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  • Symptoms of dysbiosis

    Dysbacteriosis of the intestine , caused by the prevalence of staphylococcus, is a consequence of adverse effects of drugs. It develops against a background of changes in the body's reactions to external factors and a decrease in the barrier function of the intestine. In this form of the dysbacteriosis symptoms associated with intoxication and inflammatory process developing in the intestine are noted: fever( up to 39 ° C) with chills and sweating, headache, weakness, poor appetite, sleep disturbance, constrictive or cramping pain in the abdomen, a liquid copious stool with blood, mucus and the presence of pus. The frequency of the stool is up to 7-10 times a day. Objectively recorded bloating, prolonged soreness in the course of the large intestine, spasm. Changes in blood are characterized by an increase in the number of leukocytes, and in severe cases, a decrease in the total protein content. How to use folk remedies for this disease look here.

    Depending on the cause( etiology) in modern medicine, the following types of dysbiosis are distinguished.

    Dysbacteriosis in practically healthy persons:

    Dysbacteriosis accompanying various diseases of the digestive system:

    Dysbacteriosis in infectious, allergic diseases, immunodeficiency states, hypovitaminosis, hypoxia, that is, insufficient supply of tissues with oxygen, and hypoxemia - low oxygen content in the blood, intoxications caused byboth external and internal causes, the effects of radionuclides.

    Drug dysbacteriosis as a consequence of taking antibiotics, sulfonamides, tuberculostatics, immunosuppressants, antacids, antisecretory, laxatives, etc.

    Stressor dysbacteriosis occurs with prolonged emotional or physical stress.

    Depending on the severity of the disturbance of microflora, 3 degrees of dysbiosis are distinguished:

    There is one more classification of dysbacteriosis - depending on the quantitative ratio of Escherichia coli and opportunistic microbes:

    1. Body weight disorder:

    Absence of weight gain;

    weight loss;

    deficiency of body weight.

    2. Changes in the skin, mucous membranes, subcutaneous tissue:

    pallor, grayish skin tone;

    dryness, peeling;

    decreased skin elasticity;

    erosion in the corners of the mouth;

    allergic dermatitis;

    thrush;

    brightness, "varnished" mucous membranes;

    changes in the mucosa and skin in the anus.

    3. Symptoms from the digestive system:

    decrease and lack of appetite;

    nausea;

    regurgitation;

    vomiting;

    putrefactive odor from the mouth;

    metallic taste in the mouth;

    increased salivation;

    flatulence, bloating;

    at belly palpation rumbling;

    abdominal pain( independent and with palpation);

    enhanced release of gases;

    itching and burning in the anus;

    anus compliance, disruption of the sphincter of the rectum( sphincteritis);

    diarrhea: without dehydration, with dehydration, with intoxication;

    stool: plentiful, mushy with undigested lumps of mucus;watery;liquid lean with pathological impurities;

    constipation.

    1. Symptoms from the gastrointestinal tract:

    decrease or lack of appetite;

    nausea;

    vomiting;

    metallic taste in the mouth;

    abdominal pain( dull or cramping) independent and with palpation;

    flatulence;

    rumbling, bloating;

    feeling of incomplete bowel movement;

    constipation;

    diarrhea;

    alternation of constipation and diarrhea.

    2. Hypovitaminosis:

    seizures;

    dry skin and mucous membranes.

    3. Allergic Syndrome:

    itching of the skin and mucous membranes;

    is an allergic skin rash.

    4. General Symptoms:

    fatigue;

    weakness;

    headaches;

    From dysbacteriosis of the intestine should be distinguished so-called dysbacterial( dysbacteriosis, dysbiotic) reactions - short-term changes in the intestinal microflora. These changes occur with short exposure to adverse factors and spontaneously disappear after the cause is eliminated after 3-5( less often - 10 or more) days without any special therapeutic measures.

    Symptoms of the actual dysbacteriosis are numerous - from subtle( if a person has a huge reserve of compensatory possibilities) to severe metabolic disturbances. It is especially important to note that with dysbacteriosis, completely different clinical patterns are possible: this is irritable bowel syndrome, and spastic hyper- or hypomotor dyskinesia( disorder of coordinated movements of the large intestine), and chronic non-ulcerative colitis.

    Consider the most common symptoms of dysbiosis.

    The most common clinical manifestation of dysbiosis is the syndrome of gastrointestinal dyspepsia. This is understandable: with dysbacteriosis, the digestive function is violated in the first place. How is this syndrome manifested? First of all - violations of the stool. Typically, it is diarrhea( 6-8 times a day, feces yellowish green, with a sharp unpleasant odor), but there may be constipation, and sometimes alternating diarrhea with constipation. Because of frequent defecation, patients have dull pain in the anus. There are eructations, nausea, heartburn. Many people have flatulence, due to increased gas generation, a violation of absorption and removal of gases. The flatulence in these cases is more pronounced in the afternoon and at night. Patients constantly complain of rumbling in the abdomen, its swelling, unpleasant taste in the mouth. Pay attention: intestinal infections, including dysentery, can occur with the same manifestations!

    Abdominal pain of a different nature:

    It appears in almost all patients with dysbiosis of children( 93-98%) and in the majority of adults( 80%).It is expressed, as a rule, that a person can not tolerate any products( it can sometimes be very difficult to reveal this).After a few minutes( or a few hours) after eating such foods, patients get nausea, loose stools, swells and starts to ache, often these phenomena are supplemented by common allergic reactions: urticaria, skin itching, swelling, bronchospasm.

    Characterized, first, by persistent diarrhea, and secondly, there are signs of a deficiency of certain substances in the body. If the disturbance of intestinal absorption is prolonged, then the general signs of a person's unhealthy state clearly appear: immunity decreases, against this background frequent illnesses of the nasopharynx, bronchi, lungs, skin, joints begin.

    For example, with insufficient absorption of proteins, protein-energy insufficiency is observed in patients. A person begins to lose weight quickly, he develops edema, hypoproteinemia, that is, a low protein content in the blood, dystrophic processes begin in the liver.

    If there is a violation of carbohydrate absorption in patients, hypoglycemia is observed, that is, a lowered glucose content in the blood, which can not be eliminated even by using a concentrated sugar solution.

    If due to disbacteriosis the complete absorption of calcium is disturbed, hypocalcemia begins - calcium content in the blood decreases: the bones grow weak and thin( osteoporosis is a scourge of our time), fingers and toes grow numb, anemia, depression, apathy develop.

    Decreased absorption of phosphorus leads to deformation of the skull, curvature of limbs, growth retardation in children.

    Water-electrolyte disorders are characterized by:

    The syndrome of vitamin deficiency is directly associated with impaired intestinal absorption. With dysbacteriosis, the lack of vitamins of group B is most pronounced. The very first sign of it is a violation of the motor function of the digestive tract.

    But the shortage of each particular vitamin has its own characteristic features. With a deficiency of vitamin B12( cyanocobalamin, which is of great importance for hematopoiesis), anemia develops in man. Often, vitamin B12 deficiency disturbs the production of vitamin K and folic acid, which leads to a variety of bleeding.

    When there is a lack of vitamin B2( riboflavin), stomatitis, cheilitis, inflammation of the skin of the lips, sores, dermatitis of the wings of the nose and nasolabial folds, fall out, thin out and get sick of the nails.

    The lack of vitamin B1( thiamine, or, as it is also called, an antineuritic vitamin), causes typical neurological disorders: headaches, irritability, general weakness, insomnia, intestinal atony.

    The same happens with a lack of vitamin B6( pyridoxine).When both vitamins( B1 and B6) are deficient, the common disorders of the peripheral nervous system can develop into neuritis, the dystrophic processes of the myocardium begin.

    Serious neurological failures also occur in the case of a reduction in the amount of nicotinic acid necessary for the body. At the same time, irritability, imbalance, and glossitis occur in the patient-the inflammation of the mucous membrane of the tongue( characterized by bright red coloration of the mucous tongue, throat, mouth, increased salivation).

    Often with disbacteriosis, the ability to absorb fat-soluble vitamins, in particular vitamin D, is impaired, which can lead to rickets or aggravate the course of it in children.

    Anorectal syndrome most often develops with prolonged treatment with antibiotics. It is characterized by a general poor state of health: weakness, headache, lack of appetite. Then the temperature can rise, diarrhea begins, there is a dull pain in the anorectal area( near the anus).

    In summary it is necessary to mention a widespread mistake: often a dysbacteriosis is confused with various sharp intestinal diseases, and not only patients, but in some cases also doctors. Therefore, I want to draw the attention of readers - both patients and doctors - to signs characteristic of such diseases.

    For acute intestinal infections( OCI) are characteristic:

    For acute foodborne infections:

    The main symptoms of severe dysbiosis:

    In addition, for severe dysbacteriosis, there are manifestations of polyhypovitaminosis( lack of vitamins) and a deficiency of minerals, an increase in allergic processes with a simultaneous decrease in immunity. It should pay attention to the language: it often becomes "geographic" - striated, it appears raids( whitish, yellowish, etc., especially if you are alert, if the plaque is black - this may be a sign of the development of fungi in the intestine).

    As you can see, there are a lot of symptoms of dysbacteriosis, and often they are very similar to the symptoms of other diseases. Therefore, it is very important for the doctor( of any profile) to have laboratory studies that provide information about the state of the patient's microflora. For this, there are a variety of methods.

    The most common method - sowing feces for dysbiosis. With its help, it is possible to detect not only the presence of opportunistic microorganisms, but also the deficit of bifido- and lactobacilli. True, this method is not accurate enough, since it reflects the microbial composition of only the distal parts of the intestine( the straight and part of the sigmoid colon).With the help of this analysis, only about 20 species of bacteria can be isolated, although about 500 live in their intestines. Nevertheless, the analysis provides quite reliable information for assessing the status of the most significant bacteria inhabiting the large intestine and the doctor has the opportunity to prescribe the necessary treatment.

    To diagnose dysbacteriosis, a coprological examination( coprogram) is also carried out - a biological study of intestinal contents.

    Another method is gas-liquid chromatography of feces, based on the separation and subsequent analysis of various components of intestinal contents. This method makes it possible to detect volatile fatty acids: acetic, valeric, caproic, isobutyric, etc. The deviation of their content from the physiological norm characterizes the state of the intestinal flora and the relationships within it.

    Further, endoscopy is a bacteriological study of scraping from the mucous membrane of the duodenum with the aid of an endoscope inserted into the intestine.

    Recto-manoscopy - bacteriological examination of scraping from the rectal mucosa - visual examination of the rectum and sigmoid colon;Colonoscopy - examination of the inner surface of the large intestine with a flexible optical device - a colonoscope, as well as examination of intestinal contents and bile.

    A method such as the determination of indole and scatol in urine is also used.

    For the rapid diagnosis of the small intestine, a respiratory 4C-xylose test is used, but its results are not always accurate, the probability of error is 10%.

    With the help of chloroform-methanol extract of small bowel fluid in the small intestine free bile salts are found. However, this method is rarely used.

    To determine the causes of dysbiosis, X-ray, endoscopic and ultrasound examinations of the gastrointestinal tract, as well as computed tomography of the abdominal cavity.

    You should not hesitate to visit a doctor if:

    In addition, there are a number of psychological moments that indicate that with health( in particular, with microflora), not everything is in order:

    In case the dysbacteriosis is caused by enterobacteria, Pseudomonas aeruginosa, enterococci, the following phenomena are noted: poor appetite, dull pain in the abdomen, unstable mushy stool with a lot of mucus, flatulence, spasm and soreness of the sigmoid colon. Because of the low severity of the above symptoms, the situation is often underestimated, and the developed disease supports an inflammatory( mainly local) process in the intestine.

    Dysbacteriosis caused by associations of opportunistic microorganisms( usually staphylococci, yeast-like fungi, enterococci, less frequently hemolytic and Pseudomonas aeruginosa), is much more severe than in the case of one pathogen.

    With the prevalence of fungal flora, the pattern of symptoms is often unclear or erased. Body temperature is normal, there is a slight pain in the abdomen, a stool is liquid or mushy up to 3-5 times a day, sometimes with mucus and the presence of whitish-gray mycotic lumps.

    More dysbacteriosis, caused by fungi of the genus Candida and Aspergilla, is more severe. In candidomycosis, patients complain of abdominal pain of a different nature or localized in the navel, bloating and a feeling of heaviness in the abdomen. The stool is liquid or mushy with mucus, sometimes with blood or frothy, with the presence of whitish-gray or grayish-green mycotic lumps or films up to 6 times or more per day.

    Patients with subfebrile condition, poor appetite, general weakness, weight loss are observed. When examined, they are noted raspberry tongue and stomatitis.

    Dysbacteriosis of the intestine caused by aspergillas( 15 of the known 300 species are pathogenic) is more likely to develop in patients with previous diseases of the stomach or intestines, especially with gastritis with increased acidity. The manifestations of aspergillus are observed in severely weakened, depleted patients on the background of a common, most often chronic lung disease( tuberculosis, pneumonia, bronchitis, etc.), blood diseases, in the course of prolonged use of antibiotics( especially tetracycline).The disease begins with dyspeptic phenomena: nausea, vomiting, pain in the epigastric region, bitter moldy taste in the mouth, rashes on the mucous membrane of the mouth, throat and pharynx, as well as a foamy stool with a lot of mucus and moldy odor, sometimes with an admixture of blood. Dysbacteriosis of the intestines caused by aspergillas can occur with a strong intoxication called mycotoxicosis, as these microorganisms, being biochemically active, form enzymes and thus can produce poisonous substances. Thus there are the symptoms similar to intoxication, especially after the use in food of a considerable quantity of carbohydrates.

    As a rule, fungal lesions of the intestine are accompanied by manifestations of severe somatic diseases, which makes it difficult to treat them.

    Since in some cases, dysbacteriosis does not show any symptoms, or the symptoms may be related to other diseases, the microbiological analysis is crucial in the diagnosis.

    Indications for the analysis are as follows:

    long-term intestinal disorders in which pathogenic microorganisms can not be isolated;

    prolonged recovery period after dysentery and other acute intestinal diseases;

    intestinal dysfunction in people who are exposed to radiation for a long time, chemicals, as well as for intensive antibiotic and / or immunosuppressive therapy, long-term chemotherapy, hormonal therapy;

    presence of purulent-inflammatory foci, difficult to treat( pielites, cholecystitis, ulcerative colitis, enterocolitis, lethargic pneumonia);

    allergic diseases( atopic dermatitis, bronchial asthma, etc.), difficult to treat.

    The microbiological criteria for diagnosis are:

    increase in the number of conditionally pathogenic microorganisms of one or more species in the intestine with a normal amount of bifidobacteria;

    increase in the number of one or more species of opportunistic microorganisms with a moderate decrease in the concentration of bifidobacteria( by 1-2 orders of magnitude);

    decrease in the content of bifidobacteria and( or) lactobacilli without a detectable increase in the amount of opportunistic microflora of the intestine;

    a moderate or significant decrease in the content of bifidobacteria, combined with pronounced changes in the microflora - a decrease in the number of lactobacilli, the appearance of altered forms of Escherichia coli, the detection of one or more opportunistic microorganisms in increased quantities.

    The most frequent consequence of intestinal dysbiosis, , in addition to all the unpleasant symptomatic phenomena discussed above, is the lack of vitamins. The most pronounced shortage of B vitamins, the earliest symptom of which is a violation of the motor function of the digestive tract.a deficiency of riboflavin is indicated by stomatitis, dermatitis of the wings of the nose and nasolabial folds, changes in nails, hair loss. With thiamine deficiency, neurological disorders are possible in the form of sleep disorders. Especially dangerous is the lack of vitamin B12 caused by the intestinal dysbiosis, which leads to the development of B12-deficient anemia. It is also possible to impair the absorption of fat-soluble vitamins, in particular vitamin D, which can aggravate the course of rickets.

    So, you found some of the listed symptoms, visited a doctor, underwent examination, passed tests and are sure that you have a dysbiosis, what should you do? This you will read in this book. Furthermore! Even if you do not have any of the above mentioned signs, you feel fine - this book will still be useful to you: to preserve and increase health and vivacity. Yes, it means nothing less than prevention. Since the cited methods of treatment are non-medicinal, there are no unpleasant consequences from them, although, of course, they should not be overdone. Observe the formula and rules of application - and everything will turn out exactly as intended.

    In severe cases, as you can understand from the above, treatment should be carried out under the strict supervision of a specialist doctor. If you do not have a serious, ordinary disorder, you can try to deal with it on your own. However, for severe cases, the methods of treatment described below are quite applicable, of course, subject to prior consultation with the doctor and his approval.

    Parallelism of clinical manifestations and severity of dysbiotic changes is not always available. In a number of cases, with severe disturbances in the intestinal microflora, there are no clinical manifestations, and on the contrary - marked clinical manifestations are accompanied by minor changes in the microflora.

    Clinical manifestations of dysbacteriosis depend on the disturbances in the microflora of the macroorganism( in particular, on the variant of the leading opportunistic agents or their associations) and on its compensatory possibilities. The causes of the appearance of the symptoms of the disease - a decrease in colonization resistance of the intestinal mucosa, detoxification and digestive function of the intestinal microflora, a violation of the immune status of the body.

    The main clinical manifestations of intestinal dysbacteriosis are: a general condition disorder( intoxication, dehydration);decrease in body weight;symptoms of mucosal lesions of the gastrointestinal tract;digestive disorders in various parts of the gastrointestinal tract;protein and micronutrient deficiency;decreased function of the immune system.

    Clinical manifestations of intestinal dysbiosis in children.

    1. Absence of an increase, loss or deficiency of body weight, hypotrophy of I, II, III degrees.

    2. Changes in the skin, mucous membranes, subcutaneous tissue: pallor, grayish shade of the skin, dryness, peeling, decreased skin elasticity, excoriation, erosion in the corners of the mouth, lichenization, allergic dermatitis, thrush, cheilitis( hyperemia, thickening of lips, dry scales), brightness, hyperemia, "lacquer" of the mucous membranes, aphthae, enanthemums on the mucous membrane of the gums, oral cavity and throat, changes in the mucosa and skin in the anus.

    3. Symptoms from the digestive system: decrease and lack of appetite;nausea;regurgitation;vomiting;aerophagia;putrid odor from the mouth;metallic taste in the mouth;increased salivation;flatulence;bloating;with palpation of the abdomen - rumbling and splashing noise, spasmodically reduced colon;pain in the abdomen - independent and with palpation;increased release of gases;itching and burning in the anus;disruption of the sphincter of the rectum( sphincteritis);diarrhea;change in the nature of the stool( copious, mushy with undigested lumps of mucus, liquid, watery, lean with poor pathological impurities, sheep stool, constipation).

    Clinical manifestations of intestinal dysbiosis in adults.

    1. Symptoms from the gastrointestinal tract: decreased or no appetite;nausea;vomiting;metallic taste in the mouth;abdominal pain( dull or cramping) - independent and with palpation;eructation;aerophagia;flatulence;rumbling in the abdomen, its swelling;feeling of incomplete emptying of the intestine;imperative urges for defecation;constipation;diarrhea;alternation of constipation and diarrhea;feces in the form of a cork-like stool( mushy or liquid feces with a solid first portion of it, sometimes with an admixture of mucus);Sheep feces( with constipation) with an admixture of mucus;putrefactive or sour smell of stool.

    2. Signs of hypovitaminosis: seizures, dry skin and mucous membranes.

    3. Allergic Syndrome: itching of the skin and mucous membranes, allergic skin rashes.

    4. General symptoms: fatigue, weakness, headaches, sleep disturbance.

    Dysbacteriosis of the intestine due to the prevalence of hemolytic or epidermal staphylococcus( but at a level of not more than 107 cfu per 1 g of faeces) is a consequence of adverse effects of medications. It develops against a background of altered reactivity of the organism and a decrease in the barrier function of the endothelial-macrophage intestinal system.

    In the clinical picture of the intestinal dysbiosis caused by staphylococcus, symptoms associated with intoxication and inflammatory process developing in the intestine are noted: fever( up to 39 ° C) with chills and sweating, headache, weakness, poor appetite, sleep disturbance, permanent orcramping pain in the abdomen, a liquid copious stool with blood and mucus, with the presence of pus. The frequency of the stool is up to 7-10 times a day. Objectively recorded bloating, prolonged soreness in the course of the colon, spasm. Changes in blood are characterized by an increase in the number of leukocytes, a shift in the leukocyte formula to the left and an increase in ESR, a decrease in albumin and an increase in globulin fractions, and in severe cases a decrease in the total protein content( up to 6.1 g / l).With sigmoidoscopy, a catarrhal, catarrhal-hemorrhagic and / or erosive-ulcerative inflammatory process is detected.

    With a dysbacteriosis caused by enterobacteria, Pseudomonas aeruginosa, enterococci, poor appetite, subfebrile temperature, dull abdominal pain, unstable mucus-like mucus with a lot of mucus, flatulence, spasm and soreness of the sigmoid colon are determined. Due to the low severity of the above symptoms, the situation is often underestimated, and the developed dysbacteriosis supports an inflammatory( mainly local) process in the intestine.

    Dysbacteriosis due to associations of conditionally pathogenic microorganisms( usually staphylococci, proteus, lactose-negative escherichia, yeast-like fungi, enterococci, less often hemolytic and Pseudomonas aeruginosa), is much more severe than in the case of one pathogen and is characterized by complications such as perforationulcers, bacteremia and septicopyemia.

    With the prevalence of fungal flora, the clinical picture is polymorphic and often erased. Body temperature is normal. There is a slight pain in the abdomen. The stool is liquid or mushy, up to 3-5 times a day, sometimes with mucus and the presence of whitish-gray mycotic lumps. Some of the patients have elevated ESR in their blood, and catarrhal changes in the mucosa during the recto-manoscopy.

    More dysbacteriosis, caused by fungi of the genus Candida and Aspergillus, is more severe. With candidiasis, patients complain of a pain in the abdomen of a diffuse nature or localized in the navel, a swelling and a feeling of heaviness in the abdomen. The stool is liquid or mushy, with mucus, sometimes with blood or frothy, with the presence of whitish-gray or grayish-green mycotic lumps or films, up to 6 times or more per day. Patients are observed subfebrile condition, poor appetite, general weakness, weight loss. When examined, they have a raspberry tongue, aphthous stomatitis. With sigmoidoscopy, catarrhal or catarrhal-hemorrhagic proctosigmoiditis is detected, sometimes large-ulcer lesions.

    If the yeast-like fungi of the genus Candida are detected in crops, up to 107 cfu per g of feces, the situation is estimated as a dysbacteriosis of the intestine. If the amount of fungi in crops exceeds 107 cfu per 1 g of feces and the clinical picture indicates the generalization of the process( skin, mucous membranes and internal organs), such cases are considered candidamycosis or candidamycosis sepsis.

    Dysbacteriosis of the intestines caused by aspergillas( 15 of the described 300 species are pathogenic) is more often developed in patients with previous diseases of the stomach or intestine, especially with gastritis with high acidity. Clinical manifestations of such dysbacteriosis are observed in severely weakened, depleted patients on the background of a common, most often chronic lung disease( tuberculosis, pneumonia, bronchitis, bronchiectasis, etc.), blood diseases, prolonged use of antibiotics( especially tetracycline).

    The disease begins with dyspeptic phenomena - nausea, vomiting, pain in the epigastric region, bitter moldy taste in the mouth, aphthous eruptions on the oral mucosa, throat and pharynx, as well as a foamy stool with a lot of mucus and moldy odor, sometimes with a trace of blood.

    Intestinal dysbacteriosis caused by aspergillus can occur with a strong intoxication called mycotoxicosis, as these microorganisms, being biochemically active, form proteolytic, saccharolytic and lipolytic enzymes and thus can produce poisonous substances. This creates a state similar to intoxication, especially after eating a large amount of carbohydrates.

    Generalized forms of aspergillosis, including aspergillosis sepsis, are very rare and occur very severely, usually with a fatal outcome.

    Usually fungal lesions of the intestine are accompanied by diseases with severe forms that hamper their treatment.

    With dysbacteriosis of the intestine, signs of hypovitaminosis are noted. The most pronounced deficiency of B vitamins, the earliest symptom of which is a violation of the motor function of the digestive tract with a tendency to atony. The lack of riboflavin is indicated by stomatitis, cheilitis, dermatitis of the wings of the nose and nasolabial folds, changes in nails, hair loss. With thiamine deficiency, neurological disorders are possible in the form of sleep disorders, paresthesias. With dysbacteriosis of the intestine, vitamin B12 deficiency may occur, leading to the development of B12-deficient anemia.

    In case of nicotinic acid deficiency, irritability, imbalance, glossitis, bright red color of mucous tongue, throat, mouth, increased salivation are observed in patients.

    With intestinal dysbacteriosis, absorption of fat-soluble vitamins, in particular vitamin D, is impaired, which can aggravate the course of rickets.

    With the development of dysbiotic changes, a decrease in the immunological reactivity of the organism, the production of lysozyme, as well as an increase in histamine content in organs and tissues, sensitization of the organism occurs with the development of allergic reactions. In this regard, the clinical manifestations of dysbiosis can be accompanied by signs of allergy, but their severity is individual.

    Changes in the intestinal microbiocenosis correspond to the I-II degree of microbiological disorders. Clinical manifestations of dysbacteriosis are absent.

    The examination includes clinical examination of the patient, collection of anamnesis and complaints, which allows to reveal the presence( or absence) of the patient risk factors for the development of dysbiosis, associated with the premorbid state.

    In children under the age of 1 year, the risk factors for the development of intestinal dysbacteriosis are as follows: maternal dysbacteriosis, bacterial vaginosis in the period of pregnancy, complicated course of pregnancy and childbirth, mastitis;birth of a child with caesarean section;A low assessment on the Apgar scale and the availability of resuscitation measures in a newborn;presence of purulent infection in the child;artificial feeding.

    With regard to children of the first year of life, when questioning parents( or a trusted person), specify the nature of feeding the child( natural or artificial), the timing of the introduction of complementary feeding, complementary feeding, and the features of physical development( weight gain).

    In children under the age of 15, when preparing for vaccination, for surgical intervention, referring the child to the planned hospital treatment, to sanatorium-improving institutions, the presence of risk factors for dysbacteriosis, such as: unfavorable course of the neonatal period;early artificial feeding;dyspeptic disorders;frequent acute respiratory viral infections;allergic diseases( eg, atopic dermatitis);rickets;anemia;hypotrophy;being in closed collectives;transferred intestinal and other infections;diagnosed before immunodeficiency states, endocrine, oncological and allergic( dermatitis, rhinitis, asthma, etc.) diseases;as well as the timing and nature of their treatment( courses of antibiotics, hormonal and chemotherapy, etc.);allergic dermatitis, in addition, find out the frequency and nature of the stool.

    Patients over the age of 15 years are diagnosed with one or more risk factors for intestinal dysbacteriosis: intensive antibiotic treatment, long-term hormonal and chemotherapy, primary and secondary immunodeficiencies, intestinal and other( respiratory, urogenital, etc.) infections last year, chronic gastrointestinal diseases( cholecystitis, peptic ulcer of the stomach and duodenum, colitis, including ulcerative colitis, etc.).Emphasis is placed on stool disorders( diarrhea, constipation, alternation) and nutrition( body weight deficiency) in the patient.

    Exterior examination and palpation of the patient exclude the presence of clinical signs of dysbiosis, which draw attention to:

    - skin( dryness and peeling, allergic dermatitis);

    - oral cavity( seizures, cheilitis, aphthae, glossitis, hyperemia and varnish of the mucous membrane, enanthema, etc.);

    - abdomen area( soreness and bloating).

    The microbiological study of feces is conducted with the aim of revealing violations of the intestinal microbiocenosis( Table).The obtained data on the qualitative and quantitative composition of the basic intestinal microflora are compared with normal indices.

    Table.

    Degrees of microbiological disorders in intestinal dysbacteriosis

    A coprological examination is conducted to determine the nature of intestinal dysfunction.

    The patient( or the parents of the child accompanying the person) should explain the order and rules for taking medication, repeated( control) microbiological examination of stool.

    Microbiological examination of stool is carried out 14 days after the end of therapy to assess the dynamics of microbiocenosis indicators of the intestine.

    Means used for the prevention and correction of intestinal microbiocenosis disorders.

    Medical therapy is started with the appointment of one of the means used to prevent and correct intestinal microbiocenosis disorders. These drugs include bifid-containing drugs that restore the intestinal microflora. Children these drugs are prescribed in preparation for vaccination, for surgical intervention, when referring to planned hospital treatment, to sanatoriums and health institutions. The duration of the course is 5 days for children, and 14 days for those over 15 years old.

    The choice of the drug for children older than 15 years is performed according to the results of a microbiological study of feces. The first course of correction can be carried out with monocomponent or polycomponent or combination preparations. With a low level of bifidobacteria, correction of microflora disorders begins with the use of a bifid-containing drug, with a high level of bifidobacteria and a sharply reduced content of lactobacilli-a lactose-containing drug. You should not begin correction with the use of colibacterin, as a normal E. coli can be restored with repeated courses of bifido- and lactopreparations without treatment with colibacterin.

    In case of incomplete normalization of indicators of intestinal microflora in adults, a second course of medical correction is performed: sorbed bifid-containing preparations, complex lactose-containing preparations, if necessary bifikol are recommended. With the slow growth of bifidoflora additionally used hilakforte, a complex immunoglobulin drug( KIP).The duration of each repeated course of bifido-, lactate-containing drug is 14 days. The criterion of effectiveness is the normalization of the parameters of the intestinal microbiocenosis, which is estimated from the control microbiological study of stool.

    With the normalization of the intestinal microbiocenosis, non-drug( dietary with the inclusion of probiotic products or biologically active additives) treatment continues.

    Bifidumbacterin in dosage forms: powder, tablets, capsules, lyophilizate are taken by mouth, powder and lyophilizate are also intended for topical application.

    For example, bifidumbacterin powder( for ingestion and topical administration) before consumption by its older children and adults is mixed with the liquid part of the food, preferably with a fermented milk product, or with 30-50 ml of boiled water at room temperature, not achieving complete dissolution of the powder;before the drug is used by newborns and infants it is mixed with mother's milk, an infant formula, or a baby food product, with a liquid portion of other food.

    The doses of various medicinal forms of bifidumbacterin administered in different age groups are as follows:

    - from 0 to 6 months: 1 packet of dosage form in the form of a powder( activity 5108 cfu) once a day;3 doses of a dry dosage form from a vial( ampoule)( activity 7107 cfu) once a day;5 doses of dry dosage form in the form of capsules( activity 5-108 cfu) 1 time per day;

    - from 6 months to 3 years: 1 packet of dosage form in the form of a powder 2 times a day;5 doses of dry dosage form in the form of capsules or from a vial( ampoule) 2 times a day;

    - from 3 years to 7 years: 2 packages of dosage form in powder form 1-2 times a day;5 doses of dry dosage form in the form of capsules, tablets or from a vial( ampoule) 2 times a day;

    - 7 years and older: 2 packages of dosage form in the form of a powder 2 times a day;5 doses of dry dosage form in the form of capsules, tablets or from a vial( ampoule) 2 times a day.

    Bifidumbacterin forte is given to children during feeding, mixed with mother's milk or baby food. Older children and adults are mixed with a liquid portion of food before use, preferably with a sour milk product, or with 30-50 ml of boiled water at room temperature. When the preparation is dissolved with water, a turbid suspension with black sorbent particles is formed. The resulting aqueous suspension should be drunk without achieving complete dissolution. If necessary, the drug is used regardless of food intake.

    Doses of bifidumbacterin forte given in different age groups are as follows:

    - 0 to 12 months: 1 packet 1 time per day;

    - from 1 year and older: 1 packet 2 times a day.

    Bifilysis for adults and children is prescribed inside, 5 doses 1 time per day for 20-30 minutes before meals.

    Algorithm for the treatment of intestinal dysbacteriosis with lactose-containing drugs.

    Lactose-containing drugs are used with a reduced content of lactobacilli. The duration of the course of therapy is 14 days.

    Lactobacterin is administered orally, 3 times a day, 2 times a day, dissolving boiled water at room temperature, 40-60 minutes before meals 2-3 times a day.

    Acipol is administered orally, 1 tablet once a day for 30 minutes before meals.

    Assylact prescribe inside, 5 doses 1 time per day for 30 minutes before meals.

    Algorithm for treatment with coli-containing drugs

    The course of colibacterin( adults only) or bifikol is carried out only with a steady decrease in the level of Escherichia coli, the absence of its altered forms. The duration of the course of therapy is 14 days.

    Colibacterin - appoint 6 doses or 6 tablets per day( can be in 2 divided doses) for 20-30 minutes before meals. The duration of the course of therapy is 14 days.

    Bifikol - appoint 6 doses 2 times a day for 30-40 minutes before meals.

    Restriction of stresses and stress situations, lengthening of hours of rest, sleep and stay in the open air is shown.

    Assign a diet that includes foods containing bifido- and lactobacilli for a period of at least 3-4 weeks.

    If these rules are observed, in 70% of cases a complete restoration of the intestinal normoflora is observed, which is confirmed by the absence of clinical symptoms of dysbacteriosis, normal intestinal microflora parameters, good quality of life. In 20% of the observations, the stabilization of the process is determined by the 21st day of the conducted activities, which requires the appointment of a second course of corrective therapy. In 10%, despite treatment, the progression of microbiocenosis disorders is determined, which is characterized by the appearance of clinical symptoms of intestinal dysbacteriosis( nausea, flatulence, bloating, abdominal pain, stool changes, etc.).

    Changes in the intestinal microbiocenosis in this case correspond to II-III degree of microbiological disorders.

    The presence of one or more( any combination) of clinical manifestations confirms the intestinal dysbacteriosis syndrome: stool disorder( diarrhea, constipation or alternation), dull or cramping abdominal pain, tenderness in palpation of different parts of the intestine, flatulence, skin and mucous membrane damage -dry skin and mucous membranes, dermatitis, in children of the first year of life - regurgitation, aerophagia, increased salivation, increased release of gases, a decrease in the rate of weight gain, the possibility of development of hypotrophy.

    When collecting an anamnesis, the data on the transferred intestinal infections, previously diagnosed immunodeficient conditions, allergic( dermatitis, asthma, etc.), endocrine( diabetes) and oncological diseases, courses of antibiotic treatment, hormonal and chemotherapy, professional and domestic conditions,including the nature of nutrition.

    During the collection of complaints, attention is focused on identifying and determining the nature of: stool disorders - diarrhea, constipation, alternation;abdominal pain - dull or cramping.

    Physical examination .On examination, clinical signs of dysbiosis are determined, attention is paid to changes in: skin( dryness and flaking, dermatitis) and subcutaneous fat( lack of body weight);mucous - erosion in the corners of the mouth( seizures), cheilitis, aphthae, enanthemums, hyperemia and lacqueriness of the tongue( glossitis);abdominal region( abdominal distention, palpation - diffuse soreness, splash noise, spastic-cut large intestine), etc. Children of the first year of life are noted for the presence of regurgitation, aerophagy, increased salivation, increased release of gases.

    Microbiological examination of feces is carried out with the purpose of revealing violations of intestinal microbiocenosis, determining the sensitivity of microorganisms to bacteriophages and antibiotics. The obtained data on the qualitative and quantitative composition of the basic intestinal microflora are compared with normal indices. Detection of violations of microbiocenosis of the intestines of II-III degree confirms the correctness of the diagnosis.

    With the help of coprological research determine the nature of violations of bowel functions.

    In the treatment, a general examination of the patient should be carried out each time, focusing on the condition of the skin, oral cavity, abdomen( flatulence, pain during palpation), monitor compliance with the drug, dietary and therapeutic regimens or adjust. The patient( if the patient is a child, then the trustee) explains the order and rules for taking medicines, the need for a second( control) microbiological study of stool.

    Microbiological examination of stool is carried out 14 days after the end of therapy to assess the dynamics of microbiocenosis indicators of the intestine, to determine the sensitivity to phages and antibiotics of a prevalent conditionally pathogenic microorganism.

    Therapy is carried out in stages. Begin with the appointment of one of the means used to prevent and treat dysbiosis, which suppresses the excessive growth of opportunistic microorganisms in the intestine. The following groups of drugs are used: bacteriophages, antibacterial( adults only), antifungal, apatogenic representatives of the genus Bacillus. Duration of the course is 5 days. Following this, a 21-day course of therapy with bifidobacterial or lactose-containing drugs( bifidumbacterin, bifidumbacterin forte, florin forte, bifilysis, lactobacterin, acipol, acylact) is carried out, the course is 10 days for prescribing.

    In the case of incomplete disappearance of clinical symptoms and the presence of grade II microbiological disorders in the intestine, a second course of treatment is carried out using drugs to suppress excess growth of opportunistic microorganisms( 5 days) and a course of therapy with drugs to restore normal microflora( bifidumbacterin forte, florin forte, bifilysis, acipol, acylact - 21 days, and probiophore - 10 days).Additionally, according to the indications, lactulose, hilak-forte is prescribed.

    With slow growth of bifidoflora additionally assigned instrumentation.

    Drugs are prescribed from the 1st to the 5th day of treatment, taking into account the data of microbiological examination of stool: with excessive growth of staphylococcus - bacteriophage of staphylococcus, E. coli - bacteriophage coli, protea - bacteriophage protei, etc.

    The duration of the course of therapy is 5 days.

    Doses of bacteriophages are presented in Table.

    Table. Doses of bacteriophages

    They are prescribed from the 1st to the 5th day of treatment, taking into account the data of microbiological examination of feces( only for patients older than 15 years).

    The drugs of choice are erythromycin and other macrolides, ciprofloxacin and other fluoroquinolones in conventional therapeutic doses.

    Course duration - 5 days.

    They are prescribed from the 1st to the 5th day of treatment with high titers in the feces of yeast-like fungi. The drugs of choice are: nystatin, fluconazole.

    They are used to reduce the excessive growth of microorganisms. The drugs of choice are baktisporin( 1 dose 2 times per day), biosporin( 1 dose 2 times per day), sporobacterin( 1 ml 2 times a day).

    The duration of the course of therapy is 5 days.

    They are used to normalize the intestinal microflora with a low level of bifidobacteria on the 4th day from the beginning of the use of the drug, which suppresses the excessive growth of microorganisms.

    Bifidumbacterin is a powder for oral administration and topical application;eat while eating;bred in 30-50 ml of boiled water at room temperature, not achieving dissolution of the powder, for children - mixed with mother's milk or baby food, a liquid part of other food.

    Bifidumbacterin dry( tablets, capsules) is taken by mouth. The contents of the vial( ampoules) are dissolved by boiling water at room temperature;the contents of the opened capsule - a small amount of chilled boiled water. Tablets, as well as capsules are consumed by washing them with a sufficient amount of liquid at room temperature.

    Doses of various medicinal forms of bifidumbacterin administered in different age groups are as follows:

    - 0 to 6 months: 1 packet of the dosage form in the form of a powder 2-3 times a day;3 doses of a dry dosage form from a vial( ampoule) 2-3 times a day;5 doses of dry dosage form in the form of capsules 2-3 times a day;

    - from 6 months to 3 years: 1 packet of the dosage form in the form of a powder 3-4 times a day;5 doses of a dry dosage form in the form of capsules or from a vial( ampoule) 2-3 times a day;

    - from 3 to 7 years: 1 packet of the dosage form in the form of a powder 3-5 times a day;5 doses of dry medicinal form in the form of capsules or tablets or from a vial( ampoule) 2-3 times a day;

    from 7 years and older: 2 packages of dosage form in powder form I I times a day;5 doses of dry dosage form in the form of capsules, tab-to or from a bottle( ampoule) 2-3 times a day.

    The duration of the course of therapy is 21 days.

    Bifidumbacterin forte. For children, the drug is given during feeding, mixed with mother's milk or a baby food product. For older children and adults, the drug is mixed with the liquid part of the food, preferably with a sour milk product, or with 30-50 ml of boiled water at room temperature before use. When the preparation is dissolved with water, a turbid suspension with black sorbent particles is formed. The resulting aqueous suspension should be drunk without achieving complete dissolution. If necessary, the drug is consumed regardless of food intake.

    Doses of bifidumbacterin forte given in different age groups are as follows:

    - 0 to 12 months: 1 packet 2-3 times a day;

    - from 1 year to 15 years: 1 package 3-4 times a day;

    - 15 years and older: 2 packages 2-3 times a day;

    The duration of the course of therapy is 21 days.

    Bifilysis for adults and children appoint inwards, 5 doses 2-3 times per day for 20-30 minutes before meals. The duration of the course of therapy is 21 days.

    The probiophore is administered orally;before use mixed with the liquid part of the food, preferably a sour milk product, or with 30-50 ml of boiled water at room temperature;infants and young children are given during feeding, mixed with any baby food product. When the preparation is dissolved with water, a turbid suspension with black sorbent particles is formed. The resulting aqueous suspension should be drunk without achieving complete dissolution. If necessary, the drug is consumed regardless of food intake.

    Dosages of the probiophore prescribed in different age groups are as follows:

    1. premature newborns 1 package 1-2 times a day;

    2. term infants and children under 3 years old, 1 package 2 times a day;

    3. children from 3 to 7 years - 1 package 3 times a day;

    4. children older than 7 years and adults 2-3 packs 2 times a day.

    The duration of the course of therapy is 10 days.

    They are used to normalize the intestinal microflora with a reduced content of lactobacilli on the 4 th day from the beginning of the drug, which reduces the excessive growth of microorganisms. The duration of the course of therapy is 21 days.

    Lactobacterin is taken orally, dissolving boiled water at room temperature, 40-60 minutes before meals.

    Lactobacterin doses prescribed in different age groups are as follows:

    - up to 6 months: 1 -2 doses per day;

    - from 6 months to 1 year: 2-3 doses per day;

    - from 1 year to 3 years: 3-4 doses per day;

    - from 3 to 15 years: 4-10 doses or 1 tablet per day;

    - 15 years and older: 6-10 doses or tablet per day.

    Acipol is prescribed inside, children from 3 months to 1 year - 1 tablet 2-3 times a day, the rest of the age group - 1 tablet 2-4 times a day for 30 minutes before meals.

    Assylact prescribe inside, children under 6 months - 5 doses per day in 2 doses, the remaining age groups - 5 doses 2-3 times a day for 30 minutes before meals.

    Algorithm for treatment with coli containing agents.

    Bifikol - the course is carried out only with a persistent decrease in E. coli, the absence of its altered forms.

    The drug is prescribed internally, children from 6 months to 1 year - 2 doses, from 1 to 3 years - 4 doses, over 3 years and adults - 6 doses 2-3 times a day. It is taken 30-40 minutes before meals. In tablets, the drug is used in patients with 3 years.

    The course duration of therapy is 21 days.

    The drug is consumed during meals, if necessary - regardless of food intake. Before use, the drug is mixed with liquid food, preferably a sour-milk product, newborns and infants are given with mother's milk or a mixture for artificial feeding. The drug can be mixed with 30-50 ml of boiled water at room temperature, the resulting aqueous suspension should be drunk without achieving complete dissolution.

    Age doses:

    1. children under 6 months of age - 1 package 2 times a day, children from 6 months to 3 years - 1 package 3 times a day, children from 3 years and older - 1 package 3-4 times a day;

    2. for adults - 2 packages 3 times a day.

    The duration of the course of treatment is 10-15 days.

    The drug is taken orally: children of the first 3 months of life for 15-20 capsules 3 times a day, older age groups - 20-40 drops 1 time per day, adults - 40-60 drops 3 times a day before orwhile eating, mixing with a small amount of liquid( for the claim-wetting of milk).The duration of the course of therapy is 14 days. Do not administer concurrently with lactose-containing drugs.

    Algorithm for the treatment of lactulose. Assign to children up to 3 years 5 ml and a day before the effect, then for 10 days;from 3 to 6 years - 5 10 ml per day until the effect is achieved, then for 10 days;from 7 to 14 years - the initial dose of 15 ml per day to achieve the effect, supporting - 10 ml per day for 10 days;for adults, the first day is 15 ml per day, the second day is 30 ml per day, the third day is 45 ml per day and then increasing 15 ml per day until the effect is reached( maximum daily dose is 190 ml),Further, a maintenance dose of 50% of the effective dose of 10 days is given. The daily dose is given in 2-3 divided doses. It is prescribed if the drug regimen does not include lactose-containing drugs. It is a first-line agent for dysbiosis, which occurs with constipation. Diarrhea, severe prolonged abdominal pains are a contraindication for the use of lactulose.

    Under the age of 15, .Treatment begins with a 5-day course of therapy with a specific bacteriophage or a drug from apatogenic genus Bacillus, with high titers of yeast-like fungi - antifungal drugs. In the absence of a phage, the elimination of opportunistic microorganisms in children older than 1 year is performed by spore-forming drugs( biosporin, bactisporin, sporobacterin).Continue to restore normal intestinal microflora with one of the polycomponent or combination bifido- and / or lactose-containing drugs( bifidumbacterin forte, probiophore, bifilysis, florin forte, acylact, acipol), which are prescribed from the 4th day of phagotherapy or after a course of antifungal drugs, preparations from apatogenicrepresentatives of the genus Bacillus.

    Patients with a predominant diarrhea syndrome. The main drug is a probiophore. The first 3 days the patient is prescribed a probiophore according to the scheme:

    In addition to the main therapy, short course( on average 3 days) one of the pancreatic enzymes( abomin, mezim forte, pancreatin, pancitrat, creon, festal) is prescribed, in addition one of the following drugs can be given -enterodesis, microsorb, polyphepam, smecta.

    With predominance of constipation. In addition to the main therapy, lactulose is prescribed. The course is 10 days.

    With a deficiency of the enzymatic function of the pancreas .In addition to the main therapy, one of the pancreatic enzymes( abomin, mezim forte, pancreatin, pancitrat, creon, festal) is prescribed. The duration of the course of therapy is 2 weeks. The course of therapy can be repeated at the doctor's prescription.

    Restriction of stresses and stress situations, lengthening of hours of rest, sleep and stay in the open air is shown.

    With proper intake of drugs, recommendations, diet for a month, complete disappearance of clinical symptoms, normal intestinal microflora parameters are observed in 70%, improvement in the clinical state of the patient( reduction of abdominal pain, flatulence, normalization of stool) - in 20%, absence as positive, and negative dynamics( stabilization) - in 6%, in 3% of patients there is a progression of the disease, which is manifested by fever, signs of intoxication, as well as new symptoms of intestinal dysbiosisor exacerbation of those previously present( severe diarrhea or constipation, abdominal pain, progression of mucosal changes - aphthae, cheilitis, etc.);In 1% of patients, development of iatrogenic complications was noted, i.e.the emergence of new diseases or complications not diagnosed at an early stage, proceeding hidden and not recognized by the doctor. In the absence of positive dynamics in the treatment of a patient should be sent to a highly specialized medical institution.

    Changes in the intestinal microbiocenosis in this case correspond to the III degree of microbiological disorders.

    - the presence of a rise in body temperature and signs of general intoxication( chills, headache, weakness),

    - the presence of one or more( any combination) of clinical manifestations of intestinal dysbiosis: stool, blunt or cramping abdominal pain, bloating, soreness with palpation of different parts of the intestine, flatulence, skin and mucous membranes, weight loss.

    During the collection of anamnesis and complaints, the presence or absence of dull or cramping abdominal pain, diarrhea, constipation or alternation, stool with mucus, blood veins, risk factors for dysbiosis, associated with premorbid conditions such as: recessiveintestinal and other infections, allergic diseases, immunodeficiency, endocrine system diseases, cancer, antibiotic, hormone and chemotherapy courses, etc.

    With a physical examinationdovanii determine the presence of non-specific signs of infections and intoxications: changing the frequency of respiration, heart rate, heart rate, increase in body temperature;signs of general intoxication: chills, headache, weakness;clinical signs of dysbiosis, which focuses on the detection of pathology:

    - skin( dryness and peeling, dermatitis);

    - oral cavity( erosion in the corners of the mouth - seizures, cheilitis, glossitis, hyperemia and varnish of the mucous membrane, aphthae, enanthema);

    - abdominal areas( tenderness and bloating, palpation - splash noise, spastic-cut large intestine);

    - as well as on malnutrition( lack of body mass), etc.

    Children of the 1st year of life are diagnosed with regurgitation, aerophagia, increased salivation, increased release of gases, etc.

    The microbiological study of stool is conducted with the purpose of revealing the violations of the intestinal microbiocenosis, determining the sensitivity of microorganisms to bacteriophages. The obtained data on the qualitative and quantitative composition of the basic intestinal microflora are compared with normal indices. Infringements of a microbiocenosis of an intestine correspond to III degree.

    A scrotal examination is performed to determine the nature of intestinal dysfunction.

    Thin-, colonic endoscopy, sigmoidoscopy is performed to withdraw intestinal contents in order to more accurately determine the parameters of microflora and the state of the intestinal mucosa.

    In the treatment, it is necessary to conduct a general medical examination of the patient each time, focusing on the condition of the skin, the oral cavity, the abdomen( flatulence, pain in palpation), monitor the compliance with the medicinal, dietary and therapeutic regimens or adjust them. The patient is explained the order and rules for taking medicines, the need for a repeated( control) microbiological study of stool.

    Microbiological examination of feces is carried out 14 days after the end of therapy in order to assess the dynamics of microbiocenosis indicators of the intestine, to determine the sensitivity to phages and antibiotics of the prevalent opportunistic microorganism.

    Therapy is carried out in stages. Begin with the appointment of one of the means that suppresses the excessive growth of opportunistic microorganisms in the intestine. Use the drugs of the following groups: antifungal, antibacterial( only in adults), bacteriophages( only in children).Simultaneously with bacteriophages, the instrumentation for enteral administration is prescribed. Duration of the course is 5 days. After this, a 21-day course of therapy with bifido- and / or lactose-containing drugs( bifidumbacterin, bifidumbacterin forte, florin forte, bifilysis, lactobacterin, acipol, acylact) is carried out, and the course is 10 days for prescribing.

    In the case of incomplete disappearance of clinical symptoms and grade II of microbiological disorders in the intestine, a second course of treatment is carried out using drugs to suppress excess growth of opportunistic microorganisms( 5 days) and a course of therapy with drugs to restore normal microflora( bifidumbacterin forte, florin forte, bifilysis, Acipol, acylact - 21 days, and probiophore - 10 days).In addition, appointed instrumentation, lactulose, hilak forte.

    With high titres in the feces of yeast-like fungi prescribe: nystatin, fluconazole. The duration of the course of therapy is 5 days.

    Antibacterial agents are prescribed taking into account the data of microbiological examination and the spectrum of sensitivity to antibiotics. Drugs of choice are antibiotics: erythromycin and other macrolides, ciprofloxacin and other fluoroquinolones. The duration of the course of therapy is 5 days.

    It is used to suppress the excessive growth of microorganisms taking into account the data of microbiological examination of stool( with the excessive growth of staphylococcus - bacteriophage of staphylococcus, E. coli - bacteriophage coli, protea - bacteriophage protei, etc.).Simultaneously with bacteriophages, instrumentation is prescribed.

    Instrumentation is used to enhance the effect of elimination therapy with bacteriophages. Assign inside 1 dose 2 times a day. The course is 5 days.

    Applied for normalization of intestinal microflora with a low level of bifidobacteria on the 4th day from the beginning of application of the drug, which suppresses excessive growth of microorganisms.

    Bifidumbacterin forte is given to children during feeding, mixed with mother's milk or baby food. For older children and adults, the preparation is mixed with the liquid part of the food before use, preferably with a sour-milk product, or with 30-50 ml of boiled water at room temperature. When the preparation is dissolved with water, a turbid suspension with black sorbent particles is formed. The resulting aqueous suspension should be drunk without achieving complete dissolution. If necessary, the drug is consumed regardless of food intake. The duration of the course is 21 days.

    Doses of bifidumbacterin forte, appointed in different age groups:

    - 0 to 12 months: 1 packet 2-3 times a day;

    - from 1 year to 15 years: 1 package 3-4 times a day;

    - 15 years and older: 2 packages 2-3 times a day.

    The probiophore is administered orally;before use mixed with the liquid part of the food, preferably with a fermented milk product, or with 30-50 ml of boiled water at room temperature;infants and young children are given during feeding, mixed with any baby food product. When the preparation is dissolved with water, a turbid suspension with black sorbent particles is formed. The resulting aqueous suspension should be drunk without achieving complete dissolution. If necessary, the drug is consumed regardless of food intake. Duration of the course is 10 days.

    Doses of probiophore in different age groups:

    The drug is consumed during meals, if necessary - regardless of it. Before use, the drug is mixed with liquid food, preferably with a sour milk product, newborns and infants are given with mother's milk or a mixture for artificial feeding. The drug can be mixed with 30-50 ml of boiled water at room temperature, the resulting aqueous suspension should be drunk without achieving complete dissolution.

    Age-related dosages:

    Duration of treatment 10-15 days.

    Bifilysis is recommended as a drug of choice: inside, 5 doses 2-3 times per day for 20-30 minutes before meals( children can be appointed immediately before meals or with the first portions of food).The duration of the course is 21 days.

    Applied for normalization of intestinal microflora with reduced lactobacillus content on the 4th day from the beginning of application of the drug, which suppresses excessive growth of microorganisms.

    The duration of the course of therapy is 21 days.

    Acipol is prescribed inside, children from 3 months to 1 year - 1 tablet 2-3 times a day, the rest of the age group - 1 tablet 2-4 times a day for 30 minutes before meals.

    Acylact is prescribed internally, children up to 6 months - 5 doses per day in 2 divided doses, the remaining age groups - 5 doses 2-3 times a day for 30 minutes before meals.

    Bifikol - the course is conducted only with a steady decrease in the level of Escherichia coli, the absence of its altered forms.

    The drug is prescribed by mouth, children from 6 months to 1 year - 2 doses, from 1 to 3 years - 4 doses, over 3 years and adults - 6 doses 2-3 times a day. Take for 30-40 minutes before eating. In tablets, the drug is used in persons from 3 years of age.

    The duration of the course of therapy is 21 days.

    Additional means to enhance the growth of normal microflora.

    Assign inside, children of the first 3 months of life for 15-20 drops 3 times a day, older age groups - 20-40 drops 3 times a day, adults - 40-60 drops 3 times a day before or during admissionfood, mixing with a small amount of liquid( except milk).The duration of the course of therapy is 14 days. Do not administer concurrently with lactose-containing drugs.

    Assign to children up to 3 years 5 ml per day to achieve the effect and then for 10 days;

    from 3 to 6 years - 5-10 ml per day until the effect is achieved and then within 10 days;from 7 to 14 years, the initial dose - 15 ml per day to achieve the effect, maintaining - 10 ml per day for 10 days;for adults -

    1st day - 15 ml per day, day 2 - 30 ml per day, day 3 - 45 ml per day and then increasing 15 ml per day until the effect is achieved( maximum daily dose of 190 ml), then appointmaintenance dose( 50% of the effective dose) for 10 days. The daily dose is given in 2-3 divided doses. Lactulose is used in the event that the drug regimen does not include lactose-containing drugs;it is a first-line agent for dysbacteriosis, which occurs with constipation. Diarrhea, severe prolonged abdominal pains are a contraindication for the use of lactulose.

    Under the age of 15 years. Treatment is started with a 5-day course of therapy with a specific bacteriophage along with a TRC or an antifungal drug. Continue to restore normal intestinal microflora with multicomponent or combined bifido- and / or lactose-containing drugs( bifidumbacterin forte, probiophore, florin forte, bifilysis, acylact, acipol), which are prescribed from the 4th day of phagotherapy or after therapy with antifungal drugs.

    With predominance of diarrheal syndrome. The main treatment is a probiophore. The first 3 days prescribe a probiophore according to the scheme:

    In addition to the main therapy with a short course( on average 3-5 days) pancreatic enzymes( abomin, mezim forte, pancreatin, pancitrat, creon, festal), sorbents: enterodesis,microsorb, polyphep, smect.

    With predominance of constipation. In addition to the main therapy, lactulose is prescribed. Duration of the course is 10 days.

    With the inadequacy of the enzymatic function of the pancreas. In addition to the main therapy, pancreatic enzymes( abomin, mezim forte, pancreatin, pancitrat, creon, festal) can be prescribed. The duration of the course of therapy is up to 1 month.

    With a marked pain symptom. In addition to basic therapy with a short course( an average of 3 days), no-shpa, papaverine can be prescribed.

    With skin allergic manifestations.

    In addition to the main therapy, desensitizing drugs( suprastin, tavegil, dimedrol, phencarol, etc.) can be prescribed.

    With dysbacteriosis of the intestine is shown the limitation of overstresses and stressful situations, lengthening of hours of rest, sleep and stay in fresh air, dietary food.

    With correct treatment and follow-up of recommendations at 1 month, complete disappearance of clinical symptoms, normal intestinal microflora parameters are observed in 68%, improvement in the clinical state of the patient( reduction in abdominal pain, flatulence, stool normalization) - in 22%, in 6%(the absence of both positive and negative dynamics).In 3% of patients, the progression of the process was noted: in the absence of fever, the signs of intoxication increased, as well as the manifestation of new or worsening of the symptoms of intestinal dysbiosis earlier, among which: severe diarrhea or constipation, abdominal pain, progression of mucosal changes:( aphthae, cheilitis)occurrence of complications( sepsis, perforation of ulcers, etc.).1% of patients develop iatrogenic complications( the appearance of new diseases or complications).With the progression of the process, the development of iatrogenic complications shows hospital treatment.