Background: The problem of increasing antibiotic resistance, decrease in the quality of treatment and its inefficiency, the prolongation of terms of hospitalization, development of nosocomial infections, and increasing treatment costs leads to significant social and financial losses. Based on international recommendations and consideration of the microbial landscape the local strategy for the use of antibacterial drugs was developed and implemented. Methods: In this study, an analysis of the effectiveness of the rational use of antibiotics comparing results of 2014 and 2015 was conducted: Selection of the most significant nosocomial pathogens and determination of their antibiotic susceptibility (in percentages) ABC / VEN-analysis of antimicrobial agents Calculation of ATC / DDD usage of antimicrobials Results: of 2015 compared to 2014: Despite the growth of antibiotic resistance strains of Acinetobacter spp, improvement in antibiotic susceptibility is noticable (depending on the drug) Staphilococcus aureus from 2.5% to 38.8%; Pseudomonas aeruginosa from 1.1% to 13.2%; Klebsiella pneumonia from 5% to 40.3%; E coli 5,5-32,2%.The decrease in the cost of antibiotics by 3.8%. The decrease in ATC / DDD consumption (for 22 antibiotics), except for piperacillin tazobactam with the DDD 0.47 to 0.66; meropenem from 1.69 to 2.23; cefoperazone / sulbactam from 0.39 to 0.79 and gentamicin from 0.13 to 48.99. Conclusions: Ongoing efforts to rationalize the use of antimicrobials and the containment of antimicrobial resistance in a multidisciplinary hospital should be comprehensive, in coordination of representatives of different specializations, which in the future will increase efficiency of treatment and reduce the hospitalization time of the patient.Even minor positive indicators give hope that activities were carried out in the right direction.

The article analyzes scientific publications (37 articles) devoted to phthisiology, clinical pharmacology of antimicrobial agents, laboratory methods for evaluating the effectiveness and safety of various regimens of tuberculosis chemotherapy caused by resistant strains of M. tuberculosis.It tells about prospects for expanding the line of antimicrobial agents for treatment of tuberculosis caused by resistant strains of M. tuberculosis, new approaches to the study and evaluation of the effectiveness of the drug at the stage of preclinical trials using the in vitro HFS-TV model.

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Significance. Free care delivery within the framework of the State Guarantee Programs substantiates the development of electronic platforms for information support of doctors in prescribing medicines and monitoring quality of treatment. Conceptualization of the unified information environment of clinical practice, unified interpretation of the terms and components of the diagnosed clinical situations are important conditions for effective performance of the medical electronic platforms. Purpose: to conceptualize the scheme of information environment of clinical practice to support decision-making and monitor quality of treatment. Material and methods. The conceptual schemes of the information environment of clinical practice have been developed in accordance with the system principles. The methodology for constructing conceptual schemes is based on the general principles of philosophical foundations of science. Results. The conceptual schemes, conceptual apparatus, and information environment of structural elements of the model of information environment of clinical practice have been developed. A glossary of general terms and concepts of the information environment of clinical practice has been created. The structural model of information environment was tested at the prototype electronic platforms across different medical specialties. Conclusion. The use of ontologies and intelligent systems based on the expert knowledge in combination with digital coding of the diagnosed clinical situations serve a promising approach to monitor and control quality of care delivery and cost accounting within the framework of the State Guarantee Programs implementation. Scope of application. The concepts of the components of the diagnosed clinical situations meet the requirements of the interdisciplinary level of the information environment and are applicable for creating electronic platforms in various specialized areas of clinical practice.

Studies on head injury-induced pituitary dysfunction are limited in number and conflicting results have been reported. To further clarify this issue, 29 consecutive patients (24 males), with severe (n = 21) or moderate (n = 8) head trauma, having a mean age of 37 ± 17 years were investigated in the immediate post-trauma period. All patients required mechanical ventilatory support for 8-55 days and were enrolled in the study within a few days before ICU discharge. Basal hormonal assessment included measurement of cortisol, corticotropin, free thyroxine (fT4), thyrotropin (TSH), testosterone (T) in men, estradiol (E2) in women, prolactin (PRL), and growth hormone (GH). Cortisol and GH levels were measured also after stimulation with 100 µg human corticotropin releasing hormone (hCRH) and 100 µg growth hormone releasing hormone (GHRH), respectively. Cortisol hyporesponsiveness was considered when peak cortisol concentration was less than 20 µg/dl following hCRH. TSH deficiency was diagnosed when a subnormal serum fT4 level was associated with a normal or low TSH. Hypogonadism was considered when T (males) or E2 (women) were below the local reference ranges, in the presence of normal PRL levels. Severe or partial GH deficiencies were defined as a peak GH below 3 µg/l or between 3 and 5 µg/l, respectively, after stimulation with GHRH. Twenty-one subnormal responses were found in 15 of the 29 patients (52%) tested; seven (24%) had hypogonadism, seven (24%) had cortisol hyporesponsiveness, five (17%) had hypothyroidism, and two patients (7%) had partial GH deficiency. These preliminary results suggest that a certain degree of hypopituitarism occurs in more than 50% of patients with moderate or severe head injury in the immediate post-trauma period, with cortisol hyporesponsiveness and hypogonadism being most common. Further studies are required to elucidate the pathogenesis of these abnormalities and to investigate whether they affect long-term morbidity. P2 Cortisol reserve in head trauma victims: evaluation with the low-dose (1 µ µg) corticotropin (ACTH) stimulation test