{"id":4203,"count":2,"description":"<strong>Tuberkul\u00f3za (TB)<\/strong> z\u016fst\u00e1v\u00e1 jednou z nejnebezpe\u010dn\u011bj\u0161\u00edch infek\u010dn\u00edch chorob na sv\u011bt\u011b \u2014 WHO odhaduje, \u017ee v roce 2022 onemocn\u011blo tuberkul\u00f3zou 10,6 milionu lid\u00ed a 1,3 milionu zem\u0159elo, v\u010detn\u011b 167 000 s koinfekc\u00ed HIV. Onemocn\u011bn\u00ed je zp\u016fsobeno <em>Mycobacterium tuberculosis<\/em>, pomalu rostouc\u00ed intracelul\u00e1rn\u00ed ty\u010dinkou, kter\u00e1 prim\u00e1rn\u011b postihuje pl\u00edce, ale m\u016f\u017ee zas\u00e1hnout t\u00e9m\u011b\u0159 jak\u00fdkoli org\u00e1nov\u00fd syst\u00e9m. <strong>Modern\u00ed kr\u00e1tkodob\u00e1 l\u00e9\u010dba TB je pln\u011b l\u00e9\u010debn\u00e1 \u2014 ale pouze p\u0159i spr\u00e1vn\u00e9m pou\u017eit\u00ed<\/strong>: spr\u00e1vn\u00e1 kombinace l\u00e9k\u016f, ve spr\u00e1vn\u00e9 d\u00e1vce, po celou dobu, pod odborn\u00fdm dohledem. Tato str\u00e1nka uv\u00e1d\u00ed antituberkulotika skladem v MedsBase. <strong>Nen\u00ed to n\u00e1vod k samol\u00e9\u010db\u011b aktivn\u00ed TB.<\/strong>\n4-l\u00e9kov\u00fd re\u017eim RIPE\nStandardn\u00ed re\u017eim WHO pro novou, l\u00e9ky citlivou plicn\u00ed tuberkul\u00f3zu trv\u00e1 \u0161est m\u011bs\u00edc\u016f ve dvou f\u00e1z\u00edch:\n<strong>Intenzivn\u00ed f\u00e1ze \u2014 2 m\u011bs\u00edce:<\/strong> Rifampicin + Isoniazid + Pyrazinamid + <strong>Ethambutol<\/strong> (RIPE), v\u0161echny \u010dty\u0159i l\u00e9ky denn\u011b.<strong>Pokra\u010dovac\u00ed f\u00e1ze \u2014 4 m\u011bs\u00edce:<\/strong> Rifampicin + Isoniazid (RH), pod\u00e1van\u00e9 denn\u011b.\nDel\u0161\u00ed re\u017eimy (9\u201312 m\u011bs\u00edc\u016f) plat\u00ed pro tuberkul\u00f3zn\u00ed meningitidu, kostn\u00ed a kloubn\u00ed TBC a diseminovan\u00e9 onemocn\u011bn\u00ed. L\u00e9\u010dba je vedena pod dohledem \u2014 <strong>p\u0159\u00edmo pozorovan\u00e1 terapie (DOT)<\/strong> je doporu\u010dov\u00e1na ve v\u011bt\u0161in\u011b n\u00e1rodn\u00edch program\u016f k zaji\u0161t\u011bn\u00ed adherence a prevenci vzniku multirezistentn\u00ed TBC (MDR-TB).\nPro\u010d je kombinovan\u00e1 terapie povinn\u00e1\nL\u00e9\u010dba aktivn\u00ed TBC jedn\u00edm l\u00e9kem nevyhnuteln\u011b selektuje rezistentn\u00ed kmeny. Bakteri\u00e1ln\u00ed n\u00e1lo\u017e v kavit\u00e1rn\u00ed plicn\u00ed l\u00e9zi je obrovsk\u00e1 (a\u017e 109 bacil\u016f) a p\u0159irozen\u011b se vyskytuj\u00edc\u00ed rezistentn\u00ed mutace existuj\u00ed v n\u00edzk\u00e9 frekvenci pro ka\u017ed\u00fd l\u00e9k. Pou\u017eit\u00ed jednoho l\u00e9ku zabije citlivou v\u011bt\u0161inu a ponech\u00e1 rezistentn\u00ed men\u0161inu k mno\u017een\u00ed \u2014 selh\u00e1n\u00ed l\u00e9\u010dby s nyn\u00ed nel\u00e9\u010diteln\u00fdm kmenem. <strong>Kombinovan\u00e1 terapie<\/strong> funguje, proto\u017ee pravd\u011bpodobnost, \u017ee jeden organismus bude sou\u010dasn\u011b rezistentn\u00ed k v\u00edce l\u00e9k\u016fm, je miziv\u011b mal\u00e1. Proto ka\u017ed\u00e1 str\u00e1nka v t\u00e9to kategorii nese explicitn\u00ed varov\u00e1n\u00ed, \u017ee n\u00e1kup jednoho l\u00e9ku je vhodn\u00fd <strong>pouze<\/strong> pro pokra\u010dov\u00e1n\u00ed dohledovan\u00e9ho re\u017eimu, latentn\u00ed TBC infekci (4m\u011bs\u00ed\u010dn\u00ed monoterapie rifampicinem) nebo specifick\u00e9 netuberkul\u00f3zn\u00ed indikace jako lepra, MAC nebo meningokokov\u00e1 profylaxe.\nMultirezistentn\u00ed TBC \u2014 varov\u00e1n\u00ed\nMDR-TB \u2014 rezistence alespo\u0148 na rifampicin a isoniazid \u2014 postihla v roce 2022 odhadem 410 000 lid\u00ed celosv\u011btov\u011b. MDR-TB vy\u017eaduje del\u0161\u00ed l\u00e9\u010dbu (9\u201320 m\u011bs\u00edc\u016f) s l\u00e9ky druh\u00e9 volby v\u010detn\u011b <strong>fluorochinolon\u016f<\/strong> (levofloxacin, moxifloxacin), <strong>linezolidu<\/strong>, <strong>bedaquilinu<\/strong>, a <strong>klofaziminu<\/strong>. MDR-TB je p\u0159edv\u00eddateln\u00fdm d\u016fsledkem \u010d\u00e1ste\u010dn\u00e9, nepravideln\u00e9 nebo jednoslo\u017ekov\u00e9 l\u00e9\u010dby l\u00e9ky citliv\u00e9 TB. Vyl\u00e9\u010den\u00ed je mo\u017en\u00e9, ale obt\u00ed\u017en\u011bj\u0161\u00ed, dra\u017e\u0161\u00ed a toxi\u010dt\u011bj\u0161\u00ed ne\u017e u l\u00e9\u010dby prvn\u00ed linie \u2014 proto je kl\u00ed\u010dov\u00e9 zvolit spr\u00e1vn\u00fd po\u010d\u00e1te\u010dn\u00ed re\u017eim a dokon\u010dit ho.\nL\u00e9ky proti TB skladem na MedsBase\nTato kategorie aktu\u00e1ln\u011b obsahuje <strong>dv\u011b ze \u010dty\u0159 l\u00e9k\u016f prvn\u00ed linie<\/strong>:\n<a href=\"https:\/\/medsbase.com\/cs\/r-cin\/\"><strong>R-Cin<\/strong><\/a> \u2014 <strong>rifampicin 300\/450\/600 mg<\/strong> (Cipla). Nejv\u00fdznamn\u011bj\u0161\u00ed steriliza\u010dn\u00ed l\u00e9k v terapii tuberkul\u00f3zy. Pou\u017e\u00edv\u00e1 se tak\u00e9 jako 4m\u011bs\u00ed\u010dn\u00ed monoterapie pro latentn\u00ed tuberkul\u00f3zn\u00ed infekci (re\u017eim 4R), u multibacil\u00e1rn\u00ed lepry v r\u00e1mci multilekov\u00e9 terapie, pro meningokokovou profylaxi kontakt\u016f a u z\u00e1va\u017en\u00fdch stafylokokov\u00fdch infekc\u00ed kost\u00ed, kloub\u016f nebo prot\u00e9z. Rifampicin je <strong>siln\u00fd induktor CYP3A4 \/ CYP2C9 \/ CYP2C19<\/strong> \u2014 sni\u017euje \u00fa\u010dinnost des\u00edtek sou\u010dasn\u011b pod\u00e1van\u00fdch l\u00e9k\u016f v\u010detn\u011b peror\u00e1ln\u00edch kontraceptiv, warfarinu, DOAC, statin\u016f, metadonu, imunosupresiv po transplantaci, antiretrovirotik a mnoha dal\u0161\u00edch. <strong>P\u0159ed zah\u00e1jen\u00edm l\u00e9\u010dby v\u017edy sd\u011blte v\u0161echny sou\u010dasn\u011b u\u017e\u00edvan\u00e9 l\u00e9ky.<\/strong> Zp\u016fsobuje oran\u017eovo-\u010derven\u00e9 zabarven\u00ed mo\u010di, potu, slz a slin (ne\u0161kodn\u00e9, ale trvale barv\u00ed m\u011bkk\u00e9 kontaktn\u00ed \u010do\u010dky).<a href=\"https:\/\/medsbase.com\/cs\/combutol\/\"><strong>Combutol<\/strong><\/a> \u2014 <strong>ethambutol HCl 200\/400\/800 mg<\/strong> (Lupin). Bakteriostatick\u00fd prost\u0159edek, jeho\u017e \u00falohou v re\u017eimu je potla\u010dit vznik rezistence na baktericidn\u00ed partnersk\u00e9 l\u00e9ky. Tak\u00e9 z\u00e1kladn\u00ed l\u00e9k pro infekci komplexem Mycobacterium avium (MAC) u HIV. Charakteristickou toxicitou je <strong>d\u00e1vkov\u011b z\u00e1visl\u00e1 optick\u00e1 neuritida<\/strong>: ztr\u00e1ta zrakov\u00e9 ostrosti a rozli\u0161en\u00ed \u010derven\u00e9 a zelen\u00e9 barvy, obvykle reverzibiln\u00ed, pokud je l\u00e9k vysazen p\u0159i prvn\u00edm p\u0159\u00edznaku, ale potenci\u00e1ln\u011b trval\u00e1, pokud nen\u00ed. <strong>Z\u00e1kladn\u00ed oftalmologick\u00e9 vy\u0161et\u0159en\u00ed + m\u011bs\u00ed\u010dn\u00ed kontroly zraku jsou povinn\u00e9.<\/strong> \u00daprava d\u00e1vkov\u00e1n\u00ed p\u0159i ren\u00e1ln\u00edm posti\u017een\u00ed je nezbytn\u00e1.\nDal\u0161\u00ed dva l\u00e9ky prvn\u00ed linie \u2014 <strong>isoniazid<\/strong> a <strong>pyrazinamid<\/strong> \u2014 moment\u00e1ln\u011b nejsou na MedsBase skladem. Pacienti na pln\u00e9m RIPE re\u017eimu si je budou muset obstarat od jin\u00e9ho dodavatele, nemocni\u010dn\u00ed l\u00e9k\u00e1rny nebo n\u00e1rodn\u00edho programu TB. N\u00e1rodn\u00ed TB programy ve v\u011bt\u0161in\u011b zem\u00ed poskytuj\u00ed l\u00e9ky prvn\u00ed linie na TB zdarma.\nPovinn\u00e9 monitorov\u00e1n\u00ed b\u011bhem l\u00e9\u010dby TB\n<strong>Funkce jater<\/strong> \u2014 v\u00fdchoz\u00ed a alespo\u0148 m\u011bs\u00ed\u010dn\u011b. Rifampicin, isoniazid a pyrazinamid jsou v\u0161echny hepatotoxick\u00e9; kombinovan\u00fd re\u017eim zp\u016fsobuje klinicky v\u00fdznamnou hepatitidu p\u0159ibli\u017en\u011b u 5 % pacient\u016f. P\u0159i \u017eloutence, tmav\u00e9 mo\u010di nebo bolesti v prav\u00e9m horn\u00edm kvadrantu b\u0159icha p\u0159eru\u0161te re\u017eim a vyhledejte kontrolu.<strong>Zrakov\u00e1 ostrost a barvocit<\/strong> \u2014 v\u00fdchoz\u00ed a m\u011bs\u00ed\u010dn\u011b b\u011bhem u\u017e\u00edv\u00e1n\u00ed ethambutolu. P\u0159i jak\u00e9koli nov\u00e9 st\u00ed\u017enosti na zrak okam\u017eit\u011b p\u0159eru\u0161te u\u017e\u00edv\u00e1n\u00ed ethambutolu.<strong>Vy\u0161et\u0159en\u00ed sputa a kultivace<\/strong> \u2014 hlavn\u00ed ukazatel \u00fa\u010dinnosti u aktivn\u00ed plicn\u00ed tuberkul\u00f3zy; p\u0159echod na negativn\u00ed kultivaci do 2 m\u011bs\u00edc\u016f ukazuje na dobrou odpov\u011b\u010f.<strong>Funkce ledvin a s\u00e9rov\u00e1 kyselina mo\u010dov\u00e1<\/strong> \u2014 clearance ethambutolu je ren\u00e1ln\u00ed; pyrazinamid zvy\u0161uje hladinu kyseliny mo\u010dov\u00e9 a m\u016f\u017ee vyvolat dnu.<strong>HIV status<\/strong> \u2014 koinfekce TB-HIV m\u011bn\u00ed l\u00e9\u010debn\u00fd re\u017eim, interakce l\u00e9k\u016f a progn\u00f3zu. Ka\u017ed\u00e9mu pacientovi s aktivn\u00ed TB by m\u011bl b\u00fdt nab\u00eddnut test na HIV.\nPro koho tato kategorie nen\u00ed\nPokud m\u00e1te podez\u0159en\u00ed na aktivn\u00ed TB (chronick\u00fd ka\u0161el &gt; 3 t\u00fddny, \u00fabytek v\u00e1hy, no\u010dn\u00ed pocen\u00ed, krvav\u00fd sputum), pot\u0159ebujete specialistu na TB, vy\u0161et\u0159en\u00ed sputa, testy citlivosti, trasov\u00e1n\u00ed kontakt\u016f a kombinovanou l\u00e9\u010dbu pod p\u0159\u00edm\u00fdm dohledem \u2014 <strong>ne samol\u00e9\u010dbu jedn\u00edm l\u00e9kem<\/strong>. Nel\u00e9\u010den\u00e1 nebo \u010d\u00e1ste\u010dn\u011b l\u00e9\u010den\u00e1 aktivn\u00ed tuberkul\u00f3za je naka\u017eliv\u00e1, zabije p\u0159ibli\u017en\u011b polovinu naka\u017een\u00fdch a je nej\u010dast\u011bj\u0161\u00ed p\u0159\u00ed\u010dinou vzniku MDR-TB. Tuto str\u00e1nku pou\u017eijte pro dopl\u0148ov\u00e1n\u00ed a pokra\u010dov\u00e1n\u00ed v ji\u017e zah\u00e1jen\u00e9 l\u00e9\u010db\u011b pod dohledem, pro l\u00e9\u010dbu latentn\u00ed tuberkul\u00f3zn\u00ed infekce nebo pro specifick\u00e9 indikace net\u00fdkaj\u00edc\u00ed se TB uveden\u00e9 na ka\u017ed\u00e9 produktov\u00e9 str\u00e1nce.","link":"https:\/\/medsbase.com\/cs\/tuberculosis-treatment\/","name":"L\u00e9\u010dba tuberkul\u00f3zy","slug":"tuberculosis-treatment","taxonomy":"product_cat","parent":3223,"meta":[],"menu_order":0,"acf":[],"_links":{"self":[{"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/product_cat\/4203","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/product_cat"}],"about":[{"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/taxonomies\/product_cat"}],"up":[{"embeddable":true,"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/product_cat\/3223"}],"wp:post_type":[{"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/product?product_cat=4203"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}