How is acute laryngitis treated (false croup)?

Treatment of acute laryngitis (false croup) is aimed at preventing the stenosis of the larynx, when it occurs - to restore the patency of the larynx.

[1], [2]

Indications for consultation of other specialists

For acute stenosing laryngitis, the otolaryngologist should be consulted at any stage of the child, the child with stenosing laryngitis of Stage III should also be advised by the resuscitator.

Indications for hospitalization

With acute laryngitis and laryngotracheitis without stenosis of the larynx, hospitalization is not required.

With stenosing laryngitis in the stage of compensation or subcompensation, children should be hospitalized better in specialized boxed departments of the children's hospital, focused on treating children with stenosing laryngitis and having in their arsenal, in addition to a set of medications and ultrasonic inhalers, trained medical personnel, otolaryngologists and resuscitators. Patients with acute stenosing laryngitis, regardless of age, it is important to be hospitalized with the mother (the regime "on the hands of the mother"). In the decompensated and terminal stage, children are hospitalized in the intensive care unit.

Non-pharmacological treatment of acute laryngitis

In acute laryngitis it is necessary to explain to parents that it is necessary to create an environment that excludes negative emotions, because the excitement of the baby can be an additional factor that promotes and enhances stenosis of the larynx. It is necessary to ensure the patient access to fresh air in the room. Where it is located, and moisten the air in the room. It is useful to give a sick child a warm alkaline drink (milk with soda: 1/2 teaspoon of soda for 1 glass of milk, milk with mineral water "Borjomi").

When stenosing acute laryngitis in the prehospital stage, it is necessary to calm the child as far as possible and observe a situation that excludes negative emotions. Before the ambulance car arrives, it is necessary to ensure access of fresh air to the room where the child is, the temperature in the room should be 18-20 ° C. Humidification of air in the room where the child is (use of wet sheets, household humidifier), or put the child in the bathroom, filling it with water vapor, it is good at the same time to make the child warm baths for hands and feet. Only in this case it is important not to overheat the child. Give the patient a warm alkaline drink (milk with soda - 1/2 teaspoon of soda for 1 glass of milk, milk with mineral water).

In hospital, inhalation therapy with isotonic sodium chloride solution is indicated through a spacer or nebulizer or by placing a child in a steam-oxygen tent. In general, the main role in stenosing laryngitis at all stages of treatment is inhalation therapy.

Drug treatment of acute laryngitis

In acute viral laryngitis, laryngotracheitis, not accompanied by stenosis of the larynx, anti-inflammatory therapy with fenspiride (erespal) and in children over 2.5 years of anti-inflammatory and bactericidal therapy with fusafungin (bioparox) is indicated. At an allergic anamnesis at the child or atopy are shown antihistamine preparations to prevent development of a stenosis of a larynx. Symptomatic means are shown antipyretic according to indications, and antitussive preparations of enveloping action and mucolytics.

When the patient develops a stage I stenosing laryngitis in a child, the purpose of fenspiride (erespala) is shown. It is shown that with the appointment of an erespal, inflammatory changes are significantly reduced and the duration of treatment is shortened. Children older than 2.5 years are prescribed with a bactericidal and anti-inflammatory purpose fusafungin (bioparox).

In occasion of "barking" cough mucolytics are appointed. Which are administered mainly by inhalation through a nebulizer, but can (in the absence of a nebulizer) inside:

• Acetylcysteine:
  • Inhalation - 150-300 mg per inhalation:
  • up to 2 years: 100 mg 2 times a day, inside;
  • from 2 to 6 years: 100 mg 3 times a day, inside;
  • over 6 years: 200 mg 3 times a day or ACTS Long 1 time per night, inside.
• Ambroxol:
  • Inhalation - 2 ml of solution for inhalation; o to 2 years: syrup 7.5 mg 2 times a day, inside;
  • from 2 to 5 years: syrup 7.5 mg 2-3 times a day, inside:
  • from 5 to 12 years: syrup 15 mg 2-3 times a day, inside;
  • over 12 years: 1 capsule (30 mg) 2-3 times a day, inside. Considering the role of the allergic component in the pathogenesis of stenosing laryngitis, first-generation antihistamines are prescribed: dimethindene (fenistil), chloropyramine (suprastin) or the second generation: cetirizine (zirtek), loratadine (claritin).
• Dimetinden (fenistil) in the drops prescribed for 7-14 days:
  • children older than 1 month and up to a year of 3-10 drops 3 times a day;
  • children 1-3 years of 10-15 drops 3 times a day;
  • children over 3 years of 15-20 drops 3 times a day.
• Chloropyramine (suprastin) is prescribed inside for 7-14 days:
  • children 1-12 months of 6.25 mg 2-3 times a day;
  • children 2-6 years of 8.33 mg 2-3 times a day.
• Cetirizine (zirtek) is prescribed for children from 6 months to 2 years, 2.5 mg 1-2 times a day.
• Loratadin (klaritin) is prescribed inside to children weighing less than 30 kg of 5 mg once a day for 14 days or more.

It should be remembered that some antihistamines, such as promethazine (pipolfen). Promote the drying of the laryngeal mucosa and dehydration and thereby worsen the drainage function of the bronchopulmonary system.

With hyperthermia, antipyretic agents are prescribed. Assign sedatives (rectal suppository of viburkola). The use of antipyretic and sedative agents is necessary, since hyperthermia and agitation contribute to increased respiration and thus contribute to inspiratory dyspnea. However, it must be remembered that sleeping pills or neuroplagic remedies in case of viscous mucus in the airways, relaxing the child and suppressing the cough reflex, can contribute to aggravation of the laryngeal stenosis, since viscous mucus is not removed in a weak cough, but turns into crusts.

At II, III and IV stages of a stenosing laryngitis of destination the same. That at stage I, but more importantly and prospectively the use of glucocorticoids, which become drugs of choice in these situations. Apply prednisolone inward from the calculation of 1-2 mg / kg or intramuscularly dexamethasone 0.4-0.6 mg / kg. The most expedient is to recognize the inhalation administration of glucocorticoids through a nebulizer: fluticasone is inhaled 100-200 mcg 2 times a day or budesonide in a suspension of 0.5-1-2 mg by inhalation to 2-3 times per day. Inhalation glucocorticoids (IGKS), in particular budesonide, have local anti-inflammatory, anti-allergic and antiex-suicidal effects.

The second drug of choice - a selective beta-1 agonist of short action - salbutamol. For children older than 4 years, you can also use anticholinergic ipratropium bromide (atrovent). Salbutamol is prescribed inhalation 1-2 doses (100-200 mcg) no more than 3-4 times a day. Ipratropium bromide (atrovent) is inhaled 20 μg (2 doses) 3-4 times a day.

For etiotropic treatment of viral stenosing laryngitis, in severe cases, a recombinantly interferon alfa-2 (viferon) preparation is given 1 suppository rectally 2 times a day for 5 days, then 2 days (on day 3) 1 suppository 2 times day. Such courses - 3-4.

In acute laryngitis and acute stenosing laryngitis caused by influenza A and B viruses, especially A, it can be used in children over the age of rimantadine in the first 2 days at the onset of the disease.

At present, specialists are unanimous in that. That the indications for the use of antibiotics in viral stenosing laryngitis are bacterial complications, i.e. In the II-III stages. The use of antibiotics is also justified in the bacterial etiology of stenosing laryngitis. Indications for the administration of systemic antibiotics:

• mucopurulent or purulent sputum, if any;
• detection of purulent and fibrinous-purulent supplements on the mucous membrane with laryngoscopy;
• the phenomenon of stenosis of the larynx of II-IV degree;
• prolonged course of the disease and its recurrence.

When choosing antibiotics, preference is given to cephalosporins of the 3rd and 4th generations: ceftriaxone, cefotaxime, cefepime). In III-IV stages of stenosing laryngitis, when the child is in the intensive care unit, carbapenems (imipenem, meropenem), which have a broader spectrum of activity, including Pseudomonas aeruginosa and nonspore-forming anaerobes , are also used .

With prolonged flow of stenosing laryngitis and recurrent stenosing laryngitis, chlamydial etiology of infection should be excluded and macrolides (azithromycin, clarithromycin, josamycin, roxithromycin spiramycin, etc.) should be used. In general, with recurrent stenosing laryngitis, recombinant interferon alfa-2 (viferon) is used in suppositories, 1 suppository 2 times a day for 5-7 days, then 1 suppository 2 times in 3 days, for at least 1-2 months. In addition, with recurrent stenosing laryngitis in the period of convalescence to prevent the formation of hypersensitivity of the mucous membrane of the larynx and bronchi, a hypersensitizing therapy with H1-histamine receptor blockers, loratadine or cetirizine, is prolonged for 1-2 months.

[3], [4], [5]

Surgical treatment of acute laryngitis

If the conservative treatment is ineffective, asphyxia shows intubation of the trachea and tracheostomy.