Selection of parenteral iron supplement for iron deficiency anemia: A review

The article reviews medicinal products for the treatment of iron deficiency conditions and iron deficiency anemia, the prevalence of which is about 30% among the world population. Iron deficiency is a significant cause of anemia, which can lead to hospitalization and even death. In case of intolerance or ineffectiveness of oral formulations of iron supplements, if it is necessary to replenish the iron level quickly, trivalent iron formulations for intravenous administration are used. These supplements are iron complexes with an iron hydroxide core surrounded by a carbohydrate shell. Iron formulations for intravenous administration can be divided into drugs of the "old" and "new" generation. One of the most studied and popular representatives of the "new" generation is iron carboxymaltose (ICM). The results of clinical studies showed that ICM better and faster increases hemoglobin concentration and replenishes iron stores in patients compared to the "old" generation formulations and also has a more favorable safety profile. Large doses of ICM can be administered in a short time, saving resources and increasing patient satisfaction. The injection of large doses of iron with a small number of infusions in the case of ICM is more economically beneficial for all departments of medical institutions, as it significantly reduces the total cost of medical care. Intravenous iron plays an essential role in the perioperative treatment of iron deficiency anemia, especially in elective surgery. Currently, there is a reliable evidence base confirming the efficacy and safety of intravenous iron formulations in chronic kidney disease, inflammatory bowel disease, heart failure, gynecological and obstetric diseases, and cancer

Проблема взаимозаменяемости ингаляционных лекарственных препаратов: анализ информации о нежелательных реакциях из федеральной базы данных спонтанных сообщений

The aim of this study was to analyze the possibility of inhaled drug substitutions. Methods. The authors analyzed spontaneous reports from the Federal database of adverse events associated with switching a patient from the reference ipratropium bromide/fenoterol combination to a generic one.Results. The drug substitution within one INN was reported in 15% of all reports about adverse events related to prescription of this INN. A great deal of these reports was related to drug substitution in elderly. Generally, the reference drug was well tolerated, but its substitution to a generic drug resulted in lower efficacy (18.8%) or development of adverse events, mostly respiratory (51.8% of all adverse events).Conclusion. The inhaled drug substitution could be associated with a potential risk of adverse events or lower efficacy. The substitution of inhaled drugs within one INN should be made with caution.В статье обсуждаются проблемы взаимозаменяемости ингаляционных лекарственных препаратов (ИЛП). Материалы и методы. Проведен анализ спонтанных сообщений (СС) за 2009–2018 гг., взятых из федеральной базы данных СС. Целью данного исследования явилась оценка нежелательных реакций (НР), вызванных заменой ИЛП ипратропия бромид + фенотерол. Информация о замене ЛП в рамках одного международного непатентованного наименования (МНН) составила 15,0 % всех СС о данном препарате в федеральной базе данных СС, при этом значительный удельный вес составили случаи, связанные с заменами ЛП у пожилых пациентов. Результаты. Референтный ЛП переносился преимущественно хорошо, однако в случае замены на воспроизведенный препарат наблюдалось развитие НР либо отмечалась неэффективность терапии (18,8 % всех НР), при этом преобладали сведения о нарушениях со стороны дыхательной системы (51,8 % всех НР). Заключение. При замене ИЛП подтвердились возможные риски развития НР, неэффективность генерического ЛП, а также необходимость соблюдать особую осторожность при проведении замены ИЛП в рамках одного МНН

Practical recommendations for choosing an immunobiological preparation for the treatment of severe bronchial asthma of T2-endotype

Biological therapy of bronchial asthma (BA) is a modern method of treating severe forms of the disease, that are uncontrolled by traditional pharmacotherapeutic approaches. Currently, 5 monoclonal antibody (AT) preparations are registered in the world for the treatment of severe bronchial asthma (SBA) of the T2 endotype (T2-SBA) – antibodies, binding to immunoglobulin (Ig) E (anti-IgE – omalizumab), interleukin antagonists (IL)-5 (anti-IL-5 – mepolizumab, resizumab) and its receptor (anti-IL-5Rα – benralizumab), as well as antibodies, that selectively bind to the IL-4 and -13 receptor (anti-IL-4 /13Rα – dupilumab). The article presents data on the effectiveness of these drugs in relation to the key characteristics of SBA, formulates clinical and laboratory criteria, the study of which in real practice can potentially predict the likelihood of a clinical response to a particular type of biological therapy. An algorithm is proposed for choosing a targeted therapy strategy for patients with SBA, clinically associated with allergies, for patients with severe non-allergic eosinophilic BA and for patients with eosinophilic BA of a combined phenotype.Биологическая терапия бронхиальной астмы (БА) представляет собой современный метод лечения тяжелых форм заболевания, неконтролируемых при помощи традиционных фармакотерапевтических подходамов. В настоящее время в мире зарегистрированы 5 препаратов моноклональных антител (АТ) для лечения тяжелой бронхиальной астмы (ТБА) Т2-эндотипа (Т2-ТБА) – АТ, связывающие иммуноглобулин (Ig) Е (анти-IgE – омализумаб), антагонисты интерлейкина (IL)-5 (анти-IL-5 – меполизумаб, реслизумаб) и его рецептора (анти-IL-5Rα – бенрализумаб), а также АТ, избирательно связывающиеся с рецептором IL-4 и -13 (анти-IL-4/13Rα – дупилумаб). В статье приведены данные об эффективности указанных препаратов в отношении ключевых характеристик ТБА, сформулированы клинико-лабораторные критерии, при исследовании которых в реальной практике потенциально может быть предсказана вероятность клинического ответа на тот или иной вид биологической терапии. Предложен алгоритм выбора стратегии таргетной терапии для пациентов с ТБА, клинически ассоциированной с аллергией, для больных тяжелой неаллергической эозинофильной БА и для страдающих эозинофильной БА сочетанного фенотип

Etiology of community-acquired pneumonia and prevalence of comorbidities in elderly patient population

Objective. To investigate the mortality rate, comorbidity prevalence, and etiology of community-acquired pneumonia (CAP) in elderly patient population. Materials and Methods. Hospitalized elderly patients with CAP were distributed into the following age groups: 65–74 years (group I), 75–84 years (group II) and 85–94 years (group III). The patients’ medical records were used for determining comorbidities and mortality rate. In order to determine etiology of CAP, sputum or BAL samples were collected. A total of 171 isolates were identified using MALDI-TOF MS. Results. The mortality rates were 27.1%, 31.5% and 45.7% in age groups I, II, III, respectively. The most common concomitant diseases in all age groups were arterial hypertension (47.4%, 54.6%, and 62.8% for groups I, II, and III, respectively), chronic heart failure (45.7%, 50.9%, and 60.0%, respectively), and coronary heart disease (15.2%, 25.9%, and 24.3%, respectively). The most frequently isolated bacteria by age group were the following: group I – non-fermenting Gram-negative bacteria (NFGNB) (7.4%), Enterobacterales (6.6%), S. aureus (6.6%); group II – Enterobacterales (13.9%), S. aureus (5.6%), Enterococcus spp. (5.6%), NFGNB (2.8%); group III – NFGNB (15.4%), S. aureus (7.7%), Enterococcus spp. (7.7%), Enerobacterales (7.7%). Conclusions. The mortality rates in elderly patients with CAP were high and varied from 27.1% in 65–74 years old patients to 45.7% in 85–94 years old patients. The most common comorbidities in all age groups were arterial hypertension (up to 62.8%), chronic heart failure (up to 60%), and coronary heart disease (up to 25.9%). The main pathogens causing CAP in elderly patient population were Enterobacterales and non-fermenting Gram-negative bacteria

Pharmacotherapy for acute respiratory infections caused by influenza viruses: current possibilities

Routinely the influenza virus significantly contributes to the formation of the annual incidence of acute respiratory infections, with a peak in winter season. The high level of mutagenic potential of influenza viruses is a standard factor determining the complexity of the rational choice of pharmacotherapy. The upcoming epidemiological season 20202021 brings additional challenges for health care practitioners mediated by the widespread prevalence in the human population of a new infection caused by the SARS-CoV-2 virus affecting the respiratory system among many organs and systems. An adequate choice of pharmacotherapy tools should be based on high efficiency and safety of drugs, with a possible reduction in such negative factors as polypharmacy. This review includes comparative pharmacological characteristics of drugs with activity against RNA viruses, along with parameters of their clinical efficacy

Developmental Pharmacokinetics of Antibiotics Used in Neonatal ICU: Focus on Preterm Infants

Neonatal Infections are among the most common reasons for admission to the intensive care unit. Neonatal sepsis (NS) significantly contributes to mortality rates. Empiric antibiotic therapy of NS recommended by current international guidelines includes benzylpenicillin, ampicillin/amoxicillin, and aminoglycosides (gentamicin). The rise of antibacterial resistance precipitates the growth of the use of antibiotics of the Watch (second, third, and fourth generations of cephalosporines, carbapenems, macrolides, glycopeptides, rifamycins, fluoroquinolones) and Reserve groups (fifth generation of cephalosporines, oxazolidinones, lipoglycopeptides, fosfomycin), which are associated with a less clinical experience and higher risks of toxic reactions. A proper dosing regimen is essential for effective and safe antibiotic therapy, but its choice in neonates is complicated with high variability in the maturation of organ systems affecting drug absorption, distribution, metabolism, and excretion. Changes in antibiotic pharmacokinetic parameters result in altered efficacy and safety. Population pharmacokinetics can help to prognosis outcomes of antibiotic therapy, but it should be considered that the neonatal population is heterogeneous, and this heterogeneity is mainly determined by gestational and postnatal age. Preterm neonates are common in clinical practice, and due to the different physiology compared to the full terms, constitute a specific neonatal subpopulation. The objective of this review is to summarize the evidence about the developmental changes (specific for preterm and full-term infants, separately) of pharmacokinetic parameters of antibiotics used in neonatal intensive care units

Direct Oral Anticoagulants’ Consumption and Expenditure in the COVID-19 Pandemic in Russia and Clinical Practice Guidelines for Their Use

Background: The coronavirus pandemic has led to the creation of clinical guidelines by a large number of professional medical communities. However, the quality and methodology of development of Russian clinical guidelines has been little studied. The continued relevance of studying the use of DOACs (Direct oral anticoagulants) in patients with COVID-19 was the basis for conducting this study. Aim: The objective of this study was to assess DOAC consumption and expenditure in the Russian Federation during the COVID-19 pandemic and to analyze whether it was supported by the domestic evidence base for the use of DOACs in COVID-19 patients through identifying all publicly available Russian-produced CPGs (Clinical practice guidelines) for the treatment of COVID-19 and assessing their quality as the source of recommendations for the use of oral anticoagulants for the prevention of thrombotic complications in COVID-19 patients. We searched Russian databases for CPGs, published between 2020 and 2023. We identified seven relevant documents that met our inclusion criteria. Three authors analyzed Russian clinical guidelines using an AGREE II questionnaire. We calculated DOAC DDD (defined daily dose) consumption according to Russian clinical guidelines and DDD consumption in patients with COVID-19 for the period 2020–2022. Results: Seven clinical CPGs were analyzed with the AGREE II tool. It was revealed that experts gave the highest scores for the sections on scope and purpose (from 62.98% to 100%), and clarity of presentation (from 96.30% to 100%). The lowest scores were given for the sections on stakeholder involvement (33.33% to 64.81%), rigour of development (from 0% to 49.31%), applicability (from 23.61% to 50%), and editorial independence (from 0% to 50%). When comparing the total score, it was found that two clinical guidelines received the highest scores—ROPNIZ (Livzan), and ROPNIZ (Drapkina). The minimum score was registered with the NIIOZMM (Khripun) clinical guideline. No guideline received a total score of more than 70%. According to clinical recommendations, the consumption of apixaban and rivaroxaban is 15 DDD (30-day course of therapy), or 22.5 DDD (45-day course of therapy). Consumption of apixaban in the Russian Federation in 2020 and 2021 corresponds to the indicators presented in clinical recommendations (in 2020—26.59 DDD per patient with COVID-19; in 2021—15.75 DDD per patient with COVID-19), and in 2022—10.67 DDD, which is below the recommended values. In 2020, consumption of rivaroxaban in the Russian Federation was 26.59 which corresponds to data from clinical recommendations; in 2021, consumption decreased to 7.87 DDD; in 2022 it decreased to 5.48 DDD, which is 2.74 times less than recommended. Conclusions: Analysis of seven clinical recommendations revealed that such sections of clinical recommendations as scope, purpose, and clarity of presentation had the highest degree of assessment in accordance with AGREE II. The lowest scores were given for the sections on stakeholder involvement, rigour of development, applicability, and editorial independence. When comparing the total score, it was found that two clinical guidelines received the highest scores—the Russian Society for the Prevention of Non-communicable Diseases (Livzan), and the Russian Society for the Prevention of Non-communicable Diseases (Drapkina). The minimum score was registered with the Research Institute for Healthcare Organization and Medical Management of Moscow Healthcare Department clinical guideline. No guideline received a total score of more than 70%. During the pandemic, the highest DDD consumption of DOACs was in 2020, which exceeded the DOACs’ recommended DDD by Russian clinical guidelines. DOAC consumption had decreased by 2022. There was a decrease in the consumption of rivaroxaban, with an increase in apixaban’s share in the structure of DOAC consumption during the coronavirus pandemic. Obtained data indicate that in 2021 the apixaban consumption in the Russian Federation corresponded to the recommended DDD in the national guidelines, which indicates the most correct use of apixaban according to Russian GPGs

Gene Polymorphism of Biotransformation Enzymes and Ciprofloxacin Pharmacokinetics in Pediatric Patients with Cystic Fibrosis

(1) Background: Ciprofloxacin (CPF) is widely used for the treatment of cystic fibrosis, including pediatric patients, but its pharmacokinetics is poorly studied in this population. Optimal CPF dosing in pediatric patients may be affected by gene polymorphism of the enzymes involved in its biotransformation. (2) Materials and Methods: a two-center prospective non-randomized study of CPF pharmacokinetics with sequential enrollment of patients (n-33, mean age 9.03 years, male-33.36%), over a period from 2016 to 2021. All patients received tablets of the original CPF drug Cyprobay® at a dose of 16.5 mg/kg to 28.80 mg/kg. Blood sampling schedule: 0 (before taking the drug), 1.5 h; 3.0 h; 4.5 h; 6.0 h; 7.5 h after the first dosing. CPF serum concentrations were analyzed by high performance liquid chromatography mass spectrometry. The genotype of biotransformation enzymes was studied using total DNA isolated from whole blood leukocytes by the standard method. (4) Results: a possible relationship between the CA genotype of the CYP2C9 gene (c.1075A > C), the GG genotype of the CYP2D6*4 gene (1846G > A), the AG genotype of the GSTP1 gene (c.313A > G), the GCLC* genotype 7/7 and the CPF concentration in plasma (increased value of the area under the concentration–time curve) was established. Conclusions: Gene polymorphism of biotransformation enzymes may affect ciprofloxacin pharmacokinetics in children

An Antimicrobial Copper–Plastic Composite Coating: Characterization and In Situ Study in a Hospital Environment

A method has been proposed for creating an operationally durable copper coating with antimicrobial properties for the buttons of electrical switches based on the gas dynamic spray deposition of copper on acrylonitrile butadiene styrene (ABS) plastic. It is shown that during the coating process, a polymer film is formed on top of the copper layer. Comparative in situ studies of microbial contamination have shown that the copper-coated buttons have a significant antimicrobial effect compared to standard buttons. Analysis of swabs over a 22-week study in a hospital environment showed that the frequency of contamination for a copper-coated button with various microorganisms was 2.7 times lower than that of a control button. The presented results allow us to consider the developed copper coating for plastic switches an effective alternative method in the fight against healthcare-associated infections