№ 11 (2017)

The literature review is devoted to the safety of short courses of glucocorticosteroids (GCS) in children. An analysis of the literature has shown that short courses of treatment with GCS are characterized by a satisfactory safety profile in general. The most common side effects of GCS when used from 7 to 14 days include dyspepsia (nausea, vomiting), behavioral and sleep disorders. In most cases, these side effects cause withdrawal of GCS in children. The most dangerous, in terms of prognosis, can be the use of systemic GCS at the prodromal stage of varicella. Long-term use of GCS (courses more than 2 months) is associated with both suppression of adrenal cortex function and immunosuppression. Studies show that treatment with short courses of systemic GCS (orally 1 to 2 mg/ kg/day of prednisolone or prednisone for 3-7 days) does not cause these effects, even if they are used several times in one year. However, an increase in the duration of treatment with systemic GCS beyond 7 days, according to several studies, increases the risk of serious side effects.

Currently, adverse drug reactions (ADRs) are a big problem due to the high prevalence and the potential severity of their outcomes. There are type A (dose-dependent, more common) and type B (unpredictable, often more severe and clinically problematic) ADRs. The children’s population is more vulnerable to the development of ADRs due to the immaturity of the systems involved in the absorption, metabolism, transport and elimination of drugs, which should be taken into account during prescription of pharmacotherapy in children.

The article discusses the problem of bronchitis, which refers to the diseases most frequently encountered in pediatric practice; therefore it has not only medical but also social significance. Classification, etiology, clinical manifestations, and principles of treatment of this disease are presented. The problem of bronchitis in children should be studied in terms of functional disorders, etiology, with providing the ability to the choice of sparing methods of treatment that do not require special inhalation equipment.

The problem of treatment of acute respiratory tract infections (ARTI) is discussed. Excessive use of antibiotic therapy in children with ARTI requires a revision of approaches to the treatment of this group of diseases. In particular, it is necessary to use the adequate symptomatic therapy of ARTI in pediatric patients. Combined drug containing bromhexine hydrochloride, guaifenesin and salbutamol sulfate, effectively affects the manifestations of ARTI - cough and bronchial obstruction. Clinical studies have shown that the use of this drug significantly reduces the duration of the disease. This suggests that the use of this combined drug reduces the use of antibiotics in children with ARTI. It is advisable to conduct clinical studies on the impact of pathogenetic and symptomatic drugs on the frequency of use of antibiotic therapy in children.

Acute intestinal infections are widespread in the world, and the incidence and frequency of poor outcomes in children, especially in the first years of life, is much higher than in the adult population. From modern positions, the approach to diagnosis and treatment should be comprehensive and personified. The article presents literature data and own authors’ research dats on the effectiveness of the applied methods of treatment. The issue of etiotropic therapy of invasive diarrhea is discussed separately. Nonabsorbable intestinal antiseptics are the drugs of choice in pediatric practice in most cases of invasive diarrhea.

An increase in the inflammatory marker levels is usually associated with the bacterial etiology of the disease, leading to the appointment of antacterial therapy. The study was aimed to the analysis the inflammatory markers levels - C-reactive protein (CRP) and procalcitonin -in a viral disease, because incorrect interpretation of their increased levels can serve as the basis for the unjustified use of antibacterial drugs. A retrospective analysis of250 case histories of children aged 12 days to 17 years 11 months hospitalized with acute respiratory viral disease in the Department of Diagnosis and Rehabilitation of the SCCH in 2016. Leukocytosis more than 15x109/l was detected in 13% of children, more often - in children with adenoviral tonsillitis (29%) and mononucleosis-like syndrome (23%). The CRP levels more than 30 mg/l was also more frequent in adenoviral tonsillitis (57% of cases) and tonsillitis caused by the Ebstein-Barr virus (50%). Among remaining ARVIs, an increase in the CRP levels was observed only in 10% of cases. The increase in the procalcitonin levels more than 2 ng/ml occurred only in 10% of the patients. In the clinic, antibacterial therapy was carried out only in 25 patients, including due to the increase in inflammatory marker levels against the background of fever (13 patients) and with the duration of fever more than 5 days (9 patients). The course of the disease in children who were prescribed and not prescribed an antibacterial drug was similar. Thus, in children with viral diseases, an increase in the inflammatory marker levels is possible, most often in the presence of tissue inflammation (tonsillitis). In case of a viral disease, the appointment of antibacterial drugs according to the indices of leukocytosis and CRP levels is ineffective.

Low quality of medical care can not only impede the achievement of targeted health indicators, but also lead to unjustified direct and indirect costs of the health system as a whole. The article presents the results of the analysis of the quality of medical and diagnostic care for acute respiratory diseases in children hospitalized in pediatric hospitals (based on the example of the Rostov Region), and its conformity with the clinical guidelines approved in the Russian Federation. It was revealed that low quality of medical care for children with ARI was caused by unjustified hospitalization (66%), excessive chest x-ray in the absence of indications (49%), unreasonable prescription of antibacterial therapy (70%) and antihistamines (59%), irrational antiviral and immunomodulatory therapy (51%), inadequate administration of inhalation therapy (29%). Overdiagnosis of pneumonia occurred in 71% of cases, mainly due to incorrect interpretation of the results of X-ray examination. Irrational antibiotic therapy for community-acquired pneumonia was noted in 69% of cases, and polypharmacy - in 63% of cases. The results of the expert evaluation point out the directions for improving the quality of medical care for children: training and attestation of physicians in accordance with the Federal clinical recommendations for diagnosis and treatment of respiratory diseases; control over the use of antibiotics and other medicines in hospitals; internal and external audit of radiological services of hospitals; regular internal and external audit of quality of inpatient medical care.