perinatologyРоссийский вестник перинатологии и педиатрииRossiyskiy Vestnik Perinatologii i Pediatrii (Russian Bulletin of Perinatology and Pediatrics)1027-40652500-2228Ltd. “The National Academy of Pediatric Science and Innovation”10.21508/1027-4065-2020-65-3-169-176perinatology-1166Research ArticleВ ПОМОЩЬ ПРАКТИЧЕСКОМУ ВРАЧУFOR THE PRACTITIONERМесто амоксициллина в лечении острых инфекций дыхательных путей у детей: диалог микробиолога и клинического фармакологаAmoxicillin in the treatment of acute respiratory infections in children: a dialogue between a microbiologist and a clinical pharmacologisthttps://orcid.org/0000-0003-3550-7875СидоренкоС. В.SidorenkoS. V.

Сидоренко Сергей Владимирович – д.м.н., проф., зав. отделом молекулярной микробиологии и эпидемиологии

197022 Санкт-Петербург, ул. Профессора Попова, д. 9

sidorserg@gmail.comhttps://orcid.org/0000-0002-6304-0355ДроновИ. А.DronovI. A.

Дронов Иван Анатольевич – к.м.н., доц. кафедры детских болезней, врач-клинический фармаколог

119435 Москва, Большая Пироговская ул., д. 19

dronow@yandex.ruФГБУ «Детский научно-клинический центр инфекционных болезней» ФМБА РоссииРоссияPediatric Research and Clinical Center for Infectious DiseasesRussian FederationФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский университет)РоссияSechenov First Moscow State Medical University (Sechenov University)Russian Federation202008072020653169176Copyright © Ltd. “The National Academy of Pediatric Science and Innovation”, 20202020Ltd. “The National Academy of Pediatric Science and Innovation”Ltd. “The National Academy of Pediatric Science and Innovation”https://www.ped-perinatology.ru/jour/about/submissions#copyrightNoticehttps://www.ped-perinatology.ru/jour/article/view/1166

Представлен современный взгляд на применение амоксициллина при острых инфекциях дыхательных путей у детей с позиции микробиолога и клинического фармаколога. Современные микробиологические методы поменяли представления о микробиоте дыхательных путей, однако этиология бактериальных острых инфекций дыхательных путей не претерпела существенных изменений – наиболее частыми возбудителями по-прежнему служат Streptococcus pneumoniae и Haemophilus influenzae. Амоксициллин остается препаратом выбора для большинства респираторных инфекций бактериальной этиологии. Ингибиторзащищенные аминопенициллины (амоксициллин/клавуланат и др.) в большинстве случаев острых инфекций дыхательных путей не имеют преимуществ перед амоксициллином, но увеличивают риск нежелательных явлений. Современные данные о макролидах, которые широко применяются в клинической практике, свидетельствуют о необходимости ограничения их использования при острых инфекциях дыхательных путей в связи с ростом резистентности S. pneumoniae и отсутствием клинически значимой активности в отношении H. influenzae. Актуальные сведения о резистентности S. pneumoniae и H. influenzae, а также имеющиеся данные по фармакокинетике амоксициллина требуют пересмотра подходов к дозированию препарата. Суточная доза амоксициллина у детей при острых инфекциях дыхательных путей не должна быть менее 45–60 мг/кг, а во многих случаях (острый средний отит, инфекции, вызванные H. influenzae или пенициллинрезистентными штаммами S. pneumoniae) требуется применения боле 90 мг/кг/сут. Амоксициллин обладает широким терапевтическим диапазоном, в связи с чем применение высоких доз препарата не сопряжено со снижением безопасности терапии.

The article presents a modern view of amoxicillin in the treatment of acute respiratory infections in children from point of view of a microbiologist and clinical pharmacologist. Modern microbiological methods have changed the idea of the microbiota of the respiratory tract, however, the etiology of acute bacterial infections of the respiratory tract has not undergone significant changes – Streptococcus pneumoniae and Haemophilus influenzae are still the most common pathogens. Amoxicillin remains the drug of choice for most respiratory infections of bacterial etiology. Inhibitor-protected aminopenicillins (amoxicillin/clavulanate etc.) do not have advantages over amoxicillin in most cases of acute respiratory tract infections, but increase the risk of adverse events. Current data on macrolides, which are widely used in clinical practice, indicate the need to limit their use in acute infections of the respiratory tract due to the increase in resistance of S. pneumoniae and the absence of clinically significant activity against H. influenza. Current information on the resistance of S. pneumoniae and H. influenzae, as well as available data on the pharmacokinetics of amoxicillin, require a review of dosing approaches. The daily dose of amoxicillin in children with acute respiratory infections should not be less than 45–60 mg/kg, and in many cases (acute otitis media, infections caused by H. influenzae or penicillin-resistant S. pneumoniae strains), more than 90 mg/kg/day is required. Amoxicillin has a wide therapeutic range, and therefore the use of high doses of the drug is not associated with a decrease in the safety of therapy.

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The authors declare that there are no conflicts of interest present.