Background. The oropharyngeal microbiota is important in maintaining resistance, eliminating viruses and regulating local protective reactions in response to inflammation in acute respiratory infections.
Aim. To evaluate of the effect of topical etiotropic therapy on clinical manifestations, elimination of viruses and on oropharyngeal microbiota in the treatment of acute infectious inflammation of the throat that occurred as part of acute respiratory infections in children aged 510 years.
Materials and methods. 120 outpatient patients randomized into 3 equal groups were treated for 7 days: in Group 1 0.2% hexethidine-containing aerosol, in Group 2 0.03 mg combined spray gramicidin S and 0.1 mg cetylpyridinium chloride, in Group 3 0.01% topical solution containing benzyldimethyl-myristoylamino-propylammonium. Changes in the severity of clinical manifestations were compared (integral indicator modified Tonsillopharyngitis Severity Score TSSm for children, the severity of the "sore throat" symptom on the WongBaker scale, the severity of local signs of inflammation according to pharyngoscopy data) in groups at Visit 2 (day 51) and Visit 3 (day 121) compared with the Visit 1. The elimination of acute respiratory infection pathogens was evaluated: polymerase chain reaction (PCR) of oropharyngeal smears obtained on days 1, 3 and 5 (1) PCR-1, PCR-2, PCR-3 respectively, with the detection of 12 respiratory viruses, including SARS-CoV-2. The state of the microbiota was assessed by sequencing the full-size 16S gene in samples obtained before and after treatment 1st and 12th (1) days, and compared with 19 indicators in healthy.
Results. By Visit 3, the decrease in TSSm indicators was: 4.01.07 in Group 1; 5.01.48 in Group 2 and 4.01.02 in Group 3. The intergroup differences between Group 2 and 1, Group 2 and 3 were statistically significant (p0.05). The severity of sore throat by Visit 3 decreased in groups 1, 2 and 3 respectively by 2.00.90, 2.50.61 and 2.10.60, intergroup differences between groups 2 and 1, 2 and 3 had statistical significance at p0.05. The time to achieve complete relief of the disease according to the TSSm indicator was (day, MSE): 16.61.47 in Group 1; 11.91.13 in Group 2 and 12.41.38 in Group 3, intergroup differences (groups 1 and 2) are significant, p0.05. The time of complete relief from sore throat for groups 13 was 12.60.96, 8.00.87 and 9.41.01 respectively, intergroup differences (groups 1 and 2) were significant, p0.05. By Visit 2, the proportion of patients with a negative PCR result increased in Group 1 by 25%, in Group 2 by 43% and in Group 3 by 38%, which corresponded to the elimination of 81, 92 and 74% of viruses detected in groups according to PCR-1 and PCR-2. The microbiota of participants in all groups before treatment differed from the microbiota of healthy in terms of alpha and beta diversity, as well as in terms of indicators obtained by the NearesBalance method. After completion of treatment, changes in the microbiota in terms of beta diversity were observed in all groups compared to the initial state. In contrast to groups 1 and 3, in Group 2 there were statistically significant changes in species-level balances between groups of microbes that distinguish between sick and healthy, towards indicators of healthy.
Conclusion. Topical etiotropic medications provide rapid relief of complaints and local signs of inflammation in the treatment of patients aged 510 years with sore throat in acute respiratory infections and contribute to the rapid elimination of pathogens of acute respiratory infections. A combined preparation containing an antiseptic and a bacteriocin-like antimicrobial peptide gramicidin S provides a more pronounced therapeutic effect at an earlier time and the elimination of 90% of all respiratory viruses, including SARS-CoV-2, by the fifth day of therapy, and also has the most sparing effect on the oropharyngeal microbiota compared to antiseptic monopreparations, which may explain its more pronounced anti-inflammatory effect.
