Acute respiratory viral infections. Pregnancy and acute respiratory diseases (acute respiratory infections, influenza) Acute respiratory infection ICD 10

RCHR (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Clinical protocols of the Ministry of Health of the Republic of Kazakhstan - 2013

Acute laryngopharyngitis (J06.0)

general information

Short description

Approved by the minutes of the meeting
Expert Commission on Health Development of the Ministry of Health of the Republic of Kazakhstan
No. 23 from 12/12/2013

ARVI - a group of infectious diseases caused by respiratory viruses, transmitted by airborne droplets, affecting the respiratory system, characterized by increased body temperature, intoxication and catarrhal syndrome.

I. INTRODUCTORY PART

Protocol name: ARVI in children
Protocol code:

Code (codes) by ICD-10:
J00- J06 Acute respiratory infections of the upper respiratory tract
J00 -Acute nasopharyngitis (runny nose)
J02.8 - Acute pharyngitis caused by other specified pathogens
J02.9 - Acute pharyngitis, unspecified
J03.8 - Acute tonsillitis caused by other specified pathogens
J03.9 - Acute tonsillitis, unspecified
J04 - Acute laryngitis and tracheitis
J04.0 - Acute laryngitis
J04.1 - Acute tracheitis
J04.2 - Acute laryngotracheitis
J06 - Acute respiratory infections of the upper respiratory tract of multiple and unspecified localization
J06.0 - Acute laryngopharyngitis
J06.8 - Other acute infections of the upper respiratory tract of multiple localization
J06 - Acute upper respiratory tract infection, unspecified
J10- J18 - Flu and pneumonia
J10 - Influenza caused by an identified influenza virus
J11 - Influenza, virus not identified

Date of development of the protocol: year 2013.

Abbreviations used in the protocol:
GP - general practitioner
DIC - disseminated intravascular coagulation
ELISA - enzyme immunoassay
INR - international normalized ratio
ARVI - acute respiratory viral infection
ARI - acute respiratory disease
PT - prothrombin time
PHC - primary health care
PCR - polymerase chain reaction
RNHA - indirect hemagglutination reaction
RPHA - passive hemagglutination reaction
RSK - complement fixation reaction
HRTHA - hemagglutination inhibition reaction
ESR - erythrocyte sedimentation rate
SARS - severe acute respiratory syndrome
IMCI - integrated management of childhood illnesses
HIV - human immunodeficiency virus
HH - general danger signs

Protocol users: GP PHC, pediatrician PHC, infectious disease specialist pediatric PHC;
- infectious disease doctor of a children's infectious diseases hospital/department, pediatrician of multidisciplinary and specialized hospitals

Classification

Clinical classification of ARVI:
- light,
- medium-heavy,
- heavy.

With the flow:
- smooth without complications;
- with complications.
For example: ARVI, laryngitis, moderate severity. Complication of 1st degree laryngeal stenosis. When clarifying the etiology of ARVI, the disease is classified according to its nosological form.

Clinical classification of influenza and other acute respiratory diseases (ARI):

1.1. Etiology
1.1.1. Flu type A.
1.1.2. Flu type B.
1.1.3. Flu type C.
1.1.4. Parainfluenza infection.
1.1.5. Adenoviral infection.
1.1.6. Respiratory syncytial infection.
1.1.7. Rhinovirus infection.
1.1.8. Coronavirus infection.
1.1.9. Mycoplasma infection.
1.1.10. Acute respiratory infections of bacterial etiology
1.1.11. ARVI of mixed etiology (viral-viral, viral-mycoplasma, viral-bacterial, mycoplasma-bacterial).

1.2. Form of clinical course
1.2.1. Asymptomatic.
1.2.2. Easy.
1.2.3. Medium-heavy.
1.2.4. Heavy.

1.3. Complications
1.3.1. Pneumonia.
1.3.2. Bronchitis.
1.3.3. Sinusitis.
1.3.4. Otitis.
1.3.5. Croup syndrome.
1.3.6. Damage to the cardiovascular system (myocarditis, ITS, etc.).
1.3.7. Damage to the nervous system (meningitis, encephalitis, etc.).

Diagnostics

ΙΙ. Methods, approaches and procedures for diagnosis and treatment

List of diagnostic measures

Basic:
1) Collection of complaints and medical history, including epidemiological (contact with a patient and/or a large number of people during the seasonal rise of ARVI and influenza, etc.);
2) Objective examination (visual examination, palpation, percussion, auscultation, general thermometry, blood pressure measurement, determination of pulse and respiration rate, assessment of urinary function);
3) Complete blood count (hemoglobin, erythrocytes, leukocytes, leukocyte formula, ESR).
4) General urine analysis.
5) Research to establish the etiology of the disease is necessarily carried out using immunofluorescence and serological reactions;
6) Fecal microscopy to detect helminth eggs.

Additional:
1) ELISA, virological testing and PCR are carried out in the laboratories of the State Sanitary and Epidemiological Surveillance Department to determine the etiology of influenza and ARVI;

Methods for etiological diagnosis of ARVI and influenza

Diagnosis	Immunofluorescence	RNGA RTGA	ELISA	Culture of human embryonic cells and monkey kidneys (virological study)	PCR
Flu	+	+++	+	+	+
Parainfluenza	+	RTGA	-	+	-
Adenovirus infection	+	RTGA	-	-	-
	+	RNGA	-	+	-
Rhinovirus infection	+	-	-	+	-
TORSO	-	-	+	-	+

2) Platelets, INR, PT - in the presence of hemorrhagic syndrome;
3) Microscopy of a thick drop of blood to detect malarial plasmodia (for fever more than 5 days);
4) Spinal puncture with cerebrospinal fluid examination;
5) X-ray of the lungs - if pneumonia or bronchitis is suspected;
6) ECG - in the presence of complications from the cardiovascular system;
7) Consultation with a neurologist in the presence of seizures and symptoms of meningoencephalitis;
8) Consultation with a hematologist for severe hematological changes and hemorrhagic syndrome;
- examinations that need to be carried out before planned hospitalization (minimum list) are not carried out.

Diagnostic criteria

Complaints and anamnesis, including epidemiological

Flu :
- acute onset with the development of symptoms of intoxication on the 1st day, high fever with chills;
- the total duration of the febrile period is 4-5 days;
- headache with typical localization in the forehead, brow ridges, eyeballs;
- weakness, adynamia;
- pain in bones, muscles, lethargy, “brokenness”;
- hyperesthesia;

Parainfluenza:
- the onset of the disease may be gradual;
- intoxication is mild;
- pain and sore throat, nasal congestion, copious nasal discharge, dry cough “barking cough”, hoarseness;

Adenoviral infection:
- the onset of the disease is acute;
- runny nose and nasal congestion, followed by copious mucous discharge from the nose;
- there may be a sore throat or sore throat, dry cough;
- phenomena of conjunctivitis - pain in the eyes, lacrimation.

Respiratory syncytial infection :
- gradual onset;
- low-grade fever;
- persistent cough, first dry, then productive, often paroxysmal;
- characterized by shortness of breath (asthmoid breathing in children under 5 years of age).

Rhinovirus infection :
- moderate intoxication
- the onset is acute;
- sneezing, nasal discharge, difficulty breathing through the nose, coughing;

TORSO :
- acute onset with chills, headache, muscle pain, general weakness, dizziness, fever, nasal discharge;
- sore throat, hyperemia of the mucous membrane of the palate and the back wall of the pharynx, cough;
- possible nausea, vomiting once or twice, abdominal pain, loose stools;
- after 3-7 days, a repeated increase in body temperature and the appearance of a persistent non-productive cough, shortness of breath, and difficulty breathing are possible.

Epidemiological history:
- contact with patients with influenza and ARVI

physical examination

Objective symptoms characteristic of influenza and ARVI:
- increase in body temperature;
- nasal congestion, impaired nasal breathing, sneezing, discharge of mucus from the nose (acute rhinitis);
- hyperemia of the oropharyngeal mucosa, sore and dry throat, pain when swallowing (acute pharyngitis);
- hyperemia and swelling of the tonsils, palatine arches, uvula, posterior pharyngeal wall (acute tonsillitis);
- dry barking cough, hoarseness (laryngitis);
- rawness behind the sternum, dry cough (tracheitis);
- asthmatic breathing (obstructive bronchitis)
- cough (at the beginning of the disease it is dry, after a few days it is wet with an increasing amount of sputum); sputum is often mucous in nature and may acquire a greenish tint in the 2nd week; cough may persist for 2 weeks or longer (up to 1 month for adenovirus and respiratory syncytial virus infections).

Pathogens	Main respiratory tract syndromes
Influenza viruses	Tracheitis, laryngitis, nasopharyngitis, bronchitis
Parainfluenza viruses	Laryngitis, nasopharyngitis, false croup
Respiratory syncytial virus	Bronchitis, bronchiolitis
Adenoviruses	Pharyngitis, tonsillitis, rhinitis, conjunctivitis
Rhinoviruses	Rhinitis, nasopharyngitis
Human coronaviruses	Rhinopharyngitis, bronchitis
Coronavirus SARS	Bronchitis, bronchiolitis, respiratory distress syndrome

Objective symptoms characteristic of influenza:
- temperature 38.5-39.5 0 C;
- pulse rate corresponds to an increase in temperature;
- breathing is rapid;
- moderately severe catarrhal symptoms (runny nose, dry cough);
- hyperemia of the face and neck, injection of scleral vessels, increased sweating, small hemorrhagic rash on the skin, diffuse hyperemia and granularity of the mucous membrane of the pharynx;
- in severe form: high fever, impaired consciousness, symptoms of meningism, shortness of breath, hemorrhagic rash, tachycardia, dullness of heart sounds, weak pulse, arterial hypotension, acrocyanosis and cyanosis, convulsive readiness or convulsions;
- nosebleeds, hemorrhagic rash on the skin and mucous membranes due to the development of disseminated intravascular coagulation syndrome;
- signs of acute respiratory failure in patients with severe (especially pandemic) influenza: paroxysmal ringing cough, wheezing stridor, inspiratory shortness of breath, loss of voice, central and acrocyanosis, tachycardia, weak pulse, weakened heart sounds, arterial hypotension;
- signs of acute vascular insufficiency in patients with severe (especially pandemic) influenza: decreased body temperature, pallor of the skin, cold sticky sweat, adynamia with loss of consciousness, cyanosis and acrocyanosis, tachycardia, weak thread-like pulse, muffled heart sounds, arterial hypotension, cessation of urination ;
- signs of edema and swelling of the brain substance in patients with severe (especially pandemic) influenza: psychomotor agitation and impaired consciousness, pathological type of breathing, bradycardia alternating with tachycardia, facial hyperemia, vomiting that does not bring relief, convulsions, focal neurological signs, meningeal syndromes, lability blood pressure, hypersthesia, hypercausia;
- signs of pulmonary edema in patients with severe (especially pandemic) influenza: increasing shortness of breath and suffocation, central and acrocyanosis, the appearance of foamy and bloody sputum, decreased body temperature, weak rapid pulse, many dry and moist rales of different sizes in the lungs.

Criteria for the severity of influenza and ARVI(assessed by the severity of intoxication symptoms):
L mild degree — increase in body temperature no more than 38°C; moderate headache;

Average degree — body temperature within 38.1-40°C; severe headache; hyperesthesia; tachycardia

Severe degree - acute onset, high temperature (more than 40°) with pronounced symptoms of intoxication (severe headache, body aches, insomnia, delirium, anorexia, nausea, vomiting, meningeal symptoms, sometimes encephalitic syndrome); pulse more than 120 beats/min, weak filling, often arrhythmic; systolic blood pressure less than 90 mm Hg; heart sounds are muffled; respiratory rate is more than 28 per minute.

Very severe - lightning-fast course with rapidly developing symptoms of intoxication, with the possible development of DIC syndrome and neurotoxicosis.

laboratory research:

General blood analysis:
- normo-leukopenia (normal levels of leukocytes in the blood: 4-9·10 9 /l);
- lymphocytosis (normal levels of lymphocytes in the blood: 20-37% in children over 5 years old, under 5 years old - 60-65%);
- in case of bacterial superinfection - leukocytosis and/or “shift of the formula to the left”; ;
- normal levels of red blood cells (4.0-6.0.10 12 /l), hemoglobin (120-140 g/l), ESR (boys 2-10 mm/h, girls 2-15 mm/h).
- positive results of immunofluorescence and an increase in the titer of specific antibodies by 4 or more times in serological reactions (in paired sera).

Spinal tap - cerebrospinal fluid is transparent, cytosis is normal (normal values ​​of cerebrospinal fluid: transparent, colorless, cytosis 4-6 per ml, including lymphocytes 100%, neutrophils 0%; protein 0.1-0.3 g/l, glucose 2 ,2-3.3 mmol/l).

Instrumental studies:
X-ray of the respiratory organs:
- signs of bronchitis, pneumonia, pulmonary edema.

Indications for consultation with specialists:
- neurologist for seizures and symptoms of meningoencephalitis;
- hematologist for severe hematological changes and hemorrhagic syndrome;
- ophthalmologist for cerebral edema.

Differential diagnosis

Differential diagnosis

DIAGNOSIS or cause of the disease	In favor of diagnosis
Pneumonia	Cough and rapid breathing: age< 2 месяцев ≥ 60/мин age 2 - 12 months ≥ 50/min age 1 - 5 years ≥ 40/min - Retraction of the lower chest - Fever - Auscultatory signs - weakened breathing, wet rales - Nose flaring - Groaning breathing (in young infants)
Bronchiolitis	- The first case of asthmatic breathing in a child aged<2 лет - Asthmoid breathing during the seasonal increase in the incidence of bronchiolitis - Expansion of the chest - Extended exhalation - Auscultation - weakened breathing (if very pronounced - exclude airway obstruction) - Weak or no reaction to bronchodilators
Tuberculosis	- Chronic cough (> 30 days); - Poor development/weight loss or weight loss; - Positive Mantoux reaction; - History of contact with a patient with tuberculosis - Radiological signs: primary complex or miliary tuberculosis - Detection of Mycobacterium tuberculosis during examination sputum in older children
Whooping cough	- Paroxysmal cough accompanied by characteristic convulsive wheezing, vomiting, cyanosis or apnea; - Feeling good between coughing attacks; - No fever; - No history of DTP vaccination.
Foreign body	- Sudden development of mechanical airway obstruction (child “choked”) or stridor - Sometimes asthmatic breathing or pathological expansion of the chest on one side; - Air retention in the respiratory tract with increased percussion sound and mediastinal shift - Signs of lung collapse: weakened breathing and dullness to percussion - Lack of response to bronchodilators
Effusion/empyema pleura	- “Stone” dullness of percussion sound; - No breath sounds
Pneumothorax	- Sudden onset; - Tympanic sound when percussed on one side of the chest; - Mediastinal shift
Pneumocystis pneumonia	- 2-6 month old child with central cyanosis; - Expansion of the chest; - Rapid breathing; - Fingers in the form of “drumsticks”; changes on the radiograph in the absence auscultation disorders; - Increased size of the liver, spleen, and lymph nodes; - Positive HIV test in mother or child

Criteria for differential diagnosis of acute respiratory viral infectious diseases

Signs	Pandemic cue flu	Seasonal flu	TORSO	Parainfluenza	Respirator- but-syncytial- infection	Adenovirus- infection	Rhinovirus- infection
Pathogen	Influenza A virus (H5N1)	Influenza viruses: 3 serotypes (A, B, C)	Coronavirus of a new group	Parainfluenza viruses: 5 serotypes (1-5)	Respirator- but-syncytial- virus: 1 serotype	Adenoviruses: 49 serotypes (1-49)	Rhinoviruses: 114 serotypes (1-114)
Incubation ny period	1-7 days, average 3 days	From several hours to 1.5 days	2-7 days, sometimes up to 10 days	2-7 days, more often 3-4 days	3-6 days	4-14 days	23 days
Start	Acute	Acute	Acute	Gradual	Gradual	Gradual	Acute
Flow	Acute	Acute	Acute	Subacute	Subacute, sometimes protracted	Lingering, undulating new	Acute
Leading clinical syndrome	Intoxication- tion	Intoxication- tion	Respiratory failure ness	Catarrhal	Catarrhal, respiratory failure ness	Catarrhal	Catarrhal
Expressed intoxication tions	pronounced	pronounced	Strongly expressed	moderate	Moderate or absent	Moderate	Moderate or absent
Duration - intoxication tions	7-12 days	2-5 days	5-10 days	1-3 days	2-7 days	8-10 days	1-2 days
Body temperature	390C and above	More often 39 0 C and above, but there may be low-grade fever Naya	380C and above	37-38 0 C and above	Subfebrile- Naya, sometimes normal	Febrile or subfebrile Naya	Normal or low-grade fever Naya
Catarrhal manifestations	None	Moderately expressed, attached- come later	Moderately expressed, weak exudation	Expressed from the first day of the disease. Hoarseness of voice	Pronounced, gradually increasing	Strongly expressed from the first day of the disease	Expressed from the first day of the disease.
Rhinitis	Absent	Nose. Serous, mucous or sanguineous discharge in 50% of cases	Possible at the onset of the disease	Difficulty in nasal breathing, congestion nose	Laid- nasal congestion, light serous discharge	Copious mucous-serous discharge, severe difficulty in nasal breathing	Copious serous discharge, nasal breathing is difficult or absent
Cough	Expressed	Dry, painful, annoying, with pain behind the sternum, for 3 days. wet, up to 7-10 days. course of the disease	Dry, moderately expressed	Dry, barking can persist for a long time (sometimes up to 12-21 days)	Dry attack figurative (up to 3 weeks), accompanied by pain in the chest, asthmatic breathing in children under 2 years of age	Wet	Dry, sore throat
Changes in mucous membranes	None	The mucous membrane of the pharynx and tonsils is bluish, moderately hyperemic vana; vascular injection.	Mild or moderate hyperemia of the mucous membranes	Mild or moderate hyperemia of the pharynx, soft palate, and posterior pharyngeal wall		Moderate hyperemia, swelling, hyperplasia of the follicles of the tonsils and posterior pharyngeal wall	Weak hyperemia of the mucous membranes
Physical Signs of lung damage	From 2-3 days of the disease	Absent, in the presence of bronchitis - dry scattered wheezing	From the 3rd to 5th day of the disease, signs of interstitial al pneumonia	None	Scattered dry and rarely wet medium bubbles wheezing, signs of pneumonia	None. In the presence of bronchitis - dry, scattered wheezing.	None
Leading respiratory syndrome ny lesions	Lower respirator- ny syndrome	Tracheitis	Bronchitis, acute respirator ny distress syndrome	Laryngitis, false croup	Bronchitis, bronchiolitis, possible bronchospasm	Rinofarin- goconjuncti- vit or tonsillitis	Rhinitis
Increased lymphatic some nodes	Absent	Absent	Absent	Rear- ny, less often - axillary - lymphatic Some lymph nodes are enlarged and moderately painful new	Absent	May be polyadenitis	Absent
Enlarged liver and spleen	Maybe	Absent	Reveal	Absent	Absent	Expressed	Absent
Eye damage	Absent	Scleral vascular injection	Rarely	Absent	Absent	Conjuncti- vit, kerato- conjuncti- vit	Injection of scleral vessels,
Damage to other organs	Diarrhea, possible damage to the liver, kidneys, leuko-, lympho-, thrombocytes drowning	Absent	Diarrhea often develops at the onset of the disease	Absent	Absent	There may be exanthema, sometimes diarrhea	Absent

Examples of diagnosis formulation:

J11.0. Influenza, a typical, toxic form with severe hemorrhagic syndrome. Complication: neurotoxicosis 1st degree.
J06 ARVI, mild severity.
J04 ARVI. Acute laryngitis and tracheitis, moderate severity.

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Treatment

Treatment Goals : relief of intoxication, catarrhal syndrome and seizures.

Treatment tactics

From 0 to 5 years - treatmentaccording to the order of the Ministry of Health of the Republic of Kazakhstan forNo. 172 dated March 31, 2011

Non-drug treatment:
In primary care and hospital settings:
- bed rest for the period of fever, followed by expansion as the symptoms of intoxication subside;
- diet - easily digestible food and plenty of drink.

Drug treatment

Treatment of influenza in primary care settings:

Antiviral drugs
- remantadine -

- arbidol

Treatment of ARVI in primary care settings(prescribe in the first 2-3 days from the onset of the disease):

Antiviral drugs:
- 0.25% oxolinic ointment - lubrication of the nasal passages from the first days of the disease.

Interferon and inducers of interferon synthesis (prescribe in the first 2-3 days from the onset of the disease):
- Interferon recombinant alpha-2b (Viferon) rectal suppositories 150,000 IU (up to one year), 500,000 IU (from one year to 3 years), 1,000,000 IU (over 3 years), 1 suppository 2 times a day every day. The course of treatment is 10 days;
- arbidol children over 12 years of age are prescribed 200 mg, children from 6 to 12 years old, 100 mg 3 times a day for 5 days;

To soften a dry cough - expectorants (ambroxol); (Children under 5 years of age are not prescribed expectorants)

At a high temperature of more than 38.5 degrees, once - paracetamol 10-15 mg/kg;

Antibiotics should not be prescribed to children with ARVI and acute bronchitis; laryngotracheitis; they are effective only in treating a bacterial infection. Cough suppressants should not be prescribed;

Do not prescribe medications containing atropine, codeine and its derivatives, or alcohol (they may be dangerous to the child’s health);

Do not use medicinal nasal drops;

Do not use medications containing aspirin.

Treatment in an infectious diseases hospital

Treatment of influenza in a hospital setting

Antiviral drugs (prescribe in the first 2-3 days from the onset of the disease, one of the following):
-zanamivir (powder for inhalation, dosed 5 mg/dose) When treating influenza A and B, children over 5 years of age are recommended to be prescribed 2 inhalations (2x5 mg) 2 times a day for 5 days. Daily dose - 20 mg;
-Oseltamivir - children over 12 years of age are prescribed 75 mg 2 times a day orally for 5 days. Increasing the dose to more than 150 mg/day does not increase the effect.
Children over 40 kg or over 8 years old, who are able to swallow capsules can also be treated by taking one 75 mg capsule twice daily, as an alternative to the recommended dose of Tamiflu suspension (see below).
Children over 1 year old a suspension is recommended for oral administration for 5 days:
children weighing less15 kg prescribed 30 mg 2 times a day;
children weighing 15-23kg- 45 mg 2 times a day;
children weighing 23-40 kg - 60 mg 2 times a day;
children over 40 kg - 75 mg 2 times a day.
daily dose 150 mg (75 mg twice a day) for 5 days.
- remantadine - children over 10 years of age are prescribed 100 mg 2 times a day for 5 days, children 1-9 years old 5 mg/kg per day in two doses;
- 0.25% oxolinic ointment - lubrication of the nasal passages from the first days of the disease.

Interferon and inducers of interferon synthesis (prescribe in the first 2-3 days from the onset of the disease):
- Interferon recombinant alpha-2b rectal suppositories 1,000,000 IU (over 3 years) 1 suppository 2 times a day daily. The course of treatment is 10 days;
- arbidol children over 12 years of age are prescribed 200 mg, children from 6 to 12 years old, 100 mg 3 times a day for 5 days;

Treatment of ARVI in a hospital setting(prescribe in the first 2-3 days from the onset of the disease):

Interferon and inducers of interferon synthesis (prescribe in the first 2-3 days from the onset of the disease):
- Interferon recombinant alpha-2b rectal suppositories 150,000 IU (up to one year), 500,000 IU (from one year to 3 years), 1,000,000 IU (over 3 years), 1 suppository 2 times a day every day. The course of treatment is 10 days;
- arbidol children over 12 years of age are prescribed 200 mg, children from 6 to 12 years old, 100 mg 3 times a day for 5 days;

Pathogenetic and symptomatic treatment - according to indications:
- detoxification therapy: for mild and moderate severity of the process, patients are prescribed plenty of fluids in the form of fruit and vegetable juices, fruit drinks, and drinking water. In severe cases and in cases where it is not possible to stop the effects of intoxication orally, the use of infusion therapy at the rate of 30-50 ml/kg/day is required. For this purpose, crystalloids (saline solution, acesol, lactosol, di- and trisol, etc.) and colloids (reopolyglucin, solutions of hydroxyethyl starch, gelatin) are used.
- antipyretic drugs;

Children under 5 years of age are not prescribed:
- vasoconstrictor nasal drops and sprays;
- antitussives and expectorants;
- medications containing atropine, codeine and its derivatives or alcohol (may be dangerous to the child’s health);
- medical drops in the nose;
- aspirin-containing drugs.

With the development of bacterial complications in patients with moderate and severe forms of influenza, antibacterial therapy is prescribed including semisynthetic penicillins, cephalosporins of the second and fourth generation, carbapenems, macrolides and azalides; in case of a high probability of staphylococcal etiology of complications, vancomycin is the antibiotic of choice;

For seizures:
- anticonvulsants: diazepam, GHB, convulex, droperidol, phenobarbital.

For neurotoxicosis:
- dehydration therapy: beckons, lasix, diacarb;
- Oxygen therapy first (mask), low-speed supply - up to 2 months - 0.5-1 liters per minute, older and up to 5 years - 1-2 liters per minute.

For asthmatic breathing: salbutamol inhalation.

For laryngeal stenosis: inhalation of alkaline water.

List of essential medications:
Antiviral drugs:
1. Oseltamivir capsules 75 mg, powder for oral suspension 12 mg/ml (level B).
2. Zanamivir powder for inhalation, dosed 5 mg/1 dose: rotadiscs 4 doses (5 pieces in a set with diskhaler) (level B).
3. Remantadine 100 mg, tablets;

4.Non-steroidal anti-inflammatory drugs:
- Paracetamol 200 mg, 500 mg, tablet, 2.4% suspension for oral administration in bottles of 70, 100, 300 ml

List of additional medications:
1. Mucolytic drugs:
Ambroxol 30 mg, tab. , 0.3% syrup in bottles of 100, 120, 250 ml and 0.6% - 120 ml; 0.75% for inhalation and oral administration in bottles of 40 and 100 ml.

Interferon and inducers of interferon synthesis:
1. Recombinant alpha-2 interferon rectal suppositories 150,000 IU, 500,000 IU, 1,000,000 IU.
2. Arbidol for children over 12 years old is prescribed 200 mg, for children from 6 to 12 years old 100 mg 3 times a day for 5 days;

Detoxification drugs:
1. Glucose solution for infusion 5%, 10%.
2. Sodium chloride 0.9% solution for infusion.
3. ringer's solution
4. Hydroxyethyl starch (refortan, stabizol) solutions for infusions 6%, 10%.
5. rheopolyglucin solution

For complications (pneumonia):
1. amoxicillin 500 mg, tablet, oral suspension 250 mg/5 ml;
2. amoxicillin + clavulanic acid, film-coated tablets 500 mg/125 mg, 875 mg/125 mg;
3. cefotaxime - powder for the preparation of solution for injection in bottles of 0.5, 1.0 or 2.0 g;
4. ceftazidime - powder for the preparation of solution for injection in bottles of 0.5, 1.0 or 2.0 g;
5. imipinem + cilastatin - powder for the preparation of solution for infusion 500 mg/500 mg; powder for the preparation of solution for intramuscular injection in bottles 500 mg/500 mg;
6. cefepime - powder for the preparation of a solution for injection 500 mg, 1000 mg, powder for the preparation of a solution for intramuscular injection in a bottle complete with a solvent (lidocaine hydrochloride 1% solution for injection in an ampoule of 3.5 ml) 500 mg, 1000 mg;
7. ceftriaxone - powder for the preparation of solution for injection 0.25 g, 0.5 g, 1 g, 2 g; powder for preparing solution for injection complete with solvent (water for injection in 10 ml ampoules) 1000 mg;
8. Azithromycin - capsules 0.25 g; tablets of 0.125 g and 0.5 g; syrup 100 mg/5 ml and 200 mg/5 ml; powder for preparing a suspension.

For seizures:
- diazepam 0.5% solution 2 ml, GHB 20% solution 5 and 10 ml, phenobarbital powder, tablets 0.005; tablets of 0.05 and 0.01
- Dehydration therapy: beckons 15% - 200 and 400 ml, 20% solution - 500 ml, Lasix 1% - 2ml, Diacarb tablets 0.25 each.

For asthmatic breathing:
- salbutamol.

Other treatments: No.

Surgical intervention: No.

Preventive actions:
Seasonal vaccination against influenza virus (level A) .

Anti-epidemic measures:
- isolation of patients,
- ventilation of the room where the patient is located,
- wet cleaning using 0.5% chloramine solution,
- in medical institutions, pharmacies, shops and other service enterprises, staff must work in masks,
- in the wards of medical institutions, doctors' offices and corridors of clinics, it is necessary to systematically turn on ultraviolet lamps and provide ventilation; for patients in clinics, isolated compartments with a separate entrance from the street and a wardrobe are organized.
- use of ascorbic acid, multivitamins (Level C) , natural phytoncides (Level C).

Further conduct, principles medical examination
If cough continues for more than 1 month or fever for 7 days or more, conduct additional testing to identify other possible causes (tuberculosis, asthma, whooping cough, foreign body, HIV, bronchiectasis, lung abscess, etc.).

Indicators efficiency treatment:
- normalization of body temperature;
- disappearance of intoxication (restoration of appetite, improvement of well-being);
- relief of asthmatic breathing;
- disappearance of cough;
- relief of symptoms of complications (if any).

Hospitalization

Indications for hospitalization:
Emergency hospitalization: to the infectious diseases hospital - during the period of epidemic rise in incidence up to 5 days from the onset of the disease; to specialized hospitals(depending on complications) - after 5 days from the onset of the disease:
- availability of general education in children under 5 years of age according to IMCI
- patients with severe and complicated forms of influenza and ARVI;
- patients with severe concomitant pathology, regardless of the severity of influenza and ARVI;
- children with laryngeal stenosis of II-IV degree;
- children of the first year of life;
-children from closed institutions and from families with unfavorable social and living conditions.

Information

Sources and literature

1. Minutes of meetings of the Expert Commission on Health Development of the Ministry of Health of the Republic of Kazakhstan, 2013
   1. 1. Efficacy and tolerance of ambroxol hydrochloride liquids in sore throat. Randomised, double-blind, placebo-controlled trials regarding the local anesthetic properties.. 2001 Jan 22;161(2):212-7. 2. Zanamivir for the treatment of influenza A and B infection in high-risk patients: a pooled analysis of randomized controlled trials. 2010 Oct 15;51(8):887-94. 3. Early oseltamivir treatment of influenza in children 1-3 years of age: a randomized controlled trial. University of Turku, Turku, Finland. 4. Fahey T, Stocks N, Thomas T. Systematic review of the treatment of upper respiratory tract infection. Archives of Diseases in Childhood 1998;79:225-230 5. The Database of Abstracts of Reviews of Effectiveness (University of York), Database no.:DARE-981666. In: The Cochrane Library, Issue 3, 2000. Oxford: Update Software 6. Institute for Clinical Systems Improvement (ICSI). Viral upper respiratory infection (VURI) in adults and children. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2004 May. 29 p. 7. HEALTHCARE GUIDELINE, Viral Upper Respiratory Infection in adults and children, 9th edition, may 2004, ICSI 8. Cough and cold remedies for the treatment of acute respiratory infections in young children, Department of child and adolescent health and development, world health organization , 2001 9. Management of a child with a serious infection or severe malnutrition. Guidelines for care in first-level hospitals in Kazakhstan. WHO, Ministry of Health of the Republic of Kazakhstan, 2003 10. Evidence-based medicine. Annual Quick Guide. Issue 3. Moscow, Media Sphere, 2004. 11. Clinical recommendations for practicing doctors based on Evidence-based medicine: Translated from English / Ed. Yu.L. Shevchenko, I.N. Denisova, V.I. Kulakova, R.M. Khaitov.- 2nd ed., revised. – M.: GEOTAR-MED, 2003. – 1248 p.

Information

III. ORGANIZATIONAL ASPECTS OF PROTOCOL IMPLEMENTATION

List of developers:
1. Kuttykozhanova G.G. - Doctor of Medical Sciences, Professor, Head of the Department of Children's Infectious Diseases of KAZ NMU named after. Asfendiyarov.
2. Efendiev I.M. - Candidate of Medical Sciences, Associate Professor, Head of the Department of Children's Infectious Diseases and Phthisiology of Semey State Medical University.
3. Atkenov S. B. - Candidate of Medical Sciences, Associate Professor, Department of Children's Infectious Diseases of JSC "Astana Medical University"

Reviewers:
1. Baesheva D.A. - Doctor of Medical Sciences, Head of the Department of Children's Infectious Diseases of Astana Medical University JSC.
2. Kosherova B.N. - Vice-Rector for Clinical Work and Continuous Professional Development, Doctor of Medical Sciences, Professor of Infectious Diseases of KarSMU.

Indication of no conflict of interest: No.

Indication of the conditions for reviewing the protocol:
- changes in the regulatory framework of the Republic of Kazakhstan;
- revision of WHO clinical guidelines;
- availability of publications with new data obtained as a result of proven randomized studies.

Attached files

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Approved
Union of Pediatricians of Russia


Clinical guidelines
Acute respiratory viral
infection (ARVI) in children

ICD 10:
J00 / J02.9/ J04.0/ J04.1/J04.2/J06.0/J06.9
Year of approval (revision frequency):
2016 (
review every 3 years)
ID:
URL:
Professional associations:

Union of Pediatricians of Russia

Agreed
Scientific Council of the Ministry
Healthcare of the Russian Federation
__ __________201_

2
Table of contents
Keywords................................................ ........................................................ ...................... 3
List of abbreviations................................................... ........................................................ ................ 4 1. Brief information................................... ........................................................ ........................... 6 1.1 Definition................. ........................................................ ................................................... 6 1.2 Etiology and pathogenesis.................................................... ........................................................ ..... 6 1.3 Epidemiology.................................................. ........................................................ ..................... 6 1.4 Coding according to ICD-10 ....................... ........................................................ ........................ 7 1.5
Classification................................................. ........................................................ ................. 7 1.6 Examples of diagnoses.................................. ........................................................ ........................... 7 2.
Diagnostics................................................. ........................................................ ....................... 8 2.1 Complaints, anamnesis.................................. ........................................................ .................................... 8 2.2 Physical examination......... ........................................................ .................................. 9 2.3 Laboratory diagnostics............ ........................................................ ................................ 9 2.4
Instrumental diagnostics......................................................... .................................... 10 3. Treatment......... ........................................................ ........................................................ .................. 11 3.1 Conservative treatment................................. ........................................................ .................. 11 3.2 Surgical treatment.................................. ........................................................ ..................... 16 4. Rehabilitation................................. ........................................................ ........................................... 16 5. Prevention and clinical observation.. ........................................................ ..................... 16 6. Additional information affecting the course and outcome of the disease................................. 18 6.1 Complications.................................................... ........................................................ ................... 18 6.2 Managing children.................................... ........................................................ .................................... 18 6.3
Outcomes and prognosis......................................................... ........................................................ ......... 19
Criteria for assessing the quality of medical care.................................................................... ................... 20
Bibliography................................................ ........................................................ ............... 21
Appendix A1. Composition of the working group................................................................... ............................... 25
Appendix A2. Methodology for developing clinical guidelines............................................. 26
Appendix A3. Related documents........................................................ ........................... 28
Appendix B. Patient management algorithms.................................................... ....................... 29
Appendix B: Information for Patients................................................... .......................... thirty
Appendix D. Explanation of notes.................................................... ........................... 33

3
Keywords

acute upper respiratory tract infection, unspecified;

acute respiratory infection;

acute infections of the upper respiratory tract of multiple and unspecified localization;

acute laryngitis and tracheitis;

acute laryngitis;

acute laryngotracheitis;

acute laryngopharyngitis;

acute nasopharyngitis (runny nose);

acute tracheitis;

acute pharyngitis, unspecified;

acute pharyngitis.

4
List of abbreviations

IL – interleukin
ARVI – acute respiratory viral infection

5
Terms and Definitions
The concept of “acute respiratory viral infection (ARVI)” summarizes the following nosological forms: acute nasopharyngitis, acute pharyngitis, acute laryngitis, acute tracheitis, acute laryngopharyngitis, acute upper respiratory tract infection, unspecified. New and narrowly focused professional terms are not used in these clinical guidelines.

6
1. Brief information
1.1
Definition
Acute respiratory viral infection (ARVI)– an acute, in most cases, self-limiting infection of the respiratory tract, manifested by catarrhal inflammation of the upper respiratory tract and occurring with fever, runny nose, sneezing, cough, sore throat, and disturbance of the general condition of varying severity.
1.2
Etiology and pathogenesis
The causative agents of respiratory tract diseases are viruses.
The spread of viruses occurs most often by self-inoculation onto the nasal mucosa or conjunctiva from hands contaminated by contact with a patient
Another route is airborne - when you inhale particles of an aerosol containing the virus, or when larger droplets get on the mucous membranes during close contact with a patient.
The incubation period of most viral diseases is from 2 to 7 days.
The release of viruses by patients is maximum on the 3rd day after infection, sharply decreases by the 5th day; low-intensity virus shedding can persist for up to 2 weeks.
Viral infections are characterized by the development of catarrhal inflammation.
Symptoms of ARVI are the result not so much of the damaging influence of the virus as of the reaction of the innate immune system. Affected epithelial cells release cytokines, incl. interleukin 8 (IL 8), the amount of which correlates with both the degree of attraction of phagocytes into the submucosal layer and epithelium, and the severity of symptoms. An increase in nasal secretion is associated with an increase in vascular permeability; the number of leukocytes in it can increase many times, changing its color from transparent to white-yellow or greenish, i.e. There is no reason to consider a change in the color of nasal mucus a sign of a bacterial infection.
The assumption is that with any viral infection the bacterial flora is activated (the so-called “viral-bacterial etiology
ARI" based, for example, on the presence of leukocytosis in the patient) is not confirmed by practice. Bacterial complications of ARVI occur relatively rarely.
1.3
Epidemiology

7
ARVI is the most common human infection: children under 5 years of age suffer, on average, 6-8 episodes of ARVI per year; in preschool institutions, the incidence is especially high in the 1st-2nd year of attendance - 10-15% higher than In disorganized children, however, the latter get sick more often at school. The incidence of acute upper respiratory tract infections can vary significantly from year to year. The incidence is highest between September and April, with the peak incidence occurring in February and March. A decline in the incidence of acute upper respiratory tract infections is invariably recorded in the summer months, when it decreases by 3-5 times. According to the Russian Ministry of Health and Rospotrebnadzor, in 2015 it amounted to 20.6 thousand cases of disease per 100 thousand people (versus 19.5 thousand per
100 thousand population in 2014). The absolute number of acute upper respiratory tract infections in the Russian Federation was 30.1 million cases in 2015.
Among children aged 0 to 14 years, the incidence of acute upper respiratory tract infections in 2014 was. amounted to 81.3 thousand. per 100 thousand or 19559.8 thousand registered cases.
1.4
Coding according to ICD-10
Acute nasopharyngitis (runny nose) (J00)
Acute pharyngitis (J02)
J02.9 -
Acute pharyngitis, unspecified
Acute laryngitis and tracheitis (J04)
J04.0 -
Acute laryngitis
J04.1 -
Acute tracheitis
J04.2 -
Acute laryngotracheitis
Acute upper respiratory tract infections, multiple and
unspecified location (J06)

J06.0 -
Acute laryngopharyngitis
J06.9 -
Acute upper respiratory tract infection, unspecified
1.5
Classification
Dividing ARVI (nasopharyngitis, pharyngitis, laryngotracheitis without laryngeal stenosis) according to severity is not advisable.
1
.6 Examples of diagnoses

Acute nasopharyngitis, acute conjunctivitis.

Acute laryngitis.
When the etiological role of the viral agent is confirmed, the diagnosis is clarified.

8
The term “ARVI” should be avoided as a diagnosis, using the terms
«
acute nasopharyngitis"or "acute laryngitis", or "acute pharyngitis", since the pathogens of ARVI also cause laryngitis (croup), tonsillitis, bronchitis, bronchiolitis, which should be indicated in the diagnosis. These syndromes are discussed in detail separately.
(See Clinical guidelines for the management of children with acute tonsillitis, acute bronchitis and stenosing laryngotracheitis).
2. Diagnostics
2.1
Complaints, anamnesis
The patient or parents (legal representatives) may complain about acute
emerging rhinitis and/or cough and/or conjunctival hyperemia (catarrhal
conjunctivitis) in combination with symptoms of rhinitis, pharyngitis.
The disease usually begins acutely and is often accompanied by increased
body temperature to low-grade levels (37.5°C-38.0°C). Febrile fever
more typical of influenza, adenovirus infection, enterovirus infections.
The elevated temperature in 82% of patients decreases on the 2-3rd day of illness; more
Fever lasts for a long time (up to 5-7 days) with influenza and adenovirus infection.
Increasing level of fever during the course of the disease, symptoms of bacterial
intoxication in a child should be alarming regarding the accession
bacterial infection. Repeated rise in temperature after a short period
improvement often occurs with the development of acute otitis media against the background
prolonged runny nose.
Nasopharyngitis is characterized by complaints of nasal congestion, discharge from
nasal passages, unpleasant sensations in the nasopharynx: burning, tingling, dryness,
often an accumulation of mucous discharge, which in children flows down the back wall
pharynx, may cause a productive cough.
When inflammation spreads to the mucous membrane of the auditory tubes
(
eustacheitis), clicking, noise and pain in the ears appear, and hearing may decrease.
Age-related features of the course of nasopharyngitis: in infants - fever,
discharge from the nasal passages, sometimes - restlessness, difficulty feeding and
falling asleep. In older children, typical manifestations are symptoms of rhinitis (peak
on the 3rd day, duration up to 6-7 days), in 1/3-1/2 patients - sneezing and/or coughing (peak in 1-
1st day, average duration - 6-8 days), less often - headache (20% on the 1st and 15% until the 4th
day).
The symptom that allows you to diagnose laryngitis is hoarseness

9
vote. There is no difficulty breathing or other signs of laryngeal stenosis.
With pharyngitis, there is hyperemia and swelling of the posterior wall of the pharynx, its
granularity caused by hyperplasia of lymphoid follicles. On the back of the throat
a small amount of mucus may be noticeable (catarrhal pharyngitis),
pharyngitis is also characterized by a nonproductive, often obsessive cough. This
the symptom causes extreme concern for parents and causes discomfort
child, as coughing can be very frequent. This cough is intractable
treatment
bronchodilators,
mucolytics,
inhalation
glucocorticosteroids.
Laryngitis and laryngotracheitis are characterized by a rough cough and hoarseness of voice. At
tracheitis cough can be obsessive, frequent, and debilitating for the patient. In contrast
from croup syndrome (obstructive laryngotracheitis), phenomena of laryngeal stenosis
noted, there is no respiratory failure.
On average, ARVI symptoms can last up to 10-14 days.
2.2 Physical examination
A general examination involves an assessment of general condition and physical development
child, counting breathing rate, heart rate, examining the upper
respiratory tract and pharynx, examination, palpation and percussion of the chest,
auscultation of the lungs, palpation of the abdomen.
2.3
Laboratory diagnostics
Examination of a patient with ARVI is aimed at identifying bacterial foci, not
determined by clinical methods.

Routine virological and/or bacteriological examination of all patients is not recommended, because this does not affect the choice of treatment, with the exception of a rapid test for influenza in highly febrile children and a rapid test for streptococcus in cases of suspected acute streptococcal tonsillitis.


Clinical urine analysis (including the use of test strips on an outpatient basis) is recommended for all febrile children without catarrhal symptoms.
(

Comments: 5-10% of infants and young children with urinary infection
pathways also have viral co-infection with clinical signs of ARVI.
However, urine examination in children with nasopharyngitis or laryngitis without

10
fever is carried out only if there are complaints or special recommendations in connection
with concomitant pathology of the urinary system.

A clinical blood test is recommended for severe general symptoms in children with fever.

Comments: Increased levels of bacterial inflammatory markers are
reason to search for a bacterial focus, first of all, “silent” pneumonia,
acute otitis media, urinary tract infections. Repeated
clinical blood and urine tests are necessary only if detected
deviations from the norm during the initial examination or the appearance of new
symptoms requiring diagnostic search. If the symptoms are viral
infections have stopped, the child has stopped having a fever and has good health
well-being,
repeated
study
clinical
analysis
blood
inappropriate.
Features of laboratory parameters in some viral infections
Leukopenia, characteristic of influenza and enteroviral infections, usually
absent in other ARVIs.
RS virus infection is characterized by lymphocytic leukocytosis, which
may exceed 15 x 10
9
/l.
With adenovirus infection, leukocytosis can reach a level of 15 – 20 x∙10
9
/l
and even higher, with possible neutrophilia of more than 10 x 10
9
/
l, increase
C-reactive protein level above 30 mg/l.

Determination of C-reactive protein levels is recommended to exclude severe bacterial infection in children with febrile fever.
(fever above 38ºС), especially in the absence of a visible source of infection.
(
Comments:Its increase above 30-40 mg/l is more typical for
bacterial infections (probability greater than 85%).
2.4
Instrumental diagnostics

It is recommended that all patients with ARVI symptoms undergo otoscopy.
(
Strength of recommendation 2; Level of evidence is C).
Comments: Otoscopy should be part of routine pediatric
examination of each patient, along with auscultation, percussion, etc.

11

Chest X-ray is not recommended for every child with ARVI symptoms
(
Strength of recommendation 1; Level of evidence is C).
Comments:
Indications for chest x-ray are:
-
the appearance of physical symptoms of pneumonia (see FKR on the management of pneumonia in
children)
-
decrease in SpO
2

less than 95% when breathing room air
-
the presence of pronounced symptoms of bacterial intoxication: the child is lethargic and
drowsy, inaccessible to eye contact, severe restlessness, refusal
from drinking, hyperesthesia
-
high level of markers of bacterial inflammation: increase in general
blood test leukocytes more than 15 x 10
9
/l in combination with neutrophilia more than 10 x
10
9
/l, C-reactive protein level above 30 mg/l in the absence of a lesion
bacterial infection.
It should be remembered that the detection of enhancement on a chest x-ray
bronchovascular pattern, expansion of the shadow of the roots of the lungs, increased
airiness is not enough to establish a diagnosis of pneumonia and is not
are an indication for antibiotic therapy.

X-ray of the paranasal sinuses is not recommended for patients with acute nasopharyngitis in the first 10-12 days of illness.
(Strength of recommendation: 2; Level of evidence: C).
Comments: X-rays of the paranasal sinuses in the early stages
diseases are often revealed by virus-induced inflammation of the paranasal sinuses
nose, which resolves spontaneously within 2 weeks.
3.
Treatment
3.1
Conservative treatment
ARVI is the most common reason for the use of various drugs and
procedures, most often unnecessary, with unproven effects, often causing
side effects. Therefore, it is very important to explain to parents the benign
the nature of the illness and indicate the expected duration of the existing
symptoms, and reassure them that minimal interventions are sufficient.

Etiotropic therapy is recommended for influenza A (including H1N1) and B in the first 24-48 hours of illness. Neuraminidase inhibitors are effective:
Oseltamivir ( ATX code: J05AH02) from the age of 1 year, 4 mg/kg/day, 5 days or

12
Zanamivir ( ATX code: J05AH01) children from 5 years old: 2 inhalations (total 10 mg) 2 times a day, 5 days.
(
Strength of recommendation 1; Level of evidence is A).
Comments: To achieve optimal effect, treatment should be
started when the first symptoms of the disease appear. Patients with bronchial
asthma when treated with zanamivir should be used as an emergency treatment
help with short-acting bronchodilators. For other viruses, not
containing neuraminidases, these drugs do not work. Evidence-based
base of antiviral effectiveness of other drugs in children
remains extremely limited.

Antiviral drugs with immunotropic effects do not have a significant clinical effect, and their use is not advisable.
(
Strength of recommendation 2; Level of evidence – A).
A comment: These drugs develop an unreliable effect.
It is possible to prescribe interferon-alpha no later than 1-2 days of illness
zh,vk

(ATC code:
L03AB05),
however, there is no reliable evidence of its effectiveness.
Comments: For acute respiratory viral infections, interferonogens are sometimes recommended, but
remember that children over 7 years of age have a febrile period when using them
is reduced by less than 1 day, i.e. their use in most acute respiratory viral infections with
a short febrile period is not justified. Research results
effectiveness of the use of immunomodulators for respiratory
infections, as a rule, show an unreliable effect. Drugs,
recommended for the treatment of more severe infections, such as viral
hepatitis, are not used for ARVI. For the treatment of acute respiratory viral infections in children
homeopathic remedies are recommended, since their effectiveness is not
proven.

The use of antibiotics for the treatment of uncomplicated acute respiratory viral infections and influenza, incl. if the disease is accompanied in the first 10-14 days of illness by rhinosinusitis, conjunctivitis, laryngitis, croup, bronchitis, broncho-obstructive syndrome.
(Strength of recommendation: 1; Level of evidence: A).
Comments:Antibacterial therapy in case of uncomplicated viral infection
infections not only does not prevent bacterial superinfection, but
contribute to its development due to the suppression of normal pneumotropic flora,
“restraining aggression” of staphylococci and intestinal flora. Antibiotics

13
may be indicated for children with chronic pathology affecting
bronchopulmonary system (for example, cystic fibrosis), immunodeficiency, in which
there is a risk of exacerbation of the bacterial process; Their choice of antibiotic is usually
predetermined by the nature of the flora.

It is recommended to carry out symptomatic (maintenance) therapy .
Adequate hydration helps liquefy secretions and facilitate their passage.
(Strength of recommendation: 2; Level of evidence: C).

It is recommended to carry out elimination therapy, since this therapy
effective and safe. Injecting saline into the nose 2-3 times a day removes mucus and restores the functioning of the ciliated epithelium.
(Strength of recommendation: 2; Level of evidence: C).
Comments:It is better to administer saline solution in a lying position
on the back with the head thrown back to irrigate the nasopharynx and adenoids. U
In young children with copious discharge, aspiration of mucus from the nose is effective
special manual suction followed by the introduction of physiological
solution. Positioning in a crib with the head end raised helps
discharge of mucus from the nose. In older children, saline sprays are justified.
isotonic solution.

It is recommended to prescribe vasoconstrictor nasal drops (decongestants) for a short course of no more than 5 days. These drugs do not shorten the duration of a runny nose, but can relieve symptoms of nasal congestion and also restore the function of the auditory tube. In children 0-6 years old, phenylephrine is used ( ATX code:
R01AB01
) 0.125%, oxymetazoline ( ATX code: R01AB07) 0.01-0.025%, xylometazoline w
ATX code: R01AB06) 0.05% (from 2 years), for older ones - more concentrated solutions.
(Strength of recommendation: 2; Level of evidence: C).
Comments:
Usage
systemic
drugs,
containing
decongestants (for example, pseudoephedrine) are highly undesirable, medicinal
Products in this group are permitted only from the age of 12 years.

To reduce the body temperature of a feverish child, it is recommended to uncover it and wipe it with water at a temperature of 25-30°C.
(Strength of recommendation: 2; Level of evidence: C).

In order to reduce body temperature in children, it is recommended to use only

14 two drugs - paracetamol w, vk
ATX code: N02BE01) up to 60 mg/kg/day or ibuprofen w/vk
ATX code: M01AE01) up to 30 mg/kg/day.
Strength of recommendation 1 (level of evidence: A)
Comments:Antipyretic drugs in healthy children ≥3 months
justified at temperatures above 39 - 39.5°C. For less severe fever
(38-
38.5°C) fever-reducing agents are indicated for children under 3 months of age,
patients with chronic pathology, as well as temperature-related
discomfort. Regular (course) intake of antipyretics is undesirable,
a repeat dose is administered only after a new increase in temperature.
Paracetamol and ibuprofen can be taken orally or rectally
suppositories, there is also paracetamol for intravenous administration.
Alternating these two antipyretics or using combined
drugs does not have significant advantages over monotherapy with one of the
these medicines.
It must be remembered that the most important problem during fever is timing
recognize a bacterial infection. Thus, the diagnosis of severe
bacterial infection is much more important than fighting a fever. Application
antipyretics
together
With
antibiotics
fraught
disguise
ineffectiveness of the latter.

In children, it is not recommended to use acetylsalicylic acid and nimesulide for antipyretic purposes.
(Strength of recommendation: 1; Level of evidence: C).

The use of metamizole in children is not recommended due to the high risk of developing agranulocytosis.
A comment: In many countries around the world, metamizole is already prohibited for use.
more than 50 years ago.
(
Strength of recommendation 1; Level of evidence reliability – C).

Nasal toilet is recommended as the most effective method of cough relief.
Because with nasopharyngitis, cough is most often caused by irritation of the larynx by flowing secretions.
(Strength of recommendation: 1; Level of evidence: B).

It is recommended to drink warm drinks or, after 6 years, use lozenges or lozenges containing antiseptics to eliminate cough with pharyngitis, which is associated with a “sore throat” due to inflammation of the mucous membrane of the pharynx or its drying out when breathing through the mouth.

15
(
Strength of recommendation 2; Level of evidence is C).

Antitussives, expectorants, mucolytics, including numerous patented drugs with various herbal remedies, are not recommended for use in acute respiratory viral infections due to ineffectiveness, which has been proven in randomized studies.
(
Strength of recommendation 2 Level of evidence: C).
Comments: For a dry, obsessive cough in a child with pharyngitis or
laryngotracheitis sometimes it is possible to achieve a good clinical effect with
the use of butamirate, however, the evidence base for its use
There are no antitussive drugs.

Steam and aerosol inhalations are not recommended for use, because have not shown any effect in randomized trials and are not recommended
World Health Organization (WHO) for the treatment of acute respiratory viral infections.
(
Strength of recommendation 2 Level of evidence – B).

1st generation antihistamines with atropine-like effects are not recommended for use in children: they have an unfavorable therapeutic profile, have pronounced sedative and anticholinergic side effects, and impair cognitive functions
(concentration, memory and learning ability). In randomized trials, drugs in this group did not show effectiveness in reducing the symptoms of rhinitis.
(Strength of recommendation: 2; Level of evidence: C).

It is not recommended for all children with ARVI to be prescribed ascorbic acid (vitamin
C) since it does not affect the course of the disease.
Must be hospitalized in a hospital:
- children under 3 months with febrile fever due to the high risk of developing a severe bacterial infection.
- children of any age with any of the following symptoms (key danger signs): inability to drink/breastfeed; drowsiness or lack of consciousness; respiratory rate less than 30 per minute or apnea; symptoms of respiratory distress; central cyanosis; symptoms of heart failure; severe dehydration.
- children with complex febrile seizures (lasting more than 15 minutes and/or repeating more than once within 24 hours) are hospitalized for the entire

16th period of fever.
- children with febrile fever and suspected severe bacterial infection (BUT there may also be hypothermia!), Having the following accompanying symptoms: lethargy, drowsiness; refusal to eat and drink; hemorrhagic skin rash; vomit.
- children with symptoms of respiratory failure who have any of the following symptoms: grunting breathing, flaring of the wings of the nose when breathing, nodding movements (head movements synchronized with inhalation); respiratory rate in a child under 2 months > 60 per minute, in a child aged 2-11 months > 50 per minute, in a child over 1 year > 40 per minute; indrawing of the lower chest when breathing; blood oxygen saturation The average duration of hospital stay can be 5-10 days, depending on the nosological form of the complication and the severity of the condition.
Hospitalization of children with nasopharyngitis, laryngitis, tracheobronchitis without
associated danger signs is inappropriate.
Febrile fever in the absence of other pathological symptoms in children older than 3 months is not an indication for hospitalization.
Children with simple febrile seizures (lasting up to 15 minutes, once a day), completed by the time they go to the hospital, do not need hospitalization, but the child should be examined by a doctor to exclude neuroinfection and other causes of seizures.
3.2
Surgery
Not required
4. Rehabilitation
Not required
5.
Prevention and follow-up

Preventive measures to prevent the spread of viruses are of primary importance: thorough hand washing after contact with a sick person.

It is also recommended o
wearing masks, o
cleaning surfaces around the patient, o
in medical institutions - compliance with the sanitary-epidemiological regime, appropriate processing of phonendoscopes, otoscopes, use of disposable

17 towels; o
in children's institutions - rapid isolation of sick children, compliance with the ventilation regime.

Prevention of most viral infections today remains nonspecific, since there are no vaccines against all respiratory viruses yet.
However, annual vaccination against influenza at the age of 6 months is recommended, which reduces the incidence.
(Strength of recommendation: 2; Level of evidence: B).
Comments:It has been proven that vaccinating children against influenza and pneumococcal
infection reduces the risk of developing acute otitis media in children, i.e.
reduces the likelihood of a complicated course of ARVI. When
contact of a child with a patient with influenza, as a preventive measure it is possible
use of neuraminidase inhibitors (oseltamivir, zanamivir) in
recommended age dosage.

In children of the first year of life from risk groups (prematurity, bronchopulmonary dysplasia palivizumab, the drug is administered intramuscularly at a dose of 15 mg/kg once a month from November to March.
(Strength of recommendation: 1; Level of evidence: A).

In children with hemodynamically significant congenital heart defects, passive immunization is recommended for the prevention of RS viral infection in the autumn-winter season palivizumab, the drug is administered intramuscularly in a dose
15 mg/kg monthly, once a month from November to March.
(Strength of recommendation: 2; Level of evidence: A)
A comment: see KR on providing medical care to children with bronchopulmonary
dysplasia, CD on immunoprophylaxis of respiratory syncytial virus
infections in children.

For children older than 6 months with recurrent infections of the ENT organs and respiratory tract, the use of systemic bacterial lysates is recommended (code ATC
J07AX; ATX code L03A; ATC code L03AX) These drugs are likely to reduce the incidence of respiratory infections, although the evidence base is weak.
(Strength of recommendation: 2; Level of evidence: C)

The use of immunomodulators for the purpose of prevention is not recommended

18 acute respiratory viral infections, because There is no reliable evidence of a decrease in respiratory morbidity under the influence of various immunomodulators.
The preventive effectiveness of herbal preparations and vitamin C, homeopathic preparations has also not been proven.
(
Strength of recommendation 1; level of evidence reliability – B)
6.
Additional information affecting the course and outcome of the disease
6.1 Complications
Complications of ARVI are observed infrequently and are associated with the accession
bacterial infection.

There is a risk of developing acute otitis media due to the course of
nasopharyngitis, especially in young children, usually on the 2-5th day
diseases. Its frequency can reach 20 - 40%, but not everyone
purulent otitis occurs, requiring antibiotic therapy
.

Persistence of nasal congestion for longer than 10-14 days, worsening of the condition
after the first week of illness, the appearance of pain in the face may indicate
development of bacterial sinusitis.

Against the background of influenza, the frequency of viral and bacterial (most often
caused by Streptococcus pneumoniae) pneumonia can reach 12%
children sick with viral infection.

Bacteremia complicates the course of ARVI in an average of 1% of cases with MS-
viral infection and in 6.5% of cases with enteroviral infections.

In addition, a respiratory infection may be a trigger
exacerbation of chronic diseases, most often bronchial asthma and infections
urinary tract.
6.2
Leading children
A child with ARVI is usually observed in an outpatient setting
pediatrician.
General or semi-bed mode with a quick transition to general mode after
temperature reduction. Re-inspection is necessary if the temperature persists
more than 3 days or worsening condition.
Inpatient treatment (hospitalization) is required if complications develop and
prolonged febrile fever.

19
6.3
Outcomes and prognosis
As stated above, ARVI, in the absence of bacterial complications, is transient,
although they may leave symptoms such as nasal discharge for 1-2 weeks
moves, cough. The opinion that repeated acute respiratory viral infections, especially frequent ones, are
manifestation or lead to the development of “secondary immunodeficiency” without reason.

20
Criteria for assessing the quality of medical care

Table 1.
Organizational and technical conditions for the provision of medical care.
Type of medical care
Specialized medical care
Terms of service
medical care
Inpatient / day hospital
Form of provision
medical care
Urgent
Table 2.
Criteria for the quality of medical care
No.
Quality criteria
The Power of Recommendation
Level of evidence
1.
A general (clinical) blood test was performed no later than 24 hours from the moment of admission to the hospital
2
C
2.
A general urine test was performed (if body temperature rises above 38
⁰С)
1
C
3.
A study of the level of C-reactive protein in the blood was performed (with an increase in body temperature above 38.0 C)
2
C
4.
Elimination therapy was carried out (rinsing the nasal cavity with saline solution or a sterile solution of sea water) (in the absence of medical contraindications)
2
C
5.
Treatment with local decongestants was performed
(vasoconstrictor nasal drops) in a short course from 48 to 72 hours (in the absence of medical contraindications)
2
C

21
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N.M., van der Heijden G.J. No evidence for distinguishing bacterial from viral acute rhinosinusitis using symptom duration and purulent rhinorrhea: a systematic review of the evidence base.
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10.1177/0194599814522595. Epub 2014 Feb 10.
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Wald E.R., Applegate K.E., Bordley C., Darrow D.H., Glode M.P. et al. American
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Smith M.J. Evidence for the diagnosis and treatment of acute uncomplicated sinusitis in children: a systematic review. Pediatrics. 2013 Jul;132(1):e284-96.
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4:CD008965.
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Response. WHO guidelines on the use of vaccines and antivirals during influenza pandemics.
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22 http://www.who.int/csr/resources/publications/influenza/WHO_CDS_CSR_RMD_2004_8/en/
Accessed February 18, 2015.
14.
A.A. Baranov (ed.). Guide to outpatient clinical pediatrics. M.
Geotar-Media. 2nd ed. 2009.
15.
Schaad U.B. OM-85 BV, an immunostimulant in pediatric recurrent respiratory tract infections: a systematic review. World J Pediatr. 2010 Feb;6(1):5-12. doi:10.1007/s12519-
010-0001-x. Epub 2010 Feb 9.
16.
Mathie RT, Frye J, Fisher P. Homeopathic Oscillococcinum® for preventing and treating influenza and influenza-like illness. Cochrane Database Syst Rev. 2015 Jan 28;1:CD001957. doi:
10.1002/14651858.CD001957.pub6.
17.
Kenealy T, Arroll B. Antibiotics for the common cold and acute purulent rhinitis.
Cochrane Database Syst Rev 2013; 6:CD000247 18.
Baranov A.A., Strachunsky L.S. (ed.) Use of antibiotics in children in outpatient practice. Practical recommendations, 2007 KMAH 2007; 9(3):200-210.
19.
Harris A.M., Hicks L.A., Qaseem A. Appropriate Antibiotic Use for Acute Respiratory
Tract Infection in Adults: Advice for High-Value Care From the American College of Physicians and the Centers for Disease Control and Prevention. Ann Intern Med. 2016; 164(6):425-34
(ISSN: 1539-3704)
20.
King D1, Mitchell B, Williams CP, Spurling GK. Saline nasal irrigation for acute upper respiratory tract infections. Cochrane Database Syst Rev. 2015 Apr 20;4:CD006821. doi:
10.1002/14651858.CD006821.pub3.
21.
Wong T1, Stang AS, Ganshorn H, Hartling L, Maconochie IK, Thomsen AM, Johnson
D.W. Cochrane in context: Combined and alternating paracetamol and ibuprofen therapy for febrile children. Evid Based Child Health. 2014 Sep;9(3):730-2. doi: 10.1002/ebch.1979.
22.
Smith SM, Schroeder K, Fahey T. Over-the-counter (OTC) medications for acute cough in children and adults in ambulatory settings. Cochrane Database Syst Rev 2012; 8:CD001831.
23.
Chalumeau M., Duijvestijn Y.C. Acetylcysteine ​​and carbocysteine ​​for acute upper and lower respiratory tract infections in pediatric patients without chronic broncho-pulmonary disease. Cochrane Database Syst Rev. 2013 May 31;5:CD003124. doi:
10.1002/14651858.CD003124.pub4.
24.
Singh M, Singh M. Heated, humidified air for the common cold. Cochrane Database System
Rev 2013; 6:CD001728.
25.
Little P, Moore M, Kelly J, et al. Ibuprofen, paracetamol, and steam for patients with respiratory tract infections in primary care: pragmatic randomized factorial trial. BMJ 2013;
347:f6041.

23 26.
De Sutter A.I., Saraswat A., van Driel M.L. Antihistamines for the common cold.
Cochrane Database Syst Rev. 2015 Nov 29;11:CD009345. doi:
10.1002/14651858.CD009345.pub2.
27.
Hemilä H, Chalker E. Vitamin C for preventing and treating the common cold. Cochrane
Database Syst Rev 2013; 1:CD000980 28.
Providing inpatient care to children. Guide to the treatment of the most common diseases in children: a pocket guide. – 2nd ed. – M.: World Health Organization, 2013. – 452 p.
29.
Prutsky G.J., Domecq J.P., Elraiyah T., Wang Z., Grohskopf L.A., Prokop L.J., Montori
V.M., Murad M.H. Influenza vaccines licensed in the United States in healthy children: a systematic review and network meta-analysis (Protocol). Syst Rev. 2012 Dec 29;1:65. doi:
10.1186/2046-4053-1-65.
30.
Fortanier A.C. et al. Pneumococcal conjugate vaccines for preventing otitis media.
Cochrane Database Syst Rev. 2014 Apr 2;4:CD001480.
31.
Norhayati M.N. et al. Influenza vaccines for preventing acute otitis media in infants and children. Cochrane Database Syst Rev. 2015 Mar 24;3:CD010089.
32.
Committee on infectious diseases and bronchiolitis guidelines committee: Updated
Guidance for Palivizumab Prophylaxis Among Infants and Young Children at Increased Risk of
Hospitalization for Respiratory Syncytial Virus Infection. Pediatrics 2014 Vol. 134 No. August 2
1, 2014 pp. e620-e638.
33.
Ralston S.L., Lieberthal A.S., Meissner H.C., Alverson B.K., Baley J.E., Gadomski A.M.,
Johnson D.W., Light M.J., Maraqa N.F., Mendonca E.A., Phelan K.J., Zorc J.J., Stanko-Lopp D.,
Brown M.A., Nathanson I., Rosenblum E., Sayles S. 3rd, Hernandez-Cancio S.; American
Academy of Pediatrics. Clinical Practice Guideline: The Diagnosis, Management, and
Prevention of Bronchiolitis Pediatrics Vol. 134 No. 5 November 1, 2014 e1474-e1502.
34.
Baranov A.A., Ivanov D.O. et al. Palivizumab: four seasons in Russia. Herald
Russian Academy of Medical Sciences. 2014: 7-8; 54-68 35.
Kearney S.C., Dziekiewicz M., Feleszko W. Immunoregulatory and immunostimulatory responses of bacterial lysates in respiratory infections and asthma. Ann Allergy Asthma
Immunol. 2015 May;114(5):364-9. doi: 10.1016/j.anai.2015.02.008. Epub 2015 Mar 6.
36.
Lissiman E, Bhasale AL, Cohen M. Garlic for the common cold. Cochrane Database System
Rev 2009; CD006206.
37.
Linde K, Barrett B, Wölkart K, et al. Echinacea for preventing and treating the common cold. Cochrane Database Syst Rev 2006; CD000530.
38.
Jiang L., Deng L., Wu T. Chinese medicinal herbs for influenza. Cochrane Database System

24
Rev. 2013 Mar 28;3:CD004559. doi: 10.1002/14651858.CD004559.pub4.
39.
Steinsbekk A., Bentzen N., Fønnebø V., Lewith G. Self treatment with one of three self selected, ultramolecular homeopathic medicines for the prevention of upper respiratory tract infections in children. A double-blind randomized placebo controlled trial. Br J Clin Pharmacol.
2005 Apr;59(4):447-55.

25
Appendix A1. Composition of the working group

Baranov A.A. acad. RAS, professor, doctor of medical sciences, Chairman of the Executive Committee of the Union of Pediatricians of Russia;

Lobzin Yu. V., acad. RAS, Professor, Doctor of Medical Sciences, President of the Euro-Asian Society for Infectious Diseases, Deputy Chairman of the National Scientific Society of Infectious Diseases

Namazova-Baranova L.S. acad. RAS, professor, doctor of medical sciences, deputy
Chairman of the Executive Committee of the Union of Pediatricians of Russia;

Tatochenko V.K. Doctor of Medical Sciences, Professor, Honored Scientist, expert
World Health Organization, member of the Union of Pediatricians of Russia;

Uskov A.N. Doctor of Medical Sciences, Professor

Kulichenko T.V. Doctor of Medical Sciences, Professor of the Russian Academy of Sciences, expert of the World Organization
Healthcare, member of the Union of Pediatricians of Russia;

Bakradze M.D. Doctor of Medical Sciences, member of the Union of Pediatricians of Russia;

Vishneva E.A.

Selimzyanova L.R. Candidate of Medical Sciences, member of the Union of Pediatricians of Russia;

Polyakova A.S. Candidate of Medical Sciences, member of the Union of Pediatricians of Russia;

Artemova I.V. junior researcher, member of the Union of Pediatricians of Russia.
The authors confirm that there is no financial support/conflict
interests that need to be made public.

26
Appendix A2. Methodology for developing clinical guidelines

Target audience of these clinical recommendations:

1.
Pediatricians;
2.
General practitioners (family doctors);
3.
Students of medical universities;
4.
Students in residency and internship.
Table 1.
Scheme for assessing the level of recommendations
Degree
reliability
recommendations
Risk-benefit ratio
Methodological quality of available evidence
Explanations for application of recommendations
1A
Strong
recommendation,
based
on
evidence
High Quality
Reliable, consistent evidence based on well-executed
RCTs or compelling evidence presented in some other form.
Further research is unlikely to change our confidence in the benefit-risk assessment.
A strong recommendation that can be used in most cases in the majority of patients without any modifications or exceptions
1B
Strong
recommendation,
based
on
evidence
moderate quality
The benefits clearly outweigh the risks and costs, or vice versa
Evidence based on the results of RCTs performed with some limitations (inconsistent results, methodological errors, indirect or random, etc.) or other compelling reasons.
Further research
(if carried out) are likely to influence and may change our confidence in the benefit-risk estimate.
A strong recommendation that can be applied in most cases
1C
Strong
recommendation,
based
on
evidence
Low quality
The benefits are likely to outweigh the potential risks and costs, or vice versa
Evidence based on observational studies, anecdotal clinical experience, results
RCTs performed with significant shortcomings.
Relatively strong recommendation, subject to change as higher quality evidence becomes available
2A
Weak
recommendation,
based
on
evidence
High Quality
The benefits are comparable to the possible risks and costs
Reliable evidence based on well-executed
RCT or supported by other compelling data.
Further research is unlikely to change our confidence in the benefit-risk assessment.
Weak recommendation.
The best strategy will depend on the clinical situation
(circumstances), patient or social preferences.
2B
Benefit
Proof,
Weak

27
Weak
recommendation,
based
on
evidence
moderate quality
comparable to the risks and complications, but there is uncertainty in this estimate. based on the results of RCTs performed with significant limitations (inconsistent results, methodological flaws, indirect or random), or strong evidence presented in some other form.
Further research
(if carried out) are likely to influence and may change our confidence in the benefit-risk estimate. recommendation.
An alternative strategy may be a better choice for some patients in certain situations.
2C
Weak
recommendation,
based
on
evidence
Low quality
Ambiguity in assessing the balance of benefits, risks and complications; the benefits may be weighed against the possible risks and complications.
Evidence based on observational studies, anecdotal clinical experience, or RCTs with significant limitations.
Any estimate of effect is considered uncertain.
Very weak recommendation; alternative approaches may be used equally.
*In the table, the numerical value corresponds to the strength of the recommendations, the letter value corresponds to the level of evidence.

These clinical recommendations will be updated at least as often as
than once every three years. The decision to upgrade will be made at
based on proposals submitted by medical professionals
non-profit organizations, taking into account the results of a comprehensive assessment
medicines, medical devices, as well as clinical results
testing.

28
Appendix A3. Related documents
Procedures for providing medical care:
1.
Order of the Ministry of Health and Social Development of the Russian Federation of April 16
2012 N 366n “On approval of the Procedure for the provision of pediatric care”;
2.
Order of the Ministry of Health and Social Development of the Russian Federation dated
05.05.2012 N 521n "On approval of the Procedure for providing medical care to children with infectious diseases"
Criteria for assessing the quality of medical care: Order of the Ministry of Health of Russia 520n dated
July 15, 2016 “On approval of criteria for assessing the quality of medical care”
Standards of medical care:
1.
Order of the Ministry of Health of the Russian Federation dated November 9, 2012 No. 798n Standard of specialized medical care for children with acute respiratory diseases of moderate severity
2.
Order of the Ministry of Health of the Russian Federation dated December 24, 2012
No. 1450n Standard of specialized medical care for children with severe acute respiratory diseases
3.
Order of the Ministry of Health of the Russian Federation dated December 28, 2012
No. 1654n Standard of primary health care for children with acute nasopharyngitis, laryngitis, tracheitis and acute mild upper respiratory tract infections

29
Appendix B. Patient management algorithms













NO




YES




NO






YES



NO






YES









Diagnostics (page 4)
Outpatient treatment
Specialist consultation
Treatment in hospital
There are indications for hospitalization
(p.10)?
Prevention of re-infection (page 8)
Therapy adjustment
Patient with ARVI symptoms
Is the diagnosis confirmed?
Is the therapy effective?

30
Appendix B: Patient Information
ARVI(acute respiratory viral infection) is the most common disease in children.
Cause of the disease- various viruses. The disease most often develops in autumn, winter and early spring.
How to become infected with the infection that causes ARVI: most often by contact with the nasal mucosa or conjunctiva from hands contaminated by contact with a patient
(for example, through a handshake) or with surfaces contaminated with the virus (the rhinovirus survives on them for up to a day).
Another route is airborne - when you inhale particles of saliva released when sneezing, coughing or in close contact with a patient.
The period from infection to the onset of illness: in most cases – from 2 to 7 days.
The release of viruses to patients (infectiousness to others) is maximum on the 3rd day after infection, sharply decreases by the 5th day; low-intensity virus shedding can persist for up to 2 weeks.
Signs of ARVI: The most common manifestation of ARVI in children is nasal congestion, as well as nasal discharge: transparent and/or white and/or yellow and/or green (the appearance of yellow or green nasal discharge is not a sign of a bacterial infection!). The increase in temperature often lasts no more than 3 days, then the body temperature decreases. With some infections (influenza and adenoviral infection), temperatures above 38ºC persist for a longer period (up to 5-7 days).
ARVI may also cause: sore throat, cough, red eyes, sneezing.
Examinations: in most cases, additional examinations for a child with
ARVI is not required
Treatment: ARVI, in most cases, is benign in nature, resolves within 10 days and does not always require medication.
Temperature reduction: a feverish child should be uncovered and wiped with water T°
25-
30°C. In order to reduce fever in children, it is permissible to use only 2 drugs - paracetamol or ibuprofen. Antipyretics drugs in healthy children ≥3 months are justified at temperatures above 39 - 39.5°C. For less severe fever (38-38.5°C), fever-reducing medications are indicated for children under 3 months of age, patients with chronic pathology, and for fever-related discomfort. Regular (course) intake of antipyretics is undesirable, repeated

31 doses are administered only after a new increase in temperature.
Alternating these two drugs or using them in combination does not lead to
enhancing the antipyretic effect.
In children, acetylsalicylic acid is not used for antipyretic purposes and
nimesulide. Extremely the use of metamizole is undesirable in children due to the high risk of developing agranulocytosis. In many countries around the world, metamizole has been banned for use for more than 50 years.

Antibiotics– do not act on viruses (the main cause of ARVI). The question of prescribing antibiotics is considered if a bacterial infection is suspected .
Antibiotics must be prescribed by a doctor. Uncontrolled use of antibiotics can contribute to the development of microbes resistant to them and cause complications.
How to prevent the development of ARVI:
A sick child should be left at home (not taken to kindergarten or school).
Measures to prevent the spread of viruses are of primary importance: thorough hand washing after contact with a sick person.
It is also important to wear masks, wash surfaces around the patient, and maintain proper ventilation.
Annual influenza vaccination starting at 6 months of age reduces the risk of this infection.
It has also been proven that vaccinating children against influenza and pneumococcal infection reduces the likelihood of developing acute otitis media in children and a complicated course of ARVI.
There is no reliable evidence of a decrease in respiratory morbidity under the influence of various immunomodulators. The preventive effectiveness of herbal preparations and vitamin C, homeopathic preparations has also not been proven.
Contact a specialist if:
- the child refuses to drink for a long time
- you see changes in behavior: irritability, unusual sleepiness with a decrease in response to attempts to contact the child
- the child has difficulty breathing, noisy breathing, increased breathing, retraction of the intercostal spaces, the jugular fossa (the place located in front between the neck and chest)
- the child has convulsions due to elevated temperature
- the child is delirious due to elevated temperature
- elevated body temperature (more than 38.4-38.5ºC) persists for more than 3 days
- nasal congestion persists without improvement for more than 10-14 days, especially if at the same time you see a “second wave” of increased body temperature and/or deterioration of the condition

32 children
- the child has ear pain and/or ear discharge
- the child has a cough that lasts more than 10-14 days without improvement

33
Appendix D. Explanation of notes

…
and
–
a medicinal product included in the List of vital and essential medicinal products for medical use for 2016
…
VC
–
a medicinal product included in the List of medicinal products for medical use, including medicinal products for medical use prescribed by decision of medical commissions of medical organizations
(Order of the Government of the Russian Federation dated December 26, 2015 N 2724-r)

Document Outline

• Keywords
• 2TList of abbreviations
• 1. Brief information
  • 2TU1.1 Definition
  • 2TU1.2 Etiology and pathogenesis
  • 2TU1.3 Epidemiology
• 1.4 Coding according to ICD-10
• 1.5 Classification
  • 2T12TU.6 Examples of diagnoses
• 2. Diagnostics
  • U2.1 Complaints, anamnesis
  • 2.2 Physical examination
  • U2.3 Laboratory diagnostics
  • U2.4 Instrumental diagnostics
• 3. Treatment
  • U3.1 Conservative treatment
  • U3.2 Surgical treatment
• 4. Rehabilitation
• 5. Prevention and clinical observation
• 6. Additional information affecting the course and outcome of the disease
  • 6.1 Complications
  • U6.2 Managing children
  • U6.3 Outcomes and prognosis
• Criteria for assessing the quality of medical care
• Bibliography
  • Appendix A1. Composition of the working group
  
  file -> Work program on normal physiology of the natural scientific cycle for the specialty 32.05.01 “medical and preventive care”

ARVI is a group of diseases that have similar clinical manifestations. They are characterized by damage to various parts of the respiratory tract with the obligatory presence of a number of respiratory (catarrhal) symptoms and an optional increase in temperature of varying severity (usually subfebrile). The viruses that cause these diseases have a tropism for the columnar epithelium of the respiratory tract and lead to cell degeneration, death, and desquamation. ARVIs include influenza, parainfluenza, adenovirus, respiratory syncytial, rhinovirus, enterovirus, and corona virus diseases. Diseases of this group are caused by viruses that contain DNA and are transmitted by airborne droplets and household contact.

ARVI belongs to class X (respiratory diseases J00-J99) (J00-J06) Acute respiratory infections of the upper respiratory tract (J09-18) Influenza and pneumonia (J20-J22) Other acute respiratory infections of the lower respiratory tract Formulation of the diagnosis An assessment of the nosology is given, severity of the disease, complications, background and concomitant diseases. Diagnosis of ICD Main Ds: Acute respiratory viral infection, nasopharyngitis. J00 Main Ds: ARVI: conjunctivitis, laryngotracheitis, bronchitis. J00 To make a diagnosis of “Flu”, a virological study is necessary: ​​isolate the influenza virus, and only then can a diagnosis be made. In outpatient settings during the epidemic period for influenza, all patients are diagnosed with “Influenza” based on clinical manifestations and epidemiological history data, and in inter-epidemic periods – “ARVI” with a mandatory indication of the clinical syndrome caused by the infection. Example: Basic Ds: Influenza A, moderate course.

Introduction of the pathogen into the epithelial cells of the respiratory tract and its reproduction, viremia with the development of toxicosis and toxic-allergic reactions, development of the inflammatory process in the respiratory system, reverse development of the infectious process, formation of immunity

Inflammation of the larynx with involvement of the vocal cords and subglottic space Dry barking cough Hoarseness of voice - inflammation of the larynx with involvement of the vocal cords and subglottic space Dry barking cough Hoarseness of voice Tracheitis - inflammation of the tracheal mucosa - inflammation of the tracheal mucosa Dry cough Dry cough Soreness behind the sternum Soreness behind the sternum Tracheitis - inflammation of the tracheal mucosa - inflammation of the tracheal mucosa Dry cough Dry cough Rawness behind the sternum Rawness behind the sternum Bronchitis - damage to the bronchi of various diameters Cough (initially dry, after a few days - wet, sputum is often mucous, from the 2nd week - mixed with greenery) Auscultation - scattered dry and medium- and coarse-bubbly moist rales in the lungs

Inflammation of the epiglottis with a characteristic severe breathing disorder High fever High fever Severe pain in the throat, especially when swallowing Severe pain in the throat, especially when swallowing Dysphagia Dysphagia Breathing disturbance up to stridor Breathing disturbance up to stridor

Nosological form Main syndrome Influenza Tracheitis Parainfluenza Laryngitis Adenoviral infection Tonsillopharyngitis, conjunctivitis, adenoviral pneumonia Rhinovirus infection Rhinitis Respiratory syncytial virus Bronchitis, bronchiolitis Coronaviruses Rhinopharyngitis, bronchitis Coronavirus SARS Bronchitis, bronchiolitis, ARDS

Incubation period from 12 to 48 hours, acute onset with chills, fever up to 39-40 ° C already on the first day of the disease and general symptoms of intoxication, intoxication syndrome is most pronounced on the 2-3rd day, characterized by: severe general weakness, feeling of weakness, headache in the frontal or frontotemporal regions, aching in the muscles, bones, joints, photophobia, lacrimation, pain in the eyeballs, sometimes abdominal pain, short-term vomiting and diarrhea, transient phenomena of meningism, signs of damage to the respiratory tract appear later (a few hours after the onset of symptoms of intoxication) characteristic manifestations of respiratory syndrome with influenza: nasal congestion or mild rhinorrhea, sore throat, painful dry cough, raw pain behind the sternum and along the trachea, hoarse voice after a few days, the cough becomes productive, with the release of mucous or mucopurulent sputum, catarrhal symptoms persist up to 5-7 days from the onset of the disease

Objectively: hyperemia of the face and neck, injection of scleral vessels, moist shine in the eyes, increased sweating, sometimes - herpetic rash on the lips and near the nose, bright diffuse hyperemia and granularity of the mucous membranes of the oropharynx; in most patients, complete recovery occurs after 7-10 days, general weakness and cough persist the longest In a number of patients, there is an exacerbation of concomitant somatic pathology (especially cardiopulmonary) or complications develop; the highest mortality rate is typical for persons over 65 years of age and patients of any age at risk.

Those who have had the flu are discharged after complete clinical recovery with normal results of blood and urine tests, but not earlier than 3 days after establishing normal body temperature. For a mild form of influenza, the duration of temporary disability should be at least 6 days, for a moderate form of influenza up to 8 and for a severe form at least 10–12 days. In the event of various complications, temporary release of patients from work is determined by the nature of the complications and their severity.

For persons who have had uncomplicated forms of influenza, dispensary observation is not established. Those who have suffered complicated forms of ARVI (pneumonia, sinusitis, otitis, mastoiditis, myocarditis, damage to the nervous system: meningitis, meningoencephalitis, toxic neuritis, etc.) are subject to medical examination for at least 3–6 months. For persons who have suffered a complication of influenza such as pneumonia, rehabilitation measures are carried out (in an outpatient clinic or sanatorium setting), and they are subject to mandatory medical examination for 1 year (with control clinical and laboratory examinations after 1, 3, 6 and 12 months after illness).

When deciding on hospitalization, one should take into account the severity of the condition, the likelihood of complications, as well as the possibility of organizing adequate care for the patient at home. Hospitalization should be considered first in patients aged 65 years or older, young children, and those with severe chronic illness. Age in itself is not an indication for hospitalization. Signs of a severe course of the disease, which are indications for hospitalization, are: respiratory failure; seizures (newly diagnosed) or neurological symptoms; hemorrhagic syndrome; dehydration requiring parenteral rehydration or other intravenous therapy; bronchiolitis in children under three months of age; decompensation of chronic diseases of the lungs and cardiovascular system. Hospitalization may be advisable if it is impossible to organize adequate care at home for a patient in moderate to severe condition with risk factors for complications (for example, lonely elderly people)

The main directions for the prevention of colds are: 1. hardening, a healthy lifestyle, carrying out hygienic measures, comfortable temperature conditions in the premises; regular ventilation; daily wet cleaning of premises using detergents. dress according to the weather; cover your mouth and nose when sneezing and coughing with a handkerchief (napkin), avoid touching your mouth, nose, and eyes. maintain “distance” when communicating, the distance between people when talking should be at least 1 meter (arm’s length distance) washing hands with soap before preparing food, eating it, and after coughing and blowing your nose; wearing a mask by a sick person; Use only personal hygiene products and cutlery. go to bed at the same time every night. This helps you fall asleep quickly and get proper rest;

2. specific immunization (vaccine prophylaxis) Influenza vaccines are updated annually. Vaccination is carried out with vaccines created against viruses that circulated in the previous winter, so its effectiveness depends on how close those viruses are to the present ones. It is known that with repeated vaccinations, the effectiveness increases, which is associated with the faster formation of specific antibodies in previously vaccinated people. 3 types of vaccines have been developed: Whole virion vaccines – vaccines that are a whole influenza virus (live or inactivated). Now these vaccines are practically not used, since they have a number of side effects and often cause disease. Split vaccines (begrivak, vaxigripp, fluarix) are split vaccines containing only part of the virus (surface proteins). They have significantly fewer side effects and are recommended for vaccination of adults. Subunit vaccines (Influvac, Agrippal, Grippol) are highly purified vaccines that contain only the surface antigens hemagglutinin and neuraminidase. Virtually no side effects. Can be used in children. It is necessary to get vaccinated before the outbreak of the epidemic; The vaccine is being developed exclusively against influenza viruses, therefore it will not be effective against other viruses that cause ARVI (due to this circumstance, it would be advisable to take prophylactic antiviral drugs in addition to vaccination); Vaccines have a number of contraindications for use and should only be administered to a healthy body. Before vaccination, consultation with a therapist is required!

3. use of immunomodulators Immunomodulators are substances of various natures, as well as physical effects, that stimulate immune processes and enhance the immune response. The main differences of this group are the effect on the body as a whole, and not on any part of the immune system separately, and a pronounced stimulating effect on nonspecific protective factors. Among over-the-counter drugs, there are several groups of immunomodulators: Preparations of bacterial origin: a) bacterial lysates, which include lysates of the most common bacteria inhabiting the upper respiratory tract. They combine the properties of vaccines and nonspecific immunostimulants, strengthening primarily local protective mechanisms (Bronchomunal, I PC-19, Imudon, Rib omunil) IRS -19 Pharmaceutical group: Immunostimulating drug based on bacterial lysates. Pharmaceutical action: IRS ®-19 increases specific and nonspecific immunity. When IRS ®-19 is sprayed, a fine aerosol is formed that covers the nasal mucosa, which leads to the rapid development of a local immune response. Specific protection is due to locally formed antibodies of the class of secretory immunoglobulins type A (IgA), which prevent the fixation and reproduction of infectious agents on the mucosa. Nonspecific immunoprotection manifests itself in an increase in the phagocytic activity of macrophages and an increase in the content of lysozyme. Indications: Prevention of chronic diseases of the upper respiratory tract and bronchi. Treatment of acute and chronic diseases of the upper respiratory tract and bronchi, such as rhinitis, sinusitis, laryngitis, pharyngitis, tonsillitis, tracheitis, bronchitis, etc. Restoration of local immunity after influenza or other viral infections. IRS ®-19 can be prescribed to both adults and children from 3 months of age. Contraindications: History of hypersensitivity to the drug or its components and autoimmune diseases. Dosing: intranasally by aerosol administration of 1 dose (1 dose = 1 short press of the spray).

Pharmacological action: Broncho-munal is an immunomodulator of bacterial origin for oral administration and stimulates the body's natural defense mechanisms against respiratory tract infections. It reduces the frequency and severity of these infections. The drug increases humoral and cellular immunity. Mechanism of action: stimulation of macrophages, increase in the number of circulating T - lymphocytes and antibodies lgA, lgG and lgM. The number of IgA antibodies increases, including on the mucous membranes of the respiratory tract. The bacterial lysate acts on the body's immune system through Peyer's patches in the mucous membrane of the digestive tract. Indications: For the prevention of infectious diseases of the respiratory tract, the drug is used in three ten-day courses with twenty-day intervals between them. In the acute period of the disease, it is recommended to take 1 capsule of Broncho-munal consecutively for at least 10 days. For the next 2 months, it is possible to use 1 capsule prophylactically for 10 days, maintaining a 20-day interval. Method of administration and dosage: Adults and children over 12 years of age are prescribed BRONCHO-MUNAL capsules 7.0 mg. Children from 6 months to 12 years are prescribed BRONCHO-MUNAL P. The drug is taken in the morning on an empty stomach. A single (daily) dose is one capsule.

B) probiotics Interferons and inducers of their synthesis of natural and synthetic origin (Cycloferon, Poludan, Amiksin, Lavomax, Neovir) Immunostimulants of plant origin (echinacea preparations, liana extract, cat's claw, etc.). They activate primarily nonspecific immunity: they stimulate the phagocytic activity of neutrophils and macrophages and the production of interleukins. They exhibit a wide range of associated types of biological activity. Marshmallow root, chamomile flowers, horsetail, walnut leaves, yarrow, rose hips, thyme, rosemary, etc. also help increase the body's defenses; Adaptogens. This group includes herbal (ginseng, Chinese lemongrass, Rhodiola rosea, aralia, eleutherococcus, etc.) and biogenic (mumiyo, propolis, etc.) preparations. They have a general tonic effect, increase the body’s adaptive reactions, contribute to the restoration and normalization of the immune system; Vitamins. Vitamins do not have immunotropic properties.

The scope of treatment measures is determined by the severity of the condition and the nature of the pathology. During the period of fever, bed rest must be observed. Traditionally, in the treatment of ARVI, symptomatic (plenty of warm drinks - at least 2 liters per day, it is optimal to drink a liquid rich in vitamin C: rosehip infusion, tea with lemon, fruit drinks, good nutrition), desensitizing [chloropyramine (suprastin), clemastine, cyproheptadine (Peritol)] and antipyretics (paracetamol preparations - Calpol, Panadol, Tylenol; ibuprofen) drugs. Acetylsalicylic acid is contraindicated for children (risk of developing Reye's syndrome).

Etiotropic therapy of ARVI For influenza, the effectiveness of 2 groups of drugs has been proven: 1) M channel blockers (rimantadine, amantadine). The antiviral effect is realized by blocking the ion channels (M2) of the virus, which is accompanied by a violation of its ability to penetrate cells and release ribonucleoprotein. This inhibits the stage of viral replication. It is better to start treatment on the first day of the disease and no later than 3 days! Remantadine is not recommended for children under 12 years of age, pregnant women, or people suffering from chronic liver and kidney diseases. Treatment lasts 3 days according to the following scheme: 1st day – 300 mg, 2nd and 3rd days 200 mg, 4th day – 100 mg. 2) 2) Neuraminidase inhibitors: Oseltamivir (Tamiflu) and zanamivir (Relenza). When neuroamindase is inhibited, the ability of viruses to penetrate healthy cells is impaired, their resistance to the protective effect of respiratory tract secretions is reduced, and thus the further spread of the virus in the body is inhibited. In addition, neuroaminidase inhibitors are able to reduce the production of pro-inflammatory cytokines - interleukin - 1 and tumor necrosis factor, thereby preventing the development of a local inflammatory reaction and weakening the systemic manifestations of influenza (fever, myalgia, etc.). You need to take oseltamivir 1-2 tablets 2 times a day. The advantage of oseltamivir is that it can be prescribed to children under 12 years of age. The course of treatment is 3–5 days. Applicable from 12 years of age.

Arbidol Russian antiviral chemotherapy drug. Available in tablets of 0.1 g and capsules of 0.05 g and 0.1 g. It is believed that the drug specifically suppresses influenza A and B viruses, and also stimulates the production of interferon and normalizes the immune system. It is used for the treatment and prevention of influenza caused by viruses A and B. The therapeutic effect is expressed in reducing the symptoms of influenza and the duration of the disease. Prevents the development of post-influenza complications, reduces the frequency of exacerbations of chronic diseases. Taken orally. Treatment scheme. Adults and children over 12 years of age: 0.2 g every 6 hours for 3-5 days; Arpetol is a Belarusian antiviral agent, has an immunomodulatory and anti-influenza effect, specifically suppresses viruses type A and B, severe acute respiratory syndrome. Generic arbidol.

ARVI - characterized by damage to various parts of the respiratory tract with the obligatory presence of a number of catarrhal symptoms and an optional increase in temperature of varying severity. It is transmitted by airborne droplets and contact through household contact. Pathogens: orthomyxoviruses, paramyxoviruses, coronaviruses, picornoviruses, reoviruses, adenoviruses. Catarrhal and intoxication syndromes predominate in the clinic. For a mild form of influenza, the duration of temporary disability should be at least 6 days, for a moderate form of influenza up to 8 and for a severe form at least 10–12 days. For persons who have had uncomplicated forms of influenza, dispensary observation is not established. Those who have suffered complicated forms of ARVI are subject to medical examination for at least 3–6 months. Treatment: symptomatic and etiotropic The main directions for the prevention of colds are: 1. hardening, healthy lifestyle, hygiene measures 2. specific immunization (vaccinal prophylaxis) 3. Preventive (planned) use of immunomodulators

ARI (acute respiratory disease) is a whole group of viral and bacterial infections. Their distinct feature is that they affect the upper respiratory tract. Often such diseases provoke epidemics that become widespread. To cope with the disease, you should consult a doctor.

Classification according to ICD-10

This term refers to a whole category of pathologies with general symptoms that have certain features:

• they are all infectious in nature;
• pathogens enter the body through airborne droplets;
• First of all, the organs of the respiratory system are affected;
• Such diseases develop rapidly and do not last long.

According to ICD-10, such pathologies are coded as follows: J00-J06. Acute respiratory infections of the upper respiratory tract.

And sore throats, you need to analyze the clinical picture. So, similar manifestations are characteristic, but the patient experiences pain when swallowing. Swelling in the neck area also often occurs. The temperature increases to 38-39 degrees and comes down with great difficulty.

Flu appears suddenly. The temperature can be 38.5 degrees. Sometimes it even reaches 40 degrees. This pathology is characterized by chills, cough, and body aches. Often there is severe sweating and nasal congestion without a runny nose. The eyes also become watery and red, and a nagging pain appears in the chest area.

Pathogens, incubation period

Acute respiratory infections can be the result of various viruses. In total, there are more than 200 types of viral infections. These include rhinoviruses, influenza, and coronaviruses. Adenoviruses and enteroviruses can also be causative agents of the disease.

In addition, acute respiratory infections can be associated with infection with such common microbes as meningococci, staphylococci, Haemophilus influenzae, and streptococci of various types. Sometimes the causes are chlamydia and mycoplasma.

The incubation period for acute respiratory infections usually lasts 1-5 days. It all depends on the age category and the state of the immune system. The higher the body's resistance, the longer this period. In a child, pathology develops much faster.

Features of acute respiratory infections symptoms and causes of the disease:

Causes and routes of infection, risk group

The pathogen enters the body through the upper respiratory tract, settles on the mucous membranes and multiplies. The disease leads to damage to the mucous membrane.

In this case, the primary manifestations of acute respiratory infections occur - swelling and inflammatory changes in the nose and pharynx. When the immune system is weakened, the pathogen quickly penetrates downwards, affecting the entire respiratory tract.

As a rule, after an illness, stable immunity is developed.

However, a large number of acute respiratory infections causes a person to become ill repeatedly. In this case, pathologies can have different degrees of severity.

The risk group includes people who face the following factors:

• hypothermia;
• the presence of chronic lesions in the body;
• stressful situations;
• unfavorable environmental conditions;
• poor nutrition.

Symptoms of acute respiratory infections

Characteristic manifestations of acute respiratory infections include the following:

• nasal congestion, rhinitis;
• sneezing;
• sore and sore throat;
• increase in temperature;
• cough;
• general intoxication of the body.

The main manifestations of the disease include respiratory symptoms, which indicate inflammation of the mucous membrane of the respiratory organs. All clinical signs are divided into two categories:

• respiratory tract damage;
• general intoxication of the body.

Inflammatory processes in the respiratory tract at different levels include the following:

• – is an inflammatory lesion of the nasal mucosa;
• – involves damage to the pharynx;
• – this term refers to damage to the larynx;
• - implies inflammation of the trachea.

Diagnostics

Most often, to identify acute respiratory infections, it is enough to study the medical history and general clinical symptoms. The doctor must be notified about when the temperature increased, how many days it lasts and what symptoms accompany this process.

If necessary, the specialist will prescribe additional examinations - for example, a general blood test. To identify the causative agent of the pathology, a culture of discharge from the nasopharynx is performed. A serological test may also be performed.

Express diagnostic methods include immunofluorescence and immunochromatographic procedures. Serological methods of research include reactions of indirect hemagglutination, complement fixation and hemagglutination inhibition.

What is the difference between acute respiratory infections and acute respiratory viral infections, says Dr. Komarovsky:

Treatment principle

This pathology should be treated under the supervision of a doctor. Even the mildest form of the disease can lead to dangerous complications. In difficult cases, the patient should be hospitalized in a hospital.

Typically, treatment for acute respiratory infections includes the following components:

1. Application. Most often, doctors prescribe drugs such as remantadine, oseltamivir, zanamavir.
2. Maintain strict bed rest.
3. Drink plenty of fluids. You can take decoctions of medicinal plants or rose hips. Regular tea will also work.
4. Reception.
5. Application. Such drugs should be taken only with a strong increase in temperature. Adult patients are usually prescribed tablets and injections. Children are recommended to take medications in the form of syrups.
6. Taking anti-inflammatory drugs.
7. Use of antihistamines.
8. Usage . This method of therapy is more suitable for adult patients, since children do not always know how to gargle correctly.
9. . This category includes products such as sprays and lozenges.
10. Introduction. It is also very useful to rinse the nose with saline solutions.
11. Reception.
12. Usage .

At home only with the permission of a doctor. It is very important to strictly follow the rules of therapy - this will help you quickly achieve results and avoid unpleasant complications.

Treatment errors, what not to do

Many people make common mistakes during treatment for acute respiratory infections. This leads to the development of dangerous complications. To avoid this, you need to follow these recommendations:

1. You should not use antipyretic drugs for a long time. This prevents the body from fighting the virus. In addition, there is a risk of masking the symptoms of dangerous complications - otitis media or pneumonia.
2. It is not recommended to start using antibiotics immediately. They do not act on a viral infection and can lead to a significant weakening of the immune system.
3. You should not eat if you have no appetite. This helps a person fight illness rather than waste energy on digesting food.
4. It is not recommended to carry the disease on your feet. Bed rest is one of the key conditions for a quick recovery. If this rule is violated, there is a risk of serious complications.

Complications

The most common complication of a viral infection is the addition of a bacterial one.

ARI can lead to the following consequences:

• otitis;
• sinusitis;
• myocarditis;
• tracheitis;
• pneumonia;
• neuritis;
• bronchitis.

In rare cases, there is a risk of developing more dangerous pathologies. These include viral encephalitis, liver disease, radiculoneuritis, pleural empyema.

How to cure acute respiratory infections and colds, watch our video:

Prevention

To prevent the development of acute respiratory infections, especially during pregnancy, you need to adhere to the following recommendations:

• quit smoking and alcohol;
• get flu vaccinations;
• take vitamins;
• eat foods with plenty of vitamins and beneficial elements;
• have a good rest;
• wear a mask during epidemics;
• take immunomodulators and antiviral drugs;
• Avoid contact with sick people.

Acute respiratory infections are a very common category of pathologies, which are accompanied by unpleasant symptoms and significantly reduce the quality of life. To cope with the disease, you should strictly follow medical recommendations and not suffer the disease on your feet. This will help avoid dangerous complications.

Acute respiratory infections of the upper respiratory tract have a large number of varieties. For ARVI, the ICD 10 code is designated J00-J06. To shorten the description of the disease and the complications caused by it, doctors use the abbreviations described in the international directory. This allows you to quickly find out all the necessary data about the patient’s illness.

Acute respiratory infections of the upper respiratory tract have a large number of varieties. Has ARVI ICD 10 code is designated as J00-J06. To shorten the description of the disease and the complications caused by it, doctors use the abbreviations described in the international directory. This allows you to quickly find out all the necessary data about the patient’s illness.

Source of disease

Since ARVI is entered into ICD 10 solely to designate the disease, the reference book does not provide the necessary information to patients and those wishing to know the characteristics of their illness. Almost every person suffered from respiratory diseases. They can manifest themselves in different ways, but in almost all cases caused by airborne infection. Although temperature does not cause illness, hypothermia contributes to its development.

How does the disease manifest itself?

In most cases, acute respiratory infections cause a runny nose, cough and fever. In some cases, the skin may develop:

• carbuncle;
• furunculosis;
• purulent abscesses and so on.

Abscesses and necrotic areas of the skin appear quite often and have their own ARI code according to ICD 10. Often, it is better not to touch abscesses that form on the skin, since they can spread through the blood. This will cause the formation of several abscesses.

It is also worth noting that children less than a year old are rarely exposed to acute respiratory infections, since they have immunity formed transplacentally.