Pharmateca

Urinary tract infection (UTI) is a common pathology in the pediatric population. A significant problem with this pathology is the high recurrence rate against the background of increasing antimicrobial resistance. Predisposition to recurrent UTIs is determined by the patient’s gender, urodynamic abnormalities, the presence of comorbidities, and the balance between the host’s defense mechanisms and the virulent potential of uropathogenic microorganisms. Key to the disease’s pathogenesis is a set of virulence factors, including adhesins, toxins, siderophores, and autotransporter proteins, which facilitate urinary tract colonization, invasion of epithelial cells, and evasion of the immune system and antimicrobial agents. This is made possible by the formation of intracellular colonies, reservoirs, and biofilms. With increasing antibiotic resistance, research into the mechanisms of resistance development, analysis of regional patterns of microbial resistance, and rational pharmacotherapy, including optimization of drug dosing regimens, are particularly relevant. This article examines this problem with an emphasis on the role of pathogen virulence factors, using uropathogenic E. coli as an example, as the most common and best-studied pathogen causing UTIs in the pediatric population. The article provides a detailed analysis of the mechanisms of interaction between pathogenic microorganisms and the host, highlighting the tricks used by pathogens to evade the immune response, the action of antibacterial drugs, and to reactivate the inflammatory process. The aim of the article is to systematize current knowledge for clinicians and researchers, contributing to the improvement of the diagnosis, prevention, and treatment of UTIs in the context of growing antibiotic resistance.

Background: Atopic dermatitis (AD) remains one of the most pressing issues in pediatric dermatology and allergology. Despite significant advances in understanding the pathogenesis of the disease, which is associated with filaggrin gene mutations and impaired skin barrier function, many treatment issues remain controversial. Selecting effective care methods aimed not only at relieving symptoms but also at ensuring long-term disease control is particularly challenging.

Objective: Systematization of current research data (2020–2025) on basic and supplementary skin care methods for children with AD, offering clinically relevant conclusions for practical application.

Methods: Literature on skin care in children with AD, collected through a search of the Elibrary, PubMed, and MedLine databases for the period 2020–2025, was analyzed using an expert analytical method.

Discussion: Analysis of current data indicates a paradigm shift in the management of patients with AD: from the relief of acute symptoms to proactive long-term therapy aimed at restoring and maintaining the skin barrier. Basic skin care products play a key role in this strategy.

Conclusion: Individualized, appropriate selection of skin care products, taking into account the child’s age, disease severity, and trigger factors, allows for long-term, stable disease remission and significantly improves the quality of life of patients and their families.

This article summarizes scientific data and presents a systemic analysis of the long-term practical use of an original Russian nootropic based on nicotinoyl-gamma-aminobutyric acid (nicotinoyl-GABA) in various fields of medicine. This nootropic possesses multiple pharmacological effects, including vasoactive, neuroprotective, and antioxidant effects. A key contradiction between the significant volume of positive clinical data on efficacy and the lack of inclusion of nicotinoyl-GABA-based drugs in Russian and international treatment standards and clinical guidelines is identified necessitating filling the gaps in the evidence base. The study’s uniqueness lies in its global analytical approach, integrating historical aspects of the drug’s development and implementation, its pharmacological characteristics, modern clinical and experimental studies, and new methods of drug administration (physiotherapeutic drug electrophoresis). The author’s experience with the drug is presented, and the prospects for expanding its use in therapy and medical rehabilitation are substantiated.

Irritable bowel syndrome (IBS) in children is characterized by significant prevalence and a variety of clinical manifestations. Its development is primarily influenced by disruptions in the microbiota-gut-brain system, the development of visceral hypersensitivity, and combined motility and neuroimmune disorders. Current therapeutic approaches include dietary interventions (including low-FODMAP and various elimination diets) in combination with drug therapy aimed at correcting motor, sensory, and inflammatory changes. One promising pharmacological approach involves targeting the enkephalinergic system, which is involved in the peripheral regulation of gastrointestinal functions. Trimebutine (Trimedat^®) exhibits properties as a multifactorial regulator of motility and visceral sensitivity, ensuring physiological adaptation of impaired functions without suppressing normal reflex mechanisms. Results of randomized controlled trials demonstrate its clinical efficacy in reducing abdominal pain, normalizing motor-evacuation function, and improving patients’ quality of life.

Background: Infant crying is one of the most common causes of parental anxiety and medical attention in the first months of life. Breast milk is considered the gold standard of feeding, as it contains immunologically and chronobiologically active components that can influence the development of behavioral self-regulation. However, the relationship between feeding type and the age-related dynamics of infant crying remains poorly understood.

Objective: Determination of the crying dynamics in infants during the first months of life, depending on feeding patterns.

Materials and methods: The analysis included 98 structured sleep diaries completed by the infants’ caregivers during three follow-up visits—on days 30, 60, and 120 of life. Three groups were identified based on feeding type: breastfed infants (n=34), formula-fed infants (n=40), and mixed-fed infants (n=24). The primary outcome measure was the relative proportion of time spent crying and screaming. Statistical analysis was performed in the R software environment using nonparametric methods and the Benjamini-Hochberg correction for multiple comparisons.

Results: A decrease in the proportion of time spent crying from Visit 1 to Visit 3 was observed in all study groups. No statistically significant between-group differences in absolute values were found, although the nature of the changes over time varied. Early in the observation period, the most pronounced decrease in this parameter was observed in formula-fed infants, while later, the greatest positive dynamics were recorded in the breastfed group. In infants receiving mixed feeding, the decrease in this parameter was least pronounced throughout the entire observation period. Based on these data, it can be concluded that the type of feeding likely influences not so much the absolute duration of crying as the trajectory of its changes in the first months of life. Later, the most pronounced decrease in this parameter in breastfed infants may reflect the cumulative effect of the chronobiologically active components of breast milk on the maturation of behavioral regulation mechanisms.

Conclusion: The obtained data also suggest that a stable feeding regimen is an important condition for the optimal development of infant self-regulation in early childhood.

Background: Despite the expansion of the arsenal of antipyretic and analgesic agents, the effective and safe management of acute conditions such as hyperthermia remains a pressing issue in pediatrics.

Objective: Analysis of the efficacy, safety, and feasibility of using a lytic cocktail in pediatric practice to optimize emergency care.

Materials and methods: A retrospective analysis of 7,050 visits for hyperthermia to the emergency department of Children’s City Polyclinic No. 1 of the Arkhangelsk Region was conducted from 2022 to 2024. Call cards (Form No. 120/u) and site visit logs were analyzed using mathematical and statistical analysis.

Results: Over the study period, a steady decline in the use of lytic cocktail was observed: from 28% in 2022 to 12% in 2024. In absolute numbers, the lytic cocktail was used in 1,304 cases (18.5%) over the entire period. This decrease in use correlated with active public health education efforts initiated in 2023, which led to an increase in the percentage of successful hyperthermia management at home. The lytic cocktail demonstrated high efficacy: the ьуфт time to reduce body temperature by 1.5°C was 22.4±6.7 minutes. By 2024, its use became more selective: for true resistance to oral therapy (71% of cases) and «white» fever (29%). Adverse events were recorded in 8 cases (0.6%) and were transient.

Conclusion: The lytic cocktail remains a highly effective and safe emergency treatment for persistent hyperthermia in children. However, its role has shifted from a routine method to a strictly reserved drug. Systematic educational work with parents and medical personnel has become a key factor in optimizing its use, confirming the high importance of educational programs in modern pediatrics.

Background: Diseases of the eustachian tube and middle ear in children are accompanied not only by local ventilation and drainage disturbances but also by changes in sleep, emotions, sensory perception, breathing, speech, and daily activity.

Objective: Evaluation of the dynamics of the International Classification of Functioning, Disability, and Health (ICF) domains in children with eustachitis, acute catarrhal otitis media, and otitis media with effusion under various combination therapy regimens.

Materials and methods: The study included 466 children aged 3–18 years: 150 with eustachitis, 148 with acute catarrhal otitis media, and 168 with otitis media with effusion. Within each cluster (nosology), three treatment groups were identified: standard drug treatment, standard therapy combined with laser therapy, and combination treatment including laser therapy and ultrasound. Functional status before and after treatment was assessed using 14 ICF domains. Within-group dynamics, the magnitude of improvement, and the proportion of patients with clinical response were analyzed.

Results: Across all nosological clusters, treatment was associated with positive dynamics across most ICF domains. The magnitude of improvement and the proportion of patients with signs of improvement depended on the disease type and the treatment regimen. The most consistent intergroup differences were found in auditory vestibular function, sleep, emotion, respiration, nasal cavity structure status, as well as in domains related to speech and daily activities. A more pronounced functional response was more often observed with the inclusion of physiotherapy factors, especially as part of combination therapy.

Conclusion: The dynamics of the ICF domains is an informative tool for assessing the effectiveness of combination therapy in children with eustachitis, acute catarrhal otitis media, and otitis media with effusion.

Saccharomyces boulardii CNCM I-745 (Enterol^®) is a probiotic yeast strain whose eukaryotic nature provides a number of clinically significant advantages. These include natural resistance to antibacterial drugs, stability during passage through the acidic environment of the gastrointestinal tract, and the absence of the ability to horizontally transfer antibiotic resistance genes. Its therapeutic effect is mediated through a multicomponent pathogenetic mechanism: direct microbial competition, neutralization of bacterial toxins, stimulation of reparative processes in the intestinal epithelium, and modulation of the local immune response. The efficacy of Saccharomyce boulardii CNCM I-745 in acute gastroenteritis and antibiotic-associated diarrhea has been proven in pediatric practice, as confirmed by randomized trials and enshrined in the ESPGHAN and World Gastroenterology Organization (WGO) consensus guidelines. The adjuvant use of this strain in Helicobacter pylori eradication regimens in children was separately analyzed: inclusion of the drug in combination therapy statistically significantly reduces the incidence of dyspeptic and systemic adverse events, ensuring high compliance and completion of the full course of treatment.

Differential diagnosis of Crohn’s disease and exudative enteropathy in young children is based on a comprehensive approach that includes analysis of clinical symptoms, medical history, and laboratory and instrumental examination methods [1]. If exudative enteropathy is suspected, causes of hypoproteinemia such as malnutrition, impaired protein synthesis or loss due to diseases of other organs – kidneys, liver or skin, protein loss due to inflammatory bowel disease – should be excluded [2]. The literature describes cases of secondary lymphangiectasia in Crohn’s disease in children [3], as well as in various infectious intestinal diseases – giardiasis, shigellosis, rotavirus gastroenteritis [4, 5]. This article presents an atypical clinical case of Crohn’s disease in a 6-year-old child with clinical and endoscopic manifestations of exudative enteropathy.

Background: The relevance of studying pyruvate dehydrogenase complex deficiency is attributable to the extreme rarity of the disease, the wide variability of clinical manifestations, and the need for timely diagnosis to prevent progressive neurological disorders.

Description of the clinical case: The case of severe psychomotor delay, seizure-like disturbances of consciousness, and myopathy in a three-year-old child is presented. The diagnosis was confirmed by laboratory tests revealing elevated lactate levels and decreased pyruvate dehydrogenase activity, as well as molecular genetic testing, which identified a pathogenic heterozygous variant in exon 11 of the PDHA1 gene, resulting in a missense substitution. Early diagnosis allowed for timely initiation of specific treatment and achieved positive dynamics in the patient’s condition.

Conclusion: A detailed analysis of individual cases of rare diseases helps practicing physicians more quickly recognize symptoms, properly organize the diagnostic process, and prescribe effective therapy that improves prognosis and enhances quality of life.

Background: This article presents literature data on the orphan disease, epidermolytic ichthyosis (EI) (congenital bullous ichthyosiform erythroderma of Brocq), the need for differential diagnosis of this clinical form from other genodermatoses, treatment considerations, and prognosis.

Description of the clinical case: A clinical case of a child born with EI is presented. The difficulties of diagnosis, the characteristics of the disease course, and the follow-up observation of the child during the first year of life are described.

Conclusion: This clinical case is presented to expand practitioners’ understanding of the diagnostic and treatment options for newborns with rare genodermatoses. Expanding neonatologists’ knowledge of congenital EI will facilitate prompt diagnosis and timely initiation of comprehensive treatment. This will help avoid complications, alleviate the condition, and, to a certain extent, improve the quality of life of patients with this pathology in later life.

This article describes a clinical case of an unusual foreign body in the ear, the ORBIZ hydrogel bead. Foreign bodies in the ear remain a common problem in otolaryngology practice, accounting for 5-6% of all emergency visits. Typical foreign bodies include small toy parts, various balls, beads, plant seeds (nuts, sunflower seeds), pieces of paper, and insects. The management of such patients is well-established and straightforward. Rare and unusual foreign bodies pose a health risk. A unique feature of ORBIZ beads is their ability to significantly expand when exposed to liquid. In such patients, the use of ear drops or ear irrigation leads to further foreign body impaction, risking damage to the eardrum and middle ear structures. Physicians must be alert to the possibility of this type of foreign body. Instrumental removal under general anesthesia should be considered as the initial removal method.