Scientific relevance. Vancomycin and linezolid are the antibacterial agents of choice for severe infections caused by multidrug-resistant pathogens, including methicillin-resistant Staphylococcus aureus (MRSA). However, few studies have been conducted in Russia to analyse the safety of these medicinal products. Aim. The study aimed to compare the safety of vancomycin and linezolid using the Moscow segment of the Russian Federal Service for Surveillance in Healthcare’s database for adverse drug reaction (ADR) reports. Materials and methods. The study used information from the spontaneous reporting database for 2018–2022, which contained 147 ADR reports for vancomycin (122 reports) and linezolid (25 reports). The authors analysed the ADR distribution and assessed the statistical significance of the identified differences by sex, weight, and age of patients, conditions of medical care, route of administration, single dose, daily dose, therapy duration, ICD-10 codes, ADR severity, and ADR outcome. Results. The distribution of adverse reactions to vancomycin and linezolid by patient age was relatively uniform. Outpatient linezolid was associated with a significantly higher rate of ADRs (3 of 5 reports) than outpatient vancomycin (21 of 129 reports; p= 0.0408). For ADR severity, 5 of 20 ADRs reported with linezolid required hospitalisation or prolongation of hospitalisation—considerably more than with vancomycin (16 of 94 reports; p= 0.528). The average single dose of vancomycin (794 mg) was higher than that of linezolid (467 mg; p= 0.007); the same was noted for average daily doses (1273 mg vs 998 mg; p= 0.3664). The mean duration of treatment with linezolid before ADR onset was 5.26 days, which was significantly longer than the mean duration of treatment with vancomycin (2.44 days; p= 0.0053). Oral linezolid was associated with a significantly higher ADR rate (4 of 19 cases) than oral vancomycin (5 of 96 cases; p= 0.0027). Conclusions. The ADRs observed with vancomycin and linezolid were predictable and class-specific. According to the results of the ADR report analysis, adverse reactions to vancomycin and linezolid were associated with different factors. Similar results of the literature analysis confirmed this conclusion. However, according to the results of the linear regression analysis, none of the factors considered in this study had a statistically significant influence on the probability of developing an adverse reaction to vancomycin or linezolid.

Respiratory diseases take the lead in the infectious pathology pattern of various organs and systems and are the most common. Acute bronchitis is inflammation of the bronchi due to a viral infection and is characterized by a persistent cough that can be productive or dry. The authors consider the use of herbal preparations as an effective symptomatic product for the treatment of cough of various origins. Medicinal herbs are widely used in medicine due to many useful properties and do not have any serious side effects. Ivy leaf (Hedera helix) extract preparations are common cough medicines available over the counter that are approved by the European Medicines Agency (EMA). Ivy (Hedera helix) leaves contain various biologically active components, but saponins are the main substance. Saponins are natural compounds that have a variety of biological effects. According to literature data, the action of saponins is determined not only by their bronchodilator and mucolytic properties: among additional therapeutic options of saponins are high anti-inflammatory activity, as well as antimicrobial, antifungal and antiviral effects. The article shows the potential for use of ivy saponins as carriers of pharmaceutical substances, which can significantly reduce the effective doses of certain drugs. Preparations containing ivy leaf extract are safe and approved for use even in new-borns. Also, herbal preparations with antiviral, immunomodulatory and anti-inflammatory potential become the object of study as a new strategy for treating COVID-19.

Antibacterials can have nephrotoxic effects because medicinal products of this class are primarily excreted by the kidneys. The aim of the study was to analyse literature data on the mechanisms, risk factors and specific features of toxic nephropathy development during antibiotic therapy. The article considers mechanisms of development of acute interstitial nephritis, acute tubular necrosis, crystal deposits in the tubules, proximal or distal tubulopathy with electrolyte abnormalities during the use of antibiotics. Nephrotoxicity was shown to be most often associated with the use of aminoglycosides, beta-lactams, and vancomycin. The authors analysed the dependence of nephrotoxicity on antibacterial agent lipophilicity and drug-drug interactions. The main risk factors for developing nephropathy are older age; male sex; black race; hypovolemia; arterial hypotension; angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, non-steroidal anti-inflammatory drugs or their combinations; and individual genetic characteristics. Nephrotoxicity is associated with genetic characteristics of the systems responsible for metabolism and excretion of antibacterial products: cytochrome P450 isoenzymes, P-glycoprotein, multidrug resistance protein (MRP), multidrug and toxin extrusion (MATE), breast cancer resistance protein (BCRP), and organic anion transporters. Severe generalised infections change pharmacokinetic parameters of antibacterial products. This should be taken into account when prescribing the hydrophilic antibiotics that are excreted by tubular secretion and reabsorbed in the renal tubules. The study demonstrated the effectiveness of the method comprising a combination of dose adjustment based on therapeutic drug monitoring results and renal function monitoring for improving the safety of antibiotic therapy.

Vancomycin is prescribed to patients in serious condition with infections caused by Gram-positive microorganisms; however, if the therapeutic plasma concentration of the medicinal product is exceeded, it can have a nephrotoxic effect.The aim of the study was to demonstrate the possibility of using therapeutic drug monitoring (TDM) to reduce the risk of developing nephropathy in intensive care unit patients with sepsis.Materials and methods: the study comprised a retrospective analysis of four clinical cases of patients with sepsis admitted to intensive care units of I.V. Davydovsky City Clinical Hospital in 2021 and treated with vancomycin. TDM of vancomycin plasma levels was performed by reverse-phase high-performance liquid chromatography with mass spectrometric detection.Results: using the four cases of septic patients, the study demonstrated that vancomycin at adequate case-specific doses may result in plasma concentrations beyond the therapeutic range. TDM of vancomycin concentrations helped to prevent further deterioration of renal dysfunction in one septic patient having developed acute kidney injury and to control the achievement of therapeutic vancomycin concentrations or timely adjust the dose to that effect in the other three cases.Conclusions: a timely correction of vancomycin dosing with plasma TDM allows for achieving high antimicrobial efficacy in patients with sepsis and minimising the nephrotoxic effect of the medicinal product. Studies of the feasibility of using TDM as a treatment personalisation tool for patients in serious condition will continue in the future.

Cough is considered as an unconditional reflex adaptive defense response to irritating agents such as aeropollutants, foreign bodies, sputum, and is supposed to ensure adequate airway patency for normal gas exchange. Unfortunately, this mechanism is often transformed from a protective to a pathological one, lacking an adaptive function, causing suffering to the patient and exacerbating his poor condition. The line between physiological and pathological cough is often blurred and is perceived differently by both patients and physicians. In most cases, cough, including persistent cough, is treated with neglect by the general population - as an everyday occurrence with no major problems, and with a lack of awareness of tuberculosis, cancer and a number of other serious diseases. There are a large number of medicines on the market that are positioned as effective cough medicines. However, the wide variety of ways to treat this pathology demonstrates that there is no ideal cough medicine that combines universality, high efficacy and safety. Many drugs can cause serious side-effects, imposing severe restrictions on their use. Another difficulty is that the triggers and pathways of the cough reflex are extremely varied. Identifying the causes of persistent cough requires a thorough medical history, often with a multidisciplinary approach: extended examination, doctors such as otorhinolaryngologist, cardiologist, gastroenterologist, pulmonologist, oncologist, phthisiatrician, clinical pharmacologist (druginduced cough, drug-drug interactions). This article focuses on the differential diagnosis of cough and the selection of cough medicines based on their proven efficacy and safety. This information becomes particularly relevant during the seasonal increase in the incidence of acute respiratory infections.

Urinary tract infection (UTI) is a frequent infectious disease or complication of hospital stay. The effectiveness and the recovery speed of the patient depends on the correct choice of antibacterial drug for the treatment of UTI. The choice of antibacterial therapy in the treatment of UTIs should be dictated by the predicted uropathogen flora. Since it is necessary to start treatment before obtaining the results of urine culture, UTI therapy uses empirical treatment with broad-spectrum antibiotics. However, this leads to a very rapid increase in the resistance of microorganisms to antibiotics. To reduce this effect, as well as to impove the effectiveness of treatment, it is necessary to put forward a hypothesis about the proposed microorganism which caused the UTI as precisely as possible and to try to prescribe the most suitable antibiotic. The clinical situation in which the UTI occurred may determine a probable pathogen, which will be the basis for the choice of antibiotic therapy. The article offers various therapeutic strategies for treatment of UTI, depending on the proposed bacterial flora, the clinical situation, and the characteristics of the patient.

Despite numerous activities, healthcare efforts and scientific advances, acute respiratory viral infections (ARVIs) and influenza remain poorly controlled diseases. This is due to the polyethyologicity of viruses, the mixed nature of infections, the lack of specific therapy, except for vaccination against the flu, virus antigenic variation, high contagiousness and development of antiviral drug resistance.

Review on assessment data of ADR, which must be monitored during antiretroviral therapy in patients with HIV/AIDS are presented. Questions of drug safety acquire particular importance in conducting pharmacotherapy of the most socially significant diseases, which include HIV/AIDS. Currently there is a sufficient number of generic drugs for antiretroviral therapy, which form the basis for affordable health care. The correlation of efficacy and safety of generic drugs, their interchangeability assessment require constant study of the antiretroviral drugs influence on various systems of the body. Particular attention should be given to the cardiovascular disorders and hepatotoxicity.

This article provides a retrospective analysis of a case of adverse drug reactions to the drug haloperidol - neuroleptic malignant syndrome. A literature review on the issue of neuroleptic malignant syndrome was represented. The factors that led to this syndrome development of a particular patient were evaluated. Detailed clinical and pharmacological value of gene polymorphism CYP 2D6 is discussed. The data on the successful use of a therapy of neuroleptic malignant syndrome with ethylmethylhydroxypyridine malat are presented.

Review on assessment data of ADR, which must be monitored during antiretroviral therapy in patients with HIV/AIDS are presented. Questions of drug safety acquire particular importance in conducting pharmacotherapy of the most socially significant diseases, which include HIV/AIDS. Currently there is a sufficient number of generic drugs for antiretroviral therapy, which form the basis for affordable health care. The correlation of efficacy and safety of generic drugs, their interchangeability assessment require constant study of the antiretroviral drugs influence on various systems of the body. Particular attention should be given to the cardiovascular disorders and hepatotoxicity.

Тhe article is devoted to discussion of use of rational antibacterial therapy of diseases of ENTorgans. The start of antibacterial therapy is a key to success of efficiency of treatment, leads to an eradication of bacteria and decrease of risk of chronic infections. Choosing antibacterial therapy we have to consider the previous therapy by antibiotics, hospitalization, associated diseases. All these factors will define starting antibacterial therapy. We will show in the article some questions of interaction of antibacterial drugs, and also questions of clinical importance of use of non-steroidal anti-inflammatory drugs in therapy of ENT diseases.

The growing resistance of microorganisms caused by a wide use of antimicrobial therapy (AMT) is a huge problem. Only 10–15 years ago, it seemed that medical science was able to cope with almost any severe infection, because physician’s arsenal was equipped with a large number of antibiotics. However, clinicians are confused by the current situation with antibiotic resistance, since the effectiveness and feasibility of most antibiotics face doubtful future. This means that in the next 10–12 years we will not come up with fundamentally new antibiotics and should try to keep the ones that we have today [1, 2].

A pilot study of the effect of the antioxidant drug ethylmethylhydroxypyridine malate on indicators of oxidative stress in patients with chronic cerebral ischemia. At 6 day course administration investigated the antioxidant in these patients significantly accelerates the process of generation of superoxide anion radical, established by lucigenin-depended chemiluminescence that probably regulate a feedback mechanism oxidase systems. This increases the activity of superoxide dismutase, and reduced the concentration of secondary peroxidation product - malondialdehyde, making reasonable use of antioxidants in the treatment of this pathology.

This article provides a retrospective analysis of a case of adverse drug reactions to the drug haloperidol - neuroleptic malignant syndrome. A literature review on the issue of neuroleptic malignant syndrome was represented. The factors that led to this syndrome development of a particular patient were evaluated. Detailed clinical and pharmacological value of gene polymorphism CYP 2D6 is discussed. The data on the successful use of a therapy of neuroleptic malignant syndrome with ethylmethylhydroxypyridine malat are presented.