编号 1 (2012)

The article discusses the place of azithromycin in the treatment of respiratory tract infections (RTIs) in children based on data on the etiology and antibiotic resistance of causative microorganisms for RTIs in Russia, the pharmacological properties of this macrolide, as well as current trends in antibiotic therapy of RTIs in pediatric practice. It is emphasized that azithromycin has good activity against both typical and atypical bacterial pathogens causing RTIs in children, unique pharmacokinetic properties, allowing to use short courses of treatment, and is one of the most effective and easy to administrate antibacterial drug in outpatient pediatric practice.

Headache is one of the most frequent complaints of patients visiting a doctor (from 2,5 to 15 % of children in different age groups impose similar complaints). Differentiation of headaches, causing only discomfort, and life-threatening headaches is necessary. "Dangerous" headaches are symptoms of the tumor, subarachnoid hemorrhage and bleeding at other sites, stroke, venous thrombosis, meningitis and encephalitis. Grave symptoms include sudden onset of headache, especially with the confusion, lethargy or vomiting, as well as symptoms of a stroke: hemiparesis, ataxia, Horner's syndrome; the emergence of severe or long-term headache after craniocerebral trauma, changes in the characteristics of the current headache and other symptoms. There is a real inconsistency between the complexity of the modern classification of headaches and a few of diagnoses made by doctors. Usually, in clinical practice, neurologist uses only two diagnoses: migraine and tension-type headache. Treatment of primary headaches in children is difficult due to age limits in the use of drugs with proven effectiveness in adults. Patients parents of often ignore the fact that changing of some habits, eating behavior, or simply avoiding trigger factors allows to discontinue the treatment or significantly reduce its volume.

The article discusses the problem of arterial hypertension (AH) in children and adolescents. Epidemiological data indicate a significant prevalence of hypertension in this population. The features of the structure of the clinical forms of AH in adolescents are considered; different clinical variants of AH are described. Particular attention is paid to the diagnosis of arterial hypertension based on determining the AH criteria in adolescents with special tables of blood pressure percentile distribution by gender, age and height of the patient. General principles for the management of children and adolescents with AH are formulated. Antihypertensives of five major groups with the specified doses used in treatment of children and adolescents with AH are presented.

Introduction of supplemental feeding is a key milestone in the life of a child in the transition to adult type of nutrition. The introduction of supplemental feeding should be individualized, with account of characteristics of the digestive motility of the child. In some cases, constipations may occur against the background of introduction of supplemental feeding. To solve this problem, correction of nutrition is required, and in some cases laxatives should be administered; most effective laxatives are preparations of lactulose with prebiotic effect, such as Duphalac.

The article describes the approaches to the diagnosis of community-acquired pneumonia in children; Russian diagnostic criteria with high sensitivity and specificity for bacterial etiology of pneumonia are provided. Although etiological structure of pneumonia varies at different ages, leading pathogens are pneumococci; in children under 5 years - Haemophilus influenzae, in adolescents - atypical pathogens: mycoplasma and chlamydia. Against the background of pneumococcal resistance to many antibiotics, the main drug of first choice is amoxycillin in a dosage of 50 mg/kg/day in 2 divided doses (up to 5 years - amoxicillin/clavulanate at the same dose), and for those with suspected resistance flora (children from boarding schools and preschool institutions, as well as contacting with them) - doubling the dose of these drugs. The ineffectiveness of β-lactams provides evidence of probable atypical pneumonia, which requires administration of macrolides.

Epileptic negative myoclonus (ENM) is one of the rare types of epileptic seizures in children. ENM is defined as a sudden sharp interruption of tonic muscular activity simultaneously with epileptiform discharges on EEG without prior myoclonic component. The results of study of anamnestic, clinical, electroencephalographic and neuroimaging features of patients with ENM induced by use of carbamazepine and oxcarbazepine are presented. Risk factors for aggravation of ENM in patients receiving carbamazepine/oxcarbazepine are identified. It is emphasized that administration of the carbamazepine/oxcarbazepine should be limited in idiopathic focal epilepsy, focal epilepsy syndrome of childhood with the structural changes in the brain and benign epileptiform EEG discharges (BEDC), epileptic encephalopathies associated with BEDC, symptomatic focal epilepsy with secondary bilateral synchronization phenomena on EEG, progressive myoclonus epilepsy, especially in preschool children.