IWS THEME: THE PRINCIPLES OF TREATMENT OF INFLAMMATORY DISEASES IN CHILDREN Prepared by: Bolysbek Dana Group: 466 GM Checked by: Dosanova Asem NJSC «Astana Medical university» Department of Pediatric Surgery

PLAN impact on the macroorganism, impact on the microorganism, treatment of the local process.

Treatment of purulent surgical infection is complex and includes three main components: 1) impact on the macroorganism, 2) impact on the microorganism, 3) treatment of the local process.

IMPACT ON A MACROORGANISM. One of the main tasks in the treatment of a purulent infectious process is to maintain and stimulate the immunobiological properties of the body. In this regard, it is necessary to use agents that improve antibody production and cellular immunity. In young children with congenital and acquired immunodeficiency, toxic and septicopyemic forms and in the first 5-7 days of the disease, passive immunization is preferable by introducing specific hyperimmune gamma globulin 3 ml every 1-2 days and plasma (6-10 ml per 1 kg of body weight). This is due to the low efficiency of active immunotherapy in these conditions due to the reduced ability to self-produce antibodies.

Direct blood transfusions are also advisable, due to its high bactericidal activity, phagocytic activity and the presence of antibodies. At the same time, a preliminary single immunization of donors with the appropriate toxoid is recommended, which significantly increases the antibody titer. Active immunization (toxoid and autovaccines) is used only in children over 6 months of age, as well as upon recovery from an extremely serious condition and after 5-7 days from the onset of the disease. In recent years, staphylococcal toxoid has been increasingly used in pediatric surgical clinics for purulent diseases. Having the ability to induce the formation of antibodies, at the same time it does not inhibit the reticuloendothelial system of the body. However, the speed of the immunological reaction will depend on the state of the macroorganism.

Т o stimulate the reticuloendothelial system and improve phagocytic reactions, it is advisable to use pentoxyl at a dose of 8 to 15 mg for 1 year of a child's life. This drug is re-prescribed, in severe cases at least once every 3-5 days. The next task is therapy aimed at desensitization of the body, which is especially important in conditions of staphylococcal infection. At present, it is possible to reduce the effect of body sensitization "with the help of antihistamines and steroid hormones in age-related dosages.

Hormonal therapy for purulent surgical infection is advisable to carry out: a) children with congenital adrenal insufficiency, and also if in the history there are indications of a tendency to a significant inadequate hyperthermic reaction in case of any non-severe inflammatory diseases; b) children with severe purulent infection, if they received hormone therapy shortly before the main disease, in these cases one should beware of a latent decrease in adrenal a function that can become expressed under the influence of stress - a purulent surgical infection; c) if it is necessary to prescribe large doses of antibiotics, when there is a danger of increased allergization; d) with a pronounced allergic component; e) with a violent course of the disease, when there is a danger of depletion of the function of the adrenal cortex.

In view of the significant tension in metabolism, the body needs a large amount of vitamins, especially of the B and B groups, up to 30 mg, Bz up to 5 mg, Ba up to 8 mg per day and C up to 300 mg per day. Vitamin therapy for purulent infection is carried out from the first hours. Shown the use of cocarboxylase (activated thiamine) from 0.03 to 0, i g per day, days in order to improve the oxidation of carbohydrates, especially in the nervous tissue. Due to the irritating effect of staphylococcal toxin and tissue breakdown products on the central nervous system, sedatives are indicated for patients with purulent surgical infection.

IMPACT ON THE MICROORGANISM. For successful antibiotic therapy, a number of principles must be followed. 1. Rationality of combination of antibiotics. The flora should not be resistant to the prescribed drugs. When using a bacteriostatic antibiotic, an additional bacteriolytic one must be prescribed. It is irrational to use only one antibiotic that affects one link in the microbe's metabolism. It is not advisable to prescribe two antibiotics that affect the same link in metabolism. It is inappropriate to combine antibiotics that cause similar side effects. 2. Prescribing large enough doses of antibiotics 3. Constant maintenance of the optimal concentration of antibiotics in the blood and local focus. the intervals between the administration of antibiotics should not be too long. 4. Carrying out antibiotic therapy for at least 5-7 days in full age dosage. 5. Constant monitoring of the antibioticogram (at least once every 5-7 days). When resistance appears, the drug is changed or its dosage increased.

IMPACT ON THE LOCAL PROCESS The impact on the local process consists of a set of measures. The following principles must be adhered to: 1) the sparing nature of surgical manipulations on the purulent focus and surrounding tissues, due to the danger of generalization of the infection due to a poor lymphatic barrier and widespread edema; 2) striving for minimal blood loss during manipulations due to the high sensitivity of children to blood loss; 3) ensuring maximum drainage of the focus and removal of non-viable tissues; 4) constant maintenance of the maximum concentration of antibiotics and antiseptics in the focus; 5) introduction directly into the affected area of specific antibodies; 6) the creation of immobilization of the affected organ in the acute stage of the disease.

From the very beginning, the purulent focus is sanitized as best as possible, using not only surgical, but also physiotherapy and other measures. In order to reduce fibrin formation and the destruction of fibrin around the lesion, anticoagulants are applied topically. Recently, the constant washing of the purulent focus with solutions of antiseptics and antibiotics has found more and more widespread use. This allows not only to influence the flora in the focus, but also to remove the products of purulent inflammation, to reduce tissue tension. In addition to surgical necrectomy, it is advisable to use proteolytic enzymes that promote the rejection of dead tissue. Physiotherapy is of great importance in the treatment of purulent surgical diseases. Thermal procedures (warming compresses, local warm baths, paraffin and mud applications) are used in the infiltrative phase of inflammation, when pus has not yet formed. thermal procedures help to dissolve the infiltrate, improve tissue trophism, relieve vascular spasm and reduce the content of acidic products in the focus of inflammation. In this regard, pain is significantly reduced.

Quartz irradiation has bactericidal properties, therefore it is used for superficial inflammatory processes (erysipelas, some pustular skin diseases). Ultraviolet irradiation has an irritating effect and promotes the onset of active superficial hyperemia. Therefore, quartzing is useful for the purpose of accelerating epithelialization, stimulating granulation, as well as for aseptic phlebitis (after venipuncture and venesections). Electrophoresis provides local saturation of the focus area with antibiotics, anticoagulants and other drugs.

REFERENCES Arnold G. Coran, Anthony Caldamone, N. Scott Adzick, Thomas M. Krummel, Jean-Martin Laberge, and Robert Shamberger - Pediatric Surgery, 7th Edition - Детская хирургия, 7 издание [2012, PDF, ENG] Isakov_Yu_F__Doletskiy_S_Ya_Detskaya_khirurgia Principles and Practice of Pediatric Infectious Diseases 4th Edition, Sarah Long Larry, Pickering Charles Prober