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Background Pathophysiology of appendicitis is associated with the underlying inflammatory processes. Ethyl pyruvate (EP) has potent antioxidant and anti-inflammatory properties. In this study, we aimed to investigate the effects of EP on the treatment of appendicitis and to examine whether adding EP to the antibiotic treatment could increases the effectiveness of the treatment in a rat appendicitis model. Method Thirty two Wistar rats, which had previously created appendicitis, were randomly divided into 4 groups: Group 1 (0.1 ml saline solution), Group 2 (15 mg/kg ceftriaxone), Group 3 (50 mg/kg EP), Group 4 (EP 50 mg/kg + ceftriaxone 15 mg/kg). In all groups, saline solution, ceftriaxone and EP were administered intraperitoneally and the same procedure was repeated twice a day for the following five days. On day 6, the rats underwent relaparotomy and then intraabdominal findings were recorded. Histopathological examination and interleukin-6 (IL-6) level were performed on appendiceal specimens. Results Intra-abdominal adhesion score was significantly lower in Group 4 than in Group 1. Total inflammation score was significantly lower in Group 2 than in Group 1 and was significantly lower in Group 4 than in Group 3 and 1. IL-6 level was significantly lower in Group 4 than in Group 3 and 1. Conclusion We found that adding EP to the antibiotic therapy increased the efficacy of the treatment in the rat appendicitis model. Further studies are required to apply our findings to the clinical setting.

Background The effect of bacterobilia on morbidity after pancreatoduodenectomy remains unclear. The aim of this study was to examine the influence of positive intraoperative bile cultures and perioperative antibiotic prophylaxis on morbidity measured using the Comprehensive Complication Index, a weighted composite of postoperative complications. Methods Intraoperative bile cultures of 182 patients who underwent pancreatoduodenectomy were obtained. We examined the effect of intraoperative bile cultures and perioperative antibiotic prophylaxis on the Comprehensive Complication Index and the occurrence of postoperative complications. To this aim, we performed general linear models controlling for relevant demographic and perioperative factors. Results Positive (versus negative) intraoperative bile cultures were associated with a higher mean Comprehensive Complication Index (25.34 vs 16.81, P = .025). The mean Comprehensive Complication Index differed significantly between individuals with positive intraoperative bile cultures and bacterial strains not covered by perioperative antibiotic prophylaxis (26.2) versus positive intraoperative bile cultures and bacterial strains sensitive to perioperative antibiotic prophylaxis (22.7) (P = .045). Positive (versus negative) intraoperative bile cultures were associated with 4.75 times (95% confidence interval: 1.74–13.00, P = .002) greater odds of wound infections. The odds of wound infection were 1.93 times (95% confidence interval: .47–8.04) greater in those with positive intraoperative bile cultures and adequate perioperative antibiotic prophylaxis and 6.14 times (95% confidence interval: 2.17–17.35) greater in those with positive intraoperative bile cultures and inadequate perioperative antibiotic prophylaxis (versus negative intraoperative bile cultures) (P = .001). Conclusion Bacterobilia is associated with a significant increase in Comprehensive Complication Index and wound infections after pancreatoduodenectomy, which may be reduced by administration of a specific perioperative antibiotic prophylaxis. Acquisition of bile cultures sampled through the external conduit of patients with preoperative biliary drainage could help in selecting a specific perioperative antibiotic prophylaxis and patients with bile duct stents might benefit from broad spectrum perioperative antibiotic prophylaxis.

The increasing resistance of the disease-causing pathogens to antimicrobial drugs is a public health concern and a socio-economic burden. The emergence of multi-drug resistant strains has made it harder to treat and combat infectious diseases with available conventional antibiotics. There are currently few effective therapeutic regimens for the successful prevention of infections caused by drug-resistant microbes. Various alternative strategies used in the recent past to decrease and limit antibiotic resistance in pathogens include bacteriophages, vaccines, anti-biofilm peptides, and antimicrobial peptides. However, in this review, we focus on the novel and robust molecular approach of antisense RNA (asRNA) technology and the clustered regulatory interspaced short palindromic repeat (CRISPR)-based antibiotic therapy, which can be exploited to selectively eradicate the drug-resistant bacterial strain in a sequence-specific fashion establishing opportunities in the treatment of multi-drug resistant related infections.

An extremely uncommon cause of endograft infections, listeria monocytogenes graft infections are associated with high morbidity and mortality. Best managed with complete graft resection and long-term antibiotics, we present a rare case of listeria monocytogenes aortic graft infection managed successfully with direct sac drainage and lifelong suppressive antibiotic therapy.

Antibiotic resistance is a public health concern. A critical care clinician is faced with a clinical dilemma of using the appropriate treatment without compromising the antibiotic armamentarium. Postoperative and trauma patients in the intensive care unit (ICU) pose a unique challenge of mounting a systemic inflammatory response, which makes it even more difficult to differentiate inflammation from infection. The decision for type of empirical therapy should be individualized to the patient and local ecology data and resistance profiles. After initiation of empirical therapy, deescalation should be done once microbiology data are available. Antibiotic stewardship programs are essential in the ICU.

Background: QTc prolongation is common in dangerous clinical conditions, associated with an increased risk of life-threatening arrhythmia torsades de pointes. The goal of this short communication is to evaluate the principal causes of risk of QTc prolongation that are observed in an emergency department and discuss the differences between drug- and non-drug-associated factors. Methods: The retrospective analysis was carried out on 130 patients that presented a QTc prolongation (>480 ms for man and >470 for female, respectively), admitted to the emergency department of a single Italian hospital. Patients with pace-maker (22) were excluded from this study. For each patient, a minimum of 3 ECGs (12 leads) were recorded. Attention was paid on electrolytes disturbances and to the pharmacotherapy, with a particular emphasis to the use of antibiotics. Results: Mean age of the patients was 79.6 years (SD=11.3) and females and males were almost equally present (46.6% F, 53.7% M). The average QTc value was 492.2 ms (493.3 ms F, 492.8 M). The patients were divided in those with electrolytes disturbances (24.0%), antimicrobial therapy (35.2%), both antimicrobial therapy and electrolytes disturbances (24.1%), and other causes of QTc prolongation (16.7%). Conclusion: This analysis shows the relevance of the empirical therapy established at the admission, in particular for infective diseases, as an important risk factor for the prolongation of QTc. Other factors that can increase the risk are electrolytes alterations, advanced age, cardiovascular diseases, and drug-drug interaction.

One of the main causes of morbidity in children with cancer blood diseases is development bacterial complications against the specific chemotherapy that are caused by antibiotic-resistant flora. The paper deals with a rational choice of antibiotic treatment of these patients., Одна из главных причин осложненного течения онкогематологических заболеваний у детей — развитие на фоне специфической химиотерапии бактериальных осложнений, вызываемых антибиотикорезистентной флорой. В работе рассматриваются возможности выбора рационального антибактериального лечения данной категории больных., Одна з головних причин ускладненого перебігу онкогематологічних захворювань у дітей — розвиток на фоні специфічної хіміотерапії бактеріальних ускладнень, що викликаються антибіотикорезистентною флорою. У роботі розглядаються можливості вибору раціонального антибактеріального лікування даної категорії хворих.

У статті розглядається сучасний стан проблеми антибактеріальної терапії бактеріальних інфекцій дихальних шляхів у дітей. Науково обґрунтовано застосування при патології органів дихання препарату з групи цефалоспоринів ІІІ покоління — цефподоксиму проксетилу (Цефодокс). Наведено досвід зарубіжних та вітчизняних фахівців, а також власний досвід застосування цефподоксиму проксетилу в терапії респіраторних бактеріальних інфекцій у дітей.

In the article we considered the antibacterial therapy in children with acute respiratory disease: rational of administration, the choice of an initial antibiotic and the selection of methods of antibiotic therapy. 369 case records of children with acute respiratory infection, bronchitis and pneumonias were analyzed. It was detected that the prescription of antibacterial therapy was groundless and timeless in 1/3 children with acute respiratory diseases. The Cephalosporins of the II and III generation dominates as a starting treatment of acute respiratory disease in children. We registered the rare use of sequential therapy and prevailing administration of parenteral antibiotics.

The article presents a clinical case of pneumococcal pneumonia complicated by destructive process and septicemia in a child. In addition to massive antibiotic therapy, application of immunological preparations, extracorporeal detoxification methods and thoracoscopy with drainage of the pleural cavity were required for the successful treatment. The effectiveness of therapy was confirmed by studies of the intoxication syndrome markers dynamics., В статье приведен клинический случай пневмококковой пневмонии у ребенка, осложненной деструктивным процессом и септицемией. Помимо массивной антибактериальной терапии для успешного лечения потребовалось использование иммунопрепаратов, проведение экстракорпоральных методов детоксикации и торакоскопии с дренированием плевральной полости. Эффективность терапии подтверждалась исследованием динамики маркеров интоксикационного синдрома., У статті наведений клінічний випадок пневмококової пневмонії в дитини, ускладненої деструктивним процесом та септицемією. Окрім масивної протибактеріальної терапії для успішного лікування знадобилось використання імунопрепаратів, проведення екстракорпоральних методів детоксикації та торакоскопії з дренуванням плевральної порожнини. Ефективність терапії підтверджувалась дослідженням динаміки маркерів інтоксикаційного синдрому.

Стаття присвячена одному з найпоширеніших лор-захворювань — риносинуситу, зокрема бактеріальної етіології. Наведені основні положення щодо діагностики та лікування цієї патології згідно із сучасними рекомендаціями (EP3OS, редакція 2012 року). Доведено, що антибактеріальна терапія практично всіма групами антибактеріальних препаратів, показаних при гострому бактеріальному риносинуситі, з частотою до 25 % випадків супроводжується розвитком ускладнень, найчастішим із яких є антибіотикоасоційована діарея. Для профілактики та лікування цього ускладнення рекомендується призначення пробіотиків (клас Іb, рівень доказовості А), зокрема Субаліну.

Over the past 30 years, high incidence of acute lower respiratory tract infections of bacterial origin, primarily pneumonia and bronchitis, treatment of which under the spread of antibiotic resistance is often a difficult task, cause alarm. Bronchitis — one of the most common respiratory diseases in childhood after acute respiratory viral infections. Application of antibiotics for acute bronchitis in children is not recommended, but they are prescribed for severe intoxication and prolonged hyperthermia (over 3 days), especially in infants, children with poor premorbid background and high risk of pneumonia. Antibiotic therapy is considered as the only science-based treatment of pneumonia. Taking into account the broad spectrum of modern antibiotics, monotherapy is most suitable. If it is necessary to extend their effect, combination of amoxicillin/clavulanate with macrolides, to which all the major respiratory pathogens are sensitive, is preferred., В течение последних 30 лет большую тревогу вызывает высокая частота острых инфекций нижних дыхательных путей бактериальной этиологии, прежде всего пневмоний и бронхитов, лечение которых в условиях распространенной устойчивости к антибиотикам нередко представляет трудную задачу. Бронхиты — одни из наиболее частых после острых респираторных вирусных инфекций заболеваний органов дыхания в детском возрасте. Применение антибиотиков при остром бронхите у детей не рекомендуется, но их назначают при выраженной интоксикации и длительной гипертермии (более 3 дней), особенно у больных раннего возраста, у детей с неблагоприятным преморбидным фоном и высоким риском развития пневмонии. Антибиотикотерапия признана единственным научно обоснованным методом лечения пневмонии. C учетом широкого спектра действия современных антибиотиков наиболее целесообразна монотерапия. При необходимости большего расширения спектра их действия предпочтение отдается комбинации амоксициллина/клавуланата с макролидами, к которым чувствительны все основные возбудители инфекций органов дыхания., Упродовж останніх 30 років велику тривогу викликає висока частота гострих інфекцій нижніх дихальних шляхів бактеріальної етіології, насамперед пневмоній і бронхітів, лікування яких в умовах поширеної стійкості до антибіотиків нерідко представляє складне завдання. Бронхіти — одні з найчастіших після гострих респіраторних вірусних інфекцій захворювань органів дихання в дитячому віці. Застосування антибіотиків при гострому бронхіті в дітей не рекомендується, але їх призначають при вираженій інтоксикації та тривалій гіпертермії (понад 3 дні), особливо у хворих раннього віку, у дітей із несприятливим преморбідним фоном і високим ризиком розвитку пневмонії. Антибіотикотерапія визнана єдиним науково обґрунтованим методом лікування пневмонії. З урахуванням широкого спектра дії сучасних антибіотиків найбільш доцільна монотерапія. За потреби більшого розширення спектра їх дії перевага надається комбінації амоксициліну/клавуланату з макролідами, до яких чутливі всі основні збудники інфекцій органів дихання.

Diagnosis of source of maxillofacial infection in paediatric patients can be challenging due to difficulty in eliciting a proper history and multiple potential sources of infection. Identification and removal of the nidus of infection with decompression and institution of antibiotic therapy as per the culture-sensitivity report form the mainstay treatment of the infection. Deviation from it may result in persistence or even progression of infection, resulting in significant morbidity and mortality. In the past decade, the incidence of community-acquired methicillin-resistant Staphylococcus aureus infection in the oral cavity has seen an upward trend. This has further led to an increase in complexity in the diagnosis of maxillofacial infections. In this case, the authors want to bring to light the challenges faced in managing a paediatric patient with persistent fascial space infection even after removal of the offending tooth, which signifies the importance of managing the infection by the time-tested protocol.

Sore throat is a common complaint, which can be caused by a typical viral pharyngitis, or it can be rooted in a life-threatening disease such as epiglottitis or inflammation of the cellular spaces in the throat and neck. The doctor should take a closer look at a patient with a sore throat, immediately make a differential diagnosis and prescribe adequate treatment, including surgical intervention, if necessary.The article discusses the most common causes of a sore throat, including various types of pharyngitis, paratonsillar abscess, parapharyngeal abscess, retropharyngeal abscess, epiglottitis.Viral pharyngitis has a favourable prognosis, resolves without intervention and complications, but bacterial and fungal pharyngitis have a more severe course. Streptococcal pharyngitis caused by group A в-hemolytic streptococcus holds a dominant position in bacterial etiology and requires the use of antibiotic therapy. The differential diagnosis of streptococcal pharyngitis is based on the modified Centor scores in the routine clinical practice. Antibiotic therapy for streptococcal pharyngitis includes a 10-day course of unprotected penicillins. If a patient has an allergic reaction to penicillins, it is recommended to use clindamycin or clarithromycin. The surgical intervention combined with intramuscular or intravenous antibiotic therapy is recommended for the treatment of purulent processes in the cellular spaces of the neck. These diseases can have life-threatening complications, which include neurological damage, the spread of purulent process in the mediastinum with the development of mediastinitis, laryn-geal stenosis, sepsis, necrotizing fasciitis, jugular vein thrombosis and erosion of the carotid artery. The third generation cephalosporins and protected penicillins are recommended for the treatment of epiglottitis, and respiratory fluoroquinolones are used, if a patient has a history of allergic reactions to penicillins. In severe cases with symptoms of stenosis, intubation can be performed in addition to the use of antibiotics.

According to statistics from the World Health Organization, infectious mononucleosis caused by Epstein-Barr virus affects 90% of the world's population. The aim of this study was to study the composition of the oropharyngeal microbiota and to determine the antibiotic sensitivity of its representatives, which are released in clinically significant concentrations from children with WEB infection who received antibiotic therapy. 28 patients with WEB infection in children aged 5 to 16 years were examined. Among the 28 children in inpatient treatment, 78.6% were patients under the age of 10. All children received antibiotic therapy, although according to treatment protocols, it is indicated only in the case of a bacterial infection. Streptococcus spp. with β-hemolysis (64.3%). Detection of S. aureus in 35.7% of patients indicates a violation of the structure of the normal microbiocenosis of the oropharynx. The study of antibiotic susceptibility of staphylococci and streptococci showed the presence of resistance in 52.6% of isolated strains of streptococci and 25.0% of staphylococci to azithromycin.

Under the sustainable development goals (SDG), the target for neonatal mortality rate (NMR) was proposed to be less than 12 per 1000 live births by 2030 and may not meet the SDG 2030 NMR target. It may be prudent to focus on moderately low birth weight babies, 1500-2499 g, to reach the goal. This category of babies constitutes 37% of newborn deaths. They need supervised care for a short period that consists of the provision of warmth and breastfeeding with or without antibiotic therapy, and with or without oxygen administration. Despite knowing that these interventions can reduce neonatal deaths, deficiencies in how to implement these measures may be making all the difference to the expected outcome. This paper suggests possible ways to enhance the effectiveness of some of the better-known interventions such as the provision of warmth, feeding, resuscitation, oxygen administration, delivery of continuous positive airway support, and antibiotic therapy.

OBJECTIVE: Infectious endarteritis associated with patent ductus arteriosus (PDA-IE) is an uncommon complication in the era of antibiotics. However, it implies a clinical challenge in patients with a fever of undetermined origin. Two-dimensional transthoracic echocardiography (TTE) plays a fundamental role in diagnosis and follow-up. METHODS: A retrospective analysis of the data of all patients admitted to our center with PDA-IE within 15 years was conducted, and a review of the literature regarding diagnosis, TTE findings, and treatment was performed. RESULTS: A total of 17 patients were identified with a mean age of 17.8 years. TTE done in all patients confirmed the diagnosis of PDA and pulmonary artery vegetation. In five patients, one vegetation was present; in three patients, two vegetations were found; and in the nine remaining patients, three or more vegetations were observed. In two-thirds of the patients, the size of the vegetation was three to 28 mm, and the principal morphology was filiform. In all patients, at least one vegetation developed on the lateral wall of the ductus arteriosus. Pulmonary valve was affected in 41% of the patients and caused low to moderate valvular regurgitation. Pulmonary embolism was present in seven patients and pulmonary aneurysm in one patient. CONCLUSION: The incidence of PDA-IE has decreased in the recent years with early antibiotic therapy. However, today, this complication carries a significant risk of valve damage and other cardiac structures’ involvement.

Introduction Infection after stroke is associated with unfavorable outcome. Randomized controlled studies did not show benefit of preventive antibiotics in stroke but lacked power for subgroup analyses. Aim of this study is to assess whether preventive antibiotic therapy after stroke improves functional outcome for specific patient groups in an individual patient data meta-analysis. Patients and methods We searched MEDLINE (1946–7 May 2021), Embase (1947–7 May 2021), CENTRAL (17th September 2021), trial registries, cross-checked references and contacted researchers for randomized controlled trials of preventive antibiotic therapy versus placebo or standard care in ischemic or hemorrhagic stroke patients. Meta-analysis was performed by a one-step and two-step approach. Primary outcome was functional outcome adjusted for age and stroke severity. Secondary outcomes were infections and mortality. Results 4197 patients from nine trials were included. Preventive antibiotic therapy was not associated with a shift in functional outcome (mRS) at 3 months (OR1.13, 95%CI 0.98–1.31) or unfavorable functional outcome (mRS 3–6) (OR0.85, 95%CI 0.60–1.19). Preventive antibiotics did not improve functional outcome in pre-defined subgroups (age, stroke severity, timing and type of antibiotic therapy, pneumonia prediction scores, dysphagia, type of stroke, and type of trial). Preventive antibiotics reduced infections (276/2066 (13.4%) in the preventive antibiotic group vs. 417/2059 (20.3%) in the control group, OR 0.60, 95% CI 0.51–0.71, p < 0.001), but not pneumonia (191/2066 (9.2%) in the preventive antibiotic group vs. 205/2061 (9.9%) in the control group (OR 0.92 (0.75–1.14), p = 0.450). Discussion and conclusion Preventive antibiotic therapy did not benefit any subgroup of patients with acute stroke and currently cannot be recommended.

espanolLa aparicion y la diseminacion de las resistencias a antibioticos son el resultado de un proceso de seleccion adaptativa en respuesta al uso de antibioticos denominada presion antibiotica. La presion antibiotica no solo facilita la expansion de los mutantes resistentes, sino que la exposicion a dosis subletales de antibiotico puede favorecer la mutacion de especies resistentes a distintas familias de antibioticos. Esto adquiere una gran importancia en el medio hospitalario y especialmente en las unidades de cuidados intensivos (UCI), por lo que es crucial controlar las distintas cepas endemicas del hospital y ajustar la dosis de antibioticoterapia empleada en cada paciente. Por ello se iniciaron a nivel nacional los Programas de Optimizacion de uso de Antimicrobianos (PROA). En este trabajo se realiza un analisis de la situacion de partida de la UCI del Hospital de El Bierzo, evaluando consumo de antibioticos por familias y principios activos, cepas aisladas y resistencias de las cepas aisladas, para evaluar la necesidad de implantacion de un equipo PROA. EnglishThe appearance and spread of antibiotic resistance is the result of an adaptive selection process in response to the use of antibiotics, called antibiotic pressure. Antibiotic pressure not only facilitates the expansion of resistant mutants, but exposure to sublethal doses of antibiotics can favor the mutation of species resistant to different families of antibiotics. This acquires great importance in the hospital environment and especially in intensive care units (ICU), so it is crucial to control the different endemic strains of the hospital, and to adjust the dose of antibiotic therapy used in each patient. For this reason, the Antimicrobial Use Optimization Programs (PROA) were initiated at the national level. In this work, an analysis of the initial situation of the ICU of the Hospital de El Bierzo is carried out, evaluating the consumption of antibiotics, by families and active principles, isolated strains, and resistance of the isolated strains, to evaluate the need for implantation of a PROA team.

A 79-year-old man with underlying alcoholic liver cirrhosis presented with complaints of a fever, abdominal pain, and difficulty walking. A diagnostic work-up revealed liver atrophy and chylous ascites, and spontaneous bacterial peritonitis (SBP) was diagnosed based on the cell and neutrophil counts. The Burkholderia cepacia complex (Bcc) was detected on blood and ascitic fluid cultures. Although broad-spectrum antibiotic therapy was initiated, the infection was difficult to control, and the patient died of multiple organ failure. Bcc is often multidrug-resistant and difficult to treat. SBP caused by Bcc has been rarely reported and may have a serious course, thus necessitating caution.

Introduction. Acute gastroenteritis (AGE) is one of the leading causes of pediatric morbidity and mortality. The use of cytomuco-protectors that stabilize the intestinal barrier can increase the effectiveness of treatment.The aim is to determine the gelatin tannate (GT) clinical efficacy, safety and antiviral activity in AGE in children admitted to the hospital.Materials and methods. An open, prospective, randomized study included 52 children Results. GT reduced the risk of diarrhea on day 5 by 32% [95% confidence interval 14-50%] OR 0.25 [0.11-0.25] and by 14% [4-24%] by day 7. In the GT group, on day 7 of treatment, all patients had normal stool consistency. GT reduced the time for stool normalization by 1.3 days [0.2-2.3]. A more significant effect was obtained in patients with risk factors for insufficient treatment efficacy and in patients with inflammatory AGE requiring ABT. In those who received GT, a decrease in the concentration of viruses in feces was found, in the control - no statistical differences. The recurrence of AGE symptoms during hospital treatment was recorded with a frequency of 3.6% and 16.7%, respectively (p = 0.111).Conclusions. GT significantly reduced the risks of incomplete therapy effect by day 7 of treatment and the average positiveness of stool normalization. Trends in the antiviral action of GT and its positive effect on the incidence of nosocomial viruses.

Katharina Pomej,1,2,&ast; Lorenz Balcar,1– 3,&ast; Bernhard Scheiner,1– 4 Georg Semmler,1,3 Tobias Meischl,1,2 Mattias Mandorfer,1,3,4 Thomas Reiberger,1,3– 5 Christian Müller,1,2 Michael Trauner,1,4 Matthias Pinter1,2,4 1Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria; 2Liver Cancer (HCC) Study Group Vienna, Medical University of Vienna, Vienna, Austria; 3Vienna Hepatic Hemodynamic Laboratory, Medical University of Vienna, Vienna, Austria; 4Rare Liver Disease (RALID) Centre of the ERN RARE-LIVER, Medical University of Vienna, Vienna, Austria; 5Christian Doppler Laboratory for Portal Hypertension and Liver Fibrosis, Medical University of Vienna, Vienna, Austria&ast;These authors contributed equally to this workCorrespondence: Matthias PinterDivision of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, 1090, AustriaTel +43 1 40400 47440Fax +43 1 40400 47350Email matthias.pinter@meduniwien.ac.atBackground: Antibiotic treatment (ABT) affects the outcome of cancer patients treated with immune checkpoint inhibitors (ICIs) and chemotherapy, possibly by altering the gut microbiome. We investigated the impact of ABT on overall survival (OS) and progression-free survival (PFS) in patients with advanced HCC treated with sorafenib.Methods: HCC patients treated with sorafenib between 05/2006 and 03/2020 at the Medical University of Vienna were retrospectively analyzed. ABT was defined as antibiotic use within 30 days prior to or after sorafenib initiation.Results: Of 206 patients, the majority was male (n=171, 83%) with a mean age of 66± 9.6 years. Half of patients (n=94, 46%) had impaired liver function (Child-Pugh stage B). Median time of follow-up was 10.8 (95% CI: 9.2– 12.3) months. ABT was administered in 23 (11%) patients due to different types of proven or clinically suspected bacterial infections (n=17, 74%) and hepatic encephalopathy (n=6, 26%). The median duration of ABT was 14 (IQR: 12– 30) days. Penicillin (n=13, 57%), followed by rifaximin (n=6, 26%), fluoroquinolones (n=3, 13%), and cephalosporins (n=1, 4%), was administered in the ABT group. The ABT group had a significantly shorter median OS (4.7 (95% CI: 3.2– 6.1) months vs 11.4 (95% CI: 9.9– 12.9) months, p=0.012), which was confirmed in multivariable analysis (HR: 1.91 (95% CI: 1.1– 3.2), p=0.014). Similarly, PFS trended to be shorter in the ABT group (3.5 (95% CI: 1.6– 5.4) months vs 4.8 (95% CI: 3.9– 5.7) months, p=0.099). None of the 10 patients with complete or partial response was found in the ABT group.Conclusion: ABT was independently associated with worse outcomes in sorafenib-treated HCC patients. Prospective studies are needed to elucidate the underlying mechanism.Keywords: antibiotics, hepatocellular carcinoma, sorafenib, targeted therapy

Background Nipple-areolar complex (NAC) tattooing remains a simple and safe procedure, which complements breast reconstruction. This study reviews 11 years of NAC tattooing to identify risk factors for tattoo-related complications. Methods Patients undergoing NAC tattooing from January 2009 to March 2020 were reviewed. Patient information, reconstructive, and tattoo procedural details were analyzed. Tattoo-related breast infections, defined as breast redness requiring antibiotic therapy within 30 days after tattoo, were captured. Patients with reactive breast redness during the first 2 postprocedural days were excluded. Results Overall, 539 patients (949 breasts) were included. Implant-based reconstruction (IBR) was performed in 73.6% of breasts (n = 698), whereas 26.4% (n = 251) underwent autologous-based reconstruction (ABR). Acellular-dermal matrix was used in 547 breasts (57.6%). There as a 13.7% (n = 130) of breasts that underwent pretattoo radiation. There was a 65.3% (n = 456) of breasts that underwent subpectoral IBR, whereas 34.7% (n = 242) breasts underwent prepectoral IBR. Tattoo-related infection rate was 2.2% (n = 21 breasts). Mean time to infection was 6.5 ± 5.3 days. There was a 85.7% (n = 18) of infections that occurred in IBR patients, one third occurring in radiated patients. There was a 95.2% (n = 20) of infections that were treated with oral antibiotics only. One explantation was performed after failed intravenous antibiotics. On multivariable analysis, radiation history (odds ratio, 4.1, P = 0.007) and prepectoral IBR (odds ratio, 2.8, P = 0.036) were independent predictors of tattoo-related infection. Among irradiated breasts, breasts with IBR had greater odds of developing tattoo-related infection versus breasts with ABR (P = 0.025). Conclusions Although tattoo-related infections were uncommon, previous radiation and prepectoral IBR were both found to be independent predictors of tattoo-related breast infection. There is a role for preprocedural prophylactic antibiotics in these patients to mitigate infectious risk.

Sepsis is a life-threatening condition, which is manifested by the development of organ dysfunction due to generalized inflammation caused by the infection of various nature. Timely lesion debridement combined with adequate antibiotic therapy are important components of the successful treatment of sepsis. At the moment, there is no consensus about the volume and time of intervention in the development of surgical sepsis. The article discusses modern approaches to solving the problem of adequate sanitation of the source of infection. The results of few randomized trials in this area are presented.Source control is absolutely essential for the successful treatment of sepsis. However, it is difcult to create a unifed algorithm for surgical control for all cases due to different approaches depending on the infection location. Properly designed clinical trials are necessary to determine the optimal timing of surgery for sepsis and septic shock as least.

Lyme disease (LD) or tick-borne borreliosis affects thousands of people every year in different regions of the world, primarily the United States and Europe. In endemic areas, early LD is a common disease that requires high medical vigilance. Considering the extreme relevance of this problem for public health, in November 2020, the committee of experts of three American scientific societies published an updated version of the clinical guidelines for the prevention, diagnosis and treatment of LD, the main provisions of which are presented in this article. It is emphasized that in the absence of vaccines, the risk of LD and other diseases transmitted by ticks can be reduced by using personal protective equipment and repellents. Antibiotic prophylaxis is carried out by a single oral administration of doxycycline. In the laboratory diagnosis of LD, the determination of antibodies to B. burgdorfery in the blood serum is a first-line study. At the second stage, serum samples are examined using an immunoblot for IgM and IgG. The basis of treatment of LD is rational antibiotic therapy. The choice of an antibiotic depends on a number of factors, including the presence of extracutaneous manifestations of LD (neuroborreliosis, carditis, arthritis). The most commonly used are doxycycline, amoxicillin, cefuroxime-axetil and ceftriaxone.

Brain abscesses due to odontogenic infection are infrequent, but they deserve attention due to the high incidence of serious complications and the high mortality rate. This article aimed to report five cases of cerebral abscess due to odontogenic infection, of patients attended in the Clinical Hospital of Medical School of the University of Sao Paulo (HCFMUSP). In all cases, treatment consisted of draining the brain abscess, antibiotic therapy and extraction of all teeth responsible for the infection. Streptococcus sp. was the causative agent of all the cases reported in this article. The purpose of the study was to highlight the importance of the dental approach for the resolution of cases.

Antibiotics are widely accepted as powerful medications. More and more antibiotics come into the hands of doctors. However, doctors do not always use these drugs on reflection. Often antibiotics are prescribed before the diagnosis is established, without taking into account the sensitivity to the drug of both micro- and macroorganisms, and are prescribed when other drugs can and should be dispensed with.

Urinary tract infections during pregnancy are associated with severe complications. Earlier initiation of antibiotic treatment for acute uncomplicated cystitis, reduces the various complications.Objective. To assess the effectiveness of fosfomycin in the treatment of acute uncomplicated cystitis during II and III trimester of pregnancy.Material and methods. The study included 74 pregnant women who had acute uncomplicated cystitis in II or III trimesters. All patients received fosfomycin trometamol 3.754 g (equivalent to 3 g fosfomycin) as antimicrobial therapy for acute uncomplicated cystitis. The drug was prescribed to 24 pregnant women in the II, and 50 in the III trimester of pregnancy.Results. After treatment with fosfomycin signs of acute cystitis gone in all patients. At the same time, regression of clinical symptoms was noted during the next days after therapy in 95.9% (n = 71) of cases. Repeated microbiological test of the middle portion of urine was performed 7 days after the end of antibiotic therapy. In 94.6% (n = 70) cases, total elimination of the pathogen was achieved. In 5.4% (n = 4) cases, there was a significant decrease of colonization Follow-up for three months showed the absence of recurrence of acute cystitis in all pregnant women who were included in the study.Conclusion. Fosfomycin is a highly effective drug in the treatment of uncomplicated cystitis during pregnancy.

Purpose of review Gram-negative bloodstream infections (GNBSI) are common and carry considerable mortality. Treatment is complicated by increasing antimicrobial resistance, posing a challenge for timely appropriate antibiotics and limiting the choices of effective definitive therapy. The present review aims to summarize recent studies addressing the management of GNBSI. Recent findings New rapid diagnostic tests (RDT) for pathogen identification and antibiotic susceptibility are associated with improved antimicrobial stewardship and reduced length of stay. No mortality benefit or patient-related outcomes are reported. Data regarding the use of new beta-lactam beta-lactamase inhibitors (BLBLIs) for treating multidrug resistance Gram-negative bacteria is supportive, though questions regarding combinations, optimal dosing, mode of administration, and resistance emergence remain to be clarified. Current data regarding cefiderocol necessitates further studies in order to support its use in GNBSI. Shortened (≤7 days) duration of therapy and early oral step down for GNBSI are supported by the literature. The role of repeated blood cultures should be further defined. Summary RDTs should be implemented to improve antibiotic stewardship. Clinical implications on patient-related outcomes should be evaluated. New BLBLIs show promise in the treatment of GNBSI. Additional data are needed regarding the use of cefiderocol. Antibiotic therapy should be shortened and early oral step down should be considered.

Introduction The diagnosis and management of periprosthetic knee and hip infections as well as the identification and management of possible additional infectious foci is of great importance for successful therapy. This study analyses the importance of 18F deoxyglucose PET-CT (PET-CT) in the identification of additional infectious focus and subsequent impact on management of periprosthetic infection (PPI). Material and methods A retrospective analysis of the clinical data and findings in the period from January 2008 to December 2018 was carried out. One hundred and four patients with in-hospital treatment due to PPI of a hip or knee joint were identified and included in this study. All patients underwent a standardized clinical examination and further surgical and antibiotic therapy. The reevaluation of performed PET-CTs was specifically carried out with regard to the local PPI or detection of secondary foci. Results PET-CT successfully verified the PPI in 84.2% of the patients. A total of 78 possible additional foci were detected in PET-CT in 56 (53.8%) of the examined patients. Predilection sites for possible secondary foci were joints (42.3%), pulmonary (15.4%), ear-nose-throat (15.4%), spine (11.5%), and the musculocutaneous tissues (11.5%). Fifty-four positive PET-CT findings were confirmed clinically with need of additional adequate treatment. Conclusion PET-CT is a valuable diagnostic tool to confirm periprosthetic joint infection. At the same time, the whole-body PET/CT may detect additional foci of infection with impact on subsequent treatment strategy. PET was of special value in detecting infections at distant locations far from the primary infected joint in significant number. These distant infection locations can be potential cause of a re-infection. This clearly reflects the need of their diagnosis.

Introduction: The COVID-19 pandemic in Ecuador was declared in March 2020. Since that date, there has been an exponential increase in the disease. But cases in pediatric age worldwide are reported as less frequent, without being Ecuador the exception. Until March 2021, 5,4% of cases correspond to children. Methods: A transversal analysis was applied in this research. Data was collected from the clinical records of the GEMA system. The study variables were: demographics, clinics, diagnosis tests, hospitalization length, and treatment. The descriptive analysis used percentage and median. To identify significant differences, the Chi-square test was applied. It was considered a significative result p

Актуальность. Эмпиема плевры (ЭП), как и любое гнойно-воспалительное заболевание, требует назначения антибактериальной терапии и определения чувствительности микроорганизмов к антибиотикам. Однако микробный пейзаж и антибиотикорезистентность бактерий постоянно меняются. Это делает актуальным изучение спектра и свойств возбудителей ЭП. Цель исследования: изучить микробиологическую характеристику больных острой ЭП плевры и разработать рекомендации по оптимизации эмпирической антибактериальной терапии. Материалы и методы. Проведено комплексное ретроспективное исследование 124 случаев заболевания острой неспецифической парапневмонической ЭП. Мужчин было 92 (74,2 %). Медиана возраста больных составила 50,3 (38; 61) года. Результаты. При микробиологическом исследовании плеврального экссудата положительный результат получен в 34 (27,4 %) случаях. Необходимо отметить, что большинство больных (101 — 81,5 %) получали предшествующую антибактериальную терапию. Так, среди пациентов, ранее не получавших лечения, этот показатель был существенно выше — 12 (52,2 %) vs 22 (21,8 %), p

Clostridioides difficile (formerly Clostridium) causes a potentially life-threatening diarrhoea, which is acquired predominantly in hospitals. The incidence of infections caused by this organism has increased markedly over the past 20 years, although the incidence has fallen in the UK since a peak about 10 years ago. Suspicion of the condition should be high, and cases should be managed appropriately. Initiation of early treatment and rapid confirmation of diagnosis are critical to the management of C. difficile infection (CDI). CDI should be treated as a new diagnosis and urgently assessed. After severity has been assessed, appropriate treatment should be started. Risk factors for CDI include age, immune suppression and use of broad-spectrum antibiotic therapy. Recurrence is relatively frequent, with recurrences of 15–30% after a first episode, and 33–66% after two episodes. Infection control measures to reduce CDI rates should be an integral part of the management of all hospitals. These measures include isolation of cases, hand-washing, environmental cleaning and antibiotic stewardship.

Salmonella meningitis in children represents 13% of meningitis cases in developing countries. A case of recurrent Salmonella ser. Enteritidis meningitis in a 2.5 month old baby should alert the clinician for possibility of recurrence after successful antibiotic therapy and need to investigate for the possibility of immunodeficiency

SUMMARY OBJECTIVE Acute calculous cholecystitis (AC) is a frequently encountered emergency surgery disease and its standard treatment is cholecystectomy. In patients with high risk in surgery, antibiotic treatment (AT) is important. In routine clinical practices, antibiotics are frequently used either as single or in combination in the treatment of AC. This study examined whether or not combined antibiotic treatment (CAT) had superiority over single antibiotic treatment (SAT) in AC. METHODS Patients with cholecystitis who received treatment in the period of 2016–2019 were retrospectively examined. The treatment procedures applied, patient findings, and laboratory data were analyzed using relevant statistical software. The patients were categorized into groups based on the treatment approaches applied, and the effects of SAT and CAT on infection parameters were analyzed. RESULTS In all, 184 patients received treatment for AC, with a mean age of 57.7, and the female-to-male ratio was 77:107. Of these, 139 patients received SAT and 45 received CAT. No significant difference was found in terms of effectiveness between the SAT and CAT in the patients who received early cholecystectomy treatment and those who received medical treatment with noninvasive intervention. CONCLUSIONS In patients with AC, antibiotics are commonly used either as single or in combination for prophylaxis and therapeutic purposes. As no significant difference was observed between single and combined use in terms of treatment effectiveness and hospitalization duration, CAT is not recommended due to its possibility of allergic side effects, toxicity, and cost-increasing effects.

BACKGROUND Indwelling inferior vena cava (IVC) filters might cause various complications, including filter penetration, filter fracture, filter migration, and thrombosis of the IVC. Penetration and migration complications are common, while a caudal migrated double-basket filter with associated infected iliac pseudoaneurysm has seldom been reported. CASE SUMMARY We report a 64-year-old female admitted for sudden onset of severe right abdominal pain after IVC filter placement for 3 mo. The patient had a history of failed endovascular IVC filter retrieval. Computed tomography showed that the retrieval hook of the filter penetrated the right common iliac artery and vein, leading to right iliac artery pseudoaneurysm accompanied by right ureteral obstruction with ipsilateral hydronephrosis, and bilateral iliac veins were occluded. Emergency open repair was performed to remove the IVC filter, the right iliac pseudoaneurysm, and the compromised segments of the iliac veins and IVC with right common iliac artery reconstruction. Staphylococcus aureus was isolated from the tissue culture. The patient was discharged on postoperative day 12 with anticoagulation therapy and antibiotic therapy after discharge. Six-month follow-up computed tomography revealed that the right common iliac artery was patent, and only mild hydronephrosis was detected. CONCLUSION An indwelling IVC filter, even ‘embedded’ within organized thrombus, could still cause life-threatening complications. Open procedures remain the last resort for IVC filters with severe complications.

Summary Background Despite guidelines describing the optimal diagnostic and therapeutic procedures for patients with suspected cardiac implantable electronic device (CIED) infections, their management is often challenging. Aims To describe our diagnostic and therapeutic practices for suspected CIED infection, and to compare them with European Heart Rhythm Association (EHRA) guidelines. Methods Patients hospitalized in the tertiary care Nancy University Hospital for suspected CIED infection from 2014 to 2019 were included retrospectively. We applied the EHRA classification of CIED infection, and compared diagnostic and therapeutic management with the EHRA guidelines. Results Among 184 patients (mean age 72.3 ± 12.4 years), 137 had a proven infection of the lead (by transthoracic echocardiography/transoesophageal echocardiography, 18F-fluorodesoxyglucose positron emission tomography/computed tomography or positive culture of the lead) or an isolated pocket infection without proof of lead infection, and 47 had no proof of CIED infection. According to the EHRA classification, CIED infection was considered as definite in 145 patients and possible in 31 and was excluded in eight patients. Regarding recommended diagnostic procedures, blood cultures were performed in 90.8%, transthoracic echocardiography in 97.8%, transoesophageal echocardiography in 85.9%, 18F-fluorodesoxyglucose positron emission tomography/computed tomography in 50.5% and imaging for embolisms in 78.3% of the patients. Compared with therapeutic recommendations for the 145 cases of definite CIED infection, device removal was performed in 96 patients (66.2%) and antibiotic therapy was prescribed in 130 (89.7%), with a duration equal to or longer than that recommended in 105 (72.4%) of the patients. Conclusion This study underlines the difficulties in following theoretical guidelines in daily practice, where both technical and human considerations interfere with their strict appliance.

The most common extragenital pathology during pregnancy is urinary tract infection (UTI) of various localization. In some cases, untreated UTI can contribute to the development of obstetric, urological, and perinatal pathologies. Factors predisposing to the UTI manifestation may include increased progesterone, delayed peristalsis, urine retention in the ureters, uterine growth, bladder displacement, and increased residual urine volume. Asymptomatic bacteriuria (ASB) during pregnancy can increase the risk of pyelonephritis and subsequent maternal and fetal complications. Pregnant women should be screened for ASB at least once at the beginning of pregnancy (aft er 14 weeks). E.coli is the dominant uropathogen in 70 – 95% of UTI cases in pregnant women. The main treatment for ABT and pyelonephritis in pregnancy (PiP) is antibiotic therapy (ABT), which is prescribed empirically in most cases. There is currently no consensus on the choice of ABT and the duration of treatment for UTI in pregnant women. In the case of ineff ective drug therapy of PiP, it is necessary to raise the issue of the upper urinary tract drainage promptly.

Urinary tract infections (UTIs) are the most common bacterial infections in humans. Annually in the world, about 150 million cases of UTI are registered. Several risk factors are associated with UTIs, including diabetes, immunodeficiency diseases, structural abnormalities of the kidneys and urinary tract, spinal cord injuries, multiple sclerosis, pregnancy, infancy, or elderly age. The main direction in the treatment of acute uncomplicated UTI is antibiotic therapy. The article presents data of current international recommendations on the treatment of UTI., Інфекції сечовивідних шляхів (ІСВШ) є найбільш поширеними інфекціями у людей. Щорічно у світі реєструють близько 150 млн випадків ІСВШ. Підвищений ризик розвитку ІСВШ мають немовлята, люди похилого віку, вагітні, хворі з травмами спинного мозку, з цукровим діабетом, розсіяним склерозом, дефіцитом імунітету, структурними вадами розвитку нирок та сечовивідних шляхів. Основним напрямком лікування гострої неускладненої ІСВШ є призначення антибактеріальної терапії. У статті наведені дані сучасних міжнародних рекомендацій щодо лікування ІСВШ., Инфекции мочевыводящих путей (ИМВП) являются наиболее распространенными бактериальными инфекциями у людей. Ежегодно в мире регистрируют около 150 млн случаев ИМВП. Повышенный риск развития ИМВП имеют младенцы, люди пожилого возраста, беременные женщины, пациенты с травмами спинного мозга, с диабетом, рассеянным склерозом, иммунодефицитными заболеваниями, структурными аномалиями почек и мочевыводящих путей. Основным направлением в лечении острой неосложненной ИМВП является назначение антибактериальной терапии. В статье представлены и проанализированы данные современных международных рекомендаций по лечению ИМВП.

В работе представлены данные по выбору и рациональному использованию антибиотиков при лечении острых респираторных заболеваний у детей, вызванных различными этиологически значимыми микроорганизмами.

In this article we analyzed current antibiotic resistance of S.pneumoniae. We showed local (region) data on sensitivity of pneumococcus to aminopenicillins, macrolides and cephalosporines traditionally used in schemes of empirical antibiotic therapy of community-acquired pneumonia in children under 5 years. We laid basic principles of rational antibiotic therapy based on the analysis of current national and foreign guidelines on the treatment of community-acquired pneumonia. Insignificant differences in the schemes of empirical antibiotic therapy are marked due to peculiarities of local resistance of S.pneumoniae in different countries. We discussed propriety of some positions of empirical antibiotic therapy in children of early and preschool age., В статье проанализирована текущая ситуация с антибиотикорезистентностью S.pneumoniae. Представлены локальные (региональные) данные о чувствительности пневмококка к аминопенициллинам, макролидам, цефалоспоринам, традиционно используемым в схемах эмпирической антибиотикотерапии внебольничной пневмонии у детей в возрасте до 5 лет. Изложены основные принципы рациональной антибиотикотерапии, основанные на анализе современных отечественных и зарубежных руководств по лечению внебольничной пневмонии. Отмечены незначительные отличия в схемах эмпирической антибиотикотерапии, обусловленные особенностями локальной резистентности S.pneumoniae в разных государствах. Обсуждается корректность некоторых положений эмпирической антибиотикотерапии внебольничных пневмоний у детей раннего и дошкольного возраста., У статті проаналізована поточна ситуація з антибіотикорезистентністю S.pneumoniae. Наведені локальні (регіональні) дані щодо чутливості пневмокока до амінопеніцилінів, макролідів, цефалоспоринів, які традиційно використовуються в схемах емпіричної антибіотикотерапії позалікарняної пневмонії у дітей віком до 5 років. Викладені основні принципи раціональної антибіотикотерапії, основані на аналізі сучасних вітчизняних і зарубіжних настанов з лікування позалікарняної пневмонії. Відзначені невеликі відмінності в схемах емпіричної антибіотикотерапії, що зумовлені особливостями локальної резистентності S.pneumoniae в різних країнах. Обговорюється коректність деяких положень емпіричної антибіотикотерапії позалікарняних пневмоній у дітей раннього та дошкільного віку.

В работе рассмотрены основные критерии диагностики внебольничной пневмонии у детей, характер стартовой антибактериальной терапии и выбор оптимальных лекарственных средств.

Antibiotic therapy is recognized as the only scientifically valid method for the treatment of pneumonia, the outcome of which depends on proper antibiotic and the optimal duration of its administration that ensures the achievement of microbial eradication. The article discusses the duration of antibiotic therapy in uncomplicated community-acquired pneumonia in children. There was a trend to a reduction in the duration of antibiotic use, even with severe cases of the disease course. It is shown that currently there is no serious evidence base that would reliably show the enough duration of 5-day course of antibiotic therapy. It is proposed to consider 7–10 day course of treatment as the optimal duration of effective therapy for uncomplicated pneumonia. Implementation of the concept of short courses of antibiotic therapy is possible only under the supervision of the procalcitonin level., Антибиотикотерапия признана единственным научно обоснованным методом лечения пневмонии, конечный результат которой зависит от правильно выбранного антибиотика и оптимальной продолжительности его введения, что гарантирует достижение микробной эрадикации. В статье обсуждаются вопросы продолжительности антибиотикотерапии при внебольничной неосложненной пневмонии у детей. Отмечена тенденция к сокращению сроков использования антибиотиков даже при тяжелых вариантах течения заболевания. Показано, что в настоящее время серьезная доказательная база, которая бы надежно аргументировала достаточную продолжительность 5-дневных курсов антибиотикотерапии, отсутствует. Предложено рассматривать 7–10-дневный курс лечения как оптимальную продолжительность эффективной терапии неосложненной пневмонии. Реализация концепции коротких курсов антибактериальной терапии возможна только под контролем уровня прокальцитонина., Антибіотикотерапія визнана єдиним науково обґрунтованим методом лікування пневмонії, кінцевий результат якої залежить від правильно обраного антибіотика й оптимальної тривалості його введення, що гарантує досягнення мікробної ерадикації. У статті обговорюються питання тривалості антибіотикотерапії при позалікарняній неускладненій пневмонії в дітей. Відзначено тенденцію до скорочення термінів використання антибіотиків навіть при тяжких варіантах перебігу захворювання. Показано, що на сьогодні серйозна доказова база, яка б надійно аргументувала достатню тривалість 5-денних курсів антибіотикотерапії, відсутня. Запропоновано розглядати 7–10-денний курс лікування як оптимальну тривалість ефективної терапії неускладненої пневмонії. Реалізація концепції коротких курсів антибактеріальної терапії можлива тільки під контролем рівня прокальцитоніну.

У статті зроблено огляд літератури щодо розвитку біоплівок у дихальних шляхах при респіраторній патології та впливу на них амброксолу. Оскільки біоплівкові інфекції погано реагують на стандартну терапію антибіотиками, їх лікування становить серйозну проблему в клінічній практиці. Амброксол чинить гальмуючу дію на утворення та функціональну активність біоплівки, тому є перспективним розширення показань до його застосування в клінічній практиці.

The article considers in detail the mechanisms of therapeutic action of various mucoactive agents. Modern approaches to mucoactive therapy of respiratory diseases in children are presented, they are accompanied by the formation of a viscous secretion. At the same time, the expediency of combined use of drugs having different mechanism of mucoactive action — ambroxol and carbocysteine is justified. In addition, it helps to increase the effectiveness of antibiotic therapy for respiratory diseases.

Вибір антибактеріальних препаратів при лікуванні нозокоміальних пневмоній є досить складною клінічною задачею, що чітко залежить від етіології захворювання. При проведенні антибактеріальної терапії дітям (загальні рекомендації ATS/IDSA) рекомендують: обирати антибіотик згідно з чутливістю до причинно-значимого збудника; віддавати перевагу препаратам з обмеженим спектром антибактеріальної активності; використовувати достатню дозу антибіотика для забезпечення ефективної концентрації в місці інфікування. Першим кроком в алгоритмі вибору антибіотика повинна бути оцінка ризику наявності мультирезистентного патогену як причинно-значимого збудника пневмонії.