No 3s (2012)

The article is dedicated to the conceptual goals of the antibiotic therapy. The indications for antibiotic therapy for acute respiratory infections (ARI) are discussed. Literature data on the current spectrum of causative agents for bacterial diseases of the upper respiratory tract (adenoiditis, purulent otitis, purulent sinusitis, acute streptococcal tonsillitis, paratonsillar abscess, epiglotitis) and lower respiratory tract (bacterial bronchitis and pneumonia), and the spectrum of antibiotic sensitivity of pathogens are presented. The role of a mixed microbial flora, with the participation of atypical pathogens (Mycoplasma pneumoniae and Chlamydophila pneumoniae) is analyzed. The review of properties of macrolides is presented, a comparative analysis of their pharmacological properties and spectrum of action is performed. The results of comparative international and foreign research on the efficacy and safety of clarithromycin, representative of the modern macrolides, are presented.

Fever is one of the most common reasons for use of drug therapy in children. Usually, fever is the body's defensive reaction, which manifests itself in increasing the immune response, and preventing the growth of viruses and bacteria. Antifebrile therapy is usually necessary at a child’s temperature above 39 °C. The safest drugs, paracetamol and ibuprofen, are recommended as antipyretics for children. Clinical studies show that the combined use of these drugs (either simultaneously or successively) is more effective and has a better pharmacoeconomic results than the use of each drug alone. Therefore, the use of combination drug containing paracetamol offers promise.

The article presents the current views on the etiological factors and mechanisms of development of atopic dermatitis (AD), as well as the principles of diagnosis, treatment and prevention of this disease. The role of food allergy in the development of AD since early childhood is discussed; therefore, special attention paid to creating “personalized" diet with the exclusion of individual food allergen. The complex of necessary therapeutic measures for the treatment of children with AD, which are aimed at relief of acute manifestations of the disease, control of course of AD, treatment of opportunistic diseases, and correction of immunological disturbances accompanying AD, is presented.

The article discusses the rational choice of drugs for the treatment of respiratory tract infections in children. The needs for consideration of character of disease, the mechanisms of action of drugs used and their possible adverse effects, as well as the individual characteristics of patients are emphasized. The high efficacy and safety of mucolytics in the treatment of respiratory diseases in children is demonstrated. An algorithm of choice of drugs influencing cough is recommended.

The article presents modern data on the etiology and pathogenesis of cystic fibrosis (CF); potentials for the treatment of pancreatic insufficiency observed in this disease are discussed. It is emphasized that replacement therapy in CF patients with pancreatic insufficiency should include only modern highly active microgranular pH sensitive enteric-coated pancreatic enzyme preparations, the most studied of which is Creon. Successful experience of use of Creon in the Russian Center of Cystic Fibrosis is considered. It is shown that efficacy and safety for long-term use in CF patients of all ages, including newborns, are proved only for Creon among other enzyme preparations in Russia.

The article presents the modern data on the prevalence of allergic rhinitis in adults and children. There is often combination of AR and atopic bronchial asthma (BA), because of their shared pathogenesis. The main goal of pharmacological treatment of AR is a 24-hour control of symptoms with a single daily dose of the drug. This will achieved by using second-generation antihistamines, and the most preferred drug is desloratadine (Aerius), a primary active metabolite of loratadine. Desloratadine is characterized by a similar pharmacodynamic properties with loratadine, but the activity exceeds the latter and other drugs in this group in the 2.5-4.0 times. Desloratadine has additional anti-allergic effects unrelated to the blockade of Hl-histamine receptor: inhibition of expression of adhesion molecules, production and release of inflammatory mediators and cytokines, eosinophil chemotaxis factors. Along with the high efficiency, desloratadine is characterized by high safety. Taking into account the fact that desloratadine does not cause sedation, does not affect attention, memory, motor coordination and learning ability, it may be the drug of first choice for school-age children. The severity of AR and BA is closely related; therefore, adequate treatment of AR leads to an improvement of course of BA, improving quality of life of children.

The article considers the characteristics of one of the first macrolide antibiotics - spiramycin. Spiramycin occupies a worthy place among the other macrolide antibiotics in the treatment of respiratory tract infections due to microbiological activity, pharmacokinetic parameters, and unique features of in vivo, data on clinical efficacy and safety, and population aspects of use of this drug.