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 frequency and mechanisms of resistance to macrolides in Streptococcus.pyogenes isolated within 3 periods: 2011-2012 (246 strains), 2013-2014 (273 strains) and from January to November of 2015 (120 strains) were studied. The strains of S.pyogenes (639) were isolated from 17107 nasopharyngeal, vaginal and middle ear discharge smears of children on their visits to physiciants or hospitalization at somatic hospital departments. The susceptibility was tested by the disk diffusion method and E-test strips. Identification of the mechanisms of resistance to macrolides and lincosamides included phenotypic and molecular genetic methods. PCR was used to determine ermB and mef genes in 23 erythromycin resistant isolates. As compared to 2011-2012, resistance of S.pyogenes to macrolides increased from 5 to 16% in 2015 and that to clindamycin from 2 to 10%. Among 23 erythromycin resistant strains 6 (26.1%) belonged to the M phenotype, 3 (13.0%) belonged to the iMLS(b) phenotype and 14 (60.9%) belonged to the cMLS(b) pheno-type. The results of detecting the macrolide resistance genes in S.pyogenes showed that only 26.1% of the isolates expressed the mefA gene. The predominant share (65.2%) of the erythromycin resistant isolates possesed the ermB gene as a determinant and in 4.3% of the isolates the ermB gene was associatied with the mefgene. No resistance genes were detected 1 isolate. Therefore, the main mech- anism that determined resistance of S.pyogenes to macrolides was methylation of ribosomes mediated by the ermB gene.

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 article provides latest information on the natural macrolide antibiotic josamycin, results of local and foreign trials of sensitivity and resistance of various kinds of pathogens to josamycin, evidence and success of using the antibiotic drug in the treatment of acute respiratory infections in children.