{"id":56941,"date":"2024-02-27T17:15:27","date_gmt":"2024-02-27T17:15:27","guid":{"rendered":"https:\/\/medsname.com\/combutol\/"},"modified":"2026-05-01T10:49:13","modified_gmt":"2026-05-01T10:49:13","slug":"combutol","status":"publish","type":"product","link":"https:\/\/medsbase.com\/cs\/product\/combutol\/","title":{"rendered":"Combutol"},"content":{"rendered":"

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\u26a1 Rychl\u00e1 odpov\u011b\u010f \u2014 Co je Combutol?<\/h3>\n

Combutol<\/strong> obsahuje ethambutol hydrochlorid (200 mg \/ 400 mg \/ 800 mg tablety)<\/strong> od v\u00fdrobce certifikovan\u00e9ho WHO-GMP (vyr\u00e1b\u00ed spole\u010dnost Lupin) \u2014 bakteriostatick\u00e9 antituberkulotikum, kter\u00e9 naru\u0161uje synt\u00e9zu arabinogalaktanu v bun\u011b\u010dn\u00e9 st\u011bn\u011b mykobakteri\u00ed. \u00daloha p\u0159\u00edpravku Combutol p\u0159i aktivn\u00ed TB<\/strong> spo\u010d\u00edv\u00e1 v tom, \u017ee je \u201cE\u201d v \u010dty\u0159l\u00e9kov\u00e9m re\u017eimu RIPE b\u011bhem prvn\u00ed dvoum\u011bs\u00ed\u010dn\u00ed intenzivn\u00ed f\u00e1ze \u2014 zabra\u0148uje vzniku rezistence na baktericidn\u00ed doprovodn\u00e9 l\u00e9ky (rifampicin, isoniazid, pyrazinamid). Standardn\u00ed d\u00e1vka pro dosp\u011bl\u00e9: 15 mg\/kg jednou denn\u011b<\/strong> (obvykle 800 mg pro > 55 kg). Charakteristickou toxicitou je d\u00e1vkov\u011b z\u00e1visl\u00e1 optick\u00e1 neuritida<\/strong> \u2014 ztr\u00e1ta zrakov\u00e9 ostrosti a schopnosti rozli\u0161ovat \u010dervenou a zelenou barvu, obvykle reverzibiln\u00ed, pokud je l\u00e9k vysazen p\u0159i prvn\u00edm p\u0159\u00edznaku, ale potenci\u00e1ln\u011b trval\u00e1, pokud nen\u00ed. Z\u00e1kladn\u00ed oftalmologick\u00e9 vy\u0161et\u0159en\u00ed + m\u011bs\u00ed\u010dn\u00ed kontroly zraku jsou povinn\u00e9<\/strong>, a d\u00e1vka mus\u00ed b\u00fdt sn\u00ed\u017eena p\u0159i ren\u00e1ln\u00ed insuficienci.<\/p>\n<\/div>\n

\nCo z\u00edsk\u00e1te s MedsBase:<\/strong> V\u00fdrobce certifikovan\u00fd WHO-GMP \u00b7 Diskr\u00e9tn\u00ed balen\u00ed \u00b7 Celosv\u011btov\u00e1 doprava \u00b7 V\u00edce ne\u017e 1 400 ov\u011b\u0159en\u00fdch recenz\u00ed z\u00e1kazn\u00edk\u016f<\/a>\n<\/div>\n

\ud83d\udce6 Ka\u017ed\u00e1 objedn\u00e1vka je pokryta na\u0161\u00ed Z\u00e1rukou op\u011btovn\u00e9ho odesl\u00e1n\u00ed<\/strong><\/a> \u2014 pokud va\u0161e z\u00e1silka nedoraz\u00ed do 20 pracovn\u00edch dn\u016f, p\u0159epos\u00edl\u00e1me ji.<\/p>\n

Pro\u010d objedn\u00e1vat z MedsBase<\/h3>\n

Na\u0161e generick\u00e9 l\u00e9ky poch\u00e1zej\u00ed od v\u00fdrobc\u016f certifikovan\u00fdch WHO-GMP a jsou expedov\u00e1ny po cel\u00e9m sv\u011bt\u011b v diskr\u00e9tn\u00edm, nen\u00e1padn\u00e9m balen\u00ed \u2013 na vn\u011bj\u0161\u00ed stran\u011b bal\u00edku nen\u00ed uveden n\u00e1zev l\u00e9ku. Platby kartou jsou sm\u011brov\u00e1ny prost\u0159ednictv\u00edm regulovan\u00e9ho procesoru (popisky na v\u00fdpisu zahrnuj\u00ed regulovan\u00e9ho procesora plateb kartou \u2013 nikdy \u201cMedsBase\u201d nebo n\u00e1zev l\u00e9ku). P\u0159ij\u00edm\u00e1me tak\u00e9 kryptom\u011bny a bankovn\u00ed p\u0159evody SEPA. Ka\u017ed\u00e1 objedn\u00e1vka je zaji\u0161t\u011bna na\u0161\u00ed politikou p\u0159eposl\u00e1n\u00ed.<\/p>\n

Kritick\u00e9 bezpe\u010dnostn\u00ed upozorn\u011bn\u00ed \u2014 samotn\u00fd ethambutol nen\u00ed l\u00e9\u010dbou aktivn\u00ed tuberkul\u00f3zy.<\/strong> Aktivn\u00ed TB vy\u017eaduje kombinovanou chemoterapii: 2 m\u011bs\u00edce rifampicin + isoniazid + pyrazinamid + ethambutol (RIPE), pot\u00e9 4 m\u011bs\u00edce rifampicin + isoniazid (RH). \u00daloha ethambutolu spo\u010d\u00edv\u00e1 v potla\u010den\u00ed vzniku rezistence na baktericidn\u00ed doprovodn\u00e9 l\u00e9ky. Samotn\u00fd ethambutol ne ne<\/strong> sterilizuje infekci, ale nezabra\u0148uje p\u0159enosu. Pokud m\u00e1te podez\u0159en\u00ed nebo potvrzenou aktivn\u00ed TBC, pot\u0159ebujete plnou kombinovanou terapii pod odborn\u00fdm dohledem \u2014 nel\u00e9\u010dte pouze ethambutolem.<\/div>\n
Varov\u00e1n\u00ed p\u0159ed optickou neuritidou \u2014 hlavn\u00ed toxicita ethambutolu.<\/strong> Ethambutol m\u016f\u017ee zp\u016fsobit d\u00e1vkov\u011b z\u00e1vislou retrobulb\u00e1rn\u00ed optickou neuritidu<\/strong>: rozmazan\u00e9 vid\u011bn\u00ed, sn\u00ed\u017eenou zrakovou ostrost, ztr\u00e1tu rozli\u0161en\u00ed \u010derven\u00e9 a zelen\u00e9 barvy, centr\u00e1ln\u00ed skotom a (vz\u00e1cn\u011b) bitempor\u00e1ln\u00ed v\u00fdpadky zorn\u00e9ho pole. Riziko prudce stoup\u00e1 nad 25 mg\/kg\/den nebo p\u0159i ren\u00e1ln\u00ed insuficienci. P\u0159\u00edznaky se mohou objevit od n\u011bkolika t\u00fddn\u016f a\u017e po n\u011bkolik m\u011bs\u00edc\u016f l\u00e9\u010dby. Okam\u017eit\u011b vysa\u010fte ethambutol<\/strong> p\u0159i prvn\u00edm n\u00e1znaku jak\u00e9hokoli zrakov\u00e9ho p\u0159\u00edznaku \u2014 ne ne<\/strong> \u010dekejte, zda \u201cse to zlep\u0161\u00ed\u201d. Zrakov\u00e9 zm\u011bny jsou obvykle reverzibiln\u00ed, pokud je l\u00e9k v\u010das vysazen; p\u0159i pokra\u010dov\u00e1n\u00ed l\u00e9\u010dby do\u0161lo k trval\u00e9 ztr\u00e1t\u011b zraku. Povinn\u00e9 monitorov\u00e1n\u00ed:<\/strong> p\u0159ed zah\u00e1jen\u00edm l\u00e9\u010dby stanovte z\u00e1kladn\u00ed zrakovou ostrost a barvocit (Ishiharovy tabulky); opakujte m\u011bs\u00ed\u010dn\u011b po celou dobu terapie. Vyhn\u011bte se ethambutolu u mal\u00fdch d\u011bt\u00ed nebo u osob, kter\u00e9 nemohou spolehliv\u011b hl\u00e1sit zrakov\u00e9 zm\u011bny.<\/div>\n

Co je Combutol (Ethambutol)<\/h2>\n

Combutol je zna\u010dka spole\u010dnosti Lupin pro hydrochlorid ethambutolu<\/strong>, syntetick\u00e9 bakteriostatick\u00e9 antituberkulotikum zaveden\u00e9 v roce 1961, kter\u00e9 je na Modelov\u00e9m seznamu z\u00e1kladn\u00edch l\u00e9\u010div WHO. Ka\u017ed\u00e1 tableta obsahuje 200 mg, 400 mg nebo 800 mg ethambutolu HCl. Je to jeden ze \u010dty\u0159 l\u00e9k\u016f prvn\u00ed volby pou\u017e\u00edvan\u00fdch v standardn\u00edm kr\u00e1tk\u00e9m re\u017eimu pro l\u00e9ky citlivou tuberkul\u00f3zu \u2014 \u201cE\u201d v RIPE \u2014 a tak\u00e9 z\u00e1kladn\u00ed l\u00e9k pro infekci Mycobacterium avium complex (MAC).<\/p>\n

Jak Combutol funguje (mechanismus)<\/h2>\n

Ethambutol inhibuje arabinosyltransfer\u00e1zu III (k\u00f3dovanou genem embB<\/em> gen), enzym nezbytn\u00fd pro synt\u00e9zu arabinogalaktanu a lipoarabinomananu \u2014 kl\u00ed\u010dov\u00fdch polysacharidov\u00fdch slo\u017eek bun\u011b\u010dn\u00e9 st\u011bny mykobakteri\u00ed. Bez t\u011bchto polysacharid\u016f je bun\u011b\u010dn\u00e1 st\u011bna struktur\u00e1ln\u011b oslabena, p\u0159ipojen\u00ed mykolov\u00fdch kyselin selh\u00e1v\u00e1 a bakterie se st\u00e1vaj\u00ed n\u00e1chyln\u011bj\u0161\u00edmi k jin\u00fdm antibiotik\u016fm. Ethambutol je v d\u00e1vk\u00e1ch pou\u017e\u00edvan\u00fdch v klinick\u00e9 praxi samostatn\u011b bakteriostatick\u00fd; jeho hlavn\u00edm p\u0159\u00ednosem v kombinovan\u00e9 l\u00e9\u010db\u011b je zabr\u00e1n\u011bn\u00ed vzniku rezistence<\/strong> na baktericidn\u00ed partnery (rifampicin, isoniazid).<\/p>\n

Indikace \u2014 Co Combutol l\u00e9\u010d\u00ed<\/h2>\n

1. Aktivn\u00ed tuberkul\u00f3za (kombinovan\u00e1 terapie)<\/h3>\n

Ethambutol je sou\u010d\u00e1st\u00ed WHO 4-l\u00e9kov\u00e9ho re\u017eimu RIPE b\u011bhem prvn\u00edch 2 m\u011bs\u00edc\u016f l\u00e9\u010dby nov\u00e9 plicn\u00ed nebo mimoplicn\u00ed tuberkul\u00f3zy zp\u016fsoben\u00e9 M. tuberculosis<\/em>. Jakmile testov\u00e1n\u00ed citlivosti na l\u00e9ky potvrd\u00ed plnou citlivost na rifampicin a isoniazid, ethambutol m\u016f\u017ee b\u00fdt n\u011bkdy vysazen p\u0159ed koncem intenzivn\u00ed f\u00e1ze \u2014 ale v b\u011b\u017en\u00e9 praxi se pod\u00e1v\u00e1 po cel\u00e9 2 m\u011bs\u00edce.<\/p>\n\n\n\n\n\n\n
F\u00e1ze<\/th>\nD\u00e9lka<\/th>\nL\u00e9ky<\/th>\n<\/tr>\n<\/thead>\n
Intenzivn\u00ed<\/td>\n2 m\u011bs\u00edce<\/td>\nRifampicin + Isoniazid + Pyrazinamid + Ethambutol<\/strong><\/td>\n<\/tr>\n
Pokra\u010dovac\u00ed<\/td>\n4 m\u011bs\u00edce<\/td>\nRifampicin + Isoniazid<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

2. Mycobacterium avium komplex (MAC)<\/h3>\n

Infekce MAC \u2013 jak diseminovan\u00e9 onemocn\u011bn\u00ed u pokro\u010dil\u00e9 HIV (CD4 obvykle < 50), tak chronick\u00e9 plicn\u00ed onemocn\u011bn\u00ed u pacient\u016f bez HIV s bronchiekt\u00e1ziemi \u2013 se l\u00e9\u010d\u00ed re\u017eimy zalo\u017een\u00fdmi na makrolidech. Standardn\u00ed kombinace je klarithromycin nebo azithromycin + ethambutol<\/strong>, \u010dasto s rifabutinem u t\u011b\u017ek\u00e9ho onemocn\u011bn\u00ed. \u00daloha ethambutolu zde odpov\u00edd\u00e1 jeho roli u TBC: zabra\u0148uje vzniku rezistence na makrolidy.<\/p>\n

3. Ostatn\u00ed netuberkul\u00f3zn\u00ed mykobakterie<\/h3>\n

Ethambutol je sou\u010d\u00e1st\u00ed re\u017eim\u016f pro M. kansasii<\/em> (s rifampicinem a isoniazidem), M. xenopi<\/em>, a n\u011bkter\u00e9 dal\u0161\u00ed pomalu rostouc\u00ed netuberkul\u00f3zn\u00ed mykobakterie. L\u00e9\u010dba t\u011bchto infekc\u00ed je vedena specialisty a li\u0161\u00ed se podle citlivosti izol\u00e1tu.<\/p>\n

D\u00e1vkov\u00e1n\u00ed<\/h2>\n\n\n\n\n\n\n\n\n\n
Indikace<\/th>\nD\u00e1vka pro dosp\u011bl\u00e9 (denn\u011b)<\/th>\nPozn\u00e1mky<\/th>\n<\/tr>\n<\/thead>\n
Aktivn\u00ed TB \u2014 intenzivn\u00ed f\u00e1ze<\/td>\n15 mg\/kg jednou denn\u011b
 \u2022 38\u201355 kg \u2192 800 mg
 \u2022 > 55 kg \u2192 1200 mg (zaokrouhleno; n\u011bkter\u00e9 sm\u011brnice stanov\u00ed maxim\u00e1ln\u011b 1600 mg)<\/td>\n		Pokra\u010dujte po dobu 2 m\u011bs\u00edc\u016f jako sou\u010d\u00e1st RIPE<\/td>\n<\/tr>\n
Aktivn\u00ed TB \u2014 p\u0159eru\u0161ovan\u00fd re\u017eim (3 d\u00e1vky\/t\u00fdden)<\/td>\n25\u201330 mg\/kg na d\u00e1vku<\/td>\nPouze pod p\u0159\u00edm\u00fdm dohledem l\u00e9ka\u0159e<\/td>\n<\/tr>\n
Pl\u00edcn\u00ed onemocn\u011bn\u00ed zp\u016fsoben\u00e9 MAC<\/td>\n15 mg\/kg jednou denn\u011b<\/td>\nV kombinaci s makrolidem; l\u00e9\u010dba minim\u00e1ln\u011b 12\u201318 m\u011bs\u00edc\u016f<\/td>\n<\/tr>\n
Diseminovan\u00e9 onemocn\u011bn\u00ed MAC u HIV<\/td>\n15 mg\/kg jednou denn\u011b<\/td>\nV kombinaci s klarithromycinem\/azithromycinem \u00b1 rifabutinem<\/td>\n<\/tr>\n
D\u011btsk\u00e1 d\u00e1vka (TB)<\/td>\n20 mg\/kg jednou denn\u011b<\/td>\nVyvarujte se nebo pou\u017e\u00edvejte opatrn\u011b, pokud d\u00edt\u011b nen\u00ed schopno hl\u00e1sit zrakov\u00e9 p\u0159\u00edznaky<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

\u00daprava d\u00e1vky p\u0159i ren\u00e1ln\u00ed insuficienci<\/h3>\n\n\n\n\n\n\n\n\n
Clearance kreatininu<\/th>\n\u00daprava d\u00e1vkov\u00e1n\u00ed<\/th>\n<\/tr>\n<\/thead>\n
> 50 ml\/min<\/td>\nStandardn\u00ed d\u00e1vka 15 mg\/kg jednou denn\u011b<\/td>\n<\/tr>\n
30\u201350 ml\/min<\/td>\n15 mg\/kg ka\u017ed\u00fdch 24\u201336 hodin<\/td>\n<\/tr>\n
10\u201330 ml\/min<\/td>\n15 mg\/kg ka\u017ed\u00fdch 48 hodin<\/td>\n<\/tr>\n
Hemodial\u00fdza<\/td>\n15\u201325 mg\/kg t\u0159ikr\u00e1t t\u00fddn\u011b, d\u00e1vka po<\/strong> dial\u00fdza<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

U\u017e\u00edvejte p\u0159\u00edpravek Combutol jednou denn\u011b, s j\u00eddlem nebo bez j\u00eddla \u2014 podle toho, co zp\u016fsobuje men\u0161\u00ed nevolnost. Udr\u017eujte odstup od antacid obsahuj\u00edc\u00edch hlin\u00edk alespo\u0148 4 hodiny.<\/p>\n

Povinn\u00e9 monitorov\u00e1n\u00ed<\/h2>\n
Monitorov\u00e1n\u00ed zraku je nezbytn\u00e9.<\/strong> P\u0159ed prvn\u00ed d\u00e1vkou zaznamenejte v\u00fdchoz\u00ed zrakovou ostrost (pro ka\u017ed\u00e9 oko zvl\u00e1\u0161\u0165, s korek\u010dn\u00edmi \u010do\u010dkami, pokud jsou pou\u017e\u00edv\u00e1ny) a schopnost rozli\u0161ovat \u010dervenou a zelenou barvu (Ishihara desky). Opakujte alespo\u0148 m\u011bs\u00ed\u010dn\u011b b\u011bhem l\u00e9\u010dby \u2014 d\u0159\u00edve, pokud je d\u00e1vka > 15 mg\/kg, u pacient\u016f s ren\u00e1ln\u00edm po\u0161kozen\u00edm, u star\u0161\u00edch pacient\u016f nebo pokud se objev\u00ed jak\u00e9koli zrakov\u00e9 pot\u00ed\u017ee. P\u0159i prvn\u00edm p\u0159\u00edznaku okam\u017eit\u011b vysa\u010fte ethambutol a vyhledejte neodkladn\u00e9 oftalmologick\u00e9 vy\u0161et\u0159en\u00ed.<\/div>\n

Dal\u0161\u00ed monitorov\u00e1n\u00ed: v\u00fdchoz\u00ed a pravideln\u00e9 testy jatern\u00edch funkc\u00ed (ethambutol s\u00e1m o sob\u011b je m\u00edrn\u011b hepatotoxick\u00fd, ale kombinovan\u00e9 l\u00e9ky v\u00edce), mo\u010dovina\/kreatinin, s\u00e9rov\u00e1 kyselina mo\u010dov\u00e1 u pacient\u016f s anamn\u00e9zou dny a kompletn\u00ed krevn\u00ed obraz. Konverze sputov\u00e9 kultury po 2 m\u011bs\u00edc\u00edch je hlavn\u00edm ukazatelem \u00fa\u010dinnosti u aktivn\u00ed TBC.<\/p>\n

Vedlej\u0161\u00ed \u00fa\u010dinky<\/h2>\n

Nejv\u00fdznamn\u011bj\u0161\u00ed klinick\u00e9 \u00fa\u010dinky:<\/strong><\/p>\n

    \n
  • O\u010dn\u00ed neuritida<\/strong> (viz v\u00fd\u0161e uveden\u00e9 varov\u00e1n\u00ed v \u010derven\u00e9m r\u00e1me\u010dku) \u2014 z\u00e1visl\u00e1 na d\u00e1vce; reverzibiln\u00ed, pokud je zachycena v\u010das; trval\u00e1, pokud je ignorov\u00e1na<\/li>\n
  • Hyperurik\u00e9mie \u2014 ethambutol sni\u017euje ren\u00e1ln\u00ed vylu\u010dov\u00e1n\u00ed ur\u00e1t\u016f; m\u016f\u017ee vyvolat z\u00e1chvat dny u n\u00e1chyln\u00fdch pacient\u016f<\/li>\n
  • Perifern\u00ed neuropatie \u2014 vz\u00e1cn\u00e1; necitlivost nebo brn\u011bn\u00ed v rukou nebo nohou<\/li>\n<\/ul>\n

    \u010cast\u00e9, ale m\u00edrn\u00e9:<\/strong><\/p>\n

      \n
    • Nevolnost, nechutenstv\u00ed, b\u0159i\u0161n\u00ed diskomfort \u2014 obvykle samovoln\u011b ustupuj\u00edc\u00ed<\/li>\n
    • Bolest hlavy, z\u00e1vrat\u011b<\/li>\n
    • M\u00edrn\u00e1 vyr\u00e1\u017eka<\/li>\n<\/ul>\n

      M\u00e9n\u011b \u010dast\u00e9, ale d\u016fle\u017eit\u00e9:<\/strong><\/p>\n

        \n
      • Hepatitida (vz\u00e1cn\u00e1 u samotn\u00e9ho ethambutolu; \u010dast\u011bj\u0161\u00ed v kombinaci s rifampicinem + isoniazidem + pyrazinamidem)<\/li>\n
      • Trombocytopenie, eozinofilie, leukopenie<\/li>\n
      • P\u0159ecitliv\u011blostn\u00ed vyr\u00e1\u017eka, hore\u010dka; vz\u00e1cn\u011b anafylaxe<\/li>\n
      • Zmatenost, dezorientace, halucinace \u2014 velmi vz\u00e1cn\u00e9<\/li>\n<\/ul>\n

        Interakce s l\u00e9\u010divy<\/h2>\n

        Ethambutol m\u00e1 ve srovn\u00e1n\u00ed s ostatn\u00edmi l\u00e9ky prvn\u00ed volby proti TBC relativn\u011b klidn\u00fd interak\u010dn\u00ed profil.<\/p>\n

          \n
        • Antacida obsahuj\u00edc\u00ed hlin\u00edk<\/strong> v\u00fdrazn\u011b sni\u017euj\u00ed absorpci ethambutolu \u2014 d\u00e1vky pod\u00e1vejte s odstupem alespo\u0148 4 hodin.<\/li>\n
        • Disulfiram<\/strong> m\u016f\u017ee zhor\u0161it neurotoxicitu spojenou s ethambutolem (vyvarujte se kombinace).<\/li>\n
        • \u017d\u00e1dn\u00e9 klinicky v\u00fdznamn\u00e9 interakce indukce nebo inhibice CYP enzym\u016f.<\/li>\n<\/ul>\n

          Z\u00e1va\u017en\u00e9 l\u00e9kov\u00e9 interakce v re\u017eimu proti TBC poch\u00e1zej\u00ed od partner\u016f v kombinaci (zejm\u00e9na rifampicinu) \u2014 p\u0159i zah\u00e1jen\u00ed jak\u00e9hokoli re\u017eimu proti TBC zkontrolujte v\u0161echny sou\u010dasn\u011b u\u017e\u00edvan\u00e9 l\u00e9ky, i kdy\u017e v\u00e1s hlavn\u011b zaj\u00edm\u00e1 ethambutol.<\/p>\n

          Kontraindikace a upozorn\u011bn\u00ed<\/h2>\n
            \n
          • Zn\u00e1m\u00e1 p\u0159ecitliv\u011blost na ethambutol<\/li>\n
          • P\u0159edexistuj\u00edc\u00ed optick\u00e1 neuritida (relativn\u00ed kontraindikace \u2014 konzultace specialistou)<\/li>\n
          • Neschopnost spolehliv\u011b hl\u00e1sit vizu\u00e1ln\u00ed p\u0159\u00edznaky (velmi mal\u00e9 d\u011bti, t\u011b\u017ek\u00e1 kognitivn\u00ed porucha, bezv\u011bdom\u00ed pacienti) \u2014 relativn\u00ed kontraindikace<\/li>\n<\/ul>\n

            Pou\u017e\u00edvejte s opatrnost\u00ed u: v\u00fdznamn\u00e9ho ren\u00e1ln\u00edho po\u0161kozen\u00ed (upravte d\u00e1vkov\u00e1n\u00ed viz v\u00fd\u0161e), dny, diabetick\u00e9 retinopatie nebo jin\u00e9ho p\u0159edexistuj\u00edc\u00edho o\u010dn\u00edho onemocn\u011bn\u00ed (doporu\u010duje se vstupn\u00ed o\u010dn\u00ed vy\u0161et\u0159en\u00ed), star\u0161\u00edch pacient\u016f.<\/p>\n

            T\u011bhotenstv\u00ed, kojen\u00ed a d\u011bti<\/h2>\n

            Ethambutol je sou\u010d\u00e1st\u00ed standardn\u00edho WHO re\u017eimu proti TBC pou\u017e\u00edvan\u00e9ho v t\u011bhotenstv\u00ed. Je dob\u0159e tolerov\u00e1n a nen\u00ed spojov\u00e1n s o\u010dn\u00ed toxicitou plodu. Kompatibiln\u00ed s kojen\u00edm (mal\u00e9 mno\u017estv\u00ed p\u0159ech\u00e1z\u00ed do ml\u00e9ka). U d\u011bt\u00ed lze ethambutol pou\u017e\u00edt v d\u00e1vce 20 mg\/kg\/den, pokud d\u00edt\u011b dok\u00e1\u017ee spolehliv\u011b hl\u00e1sit vizu\u00e1ln\u00ed p\u0159\u00edznaky; jinak d\u011btsk\u00fd TBC t\u00fdm zv\u00e1\u017e\u00ed p\u0159\u00ednos re\u017eimu proti rezistenci proti neschopnosti monitorovat optickou neuritidu.<\/p>\n

            Skladov\u00e1n\u00ed<\/h2>\n

            Skladujte p\u0159i 15\u201330 \u00b0C v p\u016fvodn\u00edm blistru, chr\u00e1n\u011bno p\u0159ed vlhkost\u00ed, teplem a p\u0159\u00edm\u00fdm slune\u010dn\u00edm z\u00e1\u0159en\u00edm. Uchov\u00e1vejte mimo dosah d\u011bt\u00ed. Nepou\u017eit\u00e9 nebo pro\u0161l\u00e9 tablety zlikvidujte prost\u0159ednictv\u00edm l\u00e9k\u00e1rensk\u00e9ho zp\u011btn\u00e9ho odb\u011bru.<\/p>\n

            \u010casto kladen\u00e9 dotazy<\/h2>\n

            Mohu l\u00e9\u010dit aktivn\u00ed tuberkul\u00f3zu pouze p\u0159\u00edpravkem Combutol?<\/h3>\n

            Ne. Ethambutol je bakteriostatick\u00fd prost\u0159edek \u2014 zpomaluje r\u016fst mykobakteri\u00ed, ale infekci nesterilizuje. Aktivn\u00ed TBC vy\u017eaduje kombinovanou chemoterapii: rifampicin + isoniazid + pyrazinamid + ethambutol po prvn\u00ed 2 m\u011bs\u00edce (intenzivn\u00ed f\u00e1ze), pot\u00e9 rifampicin + isoniazid dal\u0161\u00ed 4 m\u011bs\u00edce (kontinua\u010dn\u00ed f\u00e1ze). \u00dakolem ethambutolu v re\u017eimu je zabr\u00e1nit bakteri\u00edm v z\u00edsk\u00e1n\u00ed rezistence na baktericidn\u00ed partnery.<\/p>\n

            Jak\u00e9 vizu\u00e1ln\u00ed p\u0159\u00edznaky by m\u011bly v\u00e9st k okam\u017eit\u00e9mu vysazen\u00ed p\u0159\u00edpravku Combutol?<\/h3>\n

            Jak\u00e1koli nov\u00e1 zm\u011bna zraku. Klasick\u00e9 varovn\u00e9 p\u0159\u00edznaky jsou: rozmazan\u00e9 vid\u011bn\u00ed, ztmaven\u00ed centr\u00e1ln\u00edho vid\u011bn\u00ed, pot\u00ed\u017ee s rozli\u0161en\u00edm \u010derven\u00e9 a zelen\u00e9 barvy (\u0161\u00e1lek \u010daje m\u016f\u017ee vypadat hn\u011bd\u011b m\u00edsto \u010dervenohn\u011bd\u011b), tmav\u00e1 skvrna v centru zorn\u00e9ho pole (centr\u00e1ln\u00ed skotom) nebo bolest o\u010d\u00ed p\u0159i pohybu. L\u00e9k okam\u017eit\u011b vysa\u010fte a t\u00e9ho\u017e dne kontaktujte l\u00e9ka\u0159e \u2014 ne ne<\/strong> Po\u010dkejte na dal\u0161\u00ed klinick\u00e9 vy\u0161et\u0159en\u00ed. P\u0159ed\u010dasn\u00e9 ukon\u010den\u00ed l\u00e9\u010dby obvykle vede k \u00fapln\u00e9mu nebo t\u00e9m\u011b\u0159 \u00fapln\u00e9mu uzdraven\u00ed; pokra\u010dov\u00e1n\u00ed p\u0159i p\u0159etrv\u00e1vaj\u00edc\u00edch p\u0159\u00edznac\u00edch m\u016f\u017ee zp\u016fsobit trvalou ztr\u00e1tu zraku.<\/p>\n

            Jak\u00e9 o\u010dn\u00ed testy pot\u0159ebuji p\u0159ed a b\u011bhem l\u00e9\u010dby ethambutolem?<\/h3>\n

            P\u0159ed zah\u00e1jen\u00edm l\u00e9\u010dby: test zrakov\u00e9 ostrosti (Snellenova tabule) a test \u010dervenozelen\u00e9ho vid\u011bn\u00ed (Ishiharovy tabulky) pro ka\u017ed\u00e9 oko zvl\u00e1\u0161\u0165. Zdokumentujte v\u00fdchoz\u00ed stav. Stejn\u00e9 testy opakujte alespo\u0148 m\u011bs\u00ed\u010dn\u011b po celou dobu l\u00e9\u010dby; vy\u0161et\u0159en\u00ed oftalmologem se doporu\u010duje, pokud je p\u0159\u00edtomna jak\u00e1koli v\u00fdchoz\u00ed zrakov\u00e1 abnormalita, u star\u0161\u00edch dosp\u011bl\u00fdch, p\u0159i ren\u00e1ln\u00edm posti\u017een\u00ed nebo kdy\u017e d\u00e1vka p\u0159ekro\u010d\u00ed 15 mg\/kg.<\/p>\n

            Pro\u010d je t\u0159eba upravit d\u00e1vku, pokud m\u00e1m probl\u00e9my s ledvinami?<\/h3>\n

            Ethambutol se vylu\u010duje p\u0159ev\u00e1\u017en\u011b ledvinami (asi 80% nezm\u011bn\u011bn\u00e9ho l\u00e9ku se vylu\u010duje mo\u010d\u00ed). P\u0159i ren\u00e1ln\u00edm posti\u017een\u00ed se l\u00e9k hromad\u00ed, koncentrace v krvi stoup\u00e1 a s n\u00ed i riziko optick\u00e9 neuritidy. Standardn\u00ed \u00fapravy: clearance kreatininu 30\u201350 ml\/min \u2192 15 mg\/kg ka\u017ed\u00fdch 24\u201336 hodin; ClCr 10\u201330 ml\/min \u2192 ka\u017ed\u00fdch 48 hodin; p\u0159i hemodial\u00fdze \u2192 standardn\u00ed d\u00e1vka t\u0159ikr\u00e1t t\u00fddn\u011b podan\u00e1 po<\/strong> dial\u00fdza. V\u017edy znovu zkontrolujte kreatinin p\u0159ed zah\u00e1jen\u00edm a b\u011bhem l\u00e9\u010dby.<\/p>\n

            Mohou d\u011bti u\u017e\u00edvat ethambutol?<\/h3>\n

            Ano, ale s opatrnost\u00ed. Star\u0161\u00ed d\u011bti (ty, kter\u00e9 mohou spolehliv\u011b hl\u00e1sit zm\u011bny vid\u011bn\u00ed \u2013 obvykle ve \u0161koln\u00edm v\u011bku a v\u00fd\u0161e) sn\u00e1\u0161ej\u00ed ethambutol dob\u0159e v d\u00e1vce 20 mg\/kg\/den. U velmi mal\u00fdch d\u011bt\u00ed, kter\u00e9 nedok\u00e1\u017eou popsat zrakov\u00e9 p\u0159\u00edznaky, mnoho doporu\u010den\u00ed bu\u010f ethambutol vynech\u00e1v\u00e1, nebo jej pou\u017e\u00edv\u00e1 pouze kr\u00e1tkodob\u011b, kdy\u017e to vy\u017eaduje l\u00e9\u010debn\u00fd re\u017eim. Rozhodnut\u00ed je v\u017edy individu\u00e1ln\u00ed a prov\u00e1d\u00ed ho d\u011btsk\u00fd t\u00fdm pro l\u00e9\u010dbu TBC.<\/p>\n

            Je Combutol bezpe\u010dn\u00fd v t\u011bhotenstv\u00ed a p\u0159i kojen\u00ed?<\/h3>\n

            Ano. Ethambutol proch\u00e1z\u00ed placentou, ale nen\u00ed spojov\u00e1n s toxicitou pro zrak plodu a des\u00edtky let se bezpe\u010dn\u011b pou\u017e\u00edv\u00e1 u t\u011bhotn\u00fdch \u017een s aktivn\u00ed TBC. Je sou\u010d\u00e1st\u00ed standardn\u00edho l\u00e9\u010debn\u00e9ho re\u017eimu WHO v t\u011bhotenstv\u00ed. Mal\u00e9 mno\u017estv\u00ed p\u0159ech\u00e1z\u00ed do mate\u0159sk\u00e9ho ml\u00e9ka, ale kojen\u00ed m\u016f\u017ee pokra\u010dovat.<\/p>\n

            Ovliv\u0148uje j\u00eddlo vst\u0159eb\u00e1v\u00e1n\u00ed p\u0159\u00edpravku Combutol?<\/h3>\n

            M\u00edrn\u011b. Potrava m\u016f\u017ee zpomalit a m\u00edrn\u011b sn\u00ed\u017eit vst\u0159eb\u00e1v\u00e1n\u00ed, ale rozd\u00edl je natolik mal\u00fd, \u017ee ethambutol lze u\u017e\u00edvat s j\u00eddlem i bez n\u011bj \u2014 zvolte zp\u016fsob, kter\u00fd zp\u016fsobuje nejmen\u0161\u00ed nevolnost, a toho se dr\u017ete. Antacida obsahuj\u00edc\u00ed hlin\u00edk v\u00fdrazn\u011b sni\u017euj\u00ed vst\u0159eb\u00e1v\u00e1n\u00ed<\/strong> \u2014 u\u017e\u00edvejte jak\u00e9koli antacidum s odstupem nejm\u00e9n\u011b 4 hodin od d\u00e1vky p\u0159\u00edpravku Combutol.<\/p>\n

            Co je Mycobacterium avium complex (MAC) a pro\u010d se ethambutol pou\u017e\u00edv\u00e1 k jeho l\u00e9\u010db\u011b?<\/h3>\n

            MAC je skupina pomalu rostouc\u00edch netuberkul\u00f3zn\u00edch mykobakteri\u00ed, kter\u00e9 zp\u016fsobuj\u00ed diseminovanou infekci u pokro\u010dil\u00e9ho HIV (CD4 obvykle < 50) a chronick\u00e9 plicn\u00ed onemocn\u011bn\u00ed u star\u0161\u00edch dosp\u011bl\u00fdch s bronchiekt\u00e1ziemi. Standardn\u00ed re\u017eim pro MAC je klarithromycin nebo azithromycin + ethambutol \u00b1 rifabutin. Ethambutol zabra\u0148uje vzniku rezistence na makrolidy \u2014 stejnou protirezistentn\u00ed roli hraje u tuberkul\u00f3zy.<\/p>\n

            Mohu p\u00edt alkohol p\u0159i u\u017e\u00edv\u00e1n\u00ed ethambutolu?<\/h3>\n

            Ethambutol s\u00e1m o sob\u011b m\u00e1 minim\u00e1ln\u00ed hepatotoxicitu a siln\u011b neinteraguje s alkoholem. Av\u0161ak doprovodn\u00e9 l\u00e9ky v terapii tuberkul\u00f3zy (rifampicin, isoniazid, pyrazinamid) jsou v\u0161echny hepatotoxick\u00e9 a alkohol v\u00fdrazn\u011b zvy\u0161uje riziko po\u0161kozen\u00ed jater souvisej\u00edc\u00edho s l\u00e9\u010dbou. B\u011bhem kombinovan\u00e9 terapie tuberkul\u00f3zy se alkoholu vyhn\u011bte nebo jej p\u0159\u00edsn\u011b omezte \u2014 nej\u010dast\u011bj\u0161\u00edm d\u016fvodem p\u0159eru\u0161en\u00ed l\u00e9\u010dby tuberkul\u00f3zy je hepatitida.<\/p>\n

            Jak se p\u0159\u00edpravek Combutol skladuje?<\/h3>\n

            Skladujte p\u0159i teplot\u011b 15\u201330 \u00b0C v p\u016fvodn\u00edm blistru, chr\u00e1n\u011bn\u00e9 p\u0159ed vlhkost\u00ed, teplem a p\u0159\u00edm\u00fdm slune\u010dn\u00edm z\u00e1\u0159en\u00edm. Tablety jsou stabiln\u00ed v b\u011b\u017en\u00fdch dom\u00e1c\u00edch podm\u00ednk\u00e1ch. Uchov\u00e1vejte mimo dosah d\u011bt\u00ed \u2014 p\u0159ed\u00e1vkov\u00e1n\u00ed ethambutolem m\u016f\u017ee zp\u016fsobit z\u00e1va\u017enou optickou neuritidu. Nepou\u017eit\u00e9 nebo pro\u0161l\u00e9 tablety likvidujte prost\u0159ednictv\u00edm l\u00e9k\u00e1rensk\u00e9ho zp\u011btn\u00e9ho odb\u011bru.<\/p>\n

            Zdravotn\u00ed upozorn\u011bn\u00ed:<\/strong> Informace na t\u00e9to str\u00e1nce jsou ur\u010deny pro dosp\u011bl\u00e9 pod l\u00e9ka\u0159sk\u00fdm dohledem. Aktivn\u00ed tuberkul\u00f3za je z\u00e1va\u017en\u00e9, hl\u00e1\u0161en\u00edm povinn\u00e9 infek\u010dn\u00ed onemocn\u011bn\u00ed, kter\u00e9 vy\u017eaduje kombinovanou antibiotickou terapii, odborn\u00fd dohled specialisty, trasov\u00e1n\u00ed kontakt\u016f a v mnoha jurisdikc\u00edch p\u0159\u00edmo kontrolovanou l\u00e9\u010dbu. Nel\u00e9\u010dte aktivn\u00ed tuberkul\u00f3zu sami. Jak\u00e9koli zm\u011bny v anti-tuberkul\u00f3zn\u00edch l\u00e9c\u00edch, d\u00e1vkov\u00e1n\u00ed nebo pl\u00e1novan\u00e9 ukon\u010den\u00ed l\u00e9\u010dby proberte s kvalifikovan\u00fdm l\u00e9ka\u0159em. Pokud se u v\u00e1s objev\u00ed \u017eloutenka, tmav\u00e1 mo\u010d, siln\u00e1 bolest b\u0159icha, n\u00e1hl\u00e1 zm\u011bna zraku nebo ztr\u00e1ta rozli\u0161en\u00ed \u010derven\u00e9 a zelen\u00e9 barvy, siln\u00e1 vyr\u00e1\u017eka nebo p\u0159\u00edznaky z\u00e1va\u017en\u00e9 alergick\u00e9 reakce, okam\u017eit\u011b vyhledejte l\u00e9ka\u0159skou pomoc.<\/div>\n

            <\/p>\n

            Souvisej\u00edc\u00ed alternativy<\/h3>\n

            Dal\u0161\u00ed produkty v Chronick\u00e1 onemocn\u011bn\u00ed<\/strong> kter\u00e9 z\u00e1kazn\u00edci tak\u00e9 prohl\u00ed\u017eej\u00ed:<\/p>\n