The specified antiviral agents should be applied in the first days of disease, later they are not effective.

To decrease a body temperature, and to reduce a headache and muscular pain analgin, ascofen, upsarin with vitamin C, eferalgan, paracetamol are indicated. As a preparation of a choice you can use non narcotic analgetic Amison, rendering analgetic,anti-inflammatory,antipyretic and interferonogenic action. The fever is the major adaptive and protective reaction of organism, induces synthesis of an endogenic interferon. Antipyretic preparations are indicated only at a hyperpyrexia and expressed cerebral and cardiovascular disorders in adegnote dose to lower a body temperature on 1-1.5 °Ñ.

As the stimulation of endogenic interferon formation amixin is applied 0.125-0.25 gm per day for 2 days, then 0.125 gm in 48 hours for one week or in the first 2-3 days; mefanam acid 0.5 gm 2 times per day is prescribed. For patients polyvitamines, ascorutin are indicated. At excruciating tussis indicate codein phosphat, codterpin, tablets against tussis, at labored nasal respiration - halazolin, farmasolin or naphthyzin, efedrin hydrochloride, pinosol, at exaltation and disorders of sleeping - mixture of behterev, fenobarbitalum for the night.

In serious cases of influenza and the weakened patient, with indicated specified agents, infuse antiinfluenza donor immunoglobulin 3 mL (IM) unitary, sometimes repeatedly in 6-12 hours.

Reopolyglucin, solution of albumin, isotonic solution of Sodium chloride, 5 % a solution of glucose (IV) should be infused to treat severe toxicosis. For prevention of hypertension in a pulmonary blood circle, it is necessary to infuse not more than 500-800 mL of liquids slowly and simultaneously to use diuretic preparations -furosemid, diacarb, etacrinic acid. Appoint corglykon, sulfocamphocain, euphyllin, inhalations of oxygen or carbogen.

Patients with especially serious (hypertoxic) form of influenza should be treated in departament of intensive treatment. Antiinfluenza gamma-globulin or a serum polyglobulin is prescribed in dose of 3-6 mL in 4-6 hours (in muscle or even in vein). Infuse (IV) admixture of the following structure: blood plasma -150-200 mL, solution of glucose 40 % 20 ml, mesaton 1 % or noradrenalin 0.2 % 1 ml, strophanthin 0.05 % or corglykon 0.06 % 0.5 1 ml, furosemid (lasix) 40-80 mg; hydrocortizon 250-400 mg, euphyllin 2.4 % 1 ml, ascorbic acid solution 5 % 5-Þ ml, calcii chlorid solution 10 % 10 ml, polyglobulin - 3 mL. At disorders of cardiac activity - corglykon or strophanthin are used. At increase of hypoxia and fluid of lungs that should be prescribed to inhale oxygen-alcohol mixture on extremity impose venous garrots, apply diuretic preparations.

In case of development of acute edema and brain swelling in a vein infuse mannit (mannitole), furosemid (lasix), preparations of a potassium, glucocorticoids.

Widely use tinctura of the herbs, with sudorific, anti-inflammatory, soothing, spasmolytic, expectorative and antimicrobial properties.

The collecting ¹ 1 consists of root of Altea medicinal (2 parts), buds of birch white (1 part), flowers of elder black (1 part), rhizome with roots of inula

Influenza

(1 part), grass of St.-John's wort (7 parts), berries and leaves of raspberry ordinary (2 parts), leaves of mint peppery (2 parts), buds of pine ordinary (2 parts), grass of a sage medicinal (2 parts), leaves of eucaliptus (2 parts);

The collecting ¹ 2 consists of root sweetflag (1 part), buds of a birch white (2 parts), herbs of Origana ordinary (3 parts), a root of Valeriana medicinal (1 part), a herb of St.-John's wort (3 parts), leaves of Viburn ordinary (2 parts), a seed of flax sowing (2 parts), a herb of a yarrow ordinary (2 parts), fetuses of fennel garden (2 parts). It is necessary to fill 4 or 6 dining spoons of the collecting in a thermos (0.7-1 L) to fill up to top with abrupt boiled water, to sustain 3-4 houres and to drink all within day in 3-4 receptions. Course of treatment by such shock doses lasts 3-5 days. The next days use usual doses making 2-3 dining spoons of an admixture 0.5 L of boiled water. Among other medicinal herbs for preparation tinctures it is possible to use leaves of fragarias wood, tussilagoes farfara, flowers of camomily calendulaes, an elder black, lindens. For inhalations use broths of leaves of sage, eucalyptus, grasses of thyme, pine buds, buds and young branches currants, birches, raspberries, a root of willow-leaf inula, better acidified- then rinse a mouth, a throat and wash out a nose. Revaitl garlick pearls is indicated to rise immunity. The heating of a thorax with the help of Sinapismuses, mustard wrappings or pepper emplastry is prescribed. The same agents put to a plantar surface of the feet and shins.

Antibiotics at an influenza are indicated in following cases: 1) at serious course of disease (the hypertoxical form with encephalitis if disease begins with a pneumonia); 2) to children of the first 2 years of the life, the pregnant, to weaken patients, to persons of elderly and senile age; 3) at bacterial complications; 4) at accompanying chronic diseases of inflammatory character which may become aggravated at influenza. In other cases antibiotics are contrindicated, as they strengthen allergization of organism and enlarge frequency of various complications.

Treatment of bacterial complications is necessary to start, before getting results of bacterial inoculation and definitions of sensitivity on antibiotics of the allocated microflora. At the pneumonia indicate benzylpenicillin or one of semisynthetic penicillins. At a hypersensibility of organism to these preparations one can use erythromicin, oleandomycin or doxycyclin. At ambulatory treatment also frequently are indicated one of the combined preparations - oletetrin, tetraolen, and at more serious current of pneumonia - vancomycin, tienam and antiinfluenza gamma-globulin or polyglobulia The expressed effect is spotted at a combination of preparations of tetracyclines or cefalosporines with semisynthetic penicillins and gentamicin, infused parenterally. At unsuccessful treatment after 5-7 days choose antibiotic in view of sensitivity of microflora of sputum. Alternative preparations may be a fusidin-natrii, bactrim, nitroxolin.

At serious bacterial complications of influenza apply macrolides of II-IH generations: sumamed, claritromicin, cefalosporines of III-IV generations - cefotaxim, cefoperason, cedex, cefpirom, combinations of cefalosporines and penicillins with

178 Infectious diseases

inhibitors of p-lactamazes (clavulanic acid, sulbactam, tasobactam) and aminoglicosides. Preparations of a choice may be ftorhinolones - ofloxacin,ciprofloxacin,pefloxacin and others, which have high antibacterial activity and wide spectrum of action, including influence on polyresistant Gram-negative and Gram-positive bacteries.

Use antitussive (glaucini hydrochloride, libexin, tusuprex), expectorating (terpin hydrate, natrii benzoic, broth of a herb of termopsis, a root of althaea), mucolytic (acetylcystein, bronchoclar, bromhexin, ambroxole, lasolvan, fluditec) agents, physical methods of treatment.

Prophylaxis

Vaccines that include the prevalent strains of influenza viruses effectively reduce the incidence of infection among vaccinees for 1 or 2 years after vaccination. Vaccines is prepared as inactivated whole virus or as subunits of the virus, either semi-purified viral hemagglutinin or disrupted virion components. Both types of vaccine are equally protective. Under development are attenuated live vaccines given intranasally. They have the advantage of eliciting specific secretory antibody at the portal of virus entry.

Vaccination is especially important for the aged and for patients with cardiac, pulmonary or other chronic diseases. Pregnant women whose 3rd trimester occurs during the winter months should be vaccinated also. With the presently available purified vaccines, local or constitutional reactions are uncommon or minor, except sometimes in children.

Amantadine 100 mg orally can be used prophylactically against influenza A. During influenza A epidemics, it should be given to family members and other close contact of patients and to persons at high risk of increased morbility from influenza. During administration of amantadine, persons at high risk of infection who have not been vaccinated previously should receive vaccine, then amantadine may be discontinued in 3 wk. If vaccine cannot be given, amantadine must be continued for the duration of the epidemic, usually 6 or 8 weeks.

At the time of epidemic also can be used another chemical remedies (oxolinum, tebrophenum) and interferon preparations.

Control questions:

1. Etiology, epidemiology and incidence of influenza. Pathogenesis îò lniluenza.

3. Anatomic pathology of disease.

4. Main clinical symptoms and signs of influenza.

5. Complications of influenza infection.

6. Laboratory methods of influenza diagnosis: the serological, bacteriological and immunefluorescent.

7. Criteria of diagnosis.

8. Differential diagnosis of influenza.

9. Treatment of bacterial complications of influenza.

10. Treatment of influenza.

II. Prophylaxis of influenza.

Acute respiratory viral diseases 179

Date: 2014-12-21; view: 1190