No 1s (2011)

The article discusses the pathogenesis of hyperthermia and modern approaches to the treatment of fever in patients with acute respiratory infections (ARI). Particular attention is paid to antipyretic therapy in children with acute respiratory diseases, which brings relief to the sick child, improves mood and promotes a more rapid recovery. Drugs of choice for fevers in children with acute respiratory infections, including illness with pain, are ibuprofen (Nurofen) and paracetamol. Author’s own clinical studies on Nurofen are presented.

Application of Ibuclin (paracetamol+ibuprofen) is reasonable in children with febrile syndrome, as well as symptomatic treatment of acute infectious and inflammatory diseases of upper respiratory tract, tonsillitis, acute otitis, myalgia, traumatic inflammation of soft tissue and musculoskeletal system. In Russia, the use of Ibuclin for children in the dispersible form of tablets (Ibuprofen - 100 mg, paracetamol -125 mg) is permitted. The daily dose depends on age and body weight; duration of treatment assignment as antipyretic should not exceed 3 days, and in pain management - 5 days.

The article considers current indications for antibiotic therapy and characteristics of antibiotic therapy of sinusitis, in particular, the timing of the start and duration of treatment, recommendations for the rational choice of antibiotics. Combination drug of amoxicillin with β-lactamase inhibitor clavulanic acid is widely used in antibacterial therapy (ABT) of sinusitis. II and III generation cephalosporins also have high activity against the most probable causative agents of acute sinusitis. In case of intolerance to these medications, the use of modern macrolides is recommended, but possible limitations of this group of antimicrobial agents associated with the spread of resistant strains should be taking into account. Any recommendations on the duration of ABT for acute sinusitis are fairly conditional, because individual terms of regression of clinical manifestations of sinusitis, general condition of the patient, body temperature, and changes in the intensity of headaches, abnormal nasal discharge and nasal obstruction should be considered. The average duration of ABT for acute sinusitis is at least 7-10 days.

The effectiveness of standard 1-line eradication schemes recommended by Russian and international consensuses for the treatment of Helicobacter pylori (HP) infection, including the proton pump inhibitor, amoxicillin and clarithromycin or metronidazole, has declined substantially over the last decade. This is due to the growing antibiotic resistance of HP, primarily - to clarithromycin, with possible regional features. We conducted a comparative evaluation of the frequency of occurrence SagA (+) strains of HP, and mutations that determine its resistance to clarithromycin, and evaluation of effectiveness of standard first-line therapy, that included omeprazole, amoxicillin and clarithromycin (OAC) in age-related doses in 153 children and adolescents in St. Petersburg and in 104 in North Ossetia. CagA (+) strains were detected in 52 % of children and adolescents from St. Petersburg and in 35 % - from Vladikavkaz. Mutations which cause HP resistance to clarithromycin were identified in 39 % of St. Petersburg residents, and only in 12,2 % of residents of North Ossetia. HP eradication was achieved in 17 of 23 (74 %) patients from North Ossetia and in 8 of 15 (53 %) patients from St. Petersburg. The results showed significant differences in toxigenicity of HP strains and in their resistance to clarithromycin in different regions of Russia, which accounts for the differences in the effectiveness of standard therapy for HP infection.