развитие онкологии идет в ногу с фармакоэкономическими исследованиями, поскольку новые методики лечения зачастую являются не только высокоэффективными, но и затратными. Проведен АВС/VEN анализ на базе онкологического диспансера, оказывающего помощь населению с онкологическими заболеваниями в полном цикле лечения и включающего в себя три стационара и поликлинику, за 2024 год. Коечный фонд диспансера – 730 коек, в том числе 553 круглосуточные койки, 18 коек отделения анестезиологии и реанимации, 159 коек дневного пребывания. При проведении АВС/VEN – анализа выяснилось, что вся группа А приходится на препараты для противоопухолевой лекарственной терапии. Затраты на прочие лекарственные средства составили не более 5,17% от общей суммы потраченных средств. Наибольшее количество денег затрачивается на пертузумаб, пембролизумаб, олапариб, бевацизумаб, энзалутамид, палбоциклиб, цетуксимаб, атезолизумаб, кабозатиниб, ниволумаб. Все позиции из группы А относились к категории V. Проведенный ABC/VEN анализ позволяет сделать вывод, что лекарственная политика в онкологическом диспансере является рациональной, лидерами затрат являются моноклональные антитела и ингибиторы протеинкиназ, что обусловлено спецификой лечебной деятельности учреждения. oncology advances are closely linked to pharmacoeconomic research, as new treatment methods are often not only highly effective but also costeffective. An ABC/VEN analysis was conducted for 2024 at an oncology dispensary providing care for the population with cancer across the full treatment cycle and comprising three inpatient facilities and an outpatient clinic. The hospital has 730 beds. An ABC/VEN analysis revealed that the entire A group was comprised of anticancer medications. Other medications accounted for no more than 5.17% of the total expenditure. The ABC/VEN analysis suggests that the oncology clinic's drug policy is rational, with monoclonal antibodies and protein kinase inhibitors leading the cost, due to the specific nature of the clinic's treatment activities.

Introduction . Uncorrected dyslipidemia worsens the prognosis after acute coronary syndrome (ACS). The effective lipid-lowering therapy (LLT) may be important including proprotein convertase subtilisin/kexin type 9 inhibitors (iPCSK9). There is not enough data about the effect of iPCSK9 initiation time on ACS outcomes. Aim . To evaluate the effect of iPCSK9 initiation time on ACS outcomes during 18 months of follow-up. Materials and methods . We observed 33 consecutive patients discharged from the hospital who met the following criteria: 1) hospitalization with ACS, 2) low-density lipoprotein cholesterol (LDL-C) > 3.9 mmol/l, 3) consent to visits at 3, 6, 12 and 18 months after ACS, 4) initiation of iPCSK9 therapy within a year after discharge. In 17 patients iPCSK9 therapy was initiated ≥3 months (group 1), and in 16 patients – <3 months after ACS (group 2). LLT was performed in outpatient clinics or regional lipid center. Adverse outcomes were monitored for 18 months. Results . 6 and 12 months after ACS the proportions of individuals with target LDL-C values in group 2 were 2.3 (p = 0.009) and 1.6 (p = 0.024) times higher than in group 1. In groups 1 and 2, the proportions of individuals requiring cardiovascular rehospitalizations were 9 (52.9%) and 2 (12.5%), respectively, p = 0.017. There were no fatal outcomes. The need for rehospitalizations was inversely correlated with the early start of PCSK9-targeted therapy (R = -0.47; p = 0.0001) as well as with the treatment at the lipid center (R = -0.42; p = 0.0004). Conclusions . Early initiation of iPCSK9 is associated with rapid achievement of target LDL-C values in ACS survivors and 4.2-fold reduction in the need for cardiovascular rehospitalizations. The use of a lipid center as a basic institution for LLT also contributes to the lower need for rehospitalizations.

В статье представлен клинический случай лечения пациента с раком прямой кишки, осложнившимся развитием инфицированной биломы. В лечении онкологических заболеваний достигнуты значительные успехи в последние годы. Однако инфекции, связанные с оказанием медицинской помощи, могут ухудшать прогноз после хирургических вмешательств. В таком случае актуальной становится не только борьба с онкологическим процессом, но и с инфекционными осложнениями. Краеугольным камнем лечения становится антибиотикотерапия, которая может быть осложнена развитием резистентности микробной флоры. При назначении антибиотиков следует учитывать наличие факторов риска полирезистентных штаммов, что позволяет оптимизировать стартовую антибиотикотерапию.

Objective: to perform pharmacoepidemiological and drug interaction analysis of pharmacotherapy for liver/kidney transplantation.Material and methods. The study was conducted on the basis of multidisciplinary hospital in Nizhny Novgorod, which provides both therapeutic and high-tech surgical care. The object of the study was medical records of 34 patients who had undergone pharmacotherapy for liver/kidney transplantation. We evaluated the particularly dangerous moderate interactions that pose the greatest risk to patient health using Drugs.com electronic resource. Pharmacoepidemiologic assessment was performed using the ATC/DDD methodology (anatomical therapeutic chemical (ATC) classification system – defined daily dose (DDD)) recommended by the World Health Organization. The “average bed occupancy per year” was calculated using DDD per 100 bed-days. ABC analysis was used to estimate the costs of drug groups in therapy for liver/kidney transplantation. Results. In most cases, the third generation cephalosporins were used in the therapy of liver/kidney transplant patients (55.56% of all prescriptions). Antimicrobial drugs were mostly prescribed as monotherapy (61.9%). There were 111 potential major (14.41%) and moderate (72.07%) interactions detected. The largest number of moderate type risks was associated with changes in blood pressure levels (in 23.75% of cases – possible decrease, in 10% – increase), 7.5% of cases were accompanied by headaches, 6.25% – by reduction of drug effectiveness. In antimicrobial therapy, two main interactions were found: moxifloxacin – tacrolimus (arrhythmia), and metipred – moxifloxacin (tendon dystrophy), which is 12.5% of all main interactions for 21 case histories. In the ABC analysis, immunosuppressants were in group A (cost share 85.8%). Tacrolimus accounted for the largest amount of consumption: number of defined daily doses (NDDD) per year was 532.27 mg, NDDD per 100 bed days reached 432.18 (the highest among all drugs).Conclusion. Pharmacoepidemiologic analysis allows us to systematize data on medication use. The choice of drugs in order to ensure safe and effective use of the registered drug interactions is facilitated by electronic databases.

Aim. To analyze the complications of liver and pancreas surgeries, including infectious complications, and to describe the evolution of microbial flora in the hepatopancreatobiliary surgery unit.Materials and methods. The study involved 650 patients who underwent pancreatoduodenectomy and 1253 patients after liver resection. Types of preoperative biliary drainage were evaluated in terms of their influence on the treatment results. The incidence and nature of postoperative bile leakage were studied. The study included an analysis of microbial flora in the hepatopancreatobiliary surgery unit for 10 years.Results. The rate of significant complications, including infectious complications, appeared to be unaffected by a type of bile ducts drainage with potential infection at a standard course after pancreatoduodenectomy. A pancreatic fistula is considered to be a major factor in the development of abdominal infectious complications and the main cause of unfavorable outcomes. A bile leakage was most often revealed after liver resection in 95 observations (7.5%), and significantly more often after extensive liver resections. Gram-negative flora prevailed in bile from external drains of bile ducts and wound exudates in two thirds of cases. Gram-positive microorganisms were detected in one third of patients, fungi – in less than 5% of cases. The drainage fluids mostly obtained polyresistant gram-negative microorganisms. The majority of strains revealed resistance to cephalosporins, fluoroquinolones, penicillins, and an increasing resistance to carbapenems in dynamics.Conclusion. Bacterobilia after bile duct drainage significantly determines a microbial landscape of a hepatopancreatobiliary surgery unit. Pancreatodigestive anastomotic leakage is recognized as an important predictor of infectious complications in the area of intervention after pancreatoduodenectomy. Cases of this kind require the antimicrobial therapy with respect to the initial flora of the biliary tract. A bile leakage is considered to be a main contributor to infectious complications after liver resection. Extensive liver resection can lead to a sepsis-like state in the early postoperative period, predisposing to infectious complications.

Objective: pharmacoepidemiological analysis of medication list used in a multidepartmental hospital.Material and methods. The material for the analysis was the costs of medications for the reporting period of 2017–2018. We used the tools of ABC/VEN analysis and import substitution assessment. The assessment of import substitution in a medical organization was carried out in comparison of 2018 with 2017 by the change in costs for various pharmacotherapeutic groups of medications in two segments (domestic and foreign production) in percentage terms.Results. The results of the analysis revealed, that the antibiotics are the largest volume of the cost structure for various pharmacotherapeutic groups: 18.8% in 2017 and 15.6% in 2018. The analysis of the medication list used in a medical organization, regarding to the production segment, showed that in 2017 22.6% was spent on domestic medications. In 2018, this indicator increased by 15.2% and amounted to 37.8%. The correct, regular distribution of groups V, E, N in groups A, B, C was revealed. More than 80% of group A consists of medications from group V of all monetary costs and the share of medication belonging to group N is less than 3%. In total, the cost of medications of groups V and E is more than 90%.Conclusion. The use of these methods allows to optimize the costs of medications provision for therapeutic and diagnostic processes and to improve pharmaceutical diseases therapy. In 2018, compared to 2017, there is a redistribution of the cost structure for medications towards an increase in the share of Russian-made medications. Given the lower cost of Russian medications compared to imported analogues, this approach will allow in the future to save the money of medical organizations with no deterioration in the quality of treatment.

The article presents the results of a study of potential drug interactions in the treatment of moderate and severe community-acquired pneumonia (CAP) in hospital settings. The study was conducted by analysis of treatment standards and data from real clinical practice regarding antimicrobial therapy. Methods. The study used the lists of drug products for medical use for the treatment of CAP (according to the standards of specialized medical care for moderate and severe CAP with complications). Also, the medical records of patients (n = 165) with CAP, hospitalized in hospitals of medical organizations (Nizhny Novgorod) were used. The study period was 2 years (2015 - 2016). The study included all patients admitted to the hospital during the analyzed period. CAP was treated in accordance with treatment standards. Results. The analysis of potential interactions of drugs used for moderate and severe CAP according to the treatment standards, showed that 27 and 72 drugs can be used, respectively. 325 potential interactions are possible in hospital settings for moderate CAP and 2,485 for severe CAP. According to the treatment standard, the number of minimally clinically significant potential interactions during the pharmacotherapy of moderate CAP in hospital settings is 8, the number moderately clinically significant interactions - 19; undesirable interactions - 7. In case of severe CAP, the number of potential interactions increases and amounts to 27 minimally clinically significant, 105 moderately clinically significant, and 41 undesirable. The analysis of the results of antimicrobial therapy in real clinical practice showed 4 therapeutic duplications (prescribing 2 β-lactam antibacterial drugs simultaneously) and 2 moderately clinically significant interactions during antimicrobial therapy in hospital 1. Only 1 therapeutic duplication was noted during antimicrobial therapy in hospital 2. Therapeutic overlap has been found between β-lactam antibacterial drugs (ceftaroline fosamil and meropenem). It is advisable to prescribe no more than one в-lactam antibacterial drug and it is inappropriate to include > 3 antimicrobial drugs in an antimicrobial regimen. Conclusion. Electronic databases simplify the selection of medicines and thus ensure the safe and effective use of registered drug interactions.

УДК 615.036.8РАЗРАБОТКА ПРОТОКОЛОВ АНТИБИОТИКОТЕРАПИИ В ОТДЕЛЕНИИ РЕАНИМАЦИИ С УЧЕТОМ АНАЛИЗА МИКРОБНОЙ РЕЗИСТЕНТНОСТИ Руина О.В. 1,2, Фурман М.Г. 1 , Бельский В.А. 1 , Тотмина Т.Б. 1 , Конышкина Т.М. 2 , Саперкин Н.В. 2 , Жукова О.В. 2 , Шпрыкова О

The purpose of the study Is to conduct DDD analysis and DU90% analysis of antimicrobial therapy of community-acquired pneumonia in the real clinical practice of the inpatient department of the federal center in Russia. Material and methods. The materials for the study are data from 48 case histories of patients with CAP, hospitalized in the Volga District Medical Centre (VDMC) under Federal Medical and Biological Agency (FMBA) of Russia in Nizhny Novgorod in 2016. The patients' age ranged from 22 to 84 years (54.79+17.49). The diagnosis was confirmed by x-ray examinations at admission. The average severity of the disease was diagnosed in 41.67% (20 patients), the severe degree of the disease in 58.33% (28 patients). When conducting a retrospective pharmacoepidemiological assessment, DDD analysis and DU90% analysis were used. Results. The largest number of prescriptions falls on III generation cephalosporins and fluoroquinolones. The largest NDDD value corresponds to levofloxacin, followed by ceftriaxone (NDDD = 108.5 g, which is 4.3 times less than for levofloxacin). Within the framework of 100 bed-days in the hospital, 69.67% of patients receive levofloxation therapy, which is several times greater than the proportion of patients receiving therapy with other antimicrobial agents. The group constituting 90% of all the NDDD antimicrobial drugs consumed in CAP included: levofloxacin - 71.19%, ceftriaxone - 16.50%, ertapenem - 4.70%. The DU10% segment was comprised of medications with the share in the real structure of prescriptions amounting to 24.56%. The cost of one DDD in the DU90% segment (6,022.88 rubles) is 1.9 times higher than that in the DU10% segment (3,166.73 rubles), which allows discussing the extensive use of expensive drugs. Conclusions. Drugs, included in the group of 90% according to the results of DU90%, accounted for 75.44% in the real purpose structure. Expensive antimicrobials (original drugs and high-quality generics) were predominantly used in the hospital. The cost of one DDD in the DU90% segment is almost 2 times the cost of DDD in the DU10% segment.

ВЗАИМОСВЯЗЬ ПОТРЕБЛЕНИЯ АНТИБИОТИКОВ И ЛОКАЛЬНОЙ МИКРОБИОТЫРуина О.В

Научный диалог: Вопросы медицины» 2

ВЗАИМОСВЯЗЬ СТРУКТУРЫ НАЗНАЧАЕМЫХ ПРЕПАРАТОВ С КОМОРБИДНОСТЬЮ У ПАЦИЕНТОВ С САХАРНЫМ ДИАБЕТОМ 2-ГО ТИПА НА ГОСПИТАЛЬНОМ ЭТАПЕРуина О.В. 1,2, Хазов М.В. 1 , Борисов В.И. 2 , Конышкина Т.М. 2 , Жукова О.В. 2 , Зайцева Е

Clinical and anamnestic features of 85 children hospitalized for bronchial asthma, aged 5 to 17 years, were analyzed.Revealed that the severe course of the disease is characterized by an earlier onset.There is a hereditary burden of the disease.The creation of a hypoallergenic regimen and the conduct of basic drug therapy is underestimated by parents of children with mild asthma.

The necessity of implementing clinical economic studies was conditioned by a significant prevalence of infections of urinary tracts, wide variety and high cost of antibacterial pharmaceuticals for their treatment. The sampling included 539 cases of application of step schemes of antibiotics treatment in patients of urological departments in 2014-2015. Overall, six the most prevalent schemes (87.4% of all cases) were picked out. Every scheme was analyzed by application rate, clinical efficiency, treatment cost and average duration of patient stay in hospital. The most clinical efficiency was established for the scheme that included amoxicillin + сlavulanic acid in injection and peroral components without implementing peri-operational antibiotics prevention (97.7%). However, period of hospitalization was in average 2.9 days longer and transition of patient from injection component of therapy to a peroral one occurred 2.3 days later than in case of application of the same pharmaceutical in combination with peri-operational antibiotics prevention (efficiency index 96.0%). It is established that the scheme with amikacin being from economic point of view the most attractive one (cost of treatment is 2.5-6.1 times lower and period of hospitalization the shortest) and differing by high clinical efficiency (95.2%) is applied only in 4.4% of analyzed cases because amikacin has many side effects restricting its application in medical practice. The received information permits physician to rationally prescribe optimal schemes of treatment that decreases costs of therapy, risk of development of complications initiated by antibacterial therapy and also increases quality of life of patient.

AIM:to study the features of microbiota in patients of urological departments and to optimize the schemes of antibiotic therapy.MATERIALS AND METHODS:Data of microbiological studies in patients of urological departments in 2017 years were analyzed. Isolation of pathogens was carried out using standard techniques. A disk diffusion test using Mueller-Hinton agar with BioRad disks was used to determine the sensitivity. The statistical analysis was performed using the WHONET 5.4 program. In addition, a comparison with the results of the PCR study was done.RESULTS:A total of 672 etiological pathogens were isolated in whole clinic in 2017 year. From those, 173 pathogens were found in the urological clinic, which accounted for 25.7% of the total number. Gram-negative bacteria predominated and its proportion was 59.23%. Gram-positive bacteria were isolated in 24.4%, and fungi were found in 16.37% of cases. The structure of pathogens isolated from stoma or obtained by catheterization was not significantly different. Most frequently isolated pathogens included @K. pneumonia (22.8%), @E. coli (21.2%), @C. albicans (17%), @P. aeruginosa (11%), @E. aerogenes (6%) and @S. aureus (3 %). @K. pneumonia usually had an unfavorable resistance pattern. E. coli isolated from urine samples had more favorable resistance pattern in comparison to pathogens obtained from stoma. The bacteria which were found in intensive care unit had the increased level of resistance.CONCLUSION:Gram-negative bacteria predominate in the urological clinic with a relatively high proportion of extended-spectrum beta-lactamase-producing organisms. Risk factors for the emergence of multi-resistant pathogens are the treatment in the intensive care unit and the presence of stomas or catheters. The PCR method, carried out in parallel with routine microbiological studies and regular analysis of the overall bacterial spectrum, allows to optimize the starting antibiotic therapy from the first day of the disease. The use of cephalosporins is not justified in the most cases. Aminoglycosides and fluoroquinolones remain effective. The use of either -Lactamase-protected penicillins or fosfomycin is possible only after obtaining the results of bacteriological study. When prescribing carbapenems, the risk of inefficiency is especially high in patients with stomas/catheters and transferred from the intensive care unit.

The necessity of implementing clinical economic studies was conditioned by a significant prevalence of infections of urinary tracts, wide variety and high cost of antibacterial pharmaceuticals for their treatment. The sampling included 539 cases of application of step schemes of antibiotics treatment in patients of urological departments in 2014-2015. Overall, six the most prevalent schemes (87.4% of all cases) were picked out. Every scheme was analyzed by application rate, clinical efficiency, treatment cost and average duration of patient stay in hospital. The most clinical efficiency was established for the scheme that included amoxicillin + сlavulanic acid in injection and peroral components without implementing peri-operational antibiotics prevention (97.7%). However, period of hospitalization was in average 2.9 days longer and transition of patient from injection component of therapy to a peroral one occurred 2.3 days later than in case of application of the same pharmaceutical in combination with peri-operational antibiotics prevention (efficiency index 96.0%). It is established that the scheme with amikacin being from economic point of view the most attractive one (cost of treatment is 2.5-6.1 times lower and period of hospitalization the shortest) and differing by high clinical efficiency (95.2%) is applied only in 4.4% of analyzed cases because amikacin has many side effects restricting its application in medical practice. The received information permits physician to rationally prescribe optimal schemes of treatment that decreases costs of therapy, risk of development of complications initiated by antibacterial therapy and also increases quality of life of patient.

The aim is to study the clinical and economic components of antimicrobial therapy (AMT) of community-acquired pneumonia (CAP) in a hospital ptactice.Materials and methods. Case reports of 48 patients with CAP hospitalized in FBU PMLC FMBA in the city of Nizhny Novgorod during 2016 were studied. All patients with CAP hospitalized during that period were included in the study. A retrospective analysis of AMT was carried out based on the data from inpatient CAP cases.Results. We compared the real number of prescriptions of antimicrobial agents for CAP in this hospital with the number of prescriptions required by the approved standards. We found that the real numbers exceeded the recommended standards in the cases of severe CAP as follows: 2.1- fold for 3d generation cephalosporins, 1.3-fold for fluoroquinolones, and 1.3-fold for carbapenems. Also notable was the use of ceftaroline fosamil – the 5th generation cephalosporin, which was not part of the standard therapy. Macrolides were not given to patients with severe CAP. In the treatment of CAP of moderate severity, fluoroquinolones were used 1.2 times more often than that recommended by the standard protocol, 3d generation cephalosporins – 1.5 times more often; macrolides – 5 times less often, as well as carbapenems (not part of the standard) and 5th generation cephalosporins (not part of the standard). The average duration and cost of monotherapy of moderate CAP were: 10.5 days and 731.65 rubles for ceftriaxone; 9.1 days and 1353.00 rubles – for levofloxacin; 4 days and 11035.36 rubles – for ceftaroline fosamyl; 9 days and 16,153.35 rubles – for ertapenem. Positive clinical outcomes were noted in 85% of cases. In 15% of cases, additional AMT was required. As a starting therapy for severe CAP, antimicrobial monotherapy was prescribed in 89.3% of cases. Its efficacy was 0.920. The treatment regimen was changed in two cases.Conclusion. The present findings, namely the discrepancy between the real number of AMT prescriptions and the standard recommendations might be due to an ineffective previous outpatient treatment and prolonged duration of the disease. It is important to note that the treatment standard was adopted in 2012. Since then, a number of novel effective AMT agents have been approved for clinical use: for example, ceftaroline fosamil – cephalos (cephalosporin of the 5th generation) is approved for the treatment of CAP, incl. in children from 2 months of age. There is also a change in the structure of the CAP pathogens that involves bacterial associations and the emergence of AMT resistant bacteria. The widespread use of macrolides inevitably leads to the development of new resistant strains. According to the published reports, the following species play an increasing role in the etiology of CAP: Streptococcus pneumoniae, Haemophilus influenzae, and also the associations S. pneumoniae-H. Influenzae and S. pneumoniae-M. pneumoniae. Associations of pathogens are observed in more than 60% of patients with CAP.