Antibiotics for tracheitis: when you can't do without them and when they are not necessary?

In modern clinical medicine, tracheitis is considered a disease of viral origin, but bacteria are also involved in its occurrence, in particular, staphylococci, streptococci and, especially, gram-positive aerobes of the genus Moraxella catarrhalis. It is in connection with the presence of a bacterial factor in the etiology of tracheitis that the question arises: are antibiotics necessary for tracheitis?

The practically unimpeded way of "migration" of pathogenic microbes is aerogenic. By airborne droplets and airborne dust, pathogens enter the human respiratory tract, causing various diseases. One of them is tracheitis, in which the mucous membrane of the windpipe - the trachea - becomes inflamed.

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Treatment of tracheitis with antibiotics

Tracheitis occurs in two forms - acute and chronic. Acute tracheitis, the main symptom of which is a persistent dry cough that tears the throat, is in most cases combined with acute inflammation of the nasal mucosa (rhinitis), inflammation of the mucous membranes of the pharynx (pharyngitis) and larynx (laryngitis). All these inflammatory processes are the result of a viral infection. As is known, viruses do not have a cellular structure and penetrate into living cells, therefore antibiotics are powerless for acute tracheitis of viral origin, and cough is treated with antitussive drugs (in the form of tablets or mixtures), alkaline inhalations, decoctions of medicinal plants, etc.

But infectious tracheitis can develop as a result of exposure to a bacterial infection. Moreover, as microbiologists note, bacteria can become both the primary cause of the disease and accompany existing viruses. This happens because viruses, by suppressing human immunity, facilitate the development of pathogenic bacteria in the body.

In such a situation, antibiotics for tracheitis and bronchitis, as well as for other respiratory diseases of bacterial origin, perform their main therapeutic task - they suppress the growth of pathogenic microorganisms.

Indications for starting to use an antibiotic for tracheitis in adults are: suspected pneumonia; cough lasts more than three weeks; temperature is +37.5-38°C from the very beginning of the disease and continues to rise; signs of inflammation of the tonsils (tonsillitis), ears (otitis) or paranasal sinuses (sinusitis) appear.

It should be noted that acute tracheitis that is not treated in time can become chronic. But chronic inflammation of the tracheal mucosa can be associated with the anatomical features of the human respiratory tract or with the presence of pathological changes in them, as well as with frequent changes in the temperature of the environment. As a rule, chronic tracheitis - with coughing fits at night and after sleep - affects heavy smokers and people who abuse alcohol, as well as those whose work is associated with various chemicals, the vapors of which irritate the mucous membrane of the windpipe and cause its inflammation. In addition, dust is the cause of allergic tracheitis in allergy sufferers. In these cases, otolaryngologists never treat tracheitis with antibiotics.

Which antibiotic is best for tracheitis?

So, based on the anamnesis, all the symptoms, as well as the clinical blood test and bacteriological examination of sputum and throat smears, the doctor determined that tracheitis was caused by bacteria. That is, treatment of tracheitis with antibiotics is inevitable.

When prescribing antibiotics to get rid of tracheitis, everything should be taken into account: the clinical picture of the disease, the patient's age and the presence of concomitant pathologies, the spectrum of action of a specific drug and its contraindications. And the dosage of antibiotics recommended by doctors is determined by the severity of the inflammatory process.

According to many experts, the most effective antibiotics for tracheitis are penicillin group drugs administered parenterally. But there are many drugs in this group that are taken orally or have several forms. In addition, they have a wider spectrum of antibacterial activity. For example, the drug Augmentin (synonyms - Amoxicillin, potentiated by clavulanate, Amoxiclav, Amoklavin, Klavocin) contains amoxicillin (a semi-synthetic penicillin antibiotic) and clavulanic acid (which protects amoxicillin from decay and expands the spectrum of its antibacterial action). This drug is available in the form of tablets, powder for the preparation of an injection solution and powder for the preparation of a suspension.

Augmentin (1 g tablets) is used to treat adults and children over 12 years old - one tablet twice a day (at the beginning of a meal). In severe forms of acute tracheitis and other bacterial respiratory infections - one tablet 3 times a day. In gastrointestinal diseases, infectious mononucleosis and chronic renal failure, this antibiotic should be used with caution. And during pregnancy, especially in the first trimester, and during lactation, it is not recommended to take it.

If patients are intolerant to penicillin and its derivatives, antibiotics of the cephalosporin group or macrolide group are prescribed. In case of bacterial or viral-bacterial acute tracheitis, doctors recommend taking Cephalexin (synonyms - Ospexin, Keflex), which has a bactericidal effect on a wide range of pathogenic microorganisms. The active substances of the drug begin to act, disrupting the synthesis of the cell wall of microorganisms, 1-1.5 hours after administration, and are completely eliminated from the body after 8 hours - with urine. This antibiotic is available in the form of capsules, tablets and powder for suspension.

The daily dose of Cephalexin (in capsules of 0.25 g) for adults is 1-4 g, the drug should be taken every 6 hours, half an hour before meals, with 150-200 ml of water. The course of treatment is up to two weeks. The drug has side effects: from weakness, headache, urticaria and dyspepsia to cholestatic jaundice and leukopenia. Contraindications are intolerance to cephalosporins and penicillin antibiotics, as well as children under 12 years of age.

Next on the list of antibiotics for tracheitis are macrolides, which are among the least toxic agents of the antibiotic family. Macrolides cope well with gram-positive cocci and pneumococci; they act on the causative agents of whooping cough and diphtheria, legionella and spirochetes, chlamydia and mycoplasma. Antibiotics of this pharmacological group accumulate in the tissues of the respiratory organs, including the mucous membrane of the trachea, due to which their therapeutic effect becomes stronger.

The macrolide antibiotic Azithromycin is available in capsules (0.25 g), tablets (0.125 g and 0.5 g), and powder for suspension (in 15 ml and 30 ml bottles). The dosage regimen for adults is 0.5 g per day for three days or 0.5 g on the first day and 0.25 g for four more days. The entire dose is taken at one time, one hour before meals.

The drug Josamycin (synonym - Vilprafen) also belongs to the group of natural macrolide antibiotics and in 2012 was included in the Russian "List of vital and essential drugs". It is used in the treatment of infectious inflammations of the respiratory tract and oral cavity, in the treatment of chlamydia, gonorrhea, syphilis, scarlet fever, dysentery and other diseases. For tracheitis of bacterial etiology, Josamycin is prescribed to adults and children over 14 years old at 1-2 g per day - in three doses. This drug can be used during pregnancy and breastfeeding.

Serious side effects during treatment with macrolide antibiotics are rare and include nausea, vomiting, and abdominal pain. Their contraindications include severe liver dysfunction and individual hypersensitivity to drugs in this group.

Antibiotics for tracheitis in children

In case of acute viral tracheitis in children, treatment is mainly symptomatic, and cough is treated with mustard plasters, rubbing ointments, inhalations, cough mixtures. If tracheitis is bacterial, antibiotics are used.

Antibiotics recommended by pediatricians for tracheitis in children: Augmentin (a drug of the penicillin group), Azithromycin and Sumamed (macrolide antibiotics). For mild to moderate infections, the daily dose of Augmentin in suspension is:

For children under one year old - 2 ml three times a day (before meals), from 1 year to 6 years old - 5 ml three times a day, for children 7-12 years old - 10 ml three times a day.

Azithromycin in the form of syrup (100 mg/5 ml and 200 mg/5 ml) can be prescribed in a dosage of 10 mg per kilogram of body weight per day - in one dose, one hour before meals. The duration of administration is three days. According to the second scheme, it is recommended to give this amount of syrup only on the first day of treatment, and in the following four days - 5 mg per kilogram of body weight (also in one dose).

Among the antibiotics for tracheitis in children, the drug Sumamed and Sumamed forte in the form of a suspension are widely used. Its dosage is also calculated based on the child's body weight - 10 mg / kg of body weight once a day for 3 days. The course of treatment is 30 mg per kilogram. Children over 6 months with a body weight of up to 10 kg are prescribed 5 ml of suspension per day.

The antibiotic Josamycin is also available as a suspension (the dosage for adults was indicated above). Pediatric otolaryngologists prescribe this drug to newborns and infants - at a rate of 30-50 mg per kilogram of body weight per day (in three doses).

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Antibiotics for inhalation in tracheitis

Etiological inhalation treatment of tracheitis with antibiotics is quite effective, since it allows creating high concentrations of the drug directly in the inflammation site. In addition, when inhaling antibiotics, the risk of their systemic side effects is much lower than when taken internally or by injection.

Currently, in the treatment of acute bacterial tracheitis, special inhalation forms of antibiotics are used - in the form of solutions and powders for inhalation.

For example, the broad-spectrum antibiotic Fluimucil is prescribed by doctors not only for bacterial tracheitis, but also for tonsillitis, pharyngitis, bronchitis and pneumonia, as well as for suppurative lung diseases. To prepare an inhalation solution, 5 ml of saline solution is added to a bottle of Fluimucil powder. Almost half of the resulting solution, 2 ml, is used for 1 inhalation. The procedure must be carried out 2 times a day, for children under 6 years old, once is enough. The course of treatment should not exceed 10 days. This drug cannot be used in parallel with other antibiotics, as their absorption is reduced.

The aerosol preparation Bioparox is an antibiotic for local use, it has no systemic effect. For bacterial tracheitis in adults, one inhalation (4 sprays) is used every 4 hours, in children - one inhalation every 6 hours. The duration of the standard course of therapy is 5-7 days.

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How to cure tracheitis without antibiotics?

If antibiotics for tracheitis are used only if the disease is of bacterial or viral-bacterial origin, then doctors deal with ordinary viral tracheitis using other methods.

For example, with the help of traditional symptomatic therapy aimed at relieving the cough and getting rid of it completely. Among expectorant drugs for unproductive (dry) cough, doctors recommend taking Ambroxol or Bromhexine, which is not much different from it.

Ambroxol (synonyms - Lazolvan, Ambrolitik, Bronchopront, Fluixol, Lindoxil, Mucosan, Mucovent, Secretil, Viscomcil) increases the secretion of mucus in the respiratory tract and is prescribed to adults one tablet 2-3 times a day (after meals). The dosage of the drug in the form of syrup for children is as follows: up to 2 years - 2.5 ml 2 times a day, from 2 to 5 years - 2.5 ml 3 times a day, over 5 years - 5 ml 2-3 times a day. Side effects may include heartburn, dyspepsia, nausea, vomiting, skin rash.

A mucolytic drug with an expectorant effect - Bromhexine (Bronchostop, Solvin) - is available in the form of dragees, tablets, drops, injection solution, oral solution, as well as syrup and tablets for children. The therapeutic effect of the drug appears 2-5 days after the start of treatment; to increase it, you need to drink enough fluids. Prescribed to adults and children over 14 years old - 8-16 mg 3-4 times a day; children under 2 years old - 2 mg three times a day, 2-6 years - 4 mg 3 times a day, 6-14 years - 8 mg 3 times a day. Duration of use - no more than 5 days. Contraindications to this drug include hypersensitivity, gastric ulcer, pregnancy (first trimester), lactation period, childhood (up to 6 years - for taking tablets).

To relieve attacks of dry cough, doctors may prescribe drugs that reduce the sensitivity of the mucous membrane of the respiratory tract to irritants, for example, Libexin. The average dose for adults is 100 mg (1 tablet) 3-4 times a day. And the average dose for children, depending on age and body weight, is 25-50 mg (0.25-0.5 tablets) 3-4 times a day.

Various mixtures based on marshmallow root, licorice, and thermopsis provide a positive therapeutic effect in acute non-bacterial tracheitis. You can also use special chest herbal infusions, brew them and drink them according to the recommendations on the package. And for internal use, herbal decoctions based on coltsfoot, sweet clover, wild pansy, angelica, plantain, oregano or thyme are prepared. Herbal decoctions should be drunk warm, 100 ml twice a day, and they are also useful for gargling.

Inhalations with pine buds, eucalyptus leaves, sage or savory help to alleviate the condition of tracheitis. You need to prepare a decoction of these plants (a tablespoon per glass of boiling water), and then (if there is no special inhaler) breathe over the slightly cooled composition, covering your head with a terry towel.

And remember that with all the variety of medications, including antibiotics for tracheitis, no one has cancelled the therapeutic effect on the body of natural bee honey and regular hot tea with lemon...