Recommend Erdostein for children when treating with amoxicillin – symptoms of cough improve in almost 50% of cases within 3 days
Acute respiratory infections are usually treated empirically in primary care as the causative agent is not known. Amoxicillin is among the most commonly chosen antibiotics. Erdostein is a suitable addition to this antibiotic treatment for several reasons.
Erdostein – a drug with (not only) antibacterial activity
Acute respiratory infections in children often require empirical treatment at the primary care level. It is known that viruses are responsible for more than 80% of respiratory infections. Therefore, a primarily viral etiology of these diseases can be assumed. Erdostein, an effective substance, exhibits a potentially antiviral effect and simultaneously reduces the risk of bacterial superinfection.
Erdostein is primarily known as an antibacterial mucolytic, but its antiviral potential is indisputable. It strengthens the body's ability to defend against viral infections as it can influence the level of the antioxidant glutathione. This correlates with oxidative stress and pH changes in the intracellular environment, with pH having a direct impact on viral replication within cells. The antioxidant properties of erdostein, according to available studies, also provide a basis for its therapeutic use in the symptomatic treatment of COVID-19. Additionally, this substance effectively prevents bacterial superinfection by limiting bacterial adhesion to the respiratory tract mucosa.
Antibiotics + erdostein = half the success
Erdostein shows a synergistic effect with many antibiotics, especially with the following three:
- amoxicillin
- clarithromycin
- ciprofloxacin
In this context, erdostein's molecule even has a dual effect – in addition to the aforementioned inhibition of bacterial adhesion, it also increases the concentration of the antibiotic in sputum.
The efficacy of erdostein in children has been demonstrated by numerous clinical studies. For instance, in 2007, a multicenter randomized double-blind placebo-controlled study involving 158 children with respiratory infections taking amoxicillin was published. It showed that in the group of children also receiving erdostein, 47% experienced relief from cough symptoms by the third day of treatment.
Favorable outcomes from the combined use of amoxicillin and erdostein are supported by another multicenter double-blind placebo-controlled study conducted in Italy in 2000 on over 200 children. After 7 days of treatment with this combination compared to a placebo, the intensity of the cough decreased in nearly 60% of observed patients.
Erdostein enhances the inhibitory effect of clarithromycin against the bacteria Staphylococcus aureus and simultaneously extends the duration of this antibiotic's effect. When combined with ciprofloxacin, erdostein increases the anti-adhesive properties of this antibiotic against Staphylococcus aureus and Escherichia coli.
The path to reducing antibiotic use in children
More than half of respiratory infections are treated with antibiotics, and it is known that preschool children consume more than half of the prescribed antibiotics – all despite the fact that most respiratory infections do not require antibiotic therapy as they are of viral origin. Erdostein is therefore a path to rationalizing antibiotic treatment.
This is also evidenced by an observational study conducted in the Czech Republic in 2014 and 2015: the timely administration of erdostein in this study influenced the reduction of antibiotic prescriptions for children with recurrent respiratory infections.
No significant adverse effects of erdostein treatment are known, and it is generally well tolerated.
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Sources:
1. Balli F., Bergamini B., Calistru P. et al. Clinical effects of erdosteine in the treatment of acute respiratory tract diseases in children. Int J Clin Pharmacol Ther 2007; 45 (1): 16–22, doi: 10.5414/cpp45016.
2. Kopřiva F., Látalová V. Improving the primary care management of preschool children with recurrent acute respiratory tract infections in the Czech Republic: prompt use of erdosteine can reduce antibiotic prescribing. Quality in Primary Care 2019; 27 (4): 36–42.
3. Ciriolo M. R., Palamara A. T., Incerpi S. et al. Loss of GSH, oxidative stress, and decrease of intracellular pH as sequential steps in viral infection. J Biol Chem 1997; 272 (5): 2700–2708, doi: 10.1074/jbc.272.5.2700.
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