SARS ICD assigns 10th place, this pathology occupies several sections belonging to different classes. Encryption is based on a number of signs of etiological, clinical types. The basis of such a classification is the level of damage to the body, but not the clinical picture of the pathology. ICD 10 can be supplemented with other codes (related to infectious diseases), such sections may be in different classes.

The ICD code allows you to bring the disease under a special classification, which was created by specialists to facilitate their communication with each other. Classification is a set of terms that reflect the relationship of different phenomena.

The International Statistical Classification of Diseases and Related Health Problems is briefly referred to as the ICD. This document was created by specialists from the World Health Organization, it is not static, according to research, it is constantly changing. To date, the protocol is applied after the 10th revision.

The ICD allows different doctors to find the right, accurate approach to diseases, to compare their data. Each pathology has its own code, consisting of a combination of numbers and letters, used by doctors to process information in order to collect statistics. The classification of SARS is also contained in the bowels of the ICD.

The available data are grouped according to the reasons for the development of the disease, or according to the place of its localization (the same applies to ARVI, the ICD code is 10).

The World Health Organization reviews the list of diseases every 10 years, which makes it possible to distribute pathologies in a more convenient way, to supplement the available information with newly obtained data.

After the formation of statistics at different levels, starting with the clinic and ending with the state, these data are to be sent to WHO. Most often, different classes of ICD 10 are found here.

The classification consists of three volumes:

• all diseases, even extremely rare;
• instructions for the correct use of the document;
• alphabetical arrangement of the disease, facilitating their search.

By the method of standardization, medical statisticians collect data on all existing diseases. This allows you to find out the nature and causes of the development of pathologies.

How is SARS diagnosed?

The ICD code for ARVI is assigned through diagnostic measures. The classification divides them into several large groups.

Main:

• questioning the patient about his complaints, studying the epidemiological situation, having contacts with sick people;
• examination, including palpation, auscultation, body temperature measurement, percussion, measurement of indicators blood pressure, heart rate (pulse), questioning the patient about the work of the urinary system;
• taking a general blood test (to clarify the level of erythrocytes, ESR, hemoglobin, leukocyte formula, leukocytes);
• taking a urine sample general type;
• to establish the etiology, tests are shown by enzyme immunoassay or serological reactions;
• examination of feces under a microscope to identify helminths.

Additional:

• to identify the etiology of influenza, the type of SARS, conduct PCR, ELISA studies;
• with hemorrhagic syndrome, the detection of platelet count, PV is shown. INR;
• prolonged fever is an indication for a blood test to identify causative agents of malaria;
• cerebrospinal fluid research spinal cord;
• conduct x-rays (suspicions of pneumonia, bronchial tubes);
• electrocardiography (when complications from the heart, blood vessels);
• consultation with a neurologist (presence of symptoms of meningoencephalitis);
• visiting a hematologist (pronounced hemorrhagic syndrome).

How is the diagnosis made?

SARS ICD has its own diagnostic criteria to determine the type of disease.

According to the Classification, the diagnosis of influenza can be made on the following grounds:

• acute onset with a strong development of intoxication;
• increase in body temperature;
• the duration of the fever is about 5 days;
• headache, especially severe in the eyes, forehead, eyebrows;
• general weakness;
• bone, muscle pain;
• severe lethargy;
• hyperesthesia.

Parainfluenza has the following symptoms of development:

• gradual start;
• weakness of expression of intoxication;
• feeling of sore throat;
• nasal breathing difficulties;
• an abundance of discharge from the nasal cavity;
• hoarse voice;
• cough unproductive, dry.

Adenovirus has the following characteristic features:

• acuteness of initial development;
• runny nose;
• feeling of sore throat;
• unproductive cough;
• flow of tears and pain in the eyes.

Respiratory syncytial infection can be diagnosed by:

• slow start;
• the presence of low body temperature;
• cough (dry, then wet);
• shortness of breath.

Rhinovirus has the following features:

• average degree of intoxication;
• acute onset;
• frequent sneezing;
• copious discharge of mucus from the nose;
• severe swelling of the nasal mucosa;
• slight cough.

SARS is diagnosed by the following symptoms:

• acute onset;
• headaches, muscle pain;
• chills;
• redness of the throat and pain in it;
• the presence of a cough;
• nausea;
• stomach ache;
• repeated increase in thermometer readings after 3-5 days, the occurrence of shortness of breath, shortness of breath.

To make a diagnosis of influenza or SARS, it is important to conduct an epidemiological analysis, to assess the likelihood of contact with sick people.

Typical symptoms of SARS:

• an increase in body temperature above the physiological norm;
• difficulty in nasal breathing, severe runny nose (rhinitis);
• redness of the oropharynx, perspiration, dryness in the tonsils, pain during swallowing (pharyngitis);
• swelling of the tonsils, pain (acute tonsillitis);
• dry cough, hoarse voice (laryngitis);
• unproductive cough, chest discomfort (tracheitis);
• shortness of breath (obstructive bronchitis);
• cough can be observed throughout the disease, changing from dry to wet, with sputum, dragging on for a period of two weeks after recovery or more.

Formulations of the diagnosis of ARVI in accordance with the classification

The varieties of ARVI present in the Classification, the disease code, make it possible to establish quite accurately.

The diagnosis can be formulated in different ways, for example:

• J0 means influenza with a toxic form, hemorrhagic syndrome, a complication in the form of neurotoxicosis of the 1st degree;
• J 06 mild acute respiratory disease;
• J 04 acute tracheitis, laryngitis (moderate severity).

During the diagnosis in words, the doctor pays attention to:

• the main pathology, deciphering the course options;
• the severity of the disease;
• the severity of ongoing processes;
• other criteria;
• indicates complications, comorbidities that the patient has (acute or in remission).

During the formulation of the diagnosis, it is especially important to establish causal relationships, to determine the primary and secondary processes of the pathological type. If the patient has two simultaneously occurring diseases, determine which one caused the severity of the condition present on this moment.

For correct design statistical data, it is very important to designate a double or triple cipher of the disease, according to the Classification. Each diagnosis will be taken into account separately, the main, concomitant and complications that have arisen.

The correct use of the developed ciphers and codes allows doctors to submit correct data to medical statistics organizations, which is important for analyzing the epidemiological state of a city, region, country and making a number of important decisions.

What is SARS? Acute respiratory viral infections are contagious diseases of viral etiology that affect the body through the respiratory tract by airborne droplets. Most often, such an ailment is diagnosed in children of the age category of 3-14 years. As statistics show, ARVI does not develop in infants, only isolated cases were noted when a child at that age had an illness.

If expressed according to the international classification of diseases ICD-10, then ARVI is assigned the code J00-J06. Many people do not understand what is the difference between ARVI and ARI, and whether it exists at all. These two diseases differ only in the way they transmit the infection, otherwise they are indistinguishable, therefore they are considered synonymous.

What influences the formation of SARS?

Such a disease can occur when a virus enters the body. They are transmitted through the air. The most common are:

• reoviruses;
• rhinoviruses;
• adenoviruses.

The death of these harmful microorganisms is carried out under the influence of disinfectants and UV rays. Unfortunately, when diagnosing, it is not always possible to determine the type of virus that has infected the body.

The formation of SARS is also influenced by communication with a person affected by this disease. There are certain types of viral pathologies that can be transmitted from a sick bird or animal.

Characteristic manifestations

Symptoms of SARS in children are more pronounced with influenza. Parainfluenza is accompanied by lesser severity of intoxication and non-prolonged viremia. But such a pathology is very dangerous for the child's body, as false croup often develops. Small bronchi and bronchioles are affected by respiratory syncytial virus. Such a pathological process leads to impaired ventilation of the lungs and leads to the formation of atelectasis and pneumonia.

There is no definite classification of SARS in children. Regarding the severity of the course of the disease, the following forms are distinguished:

• light;
• average;
• heavy;
• hypertoxic.

The severity of the disease is determined taking into account the severity of manifestations of intoxication and catarrhal phenomena.

Flu

The incubation period of this type of SARS lasts from several hours to 1-2 days. characteristic feature the initial phase of influenza is the predominance of manifestations of intoxication over catarrhal. The ICD-10 code for the international classification of diseases is J10. The following symptoms of SARS with influenza in adults are observed:

• increase in body temperature to 39-40 degrees for several days;
• dizziness;
• general fatigue;
• feeling of brokenness.

In children, the disease can be manifested by the following symptoms:

• headache;
• painful sensations in the eyes, abdomen and muscles;
• burning in the chest;
• nausea and vomiting;
• sore throat.

Catarrhal phenomena have a more pronounced effect and are accompanied by dry cough, constant sneezing, nasal discharge.

SARS during pregnancy at the 1st trimester, are manifested by transient changes in relation to the urinary system.

How long does the temperature last with ARVI in the form of influenza? In the normal course of the disease, its indicators begin to decline after a few days of illness.

parainfluenza

The incubation period lasts 2-7 days. This form of ARVI is characterized by an acute course and an increase in symptoms. According to the ICD-10, the disease has the code J12.2. The following manifestations of SARS in children and adults are noted:

1. Body temperature up to 38 degrees. It persists for 7-10 days.
2. Rough cough, hoarseness and change in voice.
3. Painful sensations in the chest.
4. Runny nose.

ARVI in children in the form of parainfluenza can be accompanied by damage not only to the upper, but also to the lower tracts, resulting in development. How long does the temperature stay with SARS? As a rule, its decrease and the severity of all manifestations disappear after 7 days.

When the symptoms of the disease do not leave the body of children and adults after 7-10 days, you should seek the advice of a specialist. In this case, children deserve special attention, since untimely assistance entails a number of serious consequences.

Reovirus infection

The incubation period of reovirus infection is 2-5 days. According to the international classification of diseases ICD-10, the disease code is B97.5. Reovirus infection causes the following symptoms:

• runny nose and cough, combined with vomiting;
• pain syndrome in a stomach;
• liquid stool without impurities;
• severe intoxication;
• in children, the temperature rises to the level of 38-39 degrees;
• redness of the face;
• in the lungs there are dry rales and hard breathing;
• when probing the patient, pains and noises of intestinal peristalsis are felt in the iliac region on the right;
• enlargement of the liver in size;
• damage to the respiratory, digestive, nervous system;
• development , .

Rhinovirus infection

This type of disease can be transmitted in a variety of ways. For this reason, rhinovirus infection has gained great popularity today. The disease is characterized by its manifestations:

1. The rise in temperature indicators to 38-39 degrees is noted only in young children, in adult patients they rise no higher than 37.5 degrees.
2. Massive discharge from the nose, which is watery or mucopurulent. Pus may begin to stand out after a few days from the onset of the disease.
3. Swelling and inflammation in the nasal mucosa.
4. Although the patient has a sore throat, the larynx appears to be apparently healthy, with no redness or ulceration.
5. Slightly enlarged lymph nodes in the neck, pain is not felt.

adenovirus infection

If there is a pronounced one, then cerebral complications develop in the form of convulsions and meningeal syndrome.

Most often, the consequences of the disease occur against the background of incorrect or untimely treatment. If therapeutic measures were started on time, and the patient fully complies with all the recommendations of the doctor, then the risk of complications is minimized.

Therapy

Treatment of SARS in children and adults is most often carried out at home. If there is a severe form of the disease or the course is complicated, then hospitalization of the patient is required. When diagnosing viral infections it is important to observe bed rest when there is an increased body temperature.

ARVI can be treated with non-drug therapy. It is distinguished by bed rest, heavy drinking, wrapping and various inhalations using folk methods. Treatment of acute respiratory viral infections with medication involves drugs whose action is aimed at stopping the pathogen and specific symptoms.

Effective medicines

The following drugs help treat SARS:

1. Non-steroidal anti-inflammatory drugs. This category includes Ibuprofen, Paracetamol and Diclofenac. These drugs have an anti-inflammatory effect, reduce temperature, and relieve pain.
2. Antihistamines. They are characterized by the presence of a powerful anti-inflammatory effect, as a result of which it is possible to eliminate all manifestations of the disease. This category includes the following drugs: Tavegil, Diphenhydramine, Suprastin.
3. Medicines for sore throat. Here you can use Geksoral, Bioparox. Gargling with a disinfectant solution helps a lot.
4. Cough preparations. They help reduce the viscosity of sputum, making it thin and easy to cough up. Apply drugs such as ACC, Mukaltin, Bronholitin.

Antibiotics for SARS

Antibiotics for ARVI are prescribed taking into account the complications and the general condition of the patient. Antibiotics of the penicillin series are prescribed for people prone to allergies.

If it does, then you should take antibiotics for ARVI, such as Ecoclave, Amoxiclav. Antibiotics of this group have a mild effect on the human body.

When the organs of the respiratory system are affected, doctors prescribe antibiotics such as Macropen, Zetamax, Sumamed. Antibiotics from a number of fluoroquinolones are as follows: Levofloxacin, Moxifloxacin. These antibiotics are prohibited for children. Since the child's skeleton is not yet fully formed, adverse reactions may occur. In addition, the antibiotics of this group belong to the reserve drugs in the treatment of acute respiratory viral infections. If you start taking such antibiotics at an early age, then addiction will occur very quickly.

Many doctors do not recommend treating SARS with antibiotic drugs after the first manifestations of the disease appear. As a rule, antibiotics are prescribed only after an accurate diagnosis and with a severe course of the disease.

Antivirals

It is necessary to treat SARS with the help of antiviral drugs, because the main cause of the disease is the virus. Antiviral drugs have a different spectrum of action. Their reception should be carried out only after an accurate diagnosis. The following effective antiviral drugs are distinguished in the treatment of SARS:

1. Arbidol is an antiviral drug based on a component such as umifenovir.
2. Kagonets is a Russian-made antiviral drug. Its action is aimed at activating the body's production of interferon protein. Antiviral drugs such as Kagonets destroy infectious agents of viral etiology.
3. Rimantadine. This kind of antiviral drugs in the treatment of acute respiratory viral infections have a powerful effect on the relief of various viruses. Its main component is adamantine.
4. Cycloferon is a drug based on meglumine acridone acetate. Such antiviral drugs activate the production of interferon protein.
5. Amiksin is a drug that contains tilorone. Such anti-inflammatory drugs are prescribed for the treatment of acute respiratory infections, as well as as a prophylaxis.

Prevention

ARI and ARVI are diseases that differ a high degree infection, so it is very important to take care of prevention.

Prevention of ARVI and acute respiratory infections includes the following activities:

1. Do not go to places where there are large crowds of people.
2. In the midst of an influenza epidemic, the prevention of SARS and involves holidays and the cancellation of festive events.
3. Wet cleaning of the house using disinfectants and regular airing is a mandatory prevention of ARVI and acute respiratory infections.

Approved
Union of Pediatricians of Russia


Clinical guidelines
Acute respiratory viral
infection (ARVI) in children

ICD 10:
J00 / J02.9 / J04.0 / J04.1 / J04.2 / J06.0 / J06.9
Year of approval (revision frequency):
2016 (
review every 3 years)
ID:
URL:
Professional associations:

Union of Pediatricians of Russia

Agreed
Scientific Council of the Ministry
Health of the Russian Federation
__ __________201_

2
Table of contents
Keywords................................................ ................................................. ...................... 3
List of abbreviations................................................... ................................................. .................................. 4 1. Brief information .............................. ................................................. .............................. 6 1.1 Definition .................. ................................................. ................................................. 6 1.2 Etiology and pathogenesis.................................................... ................................................. ..... 6 1.3 Epidemiology .......................................... ................................................. .................... 6 1.4 Coding according to ICD-10 .............................. ................................................. ........................... 7 1.5
Classification................................................. ................................................. ................................. 7 1.6 Examples of diagnoses .............................. ................................................. ......................... 7 2.
Diagnostics................................................. ................................................. ....................... 8 2.1 Complaints, anamnesis ............................... ................................................. .................................................. 8 2.2 Physical examination .......... ................................................. .................................. 9 2.3 Laboratory diagnostics .............................. ................................................. .................................. 9 2.4
Instrumental diagnostics .................................................................. .................................... 10 3. Treatment .......... ................................................. ................................................. .................. 11 3.1 Conservative treatment .............................. ................................................. ................. 11 3.2 Surgery................................................. ............................................... 16 4. Rehabilitation................................................. ................................................. .................... 16 5. Prevention and dispensary observation .............................. ............................................... 16 6. Additional information influencing the course and outcome of the disease .................................... 18 6.1 Complications .................................. ................................................. ................................................. 18 6.2 Caring for children .................................................. ................................................. ............... 18 6.3
Outcomes and prognosis ............................................... ................................................. ......... nineteen
Criteria for assessing the quality of medical care ....................................................... ................... 20
Bibliography................................................ ................................................. ............... 21
Annex A1. Composition of the working group ............................................... ........................... 25
Annex A2. Methodology for the development of clinical guidelines .......................................... 26
Annex A3. Related Documents................................................... .............................. 28
Appendix B. Patient Management Algorithms............................................................... ............................... 29
Appendix B. Information for Patients .............................................................. .......................... thirty
Appendix D. Explanation of notes............................................................... ...................... 33

3
Keywords

acute infection of the upper respiratory tract unspecified;

acute respiratory infection;

acute infections of the upper respiratory tract of multiple and unspecified localization;

acute laryngitis and tracheitis;

acute laryngitis;

acute laryngotracheitis;

acute laryngopharyngitis;

acute nasopharyngitis (runny nose);

acute tracheitis;

acute pharyngitis, unspecified;

acute pharyngitis.

4
List of abbreviations

IL - interleukin
SARS - acute respiratory viral infection

5
Terms and Definitions
The concept of "acute respiratory viral infection (ARVI)" - summarizes the following nosological forms: acute nasopharyngitis, acute pharyngitis, acute laryngitis, acute tracheitis, acute laryngopharyngitis, acute infection of the upper respiratory tract, unspecified. New and narrowly focused professional terms are not used in these clinical guidelines.

6
1. Brief information
1.1
Definition
Acute respiratory viral infection (ARVI)- an acute, in most cases, self-limiting infection of the respiratory tract, manifested by catarrhal inflammation of the upper respiratory tract and occurring with fever, runny nose, sneezing, cough, sore throat, and a violation of the general condition of varying severity.
1.2
Etiology and pathogenesis
The causative agents of diseases of the respiratory tract are viruses.
The spread of viruses occurs most often by self-inoculation on the nasal mucosa or conjunctiva from hands contaminated by contact with the patient.
Another way - airborne - when inhaling particles of an aerosol containing a virus, or when larger drops get on the mucous membranes in close contact with the patient.
The incubation period for most viral diseases is from 2 to 7 days.
Isolation of viruses by patients is maximum on the 3rd day after infection, sharply decreases by the 5th day; mild shedding of the virus can persist for up to 2 weeks.
Viral infections are characterized by the development of catarrhal inflammation.
Symptoms of SARS are the result not so much of the damaging effect of the virus as the reaction of the innate immune system. Affected epithelial cells secrete cytokines, incl. interleukin 8 (IL 8), the amount of which correlates both with the degree of involvement of phagocytes in the submucosal layer and epithelium, and the severity of symptoms. An increase in nasal secretion is associated with an increase in vascular permeability, the number of leukocytes in it can increase many times, changing its color from transparent to white-yellow or greenish, i.e. it is unreasonable to consider a change in the color of nasal mucus as a sign of a bacterial infection.
The attitude that with any viral infection, the bacterial flora is activated (the so-called "viral-bacterial etiology").
ARI" based, for example, on the presence of leukocytosis in a patient) is not confirmed by practice. Bacterial complications of SARS are relatively rare.
1.3
Epidemiology

7
ARVI is the most common human infection: children under the age of 5 suffer, on average, 6-8 episodes of ARVI per year, in preschool institutions, the incidence is especially high in the 1st-2nd year of visit - 10-15% higher than in unorganized children, however, the latter get sick more often at school. The incidence of acute upper respiratory tract infections can vary significantly from year to year. The incidence is highest in the period from September to April, the peak incidence occurs in February-March. A decrease in the incidence of acute infections of the upper respiratory tract is invariably recorded in the summer months, when it decreases by 3-5 times. According to the data of the Ministry of Health of Russia and Rospotrebnadzor in 2015, it amounted to 20.6 thousand cases of diseases per 100 thousand people (versus 19.5 thousand per
100 thousand population in 2014). The absolute number of cases of acute infections of the upper respiratory tract in the Russian Federation in 2015 was 30.1 million cases.
Among children aged 0 to 14 years, the incidence of acute infections of the upper respiratory tract in 2014 amounted to 81.3 thousand. per 100 thousand or 19559.8 thousand registered cases.
1.4
ICD-10 coding
Acute nasopharyngitis (runny nose) (J00)
Acute pharyngitis (J02)
J02.9-
Acute pharyngitis, unspecified
Acute laryngitis and tracheitis (J04)
J04.0-
Acute laryngitis
J04.1-
Acute tracheitis
J04.2-
Acute laryngotracheitis
Acute upper respiratory tract infections, multiple and
location unspecified (J06)

J06.0-
Acute laryngopharyngitis
J06.9-
Acute upper respiratory tract infection, unspecified
1.5
Classification
The division of acute respiratory viral infections (nasopharyngitis, pharyngitis, laryngotracheitis without laryngeal stenosis) according to severity is not advisable.
1
.6 Examples of diagnoses

Acute nasopharyngitis, acute conjunctivitis.

Acute laryngitis.
When the etiological role of the viral agent is confirmed, the diagnosis is clarified.

8
As a diagnosis, the term "ARVI" should be avoided, using the terms
«
acute nasopharyngitis"Or" acute laryngitis ", or" acute pharyngitis ", since ARVI pathogens also cause laryngitis (croup), tonsillitis, bronchitis, bronchiolitis, which should be indicated in the diagnosis. These syndromes are considered in detail separately.
(See Clinical guidelines for the management of children with acute tonsillitis, acute bronchitis and stenosing laryngotracheitis).
2. Diagnostics
2.1
Complaints, anamnesis
Patient or parents legal representatives) can complain acutely
rhinitis and / or cough and / or conjunctival hyperemia (catarrhal
conjunctivitis) in combination with the phenomena of rhinitis, pharyngitis.
The disease usually has an acute onset, often accompanied by an increase in
body temperature to subfebrile figures (37.5 ° C-38.0 ° C). Febrile fever
more characteristic of influenza, adenovirus infection, enterovirus infections.
Elevated temperature in 82% of patients decreases on the 2-3rd day of illness; more
for a long time (up to 5-7 days), febrile condition lasts with influenza and adenovirus infection.
Increasing fever during illness, symptoms of bacterial
intoxication in a child should be alert regarding the accession
bacterial infection. Re-rise in temperature after a brief
improvement often occurs with the development of acute otitis media against the background of
prolonged runny nose.
Nasopharyngitis is characterized by complaints of nasal congestion, discharge from
nasal passages, discomfort in the nasopharynx: burning, tingling, dryness,
often an accumulation of mucous discharge, which in children, flowing down the back wall
pharynx, can cause a productive cough.
When inflammation spreads to the mucous membrane of the auditory tubes
(
eustacheitis), clicking, noise and pain in the ears appear, hearing may decrease.
Age-related features of the course of nasopharyngitis: in infants - fever,
discharge from the nasal passages, sometimes anxiety, difficulty feeding and
falling asleep. In older children, typical manifestations are symptoms of rhinitis (peak
on the 3rd day, duration up to 6-7 days), in 1/3-1/2 patients - sneezing and / or coughing (peak in 1-
day, average duration - 6-8 days), less often - headache (20% in the 1st and 15% - up to the 4th
days).
A symptom that allows diagnosing laryngitis is hoarseness

9
vote. At the same time, there is no difficulty in breathing, other signs of stenosis of the larynx.
With pharyngitis, hyperemia and swelling of the posterior pharyngeal wall are noted, its
granularity caused by hyperplasia of lymphoid follicles. On the back of the throat
a small amount of mucus may be noticeable (catarrhal pharyngitis),
pharyngitis is also characterized by an unproductive, often obsessive cough. This
the symptom causes extreme anxiety of parents, delivers discomfort
child, as coughing can be very frequent. This cough is unbearable
treatment
bronchodilators,
mucolytics
inhalation
glucocorticosteroids.
Laryngitis, laryngotracheitis are characterized by a rough cough, hoarseness of voice. At
tracheitis cough can be obsessive, frequent, debilitating patient. In contrast
from croup syndrome (obstructive laryngotracheitis), stenosis of the larynx is not
noted no respiratory distress.
On average, SARS symptoms can last up to 10-14 days.
2.2 Physical examination
General examination involves an assessment of the general condition, physical development
child, counting the respiratory rate, heart rate, examination of the upper
respiratory tract and pharynx, examination, palpation and percussion of the chest,
auscultation of the lungs, palpation of the abdomen.
2.3
Laboratory diagnostics
Examination of a patient with ARVI is aimed at identifying bacterial foci that do not
determined by clinical methods.

Routine virological and/or bacteriological examination of all patients is not recommended. this does not affect the choice of treatment, except for the rapid influenza test in high fever children and the rapid streptococcus test for suspected acute streptococcal tonsillitis.


Clinical analysis of urine (including using test strips on an outpatient basis) is recommended for all febrile children without catarrhal phenomena.
(

Comments: 5-10% of infants and young children with urinary infection
pathways also have viral co-infection with clinical signs SARS.
However, urinalysis in children with nasopharyngitis or laryngitis without

10
fever is carried out only if there are complaints or special recommendations in connection with
with concomitant pathology of the urinary system.

A clinical blood test is recommended for severe general symptoms in children with fever.

Comments: An increase in bacterial inflammation markers is
a reason to search for a bacterial focus, first of all, “silent” pneumonia,
acute otitis media, urinary tract infections. Repeated
clinical blood and urine tests are necessary only in case of detection
deviations from the norm during the initial examination or the appearance of new
symptoms requiring a diagnostic search. If the symptoms of a viral
infections stopped, the child stopped fever and has a good
well-being,
repeated
study
clinical
analysis
blood
impractical.
Peculiarities laboratory indicators with some viral infections
Leukopenia characteristic of influenza and enterovirus infections, usually
absent in other SARS.
MS virus infection is characterized by lymphocytic leukocytosis, which
may exceed 15 x 10
9
/ l.
With adenovirus infection, leukocytosis can reach a level of 15 - 20 x 10
9
/l
and even higher, while neutrophilia more than 10 x 10 is possible
9
/
l, boost
the level of C-reactive protein is above 30 mg / l.

Determination of the level of C-reactive protein is recommended to exclude severe bacterial infection in children with febrile fever.
(temperature rise above 38ºС), especially in the absence of a visible focus of infection.
(
Comments:Its increase above 30-40 mg/l is more typical for
bacterial infections (more than 85% chance).
2.4
Instrumental diagnostics

It is recommended that all patients with symptoms of SARS undergo otoscopy.
(
Strength of recommendation 2; level of evidence - C).
Comments: Otoscopy should be part of the routine pediatric
examination of each patient, along with auscultation, percussion, etc.

11

A chest x-ray is not recommended for every child with symptoms of SARS.
(
Strength of recommendation 1; level of evidence - C).
Comments:
Indications for chest radiography are:
-
the onset of physical symptoms of pneumonia (see FCR for the management of pneumonia in
children)
-
decrease in SpO
2

less than 95% when breathing room air
-
the presence of pronounced symptoms of bacterial intoxication: the child is lethargic and
drowsy, not available for eye contact, pronounced restlessness, refusal
drinking, hyperesthesia
-
high levels of bacterial inflammation markers: increased overall
leukocyte blood count more than 15 x 10
9
/l in combination with neutrophilia more than 10 x
10
9
/l, the level of C-reactive protein is above 30 mg/l in the absence of a focus
bacterial infection.
It should be remembered that the detection of amplification on the radiograph of the lungs
bronchovascular pattern, expansion of the shadow of the roots of the lungs, increased
airiness is not enough to establish the diagnosis of "pneumonia" and not
are indications for antibiotic therapy.

X-ray of the paranasal sinuses is not recommended for patients with acute nasopharyngitis in the first 10-12 days of illness.
(Strength of recommendation 2; level of evidence C).
Comments: radiography of the paranasal sinuses in the early stages
disease often reveals viral-induced inflammation of the paranasal sinuses
nose, which resolves spontaneously within 2 weeks.
3.
Treatment
3.1
Conservative treatment
ARVI is the most common reason for the use of various medicines and
procedures, most often unnecessary, with unproven action, often causing
side effects. Therefore, it is very important to explain to parents the benign
the nature of the disease and report what is the expected duration of the available
symptoms, and to reassure them that minimal interventions are sufficient.

Etiotropic therapy is recommended for influenza A (including H1N1) and B in the first 24-48 hours of illness. Neuraminidase inhibitors are effective:
Oseltamivir ( ATX code: J05AH02) from the age of 1 year, 4 mg / kg / day, 5 days or

12
Zanamivir ( ATX code: J05AH01) for children from 5 years old, 2 inhalations (total 10 mg) 2 times a day, 5 days.
(
Strength of recommendation 1; level of certainty of evidence - A).
Comments: For optimal effect, treatment should be
started when the first symptoms of the disease appeared. Patients with bronchial
asthma in the treatment of zanamivir should have as an ambulance
help with short-acting bronchodilators. For other viruses, not
containing neuraminidase, these drugs do not work. Evidence-based
database of antiviral efficacy of other drugs in children
remains extremely limited.

Antiviral drugs with immunotropic action do not have a significant clinical effect, their appointment is impractical.
(
Strength of recommendation 2; level of evidence –A).
Comment: These drugs develop an unreliable effect.
Perhaps the appointment no later than the 1-2nd day of interferon-alpha disease
w, vk

(ATX code:
L03AB05),
however, there is no reliable evidence of its effectiveness.
Comments: In ARVI, interferonogens are sometimes recommended, but should
remember that in children over 7 years of age, when using them, a febrile period
is reduced by less than 1 day, i.e. their use in most acute respiratory viral infections with
a short febrile period is not justified. Research results
the effectiveness of the use of immunomodulators in respiratory
infections, as a rule, show an unreliable effect. drugs,
recommended for the treatment of more severe infections, such as viral
hepatitis, with SARS are not used. For the treatment of SARS in children
homeopathic remedies are recommended, as their effectiveness is not
proven.

It is not recommended to use antibiotics for the treatment of uncomplicated SARS and influenza, incl. if the disease is accompanied in the first 10-14 days of illness by rhinosinusitis, conjunctivitis, laryngitis, croup, bronchitis, broncho-obstructive syndrome.
(Strength of recommendation 1; level of evidence A).
Comments:Antibacterial therapy in case of uncomplicated viral
infection not only does not prevent bacterial superinfection, but
contribute to its development due to the suppression of normal pneumotropic flora,
"restraining aggression" of staphylococci and intestinal flora. Antibiotics

13
can be shown to children with chronic pathology affecting
bronchopulmonary system (for example, cystic fibrosis), immunodeficiency, in which
there is a risk of exacerbation of the bacterial process; their choice of antibiotic is usually
predetermined in advance by the nature of the flora.

Symptomatic (supportive) therapy is recommended .
Adequate hydration helps to thin the secretions and facilitate their discharge.
(Strength of recommendation 2; level of evidence C).

It is recommended to carry out elimination therapy, because this therapy
effective and safe. The introduction of physiological saline into the nose 2-3 times a day ensures the removal of mucus and the restoration of the work of the ciliated epithelium.
(Strength of recommendation 2; level of evidence C).
Comments:It is better to inject saline in the supine position.
back with the head thrown back for irrigation of the nasopharynx and adenoids. At
in small children with copious discharge, aspiration of mucus from the nose is effective
special manual suction followed by the introduction of physiological
solution. The position in the crib with a raised head end contributes to
discharge of mucus from the nose. In older children, saline sprays are justified.
isotonic solution.

It is recommended to prescribe vasoconstrictor nasal drops (decongestants) in a short course of no more than 5 days. These drugs do not shorten the duration of a runny nose, but they can relieve the symptoms of nasal congestion, as well as restore the function of the auditory tube. In children 0-6 years old, phenylephrine is used ( ATX code:
R01AB01
) 0.125%, oxymetazoline ( ATX code: R01AB07) 0.01-0.025%, xylometazoline w
ATX code: R01AB06) 0.05% (from 2 years old), in older ones - more concentrated solutions.
(Strength of recommendation 2; level of evidence C).
Comments:
Usage
systemic
drugs,
containing
decongestants (eg, pseudoephedrine) highly discouraged, medicinal
funds of this group are allowed only from the age of 12 years.

To reduce the body temperature of a feverish child, it is recommended to open, wipe with water T ° 25-30 ° C.
(Strength of recommendation 2; level of evidence C).

In order to reduce body temperature in children, it is recommended to use only

14 two drugs - paracetamol f, vk
ATX code: N02BE01) up to 60 mg/kg/day or ibuprofen f, uc
ATX code: M01AE01) up to 30 mg/kg/day.
Strength of recommendation 1 (level of evidence - A)
Comments:Antipyretic drugs in healthy children ≥3 months
justified at temperatures above 39 - 39.5 ° C. For less severe fever
(38-
38.5°C) fever-reducing agents are indicated for children under 3 months of age,
patients with chronic pathology, as well as temperature-related
discomfort. Regular (course) intake of antipyretics is undesirable,
a second dose is administered only after a new increase in temperature.
Paracetamol and ibuprofen can be taken orally or in the form of rectal
suppositories, there is also paracetamol for intravenous administration.
Alternating these two antipyretics or using a combination
drugs has no significant advantages over monotherapy with one of the
these medicines.
It must be remembered that the main problem with fever is time
recognize a bacterial infection. Thus, the diagnosis of severe
bacterial infection is much more important than fighting a fever. Application
antipyretic
together
with
antibiotics
fraught with
disguise
the inefficiency of the latter.

In children with an antipyretic purpose, it is not recommended to use acetylsalicylic acid and nimesulide.
(Strength of recommendation 1; level of evidence C).

The use of metamizole in children is not recommended due to the high risk of developing agranulocytosis.
Comment: In many countries of the world, metamizole has already been banned for use.
over 50 years ago.
(
Strength of recommendation 1; level of evidence - C).

Nasal toilet is recommended as the most effective method of cough relief.
Since coughing with nasopharyngitis is most often caused by irritation of the larynx with a flowing secret.
(Strength of recommendation 1; level of evidence B).

A warm drink is recommended or, after 6 years, the use of lozenges or lozenges containing antiseptics to eliminate cough in pharyngitis, which is associated with a "sore throat" due to inflammation of the pharyngeal mucosa or its drying out when breathing through the mouth.

15
(
Strength of recommendation 2; level of evidence - C).

Antitussives, expectorants, mucolytics, including numerous proprietary preparations with various herbal remedies, are not recommended for use in ARVI due to inefficiency, which has been proven in randomized trials.
(
Strength of recommendation 2 level of evidence – C).
Comments: With a dry obsessive cough in a child with pharyngitis or
laryngotracheitis sometimes it is possible to achieve a good clinical effect with
use of butamirate, however, the evidence base for the use
there are no antitussive drugs.

Steam and aerosol inhalations are not recommended for use, because. showed no effect in randomized trials, and are also not recommended
World Health Organization (WHO) for the treatment of SARS.
(
Strength of recommendation 2 level of evidence – B).

1st generation antihistamines with atropine-like action are not recommended for use in children: they have an unfavorable therapeutic profile, have pronounced sedative and anticholinergic side effects, and impair cognitive functions.
(concentration, memory and learning ability). In randomized trials, drugs in this group have not been shown to be effective in reducing the symptoms of rhinitis.
(Strength of recommendation 2; level of evidence C).

It is not recommended to prescribe ascorbic acid (vitamin
C) since it does not affect the course of the disease.
Must be hospitalized:
- children under 3 months of age with febrile fever due to their high risk of developing a severe bacterial infection.
- children of any age with any of the following symptoms (major danger signs): inability to drink / breastfeed; drowsiness or lack of consciousness; respiratory rate less than 30 per minute or apnea; symptoms of respiratory distress; central cyanosis; phenomena of heart failure; severe dehydration.
- children with complex febrile seizures (lasting more than 15 minutes and / or recurring more than once in 24 hours) are hospitalized for the entire

16 fever period.
- children with febrile fever and suspected severe bacterial infection (BUT may be hypothermia!), with the following concomitant symptoms: lethargy, drowsiness; refusal to eat and drink; hemorrhagic rash on the skin; vomit.
- children with symptoms of respiratory failure, having any of the following symptoms: grunting breathing, swelling of the wings of the nose when breathing, nodding movements (head movements synchronized with inspiration); respiratory rate in a child up to 2 months > 60 per minute, in a child aged 2-11 months > 50 per minute, in a child older than 1 year > 40 per minute; retraction of the lower part of the chest during breathing; blood oxygen saturation The average duration of stay in the hospital can be 5-10 days, depending on the nosological form of the complication and the severity of the condition.
Hospitalization of children with nasopharyngitis, laryngitis, tracheobronchitis without
related dangerous signs inappropriate.
Febrile fever in the absence of other pathological symptoms in children older than 3 months is not an indication for hospitalization.
Children with simple febrile seizures (lasting up to 15 minutes, once a day) that have ended by the time they go to the hospital do not need hospitalization, but the child should be examined by a doctor to rule out neuroinfection and other causes of seizures.
3.2
Surgery
Not required
4. Rehabilitation
Not required
5.
Prevention and dispensary observation

Of paramount importance are preventive measures that prevent the spread of viruses: thorough hand washing after contact with the patient.

Recommended also o
wearing masks, o
washing surfaces around the patient, o
in medical institutions - compliance with the sanitary and epidemic regime, appropriate processing of phonendoscopes, otoscopes, use of disposable

17 towels; o
in children's institutions - the rapid isolation of sick children, compliance with the ventilation regime.

Prevention of most viral infections today remains non-specific, since vaccines against all respiratory viruses are not yet available.
However, annual influenza vaccination at 6 months of age is recommended to reduce the incidence.
(Strength of recommendation 2; level of evidence B).
Comments:It has been proven that vaccination of children against influenza and pneumococcal
infection reduces the risk of developing acute otitis media in children, i.e.
reduces the likelihood of a complicated course of SARS. When
contact of a child with a sick flu, as a preventive measure, it is possible
use of neuraminidase inhibitors (oseltamivir, zanamivir) in
recommended age dosage.

In children of the first year of life from risk groups (prematurity, bronchopulmonary dysplasia palivizumab, the drug is administered intramuscularly at a dose of 15 mg/kg monthly once a month from November to March.
(Strength of recommendation 1; level of evidence A).

In children with hemodynamically significant congenital heart defects, passive immunization is recommended for the prevention of RS-virus infection in the autumn-winter season. palivizumab, the drug is administered intramuscularly at a dose
15 mg/kg monthly once a month from November to March.
(Strength of recommendation 2; level of evidence A)
Comment: see CG on providing medical care to children with bronchopulmonary
dysplasia, KR on immunoprophylaxis of respiratory syncytial virus
infections in children.

For children older than 6 months with recurrent infections of the upper respiratory tract and respiratory tract, the use of systemic bacterial lysates is recommended (ATC code
J07AX; ATX code L03A; ATC code L03AX) These drugs are likely to reduce the incidence of respiratory infections, although the evidence base is weak.
(Strength of recommendation 2; level of evidence C)

The use of immunomodulators for the purpose of prophylaxis is not recommended.

18 acute respiratory viral infections, tk. there is no reliable evidence of a decrease in respiratory morbidity under the influence of various immunomodulators.
The prophylactic efficacy of herbal preparations and vitamin C, homeopathic preparations has not been proven either.
(
Strength of recommendation 1; level of evidence - B)
6.
Additional information affecting the course and outcome of the disease
6.1 Complications
Complications of acute respiratory viral infections are observed infrequently and are associated with the addition
bacterial infection.

There is a risk of developing acute otitis media against the background of the course
nasopharyngitis, especially in young children, usually on the 2nd-5th day
illness. Its frequency can reach 20 - 40%, but not all
purulent otitis occurs, requiring the appointment of antibiotic therapy
.

Preservation of nasal congestion for longer than 10-14 days, deterioration
after the first week of illness, the appearance of pain in the face may indicate
development of bacterial sinusitis.

Against the background of influenza, the frequency of viral and bacterial (most often
caused by Streptococcus pneumoniae) pneumonia can reach 12%
children with viral infections.

Bacteremia complicates the course of ARVI in an average of 1% of cases with MS-
viral infection and in 6.5% of cases with enterovirus infections.

In addition, a respiratory infection can be a trigger
exacerbations chronic diseases, most often bronchial asthma and infections
urinary tract.
6.2
Keeping children
A child with ARVI is usually observed on an outpatient basis
pediatrician.
General or semi-bed mode with a quick transition to general after
decrease in temperature. Re-inspection is necessary if the temperature is maintained
more than 3 days or deterioration.
Inpatient treatment (hospitalization) is required with the development of complications and
prolonged febrile fever.

19
6.3
Outcomes and forecast
As stated above, SARS, in the absence of bacterial complications, are transient,
although they can leave symptoms such as nasal discharge for 1-2 weeks
moves, cough. The opinion that repeated SARS, especially frequent ones, are
manifestation or lead to the development of "secondary immunodeficiency" unreasonably.

20
Criteria for assessing the quality of medical care

Table 1.
Organizational and technical conditions for the provision of medical care.
Type of medical care
Specialized medical care
Conditions of rendering
medical care
Stationary / day hospital
Form of rendering
medical care
urgent
Table 2.
Criteria for the quality of medical care
No. p / p
Quality Criteria
Strength of recommendation
Level of Evidence
1.
Performed a general (clinical) blood test deployed no later than 24 hours from the moment of admission to the hospital
2
C
2.
Completed general analysis urine (with an increase in body temperature above 38
⁰С)
1
C
3.
A study of the level of C-reactive protein in the blood was performed (with an increase in body temperature above 38.0 C)
2
C
4.
Conducted elimination therapy (washing the nasal cavity with saline or sterile sea water solution) (in the absence of medical contraindications)
2
C
5.
Treated with topical decongestants
(vasoconstrictor nasal drops) in a short course of 48 to 72 hours (in the absence of medical contraindications)
2
C

21
Bibliography
1.
Van den Broek M.F., Gudden C., Kluijfhout W.P., Stam-Slob M.C., Aarts M.C., Kaper
N.M., van der Heijden G.J. No evidence for distinguishing bacterial from viral acute rhinosinusitis using symptom duration and purulent rhinorrhea: a systematic review of the evidence base.
Otolaryngol Head Neck Surg. 2014 Apr;150(4):533-7. doi:
10.1177/0194599814522595. Epub 2014 Feb 10.
2.
Hay AD, Heron J, Ness A, ALSPAC study team. The prevalence of symptoms and consultations in pre-school children in the Avon Longitudinal Study of Parents and Children
(ALSPAC): a prospective cohort study. Family Practice 2005; 22:367–374.
3.
Fendrick A.M., Monto A.S., Nightengale B., Sarnes M. The economic burden of non-influenza-related viral respiratory tract infection in the United States. Arch Intern Med. February 2003
24; 163(4):487-94.
4.
Union of Pediatricians of Russia, International Foundation for Maternal and Child Health.
Scientific and practical program “Acute respiratory diseases in children. Treatment and prevention". M., 2002
5.
Health care in Russia. 2015: Stat.sb. / Rosstat. - M., 2015. - 174 p.
6.
http://rospotrebnadzor.ru/activities/statistical-materials/statictic_details.php?ELEMENT_ID=5525 7.
Tatochenko V.K. Respiratory diseases in children. M. Pediatrician. 2012 8.
Pappas DE, Hendley JO, Hayden FG, Winther B. Symptom profile of common colds in school-aged children. Pediatr Infect Dis J 2008; 27:8.
9.
Thompson M., Cohen H. D , Vodicka T. A et al. Duration of symptoms of respiratory tract infections in children: systematic review BMJ 2013; 347 doi: http://dx.doi.org/10.1136/bmj.f7027.
10.
Wald E.R., Applegate K.E., Bordley C., Darrow D.H., Glode M.P. et al. American
Academy of Pediatrics. Clinical practice guideline for the diagnosis and management of acute bacterial sinusitis in children aged 1 to 18 years. Pediatrics. 2013 Jul;132(1):e262-80.
11.
Smith M.J. Evidence for the diagnosis and treatment of acute uncomplicated sinusitis in children: a systematic review. Pediatrics. 2013 Jul;132(1):e284-96.
12.
Jefferson T, Jones MA, Doshi P, et al. Neuraminidase inhibitors for preventing and treating influenza in healthy adults and children. Cochrane Database Syst Rev. 2014;
4:CD008965.
13.
World Health Organization Department of Communicable Disease Surveillance and
Response. WHO guidelines on the use of vaccines and antivirals during influenza pandemics.
2004.

22 http://www.who.int/csr/resources/publications/influenza/WHO_CDS_CSR_RMD_2004_8/en/
Accessed February 18, 2015.
14.
A.A. Baranov (ed.). Guide to outpatient clinical pediatrics. M.
Geotar Media. 2nd ed. 2009.
15.
Schaad U.B. OM-85 BV, an immunostimulant in pediatric recurrent respiratory tract infections: a systematic review. World J Pediatr. 2010 Feb;6(1):5-12. doi:10.1007/s12519-
010-0001-x. Epub 2010 Feb 9.
16.
Mathie RT, Frye J, Fisher P. Homeopathic Oscillococcinum® for preventing and treating influenza and influenza-like illness. Cochrane Database Syst Rev. 2015 Jan 28;1:CD001957. doi:
10.1002/14651858.CD001957.pub6.
17.
Kenealy T, Arroll B. Antibiotics for the common cold and acute purulent rhinitis.
Cochrane Database Syst Rev 2013; 6:CD000247 18.
Baranov A.A., Strachunsky L.S. (ed.) The use of antibiotics in children in outpatient practice. Practical recommendations, 2007 KMAX 2007; 9(3):200-210.
19.
Harris A.M., Hicks L.A., Qaseem A. Appropriate Antibiotic Use for Acute Respiratory
Tract Infection in Adults: Advice for High-Value Care From the American College of Physicians and the Centers for Disease Control and Prevention. Ann Intern Med. 2016; 164(6):425-34
(ISSN: 1539-3704)
20.
King D1, Mitchell B, Williams CP, Spurling GK. Saline nasal irrigation for acute upper respiratory tract infections. Cochrane Database Syst Rev. 2015 Apr 20;4:CD006821. doi:
10.1002/14651858.CD006821.pub3.
21.
Wong T1, Stang AS, Ganshorn H, Hartling L, Maconochie IK, Thomsen AM, Johnson
D.W. Cochrane in context: Combined and alternating paracetamol and ibuprofen therapy for febrile children. Evidence Based Child Health. 2014 Sep;9(3):730-2. doi: 10.1002/ebch.1979.
22.
Smith SM, Schroeder K, Fahey T. Over-the-counter (OTC) medications for acute cough in children and adults in ambulatory settings. Cochrane Database Syst Rev 2012; 8:CD001831.
23.
Chalumeau M., Duijvestijn Y.C. Acetylcysteine ​​and carbocysteine ​​for acute upper and lower respiratory tract infections in pediatric patients without chronic broncho-pulmonary disease. Cochrane Database Syst Rev. 2013 May 31;5:CD003124. doi:
10.1002/14651858.CD003124.pub4.
24.
Singh M, Singh M. Heated, humidified air for the common cold. Cochrane Database Syst
Rev 2013; 6:CD001728.
25.
Little P, Moore M, Kelly J, et al. Ibuprofen, paracetamol, and steam for patients with respiratory tract infections in primary care: pragmatic randomized factorial trial. BMJ 2013;
347:f6041.

23 26.
De Sutter A.I., Saraswat A., van Driel M.L. Antihistamines for the common cold.
Cochrane Database Syst Rev. 2015 Nov 29;11:CD009345. doi:
10.1002/14651858.CD009345.pub2.
27.
Hemilä H, Chalker E. Vitamin C for preventing and treating the common cold. Cochrane
Database Syst Rev 2013; 1:CD000980 28.
Providing hospital care to children. Guidelines for the treatment of the most common diseases in children: a pocket guide. - 2nd ed. – M.: World Health Organization, 2013. – 452 p.
29.
Prutsky G.J., Domecq J.P., Elraiyah T., Wang Z., Grohskopf L.A., Prokop L.J., Montori
V.M., Murad M.H. Influenza vaccines licensed in the United States in healthy children: a systematic review and network meta-analysis (Protocol). System Rev. 2012 Dec 29;1:65. doi:
10.1186/2046-4053-1-65.
30.
Fortanier A.C. et al. Pneumococcal conjugate vaccines for preventing otitis media.
Cochrane Database Syst Rev. 2014 Apr 2;4:CD001480.
31.
Norhayati M.N. et al. Influenza vaccines for preventing acute otitis media in infants and children. Cochrane Database Syst Rev. 2015 Mar 24;3:CD010089.
32.
Committee on infectious diseases and bronchiolitis guidelines committee: Updated
Guidance for Palivizumab Prophylaxis Among Infants and Young Children at Increased Risk of
Hospitalization for Respiratory Syncytial Virus Infection. Pediatrics 2014 Vol. 134 no. August 2
1, 2014 pp. e620-e638.
33.
Ralston S.L., Lieberthal A.S., Meissner H.C., Alverson B.K., Baley J.E., Gadomski A.M.,
Johnson D.W., Light M.J., Maraqa N.F., Mendonca E.A., Phelan K.J., Zorc J.J., Stanko-Lopp D.,
Brown M.A., Nathanson I., Rosenblum E., Sayles S. 3rd, Hernandez-Cancio S.; American
Academy of Pediatrics. Clinical Practice Guideline: The Diagnosis, Management, and
Prevention of Bronchiolitis Pediatrics Vol. 134 no. November 5, 2014 e1474-e1502.
34.
Baranov A.A., Ivanov D.O. et al. Palivizumab: four seasons in Russia. Herald
Russian Academy of Medical Sciences. 2014: 7-8; 54-68 35.
Kearney S.C., Dziekiewicz M., Feleszko W. Immunoregulatory and immunostimulatory responses of bacterial lysates in respiratory infections and asthma. Ann Allergy Asthma
Immunol. 2015 May;114(5):364-9. doi: 10.1016/j.anai.2015.02.008. Epub 2015 Mar 6.
36.
Lissiman E, Bhasale AL, Cohen M. Garlic for the common cold. Cochrane Database Syst
Rev 2009; CD006206.
37.
Linde K, Barrett B, Wölkart K, et al. Echinacea for preventing and treating the common cold. Cochrane Database Syst Rev 2006; CD000530.
38.
Jiang L., Deng L., Wu T. Chinese medicinal herbs for influenza. Cochrane Database Syst

24
Rev. 2013 Mar 28;3:CD004559. doi: 10.1002/14651858.CD004559.pub4.
39.
Steinsbekk A., Bentzen N., Fønnebø V., Lewith G. Self treatment with one of three self selected, ultramolecular homeopathic medicines for the prevention of upper respiratory tract infections in children. A double-blind randomized placebo controlled trial. Br J Clin Pharmacol.
2005 Apr;59(4):447-55.

25
Annex A1. Composition of the working group

Baranov A.A. acad. RAS, Professor, MD, Chairman of the Executive Committee of the Union of Pediatricians of Russia;

Lobzin Yu. V., acad. RAS, Professor, Doctor of Medical Sciences, President of the Euro-Asian Society for infectious diseases, Deputy Chairman of the National Scientific Society of Infectious Diseases

Namazova-Baranova L.S. acad. RAS, Professor, Doctor of Medical Sciences, Deputy
Chairman of the Executive Committee of the Union of Pediatricians of Russia;

Tatochenko V.K. Doctor of Medical Sciences, Professor, Honored Scientist, Expert
World Health Organization, member of the Union of Pediatricians of Russia;

Uskov A.N. MD, Professor

Kulichenko T.V. Doctor of Medical Sciences, Professor of the Russian Academy of Sciences, expert of the World Organization
Healthcare, member of the Union of Pediatricians of Russia;

Bakradze M.D. MD, member of the Union of Pediatricians of Russia;

Vishneva E.A.

Selimzyanova L.R. Candidate of Medical Sciences, Member of the Union of Pediatricians of Russia;

Polyakova A.S. Candidate of Medical Sciences, Member of the Union of Pediatricians of Russia;

Artemova I.V. junior researcher, member of the Union of Pediatricians of Russia.
Authors confirm lack of financial support/conflict
interests to be disclosed.

26
Annex A2. Methodology for the development of clinical guidelines

Target audience of these clinical guidelines:

1.
pediatricians;
2.
General practitioners (family doctors);
3.
Medical students;
4.
Students in residency and internship.
Table 1.
Scheme for assessing the level of recommendations
Degree
credibility
recommendations
Risk to Benefit Ratio
Methodological quality of the available evidence
Explanations for the application of recommendations
1A
strong
recommendation,
founded
on the
evidence
High Quality
Reliable consistent evidence based on well-executed
RCT or hard evidence presented in some other form.
Further research is unlikely to change our confidence in the benefit-risk assessment.
Strong recommendation that can be used in most cases in a predominant number of patients without any changes and exceptions
1B
strong
recommendation,
founded
on the
evidence
moderate quality
Benefits clearly outweigh risks and costs, or vice versa
Evidence based on the results of RCTs performed with some limitations (inconsistent results, methodological errors, indirect or accidental, etc.) or other good reasons.
Further research
(if they are) are likely to affect and change our confidence in the benefit-risk assessment.
Strong recommendation that can be applied in most cases
1C
strong
recommendation,
founded
on the
evidence
Low quality
The benefits are likely to outweigh the possible risks and costs, or vice versa
Evidence based on observational studies, anecdotal clinical experience, results
RCTs performed with significant shortcomings.
Relatively strong recommendation, subject to change as better evidence becomes available
2A
Weak
recommendation,
founded
on the
evidence
High Quality
The benefits are commensurate with the possible risks and costs
Reliable evidence based on well-executed
RCTs or supported by other hard evidence.
Further research is unlikely to change our confidence in assessing the benefit/risk ratio.
Weak recommendation.
The choice of the best tactics will depend on the clinical situation.
(circumstances), the patient or social preferences.
2B
Benefit
Proof of,
Weak

27
Weak
recommendation,
founded
on the
evidence
moderate quality
comparable to the risks and complications, however, there is uncertainty in this assessment. based on the results of RCTs performed with significant limitations (inconsistent results, methodological defects, circumstantial or incidental), or strong evidence presented in some other form.
Further research
(if they are) are likely to affect and change our confidence in the benefit-risk assessment. recommendation.
Alternative tactics in certain situations may appear for some patients. the best choice.
2C
Weak
recommendation,
founded
on the
evidence
Low quality
Ambiguity in assessing the ratio of benefits, risks and complications; the benefits may be commensurate with the possible risks and complications.
Evidence based on observational studies, anecdotal clinical experience, or RCTs with significant weaknesses.
Any estimate of the effect is regarded as uncertain.
Very weak recommendation; alternative approaches can be used in equally.
*In the table, the numerical value corresponds to the strength of recommendations, the letter value corresponds to the level of evidence.

These clinical guidelines will be updated at least
than once every three years. The decision to upgrade will be made at
based on proposals submitted by medical professionals
non-profit organizations, taking into account the results of a comprehensive assessment
medicines, medical devices, as well as the results of clinical
approbation.

28
Annex A3. Related Documents
Orders for the provision of medical care:
1.
Order of the Ministry of Health and Social Development of the Russian Federation of April 16
2012 N 366n "On approval of the Procedure for the provision of pediatric care";
2.
Order of the Ministry of Health and Social Development of the Russian Federation No.
05/05/2012 N 521n "On approval of the Procedure for the provision of medical care to children with infectious diseases"
Criteria for assessing the quality of medical care: Order of the Ministry of Health of Russia 520n dated
July 15, 2016 "On approval of criteria for assessing the quality of medical care"
Medical care standards:
1.
Order of the Ministry of Health of the Russian Federation dated November 9, 2012 No. 798n Standard for specialized medical care for children with acute respiratory diseases of moderate severity
2.
Order of the Ministry of Health of the Russian Federation dated 12/24/12
No. 1450n Standard for specialized medical care for children with acute respiratory diseases of severe severity
3.
Order of the Ministry of Health of the Russian Federation dated 28.12.12
No. 1654n Standard for primary health care for children with acute nasopharyngitis, laryngitis, tracheitis and acute infections of the upper respiratory tract of mild severity

29
Appendix B. Patient Management Algorithms













NO




YES




NO






YES



NO






YES









Diagnostics (page 4)
Outpatient treatment
Specialist consultation
Treatment in a hospital
There are indications for hospitalization
(page 10)?
Prevention of reinfection (page 8)
Therapy correction
Patient with SARS symptoms
Is the diagnosis confirmed?
Is the therapy effective?

30
Appendix B. Information for Patients
SARS(acute respiratory viral infection) is the most common disease in children.
Cause of the disease- Various viruses. The disease often develops in autumn, winter and early spring.
How do you get an infection that causes SARS: most often by contact with the nasal mucosa or conjunctiva from hands contaminated by contact with the patient
(for example, through a handshake) or with virus-infected surfaces (rhinovirus persists on them for up to a day).
Another way - airborne - by inhalation of particles of saliva released during sneezing, coughing or in close contact with the patient.
The period from infection to the onset of the disease: in most cases - from 2 to 7 days.
Isolation of viruses by patients (infectiousness for others) is maximum on the 3rd day after infection, sharply decreases by the 5th day; mild shedding of the virus can persist for up to 2 weeks.
Signs of SARS: the most common manifestation of acute respiratory viral infections in children is nasal congestion, as well as nasal discharge: transparent and / or white and / or yellow and / or green (the appearance of a yellow or green nasal discharge is not a sign of a bacterial infection!). An increase in temperature often lasts no more than 3 days, then the body temperature decreases. In some infections (influenza and adenovirus infection), the temperature above 38ºC persists for a longer time (up to 5-7 days).
When SARS can also be: sore throat, cough, redness of the eyes, sneezing.
Surveys: in most cases, additional examinations of a child with
SARS is not required
Treatment: ARVI, in most cases, is benign, resolved within 10 days and does not always require medication.
Temperature drop: a feverish child should be opened, wiped with water T °
25-
30°C. In order to reduce the temperature in children, it is permissible to use only 2 drugs - paracetamol or ibuprofen. Antipyretic drugs in healthy children ≥3 months are justified at temperatures above 39 - 39.5 ° C. With a less pronounced fever (38-38.5 ° C), fever-reducing agents are indicated for children under 3 months of age, patients with chronic pathology, as well as temperature-related discomfort. Regular (course) intake of antipyretics is undesirable, repeated

31 doses are administered only after a new increase in temperature.
Alternating these two drugs or using them in combination does not lead to
enhancing the antipyretic effect.
In children with an antipyretic purpose, do not use acetylsalicylic acid and
nimesulide. Extremely undesirable use of metamizole in children due to the high risk of developing agranulocytosis. In many countries of the world, metamizole has been banned for use for over 50 years.

Antibiotics- do not act on viruses (the main cause of SARS). Consider antibiotics if a bacterial infection is suspected .
Antibiotics must be prescribed by a doctor. Uncontrolled use of antibiotics can promote the development of resistant microbes and cause complications.
How to prevent the development of SARS:
A sick child should be left at home (do not take Kindergarten or school).
Of paramount importance are measures to prevent the spread of viruses: thorough hand washing after contact with the sick.
It is also important to wear masks, wash surfaces around the patient, and observe the ventilation regime.
Annual influenza vaccination from the age of 6 months reduces the risk of this infection.
It has also been proven that vaccination of children against influenza and pneumococcal infections reduces the likelihood of developing acute otitis media in children and the complicated course of SARS.
There is no reliable evidence of a decrease in respiratory morbidity under the influence of various immunomodulators. The preventive effectiveness of herbal preparations and vitamin C, homeopathic preparations has not been proven either.
Contact a specialist if:
- the child refuses to drink for a long time
- you see changes in behavior: irritability, unusual drowsiness with a decrease in reaction to attempts to contact the child
- the child has difficulty breathing, noisy breathing, rapid breathing, retraction of the intercostal spaces, jugular fossa (a place located in front between the neck and chest)
- the child has convulsions due to high temperature
- the child has delirium on the background of high temperature
- elevated body temperature (more than 38.4-38.5ºC) persists for more than 3 days
- nasal congestion persists without improvement for more than 10-14 days, especially if you see a “second wave” of fever and / or worsening

32 children
- the child has ear pain and/or discharge from the ear
- the child has a cough that lasts more than 10-14 days without improvement

33
Appendix D. Explanation of notes

…
well
–
medicinal product included in the List of vital and essential drugs for medical use for 2016
…
VK
–
medicinal product included in the List of medicinal products for medical use, including medicinal products for medical use prescribed by decision of medical commissions of medical organizations
(Decree of the Government of the Russian Federation of December 26, 2015 N 2724-r)

document outline

• Keywords
• 2T List of abbreviations
• 1. Brief information
  • 2TU1.1 Definition
  • 2TU1.2 Etiology and pathogenesis
  • 2TU1.3 Epidemiology
• 1.4 ICD-10 coding
• 1.5 Classification
  • 2T12TU.6 Sample diagnoses
• 2. Diagnostics
  • U2.1 Complaints, history
  • 2.2 Physical examination
  • U2.3 Laboratory diagnostics
  • U2.4 Instrumental diagnostics
• 3. Treatment
  • U3.1 Conservative treatment
  • U3.2 Surgical treatment
• 4. Rehabilitation
• 5. Prevention and follow-up
• 6. Additional information affecting the course and outcome of the disease
  • 6.1 Complications
  • U6.2 Keeping children
  • U6.3 Outcomes and forecast
• Criteria for assessing the quality of medical care
• Bibliography
  • Annex A1. Composition of the working group
  
  file -> Work program on normal physiology of the natural science cycle for the specialty 32. 05. 01 "medical and preventive work"

Acute respiratory diseases (ARI) - a group of diseases characterized by damage to various parts of the respiratory tract, a short incubation period, short fever and intoxication. Acute respiratory diseases include both SARS and diseases caused by bacteria.

SYNONYMS

Acute respiratory infections, SARS, colds
ICD-10 CODE
J06.9 Acute upper respiratory tract infection, unspecified.
J02.0 Streptococcal pharyngitis.
J20 Acute bronchitis.
O99.5 Diseases of the respiratory system complicating pregnancy, childbirth and the puerperium.

EPIDEMIOLOGY

ARI - widespread diseases, they account for about 90% of all infectious diseases. During pregnancy, acute respiratory infections are observed in 2–9% of patients. The source of infection is a sick person. Infection occurs by airborne droplets. Diseases often occur in the form of epidemics. In temperate latitudes, the peak incidence is observed from late December to early March. The disease easily spreads in various institutions, places of increased congestion of people.

PREVENTION OF ARI DURING PREGNANCY

General preventive measures include the maximum restriction of communication with strangers during a period of increased morbidity, taking vitamins. Among the specific preventive measures, vaccination is of particular importance (for influenza). Taking various antiviral drugs (amantadine, rimantadine, oseltamivir, acyclovir, ribavirin). It should be noted that at present, from the point of view of evidence-based medicine, the effectiveness of such antiviral agents ashalene, tetrabromotetrahydroxydiphenyl, interferon-a2 in the form of nasal applications has not been confirmed.

CLASSIFICATION OF ARI

ARI is classified according to etiology. These include both viral infections and diseases caused by bacteria. Influenza, parainfluenza, adenovirus, respiratory syncytial, rhinovirus and reovirus infections are of the greatest importance.

ETIOLOGY (CAUSES)

The causative agents include various types of viruses, less often a bacterial infection. Among the most common viruses are rhinoviruses, coronoviruses, adenoviruses, influenza virus and parainfluenza. Among bacterial pathogens, streptococci are the most important. Mycoplasma, chlamydia, gonococci are also noted.

PATHOGENESIS

The gate of infection is the mucous membranes of the respiratory tract. The causative agent, getting into the upper respiratory tract, penetrates into the cylindrical ciliated epithelium, where it actively reproduces, which leads to cell damage and an inflammatory reaction. In severe forms of the disease (influenza), all parts of the airways can be involved up to the alveoli with the development of complications in the form of acute bronchitis, sinusitis, otitis, pneumonia.

PATHOGENESIS OF GESTATION COMPLICATIONS

An acute infectious process in the first trimester of pregnancy has a direct toxic effect on the fetus up to its death. In some cases, infection of the placenta occurs with the development of placental insufficiency in the future, the formation of IGR and intrauterine infectious pathology of the fetus.

CLINICAL PICTURE (SYMPTOMS) OF ARI DURING PREGNANCY

The incubation period lasts from several hours to two days. The disease has an acute onset: fever up to 38–40 ° C, chills, severe general intoxication (headache, weakness, pain in the muscles of the arms, legs, lower back, eye pain, photophobia, weakness). Dizziness, nausea, vomiting may occur. The fever lasts 3-5 days, the temperature drops critically, with profuse sweating. Later, there may be more or less prolonged subfebrile condition. On examination, hyperemia of the face, neck, pharynx, injection of scleral vessels, sweating, bradycardia are noted. Coated tongue. Blood tests reveal leukopenia and neutropenia. During a feverish period, protein, erythrocytes, and casts may appear in the urine. Catarrhal syndrome with influenza is expressed by pharyngitis, rhinitis, laryngitis, tracheitis is especially characteristic. With rhinovirus, adenovirus infection, the incubation period lasts longer and can last a week or more. Intoxication is expressed moderately. Body temperature may remain normal or subfebrile. The leading syndrome is catarrhal; manifests itself in the form of rhinitis, conjunctivitis, pharyngitis, laryngitis with the appearance of a dry cough.

COMPLICATIONS OF GESTATION

They note the formation of malformations (with infection in the first trimester of pregnancy - from 1 to 10%), the threat of abortion in 25–50% of cases, intrauterine infection of the fetus, placental insufficiency with the formation of intrauterine growth retardation and chronic fetal hypoxia. Placental abruption is possible in 3.2% of cases.

DIAGNOSTICS OF ARI DURING PREGNANCY

ANAMNESIS

When collecting an anamnesis, special attention is paid to possible contacts with patients, susceptibility to frequent colds.

PHYSICAL EXAMINATION

Physical examination is of particular importance in the diagnosis of complications of acute respiratory infections. Attentive auscultation allows you to suspect and diagnose the development of acute bronchitis, pneumonia in a timely manner.

LABORATORY RESEARCH

During epidemic outbreaks, diagnosis is not difficult, while sporadic cases of the disease (influenza, adenovirus infection) require laboratory confirmation. The study of smears from the throat and nose by ELISA. The serological method (retrospectively) allows you to determine the increase in the titer of antibodies to the virus in dynamics after 5–7 days. Clinical blood test (leukopenia or leukocytosis with a moderate stab shift, ESR may be normal). For the timely diagnosis of complications, the determination of the level of AFP, b-hCG at a period of 17–20 weeks of pregnancy is shown. A study in the blood of hormones of the fetoplacental complex (estriol, PL, progesterone, cortisol) is carried out at 24 and 32 weeks of pregnancy.

INSTRUMENTAL STUDIES

In case of suspicion of the development of complications of acute respiratory infections (sinusitis, pneumonia), an X-ray examination is possible to clarify the diagnosis according to vital indications.

DIFFERENTIAL DIAGNOSIS

Differential diagnosis is carried out between various types ARI (influenza, adenovirus, respiratory syncytial infection), acute bronchitis and other acutely contagious infections (measles, rubella, scarlet fever).

INDICATIONS FOR CONSULTATION OF OTHER SPECIALISTS

It is indicated for severe disease with pronounced signs of intoxication, with the development of complications in the form of bronchitis, sinusitis, pneumonia, otitis media, etc.

EXAMPLE FORMULATION OF THE DIAGNOSIS

Pregnancy 33 weeks. SARS. The threat of premature birth.

TREATMENT OF ARI (COLDS, FLU) IN PREGNANT WOMEN

PREVENTION AND PREDICTION OF GESTATION COMPLICATIONS

Includes timely treatment of the infectious process.

FEATURES OF TREATMENT OF GESTATION COMPLICATIONS

Treatment of complications of gestation by trimester

I trimester: symptomatic treatment of SARS. In the future, careful monitoring of the development of pregnancy, the formation and growth of the fetus. With the development of complications of SARS (pneumonia, otitis media, sinusitis), pathogenetic antibacterial, anti-inflammatory and immunostimulating therapy is used. With influenza, abortion is carried out due to a high (10%) risk of developmental anomalies.

II and III trimesters: therapy using interferons (other antiviral drugs are prohibited during pregnancy). With a bacterial infection, antibiotics are used, taking into account the possible harmful effects on the fetus. If necessary, the threat of miscarriage, placental insufficiency is treated according to generally accepted schemes. If signs of intrauterine infection are detected, normal human immunoglobulin is administered intravenously at 50 ml every other day three times, followed by the appointment of interferons (interferon-a2) in the form of rectal suppositories of 500 thousand IU twice a day daily for 10 days, then 10 suppositories of 500 thousand IU twice a day twice a week.

Treatment of complications in childbirth and the postpartum period

In childbirth, careful anesthesia is indicated to prevent abnormalities in labor and bleeding.

Prevention of fetal hypoxia, treatment of labor anomalies is carried out by generally accepted methods. In the postpartum period, on the first day, the puerperal woman should be given uterotonic drugs, and prophylactic antibiotic therapy should be carried out.

TREATMENT EFFECTIVENESS ASSESSMENT

Carried out according to the results of a blood test for hormones of the fetoplacental complex, ultrasound and CTG data.

CHOICE OF DATE AND METHOD OF DELIVERY

Delivery in the acute period is associated with a high risk of labor anomalies, bleeding, and postpartum purulent-septic complications. In this regard, along with antiviral and antibacterial therapy, treatment is carried out during this period, aimed at improving the function of the fetoplacental complex and prolonging pregnancy. Delivery should be carried out after the signs of an acute infectious process subside. Vaginal delivery is considered preferable.

INFORMATION FOR THE PATIENT

With SARS, the patient is contagious for 5-7 days from the onset of the disease. If acute respiratory viral infections occur, a doctor's consultation is mandatory due to the high risk of complications in both the pregnant woman and the fetus.

ARVI is a group of diseases with similar clinical manifestations. They are characterized by damage to various parts of the respiratory tract with the obligatory presence of a number of respiratory (catarrhal) symptoms and an optional increase in temperature of varying severity (usually subfebrile). The viruses that cause these diseases have a tropism for the cylindrical epithelium of the respiratory tract and lead to cell degeneration, death, and desquamation. SARS include influenza, parainfluenza, adenovirus, respiratory syncytial, rhinovirus, enterovirus, corona virus diseases. Diseases of this group are caused by viruses that contain DNA and are transmitted by airborne droplets and household contact.

ARVI belongs to class X (respiratory diseases J00-J99) (J00-J06) Acute respiratory infections of the upper respiratory tract (J09-18) Influenza and pneumonia (J20-J22) Other acute respiratory infections of the lower respiratory tract Formulation of the diagnosis Nosology is assessed, disease severity, complications, underlying and concomitant diseases. ICD diagnosis Main Ds: Acute respiratory viral infection, nasopharyngitis. J00 Main Ds: SARS: conjunctivitis, laryngotracheitis, bronchitis. J00 To make a diagnosis of "Influenza", a virological examination is necessary: ​​to isolate the influenza virus, and only then can a diagnosis be made. In an outpatient clinic during the epidemic period for influenza, all patients are diagnosed with "Influenza" on the basis of clinical manifestations and epidemiological history data, and in inter-epidemic periods - "SARS" with a mandatory indication of the clinical syndrome caused by infection. Example: Primary Ds: Influenza A, moderate.

The introduction of the pathogen into the epithelial cells of the respiratory tract and its reproduction viremia with the development of toxicosis and toxic-allergic reactions the development of the inflammatory process in respiratory system reverse development of the infectious process, the formation of immunity

Inflammation of the larynx with involvement of the vocal cords and subglottic space Dry barking cough Hoarseness of voice - inflammation of the larynx with involvement of the vocal cords and subglottic space Dry barking cough Hoarseness of the voice Tracheitis - inflammation of the tracheal mucosa - inflammation of the tracheal mucosa Dry cough Dry cough Dry cough Rawness behind the sternum Rawness behind the sternum Tracheitis - inflammation of the tracheal mucosa - inflammation of the tracheal mucosa Dry cough Dry cough Rawness behind the sternum Rawness behind the sternum Bronchitis - damage to the bronchi of various diameters Cough (at first dry, after a few days - wet, sputum is often mucous, from the 2nd week - with an admixture of greenery) Auscultatory - scattered dry and medium - and coarse bubbling moist rales in the lungs

Inflammation of the epiglottis with characteristic severe respiratory failure High fever High fever Severe sore throat, especially when swallowing Severe sore throat, especially when swallowing Dysphagia Dysphagia Respiratory failure up to stridor Respiratory failure up to stridor

Nosological form Main syndrome Influenza Tracheitis Parainfluenza Laryngitis Adenovirus infection Tonsillopharyngitis, conjunctivitis, adenovirus pneumonia Rhinovirus infection Rhinitis Respiratory syncytial virus Bronchitis, bronchiolitis Coronavirus Rhinopharyngitis, bronchitis Coronavirus SARS Bronchitis, bronchiolitis, ARDS

The incubation period is from 12 to 48 hours; acute onset with chills, fever up to 39-40 ° C already on the first day of the disease and general symptoms of intoxication; in the frontal or fronto-temporal areas, aches in muscles, bones, joints, photophobia, lacrimation, pain in eyeballs sometimes pain in the abdomen, short-term vomiting and diarrhea, transient phenomena of meningism signs of damage to the respiratory tract join later (a few hours after the onset of symptoms of intoxication) characteristic manifestations of the respiratory syndrome with influenza: nasal congestion or mild rhinorrhea sore throat, painful dry cough, pain behind the sternum and along the trachea, a hoarse voice after a few days, the cough becomes productive, with the release of mucous or mucopurulent sputum, catarrhal symptoms persist up to 5-7 days from the onset of the disease

Objectively: flushing of the face and neck, injection of scleral vessels, moist luster of the eyes, increased sweating, sometimes - herpetic rash on the lips and near the nose, bright diffuse hyperemia and granularity of the mucous membranes of the oropharynx in most patients, complete recovery occurs in 7-10 days, general weakness and cough persist for the longest time. in a number of patients there is an exacerbation of concomitant somatic pathology (especially cardiopulmonary) or complications develop; the highest mortality is typical for people over 65 years of age and patients of any age from the risk group.

Those who have been ill with influenza are discharged after a complete clinical recovery with normal results of blood and urine tests, but not earlier than 3 days after normal body temperature is established. With a mild form of influenza, the duration of temporary disability should be at least 6 days, with moderate influenza up to 8 and severe, at least 10–12 days. In the case of accession of various complications, the temporary release of patients from work is determined by the nature of the complications and their severity.

For persons who have undergone uncomplicated forms of influenza, dispensary observation is not established. Those who have had complicated forms of acute respiratory viral infections (pneumonia, sinusitis, otitis media, mastoiditis, myocarditis, damage to the nervous system: meningitis, meningoencephalitis, toxic neuritis, etc.) are subject to clinical examination for at least 3-6 months. In relation to persons who have undergone such a complication of influenza as pneumonia, rehabilitation measures are carried out (in outpatient or sanatorium conditions), and they are subject to mandatory medical examination within 1 year (with control clinical and laboratory examinations after 1, 3, 6 and 12 months after illness).

When deciding on hospitalization, one should take into account the severity of the condition, the likelihood of complications, as well as the possibility of organizing adequate care for the patient at home. Hospitalization should primarily be considered in patients aged 65 years and older, young children, and those with severe chronic illnesses. Age alone is not an indication for hospitalization. Signs of a severe course of the disease, which are indications for hospitalization, are: respiratory failure; seizures (newly diagnosed) or neurological symptoms; hemorrhagic syndrome; dehydration requiring parenteral rehydration or other intravenous therapy; bronchiolitis in children under three months old; decompensation of chronic diseases of the lungs, cardiovascular system. Hospitalization may be appropriate if it is not possible to organize adequate home care for a patient in moderate to severe condition with risk factors for complications (for example, lonely elderly and elderly)

The main directions for the prevention of colds are: 1. hardening, healthy lifestyle life, carrying out hygiene measures comfortable temperature regime premises; regular ventilation; daily wet cleaning of premises with the help of detergents. dress according to the weather; cover your mouth and nose when sneezing and coughing with a handkerchief (napkin), avoid touching your mouth, nose, eyes. keep a “distance” when communicating, the distance between people when talking should be at least 1 meter (arm's length distance) washing hands with soap before preparing food, eating it, and also after coughing and blowing your nose; wearing a mask by a sick person; use only personal hygiene products and cutlery. go to bed at the same time. This contributes to a quick fall asleep and good rest;

2. specific immunization (vaccine prophylaxis) Influenza vaccines are updated annually. Vaccination is carried out with vaccines created against viruses circulating in the previous winter, so its effectiveness depends on how close those viruses are to the present. It is known that with repeated vaccinations, the effectiveness increases, which is associated with a faster formation of specific antibodies in previously vaccinated people. 3 types of vaccines have been developed: Whole virion vaccines - vaccines that are a whole influenza virus (live or inactivated). Now these vaccines are practically not used, because they have a number of side effects and often cause disease. Split vaccines (begrivak, vaxigripp, fluarix) are split vaccines containing only part of the virus (surface proteins). They have significantly fewer side effects and are recommended for adult vaccination. Subunit vaccines (influvac, agrippal, grippol) are highly purified vaccines containing only surface antigens hemagglutinin and neuraminidase. Virtually no side effects. May be used in children. It is necessary to get vaccinated before the start of the epidemic; The vaccine is being developed exclusively against influenza viruses, therefore it will not be effective against other viruses that cause SARS (in connection with this circumstance, it would be advisable to take prophylactic antiviral drugs in addition to vaccination); Vaccines have a number of contraindications for use and should only be administered to a healthy body. Before vaccination, a consultation with a therapist is required!

3. use of immunomodulators Immunomodulators are substances of various nature, as well as physical effects, stimulating immune processes and enhancing the immune response. The main differences of this group are the effect on the body as a whole, and not on any part of the immune system in particular, and a pronounced stimulating effect on non-specific factors protection. There are several groups of immunomodulators among non-prescription drugs: Preparations of bacterial origin: a) bacterial lysates, which include lysates of the most common bacteria inhabiting the upper respiratory tract. They combine the properties of vaccines and non-specific immunostimulants, primarily enhance local defense mechanisms (Bronchomunal, I PC-19, Imudon, Rib omunil) IRS-19 Farmgroup: Immunostimulating drug based on bacterial lysates. Pharmaceutical action: IRS ®-19 increases specific and non-specific immunity. When spraying IRS ®-19, a fine aerosol is formed, which covers the nasal mucosa, which leads to the rapid development of a local immune response. Specific protection is due to locally formed antibodies of the class of secretory immunoglobulins type A (IgA), which prevent the fixation and reproduction of infectious agents on the mucosa. Nonspecific immunoprotection is manifested in an increase in the phagocytic activity of macrophages and an increase in the content of lysozyme. Indications: Prevention of chronic diseases of the upper respiratory tract and bronchi. Treatment of acute and chronic diseases of the upper respiratory tract and bronchi, such as rhinitis, sinusitis, laryngitis, pharyngitis, tonsillitis, tracheitis, bronchitis, etc. Restoration of local immunity after influenza or other viral infections. IRS ®-19 can be administered to both adults and children from 3 months of age. Contraindications: Hypersensitivity to the drug or its components in history and autoimmune diseases. Dosage: intranasally by aerosol administration of 1 dose (1 dose = 1 short press of the sprayer).

pharmachologic effect: Broncho-munal is an immunomodulator of bacterial origin for oral administration and stimulates the body's natural defense mechanisms against respiratory tract infections. It reduces the frequency and severity of these infections. The drug increases humoral and cellular immunity. Mechanism of action: stimulation of macrophages, increase in the number of circulating T - lymphocytes and antibodies lgA, lgG and lgM. The number of lgA antibodies increases, including on the mucous membranes of the respiratory tract. Bacterial lysate acts on immune system organism through Peyer's patches in the mucous membrane of the digestive tract. Indications: For the prevention of infectious diseases of the respiratory tract, the drug is used for three ten-day courses with twenty-day intervals between them. In the acute period of the disease, it is recommended to take 1 capsule of Broncho-munal consecutively for at least 10 days. For the next 2 months, it is possible to use 1 capsule prophylactically for 10 days, maintaining a 20-day interval. Dosage and administration Adults and children over 12 years of age are prescribed BRONCHO - MUNAL capsules 7.0 mg. Children from 6 months to 12 years of age are prescribed BRONCHO - MUNAL P. The drug is taken in the morning on an empty stomach. A single (daily) dose is one capsule.

B) probiotics Interferons and inducers of their synthesis of natural and synthetic origin (Cycloferon, Poludan, Amiksin, Lavomax, Neovir) Immunostimulants of plant origin (echinacea preparations, liana extract, cat's claw, etc.). First of all, they activate nonspecific immunity: they stimulate the phagocytic activity of neutrophils and macrophages, the production of interleukins. They exhibit a wide range of related biological activities. Althea root, chamomile flowers, field horsetail, walnut leaves, yarrow, wild rose, thyme, rosemary, etc. also help to increase the body's defenses; Adaptogens. This group includes herbal (ginseng, Chinese magnolia vine, Rhodiola rosea, aralia, eleutherococcus, etc.) and biogenic (mummy, propolis, etc.) preparations. They have a general tonic effect, increase the adaptive reactions of the body, contribute to the restoration and normalization of the immune system; Vitamins. Vitamins do not possess immunotropic properties.

The volume of therapeutic measures is determined by the severity of the condition and the nature of the pathology. During the period of fever, bed rest must be observed. Traditionally, in the treatment of acute respiratory viral infections, symptomatic ones are widely used (plenty of warm drink - at least 2 liters per day, it is optimal to drink a liquid rich in vitamin C: rosehip infusion, tea with lemon, fruit drinks. Whole food), desensitizing [chloropyramine (suprastin), clemastine, cyproheptadine (peritol)] and antipyretics (paracetamol preparations - kalpol, panadol, tylenol; ibuprofen) agents. Acetylsalicylic acid is contraindicated in children (risk of developing Reye's syndrome).

Etiotropic therapy of acute respiratory viral infections In influenza, the effectiveness of 2 groups of drugs has been proven - these are: 1) blockers of M - channels (rimantadine, amantadine). The antiviral effect is realized by blocking the ion channels (M 2) of the virus, which is accompanied by a violation of its ability to penetrate cells and release ribonucleoprotein. This inhibits the stage of viral replication. It is better to start treatment on the first day of the disease and no later than 3 days! Remantadine is not recommended for children under 12 years of age, pregnant women, people suffering from chronic liver and kidney diseases. Treatment continues for 3 days according to the scheme: 1st day - 300 mg, 2nd and 3rd days 200 mg each, 4th day - 100 mg. 2) 2) Neuraminidase inhibitors: Oseltamivir (Tamiflu) and zanamivir (Relenza). Inhibition of neuraminidase disrupts the ability of viruses to penetrate into healthy cells, reduces their resistance to the protective action of respiratory secretions, and thus inhibits the further spread of the virus in the body. In addition, neuraminidase inhibitors are able to reduce the production of pro-inflammatory cytokines - interleukin - 1 and tumor necrosis factor, thereby preventing the development of a local inflammatory reaction and weakening the systemic manifestations of influenza (fever, myalgia, etc.). It is necessary to take oseltamivir 1-2 tablets 2 times a day. The advantage of oseltamivir is the possibility of prescribing to children under 12 years of age. The course of treatment is 3-5 days. Used from 12 years old.

Arbidol Russian antiviral chemotherapy drug. Available in tablets of 0.1 g and in capsules of 0.05 g and 0.1 g. It is believed that the drug specifically suppresses influenza A and B viruses, and also stimulates the production of interferon and normalizes the immune system. It is used for the treatment and prevention of influenza caused by viruses A and B. The therapeutic effect is expressed in a decrease in the symptoms of influenza and the duration of the disease. Prevents the development of post-influenza complications, reduces the frequency of exacerbations of chronic diseases. It is taken orally. The scheme of treatment. Adults and children over 12 years old: 0.2 g every 6 hours for 3-5 days; Arpetol Belarusian antiviral agent, has an immunomodulatory and anti-influenza effect, specifically suppresses viruses of type A and B, severe acute respiratory syndrome. Generic arbidol.

SARS - characterized by damage to various parts of the respiratory tract with the obligatory presence of a number of catarrhal symptoms and an optional increase in temperature of varying severity. It is transmitted by airborne droplets and contact-by-household. Pathogens: orthomyxoviruses, paramyxoviruses, coronaviruses, picornaviruses, reoviruses, adenoviruses. Catarrhal and intoxication syndromes predominate in the clinic. With a mild form of influenza, the duration of temporary disability should be at least 6 days, with moderate influenza up to 8 and severe, at least 10–12 days. For persons who have undergone uncomplicated forms of influenza, dispensary observation is not established. Those who have undergone complicated forms of acute respiratory viral infections are subject to medical examination for at least 3-6 months. Treatment: symptomatic and etiotropic The main directions for the prevention of colds are: 1. hardening, a healthy lifestyle, hygiene measures 2. specific immunization (vaccination) 3. Preventive (scheduled) use of immunomodulators