Rational pharmacotherapy in modern gastroenterology

Introduction. Modern gastroenterology is characterized by the combined (comorbid) nature of the diseases. In treatment, this promotes polypharmacy and increases complications (drug lesions, allergic reactions, exacerbation of diseases of other organs and systems), and, importantly, increases the cost of pharmacotherapy.Aim. To compare two pharmacotherapy options for patients with gallstone disease at the stage of biliary sludge and patients with biliary sludge combined with irritable bowel syndrome.Materials and methods. In the work, based on the experience of treating 170 patients, two options for pharmacotherapy are considered, which may well turn out to be rational in all respects. Option 1 - monotherapy aimed at one of the components that form a complex pathogenetic symptom complex. The basis for offering this treatment option is the biological concept of the “regulatory cascade”. Option 2 – “stepwise” (stepwise) therapy with the choice of the “base” drug for the first step. Evaluation of the effectiveness and rational correction for the second step of treatment and subsequent ones – if necessary. Results. The biliary sludge was eliminated or reduced in patients who received the UDCA monotherapy against the background of recovery of gastrointestinal motility. The overall treatment effect (for each nosology) in patients with biliary sludge and irritable bowel syndrome using the complex therapy (UDCA and mebeverin) was 84 and 87.8% respectively.Conclusions. Both options are rational today: 1st requires further study; 2nd – active use. Both options exclude polypharmacy and other adverse effects.

Rational Pharmacotherapy in Infectious Diseases: Issues Related to Drug Residues in Edible Animal Tissues

Drugs are used in veterinary medicine to prevent or treat animal diseases. When rationally administered to livestock following Good Veterinary Practices (GVP), they greatly contribute to improving the production of food of animal origin. Since humans can be exposed chronically to veterinary drugs through the diet, residues in food are evaluated for effects following chronic exposures. Parameters such as an acceptable daily intake (ADI), the no-observed-adverse-effect level (NOAEL), maximum residue limits (MRLs), and the withdrawal periods (WPs) are determined for each drug used in livestock. Drug residues in food exceeding the MRLs usually appear when failing the GVP application. Different factors related either to the treated animal or to the type of drug administration, and even the type of cooking can affect the level of residues in edible tissues. Residues above the MRLs can have a diverse negative impact, mainly on the consumer’s health, and favor antimicrobial resistance (AMR). Drug residue monitoring programmes are crucial to ensure that prohibited or authorized substances do not exceed MRLs. This comprehensive review article addresses different aspects of drug residues in edible tissues produced as food for human consumption and provides relevant information contributing to rational pharmacotherapy in food-producing animals.

Clarification of principles of evidence-based medicine when considering issues of rational pharmacotherapy with medical students

Purpose of the study. Accentuate attention to the need to inform students about the achievements of evidence-based medicine in the field of rational pharmacotherapy when considering issues related to the choice of treatment and prevention of problems associated with taking medicines. Methodology. Descriptive and comparative methods were used in the study. Scientific novelty. The advantages of teaching the basics of pharmacotherapy of pathological processes using evidence-based medicine data for the formation of skills to critically evaluate information of scientific practical and make the right choices for the benefit of the patient. Conclusions. This approach increases the level of competence of medical students in matters of rational pharmacotherapy. Prospects for further research. Analysis of the effectiveness of teaching pharmacotherapy taking into account the results of student questionnaires.

The role of information service in rational pharmacotherapy with thioctic acid in patients in Preferential Medicinal Providing

Rational pharmacotherapy in the Program of Preferential Medicinal Providing can be implemented subject to high-quality information support from healthcare professionals. Thioctic (Alpha-lipoic) Acid preparations are widely used in the preferential segment, their appointment is not always advisable due to the frequent use «off-label», which leads to ineffective treatment and unreasonable economic costs. Aim. Conduct an information search and filling the electronic service «Database of Clinical Trials of Medicines» for medicinal products containing Thioctic (Alpha-lipoic) Acid and provide author’s recommendations for rational pharmacotherapy. Materials and methods. The search and analysis of the results of clinical trials, systematic reviews and meta-analysis in international and Russian Databases — PubMed, EMBASE, Cochrane Collaboration, e-Library, «Cyberlininka» for medicines of metabolic action — Thioctic (Alpha-lipoic) Acid with their subsequent introduction into the Information Service «Database of Clinical Trials of Medicines». Results. Thioctic (Alpha-lipoic) Acid has a positive effect in the form of improvement of the clinical condition of patients and indicators of neurological scales in diabetic and alcoholic polyneuropathy without affecting the «hard» endpoints (decrease in the number of fatal complications and mortality). Conclusion. Service «Database of Clinical Trials of Medicines» for use by health care professionals and the author’s recommendations for the use of Thioctic (Alpha-lipoic) Acid can be used for the rational prescription of this medicines in Preferential Medicinal Providing.

Effective, safe and rational pharmacotherapy of endogenic progesterone deficiency

Today, the most frequent complication of pharmacotherapy is an allergic reaction, the so-called drug or drug allergy. An allergic reaction can be caused both by the active ingredients and by the excipients included in the composition of the drug to provide a certain dosage form and its physicochemical properties. Vaginal progesterone preparations are characterized by a large variety of dosage forms: gels, tablets and gelatin capsules for intravaginal administration. It is known that the safety and efficacy of pharmacotherapy depend on the active substance, the dosage form, and the base of the intravaginal preparation, as well as the indices of adherence to medication therapy. At the same time, the base - excipients can cause the development of adverse reactions.The authors of the article, based on an analytical review of domestic and foreign literature, analyzed effective, safe and rational pharmacotherapy of endogenous progesterone deficiency.It is shown that micronization is currently used to improve the bioavailability of natural progesterone – a method of increasing solubility by reducing the particle size of the drug substance. Due to the high solubility of the substance, the risk of possible side effects is reduced, which allows increasing the safety of the drug.The peculiarity of the dosage form for vaginal administration is described. On the basis of the analysis of various forms of progesterone, the clinical efficacy of natural progesterone for vaginal administration has been substantiated.The authors found that the use of progesterone in sublingual and vaginal forms is the most rational in terms of convenience, efficacy and safety.

The assortment analysis of chlorhexidine-containing medicines and procurement data of state and municipal organizations

Chlorhexidine is an effective cationic antiseptic and disinfectant that has been used in medical practice for decades. It is generally recommended to use different concentrations of aqueous or alcoholic solutions of chlorhexidine for different therapeutic purposes. Objective. To determine the proportions of different chlorhexidine concentrations in medicines purchased by state and municipal organizations and to identify possible issue of chlorhexidine formulations utilization in the suboptimal or insufficient concentrations. Results. The vast majority of the chlorhexidine-containing medicines found in the State Register of Medicines of Ukraine are 0.05% solutions for external use, 0.05% gels for dental and urological use and vaginal suppositories (pessaries) with 16 mg of chlorhexidine in one dose. While the most common representatives of chlorhexidine-containing medicines abroad are solutions with a concentration of 4% and 2%, as well as mouthwashes with a concentration of 0.12%. The highest share - 96% - among the procurements of chlorhexidine-containing medicines by state and municipal organizations is 0.05% aqueous solution for external use. Instructions for medical use of 0.05% aqueous chlorhexidine solution for external use contain indications that are not supported by international documents: WHO Model List of Essential Medicines and British National Formulary. Conclusions. The obtained results suggest probable cases of irrational use of chlorhexidine medicines in medical practice in Ukraine. The consequences of such cases are not limited to the failure to achieve therapeutic goals or to the development of nosocomial infection, but includes also the selection of chlorhexidine-resistant strains of microorganisms. Key words: chlorhexidine; assortment analysis; medicinal procurements study; suboptimal concentration; rational pharmacotherapy