No 15 (2014)

The article discusses the problems associated with community-acquired pneumonia (CAP) «not responding» to the antibacterial therapy. Information regarding the prevalence, prognosis, reasons of therapeutic inefficiency, risk factors, and tactics of management of patients with CAP is presented.

In the Republic of Tatarstan, a comparative analysis of the provision of medical care to patients with a variety of outcomes of community-acquired pneumonia (CAP) in hospitals in 2009-2011, as well as analysis of changes in the management of these patients during the period from 1999 to 2011, were performed. It has been found that deaths of patients with CAP in the hospitals of Republic of Tatarstan were associated with the presence of HIV infection, infectious and toxic hepatitis, and previous tuberculosis. After excluding these three factors, increased mortality was associated with extremely critical condition at admission, degradation of lung tissue, II-III degree pulmonary insufficiency, increased neutrophils/leukocytes ratio in peripheral blood, and the use of systemic corticosteroids. Factors improving outcomes of CAP in hospital included more complete examination at outpatient stage, hospitalization in pulmonological department, participation of pulmonologist and head of the department in the treatment process. The results of study indicate a decrease of efficiency of III generation cephalosporins, including in combination with macrolides and II generation fluoroquinolones. It was noted that in the Republic of Tatarstan in the period from 1999 to 2011, the providing of medical care to patients with CAP became as close as possible to the requirements of the federal guidelines.

Immunoglobulins for intravenous administration are the main group of drugs for the replacement therapy of diseases accompanied by agammaglobulinemia. In each case, the choice of drug should be determined by clinical indications for its use, data on efficacy and safety, as well as individual patient’s tolerance.

The problem of management of patients with exacerbation of chronic obstructive pulmonary disease (COPD) is discussed. Information on the etiology of COPD exacerbations, assessment of the severity of an exacerbation, pharmacotherapy of COPD exacerbations, prevention of thromboembolic complications, and the algorithm for management of patients with COPD exacerbation are presented.

The high prevalence of acute respiratory infections (ARI) and the extremely low efficiency of prevention are largely attributable to the variety of etiologically significant pathogens. The main direction of causal treatment of ARVI includes the use of antiviral drugs. Along with this, combined drugs are widely used in the treatment of patients with SARS; the components of combined drugs affect the basic symptoms and pathogenetic mechanisms of respiratory viral infections. This group of drugs includes Caffetin Cold, which is composed of paracetamol, pseudoephedrine hydrochloride, dextromethorphan hydrobromide, and ascorbic acid. In general, the components of the drug Caffetin Cold, acting on the leading symptoms of ARVI, provide a vasoconstrictor, anti-inflammatory and antitussive effects. In this connection, application of Caffetin Cold at the early stages and/or in mild disease contributes to the regression of the symptoms of acute respiratory disease, and improvement of subjective feelings of patients.

Influenza and acute respiratory infection (ARI) remain unmanageable annually exposing hundreds of thousands of people at risk of severe complications and death. The article discusses the controversial views on issues regarding influenza vaccinations in the light of recent M. Osterholm, et al. publication (2012), which shows the low effectiveness of influenza vaccines. The own first experience of family ARI and flu prevention using drug Oscillococcinum in 2009-2010, during circulation of pandemic influenza virus A/H1N1/09, is described. A randomized controlled trial in two comparable groups (376 people, 72 families, 36 families in each group) has shown high efficiency of Oscillococcinum (protection criterion = 66.32 %, efficiency index = 2.97), which is comparable to that of influenza vaccination. The safety of its long-term use by the whole family (age from 3.5 months to 76 years), reducing the risk of complications, and possibility of combination with other drugs are also shown.