Vol 27, No 9 (2020)

Currently, antihistamines are the one of most commonly used drugs in children. They are used to treat symptoms that are associated with the histamine release, primarily allergic diseases - atopic dermatitis, allergic rhinitis, bronchial asthma, allergic conjunctivitis, urticaria, systemic anaphylactic reactions, and histamine plays one of the key roles in their development. There are first and second generation (old and new) antihistamines. Their pharmacological effects and therapeutic indications are similar, but second generation antihistamines have significantly fewer side effects, since they are characterized by a selective effect on H1-histamine receptors. Despite the fact that antihistamines have been present on the pharmaceutical market for many years, there are still many side effects associated with their unfavorable safety profile, especially in pediatric practice. Antihistamines are predominantly over-the-counter drugs and are often misused, which is undesirable, especially for children under 2 years of age, since most drugs have no safety data for this age group and many antihistamines are not recommended. The article provides information on histamine receptors and Hi receptor agonists, as well as information on the use of antihistamines in children.

The article presents a review of the literature and own authors’ data on the study of the efficacy, safety and tolerability of topical bacterial lysates (IRS-19, Imudon) in children. The mechanisms of action and the pathogenetic substantiation of the use of topical bacterial lysates for the treatment and prevention of acute and recurrent respiratory infections in children are described. There was a significant decrease in the incidence of acute respiratory infections and the frequency of exacerbations of recurrent ENT diseases in children while taking IRS-19. The positive effect of the Imudon on the regression of clinical manifestations of infectious and inflammatory diseases of the oropharynx was shown. The article presents data indicating that the therapeutic and prophylactic efficacy of topical bacterial lysates is attributable to their positive effects on the key links of innate and adaptive immunity. Good tolerance and high safety of topical bacterial lysates in pediatric practice is discussed.

Objective. Summation of the results of monitoring the therapeutic efficacy of Orvirem in ARVI, including coronavirus infection (CVI) in children. Methods. When studying the therapeutic efficacy of Orvirem for patients with acute respiratory viral infections (stage 1), 453 children aged 1 to 6 years were under observation, and with CVI (CoV 229E and CoV OC43; stage 2) - 184 children of the same age group hospitalized on the 1-3rd day of disease onset. The etiology of acute respiratory viral infections was established by detecting pathogen antigens in the material from the nasal lumen and nasopharynx of patients by PCR or by immunofluorescence express test, followed by (after 2-3 days and before hospitaldischarge) determination of their retention or the appearance of new pathogens. Results. The inclusion of the drug in ARVI therapy at the early stages of the disease contributed to a more rapid elimination of the main symptoms of the disease (fever, intoxication, signs of catarrhal inflammation in the nasopharynx and larynx), and in the case of influenza and CVI caused by COV 229E and COV OC43 - elimination of the gastrointestinal syndrome. The cases of superinfection in those who received the drug were recorded 9.5 times less frequently than in the comparison group (p<0.001). Conclusion. A two-stage clinical and laboratory evaluation of the therapeutic efficacy and safety of the domestic drug Orvirem showed that its inclusion in the complex therapy of acute respiratory viral infections at the early stages of the disease contributes to the faster elimination of the main symptoms of the disease (fever, intoxication, signs of catarrhal inflammation in the nasopharynx and larynx), and in CVI - gastrointestinal syndrome, which ensures a faster return of children to daily activities.

Background. Herpes simplex viruses (HSV) types 1 and 2 are widespread in the human population and can cause a number of conditions in the human body, ranging from asymptomatic to severe generalized forms of the disease. Objective. Evaluation of the antiviral activity of benzydamine hydrochloride in an experimental model of herpesvirus infection in vitro. Methods. Evaluation of the antiviral activity of benzydamine hydrochloride was carried out on a model of herpesvirus infection caused by HSV types 1 and 2 in a VERO-B cell culture using virological and statistical research methods. Results. It was found that the use of benzydamine hydrochloride according to the therapeutic scheme (one hour after the adsorption of the virus) led to a decrease in the infectious activity of HSV-1 by 1.5-3.6 lg TCD50, and the infectious activity of HSV-2 by 1.5-3.06 lg TCD50 compared with the activity of control test viruses. The maximum statistically significant inhibitory effect in relation to HSV-1 and -2 was detected when using the drug at a concentration of 62.5 pg/ml; the inhibition coefficient in relation to HSV-1 and -2 was 60 and 54.45%, respectively. Conclusion. As a result of the study, it was established that benzydamine hydrochloride has therapeutic activity against herpesvirus infection caused by widespread pathogens - HSV-1 and -2 in vitro, during the early period of viral replication. The antiviral activity of the drug is dose-dependent.

Background. Acute intestinal infections (AEI) remain one of the pressing health problems, causing significant economic damage both in our country and around the world. The incidence of AEI in children is significantly higher than in adults, with the largest number of their registered cases occurring in children under the age of 7 years. Objective. Analysis of published studies of the effectiveness of probiotics in the treatment and prevention of AEI in children and assessment of the strain sensitivity of a number of Campylobacter bacteria, common causative agents of AEI, to various probiotic strains. Methods. The analysis of publications on the clinical use of probiotics in AEI in children in PubMed, EMBASE and Web of Science systems from December 2000 to June 2020 was carried out. For the study of anticampylobacter activity, the following probiotics were used: Enterococcus faecium L3, Lactobacillus plantarum 8 R-A3, a mixture of Lactobacillus acidophilus, Enterococcus faecium SF68, Bifidobacterium bifidum and Saccharomyces boulardii. Results. Analysis of literature data shows that the treatment and prevention of AEI are the most reliable indications for the use of probiotics, including in children. Conclusion. At the moment, there is significant evidence of the effectiveness of probiotic strains both in the treatment and prevention of intestinal infections. Problems with the dosage and duration of probiotic therapy in various nosological forms of AEI in children remain not fully resolved. Multi-strain probiotics require further research. Differences in the sensitivity of campylobacter to various probiotic strains indicate that for patients with severe forms of acute intestinal infections, it is advisable to select an individual probiotic to increase the effectiveness of complex therapy.

Background. Chronic non-specific lung diseases (CNSLDs) in children are considered an important medical and social problem. Hereditary lung diseases are basically associated with certain genetic mutations in certain chromosomal loci, and their course and outcomes are largely dependent on genetic predictors encoding the system of cellular proteinases, surfactant and vitamin D receptors (VDR). The influence of VDR gene polymorphisms (BsmI, FokI, TaqI, ApaI) on the risk and development of chronic allergic diseases of the lungs and COPD has been established. Objective. Evaluation of the phenotypic effect of VDR gene FokI polymorphism on the course of CNSLDs in children. Methods. The main cohort consisted of 98 children with CNSLDs divided into 2 subgroups. The group1 was composed of children with CNSLDs formed on initially healthy lung tissue (chronic bronchitis, obliterating bronchiolitis; n=42). The group 2 was represented by patients with secondary CNSLDs, namely cystic fibrosis (n=34), immunodeficiencies (n=12) and pulmonary malformations (n=10). The control group consisted of 93 conditionally healthy children. The molecular genetic testing of the VDR gene FokI was carried out by polymerase chain reaction and restriction fragment length polymorphism. Results. According to statistical analysis, significant differences were found in the frequency of various polymorphic variants of the VDR gene FokI between the main and control groups. There were no significant associations between the polymorphic variants of the VDR gene FokI and the frequency, severity of exacerbations, severity of respiratory failure, and the nature of the microbiota of the airways between patients with primary and secondary CNSLDs. The results of statistical analysis indicate a significant prevalence of the F/F genotype in children with mild obstructive and restrictive changes (not more than 80% of the normal values), and the dominance of genotypes containing the mutant f allele in patients with moderate decrease in vital lung capacity and forced expiratory volume in subgroup 2. Conclusion. No pronounced phenotypic effect of VDR gene FokI polymorphism on the course of CNSLDs in children was found. Possibly, the phenotypic effect of VDR gene FokI polymorphism is realized at an older age, which necessitates the continuation of this study in a cohort of adult patients.

The problems of timely and safe vaccination of children in the current epidemiological situation have acquired particular importance. Combined vaccines containing several antigens can increase the vaccination coverage of children in the first years of life, reduce the cost of vaccination, and minimize the number of errors in the introduction of vaccines. The data of recent studies on the immunological efficacy and safety of the combined hexavalent vaccine Infanrix Hexa are presented. The possibilities of interchangeability and mixed vaccination with the use of other vaccines against 6 infections, as well as in combination with vaccines against other infections are considered. The features of the use of the vaccine in special clinical settings in accordance with the current foreign and domestic regulatory documents are discussed.

Background. Observation data on children with a verified diagnosis of COVID-19 indicate a fairly frequent presence of acute diarrhea (AD). Description of the clinical case. The article presents the features of the course and a differentiated approach to the etiological diagnosis of AD in children during the pandemic of the new coronavirus infection COVID-19 using clinical examples. The difficulties of clinical decoding of the etiology of the disease and the importance of laboratory examination of pediatric patients with AD in the current epidemiological season in order to verify the diagnosis and prescribe adequate treatment have been demonstrated. Conclusion. Thus, in the current and possibly in future epidemiological seasons, the problem of differential diagnosis of AD in children is of particular relevance, given the ability of the new SARS-CoV-2 virus to infect not only the respiratory system, but also the gastrointestinal tract. When establishing the etiology of AD in childhood, it is advisable to widely introduce into clinical practice PCR not only for the most common causative agents of AEI, but also for SARS-CoV-2 in feces.