The September issue of Clinical Infectious Diseases published articles representing an opinion on this problem by a group of leading experts in the fields of clinical microbiology, infectious diseases and chemotherapy antimicrobial from around the world (United States, Canada, Great Britain, France, etc.)

The authors point out that the irrational use of antibiotics has led to the emergence and widespread use of antibiotic-resistant microorganisms, in some cases resistant to several classes of antibacterial drugs (multi-resistant strains). At the same time, it has been found that there is a direct correlation between the consumption of an antibiotic and the appearance and spread of resistant microorganisms.

Pneumococcus (Streptococcus pneumoniae) is one of the most important "respiratory" pathogens and plays a leading role in the etiology of upper respiratory infections (otitis media, sinusitis) and lower (exacerbation of chronic bronchitis, pneumonia). Antibiotic resistance in S. pneumoniae strains results from two main mechanisms: mutations and recombinations of genetic material with the acquisition by pneumococci of resistance genes from microorganisms that make up the normal microflora of the oral cavity. The main therapeutic problems today are the strains of pneumococci resistant to penicillin and / or macrolides, the number of which is increasing. However, recently strains of S. pneumoniae resistant to fluoroquinolones have been reported.

It was previously thought that, compared to "traditional" fluoroquinolones (ciprofloxacin and levofloxacin), the "new" drugs (for example, moxifloxacin and gatifloxacin) are much more active against pneumococci, and their resistance to S. pneumoniae is not arisen. However, the recently published results of several studies indicate that the resistance of pneumococci to fluoroquinolones (PX) extends to all drugs of this class, i.e. strains resistant to ciprofloxacin or ofloxacin are characterized by reduced sensitivity to other compounds with a similar chemical structure (eg moxifloxacin).

We know that the main "reservoir" of pneumococcal strains is the child. The frequency of pneumococcal carriage in healthy children has been shown to exceed 50%, and prior antibiotic use significantly increases the risk of antibiotic-resistant S. pneumoniae. The use of antibiotics in children greatly affects the level of antibiotic resistance in the population as a whole. Thus, a study in the United States showed that the increase in macrolide resistance in pneumococci was doubled from 1995 to 1999. is associated with a 320% increase in the frequency of use of this group of drugs in children under 5 years of age, while the consumption of macrolides in patients over 5 years of age has not changed.

To date, PF is not approved for use in children, as it is known that in immature animals, they can damage the cartilage of large joints. As a similar effect on articular cartilage has not been proven in humans, some authors suggest lifting the ban on the use of FP in children. At the same time, FPs have a number of other adverse reactions: neurotoxicity (up to the development of seizures), cardiotoxicity (QT prolongation, arrhythmias) and phototoxicity, which also casts doubt on the validity of their administration to children.

If you allow the use of FP in children, three main factors: irrational administration of antibiotics; the presence of a reservoir of resistance genes in the streptococci of the viridans group, which constitute the normal microflora of the oral cavity; and frequent pneumococcal infections (eg acute otitis media) in this group of patients will have a joint effect on the development and spread of resistance of S. pneumoniae to drugs in this class. The authors are convinced that with the official authorization to use FP in pediatric practice, the therapeutic benefits of this stage will be quickly offset by the spread of resistant strains, which will lead to undesirable results not only in the treatment of children. , but also adult patients.

Thus, FP should only be used to treat infections in adult patients and diseases in children (exacerbations of bronchopulmonary infections in cystic fibrosis due to Pseudomonas aeruginosa; complicated urinary tract infections; invasive intestinal infections; otitis media chronic), in which there are no other alternative therapies. This approach is an important step in the fight against the spread of antibiotic resistance, which will maintain the effectiveness of HR in clinical practice.