[Clinical efficacy of the antimicrobial drug furamag in nosocomial urinary tract infections].

AIM: To evaluate the efficacy of the combined drug furamag (furasidine potassium and magnesium hydroxycarbonate) in combination with the third-generation cephalosporin cefotaxime versus cephalosporin monotherapy for nosocomial urinary tract infections (NUTI). SUBJECTS AND METHODS: The randomized open-label comparative parallel group clinical trial enrolled 52 male and female patients aged over 18 years with a documented diagnosis of NUTI. Group 1 (a study group) took oral furamag 300 mg/day in combination with intravenous cefotaxime 6 g/day; Group 2 (a control group) received cefotaxime monotherapy. The duration of therapy in both groups was 7 to 10 days until the efficiency levels were achieved. RESULTS: A final efficiency analysis was made in 24 and 25 patients from Groups 1 and 2 who had different forms of NUTI (catheter-associated NUTI, cystitis, pyelonephritis). On day 3 of treatment, most patients were noted to have a decreased systemic inflammatory response; lower C-reactive protein and procalcitonin levels being in the study group patients. The clinical efficiency of antibacterial therapy, which had been evaluated both immediately after treatment termination and during further control, did not substantially differ in the furamag/cefotaxime combination and control groups although there was an obvious tendency towards the more marked effect of combined therapy 7-14 days after treatment (11.8% efficiency differences; p>0.05). Analysis of bacteriological efficacy revealed its most pronounced and clinically significant differences between the groups: the cefotaxime/furamag combination led to higher pathogen eradication in all follow-up periods: after 3 days of treatment (82.6%) and following a complete therapy cycle (95.8%) versus the cefotaxime monotherapy group (43.5 and 70.8%, respectively; p<0.01). Microbiological results showed that the major NUTI pathogens (Escherichia coli, enterococci) were more susceptible to potassium furasidine (furamag) versus cefotaxime. The in vitro higher activity of furamag versus cefotaxime was attended by the significantly higher eradication of one of the two important NUTI pathogens - Enterococcus faecalis. CONCLUSION: Furamag used in combination with the third-generation cephalosporin cefotaxime showed a higher bacteriological efficacy and a rapider reduction in the symptoms of a systemic inflammatory response in patients with NUTI. On the basis of the findings, the above combination of furamag and cefotaxime may be recommended as first-line therapy for NUTI when multidrug- resistant nosocomial infection pathogens are widely distributed now.

[Experience of medical backup of military parade on Red Square. Authors showed data about medical backup of military personnel taking part in the parade on Red Square dedicating to anniversary of victory in the Great Patriotic War].

Authors showed data about medical backup of military personnel taking part in the parade on Red Square dedicating to anniversary of Victory in the Great Patriotic War. Experience of running such events allowed to work out an algorithm for medical service: preparatory stage, training stage, running of parade, stage of move out to permanent base. During the parade on Red Square for medical care asked 18 people (participants of parade and civilians). Authors came to conclusion that as a result of medical backup of military personnel taking part in the parade no infectious and group diseases were registered.

[Synergetic basis of the system of specialized medical care, specialized treatment and medical rehabilitation of minimally injured and minimally ill].

The article is devoted to analysis of the current system of specialized medical care, specialized treatment and medical rehabilitation of military casualties of minor nature. The author suggested a synergistic approach to combination of the given system with the aim of determination of development conception. Two main schemes of organization of specialized medical care are considered: medical care during the military conflict and local war; medical care during the regional and large-scale war. Taking into account the function of military field hospital for the treatment of walking wounded it was suggested to add a word combination "center of rehabilitation". The functions of the hospital are considered.

[Experience of medical support organization of the tank biathlon competition].

Authors presented information about medical support of the tank biathlon competition taking part on 12-17 August 2013 at the Alabino. Crews from Belarus, Kazakhstan and Armenia (The Collective Security Treaty Organization) were invited for the contest. On the basis of the idea of the contest and location of the Alabino, the Main military-medical board of the Ministry of Defence of the Russian Federation developed and passed the Programme of medical support of the contest, gave the word to medical service of the Western Military District and central military-medical facilities about appropriation of funds. Personnel, providing the contest, was training every day during the period of preparation. Over a period of field ambulance station 73 people sought medical advice, 12 of them were sent to hospital. Authors came to conclusion the set tasks were completely fulfilled.

[Organization of medical support U.S. Armed Forces].

The article describes the structure of the medical service of the U.S. Army, presented by seven corps,principles of planning of capabilities of medical services and their management, personnel policy of the Medical Service, that focuses on the staffing of the medical service of the officers of the possibilities. Organization of medical care during the combat theater provided by 4 echelons is represented. The first echelon "battlefield-Battalion", the second--"brigade combat team", the third is the rear of the theater of operations, the fourth--stationary hospitals outside the theater of operations. The basic direction of reducing the medical costs of all the troops: military personnel, their families, civilian employees of the Ministry of Defence, members of their families, veterans of military service and their families.

[Historical aspects of formation of Disaster Medicine Service of the Ministry of Defence of the Russian Federation].

International and domestic experience of recent years is convincing evidence that military medical staff can and should be an important part of the national system of emergency medical assistance in emergency situations. The article is concerned with the participation of military medical personnel in Russia and the USSR in the aftermath of natural and technological disasters in the twentieth and twenty-first century. Historical background and 20 years of experience in the formation of Disaster Medicine Service of the Ministry of Defense of the Russian Federation.

[Service for Disaster Medicine of the Ministry of Defence of the Russian Federation at the present stage].

The basic documents of the history of service Disaster Medicine in the USSR and the Armed Forces of the country, employed in this branch of medical terminology, classification of emergency situations are presented. The problem of Disaster Medicine Service of the Ministry of Defence of the Russian Federation at the present stage, the levels of its operations and readiness, as well as the structure and objectives of the medical detachment for special purposes are considered. The involvement of service in peacekeeping operations and medical support of local armed conflicts are assessed.

[The experience of 183 medical special forces of the Volga-Urals Military District in the elimination of the health effects of the emergency in the Republic of Indonesia].

The article is based on personal experience of the authors with assistance in the aftermath of the tsunami in the Republic of Indonesia, which killed about 120 thousand (December 26, 2004 at 255 km to the west coast of Sumatra). In the disaster area were sent to 183 medical detachments for special purposes of the Volga-Urals Military District, reinforced brigade of specialized medical care of military medical institutions under the central government and the Moscow Military District. As the authors noted, in the aftermath of a disaster like the tsunami, at first put forward preventive measures among displaced persons. The experience gained by the Medical Service of the Armed Forces of the Russian Federation in the aftermath of natural disaster in the Republic of Indonesia, is used to plan future humanitarian operations abroad with the assistance of military medical specialists from Russia.

[Experience with mobile units of Disaster Medicine Service of the Russian Defense Ministry in local wars and armed conflicts].

The article describes the experience of using of mobile medical units for medical support of combat operations in the armed conflicts in the North Caucasus. The factors affecting the operation of medical services in local wars and armed conflicts are analyzed. Suggestions for the optimization of organizational structure and principles of the use of mobile units service Emergency Medicine are formulated.

[Status and directions of improving of surveillance subsystem of sanitary-epidemiological situation in the service of emergency medicine of the Ministry of Defense].

The article provides a description of the composition and tasks of government, forces and means of preventive direction of Disaster Medicine Service in countering the biological threats. The subsystem of supervision of sanitary-epidemiological situation, functioning at the central, regional and territorial levels is entrusted with the organization and conduct of monitoring activities, monitoring, assessment, prediction, prevention and elimination of the adverse health and sanitary emergencies. The author suggests the promising areas of optimization of the subsystem of supervision of sanitary-epidemiological situation.

[Application of new technologies in the design, manufacture and use of technology deployment of field medical units and establishments].

Presented data is about attendance means of deployment of field medical units and pieces of army-level medical services and disaster medicine Defense Ministry did not ensure compliance with requirements to create optimal conditions for highly effective work of the medical staff, placing the wounded, the use of modern aids and appliances. The prospects of creation of mobile unit for high-availability modular pre-fabricated on the basis of tent structures, pneumoconstructions and removable habitable bodies, containers, tents, pneumocovers till 2020 are analyzed. Livelihood systems provide armor protection against fragments, bullets, flames, damaging factors of chemical and biological weapons.

[Organization of medical equipment and stock supply of military medical facilities and groups of Disaster Medicine Service of the Russian Defense Ministry in emergency situations].

The article outlined the modern concept of medical equipment and stock supply of medical facilities and groups of Disaster Medicine Service of the Russian Defense Ministry involved into the remedial of the medical actions of emergency situations. The structure of the units of medical supplies in these conditions is presented.

[Analysis of the use of field medical units in the armies of NATO and Russian Armed Forces].

An analysis of medical services of NATO and the Medical Service of the Armed Forces of the Russian Federation of modern technology deployment stages of medical evacuation (tents, inflatable structures, shelters, containers, medical armored vehicles, cars, etc.) is presented. Examples of their usage in isolated employment, usage in the group as a mobile medical stations and field hospitals in various conditions, the prospects and directions of development of technical means deployment of medical service are given.

[Infective endocarditis of staphylococcal etiology: clinical process and antibacterial therapy].

Characteristics of the clinical process of staphylococcal endocarditis in 115 inpatients and the adequacy of various regimens for their antibiotic therapy within a period of 10 years were analysed. Four clinical criteria for prognosis of staphylococcal endocarditis were determined: intravenous narcomania, splenomegalia, leukocytosis and hemorrhagic skin eruption. The analysis of the Russian and foreign findings showed that the use of betalactams (oxacillin, the 1st and 3rd generation cephalosporins) and lincomycin provided the adequate therapy resulting in eradication of the pathogen in case of oxacillin resistant staphylococci, whereas the use of ciprofloxacin and vancomycin was inexpedient. In case of MRSA it was recommended to use vancomycin and in case of endocarditis due to S. aureus with intermediate resistance to vancomycin (VISA, MIC > 0.5 mcg/ml) the use of linezolid was recommended.

[Organization of medical support of troops in the course of Georgia peace enforcement operation].

In the course of operation the medical armed units and institutes of permanent readiness realized the buildup of forces and measures of the medical service. Supplementary were provided: to enforce the 236th military hospital (Vladikavkaz)--group of medical enforcement from Main and central military hospitals; to enforce the 1602nd regional hospital (Rostov-on-Don)--brigade of specialized medical aid of MMA of Kirov S.M.; the 183rd separated medical group of special purpose (semegosp SP) (PUMR). From 14 to 28 of August 2008 the 529 semegosp SP provided the medical aid to 456 patients (350 persons of them were servicemen), 221 persons were hospitalized, 136 persons were evacuated. Additionally an autobandaging room was established in the structure of surgical group. From 14 to 28 of August 2008 the 183 MU SP provided the medical aid to 115 patients (104 persons of them were servicemen), 32 persons get a stationary treatment, 21 persons were hospitalized, 25 persons were evacuated, 8 persons were discharged. Generally, medical service, which took party in operation of Georgia peace enforcement, realized all missions.

[Levofloxacin and macrolides in chronic bronchitis exacerbation: comparative analysis of the treatment efficacy and nonrelapsing periods].

Clinical and bacteriological efficacies of levofloxacin versus clarithromycin and azithromycin were evaluated in 41 patients with chronic bronchitis infectious exacerbation in the Respiratory-Recovery Centre of Polyclinic No. 7. The effect of the drugs on the nonrelapsing period was estimated as well. With the use of levofloxacin there was observed a more rapid elimination of the clinical signs of the exacerbation as compared to the use of the macrolides. Levofloxacin provided a more pronounced and stable eradication of the main pathogens of the exacerbation as compared to the macrolide antibiotic. Long-term monitoring for 12 months after discontinuation of the treatment showed that the nonrelapsing period in the patients treated with levofloxacin was higher and the frequency of the relapses and their intensity were lower in comparison to the group of the patients treated with the macrolides.

[Evaluation of efficacy and safety of josamycin (Vilprafen) in the treatment of patients with community-acquired pneumonia].

Clinical and bacteriological efficacy ofjosamycin (Vilprafen), a macrolide antibiotic, was studied in 30 out- and inpatients at the age of 18 to 68 years (the average of 43.4+/-16.7 years old) with nonsevere (PORT) community-acquired pneumonia in the case histories. Josamycin was administered orally in a dose of 500 mg every 8 hours for 7 to 10 days. The treatment course was 5 to 10 days (the average of 7.7+/-1.3 days). The recovery was stated in 28 (93.3%) patients and the pathogen eradication was recorded in 16 (88.9%) patients. Moderate side effects not requiring discontinuation of the drug use were observed in 3 patients. The results of the treatment were indicative of the josamycin high efficacy in the treatment of the patients with nonsevere community-acquired pneumonia.

[Efficacy of moxifloxacin in the treatment of secondary peritonitis].

Moxifloxacin efficacy was studied in a prospective open controlled incomparable surveillance of 22 patients at the age of 24 to 78 years (the average of 56.6 +/- 15.9 years old) with extended secondary peritonitis that developed before the hospitalization or not later than 48 hours after the hospitalization. Moxifloxacin (Avelox) was used in a dose of 400 mg every 24 hours at first intravenously as infusions and then orally in the same dose. The abdominal infection was severe (APACHE II of 6 to 12, the average of 8.0 +/- 2.2), in 6 (27.3%) patients signs of severe sepsis with polyorganic insufficiency were observed. The intravenous therapy was used for 3 to 7 days (the average of 3.91 +/- 0.92 days) and the oral therapy was used for 2 to 7 days (the average of 4.50 + 1.37 days). The total time of the treatment was 7 to 12 days (the average of 8.45 +/- 1.53 days). The recovery was recorded in 20 out of the 22 patients (90.9%), disappearance of the main signs of peritonitis being observed within 3-5 days of the treatment. Before the treatment 34 microbial strains were isolated. The most frequent pathogens were E.coli (35.4%) and Enterococcus faecalis (20.6%). In the etiological structure of the community-acquired peritonitis gramnegative enterobacteria prevailed (65%). All the isolates (except 1 strain of E. faecalis) were susceptible to moxifloxacin. The pathogen eradication was stated in 17 out of 18 patients (94.4%). Moderate adverse reactions were observed in 3 patients. Moxifloxacin evidently showed high clinical and bacteriological efficacies in the hospitalized patients with complicated intraabdominal infection including severe abdominal sepsis with the syndrome of polyorganic insufficiency. It can be used for monotherapy of patients with secondary extended peritonitis.

[Clinicomicrobiological monitoring of patients with exacerbation of chronic bronchitis treated with antibacterial drugs].

AIM: To compare clinical and microbiological efficacy of penicillines and macrolids in patients with exacerbation of chronic bronchitis (CB) basing on long-term follow-up after antibacterial treatment. MATERIALS AND METHODS: Twenty patients with exacerbated CB or chronic obstructive pulmonary disease (COPD) received amoxicillin/clavulanic acid (augmentin) while 20 other patients were given macrolides (sumamed or clacide). Clinical efficacy was assessed by the rate of exacerbation regression and duration of recurrence-free period in the course of 12-month follow-up. Bacteriological examination was conducted 3-5 days, 1 month after the treatment and at recurrent exacerbation. RESULTS: Patients on augmentin showed faster regression of exacerbation, earlier remission and higher quality of remission than patients on macrolides. Eradication of etiologically significant pathogens on day 3-5 after therapy with augmentin and macrolides was achieved in 92 and 30% patients, respectively, persistence--in 8 and 70%, respectively. Mean duration of remission was 263 +/- 107.1 and 164.9 +/- 112,2 days, respectively. A correlation was found between duration of recurrence-free period and frequency of eradication and persistence of the agents after antibacterial therapy of CB and COPD. CONCLUSION: Augmentin promotes a significantly earlier regress of exacerbation symptoms and persistent remission. Eradication potential of augmentin in CB/COPD patients is higher than that of macrolides. Long-term post-exacerbation monitoring (12-month follow-up) discovered that recurrence-free period of augmentin-treated patients is much longer than in patients on macrolides.

[Multicentre study of comparative efficacy of meropenem and combined regimens for empirical antibacterial therapy of severe nosocomial infections: results of clinical and pharmacoeconomic analysis].

Adequacy and effectiveness of empirical antibacterial therapy of severe nosocomial infections with meropenem vs. combined regimens of antibacterial therapy were investigated and the ratio of the cost and effectiveness of the compared regimens was evaluated. A prospective, randomized, open, comparative study of two initiative regimens of empirical antibacterial therapy of severe nosocomial infections was performed: meropenem in a daily dose of 1.5-3 g and the standard regimen with the use of betalactams and fluoroquinolones in combination with aminoglycosides and/or metronidazole. Patients with recorded diagnosis of nosocomial pneumonia (including the ventilator-associated one) or abdominal infection with the signs of severe sepsis and severity of APACHE II > 14 were enrolled. The patients were stratified into 2 groups subject to the disease severity, i.e. APACHE II 15-20 and APACHE II 21-25. One hundred thirty five out of 166 patients with recorded nosocomial infection were included into the final estimate of the therapy adequacy and effectiveness (Protocol Analysis): 62 patients were treated with meropenem and in the treatment of 73 patients the standard antibacterial therapy was used. In the group of the patients treated with meropenem there were stated significantly higher clinical effectiveness (recovery in 80.6% of the patients vs. the control of 46.6%, p < 0.01) and pathogen eradication (89.6 and 48.1% respectively, p < 0.01). The difference in the clinical and bacteriological effectiveness of meropenem and the standard therapy was more evident in the subgroups of more severe patients (APACHE > 20). With the use of meropenem the probability of recovery from nosocomial infection was significantly higher (RR 1.73-1.94, p < 0.001) vs. the control. Meropenem provided significantly higher eradication of the pathogens: P. aeruginosa (88 and 40% respectively, p = 0.007), E. coli (100 and 46.7%, p = 0.003), Acinetobacter spp. (90.9 and 40%, p = 0.02). The antibacterial therapy with the use of meropenem was assessed as adequate in 51 out of 56 patients (91.1%), that was 3 times as frequent as with the use of the standard antibacterial therapy (33.9%). The cost-effectiveness coefficient with the use of meropenem was 2.2 times lower vs. the control. Therefore, the empirical therapy of severe nosocomial infections with meropenem proved to be more adequate and from the economic viewpoint more advantageous vs. the standard combined regimens of antibacterial therapy, that was evident from significantly higher clinical and bacteriological efficacy of the treatment and decrease of the terms of the patients hospitalization in intensive care units (on the average by 5 days).