编号 5 (2009)

We discuss the problem of patient compliance (adherence to treatment) with antibacterial therapy of respiratory infections. It is emphasized that the high compliance significantly increases efficacy of treatment. Experimental methods for compliance assessment are presented; we describe the main errors associated with noncompliance of antibacterial therapy, and factors affecting the compliance. Methods of compliance improvement during the course of antibiotic therapy (reduction of number of intakes of antibiotics, short courses, convenient form of drug, etc.) are presented.

The basis of hepato-pulmonary syndrome (HPS) in patients with chronic liver disease is intrapulmonary vasodilatation breaking arterial oxygenation. The concerns for pathophysiology, diagnosis and treatment of this pathology are discussed. There are many techniques such as contrast echocardiography and standard cardiopulmonary test for HPS diagnosis. Treatment of this condition consists in oxygen therapy and orthotopic liver transplantation, in severe hypoxemia especially.

Modern pharmacotherapy of bronchial asthma passed from the therapeutic approach in accordance with the severity of the disease to implementation of two general concepts: disease control in some patients and decrease of the potential risks associated with the disease in all patients. To perform the latter task, administration of the best combinations of inhalation glucocorticosteroids and long-acting beta2-agonists in single inhaler for basic therapy and for needs is the most effective. To date, Symbicort with unique delivery system (Turbuhaler) is the exclusive drug providing the optimal effect in SMART mode (Symbicort Maintenance and Reliever Therapy).

The article is concerned with the results of the CASTLE study, which compared the efficacy and safety of two antiretroviral treatment regimens, including 2 nucleoside reverse transcriptase inhibitor (NRTI): tenofovir (TDF) and emtricitabine (FTC), as well as "enhanced" protease inhibitor (PI) HIV - atazanavir/ritonavir (ATV/r) or lopinavir/ ritonavir (LPV/r) in 883 patients with HIV infection who have not previously received ART. After 96 weeks of treatment virological efficacy of the treatment regimen based on ATV/r was somewhat higher (particularly in patients with initially low number of CD4-lymphocytes) than the treatment regimen based on LPV/r, because the proportion of patients dropped out of a study was higher in case the latest regimen application. Immunological efficacy of two ART regimens was also comparable. The frequency of virological treatment failure was low in both groups of patients, and the development of HIV resistance (mainly to the FTC) was recorded only in few patients. Both ART regimens were well tolerable, however, the frequency of gastrointestinal disorders was significantly lower in patients treated with ATV/r. Application of the ARV regimen based on ATV/r has a much smaller effect on blood lipid parameters. The CASTLE study conclusively showed that ARV treatment regimen with TDF/FTC and ATV/r administration once a day is the therapy of choice in patients with HIV infection treated with ART for the first time.

Bronchobos (carbocisteine) has both mucolytic and mucoregulator effects. The mechanism of carbocisteine action is associated with activation of sialic transferase - enzyme of goblet cells of the bronchial mucus membrane, forming the composition of bronchial secretion. Carbocisteine cause mucosal regeneration, restoration of its structure, normalization of the number of goblet cells, and reduction of mucus hypersecretion consequently. In addition, mucociliar clearance and specific protection are improved. Carbocisteine have impact on all parties of respiratory tract (upper and lower), involved in the pathological process, as well as paranasal sinuses, Eustachian tubes, middle ear cavity. Addition of Bronhobos in the treatment regimen in patients with paranasal sinuses and middle ear diseases lead to dynamic improvement of all clinical parameters, and significant reduction of the duration of treatment.