#1
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Ñíîâà ïðî ÊÎÊ è àíòèáèîòèêè
Âîò óâèäåëà ñîñåäíþþ òåìó è çàèíòåðåñîâàëàñü. Ïðèíèìàþ óæå øåñòü ìåñÿöåâ ßñìèí, î÷åíü íðàâèòñÿ. Èíîãäà áûâàþò ïðîáëåìû ñî çäîðîâüåì â âèäå öèñòèòà (îñòðîãî, 3-5 äíåé íîëèöèíà óáèðàþò), ê òîìó æå (êàê è ìíîãèå, ê ñîæàëåíèþ) ñòðàäàþ (íó, ïîêà íå î÷åíü) ïåðèîäîí... òüôó, ïî-ðóññêè ýòî ïàðîäîíòèò => ïðèíèìàþ àíòèáèîòèêè (ìàêðîëèäû). Áåðåìåííîñòåé íå íàñòóïàëî íè ðàçó.
Íåóæåëè ÂÑÅ àíòèáèîòèêè ïðè êîìáèíàöèè ñ ÊÎÊ òðåáóþò áàðüåðíîé ïîäñòðàõîâêè? ß äóìàëà, òîëüêî ðèôàìïèöèí, íó è ïåíèöèëëèí ñ àìîêñèöèëëèíîì... |
#2
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×èòàéòå âíèìàòåëüíî àííîòàöèè ê ïðåïàðàòàì. Ó êàæäîãî ïðåïàðàòà ìîãóò áûòü ñâîè îñîáåííîñòè.
Åñëè Âû íå õîòèòå ïîëó÷èòü áåðåìåííîñòü íà ôîíå ïðèåìà àíòèáèîòèêîâ, ÷òîáû ïîòîì ðåøàòü, "âðåäíî" ýòî äëÿ áóäóùåãî ðåáåíêà èëè "íå âðåäíî", ëó÷øå äîïîëíèòåëüíî ïðåäîõðàíÿòüñÿ ïðåçåðâàòèâîì íà âðåìÿ ïðèåìà àíòèáèîòèêîâ. Íå òàê ëè? |
#3
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Dr. IrMa,
ñïàñèáî çà îòâåò, îáÿçàòåëüíî âñå ÷èòàþ. Åñëè áû ÿ õîòåëà ïîëó÷èòü áåðåìåííîñòü, âðÿä ëè áû ïðèíèìàëà ÊÎÊ ß ïðîñòî õîòåëà óçíàòü, à íåò ëè òóò íåêîé ïåðåñòðàõîâêè. Âèòàìèí Ñ, ãäå-òî ÷èòàëà, òîæå ñíèæàåò ýôôåêòèâíîñòü ÊÎÊ. |
#4
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Ïðîâåëà research, òàê ñêòü.
Âîò ÷òî íàì ãîâîðèò êëèíèêà Ìýéî (ìàé 2007): Can antibiotics decrease the effectiveness of birth control pills? The effects of antibiotics on birth control pills may be overstated — except in the case of one antibiotic, rifampin. Studies clearly show that rifampin decreases the effectiveness of birth control pills in preventing ovulation. However, rifampin isn't a widely used antibiotic. Chances are you wouldn't be taking it unless you had tuberculosis or had tested positive for the disease. Hypothetically speaking, other antibiotics, particularly penicillin and tetracycline derivatives, could impair the effectiveness of birth control pills. However, no large studies have proved such an effect. Researchers can't rule out the possibility that a small percentage of women may experience decreased effectiveness of birth control pills while taking an antibiotic. And if you're taking a newer, extremely low-dose oral contraceptive, you could be more susceptible to these potential effects from antibiotics. If you're concerned, consider using a barrier method of contraception for the duration of your antibiotic prescription. Âîò ÷òî ãîâîðèò óíèâåðñèòåò Ïåíñèëüâàíèè: With the exception of rifampin-like drugs, there is a lack of scientific evidence supporting the ability of commonly prescribed antibiotics, including all those routinely employed in outpatient dentistry, to either reduce blood levels and/or the effectiveness of oral contraceptives. To date, all clinical trials studying the effects of concomitant antibiotic therapy (with the exception of rifampin and rifabutin) have failed to demonstrate an interaction. Like all drugs, oral contraceptives are not 100% effective with the failure rate in the typical United States population reported to be as high as 3%. It is thus possible that the case reports of unintended pregnancies during antibiotic therapy may simply represent the normal failure rate of these drugs. Considering that both drug classes are prescribed frequently to women of childbearing potential, one would expect a much higher rate of oral contraceptive failure in this group of patients if a true drug:drug interaction existed. À Íèäåðëàíäû ñîîáùàþò: CONCLUSION: The results from these studies demonstrate the absence of pharmacokinetic interactions between etonogestrel and ethinylestradiol released from NuvaRing and the oral antibiotics amoxicillin and doxycycline, suggesting that contraceptive efficacy would also be unaffected. Âîò... |
#5
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×èòàéòå Speroff. Êëàññèêà. Òàì âñå-âñå íàïèñàíî.
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#6
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Òàê ÷èòàþ æå:
There are many anecdotal reports of patients who conceived on oral contraceptives while taking antibiotics. There is little evidence, however, that antibiotics such as ampicillin, metronidazole, quinolone, and tetracycline, which reduce the bacterial flora of the gastrointestinal tract, affect oral contraceptive efficacy. Studies indicate that while antibiotics can alter the excretion of contraceptive steroids, plasma levels are unchanged, and there is no evidence of ovulation.299, 300 A review of a large number of patients derived from dermatology practices failed to find an increased rate of pregnancy in women on oral contraceptives and being treated with antibiotics (tetracyclines, penicillins, cephalosporins).301 |
#7
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Kitty
ÅÂÌ èìååò êîíêðåòíûé îòâåò íà âàø âïðîñ: [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] FFPRHC CEU guidance advises that it has been practice in the UK to advise additional contraceptive protection forwomen using combined hormonal contraception when broad-spectrum antibiotics are used. When taking a short course (<3 weeks) of any non-liver enzyme inducing antibiotic additional contraceptive protection, such as condoms, is advised during the treatment and for 7 days after the antibiotic is stopped. If fewer than seven pills are left in the packet after antibiotics have stopped she should to omit the pill free interval or discard any inactive pills. When any non-liver enzyme-inducing antibiotic is taken for ≥3 weeks additional contraceptive protection is no longer required. If a new antibiotic is prescribed however, advice is as for short courses. New COC user: When starting a COC if currently taking a short course (<3 weeks) of any non-liver enzyme inducing antibiotic additional contraceptive protection, such as condoms, is advised during the treatment and for 7 days after the antibiotic is stopped. When starting a COC if any non-liver enzyme-inducing antibiotic has been taken for ≥3 weeks additional contraceptive protection is not required. Ïðîøó ïðîùåíèÿ ó ìîäåðàòîðîâ, ÷òî ïðèâîæó öèòàòó íà àíãëèéñêîì, íî èç ñîîáùåíèé àâòîðà ïîñòà ñëåäóåò, ÷òî àâòîð àíãëèéñêèé ïîíèìàåò:-) |
#8
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Dr. Nika,
ñïàñèáî áîëüøîå çà ñâÿçíûå ðåêîìåíäàöèè. Ìíå ïîõîæåå ïðèøëîñü âûëàâëèâàòü ïî äþæèíå èñòî÷íèêîâ ðàçäåëüíî Òîëüêî âñå ðàâíî ýòîò ïîäõîä, õîòÿ òåîðåòè÷åñêè è ïîíÿòåí, íà ïðàêòèêå, êàê ìíå ïîäñêàçûâàåò ëèòåðàòóðà (è ñàì ýòîò äîêóìåíò), shows little evidence... if any Âû ïðîñòèòå çà íàçîéëèâîñòü, ìíå õî÷åòñÿ ïîíÿòü Çû. Çà÷èòàëàñü Speroff'îì. "...the estrogenic component significantly contributes to the contraceptive efficacy. However, even if follicular growth and development were not sufficiently inhibited, the progestational component would prevent the surge-like release of LH necessary for ovulation". È â ññûëêå Dr.Nika: "Antibiotics do not affect progestogens, as metabolites are inactive." Ïîëó÷àåòñÿ, ÷òî ïðîãåñòèíîâûé êîìïîíåíò âñå ðàâíî ïîäñòðàõóåò íà ñëó÷àé ãèïîòåòè÷åñêîé óòðàòû ýñòðîãåíîâîãî? Íó êàê ìèíè-ïèëè? Ïî Speroff'ó 0,5% ïîïàäàíèé âìåñòî 0,1%... Ïîëó÷àåòñÿ èëè íå ïîëó÷àåòñÿ? |
#9
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Ïîëó÷àåòñÿ, ÷òî ïîêà ïðèäåðæèâàåìñÿ ÅÂÌ, êàê è âî ìíîãèõ ñëó÷àÿõ, êîãäà ïðàêòèêà è òåîðèÿ ïîêàçûâàåò íåêóþ ñòàòèñòèêó, íî äàííûõ ýòèõ íåäîñòàòî÷íî, ÷òîáû èõ âíåñëè â ðåêîìåíäàöèè ÅÂÌ :-)
Æäåì îáíîâëåíèÿ:-) Óâåðåíà, ÷òî íå òîëüêî Âû îçàäà÷èëèñü ýòîé öåïî÷êîé çàêëþ÷åíèé è ÷òî íîâûå ðåêîìåíäàöèè íå çà ãîðàìè:-) |
#10
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Ñïàñèáî, Dr. Nika, è îñòîðîæíî, è ëîãè÷íî.
À äëÿ òåõ, êòî åùå îçàäà÷èëñÿ: (UpToDate 15.1) Antibiotics — Rifampin may be among the most potent agents in decreasing oral contraceptive efficacy [17]. Other antibiotics do not affect the pharmacokinetics of ethinyl estradiol [26,27]. However, individual women have had been reported to have significant decreases in the plasma concentrations of ethinyl estradiol when taking certain other antibiotics, such as tetracycline, penicillin derivatives, and cephalosporins [26,28]. Because it is not possible to identify these women in advance, a cautious approach has been advised. The Council on Scientific Affairs of the American Medical Association recommends that women be informed of this small risk. Women who are either uncomfortable with this risk or who have had previous breakthrough bleeding or contraceptive failure during concomitant use of antibiotics, should be counseled about additional use of nonhormonal contraceptive methods [28]. UPD: íå ïîëíîñòüþ ñêîïèðîâàëà Recommendation — A nonhormonal contraceptive method is recommended for women taking rifampin or anticonvulsants, while hormonal methods are reasonable for women on griseofulvin [19,29]. Back-up contraception is advised for those receiving tetracyclines, penicillins, or cephalosporins. Women using both St. John's wort and OCs should be cautioned about possible reduced contraceptive efficacy. |