The role of symptomatic treatment of acute respiratory infection in the prevention of antibiotic resistance | Ukrainian Medical Journal

The development of antimicrobial resistance has been an acknowledged reality almost since the beginning of the antibiotic era, but only in the last few decades have dangerous resistant strains emerged with alarming regularity. A balanced and justified approach to prescribing antibacterial therapy is one of the conditions for curbing the escalating evolution of antimicrobial resistance. A sore throat in most cases is an example when «recovery does not depend on treatment» and complications in the absence of antibiotic therapy are unlikely. However, primary care physicians often continue to prescribe antibiotics for various conditions that are accompanied by a sore throat. Flurbiprofen 8.75 mg — Strepsils^® Intensive, oromucosal spray, and Strepsils^® Intensive, lozenges with honey and lemon, penetrates into the deep layers of the mucous membrane and acts in the area of inflammation, quickly and for a long time relieves even severe symptoms. Topical use of flurbiprofen as a symptomatic agent prevents the unnecessary prescription of antibacterial agents and, accordingly, reduces the burden of antimicrobial resistance. When antibacterial therapy is clinically justified, flurbiprofen, oromucosal spray and lozenges, can improve the patient’s quality of life from the very beginning of topical therapy and potentially shorten the duration of antibiotic use.

References

1. http://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance.
2. ec.europa.eu/health/amr/sites/amr/files/amr_action_plan_2017_en.pdf22.
3. US Centers for Disease Control and Prevention. Antibiotic resistance threats in the United States, 2019. US Department of Health and Human Services, Atlanta, GA201.
4. Fair R.J., Tor Y. (2014) Antibiotics and Bacterial Resistance in the 21st Century. Perspect. Medicin. Chem., 6: 25–64. DOI: 10.4137/PMC.S14459.
5. Singh P., Holmen J. (2022) Multidrug-Resistant Infections in the Developing World. Pediatr. Clin. North Am., 69(1): 141–152. DOI: 10.1016/j.pcl.2021.09.003.
6. Панченко Л.О., Васіна С.І., Звягольська І.Н. та ін. (2015) Емерджентні і ре-емерджентні вірусні інфекції: глобальна проблема XXI століття. Інфекційні хвороби, 4(82).
7. Широбоков В.П. (2020) Коронавірус та інші емерджентні інфекції. Укр. мед. часопис, 2(1) (136). http://www.umj.com.ua/article/175048.
8. Magiorakos A.-P., Srinivasan A., Carey R.B. et al. (2011) Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin. Microbiol. Inf., 8(3). DOI: 10.1111/j.1469-0691.2011.03570.x.
9. Appelbaum P.C. (2012) 2012 and Beyond: Potential for the Start of a Second Pre-antibiotic Era? J. Antimicrob. Chemother., 67(9): 2062–2068.
10. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis (2022) Antimicrobial Resistance Collaborators. Lancet, 399: 629–655. DOI: 10.1016/S0140-6736(21)02724-0.
11. O’Neill J. (2016) Tackling drug-resistant infections globally: final report and recommendations. Review on Antimicrobial Resistance, London.
12. O’Neill J. (2014) Antimicrobial resistance: tackling a crisis for the health and wealth of nations. Review on Antimicrobial Resistance, London.
13. de Kraker M.E., Stewardson A.J., Harbarth S. (2016) Will 10 million people die a year due to antimicrobial resistance by 2050? PLoS Med., 13: e1002184. DOI: 10.1371/journal.pmed.1002184.
14. Prestinaci F., Pezzotti P., Pantosti A. (2015) Antimicrobial resistance: a global multifaceted phenomenon. Pathog. Glob. Health, 109: 309–318.
15. Center for Disease Control and Prevention. Antibiotic Resistance Threats in the United States, 2013 (http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013–508.pdf).
16. Special Eurobarometer 338 ‘Antimicrobial Resistance’, 2009. Survey Commissioned by the Directorate-General for Health and Consumers and Coordinated by the Directorate-General Communication (‘Research and Political Analysis’ Unit).
17. Kunin C.M. (1993) Resistance to Antimicrobial Drugs: A Worldwide Calamity. Ann. Intern. Med., 118(7): 557–561. DOI: 10.7326/0003-4819-118-7-199304010-00011.
18. Pendleton J.N., Gorman S.P., Gilmore B.F. (2013) Clinical Relevance of the ESKAPE Pathogens. Expert. Rev. Anti Infect. Ther., 11(3): 297–308. DOI:10.1586/eri.13.12.
19. Nieuwlaat R., Mbuagbaw L., Mertz D. et al. (2021) Coronavirus Disease 2019 and Antimicrobial Resistance: Parallel and Interacting Health Emergencies. Clin. Infect. Dis., 72(9): 1657–1659. DOI: 10.1093/cid/ciaa773.
20. Rizvi S.G., Ahammad S.Z. (2022) COVID-19 and antimicrobial resistance: A cross-study. Sci. Total Environ., 807(Pt. 2): 150873. doi: 10.1016/j.scitotenv.2021.150873.
21. Antimicrobial resistance: time to repurpose the Global Fund. The Lancet, 399(10322): 335–410. DOI: 10.1016/S0140-6736(22)00091-5.
22. Arroll B. (2008) Common cold. BMJ Clin. Evid., 2008: 1510.
23. Simasek M., Blandino D.A. (2007) Treatment of the common cold. Am. Fam. Physician, 75(4): 515–520.
24. Печінка А.М., Дземан М.І. (2010) Гострі респіраторні захворювання: питання клінічної діагностики та лікування. Укр. мед. часопис, 5(79): 94–103. http://www.umj.com.ua/article/6986.
25. Уніфікований клінінчний протокол первинної медичної допомоги дорослим та дітям «Гострі респіраторні інфекції» (dec.gov.ua/wp-content/uploads/2019/11/2014_499ykpmd_gri.pdf).
26. Najjar Y., Hassan Z. (2021) Self-Treatment with Antibiotics: Knowledge level, Prevalence and Indications for Practicing Among University Students in Jordan. Curr. Drug Saf., 16(1): 82–89. DOI: 10.2174/1574886315666200902153950.
27. Nowakowska M., van Staa T. , Mölter A. et al. (2019) Antibiotic choice in UK general practice: rates and drivers of potentially inappropriate antibiotic prescribing. J. Antimicrob. Chemother., 74(11): 3371–3378. DOI: 10.1093/jac/dkz345.
28. Kenealy T. (2014) Sore throat. BMJ Clin. Evid., 2014: 1509.
29. Addey D., Shephard A. (2012) Incidence, causes, severity and treatment of throat discomfort: a four-region online questionnaire survey. BMC Ear. Nose Throat Disord., 12: 9. DOI: 10.1186/1472-6815-12-9.
30. Renner B., Mueller C.A., Shephard A. (2012) Environmental and non-infectious factors in the aetiology of pharyngitis (sore throat). Inﬂamm. Res., 61(10): 1041–1052. DOI:10.1007/s00011-0120540-9.
31. Зупанец И.А., Безуглая Н.П. (2013) Фармацевтическая опека при симптоматическом лечении боли в горле. Аптека online, 14(885).
32. Del Mar C.B., Glasziou P.P., Spinks A.B. (2004) Antibiotics for sore throat. Cochrane Database Syst Rev., 2: CD000023. DOI: 10.1002/14651858.CD000023.pub2.
33. Krüger K., Töpfner N., Reinhard В. et al. (2021) Guideline group. Clinical Practice Guideline: Sore Throat. Dtsch Arztebl Int., 118(Forthcoming): 188–194. DOI: 10.3238/arztebl.m2021.0121.
34. Little P., Hobbs F.D.R., Moore M. et al. (2013) Clinical score and rapid antigen detection test to guide antibiotic use for sore throats: randomised controlled trial of PRISM (primary care streptococcal management). BMJ, 347: f5806. DOI: 10.1136/bmj.f5806.
35. Fine A.M., Nizet V., Mandl K.D. (2012) Large-scale validation of the Centor and McIsaac scores to predict group A streptococcal pharyngitis. Arch. Intern. Med., 172: 847–852. DOI: 10.1001/archinternmed.2012.950.
36. Little P., Hobbs F.R., Moore M. et al. (2014) PRImary care Streptococcal M anagement (PRISM) study: in vitro study, diagnostic cohorts and a pragmatic adaptive randomised controlled trial with nested qualitative study and cost-effectiveness study. Health Technol. Assess, 18. DOI: 10.3310/hta18060.
37. Устінов О.В. (2014) Алгоритм дії лікаря при наданні медичної допомоги хворим на гострі респіраторні інфекції. Укр. мед. часопис, 6(104). http://www.umj.com.ua/article/83046.
38. Little P. (2005) Delayed prescribing of antibiotics for upper respiratory tract infection. BMJ, 331(7512): 301–302.
39. Llor C., Moragas A., Bayona C. et al. (2021) Efficacy and safety of discontinuing antibiotic treatment for uncomplicated respiratory tract infections when deemed unnecessary. A multicentre, randomised clinical trial in primary care. Clin. Microbiol. Infect., 430–434. DOI:10.1016/j.cmi.2021.07.035.
40. van Driel M.L., De Sutter A., Deveugele M. et al. (2006) Are Sore Throat Patients Who Hope for Antibiotics Actually Asking for Pain Relief? Ann. Fam. Med., 4: 494–499. DOI: 10.1370/afm.609.
41. Spurling G.K., Del Mar C.B., Dooley L. et al. (2017) Delayed antibiotic prescriptions for respiratory infections. Cochrane Database Syst Rev. 9(9): CD004417. DOI: 10.1002/14651858.
42. Наказ МОЗ України від 16.07.2014 р. № 499 «Про затвердження та впровадження медико-технологічних документів зі стандартизації медичної допомоги при грипі та гострих респіраторних інфекціях».
43. Попович В.І. (2020) Раціональне лікування небактеріальних та бактеріальних інфекцій верхніх дихальних шляхів у рамках проблеми стримування зростання бактеріальної резистентності. Укр. мед. часопис, 1(1)(135). http://www.umj.com.ua/article/169299.
44. Catic T., Kapo B., Pintol Z. et al. (2018) An Instrument for Rating Quality of Life Related to Sore Throat in Patients Suffering from Acute Pharyngitis or Tonsillitis. Mater. Sociomed., 30(1): 43–48. DOI: 10.5455/msm.2018.30.43-48.
45. Mahase E. (2021) Covid-19: Sore throat, fatigue, and myalgia are more common with new UK variant. BMJ, 372: n288. DOI: 10.1136/bmj.n288.
46. Priestley T. (2004) Current Drug targets. CNS and Neurological Disorders, 3(6): 441–456. DOI: 10.2174/1568007043336888.
47. Bolt P., Barnett P., Babl F.E. et al. (2008) Topical lignocaine for pain relief in acute otitis media: results of a double-blind placebo-controlled randomised trial. Arch. Dis. Child, 93: 40–44. DOI: 10.1136/adc.2006.110429.
48. Aschenbrenner D.S. (2018) Warning For Oral Drugs Containing Benzocaine. Am. J. Nurs., 118(9): 23–24. DOI: 10.1097/01.NAJ.0000544976.10560.e6.
49. Veltri K.T., Rudnick E. (2016) Benzocaine-Induced Methemoglobinemia: A Case Report. PT, 41(3): 180–191.
50. Stalker D.J., Pollock S.R. (1991) Bioavailability of flurbiprofen following buccal administration. Pharm. Res., 8(5): 605–607. DOI: 10.1023/a:1015852623136.
51. Turner R., Wevrett S.R., Edmunds S. et al. (2020) Determination of the Permeation and Penetration of Flurbiprofen into Cadaveric Human Pharynx Tissue. Clin. Pharmacol. Advances Applications, 12: 13–20. DOI: 10.2147/CPAA.S234227.
52. Lambkin-Williams R., Mann A., Shephard A. (2020) Inhibition of viral and bacterial trigger-stimulated prostaglandin E2 by a throat lozenge containing flurbiprofen: An in vitro study using a human respiratory epithelial cell line. SAGE Open Med., 8: 1–6. DOI.org/10.1177/2050312120960568.
53. Benrimoj S.I., Langford J.H., Christian J. et al. (2001) Efficacy and tolerability of the anti–inflammatory throat lozenge flurbiprofen 8.75 mg in the treatment of sore throat — a randomized, double-blind,placebo-controlled study. Clin. Drug Invest., 21(3): 183–193. DOI: 10.2165/00044011-200121030-00004.
54. Watson N., Nimmo W.S., Christian J. et al. (2000) Relief of sore throat with the anti–inflammatory throat lozenge flurbiprofen 8.75 mg: a randomized, double-blind, placebo-controlled study of efficacy and safety. Int. J. Clin. Pract., 54(8): 490–496.
55. de Looze F., Russo M., Bloch M. et al. (2016) Efficacy of flurbiprofen 8.75 mg spray in patients with sore throat due to an upper respiratory tract infection: a randomised controlled trial. Eur. J. Gen. Pract., 22(2): 111–118. doi: 10.3109/13814788.2016.1145650.
56. Radkova E., Burova N., Bychkova V. et al. (2017) Efficacy of flurbiprofen 8.75 mg delivered as a spray or lozenge in patients with sore throat due to upper respiratory tract infection: a randomized, non-inferiority trial in the Russian Federation. J. Pain Res., 10: 1591–1600. doi:10.2147/JPR.
57. Schachtel B., Aspley S., Shephard A. et al. (2014) Onset of action of a lozenge containing flurbiprofen 8.75 mg: a randomized, double-blind, placebo-controlled trial with a new method for measuring onset of analgesic activity. Pain, 155: 422–428. DOI: 10.1016/j.pain.2013.11.001.
58. Schachtel B., Aspley S., Shephard A. (2018) Onset of analgesia by a topically administered flurbiprofen lozenge: a randomised controlled trial using the double stopwatch method. Br. J. Pain, 12(4): 208–216. DOI: 10.1177/2049463718756152.
59. Türk B., Akpinar M., Erol Z.N. (2018) The effect of flurbiprofen oral spray and ibuprofen vs ibuprofen alone on postoperative tonsillectomy pain: an open, randomised, controlled trial. Clin. Otolaryngol., 43: 835–840. DOI: 10.1111/coa.13058.
60. Muderris T., Gul F., Yalciner G. (2016) Oral Flurbiprofen Spray for Posttonsillectomy Pain Otolaryngol. Head Neck Surg., 155(1): 166–172.
61. Muderris T., Tezcan G., Sancak M. et al. (2019) Oral flurbiprofen spray for postoperative sore throat and hoarseness: a prospective, randomized, double-blind, placebo-controlled study. Minerva Anestesiologica, 85(1): 21–27. DOI: 10.23736/S0375-9393.18.12703-9.
62. Imberti R., De Gregori S., Lisi L. (2014) Influence of the oral dissolution time on the absorption rate of locally administered solid formulations for oromucosal use: the flurbiprofen lozenges paradigm. Pharmacology, 94(3–4): 143–147. DOI: 10.1159/0003 67663.