Topical antiseptic therapy for infectious and inflammatory diseases of the oropharynx and oral cavity: diagnostic minimum and patient routing: a review

Abstract

Inflammatory and infectious diseases of the oropharynx and oral cavity are among the most common reasons for visiting primary care outpatient specialists. The key challenge is the excessively frequent use of systemic antibacterial agents, although in most cases the disease has a viral etiology. This practice directly contributes to the increase in antimicrobial resistance. The aim of this work is to demonstrate the role of local antiseptic therapy as a tool for limiting the growth of resistance and to identify the most appropriate agent for topical use. The available scientific data and clinical guidelines on the problem of antimicrobial resistance were analyzed. A comparative analysis of the mechanisms of inflammatory processes in periodontal tissues and the pharyngeal mucosa was performed. Information on indications, regimens, and criteria for evaluating the effectiveness of local therapy was systematized. Particular attention was paid to such aspects as the diagnostic minimum, patient routing, and outpatient practice in infectious and inflammatory diseases of the oropharynx and infectious and inflammatory diseases of the oral cavity. The management of such conditions as pharyngitis, tonsillitis, stomatitis, and gingivitis was considered. According to the analysis, β-hemolytic group A streptococcus is detected in only 5–15% of adult patients complaining of sore throat, while antibacterial agents are prescribed in 64% of such cases. In this context, rational local antiseptic therapy is of particular importance, as it allows direct action on the inflammatory focus and helps limit the unjustified use of systemic antibacterial agents. The clinical and pharmacological properties of the local antiseptic drug Miramistin® − benzyldimethyl-[3-(myristoylamino)-propyl] ammonium chloride monohydrate − were reviewed. The drug at a concentration of 0.01% demonstrates a broad spectrum of activity against bacteria, fungi, and viruses, exerts an immunomodulatory effect, and does not lead to the development of resistance in pathogens. The use of the drug Miramistin® as the first-choice agent for local antiseptic therapy of infectious and inflammatory lesions of the oropharynx and oral cavity is pathogenetically justified, especially within the framework of a comprehensive approach to patient treatment.