Selection of a topical drug for the treatment of BHSA-negative tonsillopharyngitis in children

Introduction. Inflammation of the mucous membrane and lymphoid structures of the oropharynx (tonsillopharyngitis – TP) occurs frequently in paediatric practice, both against the background of acute respiratory infection and outside catarrhal manifestations. The main focus of the medical treatment of TP is on the indications for systemic antibacterial agents, and the choice of pathogenic and/or symptomatic agents is not strictly regulated and is left to the discretion of the physician. At the same time data on anti-inflammatory activity of different topical drugs for local treatment of TP are practically absent, though inflammatory process affects oropharyngeal mucosa, which is a part of mucosal immunity system (NALT-level MALT system) and can be of different genesis and connected to formation of different cytokines (both pro- and anti-inflammatory).

Objective. To determine cytokine levels in patients with acute TP (ATP) before and after administration of various topical medicines used for the treatment of ATP.

Materials and methods. Patients diagnosed with uncomplicated ATP over 3 years of age who agreed to be examined, treated and biomaterial (scraped oropharyngeal mucosa) were included in the study. All patients underwent routine ENT examinations, a rapid test for BHSA-positive TP and biomaterial sampling for proinflammatory cytokines. Patients included in the study were randomly allocated into 2 groups: Group 1 patients used benzidamine and Group 2 patients used benzyl dimethyl ammonium chloride monohydrate. Both drugs are indicated for the treatment of ATP in patients over 3 years of age and are available in the form of a throat spray.

Results. Forty-nine patients with BHSA-negative ATP were included. Forty-five of them received benzidamine and 24 received benzyl dimethyl ammonium chloride monohydrate by random assignment (both drugs were applied to the oropharyngeal mucosa). There was a significant reduction in the proinflammatory cytokine interleukin (IL)-1 in patients in whom benzidamine was used compared to the group of patients where benzildimethyl ammonium chloride was used. A similar trend was detected in the analysis of the proinflammatory cytokine IL-6. A marked decrease in the level of IL-8 under the influence of benzidamine compared to benzildimethyl ammonium chloride was also observed. The general dynamics of the proinflammatory cytokine level reduction was traced at the evaluation of the tumour necrosis factor α level.

Conclusion. The data obtained suggest that the use of benzidamine has a more pronounced anti-inflammatory effect. This aspect is important for the practitioner (otorhinolaryngologist, paediatrician) when choosing a topical drug for the treatment of TP, especially at the first symptoms of the disease.