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”10.21508/1027-4065-2018-63-1-106-112perinatology-628Research ArticleВ ПОМОЩЬ ПРАКТИЧЕСКОМУ ВРАЧУGUIDELINES FOR THE PRACTITIONERНеантибактериальные альтернативные мероприятия при инфекции мочевых путей у детей. Часть 1. Подавление микробной инициации воспаленияNon-antibacterial alternative measures for urinary tract infection in children. Part 1. Suppression of the microbial initiation of the inflammationКирилловВ. И.KirillovV. I.

д.м.н., проф. кафедры педиатрии Московского государственного медико-стоматологического университета имени А.И. Евдокимова

БогдановаН. А.BogdanovaN. A.

к.м.н., доцент кафедры педиатрии Московского государственного медико-стоматологического университета имени А.И. Евдокимова

МорозовС. Л.MorozovS. L.

к.м.н., ст. научн. сотр. отдела наследственных и приобретенных болезней почек Научно-исследовательского клинического института педиатрии им. академика Ю.Е. Вельтищева

Московский государственный медико-стоматологический университет имени А.И. Евдокимова, МоскваРоссияA.I. Evdokimov Moscow State University of Medicine and DentistryRussian FederationОСП «Научно-исследовательский клинический институт педиатрии им. академика Ю.Е. Вельтищева» ФГБОУ ВО РНИМУ им. Н.И. Пирогова Минздрава РФ, МоскваРоссияResearch Clinical Institute of Pediatry named after Academician Yu.E. Veltishchev, Russian National Research Medical University named after N.I. Pirogov of the Ministry of Health of the Russian Federation, MoscowRussian Federation201813032018631106112Copyright © Ltd. “The National Academy of Pediatric Science and Innovation”, 20182018Ltd. “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/628

У детей с инфекцией мочевых путей рассматривается возможность проведения альтернативных мероприятий помимо антибактериальной терапии, которая в последние годы становится недостаточной из-за неуклонного роста антибиотикорезистентности, а также в связи с созданием условий для заселения урогенитального тракта уропатогенами. Постоянно расширяющаяся номенклатура антибиотиков, оказывающих цитотоксическое воздействие на почечную ткань, значимо повышает вероятность нефротоксического действия препаратов. Нормализация уродинамики и  биоценоза слизистых, а также «рецепторная терапия» и восстановление муцинового слоя обычно в сочетании с той или иной долей этиотропного воздействия дают благоприятный лечебный и профилактический эффект.

 

The possibility to carry out the alternative measures for the children with the urinary tract infection is considered in addition to the antibiotic therapy, which has become insufficient in recent years due to the steady growth of the antibiotic resistance as well as owing to the creation of the conditions for population of the urogenital tract with the uropathogenic bacteria. Constantly expanding range of the antibiotics, which provides a cytotoxic effect on the kidney tissue, significantly increases the likelihood of the nephrotoxicity of the drugs. The normalization of the urodynamics and biocenosis of the mucous membranes, as well as so-called receptor therapy and mucin layer recovery usually in combination with some etiotropic influence renders the favorable medical and preventive effect.

 

детиинфекция мочевой системылечениевосстановление биоценоза и муцинового слоярецепторная терапияантимикробная резистентностьchildrenurinary tract infectiontreatmentbiocenosis and mucin layer recoveryreceptor therapyantimicrobial resistanceReferencesHarambat J., van Stralen K.J., Kim J.J., Tizard E.J. Epidemiology of chronic kidney disease in children. Pediatr Nephrol 2012; 27(2): 363–373. DOI: 10.1007/s00467-011-1939-1.Harambat J., van Stralen K.J., Kim J.J., Tizard E.J. Epidemiology of chronic kidney disease in children. Pediatr Nephrol 2012; 27(2): 363–373. DOI: 10.1007/s00467-011-1939-1.Doganis D., Siafas K., Mavrikou M., Issaris G., Martirosova A., Perperidis G. et al. Does early treatment of urinary tract infection prevent renal damage? Pediatrics 2007; 120(4): 922–928. DOI: 10.1542/peds.2006-2417.Doganis D., Siafas K., Mavrikou M., Issaris G., Martirosova A., Perperidis G. et al. Does early treatment of urinary tract infection prevent renal damage? Pediatrics 2007; 120(4): 922–928. DOI: 10.1542/peds.2006-2417.Chen P.C., Chang L.Y., Lu C.Y., Shao P.L., Tsai I.J., Tsau Y.K. et al. Drug suseptibility and treatment response of common urinary tract infection pathogens in children. J Micro-biol Immunol Infect 2014; 47(6): 478–483. DOI: 10.1016/ j.jmii.2013.07.011.Chen P.C., Chang L.Y., Lu C.Y., Shao P.L., Tsai I.J., Tsau Y.K. et al. Drug suseptibility and treatment response of common urinary tract infection pathogens in children. J Micro-biol Immunol Infect 2014; 47(6): 478–483. DOI: 10.1016/ j.jmii.2013.07.011.Возрастающая угроза антимикробной резистентности. Возможные меры. ВОЗ, 2013. http: apps.who. int/iris/bistrem110665144812/16/97892445503188-rus. pdfThe evolving threat of antimicrobial resistance: options for action. WHO 2013. http: apps.who.int/iris/bistr em110665144812/16/97892445503188-rus.pdfСтратегия и тактики применения антимикробных средств в лечебных учреждениях России. Российские национальные рекомендации. Под ред. В.С. Савельева, Б.Р. Гельфанда, С.В. Яковлева. М: ООО «Компания БОРГЭС» 2012; 92.Strategies and tactics of antimicrobial therapy in medical departments of Russia. Russian national recomendations. V.S. Saveljev, B.R. Gelfand, S.V. Jakovlev (eds). Moscow: OOO “Companiya BORGES” 2012; 92. (in Russ)Ferry S.A., Holm S.E. Stenlund H., Lundholm R., Monsen T.J. Clinical and bacteriological outcome of different doses and duration of piv-mecillinam compared with placebo therapy of uncompicated lower urinary tract infection in women: the LUTIW project. Scand J Prim Health Care 2007; 25(1): 49–57. DOI: 10.1080/02813430601183074.Ferry S.A., Holm S.E. Stenlund H., Lundholm R., Monsen T.J. Clinical and bacteriological outcome of different doses and duration of piv-mecillinam compared with placebo therapy of uncompicated lower urinary tract infection in women: the LUTIW project. Scand J Prim Health Care 2007; 25(1): 49–57. DOI: 10.1080/02813430601183074.Bleidorn J., Gagyor L., Kochen M.M., Wegscheider K., Hummers-Pradier E. Symptomatic treatment (ibuprofen) or antibiotics (ciprofloxacin) for uncumplicated urinary tract infection? Results of a randomized controlled pilot trial. BMC Medicine 2010; 8: 30-37. DOI: 10.1186/1741-7015-8-30.Bleidorn J., Gagyor L., Kochen M.M., Wegscheider K., Hummers-Pradier E. Symptomatic treatment (ibuprofen) or antibiotics (ciprofloxacin) for uncumplicated urinary tract infection? Results of a randomized controlled pilot trial. BMC Medicine 2010; 8: 30-37. DOI: 10.1186/1741-7015-8-30.Кириллов В.И., Богданова Н.А., Никитина С.Ю. Альтернативные подходы к лечению инфекций мочевой системы у детей. Рос вестн перинатол и педиатр 2015; 60(4): 205– 206.Kirillov V.L., Bogdanova N.A., Nikitina S.Yu. Alternative approaches to treatment of urinary tract infections in children. Ros vestn perinatal i pediatr 2015; 60(4): 205–206. (in Russ)Naber R., Stendl H., Abramov-Sommariva D., Es Koetter H. Non-antibiotic herbal therapy of un complicated lower urinary tract infections in women – a pilot study (Abstr). 61 st International Congress and Annual Meeting of the Society for Medicinal Plant and Natural Product Research, Muenster. Planta Medica 2013; 79: 1140.Naber R., Stendl H., Abramov-Sommariva D., Es Koetter H. Non-antibiotic herbal therapy of un complicated lower urinary tract infections in women – a pilot study (Abstr). 61 st International Congress and Annual Meeting of the Society for Medicinal Plant and Natural Product Research, Muenster. Planta Medica 2013; 79: 1140.Антимикрoбная терапия и профилактика инфекций почек, мочевыводящих путей и мужских половых органов. Российские национальные рекомендации. Под ред. О.И. Аполихина, Д.Ю. Пушкарь, А.А. Камалиева, Т.С. Перепановой. М 2015; 64.Antimocrobial therapy and prophilaxis of renal infections, urinary tract infections and male genital tract infections. Russian national Recommendations. O.L. Apolihin, D.Yu. Pushkar, A.A. Kamalov, T.S. Perepanova (eds). Moscow 2015; 64. (in Russ)Vega P.J.M., Pascual L.A. High-pressure blader an underlying factror mediating renal damage in the absense of reflux. Brit J Urol 2001; 87(4): 581–584.Vega P.J.M., Pascual L.A. High-pressure blader an underlying factror mediating renal damage in the absense of reflux. Brit J Urol 2001; 87(4): 581–584.Зоркин С.Н., Гусарова Т.Н., Борисова С.А. М-холинолитики в предоперационной подготовке у детей с обструктивными уропатиями. Педиатрич фармакол 2008; 5(6): 62–66.Zorkin S.N. Gusarova T.N., Borisova S.A. M-cholinolytics in preoperative preparation of children with obstructive uropathies. Pediatrich farmacol 2008; 5(6): 62–66. (in Russ)Кириллов В.И., Богданова Н.А. Инфекция мочевой системы у детей: патогенетические сдвиги и их коррекция с целью профилактики обострений. Вопр соврем педиатр 2011; 10(4): 100–104.Kirillov V.I., Bogdanova N.A. Urinary infection in children: pathogenical disordes and their correction for the prophilaxis of exacerbation. Vopr sovrem pediatr 2011; 10(4): 100–104. (in Russ)Shreedar B., Yeung Ch. The natural history of transient urodynamic abnormality of infancy with high-grade primary vesicoureteral reflux: follow-up to early childhood. J Pediatr Urol 2008; 4: 218–219.Shreedar B., Yeung Ch. The natural history of transient urodynamic abnormality of infancy with high-grade primary vesicoureteral reflux: follow-up to early childhood. J Pediatr Urol 2008; 4: 218–219.Лопаткин Н.А., Пугачев А.Г., Москалева Н.Г. Интремитт-тирующий пузырно-мочеточниковый рефлюкс у детей. М: ОАО «Издательство “Медицина”» 2004; 136.Lopatkin N.A., Pugachev A.G., Moskaleva N.G. Intermitten vesicoureteral reflux in children. Moscow: “Meditsina Publishers” 2004; 136. (in Russ)Франц М., Хорл У. Наиболее частые ошибки диагностики и ведения инфекции мочевых путей. Нефрология и диализ 2000; 2(4): 340–347.Franz M., Horl W.H. Common errors in diagnosis and management of urinary tract infection. Nefrologiya i dializ 2000; 2(4): 340–347. (in Russ)Winberg J., Herthelius-Elman M., Mollby R., Nord C.E. Pathogenesis of urinary tract infection experimental studies of vaginal resistance to colonization. Pediatr Nephrol 1993; 7(5): 509–514.Winberg J., Herthelius-Elman M., Mollby R., Nord C.E. Pathogenesis of urinary tract infection experimental studies of vaginal resistance to colonization. Pediatr Nephrol 1993; 7(5): 509–514.Marild S., Jodal V., Mangelius L. Medical history among children with acute pyelonepritis compared to controls. Pediatr Infect Dis J 1989; 8: 511–515.Marild S., Jodal V., Mangelius L. Medical history among children with acute pyelonepritis compared to controls. Pediatr Infect Dis J 1989; 8: 511–515.Salvador E., Wagenlehner F., Köhler C.D., Mellmann A., Hacker J., Svanborg C., Dobrindt U. Comparison of symptomatic bacteriuria Escherichia coli isolates from healthy individuals versus those from hospital patients shows that long-term bladder colonization selects for attenuated virulence phenotypes. Infect Immun 2012; 80(2): 668–678. DOI: 10.1128/ IAI.06191-11.Salvador E., Wagenlehner F., Köhler C.D., Mellmann A., Hacker J., Svanborg C., Dobrindt U. Comparison of symptomatic bacteriuria Escherichia coli isolates from healthy individuals versus those from hospital patients shows that long-term bladder colonization selects for attenuated virulence phenotypes. Infect Immun 2012; 80(2): 668–678. DOI: 10.1128/ IAI.06191-11.Fraga M., Scavone P., Zunino P. Preventive and therapeutic administration of an indigenous Lactobacillus sp. strain againist Proteus mirabilis ascending urinary in a mouse model. Antonie Van Leeuwen-hock 2005; 88(1): 25–34.Fraga M., Scavone P., Zunino P. Preventive and therapeutic administration of an indigenous Lactobacillus sp. strain againist Proteus mirabilis ascending urinary in a mouse model. Antonie Van Leeuwen-hock 2005; 88(1): 25–34.Anukam K.C., Osazuwa E., Osemene G.I., Ehigiagbe F., Bruce A.W., Reid G. Clinical study comparing probiotic Lac-tobacillus GR-1 and RC-14 with metronidazole vaginal gel to treat symptomatic bacterial vaginosis. Microb Infect 2006; 8(12–13): 2772–2776. DOI: 10.1016/j.micinf.2006.08.008.Anukam K.C., Osazuwa E., Osemene G.I., Ehigiagbe F., Bruce A.W., Reid G. Clinical study comparing probiotic Lac-tobacillus GR-1 and RC-14 with metronidazole vaginal gel to treat symptomatic bacterial vaginosis. Microb Infect 2006; 8(12–13): 2772–2776. DOI: 10.1016/j.micinf.2006.08.008.Stapleton A.E., Au-Yeung M., Hooton T.M., Fredricks D.N., Rob-erts P.L., Czaja C.A. et al. Randomised placebo-controlled phase 2 trial of Lactobacillus crispatum probiotic given intravaginally for prevent of recurrent urinary tract infection. Clin Infect Dis 2011; 52(10): 1212–1217. DOI: 10.1093/cid/cir183.Stapleton A.E., Au-Yeung M., Hooton T.M., Fredricks D.N., Rob-erts P.L., Czaja C.A. et al. Randomised placebo-controlled phase 2 trial of Lactobacillus crispatum probiotic given intravaginally for prevent of recurrent urinary tract infection. Clin Infect Dis 2011; 52(10): 1212–1217. DOI: 10.1093/cid/cir183.Вялкова А.А., Гриценко В.А., Данилова Е.И., Седашкина О.А. Обоснование клинико-микробиологических подходов к лечению и профилактике рецидивов пиелонефрита у детей. Педиатр фармакол 2009; 6(2): 94–98.Vialkova A.A., Gritsenko V.A., Danilova E.J., Sedashkina O.A. Justification of clinical and microbiological approaches to pyelonephritis recurrence treatment and prevention in children. Pediatrich far-makol 2009; 6(2): 94–98. (in Russ)Кириллов В.И., Теблоева Л.Т., Алексеев Е.Б. Идентификация возбудителей инфекций мочевыводящих путей у детей. Педиатрия 1997; 6: 8–13.Kirillov V.I., Tebloeva L.T., Alekseev E.B. The identification of infectious agents for urinary tract infections in children. Pediatriya 1997; 6: 8–13. (in Russ)Sudo N, Sawamura S.A. TanaKa K., Aiba Y., Kubo C., Koga Y. The requirement of intestinal bacterial flora for the development of an IgE production system fully susceptible to oral tolerance induction. J Immunol 1997; 159: 1739–1745.Sudo N, Sawamura S.A. TanaKa K., Aiba Y., Kubo C., Koga Y. The requirement of intestinal bacterial flora for the development of an IgE production system fully susceptible to oral tolerance induction. J Immunol 1997; 159: 1739–1745.Кузьмин М.Д., Титов Р.В., Кузьмин А.М. Комплексный подход к лечению хронического первичного пиелонефрита. Тезисы научно-практической конференции «Рациональная фармакотерапия в урологии». М 2015; 19–21.Kuzmin M.D., Titov R.V., Kuzmin A.M. Complex approach to treatment chronical primary pyelonephritis. Theses of the scientific-practical conference: «Rational pharmacotherapy in urology». Moscow 2015; 19–21. (in Russ)Перепанова Т.С. Проблема лечения и профилактики рецидивирующих инфекций нижних мочевых путей. Роль иммунопрофилактики. Эффективная фармакотерапия. Урология и нефрология 2014; 54: 4–16.Perepanova T.S. Problems of treatment and profilactic for lower urinary tract infections. Role of immunoprophilactic. Effectivnaja farmacoterapija. Urologia i Nephrologia 2014; 54: 4–6. (in Russ)Liu Y., Black M.A., Caron L., Camesano T.A. Role of cranberry juice on molecular scale surface charakteristics and adhesion behavior of Escherichia coli. Biotechnol Biong 2006; 93(2): 297–305. DOI: 10.1002/bit.20675.Liu Y., Black M.A., Caron L., Camesano T.A. Role of cranberry juice on molecular scale surface charakteristics and adhesion behavior of Escherichia coli. Biotechnol Biong 2006; 93(2): 297–305. DOI: 10.1002/bit.20675.Jepson R.G., Williams G., Craig J.C. Cranberries for preventing urinary tract infections. Cochrane Database Syst Rev 2012; 10: CD001321. DOI: 10.1002/14651858.CD001321.pub5.Jepson R.G., Williams G., Craig J.C. Cranberries for preventing urinary tract infections. Cochrane Database Syst Rev 2012; 10: CD001321. DOI: 10.1002/14651858.CD001321.pub5.Kunstle G., Brenneis C., Haunschild J. Efficacy of Canephron N against bacterial adhesion, inflamation and blader hyperactivity. Poster 28 th Annual Congress of European Association of Urology (EUA). Mailand 2013; 112.Kunstle G., Brenneis C., Haunschild J. Efficacy of Canephron N against bacterial adhesion, inflamation and blader hyperactivity. Poster 28 th Annual Congress of European Association of Urology (EUA). Mailand 2013; 112.Guidelines on urological infections. EUA 2015; 88.Guidelines on urological infections. EUA 2015; 88.Ruggieri M.R., Levin R.M., Hanno P.M., Witkowski B.A., Gill H.S., Steinhardt G.F. Defective antiadherence activity of bladder extracts from patients with recurrent urinary tract infection. J Urol 1988; 140: 157–159.Ruggieri M.R., Levin R.M., Hanno P.M., Witkowski B.A., Gill H.S., Steinhardt G.F. Defective antiadherence activity of bladder extracts from patients with recurrent urinary tract infection. J Urol 1988; 140: 157–159.Constantinides C., Manousakas T., Nikoioponlos P. Stanitsas A. Prevention o recurrent bacterial cystitis by intravesical administration of hyaloronic acid: pilot Study. Brit J Urol Intern 2004; 93(9): 1262–1266.Constantinides C., Manousakas T., Nikoioponlos P. Stanitsas A. Prevention o recurrent bacterial cystitis by intravesical administration of hyaloronic acid: pilot Study. Brit J Urol Intern 2004; 93(9): 1262–1266.Mannhardt W., Becker A., Putzer M., Bork M., Zepp F., Hacker J., Schulte-Wissermann H. Host defense within the urinary tract. I Bacterial adhesion initiates an uroepithelial defense mechanism. Pediatr Nephrol 1996; 10(5): 568–572.Mannhardt W., Becker A., Putzer M., Bork M., Zepp F., Hacker J., Schulte-Wissermann H. Host defense within the urinary tract. I Bacterial adhesion initiates an uroepithelial defense mechanism. Pediatr Nephrol 1996; 10(5): 568–572.De Smet K., Contreras R. Human antimicrobial peptides: defensins, cathelicidins and histatins. Boitechnol Letters 2005; 27: 1337–1347.De Smet K., Contreras R. Human antimicrobial peptides: defensins, cathelicidins and histatins. Boitechnol Letters 2005; 27: 1337–1347.

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