides.

For atypical bronchitis (normal or subfebrile temperature, absence of distinct intoxication and shortness of breath, inexpressive physical findings in the presence of a persistent, dry or unproductive whooping cough-like obsessive cough), with a protracted course of bronchitis, macrolides are the drugs of choice.

Literature

1. Artamonov R. G. Condition of the bronchi in protracted and chronic segmental and lobar pneumonia in children of the first years of life. Author's abstract. dis... cand. honey. Sci. M., 1958. 2. White book. Health of mother and child // Medical Courier. 1998. No. 1 (8). pp. 14-16. 3. Belousov Yu. B., Omelyanovsky V. V. Clinical pharmacology of respiratory diseases. Reference manual. M., 1996. pp. 144-147. 4. International Journal of Medical Practice. 1997. No. 4. P. 29. 5. Rachinsky S.V. et al. Bronchitis in children. L.: Medicine, 1978. 211 p. 6. Guide to medicine. Diagnostics and therapy. Ed. R. Bercow. M., 1997, vol. 1, pp. 449-450. 7. Samsygina G. A., Zaitseva O. V., Brashnina N. P., Kazyukova T. V. // Pediatrics. 1998, No. 3. P. 50-53. 8. Samsygina G. A., Okhlopkova K. A., Suslova O. V. Respiratory diseases in children. Mater. conf. M. 21-22.09.99, p. 112.

Note!

Currently, there are three clinical forms of bronchitis: acute, recurrent and chronic.
The causes of acute and recurrent bronchitis in the vast majority of cases are infectious agents: viruses, bacteria, viral-bacterial associations
Treatment of bronchitis during the febrile period of the disease includes bed rest, plenty of fluids, antipyretic and anti-inflammatory drugs
The indication for antibacterial therapy is the bacterial nature of the inflammatory process (according to clinical signs) in combination with severe intoxication

What drugs are used for bronchitis?

Treatment of the disease is complex, so different drugs are prescribed to combat it - antibiotics, mucolytics and bronchodilators, antihistamines, anti-inflammatory and other drugs.

Antibacterial agents

Most cases of bronchitis are bacterial in nature. Therefore, antibiotics are the main drugs for treating bronchitis. There are many remedies, they differ in composition and mode of action. Only a doctor prescribes injections for bronchitis in adults; he will indicate the name of the drug in the prescriptions.

There are groups of antibacterial agents:

Cephallosporins. These are broad-spectrum antibiotics that are effective against a variety of bacteria. They are the first in the line of choice in the treatment of acute bronchitis, when the pathogen has not yet been identified and its sensitivity to drugs has not been established. These are Ceftriaxone, Ceftazidime, Ceftum. There are several generations in the antibiotic group; the higher the number, the wider the range of microorganisms sensitive to the drug and the fewer side effects. Treatment period is 7-14 days.
Macrolides. Another popular group of broad-spectrum antibiotics. It has more tablet forms, but there are also injectable forms. They are gentle and have fewer side effects. They are prescribed once a day, requiring fewer days of administration - 3-5. Well-known ones are Azithromycin, Clarithromycin.
Penicillins. Drugs in this group are broad-spectrum antibiotics and are effective in treating diseases of the respiratory system. Currently, more and more microorganisms are showing resistance to them. Penicillins are prescribed if tests have proven the sensitivity of microorganisms to the drug. Antibiotic injections are given 2-4 times a day, depending on the type of drug, treatment periods are 7-14 days. These include Penicillin, Ampicillin.

Antibacterial drugs can also inhibit beneficial microflora, so they must be taken in combination with probiotics. Injectable forms contribute less to the development of intestinal dysbiosis than tablet forms.

Medicines cause allergic reactions, especially in children; before administration, a subcutaneous test must be done.

Antibiotic injections are painful; when injected into the buttock, the pain spreads to the knee. It is recommended to make solutions with painkillers (Lidocaine), but it has many contraindications. It is necessary to agree on the possibility of preparing an antibiotic solution for injection based on Lidocaine with your doctor!

Hormonal drugs

These are drugs that inhibit the immune system’s response to pathological changes in the body. They help reduce the inflammatory process. When taken, body temperature decreases and mucus secretion decreases. Prescribed for severe cases or risk of complications. Administered by injection.

Antihistamines

If the inflammation and swelling in the bronchi is severe, severe respiratory failure occurs - uncontrollable cough, shortness of breath. In this case, antihistamines will help, which reduce swelling. In this case, the injection method of administration will give a quick effect, which means the patient will feel better faster.

Bronchodilators

These drugs are prescribed in tablet form, syrup, or inhalation. However, in advanced cases, there is no effect from taking them. Then the doctor decides on their parenteral administration, for a faster and stronger effect. Mucolytic cough suppressants can also be given to adults as injections for bronchitis to reduce the viscosity of sputum and ensure its rapid clearance.

Anti-inflammatory and antipyretic

At very high temperatures, when the tablets do not give the desired effect, an antipyretic injection based on analgin is given. It reduces temperature well. Often used in children.

Hot injections are sometimes prescribed as an anti-inflammatory agent for bronchitis in adults and children. They got their name because of the effect that is observed when they are introduced. The person feels intense heat throughout the body and it becomes difficult to breathe.

This phenomenon is short-lived, just a few seconds. Hot injections for bronchitis are given only in a hospital setting, because these are intravenous injections. Not everyone tolerates them easily; making them at home is unacceptable! If you saw calcium gluconate injections in your prescriptions for bronchitis, then this is the same hot injection.

Antibacterial therapy for patients with chronic bronchitis

Etiology and pathogenesis

The main cause of chronic bronchitis is prolonged exposure of the bronchial mucosa to harmful impurities in the inhaled air, primarily tobacco smoke. Production factors (dust and gas contamination of workplaces), as well as general air pollution, are of significant importance. A major role in the development of chronic bronchitis is played by the pathology of the ENT organs, possibly being a manifestation of general damage to the respiratory tract, and a violation of the conditioning function of nasal breathing. The above factors lead to a restructuring of the mucous membrane, consisting in hypertrophy of the mucous glands and an increase in the number of mucus-producing cells of the bronchial epithelium, gradually replacing ciliated cells responsible for the evacuation of mucus and mechanical cleansing of the bronchi from dust and microbial contamination. Simultaneously with hypersecretion of mucus (hypercrinia), a violation of physicochemical (viscosity, elasticity) and antimicrobial properties (discrinia) occurs. This leads to stagnation of mucus along with the contaminants it contains, necessitating its evacuation through a pathological process - coughing and contributes to the secondary development of intrabronchial infection, the main causative agents of which are pneumotropic microorganisms - streptococcus and Haemophilus influenzae. Intrabronchial infection usually occurs with periodic exacerbations, the causes of which are unfavorable weather conditions, cooling, or viral infection. Violation of the protective and cleansing functions of the bronchi and the persistence of infection in them determine an increased likelihood of the development of infectious processes in the lung tissue (acute pneumonia, destructive pneumonia), which in patients with chronic bronchitis are observed several times more often than in persons without previous bronchial pathology, and are often characterized by protracted and complicated course. In some patients with chronic bronchitis, there is a progressive obstruction of the patency of predominantly small bronchi. An important role in this is played by expiratory collapse of the small airways, spasm of the bronchial muscles, swelling of the mucous membrane and other factors. As a result of obstruction, the ventilation-perfusion relationship is disrupted and hypoxemia develops. This, in turn, causes spasm of the pulmonary arterioles, increased pulmonary vascular resistance, hypertension and the formation of “pulmonary heart”. Thus, obstruction of the small bronchi leads to respiratory and heart failure, which causes disability and death in patients. In most cases, obstructive bronchitis is accompanied by emphysema, which aggravates functional disorders.

Classification

It is fundamentally important to divide chronic bronchitis into obstructive

and
non-obstructive
.
The diagnosis also reflects the presence of a mucopurulent inflammatory process. There are 4 forms of chronic bronchitis:
simple, purulent, obstructive and purulent-obstructive. Important characteristics of the disease are its course (latent, with rare exacerbations, with frequent exacerbations, continuously relapsing) and phase (exacerbation or remission). In recent years, according to the recommendations of the European Respiratory Society, it has been proposed to assess the severity of COPD or chronic obstructive bronchitis depending on the FEV1 value, expressed as a percentage of the proper value: mild FEV1 70%, moderate - ranging from 50-69% and severe - FEV1 is less than 50%.

Clinical picture, course

Chronic bronchitis is characterized by the absence of an acute onset of the disease and its slow progression. The first symptom of the disease is usually a morning cough, which intensifies in the cold and damp seasons, weakens or completely stops in the summer. Subsequently, the cough gradually increases and is observed throughout the day and at night. The amount of sputum in chronic bronchitis is small. Exacerbations of chronic bronchitis are characterized as sluggish, manifested by malaise, sweating, especially at night, increased cough, tachycardia, normal or subfebrile body temperature, and the appearance or intensification of shortness of breath. The duration of an exacerbation of chronic bronchitis can be 3–4 weeks or more. Along with the relapsing course of chronic bronchitis, a latent or asymptomatic course is often observed for a long time, without pronounced exacerbations. With chronic obstructive bronchitis, persistent symptoms of chronic bronchial obstruction appear:

– shortness of breath on exertion; – increased shortness of breath under the influence of nonspecific stimuli; – an annoying, unproductive cough, in which the release of a small amount of sputum requires significant effort from the patient, but the cough impulse is weak due to the weakness of the respiratory muscles and the collapse of the respiratory tract with increased intrathoracic pressure; – prolongation of the expiratory phase during quiet and especially forced breathing; – scattered dry wheezing of predominantly high tones on exhalation; – symptoms of increased air filling of the lungs. The results of long-term observations of patients have made it possible to establish that chronic obstructive bronchitis is a slowly progressive disease that begins many years before the onset of clinical symptoms of respiratory failure, and the prognosis depends on the rate of progression of the process. The main causes of death in patients with chronic bronchitis are acute respiratory failure, which occurs against the background of chronic breathing disorders, an active inflammatory process in the bronchopulmonary system and circulatory failure. There are also indications of pulmonary embolism and spontaneous pneumothorax.

Treatment

Particular importance in chronic bronchitis is given to etiotropic treatment

which gives the greatest effect.
All other types of therapy are essentially symptomatic. Smoking cessation is the basis for starting therapy. Already a few months after stopping smoking, cough and sputum production usually significantly decrease or completely stop, but previously formed irreversible changes in the respiratory tract and lungs do not disappear. Sanitation of foci of infection is also of paramount importance in connection with the removal of places where pathogenic microorganisms accumulate. In this regard, great importance is attached to prescribing antibiotic therapy to patients. The main indications for prescribing antibiotics for chronic bronchitis are active bacterial inflammatory processes in the bronchial tree. The use of an antibiotic that is specifically active against a significant infectious agent is considered optimal. The use of broad-spectrum drugs that suppress normal microflora contributes to the growth of resistant gram-negative microorganisms in the nasopharynx and further progression of the chronic inflammatory process. The method of administration of the drug (oral, parenteral or aerosol) is determined by the severity of the exacerbation and the ability of the antibiotic to create a high concentration in the bronchial tissues and bronchial mucus. The clinical result (and not the antibiogram data) is the basis for judging the correctness of the choice of drug. It should be noted that in chronic bronchitis, effective antibacterial therapy can cause a deterioration in sputum production, since a decrease in its infection is accompanied by a decrease in the mucolytic effect of bacterial enzymes. As mentioned above, the most common causative agents of the infectious process in the bronchi are H. Influenzae and S. Aureus, the main mechanism for the development of resistance to antibiotics is the production of broad-spectrum β-lactamases (up to 10% of H. Influenzae strains and 70–80% of S. Aureus), respectively, these microorganisms are capable of destroying natural and semi-synthetic penicillins, first generation cephalosporins. Therefore, the drugs of choice for the treatment of bronchitis of this etiology are protected aminopenicillins (for example, amoxicillin/clavulanate) and second-generation cephalosporins (III-IV generation cephalosporins and carbapenems have no advantages). The combination of amoxicillin/clavulanate (Panklav) provides high bactericidal activity of the drug
. The main pharmacokinetic parameters of amoxicillin and clavulanic acid are similar. After oral administration, both components of the drug are quickly absorbed from the gastrointestinal tract. Concomitant food intake does not affect absorption. Cmax in blood plasma is reached approximately 1 hour after administration. Both components are found in high concentrations in body fluids and tissues, including bronchial secretions. The drug is prescribed orally for adults and children over 12 years of age (or weighing more than 40 kg) 1 tablet. 250 mg 3 times/day. for mild to moderate cases and 2 tablets. 250 mg or 1 tablet. 500 mg 3 times/day. In case of severe infection, the maximum daily dose of clavulanic acid (in the form of potassium salt) is 600 mg for adults, 10 mg/kg body weight for children. The maximum daily dose of amoxicillin is 6 g for adults and 45 mg/kg body weight for children. Most drugs from the group of second and third generation cephalosporins are administered parenterally and can be used for severe exacerbation of chronic bronchitis in a hospital setting. For the treatment of uncomplicated forms of chronic bronchitis, macrolides can be recommended, which have the ability to create a high local concentration of the drug in tissues and penetrate into cells, suppressing the growth of obligate parasites (mycoplasma, legionella, chlamydia), which can cause exacerbations of chronic bronchitis. These drugs (azithromycin, spiramycin, clarithromycin) rarely cause allergic reactions and do not interact with theophylline. Tetracyclines (in particular, doxycycline) retain their value in chronic bronchitis only as second-line drugs. Most fluoroquinolines (ciprofloxacin, sparfloxacin, trovafloxacin) have little effect on streptococci, but a fairly wide spectrum of action, especially with legionella, mycoplasma, chlamydia infections, the ability to create a high concentration in the tissues of the bronchi and bronchial mucus makes them in demand in patients with a high risk of developing dysbacteriosis and in weakened patients. Thus, a fairly large list of antibacterial drugs allows the doctor, taking into account the patient’s condition, the severity of his disease, the microorganism that caused the pathological process, to make the right choice of the drug and the method of its administration.

What injections are prescribed for children?

In a child, bronchitis occurs rapidly, with a significant increase in temperature and severe cough. Obstruction often occurs. Bronchitis can develop into pneumonia in a short time, especially for children under one year of age. Many antibiotics in syrup have a bitter taste and cause vomiting immediately after administration.

Side effects in the form of upset stool, nausea, vomiting, and abdominal pain are more common in children. Therefore, children are often prescribed injections. The main drugs that are administered by injection are antibiotics, antihistamines, and hormonal agents.

Rules for injection and preparation

The manipulation is carried out by medical personnel who have the skill. This is especially true for intravenous injections and administration of drugs to children.

Intravenous injections

It is done in the area of the elbow, where the veins are closest to the skin. The injection site is wiped with an antiseptic solution. The needle is inserted at an acute angle, piercing the skin and vein wall. The drug is administered slowly (drip). Place cotton wool with alcohol at the injection site and bend your arm at the elbow for 5-10 minutes to prevent the formation of a bruise in the puncture area.

Intramuscular injections

They are done in the buttock, in the outer upper square. The injection site is rubbed with an antiseptic. A puncture is made, the needle is inserted to a certain level perpendicular to the surface of the body. Some drugs are given slowly, others faster. After removing the needle, cotton wool with alcohol is applied to the puncture site for several minutes.