Нежелательные эффекты антибактериальной терапии в педиатрической практике. Роль пре- и пробиотиков в профилактике антибиотико-ассоциированной диареи

The era of antibiotics began in the mid-twentieth century, which resulted in changing the basic views on the treatment of infectious diseases and significantly increased the life expectancy among individuals on average by 20 to 30 years. The widespread uncontrolled use of antibacterial drugs has led to development of resistance to antibiotics and a number of adverse events, one of which is diarrhoea. Diarrhoea is caused by the use of antibiotics in 6–7% of cases. Pre- and probiotics are used to prevent diarrhoea. A study of the efficacy and safety of Ecomed (a powder to prepare a suspension containing 100 mg/5 ml azithromycin manufactured by AVVA RUS JSC (Russia) in combination with prebiotics lactulose) in comparison with azithromycin without lactulose was conducted in children with acute bacterial rhinosinusitis. A total of 100 patients were included in the study (50 boys and 50 girls) aged 3 to 14 years, who were divided into 2 groups: the main group consisted of 50 children (mean age 6.16 ± 2.78 years) who received Ecomed for 3 days; the control group of 50 children (mean age 6.9 ± 3.24 years) who received azithromycin for 3 days. The observation period was 2 months. During the observation period, the gastrointestinal tract state was evaluated for such symptoms as flatulence, bloating, frequency of bowel movements and consistency of feces. Feces were collected from children of both groups for gene sequencing by the 16s rRNA method during 4 visits: visit 1: before therapy, visit 2: 3 days after start of the therapy (end of the therapy), visit 3: 17 days after start of the therapy, visit 4: 60 days after start of the therapy. The study showed a significant difference between the microbiota profiles against the background of therapy with azithromycin and Ecomed. It was established that the total share of micro-organisms exposed to the drugs accounted for approximately 20–25%. The use of azithromycin provoked the development of intestinal dysbiosis according to the criteria for the deviation of the microbiota families, genera and species profile from the initial state, and according to the diagnostic signs of clinical symptomatology. An important observation was the fact that even after 2 months the dysbiotic state did not return to normal. The use of Ecomed containing a combination of azithromycin and lactulose reduced dysbiosis of the intestinal microbiota exposed to azithromycin. The main advantages were that opportunistic microorganisms had been prevented from growing against the background of azithromycin therapy and useful and other microorganisms had been preserved.