No 4 (2017)

The article describes to the rational choice of mucolytics in the treatment of cough in children with acute respiratory infection (ARI). The data of systematic reviews and multicenter studies show that the appointment of mucolytics for ARI children with cough is justified and reasonable. The article describes mechanisms of action of different groups of mucolytics: acetylcysteine, ambroxol, bromhexine and carbocysteine; the advantages of each drug and the features of its use in relation to children are discussed; recommendations on the choice of mucolytics depending on the clinical situation are given.

The article discusses the mechanisms of action of various immunomodulators (IM) and analyzes their effectiveness in the treatment of patients with respiratory tract diseases. It is noted that bacterial lysates and some IMs obtained as a result of directed chemical synthesis are drugs that have the largest evidence base. It is concluded that IMs can have a positive effect on the course of acute and chronic diseases of the respiratory tract.

The article provides information on the number of children in Moscow, the dynamics of childbirth, infant mortality, overall morbidity and age structure of disabled children. The data presented demonstrate the need for continuously improvement of the quality, efficiency and accessibility of comprehensive multidisciplinary medical care for children and adolescents in Moscow.

Children with tuberculosis infection (TI) are at risk for the development of severe invasive pneumococcal infection (PI); furthermore, PI exacerbates the TI. These patients, however, usually do not get the necessary vaccinations before removal from the observation in the phthisiatrician. The problem of immunization of children with TI is not only connected with the fear of vaccination at the hands of parents, but also with the fact that pediatricians have a sense of uncertainty, whether vaccination will reach proper efficiency and does not cause complications or recurrence of the underlying disease. The article presents the results of evaluation of post-vaccination period after immunization with 23-valent polysaccharide pneumococcal vaccine (PPV23) in 35 children aged 3 to 14 years with various manifestations of TI. It is concluded that vaccination with PPV23 is not accompanied by the development of post-vaccination complications and does not cause exacerbation of current TI. The frequency of local and systemic reactions after vaccination does not exceed permissible values. The dynamics of immunological parameters does not confirm immunosuppressive or adverse effects of the vaccine. Immunization against PI is effective in reducing the incidence of acute respiratory infections both in children infected with Mycobacterium tuberculosis and children with respiratory tuberculosis.

For many years, varicella remains a topical problem of infectious diseases in children, despite a slight decline in incidence rates. The article presents the analysis of varicella morbidity among adults and children in 2007-2015; the basic principles of the diagnosis of severe varicella; clinical analysis of adverse outcomes of infection in children in Moscow region, the development of which is the basis for vaccination of specific groups of patients. The results of the varicella vaccination in six districts of the Moscow region, as well as in immunocompromised patients are presented.