Complex use of nonspecific and specific therapeutic agents. Medicines for the treatment of nonspecific lung diseases. What is prevention

The influence on the infectious agent is carried out using specific and nonspecific methods. Specific treatment methods include the use of drugs whose action is aimed at a single type of microorganism - therapeutic sera, immunoglobulins and gamma globulins, immune plasma, bacteriophages and therapeutic vaccine.

Healing serums contain antibodies to microorganisms (antimicrobial serums) or to bacterial toxins (antitoxic serums - antibotulinum, antigangrenous, antidiphtheria, antitetanus) and are produced from the blood of immunized animals. The blood serum of such animals serves as material for the production of specific gamma globulin preparations containing purified antibodies in high titers (anti-leptospirosis, anti-anthrax, anti-tetanus, anti-plague).

Specific immunoglobulins obtained from the blood of immunized donors or convalescents of infectious diseases (anti-rabies, anti-influenza, anti-diphtheria, anti-measles, anti-staphylococcal, anti-tetanus, anti-encephalitis). Homologous immune drugs have the advantages of circulating in the body for a long time (up to 1–2 months) and having no side effects. In some cases, blood plasma from immunized donors or convalescents is used (antimeningococcal, antistaphylococcal, etc.).

Bacteriophages . Currently, they are used mainly for intestinal infections as an additional treatment and on a limited scale.

Vaccine therapy . As a method of treating infectious diseases, it is aimed at specifically stimulating defense mechanisms. Typically, vaccines are used in the treatment of chronic and protracted forms of infectious diseases, in which the development of immune mechanisms during the natural course of infections is insufficient to free the body from the pathogen (chronic brucellosis, chronic toxaplasmosis, recurrent herpesvirus infection), and occasionally in acute infectious processes (with abdominal typhus, for the prevention of chronic convalescent bacterial carriage). Currently, vaccine therapy is inferior to more advanced and safe methods of immunotherapy.

Etiotropic treatment

Various families and groups of antibacterial drugs are used as etiotropic treatment. Indications for use antibiotics is the presence in the body of a pathogen that the body itself cannot cope with, or under the influence of which serious complications may develop.

The impact on the pathogen consists of prescribing various medications: not only antibiotics, but also chemotherapy drugs. This treatment aims to kill or inhibit the growth of pathogens. The existence of a large number of antibacterial drugs is due to the diversity of pathogenic bacteria.

Any antibacterial drug is used to some extent forcibly, sometimes for health reasons. The main thing we expect from prescribing a medicine is its effect on the pathogen. However, any chemotherapy drug or antibiotic is not always safe for the human body. Hence the conclusion - the antibacterial drug should be prescribed strictly according to indications.

Antibiotics By The mechanism of action is divided into three groups - inhibitors of microorganism cell wall synthesis; inhibitors of microbial nucleic acid and protein synthesis: drugs that disrupt the molecular structure and function of cell membranes. Based on the type of interaction with microbial cells, they are distinguished bactericidal And bacteriostatic antibiotics.

Based on their chemical structure, antibiotics are divided into several groups: aminoglycosides(gentamicin, kanamycin, etc.), ansamacrolides(rifamycin, rifampicin, etc.), betalactams(penicillins, cephalosporins, etc.). macrolides(oleandomycin, erythromycin, etc.), polyenes(amphotericin B, nystatin, etc.), polymyxins(polymyxin M, etc.), tetracyclines(doxycycline, tetracycline, etc.), fusidine, chloramphenicol(chloramphenicol), etc.

Along with natural medicines, synthetic and semi-synthetic drugs of the 3rd and 4th generations , having a high antimicrobial effect, resistance to acids and enzymes. Depending on the spectrum of antimicrobial action of antibiotics, a number of groups of drugs are distinguished:

- antibiotics effective against gram-positive and gram-negative cocci (meningococci, streptococci, staphylococci, gonococci) and some gram-positive bacteria (corynobacteria, clostridia) - benzylpenicillin, bicillin, oxacillin, methicillin, first generation cephalosporins, macrolides, lincomycin, vancomycin and others;

- broad spectrum antibiotics for gram-positive and gram-negative bacilli - semisynthetic penicillins (ampicillin, etc.), chloramphenicol, tetracyclines, cephalosporins of the second generation; antibiotics with predominant activity against gram-negative bacilli - polymyxins, third generation cephalosporins;

- anti-tuberculosis antibiotics- streptomycin, rifampicin and others;

- antifungal antibiotics- levorin, nystatin, amphotericin B, acoptil, defflucan, ketoconazole, etc.

Despite the development of new highly effective antibiotics, their use is not always sufficient to cure patients, therefore, at present, chemotherapy drugs of various groups - derivatives of nitrofurans, 8-hydroxyquinoline and quinolone, sulfonamides and sulfones, etc. - have remained relevant.

Nitrofuran drugs (furazolidone, furadonin, furagin, furatsilin, etc.) have a broad antibacterial and antiprotozoal effect, the ability to penetrate intracellularly, they have found use in the treatment of many infectious diseases of the intestines and urinary tract and as a local antiseptic.

8-hydroxyquinoline derivatives (mexase, mexaform, chlorquinaldone, 5-NOC and nalidixic acid) are effective against many bacterial, protozoal and fungal pathogens of intestinal and urogenital diseases.

Quinolone derivatives , namely, fluoroquinolones (lomefloxacin, norfloxacin, ofloxacin, pefloxacin, ciprofloxacin, etc.) currently occupy one of the leading places among antibacterial drugs due to their high antimicrobial effect against many gram-positive and gram-negative aerobic and anaerobic bacteria and some protozoa, in including intracellular localization, as well as due to their low toxicity and the slow formation of drug resistance to them in microorganisms.

Sulfanilamide (sulgin, sulfadimezin, sulfadimethoxine, sulfapyridazine, phthalazole, etc.) and sulfone drugs(diaphenylsulfone, or dapsone, etc.) are used to treat a wide range of diseases of the intestines, respiratory, urinary and other systems caused by gram-positive and gram-negative bacteria or protozoa. However, the use of this group of drugs is limited due to the frequent occurrence of various complications. New generation drugs - combinations of sulfonamides and trimethoprim - cotrimoxazoles (Bactrim, Biseptol, Groseptol, Septrim, etc.) have a high antibacterial effect and fewer side effects, which can be used alone or in combination with other antibacterial agents.

Antiviral drugs , the arsenal of which is rapidly being replenished with new and highly effective agents, belong to different chemical groups and affect different stages of the life cycle of viruses. In clinical practice, the most widely used chemotherapy drugs are for the treatment of influenza (amantadine, arbidol, remantadine, etc.), herpes infections (acyclovir, valaciclovir, ganciclovir, polyrem, etc.), viral hepatitis B and C (lamivudine, ribavirin, rebetol , pegintron, etc.), HIV infections (azidothymidine, zidovudine, nevirapine, saquinavir, epivir, etc.). Modern therapy for viral infections includes the use of interferons (leukocyte human interferon, recombinant drugs - intron A, reaferon, roferon, realdiron, etc.), which have both an antiviral and a pronounced immunomodulatory effect.

The therapeutic effect depends on the rational combination of drugs of various groups that have a combined effect, on the method and correct mode of administration of the drug, ensuring its maximum concentration in the area of ​​the pathological process, on the pharmacokinetic and pharmacodynamic characteristics of the drugs used and the functional state of the body systems involved in the metabolism of the drugs used .

The activity of antibacterial drugs may significantly depend on the type of their interaction with other medications (for example, a decrease in the effectiveness of tetracycline under the influence of calcium supplements, fluoroquinolones when using antacids, etc.). In turn, antibiotics can change the pharmacological effect of many drugs (for example, aminoglycosides increase the effect of muscle relaxants, chloramphenicol enhances the effect of anticoagulants, etc.).

Pathogenetic therapy

It is also necessary to carry out pathogenetic therapy aimed at eliminating the pathogenic chain reactions that have arisen in the body. In this regard, it is important to restore impaired functions of organs and systems, which means influencing individual links of pathogenesis. Such treatment includes proper nutrition, supply of sufficient vitamins, treatment with anti-inflammatory drugs, cardiac drugs, drugs that calm the nervous system, etc. Sometimes this strengthening therapy plays a leading role in restoring the patient’s strength, especially when the person has already gotten rid of the pathogenic microbe

The indication for the treatment of impaired metabolism (pathogenetic pharmacotherapy) is such a change in the functions of organs and systems when they cannot be corrected by the body itself with the help of general hygiene and dietary prescriptions. The main direction of pathogenetic treatment is detoxification therapy, which, depending on the severity of the intoxication syndrome, can be carried out using infusion, enteral, efferent methods and their combinations. Pathogenetic treatment should also include rehydration therapy with severe dehydration of the body (cholera, salmonellosis, food poisoning, etc.).

Infusion method detoxification therapy is carried out using intravenous, less often intra-arterial, administration of crystalloid (glucose, polyionic, Ringer's, physiological, etc.) and colloidal (albumin, amino acids, reamberin, dextrans - rheo- and polyglucin, gelatinol, mafusol, etc.) solutions. The principle of controlled hemodilution provides, along with the introduction of solutions, the use of diuretics that ensure enhanced excretion of toxins in the urine . Rehydration therapy It involves the administration (intravenous or enteral) of saline solutions depending on the degree of dehydration.

Enteral method is implemented by oral (sometimes through a nasogastric tube) administration of crystalloid solutions, enterosorbents (activated carbon, lignosorb, ion exchange resins, polyphepan, polysorb, enterodes, etc.).

Efferent methods detoxification is usually carried out for the most severe forms of diseases using extracorporeal treatment methods (hemodialysis, hemosorption, plasmapheresis, etc.).

Along with detoxification, correction of identified disturbances in water-electrolyte, gas and acid-base homeostasis, carbohydrate, protein and fat metabolism, hemocoagulation, hemodynamic and neuropsychic disorders is carried out.

Increasing immunobiological resistance is achieved by carrying out a set of measures, including a rational physical and dietary regimen, the administration of adaptogens, vitamins and microelements, as well as physical methods of treatment (for example, laser or ultraviolet irradiation of blood, hyperbaric oxygenation, etc.).

Found widespread use bacterial preparations - eubiotics, promoting the restoration of normal human microflora (bifidum-, coli-, lactobacterin, bactisubtil, enterol, narine, etc.).

In case of atypical course of the disease, according to indications, use immunocorrective drugs - donor immunoglobulin and polyglobulin, immunomodulators (cytomedins - t-activin, thymalin and thymogen, interleukins; bacterial polysaccharides - pyrogenal and prodigiosan; interferons and inducers of interferonogenesis - cycloferon, neovir, amixin, etc.) or immunosuppressors (azathioprine, glucocorticosteroid hormones, D -penicillamine, etc.).

Pathogenetic therapy is often combined with the use of symptomatic remedies - painkillers and anti-inflammatory, antipyretic, antipruritic and local anesthetic drugs.

General strengthening treatment. The use of vitamins in infectious patients is undoubtedly useful, but it does not cause a decisive turning point in the course of the infectious disease. In practice, they limit themselves to the use of three vitamins (ascorbic acid, thiamine and riboflavin) or give patients multivitamin tablets.

Complications of drug therapy for infectious patients

Treatment of infectious patients may be complicated by side effects of drugs, as well as the development medicinal disease in the form of dysbacteriosis, immunoallergic lesions (anaphylactic shock, serum sickness, Quincke's edema, toxic-allergic dermatitis, vasculitis, etc.), toxic (hepatitis, nephritis, agranulocytosis, encephalopathy, etc.) and mixed origin, due to the individual or perverted reaction of the patient on this drug or products of its interaction with other medications.

Drug disease most often occurs during etiotropic treatment with specific and chemotherapeutic drugs. The most dangerous manifestation of a drug-induced disease is anaphylactic shock.

Serum sickness develops in cases of repeated administration of an allergen (usually therapeutic serums, gammaglobulins, less often immunoglobulins, penicillin and other medications). It is characterized by inflammatory damage to blood vessels and connective tissue.

When an antigen is reintroduced, the body produces antibodies of various classes and types. They form circulating immune complexes, which are deposited on areas of the vascular wall and activate complement. This leads to increased vascular permeability, infiltration of the vascular wall, narrowing or blockage of the lumen of the blood capillaries of the renal glomeruli, myocardium, lungs and other organs, damage to the heart valves and synovial membranes. 3-7 days after the appearance of antibodies in the blood, immune complexes and antigen are removed, and gradual recovery occurs.

Complications of serum sickness in the form of polyneuritis, synovitis, necrosis of the skin and subcutaneous tissue, and hepatitis are rarely observed.

Dysbacteriosis As one of the forms of drug-induced disease, it usually develops as a result of the use of antibacterial drugs, mainly broad-spectrum antibiotics. Dysbacteriosis is divided according to the nature of the disturbance of the biocenosis: candidiasis, proteus, staphylococcal, colibacillary, mixed. According to the degree of change in the microflora, compensated, sub- and decompensated variants are distinguished, which can occur in the form of localized ones. widespread and systemic (generalized or septic) processes. Intestinal dysbiosis develops most often.

Violation of the intestinal microflora leads to disruption of the digestive processes, contributes to the development of malabsorption syndrome, and causes the appearance of endogenous intoxication and sensitization to bacterial antigens. In addition, it can cause secondary immunodeficiency and inflammatory processes in various parts of the digestive tract.

Intestinal dysbiosis in most cases, it is manifested by frequent loose or semi-formed stools, pain or discomfort in the abdomen, flatulence, against the background of which a decrease in body weight gradually develops, signs of hypovitaminosis in the form of glossitis, cheilitis, stomatitis, dry and brittle skin, as well as asthenia and anemia. In many patients, dysbiosis is the leading cause of long-term low-grade fever. Sigmoidoscopy can reveal inflammatory and subatrophic changes in the mucous membrane of the rectum and sigmoid colon. In case of colonization of the intestine with anaerobes Cl. difficile, pseudomembranous colitis is detected; with candidal dysbacteriosis, crumbly or confluent white deposits and polypous formations are found on the intestinal mucosa.

Oropharyngeal (oropharyngeal) dysbiosis manifested by discomfort and a burning sensation in the oropharyngeal cavity, and impaired swallowing. On examination, hyperemia and dryness of the mucous membrane of the oropharynx, glossitis, cheilitis are detected, and in the case of candidiasis, cheesy deposits are detected.

The use of both medicinal and non-medicinal treatment methods.

Non-drug methods for treating infectious diseases

Mode
For infectious diseases, patients, depending on their general condition, are recommended to follow four main types of individual regimen: strict bed rest (sitting is prohibited),
bed (allows you to move in bed without leaving it), semi-bed (allows you to walk around the room) and general (the patient’s motor activity is not significantly limited).

Diet therapy
Patients need an optimally complete, gentle diet with a high content of vitamins.
In severe cases, when patients cannot eat food on their own (coma, paresis of the swallowing muscles, profound disorders of absorption and digestion of food), tube feeding is used
special mixtures (enpits), parenteral and enteral-parenteral nutrition.

Physiotherapy
Physical methods of treatment are used in the period of convalescence of acute forms (after the disappearance of fever and symptoms of intoxication), in chronic forms and protracted course
infectious diseases. It is extremely rare that physiotherapy is prescribed during a febrile period, for example, aerosol therapy is used to relieve laryngeal stenosis in acute respiratory infections, and ultraviolet
irradiation with suberythemal doses - for erysipelas.

Spa treatment
Sanatorium-resort treatment is a rehabilitation stage of complex therapy for a patient, including a combination of natural physical factors with physiotherapy, physical therapy (physical therapy), dosed physical activity and dietary nutrition.

Medication

etiotr opnaya therapy The analysis is aimed at the cause of the disease - the etiological factor, the pathogen and the products of its vital activity and decay. Specific ical etiotropic therapy - treateni e serum preparations, immune sera and immunoglobulins, from which antibodies act specifically on the pathogen and its toxins. With some reservations, vaccine therapy should be considered a specific etiotropic therapy. However, in vaccine therapy for chronic diseases of microbial etiology, the therapeutic effect is usually achieved due to both specific stimulation of the immune system and a significant nonspecific stimulating effect. Phage therapy is also a specific etiotropic therapy, but it is currently used relatively rarely.

Nespets ific etiotropic therapy - treatment e antimicrobial drugs (antibiotics, sulfonamides, chemotherapy drugs). Please note that antibiotic treatment is not a specific therapy method, since there is not a single antibiotic that affects only one type of pathogen.

When independently studying individual topics, it is necessary to pay attention mainly to specific etiotropic therapy, since antibiotic therapy is used for almost all bacterial infections.

Simp tomato lech Treatment is based on the use of medicinal drugs in accordance with the symptoms of the disease - for pain - give analgesics, for elevated temperatures - antipyretics, etc. Usually, when applying symptomatic treatment, we try to alleviate the patient’s condition, often without taking into account the etiology and mechanism of development of the pathological syndrome. Strictly speaking, if symptomatic treatment has an effect, it becomes pathogenetic.

Patoge netic therapy I am aimed at normalizing the disturbed physiological functions of the body. This is one of the essential ways to treat infectious diseases. In some cases, in the absence of etiotropic therapy, correctly carried out pathogenetic treatment is the main one, for example, in the treatment of most viral diseases. Pathogenetic therapy also plays a significant role in bacterial infections.

For example m Er, in cholera, the leading link in pathogenesis is tissue dehydration due to the action of cholera exotoxin, choleragen. Only properly carried out rehydration therapy ensures the success of treatment, and we are not talking about simply administering fluids through drinking or parenterally. At the Department of Infectious Diseases, you should become familiar with this method of treatment in detail; this is all the more important since the department’s employees have experience working during the last cholera pandemic.

Treatment of a specific patient in each case requires taking into account the period, form, severity of the disease, a detailed pathogenetic diagnosis and an assessment of the characteristics of the patient’s body (age, reactivity, concomitant and past diseases, etc.).

The uniqueness of many infectious diseases, which consists in a tendency towards a protracted, relapsing course, determines the principle of successive treatment, which provides for a period of clinical observation by a general practitioner and (or) an infectious disease specialist in the infectious diseases office of a clinic in order to prevent, early detection and treatment of relapses and complications, medical and social rehabilitation of survivors of an infectious disease.

In the treatment of infectious patients and especially in their follow-up treatment, rehabilitation of convalescents of infections, the so-called non-traditional methods of therapy retain their importance: herbal medicine (for acute intestinal infections, influenza, acute respiratory infections), acupuncture and laser reflexotherapy (for cholestasis syndrome, consequences of neuroinfections), magnetic therapy (for prolonged convalescence of viral hepatitis), etc. A rich arsenal of physiotherapeutic agents is also widely used.

Etiotropic therapy of infectious patients. Among the means of etiotropic therapy, drugs with specific effects should be distinguished, i.e. action aimed at one single type of pathogen. These are immune serums, specific immunoglobulins, gamma globulins, therapeutic vaccines, bacteriophages, and chemotherapy drugs.

Serotherapy.

There are antitoxic and antibacterial serums. Antitoxic serums contain specific antibodies against toxins - antitoxins and are dosed in antitoxic units (AU). Their action is reduced to neutralizing toxins produced by pathogens. Anti-diphtheria, anti-tetanus, anti-botulinum, anti-gangrenosis, and anti-anthrax serums are antitoxic. Antibacterial serums contain antibodies against bacteria (agglutinins, bacteriolysins, opsonins). In most cases, serums are administered intramuscularly and only in special cases intravenously.

The effect of using the serum depends on the dose and timing of its administration. The earlier the serum is administered from the onset of the disease, the better the result. This is due to the fact that the serum effectively inactivates the toxin that circulates freely in the blood. Its circulation duration is limited to 1-3 days; subsequently, it is bound by cells and tissues.

In the treatment of patients with certain infectious diseases, immunoglobulins and gamma globulins occupy an important place. They have a high concentration of antibodies, are devoid of ballast proteins, penetrate tissues better, etc. Homologous immunoglobulins can be administered without prior hyposensitization of the patient to foreign proteins, heterologous gamma globulins - only after appropriate preparation of the patient (as with the administration of heterologous sera).

Currently, medical practice has immunoglobulins (gamma globulins) against smallpox, influenza, measles, tick-borne encephalitis, staphylococcal infection, anthrax, leptospirosis, whooping cough, herpes infection and other diseases.

Complications during serotherapy of infectious patients can be of two types - anaphylactic shock and serum sickness.

To avoid complications (especially anaphylactic shock) in response to the administration of heterologous sera and gamma globulins, strict adherence to the relevant rules is necessary.

The serum is injected intramuscularly into the area of ​​the upper third of the anterior outer surface of the thigh or into the buttock.

Before the first administration of the serum, it is mandatory to perform a skin test with the serum diluted in a ratio of 1:100 (the ampoule is marked in red) to determine the sensitivity to the animal’s serum proteins. Serum, diluted in a ratio of 1:100, is injected in a volume of 0.1 ml intradermally into the flexor surface of the forearm. The reaction is recorded after 20 minutes. The test is considered negative if the diameter of the swelling and (or) redness that appears at the injection site is less than 1 cm. The test is considered positive if the swelling and (or) redness reaches a diameter of 1 cm or more.

If the skin test is negative, the serum (the ampoule is marked in blue) is injected in a volume of 0.1 ml subcutaneously into the area of ​​the middle third of the shoulder. In the absence of a local or general reaction, after 45+15 minutes, the prescribed dose of serum heated to a temperature of 36±1 °C is administered intramuscularly. The maximum volume of the drug administered to one site should not exceed 8±2 ml. The patient who received the serum should be under medical supervision for 1 hour.

In case of a positive skin test, as well as in the case of reactions to subcutaneous administration of 0.1 ml of serum, the drug is used only for health reasons. For hyposensitization, serum diluted in a ratio of 1:100 is injected subcutaneously in a volume of 0.5, 2, 5 ml at intervals of 15-20 minutes, then 0.1 and 1 ml of undiluted serum are injected subcutaneously at the same intervals and in case of no reaction the prescribed dose of serum is administered. Simultaneously with the onset of hyposensitization, the patient is administered antishock therapy. If symptoms of anaphylactic shock appear at one of the above doses, the serum is administered under anesthesia.

Opening ampoules etc. the procedure for administering the drug is carried out in strict compliance with the rules of asepsis and antisepsis. An opened ampoule with serum is stored, covered with a sterile napkin at a temperature of 20±2 °C for no more than 1 hour. An opened ampoule with serum diluted in a ratio of 1:100 cannot be stored.

The drug is unsuitable in ampoules with damaged integrity or labeling, if the physical properties have changed (color, transparency, presence of unbreakable flakes), if the expiration date has expired, or if stored improperly.

The vaccination site must be provided with anti-shock therapy.

All of the above fully applies to the rules for introducing heterologous gamma globulins.

Bacteriophage therapy.

Great hopes were pinned on the use of bacteriophages in the treatment of infectious diseases. In vitro, bacteriophages have a pronounced ability to destroy bacteria. However, their use in the clinic has not yet produced the expected results. This is due to the presence of a large number of phage types of the same pathogen, which requires the selection of an individual phage. In addition, the body responds to the introduction of a bacteriophage by producing antiphage antibodies. Nevertheless, in some cases, phage therapy is a valuable aid in the complex therapy of certain infections, primarily intestinal.

Bacteriophages are produced in dry, tablet form (typhoid, dysenteric, salmonella) with an acid-resistant coating and in the form of suppositories (dysenteric), as well as in liquid form - typhoid (in bottles), staphylococcal, coliproteus, streptococcal, etc. (in ampoules). Liquid bacteriophages can be administered orally, in enemas, subcutaneously and intramuscularly, used for puncturing purulent foci, introduction into purulent cavities, in the form of rinses, irrigations, lotions, for wetting tampons, etc.

All bacteriophages are used both simultaneously with antibacterial drugs and independently, in particular for follow-up treatment and sanitization of bacterial excretors. The duration of phage therapy is 5-7 days; if necessary, the course of treatment is repeated. There are no contraindications to the use of phages. Phage therapy is used mainly in pediatric practice.

Interferon therapy.

Interferons are currently considered as factors of nonspecific resistance and as factors that have a regulatory effect on the body's immune system. Interferons as drugs are characterized by universal antiviral activity and, being etiotropic agents, they cannot be considered specific. Nevertheless, they are used with greater or lesser success in the treatment of patients with certain viral infections (influenza, herpes infection, viral encephalitis, adenoviral diseases, etc.). In addition to natural interferons obtained from leukocytes and fibroblasts, in recent years (genoferons, or clonal) interferons obtained by genetic engineering have found widespread use. Along with the local use of native or partially purified interferon, intramuscular, intravenous administration, and the introduction of specially purified drugs into the spinal canal (reoferon) are increasingly used. Interferon therapy is a method of treating (and preventing) viral infections by inducing the human body’s own interferons. Among the interferonogens, we should mention well-known drugs from the group of central nervous system stimulants, adaptogens - tinctures of zamanika, aralia, leuzea, Rhodiola rosea, ginseng, Eleutherococcus, Chinese schisandra. Synthetic interferonogens have also been created and are currently undergoing clinical trials.

Vaccine therapy.

The therapeutic effect of vaccines is based on the principle of specific stimulation of the body's defenses. The introduction of an antigenic stimulus enhances phagocytosis and promotes the production of specific antibodies. For vaccine therapy, killed vaccines, individual antigens, and toxoids are used. The most effective autovaccines are those prepared from a pathogen strain isolated from a patient. Vaccine therapy is indicated during the period of subsidence of acute manifestations of the disease, during a protracted or chronic course of the disease (brucellosis, tularemia, dysentery) and less often at the height of infection (typhoid fever), usually in combination with antibiotic therapy. In persons receiving antigenic drugs in the acute period of the disease, an increase in antibody titers and immunoglobulin levels is observed. Vaccines also have a hyposensitizing effect. In recent years, interest in vaccine therapy has been declining, which is mainly due to the creation of modern immunomodulatory agents and immunocorrective drugs.

Chemotherapy.

Chemotherapy plays in most cases a decisive role in the overall complex of treatment and preventive measures in infectious practice. One cannot but agree that the successes achieved in the fight against widespread infectious diseases were largely associated with the use of chemotherapeutic drugs, in particular antibiotics. It was thanks to their use that cases of recovery of patients with pneumonic plague became possible, and mortality rates for diseases such as typhoid fever, typhus, meningococcal infection, etc., sharply decreased.

The number of known chemotherapeutic agents, including antibiotics, is increasing every year. More than 2000 antibiotics have been described, and the mechanism of action of 200 of them has been studied in detail. In everyday practice, general practitioners and hospital doctors use no more than 50 drugs with antibacterial action. Their widespread use has revealed a number of undesirable consequences: a widespread increase in antibiotic resistance and multidrug resistance of microorganisms and their selection, damage to some organs and systems during chemotherapeutic intervention (for example, suppression in some cases of the function of the immune system), the development of nonspecific sensitization, disruption of complex ecological relationships in the biocenosis of the patient and an increase in the frequency of endogenous, mixed infections, as well as superinfections. The problem of overcoming the negative consequences of antibiotic therapy is solved by creating new, more advanced, highly effective and non-toxic drugs and developing methods for correcting the side effects of the best available antibacterial agents, followed by their rational use in accordance with the basic principles of chemotherapy.

The basic principles of antibiotic therapy for infectious diseases are as follows.

1. Isolation and identification of pathogens, study of their antibiograms.
2. Selection of the most active and least toxic drug.
3. Determination of optimal doses and methods of antibiotic administration.
4. Timely initiation of treatment and courses of chemotherapy (antibiotic therapy) of the required duration.
5. Knowledge of the nature and frequency of side effects when prescribing drugs.
6. Combining antibacterial drugs to enhance the antibacterial effect, improve their pharmacokinetics and reduce the incidence of side effects.

The choice of antibiotic is determined primarily by the type of pathogen and, therefore, the etiological (nosological) diagnosis of the disease. It is known that drugs of the penicillin group (benzylpenicillin salts, bicillin, phenoxymethylpenicillin, oxacillin, ampicillin, carbenicillin) are highly effective against gram-positive (streptococci, staphylococci, pneumococci) and gram-negative (gonococci, meningococci) cocci, as well as anthrax bacillus, clostridia, the pathogen teria, Treponema, Leptospira.

Cephalosporins (cephaloridine), or ceporin, cefazolin, or cefamezin, cephalexin, cephalothin sodium salt are similar to penicillins in structure and mechanism of action. They have a wider spectrum of action: they are effective primarily against cocci, but have a pronounced effect on most gram-negative bacteria.

In the past, drugs of the streptomycin group were highly effective against gram-negative bacteria (Escherichia coli, the causative agents of dysentery, plague, tularemia, brucellosis) and mycobacteria (the causative agent of tuberculosis). Currently, these microorganisms have partially lost sensitivity to streptomycins, and therefore the use of these antibiotics is, unfortunately, limited.

Levomycetin is effective against many gram-negative and gram-positive bacteria, rickettsia and spirochetes, therefore it belongs to the group of broad-spectrum antibiotics, is widely used in infectious practice, and remains the drug of choice in the treatment of patients with typhoid fever.

Tetracyclines (tetracycline, oxytetracycline, doxacycline hydrochloride, or vibramycin, metacycline hydrochloride, or rondomycin) and rifampicin also have a wide antibacterial spectrum of action, inhibit the growth of most gram-positive and gram-negative bacteria, rickettsia, chlamydia.

Aminoglycosides - antibiotics of the neomycin group (neomycin sulfate, monomycin, kanamycin, gentamicin sulfate) - act on most gram-positive and gram-negative bacteria; they are active against microorganisms resistant to penicillin, chloramphenicol, and tetracyclines.

Macrolide antibiotics (erythromycin, oleandomycin phosphate) are effective against a large group of bacteria, but mainly gram-positive ones. Their use is limited mainly to severe forms of the disease; They are primarily prescribed to patients with staphylococcal infections. Other antibiotics (ceporin, kefzol, ristomycin) are also used for the same purpose.

Polymyxins have a detrimental effect on gram-negative bacteria (Shigella, Salmonella, Escherichia, Pseudomonas aeruginosa).

Antibiotics of other groups, in particular lincomycin hydrochloride, are widely used in clinical practice. It is active mainly against gram-positive cocci, mycoplasmas and, therefore, is especially indicated for the treatment of complicated influenza, pneumonia, erysipelas, purulent lesions of bone and muscle tissue. Fuzidin sodium has a narrow spectrum of action (staphylococci, meningococcus, gonococcus); Polymyxin B sulfate (aerosporin) is used almost exclusively for infections caused by Pseudomonas aeruginosa.

Antifungal antibiotics and other drugs for the treatment of fungal diseases (nystatin, levorin, monistat, clotrimazole, mycoseptin, mycozolon, nitrofungin, etc.) are effective against many fungi that cause mycoses. Some of them are used not only for the purpose of treatment, but also for the prevention of candidiasis in immunocompromised individuals and in patients who have received long courses of massive antibiotic therapy using broad-spectrum drugs.

In recent years, many traditional, natural antibiotics have been replaced by drugs of the third and fourth generations, represented mainly by semisynthetic penicillins (ampicillin, oxacillin, amoxicillin, ticarcillin, cyclocillin, carbenicillin), cephalosporins (cephalothin, cephaloridin), aminoglycosides (amikacin, netilmecin, dibekacin , tobramycin), tetracyclines (methacycline, doxycycline, monocycline), rifampicins (rifampicin, rifadin). Compared to natural antibiotics, they have many advantages: acid and enzyme resistance, an extended spectrum of action, improved distribution in tissues and body fluids, a changed mechanism of action on the bacterial cell, and fewer side effects.

Along with antibiotics, other chemotherapeutic drugs are also used to influence the causative agent of the disease. Nitrofuran derivatives (furazolidone, furadonin, furagin, furatsilin, etc.) have high antimicrobial activity. They are effective against many gram-negative and gram-positive bacteria, including those resistant to antibiotics and sulfonamide drugs, as well as some protozoa (Trichomonas, Giardia).

In recent years, broad-spectrum drugs - quinolone derivatives (ofloxacin, or tarivid, ciprofloxacin, or ciprobay, ciprofluxazine, etc.) have become widespread. They remain reserve drugs and are used for particularly severe forms of infections caused by intestinal bacteria, as well as chlamydia and mycoplasmas.

The advantages of antibacterial agents of non-antibiotic origin are the slower development of microorganism resistance to them and the absence of cross-resistance to antibiotics.

Sulfonamide drugs have not lost their importance either. The recent decline in interest in them on the part of practicing doctors must be considered unjustified. When treating patients with acute intestinal infections, you can successfully use drugs characterized by slow absorption from the intestine (sulgin, phthalazole), which allows you to maintain their high concentration in the intestine when administered orally. Of therapeutic interest are long-acting sulfonamide drugs (sulfapyridazine, sulfadimethoxine, or madribon), used alone and in combination with salicylic acid (salazosulfapyridine) and trimethoprim (bactrim, or biseptol, sulfatene, groseptol). These drugs are used to treat a wide range of diseases caused by gram-positive and gram-negative bacteria - from sore throats and pneumonia to intestinal infections. Side effects caused by sulfonamides include irritation to the gastric mucosa, formation of stones in the urinary system, etc. Drinking plenty of alkaline water partly prevents these side effects, especially impaired renal function.

The combined use of various antibacterial drugs often leads to increased therapeutic efficacy. However, one should take into account the possibility of not only synergism, but also antagonism of the combined agents, as well as the accumulation of side effects of each of the components of the combination (suppression of normal microflora, increased risk of secondary infection, increased frequency and severity of adverse reactions).

Antiviral drugs used in clinical practice have a selective effect on a limited number of types of viruses; in most cases their effectiveness is not high enough. For example, amantadine and its derivative rimantadine act only on the influenza A virus. For herpes infection, idoxuridine (Herplex, IDU, Stoxil), vidarabine (Vira-A, adenine arabinoside), acyclovir (Zovirax), trifluridine (Viroptik) have some effect. Ribamidil, or ribovirin, is considered promising for the treatment of viral hepatitis B, influenza and herpes. For the prevention of smallpox in previous years, and for the treatment of vaccinia complications even today, metisazone (Marboran) is used. The drug of choice, “hope and despair” for HIV infection is the antiviral drug azidothymidine. Oxolin, florenal, bonafton, gossypol, which were previously used for the treatment and prevention of influenza, herpes infection, and viral hepatitis, are of historical importance.

Complications arising from chemotherapy of infectious patients. According to A.F. Bilibin, during the treatment of infectious patients with chemotherapy, three types of complications can arise - allergic reactions, endotoxic reactions and dysbiosis.

Allergic reactions observed most often are manifested by capillary toxicosis, catarrhal changes in the mucous membranes, dermatitis, and edematous syndrome. Possible damage to the heart (allergic myocarditis), lungs and bronchi (bronchitis and pneumonia, Leffler infiltrates), liver (hepatitis). Sometimes anaphylactic shock occurs in response to drug administration. It can develop in response to the administration of antibiotics (as well as to the administration of other drugs) due to the formation of a drug-protein complex. Allergic reactions develop regardless of the dose and duration of use of the drug.

Endotoxic reactions usually occur after the administration of loading doses of antibiotics and depend on the massive breakdown of bacterial cells with the release of endotoxins. For the first time, such reactions were described during antibiotic therapy for syphilis, typhoid fever, brucellosis, and sepsis.

To mitigate and prevent such reactions, detoxification and antihistamines, and sometimes glucocorticosteroids, should be prescribed in combination with antibiotics.

Dysbacteriosis deserves serious attention, since as a result it may lead to the development of autoinfection due to the selection of microorganisms resistant to antibiotics. Of great importance among them are representatives of the coccal group of bacteria, primarily staphylococci, some gram-negative bacteria and yeast-like fungi of the genus Candida.

The possibility of developing various forms of drug-induced disease requires a thoughtful and prudent attitude to the prescription of chemotherapy drugs, taking into account indications and contraindications for their use, and individual tolerance.

Despite the exceptional, often decisive role of chemotherapy in the treatment of infectious patients, it should be borne in mind that “chemotherapy with all its achievements is only part of the treatment, and not the whole treatment” (A.F. Bilibin).

Pathogenetic therapy of infectious patients. Methods and means of pathogenetic therapy play a very important role in the treatment of infectious patients, and in cholera, for example, they determine the outcome of the disease.

The principles of pathogenetic therapy have been developed quite fully in recent years and are based on the results of a detailed study of the most important characteristics of homeostasis and the patterns of its disturbance in infectious diseases. Pathogenetic therapy is carried out taking into account indicators of acid-base status, mineral and water metabolism, rheological properties of blood, immune status of the body, microcirculation disorders in organs and tissues, etc.

Among pathogenetic drugs, the first place is occupied by detoxification and corrective agents in the form of colloidal and crystalloid solutions. Colloidal solutions include solutions of polyvinyl alcohol (polydez, polyvinol), polyvinylpyrrolidone (hemodez, hemovinyl, periston, neocompensan), partially hydrolyzed dextran (polyglucin, rheopolyglucin, macrodex, reomacrodex), as well as gelatinol, albumin, proteins, etc. Among the crystalloid solutions, the most widely used are Ringer's solutions, Disol, Trisol (Phillips solution No. 1), Quartasol, Acesol, Chlosol, Lactasol. In addition to intravenous crystalloid drugs, oral polyionic solutions intended for detoxification, as well as (primarily) for rehydration and remineralization - Oralit, Rehydron, citroglucosolan - have become widespread.

In recent years, enterosorbents - enterodes, polyphepan, polysorb, lignosorb, activated carbons, ion exchange resins - have been widely used in clinical medicine, including in the treatment of infectious patients with severe intoxication syndrome. In especially severe cases (viral hepatitis, leptospirosis, meningococcal infection, sepsis, etc.) in intensive care and resuscitation, other methods of artificial extrarenal cleansing of the body from toxins (diffusion, convection, adsorption) are used.

A significant place in the treatment of infectious patients is occupied by means of nonspecific stimulation, immunotherapy and immunocorrection. Indications for their use are determined by the characteristics of the pathogenesis of the infectious disease, depend on the phase and severity of the disease, premorbid background, the state of specific and nonspecific protective factors, the severity of the allergic and immunopathological component in the pathogenesis. Most drugs used for immunocorrection belong to immunostimulants (various pyrogens, pyrimidine derivatives, levamisole, natural and synthetic polymers) and immunosuppressants (antilymphocyte serum, antilymphocyte immunoglobulin, azathioprine, or imuran, cyclophosphamide, etc.). All immunotropic drugs can be used only under dynamic monitoring of immunity parameters and the state of nonspecific reactivity of the body.

Glucocorticosteroids (hydrocortisone, prednisolone, dexamethasone, triamcinolone, etc.) have found widespread use in the pathogenetic therapy of infectious patients. By influencing tissues as physiological regulators of metabolic processes, they prevent the development of excessive inflammatory and allergic reactions in the body. The absolute indication for glucocorticosteroid therapy is acute adrenal insufficiency, which can develop in many infectious diseases.

Currently, the dominant place in the structure of morbidity on a global scale is occupied by chronic nonspecific diseases, among which the most serious are nonspecific lung diseases. These are inflammatory respiratory diseases, bronchial asthma, diseases of the upper respiratory tract with an asthmatic component, etc.

To treat these diseases, various groups of drugs are used, both with antibacterial action and specific drugs that relieve bronchospasms.

In the complex treatment of nonspecific lung diseases, antiallergic drugs belonging to the group of antihistamines are of great importance.

NON-NARCOTIC ANTI-COUGH DRUGS

Non-narcotic antitussives include drugs that depress the cough center, but are not addictive and do not depress breathing.

Glaucine- table from raw materials of plant origin (alkaloids of the yellow maca grass). Sp. B (Russia), dragee Glauvent(Bulgaria).

Prenoxdiazine (INN) or Libexin- approximately equal in activity to codeine, table. Sp. B (Hungary).

EXPECTORANTS

In the treatment of bronchopulmonary diseases accompanied by a cough with sputum difficult to separate, drugs that stimulate expectoration and are collectively called secretomotor drugs are usually used. There are two groups of such drugs, differing in the mechanism of secretomotor action. Thus, preparations of thermopsis, istoda, marshmallow and other medicinal plants, terpin hydrate, lycorin, essential oils have a slight irritating effect on the receptors of the gastric mucosa with subsequent (through the vomiting center of the medulla oblongata) reflex stimulation of the secretion of the bronchial and salivary glands. In contrast, sodium and potassium iodide, ammonium chloride and some others, after ingestion and absorption into the systemic circulation, are secreted by the bronchial mucosa, stimulating bronchial secretion and, partially, diluting sputum. In general, representatives of both groups increase the physiological activity of the ciliated epithelium and the peristalsis of the respiratory bronchioles in combination with a slight increase in the secretion of the bronchial glands and a slight decrease in the viscosity of sputum.

Bronchosecretolytic drugs (or mucolytics) are widely used in clinical practice. Medicines that affect the rheological properties of bronchial secretions include enzymes - trypsin, chymotrypsin, ribonuclease, deoxyribonuclease (use is limited due to the large number of adverse reactions), carriers of sulfhydryl groups (acetylcysteine, mesna), derivatives of the alkaloid vizicine (bromhexine, ambroxol ).

Vasicine, obtained from the Adhatoda vasica plant, has long been used in the East as an expectorant. A synthetic homologue - bromhexine (in the body it turns into an active metabolite - ambroxol) - reduces the viscosity of the secretion of the bronchial glands, has a mucolytic (secretolytic) and expectorant effect. Also important is its ability to restore mucociliary clearance by activating the synthesis of surfactant by alveolar pneumocytes of the second order. Thus, bromhexine dilutes the viscous, sticky bronchial secretion and ensures its movement through the respiratory tract. For inflammatory diseases of the respiratory tract, combination drugs are often used, incl. in combination with antibiotics. When prescribing mucolytics and antibiotics simultaneously, their compatibility must be taken into account: acetylcysteine ​​during inhalation or instillation should not be mixed with antibiotics (mutual inactivation); when taking acetylcysteine ​​orally, antibiotics (penicillins, cephalosporins, tetracyclines) should be taken no earlier than 2 hours later; mesna is incompatible with aminoglycosides; carbocysteine, bromhexine, ambroxol, on the contrary, enhance the penetration of antimicrobial agents into the bronchial secretions and bronchial mucosa (primarily this applies to amoxicillin, cefuroxime, erythromycin, doxycycline, sulfonamides); carbocysteine, in addition, prevents the thickening of sputum provoked by taking antibiotics.

In patients with chronic obstructive bronchitis, a good effect is observed when bronchodilators are combined with mucolytics or with each other. Beta2-sympathomimetics (fenoterol, salbutamol, etc.) and theophylline potentiate increased mucociliary clearance; theophylline and m-anticholinergics (ipratropium bromide), reducing inflammation and swelling of the mucous membrane, facilitate the discharge of sputum.

Belong to this group:

· drugs - 2124,

· trade names – 240,

· active ingredients - 52,

· manufacturing companies – 220.

Drugs thermopsis herbs- contain easily soluble alkaloids that stimulate respiration, have an expectorant, and in large doses, emetic effect. Table thermopsis grass and sodium bicarbonate for cough. Sp. B (Russia).

Mukaltin- table from marshmallow (Russia).

Pertusin- syrup in bottle, contains extracts of thyme and thyme (Russia).

Bromhexine (INN)- mucolytic, expectorant, antitussive; Tables are issued. for adults and children, dragees, solution for injection, solution for oral administration, syrup, drops, elixir. Sp. B (Russia, Germany, Bulgaria, India, etc.), Phlegamine(Poland), etc. In the State Register of Medicines Bromhexine is registered in 18 trade names, in 10 dosage forms; offers from 15 countries.

Bronholitin- a syrup of complex composition containing glaucine hydrochloride, ephedrine hydrochloride, etc. B (Bulgaria).

Acetylcysteine ​​(INN)– Acetylcysteine-Hemofarm(Serbia), ACC, ACC 100, ACC 200, ACC long, ACC injection(Germany). They produce effervescent tablets, granules for preparing a solution for oral administration, and a solution for injection.

ANTI-CONGESTANTS

Medicines in this group are used topically for rhinitis (including allergic), laryngitis, sinusitis, eustachitis, conjunctivitis and other diseases associated with swelling of the mucous membrane, to stop nosebleeds, before rhinoscopy.

The anticongestive (anti-edematous) effect is exerted by vasoconstrictors that excite alpha1-adrenergic receptors (xylometazoline, naphazoline, oxymetazoline, tetrizoline, etc.), H1-antihistamines (levocabastine, etc.) and drugs of combined action (Vibrocil, Koldar, Clarinase-12, etc. ), reducing swelling of the mucous membrane, due to vasoconstrictor and antiallergic activity. When applied to the mucous membranes, they have an anti-inflammatory (relieves swelling) effect. For rhinitis and difficulty in nasal breathing (including colds), nasal breathing is facilitated by reducing blood flow to the venous sinuses. It should be taken into account that long-term use of adrenergic agonists (naphazoline, xylometazoline, etc.) may be accompanied by the development of tachyphylaxis (gradual decrease in effect).

Belong to this group:

· drugs - 642,

· trade names – 87,

· active ingredients – 18,

· manufacturing companies – 151.

Naphazoline (INN) (Naphthyzin)- a vasoconstrictor, used for rhinitis and other diseases of the nasal cavity. Nasal drops are available in a bottle. Sp. B (Russia). Sanorin- emulsion, drops and nasal spray (Czech Republic).

Xylometazoline (INN) (Galazolin)- alpha adrenergic stimulator; Nasal drops and gel are available.Sp. B (Poland), Xylene(Russia), For the nose(India), Otrivin(Switzerland), etc.

Oxymetazoline (INN) – release drops and nasal spray Nazivin(Russia), Nazol(USA).

Sea water - used for rhinitis, pharyngitis, sinusitis Aqua Maris(Croatia), Marimer(France), Fluimarin(Germany, Italy). Nasal drops and nasal spray are available.

ANTIHISTAMINES

Histamine- a biogenic derivative of the amino acid histidine, found in inactive form in various organs and tissues of animals and humans, is one of the factors regulating metabolism.

In some pathological conditions (burns, frostbite, ultraviolet irradiation, the action of certain medications, allergic diseases), the amount of free histamine released from tissues increases sharply, which causes redness of the skin, rash, itching, narrowing of the bronchi, increased secretion of the bronchial glands, etc. In severe cases, blood pressure drops significantly, vomiting and convulsions develop.

The first drugs that block H1-histamine receptors were introduced into clinical practice in the late 40s. They are called antihistamines, because. effectively inhibit the reactions of organs and tissues to histamine. Histamine H1 receptor blockers weaken histamine-induced hypotension and spasms of smooth muscles (bronchi, intestines, uterus), reduce capillary permeability, prevent the development of histamine edema, reduce hyperemia and itching and, thus, prevent the development and facilitate the course of allergic reactions. The term “antihistamine” does not fully reflect the range of pharmacological properties of these drugs, because they also cause a number of other effects. This is partly due to the structural similarity of histamine and other physiologically active substances, such as adrenaline, serotonin, acetylcholine, and dopamine. Therefore, blockers of histamine H1 receptors may, to varying degrees, exhibit the properties of anticholinergics or alpha-blockers (anticholinergics, in turn, may have antihistamine activity). Some antihistamines (diphenhydramine, promethazine, chloropyramine, etc.) have a depressant effect on the central nervous system and enhance the effect of general and local anesthetics and narcotic analgesics. They are used in the treatment of insomnia, parkinsonism, and as antiemetics. Associated pharmacological effects may also be undesirable. For example, sedation, accompanied by lethargy, dizziness, poor coordination of movements and decreased concentration, limits the outpatient use of some antihistamines (diphenhydramine, chloropyramine and other representatives of the first generation), especially in patients whose work requires quick and coordinated mental and physical reactions. The presence of anticholinergic action in most of these drugs causes dry mucous membranes, predisposes to deterioration of vision and urination, and gastrointestinal dysfunction.

First generation drugs are reversible competitive antagonists of H1-histamine receptors. They act quickly and briefly (prescribed up to 4 times a day). Their long-term use often leads to a weakening of therapeutic effectiveness.

Recently, blockers of histamine H1 receptors (antihistamines of the 2nd and 3rd generation) have been created, which are characterized by high selectivity of action on H1 receptors (hifenadine, terfenadine, astemizole, etc.). These drugs have little effect on other mediator systems (cholinergic, etc.), do not pass through the BBB (do not affect the central nervous system) and do not lose activity with long-term use. Many second-generation drugs bind noncompetitively to H1 receptors, and the resulting ligand-receptor complex is characterized by relatively slow dissociation, causing an increase in the duration of the therapeutic effect (prescribed once a day). The biotransformation of most histamine H1 receptor antagonists occurs in the liver with the formation of active metabolites. A number of H1-histamine receptor blockers are active metabolites of known antihistamines (cetirizine is an active metabolite of hydroxyzine, fexofenadine is terfenadine).

1st generation drugs

Diphenhydramine (INN) (Diphenhydramine)- H2-histamine receptor blocker; Powder, tablet are produced. for adults and children, injection solution, incl. in tubes, suppositories for children, sticks (for the treatment of allergic rhinitis). Sp. B (Russia, etc.). Diphenhydramine is registered in the State Register of Medicines in 6 trade names and 8 dosage forms; offers from 8 countries.

Clemastine (INN)- H2-histamine receptor blocker; Tablets, syrup, and solution for injection are produced. Sp. B (Poland). Tavegil(Switzerland, India).

Chloropyramine (INN) (Suprastin)- H2-histamine receptor blocker; is issued in the form of a table. and solutions for injections. Sp. B (Hungary).

Ketotifen (INN)- antiallergic, antihistamine; mast cell membrane stabilizer. Available in tablets, capsules and syrup. Sp. B (Russia, Germany, Switzerland, Bulgaria), Zaditen(India, Slovenia, etc.). In the State Register of Medicines Ketotifen is registered in 12 trade names, in 5 dosage forms; proposals from 11 countries.

2nd generation drugs

Astemizole (INN)- has no effect on the central nervous system, taken once a day; Tablets and suspensions are produced. Sp. B (Russia, Macedonia). Astemisan(Yugoslavia), Gismanal(Belgium).

3rd generation drugs

Loratadine (INN) (Clarotadine)- H2-histamine receptor blocker; Available in tablets, syrup, taken once a day. Sp. B (Russia), Clarotin(Belgium), Loratadine(Slovakia).

Effective treatment of respiratory infectious pathologies of young farm animals, especially in the stages of development of the pathological process and pronounced clinical signs, is possible only with an integrated approach and the use of all methods of therapy. These include: etiotropic method - eliminating the cause of the disease; pathogenetic method aimed at eliminating links in the pathogenetic chain of the disease, restoring the body’s self-regulation, mobilizing and stimulating defenses; a replacement method of treatment aimed at introducing and replacing missing substances in the body lost due to a pathological process; a method regulating neurotrophic functions that prevents the development of damage due to overstimulation of innervating links, and a symptomatic method aimed at eliminating the symptoms of the disease.

When treating infectious diseases of young animals, it is necessary to rely on certain principles.

1. Preventive principle. When establishing an infectious disease, a set of measures is first necessary to prevent the development of an epizootic process. According to this principle, it is necessary to isolate animals of the first group - patients (with pronounced clinical signs); carry out therapeutic treatments using specific or nonspecific etiotropic therapy for animals of the second group - conditionally sick or suspected of disease (those in direct contact with animals of the first group); carry out preventive treatment with means of passive immunization, and in some diseases - with chemotherapy, for animals of the third group - conditionally healthy, or suspected of infection (animals from a dysfunctional farm that do not have clinical signs of the disease and have not been in direct contact with sick animals).

2. Physiological. A principle based on the close relationship of all organs and systems in the body, requiring simultaneous influence not only on the area of ​​the pathological focus, but also on related areas.

3. Active. A principle that calls for active, targeted therapeutic work, determining the optimal timing of treatment treatments, doses, frequency of administration of drugs, etc.

4. Comprehensive. The same principle, based on the previous ones, on which the effectiveness of therapeutic measures, the recovery of a sick organism and the improvement of a dysfunctional farm (economy) are based. Simultaneous impact on the cause of an infectious disease (infectious agent), on contributing factors (violations of the conditions of feeding and keeping animals), pathogenetic connections, immune defense and metabolic systems, nerve-regulatory functions and symptoms, as well as the use of priority exposure and analysis of the epicrisis are necessary components of an integrated treatment principle.

5. Economic feasibility. Before starting treatment of patients, it is necessary to assess the degree and speed of development of the pathological process, the possibility of recovery and the economic factor of treatment. It is not always advisable to treat deep lesions with expensive drugs, especially taking into account the fact that after recovery from the disease, animals lag behind in growth and development, take months to restore productivity, and remain susceptible to other infectious diseases.

When treating infectious diseases of young farm animals, accompanied by damage to the respiratory organs, the therapeutic effect must be based on the following points: first of all - etiotropic therapy, combating the infection - the causative agent of the disease, the pathogenic microflora that has assimilated the lungs due to the primary pathological effect of the pathogen and related factors; in parallel with this, it is necessary to restore the drainage function of the bronchi, relieve bronchospasm, eliminate respiratory and cardiovascular failure; combating toxicosis, stabilizing metabolic processes and strengthening the body's protective functions.

Etiotropic therapy begins with isolating sick animals, stabilizing and controlling microclimate parameters during their maintenance, improving feeding conditions, and reducing stress load. The use of specific therapy is most effective in the initial stages of development of an infectious disease. (They are described in detail in the description of each disease).

The use of specific hyperimmune serums and globulins, polyphage, and allogeneic immune serums of cows in the initial stages of the development of viral respiratory infections is especially effective. Complex (polyvalent) sera produced by the biological industry make it possible to begin to have a therapeutic effect on the basis of a preliminary diagnosis based on epidemiological data, clinical signs, and pathological changes.

The effect of convalescent antibodies on the pathogen is effective. For this purpose, mothers' blood is used, which contains high titers of antibodies to pathogens circulating on the farm. Blood is obtained from cows free from leukemia, tuberculosis, brucellosis, leptospirosis and hemoprotozoal diseases, up to 1.5 liters per cow. The puncture is performed, observing the rules of asepsis and antiseptics, in a sterile container containing 100 ml of saline and sodium citrate at the rate of 5 g per 1 liter of blood. To the resulting blood, to prevent bacterial contamination, add per 1 liter: 1 million units of penicillin and streptomycin (such blood must be used within 24 hours), or 1 g of sulfadimethoxine, as well as 1 g of dioxidine (citrated blood is stored until complete use - 5 days), or 5 g of carbolic acid (phenol), while the shelf life of convalescent blood increases to 6 months at a temperature of 4°C and periodic stirring. Citrated blood of mothers is used at several points subcutaneously or intramuscularly in a therapeutic dose of 2-3 ml/kg, in a prophylactic dose of 1-2 ml/kg, as well as aerosol at the rate of 5 cm 3 per 1 m 3 of room or 10-15 cm 3 per room animal. Some researchers note a greater effect from the intravenous use of convalescent blood, but here it is necessary to take into account the possibility of anaphylactic reactions.

To prepare convalescent blood, it is necessary to use only donors from the given farm. Each farm where respiratory diseases are recorded has its own specific viral and bacterial flora, which determines the immune status of the herd.

As an option for nonspecific antiviral therapy, it is possible to use nonspecific globulins and antiviral drugs - interferonogens, triaphen, sialic acid analogues, rimantandine, fosprenil, myxoferon, etc.

Pathogenetic therapy for the prevention of bacterial complications according to the modern concept of respiratory diseases of young farm animals, as well as direct etiotropic treatment of bacterial infections of the lungs and respiratory tract, includes the use of phanilamide drugs. Sensitivity is determined by the standard disc method and the more accurate dilution method. In this case, for treatment it is recommended to use those drugs to which the sensitivity of the microflora has been established at a drug dilution of 1:10,000 or (when using the standard disk method) a zone of microflora growth inhibition of at least 20 mm. The first administration of the antibacterial drug is carried out in the usual therapeutic dose according to the temporary instructions for use. The introduction of shock doses is dangerous due to the massive death of microflora and the release of endotoxins into the blood of sick young animals, and increased intoxication of the body can lead to death. As an exception, it is possible to use an antibiotic with an established zone of growth inhibition of at least 15 mm, followed by re-analysis using discs of other drugs.

It is advisable to use long-acting antibacterial drugs that create maximum concentrations in the organs of the chest cavity. Their use is less labor-intensive, allows for more accurate dosing and maintenance of the required concentrations. These drugs include bicillin-3, bicillin-5, pentard, imsauf, suanovil 20, inicillin, levotetrasulfin, levoerythrocycline, clamoxil LA, amoxivet, tilmicosin, vetrimoxil A, doxyvetin AB, sulfapyridazine, sultimon, norsulfazole sodium in the form 10-25% suspension on fish oil, etc.

However, it is more effective to use antibacterial agents directly in the area of ​​the pathological focus - in the bronchi and lungs. For this purpose, individual and group methods of drug administration have been developed. The first includes intratracheal injections, the second - aerosol inhalations.

The intratracheal injection technique involves introducing into the lower third of the trachea first 5-10 ml of a 5% solution of novocaine, and then, after 5-10 minutes (after the cough reflex subsides), an antibacterial drug in an isotonic sodium chloride solution, for example penicillin or oxytetracycline at a dose of 15,000 units/kg. With intratracheal injections, therapeutic concentrations in the lungs are maintained for a longer time, which makes it possible to reduce the number of injections per day to 1-2 instead of 3-5.

Infectious disease is characterized by high morbidity. In production conditions for the treatment of respiratory infections of young animals, it is more expedient to organize a sealed room for group treatment methods - aerosol treatments. The aerosol method of antibiotic therapy and the use of other drugs provides high therapeutic efficiency, reduces labor costs, and makes it possible to simultaneously use etiotropic, pathogenetic, and replacement therapy. Treatments are carried out 1 - 2 hours before or after feeding in specially equipped chambers (hermetically sealed rooms) with an air volume of 2-3 m 3 per calf and 0.4-0.8 m 3 per piglet or lamb. The air temperature in the chamber should be within 15-20 "C, relative humidity - 65-70%. Treatments are carried out once a day for 40-60 minutes. Animals with severe symptoms of pulmonary edema (immobility, depression, intense shortness of breath, extensive zones of dullness upon percussion of the pulmonary field) are not allowed for inhalation. The effect of medicinal substances administered by inhalation occurs 20 times faster than with oral administration, and the dose is 4 times less.

Aerosols are created using DAG, SAG, VAU, AI devices, RSSG attachments, etc. The preparations are dissolved in distilled water at a temperature of 35-40 °C. As stabilizers, a 10-20% glycerin solution or a 10% glucose solution, a 15% solution of fresh fish oil, and an 8% solution of skimmed milk powder are used. The last two products are not recommended for use in the summer, during the flight season of flies.

Classic antibiotics (ampicillin, streptomycin, kanamycin, oxytetracycline, neomycin, erythromycin, morphocycline, polymyxin, enroflon, etc.) are used in the form of aerosols at an average rate of 30,000-50,000 U/m 3, sulfonamide drugs (sulfapyridazine , sulfadimethoxine, etazol, norsulfazole, etc.) - 0.5 g/m 3 . The aerosol method is also applicable for sanitizing and antiseptic drugs, which is etiotropic therapy for both viral respiratory diseases and chronic bacterial ones. In the latter case, the use of sanitizing aerosols exacerbates the sluggish process, facilitating its rapid resolution.

A variety of agents that have a disinfectant effect are successfully used, including in the respiratory tract of young animals: 10% solutions of hydrogen peroxide, lactic acid, acetic acid; 0.25% solutions of aethonium and thio-nium; 5% chloramine-B; 1% dioxidine solution; 0.5% solutions of lomaden, paraform; 0.002% solution of metacid; 2% rivanol; 20% solutions of ammonium chloride and potassium iodide; a mixture of 5% sodium carbonate solution and 1% ichthyol (1:1) in doses of 4-5 cm 3 /m 3; 20% peracetic acid at the rate of 20 cm 3 / m 3; 10% aqueous solution of estosteryl-1 at a dose of 0.3 ml/m 3 ; 0.3% solution of acetylsalicylic acid 1 ml/m 3; 1% isatizone at the same dose; a mixture of chlorophyllipt, glucose and ascorbic acid in doses of 70, 20 and 5 cm 3 per 1 m 3, respectively; iodine monochloride in a dose of 3-5 ml/m 3; farmazin, furatsilin in a dilution of 1: 1000 - 4 ml/m 3; thymol and potassium permanganate 1% solution in a dose of 1-1.2 ml/m 3; Iodinol and iodinocol at a dose of 2-3 ml/m 3; 40% resorcinol - 1-2 ml/m3; 0.3% dodeconic solution at a rate of 5 ml/m 3 and many others.

The parallel use of mucolytic and expectorant drugs activates the elimination of respiratory failure. Complex preparations containing antiseptic and mucolytic components for aerosol use include forest balm A (0.3-0.5 g/m 3), EKB balm (0.3 ml/m 3), bronchopneumosol (10 g/m 3), an aqueous solution of pine extract (50 mg/m 3), as well as mixtures, for example, per 1 m 3: 50% solution of iodotriethylene glycol 1 cm 3 with 0.1 cm 3 20% lactic acid ; 5 cm* 10% turpentine and 15 cm 3 camphor serum according to Kadykov; water-alcohol emulsion of propolis in a 5% glucose solution in a dose of 5 cm 3.

Inactivation of residual aerosols is carried out with a 6% solution of hydrogen peroxide at a rate of 70-80 ml/m 3 or a 4% solution of potassium permanganate at 30-50 ml/m 3 with an exposure of 10-15 minutes.

If there are no aerosol generators or nozzles on the farm, a group therapy method is possible using condensation (chemical) aerosols.

Using a non-hardware method, aerosols per 1 m3 are obtained:

1) aluminum iodide - to 0.3 g of crystalline iodine add 0.13 g of ammonium chloride and 0.09 g of aluminum powder, or for 8 parts of crystalline iodine, 0.7 parts of aluminum powder and 1.2 parts of ammonium chloride;

2) chlorine turpentine - to 2 g of calcium hypochloride with an active chlorine content of at least 25% add 0.5 cm 3 of purified turpentine oil (medical turpentine);

3) iodine monochloride - aluminum wire is lowered into 1 cm 3 of the preparation at a weight ratio of 10: 1;

4) a chlorine aerosol is obtained by the interaction of 1.5 cm 3 of hydrochloric acid and 0.3 g of potassium permanganate.

In the first and second cases, to start a chain reaction of aerosol formation after mixing the components, you need to add a little water.

In the complex therapy of respiratory diseases of young animals, simultaneously with etiotropic treatment, as already noted, it is necessary restoration of the drainage function of the bronchi, relief of bronchospasm, elimination of respiratory and cardiovascular failure. In this case, a targeted impact on the general links in the pathogenesis of respiratory diseases is necessary.

Due to increased concentrations of histamine, bradykinin, and other inflammatory mediators at the level of the pathological process and increased permeability of vascular walls, it is necessary to use antiallergic agents that reduce the permeability of vascular walls: calcium gluconate orally 2-3 times a day at a dose of 50 mg/kg animal weight ; intravenously 1 time per day for 3-5 days in case of acute respiratory failure, a 5% aqueous solution of sodium thiosulfate, which also has an antitoxic effect, at the rate of 1.5 cm 3 /kg. With individual therapy, it is possible to prescribe antihistamines: pipolfen, suprastin, etc. at a dose of 0.5-1 mg/kg.

To eliminate pulmonary edema, diuretics are used: furosemide 1 mg/kg, decoctions of bearberry leaves, dill fruits, birch buds, forest pine needles in a ratio of 1: 10. The latter also have an expectorant effect. In addition, slow intravenous administration of a 10% calcium chloride solution at a rate of 2 cm 3 /kg is indicated once every 2 days.

Bronchospasm is eliminated by introducing antispasmodics: subcutaneously 2% solution of papaverine hydrochloride 2-4 ml per calf or orally at a dose of 1-2 mg/kg; theophylline 15 mg/kg; dibazol, sustak, no-shpa, 1 ml of official solutions per calf. Eufillin has both antispasmodic and diuretic effects, inhibits platelet aggregation, and has a stimulating effect on the respiratory center. It is administered at a dose of 15 mg/kg orally; Its effective use is aerosol at a dose of 30 mg/m 3 . Bronchodilators are used: amyl nitrite - 2 cm 3 /100 m 3; theobromine at a dose of 3-5 mcg/kg. The drugs are used 2-3 times a day to dilate the bronchi, eliminate hypoxia and increase diuresis (to relieve pulmonary edema).

To free the bronchi, bronchioles and alveoli from accumulated inflammatory exudate, leukocytes, sloughed and dead epithelium, and to cleanse the respiratory tract, expectorants must be used. In cases of chronic protracted processes with viscous exudate, partial induration, it is most effective to first use mucolytic expectorants, and then reflex (resorptive) ones.

Enzyme preparations are used as mucolytics: crystalline trypsin - 5-10 mg; chymotrypsin - 25-30 mg; chemotrypsin - 5-10 mg; terrilitin 100-150 PE; gigrolitin 75-100 PE; deoxyribonuclease - 5 mg; ribonuclease - 25 mg. Proteolytic enzymes are also used aerosolly, the doses correspond to doses calculated for 1 m 3 of room air for treatment. Ribonuclease and deoxyribonuclease, which destroy viral nucleic acids, can be prescribed simultaneously as a means of etiotropic therapy.

Prevention of induration, cornification of the affected lung, exacerbation of the process and increased rejection of affected tissues with their sanitation are achieved by administering potassium iodide by inhalation, as described earlier, or orally. However, its use using electrophoresis is even more effective.

Expectorants of resorptive action: sodium bicarbonate - orally 1 g/kg of animal weight; ammonium chloride, which also has a diuretic effect, - 1 mg/kg of animal weight; preparations of istoda, marshmallow, licorice. Mucolytic and expectorant effects were combined with bromhexine (used at a dose of 0.3-0.5 mg/kg), infusions and decoctions of medicinal plants.

To prepare infusions and decoctions, herbal medicinal raw materials are crushed, placed in preheated porcelain or enamel dishes, as well as in a stainless steel bucket, and filled with boiling water in the required proportion. The decoctions continue to boil for 10-15 minutes with the lid closed or kept in a boiling water bath for 30 minutes. After pouring, the infusions are kept for 30-40 minutes at room temperature, stirring occasionally. Decoctions and infusions that have cooled to 30-40 °C are drunk in doses of 1-3 ml/kg of animal weight.

As expectorants, infusions of 1:20 of plantain leaf, wild rosemary, alpine aster, anise fruit, lungwort, cordate linden flowers, as well as an infusion of 1:200 of Thermopsis lanceolata herb are used; decoctions 1: 10 leaves of coltsfoot, fireweed, marshmallow root, birch and pine buds, decoctions 1:20 heads of meadow clover, roots of isod and licorice (licorice).

To quickly clear the airways, physiotherapy is necessary: ​​local heating of the chest, infrared and dosed ultraviolet irradiation, UHF therapy, inducto therapy, the use of distracting methods of therapy (mustard plasters). For example, high-frequency ultrasound 880 kHz is used with an intensity of 0.2-0.4 W/cm 2 in a pulse mode of 2 ms and an exposure time of 1-3 minutes.

As a therapy that regulates neurotrophic functions, the use of novocaine blockade of the stellate (lower cervical) sympathetic nodes, 20-30 cm 3 of 0.25% novocaine solution on both sides, is effective.

Combating toxicosis and stimulating the body's protective functions carried out by a complex of pathogenetic and replacement antitoxic therapy. In the absence of appetite and refusal to feed, intravenous or subcutaneous infusions of a glucose solution (10 or 40%) together with ascorbic acid (2-5 ml of a 2% solution) are indicated. A 5% solution of sodium thiosulfate, lipoic acid, and aminovit are applicable as detoxification agents. Intravenous administration of 100-200 cm 3 hemodez is effective.

Among the means used to regulate immunity and in therapy, much attention is paid to biologically active substances. These include nucleic acids, immunomodulators, vitamins and microelements. For bacterial infections, the combination of immunomodulators with antibiotics increases the therapeutic effect of the latter.

Vitamin therapy provides the body with lost vitamin and coenzyme complexes. The use of retinol, tocopherol, and ascorbic acid has an anti-stress, immunostimulating and antioxidant effect.

Natural catalysts for metabolic processes are vitamins, and building materials for proteins and protein compounds are amino acids and mineral salts. For treatment and preventive purposes, multivitamin preparations are recommended, which have a greater effect than 2-3 vitamin preparations administered separately.

An effective multivitamin is a concentrated sterile solution of essential vitamins (A, E, D, B, B 2, B5, Bg, B12), which is used in the form of a one-time subcutaneous or intramuscular injection in a dose of 2 cm 3 /50 kg of weight; aminovital - a combination of 8 vitamins with amino acids and mineral elements in the form of an aqueous concentrate with colostrum or milk in a dose of 3-4 cm 3 per day for calves, and 0.05-0.1 cm 3 for piglets; aminovit (A, D 3, E, C, B b 2, B 6, PP, K 3, N, etc.) intramuscularly 1 time every 2-3 days in doses (per animal weight): up to 5 kg - 1 ,0-1.5 cm 3, 20 kg - 3 cm 3, up to 40 kg - 6 cm 3, over 9-10 cm 3; eleovit (A, D 3, E, K 3, B b B 2, B5, B 6, B c, B 12, N) intramuscularly or subcutaneously in doses per 1 animal: foals, calves - 2-3 cm 3, lambs - 1 cm 3, for piglets - 1-1.5 cm 3, etc.

The immunological reactivity of the body of young animals largely depends on the provision of biologically active microelements in the required proportions (zinc, copper, manganese, cobalt, iron, selenium, molybdenum, etc.). One of the promising complexes is hemovit-plus, which is used for calves at a dose of 5.0 cm 3 per head per day, which helps normalize metabolism and increases growth energy.

In acute inflammatory lesions of the respiratory organs, many under-oxidized products accumulate, which play a role in the development of pathological processes. Their formation increases when the body is exposed to stress and the concentration of adrenaline in the blood increases. Therefore, the use of antioxidants (ligfol, selenium, succinic acid, emicidin) and anti-stress drugs (lithium carbonate, lithium sulfate, phenozepam, glycine) will more effectively fight the disease. Moreover, these actions are inextricably linked with immune defense.

The drug ligfol combines the properties of a stress corrector, adaptogen, antioxidant and immunomodulator. It is used as an important component of complex treatment of respiratory and other pathologies of animals intramuscularly once every 2-7 days and 3-5 days before expected adverse effects at a dose of 0.1 ml/kg for young animals.

Antioxidants are used in medical practice due to their ability to inhibit lipid peroxidation, stabilize the structure and improve the function of cell membranes, thereby creating optimal conditions for homeostasis when exposed to pathogenic factors on the body. Pronounced long-term exposure to lipid peroxidation of biomembranes leads to a decrease in detoxification of endogenous substances and xenobiotics, dystrophy, and then cell death, tissue infarction and cessation of vital processes in the body. The damaging effects of free radicals are counteracted by the body's own endogenous antioxidant system, including the enzyme system (catalase, glutathione peroxidase, superoxide dismutase, etc.) and vitamins (alpha-tocopherol, ascorbic acid).

However, with the intensive formation of free radicals, the body's resources are insufficient - agents that inhibit the processes of lipid peroxidation and protect the cell apparatus from destructive influences come to the rescue. For these purposes, succinic acid is used at a dose of 4-5 mg/kg orally. Emicidin is used in the form of a 2.5-5% aqueous solution for injection or in capsules for oral administration with individual dosing. Selenium is also actively involved in various metabolic processes, regulates the rate of redox reactions and is used both in the form of feed additives and premixes, and in the form of drugs - selenor (intramuscularly at 3.0-12.0 mcg/kg), sodium selenite (0.1 µg/kg).

As immunomodulators for respiratory infectious diseases, it is effective to use, according to the instructions, thymogen, T-activin, B-activin, immunofan, valexin-1 and 2, ASD fraction 2, immunoferron, dostim, ligfol, Filatov's agar-tissue preparation, levamisole , polyoxidonium, ribotan, fosprenyl, bursin, gangliin, bactoferon, lactoferon, immunobak, alpha-peptoferon, neoferon, leukinferon, quacycline, isoquaterine, cytokines, cytomedins, vestin, timogar, ceophract, histoseroglobin, argequin, sodequin , gangliin, etc. Phagocytic activity and cellular immunity are stimulated by iron, retinol and tocopherol preparations, ascorbic acid, complex vitamin-amino acid preparations (Gamavit, Aminovit, Ursovit, Vitaperos).

It must be remembered that the use of certain immunostimulants for infections, the pathogen of which replicates in macrophages (for example, viral diarrhea), can cause increased propagation of the infection.

Stimulates the immune response and general protective functions by subcutaneous injection of 1 cm 3 of 0.2% formaldehyde solution. The effectiveness of hematotherapy for lung damage has been noted: blood obtained from the jugular vein with an anticoagulant (per 100 ml of blood, 5 ml of 5% sodium citrate solution or 10 ml of 10% sodium salicylate solution) is injected subcutaneously into the border areas once every 2-4 days. pathological percussion dullness of the lung field, as well as in the neck and inner thigh. Studies have shown an increase in the effectiveness of classical treatment regimens when using this method by 30%.

For symptomatic therapy, it is first necessary to use drugs that support cardiac activity (sulfocamphocaine, camphor, cocarboxylase, theobromine). Sulphocamphocaine is administered intramuscularly, a 20% oil solution of camphor is administered subcutaneously at a dose of 0.05 cm 3 /kg, cocarboxylase is administered intramuscularly at a rate of 1 mg/kg per day. Theobromine is used as an aerosol - 150 mg/m 3 .

In cases of severe cough, the use of antitussives is indicated - butamirate 0.2 mg/kg for calves and foals, 0.3 mg/kg for piglets, lambs, kids 2 times a day, peppermint infusion 1:20, rhizome decoction 1:20 elecampane, rose hips, thyme leaves. This symptomatic treatment is indicated in the initial stages of adenovirus infection, parainfluenza and other respiratory viruses, when a painful cough does not serve for expectoration, but is a consequence of overirritation of the receptors of the bronchi and lungs and leads to an intensification of the pathological condition. Also, the prescription of drugs that inhibit the cough reflex is indicated for pleurisy (porcine hemophilus polyserositis), where there is no possibility of exudative release.

Thus, complex treatment affects many systems and links of the pathological process during respiratory infections of young farm animals. Recently, more and more products have been produced that combine components of several areas of therapy. Thus, pneumonia contains an immunomodulator (quinoxaline derivative), an antibiotic from the tylosin group, an antihistamine component and a cardiac glycoside. Pneumonia is used for therapeutic purposes 1-2 times a day intramuscularly at a dose of 0.2 cm 3 /kg.