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Antibiotic name for fever: Fever – Diagnosis and treatment

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Fever – Diagnosis and treatment

Diagnosis

To evaluate a fever, your doctor may:

  • Ask questions about your symptoms and medical history
  • Perform a physical exam
  • Order tests, such as blood tests or a chest X-ray, as needed, based on your medical history and physical exam

Because a fever can indicate a serious illness in a young infant, especially one 28 days or younger, your baby might be admitted to the hospital for testing and treatment.

Treatment

For a low-grade fever, your doctor may not recommend treatment to lower your body temperature. These minor fevers may even be helpful in reducing the number of microbes causing your illness.

Over-the-counter medications

In the case of a high fever, or a low fever that’s causing discomfort, your doctor may recommend an over-the-counter medication, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin IB, others).

Use these medications according to the label instructions or as recommended by your doctor. Be careful to avoid taking too much. High doses or long-term use of acetaminophen or ibuprofen may cause liver or kidney damage, and acute overdoses can be fatal. If your child’s fever remains high after a dose, don’t give more medication; call your doctor instead.

Don’t give aspirin to children, because it may trigger a rare, but potentially fatal, disorder known as Reye’s syndrome.

Prescription medications

Depending on the cause of your fever, your doctor may prescribe an antibiotic, especially if he or she suspects a bacterial infection, such as pneumonia or strep throat.

Antibiotics don’t treat viral infections, but there are a few antiviral drugs used to treat certain viral infections. However, the best treatment for most minor illnesses caused by viruses is often rest and plenty of fluids.

Treatment of infants

For infants, especially those younger than 28 days, your baby might need to be admitted to the hospital for testing and treatment. In babies this young, a fever could indicate a serious infection that requires intravenous (IV) medications and round-the-clock monitoring.

Lifestyle and home remedies

You can try a number of things to make yourself or your child more comfortable during a fever:

  • Drink plenty of fluids. Fever can cause fluid loss and dehydration, so drink water, juices or broth. For a child under age 1, use an oral rehydration solution such as Pedialyte. These solutions contain water and salts proportioned to replenish fluids and electrolytes. Pedialyte ice pops also are available.
  • Rest. You need rest to recover, and activity can raise your body temperature.
  • Stay cool. Dress in light clothing, keep the room temperature cool and sleep with only a sheet or light blanket.

Preparing for your appointment

Your appointment may be with your family doctor, general practitioner or pediatrician. Here’s some information to help you get ready for your appointment and know what to expect from the doctor.

What you can do

  • Be aware of any pre-appointment restrictions. When you make the appointment, ask if there’s anything you need to do in advance.
  • Write down information about the fever, such as when it started, how and where you measured it (orally or rectally, for example) and any other symptoms. Note whether you or your child has been around anyone who’s been ill.
  • Write down key personal information, including possible exposure to anyone who’s been ill or recent travel out of the country.
  • Make a list of all medications, vitamins and supplements that you or your child is taking.
  • Write down questions to ask the doctor.

For a fever, some basic questions to ask your doctor include:

  • What’s likely causing the fever?
  • Could anything else be causing it?
  • What kinds of tests are needed?
  • What treatment approach do you recommend? Are there any alternatives?
  • Is medicine necessary to lower the fever? What are the side effects of such medications?
  • Are there any restrictions that I need to follow?
  • Is there a generic alternative to the medicine you’re prescribing?
  • Do you have any printed materials that I can take with me? What websites do you recommend?

Don’t hesitate to ask other questions during your appointment as they occur to you.

What to expect from your doctor

Be prepared to answer questions your doctor might ask you, such as:

  • When did the symptoms first occur?
  • What method did you use to take your or your child’s temperature?
  • What was the temperature of the environment surrounding you or your child?
  • Have you or your child taken any fever-lowering medication?
  • What other symptoms are you or your child experiencing? How severe are they?
  • Do you or your child have any chronic health conditions?
  • What medications do you or your child regularly take?
  • Have you or your child been around anyone who’s ill?
  • Have you or your child recently had surgery?
  • Have you or your child recently traveled outside the country?
  • What, if anything, seems to improve the symptoms?
  • What, if anything, appears to worsen the symptoms?

Antibiotics, Other, Antimalarials, Analgesics, Other, Salicylates, Antitussives

Author

Kerry O Cleveland, MD Professor of Medicine, University of Tennessee College of Medicine; Consulting Staff, Department of Internal Medicine, Division of Infectious Diseases, Methodist Healthcare of Memphis

Kerry O Cleveland, MD is a member of the following medical societies: American College of Physicians, Society for Healthcare Epidemiology of America, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

John L Brusch, MD, FACP Corresponding Faculty Member, Harvard Medical School; Consulting Staff, Department of Medicine and Infectious Disease Service, Cambridge Health Alliance

John L Brusch, MD, FACP is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Acknowledgements

Leslie L Barton, MD Professor Emerita of Pediatrics, University of Arizona College of Medicine

Leslie L Barton, MD is a member of the following medical societies: American Academy of Pediatrics, Association of Pediatric Program Directors, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Dan Danzl, MD Chair, Department of Emergency Medicine, Professor, University of Louisville Hospital

Dan Danzl, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Kentucky Medical Association, Society for Academic Emergency Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Robert G Darling, MD, FACEP Clinical Assistant Professor of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, F Edward Hebert School of Medicine; Associate Director, Center for Disaster and Humanitarian Assistance Medicine

Robert G Darling, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, and Association of Military Surgeons of the US

webmd.com”>Disclosure: Nothing to disclose.

Vinod K Dhawan, MD, FACP, FRCP(C) Professor, Department of Clinical Medicine, University of California, Los Angeles, David Geffen School of Medicine; Chief, Division of Infectious Diseases, Rancho Los Amigos National Rehabilitation Center, Downey, California.

Vinod K Dhawan, MD, FACP, FRCP(C) is a member of the following medical societies: American College of Physicians, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, and Royal College of Physicians and Surgeons of Canada

Disclosure: Pfizer Inc Honoraria Speaking and teaching

Jonathan A Edlow, MD Associate Professor of Medicine, Department of Emergency Medicine, Harvard Medical School; Vice Chairman, Department of Emergency Medicine, Beth Israel Deaconess Medical Center

webmd.com”>Jonathan A Edlow, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Jon Mark Hirshon, MD, MPH Associate Professor, Department of Emergency Medicine, University of Maryland School of Medicine

Jon Mark Hirshon, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Public Health Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Joseph F John Jr, MD, FACP, FIDSA, FSHEA Clinical Professor of Medicine, Molecular Genetics and Microbiology, Medical University of South Carolina College of Medicine; Associate Chief of Staff for Education, Ralph H Johnson Veterans Affairs Medical Center

webmd.com”>Disclosure: Nothing to disclose.

Alexandre Lacasse, MD, MSc Internal Medicine Faculty, Assistant Director, Medicine Clinic, Infectious Disease Consultant, St Mary’s Health Center

Alexandre Lacasse, MD, MSc is a member of the following medical societies: American College of Physicians, American Medical Association, Association of Program Directors in Internal Medicine, Infectious Diseases Society of America, and Society for Healthcare Epidemiology of America

Disclosure: Nothing to disclose.

John M Leedom, MD Professor Emeritus of Medicine, Keck School of Medicine of the University of Southern California

John M Leedom, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, American Society for Microbiology, Infectious Diseases Society of America, International AIDS Society, and Phi Beta Kappa

webmd.com”>Disclosure: Nothing to disclose.

Geofrey Nochimson, MD Consulting Staff, Department of Emergency Medicine, Sentara Careplex Hospital

Geofrey Nochimson, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Robert L Norris, MD Associate Professor, Department of Surgery; Chief, Division of Emergency Medicine, Stanford University Medical Center

Robert L Norris, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, California Medical Association, International Society of Toxinology, Society for Academic Emergency Medicine, and Wilderness Medical Society

webmd.com”>Disclosure: Nothing to disclose.

Miller B Pearsall, MD Resident Physician and Clinical Assistant Instructor, Department of Emergency Medicine, State University of New York Downstate School of Medicine, Kings County Hospital Center, University Hospital of Brooklyn

Miller B Pearsall, MD is a member of the following medical societies: American College of Emergency Physicians and Emergency Medicine Residents Association

Disclosure: Nothing to disclose.

Hari Polenakovik, MD Associate Professor of Medicine, Wright State University, Boonshoft School of Medicine

Hari Polenakovik, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Society for Microbiology, European Society of Clinical Microbiology and Infectious Diseases, Infectious Diseases Society of America, and Society for Healthcare Epidemiology of America

webmd.com”>Disclosure: Nothing to disclose.

José Rafael Romero, MD Director of Pediatric Infectious Diseases Fellowship Program, Associate Professor, Department of Pediatrics, Combined Division of Pediatric Infectious Diseases, Creighton University/University of Nebraska Medical Center

José Rafael Romero, MD is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, New York Academy of Sciences, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Annie Ruest, MD, FRCPC Consultant Physician in Infectious Diseases and Medical Microbiology, CHUQ-Hôtel-Dieu de Québec, Departments of Medicine and Medical Biology, Laval University Faculty of Medicine, Canada

webmd.com”>Annie Ruest, MD, FRCPC is a member of the following medical societies: Canadian Infectious Disease Society and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Christian P Sinave, MD Associate Professor, Department of Medical Microbiology and Infectious Diseases, University of Sherbrooke Faculty of Medicine, Canada

Christian P Sinave, MD is a member of the following medical societies: American Society for Microbiology and Canadian Infectious Disease Society

Disclosure: Nothing to disclose.

Richard H Sinert, DO Associate Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Department of Emergency Medicine, Kings County Hospital Center

webmd.com”>Richard H Sinert, DO is a member of the following medical societies: American College of Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Russell W Steele, MD Head, Division of Pediatric Infectious Diseases, Ochsner Children’s Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

webmd.com”>Kelley Struble, DO Fellow, Department of Infectious Diseases, University of Oklahoma College of Medicine

Kelley Struble, DO is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Jeter (Jay) Pritchard Taylor III, MD Compliance Officer, Attending Physician Emergency Medicine Residency, Department of Emergency Medicine, Palmetto Richland Memorial Hospital, University of South Carolina

webmd.com”>Jeter (Jay) Pritchard Taylor III, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, Medscape

Disclosure: Nothing to disclose.

Fever in Adults – What You Need to Know

  1. CareNotes
  2. Fever in Adults

This material must not be used for commercial purposes, or in any hospital or medical facility. Failure to comply may result in legal action.

WHAT YOU NEED TO KNOW:

What is a fever?

A fever is an increase in your body temperature. Normal body temperature is 98.6°F (37°C). Fever is generally defined as greater than 100.4°F (38°C).

What are common causes of a fever?

The cause of your fever may not be known. This is called fever of unknown origin. It occurs when you have a fever above 100.9˚F (38.3°C) for 3 weeks or more. The following are common causes of fever:

  • An infection caused by a virus or bacteria
  • An inflammatory disorder, such as arthritis
  • A brain infection or injury
  • Alcohol or illegal drug use, or withdrawal

What other signs and symptoms may I have?

  • Chills and shivers
  • Muscle stiffness
  • Weight loss
  • Night sweats
  • Fever that comes and goes.
  • Fever that is higher in the morning.

How is the cause of a fever diagnosed?

Your healthcare provider will ask when your fever began and how high it was. He or she will ask about other symptoms and examine you for signs of infection. He or she will feel your neck for lumps and listen to your heart and lungs. Tell your provider if you recently had surgery or an infection. Tell him or her if you have any medical conditions, such as diabetes or arthritis. You may also need blood or urine tests to check for infection. Ask about other tests you may need if blood and urine tests do not explain the cause of your fever.

How is a fever treated?

You may need any of the following, depending on the cause of your fever:

  • NSAIDs , such as ibuprofen, help decrease swelling, pain, and fever. This medicine is available with or without a doctor’s order. NSAIDs can cause stomach bleeding or kidney problems in certain people. If you take blood thinner medicine, always ask if NSAIDs are safe for you. Always read the medicine label and follow directions. Do not give these medicines to children under 6 months of age without direction from your child’s healthcare provider.
  • Acetaminophen decreases pain and fever. It is available without a doctor’s order. Ask how much to take and how often to take it. Follow directions. Read the labels of all other medicines you are using to see if they also contain acetaminophen, or ask your doctor or pharmacist. Acetaminophen can cause liver damage if not taken correctly. Do not use more than 4 grams (4,000 milligrams) total of acetaminophen in one day.
  • Antibiotics may be given if you have an infection caused by bacteria.

What can I do to be more comfortable while I have a fever?

  • Drink more liquids as directed. A fever makes you sweat. This can increase your risk for dehydration. Liquids can help prevent dehydration.
    • Drink at least 6 to 8 eight-ounce cups of clear liquids each day. Drink water, juice, or broth. Do not drink sports drinks. They may contain caffeine.
    • Ask your healthcare provider if you should drink an oral rehydration solution (ORS). An ORS has the right amounts of water, salts, and sugar you need to replace body fluids.
  • Dress in lightweight clothes. Shivers may be a sign that your fever is rising. Do not put extra blankets or clothes on. This may cause your fever to rise even higher. Dress in light, comfortable clothing. Use a lightweight blanket or sheet when you sleep. Change your clothes, blanket, or sheets if they get wet.
  • Cool yourself safely. Take a bath in cool or lukewarm water. Use an ice pack wrapped in a small towel or wet a washcloth with cool water. Place the ice pack or wet washcloth on your forehead or the back of your neck.

When should I seek immediate care?

  • Your fever does not go away or gets worse even after treatment.
  • You have a stiff neck and a bad headache.
  • You are confused. You may not be able to think clearly or remember things like you normally do.
  • Your heart beats faster than usual even after treatment.
  • You have shortness of breath or chest pain when you breathe.
  • You urinate small amounts or not at all.
  • Your skin, lips, or nails turn blue.

When should I contact my healthcare provider?

  • You have abdominal pain or feel bloated.
  • You have nausea or are vomiting.
  • You have pain or burning when you urinate, or you have pain in your back.
  • You have questions or concerns about your condition or care.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your healthcare providers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

© Copyright IBM Corporation 2021 Information is for End User’s use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or IBM Watson Health

Learn more about Fever in Adults

Associated drugs
IBM Watson Micromedex
Symptom checker

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer

Fever in Children – What You Need to Know

  1. CareNotes
  2. Fever in Children

This material must not be used for commercial purposes, or in any hospital or medical facility. Failure to comply may result in legal action.

WHAT YOU NEED TO KNOW:

What is a fever?

A fever is an increase in your child’s body temperature. Normal body temperature is 98.6°F (37°C). Fever is generally defined as greater than 100.4°F (38°C). A fever can be serious in young children.

What causes a fever in children?

Fever is commonly caused by a viral infection. Your child’s body uses a fever to help fight the virus. The cause of your child’s fever may not be known.

What temperature is a fever in children?

  • An ear or forehead temperature of 100.4°F (38°C) or higher
  • An oral or pacifier temperature of 100°F (37.8°C) or higher
  • An armpit temperature of 99°F (37.2°C) or higher

What is the best way to take my child’s temperature?

The following are guidelines based on a child’s age. Ask your child’s healthcare provider about the best way to take your child’s temperature.

  • If your baby is 3 months or younger , take the temperature in his or her armpit.
  • If your child is 3 months to 5 years , use an electronic pacifier temperature, depending on his or her age. After age 6 months, you can also take an ear, armpit, or forehead temperature.
  • If your child is 5 years or older , take an oral, ear, or forehead temperature.

What other signs and symptoms may my child have?

  • Chills, sweating, or shivering
  • A rash
  • Being more tired or fussy than usual
  • Nausea and vomiting
  • Not feeling hungry or thirsty
  • A headache or body aches

How is the cause of a fever in children diagnosed?

Your child’s healthcare provider will ask when your child’s fever began and how high it was. He or she will ask about other symptoms and examine your child for signs of a viral infection. The provider will feel your child’s neck for lumps and listen to his or her heart and lungs. Tell the provider if your child recently had surgery or an infection. Tell him or her if your child has any medical conditions, such as diabetes. Tell your provider if your child has had recent contact with a sick person. He or she may ask for a list of your child’s medications or immunization records. Your child may also need blood or urine tests to check for infection. Ask about other tests your child may need if blood and urine tests do not explain the cause of your child’s fever.

How is a fever treated?

Treatment will depend on what is causing your child’s fever. The fever might go away on its own without treatment. If the fever continues, the following may help bring the fever down:

  • Acetaminophen decreases pain and fever. It is available without a doctor’s order. Ask how much to give your child and how often to give it. Follow directions. Read the labels of all other medicines your child uses to see if they also contain acetaminophen, or ask your child’s doctor or pharmacist. Acetaminophen can cause liver damage if not taken correctly.
  • NSAIDs , such as ibuprofen, help decrease swelling, pain, and fever. This medicine is available with or without a doctor’s order. NSAIDs can cause stomach bleeding or kidney problems in certain people. If your child takes blood thinner medicine, always ask if NSAIDs are safe for him or her. Always read the medicine label and follow directions. Do not give these medicines to children under 6 months of age without direction from your child’s healthcare provider.
  • Do not give aspirin to children under 18 years of age. Your child could develop Reye syndrome if he takes aspirin. Reye syndrome can cause life-threatening brain and liver damage. Check your child’s medicine labels for aspirin, salicylates, or oil of wintergreen.

How can I make my child more comfortable while he or she has a fever?

  • Give your child more liquids as directed. A fever makes your child sweat. This can increase his or her risk for dehydration. Liquids can help prevent dehydration.
    • Help your child drink at least 6 to 8 eight-ounce cups of clear liquids each day. Give your child water, juice, or broth. Do not give sports drinks to babies or toddlers.
    • Ask your child’s healthcare provider if you should give your child an oral rehydration solution (ORS) to drink. An ORS has the right amounts of water, salts, and sugar your child needs to replace body fluids.
    • If you are breastfeeding or feeding your child formula, continue to do so. Your baby may not feel like drinking his or her regular amounts with each feeding. If so, feed him or her smaller amounts more often.
  • Dress your child in lightweight clothes. Shivers may be a sign that your child’s fever is rising. Do not put extra blankets or clothes on him or her. This may cause his or her fever to rise even higher. Dress your child in light, comfortable clothing. Cover him or her with a lightweight blanket or sheet. Change your child’s clothes, blanket, or sheets if they get wet.
  • Cool your child safely. Use a cool compress or give your child a bath in cool or lukewarm water. Your child’s fever may not go down right away after his or her bath. Wait 30 minutes and check his or her temperature again. Do not put your child in a cold water or ice bath.

When should I seek immediate care?

  • Your child’s temperature reaches 105°F (40.6°C).
  • Your child has a dry mouth, cracked lips, or cries without tears.
  • Your baby has a dry diaper for at least 8 hours, or he or she is urinating less than usual.
  • Your child is less alert, less active, or is acting differently than he or she usually does.
  • Your child has a seizure or has abnormal movements of the face, arms, or legs.
  • Your child is drooling and not able to swallow.
  • Your child has a stiff neck, severe headache, confusion, or is difficult to wake.
  • Your child has a fever for longer than 5 days.
  • Your child is crying or irritable and cannot be soothed.

When should I contact my child’s healthcare provider?

  • Your child’s ear or forehead temperature is higher than 100.4°F (38°C).
  • Your child’s oral or pacifier temperature is higher than 100°F (37.8°C).
  • Your child’s armpit temperature is higher than 99°F (37.2°C).
  • Your child’s fever lasts longer than 3 days.
  • You have questions or concerns about your child’s fever.

Care Agreement

You have the right to help plan your child’s care. Learn about your child’s health condition and how it may be treated. Discuss treatment options with your child’s healthcare providers to decide what care you want for your child. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

© Copyright IBM Corporation 2021 Information is for End User’s use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or IBM Watson Health

Learn more about Fever in Children

Associated drugs
IBM Watson Micromedex
Symptom checker

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer

The Common Cold and the Flu: Treatment, Symptoms & Causes



Overview

What are colds and the flu?

The common cold and the flu (influenza) are infections of the upper respiratory system – the nose, mouth, throat and lungs. The infections are caused by viruses.

How can I tell if I have a cold or the flu?

Colds and flu have many of the same symptoms. However, cold symptoms are usually milder than flu symptoms and develop more slowly.



Symptoms and Causes

What are the symptoms of colds and flu?

Symptoms of Colds and Flu

SymptomColdFlu
FeverAdults-rare; children- sometimesHigh fever (100°F and higher; can last 3 to 4 days)
Runny noseCommon (Nasal discharge may have a yellow- or green-colored tint)Sometimes
Stuffy noseCommonSometimes
HeadacheSometimes (usually mild)Common
Body achesSometimes (usually mild)Common (can be severe)
FatigueSometimes (usually mild)Common (can last up to 2-3 weeks)
ExhaustionNeverCommon (at the start of flu)
Chills, sweatNoCommon (extreme)
NauseaUncommonCommon
Loss of appetiteSometimesCommon
SneezingCommonSometimes
CoughCommonCommon (can be intense)
Sore throatCommonSometimes
Chest congestion, discomfortCommon (mild to moderate)Common (can be severe)
Watery eyesCommonSometimes



Management and Treatment

Can colds and the flu be “cured” with medications?

No medicines can “cure” colds and flu. However, there are many over-the-counter (OTC) medicines that can ease the discomfort caused by the symptoms of colds and flu. In addition, there are prescription medicines and a vaccine that can treat and prevent the flu.

Note on antibiotics: Colds and the flu are causes by viruses and cannot be cured with antibiotics. Antibiotics are used to treat bacterial infections, such as strep throat and ear, skin and urinary tract infections. Using antibiotics for infections they are not able to treat makes the antibiotics less effective for infections they are supposed to treat (a situation called antibiotic resistance). Never take antibiotics to treat colds and flu.

To ease the discomfort from specific cold and flu symptoms, consider using the following types of OTC medicines:

  • To reduce fever and pain — analgesics: Acetaminophen (Tylenol®) is generally preferred. Ibuprofen (Advil®) or naproxen (Naprosyn®) is also commonly used. Aspirin should be avoided due to its risk of developing Reye’s syndrome. (Reye’s syndrome is a condition that affects all body organs and is most harmful to the brain and liver.) Note on acetaminophen: Read all cold medicine package labels. Do not take more than one drug that contains acetaminophen. Taking too much acetaminophen can damage your liver. Acetaminophen doses should not exceed four grams per day. Individuals with liver damage or liver problems should not exceed two grams of acetaminophen per day.
  • To dry out the nose — antihistamines: Try an antihistamine, such as diphenhydramine (Benadryl®). Because these products can make you sleepy, avoid driving and other complex tasks while taking these medicines. Loratadine (Claritin®), available (OTC), is a non-drowsy alternative, but may not be as effective as other antihistamines for reducing cold and flu symptoms. Other OTC antihistamines include Allegra®, Zyrtec® and Xyzal®.
  • To relieve a stuffy, clogged nose — decongestants: Try an oral decongestant, such as pseudoephedrine (Sudafed®). However, insomnia, nervousness and irritability can occur when taking these drugs. Those who are pregnant or have uncontrolled high blood pressure should avoid pseudoephedrine products. Often decongestants are combined with other drugs (especially antihistamines) in OTC medicines. A “-D” at the end of a medicine’s name means it includes an oral decongestant.
  • To relieve a runny nose or sinus pressure — nasal steroids: Medications like fluticasone (Flonase®, available without a prescription) or mometasone (Nasonex®; prescription needed) can relieve symptoms. These medicines are also used for seasonal allergies. These are not the same as Afrin® or other OTC nasal preparations. Antihistamines will also help.
  • To make blowing your nose easier or loosening cough/mucus production — expectorants: Try guaifenesin (Robitussin®, Mucofen®, Humibid LA®, Mucinex®, Humibid E®). These products help thin the thick, discolored drainage coming out of the nose and mouth.
  • To reduce coughing — antitussives: Dextromethorphan can help suppress cough.
  • To relieve a sore throat: Try throat lozenges (such as Cepacol®) or gargle with warm salt water a few times a day. Analgesics are also helpful.
  • For other symptoms: OTC cold products (for example, Nyquil® or Tylenol Cold & Sinus®) can provide much relief. Be sure to read product labels to find the best cold preparation to match your symptoms and to determine if that medicine is safe for you.

What are other ways to treat and prevent the flu?

Antiviral prescription medicines and an annual flu vaccine are available for treating and preventing the flu.

Prescription anti-flu medicines include amantadine (Symmetrel®), rimantadine (Flumadine®), zanamivir (Relenza®) and oseltamivir (Tamiflu®). These drugs do not cure the flu, but they can make the symptoms milder and make you feel better more quickly. They are only effective when used in the first 48 hours of flu-like symptoms.

These drugs are not needed for healthy people who get the flu. They are usually reserved for people who are very sick with the flu (for example, those who have been hospitalized) or those who are at risk of complications from the flu, such as people with long-term chronic medical conditions (such as diabetes or chronic obstructive lung disease, asthma) or older age.

Flu vaccine (by shot and nasal spray). Although there is currently no vaccine against the common cold, there is a vaccine to prevent the flu. The vaccine is available by both shot and nasal spray. It works by exposing the immune system to the viruses. The body responds by building antibodies (the body’s defense system) against the flu. The flu shot contains dead flu viruses. The nasal spray contains live, but weakened, flu viruses. The nasal spray is only approved for healthy children and adults two to 49 years old and who are not pregnant.



Prevention

Who should get an annual flu shot?

The Centers for Disease Control (CDC) recommends the following groups receive an annual flu vaccine shot between November and February (flu season):

  • All people aged six months and older.

It is especially important for certain individuals at high risk of flu complications and those who come in contact with people at high risk of complications to receive the flu vaccine. These people at high risk include:

  • Residents of nursing homes and other long-term care facilities.
  • People who have chronic medical conditions such as asthma, heart disease, diabetes, kidney and liver disorders and chronic lung diseases.
  • People with a weakened immune system, for example, people with cancer, HIV/AIDS, or chronic steroid users.
  • Household members and caregivers of patients at risk of complications from the flu.
  • Women who are — or will be — pregnant during the flu season (regardless of trimester).
  • Healthcare workers who come into close contact with patients in hospitals, nursing homes, long-term care facilities, and other healthcare facilities.
  • Infants and children ages six months through 18 years who are taking long-term aspirin therapy. This puts these individuals at risk for experiencing Reye syndrome after flu infection.
  • American Indians/Alaska natives.
  • People who have close contact with children under five years of age — for example, people who live with children, nannies and providers of daycare services.
  • People who are morbidly obese (body-mass index of 40 or higher).

Can I get the flu from the flu shot or nasal spray?

No, you cannot get the flu from the flu shot or nasal spray. However, some people can still get the flu even though they had the vaccine. In these cases, the flu symptoms are milder compared with unvaccinated people who get the flu.

What else can I do to prevent getting colds and the flu?

Wash your hands frequently with soap and water or alcoholic hand wipes. Cold and flu viruses are spread by touching your nose or mouth after touching an infected person, breathing in the air of an infected person’s sneeze or cough, or touching objects that have come in contact with the virus and then touching your nose.

Other prevention tips are to eat healthy, exercise, get plenty of sleep, drink plenty of liquids (try to drink eight eight-ounce glasses of fluid/day), and avoid close contact with people who have colds. Also, get an annual flu vaccine.



Living With

What can happen if colds or the flu worsen?

Colds or flu that worsen can lead to:

Complications triggered by the flu can lead to hospitalization, life-threatening situations and even death.

When should I call my healthcare provider?

Call if you experience any of the following:

  • Symptoms that last or get worse after 10 days.
  • Shortness of breath or trouble breathing.
  • High fever (greater than 102°F) for three or more days.
  • Pain or pressure in your chest.
  • Coughing up blood.
  • Sudden dizziness or feeling faint.
  • Severe vomiting.
  • Confusion.
  • Severe sinus pain.
  • Swollen glands in neck or jaw.

The Common Cold and the Flu: Treatment, Symptoms & Causes



Overview

What are colds and the flu?

The common cold and the flu (influenza) are infections of the upper respiratory system – the nose, mouth, throat and lungs. The infections are caused by viruses.

How can I tell if I have a cold or the flu?

Colds and flu have many of the same symptoms. However, cold symptoms are usually milder than flu symptoms and develop more slowly.



Symptoms and Causes

What are the symptoms of colds and flu?

Symptoms of Colds and Flu

SymptomColdFlu
FeverAdults-rare; children- sometimesHigh fever (100°F and higher; can last 3 to 4 days)
Runny noseCommon (Nasal discharge may have a yellow- or green-colored tint)Sometimes
Stuffy noseCommonSometimes
HeadacheSometimes (usually mild)Common
Body achesSometimes (usually mild)Common (can be severe)
FatigueSometimes (usually mild)Common (can last up to 2-3 weeks)
ExhaustionNeverCommon (at the start of flu)
Chills, sweatNoCommon (extreme)
NauseaUncommonCommon
Loss of appetiteSometimesCommon
SneezingCommonSometimes
CoughCommonCommon (can be intense)
Sore throatCommonSometimes
Chest congestion, discomfortCommon (mild to moderate)Common (can be severe)
Watery eyesCommonSometimes



Management and Treatment

Can colds and the flu be “cured” with medications?

No medicines can “cure” colds and flu. However, there are many over-the-counter (OTC) medicines that can ease the discomfort caused by the symptoms of colds and flu. In addition, there are prescription medicines and a vaccine that can treat and prevent the flu.

Note on antibiotics: Colds and the flu are causes by viruses and cannot be cured with antibiotics. Antibiotics are used to treat bacterial infections, such as strep throat and ear, skin and urinary tract infections. Using antibiotics for infections they are not able to treat makes the antibiotics less effective for infections they are supposed to treat (a situation called antibiotic resistance). Never take antibiotics to treat colds and flu.

To ease the discomfort from specific cold and flu symptoms, consider using the following types of OTC medicines:

  • To reduce fever and pain — analgesics: Acetaminophen (Tylenol®) is generally preferred. Ibuprofen (Advil®) or naproxen (Naprosyn®) is also commonly used. Aspirin should be avoided due to its risk of developing Reye’s syndrome. (Reye’s syndrome is a condition that affects all body organs and is most harmful to the brain and liver.) Note on acetaminophen: Read all cold medicine package labels. Do not take more than one drug that contains acetaminophen. Taking too much acetaminophen can damage your liver. Acetaminophen doses should not exceed four grams per day. Individuals with liver damage or liver problems should not exceed two grams of acetaminophen per day.
  • To dry out the nose — antihistamines: Try an antihistamine, such as diphenhydramine (Benadryl®). Because these products can make you sleepy, avoid driving and other complex tasks while taking these medicines. Loratadine (Claritin®), available (OTC), is a non-drowsy alternative, but may not be as effective as other antihistamines for reducing cold and flu symptoms. Other OTC antihistamines include Allegra®, Zyrtec® and Xyzal®.
  • To relieve a stuffy, clogged nose — decongestants: Try an oral decongestant, such as pseudoephedrine (Sudafed®). However, insomnia, nervousness and irritability can occur when taking these drugs. Those who are pregnant or have uncontrolled high blood pressure should avoid pseudoephedrine products. Often decongestants are combined with other drugs (especially antihistamines) in OTC medicines. A “-D” at the end of a medicine’s name means it includes an oral decongestant.
  • To relieve a runny nose or sinus pressure — nasal steroids: Medications like fluticasone (Flonase®, available without a prescription) or mometasone (Nasonex®; prescription needed) can relieve symptoms. These medicines are also used for seasonal allergies. These are not the same as Afrin® or other OTC nasal preparations. Antihistamines will also help.
  • To make blowing your nose easier or loosening cough/mucus production — expectorants: Try guaifenesin (Robitussin®, Mucofen®, Humibid LA®, Mucinex®, Humibid E®). These products help thin the thick, discolored drainage coming out of the nose and mouth.
  • To reduce coughing — antitussives: Dextromethorphan can help suppress cough.
  • To relieve a sore throat: Try throat lozenges (such as Cepacol®) or gargle with warm salt water a few times a day. Analgesics are also helpful.
  • For other symptoms: OTC cold products (for example, Nyquil® or Tylenol Cold & Sinus®) can provide much relief. Be sure to read product labels to find the best cold preparation to match your symptoms and to determine if that medicine is safe for you.

What are other ways to treat and prevent the flu?

Antiviral prescription medicines and an annual flu vaccine are available for treating and preventing the flu.

Prescription anti-flu medicines include amantadine (Symmetrel®), rimantadine (Flumadine®), zanamivir (Relenza®) and oseltamivir (Tamiflu®). These drugs do not cure the flu, but they can make the symptoms milder and make you feel better more quickly. They are only effective when used in the first 48 hours of flu-like symptoms.

These drugs are not needed for healthy people who get the flu. They are usually reserved for people who are very sick with the flu (for example, those who have been hospitalized) or those who are at risk of complications from the flu, such as people with long-term chronic medical conditions (such as diabetes or chronic obstructive lung disease, asthma) or older age.

Flu vaccine (by shot and nasal spray). Although there is currently no vaccine against the common cold, there is a vaccine to prevent the flu. The vaccine is available by both shot and nasal spray. It works by exposing the immune system to the viruses. The body responds by building antibodies (the body’s defense system) against the flu. The flu shot contains dead flu viruses. The nasal spray contains live, but weakened, flu viruses. The nasal spray is only approved for healthy children and adults two to 49 years old and who are not pregnant.



Prevention

Who should get an annual flu shot?

The Centers for Disease Control (CDC) recommends the following groups receive an annual flu vaccine shot between November and February (flu season):

  • All people aged six months and older.

It is especially important for certain individuals at high risk of flu complications and those who come in contact with people at high risk of complications to receive the flu vaccine. These people at high risk include:

  • Residents of nursing homes and other long-term care facilities.
  • People who have chronic medical conditions such as asthma, heart disease, diabetes, kidney and liver disorders and chronic lung diseases.
  • People with a weakened immune system, for example, people with cancer, HIV/AIDS, or chronic steroid users.
  • Household members and caregivers of patients at risk of complications from the flu.
  • Women who are — or will be — pregnant during the flu season (regardless of trimester).
  • Healthcare workers who come into close contact with patients in hospitals, nursing homes, long-term care facilities, and other healthcare facilities.
  • Infants and children ages six months through 18 years who are taking long-term aspirin therapy. This puts these individuals at risk for experiencing Reye syndrome after flu infection.
  • American Indians/Alaska natives.
  • People who have close contact with children under five years of age — for example, people who live with children, nannies and providers of daycare services.
  • People who are morbidly obese (body-mass index of 40 or higher).

Can I get the flu from the flu shot or nasal spray?

No, you cannot get the flu from the flu shot or nasal spray. However, some people can still get the flu even though they had the vaccine. In these cases, the flu symptoms are milder compared with unvaccinated people who get the flu.

What else can I do to prevent getting colds and the flu?

Wash your hands frequently with soap and water or alcoholic hand wipes. Cold and flu viruses are spread by touching your nose or mouth after touching an infected person, breathing in the air of an infected person’s sneeze or cough, or touching objects that have come in contact with the virus and then touching your nose.

Other prevention tips are to eat healthy, exercise, get plenty of sleep, drink plenty of liquids (try to drink eight eight-ounce glasses of fluid/day), and avoid close contact with people who have colds. Also, get an annual flu vaccine.



Living With

What can happen if colds or the flu worsen?

Colds or flu that worsen can lead to:

Complications triggered by the flu can lead to hospitalization, life-threatening situations and even death.

When should I call my healthcare provider?

Call if you experience any of the following:

  • Symptoms that last or get worse after 10 days.
  • Shortness of breath or trouble breathing.
  • High fever (greater than 102°F) for three or more days.
  • Pain or pressure in your chest.
  • Coughing up blood.
  • Sudden dizziness or feeling faint.
  • Severe vomiting.
  • Confusion.
  • Severe sinus pain.
  • Swollen glands in neck or jaw.

The Common Cold and the Flu: Treatment, Symptoms & Causes



Overview

What are colds and the flu?

The common cold and the flu (influenza) are infections of the upper respiratory system – the nose, mouth, throat and lungs. The infections are caused by viruses.

How can I tell if I have a cold or the flu?

Colds and flu have many of the same symptoms. However, cold symptoms are usually milder than flu symptoms and develop more slowly.



Symptoms and Causes

What are the symptoms of colds and flu?

Symptoms of Colds and Flu

SymptomColdFlu
FeverAdults-rare; children- sometimesHigh fever (100°F and higher; can last 3 to 4 days)
Runny noseCommon (Nasal discharge may have a yellow- or green-colored tint)Sometimes
Stuffy noseCommonSometimes
HeadacheSometimes (usually mild)Common
Body achesSometimes (usually mild)Common (can be severe)
FatigueSometimes (usually mild)Common (can last up to 2-3 weeks)
ExhaustionNeverCommon (at the start of flu)
Chills, sweatNoCommon (extreme)
NauseaUncommonCommon
Loss of appetiteSometimesCommon
SneezingCommonSometimes
CoughCommonCommon (can be intense)
Sore throatCommonSometimes
Chest congestion, discomfortCommon (mild to moderate)Common (can be severe)
Watery eyesCommonSometimes



Management and Treatment

Can colds and the flu be “cured” with medications?

No medicines can “cure” colds and flu. However, there are many over-the-counter (OTC) medicines that can ease the discomfort caused by the symptoms of colds and flu. In addition, there are prescription medicines and a vaccine that can treat and prevent the flu.

Note on antibiotics: Colds and the flu are causes by viruses and cannot be cured with antibiotics. Antibiotics are used to treat bacterial infections, such as strep throat and ear, skin and urinary tract infections. Using antibiotics for infections they are not able to treat makes the antibiotics less effective for infections they are supposed to treat (a situation called antibiotic resistance). Never take antibiotics to treat colds and flu.

To ease the discomfort from specific cold and flu symptoms, consider using the following types of OTC medicines:

  • To reduce fever and pain — analgesics: Acetaminophen (Tylenol®) is generally preferred. Ibuprofen (Advil®) or naproxen (Naprosyn®) is also commonly used. Aspirin should be avoided due to its risk of developing Reye’s syndrome. (Reye’s syndrome is a condition that affects all body organs and is most harmful to the brain and liver.) Note on acetaminophen: Read all cold medicine package labels. Do not take more than one drug that contains acetaminophen. Taking too much acetaminophen can damage your liver. Acetaminophen doses should not exceed four grams per day. Individuals with liver damage or liver problems should not exceed two grams of acetaminophen per day.
  • To dry out the nose — antihistamines: Try an antihistamine, such as diphenhydramine (Benadryl®). Because these products can make you sleepy, avoid driving and other complex tasks while taking these medicines. Loratadine (Claritin®), available (OTC), is a non-drowsy alternative, but may not be as effective as other antihistamines for reducing cold and flu symptoms. Other OTC antihistamines include Allegra®, Zyrtec® and Xyzal®.
  • To relieve a stuffy, clogged nose — decongestants: Try an oral decongestant, such as pseudoephedrine (Sudafed®). However, insomnia, nervousness and irritability can occur when taking these drugs. Those who are pregnant or have uncontrolled high blood pressure should avoid pseudoephedrine products. Often decongestants are combined with other drugs (especially antihistamines) in OTC medicines. A “-D” at the end of a medicine’s name means it includes an oral decongestant.
  • To relieve a runny nose or sinus pressure — nasal steroids: Medications like fluticasone (Flonase®, available without a prescription) or mometasone (Nasonex®; prescription needed) can relieve symptoms. These medicines are also used for seasonal allergies. These are not the same as Afrin® or other OTC nasal preparations. Antihistamines will also help.
  • To make blowing your nose easier or loosening cough/mucus production — expectorants: Try guaifenesin (Robitussin®, Mucofen®, Humibid LA®, Mucinex®, Humibid E®). These products help thin the thick, discolored drainage coming out of the nose and mouth.
  • To reduce coughing — antitussives: Dextromethorphan can help suppress cough.
  • To relieve a sore throat: Try throat lozenges (such as Cepacol®) or gargle with warm salt water a few times a day. Analgesics are also helpful.
  • For other symptoms: OTC cold products (for example, Nyquil® or Tylenol Cold & Sinus®) can provide much relief. Be sure to read product labels to find the best cold preparation to match your symptoms and to determine if that medicine is safe for you.

What are other ways to treat and prevent the flu?

Antiviral prescription medicines and an annual flu vaccine are available for treating and preventing the flu.

Prescription anti-flu medicines include amantadine (Symmetrel®), rimantadine (Flumadine®), zanamivir (Relenza®) and oseltamivir (Tamiflu®). These drugs do not cure the flu, but they can make the symptoms milder and make you feel better more quickly. They are only effective when used in the first 48 hours of flu-like symptoms.

These drugs are not needed for healthy people who get the flu. They are usually reserved for people who are very sick with the flu (for example, those who have been hospitalized) or those who are at risk of complications from the flu, such as people with long-term chronic medical conditions (such as diabetes or chronic obstructive lung disease, asthma) or older age.

Flu vaccine (by shot and nasal spray). Although there is currently no vaccine against the common cold, there is a vaccine to prevent the flu. The vaccine is available by both shot and nasal spray. It works by exposing the immune system to the viruses. The body responds by building antibodies (the body’s defense system) against the flu. The flu shot contains dead flu viruses. The nasal spray contains live, but weakened, flu viruses. The nasal spray is only approved for healthy children and adults two to 49 years old and who are not pregnant.



Prevention

Who should get an annual flu shot?

The Centers for Disease Control (CDC) recommends the following groups receive an annual flu vaccine shot between November and February (flu season):

  • All people aged six months and older.

It is especially important for certain individuals at high risk of flu complications and those who come in contact with people at high risk of complications to receive the flu vaccine. These people at high risk include:

  • Residents of nursing homes and other long-term care facilities.
  • People who have chronic medical conditions such as asthma, heart disease, diabetes, kidney and liver disorders and chronic lung diseases.
  • People with a weakened immune system, for example, people with cancer, HIV/AIDS, or chronic steroid users.
  • Household members and caregivers of patients at risk of complications from the flu.
  • Women who are — or will be — pregnant during the flu season (regardless of trimester).
  • Healthcare workers who come into close contact with patients in hospitals, nursing homes, long-term care facilities, and other healthcare facilities.
  • Infants and children ages six months through 18 years who are taking long-term aspirin therapy. This puts these individuals at risk for experiencing Reye syndrome after flu infection.
  • American Indians/Alaska natives.
  • People who have close contact with children under five years of age — for example, people who live with children, nannies and providers of daycare services.
  • People who are morbidly obese (body-mass index of 40 or higher).

Can I get the flu from the flu shot or nasal spray?

No, you cannot get the flu from the flu shot or nasal spray. However, some people can still get the flu even though they had the vaccine. In these cases, the flu symptoms are milder compared with unvaccinated people who get the flu.

What else can I do to prevent getting colds and the flu?

Wash your hands frequently with soap and water or alcoholic hand wipes. Cold and flu viruses are spread by touching your nose or mouth after touching an infected person, breathing in the air of an infected person’s sneeze or cough, or touching objects that have come in contact with the virus and then touching your nose.

Other prevention tips are to eat healthy, exercise, get plenty of sleep, drink plenty of liquids (try to drink eight eight-ounce glasses of fluid/day), and avoid close contact with people who have colds. Also, get an annual flu vaccine.



Living With

What can happen if colds or the flu worsen?

Colds or flu that worsen can lead to:

Complications triggered by the flu can lead to hospitalization, life-threatening situations and even death.

When should I call my healthcare provider?

Call if you experience any of the following:

  • Symptoms that last or get worse after 10 days.
  • Shortness of breath or trouble breathing.
  • High fever (greater than 102°F) for three or more days.
  • Pain or pressure in your chest.
  • Coughing up blood.
  • Sudden dizziness or feeling faint.
  • Severe vomiting.
  • Confusion.
  • Severe sinus pain.
  • Swollen glands in neck or jaw.

90,000 Diarrhea after antibiotics: causes and treatment

A wide variety of microorganisms live in the intestines of each person. Some bring unconditional benefit, participating, for example, in the synthesis of vitamin B12: some are absolutely indifferent and pass through the digestive tract; some cause disease.

There is a special group of microorganisms that we call “opportunistic pathogens”. These are gram-positive obligate anaerobes, the name of which comes from the Greek “closted” – spindle.Clostridia live quietly in the intestines of many people, without causing any harm. Until a certain point.

Intake of antibiotics becomes a kind of “trigger mechanism” for the activation of the pathogenic properties of antibiotics of Clostridia. Antibiotics tend to kill microorganisms, and all of them indiscriminately. But for clostridia, for the most part, they are harmless. Due to the absence of competing microorganisms, “opportunistic” clostridia become “pathogenic”. Microorganisms actively multiply, create colonies.And then, at one moment, as if on command, all members of the “Clostridial community” begin to secrete toxins that cause a disease called “pseudomembranous colitis.”

Clostridial infection is dangerous because these microorganisms secrete 2 toxins at once – cytotoxin and enterotoxin. One causes destruction of intestinal mucosa cells, up to ulceration and perforation.

The second toxin freely penetrates the bloodstream through the destroyed intestinal mucosa, spreads throughout the body and causes general intoxication.

The clinical picture of pseudomembranous colitis can develop both on the 3rd day from the start of taking the antibiotic, and after 1-10 days after the end of its intake. And possibly a more delayed development of colitis – up to 8 weeks after antibiotic therapy. Therefore, it can be difficult to identify the etiology of diarrhea and make a diagnosis.

A typical manifestation of pseudomembranous colitis is loose stools, sometimes with greenish, brown, or bloody mucus. The patient is tormented by cutting pains in the abdomen, aggravated by palpation.The pain is due to mucosal damage and inflammation in the intestines.

In some cases, the manifestation of the disease may begin with fever. The temperature can rise to 40 ° C, and in some cases even higher.

The severity of symptoms varies greatly from patient to patient.

When examining the intestines, whitish-yellow pseudomembranous plaques are found along the entire length of the mucosa. In severe cases, focal necrosis, deep perforated ulcers are visible.The unchanged mucous membrane in the form of bridges is thrown between the sites of ulceration.

The most common cause of activation is the intake of antibiotics such as lincomycin, clindamycin, tetracycline, ampicillin, cephalosporins. Even a single dose of antibiotics can lead to pseudomembranous colitis. With mild manifestations of antibiotic-associated diarrhea, sometimes antibiotic withdrawal is enough to cure. For more severe therapy, vancomycin and / or metronidazole are prescribed.An important role in the treatment of pain is played by rehydration and restoration of electrolyte balance. The patient should be advised more warm drinks and a gentle diet.

But taking an antibiotic is a half-measure. Along with antibiotics, it is necessary to prescribe probiotics (preparations containing live microorganisms.) If doctors remembered this and prescribed probiotics at the same time as prescribing antibiotic therapy, then the development of pseudomembranous colitis in most cases could be avoided.

There is a debate among doctors about the correctness of the term “dysbiosis”. But no matter what conclusion the disputing parties eventually come to, reality remains a reality – as a result of taking antibiotics, the normal intestinal microflora is disrupted and harmful microbes replace the bacteria habitual for the body.

Since 1995, microorganisms with specific therapeutic properties that inhibit the growth of pathogenic bacteria have been used in official medicine and are called probiotics.These microorganisms, when administered naturally, have a positive effect on physiological, metabolic functions, as well as biochemical and immune reactions of the body.

If you believe not advertising brochures, but controlled randomized trials, then the most effective in the treatment of antibiotic-associated intestinal lesions are yeast fungi – saccharomyces. It is not for nothing that people with indigestion have long been recommended to take kefir – the fermenting agent of kefir is a symbiont of lactobacilli and saccharomyces.But the content of beneficial yeast in lactic acid products is not enough to have a therapeutic effect. Therefore, as a prevention of the development of imbalance in the bacterial flora in the intestine and for the treatment of antibiotic-associated diarrhea, it is recommended to take drugs with live saccharomycetes.

Predisposing factors for the development of pseudomembranous colitis

  • Antibiotic therapy
  • Age over 60.
  • Hospital stay (especially in the same ward with an infectious patient or in the intensive care unit).
  • Recently underwent surgery on the abdominal organs.
  • The use of cytostatic drugs (especially methotrexate).
  • Hemolytic uremic syndrome.
  • Malignant diseases.
  • Intestinal ischemia.
  • Renal failure.
  • Necrotizing enterocolitis
  • Chronic inflammatory bowel disease.

HYPERTHERMIA IN PATIENTS WITH INJURY OF THE CENTRAL NERVOUS SYSTEM | Tokmakov

HYPERTHERMIA IN PATIENTS WITH CENTRAL NERVOUS SYSTEM DAMAGE

HYPERTHERMIA IN PATIENTS WITH CENTRAL NERVOUS SYSTEM DAMAGE

Tokmakov K.A., Gorbacheva S.M., Unzhakov V.V., Gorbachev V.I.

Irkutsk State Medical Academy of Postgraduate Education
– branch of the FSBEI DPO “Russian Medical Academy of Continuous
vocational education “, Irkutsk, Russia,
Regional State Budgetary Healthcare Institution” Regional
Clinical Hospital No. 2 “of the Ministry of Health of the Khabarovsk Territory, Khabarovsk, Russia

CLASSIFICATION
HYPERTHERMAL STATES

Promotion
body temperature above normal is a cardinal sign of hyperthermic conditions.From the standpoint of the course of pathophysiology, hyperthermia is a typical form of the disorder
heat exchange resulting from the action of high temperature
environment and / or disruption of the body’s heat transfer processes;
characterized by a disruption of the mechanisms of heat regulation, manifested by an increase
body temperature above normal [38]. There is no generally accepted classification of hyperthermia. IN
in the domestic literature, hyperthermic states include: 1) overheating
organism (actually hyperthermia), 2) heatstroke, 3) solar
stroke, 4) fever, 5) various hyperthermic reactions [38].IN
in the English-language literature, hyperthermic states are classified into
hyperthermia and fever (pyrexia). Hyperthermia includes heatstroke,
drug-induced hyperthermia (malignant hyperthermia [16],
neuroleptic malignant syndrome [40], serotonin syndrome [9]),
endocrine hyperthermia (thyrotoxicosis, pheochromocytoma, sympathoadrenal
crisis) [66]. In these cases, the body temperature rises to 41 ° C and above, and
traditional antipyretic pharmacotherapy is usually ineffective.Fevers are classified according to two principles: infectious and non-infectious;
out-of-hospital and in-hospital (48 hours and later after
admission to the hospital) [23].
For such
patients experience less significant rises in body temperature, and
traditional pharmacotherapy is very effective in this case. In this way,
with stimulation of neurons of the thermoregulation center, as well as associated with it
zones of the cortex and trunk of the GM, which occurs when the corresponding parts of the brain are damaged,
according to the Russian-language literature, a centrogenic hyperthermic
reaction (one of the forms of hyperthermic reactions) [38], from the standpoint of foreign literature
– neurogenic fever, neurogenic fever
(non-infectious fever) [46].

EFFECT OF INCREASED BODY TEMPERATURE ON
NEURO-REANIMATION PATIENTS

Proved that hyperthermic conditions are more common
in intensive care patients with acute brain injury, compared with
patients in general intensive care units [3, 56]. There was also
it has been suggested that fever in patients in intensive care units
profile may be a useful response of the body to infection [8, 43], and
aggressive temperature drop in this case can be not only not
shown, but may also be accompanied by an increase in the risk of developing a fatal
the outcome [59].One such study demonstrated that the use of
antipyretic drugs increased mortality in patients with
sepsis, but not in non-infectious patients [37]. In a controlled
a randomized study of 82 patients with various injuries (for
excluding TBI) and body temperature ≥ 38.5 ° C were divided into two
groups: one was carried out “aggressive” antipyretic therapy (650 mg
acetaminophen (paracetamol) every 6 hours at body temperature ≥ 38.5 ° C and
physical cooling at body temperature ≥ 39.5 ° C), others – “permissive”
(therapy was started only at body temperature ≥ 40 ° C, acetaminophen was administered, and
physical cooling was carried out until the temperature reached below 40 ° C).Study
was stopped when mortality in the “aggressive” therapy group was 7 cases
to one in the permissive therapy group [62].
However, there is compelling evidence that
in patients with brain damage, the hyperthermic response increases
the probability of death [17, 20, 25, 43, 54, 60]. It has been shown that
mortality increases in patients with TBI, stroke, if they have
increased body temperature in the first 24 hours from the moment of admission to the department
critical conditions; but in patients with a central nervous system infection
(CNS) no such pattern was found [60].In another job
390 patients with acute cerebrovascular accident were studied,
analyzed the relationship between high body temperature and mortality,
the degree of neurological deficit in survivors and the size of the lesion in
GM. It turned out that for every 1 ° C increase in body temperature,
the relative risk of an unfavorable outcome (including death) by 2.2 times,
also the hyperthermic state is associated with the large size of the focus
damage to GM [54].Out of 580 patients with subarachnoid hemorrhage
(SAH) 54% had fever and worse results
the outcome of the disease [70]. Meta-analysis of data from 14 431 case histories
patients with acute GM injury (primarily stroke) associated
increased body temperature with the worst outcome for each assessed indicator
[25]. Finally, an analysis of 7,145 case histories of TBI patients (of which 1,626 were
with severe TBI) showed that the likelihood of an unfavorable outcome (including
lethality) on the Glasgow Outcome Scale is higher in patients with
increased body temperature in the first three days of being in the intensive unit
therapy, moreover – the duration of the fever and its degree directly affect
outcome [30].
There are several possible explanations for why
hyperthermic conditions increase mortality in patients with
damage to GM. It is known that the temperature of the GM is not only slightly higher
internal body temperature, but the difference between them increases as
increasing the latter [57]. Hyperthermia increases metabolic requirements
(an increase in temperature by 1 ° C leads to an increase in the metabolic rate by
13%), which is detrimental to ischemic neurons [28].Temperature increase
GM is accompanied by an increase in intracranial pressure [57]. Hyperthermia
increases edema, inflammation in the damaged tissue of the GM [4]. Other possible
mechanisms of GM damage: violation of the integrity of the blood-brain barrier,
violation of the stability of protein structures and their functional activity [25]. Evaluating
metabolism in 18 patients with SAH with hyperthermia and induced
normothermia, found a decrease in the lactate / pyruvate ratio and a lower number
cases where lactate / pyruvate> 40 (“metabolic crisis”) in
patients with normal body temperature [49].
Considering the influence
high temperature on the damaged GM, it is very important to quickly and accurately
determine the etiology of the hyperthermic state and begin the correct treatment.
Of course, if indicated, the appropriate antibacterial drugs –
life-saving means. However, early and accurate diagnosis of centrogenic
hyperthermia can prevent patients from prescribing unnecessary antibiotics
and associated complications.

HYPERTHERMAL
CONDITIONS IN THE INTENSIVE THERAPY DEPARTMENTS OF NEUROSURGICAL PROFILE

According to Badjatia N.(2009), 70% of patients with GM damage have an increased body temperature in
during the period of their stay in intensive care, and, for example, among patients of general intensive care – only 30–45%. Moreover, only half
cases of fever (infectious cause) were noted [3]. Among patients
neurosurgical intensive care units (ICU), patients with SAH had
the greatest risk of developing a hyperthermic state, moreover, as a fever
(infectious genesis) and centrogenic hyperthermic reaction
(non-infectious genesis) [12].
Other factors
risk for centrogenic hyperthermia is ventricular catheterization of the GM and
duration of ICU stay [13]. Out of 428 patients of the neurosurgical
ICU 93% with hospital stay> 14 days
had a fever, 59% of patients with SAH also experienced
rises in body temperature above febrile numbers [33]. In turn, among
of patients with SAH, the highest risk of developing a hyperthermic reaction was in patients
with a high degree according to the Hunt & Hess scale, with intraventricular hemorrhage and
large size of the aneurysm [20].

FEVER
NON-INFECTIOUS GENESIS

Not all
patients with high body temperature, an infectious etiology is detected as
the cause of the fever. Among ICU patients with a neurosurgical profile, only 50%
cases of fever, an infectious cause is identified [3]. In intensive care units
general profile, the most common cause of noncommunicable fever is the so-called
postoperative fever [7]. Other possible non-infectious causes
fevers: drugs, venous thromboembolism, non-calculous
cholecystitis.Almost any drug can cause fever.
but among the most commonly used in ICU settings: antibiotics (especially
β-lactams), anticonvulsants (phenytoin), barbiturates [31].
Medicinal
fever remains a diagnosis of exclusion. There are no characteristic signs. In a number of
cases, this fever is accompanied by relative bradycardia, rash,
eosinophilia [39]. There is a temporary connection between the prescription of the drug and
the appearance of fever or discontinuation of the drug and the disappearance of increased
temperature.Possible mechanisms of development: hypersensitivity reactions,
idiosyncratic reactions [31]. In 14% of patients diagnosed with
pulmonary embolism was observed body temperature ≥ 37.8 ° C without
association with any other alternative cause, according to the PIOPED (Prospective Investigation of Pulmonary Embolism Diagnosis) study [64]. Fever associated with venous thromboembolism
usually short-term, with low temperature rises, stops after
initiation of anticoagulant therapy [48].Hyperthermia associated with venous
thromboembolism, accompanied by an increased risk of 30-day mortality [6].
Spontaneous ischemic or inflammatory damage to the gallbladder also
can occur in a critically ill patient. Vesicular occlusion
duct, bile stasis, secondary infection can lead to gangrene and
perforation of the gallbladder [29]. The diagnosis should be suspected in patients with
fever, leukocytosis, pain in the right hypochondrium.Ultrasonic
examination (ultrasound) of the gallbladder has a sensitivity and specificity> 80%,
while the diagnostic value of spiral computed tomography (SCT)
the gallbladder area is higher [32].

CENTROGENIC
HYPERTHERMAL REACTION

Even
after a thorough examination in some patients it will not be established
etiology of fever. The genesis of fever in 29% of neurological ICU patients remains
riddle [50, 53].So, by
Oliveira – Filho J., Ezzeddine M.A. et
al. (2001), among 92 examined patients
with SAK 38 had a febrile temperature, and 10 (26%) of them had an infectious
the source of the fever has not been identified [50].
Among patients with TBI, 4–37% have
centrogenic hyperthermia (after excluding other
reasons) [67]. Pathogenesis of centrogenic
hyperthermia is not fully understood [34]. Damage to the hypothalamus with
corresponding rises in the PgE level underlies the origin of centrogenic hyperthermia [58].A study in rabbits revealed hyperthermia and increased levels of PgE in the cerebrospinal fluid (CSF) after
introduction of hemoglobin into the ventricles of the GM [22]. it
correlates with many clinical observations in which
intraventricular blood is a risk factor for the development of non-infectious fever [20,
12].
Centrogenic hyperthermic reactions also have
a tendency to occur at the beginning of the course of treatment, thereby confirming the fact that
the initial damage is centrogenic [53].Among patients with TBI, patients with diffuse axonal injury (DAP) and
damage to the frontal lobes are at risk for the development of centrogenic
hyperthermia [67]. Probably, these types of TBIs are accompanied by damage
hypothalamus. A study on cadavers showed that damage to the hypothalamus
occur in 42.5% of cases of TBI combined with hyperthermia [68]. Also
it is believed that one of the causes of centrogenic hyperthermia may be
called an imbalance of neurotransmitters and neurohormones involved in the processes
thermoregulation (norepinephrine, serotonin, dopamine) [34].With a deficit
dopamine, persistent centrogenic hyperthermia develops [34]. A number of
research was aimed at identifying patient-specific
neurosurgical ICU predictors of centrogenic hyperthermia. One of these
predictors – time of fever onset. For non-infectious fevers, it is typical
emergence in the early stages of hospitalization of the patient in the ICU. So, one
the study showed that the occurrence of hyperthermia in the first 72 hours
hospitalizations along with SAH are the main predictors of non-infectious etiology
fever [53].A study of 526 patients found that SAH,
intraventricular hemorrhage (IVH) causes hyperthermia in the first 72 hours
from the moment of admission to intensive care, a long period of fever are predictors of centrogenic
hyperthermia [27]. Another study linked long-term ICU stays,
Ventricular catheterization of GM and SAH with non-infectious etiology of fever [12].
The authors of the study concluded that, after all, blood in the ventricles is
a risk factor, since catheterization of the ventricles of the GM occurs often with
intraventricular hemorrhage.

DIFFERENTIAL
DIAGNOSTICS

Skill
to differentiate infectious and non-infectious causes of fever has a decisive
importance in the treatment of patients with neurological ICU. Should be held
a thorough examination aimed at identifying an infectious source.
If the risk of infection is high or the patient is unstable, antibiotic therapy should be
be started immediately [41]. One of the possible detection tools
infectious nature of fever – serum biomarkers of infection.Procalcitonin
– one such marker – has been widely studied as an indicator of sepsis.
A 2007 meta-analysis (based on 18 studies) showed
sensitivity and specificity of the procalcitonin test> 71%
[65].
Duration
antibiotic therapy started after a positive result of procalcitonin
dough should theoretically decrease. Thus, a recent meta-analysis of 1,075 stories
disease (7 studies) showed that antibiotic therapy started after
positive result of procalcitonin test, does not affect mortality,
however, the duration of antibiotic therapy is significantly reduced [52].Also for
differential difference of centrogenic hyperthermia from
infectious-inflammatory fever, a symptom such as
insignificant (<0.5 ° C) difference between basal and peripheral temperatures - isothermy [34]. To detect it, thermometry is performed in three different points (axillary and rectally).
Interesting
clinical observation that an extremely high
body temperature (> 41.1 ° C), occurring in patients of departments
intensive care neurosurgical profile, as a rule, has
non-infectious etiology and may be a manifestation of centrogenic hyperthermic
reactions, malignant hyperthermia, neuroleptic malignant
syndrome, drug fever [14].In addition to testing for
identification of infectious genesis of fever should also exclude drug
genesis of hyperthermia [31]. The ratio of temperature to heart rate
can be an important criterion for the differential diagnosis of hyperthermic
states. Typically, the heart rate increases with
an increase in body temperature (with an increase in body temperature by 1 ° C, the frequency
heart rate increases by about 10 beats / min).If a
heart rate is lower than predicted at a given temperature (> 38.9 ° C),
then there is relative bradycardia, unless the patient
is receiving β-blockers, verapamil, diltiazem, or has a
pacemaker.
Given data
exclusion criteria, relative bradycardia in department patients
intensive neurosurgical therapy with hyperthermia (with a high proportion of
probability) indicates its non-infectious genesis, in particular, centrogenic
hyperthermic reaction or drug fever.Moreover, only in
in rare cases, relative bradycardia is observed in “feverish”
patients of general intensive care units against the background of the developed
nosocomial pneumonia, ventilator-associated pneumonia due to
outbreaks of nosocomial legionellosis [15].
Medicinal
fever occurs in about 10% of ICU patients. Moreover
its occurrence does not exclude the possibility of developing an infectious disease
or other condition accompanied by hyperthermia.Classically such
patients look “relatively good” for their temperature numbers. Patients with
drug fever invariably show relative bradycardia, but
if the body temperature is <38.9 ° C, then the pulse deficit may not be so obvious. In laboratory, such patients will have an unexplained leukocytosis with a shift to the left (imitation of an infectious process), eosinophilia, increased ESR, but blood cultures for sterility will not show signs infectious genesis of hyperthermia; levels may also rise slightly aminotransferases, immunoglobulin E.As a rule, such patients are burdened with allergic history, in particular, medicinal. Very common misconception is that the patient cannot develop a drug a fever for a drug he has been taking for a long time and if previously, such reactions to it did not arise. In most cases it turns out that the cause of such a fever is precisely the drug that the patient took for a long time [14].
In case
the patient continues to “fever” despite taking antibiotics, or
microbial source not found, screening for venous thrombosis should be performed – how
clinical and instrumental (ultrasound of the veins of the upper and lower extremities) [71].
Atelectasis has often been cited as a cause of noncommunicable fevers, but several
the studies carried out did not find any regularity [19].
Non-calculous cholecystitis can be a life-threatening condition given
very vague symptoms in patients in coma [51].An abdominal ultrasound should
help diagnose. Only after careful exclusion of infection and
of the aforementioned non-infectious causes of fever in the ICU neurological
profile can be diagnosed with centrogenic hyperthermia. What already
mentioned, some nosologies are more predisposed to the development of centrogenic
hyperthermia [12, 27, 67]. Aneurysmal SAH is the most significant factor
risk, followed by IVH [28]. Among patients with TBI, patients with DAP and
damage to the frontal lobes – in the risk group for the development of hyperthermia [67].Continuing fever despite treatment [27] and onset within the first 72 hours
from the moment of admission to the ICU [27, 53] also indicates a centrogenic
hyperthermia. Centrogenic hyperthermia may not be accompanied by tachycardia and
sweating, as is usual with an infectious fever, and may be resistant to
the action of antipyretics [68]. Thus, the diagnosis “centrogenic
hyperthermic reaction ”- a diagnosis of exclusion [41]. Although it is advisable to avoid
prescribing antibiotics without indications due to the development of undesirable side effects
effects, refusal of antibiotic therapy in patients with sepsis may be
fatal.

THERAPEUTIC CAPABILITIES

Since the fever is caused by prostaglandin-induced
displacement of the “setting temperature” of the hypothalamus, appropriate therapy
should block this process. Conventional antipyretic drugs, including paracetamol
and non-steroidal anti-inflammatory drugs (NSAIDs) that interfere with the synthesis
prostaglandins [4]. Several studies have shown their effectiveness in arresting
fever [44, 26], but they do not affect the mortality rate.Also
studies have shown that centrogenic hyperthermic reactions in one way or another
degrees are resistant to traditional pharmacological therapy [68, 61]. Only 7%
of patients with TBI and 11% of patients with SAH, there was a decrease in temperature
body while taking antipyretics [2]. The generally accepted technique of cupping
there are no centrogenic hyperthermic reactions. Some
drugs: continuous intravenous infusion of clonidine as part of
so-called neurovegetative stabilization [35], the use of
dopamine receptor agonists –
bromocriptine in combination with amantadine [34], propranolol [42], continuous infusion of low doses of diclofenac [13].Physiotherapeutic methods of therapy have been proposed, in particular, the effect
electromagnetic radiation is in contact with the area located between the spinous processes of the C7 – Th2 vertebrae. One study even showed that decompression hemicraniectomy for severe TBI reduces
brain temperature, probably due to an increase in conductive heat transfer
[45]. In a clinical study involving 18 children aged 1 week and older
up to 17 years of age, among whom most of them had severe TBI, for a quick
for relief of hyperthermia, a 10-15-minute intravenous infusion of cold saline (4 ° C) was used in an average volume of 18 ml / kg.The authors concluded that this technique is safe and effective [21].
Similar studies were carried out in adult patients with severe TBI and also
have shown their effectiveness [5]. Physical cooling is used when
drug therapy is insufficient. Basically all medical methods
hypothermia can be divided into two categories: invasive and non-invasive. General
external cooling can cause muscle tremors, which in turn will reduce
the effectiveness of the technique and will increase the metabolic needs of the body [4].To avoid this, deep sedation of the patient with
using including muscle relaxants. Alternatively in a number
research is proposed to use selective craniocerebral
hypothermia [10], as well as non-invasive intranasal hypothermia [1, 63], although
data from clinical studies conducted in patients with severe TBI are very
contradictory primarily regarding the effectiveness of this method.
For the rapid induction of hypothermia,
endovascular (invasive) cooling devices.Comparing efficiency and
safety of endovascular coolants and external devices
hypothermia, it can be noted that today both methods are the same
effective for inducing hypothermia, there is no significant difference in the incidence
side effects, mortality, poor outcome in patients. but
external cooling gives less precision in the maintenance phase of hypothermia [24].

CONCLUSION

Enhanced
body temperature among patients in critical care units –
a common symptom.Damaged GM is especially sensitive to hyperthermia,
numerous experimental and clinical studies show
poor outcome in patients with TBI with elevated body temperature,
regardless of its genesis. Besides fever, the cause of the rise in temperature
the body in patients with acute GM injury may have a so-called
centrogenic hyperthermia, in other words, the neurological disease itself.
Subarachnoid
hemorrhage, intraventricular hemorrhage, certain types of TBI –
risk factors for the development of the latter.Centrogenic hyperthermia – diagnosis of exclusion,
which should only be installed after careful examination of the patient
to identify an infectious or non-infectious cause of fever. And fever and
centrogenic hyperthermia should be stopped in patients with acute injury
GM. For this, pharmacological antipyretics can be used (effective for
fever, to a lesser extent with centrogenic hyperthermia) and physical methods
cooling (effective both for fever and for centrogenic hyperthermia).
Considering that today the generally accepted
there is no method for stopping centrogenic hyperthermia, in the future it is necessary
conducting more and better quality clinical trials,
aimed at determining an effective and safe method of cupping
centrogenic hyperthermia.

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Virus and antibiotics: a gentle educational program for those in panic

“In a week the infection will pass, because it would have gone anyway, and the belief in antibiotics is reinforced. This is bad for themselves because of dysbiosis and resistance, bad for society and bad for doctors. We have optimal treatment regimens for the disease, groups of first-line drugs are prescribed there. And the patient is like: “I already drank this, but this is the second two weeks ago.”When you are in a hospital in the Russian region or in Africa, you often find yourself in a situation where there is nothing to prescribe. It is correct to prescribe a test for the resistance of a pathogen to different antibiotics, grow a culture, take antibiotic discs and see which works best. But time and laboratory are not close. One choice is made and the test takes place inside the patient. Moreover, only second-third-line antibiotics remain, which are more toxic or less effective. Therefore, people who are hypochondriacs and drink antibiotics for reinsurance simply reduce their chances of the next recovery. Never play with antibiotics without a doctor!

About resistance to almost everything – not fairy tales, and not cases from sterile American hospitals. I had a woman in Guatemala who did not finish her antibiotic courses. She claimed that she had vaginal discharge, was examined over and over again, prescribed antifungal or antibiotics, she took 20 pills, drank 5. Then she herself decided that they did not help, found another doctor in the clinic, “forgot” the card, she said, that for the first time, I received new antibiotics.Judging by the resistance seeding, she did this not only in our clinic, because the entire range of local pharmacies and shops glowed red on her. As a result, they did not know what to treat, so they had to order an expensive drug from reserves. It was lucky that she did not reach him and train stability. We checked that the full cycle was cut.

There were women who did not know they were pregnant. One 4 months did not have a period, she still went to the market and bought something for cystitis.According to the description, ciprofloxacin. As a result, a child with a defect was born. I don’t know if it’s because of this or because heredity, we do not have genetic tests of our parents here. Doxycycline is also often found here, it causes serious defects in bone tissue.

We try not to prescribe amoxicillin and the penicillin series to anyone, except for pregnant women, because they can’t really do anything else. They have been in Guatemala for so long in this population bought them on the market and drank constantly that in the end they simply do not work.In Africa, azithromycin, fluoroquinolones (for example, levofloxacin) are expensive, and people cannot buy them themselves, so there is no resistance to them. Our clinics receive them from international donations, while other hospitals do not have such expensive drugs. ”

Arpimed

If you are pregnant or breastfeeding, suspect that you are pregnant or planning to have a baby, consult your doctor before taking this medicine. The doctor will compare the expected benefits of the drug to the mother against the potential risk to the baby.

Driving and using machinery:

Ceftriaxone may cause dizziness. If you feel dizzy, do not drive or use any other machinery. See your doctor if you experience these symptoms.

How to take Ceftriaxone

Ceftriaxone is usually given by a doctor or nurse. Accepted in the form:

  • Dropper (intravenous infusion) or injection directly into a vein.
  • Intramuscular injection.

This product is prepared by a doctor, pharmacist or nurse and should not be mixed with or given at the same time as the calcium injection.

Usual dose :

Your healthcare professional will determine the correct dose of Ceftriaxone for you. The dose will depend on the severity and type of infection; whether you are using any other antibiotics; Your weight and age; how well your kidneys and liver are functioning.The length of treatment depends on the type of infection.

Use in adults, the elderly and children over 12 years of age and weighing more than or equal to 50 kilograms :

From 1 to 2 g of ceftriaxone once a day, depending on the severity and type of infection. If you have a severe infection, your doctor will prescribe a higher dose (up to 4 g once a day). If the daily dose exceeds 2 g, then it can be taken once a day or 2 times a day in divided doses.

Use in newborns, infants and children aged 15 days to 12 years with a body weight of less than 50 kilograms :

  • 50-80 mg of ceftriaxone for each kilogram of the child’s body weight once a day, depending on the severity and type of infection. If a child has a severe form of infection, the attending physician will prescribe a higher dose of 100 mg for each kilogram of the child’s body weight up to 4 g once a day. If the daily dose exceeds 2 g, then it can be taken 1 time per day or 2 times a day in divided doses.
  • Children weighing 50 kg or more should be given the same doses as adults.

Newborns (0-14 days) :

  • 20-50 mg of ceftriaxone for each kilogram of the child’s body weight, once a day. The dose depends on the severity and type of infection.
  • The maximum daily dose should not exceed 50 mg for each kilogram of the child’s body weight.

If you have liver or kidney problems :

You can take a dose different from the usual dose.Your doctor will determine the dose of Ceftriaxone and perform a complete test based on the severity of your liver or kidney disease.

If you have taken more Ceftriaxone than you recommended :

If you have taken too much , , contact your doctor immediately or go to the nearest hospital or emergency department.

If you forget to take Ceftriaxone :

If you forget to take the next dose of the drug, take it as soon as you remember.If it is time for your next dose, do not take the missed dose.

Do not take a double dose of the drug to make up for the missed dose.

If you want to stop taking Ceftriaxone :

If you intend to stop taking Ceftriaxone, you should contact your healthcare professional for advice. If you have any further questions about Ceftriaxone, ask your doctor or pharmacist.

90,000 Preparations for pharyngitis: description of the disease, causes, symptoms, cost of treatment in Moscow

Pharyngitis is a common disease in which the back of the throat or the sides of the throat becomes inflamed. Pathology is predominantly infectious in nature and proceeds with a pronounced inflammatory process. For its treatment, drugs from various categories are used, as well as folk remedies necessary to accelerate recovery.

Pharyngitis treatment largely depends on the cause of the pathology.Since the therapy of the disease is directed without fail to eliminate the pathogen, it is first of all required to establish it, because the inflammatory process can be triggered due to damage to the mucous membrane by bacteria, viruses or fungi. In some cases, the appearance of an allergic form of the disease is possible.

Due to the fact that the disease threatens the development of severe complications, treatment should be carried out only under medical supervision. It is unacceptable to prescribe drugs to eliminate pharyngitis on your own.It is especially dangerous to do this in relation to antibiotics, since an incorrect choice of medicine can easily lead to the emergence of microorganisms that have become resistant to a particular group of antibiotics, which will further complicate therapy many times over. Seeking medical help for pharyngitis is required at any age.

When antibiotics are needed

If, after the results of a pharyngeal smear are obtained, it is established that the disease is of a bacterial nature, antibiotic drugs are prescribed.Antibiotics for pharyngitis can be prescribed for local (local) or general action. The choice of a specific drug depends on the patient’s condition and his individual characteristics. So, during pregnancy, a woman (if you cannot do without antibiotics) is prescribed mainly local preparations for irrigating the pharynx, since they penetrate into the systemic circulation to a lesser extent.

The use of antibiotics is required in order to stop the multiplication of the pathogen and destroy it.Thanks to this, drugs in this category help prevent the spread of the inflammatory process to the surrounding tissues. In the first days of taking antibiotics, an increase in temperature is the norm, since due to the large number of dead pathogens, intoxication of the body occurs. The duration of taking antibiotic drugs is at least 5 days. If you quit the course earlier, then bacteria resistant to the drug will form, which will make its use ineffective. Each specific remedy has its own contraindications, which must be taken into account when prescribing a medicine.

Side effects from taking antibiotics of general action may be:

  • fever;

  • joint pain;

  • disturbances in the work of the intestines;

  • general weakness.

Such manifestations are considered the norm and, as a rule, do not require replacement of the drug.However, with their development, it is necessary to inform the attending physician about this.

With pharyngitis, drugs of the penicillin series or cephalosparins are most often used. In the event that they are not tolerated by the patient, treatment is carried out using Azithromycin, Amoxiclav, Lincomycin, Erythromycin or Amoxicillin. Antibiotics for pharyngitis in adults and children are prescribed the same.

In the chronic form of the disease, pharyngitis without antibiotics is treated only until the moment of exacerbation.If it happens, antibiotic drugs are prescribed.

Antiviral agents

Antiviral medicine for pharyngitis is required if the throat is viral in nature. In this case, the attachment of a bacterial infection is absent, and antibiotics will not be effective. Antiviral drugs can even be homeopathic, but they are prescribed much less often because of the rather long period of their accumulation in the body before the action begins.

For the use of antiviral agents to be effective, it is necessary to establish that the disease is of a viral nature. It will not be possible to determine the causative agent of the disease on your own, therefore you need to contact an ENT doctor. The specific antiviral drug will be prescribed depending on which pathogen has affected the mucous membrane.

Antifungal drugs

Not often, but pharyngitis can also develop due to the defeat of the mucous membrane of the pharynx by fungi.Their presence also determines a smear from the pharynx. It allows you to identify not only the presence of the fungus, but also its type. Systemic drugs are usually required. Local antifungal compounds in most cases do not give the desired result and can only lead to a delay in the inflammatory process and the transition of pathology to a chronic form. At the same time, in parallel with systemic drugs, they can significantly accelerate recovery.

Inhalation and gargling

Inhalation with pharyngitis, like rinsing, helps to greatly speed up recovery.An action directly aimed at the inflamed mucosa gives a quick result, especially if the pathology is in an unreleased degree.

Inhalation can be carried out using steam using essential oils and medicinal plants, or using a nebulizer, which is filled with the necessary medications. Specific medications in this case are prescribed by the doctor. With the help of a nebulizer, cold inhalations can be carried out with antibiotics, saline (if it is necessary to soften and moisturize the mucous tissue), as well as mucolytics.

Antiseptic agents are used for rinsing. This can be a simple saline solution or decoctions of eucalyptus, sage or calendula. Pharmacy antiseptics are also used, such as hydrogen peroxide, miramistin, furacilin, propolis tincture and other means that can destroy pathogenic bacteria and at the same time not irritate a sore throat.

Tablets and lozenges, lozenges and sprays

A pharyngitis remedy for resorption necessarily includes an antiseptic drug, a throat softener and a moisturizer.Some of the drugs also include an anesthetic component to quickly eliminate unpleasant manifestations. Also, herbal extracts or essential oils may be present in pharyngitis tablets.

Lozenges are less therapeutic than tablets. At the same time, during the day they can be consumed quite a lot, combined with tablets. The main drugs for resorption in case of illness are as follows:

  • Falimint – an effective anti-inflammatory agent with an analgesic effect;

  • Lizobact – the medicine should be sucked, and not chewed or gnawed.In order for the drug to act on the mucous membrane as long as possible, it is required to swallow saliva, try to keep it in the throat;

  • Septolete – popular pastilles that contain an antiseptic and essential oils. The components of the drug slowly act on the mucous membrane, which allows you to achieve the maximum therapeutic effect. They are recommended as an aid;

  • Septogal is a medicine with antiviral and antiseptic effects.Essential oils are also present in the preparation. The effect of using the product is felt after the first time.

There are still a large number of drugs with a similar effect, but less popular.

Throat sprays for pharyngitis are most often prescribed as an adjunct to therapy. The most popular are Chlorophyllipt and Ingalipt.

This category of drugs is one of the few that can be used without a medical prescription, since it is not capable of causing harm if all contraindications are taken into account.

Immunostimulants

Funds from this category are necessary to restore the body’s natural defenses and enhance the immune response against pathogens. Most often, herbal preparations are prescribed, which cannot cause a further decrease in the immune response. Such treatment is useful not only during the disease, but also after it, when it is required to restore a satisfactory state of immunity.

Herpes zoster: phases of disease development, symptoms and treatment

Contents:

Infection is sometimes caused by the awakening of a latent varicella-zoster virus.It intensifies against the background of problems that contribute to a decrease in resistance: hypothermia, chronic diseases, malignant formations, impaired metabolism, HIV infection. Therefore, it is important to conduct an in-depth examination to identify the root of the problem.

With this disease, the temperature rises, the patient is in a fever, and intoxication is manifested. Feelings resemble general infectious. Skin problems (blistering rash) occur with a noticeable pain syndrome. Varicella acts as a dermatoneurotropic virus.It penetrates into the mucous membrane and skin, affecting in particularly severe forms areas of the spinal cord and brain.

In the fall and winter, herpes zoster occurs more often. People who have once had chickenpox are especially susceptible to it. About 15 people per hundred thousand are ill. In rare situations, the disease can recur. When communicating with a patient, a child may contract chickenpox.

Histopathology resembles common herpes. Inflammatory infiltrates develop in ganglion cells, nerve fibers.Microscopic hemorrhages occur, nerve fibers undergo dystrophy; the cerebrospinal fluid contains an increased amount of proteins.

It is important to know that the incubation period sometimes lasts two to three years from the moment of infection.

Phases of development of the disease

The development of the disease is usually accompanied by high fever, lethargy, intercostal neuralgia. The head often hurts. Spots appear on the skin, vesicles with serous matter are grouped, pustules are formed.Then erosion, crust. Swelling spots may occur. They merge in a ribbon-like manner into painful lesions. The pain is shooting, dull, pulling. Sometimes it is limited to external affected foci, sometimes wandering. An unpleasant feature of the disease is the persistence of pain (postherpetic neuralgia), which sometimes lasts for years, regardless of therapy, even after getting rid of external skin pathology.

Clinical varieties of herpes zoster:

  • bullous;
  • hemorrhagic;
  • gangrenous;
  • generalized.

Diagnosis of the disease for an experienced specialist usually does not pose a problem – along the innervation, on the edematous basis, the typical location of herpetiform elements, pronounced pain.

Herpes zoster clinic

The disease is treated in a comprehensive manner. Most likely, you will not need to go to the clinic. Therapy is carried out with medications, antiviral and immunomodulatory drugs.The effectiveness of therapy directly depends on the pace of its initiation: it is better to start as early as possible.

With complex gangrenous and common forms of herpes zoster, or when the eye (ear) is affected, you will need to go to the hospital. Physiotherapeutic agents help well: microwave irradiation, UV irradiation, UHF, electrophoresis. Local therapy is used – aniline dyes, ointments, which, when used in a complex, also accelerate recovery. In severe forms of the disease, antibiotics will be included in the complex therapy.

In our clinic, complex therapy is used in the treatment of this type of herpes. It includes oral administration (tablets), topical application of external agents, together with complex therapy of concomitant diseases. Tablets, especially for relapses, are effective in combination with ointments, physiotherapy and other therapy.

Anti-relapse therapy is also helpful. However, we warn you – in no case try to use all these tools yourself, without the appointment of a specialist!

After elimination of skin rashes, therapy will be continued by our neuropathologists until the disappearance of post-herpes neurological pain sensations.Herpes zoster is an excellent cure, with the exception of rare complicated and gangrenous forms. In our clinic, we will definitely help you cope with the problem and significantly improve your well-being.

Read also:

Antibiotics in the treatment of tonsillar pathology

A.I. KRYUKOV, MD, DSc, Professor, N.L. KUNELSKAYA , MD, DSc, Professor, G.Yu. TSARAPKIN , d.M.S., A.S. TOVMASYAN , Ph.D., O.A. KISELEVA , Research Clinical Institute of Otorhinolaryngology named after L.I. Sverzhevsky Department of Health of Moscow

Tonsillar pathology is one of the most common in the world. It affects people of all ages, but inflammatory diseases of the tonsils are of greatest relevance in childhood due to the danger of severe complications. Algorithms for the treatment of tonsillar pathology are described in various international and national guidelines, however, the issues of the practical choice of antimicrobial agents often cause difficulties for practitioners.

Up to 80% of acute and exacerbations of chronic respiratory diseases are accompanied by a sore throat symptom, which is one of the most common reasons for patients to visit a pediatrician, therapist, otorhinolaryngologist and doctors of other specialties. Acute inflammation of the pharynx accounts for 1.1% of all patient visits to doctors; 6% of all visits to a pediatrician; acute tonsillopharyngitis are among the 20 most frequently diagnosed diseases [1, 2].At the same time, sore throat can be a dominant problem, inevitably affecting the patient’s quality of life [3]. The urgency of the tonsillar problem is determined not only by the high prevalence of the disease, but also by the significant risk of developing associated systemic diseases, such as acute rheumatic fever, bacterial endocarditis, glomerulonephritis, toxic shock, etc. the term “angina” or “tonsillitis”, and inflammation of the lymphoid follicles of the posterior pharyngeal wall is usually characterized by the term “pharyngitis”.In clinical practice, often, especially in childhood, a combination of tonsillitis and pharyngitis is observed, therefore, in the literature, especially in English, the term “tonsillopharyngitis” is widely used, suggesting inflammation of the walls of the oropharynx. In particular, the development of bacterial tonsillitis is more often caused by an infection caused by group A beta-hemolytic streptococcus (GABHS), pharyngitis is usually caused by respiratory viruses, adenoiditis by viruses, Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, Moraxella catar8 H.influenzae .

Acute tonsillitis is classified into primary (banal) tonsillitis (catarrhal, follicular, lacunar, mixed, phlegmonous), secondary, arising in infectious diseases (scarlet fever, measles, diphtheria, syphilis, etc.), in blood diseases (leukemia, agranulocytosis monocytosis), atypical (Simanovsky – Plaut – Vincent, viral, fungal). In clinical practice, the most common form of the disease is epidemic, when the infection is transmitted by airborne droplets or by contact and causes primary tonsillitis.In childhood, up to 30% of sore throats have a bacterial nature; in the overwhelming majority of cases, the etiological factor is GABHS. Much more often, a viral infection leads to the development of acute tonsillitis, primarily adenoviruses, respiratory syncytial viruses, and the Epstein-Barr virus. Viral forms of acute tonsillitis mainly occur in the autumn-winter period and prevail in children of the first 3 years of life (up to 90%), and at the age of 5 years, the frequency of bacterial forms increases (up to 50%) [4].Intracellular pathogens – Mycoplasma pneumoniae, Chlamydia pneumoniae, which are sown in 10-24 and 5-21% of cases, respectively, also have a significant role in the development of the disease in childhood, and the entire epithelium of the pharynx is infected with chlamydia, which may be the cause of the chronicity of the process [ 5, 6].

It is believed that the development of angina occurs as a hyperergic allergic reaction, and a variety of microflora of tonsils lacunae and products of protein breakdown leads to sensitization of the body, and various factors of an exogenous or endogenous nature can be the trigger mechanism for the development of the disease.An allergic factor can serve as a prerequisite for the occurrence of infectious and allergic diseases, such as rheumatism, glomerulonephritis, nonspecific infectious polyarthritis, which are quite often a complication of tonsillitis, especially those induced by GABHS, since they have a high adhesive capacity to the membranes of the mucous membranes, resistance to phagocytosis, numerous exotoxins causing a strong immune response contain antigens that cross-react with the myocardium, and the immune complexes that include them are involved in kidney damage [7, 8].

Treatment of acute tonsillitis and pharyngitis is complex and includes irrigation therapy, the use of local antibacterial drugs and systemic antibiotics.

With viral etiology of tonsillitis and pharyngitis, it is possible to limit yourself to the appointment of irrigation therapy and local antiseptics, however, the bacterial etiology of the disease, especially GABHS, requires the mandatory use of systemic antibiotics.

In this regard, it is extremely important to follow the principles of rational antibacterial therapy, namely: the appointment of the drug with the aim of the fastest possible clinical and bacteriological recovery; the spectrum of action of the drug should correspond to the probable causative agent of the infection, overcome the possible existing mechanisms of resistance and create the maximum concentration in the focus of infection.What is especially important in pediatric practice is that the prescribed drug should be easy to use.

An adequate interpretation of the leading etiological factor (bacteria, viruses, fungi, protozoa), the clinical form of angina (primary or secondary), the severity of the disease (in acute tonsillitis, usually one pathogen, with exacerbation of chronic – mixed flora) [9] allow to prescribe therapy empirically, taking into account information about sensitivity to antibiotics, the ability of the drug to create adequate concentrations in the focus of infection and the proven efficacy and safety of its use.

Traditionally, the drugs of choice for GABHS tonsillitis are semisynthetic broad-spectrum penicillins. They are effective against the most probable pathogens of tonsillitis (GABHS), belong to the safe groups of antibiotics, and all have oral forms. In the typical picture of the disease, they are considered the drugs of choice.

The most famous representative of this group is amoxicillin, which has a pronounced bactericidal effect. The mechanism of action of the drug is associated with inhibition of the synthesis of peptidoglycan (a substance that is the basis of the bacterial membrane), which leads to a violation of the integrity of the cell membranes of bacteria and their death.Amoxicillin is active against Staphylococcus spp. and Streptococcus spp. . and Neisseria meningitidis, Neisseria gonorrhoeae, Escherichia coli, Salmonella spp., Shigella spp., Klebsiella spp. Therapeutic plasma concentrations of amoxicillin are maintained for 8 hours after oral administration. Amoxicillin is rapidly absorbed in the digestive tract and reaches peak plasma concentrations within 1-2 hours after ingestion. Food intake practically does not affect the bioavailability and absorption rate of amoxicillin.The active ingredient is stable in the acidic environment of the stomach. High concentrations of the active substance are created in bronchial secretions, sputum, blood plasma, peritoneal and pleural fluids, as well as in the tissues of the lungs. Concentrations of amoxicillin in tissues and body fluids are proportional to the dose taken.

In the process of metabolism of amoxicillin, pharmacologically inactive substances are formed. About 50-70% of the dose taken is excreted by the kidneys unchanged, about 10-20% – by the liver, the rest of amoxicillin is excreted in the form of metabolites.Currently available amoxicillin of Russian production Amosin (JSC “Sintez”, Kurgan). The drug is intended for oral administration. Capsules are taken before or after meals at regular intervals. As a rule, adults and children over 10 years old (with a body weight of more than 40 kg) are prescribed 500 mg of amoxicillin three times a day. In severe cases of the disease, the dose of amoxicillin is increased to 750-1,000 mg three times a day. For children from 5 to 10 years old, the therapeutic dose is 250 mg of amoxicillin three times a day.The average course of therapy lasts from 5 to 12 days (as a rule, therapy is continued for 2-3 days after the disappearance of the clinical manifestations of the disease).

However, it should be borne in mind that H. influenzae , as well as M. catarrhalis are active producers of β-lactamases. This dictates the need to use protected aminopenicillins as starting therapy drugs, which are rightfully considered the “gold standard” of therapy for acute purulent-inflammatory pathology of ENT organs.One of the most commonly used antibiotics in the treatment of tonsillar pathology is a combined preparation containing a semi-synthetic penicillin – amoxicillin and an irreversible inhibitor of lactamases – clavulanic acid. On the market, amoxicillin clavulanate is represented by a number of trade names, among which the Russian drug Arlet® can be distinguished. Clavulanic acid, due to the presence of a β-lactam ring in its structure, forms stable complexes with bacterial lactamases and protects amoxicillin from destruction by these enzymes.This combination of components provides a high bactericidal activity of the drug. Arlet® is active against both microorganisms sensitive to amoxicillin and strains producing β-lactamases:

• gram-positive aerobes: Streptococcus pneumoniae , BGSA, Staphylococcus aureus (except for methicillin-resistant strains), S. methicillin-resistant strains), Listeria spp., Enteroccocus spp .;
• gram-negative aerobes: Bordetella pertussis, Brucella spp., Campylobacter jejuni, Escherichia coli, Gardnerella vaginalis, Haemophilus influenzae, H. ducreyi, Klebsiella spp., Moraxella catarrhalis, Neisseria gonorrhoeae, N. meningitidis, Pasteurela multocida, Proteus spp., Salmonella spp., Salmonella spp., Salmonella spp., Salmonella spp., Salmonella spp. enterocolitica ;
• anaerobes: Peptococcus spp., Peptostreptococcus spp., Clostridium spp., Bacteroides spp., Actinomyces israelii .

The pharmacokinetics of amoxicillin and clavulanic acid have much in common.Both components are well absorbed in the gastrointestinal tract, food intake does not affect the degree of their absorption. The peak plasma concentrations are reached approximately one hour after taking the drug. Amoxicillin and clavulanic acid are characterized by good distribution in body fluids and tissues, creating therapeutic concentrations in foci of upper respiratory tract infections (palatine tonsils, mucous membrane of the pharynx, paranasal sinuses, tympanic cavity, etc.). Amoxicillin is excreted by the kidneys unchanged by tubular secretion and glomerular filtration.Clavulanic acid is eliminated through glomerular filtration, partly in the form of metabolites. Small amounts can be excreted through the intestines and lungs. The half-life is 1–1.5 hours. In patients with severe renal failure, the half-life of amoxicillin increases to 7.5 hours, and of clavulanic acid to 4.5.

Amoxicillin / clavulanate is well tolerated. Adverse events are relatively rare in the form of diarrhea, nausea and skin rash.The tablets of the drug Arlet® should be taken orally during meals with a small amount of water without chewing. For adults and children over 12 years old (or weighing more than 40 kg), the usual dose for mild to moderate infections is 1 tablet 250/125 mg 3 times a day. In severe infections, a 500/125 mg tablet is prescribed 3 times a day, and, if necessary, Arlet® tablets are used at a dose of 875/125 mg or 1 tablet 500/125 mg 3 times a day. The course of treatment reaches 5-14 days.The duration of treatment is determined by the attending physician. Treatment should not continue for more than 14 days without a second medical examination.

In atypical manifestations of the disease (mycoplasma and chlamydophilic infection), macrolides are the drugs of choice. They are recommended for use in children as a starting therapy in the treatment of atypical forms of tonsillitis, as well as in cases where there is intolerance to beta-lactam antibiotics. Macrolides are considered as alternative antibacterial agents that can be prescribed in the absence of an effect from the initial therapy, with the development of side and undesirable effects associated with the use of first-line drugs [10, 11].

Literature

1. Nash DR, Harman J, Wald ER, Kelleher KJ. Antibiotic prescribing by primary care physicians for children with upper respiratory tract infections. Arch Pediatr Adolesc Med 2002 156 11: 1114-1119.
2. Panasiuk L, Lukas W, Paprzycki P. Empirical first-line antibiotic therapy in adult rural patients with acute respiratory tract infections. Ann Agric Environ Med, 2007.14.2: 305-311.
3. Babiyak V.I., Govorukhin M.I., Mitrofanov V.V. Some psychological aspects of the problem of “quality of life” of a person. Russian otorinolar., 2004.1 (8): 3-6.
4. Tatochenko V.K., Bakradze M.D., Darmanyan A.S. Acute tonsillitis in childhood: diagnosis and treatment. Pharmateca, 2009.14: 65-69.
5. Garashchenko T.I., Strachunsky L.S. Antibiotic therapy of ENT diseases in childhood. In the book: Pediatric Otorhinolaryngology: A Guide for Physicians. Ed. M.R. Bogomilsky, V.R. Chistyakova.T. II. M .: Medicine, 2005: 275-317.
6. Linkov V.I., Tsurikova G.P., Nuralova I.V., Pankina N.A. The importance of chlamydial infection in the development of chronic inflammatory diseases of the pharynx. Otolaryngology and Logopathology News, 1995.3 (4): 146-146.
7. Kryukov A.I. Clinic, diagnosis and treatment of tonsillar pathology (Manual for doctors). M., 2011.32 p.
8. Luchikhin L.A. Angina. Otorhinolaryngology: national guidelines. Ed. V.T. Palchun. M.: GEOTAR-Media, 2008: 652–673.
9. Garashchenko T.I. Macrolides in the treatment of acute tonsillitis and its complications in children. RMZh, 2001.9, 19: 812-816.