Aké sú odporúčania? Dnes sa budeme venovať postaveniu perorálneho klindamycínu v liečbe bakteriálnych infekcií.
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- Elijah Lamb
- 5 years ago
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1 Vážená pani doktorka, vážený pán doktor, vítame Vás v tretej časti vzdelávacieho projektu. Dnes sa budeme venovať postaveniu perorálneho u v liečbe bakteriálnych infekcií. Aké sú odporúčania?
2 Antimikrobiálna terapia odporúčaná na liečbu miestne špecifických anaeróbnych infekcií 1* Typ infekcie Perorálne Parenterálne zubná 1., amoxicilín + klavulanát metronidazol + penicilín 2. metronidazol + penicilín, ampicilín + sulbaktam + doxycyklín horné cesty dýchacie 1., amoxicilín + klavulanát 1. pľúcna 2. metronidazol + makrolid 1. + fluorochinolón (len u dospelých) 2. metronidazol + makrolid, amoxicilín + klavulanát 2. ampicilín + sulbaktam + doxycyklín 3. metronidazol + penicilín 1. + makrolid 2. ampicilín + sulbaktam + doxycyklín, imipeném alebo meropeném 1. = liek prvej voľby, 2. = alternatívny liek. Prevzaté a upravené z Brook I (2016). * v kapsulách je určený pre infekcie ľahšieho až stredne závažného charakteru
3 Antimikrobiálna terapia odporúčaná na liečbu miestne špecifických anaeróbnych infekcií 1* Typ infekcie Perorálne Parenterálne panvová 1. + doxycyklín 1. + aminoglykosid koža a mäkké tkanivá 2. amoxicilín + klavulanát + doxycyklín, metronidazol + doxycyklín 1., amoxicilín + klavulanát piperacilín + tazobaktám, + doxycyklín, ampicilín + sulbaktám + doxycyklín, metronidazol + doxycyklín 2. metronidazol + linezolid 2. metronidazol + vankomycín 3. tigecyklín kosti a kĺby metronidazol + oxazolidinón 1., imipenem alebo meropenem 2. metronidazol + vankomycín, piperacilín + tazobaktam 1. = liek prvej voľby, 2. = alternatívny liek. Prevzaté a upravené z Brook I (2016). * v kapsulách je určený pre infekcie ľahšieho až stredne závažného charakteru
4 Antimikrobiálna terapia odporúčaná na liečbu miestne špecifických aeróbnych a zmiešaných infekcií * Orgánová trieda Druh infekcie Liek 1. voľby Alternatíva Dávkovanie u Dĺžka podávania u dýchací trakt akútna tonzilitída 2 fenoxymetylpenicilín klaritromycín azitromycín cefalosporíny 1. alebo 2. generácie 10 dní streptokoková faryngitída 3 penicilín, amoxicilín cefalosporín 1. generácie klaritromycín azitromycín 7 mg/kg každých 8 hodín (max. 300 mg/dávka) 10 dní * v kapsulách je alternatívou lieku 1. voľby, ak sú hlavným etiologickým agens streptokoky alebo Staphylococcus aureus a ak je preukázaná ich laboratorná citlivosť ku u.
5 Antimikrobiálna terapia odporúčaná na liečbu miestne špecifických aeróbnych a zmiešaných infekcií * Orgánová trieda Druh infekcie Liek 1. voľby Alternatíva Dávkovanie u Dĺžka podávania u koža a mäkke tkanivá impetigo 2,4 mupirocin (lokálne) penicilín, amoxicilín/ klavulanát makrolidy cefalosporíny 1. generácie 600 mg á 8 hod 10 dní erysipel 2,4 penicilín cefalosporín 2. generácie 600 mg á 6 8 hod 10 dní flegmóna (Streptococcus pyogenes) 4 penicilín linezolid 7 10 dní flegmóna (Staphylococcus aureus) 4 oxacilín linezolid, ceftarolín tigecyklín 7 10 dní syndróm diabetickej nohy (mierna infekcia bez komplikácií) 5 cefalosporíny 1. generácie oxacilín fluorochinolón trimetoprim/ sulfametoxazol makrolidy mg každých 6 8 hodín podľa klinického stavu pacienta * v kapsulách je alternatívou lieku 1. voľby, ak sú hlavným etiologickým agens streptokoky alebo Staphylococcus aureus a ak je preukázaná ich laboratorná citlivosť ku u.
6 Antimikrobiálna terapia odporúčaná na liečbu miestne špecifických aeróbnych a zmiešaných infekcií * Orgánová trieda Druh infekcie Liek 1. voľby Alternatíva kostrový systém (kosti a kĺby) infekcia endoprotézy (G+ anaeróbna etiológia, pokračovacia liečba) 6 + rifampicín amoxicilín + rifampicín Dávkovanie u mg každých 6 8 hodín p. o. Dĺžka podávania u 2 4 týždne pokračovať podľa klinického stavu pacienta osteomyelitída p. o. (streptokoky, S. aureus, Peptostreptococcus, pokračovacia liečba) 7 penicilín oxacilín vankomycín mg každých 6 8 hodín p. o. 2 4 týždne pokračovať podľa klinického stavu pacienta * v kapsulách je alternatívou lieku 1. voľby, ak sú hlavným etiologickým agens streptokoky alebo Staphylococcus aureus a ak je preukázaná ich laboratorná citlivosť ku u.
7 Ďakujeme Vám za pozornosť. Veríme, že prezentované informácie boli pre Vás užitočné a prajeme úspešnú terapiu Vašich pacientov liekom Dalacin C.
8 SKRÁTENÁ INFORMÁCIA O LIEKU DALACIN C 150 mg tvrdé kapsuly, DALACIN C 300 mg tvrdé kapsuly Každá kapsula obsahuje 150 mg alebo 300 mg u. Lieková forma: tvrdé kapsuly. Charakteristika: je polosyntetické antibiotikum odvodené od linkomycínu; inhibuje syntézu bakteriálnych bielkovín pôsobením na bakteriálne ribozómy, prednostne sa viaže na 50S ribozomálnu podjednotku a ovplyvňuje proces iniciácie peptidového reťazca. Farmakoterapeutická skupina: antibiotiká na systémové použitie, linkozamidy, ATC kód: J01FF01. Indikácie: liečba infekcií vyvolaných citlivými anaeróbnymi baktériami, citlivými kmeňmi grampozitívnych aeróbnych baktérií, ako sú streptokoky, stafylokoky a pneumokoky, a citlivými kmeňmi Chlamydia trachomatis. Infekcie horných dýchacích ciest vrátane tonzilitídy, faryngitídy, sinusitídy, otitis media a šarlachu. Infekcie dolných dýchacích ciest vrátane bronchitídy, pneumónie, pľúcneho abscesu a empyému. Infekcie kože a mäkkých tkanív. Infekcie kostí a kĺbov vrátane osteomyelitídy a septickej artritídy. Gynekologické infekcie zahŕňajúce endometritídu, celulitídu, infekciu vaginálneho pahýľa, tuboovariálny absces, salpingitídu a panvové zápalové ochorenie. Dentálne infekcie ako periodontálny absces a periodontitída. Toxoplazmová encefalitída u pacientov s AIDS. Pneumónia spôsobená Pneumocystis jiroveci (pôvodne klasifikovaný ako Pneumocystis carinii) u pacientov s AIDS. Malária. Citlivosť na in vitro sa dokázala u nasledujúcich mikroorganizmov: B. melaninogenicus, B. disiens, B. bivius, Peptostreptococcus sp., G. vaginalis, M. mulieris, M. curtisii a Mycoplasma hominis. Dávkovanie: dospelí: zvyčajná denná dávka je 600 až mg u rozdelená do 2, 3 alebo 4 rovnakých dávok. Odporúča sa kapsuly pri prehĺtaní zapiť pohárom vody, aby sa zabránilo podráždeniu pažeráka. Dávkovanie u detí (staršie ako 1 mesiac): dávka 8 25 mg/kg/deň rozdelená do 3 alebo 4 rovnakých dávok. Dávkovanie u starších ľudí: nie je potrebná úprava dávkovania. U pacientov s poruchou funkcie obličiek a pečene nie je potrebná úprava dávkovania. Kontraindikácie: pacienti so známou precitlivenosťou na, linkomycín alebo na ktorúkoľvek z pomocných látok. Špeciálne upozornenia: liečba antibakteriálnymi látkami vyvoláva zmeny normálnej mikrobiálnej flóry hrubého čreva, a tým môže umožniť premnoženie Clostridium difficile. Ak sa vysloví podozrenie alebo sa potvrdí postantibiotická hnačka alebo postantibiotická kolitída, liečba antimikrobiálnymi látkami vrátane u sa musí ukončiť a okamžite sa musia prijať vhodné liečebné opatrenia. Keďže dostatočne nepreniká do cerebrospinálneho moku, nesmie sa používať pri liečbe meningitídy. Pri predĺženej liečbe majú byť monitorované funkcie pečene a obličiek. Užívanie u môže viesť k premnoženiu necitlivých mikroorganizmov, najmä kvasiniek. DALACIN C obsahuje laktózu. Pacienti so zriedkavými dedičnými problémami galaktózovej intolerancie, vrodeného nedostatku laktázy alebo glukózo-galaktózovej malabsorbcie nesmú užívať tento liek. Interakcie: Klindamycín má vlastnosti blokátora neuromuskulárneho prenosu, preto môže zvýšiť účinok iných neuromuskulárnych blokátorov. U pacientov liečených om v kombinácii s antagonistami vitamínu K (napr. warfarín, acenokumarol a fluindión) sa zaznamenali zvýšené hodnoty koagulačných testov (PT/INR) a/alebo krvácanie. Nežiaduce účinky: časté: pseudomembranózna kolitída, eozinofília, hnačka, makulopapulárna výražkaa, abnormálne výsledky funkčných testov pečene. Gravidita a laktácia: sa môže používať počas gravidity, len ak je to nevyhnutné. Dojčiace ženy nesmú užívať. Ovplyvnenie schopnosti viesť motorové vozidlá a obsluhovať stroje: nemá žiadny, alebo má zanedbateľný vplyv na schopnosť viesť vozidlá a obsluhovať stroje. Uchovávanie: pri teplote neprevyšujúcej 30 C. Informácia je určená pre odbornú verejnosť. Výdaj lieku je viazaný na lekársky predpis. Pred podaním lieku sa zoznámte s úplným znením Súhrnu charakteristických vlastností lieku (SPC). Dátum aktualizovania skrátenej informácie o lieku: apríl Držiteľ rozhodnutia o registrácii: Pfizer Europe MA EEIG, Ramsgate Road, Sandwich, Kent CT13, 9NJ, Veľká Británia. Miestne zastúpenie držiteľa rozhodnutia o registrácii: PFIZER Luxembourg SARL, o.z., tel.: Upravené podľa SPC schváleného ŠÚKL február PFIZER Luxembourg SARL, o. z. Pribinova 25, Bratislava, tel.: 02/ , fax: 02/ PP-DAL-SVK-0011
9 Literatúra: 1. Brook I, Spectrum and treatment of anaerobic infections. J Infect Chemother 2016; 22 (1): Karan I, Havlík J, Kolek V, et. al. Racionální antibiotická terapie respiračních a kožních infekci v ordinaci všeobecného praktického lékaře. Praha: SVL ČSL JEP, 2011: Shulman ST, Bisno AL.Clegg HW, et. al. Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: 2012 Update by the Infectious Diseases Society of America. Clin infects Dis 2012; 55 (10): e86-e Gürlich R, Adamková V, Ulrych J, et. al. Základní principy diagnostiky a léčby sekundární peritonitídy doporučení odborníku s podporou SIS. Rozhl Chir 2014; 93 (6): Jirkovská A, Lacigová S, Rušavý Z, et. al. Doporučený postup pro prevenci, diagnostiku a terapii syndromu diabetické nohy [online]. Česká diabetologická společnosť ČSL JEP, Dostupné z: 6. Musil D, Balejová M, Horníková M, et. al. Infekce endoprotéz: doporučení antibiotické léčby [online]. Release Date: Česká společnost pro ortopedii a traumatologii (ČSOT) a Spolešnost infekčního lékařsví (SIL) ČSL JEP, 2017, Dostupné z DoporTEP17.htm. 7. Adamková V, et. al. Antibiotika v chirurgických oborech. Praha: Mladá fronta, ISBN PFIZER Luxembourg SARL, o. z. Pribinova 25, Bratislava, tel.: 02/ , fax: 02/ PP-DAL-SVK-0011
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