Chronic pancreatitis is a multifactorial disease in which repeated episodes of inflammation of the pancreas contribute to the development of fibrous tissue, leading to chronic pain, as well as exocrine and endocrine insufficiency. The incidence and prevalence of chronic pancreatitis in the world are growing, as evidenced by current statistics. In addition, the annual costs associated with the treatment of exocrine and endocrine insufficiency are also increasing. In the United States alone, the annual cost of treating these complications is $ 75.1 million. Exocrine insufficiency is one of the most frequent complications, which is characterized by a deficiency of pancreatic enzymes, leading to the development of malabsorption syndrome (impaired absorption of nutrients, vitamins and minerals). Due to the increased incidence and deterioration of the quality of life associated with this condition, the goal of treatment is to compensate for the deficiency of exocrine enzymes with oral pancreatic enzyme replacement therapy. The core of this therapy is to deliver activated, unbroken enzymes directly to the small intestine during a meal. Many studies have shown that prescribing enzyme replacement therapy improves symptoms associated with exocrine insufficiency, reduces the progression of osteopenia, and improves survival in such patients. The use of pancreatin contributes to the correction of exocrine insufficiency in patients with chronic pancreatitis. The data presented in the article indicate that the drug is a safe and effective agent, meets all modern standards and requirements, and can be used to correct enzymatic pancreatic insufficiency.

Introduction. IBS is a functional bowel disorder that has a significant impact on patients and society, especially in terms of quality of life and medical costs.Pathogenesis. It is believed that the pathogenesis of IBS consists of several mechanisms: the syndrome of intersection of functional disorders (gut-brain), stress, visceral hypersensitivity and changes in motor skills.Visceral hypersensitivity. Changes in visceral sensitivity in IBS are characterized by central abnormalities in areas of the cerebral cortex. Motility impairment in IBS manifests itself as abnormal myoelectric activity in the colon, resulting in repetitive contractions of the small intestine and colon, which appear to cause pain.Intestinal microflora. FODMAPs are found in high amounts in some fruits, artificial sweeteners, legumes, and green vegetables and are poorly absorbed by all people. FODMAPs have enzymatic and osmotic effects that may contribute to the onset of symptoms in some patients.The principles of IBS therapy. Treatment for IBS should be based on the type and severity of symptoms. For the treatment of IBS, drugs of various pharmacological groups are used, depending on the prevailing symptoms. These include opioid receptor agonists, bile acid sequestrants, guanylate cyclase agonists, chlorine channel activators, as well as antibiotics, probiotics, antidepressants, 5-HT3 receptor antagonists, and antispasmodics.Myotropic antispasmodics. Drugs with antispasmodic activity are used to treat functional and organic diseases of the gastrointestinal tract as a basic therapy or «on demand». Mebeverine quickly and effectively relieves spasm, pain and the entire complex of intestinal symptoms, in addition, the drug reduces visceral hypersensitivity due to a local anesthetic effect. The drug has a high safety profile and has a number of advantages over drugs of the same pharmacological group.Conclusion. Myotropic antispasmodics have been shown to be highly effective in the treatment of IBS. Mebeverine occupies a special place among myotropic antispasmodics. Its combined action provides a pronounced antispasmodic activity along with a high safety profile.

TNF-α has been known since 1985. It is a multifunctional proinflammatory cytokine, synthesized mainly by monocytes and macrophages. Since its discovery, many studies have been conducted that have proven that it provides homeostatic function and regulates many biological processes in the body. Violation of its regulation in humans is associated with the development of many autoimmune diseases. The intensive studies that led to the understanding of its polyfunctionality and its role in the immunopathogenesis of a number of diseases served as the basis for the development of anti-cytokine therapy with monoclonal antibodies. In 1975, a technique for producing such antibodies was developed. The first antibodies against TNF-α obtained were chimeric, consisting of 30% mouse protein. Because of this feature, drugs based on chimeric antibodies had immunogenicity, which was manifested in the formation of antibodies to the drug, which led to a decrease in their effectiveness. To reduce immunogenicity, scientists in 1990 created the first fully human monoclonal antibody based on a technology called phage display. This is how adalimumab was born, the first fully human multi-clonal antibody to TNF-α. Humira® (adalimumab) is currently considered a widely studied drug from the group of TNF-α inhibitors, with a good safety and efficacy profile. The article presents current data that demonstrate that the drug significantly improves the course of diseases such as rheumatoid and psoriatic arthritis, and will allow for long-term remission in Crohn’s disease.

Combination of amoxicillin/clavulanate firstly occurred on a pharmacological market in 1977 and it is still has been used successfully for treatment of infections in children and adults. Clavulanic acid provides an opportunity to fight microorganisms that produce specific enzymes – beta-lactamases. Despite the global antibiotic resistance problem, amoxicillin/clavulanate is still active against different infections in children. The level of susceptibility to amoxicillin/clavulanate of St. pneumonia is high for a period of 40 years. Based on the multicenter study of the antimicrobial resistance of pneumococci, haemophilus, group A streptococci, moraxella PeGAS I-III findings, susceptibility to amoxicillin/clavulanate of St. Pneumoniae in Russian Federation has been changed slightly from 100% to 99.6% over a period of 1993 – 2009 y. The systematic review with meta-analysis published in 2019 showed that the sensitivity of hemophilic bacillus and moraxella to amoxicillin/clavulanate in the treatment of acute otitis media accounted for 98% each. The article presents data on clavulanic acid action mechanism, spectrum of amoxicillin/clavulanate activity on the ground of clinical trials and meta-analyses, priority of suspension usage in pediatric practice is explained. Possibilities of using in pediatric practice were also viewed.

Main groups of antisecretory drugs used in the treatment of acid-dependent diseases, including gastroesophageal reflux disease (GERD), are described in a review. Mechanisms of activation, degradation and inactive metabolites formation of proton pump inhibitors (PPIs) – final elements of acid production blockage – are considered in detail. Special attention is paid to the presence of PPIs’ derivatives with different functional activity: inactive derivatives, active and inactive metabolites. Topographic description of these derivatives, their significance in terms of an effect on bioavailability, clinical effectiveness and a potential of PPIs interactions with other administered drugs. The combined decision-making algorithm in the presence of gastroesophageal reflux disease symptoms is presented, compiled on the basis of the most authoritative current recommendations. This algorithm provides for the use of PPIs in standard doses once a day for 4–8 weeks with a possible dose escalation in a case of ineffectiveness. If treatment with high doses of PPIs is ineffective, a set of measures is needed to identify the causes of this inefficiency and to choose additional medical strategy. Depending on the clinical situation, after erosions epithelization the treatment can be stopped, used on demand, prolonged in the intermittent or supportive forms. Particular attention is paid to the Panum® drug, which has proven its effectiveness in patients with different degrees of reflux esophagitis. The availability of dosage forms for prescription and over-the-counter leave allows ensuring its comfortable and unhindered purchase by patients and eliminating excessive burden on the healthcare system.

One of the serious problems during the treatment of osteoarthritis (OA) is the developing of adverse drug events during therapy. Nonsteroidal anti - inflammatory drugs (NSAIDs) are the first drugs with the high incidence and severity of adverse events. This article describes OA treatment strategies approaches for OA are presented using the complex drug Alflutop, which has a composition similar to the human hyaline cartilage. The drug has anti - inflammatory and analgesic effects, normalizes the function of the affected joints, improves the quality of patients' life, also has a structure - modifying effect. Such therapy is safe, well tolerable for patients, and can be used used as a starting complex OA treatment.

Aim: The aim of this work is to assess the organizational risks of H. pylori eradication therapy and the control methods of antibiotic resistance by a clinico-pharmacological analysis of the purchases structure in Russian state-funded medical facilities. Materials and methods: A legal framework in the fields of purchases of products, works, services for state and municipal needs, open contract bids, schedule and annual procurement plans for 2017, the Ministry of Health of Russian Federation statistical materials were explored. Results: According to Russian and international guidelines, current purchases of products, works, services are mainly related to a primary H. pylori identification not its eradication control. “Quasi-reference” H. pylori diagnostic methods with lower sensitivity in comparison to reference ones and extremely low specificity are relatively popular. Conclusion: Information related to the structure of products, works and services purchases for H. pylori diagnostics on the Federal Acts No. 44 and 223 united information web-system (http://zakupki.gov.ru) shows no rational assessment of effective eradication therapy while H. pylori is recognized as a microorganism with a high potential for adverse drug reactions and drug-to-drug adverse interactions development. WHO made H. pylori a priority pathogen for antibiotics research and development.

Onset of fever and pain syndrome in children is one of the most frequent reasons parents take their children to a paediatrician. Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used to relieve such symptoms. The mechanism of action of NSAIDs is to inhibit the activity of the enzyme called cyclooxygenase (COX). Paracetamol, one of the drugs that inhibit COX, exerts its pharmacodynamic effect in the central nervous system, thereby providing antipyretic and analgesic effects, but it is ineffective in stopping inflammation. Such common conditions in children as fever and pain syndrome of mild to medium intensity are among the indications for use of Efferalgan containing paracetamol as an active ingredient. Solution and rectal suppositories are the most commonly used dosage forms of Efferalgan in children, as these dosage forms can be used, when the child reaches 1 and 3 months of age, respectively. The correct dose of paracetamol for a child depends on their weight. It should be remembered that the relief of a fever or pain syndrome is a symptomatic treatment. Therefore, if they appear, you should visit a doctor to identify carefully the possible cause and select the appropriate therapy.

Current risks from resistance, adverse drug reactions, and drug – drug interactions of clarithromycin used as a component of Helicobacter pylori eradication therapy are reviewed. The acid sensitivity of clarithromycin i responsible for the dependence of its pharmacological properties on the efficacy of proton-pump inhibitors, which could be one reason for the resistance of H. pylori to the macrolide. The potential for clarithromycin drug – drug interactions is related to its metabolism by CYP3A4 and strong inhibition of this enzyme.

A comparative dissolution kinetics test was performed to model the actions of pathological duodenogastric reflux and therapeutic acid suppression on the stability of esomeprazole formulations from three different manufacturers. After exposure to solutions pH (1.2 ±0.05) or (4.0 ±0.05), formulations were transferred to medium pH (7.0 ±0.05), from which aliquots were collected at 0, 4, 10, 15, 20, 30, 45, and 60 min for estimation of esomeprazole concentrations. The duration of exposure of the medicinal formulation of esomeprazole to pathological duodenogastric refluxate was 4 min. In these test conditions, Generic-1 and Generic-2 were found not to be equivalent to the reference drug (RD); the medicinal formulation of the RD was probably influenced by pathological duodenogastric reflux in the stomach, while Generic-2 was completely degraded in moderately acidic medium pH 4.0, which is evidence of the possible adverse influence of its main antisecretory pharmacodynamic effect of the intragastric stability of the medicinal formulation and the active substance.

Constipation, which is currently one of the global problems of mankind, requires modern approaches to its pharmacological correction. Constipation that occurs in the absence of organic digestive pathology is in most cases considered a symptom of functional constipation or irritable bowel syndrome, the diagnosis of which is based on the compliance of the patient’s complaints and anamnestic data with the Rome IV criteria for the diagnosis of these functional disorders. Regulax Picosulphate, an intravenous droplet, is a modern laxative drug with a possibility of precise and easy dosing that does not have a local irritant effect on the gastric and duodenal mucous membranes; the efficacy and safety of this drug has been proven in controlled clinical trials.

The article analyzes the results of recent studies on the relationship of iron deficiency, iron deficiency anemia and H. Pylori infection. The results of recent epidemiological studies of the combination of these diseases and the proposed theory of the pathogenesis of iron deficiency in infection with HP, including the role of chronic inflammation supported by HP in the formation of anemia of chronic diseases.

Хроническая сердечная недостаточность (ХСН) относится к числу распространенных и наиболее затратных для системы здравоохранения заболеваний. Заболеваемость ХСН столь велика, что еще в 1996 г. Национальный институт сердца, легких и крови США обозначил эту проблему, как «новую эпидемию в США». В США на 1000 жителей старше 65 лет ежегодно приходится 10 новых случаев ХСН, а 5-летняя выживаемость этих больных не превышает 30-50%. Общая распространенность ХСН составляет от 3-20 случаев на 1000 человек, а у лиц старше 65 лет – до 100 на 1000 населения. С 1968 г. по 1993 г. уровень смертности от ХСН вырос более чем в 4 раза. На лечение больных ХСН тратится от 1,2% (Великобритания) до 2% (Швеция) от всех средств, расходуемых на здравоохранение. Цель настоящего обзора – дать читателю систематизированные данные о группах препаратов, применение которых для терапии ХСН является рациональным с позиций доказательной медицины. Традиционно для терапии ХСН применяются препараты различных фармакологических групп, однако с позиций доказательной медицины лишь у небольшой их части было выявлено положительное влияние на течение заболевания и его исходы. Оптимизация терапии ХСН признается в качестве одной из приоритетных задач в США и Европе. В частности, в последние 5 лет появились американские (Американская ассоциация сердца) и европейские (Европейское кардиологическое общество) рекомендации по терапии ХСН, построенные на принципах доказательной медицины и ступенчатом подходе к выбору препаратов для терапии (выбор групп препаратов основан на тяжести клинических проявлений заболевания).

В обзоре литературы освещено современное состояние проблемы оценки безопасности одного из наиболее широко применяемых в клинической практике прокинетика и антиэметика — домперидона. Особое внимание уделено потенциальной кардиотоксичности препарата, механизмов ее развития и факторов риска. Для снижения риска развития дозозависимых побочных эффектов препаратов созданы новые лекарственные формы, обеспечивающие поддержание концентрации действующего вещества в плазме крови в пределах терапевтического диапазона. Другим способом повышения эффективности и безопасности является использование эффекта потенцирования. В качестве примера приведен домперидон в составе фиксированной лекарственной комбинации с омепразолом (Омез-ДСР), в которой прокинетик представлен формой модифицированного высвобождения, обеспечивающей равномерное поступление действующего вещества в системный кровоток без развития высоких «пиковых» концентраций, сопряженных с повышенным риском дозозависимых нежелательных лекарственных реакций.

Immediacy of the problem of combination therapy of respiratory diseases in paediatric practice is caused by their multifactorial pathogenesis in children and the need to achieve a high clinical effect in the use of drugs at relatively low doses and with minimum risks of serious adverse effects and drug interactions. The fixed-dose combination of salbutamol, bromhexine and guaifenesin produced in the form of tablets and syrup fully meets these requirements, which makes it possible to use it in children and adults with acute, chronic infectious (ARVI, bacterial pneumonia, respiratory tuberculosis, etc.) and non-infectious (bronchial asthma, pulmonary cystic fibrosis, primary ciliary dyskinesia, etc.) diseases.

Aim: To develop evidence-based recommendations for primary care physicians and general practitioners (GP) on choosing the proper management tactics and making valuable & quick diagnostic decisions at outpatient phase for patients with symptoms of dyspepsia, and also reveal possible oncology on time. Summary of recommendations: Approximately 40% of the patients in Russia presenting to primary care with symptoms of dyspepsia. A doctor has to focus on the warning signs, which may require an urgent additional examination & the consultation with a surgeon/onco-surgeon or other specialists if required. With regard to a risk of cancer, a doctor should be more cautious in patients over 45 years of age. Early diagnosis of oncology depends mainly on cautiousness of GP, primary care physicians and their knowledge, future tactics with regard to the patients. From the mandatory diagnostic tests during the first visit, esophagogastroduodenoscopy and H. pylori diagnostics helps to exclude any organic esophagus and stomach pathology, possible oncology. While waiting for endoscopy results, a physician should use the preliminary diagnoses “Uninvestigated Dyspepsia” (ICD-10 К 31.9) (disease of stomach and duodenum, unspecified). After exclusion of all warning signs, therapy of dyspepsia should be in accordance to the order of the Ministry of Health No 248 which gives an option to use proton pump inhibitors (omeprazole or rabeprazole 20 mg daily) in combination with prokinetic (domperidone 30 mg daily). Fixed drug combination of omeprazole 20 mg and modified-release domperidone 30 mg/daily (Omez® DSR) is medically reasonable. Conclusion: The introduction of this recommendation into clinical practice will help clinicians to prevent diagnostic mistakes, unreasonable use of expensive diagnostic examinations and inappropriate treatment leads to improvement in the overall prognosis and quality of life for the patients.

For the first time at children of five various nationalities living in the territory of the Astrakhan region, polymorphism of a gene of CYP2C19 on a polymorphic marker of G681A is studied. Statistically authentic distinction in frequencies of occurrence of genotypes of CYP2C19 associated both with fast, and with a slow metabolism of medicinal means substrata that testifies to importance of individual studying of polymorphism of CYP2C19 is revealed. It is studied, on restored glutathione blood, activity of the second phase of biotransformation of anti-epileptic preparations. Offers on improvement of pharmacotherapy of epilepsy at children are created.

Aim. To evaluate the therapeutic equivalence between generic perindopril (Parnavel, LLC Ozone, Russia) and the original perindopril (Prestarium A, Laboratories Servier, France). Material and methods. Patients with arterial hypertension, grade 1-2 (n=40, aged 35-75 years) were included into the open randomized cross-over trial. The previous anti- hypertensive therapy was discontinued before study for 14 days in all patients. Each of the patients was randomized for alternate 8-week treatment with the original (Prestarium A) and generic (Parnavel) perindopril. Treatment efficacy was assessed by the achievement of target blood pressure (BP) <140/90 mm Hg. The drug dose was increased in the efficacy lack and inapamide was added if necessary. Therapy was discontinued for 14 days after 8 weeks of treatment with the first randomization drug, and the same therapy course with the other study drug was carried out. Side effects were also recorded.Results. A significant reduction in systolic (SBP) and diastolic BP (DBP) was found in patients of Parnavel group by 28 mm Hg (19%) and 17 mm Hg (19%), respectively. In the patients of Prestarium A group SBP and DBP reduction was 27 mm Hg (18.5%) and 16 mm Hg (18.7%), respectively. After 2 months of therapy the target BP level (<140/90 mm Hg) was achieved in 95% and 90% of patients in Parnavel and Prestarium A groups, respectively. Drug tolerability was comparable.Conclusion. Efficacy and tolerability data demonstrated therapeutic equivalence of generic perindopril (Parnavel) to the original perindopril.