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MECHANISM OF ACTION OF ANTIBACTERIAL DRUGS IN COMMUNITY-
ACQUIRED PNEUMONIA IN YOUNG CHILDREN
Abdurahmonov Ilhom Rustamovich
Head of the department of clinical pharmacology,
Samarkand State Medical University.
https://doi.org/10.5281/zenodo.14191561
Abstract. The prevalence of infectious diseases of the respiratory system and, first of all,
pneumonia among the population, the presence of various etiological factors and conditions for
the appearance of diseases, doctors of various specialties - therapists, surgeons, neuropathologists
- predetermine the occurrence of this disease. Faced with this pathology. Few or atypical clinical
signs characteristic of the modern course of pneumonia complicate the diagnosis and complicate
the treatment of the patient. The presence of diseases accompanied by decompensation against the
background of an infectious lung lesion worsens the prognosis and increases the risk of death. It
is especially important to correctly diagnose infectious lung disease in time and to prescribe
adequate antibacterial therapy.
Key words: drugs, antibiotics, pharmacokinetics, drug effects.
МЕХАНИЗМ ДЕЙСТВИЯ АНТИБАКТЕРИАЛЬНЫХ ПРЕПАРАТОВ ПРИ
ВНЕБОЛЬНИЧНОЙ ПНЕВМОНИИ У ДЕТЕЙ РАННЕГО ВОЗРАСТА
Аннотация. Распространенность инфекционных заболеваний органов дыхания и, в
первую очередь, пневмонии среди населения, наличие различных этиологических факторов
и условий возникновения заболеваний, врачи различных специальностей — терапевты,
хирурги, невропатологи — предопределяют возникновение этого заболевания.
Столкнувшись с этой патологией. Малочисленные или нетипичные клинические
признаки, характерные для современного течения пневмонии, затрудняют диагностику и
осложняют лечение пациента. Наличие заболеваний, сопровождающихся декомпенсацией
на фоне инфекционного поражения легких, ухудшает прогноз и увеличивает риск
летального исхода. Особенно важно вовремя правильно диагностировать инфекционное
заболевание легких и назначить адекватную антибактериальную терапию.
Ключевые слова: лекарственные препараты, антибиотики, фармакокинетика,
лекарственные эффекты.
The prevalence of infectious diseases of the respiratory system and, first of all, pneumonia
among the population, the presence of various etiological factors and conditions for the appearance
of diseases, doctors of various specialties - therapists, surgeons, neuropathologists - predetermine
the presence of this disease. Faced with this pathology. Few or atypical clinical signs characteristic
of the modern course of pneumonia complicate the diagnosis and complicate the treatment of the
patient. The presence of diseases accompanied by decompensation against the background of an
infectious lung lesion worsens the prognosis and increases the risk of death.
It is especially important to correctly diagnose infectious lung disease in time and to
prescribe adequate antibacterial therapy. Pneumonia is a group of acute infectious diseases of
different etiology and pathogenesis, characterized by focal damage of the respiratory parts of the
lungs and the presence of alveolar exudation (see picture).
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Modern classification defines the following types of pneumonia: 1) community-acquired -
CP (ambulatory) - acquired outside a medical institution; 2) nosocomial (hospital, in-hospital) -
acquired in a medical institution; 3) aspiration; 4) pneumonia in people with severe immune
deficiencies - pneumonia caused by congenital immunodeficiency, HIV infection, iatrogenic
immunosuppression.
This division is based on the difference in the conditions in which the disease occurs and
the approaches to the selection of antimicrobial therapy. Among registered pneumonias, the most
common is CAP (ambulatory). They firmly occupy a leading position in the composition of acute
infectious diseases of urban residents. Etiological factors of SAP Due to significant limitations,
none of the microbiological methods can detect all potential triggers of bronchopulmonary
infection, so the etiology of the infectious process cannot be determined in 30-50% of patients.
More than 100 microorganisms that can cause SAP have been described, almost all of
which have been isolated at least once during lung tissue biopsy. However, in routine practice,
they rely on microbiological studies of blood, sputum or pleural fluid and the results of serological
studies to make an etiological diagnosis. Information on the etiology of SAP obtained in various
studies depends on the following factors: the investigated patient population (age, the presence
and severity of concomitant diseases - chronic obstructive pulmonary disease - COPD,
immunodeficiency conditions; places of development of pneumonia - nursing homes, isolated
groups); endemic characteristics and epidemiological situation of the region during the study; set
of used diagnostic methods, their sensitivity and specificity, criteria for evaluating the obtained
results. The etiology of CAP is directly related to the microflora, usually colonizing the upper
respiratory tract. The most common causative agent of CAP is Streptococcus pneumoniae, which,
according to various authors, causes the disease in 30-50% of cases in people of all ages.
Haemophilus influenzae is less common (10-20%). Up to 10% of CAP is caused by an
association of two or more microorganisms, most commonly S. pneumoniae and H. influenzae.
However, in each case, it is not clear whether both microorganisms are equivalent
etiological agents or whether one of them serves only as a predisposing factor for infection caused
by another pathogen. Staphylococcus aureus, Moraxella, gram-negative bacteria (Klebsiella
pneumoniae, Escherichia coli, Enterobacter spp., Pseudomonas spp., etc.), viruses (respiratory
syncytial, influenza A and B viruses, parainfluenza) play a lesser role. . Although atypical
microorganisms - Chlamydophila (Chlamydia) pneumonia, Mycoplasma pneumoniae and
Legionella pneumophila - cause 8 to 30% of SAP cases, it is difficult to accurately assess the role
of these pathogenic microorganisms in the etiological structure of SAP. adequate diagnostic
methods. The role of oral microflora anaerobes (Peptostreptococcus spp., Bacteroides spp.,
Veilonella spp., etc.) in the genesis of CAP is small, but significantly increases with aspiration
pneumonia, which occurs in 6-10%. conditions against the background of mental retardation,
encephalopathy, trauma, cerebrovascular diseases.
Post-influenza pneumonia is most often caused by hemolytic streptococcus serogroup A
(Streptococcus pyogenes), S. aureus, H. influenzae, or S. pneumoniae. The most common
causative agent of CAP in smokers is nontypeable strains of H. influenzae. In patients with
immunodeficiency, including neutropenia, in addition to pneumococci, staphylococci and gram-
negative bacteria, pneumocystis carinii (Pneumocystis carinii), atypical mycobacteria, fungi and
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cytomegalovirus are often found (the latter are symptoms of HIV infection). It should also be noted
that a number of infectious diseases - pulmonary tuberculosis (Mycobacterium tuberculosis), Q
fever (Coxiella burnetii), psittacosis (Chlamydophila psittaci), chlamydia infection in children
(Chlamydia trachomatis), endemic mycoses (histoplasmosis, blastomycosis), gantavirus
pulmonary syndrome (Hantaviruses), tularemia (Francisella tularensis), other highly dangerous
infections (anthrax - Bacillus anthracis, cholera - Yersinia pestis) - is caused by damage to the
lower respiratory tract.
The pathogenesis of CAP has four pathogenetic mechanisms of infection of the respiratory
tract of the lungs leading to the development of pneumonia. The main mechanism is
microaspiration of bacteria that make up the normal microflora of the oropharynx. In this case, it
is important to increase their virulence against the background of the massiveness of the dose of
microorganisms or damage to the protective mechanisms of clearing the tracheobronchial tree.
Such conditions can occur with a viral respiratory infection, associated with the
dysfunction of the ciliated epithelium and a decrease in the phagocytic activity of alveolar
macrophages. A less observed way of pneumonia is the inhalation of microbial aerosol, which is
usually observed during infection with obligate pathogens (Legionella spp., etc.). In terms of the
frequency of infection, microorganisms are hematogenously transmitted from an extrapulmonary
focus of infection (endocarditis of the tricuspid valve, septic thrombophlebitis of the pelvic veins)
and directly from a limited focus of infection (liver). spread is less important. abscess, mediastinal
diseases, penetrating wounds of the chest cavity, etc.). Based on the pathogenesis of pneumonia,
their etiological structure is often represented by the microflora of the upper respiratory tract, the
composition of which may differ in different patients depending on the external environment
surrounding the person, age, general health, and the presence of concomitant diseases. diseases
and previous antibacterial therapy. Taking into account these features is important for predicting
the etiology of CAP, planning the tactics of microbiological examination of the patient and
choosing a rational empiric antimicrobial therapy. Microbiological diagnosis Despite the
development of laboratory diagnostic methods, the etiological diagnosis of SAP cannot be
determined in 30-50% of cases.
This is partly due to certain difficulties in obtaining the complete material from the site of
inflammation in time and interpreting the research results. What makes the etiological diagnosis
of SAP extremely difficult is the following: the absence of sputum (especially in the early stages
of the disease) and the difficulty of obtaining it in children; it is impossible to obtain bronchial
secretion by invasive methods due to the severity of the patient's condition, insufficient
qualification of medical personnel or other reasons; contamination of the bronchial contents with
microflora of the oropharynx; High rate of carriage of S. pneumoniae, H. influenzae and other
conditional pathogens (from 5 to 60% in different age groups and populations); use of antibacterial
drugs at the pre-hospital stage. It cannot be ruled out that some cases of SAP of unknown etiology
are caused by pathogens that are still unknown to science or uncultivable forms of microorganisms
(including L-forms of bacteria that require special growth factors).
Despite the limited diagnostic value of the examination of freely expectorated sputum in
patients without mechanical ventilation, this type of material is essential in microbiology
laboratories.
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It is mandatory to evaluate the suitability of the sputum sample before performing the
culture examination. Sputum is of satisfactory quality if more than 25 neutrophils and less than 10
epithelial cells are detected in the field of view of sputum under a Gram-stained smear microscope
at a magnification of 100. The importance of examining sputum culture is also the diagnosis of
nosocomial pneumonia (NP). also lies in the identification of resistant strains of possible pathogens.
It should be remembered that even if microorganisms are isolated from sputum, difficulties
may arise in the correct interpretation of the test result.
The importance of isolated microorganisms to distinguish colonization from infection
should be critically evaluated, since sputum samples are often contaminated with microflora
colonizing the oropharynx and upper respiratory tract of patients. At the same time, it is necessary
to try to determine the etiology of CAP, which will first of all allow choosing the most appropriate
drug against a specific microorganism in a specific patient and reduce the risk of developing
unwanted drug reactions and resistance of the pathogen to antibiotics. during treatment. Second,
to obtain information about the occurrence of infections that require infection control measures
(for example, legionellosis) or preventive measures in contact persons (M. tuberculosis); collecting
information on resistant pathogens, avoiding unnecessary overuse of antibiotics in the population.
Third, improving the cost-effectiveness index by using a narrow-spectrum antibiotic that
is cheaper to treat and less harmful to the patient. The effectiveness and reliability of
microbiological diagnosis of CAP largely depends on the nature of the studied material, the
methods used and their combinations, and the correct interpretation of the obtained results.
A reasonable balance should be maintained between the intensity and invasiveness of the
diagnostic procedures performed on the patient and the prescription of empiric antibiotic therapy
without establishing a clear etiological diagnosis. Bacteriological examination of sputum is
indicated for patients with SAP treated in an outpatient setting. Epidemic (eg, legionellosis,
mycoplasma infection) or special clinical or epidemiological reasons may require serological
testing. The set of studies in hospitalized patients is determined by the severity of the disease, the
presence of epidemiological risk factors, and the effectiveness of empiric therapy.
The microbiological diagnostic program includes the study of clinical material from the
respiratory tract, blood and pleural fluid (see table). Serological tests have limited diagnostic value
and, as a rule, are not used in the examination of patients with suspected NP. These tests, which
are of epidemiological importance, may be useful in some cases, for example, in the retrospective
diagnosis of Legionnaires' disease. Antimicrobial therapy Taking into account the expansion of
the range of potential infectious agents, there is a clear trend to use broad-spectrum antibacterial
agents as initial therapy. anaerobes in pneumonia), now H. influenzae, M. catarrhalis and the
possible role in drug selection. gram-negative bacteria are taken into account, chlamydia,
legionella, viruses and fungi in the etiology of CAP in adult patients.
For S.pneumoniae, the most common causative agent of S.pneumoniae in all age groups of
patients, the increasing number of penicillin-resistant strains is a significant problem. In some
countries, the resistance of pneumococci to penicillin can reach 60%. The drugs of choice for the
treatment of pneumococcal pneumonia are β-lactam antibiotics - benzylpenicillin,
aminopenicillins, including protected ones, second and third generation cephalosporins. Macrolide
antibiotics are backup agents for β-lactam intolerance.
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Early fluoroquinolones (ciprofloxacin, ofloxacin, pefloxacin, lomefloxacin) are
characterized by low activity against pneumococci (risk of clinical and bacteriological treatment
failure). New drugs, new fluoroquinolones (levofloxacin, moxifloxacin) are also highly effective.
At the same time, pneumococcal resistance to tetracyclines (34-43%) and co-trimoxazole
(14-38%) continues to increase.
Later, drugs of this group (levofloxacin, moxifloxacin, gatifloxacin) are characterized by
high antipneumococcal activity (B. Kronemyer, 2003), resistance was not detected when used in
Russia. H. influenzae is the second most common cause of SAP, especially in smokers and patients
with COPD. Aminopenicillins (amoxicillin, taken orally, is preferable to ampicillin because it is
absorbed 2 times better from the gastrointestinal tract), 2-4 generation cephalosporins,
carbapenems and fluoroquinolones have high natural activity against Haemophilus influenzae.
The main mechanism of resistance development in H. influenzae is the production of
broad-spectrum β-lactamases (up to 10% of strains) capable of destroying natural and semi-
synthetic penicillins and first-generation cephalosporins. The drugs of choice for the treatment of
CAP caused by resistant strains of H. influenzae are protected aminopenicillins and second-
generation cephalosporins (III-IV generation cephalosporins and carbapenems have no advantage).
Macrolides have clinically significant activity. M. catarrhalis ranks third among the
causative agents of CAP, and 80-90% of strains produce β-lactamases that destroy benzylpenicillin,
aminopenicillins, and first-generation cephalosporins. The activity of β-lactamases is completely
suppressed by inhibitors, so amoxicillin/clavulanate, second-generation cephalosporins,
fluoroquinolones, and to some extent macrolides remain active. S. aureus is not a typical causative
agent of KAP, but its importance increases in elderly patients, alcohol abusers and drug addicts,
as well as after influenza. 70-80% of strains produce β-lactamases, destroying natural and semi-
synthetic penicillins except for oxacillin and methicillin.
However, they are completely suppressed by inhibitors and are not able to destroy
cephalosporins and carbapenems. The drugs of choice for the treatment of staphylococcal CAP are
oxacillin, amoxicillin/clavulanate, and I-II generation cephalosporins (III generation
cephalosporins are less active in vitro, oral cefixime and ceftibuten have no antistaphylococcal
activity). For allergies to β-lactams, macrolides are used (clarithromycin has the best effect against
S. aureus), lincosamides; Moxifloxacin has the highest antistaphylococcal activity among
fluoroquinolones. Methicillin-resistant strains of S. aureus (MRSA) are not specific for CAP, but
can be isolated from patients with cystic fibrosis (often associated with P. aeruginosa) (VE
Nonikov et al., 1993). Glycopeptides (vancomycin), oxazolidinones (linezolid) and rifampicin (80%
of cases) are active against MRSA.
In the treatment of mycoplasma pneumonia, the macrolides and tetracyclines with the
greatest natural activity against M. pneumoniae are used, and the new fluoroquinolones used
against this pathogen are more active than the previous fluoroquinolones. M. pneumoniae is
naturally resistant to β-lactam antibiotics because it lacks the cell wall and its component,
peptidoglycan, which is the target of β-lactams. C. pneumoniae is also resistant to β-lactams and
aminoglycosides, and the drugs of choice for the treatment of chlamydial CAP are macrolide
antibiotics and tetracyclines. Legionella spp. - a gram-negative microorganism with mainly
intracellular localization, is the causative agent of CAP with a severe course.
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The drug of choice for the treatment of Legionella pneumonia is erythromycin, which is
often used in combination with rifampicin.
Early and newer fluoroquinolones are also highly effective drugs in the treatment of
Legionella pneumonia. Other macrolides are also effective (especially clarithromycin and
azithromycin, which produce high concentrations in bronchial secretions). K. pneumoniae is rare,
usually found in patients with severe comorbidities (diabetes, heart failure, liver cirrhosis, etc.).
III-IV generation cephalosporins, carbapenems and fluoroquinolones have the highest natural
activity against this pathogen. P. aeruginosa plays a minimal role in CAP and rarely occurs in
bronchiectatic and immunosuppressive patients (eg, glucocorticoid therapy), heroin addicts, and
cystic fibrosis (often associated with S. aureus, Candida fungi) can cause illness. ).Some β-lactams
(piperacillin/tazobactam, ceftazidime, cefoperazone, cefepime, imipenem, meropenem),
aminoglycosides and fluoroquinolones (the most active ones are ciprofloxacin and moxifloxacin)
are active against Pseudomonas aeruginosa.
Currently, one of the most urgent problems of modern medicine is the rational use of
antimicrobial drugs (AMP). Interest in this problem is associated with a number of important
circumstances. First, antibiotics are one of the most frequently prescribed drugs both in outpatient
practice [1] and in hospitals [2], often irrationally and without appropriate indications. Second,
antibiotic therapy is an expensive method of treatment, accounting for 50% of the costs of medical
institutions [3] and taking a leading place in the composition of outpatient costs of infectious
diseases. In addition, over time, the use of antibacterial drugs is accompanied by a decrease in their
activity due to the development of resistance of microorganisms to them. Accordingly, the term
"rational antibacterial therapy" for various infectious diseases is understood as achieving the
predicted treatment result with the lowest economic costs and the lowest risk of selecting resistant
strains of microorganisms [4].
Today, the guidelines and principles of antibacterial therapy are clearly described in the
pages of many international and local recommendations for the treatment of patients with
respiratory tract infections (RTI) [5-8]. However, the availability of the most up-to-date
recommendations does not guarantee their practical use, and mistakes related to an irrational
approach to the use of antibiotics in RTIs are often encountered in daily practice. It should be noted
that errors in antibacterial therapy of IDPs have the largest share of all treatment errors made in
pulmonology practice. At the same time, the incorrect prescription of antibiotics has a decisive
effect on the outcome of the disease, the economic component of treatment, and leads to the
selection of antibiotic-resistant strains of pathogens [9,10].
The main errors in antimicrobial therapy [11,12] include:
1) unjustified antibiotic prescription;
2) wrong choice of medicine;
3) antibiotic selection without taking into account the regional characteristics of current
pathogen resistance;
4) insufficient dosage regimen;
5) unreasonable or irrational combination of drugs;
6) incorrect assessment of treatment efficiency criteria;
7) unreasonable duration of antibacterial therapy.
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Thus, during a multicenter pharmacoepidemiological study, the practice of treating acute
respiratory viral infections (ARVI) in children was evaluated [13]. Antimicrobial therapy was
indicated in 52% of outpatients. It is noted that 8.2% of patients experienced various adverse events
during treatment. In the study of VK. Tatochenko and others. [14] analyzed 1469 episodes of acute
respiratory illness (ARI) in children between 1998 and 2001. It is known that the frequency of
prescribing
antibiotics
for
ARVI
by
local
pediatricians
is
26-36%
[10].
A
pharmacoepidemiological study of the current practice of treatment of ARVI in conscripted
military personnel in the troops of the Moscow Military District showed that in 74.2% of cases
aminopenicillins were prescribed at the beginning of treatment [15]. However, it should be noted
that the practice of prescribing antibiotics for ARVI in childhood is widespread throughout the
world. For example, the frequency of their use in Canada is 14% [16], in France - 24% [17], in the
USA - 25% [18]. In China, 97% of children with acute respiratory infections who contact a
healthcare professional receive antimicrobial therapy [19].
Thus, it should be recognized that the current practice of ambulatory treatment of OB in
adults includes the prescription of broad-spectrum antibacterial drugs in most cases (85.7%). At
the same time, the frequency of prescribing antimicrobial therapy was high in all outpatient
medical institutions, regardless of their geographic location. It is clear that the practice of
widespread use of antimicrobial agents for diseases of mainly viral etiology is incorrect and only
leads to an increase in the number of adverse events, the "increase" in the cost of treatment, and
with the increase in the number of can be. antibiotic-resistant strains of microorganisms.
In the analysis of outpatient treatment of adult patients with acute tonsillopharyngitis (ATP)
aggravated by chronic bronchitis and acute otitis media (AOM), a high frequency of use of
antibacterial therapy was noted - in 95, 84 and 79% of cases, respectively [20] –22]. At the same
time, the percentage of bacterial pathogens in ATF does not exceed 30%, and the treatment of
patients with mild forms of AOM includes prescribing antibiotics only in the presence of persistent
symptoms against the background of adequate symptomatic therapy.
Another serious problem that often occurs in the treatment of IDPs is the irrational tactics
of
antibacterial
therapy.
According
to
a
number
of
large-scale,
multicenter
pharmacoepidemiological studies conducted in Russian polyclinics, the choice of antibacterial
drugs for tonsillopharyngitis, AOM, acute sinusitis in most cases is the range of the most relevant
pathogens, without taking into account modern data done. their resistance to antibiotics, as well as
the pharmacokinetics and safety profile of the drugs [20-21,23]. For example, in the treatment of
acute sinusitis only 18% of cases recommended by experts, and in 82% of cases antibiotics that
have lost their clinical significance (co-trimoxazole, doxycycline) were used. 23]. Antibiotics were
used in patients with ATF, whose activity did not allow the necessary destruction of group A β-
hemolytic streptococci (doxycycline, ciprofloxacin, etc.).
Currently, the pages of local recommendations for the management of patients with
community-acquired pneumonia (CAP) focus on the analysis of the most common errors in
antibacterial therapy for this disease.
In a multicenter prospective pharmacoepidemiological study conducted in 2007, the
current practice of antibiotic therapy in patients with SAP was further analyzed [7].
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In addition to the recommended drugs (amoxicillin, amoxicillin/clavulanate, macrolide
antibiotics), cefazolin and ciprofloxacin (drugs with low pneumococcal activity) took an important
part in the prescriptions; There was a high frequency of prescribing third-generation parenteral
cephalosporins (cefotaxime, ceftriaxone). At the same time, widespread unreasonable use of
"early" fluoroquinolones (ciprofloxacin) may be accompanied by the formation of antibiotic-
resistant strains of microorganisms, including new representatives of this class of antibiotics
(levofloxacin, moxifloxacin). In 2007, the composition of AMPs used for the initial monotherapy
of CAP in the outpatient setting is presented in Figure 2.
Currently, the following approach is presented in the pages of local recommendations [7]
for ambulatory treatment of patients with SAP. In the case of non-severe pneumonia in patients
without concomitant diseases and who have not received it in the last 3 months. Antibacterial drugs
Adequate clinical effect can be obtained by using amoxicillin or macrolide antibiotics with
improved pharmacokinetic properties (azithromycin, clarithromycin) (Table 2). On the contrary,
the patient has concomitant diseases (chronic obstructive pulmonary disease (COPD), diabetes
mellitus (DM), congestive heart failure, liver disease, alcohol abuse, drug addiction, underweight)
and / or received in the last 3 months if antibacterial drugs (the risk of identifying pathogens
resistant to antibiotics, the proliferation of gram-negative microorganisms, it is recommended to
prescribe aminopenicillins "protected" from co-infection); In particular, taking into account the
possible contribution of pathogens such as Chlamydophila and Mycoplasma pneumoniae to the
etiology of pneumonia, combined therapy can be prescribed: "protected" aminopenicillin +
macrolide (Table 2). An alternative to this approach for the treatment of non-severe CAP with risk
factors for treatment failure may be the use of "inhaled" fluoroquinolones.
REFERENCES
1.
Rustamovich, A. I., Negmatovich, T. K., & Fazliddinovich, S. D. (2022). БОЛАЛИКДАН
БОШ МИЯ ФАЛАЖИ ФОНИДА РИНОСИНУСИТИ БОР БЕМОРЛАРДА БУРУН
БЎШЛИҒИ МУКОЦИЛИАР ТРАНСПОРТИ НАЗОРАТИ ТЎҒРИСИДАГИ
ЗАМОНАВИЙ ҚАРАШЛАР (адабиётлар шарҳи). JOURNAL OF BIOMEDICINE
AND PRACTICE, 7(2).
2.
Абдурахмонов, И. Р., & Шамсиев, Д. Ф. (2021). Эффективность применения местной
антибиотикотерапии в лечении параназального синусита у детей с церебральным
параличем. In НАУКА И ОБРАЗОВАНИЕ: СОХРАНЯЯ ПРОШЛОЕ, СОЗДАЁМ
БУДУЩЕЕ (pp. 336-338).
3.
Абдураҳмонов, И. Р., & Шамсиев, Д. Ф. (2021). Болаликдан бош мия фалажи билан
болалардаги ўткир ва сурункали параназал синуситларни даволашда мукорегуляр
дори воситасини самарадорлигини ўрганиш. T [a_XW [i [S US S_S^[ǜe YfcS^, 58.
4.
Siddikov, O., Daminova, L., Abdurakhmonov, I., Nuralieva, R., & Khaydarov, M.
OPTIMIZATION OF THE USE OF ANTIBACTERIAL DRUGS DURING THE
EXACERBATION OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE. Turkish
Journal of Physiotherapy and Rehabilitation, 32, 2.
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2024
International scientific journal
«MODERN
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VOLUME 3 / ISSUE 11 / UIF:8.2 / MODERNSCIENCE.UZ
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5.
Тураев, Х. Н. (2021). Абдурахмонов Илхом Рустамович Влияние будесонида на
качество жизни пациентов с бронхиальным обструктивным синдромом. Вопросы
науки и образования, 7, 132.
6.
Абдурахманов, И., Шамсиев, Д., & Олимжонова, Ф. (2021). Изучение
эффективности мукорегулярных препаратов в лечении острого и хронического
параназального синусита при детском церебральном параличе. Журнал
стоматологии и краниофациальных исследований, 2(2), 18-21.
7.
Абдураҳмонов, И. Р., & Шамсиев, Д. Ф. (2023). БОШ МИЯ ФАЛАЖИ ФОНИДАГИ
ПАРАНАЗАЛ
СИНУСИТЛАРНИ
ДАВОЛАШДА
ЎЗИГА
ХОС
ЁНДАШИШ. MedUnion, 2(1), 14-26.
8.
Орипов, Р. А., Абдурахмонов, И. Р., Ахмедов, Ш. К., & Тураев, Х. Н. (2021).
ОСОБЕННОСТИ ПРИМЕНЕНИЕ АНТИОКСИДАНТНЫХ ПРЕПАРАТОВ В
ЛЕЧЕНИИ НЕЙРОДЕРМИТА.
9.
Ахмедов, Ш. К., Тураев, Х. Н., Абдурахмонов, И. Р., & Орипов, Р. А. (2021).
НЕКОТОРЫЕ ОСОБЕННОСТИ ТАКТИКИ ПРОДУКТИВНОГО ЛЕЧЕНИЯ
ХРОНИЧЕСКОЙ КРАПИВНИЦЫ.
10.
Абдурахмонов, И. Р. (2021). Исследование мукоцилиарной транспортной функции
слизистой оболочки полости носа у больных с параназальным синуситом на фоне
детского церебрального паралича. In Актуальные аспекты медицинской
деятельности (pp. 256-259).
11.
Абдурахмонов, И. Р., & Тураев, Х. Н. (2022). ОПЫТ ПРИМЕНЕНИЯ СИНУПРЕТА
С АНТИБАКТЕРИАЛЬНЫМИ ПРЕПАРАТАМИ В КОМПЛЕКСНОЙ ТЕРАПИИ
РИНОСИНУСИТОВ
У
БОЛЬНЫХ
ДЕТСКИМ
ЦЕРЕБРАЛЬНЫМ
ПАРАЛИЧОМ. Достижения науки и образования, (2 (82)), 88-92.
12.
Abdurakhmanov, I., & Shernazarov, F. (2023). SPECIFIC ASPECTS OF TREATMENT
OF CHRONIC RHINOSINUSITIS IN CHILDREN. Science and innovation, 2(D10), 164-
168.
13.
Andryev S. et al. Experience with the use of memantine in the treatment of cognitive
disorders //Science and innovation. – 2023. – Т. 2. – №. D11. – С. 282-288.
14.
Antsiborov S. et al. Association of dopaminergic receptors of peripheral blood
lymphocytes with a risk of developing antipsychotic extrapyramidal diseases //Science and
innovation. – 2023. – Т. 2. – №. D11. – С. 29-35.
15.
Asanova R. et al. Features of the treatment of patients with mental disorders and
cardiovascular pathology //Science and innovation. – 2023. – Т. 2. – №. D12. – С. 545-
550.
16.
Begbudiyev M. et al. Integration of psychiatric care into primary care //Science and
innovation. – 2023. – Т. 2. – №. D12. – С. 551-557.
17.
Bo’Riyev B. et al. Features of clinical and psychopathological examination of young
children //Science and innovation. – 2023. – Т. 2. – №. D12. – С. 558-563.
18.
Borisova Y. et al. Concomitant mental disorders and social functioning of adults with high-
functioning autism/asperger syndrome //Science and innovation. – 2023. – Т. 2. – №. D11.
– С. 36-41.
ISSN:
2181-3906
2024
International scientific journal
«MODERN
SCIENCE
АND RESEARCH»
VOLUME 3 / ISSUE 11 / UIF:8.2 / MODERNSCIENCE.UZ
362
19.
Ivanovich U. A. et al. Efficacy and tolerance of pharmacotherapy with antidepressants in
non-psychotic depressions in combination with chronic brain ischemia //Science and
Innovation. – 2023. – Т. 2. – №. 12. – С. 409-414.
20.
Nikolaevich R. A. et al. Comparative effectiveness of treatment of somatoform diseases in
psychotherapeutic practice //Science and Innovation. – 2023. – Т. 2. – №. 12. – С. 898-
903.
21.
Novikov A. et al. Alcohol dependence and manifestation of autoagressive behavior in
patients of different types //Science and innovation. – 2023. – Т. 2. – №. D11. – С. 413-
419.
22.
Pachulia Y. et al. Assessment of the effect of psychopathic disorders on the dynamics of
withdrawal syndrome in synthetic cannabinoid addiction //Science and innovation. – 2023.
– Т. 2. – №. D12. – С. 240-244.
23.
Pachulia Y. et al. Neurobiological indicators of clinical status and prognosis of therapeutic
response in patients with paroxysmal schizophrenia //Science and innovation. – 2023. – Т.
2. – №. D12. – С. 385-391.
24.
Pogosov A. et al. Multidisciplinary approach to the rehabilitation of patients with
somatized personality development //Science and innovation. – 2023. – Т. 2. – №. D12. –
С. 245-251.
25.
Pogosov A. et al. Rational choice of pharmacotherapy for senile dementia //Science and
innovation. – 2023. – Т. 2. – №. D12. – С. 230-235.
26.
Pogosov S. et al. Gnostic disorders and their compensation in neuropsychological
syndrome of vascular cognitive disorders in old age //Science and innovation. – 2023. – Т.
2. – №. D12. – С. 258-264.
27.
Pogosov S. et al. Prevention of adolescent drug abuse and prevention of yatrogenia during
prophylaxis //Science and innovation. – 2023. – Т. 2. – №. D12. – С. 392-397.
28.
Pogosov S. et al. Psychogenetic properties of drug patients as risk factors for the formation
of addiction //Science and innovation. – 2023. – Т. 2. – №. D12. – С. 186-191.
29.
Prostyakova N. et al. Changes in the postpsychotic period after acute polymorphic disorder
//Science and innovation. – 2023. – Т. 2. – №. D12. – С. 356-360.
30.
Prostyakova N. et al. Issues of professional ethics in the treatment and management of
patients with late dementia //Science and innovation.
– 2023. – Т. 2. – №. D12. – С. 158-165.
31.
Prostyakova N. et al. Sadness and loss reactions as a risk of forming a relationship together
//Science and innovation. – 2023. – Т. 2. – №. D12. – С. 252-257.
32.
Prostyakova N. et al. Strategy for early diagnosis with cardiovascular diseaseisomatized
mental disorders //Science and innovation. – 2023. – Т. 2. – №. D12. – С. 166-172.
33.
Rotanov A. et al. Comparative effectiveness of treatment of somatoform diseases in
psychotherapeutic practice //Science and innovation.
– 2023. – Т. 2. – №. D12. – С. 267-272.
34.
Rotanov A. et al. Diagnosis of depressive and suicidal spectrum disorders in students of a
secondary special education institution //Science and innovation. – 2023. – Т. 2. – №. D11.
– С. 309-315.
35.
Rotanov A. et al. Elderly epilepsy: neurophysiological aspects of non-psychotic mental
disorders //Science and innovation. – 2023. – Т. 2. – №. D12. – С. 192-197.
