Introduction. IBS is a functional bowel disorder that has a significant impact on patients and society, especially in terms of quality of life and medical costs.Pathogenesis. It is believed that the pathogenesis of IBS consists of several mechanisms: the syndrome of intersection of functional disorders (gut-brain), stress, visceral hypersensitivity and changes in motor skills.Visceral hypersensitivity. Changes in visceral sensitivity in IBS are characterized by central abnormalities in areas of the cerebral cortex. Motility impairment in IBS manifests itself as abnormal myoelectric activity in the colon, resulting in repetitive contractions of the small intestine and colon, which appear to cause pain.Intestinal microflora. FODMAPs are found in high amounts in some fruits, artificial sweeteners, legumes, and green vegetables and are poorly absorbed by all people. FODMAPs have enzymatic and osmotic effects that may contribute to the onset of symptoms in some patients.The principles of IBS therapy. Treatment for IBS should be based on the type and severity of symptoms. For the treatment of IBS, drugs of various pharmacological groups are used, depending on the prevailing symptoms. These include opioid receptor agonists, bile acid sequestrants, guanylate cyclase agonists, chlorine channel activators, as well as antibiotics, probiotics, antidepressants, 5-HT3 receptor antagonists, and antispasmodics.Myotropic antispasmodics. Drugs with antispasmodic activity are used to treat functional and organic diseases of the gastrointestinal tract as a basic therapy or «on demand». Mebeverine quickly and effectively relieves spasm, pain and the entire complex of intestinal symptoms, in addition, the drug reduces visceral hypersensitivity due to a local anesthetic effect. The drug has a high safety profile and has a number of advantages over drugs of the same pharmacological group.Conclusion. Myotropic antispasmodics have been shown to be highly effective in the treatment of IBS. Mebeverine occupies a special place among myotropic antispasmodics. Its combined action provides a pronounced antispasmodic activity along with a high safety profile.

TNF-α has been known since 1985. It is a multifunctional proinflammatory cytokine, synthesized mainly by monocytes and macrophages. Since its discovery, many studies have been conducted that have proven that it provides homeostatic function and regulates many biological processes in the body. Violation of its regulation in humans is associated with the development of many autoimmune diseases. The intensive studies that led to the understanding of its polyfunctionality and its role in the immunopathogenesis of a number of diseases served as the basis for the development of anti-cytokine therapy with monoclonal antibodies. In 1975, a technique for producing such antibodies was developed. The first antibodies against TNF-α obtained were chimeric, consisting of 30% mouse protein. Because of this feature, drugs based on chimeric antibodies had immunogenicity, which was manifested in the formation of antibodies to the drug, which led to a decrease in their effectiveness. To reduce immunogenicity, scientists in 1990 created the first fully human monoclonal antibody based on a technology called phage display. This is how adalimumab was born, the first fully human multi-clonal antibody to TNF-α. Humira® (adalimumab) is currently considered a widely studied drug from the group of TNF-α inhibitors, with a good safety and efficacy profile. The article presents current data that demonstrate that the drug significantly improves the course of diseases such as rheumatoid and psoriatic arthritis, and will allow for long-term remission in Crohn’s disease.

Chronic pancreatitis is a multifactorial disease in which repeated episodes of inflammation of the pancreas contribute to the development of fibrous tissue, leading to chronic pain, as well as exocrine and endocrine insufficiency. The incidence and prevalence of chronic pancreatitis in the world are growing, as evidenced by current statistics. In addition, the annual costs associated with the treatment of exocrine and endocrine insufficiency are also increasing. In the United States alone, the annual cost of treating these complications is $ 75.1 million. Exocrine insufficiency is one of the most frequent complications, which is characterized by a deficiency of pancreatic enzymes, leading to the development of malabsorption syndrome (impaired absorption of nutrients, vitamins and minerals). Due to the increased incidence and deterioration of the quality of life associated with this condition, the goal of treatment is to compensate for the deficiency of exocrine enzymes with oral pancreatic enzyme replacement therapy. The core of this therapy is to deliver activated, unbroken enzymes directly to the small intestine during a meal. Many studies have shown that prescribing enzyme replacement therapy improves symptoms associated with exocrine insufficiency, reduces the progression of osteopenia, and improves survival in such patients. The use of pancreatin contributes to the correction of exocrine insufficiency in patients with chronic pancreatitis. The data presented in the article indicate that the drug is a safe and effective agent, meets all modern standards and requirements, and can be used to correct enzymatic pancreatic insufficiency.

Combination of amoxicillin/clavulanate firstly occurred on a pharmacological market in 1977 and it is still has been used successfully for treatment of infections in children and adults. Clavulanic acid provides an opportunity to fight microorganisms that produce specific enzymes – beta-lactamases. Despite the global antibiotic resistance problem, amoxicillin/clavulanate is still active against different infections in children. The level of susceptibility to amoxicillin/clavulanate of St. pneumonia is high for a period of 40 years. Based on the multicenter study of the antimicrobial resistance of pneumococci, haemophilus, group A streptococci, moraxella PeGAS I-III findings, susceptibility to amoxicillin/clavulanate of St. Pneumoniae in Russian Federation has been changed slightly from 100% to 99.6% over a period of 1993 – 2009 y. The systematic review with meta-analysis published in 2019 showed that the sensitivity of hemophilic bacillus and moraxella to amoxicillin/clavulanate in the treatment of acute otitis media accounted for 98% each. The article presents data on clavulanic acid action mechanism, spectrum of amoxicillin/clavulanate activity on the ground of clinical trials and meta-analyses, priority of suspension usage in pediatric practice is explained. Possibilities of using in pediatric practice were also viewed.

Main groups of antisecretory drugs used in the treatment of acid-dependent diseases, including gastroesophageal reflux disease (GERD), are described in a review. Mechanisms of activation, degradation and inactive metabolites formation of proton pump inhibitors (PPIs) – final elements of acid production blockage – are considered in detail. Special attention is paid to the presence of PPIs’ derivatives with different functional activity: inactive derivatives, active and inactive metabolites. Topographic description of these derivatives, their significance in terms of an effect on bioavailability, clinical effectiveness and a potential of PPIs interactions with other administered drugs. The combined decision-making algorithm in the presence of gastroesophageal reflux disease symptoms is presented, compiled on the basis of the most authoritative current recommendations. This algorithm provides for the use of PPIs in standard doses once a day for 4–8 weeks with a possible dose escalation in a case of ineffectiveness. If treatment with high doses of PPIs is ineffective, a set of measures is needed to identify the causes of this inefficiency and to choose additional medical strategy. Depending on the clinical situation, after erosions epithelization the treatment can be stopped, used on demand, prolonged in the intermittent or supportive forms. Particular attention is paid to the Panum® drug, which has proven its effectiveness in patients with different degrees of reflux esophagitis. The availability of dosage forms for prescription and over-the-counter leave allows ensuring its comfortable and unhindered purchase by patients and eliminating excessive burden on the healthcare system.

Atopic dermatitis is one of the most common inflammatory diseases. This disease is characterized by severe itching, recurrent eczematous lesions and has a heterogeneous clinical picture. AD occurs in all countries, in both sexes, in different age groups. There has been a steady increase in the incidence of AD detection over the past three decades. The prevalence of AD symptoms in various regions of the Russian Federation (RF) ranged from 6.2 to 15.5%. There is no generally accepted classification of AD, the working classification of AD reflects the age dynamics, clinical and morphological forms, severity and stages of the course of the disease. Treatment of AD should be patient-centered and should include prevention of individual trigger factors, restoration of the skin barrier, and a stepwise and gradual approach to reduce inflammation based on the severity of the disease. mGCS are the first-line treatment for exacerbations of AD. Topical calcineurin inhibitors are tacrolimus and pimecrolimus. Pimecrolimus is indicated for the treatment of mild to moderate AD, and tacrolimus is indicated for moderate to severe AD. Tacrolimus and pimecrolimus are characterized by low systemic absorption, they do not cause skin atrophy and do not affect the function of the hypothalamic-pituitary-adrenal system. Systemic corticosteroids should be used only in exceptional cases for short-term treatment of an exacerbation or when starting another systemic therapy. The therapeutic value of 1st generation antihistamines lies in their sedative properties by normalizing nighttime sleep and reducing the intensity of itching. Dimetindene maleate is an effective and safe treatment for relieving symptoms of pruritus and normalizing sleep in patients with AD. Dimetindene maleate has a high safety profile and can be prescribed from 1 month of age.