Pharmateca

The article is devoted to current issues of supporting breastfeeding and domestic experience based on scientific developments. In the historical aspect, the issues of introducing perinatal technologies aimed at increasing the prevalence of breastfeeding are considered.

Objective: Systematization of the data on the efficacy and safety of ezetimibe in patients aged 6 to 18 years with type 1 (DM1) and type 2 (DM2) diabetes mellitus, and to compare the findings with current clinical guidelines.

Methods: A narrative literature review using the key words «ezetimibe,» «children,» «adolescents,» «diabetes,» «dyslipidemia,» and «low-density lipoprotein» in PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov (January 2000 – June 2025) was conducted.

Results: A total of 34 publications were analyzed, including 6 randomized controlled trials (RCTs), 12 observational studies, 5 systematic reviews/meta-analyses, 4 clinical guidelines/consensus papers, 6 reviews and reference articles, and 1 registry document. A single pediatric RCT (n=138, 6–10 years; predominantly heterozygous familial hypercholesterolemia (heFH)) showed a 27% reduction in low-density lipoprotein (LDL) cholesterol with ezetimibe monotherapy, with a safety profile comparable to placebo. In a small crossover study in adolescents with DM1, ezetimibe monotherapy provided a greater reduction in LDL cholesterol compared to simvastatin (≈13 pp); the combination of a statin and ezetimibe was not evaluated in this study. There are no pediatric RCTs in DM2. A network meta-analysis (n=1649; pediatric cohorts with heFH) found that adding ezetimibe to a statin reduced LDL cholesterol by an additional ~16% without increasing the risk of adverse effects. These results are extrapolated to adolescents with diabetes using an individual risk assessment.

Conclusion: Long-term studies of the efficacy and safety of ezetimibe in children with DM2 are required.

This article briefly describes the main etiological factors, development mechanisms, and traditional approaches to the treatment of rhinosinusitis in children. The emergence of antibiotic-resistant microorganisms is a serious clinical problem associated with more severe disease progression. Acute rhinosinusitis remains a common cause of unnecessary systemic antibacterial therapy. In most cases, antibiotics can be considered overtreatment, as they are completely inappropriate for the treatment of viral infections. When determining the indications for antibacterial therapy, as well as when choosing a specific drug, it is necessary to follow current national clinical guidelines. This article discusses the general principles of rational antibacterial therapy for the treatment of rhinosinusitis in children, the criteria for the selection and use of cephalosporins, in particular cefixime in a dispersible form, which has particular advantages in treating children and ensures high patient compliance due to its high efficacy against most respiratory pathogens, favorable safety profile, convenient administration, and the ability to be administered once daily.

This review was aimed to the systematization of modern data on the prevalence of smoking among adolescents, the pathogenesis of «smoker’s cough» in minors and the possibilities of symptomatic therapy with butamirate. The analysis of publications from international databases (Medline/PubMed, Scopus, eLIBRARY) for 2000–2025, normative and methodological documents of WHO, the European Respiratory Society and the National Institute for Clinical Excellence (NICE) was conducted. It was shown that active or passive consumption of nicotine-containing products is observed in 8–12% of Russian schoolchildren aged 15–17, and the incidence of chronic productive cough in young smokers is 2–3 times higher than in non-smoking peers. The key pathogenetic mechanisms of cough formation include activation of TRPV1/TRPA1 sensitive afferent fibers, neutrophil-mediated inflammation, impaired mucociliary clearance and puberty-dependent increase in the sensitivity of the cough reflex (more pronounced in girls). Butamirate exhibits a dose-dependent central antitussive effect, moderate bronchodilator and anti-inflammatory potential; the cumulative reduction in the frequency of cough shocks in the child and adolescent population reaches 40–60% within the first week of treatment, and the frequency of adverse reactions does not exceed 2%. Based on a comparison with alternative agents (dextromethorphan, levodropropizine, inhaled GCS), an algorithm for managing adolescents with chronic «smoker’s cough», including the stages of screening for tobacco smoking, basic differential diagnostics of the causes of chronic cough and a short-term course of butamirate (7–14 days) with subsequent evaluation of effectiveness is proposed.

Treatment of atopic dermatitis (AD) is based on the use of topical anti-inflammatory agents, and in cases of moderate and severe course – systemic drugs. The latter include glucocorticosteroids and classical immunosuppressants (cyclosporine A, methotrexate, azathioprine), which have many side effects and are poorly tolerated. Since 2017, the monoclonal antibody dupilumab (biological therapy) has been approved for the treatment of AD in adults and children (including those aged 6 months), and since 2021 – Janus kinase inhibitors (small molecules, or molecular therapy). Small molecule inhibitor research began over 50 years ago in the world’s leading pharmaceutical companies and was aimed at developing drugs that affect cytokine receptor signaling and regulation of the JAK/STAT response. This review describes the efficacy and safety of treating AD with upadacitinib, a selective, fast-acting JAK1 kinase inhibitor that significantly reduces itching and other clinical symptoms in patients with this difficult-to-treat disease as early as day 2 after administration. Upadacitinib is a systemic immunomodulator, the use of which will undoubtedly expand the available treatment options for moderate to severe AD in children and adults and, due to its modifying effect, represents an alternative to other systemic drugs.

Intestinal microbiota plays a significant role in the development of the immune system and has a protective effect in the formation of atopy. Recently; there has been a growing interest in studying the role of intestinal microbiota in the pathogenesis of atopic dermatitis (AD). The review discusses the mechanisms of influence of the intestinal microbiome on the development and course of AD. Patients with AD have intestinal dysbiosis; characterized by a deficiency of lactobacilli; bifidobacteria and excessive growth of pathogenic and opportunistic microorganisms. Prospects for correction of the intestinal microbiome for the treatment of AD are presented.

Department; Moscow; Russia

Background: This review presents a brief overview of fosfomycin’s spectrum of activity; its efficacy in children; safety data; and information on ongoing clinical trials in children; which are defining more precise pharmacokinetic safety parameters across different age groups. These studies will provide additional information on expanding the indications for fosfomycin use in children.

Objective: Provision of a substantiated opinion on the role of fosfomycin in improving antimicrobial treatment outcomes for infections caused by resistant microorganisms in children; based on available evidence.

Conclusion: Fosfomycin in intravenous dosage form can be used to treat infections caused by resistant microorganisms as part of combination antimicrobial therapy. It is particularly important to note that in the adult population; increased survival was demonstrated for bacteremia caused by KPC carbapenemase-producing K. pneumoniae with the use of a combination of fosfomycin and ceftazidime avibactam compared with ceftazidime avibactam alone. Fosfomycin has demonstrated synergistic and additive activity in vitro in combination with various classes of antibiotics; particularly beta-lactams; daptomycin; polymyxins; and aminoglycosides. It should be preferred as part of combination antimicrobial therapy for the treatment of infections associated with invasive implantable devices due to its activity against biofilms. For the treatment of infections caused by microbes resistant to multiple antibiotics in children; high doses of intravenous fosfomycin (more than 200 mg/kg/day) should be used. Improving the safety profile of high-dose intravenous fosfomycin in children is possible with regular monitoring of electrolyte levels; especially in neonates and/or critically ill children with renal failure.

Acute respiratory viral infections (ARVI) in children can proceed in various ways with various catarrhal symptoms due to the development of inflammation. But ARVIs are almost always accompanied by cough. And in children, especially young children, ARVIs are often aggravated by the development of bronchial obstruction. In half of the cases, episodes of bronchial obstruction against the background of ARVI recur within a year. In young children, due to physiological (thick bronchial secretion, insufficient smooth muscle function, weak cough reflex) and anatomical features (narrow airways), an unproductive «wet» cough is often observed. The main cause of pathological cough in acute respiratory infections is a violation of mucociliary clearance as a result of changes in the production and rheological properties of sputum due to the infectious process, which predispose to the formation of bronchial hyperreactivity. Inflammation of the respiratory organs in ARVI is also accompanied by compensatory increasing of bronchial secretion. The composition of tracheobronchial secretion also changes: an increase in the content of glycoproteins along with a decrease in the level of sialomucins leads to a decrease in the aqueous component of sputum and an increase in its viscosity, a violation of the ratio of gel/sol layers, which complicates the work of the ciliated epithelium. Medicinal cough management is primarily aimed at changing the viscosity, elasticity and adhesiveness of bronchial mucus to facilitate its expectoration, as well as eliminating smooth muscle spasm. Hyperproduction of viscous bronchial secretions often requires the administration of several mucoactive drugs with different mechanisms of action, since the nature of the cough (dry, wet) and the rheological properties of sputum (increased viscoelastic adhesive properties of secretions, impaired mucociliary clearance) may change during the treatment of an acute respiratory disease and the physician may encounter the problem of ineffective therapy with single-component drugs. To exclude polypharmacy, the use of combination drugs in cases of cough with a broncho-obstructive component is justified, which allows increasing patient compliance, ensuring maximum effectiveness of complex pharmacotherapy with the inclusion of all its components in a single dosage form. Studies conducted in patients with acute bronchitis with productive cough and bronchial obstruction syndrome have shown that the use of combination drugs containing bromhexine hydrochloride, guaifenesin and salbutamol sulfate is accompanied by a more rapid regression of cough.

Vitamin D deficiency is a pressing issue for the healthcare system from both a medical and economic perspective. This article provides an overview of the sections of the Endocrine Society’s 2024 clinical guidelines for vitamin D use related to pediatric practice. The expert recommendations address the prevention of diseases associated with vitamin D deficiency during pregnancy and in children aged 1 to 18 years; comparison with Russian clinical guidelines is provided. According to experts from the Endocrine Society, there is no need to determine vitamin D levels in these groups to prevent deficiency. An empirical approach using a weighted average prophylactic dose is proposed.

Background: The high prevalence of vitamin D deficiency in children necessitates finding optimal approaches to prevention, which in turn is impossible without identifying risk factors, including in different age groups.

Objective: Determination of the contribution of modifiable risk factors and the role of genotypes of polymorphic markers Fok I and Taq I of the VDR gene in the development of vitamin D deficiency in infants and young children.

Materials and methods: 94 children aged 4.5 to 18 months were examined. The study included determination of blood vitamin D levels (25-hydroxyergocalciferol + 25-hydroxycholecalciferol), determination of Fok I and Taq I polymorphisms of the VDR gene. The following anamnestic data were analyzed: maternal intake of vitamin D during pregnancy, type of feeding, consistency of drug prophylaxis of vitamin D deficiency in children. For each of the listed factors, the risk levels (and their statistical significance) for the development of vitamin D deficiency were determined.

Results: With seasonal intake of vitamin D, the risk of a decrease in plasma 25-OH-D to a level of less than 30 ng/ml increased by 10.36 times (p=0.0001) compared with year-round prophylaxis; refusal of maternal vitamin D intake during pregnancy resulted in a 2.95-fold (p=0.006) increase in the risk of vitamin D deficiency compared to children whose mothers took vitamin D during pregnancy. Breastfeeding did not statistically significantly increase the risk of vitamin D deficiency in children. It was found that homozygous carriers of minor alleles of Fok I (TT) had a 2.67-fold increase in the risk of developing this condition (p=0.015).

Conclusion: Modifiable risk factors are of the greatest importance. Irregularity of drug prophylaxis of vitamin D deficiency (seasonal intake) and refusal to take vitamin D during pregnancy increase the risk of vitamin D deficiency in infants and young children. Homozygous carriage of minor alleles of the Fok I gene does not correlate with the blood vitamin D level in the of children, but increases the risk of developing vitamin D deficiency.

Background: Behavioral disorders occur in 1–11% of children and adolescents. Antipsychotics, which are unsafe medications, are often used for behavioral disorders. There are studies that demonstrate different rates of adverse drug reactions (ADRs) among children under 13 years of age or older. This emphasizes the need for separate analysis of children and adolescents when assessing risk factors for ADRs to pharmacotherapy.

Objective: Determination of clinical and demographic risk factors for ADRs to pharmacotherapy for behavioral disorders with separate analysis for children and adolescents.

Materials and methods: The study included 300 case histories of children and adolescents hospitalized in an acute psychiatric hospital for behavioral disorders. The sample was divided into 150 patients aged 12 years or younger (subgroup «Children») and 150 aged 13 years and older (subgroup «Adolescents»). All patients received an antipsychotic as their primary therapy. Using the global trigger method, each case history was searched for ADRs. Data on the pharmacotherapy taken were extracted, potentially dangerous drug interactions were recorded, and the Medical appropriateness index and Anticholinergic scale score were calculated. Risk factors for the development of ADRs were assessed using nonparametric statistics and logistic regression analysis.

Results: 57 ADRs were detected among patients (28 in the Children subgroup, 29 in the Adolescents subgroup). Most often, ADRs were detected in patients aged 11 to 15 years. The subgroups of children and adolescents differed significantly in the maximum dose of the second prescribed antipsychotic (higher in adolescents: 60 [37.5; 108] versus 45 [25; 72] mg/day, p=0.019), the number of hospitalizations over the past 12 months (children – 1 [1; 2], adolescents – 1 [1; 1]; p=0.005). Logistic regression identified significant risk factors for the development of ADRs: 1) for the entire sample «Duplicate antipsychotics» (OR=2.505; 95% CI: 1.308–4.798; p = 0.006), high body mass index (OR=0.915; 95% CI: 0.845–0.991; p = 0.029); 2) for the subgroup «Adolescents» – «Duplicate antipsychotics» (OR=2.461; 95% CI: 1.072–5.65; p = 0.034); 3) for the subgroup «Children» no significant risk factors for the development of ADRs were identified.

Conclusion: ADRs to antipsychotics in children and adolescents with behavioral disorders depend on the rationality of pharmacotherapy. Duplicate antipsychotics is a significant risk factor for the development of ADRs. The risk of developing ADRs in patients under 13 years of age is less dependent on the parameters of pharmacotherapy (antipsychotic dosage, duplication of antipsychotics). This study indicates the need for a detailed study of risk factors for ADRs depending on the child’s age.

Background: Acute lymphoblastic leukemia (ALL) is a leading childhood cancer and is characterized by high mortality with late diagnosis.

Description of the clinical case: The article presents a case of ALL in the practice of a pediatrician. The features of the clinical picture, diagnosis at the outpatient stage, patient routing, as well as modern treatment protocols that made it possible to achieve rapid remission are considered.

Conclusion: High oncological alertness of primary care physicians, early detection and timely protocol therapy are decisive factors in the successful treatment of children with lymphoblastic leukemia.

The article is devoted to the demonstration of a clinical case of ROHHAD syndrome in a 5-year-old child.

ROHHAD is an abbreviation that stands for and translates as rapidly progressive obesity with hypothalamic dysregulation, hypoventilation and autonomic dysfunction. The first clinical case of ROHHAD syndrome (formerly known as Late-Onset Central Hypoventilation Syndrome (LO-CHS) with Hypothalamic Dysfunction), a central hypoventilation syndrome with late onset and hypothalamic dysfunction, was described in the American Journal of Pediatrics in 1965.

According to the ROHHAD association, 100 cases of the disease have been reported worldwide. The etiology and pathogenesis of this disease are still not fully understood, to date, three main etiopathogenetic hypotheses have been put forward: genetic, epigenetic and autoimmune. Treatment of ROHHAD syndrome is currently only symptomatic. Patients receive hormone replacement therapy, water-electrolyte balance correction, and respiratory support.