RESUMEN
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.
Asunto(s)
Control de Enfermedades Transmisibles , Enfermedades Transmisibles , Brotes de Enfermedades/prevención & control , Personal Militar , Vacunas Neumococicas/uso terapéutico , Neumonía Bacteriana , Adulto , Femenino , Humanos , Masculino , Medicina Militar/métodos , Neumonía Bacteriana/epidemiología , Neumonía Bacteriana/prevención & controlRESUMEN
AIM: To make a comparative clinical and economic evaluation of the use of the combination drug Influnet in the treatment of acute respiratory viral infections (ARVI). SUBJECTS AND METHODS: A total of 103 medical records of outpatients with uncomplicated mild and moderate ARVI were studied. There were three groups: 1) 35 patients who received therapy with Influnet; 2) 31 patients who took Rinza; 3) 34 patients who were on treatment without the combination drug. RESULTS: Analysis of comparative clinical effectiveness of the drugs revealed that the use of Influnet was accompanied by the rapider alleviation of fever and other ARVI symptoms and by its shorter treatment duration (4.5 ± 0.5 days) versus that of Rinza (5.5 ± 1.4 days) and monocomponent drugs (5.6 ± 1.2 days). Economic analysis showed that in terms of indirect costs associated with shorter temporary disability in patients with ARVI, Influnet therapy was more economically sound for them. CONCLUSION: The results demonstrate the higher clinical and economic feasibility of Influnet therapy for ARVI versus its alternative therapy. Combination drugs cause fewer adverse reactions than a combination of monocomponent drugs used to treat ARVI and are more cost- effective for the patient.
Asunto(s)
Antivirales/uso terapéutico , Combinación de Medicamentos , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Virosis/tratamiento farmacológico , Enfermedad Aguda/economía , Enfermedad Aguda/terapia , Adulto , Antivirales/economía , Femenino , Humanos , Masculino , Evaluación de Resultado en la Atención de Salud/economía , Infecciones del Sistema Respiratorio/economía , Virosis/economía , Adulto JovenRESUMEN
The article presents broad information, which is the result of longstanding observation (2002-2006) There are also presented adequate financial data. The article unfolds peculiarities of multiyear and annual dynamics of morbidity rate by out-hospital pneumonias in Moscow military circuit, educes and proves the basic risk factors of disease, shows its value. The accent is made on military and study units. Recommendations on lowering morbidity rate by out-hospital pneumonias, existing in the article, are based on the own experience of the authors, their effectiveness is proved by real positive results.
Asunto(s)
Higiene Militar , Personal Militar , Neumonía , Infecciones Comunitarias Adquiridas/epidemiología , Infecciones Comunitarias Adquiridas/etiología , Humanos , Higiene Militar/organización & administración , Higiene Militar/normas , Higiene Militar/tendencias , Moscú , Neumonía/epidemiología , Neumonía/etiologíaAsunto(s)
Antibacterianos/uso terapéutico , Adhesión a Directriz , Hospitales Militares , Personal Militar , Neumonía Bacteriana/tratamiento farmacológico , Adolescente , Adulto , Antibacterianos/administración & dosificación , Farmacorresistencia Bacteriana , Quimioterapia Combinada , Humanos , Masculino , Medicina Militar , Neumonía Bacteriana/prevención & control , Control de CalidadAsunto(s)
Ácido Ascórbico/uso terapéutico , Aspirina/uso terapéutico , Difenhidramina/uso terapéutico , Personal Militar , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Rutina/uso terapéutico , Enfermedad Aguda , Adolescente , Adulto , Ácido Ascórbico/administración & dosificación , Ácido Ascórbico/efectos adversos , Aspirina/administración & dosificación , Aspirina/efectos adversos , Difenhidramina/administración & dosificación , Difenhidramina/efectos adversos , Combinación de Medicamentos , Humanos , Rutina/administración & dosificación , Rutina/efectos adversos , Resultado del TratamientoAsunto(s)
Enfermedades Respiratorias/tratamiento farmacológico , Acetaminofén/uso terapéutico , Enfermedad Aguda , Adolescente , Adulto , Analgésicos/uso terapéutico , Antioxidantes/uso terapéutico , Antivirales/uso terapéutico , Ácido Ascórbico/uso terapéutico , Gluconato de Calcio/uso terapéutico , Terapia Combinada , Dibenzoxepinas/uso terapéutico , Combinación de Medicamentos , Antagonistas de los Receptores Histamínicos H1/uso terapéutico , Humanos , Masculino , Clorhidrato de Olopatadina , Rimantadina/uso terapéutico , Rutina/uso terapéutico , Resultado del TratamientoRESUMEN
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.
Asunto(s)
Dipiridamol/uso terapéutico , Brotes de Enfermedades/prevención & control , Inductores de Interferón/uso terapéutico , Personal Militar , Infecciones del Sistema Respiratorio/prevención & control , Adolescente , Adulto , Dipiridamol/administración & dosificación , Humanos , Inductores de Interferón/administración & dosificación , Masculino , Estudios Prospectivos , Infecciones del Sistema Respiratorio/epidemiología , Infecciones del Sistema Respiratorio/etiología , Federación de Rusia , Estaciones del Año , Virosis/complicaciones , Virosis/epidemiologíaRESUMEN
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.
Asunto(s)
Dipiridamol/uso terapéutico , Inhibidores de Fosfodiesterasa/uso terapéutico , Infecciones del Sistema Respiratorio/prevención & control , Enfermedad Aguda , Adolescente , Adulto , Método Doble Ciego , Humanos , Masculino , Vigilancia de la Población/métodos , Estudios ProspectivosRESUMEN
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.
Asunto(s)
Antibacterianos/uso terapéutico , Profilaxis Antibiótica , Azitromicina/uso terapéutico , Portador Sano/prevención & control , Infecciones Comunitarias Adquiridas/prevención & control , Personal Militar , Enfermedades Nasofaríngeas/prevención & control , Infecciones Neumocócicas/prevención & control , Infecciones del Sistema Respiratorio/prevención & control , Administración Oral , Adolescente , Adulto , Antibacterianos/administración & dosificación , Antibacterianos/farmacología , Azitromicina/administración & dosificación , Azitromicina/farmacología , Clindamicina/farmacología , Infecciones Comunitarias Adquiridas/epidemiología , Farmacorresistencia Bacteriana , Eritromicina/farmacología , Humanos , Pruebas de Sensibilidad Microbiana , Penicilinas/farmacología , Federación de Rusia , Streptococcus pneumoniae/efectos de los fármacos , Streptococcus pneumoniae/aislamiento & purificaciónRESUMEN
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).
Asunto(s)
Antibacterianos/uso terapéutico , Azitromicina/uso terapéutico , Bronconeumonía/prevención & control , Personal Militar , Infecciones del Sistema Respiratorio/prevención & control , Adolescente , Adulto , Amoxicilina/uso terapéutico , Bronconeumonía/tratamiento farmacológico , Bronconeumonía/microbiología , Humanos , Masculino , Infecciones del Sistema Respiratorio/tratamiento farmacológicoAsunto(s)
Antibacterianos/uso terapéutico , Eucariontes/efectos de los fármacos , Hongos/efectos de los fármacos , Bacterias Gramnegativas/efectos de los fármacos , Bacterias Grampositivas/efectos de los fármacos , Sepsis/tratamiento farmacológico , Animales , Antiinflamatorios/uso terapéutico , Antiprotozoarios/uso terapéutico , Eucariontes/aislamiento & purificación , Eucariontes/patogenicidad , Hongos/aislamiento & purificación , Hongos/patogenicidad , Bacterias Gramnegativas/aislamiento & purificación , Bacterias Gramnegativas/patogenicidad , Bacterias Grampositivas/aislamiento & purificación , Bacterias Grampositivas/patogenicidad , Humanos , Sepsis/etiologíaAsunto(s)
Neumonía Bacteriana/prevención & control , Neumonía Neumocócica/prevención & control , Antibacterianos/uso terapéutico , Azitromicina/uso terapéutico , Chlamydophila pneumoniae/efectos de los fármacos , Chlamydophila pneumoniae/aislamiento & purificación , Chlamydophila pneumoniae/patogenicidad , Farmacorresistencia Bacteriana/genética , Humanos , Personal Militar/estadística & datos numéricos , Neisseria meningitidis/efectos de los fármacos , Neisseria meningitidis/aislamiento & purificación , Neisseria meningitidis/patogenicidad , Neumonía Bacteriana/epidemiología , Neumonía Neumocócica/epidemiología , Streptococcus pneumoniae/efectos de los fármacos , Streptococcus pneumoniae/aislamiento & purificación , Streptococcus pneumoniae/patogenicidad , Vacunas/uso terapéuticoAsunto(s)
Antibacterianos/uso terapéutico , Azitromicina/uso terapéutico , Neumonía Bacteriana/tratamiento farmacológico , Neumonía Bacteriana/prevención & control , Adolescente , Adulto , Farmacorresistencia Microbiana/genética , Humanos , Incidencia , Masculino , Personal Militar , Neumonía Bacteriana/epidemiología , Federación de RusiaAsunto(s)
Antibacterianos/uso terapéutico , Neumonía/tratamiento farmacológico , Índice de Severidad de la Enfermedad , Adolescente , Adulto , Chlamydophila pneumoniae/efectos de los fármacos , Humanos , Masculino , Personal Militar , Neumonía por Mycoplasma/tratamiento farmacológico , Neumonía Neumocócica/tratamiento farmacológico , Resultado del TratamientoRESUMEN
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).
Asunto(s)
Antibacterianos/uso terapéutico , Claritromicina/uso terapéutico , Infecciones Comunitarias Adquiridas/tratamiento farmacológico , Personal Militar , Neumonía Neumocócica/tratamiento farmacológico , Streptococcus pneumoniae/aislamiento & purificación , Adolescente , Adulto , Antígenos Bacterianos/análisis , Cromatografía/métodos , Claritromicina/efectos adversos , Infecciones Comunitarias Adquiridas/diagnóstico , Enfermedades Gastrointestinales/inducido químicamente , Humanos , Técnicas Inmunológicas , Masculino , Neumonía Neumocócica/diagnóstico , Estudios Prospectivos , Juego de Reactivos para Diagnóstico , Esputo/microbiología , Streptococcus pneumoniae/inmunología , Urticaria/inducido químicamenteAsunto(s)
Medicina Militar , Personal Militar , Neumonía Bacteriana/tratamiento farmacológico , Antibacterianos/uso terapéutico , Brotes de Enfermedades/prevención & control , Humanos , Neumonía Bacteriana/diagnóstico , Neumonía Bacteriana/epidemiología , Neumonía Bacteriana/microbiología , Neumonía Bacteriana/prevención & control , Federación de Rusia/epidemiologíaRESUMEN
The paper presents clinical examples evidencing complicated diagnosis and course characteristics for the pulmonary variant of ornithosis infection. There is a table of the leading diagnostic signs promoting more rapid and precise determination of the ornithosis origin of the pulmonary inflammation.
Asunto(s)
Neumonía/diagnóstico , Psitacosis/diagnóstico , Enfermedad Aguda , Diagnóstico Diferencial , Errores Diagnósticos , Humanos , Masculino , Persona de Mediana Edad , Psitacosis/clasificaciónRESUMEN
The results of the catamnestic study of case reports and records of postmortem examination of 102 patients with bronchial asthma (BA) aged 47 to 88 years who died at a general hospital during 1976-1988 indicate that in the overwhelming majority of cases, there took place death "with asthma" rather than death "from asthma". At the same time the dominant pathology was coronary heart disease (acute coronary failure, myocardial infarction, progressive heart failure associated with atherosclerotic and postinfarction cardiosclerosis). Emphasis is laid on the fact that according to the autopsy data, the rate of the recognized stenosing atherosclerosis of the coronary arteries considerably exceeded the number of cases of coronary heart disease documented clinically (typical angina pectoris of effort, significant macrofocal myocardial infarction). The characteristic features of the group under observation included an unexpectedly frequent combination of BA and malignant neoplasms (24 cases), including lung cancer in 13 of these cases.