What antibacterial preparations and means of pathogenetic therapy are more preferable to be included in the scheme of treatment of acute bacterial sinusitis at adults?

This question was answered by professor Sergey Borisovich Bezshapochniy , the head of otorhinolaryngology department in the Ukrainian medical stomatologic academy, who did the report on the ХІ congress of otorhinolaryngologists of Ukraine ( May 17-19th, Sudak). - On the basis of ENT - DISEASES hospital of the Ukrainian medical stomatologic academy we have carried out the research purposed to estimate the efficiency of a combination of Cefodox and Trifed-expectorant in treatment of patients with acute bacterial rhinosinusitis. Cefodox (Cefodoxime Proxetile) is the first in Ukraine semisynthetic oral cefalosporine of III generation.

Cefodox possesses the pronounced bactericidal action against the majority of gram-positive and gram-negative pathogens including the strains producing β-lactamase and consequently is an optimum choice for initial empirical antibiotic therapy of acute bacterial rhinosinusitis.

Essential advantage of Cefodox against other antibiotics is its favorable profile of safety.

The preparation enters the gastroenteric tract in the inactive form (promedicine) and only in the course of absorption in small intestine under the influence of hydrolase it is transformed to its active form, that is cefpodoxime.

This feature of Cefodox reduces to the minimum the risk of intestine disbiosis. Besides, the preparation is almost completely excreted with urine and is not exposed to hepatic transformation that gives the chance to apply the preparation for the patients suffering liver diseases.

Trifed-expectorant is a complex preparation which is applied to symptomatic treatment of inflammatory diseases of the upper and inferior air passages accompanied by cough.

It contains triprolidine hydrochloride,pseudoephedrine hydrochloride and guaifenesin and consequently acts as antihistamine agent, the bronchial spasmolytic, decongestant and mucolitic agent.

These properties of a preparation give the chance to influence the acute rhinosinusitis pathogenesis In the study we have included 97 patients suffering acute bacterial sinusitis, and divided them in two groups administering different schemes of treatment.

Patients of the first group (n=35) received Trifed expectorant and Cefodox 0,2 g orally 2 times a day, the second group(n=62) — Ceftriaxone, 1,0 g intramuscularly every 12 hours, non-steroid anti-inflammatory preparations and mucolitic agents.

To determine the efficiency of treatment they estimated the dynamics of the patients' complaints (stuffy nose, rhinorrhea, headache, indisposition), the data of endomicrorhinoscopy, and the parameters of mucociliary clearance.

The subjective complaints were estimated according the 4-grade system: 0 - complaints are absent, 1 - poorly expressed, 2 - average expressed, 3 - strongly expressed complaints. Prior to the beginning of therapy the average index of subjective stuffiness in nose in both groups had made 3,8 points, for the third day of treatment it decreased to 2,1 points in the first group and to 2,3 points in the second, for the fifth day – to 0,4 and 0,6 points accordingly.

Hence, reduction of subjective stuffiness in nose was faster and expressed in the group of the patients receiving a combination of preparations of Cefodox and Traifed expectorant.

Expressiveness of a headache by fifth day of therapy had decreased to 0 points in both groups of patients. Also the speed of normalisation of mucociliary transport was comparable.

Thus, the offered scheme of complex treatment of acute bacterial rhinosinusitis with use of preparations of Cefodox and Trifed-expectorant is at least as effective, as application of more complicated scheme with inclusion parenteral antibiotics, mucolitic and non- steroid anti-inflammatory preparation.

At that, oral administration of the antibiotic allows to provide treatment on out-patient basis and to raise adherence of patients to this treatment.