编号 14 (2015)

This paper reviews the problem of bacterial resistance to β-lactam antibiotics, in particular to carbapenem antibiotics. The authors describe the mechanisms of antimicrobial resistance (modification of the target, reduction of the permeability of the outer structures, efflux, inactivation). It is emphasized that one of the basic mechanisms of bacterial resistance to β-lactam antibiotics is the enzymatic hydrolysis. To date, more than 1000 β-lactamases are described differing in substrate specificity, sensitivity to inhibitors and gene localization. It is a widespread beta-lactamase extended spectrum led to a sharp reduction in the clinical significance of cephalosporins III-IV generations. Carbapenems had long been the only reliable means of antibacterial therapy, but emergence of carbapenemase enzymes with genes located on mobile elements has radically changed the situation. The authors elaborate on various classes of car-bapenemases, present the data on their prevalence in Russia, describe methods of their laboratory detection and possibilities of therapy of infections caused by their producers. A strategy to slow the spread of carbapenemase producers might include testing to detect the carriage of carbapenemase producing micro-organisms, implementation of methods for identifying carbapenemase production in the routine of bacteriological laboratories, as well as measures to contain and prevent nosocomial outbreaks.

The review considers topical issues of the etiology, diagnosis and treatment of mycoplasmal infection of the respiratory tract. The features of the clinical course, the main approaches to drug therapy, indications for antibacterial agents are discussed. The high efficiency and safety of macrolides in the treatment of respiratory mycoplasmosis are demonstrated. The application of roxithromycin as one of the drugs of choice is justified. The mechanisms of its action, the spectrum of antibacterial activity and pharmacokinetic characteristics are presented. Pharmacoeconomic benefits of the drug Esparoxy in the treatment of community-acquired respiratory tract infections, including mycoplasmal etiology, are discussed.

The article presents a review of clinical studies on the efficacy and safety of the intranasal spray Euphorbium compositum. Spray for nasal application is an alternative to traditional drugs used for the treatment of rhinitis and sinusitis, which has no side effects and limitations characteristic for these drugs. Best tolerability compared with xylometazoline allows to recommend Euphorbium compositum as a drug for the long-term treatment of chronic sinusitis. The complex mechanism of action of the drug provides its anti-viral and antiinflammatory activity.

The article is devoted to the treatment of acute otitis media (AOM) in children with emphasis on the rational choice of systemic antibiotic therapy and topical drugs based on the experience of Russian and foreign authors. The recommendations of the American Academy of Pediatrics for the treatment of AOM are presented. The necessity of complex therapy aimed at the various links in the pathogenesis of AOM and taking into account the individualized approach to patient is discussed.

The study included 139 3-year old children having a history of at least six episodes of recurrent rhinopharyngitis (RRP) in the previous year. All the children were tested for the presence of herpes virus types 1, 2, 4, 5, and 6. Association of disease with at least one of them was found in 93 of 139 (66.9%) patients. Incorporating Isoprinosine in combination therapy of RRP associated with cytomegalovirus or Epstein-Barr virus reduced the number of respiratory infections during the following year.

The study was aimed to the evaluation of the efficiency of the drug Fluditec in the complex treatment of inflammatory diseases of the upper respiratory tract. The study included 58 sickly children aged from 3 to 8 years. After a course of treatment, exfoliative cytograms were assessed. In 64.7% of the children in the study group, results of cytograms indicated the regulation of process of phagocytosis and the absence of exudation suppression while reducing the number of microorganisms. In the control group, similar changes have occurred only in 36.4% of patients, and were less pronounced. The results show the effectiveness of the use of the drug Fluditec in the complex treatment of inflammatory diseases of the upper respiratory tract, as well as the rationality of its inclusion in the complex treatment of children during sanatorium stage of rehabilitation.

The article considers the principles of application of mucoactive drugs, which include mucokinetics, mucolytics, mucoregulators, as well as drugs reducing or maintaining the functional activity of the ciliary cells of the bronchial mucosa - stimulators of mucociliary clearance. There are two groups among mucolytics and mucoregulators: drugs realizing its effect mainly in the lumen of the bronchi (bromhexine, ambroxol, guaifenesin), and preparations normalizing the formation of bronchial secretions (acetylcysteine, dornase alpha). In cases when patients have several symptoms of affect of the tracheobronchial tree (eg, cough, presence of viscous sputum, bronchial obstruction), it is reasonable to use the combined mucoactive drugs such as Ascoril containing mucolytic (Bromhexine), mucolytic/mucokinetic (guaifenesin) and ß2-adrenoagonist (salbutamol).

The review is dedicated to the analysis of modern methods of treatment of acute bronchitis (AB). In spite of popular stereotypes, AB often has viral nature, which calls into question about the reasonability of use of antibiotics. Antibiotic treatment of viral AB in order to prevent bacterial complications is doubtful because the effectiveness of such an approach has no serious evidence. Viral diseases require antiviral therapy. The main classes of drugs in this case are the interferons and interferon inducers. The article describes in detail the mechanisms of action of interferon inducers, analyzes data on efficacy of drugs related to these pharmacotherapeutic groups.