Features of antitussive therapy in whooping cough in pediatric practice

Abstract

Whooping cough is an acute highly contagious infectious disease, the main manifestation of which is a prolonged paroxysmal cough. Despite the availability of the vaccine, over the past 10 years there has been an increase in the incidence of pertussis in both Russia and the world, which is associated both with the refusal of the parents to vaccinate and with the use of the acellular vaccine that induces a time-limited immune response. In the phase of spasmodic cough, the severity of the condition is determined by the frequency and intensity of cough paroxysms. Against the background of coughing, young children may develop apnea and hypoxic encephalopathy, and older children and adolescents may develop neurosis-like reactions, sleep disturbance, enuresis. Virulence factors for bacteria of the genus Bordetella are known, but the pathogenesis of coughing with whooping cough has not been adequately studied. Antibacterial therapy accelerates the eradication of the pathogen, but practically does not affect the duration of symptoms. Due to the severe course of whooping cough, children in the first year of life often require hospitalization in the intensive care unit. Many common methods of treating cough (inhalation therapy, the use of acetylcysteine, carbocysteine, codeine-containing drugs) worsen the course of disease. In this regard, the main place in therapy is the correct treatment of cough. The article provides an overview of the main pathogenetic concepts of coughing and approaches to therapy: during the period of an obsessive spasmodic cough, to reduce the frequency and intensity of coughing, it is recommended to use an antitussive drug with a central effect of butamirate, oxygen therapy, refuse to perform invasive ventilation methods when child has apnea, and rapid rehabilitation of the children.