Background: Amoxicillin is the drug of choice for treating the majority of community-acquired respiratory tract infections in children, including pneumonia and acute otitis media according to both international and national guidelines. Nevertheless, the practice of not following these guidelines is widespread. Objective : Our aim was to study a range of antibiotics prescribed prior to hospitalization to children with community-acquired pneumonia (CAP) and acute otitis media (AOM), and to evaluate their effectiveness. Methods.  Observational study of children with hospital-verified diagnosis CAP or AOM. Results. Amoxicillin was prescribed to only 4.5% of children with CAP and 1% of patients with AOM; along with parenteral cephalosporines and amoxicillin/clavulanate in adequate doses therapy was started in 34 and 25% respectively. Other children received 3d generation oral cephalosporines or macrolides, which rendered a very low effectiveness (19 and 10% respectively). In view of a flagrant inconformity of the prescribed antibiotics and their doses to the guidelines, non-effective prescriptions were made for 72% of children with CAP and 69% — with AOM. For children with atypical pneumonia macrolides were prescribed in only 19%. Conclusion . Since amoxicillin remains the main drug for treating infections caused by an ever increasing number of resistant strains of S. pneumonia and S. pyogenes, it should be prescribed to children with CAP and AOM: its doses (as well as doses of amoxicillin/clavulanate) should be not less than 45 mg/kg/d, and in risk group patients — 80–100 mg/kg/d. The pediatricians’ skills of differentiating atypical pneumonia should be improved.

Background: Amoxicillin is the drug of choice for treating the majority of community-acquired respiratory tract infections in children, including pneumonia and acute otitis media according to both international and national guidelines. Nevertheless, the practice of not following these guidelines is widespread.Objective: Our aim was to study a range of antibiotics prescribed prior to hospitalization to children with community-acquired pneumonia (CAP) and acute otitis media (AOM), and to evaluate their effectiveness.Methods. Observational study of children with hospital-verified diagnosis CAP or AOM.Results. Amoxicillin was prescribed to only 4.5% of children with CAP and 1% of patients with AOM; along with parenteral cephalosporines and amoxicillin/clavulanate in adequate doses therapy was started in 34 and 25% respectively. Other children received 3d generation oral cephalosporines or macrolides, which rendered a very low effectiveness (19 and 10% respectively). In view of a flagrant inconformity of the prescribed antibiotics and their doses to the guidelines, non-effective prescriptions were made for 72% of children with CAP and 69% — with AOM. For children with atypical pneumonia macrolides were prescribed in only 19%.Conclusion. Since amoxicillin remains the main drug for treating infections caused by an ever increasing number of resistant strains of S. pneumonia and S. pyogenes, it should be prescribed to children with CAP and AOM: its doses (as well as doses of amoxicillin/clavulanate) should be not less than 45 mg/kg/d, and in risk group patients — 80–100 mg/kg/d. The pediatricians’ skills of differentiating atypical pneumonia should be improved.

The etiology of respiratory diseases (RD) is represented by viral and bacterial pathogens [1]. Obviously, viral infections cause most of respiratory diseases in children, while antibiotic treatment is at least useless and often considered inefficient due to a multitude of adverse events. Antibiotics may cause allergic reactions, impair biocenosis of the respiratory tract and colonization of its mucous membranes with unwanted, often intestinal, flora. The greatest danger, however, is the development of overall antibiotic resistance of microbial flora which currently is one of the most serious public healthcare problems [2]. At the same time, bacterial infection, in case of late detection and inadequate treatment, poses a greater risk for serious complications and therefore requires reasonable prescription of systemic antibiotic therapy.

Background: Pneumonia is one of the most frequent serious potentially life threatening childhood diseases. The criteria for diagnostics and treatment were designed long ago and are clearly articulated. Nevertheless, diagnostics and therapy happen most often during outpatient management.Objective: The aim was to compare the diagnostic criteria of CAP among children in Russian and foreign guidelines and also to compare the incidence. Another aim is to find out the aptness to the Russian guidelines for the management of CAP among children.Materials and methods: The comparative analysis of childhood pneumonia diagnostics and treatment guidelines have been recently published in a range of countries. We reviewed some recently published pneumonia recommendations. The timeliness and adequacy of hospitalization and treatment was analyzed for 167 hospitalized children with pneumonia diagnosed according to Russian and WHO recommendations. We also used the information about the quality of X-ray pneumonia diagnosis in 679 patients from hospitals in Barnaul, Ekaterinburg and Murmansk (PAPIRUS research project).Results: We found a high percentage of late (5-th day and later) hospitalization of children with pneumonia (37 percent in 2002–2007 and 47 percent in 2013–2014) as well as a late ( 5 days) start of therapy (20 and 34 percent accordingly). In three regional hospitals only 27 percent of X-ray films of children treated for pneumonia were attested as meeting the pneumonia criteria. We found a high frequency of macrolides as a starting therapy in typical pneumonia which often had been ineffective. Amoxicillin/clavulanate and oral cephalosporins were also ineffective in doses < 45 mg/kg/day. A poor knowledge of the clinical features of atypical pneumonia was noted with a corresponding high frequency of -lactams as a starting medication.Conclusion. Our data shows the importance of training paediatricians in modern pneumonia diagnosis and treatment.

The etiology of respiratory diseases (RD) is represented by viral and bacterial pathogens [1]. Obviously, viral infections cause most of respiratory diseases in children, while antibiotic treatment is at least useless and often considered inefficient due to a multitude of adverse events. Antibiotics may cause allergic reactions, impair biocenosis of the respiratory tract and colonization of its mucous membranes with unwanted, often intestinal, flora. The greatest danger, however, is the development of overall antibiotic resistance of microbial flora which currently is one of the most serious public healthcare problems [2]. At the same time, bacterial infection, in case of late detection and inadequate treatment, poses a greater risk for serious complications and therefore requires reasonable prescription of systemic antibiotic therapy.

Respiratory infections are among the most common diseases of childhood and the main reason for seeking medical help. Most of them are known to be viral; however, a big role among upper and lower respiratory tract infections belongs to those caused by pathogens such as pneumococci, Haemophilus influenzae and pyogenic streptococci. Despite the availability of international guidelines and medical literature on antimicrobial chemotherapy, the percentage of unjustified antibiotic therapies remains high, leading to enhanced resistance of pathogens.

Due to the widespread prevalence of ARI, its treatment and prevention remain a relevant issue. Even mild ARI may cause exacerbation of a chronic disease. The economic damage to the state equals $ 1.6 billion each year. ARI distribution pattern dictates the need to isolate the child from the ill person or the potential source of infection. There are a number of vaccines against certain pathogens causing ARI; bacterial vaccines are widely used; interferon prophylaxis is recommended to children with a history of premorbid conditions, who just started to attend child care centers, and during flu epidemics. The effectiveness of some prevention methods may cause doubts. We should not forget about alternative methods of improving child's resistance to infectious agents and cold training.