[Search for new modes of antibiotic prophylaxis of septic complications after percutaneous nephrolithotripsy].

The risk of infectious and inflammatory complications after PNL is based on presence of microorganisms in the form of biofilms inside the stone. Destruction of stones during surgery or lithotripsy may be a trigger for the growth of microorganisms that are integrated into the biofilms, and the migration of bacteria and their toxins in the blood flow under pressure of irrigation fluid can cause septic complications. The danger of infectious and inflammatory complications after percutaneous interventions for kidney stones requires a search for specific antibiotics for antimicrobial prophylaxis and efficient modes of their administration. The results of a comparative study of pharmacokinetic parameters of ciprofloxacin, and the effectiveness of two modes of administration (bolus dosing and prolonged intravenous administration) at a dose of 1000 mg are presented.

[Pharmacokinetic aspects of carbamazepine and valproic acid using in reproductive-age women with epilepsy]. / Nekotorye farmakokineticheskie aspekty primeneniia karbamazepina i val'proevoi kisloty u bol'nykh épilepsiei zhenshchin fertil'nogo vozrasta.

Dynamics of carbamazepine and valproic acid concentrations in the middle of follicular and lutein menstrual cycle phases has been studied in women with epilepsy, aged 21-30 years. Nineteen patients were treated with valproic acid (Depakine 900-2000 mg/day), 35--with carbamazepine (500-1200 mg/day). All the patients have been treated during at least 6 months, the remission being observed during the last 3 months. Control group consists of 17 healthy age-matched women with no positive familial history of nervous and endocrine diseases. Carbamazepine and valproic acid concentrations were measured in blood serum using high-performance liquid chromatography. Blood for analysis was donated on an empty stomach in the morning before the next dose (i.e. at the lowest concentration) and two hours after the drug taking. Mean carbamazepine concentrations (4-12 mcg/ml) in the women with epilepsy were adequate when the day dose was more than 10 mg/kg. Carbamazepine concentrations during lutein phase were significantly lower (p < 0.03), comparing to those in the follicular phase. However, in the lutein phase, progesterone, which concentration was ten times higher is follicular one, has an additional effect, acting as anticonvulsive agent. Valproic acid concentrations do not significantly differ in the lutein and follicular phases that allows Depakine using in catamenial epilepsy. Practitioners are not recommended to overestimate the anti-epileptic drug (AED) concentration monitoring because the usage of the lower AED individual therapeutic dose, not achieving even the mean therapeutic drug concentrations, is acceptable. This seems to be of extremely importance for women with potential maternal role function.

[Treatment of lower respiratory tract infections in the elderly]. / Lecheniie infektsil nizhnikh dykhatel'nykh putel u lits pozhilogo vozrasta.

Sixty outpatients at the age of 65 to 75 years with exacerbated chronic bronchitis were treated with antibiotics: amoxycillin/clavulanic acid (20 patients), cefaclor (20 patients) and ciprofloxacin (20 patients). The treatment course in all the cases was 5 days. Bacteriological tests of the sputum specimens and estimation of the isolate antibiotic susceptibility by the disk diffusion method were applied to all the patients before and after the treatment. 73 per cent of the patients had mixed infection. The microflora mainly included various species of streptococci highly susceptible to the drugs (54 per cent) as well as highly susceptible strains of pneumococci and hemophilic bacilli (33 and 17 per cent respectively). Atypical microflora was detected in 10 per cent of the cases. Pseudomonas aeruginosa strains were isolated in 2 cases. Acinetobacter sp. slightly susceptible only to ciprofloxacin was isolated in 1 case. Citrobacter sp. slightly susceptible to cefaclor and moderately susceptible to ciprofloxacin was detected in 1 case. Enterobacter sp. moderately susceptible only to ciprofloxacin was isolated in 1 case. A positive factor was moderate susceptibility of Proteus mirabilis to all the three drugs. In 24 patients (the average age of 54.7 years) the pharmacokinetics of ofloxacin administered under 2 different regimens was studied. The drug was used in a single dose of 400 mg once a day (group 1) or in a dose of 200 mg twice a day (group II) followed by estimation of the drug concentration in the blood and sputum. The pathogen eradication was stated in 61.5 and 72.7 per cent of the patients in groups I and II, respectively. By the results of the treatment with the use of the above mentioned antibiotics in the elderly patients fluoroquinolones should be considered preferable from the clinical and pharmacoeconomic viewpoints.

[Clinical and pharmacokinetic evaluation of ofloxacin under various regimens of administration in patients with bronchopulmonary infections]. / Klinicheskaia i farmakokineticheskaia otsenka ofloksatsina pri raznykh rezhimakh vvedeniia u bol'nykh s bronkholegochnoi infektsiei.

Ofloxacin was used in the treatment of 24 patients with chronic bronchitis or pneumonia at the background of chronic bronchopulmonary and cardiovascular diseases. The drug was administered in accordance with 2 regimens: orally in a dose of 400 mg once a day (group I) and intravenously in a dose of 200 mg twice a day for 2 to 4 days followed by the drug oral use in the same dosage for 6 to 8 days (group II). The trial included comparison of the treatment efficacy by a complex of clinicobacteriological indices, estimation of the drug pharmacokinetics under the two regimens and prediction of the drug concentrations in blood with the mathematical models. High clinical and bacteriological efficacies of ofloxacin were shown under both the regimens. The pathogen eradication under both the regimens was observed in 61.5 and 72.7 per cent of the cases in groups I and II respectively. Dependence of the ofloxacin blood concentrations in the patients on the dosage regimen was detected. The pharmacokinetic studies demonstrated the possible prediction of the drug blood concentrations after the multiple administrations based on the calculated parameters.

[Therapeutic drug monitoring and the pharmacokinetics of carbamazepine in children with a convulsive syndrome]. / Terapevticheskii lekarstvennyi monitoring i farmakokinetika karbamazepina u detei s sudorozhnym sindromom.

An analysis of maximal and minimal serum concentrations of carbamazepine was performed in 40 children with convulsive syndrome. All the patients received the drug for a long period. Considerable case-to-case differences of serum concentrations in spite of practically equal doses were revealed. Serum drug concentrations were therapeutically optimal (6-8 mg/ml) only in one third of children. On the basis of pharmacokinetic parameters, mean optimal dosages sufficient for maintenance of effective and safe carbamazepine concentrations were calculated. As the child grows general clearance of carbamazepine decreases. Over the age of 9 years it is significantly lower in girls than in boys of the same age. Speed of carbamazepine elimination was higher in cases of combined treatment than in cases of monotherapy. Indications and optimal time for therapeutic drug monitoring of carbamazepine are determined and clinical illustrations are presented.

[Clinical and experimental studies of the combined use of dibasol and furosemide]. / Kliniko-éksperimental'noe izuchenie sochetannogo ispol'zovaniia dibazola i furosemida.

A combined use of dibasol and furosemide was demonstrated to be followed by a decrease of furosemide toxic effect on the rat liver, an increase of its diuretic effect in patients and changes of furosemide metabolism kinetics in individuals.