vspВопросы современной педиатрииCurrent Pediatrics1682-55271682-5535Издательство «ПедиатрЪ»10.15690/vsp.v12i4.741vsp-315Research ArticleОБМЕН ОПЫТОМEXCHANGE OF EXPERIENCEМУКОЛИТИКИ В ПЕДИАТРИЧЕСКОЙ ПРАКТИКЕ: РАЦИОНАЛЬНЫЙ ВЫБОР, ЛЕЧЕБНЫЕ ЭФФЕКТЫ И ОСОБЕННОСТИ ТЕРАПИИMUCOLYTIC AGENTS IN PEDIATRICS: RATIONAL SELECTION, THERAPEUTIC EFFECTS AND SPECIFIC ASPECTS OF TREATMENTСимоноваО. И.SimonovaO. I.

Simonova Ol’ga Igorevna, PhD, professor, Head of the Department of Pneumology and Allergology

oisimonova@mail.ruНаучный центр здоровья детей РАМН, МоскваРоссияScientific Centre of Children Health of RAMS, MoscowRussian Federation201312072013124Вопросы современной педиатрии136141Copyright © Симонова О.И., 20132013Симонова О.И.Simonova O.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://vsp.spr-journal.ru/jour/article/view/315

The article deals with the cough treatment options with mucolytic agents administration at the first several days of acute respiratory tract infections in children. Efficacy of treatment with secretolytic and secretomotoric drugs significantly depends on certain factors. The article contains the criteria of therapeutic efficacy of expectorants. A special attention is given to N-acetylcysteine — a direct acting mucolytic agent, which effect is caused by presence of free sulfhydryl groups, disrupting disulfide bonds between molecules of acid mucopolysaccharides and glycoproteins therefore changing the structure of sputum. Acetylcysteine is active against every type of sputum (mucous, muco-purulent, purulent), that is especially important in treatment of bacterial infections, when it is necessary to quickly decrease sputum thickness, eliminate it from the respiratory tract and prevent dissemination of the infection. High efficacy of acetylcysteine is caused by its unique triple action: mucolytic, antioxidant and antitoxic. Mechanism of action of acetylcysteine is discussed in detail. Timely administered treatment will improve sputum discharge and therefore eliminate one of the main factors of bronchial obstruction and decrease the risk of microbial colonization of the respiratory tract. The article also includes indications, contraindications and dosage regimens of acetylcysteine in children. The most common mistakes and specific aspects of mucolytic drugs in pediatrics are listed in the conclusion.

 

детимукостазкашельвязкость бронхиального секретаацетилцистеинchildrenmucostasiscoughthickness of bronchial sputumacetylcysteineReferencesMukoaktivnaya terapiya. Pod red. A. G. Chuchalina, A. S. Belevskogo [Mukoactive Therapy. Edited by A. G. Chuchalin, A. S. Belevskii]. Moscow, Atmosfera, 2006. 127 p.Mukoaktivnaya terapiya. Pod red. A. G. Chuchalina, A. S. Belevskogo [Mukoactive Therapy. Edited by A. G. Chuchalin, A. S. Belevskii]. Moscow, Atmosfera, 2006. 127 p.Soroka N. D. Voprosi sovremennoi pediatrii — Current Pediatrics. 2008; 7 (4): 111–114.Soroka N. D. Voprosi sovremennoi pediatrii — Current Pediatrics. 2008; 7 (4): 111–114.Rossiiskii natsional'nyi pediatricheskii formulyar. Pod red. A. A. Baranova [Russian National Pediatric Formulary. Edited by A. A. Baranov]. Moscow, GEOTAR-Media, 2009. 912 p.Rossiiskii natsional'nyi pediatricheskii formulyar. Pod red. A. A. Baranova [Russian National Pediatric Formulary. Edited by A. A. Baranov]. Moscow, GEOTAR-Media, 2009. 912 p.Sheffner A. L. The reduction in vitro in viscosity of mucoprotein solution by a newmucolytic agent, N-acetylcysteine. Ann. N. Y. Acad. Sci. 1963; 106: 298–310.Sheffner A. L. The reduction in vitro in viscosity of mucoprotein solution by a newmucolytic agent, N-acetylcysteine. Ann. N. Y. Acad. Sci. 1963; 106: 298–310.Den'gin V. V. Farmateka — Pharmateca. 2008; 4: 48–52.Den'gin V. V. Farmateka — Pharmateca. 2008; 4: 48–52.Simonova O. I. Vrach — The Doctor. 2010; 2: 56–61.Simonova O. I. Vrach — The Doctor. 2010; 2: 56–61.Davis S. S., Deverell L. C. Rheological factors in mucociliary clearance: the assessment of mucotropic agents using in vitro model. Mod. Prob. Paediatric. 1977; 19: 207–232.Davis S. S., Deverell L. C. Rheological factors in mucociliary clearance: the assessment of mucotropic agents using in vitro model. Mod. Prob. Paediatric. 1977; 19: 207–232.Maev I. V., Busarova G. A. Lechashhij vrach — Practicing Doctor. 2003; 1: 41–47.Maev I. V., Busarova G. A. Lechashhij vrach — Practicing Doctor. 2003; 1: 41–47.Trastotenojo M. S., Harsoyo N., Sachro A. D., Soemantri A. G., Said H. W. Use of acetyl cysteine in respiratory tract disease in children. Paediatrica Indonesiana. 1984; 24: 1–10.Trastotenojo M. S., Harsoyo N., Sachro A. D., Soemantri A. G., Said H. W. Use of acetyl cysteine in respiratory tract disease in children. Paediatrica Indonesiana. 1984; 24: 1–10.Bellomo G., Giudice S. Controlled study on the efficacy of a combination «thiamphenicol-acetylcysteine» in oral administration in respiratory infections in pediatrics. Clin. Pediatrics. 1972; 54: 30–51.Bellomo G., Giudice S. Controlled study on the efficacy of a combination «thiamphenicol-acetylcysteine» in oral administration in respiratory infections in pediatrics. Clin. Pediatrics. 1972; 54: 30–51.Bellomo G. Comparative study of the efficacy of acetylcysteine by the oral and intramuscular routes in acute respiratory affections in pediatrics. Minerva Pediatrica. 1973; 25: 844–849.Bellomo G. Comparative study of the efficacy of acetylcysteine by the oral and intramuscular routes in acute respiratory affections in pediatrics. Minerva Pediatrica. 1973; 25: 844–849.Biscatti G., Bruschelli M., Damonte G., Capozzi F. Controlled studies of the clinical effects of acetylcysteine in oral administration in respiratory infections in pediatrics. Minerva Pediatrica. 1972; 24: 1075–1084.Biscatti G., Bruschelli M., Damonte G., Capozzi F. Controlled studies of the clinical effects of acetylcysteine in oral administration in respiratory infections in pediatrics. Minerva Pediatrica. 1972; 24: 1075–1084.Caramia G., Bizzarri V., Compagnoni L., Gregorini S. Combined anti biotic plus mucolytic treatment in broncho-pulmonary disease: cefuroxime plus acetylcysteine. Curr. Ther. Res. Clin. Exp. 1984; 36: 658–663.Caramia G., Bizzarri V., Compagnoni L., Gregorini S. Combined anti biotic plus mucolytic treatment in broncho-pulmonary disease: cefuroxime plus acetylcysteine. Curr. Ther. Res. Clin. Exp. 1984; 36: 658–663.Ramenghi M., Sabayini G., Mengoni M. Combined antibiotic plus mucolytic treatment for recurrent bronchial diseases in infancy. Curr. Ther. Res. 1984; 36: 664–667.Ramenghi M., Sabayini G., Mengoni M. Combined antibiotic plus mucolytic treatment for recurrent bronchial diseases in infancy. Curr. Ther. Res. 1984; 36: 664–667.Santangelo G., Lombardo S., Giannotti G. A combination of сefuroxime and N-acetylcysteine for the treatment of lower respiratory tract infections in children. Int. J. Clin. Pharmacol. Ther. Toxicol. 1985; 23: 279–281.Santangelo G., Lombardo S., Giannotti G. A combination of сefuroxime and N-acetylcysteine for the treatment of lower respiratory tract infections in children. Int. J. Clin. Pharmacol. Ther. Toxicol. 1985; 23: 279–281.Fiocchi A., Vignati B., Sala M., Arancio R., Banderali G., Marangione P. et al. A new N-acetylcysteine formulation in acute bronchopneumopathy in children. Giornale Italiano Delle Malattie del Torace. 1989; 43: 327–334.Fiocchi A., Vignati B., Sala M., Arancio R., Banderali G., Marangione P. et al. A new N-acetylcysteine formulation in acute bronchopneumopathy in children. Giornale Italiano Delle Malattie del Torace. 1989; 43: 327–334.Camurri S., Marenco G. Clinical evaluation of the safety and efficacy of a new pharmaceutical formulation of bromhexine compared to N-acetylcysteine in pediatric patients with acute bronchitis Gazzetta Medica Italiana. 1990; 149: 45–48.Camurri S., Marenco G. Clinical evaluation of the safety and efficacy of a new pharmaceutical formulation of bromhexine compared to N-acetylcysteine in pediatric patients with acute bronchitis Gazzetta Medica Italiana. 1990; 149: 45–48.Amir J., Wilunsky E., Zelikovic I., Reisner S. H. Acetylcysteine for severe atelectasis in premature infants. Clin. Pharm. 1985; 4: 255.Amir J., Wilunsky E., Zelikovic I., Reisner S. H. Acetylcysteine for severe atelectasis in premature infants. Clin. Pharm. 1985; 4: 255.Мayaud C., Lentschner C., Bouchoucha S., Marsac J. Thiamphenicol glycinate acetylcysteinate in the treatment of acute respiratory infections with mucostasis. Eur. J. Resp. Dis. Suppl. 1980; 61 (111): 70–73.Мayaud C., Lentschner C., Bouchoucha S., Marsac J. Thiamphenicol glycinate acetylcysteinate in the treatment of acute respiratory infections with mucostasis. Eur. J. Resp. Dis. Suppl. 1980; 61 (111): 70–73.Szekely E., Farkas E. Treament of chronic bronchitis with oral acetylcysteine in children. Eur. J. Resp. Dis. Suppl. 1980; 61 (111): 142.Szekely E., Farkas E. Treament of chronic bronchitis with oral acetylcysteine in children. Eur. J. Resp. Dis. Suppl. 1980; 61 (111): 142.Volkl V.K.P., Schneider B. Treatment of airway diseases with N-acetylcystein. An open therapeutic observational study involving 2512 patients. Fortschritte der Medizin. 1992; 10: 346–350.Volkl V.K.P., Schneider B. Treatment of airway diseases with N-acetylcystein. An open therapeutic observational study involving 2512 patients. Fortschritte der Medizin. 1992; 10: 346–350.Zens V. M. Clinical trial with a mucolytic agent, acetylcysteine, in children with bronchitis. Fortschritte der Medizin. 1967; 85: 206–207.Zens V. M. Clinical trial with a mucolytic agent, acetylcysteine, in children with bronchitis. Fortschritte der Medizin. 1967; 85: 206–207.Duijvestijn Y. C., Mourdi N., Smucny J. et al. Acetylcysteine and carbocysteine for acute upper and lower respiratory tract infections in paediatric patients without chronic broncho-pulmonary disease. Cochr. Database Syst. Rev. 2009; 21 (1).Duijvestijn Y. C., Mourdi N., Smucny J. et al. Acetylcysteine and carbocysteine for acute upper and lower respiratory tract infections in paediatric patients without chronic broncho-pulmonary disease. Cochr. Database Syst. Rev. 2009; 21 (1).Zaitseva O. V. RMZh — Russian Medical Journal. 2009; 19: 1217–1222.Zaitseva O. V. RMZh — Russian Medical Journal. 2009; 19: 1217–1222.Pikuza O. I., Zakirova A. M. RMZh — Russian Medical Journal. 2009; 2: 82–84.Pikuza O. I., Zakirova A. M. RMZh — Russian Medical Journal. 2009; 2: 82–84.Lokshina E. E., Zaitseva S. V., Zaitseva O. V. Voprosi prakticheskoi pediatrii — Problems of Practical Pediatrics. 2011; 6 (1): 67–72.Lokshina E. E., Zaitseva S. V., Zaitseva O. V. Voprosi prakticheskoi pediatrii — Problems of Practical Pediatrics. 2011; 6 (1): 67–72.

The authors declare that there are no conflicts of interest present.