[Clinical and bacteriological efficacy and tolerability of meropenem in the treatment of bronchopulmonary affections in children with mucoviscidosis].

Meropenem (in combination with amikacin) was used in the treatment of children and adolescents with mucoviscidosis and severe exacerbation of bronchopulmonary affections. The drug showed satisfactory clinical and moderate bacteriological effects (48.3%) as dependent on the severity and duration of the disease and the microbial flora. Meropenem was well tolerated: no side effects were observed during the treatment, whereas it was used in high doses (60-105 mg/kg daily).

[Efficacy and safety of cefepime in the treatment of bronchopulmonary disease exacerbation in pediatric patients with mucoviscidosis].

Clinicobacteriological effect of cefepime (in combination with amikacin) was studies in 25 pediatric patients of the age of 7 to 17 years with a mixed form of mucoviscidosis at the stage of the bronchopulmonary infection exacerbation. The basic pathogens isolated from the sputum were: Pseudomonas aeruginosa sm., P. aeruginosa muc. (67.5%) and Staphylococcus aureus (29.1%). The 2-week treatment course resulted in a marked clinical effect with improvement of the lung functional indices and eradication of the majority of the S. aureus strains (81.2%) and half of the P. aeruginosa strains (49.6%). The only side effect was moderate diarrhea not requiring discontinuation of the drug use.

[Efficacy and safety of cefoperazone/sulbactam in the treatment of children with mucoviscidosis during exacerbation of the bronchopulmonary process]. / Effektivnost' i bezopasnost' tsefoperazona/sul'baktama pri lechenii obostrenii bronkholegochnogo protsessa u detei s mukovistsidozom.

The use of cefoperazone/sulbactam in combination with amikacin in the treatment of 20 patients with mucoviscidosis and exacerbation of bronchopulmonary pathological process resulted in marked positive dynamics of the clinical and functional indices of the lungs state. The bacteriological effect with respect to the main pathogens in the cases of mucoviscidosis was strain-dependent: eradication of 10 (83.4%) out of 12 Staphylococcus aureus strains and only 3 (15.8%) out of 19 Pseudomonas aeruginosa strains. The most frequent adverse reaction was diarrhea (5 children) successfully corrigated by loperamide. Discontinuation of the drug use was required in 3 patients because of macrohematuria (1 child) and allergic eruption.

[Pefloxacin in the treatment of patients with mucoviscidosis]. / Mesto pefloksatsina v lechenii bol'nykh mukovistsidozom.

It was shown that microbial flora isolated from the bronchial secretion of 39 patients with mucoviscidosis in 1999-2001 consisted in one third (32.8%) of S. aureus strains. Evaluation of pefloxacin efficacy in the case of monoinfection and pathogens association revealed potent antistaphylococcal effect of the drug. Positive result was demonstrated in 82.3% cases by the 7th day. Among the side effects dominated arthropathy which disappeared at the period from 3 days to 3 months after drug administration was stopped.

[On fluoroquinolones treatment safety in children (clinical, morphological and catamnesis data)]. / O bezopasnosti primeneniia ftorkhinolonov u detei (kliniko-morfologicheskie i katamnesticheskie dannye).

Results of prospective comparative investigation of monofluoroquinolones (ciprofloxacin, ofloxacin, pefloxacin) arthropathy are presented. The trial was performed at 144 children with mucoviscidosis (aged 0.5-16) and at 37 children with aplastic anemia (aged 1.75-15). Two groups differ by necessary antibacterials regimes and hence by different abilities for arthropathy development: patients with mucoviscidosis were treated with fluoroquinolones followed by repeated short courses in combination with other antibacterials; patients with aplastic anemia--were treated permanently for a long time with low doses as monotherapy for autoinfection prophylaxis. Analysis was performed on the base of catamnesis, year growth rate, postmortal morphological investigation of the right knee joint. It was shown that quinolone arthropathy development didn't depend on treatment duration, as it developed during the first three weeks of the fluoroquinolone use, but depended on the drug, patient age and nosology. Arthropathy has favourable prognosis and was fully resolved at the period from 7 days to 3 month according to the arthropathy form (arthrologic, arthritic). Quinolones arthropathy at the children has specific features, the main one is absence of cartilage damage confirmed by morphological analysis.

[Comparative efficacy and safety of ciprofloxacin, ofloxacin, and pefloxacin in treatment of respiratory infections in children with cystic fibrosis]. / Sravnitel'naia éffektivnost' i bezopasnost' tsiprofloksatsina, ofloksatsina i pefloksatsina pri lechenii infektsii dykhatel'nykh putei u detei s mukovitsidozom.

Data on comparative investigation of the clinical and bacteriological efficacy and tolerability of monofluoroquinolones ciprofloxacin, ofloxacin and pefloxacin are given. The results confirm good clinical efficacy of all three monofluoroquinolones and high antistaphylococcal activity of pefloxacin. Efficacy of monofluoroquinolones against P. aeruginosa and S. maltophilia was moderate--only isolation of bacteria from spetrum became lower. Tolerability of monofluoroquinolones was good. Only at 5 patients the drugs use was stopped (4 in the ciprofloxacin group and 1--in the pefloxacin group). At 2 patients it was caused by arthropathy which was drug- and age-dependent. Quinolone-arthropathy was more often in the pefloxacin group and was registered only at the children elder than 10 years old with arthrological anamnesis. This arthropathy differed from experimental one by positive outcome and full recovery in the period from 7 days to 3 months. Results of morphological investigation confirmed clinical data--no invalidizing cartilage damage was revealed.

[Antibiotic therapy of cystic fibrosis in children]. / Antibiotikoterapiia pri muskovistsidoze u detei.

It is postulated that P. aeruginosa in monoculture or in association with Staphylococcus aureus keeps its leading position in chronic bacterial inflammatory broncho-pulmonary processes in children with cystic fibrosis. Antibiotic resistant strains of Burkholderia cepacia, Stenotrophomonas maltophila, Alcaligenes xylosoxidans were revealed (7.1% of the strains). P. aeruginosa strains were susceptible to aminoglycosides, ciprofloxacin, and polymixin B. Susceptibility of smooth and mucoid forms of P. aeruginosa to ceftazidime stayed at the level of 49.6-57.1%. Such microbial associations as P. aeruginosa sm. + S. aureus, P. aeruginosa sm. + P. aeruginosa muc. + S. aureus were mainly susceptible to ciprofloxacin, aminoglycosides and resistant to ceftasidime. Meropenem, cefepim and ciprofloxacin are highly effective antibiotics for the treatment of broncho-pulmonary processes exacerbations at children with chronic P. aeruginosa cystic fibrosis. Intravenous use of antibiotics out of hospital for the treatment of the children with cystic fibrosis is clinically effective, and is economically and psychologically reasonable. It should be used more widely in medical practice.

[Evaluation of tolerance and efficacy of pefloxacin in the treatment and prevention of severe infections in children with mucoviscidosis and aplastic anemia]. / Otsenka éffektivnosti i perenosimosti pefloksatsina pri lechenii i profilaktike tiazhelykh infektsii u detei s mukovistsidozom i aplasticheskoi anemiei.

Pefloxacin (Abaktal) efficacy and safety were investigated at 21 children (7-16 years old) randomized in 2 groups: children with mucoviscidosis and children with aplastic anemia. The drug was used at the dose 15-20 mg/kg per day bid for 14-28 days. Pefloxacin was used in combination with ceftazidime and amikacin. Combined therapy demonstrated good clinical efficacy. Bacteriological efficacy was not uniform: staphylococci were not isolated from sputum since the 7th day of treatment, but pseudomonads were cultured even on the 14th day of the treatment (the sensitivity to pefloxacin remained). The only but frequent side-effect was arthropathy. The background and some peculiarities of arthropathy development were analyzed. This phenomenon is called quinolone-induced synovitis. The risk group for quinolone-induced synovitis was estimated--children elder than 10 years with allergic anamnesis. Good clinical efficacy and tolerability of pefloxacin at the children with mucoviscidosis or aplastic anemia is a reason and base to cancel the limits to its use in pediatrics.

[The efficacy and safety of ciprofloxacin in treating children with mucoviscidosis]. / Effektivnost' i bezopasnost' tsiprofloksatsina pri lechenii detei s mukovistsidozom.

Ciprofloxacin clinical and bacteriological efficacies, as well as tolerability mainly with respect to chondrotoxicity were evaluated in the treatment of children with mucoviscidosis. The drug was shown to have high clinical and moderate bacteriological efficacies. As for its tolerability, adverse reactions chiefly associated with affection of the gastrointestinal tract, i.e. nausea, stomach pain, diarrhea, increased transaminase levels were recorded. The arthrotoxicity episode was single and transitory. The use of ciprofloxacin had no negative effect on the children growth. No chondrotoxic effect of ciprofloxacin in the treatment of children was observed which is explained in the paper. It is concluded that ciprofloxacin is in general an efficient and safe antibiotic useful for the treatment of children.

[Comparative morphological analysis of the articular cartilage, epiphyseal plate, spongy bone, and synovial membrane of the knee joint in children treated and not treated with ciprofloxacin]. / Sravnitel'nyi morfologicheskii analiz sostoianiia sustavnogo khriashcha, épifizarnoi plastinki, gubchatoi kosti i sinovial'noi obolochki kolennogo sustava u detei, poluchavshikh i ne poluchavshikh tsiprofloksatsin.

Comparative data on he postmortem morphological examination of the knee joint in children treated and not treated with ciprofloxacin while alive are presented. Nine children were ill with mucoviscidosis and 8 children were ill with aplastic anemia. The patients were ill with mucoviscidosis and 8 children were ill with aplastic anemia. The patients were treated with ciprofloxacin in a daily dose of 20 to 40 mg/kg body weight at the average for 148 days. The condition of the articular cartilage, growth area, spongy bone and synovial membrane of the knee joint was examined visually, histologically and morphologically. It was revealed that ciprofloxacin had no chondrotoxic effect. The structure affected in some cases by the ciprofloxacin treatment was the synovial membrane which developed subacute synovitis not clinically manifested (latent) in life. The phenomenon is explained.

[Fluorine level in the bone and cartilage in children treated with ciprofloxacin (data obtained from the femur distal part]. / Soderzhanie ftora v kosti i khriashche u detei, poluchavshikh tsiprofloksatsin (na modeli distal'nogo otdela bedrennoi kosti)

Comparative data on the content of fluorine in various sections of the left femur distal part, i.e. spongy bone, process zone and articular cartilage are presented. The examination was performed on postmortem sections from 10 pediatric cases (the average age of 9.5 years) with mucoviscidosis or aplastic anemia treated before the death for up to 12 months with ciprofloxacin in a dose of 20 to 40 mg/kg body weight. The control postmortem sections were from 10 practically healthy children (the average age of 10.4 years) killed in a car accident. The sections were subjected to 2-stage dry ashing with ionometric determination of the fluorine ions. The results were treated according to the V.Yu. Urbach procedure. It was shown that the content of fluorine in the sponge bone and process zone in both the groups did not significantly differ. A comparatively high content of fluorine was detected only in the postmortem sections of the articular cartilage from the children of the main group who however had no chondrotoxic symptoms while alive. That means that the difference is statistically and clinically insignificant.

[The safety of ofloxacin]. / K voprosu o bezopasnosti ofloksatsina.

The data on a comparative study of ofloxacin arthrotoxicity in pediatric and adult patients are presented. The tolerability of ofloxacin used in various doses and treatment terms (acute and cumulative effects) was investigated in children. The impact of the patient pubertal age, sex, ofloxacin concentrations (Cmax above 4 micrograms/ml) and arthrological diseases (in adult patients) on the risk of the quinolone arthropathy was evaluated. Good tolerability of the various ofloxacin dosing regimens in both the adult and pediatric patients was shown.

[Therapeutic drug monitoring and the pharmacokinetics of carbamazepine in children with a convulsive syndrome]. / Terapevticheskii lekarstvennyi monitoring i farmakokinetika karbamazepina u detei s sudorozhnym sindromom.

An analysis of maximal and minimal serum concentrations of carbamazepine was performed in 40 children with convulsive syndrome. All the patients received the drug for a long period. Considerable case-to-case differences of serum concentrations in spite of practically equal doses were revealed. Serum drug concentrations were therapeutically optimal (6-8 mg/ml) only in one third of children. On the basis of pharmacokinetic parameters, mean optimal dosages sufficient for maintenance of effective and safe carbamazepine concentrations were calculated. As the child grows general clearance of carbamazepine decreases. Over the age of 9 years it is significantly lower in girls than in boys of the same age. Speed of carbamazepine elimination was higher in cases of combined treatment than in cases of monotherapy. Indications and optimal time for therapeutic drug monitoring of carbamazepine are determined and clinical illustrations are presented.

[Use ciprofloxacin in children with mucoviscidosis]. / Opyt primeneniia tsiprofloksatsina u detei, bol'nykh mukovistsidozom.

Ciprofloxacin was used in treatment of 13 children aged 6 to 18 years with mucoviscidosis and exacerbation of the bronchopulmonary process. The dose of the drug was 20 to 30 mg/kg a day when administered orally or 15 mg/kg a day when administered at first intravenously and then orally. The treatment course averaged 14 days. The indications to the drug use were: severe processes of mucoviscidosis and chronic colonization of the bronchial mucosa and lung tissues with Pseudomonas aeruginosa (mucoid or nonmucoid form) sensitive to ciprofloxacin and resistant to other antibiotics. The trials showed that ciprofloxacin was highly efficient: the state of the patients improved and the inflammation index of the total blood count normalized. However, eradication of P. aeruginosa from the respiratory tracts was not observed. The drug allergy in 1 patient and a transient increase in the level of transaminases in 5 patients as the adverse reactions were recorded.