В статье представлены основные диагностические критерии острого синусита, приведены различия клинического течения вирусного и бактериального синусита. Авторы сравнивают различные рекомендации по срокам назначения антибактери-альной терапии, рассматривают препараты для стартовой терапии острого синусита. Обсуждаются возможности и эффек-тивность сопутствующей вспомогательной терапии, в том числе топических глюкокортикостероидов, растворов для оро-шения полости носа и современных деконгестантов.
В статье представлены наиболее часто встречающиеся заболевания верхних дыхательных путей у взрослых, дифферен-циально-диагностические критерии острой респираторной вирусной инфекции, острого тонзиллофарингита, острого и хронического риносинусита. Обсуждаются необходимость, сроки назначения антибактериальной терапии, а также группы антибиотиков и их дозировки при этих заболеваниях.
Rhinitis is inflammation of the mucous membrane inside the nose. The clinical symptoms of this disease include nasal congestion, sneezing, itching of the nose and roof of mouth, rhinorrhea, and mucus draining down the back of the throat. Both allergic and non-allergic factors can play a role in the development of rhinitis. The most commonly used classification of rhinitis includes allergic rhinitis, non-allergic rhinitis, infectious rhinitis, and its specific forms. Allergic rhinitis is classified into the intermittent or persistent types, and may also be classified as mild, moderate and severe according to the severity of symptoms. Treatment of allergic rhinitis includes elimination of contact with allergen, allergen-specific immunotherapy and pharmacotherapy, which is selected depending on the severity of the symptoms. Infectious rhinitis develops in acute viral infection, and rhinitis symptoms are present in acute and chronic rhinosinusitis. Non-allergic rhinitis comprises conditions ranging from vasomotor rhinitis and gustatory rhinitis to non-allergic rhinitis with eosinophilia syndrome. Mixed rhinitis has components of allergic and non-allergic rhinitis. In addition, there are CPAP rhinitis, occupational rhinitis, medication rhinitis, rhinitis in systemic administration of drugs, rhinitis of pregnant women, atrophic rhinitis, rhinitis in systemic diseases. The type of rhinitis is diagnosed based on the patient’s complaints, anamnesis and clinical picture, some cases require laboratory tests and CT scan of the paranasal sinuses to differentiate the diagnosis. Approaches to the treatment of rhinitis depend on its type and include elimination of allergens or provoking factors, administration of saline solutions, intranasal glucocorticosteroids, systemic antihistamines, intranasal cromones, decongestants, antibacterial drugs may be prescribed to treat infectious rhinitis. Rhinitis should be differentiated from structural abnormalities, including congenital features, acquired conditions, neoplasms, gastroesophageal reflux, nasal liquorrhea.
Allergic rhinitis is a common allergic disease that have a substantially negative impact on the patients’ quality of life. Pharmacotherapy is essential to the treatment of allergic rhinitis, including the use of antihistamines, leukotriene receptor antagonists, topical steroids, decongestants, cromones, anticholinergics and their various combinations. Antihistamines are commonly prescribed drugs to treat mild, moderate, and severe disease. The article discusses the mechanisms of action of first- and second-generation antihistamines and compares the potential side effects and drug interactions.First-generation antihistamines differ in their significant sedative and hypnotic effect, mainly due to their pronounced lipophilic properties and ability to transverse the blood–brain barrier and bind to H1-histamine receptors in the central nervous system. Due to low selectivity of the first-generation antihistamines, they may interact with other receptors and develop adverse side effects, including dry mouth, nasopharynx, more rarely pupillary dilation, increased intraocular pressure, tachycardia, and urine retention. Bilastine is a highly selective second-generation antihistamine that has a rapid onset and a prolonged action. This drug does not interact with the P450 cytochrome system or undergo significant metabolism in the human body, and therefore the drug has low potential for drug-drug interactions. Bilastine is excreted almost completely unchanged and therefore does not require dose adjustment in patients with renal or hepatic impairment. Bilastine demonstrated similar efficacy in seasonal allergic rhinitis compared to cetirizine and desloratadine, as well as similar efficacy and safety in long-term treatment of patients with perennial rhinitis compared to cetirizine. Bilastine is well tolerated both at standard and at supratherapeutic doses, appears to have less sedative potential than other second-generation antihistamines, and has no cardiotoxicity.
The clinical picture of allergic rhinitis includes sneezing, nasal discharge, impaired nasal breathing, and itching of the nose and roof of mouth. Depending on the duration of symptoms, allergic rhinitis is divided into intermittent and persistent forms, and depending on the severity of symptoms, it can be mild, moderate, and severe. Treatment for allergic rhinitis includes elimination of allergic contacts, allergen-specific immunotherapy, and pharmacotherapy. The choice of a treatment regimen is determined by the severity of symptoms, age of a patient and presence of concomitant diseases. The work is aimed to review the most common pharmaceuticals to treat allergic rhinitis. Saline solutions are used as monotherapy when symptoms are mild, or before use of other topical drugs to clean mucous membranes before their application. Intranasal glucocorticosteroids can be used as monotherapy, if symptoms have different levels of severity, and supplemented with other drugs, in case they are not efficient. Intranasal glucocorticosteroids do not have a systemic effect due to minimal bioavailability. The patients with moderate/severe allergic rhinitis are recommended to use them jointly with second generation antihstamines, intranasal cromones, intranasal antihistamines and leukotriene receptor antagonists. The significant side effect of antihistamines, especially of the first generation, are sedative effects on the central nervous system. The side effects of leukotriene receptor antagonists are neuropsychological disorders. Intranasal cromones have a high safety profile, which makes them popular in paediatric practice. However, the dosage regimen up to 3–4 times a day reduces patient adherence to treatment. Decongestants are not indicated as monotherapy for allergic rhinitis but can be used in combination with other drugs in short courses, taking into account the possible side effects.
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