#16
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- ÿ ïðåêðàñíî ïîìíþ, î ÷åì èäåò ðå÷ü
- âû õîòèòå ñêàçàòü, ÷òî ïðè äèàðåå ïóòåøåñòâåííèêîâ ìîæåò ïðèìåíÿòüñÿ íàëèäèêñîâàÿ êèñëîòà? Öèòàòà:
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#17
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Êàêèìè æå èññëåäîâàíèÿìè ïîêàçàíà ýôôåêòèâíîñòü íàëèäèêñîâîé êèñëîòû â ïîäîáíîé ñèòóàöèè?
Öèòàòà:
The following antibiotic dosing is suggested in the treatment of travelers' diarrhea in children: Drug Pediatric Dosage Azithromycin 10 mg/kg/day orally in 2 divided doses Ciprofloxacin (not FDA approved in patients less than 18 years of age) 20 to 30 mg/kg/day orally in 2 divided doses (MAX dose 1.5 g/day) Nalidixic acid 55 mg/kg/day orally in 4 divided doses Mackell, S. Traveler's diarrhea in the pediatric population: etiology and impact. Clin Infect Dis 2005; 41:S547. Âïîñëåäñòâèè, îäíàêî, îíà è èç Uptodate èñ÷åçëà. Íåòó íè îäíîãî èññëåäîâàíèÿ, äîêàçûâàþùåãî åå ýôôåêòèâíîñòü ïî ñðàâíåíèþ ñ äðóãèìè ñðåäñòâàìè ïðè êèøå÷íûõ èíôåêöèÿõ. Íè â êàêèõ ìåæäóíàðîäíûõ ðåêîìåíäàöèÿõ ïî ëå÷åíèþ ÎÊÈ íå ôèãóðèðóåò. Ñðàâíåíèå ñ àìïèöèëëèíîì ïðè øèãåëëåçå ïîëíîñòüþ ïðîâàëèëà (Haltalin KC, Nelson JD, & Kusmiesz HT: Comparative efficacy of nalidixic acid and ampicillin for severe shigellosis. Arch Dis Child 1973; 48:305-312). FDA îäîáðÿåò åå ïðèìåíåíèå òîëüêî ïðè èíôåêöèÿõ ìî÷åâûâîäÿùèõ ïóòåé. Ìíå ìíåíèå ýòîé îðãàíèçàöèè êàæåòñÿ äîñòàòî÷íî àâòîðèòåòíûì. |
#18
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Öèòàòà:
Åñòü åùå âàðèàíò ïåðîðàëüíîãî ïðèìåíåíèÿ àìèíîãëèêîçèäîâ - äëÿ ñåëåêòèâíîé äåêîíòàìèíàöèè êèøå÷íèêà, íî ýòà ìåòîäèêà ñïîðíà è â íåé, êëàññè÷åñêè, èñïîëüçóåòñÿ íåîìèöèí. |
#19
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Öèòàòà:
Òîãäà ïîæàëóéñòà: Öèòàòà:
Öèòàòà:
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#20
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Óâàæàåìûå êîëëåãè! Ñïàñèáî çà èíòåðåñíûå ññûëêè.
Îäíàêî îé âîïðîñ áûë â ñëåäóþùåì: âîçìîæåí ëè ïðèåì îäíîé è òîé æå ëåêàðñòâåííîé ôîðìû ( âñå ê òîìó æå âàíêîìèöèíó) äëÿ ïàðåíòåðàëüíîãî è ýíòåðàëüíîãî ïðèìåíåíèÿ. Ýòî îäíà è òà æå ñóáñòàíöèÿ. Èëè äëÿ â/ì ðàñòâîðà - îäíî äëÿ ïåð îñ äðóãîå? Âîò â ÷åì ñóòü âîïðîñà? ×òî êàñàåòñÿ ïðåèìóùåñòâ ïðèìåíåíèÿ âàíêîìèöèíà ïåð îñ ïðè ïñåâäîìåìáðíîçíîì êîëèòå - îá ýòîì íèêòî íå ñïîðèò è íå îá ýòîì ðå÷ü, óâàæàåìûé Strix. |
#21
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Ñóáñòàíöèÿ îäíà è òà æå, ðàçíèöà òîëüêî â íàïîëíèòåëÿõ, ñâÿçóþùèõ âåùåñòâàõ, âêóñîâûõ äîáàâêàõ (äëÿ òàáëåòîê).
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#22
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...ïå÷àëüíî, íî "óøè ïåðîðàëüíîãî ãåíòàìèöèíà âûðîñëè" çàäîëãî äî èññëåäîâàíèé ïåîðàëüíîãî ïðèìåíåíèÿ âàíêîìèöèíà - ýòî áåçîñíîâàòåëüíî ïåðåêî÷åâàëî èç âåòåðèíàðèè, ãäå ãåíòàìèöèí (êàê äîñòóïíûé è äåøåâûé àãåíò) ïðèìåíÿåòñÿ âåñüìà øèðîêî (ïðàâäà ñ îãðàíè÷åíèåì íà 3 íåäåëè óïîòðåáëåíèÿ ìÿñà ïîñëå ãåíòàìèöèíà áåç óòî÷íåíèÿ ôîðìû).
Ìíîãî÷èñëåííûå ôîðìû äëÿ ìåñòíîãî ïðèìåíåíèÿ (ñ 70õ ïîïóëÿðíû ìåòàêðèëàòíûå ãóáêè ñ ãåíòàìèöèíîì, íå ãîâîðþ óæå î ìàçÿõ è êàïëÿõ) ñîäåðæàò íåñîïîñòàâèìûå äîçû. Âñåãäà îáðàùàë âíèìàíèå ïîáîðíèêîâ ïåðîðàëüíîãî ãåíòàìèöèíà íà ïðîïèñàííûå èíñòðóêöèè ïðåäîñòîðîæíîñòè ìåñòíîãî ïðèìåíåíèÿ ïðè çíà÷èòåëüíûõ ðàíåâûõ ïîâåðõíîñòÿõ è äðóãèõ ñèòóàöèÿõ, êîãäà äàæå íåçíà÷èòåëüíîå ñèñòåìíîå äåéñòâèå ãóáèòåëüíî (ìèàñòåíèÿ è ò.ä.), ê òîìó æå ïðîñòî íå ìîãó ïðåäñòàâèòü ñåáå äàæå òåîðåòè÷åñêóþ íèøó ïåðîðàëüíîãî ãåíòàìèöèíà (êðîìå ñàëüìîíåëëåçà ó ñâèíåé è ãèïîòåòè÷åñêîé äåêîíòàìèíàöèè). |
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#23
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Öèòàòà:
FDA Approval: Adult, no; Pediatric, no Efficacy: Adult, Evidence is inconclusive Recommendation: Adult, Class III - Not Recommended Strength of Evidence: Adult, Category C Ïðî îñòàëüíûå êèøå÷íûå èíôåêöèè - âîâñå íè ñëîâà. Íî ñïàñèáî çà èíòåðåñíûå ññûëêè. Öèòàòà:
FDA Approval: Adult, no; Pediatric, no Efficacy: Pediatric, Evidence is inconclusive Recommendation: Pediatric, Class IIb Strength of Evidence: Pediatric, Category B Öèòàòà:
Öèòàòà:
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#24
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Èññëåäîâàíèÿ ïî íàëèäèêñîâîé ê-òå êàêèå-òî óæ î÷åíü âñå ñòàðûå...  óâàæàåìîì The Sanford guide to antimicrobial therapy 2006 íàëèäèêñîâàÿ ê-òà íå óïîìèíàåòñÿ âîîáùå. À äëÿ ëå÷åíèÿ äèàððåè ïóòåøåñòâåííèêîâ ïðåïàðàò ïåðâîãî ðÿäà - ëåâîôëîêñàöèí (èëè öèïðîôëîêñàöèí "or otherFQ"), àëüòåðíàòèâíûå ïðåïàðàòû (Peds & pregnancy) - àçèòðîìèöèí èëè ðèôàêñèìèí.
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#25
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×èòàë Ñýíôîðäñêîå ðóêîâîäñòâî 2006 ãîäà âåñüìà ïëîòíî, ñîìíåâàþñü, ÷òî òàì ñîâåòóþò ëåâîôëîêñàöèí ïðè äèàðåå ïóòåøåñòâåííèêîâ. Ñêîðåå öèïðî.
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#26
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Çà "the reconstituted intravenous formulation may be administered orally if desired. If the intravenous formulation is used for oral administration, dilute in 1 ounce of water (Prod Info vancomycin hcl IV injection)" - ñïàñèáî,óâàæàåìûé Strix.
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#27
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