FISHBURNE's METHOD AND THE CLASSICAL METHOD OF PHARMACOECONOMIC ANALYSIS IN THE EVALUATION OF ANTIBIOTIC TREATMENT OF ACUTE AND RECURRENT BRONCHITIS IN CHILDREN

Objective: This study was performed in order to estimate clinical effectiveness of antibiotic therapy in acute and recurrent obstructive bronchitis. For estimation the following was used: the Fishbern method of antibiotics distribution according to clinical effectiveness levels with the help of weighted coefficients and classical cost–efficiency†pharmacoeconomic analysis of the given antibiotic therapy. Then, for the first time ever, the obtained results of both methods were combined.Methods: Materials were presented by the data on antibiotic therapy, given for patients who were hospitalized to the in-patient medical facilities due to acute or recurrent obstructive bronchitis. Medical records of 2 259 patients were included in the study. The patients were 0 to 18 y old. In order to determine the weighed coefficients of each used antibiotic with subsequent distribution according to the levels of clinical effectiveness the Fishbern method was applied. Three levels of clinical effectiveness were used in this study, i.e. high, medium and low. The cost–efficiency†pharmacoeconomic analysis was applied to combine costs and efficiency of the compared therapy courses in acute and recurrent obstructive bronchitis.Results: Finally we found out that the highest probability of positive effect of cephalosporins group agents was associated with the use of Cefotaximum. (Biosynthesis). From the pharmacoeconomic point of view the most effective in treating acute and recurrent obstructive bronchitis in children in the in-patient facilities was Ceftriaxonum (Synthesis). Out of protected penicillins group, we used Amoxicillin/clavulanic acid–original drug Augmentin (Smithkline Beecham Pharmaceuticals) and generic drug Amoxiclav (Lek d. d). Augmentin effectiveness was 0.591, and Amoxiclav effectiveness–0.530. Cost of Augmentin treatment course was 106.26 rub. (1.68 US$), cost of Amoxiclav treatment course–103.50 rub.(1.63 US$). Augmentin use turned out to be the most reasonable. Augmentin treatment course was characterized by lower ICER coefficient versus Amoxiclav. We found out that from the pharmacoeconomic point of view Azitromicin (Vertex Ltd.) treatment turned out to be the most reasonable of the whole macrolides antibiotics for treatment of acute and recurrent obstructive bronchitis. However, according to the Fishbern clinical effectiveness classification this antibiotic belonged to the group with medium effectiveness level. The group with high effectiveness level included Sumamed, Azitral, Hemomicin, Clacid, Zitrocin and Clabax. Clacid and Clabax were excluded during the pharmacoeconomic analysis. The highest value of ICER coefficient was obtained for Sumamed and made up 39,367.50 rub. (621.53 US$). The highest level of clinical effectiveness was characteristic for Sumamed as well. Besides Sumamed was an original drug of azitromicin. According to the obtained data Azitral and Hemomicin had the lowest values of ICER coefficient (1151.67 rub. (18.18 US$) and 1812.22 rub. (28.61 US$) respectively). Therefore based on the clinical economic analysis these medical agents turned out to be the most suitable.Conclusion: The results of the pharmacoeconomic analysis showed that the most effective drugs in treatment of acute and recurrent obstructive bronchitis in children in in-patient facilities appeared to be the following: out of cephalosporins-Ceftriaxonum (Synthesis), out of protected penicillins-Augmentin (Smithkline Beecham Pharmaceuticals), out of macrolides-Azitromicin (Vertex Ltd.). According to the Fishbern classification, these drugs belonged to the group with medium level of effectiveness.Â

ROLE OF "ATYPICAL" MICROORGANISMS ON THE FORMATION OF BRONCHIAL ASTHMA IN CHILDREN WITH ACUTE AND RECURRENT OBSTRUCTIVE BRONCHITIS

Objective: This study was undertaken to determine the link between the presence of atypical†infections in patients with acute obstructive andrecurrent obstructive bronchitis (AOB/ROB) and bronchial asthma (BA) development based on the concept of risk.Methods: The materials for the study were the data records of patients hospitalized with AOB or ROB and whose analysis was performed to identifyantibodies to atypical†microflora (796 patients). The study period was 4 years from 2008 to 2011. In the analyzed period, immunosorbent assay forthe detection of antibodies to atypical†microflora (Chlamydophila pneumoniae, Mycoplasma pneumoniae, Mycoplasma hominis) was performed. Theconcept of risk identification was based on the determination of the absolute risk, attributable risk (AtR), relative risk, population attributable risk, aswell as on the definition of the standard errors for each type of risk and the confidence interval.Results and Conclusion: Methodical aspects of determining the relationship between the presence of atypical†infections in patients with AOBor ROB and BA development were based on the concept of risk. The analysis showed a direct link between the increase of cases of BA formationagainst the backdrop of atypical†infections. Therefore, the performed analysis of atypical pathogens influences on BA occurrence in patients withAOB/ROB which indicates direct dependence increase of BA incidence on atypical infection. In experimental group, Frequency of event is 14.84% inexperimental group. Frequency of event is 1.67% in control group. The risk factor increases probability of event by 13.17%, the risk factor increasesprobability of event by 13.17%. Presence of atypical infection leads to increase of BA incidence by 8.9 times. Number needed to harm (NNH) is 7.59,i.e., in the presence of atypical infection in patients with AOB/ROB, each eighth exposed person develops BA in addition to background level of BAincidence.Keywords: Acute obstructive bronchitis, Recurrent obstructive bronchitis, Bronchial asthma, The concept of risk, Risk factor, The absolute risk,Relative risk, Attributable risk, Population attributable risk, Number needed to harm

Фармакоэпидемиологический DDD-, DU90%-анализ антимикробной терапии внебольничной пневмонии в условиях стационаров федерального и муниципального подчинения

This study was designed to compare results of pharmacoepidemiological analysis of antibacterial therapy in patients with community-acquired pneumonia (CAP) admitted to hospitals of Nizhniy Novgorod. Methods. Data for analysis were obtained from medical records of all patients with CAP (n = 117; 51.3% were males) admitted to two city hospitals in 2015 and 2016. Therapy of CAP was in agreement with corresponding standards. We analyzed real drug utilization using the defined daily dose (DDD) and drug utilization accounting for 90% of the total amount of DDD prescribed (DU90%).Results. Penicillinase-resistant penicillins, the 3rd generation cephalosporins and fluoroquinolones were the most often prescribed antibiotics in hospitals. The highest number of DDD was for ceftriaxone (376.0 g) in the hospital 1 and levofloxacin (468.16 g) in the hospital 2. The drugs constituting 90% of the prescription volume for inpatient therapy of CAP were ceftriaxone (46.09%), levofloxacin (20.0%), azythromycin (9.19%), and ciprofloxacin (9.19%) in the hospital 1 and ceftriaxone (16.50%), levofloxacin (71.19%), and ertapenem (4.70%) in the hospital 2. In the hospital 1, the cost of one DDD in DU10% segment (982.12 RUB) was 4-fold higher than that in DU90% segment (200.0 RUB); this suggests that inexpensive drugs were predominantly used in the hospital 1. In the hospital 2, DU10% consisted of two drugs accounting 24.56% of the total prescriptions. The cost of one DDD in DU90% segment (6 022.88 RUB) was 1.9-fold higher than that in DU10% segment (3 166.73 RUB); this suggests that more expensive antibiotics were widely used in the hospital 2. Conclusion. The strategy used in the hospital 2 is recommended according to the study results. The initial therapy with a single antibiotic could significantly reduce the drug load for the patient. Addition of the second antibiotic to the treatment was needed in 15% only, though patients were admitted to a hospital after the treatment failure both in ambulatory settings and in other hospitals.Цель исследования заключалось в сопоставлении результатов фармакоэпидемиологического анализа антимикробной терапии (АМТ) внебольничной пневмонии (ВП) в 2 стационарах Нижнего Новгорода различного уровня подчинения. Материалы и методы. Материалом для исследования послужили данные историй болезни пациентов с ВП (n = 117: 51,3 % – мужчины, 48,7 % – женщины), госпитализированных в Государственное бюджетное учреждение здравоохранения Нижегородской области «Городскаяклиническаябольница№ 5 Нижегородского района городаНижнегоНовгорода» в 2015 г. (стационар 1) и Федеральное бюджетное учреждение здравоохранения «Приволжский окружной медицинский центр» Федерального медико-биологического агентства (Нижний Новгород) в 2016 г. (n = 48) (стационар 2). В исследование были включены все больные, госпитализированные в стационар за анализируемый период. Терапия ВП осуществлялась в соответствии со стандартами лечения. При проведении ретроспективной фармакоэпидемиологической оценки анализировались фактическое потребление лекарственных средств (ЛС) на основе установленной суточной дозы (DDD-анализ) и потребление ЛС на основе их доли в общем числе установленных суточных доз (DU90%-анализ). Результаты. Наибольшее число назначений в стационаре 1 приходится на защищенные пенициллины и цефалоспорины III поколения, в стационаре 2 – на цефалоспорины III поколения и фторхинолоны. Самое большое значение числа установленных суточных доз (number of determined daily doses – NDDD) в стационаре 1 соответствует цефтриаксону (NDDD = 376,0 г), в стационаре 2 – левофлоксацину (NDDD = 468,16 г). В группу, составляющую 90 % всех потребляемых NDDD антимикробных препаратов (АМП) при ВП в стационаре 1, вошли цефтриаксон (46,09 %), левофлоксацин (20,0 %), азитромицин (9,19 %), ципрофлоксацин (9,19 %); в стационаре 2 – левофлоксацин (71,19 %), цефтриаксон (16,50 %), эртапенем (4,70 %). Стоимость 1 DDD в сегменте DU10% (982,12 руб.) более чем в 4 раза превышает таковую в сегменте DU90% (200,0 руб.), что позволяет говорить о преимущественном использовании недорогих по стоимости ЛС в стационаре 1. В сегмент DU10% в стационаре 2 вошли ЛС, доля которых в реальной структуре назначений составила 24,56 %. Стоимость 1 DDD в сегменте DU90% (6 022,88 руб.) в 1,9 раза превышает таковую в сегменте DU10% (3 166,73 руб.), что позволяет говорить о широком использовании дорогостоящих ЛС в стационаре 2.Заключение. По результатам проведенного анализа рекомендуется использовать опыт терапии ВП стационара 2. При использовании монотерапии в качестве стартовой значительно снижается лекарственная нагрузка на пациента. Введение дополнительного ЛС в схему лечения отмечено лишь в 15 % случаев, при этом в стационар 2 госпитализированы больные, у которых предшествующая АМТ, проводимая как амбулаторно, так и в условиях других стационаров, была неэффективной. Преемственность опыта АМТ связана со значительным увеличением затрат на АМП. Так, стоимость 1 DDD АМП в сегменте DU90%, используемой в стационаре 1 в 2015 г., составила 200,0 руб., в то время как стоимость 1 DDD в стационаре 2 – 6 022,88 руб

Detection of tick-borne pathogens in wild birds and their ticks in Western Siberia and high level of their mismatch

Abstract: The Tomsk region located in the south of Western Siberia is one of the most high-risk areas for tick-borne diseases due to elevated incidence of tick-borne encephalitis and Lyme disease in humans. Wild birds may be considered as one of the reservoirs for tick-borne pathogens and hosts for infected ticks. A high mobility of wild birds leads to unpredictable possibilities for the dissemination of tick-borne pathogens into new geographical regions. The primary goal of this study was to evaluate the prevalence of tick-borne pathogens in wild birds and ticks that feed on them as well as to determine the role of different species of birds in maintaining the tickborne infectious foci. We analysed the samples of 443 wild birds (60 species) and 378 ticks belonging to the genus Ixodes Latraille, 1795 collected from the wild birds, for detecting occurrence of eight tick-borne pathogens, the namely tick-borne encephalitis virus (TBEV), West Nile virus (WNV), and species of Borrelia, Rickettsia, Ehrlichia, Anaplasma, Bartonella and Babesia Starcovici, 1893, using RT-PCR/or PCR and enzyme immunoassay. One or more tick-borne infection markers were detected in 43 species of birds. All markers were detected in samples collected from fieldfare Turdus pilaris Linnaeus, Blyth’s reed warbler Acrocephalus dumetorum Blyth, common redstart Phoenicurus phoenicurus (Linnaeus), and common chaffinch Fringilla coelebs Linnaeus. Although all pathogens have been identified in birds and ticks, we found that in the majority of cases (75.5%), there were mismatches of pathogens in birds and ticks collected from them. Wild birds and their ticks may play an extremely important role in the dissemination of tick-borne pathogens into different geographical regions

Polymer Nanocomposite Membranes

Based on the results of research works reflected in the scientific literature, the main examples, methods and approaches to the development of polymer inorganic nanocomposite materials for target membranes are considered. The focus is on membranes for critical technologies with improved mechanical, thermal properties that have the necessary capabilities to solve the problems of a selective pervaporation. For the purpose of directional changes in the parameters of membranes, effects on their properties of the type, amount and conditions of nanoparticle incorporation into the polymer matrix were analyzed. An influence of nanoparticles on the structural and morphological characteristics of the nanocomposite film is considered, as well as possibilities of forming transport channels for separated liquids are analyzed. Particular attention is paid to a correlation of nanocomposite structure-transport properties of membranes, whose separation characteristics are usually considered within the framework of the diffusion-sorption mechanism

Effect of Phase Heterogeneity on the Properties of Poly(vinyl alcohol)-Based Composite Pervaporation Membranes

The structure, thermophysical characteristics, and pervaporation properties of composite membranes based on poly(vinyl alcohol) (PVA) are studied in dependence of the film preparation conditions. It is shown that the nature of the supramolecular organization of the composite polymer film determines which of the components of the separated mixtures of toluene and heptane predominantly penetrate through the corresponding pervaporation membrane. The observed structural effects can become more pronounced if the second component of a polymer mixture is purposefully selected (in this case, poly(N,N-dimethylaminoethyl methacrylate) instead of poly(acrylic acid)) or a nano-sized filler that can be well dispersed in the polymer matrix is introduced. Multi-wall carbon nanotubes are introduced into binary PVA-containing polymer blends. The influence of these fillers on the structure and transport properties of the obtained membranes is studied

Two-Ply Composite Membranes with Separation Layers from Chitosan and Sulfoethylcellulose on a Microporous Support Based on Poly(diphenylsulfone-N-phenylphthalimide)

Two-ply composite membranes with separation layers from chitosan and sulfoethylcellulose were developed on a microporous support based on poly(diphenylsulfone-N-phenylphthalimide) and investigated by use of X-ray diffraction and scanning electron microscopy methods. The pervaporation properties of the membranes were studied for the separation of aqueous alcohol (ethanol, propan-2-ol) mixtures of different compositions. When the mixtures to be separated consist of less than 15 wt % water in propan-2-ol, the membranes composed of polyelectrolytes with the same molar fraction of ionogenic groups (-NH3+ for chitosan and -SO3− for sulfoethylcellulose) show high permselectivity (the water content in the permeate was 100%). Factors affecting the structure of a non-porous layer of the polyelectrolyte complex formed on the substrate surface and the contribution of that complex to changes in the transport properties of membranes are discussed. The results indicate significant prospects for the use of chitosan and sulfoethylcellulose for the formation of highly selective pervaporation membranes

New Membrane-Forming Aromatic Co-Poly(amide-imide)s: Influence of the Chemical Structure on the Morphological, Thermal and Transport Properties

Polymer film membranes are used to solve specific separation problems that dictate structural requirements. Structural and morphological parameters of film membranes based on glassy polyheteroarylenes can be controlled in the process of preparation from solutions that opens up prospects for obtaining structured membranes required for targeted separation. In the case of aromatic poly(amide-imide)s, the possibility of controlling film formation and structure virtually has not been studied. In the present work, a series of homologous co-poly(amide-imide)s differing in the number of repeating units with carboxyl-substituted aromatic fragments was synthesized by polycondensation. Comparative analysis of the processes of formation of membranes with different morphologies based on these polymers under equal conditions was performed. New information was obtained about the influence of the amounts of carboxyl groups and the residual solvent on structural properties of asymmetric membranes. The influence of these factors on transport properties of dense membranes under pervaporation conditions was studied. It was demonstrated that in the case of carboxyl-containing poly(amide-imide)s, the domains formed during film preparation had a significant effect on membrane properties

Effect of Hydroxyl-Containing Fragments on the Structure and Properties of Membrane-Forming Polyamide-Imides

The structural features and thermophysical and transport properties of dense nonporous membranes of the casting type from (co)polyamide-imides synthesized by the polycondensation of the diacid chloride of 2-(4-carboxyphenyl)-1,3-dioxoisoindoline-5-carboxylic acid and diamines 5,5′-methylene-bis (2-aminophenol) (DADHyDPhM) and 4,4′-methylenebis(benzeneamine) (DADPhM), taken in molar ratios of 7:3, 1:1, and 3:7, have been studied. The effect of hydroxyl-containing modifying fragments of dihydroxy diphenylmethane introduced in various amounts into the main polymer chain on the pervaporation properties of the formed films is discussed. It has been shown that the presence of the residual solvent N-methyl-2-pyrrolidone in the films not only has a plasticizing effect on the characteristics of film membranes but also promotes the preferential transmembrane transport of polar liquids, primarily methanol (permeation rate over 2 kg for a copolymer with a ratio of DADHyDPhM:DADPhM = 7:3). The removal of the residual solvent from the polymer film, both thermally (heating to 200 °C) and by displacement with another solvent as a result of sequential pervaporation, led to a significant decrease in the rate of transfer of polar liquids and a decrease in the selectivity of the membrane. However, the dehydrocyclization reaction resulted in more brittle films with low permeability to penetrants of different polarities. The results of our comprehensive study made it possible to assume the decisive influence of structural changes in membranes occurring in connection with the competitive formation of intra- and intermolecular hydrogen bonds