Медицинский совет (Nov 2020)
Macrolides in the modern therapy of community-acquired pneumonia in children
Abstract
Community-acquired pneumonia remains one of the most pressing problems in pediatrics. The article presents data on its prevalence, child mortality from this disease, diagnostic criteria and approaches to therapy. In the Russian Federation, respiratory diseases in children aged 0-17 take third place in the structure of causes of death after external causes and malformations. The age characteristics of the etiological spectrum of community-acquired pneumonia in children and the problem of drug resistance of pathogens are discussed in detail. The sharp increase in resistance to macrolide antibiotics of the most common pathogen of the disease in early and pre-school age, pneumococcus, which occurred in recent years, makes it necessary to reconsider the question of the place of these drugs in pediatric practice. At the same time, macrolides remain highly active against atypical pathogens, whose etiological significance increases with age. In this regard, modern indications for prescription of macrolides, unique distinctions of 16-membered josamycin macrolide from other drugs of this series, and mechanisms of its action are reviewed and clarified in the article. Due to the peculiarities of its chemical structure, josamycin remains active against a significant part of pneumococci, which is increasingly resistant to 14- and 15-membered macrolides. The advantages of children’s dosage forms are presented, in particular, the dispersible tablet (solutab). This form, due to controlled release, provides convenience of use, maximum bioavailability (regardless of food intake), minimal frequency of side effects, and does not affect the gastrointestinal motility. Treatment of pneumonia and other respiratory tract infections, especially in young children, is not limited by antibiotics, is always complex and is based on the prevailing syndromes in the clinical picture.
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