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#1
14.05.2007, 19:36
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Флуконазол
Здравствуйте уважаемые!
Сейчас по ящику идет полно рекламы по поводу данного лекарственного препарата в виде его различных коммерческих версий. В аннотации к таблетке и в рекламе говорится, что достаточно лишь одной таблэтки для лечения вагинального кандидоза и всё будет в порядке, так ли это? И надо ли параллельно девушке использовать свечи при этом? Вопрос третий, действует ли препарат на мужчин, или нам пользоваться кремом? Вопрос четвертый и последний, можно ли насовсем избавится от генитальных грибов? 
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#2
14.05.2007, 19:39
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Treatment
Numerous agents are available for treatment of Candida vulvovaginitis in both topical and oral preparations (Box 73-5). Among topical agents, cure rates range from 75 to 90%, with the azole preparations (clotrimazole, miconazole, terconazole) having slightly better efficacy than nystatin. The formulation (cream versus suppository versus vaginal tablet) does not alter the success rate; therefore the choice of formulation is a matter of patient preference. Currently there is a trend toward higher doses of topical agents with shorter durations of therapy, with success reported with even high-dose, one-time therapy. Anecdotal failure rates are fairly high with one-dose therapy; thus this is best reserved for women with infrequent infections and mild or moderate symptoms. Oral azole agents are quite effective for vaginal infection and are more convenient than topical therapy but are more expensive. Fluconazole and itraconazole single-dose therapy are at least as effective as topical therapy. Cure of Candida vulvovaginitis during pregnancy can be difficult, with relapses frequently occurring. If therapy is extended to 1-2 weeks, topical antifungal therapy is effective. Oral azoles should be avoided during pregnancy. In women with frequent recurrent infections, therapy is often disappointing, with symptoms recurring within weeks of withdrawal of antifungal agents. In these women, predisposing factors such as diabetes or HIV infection should be considered. HIV testing is appropriate in women with risk factors for HIV infection. If fasting blood glucose values are normal, further testing for diabetes is not required. Oral contraceptives should be discontinued if possible, although continuation of low-dose estrogen preparations, as long as long-term antifungal therapy is used, may be considered. Vaginal douching and treatment of the sexual partner are not recommended. Frequently, no risk factors are identified, and prophylactic therapy is required. The best-studied regimen with proven efficacy for prophylaxis is ketoconazole, 100 mg daily. Toxicity, such as hepatitis, is infrequent but may occur. Other regimens with anecdotal support include fluconazole, 100-200 mg once weekly, and clotrimazole vaginal tablets, 500 mg once weekly. CANDIDURIA, CANDIDA CYSTITIS & URINARY TRACT CANDIDIASIS Introduction The presence of Candida spp. in the urine is common and does not necessarily represent infection. Candiduria is commonly associated with antibiotic use, indwelling urinary catheters, and diabetes mellitus and frequently resolves if predisposing factors can be corrected. Patients are generally asymptomatic, although some will have symptoms similar to bacterial cystitis, with dysuria, frequency, and urgency (Box 73-2). Urinalysis shows fungal elements and may reveal pyuria. At cystoscopy, the mucosa of the bladder typically has an inflamed appearance with adherent white plaques that may be removed with the scope. Candida spp. may also cause urethritis, typically in male sexual partners of women with vaginal Candida infection, as well as higher urinary tract infection. The upper urinary tract and renal parenchyma may be infected from ascending infection or, more commonly, from hematogenous spread as part of a syndrome of disseminated candidiasis. With ascending infection, perinephric abscesses, papillary necrosis, fungus balls, and calyceal involvement have all been described. Risk factors are generally present and include diabetes mellitus, urinary tract obstruction, and renal stones. With hematogenous spread, the renal parenchyma becomes studded with multiple microabscesses. Diagnosis Candiduria is usually discovered when a urine culture reveals the presence of Candida spp. The presence of pyuria generally indicates true infection if other etiologies, such as bacterial infection, have been excluded. Infection may also be diagnosed by demonstrating the presence of a typical appearing fungus in biopsy specimens obtained during cystoscopy. Of particular importance for treatment is whether candiduria represents colonization or true infection, and whether the upper urinary tract is involved, a distinction that can be troublesome. Those with risk factors for ascending infection (diabetes, stones) and those at risk for disseminated disease are more likely to have upper urinary tract infection. Computerized tomographic scans or ultrasound may reveal microabscesses or fungus balls. Treatment When treating Candida infection of the urinary tract, careful consideration must be given to whether candiduria represents colonization or true infection, and whether the upper urinary tract is involved. Asymptomatic candiduria usually does not require antifungal treatment, but indwelling catheters should be removed as soon as possible. (Treatment is summarized in Box 73-6.) In the presence of pyuria, diabetes mellitus, or renal transplantation, treatment is indicated. Oral fluconazole is recommended as the initial agent. Bladder irrigation with amphotericin B is also effective. Patients with candiduria should be treated prior to instrumentation of the urinary tract. In patients with evidence of systemic toxicity, Candida infection at other sites, risk factors for ascending infection (structural or metabolic abnormality of the urinary tract such as stones or diabetes), or risk factors for disseminated candidiasis (burns, neutropenia, or GI surgery), consideration must be given to the possibility of upper urinary tract infection or disseminated candidiasis. Upper urinary tract involvement usually will respond to oral fluconazole, although intravenous amphotericin B is required for infections resistant to fluconazole or unresponsive to initial fluconazole treatment. Fungus balls and large perinephric abscesses may require surgical intervention. Treatment of disseminated candidiasis is discussed next.
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#3
14.05.2007, 21:01
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Цитата:
1.Осложненный или неосложненный или рецидивирующий кандидоз 2.И какими дрожжеподобными грибами он вызван - Candida albicans или Candida glabrata Если кандидоз неосложненный и вызыван Candida albicans - то однократная доза 150 мг флуконазола является эффективно доказанной При осложненном кандидозе,вызыванном Candida albicans, рекомнендуется трехкратное повторение дозы с интервалом 3 дня При рецидивирующем кандидозе,вызыванном Candida albicans ,еженедельный прием дозы флуконазола в течении 6 месяцев Если кандидоз вызыван Candida glabrata - то прием флуконазола неэффективен,так как они к нему резистентны (не чувствительны) Поэтому рекламе верить не надо,а надо найти в Миассе врача,который имеет представления об осложненном,неосложненном и рецидивирующем кандидозе и о существовании резистентных к флуконазолу кандид и назначит адекватное лечение.
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#4
15.05.2007, 12:18
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Цитата:
На приеме гинеколог сказала, что у неё там какие-то грибы, но не Кандиды, после чего назначила Флуконазол, бетадин, и ещё какие-то таблетки(помоему из иммуномодуляторов), на тот момент все прошло, но настала весна и снова повторяется тоже самое. Цитата:
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Линейный вид
