antibiotiki

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antibiotiki antibiotiki antibiotiki – eto ximioterapevticheskie veshestva biologicheskogo proisxojdeniya, izbiratelno ugnetayushie jiznedeyatelnost mikroorganizmov (tormozyashie rost ili vizivayushie ix gibel). klassifikatsii antibiotikov po ximicheskomu stroeniyu: b-laktamnie (penitsillini, tsefalosporini, karbapenemi, monobaktami) makrolidi i azalidi aminoglikozidi tetratsiklini linkozamidi glikopeptidi amfenikoli polimiksini fosfonati polieni rifamitsini 2. po xarakteru deystviya na bakterialnuyu kletku: bakteritsidnie (vizivayushie gibel bakteriy) bakteriostaticheskie (ostanavlivayushie rost i delenie bakteriy) 3. po mexanizmu deystviya : narushayushie sintez kletochnoy stenki narushayushie pronitsaemost tsitoplazmaticheskoy membrani narushayushie sintez belka na ribosomax narushayushie sintez rnk 4. po spektru antimikrobnogo deystviya: preparati shirokogo spektra deystviya preparati s preimushestvennim deystviem na gr(+) floru preparati s preimushestvennim deystviem na gr(-) floru protivogribkovie antibiotiki 5. po klinicheskomu primeneniyu: osnovnie antibiotiki (preparati vibora) rezervnie antibiotiki (alternativnie) 6. po istochnikam polucheniya: prirodnie (biosinteticheskie) polusinteticheskie mexanizm, xarakter i spektr deystviya antibiotikov gruppi mexanizm xarakter spektr penitsillini narushenie sinteza kletochnoy stenki bakteritsidniy gr + (bs), shir (ps) tsefalosporini shirokiy karbapenemi shirokiy monobaktami gr - …

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viya - bakteritsidniy penitsillini tsefalosporini karbapenemi monobaktami penitsillini i. prirodnie (biosinteticheskie) parenteralnie: korotkogo deystviya (3-4 chasa) benzilpenitsillina natrievaya sol dlitelnogo deystviya (depo - penitsillini) benzilpenitsillin prokain (bp novokainovaya sol) 12-18 ch. benzatin benzilpenitsillin (retarpen, bitsillin-1) 7-10 dney benzatin benzilpenitsillin + benzilpenitsillin prokain (4:1) (bitsillin-5) 1 mesyats peroralnie: fenoksimetilpenitsillin (megatsillin) 4-6 ch. benzatin fenoksimetilpenitsillin (ospen) 4-6 ch. ii. polusinteticheskie ustoychivie k penitsillinaze (antistafilokokkovie penitsillini) oksatsillin naftsillin kloksatsillin 2. shirokogo spektra deystviya (aminopenitsillini) ampitsillin amoksitsillin 3. shirokogo spektra deystviya s antisinegnoynoy aktivnostyu (antisinegnoynie penitsillini) ureidopenitsillini karboksipenitsillini piperatsillin karbenitsillin azlotsillin karfetsillin mezlotsillin tikartsillin piperatsillin = azlotsillin > mezlotsillin = = tikartsillin >> karfetsillin > karbenitsillin 4. ingibitorozashishennie (penitsillin shirokogo spektra + ingibitor b-laktamaz) amoksiklav (augmentin) = amoksitsillin + klavulanovaya k-ta trifamoks = amoksitsillin + sulbaktam unazin = ampitsillin + sulbaktam tazotsin = piperatsillin + tazobaktam timentin = tikartsillin + klavulanovaya k-ta 5. kombinatsiya dvux penitsillinov (penitsillin shirokogo spektra + penitsillin ustoychiviy k penitsillinaze) …

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ya treponema, leptospiri, borrelii anaerobi: klostridii aktinomitseti 2. pokazaniya k primeneniyu: infektsii, vizvannie bgsa: tonzillofaringit, roja, skarlatina, ostraya revmaticheskaya lixoradka i profilaktika obostreniy revmatizma vnebolnichnaya pnevmokokkovaya pnevmoniya difteriya meningit (u vzroslix i detey starshe 2 let) bakterialniy endokardit (v sochetanii s aminoglikozidami) sifilis leptospiroz kleshevoy borrelioz (bolezn layma) sibirskaya yazva anaerobnie infektsii: gazovaya gangrena, stolbnyak aktinomikoz polusinteticheskie penitsillini shirokogo spektra: dopolnitelno deystvuyut na ryad gr(-) bakteriy: kishechnaya palochka, salmonelli, shigelli, gemofilnaya palochka (n.influenzae), indolotritsatelnie shtammi proteya (r.mirabilis) bolee aktivni v otnoshenii enterokokkov i listeriy, amoksitsillin visokoaktiven v otnoshenii h.pylori menee aktivni v otnoshenii streptokokkov, penitsillinochuvstvitelnix stafilokokkov, spiroxet, anaerobov razrushayutsya β-laktamazami pokazaniya k primeneniyu penitsillinov shirokogo spektra infektsii vdp (ostriy sredniy otit, ostriy sinusit) infektsii ndp (obostrenie xronicheskogo bronxita, vnebolnichnaya pnevmoniya) infektsii jelche- i mochevivodyashix putey kishechnie infektsii (salmonellez, shigellyoz) – tolko ampitsillin bakterialniy meningit bakterialniy endokardit leptospiroz eradikatsiya h.pylori - tolko amoksitsillin kleshevoy borrelioz (bolezn layma) profilaktika sibirskoy yazvi (u …

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e urovnya gemoglobina, neytropeniya, snijenie agregatsii trombotsitov, gematuriya depo-penitsillini vvodit tolko v/m! pri sluchaynom v/v vvedenii – emboliya sosudov, ishemiya i daje gangrena konechnostey! tsefalosporini obshie svoystva mexanizm deystviya – narushenie sinteza kletochnoy stenki bakteriy xarakter deystviya – bakteritsidniy spektr deystviya – shirokiy (krome tss i pokoleniya) perekrestnaya allergiya u 5-10% patsientov s allergiey na penitsillin ne deystvuyut na enterokokki, listerii, mrsa ustoychivi k β-laktamazam s.aureus, no razrushayutsya β-laktamazami rasshirennogo spektra sinergizm s aminoglikozidami klassifikatsiya tsefalosporinov i pokolenie i i pokolenie iii pokolenie iv pokolenie parenteralnie tsefazolin (kefzol) tsefuroksim (zinatsef) tsefotaksim (klaforan) tsefepim (maksipim) tsefalotin (keflin) tsefamandol (mandol) tseftriakson (rotsefin) tsefpirom (keyten) tsefoksitin (mefoksitin) tseftazidim (fortum) tsefoperazon (tsefobid) tsefoperazon/sulbaktam (sulperazon) peroralnie tsefaleksin (kefleks) tsefaklor (tseklor) tsefiksim (supraks) tsefadroksil (duratsef) tsefuroksim aksetil (zinnat) tsefditoren (spektratsef) spektr deystviya tss i pokolenie i i pokolenie iii pokolenie iv pokolenie ne pronikayut cherez geb pronikayut cherez geb (iskyuchenie – tsefoperazon) ne vliyayut na sinegnoynuyu …

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koprofilaktika preduprejdenie ne sleduet ispolzovat pri ostrix otitax i sinusitax, tak kak oni obladayut nizkoy aktivnostyu po otnosheniyu k n.influenzae i ploxo pronikayut v sinusi i polost srednego uxa tss ii pokoleniya spektr aktivnosti bolee aktivni, chem tss i pokoleniya, v otnoshenii gramotritsatelnix bakteriy: n.influenzae, m.catarrhalis, e.coli, nekotorix shtammov klebsiell, proteya (r.mirabilis, p.vulgaris) i dr. po deystviyu na grampolojitelnuyu floru (streptokokki, stafilokokki) sopostavimi libo neskolko ustupayut tss i pokoleniya kak i tsefalosporini i pokoleniya, ne deystvuyut na mrsa, sinegnoynuyu palochku, listerii, bolshinstvo anaerobov; razrushayutsya blrs pokazaniya infektsii vdp (tonzillofaringit, ostriy sinusit, otit) infektsii ndp (obostrenie xronicheskogo bronxita, vnebolnichnaya pnevmoniya) infektsii mvp infektsii koji, myagkix tkaney, kostey i sustavov predoperatsionnaya antibiotikoprofilaktika osnovnoe otlichie ot tsefalosporinov i pokoleniya zaklyuchaetsya v bolee visokoy aktivnosti protiv gramotritsatelnoy flori. tss iii pokoleniya spektr aktivnosti gram(+) kokki: streptokokki, stafilokokki (no deystvuyut slabee tss i-ii) gram(-) kokki: meningokokki, gonokokki, m.catarrhalis, vklyuchaya β-laktamazoprodutsiruyushie shtammi gram(-) palochki: e.coli, proteus …

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antibiotiki antibiotiki antibiotiki – eto ximioterapevticheskie veshestva biologicheskogo proisxojdeniya, izbiratelno ugnetayushie jiznedeyatelnost mikroorganizmov (tormozyashie rost ili vizivayushie ix gibel). klassifikatsii antibiotikov po ximicheskomu stroeniyu: b-laktamnie (penitsillini, tsefalosporini, karbapenemi, monobaktami) makrolidi i azalidi aminoglikozidi tetratsiklini linkozamidi glikopeptidi amfenikoli polimiksini fosfonati polieni rifamitsini 2. po xarakteru deystviya na bakterialnuyu kletku: bakteritsidnie (vizivayushie gibel bakteriy) bakteriostaticheskie (ostanavlivayushie rost i delenie bakteriy) 3. po mexanizmu deystviya : narushayushie sintez kletochnoy stenki narushayushie pronitsaemost tsitoplazmaticheskoy membrani narushayushie sintez belka na ribosomax narushayushi...

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