[Prophylaxis of Community-Acquired Pneumonia Outbreaks with Pneumococcal Polysaccharide Vaccine. Prospects Analysis for Russian Military Community].

Pneumococcal pneumonia and other diseases caused by pneumococci still remain the main factors of high morbidity and mortality rates throughout the world. Pneumococci as the leading pathogens of community-acquired pneumonia (CAP), acute otitis media and sinusitis also cause a number of other serious systemic disorders including invasive infections with high mortality in spite of the antimicrobial resistance status and adequate antimicrobials choice. Pneumococcal infections are responsible for 5-35% or more of community-acquired pneumonias. The burden of pneumonia (up to 100-200 per thousand) is recorded among military recruits in training centers. Since the specific environment of the soldiers could be carrected, their health protection requires medical surveillance. For these reasons, polysaccharide and more immunogenic conjugated pneumococcal vaccines were developed. There is now an urgent need to understand whether such vaccines are effective in military conscripts. Controversy about the effectiveness and value of the polysaccharide (PPV-23) vaccine as a CAP morbidity restriction measure still persists. There were implemented plenty of metaanalyses of pneumococcal vaccines in adults. Some of them showed that the vaccine was effective against bacteremic pneumococcal pneumonia in 'low risk' healthy adults and elders. There have been a number of poor quality observational studies in Russia where 'all pneumonia cases' were considered as an endpoint. It remains controversial whether these observational studies provide adequate evidence to justify the use of the polysaccharide vaccine in the groups of healthy young men for whom it is being advocated. In our analysis we found weak evidence supporting pneumococcal vaccination with PPV-23 for this group. Nevertheless, favorable tendency was found to immunize. It is the reason for a trail to find pharmacoepidemiological support for vaccination by novel conjugated vaccines with better immunogenicity.

[Vaccinal Prevention of Lower Respiratory Tract Pneumococcal Disease in Adults Without Immunosuppression.]

Community-acquired pneumonia (CAP) remains one of the major healthcare problems globally. Pneumococcal disease is the leading cause of deaths among vaccine preventable diseases in children and adults. Plain polysaccharide vaccine PPSV-23 and conjugated pneumnococcal polysaccharide vaccine PCV-13 are widely used to prevent pneumococcal disease and CAP in adults without immunosuppression. The review concerns the results of trials and meta-analysis of PPSV-23 and PCV-13 effectiveness in invasive pneumococcal disease (IPD) and CAP prevention in immunocompetent adults. More and more expert immunization committees in different countries are taking into consideration uncertain effectiveness of PPSV-23 in CAP prevention in immunocompetent adults, and recommend the PCV-13 priority use for mass immunization campaigns in high-risk groups and elder population. Since the Russian Federation has started the PCV-13 vaccination campaign for early childhood only at the end of 2014, the anticipated serotype replacement should not be taken into consideration at the moment across all the age groups, and therefore the risk and age based approach to adult vaccination should be used with the PCV-13 priority.

[Prophylaxis of respiratory infections outbreaks with dipyridamol in young servicemen]. / Profilaktika dipiridamolom vspyshek respiratornykh infektsii u molodogo popolneniia.

The purpose of investigation was to evaluate the efficiency and safety of dipyridamole (the inductor of endogenous interferon) in prevention of outbreaks of extrahospital pneumonia (EP) and acute respiratory diseases (ARD). 2226 servicemen arrived to the educational center were studied. In the control group (n = 1034) EP developed in 11.9%, clinically significant ARD cases were noted in 18.7% (in prophylaxis group 9.6 and 11.7% respectively). The efficiency and safety of dipyridamole used to prevent ARD was demonstrated.

[The use of azithromycin in prophylaxis of respiratory infections occurred in the organized collectives, clinical sequelae]. / Klinicheskie posledstviia profilaktiki azitromitsinom infektsii dykhatel'nykh putei v organizovannykh kollektivakh.

The influence of azithromycin prophylaxis on clinical course of extra-hospitalpneumonia (EP) and efficiency of empirical antibiotic therapy was studied. During 5 months EP was diagnosed in 2 groups (prophylaxis and control) in 8.6% (47/548) and 20.2% (137/678) subjects respectively. Mild EP was diagnosed in all cases. No significant differences in EP clinical course between the groups were noted. The empirical therapy using benzylpenicillin was considered as effective in 90.5% [95% CI=84.3-94.9%] and in 89.4% [95% CI=76.9-96.5%] cases in the control group and group of prophylaxis respectively (P=0.84).

[Efficacy and safety of azithromycin prophylaxis of respiratory tract infections in military community]. / Effektivnost' i bezopasnost' profilaktiki infektsii respiratornogo trakta azitromitsinom v organizovannom kollektive.

The efficacy and safety of azithromycin prophylaxis of community-acquired pneumonia (CAP) in young adults in a military training centre of the Ministry of Defence of the Russian Federation located in the Central European Region of Russia were studied. Two prophylactic regimens with azithromycin vs. the control were evaluated: azithromycin, 500 mg/w for 8 weeks (R1), azithromycin, 1500 mg once upon the enrolment (R2) and no drugs (R3). Nasopharyngeal carriage of Streptococcuspneumoniae and its susceptibility to antibacterials were estimated thrice: before the exposure, after the exposure within the 9th week and after the exposure within the 20th week. The MLS(B) phenotype was suspected when the isolates were resistant to erythromycin and clindamycin. During the observation period of 22 weeks CAP was diagnosed in 20.2% of 678 subjects in group R3, 8.6% of 508 subjects in group R1 (Risk Ratio =0.4, 95% Cl = 0.3-0.6) and 10.3% of 507 subjects in group R2 (Risk Ratio = 0.5, 95% Cl = 0.4-0.7). The S.pneumoniae carriage rate at visit 0 was 34-35%, within the 9th week it was 75, 66 and 50% (p<0.05) in groups R1, R2 and R3 respectively, and within the 20th week it was 69, 57 and 36% in the same groups (p<0.05). At visit 0 no macrolide resistance was detected in any of the 40 isolates tested. The background level of intermediate penicillin resistance was revealed in 0-14% of the isolates. Dramatic growth of macrolide resistance was observed within the 9th week in group R1 (95.7%, 44 resistant strains, Azithro+Clinda resistance in 37% of them) and in group R2 (89.5%, 34 resistant strains, Azithro+Clinda resistance in 11.9% of them). By the 20th week the resistance rate decreased up to 40 % (16 resistant strains, Azithro+Clinda resistance in 10% of them) in group R1 and up to 22.6% (7 resistant strains, Azithro+Clinda resistance in 5.4% of them) in group R2. As for penicillin resistance, no unfavourable shifts were detected. The study demonstrated the effectiveness of the azithromycin prophylaxis of CAP in healthy young men at high transient risk of the disease, as well as the possible risk for selection of resistant endemic pathogens.

[Dipyridamole prevention of outbreaks of respiratory infections in the homogeneous population]. / Profilaktika dipiridamolom vspyshek respiratornykh infektsii v gomogennoi populiatsii.

The purpose of the study was to evaluate the effectiveness and prevention of outbreaks of community-acquired pneumonia (CAP) and acute respiratory diseases (ARD). The study included conscripts arrived at a training center. An 8-week course of prevention (curantyl, 100 mg a week) was assessed. The end point of the study was a new case of CAP and ARD. The study covered 2333 persons, of them 2226 completed the study. In the control group (n = 1034), CAP developed in 11.9% of the examinees (95% confidence interval (CI), 10-14%), clinical cases of ARD were observed in 18.7% (95% CI, 16-21%. The same parameters in the prophylaxis group (n = 1192) were 9.6% (95% CI, 8-11%) and 11,7% (95 CI, 10-14%). The relative risk of the diseases for a prevention group was 0.8 (95% CI, 0.7-1.1) (p = 0.34) and 0.6% (95% CI, 0.5-0.8) (p < 0.0001), respectively. The study has demonstrated that dipyridamole is effective and safe as a drug for preventing ARD. The findings were slightly more scarce than those obtained by other authors, which may explain the performance of the study in summer when the role of respiratory viruses and related disease is not so significant.

[Exacerbation of chronic obstructive pulmonary disease: current approaches to antibacterial therapy]. / Obostrenie khronicheskoi obstruktivnoi bolezni legkikh: sovremennye podkhody k antibakterial'noi terapii.

The article outlines current approaches to empiric antibacterial therapy of patients who had exacerbation of chronic obstructive pulmonary disease (COPD). The choice of the antibiotics should be made basing on the frequency of exacerbations, COPD duration, severity of bronchial obstruction, age of the patient, concomitant visceral lesions. Common errors in antibacterial therapy are analysed: wrong choice of the antibiotic, mode of drug administration, dose, dose regimen, duration of treatment (too long); simultaneous intake of antibiotics and nistatine; frequent change of antibiotics throughout the treatment.

[Evaluation of clarithromycin efficacy in the treatment of community-acquired pneumonia on the basis of the Binax NOW test results (a prospective open trial)]. / Otsenka éffektivnosti klaritromitsina pri terapii vnebol'nichnykh pnevmonii, osnovannoi na rezul'tatakh testa Binax NOW (otkrytoe prospektivnoe issledovanie).

The results of the treatment of community-acquired pneumonia with clarithromycin (500 mg bid for 6-8 days) at 172 patients (military recruits aged 18-25) are presented. Diagnosis, infection performance, treatment efficacy were evaluated by complex of data (X-ray, sputum analysis by bacteriological and cultural tests and immunochromatography test Binax NOW for pneumococcal antigen identification). High efficacy of clarithromycin for the treatment of moderate and mild pneumonia (including pneumococcal pneumonia) was demonstrated. Side effects were registered at 6.2 per cent of patients (gastro-intestinal disorders at 5 patients) and 1 general urticaria at 1 patient whose treatment had to be changed).