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 APPLICATION OF CLAVOMED IN THE TREATMENT OF COMPLICATED ACUTE BRONCHITIS IN CHILDREN 
INGA MAMUCHISHVILI, Doctor of Medicine, M.D.
Pediatric Clinic named Brothers Zubalashvili
 
Infectional - inflamational diseases of the respiratory system take the main part in the structure of children infectious diseases. Acute bronchitis represents one of the common forms of respiratory organ lesions.         
 
Cough is the leading symptom of acute bronchitis. Initially the cough is dry and with the increasing of sputum production it becomes productive in 1-2 days. Sputum is usually mucous and may take greenish color on the second week (caused by fibrin) but this does not indicate presence of microbial infection. Cough usually lasts for two weeks. There is diffuse, dry wheezing and crackles which changes with cough on auscultation and there are no percutorial changes during bronchitis. Hematologic abnormalities are not constant finding.      
 
The goal of our clinical trial was to study clinical effectivity and safety of Clavomed in complex therapy of acute bronchitis developed on the basis of acute viral respiratory infection.    
 
More common causatives of acute bronchitis are: staphylococcus aureus, hemolytic streptococcus, H. influenzae and rarely intestinal flora.   
 
Natural penicillins were used against mentioned pathogens years ago.   
 
Common shortcomings of natural penicillins are:
·        Narrow range of antimicrobial activity
·        Relatively high complication rate.
·        Short half life
·        Increasing the number of cultures with the natural penicillin resistance. 
 
Shortcomings mentioned for natural penicillins are relatively same for synthetic ones.     "Protected" penicillins are combinations of aminopenicillins and beta-lactamase inhibitors (amoxicillin+clavulanic acid; ampicillin+sulbactam). "Protected" penicillins are effective against pneumococci, beta-hemolytic streptococci, hemophylic rod and others. 
 
We observed 45 children (19 boys and 26 girls) of 1-6 age groups with acute bronchitis. Acute bronchitis was the complication of acute respiratory viral infection in all of the cases. The disease continued for 7-9 days, with febrile temperature elevation, with wet wheezing, and auscultative signs. There was widening of pulmonary hiluses and exaggerated pulmonary picture on X-ray. There was leucocytosis and elevated ESR in blood. We also conducted bacterioscopy of Gram's stained sputum. Gram-positive microorganisms are stained violet-blue. This diagnostic method gives us opportunity to define if the causative organism is gram-positive or gram-negative, which actually makes easier to choose the appropriate antibiotic in specific situation.
 
Clavomed contains clavulanic acid, which is derived from fermentation of Streptomyces clavuligerus. Clavulanic acid irreversibly binds to the bacterial beta-lactamase and protects beta-lactam nucleus of amoxicillin from fermentative inactivation. Antibacterial properties of Clavomed cover gram-positive and gram-negative aerobes.   
 
Clavomed was used in complex with expectorating agents and other symptomatic treatment preparations in respective age doses (every 5 ml of Clavomed suspension contains 312,5 mg of active substance) during 5-7 days. Normalization of body temperature, decreasing of cough and liquefying of the sputum was mentioned already on the third- fourth day of the treatment.
 
There was positive dynamics of clinical manifestations of acute bronchitis on the basis of conducted complex treatment.  
 
Our study proved start antibiotic-Clavomed-to be highly effective and safe preparation in the treatment of complicated bronchitis.