Ко-тримоксазол рекомендуют при заболеваниях, ассоциированных с чувствительной патогенной флорой. Состояния, при которых показан Ко-тримоксазол: - ЛОР-практика: ларингит, воспаление среднего уха, синусит . - патологии дыхательных путей: бронхоэктатическая болезнь, бронхит (показаниями являются как острая и хроническая форма, так и необходимость предупреждения ...
непереносимость действующих и вспомогательных компонентов . - нарушенная функция печени (тяжелая форма) . - недостаточность выделительной функции почек (менее 15 мл/мин клиренс креатинина) . - патологии кроветворения: В12-дефицитная анемия, лейкопения, агранулоцитоз . - недостаток глюкозо-6-фосатдегидрогеназы . - возраст менее 2 месяцев . - кормление грудью, беременность . Относительные противопоказания (препарат может назначаться под контролем врача): - недостаточная выделительная функция почек (15-30 мл/мин клиренс креатинина) – Ко-тримоксазол назначается в обычных дозах первые 3 дня лечения, далее дозу уменьшают вдвое . - потенциальный дефицит фолиевой кислоты . - склонность к реакциям аллергического типа . - бронхиальная астма . - умеренно нарушенная функция щитовидной железы и печени . - пожилые пациенты (требуется дополнительное назначение препаратов фолиевой кислоты). Ко-тримоксазол не является средством первого ряда при инфекциях, ассоциированных с бета-гемолитическим стрептококком группы А (при учете распространенности устойчивых штаммов).
Комбинированный противомикробный препарат, состоящий из сульфаметоксазола и триметоприма. Сульфаметоксазол, сходный по строению с пара-аминобензойной кислотой (ПАБК), нарушает синтез дигидрофолиевой кислоты в бактериальных клетках, препятствуя включению ПАБК в ее молекулу. Триметоприм усиливает действие сульфаметоксазола, нарушая восстановление дигидрофолиевой кислоты в тетрагидрофолиевую - активную форму фолиевой кислоты, ответственную за белковый обмен и деление микробной клетки. Является бактерицидным препаратом широкого спектра действия, активен в отношении следующих микроорганизмов: Streptococcus spp. (гемолитические штаммы более чувствительны к пенициллину), Staphylococcus spp., Streptococcus pneumoniae, Neisseria meningitidis, Neisseria gonorrhoeae, Escherichia coli (включая энтеротоксогенные штаммы), Salmonella spp. (включая Salmonella typhi и Salmonella paratyphi), Vibrio cholerae, Bacillus anthracis, Haemophilus influenzae (включая ампициллиноустойчивые штаммы), Listeria spp., Nocardia asteroides, Bordetella pertussis, Enterococcus faecalis, Klebsiella spp., Proteus spp., Pasteurella spp., Francisella tularensis, Brucella spp., Mycobacterium spp. (в т.ч. Mycobacterium leprae), Citrobacter, Enterobacter spp., Legionella pneumophila, Providencia, некоторые виды Pseudomonas (кроме Pseudomonas aeruginosa), Serratia marcescens, Shigella spp., Yersinia spp., Morganella spp., Pneumocystis carinii . Chlamydia spp. (в т.ч. Chlamydia trachomatis, Chlamydia psittaci) . простейшие: Plasmodium spp., Toxoplasma gondii, патогенные грибы, Actinomyces israelii, Coccidioides immitis, Histoplasma capsulatum, Leishmania spp. Устойчивы к препарату: Corynebacterium spp., Pseudomonas aeruginosa, Mycobacterium tuberculosis, Treponema spp., Leptospira spp., вирусы. Угнетает жизнедеятельность кишечной палочки, что приводит к уменьшению синтеза тимина, рибофлавина, никотиновой кислоты и др. витаминов группы В в кишечнике.
Показания к применению
Ко-тримоксазол рекомендуют при заболеваниях, ассоциированных с чувствительной патогенной флорой. Состояния, при которых показан Ко-тримоксазол: - ЛОР-практика: ларингит, воспаление среднего уха, синусит . - патологии дыхательных путей: бронхоэктатическая болезнь, бронхит (показаниями являются как острая и хроническая форма, так и необходимость предупреждения обострений), эмпиема плевры, пневмония (лечение и для профилактики), абсцесс легких. Ко-тримоксазол может применяться при пневмонии, ассоциированной с Pneumocystis carinii у лиц со СПИДом . - дерматология: акне, пиодермия, абсцессы тканей, фурункулы, инфицирование ран . - гастроэнтерология: диарея бактериального генеза, холера (в комплексе с прочими средствами), шигеллез, паратиф, брюшной тиф, гастроэнтерит (ассоциированный с E. coli), холангит, холецистит . - урологическая практика: пиелиты, пиелонефриты, острые и хронические формы цистита, уретриты, эпидидимиты, простатиты . - заболевания, передающиеся половым путем: гонорея, паховая гранулема, венерическая лимфогранулема, мягкий шанкр . - хирургия и прочие инфекции: воспаление мозговых оболочек, абсцесс головного мозга, малярия, септицемия, коклюш (сочетано с прочими средствами), токсоплазмоз, остеомиелит (и хроническая, и острая форма), бруцеллез, южноамериканский бластомикоз.
Противопоказания
непереносимость действующих и вспомогательных компонентов . - нарушенная функция печени (тяжелая форма) . - недостаточность выделительной функции почек (менее 15 мл/мин клиренс креатинина) . - патологии кроветворения: В12-дефицитная анемия, лейкопения, агранулоцитоз . - недостаток глюкозо-6-фосатдегидрогеназы . - возраст менее 2 месяцев . - кормление грудью, беременность . Относительные противопоказания (препарат может назначаться под контролем врача): - недостаточная выделительная функция почек (15-30 мл/мин клиренс креатинина) – Ко-тримоксазол назначается в обычных дозах первые 3 дня лечения, далее дозу уменьшают вдвое . - потенциальный дефицит фолиевой кислоты . - склонность к реакциям аллергического типа . - бронхиальная астма . - умеренно нарушенная функция щитовидной железы и печени . - пожилые пациенты (требуется дополнительное назначение препаратов фолиевой кислоты). Ко-тримоксазол не является средством первого ряда при инфекциях, ассоциированных с бета-гемолитическим стрептококком группы А (при учете распространенности устойчивых штаммов).
Применение при беременности и в период грудного вскармливания
Противопоказан при беременности и в период лактации.
Способ применения и дозы
Таблетки предназначены для приема перорально, перерыв между принятием каждой из разовых доз – 12 часов. Рекомендуется максимально точно придерживаться указанного интервала между приемами (это позволяет поддерживать терапевтические уровни антибактериальных веществ в организме). Дозирование – индивидуальное (следует учитывать патогенную флору, тяжесть и динамику заболевания, а также возраст, вес и выделительную функцию почек). Средние рекомендованные разовые дозы (разовая доза принимается дважды в сутки): - лицам старше 12 лет – 2 таблетки . - пациентам 6-12 лет – 1 таблетка . - пациентам с 6 месяцев до 5 лет – 1/2 таблетки . - пациентам с 2 месяцев до 6 месяцев – 1/4 таблетки. Средняя продолжительность антибактериальной терапии средством Ко-тримоксазол – 5-7 дней. Не следует прерывать курс антибактериального лечения даже в случае исчезновения клинических признаков заболевания. При необходимости более продолжительной терапии (до 14 дней) взрослым, начиная с 7 дня терапии, рекомендуют прием 50% средней дозы. При острой форме бруцеллеза длительность приема антибактериальных средств должна составлять 3-4 недели, при паратифе и тифе – 1-3 месяца. Особые случаи дозирования: - Хронические формы инфекционных заболеваний мочевыделительной системы (в качестве профилактики) – взрослым 1 таблетка на ночь, детям до 12 лет 12 мг/кг веса в сутки на ночь (доза указана из расчета сульфаметоксазола). Продолжительность профилактики до 12 месяцев. - При цистите пациентам 7-16 лет назначают по 1 таблетке каждые 12 часов на протяжении 3 дней (всего 6 разовых доз). - При гонорее назначают 4-6 таблеток, которые делят на 3 приема с перерывами 12 часов. - При пневмонии, ассоциированной с Pneumocystis carinii, назначают 15-20 мг/кг веса триметоприма и 120 мг/кг веса сульфаметоксазола в сутки. Суточную дозу делят на 4 принятия (с перерывами по 6 часов). Курс – 14 дней. Функциональную активность почек, печени и системы кроветворения следует контролировать, если время лечения более 14 дней подряд. При назначении высоких (ударных) доз требуется обильное питье (для предупреждения кристаллурии). Ультрафиолетовое облучение может провоцировать развитие нежелательных реакций (светочувствительность) на фоне терапии. Пациент должен исключить солнечные ванны и солярий на период лечения.
Побочное действие
Нежелательные эффекты, которые регистрировались при исследовании препарата Ко-тримоксазол, рассортированы по системам организма: - ЖКТ: снижение аппетита, рвота, нарушения диспепсического характера, некротический и холестатический гепатит, панкреатит, глоссит, псевдомембранозный энтероколит, стоматит. - Кроветворение: лейкопения, тромбоцитопения, анемия гемолитическая и апластическая, эозинофилия, агранулоцитоз. - Мочевыделительная система: токсическая форма нефропатии, интерстициальный нефрит, кристаллурия (преимущественно при применении ударных доз), недостаточность функции почек. - Реакции аллергического характера: полиморфная эритема, крапивница, зуд и сыпь на коже, синдром Лайелла, аллергический миокардит, синдром Стивенса-Джонсона. - Прочие нежелательные эффекты, которые регистрировались у пациентов: периферический неврит, легочный инфильтрат, головная боль, гиперкалиемия, гипонатриемия, слабость, гипертермия, боль в суставах и мышцах, реакции светочувствительности. Немедленная отмена препарата требуется при развитии кашля, сыпи и боли в суставах, а также прочих выраженных побочных эффектов.
Особые указания
Нежелательные эффекты, которые регистрировались при исследовании препарата Ко-тримоксазол, рассортированы по системам организма: - ЖКТ: снижение аппетита, рвота, нарушения диспепсического характера, некротический и холестатический гепатит, панкреатит, глоссит, псевдомембранозный энтероколит, стоматит. - Кроветворение: лейкопения, тромбоцитопения, анемия гемолитическая и апластическая, эозинофилия, агранулоцитоз. - Мочевыделительная система: токсическая форма нефропатии, интерстициальный нефрит, кристаллурия (преимущественно при применении ударных доз), недостаточность функции почек. - Реакции аллергического характера: полиморфная эритема, крапивница, зуд и сыпь на коже, синдром Лайелла, аллергический миокардит, синдром Стивенса-Джонсона. - Прочие нежелательные эффекты, которые регистрировались у пациентов: периферический неврит, легочный инфильтрат, головная боль, гиперкалиемия, гипонатриемия, слабость, гипертермия, боль в суставах и мышцах, реакции светочувствительности. Немедленная отмена препарата требуется при развитии кашля, сыпи и боли в суставах, а также прочих выраженных побочных эффектов.
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Сульфаметоксазол, сходный по строению с пара-аминобензойной кислотой (ПАБК), нарушает синтез дигидрофолиевой кислоты в бактериальных клетках, препятствуя включению ПАБК в ее молекулу. Триметоприм усиливает действие сульфаметоксазола, нарушая восстановление дигидрофолиевой кислоты в тетрагидрофолиевую - активную форму фолиевой кислоты, ответственную за белковый обмен и деление микробной клетки. Является бактерицидным препаратом широкого спектра действия, активен в отношении следующих микроорганизмов: Streptococcus spp. (гемолитические штаммы более чувствительны к пенициллину), Staphylococcus spp., Streptococcus pneumoniae, Neisseria meningitidis, Neisseria gonorrhoeae, Escherichia coli (включая энтеротоксогенные штаммы), Salmonella spp. (включая Salmonella typhi и Salmonella paratyphi), Vibrio cholerae, Bacillus anthracis, Haemophilus influenzae (включая ампициллиноустойчивые штаммы), Listeria spp., Nocardia asteroides, Bordetella pertussis, Enterococcus faecalis, Klebsiella spp., Proteus spp., Pasteurella spp., Francisella tularensis, Brucella spp., Mycobacterium spp. (в т.ч. Mycobacterium leprae), Citrobacter, Enterobacter spp., Legionella pneumophila, Providencia, некоторые виды Pseudomonas (кроме Pseudomonas aeruginosa), Serratia marcescens, Shigella spp., Yersinia spp., Morganella spp., Pneumocystis carinii . Chlamydia spp. (в т.ч. Chlamydia trachomatis, Chlamydia psittaci) . простейшие: Plasmodium spp., Toxoplasma gondii, патогенные грибы, Actinomyces israelii, Coccidioides immitis, Histoplasma capsulatum, Leishmania spp. Устойчивы к препарату: Corynebacterium spp., Pseudomonas aeruginosa, Mycobacterium tuberculosis, Treponema spp., Leptospira spp., вирусы. Угнетает жизнедеятельность кишечной палочки, что приводит к уменьшению синтеза тимина, рибофлавина, никотиновой кислоты и др. витаминов группы В в кишечнике."}}]},{"id":3,"name":"Показания к применению","slug":"indications","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Ко-тримоксазол рекомендуют при заболеваниях, ассоциированных с чувствительной патогенной флорой. Состояния, при которых показан Ко-тримоксазол: - ЛОР-практика: ларингит, воспаление среднего уха, синусит . - патологии дыхательных путей: бронхоэктатическая болезнь, бронхит (показаниями являются как острая и хроническая форма, так и необходимость предупреждения обострений), эмпиема плевры, пневмония (лечение и для профилактики), абсцесс легких. Ко-тримоксазол может применяться при пневмонии, ассоциированной с Pneumocystis carinii у лиц со СПИДом . - дерматология: акне, пиодермия, абсцессы тканей, фурункулы, инфицирование ран . - гастроэнтерология: диарея бактериального генеза, холера (в комплексе с прочими средствами), шигеллез, паратиф, брюшной тиф, гастроэнтерит (ассоциированный с E. coli), холангит, холецистит . - урологическая практика: пиелиты, пиелонефриты, острые и хронические формы цистита, уретриты, эпидидимиты, простатиты . - заболевания, передающиеся половым путем: гонорея, паховая гранулема, венерическая лимфогранулема, мягкий шанкр . - хирургия и прочие инфекции: воспаление мозговых оболочек, абсцесс головного мозга, малярия, септицемия, коклюш (сочетано с прочими средствами), токсоплазмоз, остеомиелит (и хроническая, и острая форма), бруцеллез, южноамериканский бластомикоз."}}]},{"id":4,"name":"Противопоказания","slug":"contraindications","displayInMenu":true,"body":[{"type":"list","data":{"style":"unordered","items":["непереносимость действующих и вспомогательных компонентов . - нарушенная функция печени (тяжелая форма) . - недостаточность выделительной функции почек (менее 15 мл/мин клиренс креатинина) . - патологии кроветворения: В12-дефицитная анемия, лейкопения, агранулоцитоз . - недостаток глюкозо-6-фосатдегидрогеназы . - возраст менее 2 месяцев . - кормление грудью, беременность . Относительные противопоказания (препарат может назначаться под контролем врача): - недостаточная выделительная функция почек (15-30 мл/мин клиренс креатинина) – Ко-тримоксазол назначается в обычных дозах первые 3 дня лечения, далее дозу уменьшают вдвое . - потенциальный дефицит фолиевой кислоты . - склонность к реакциям аллергического типа . - бронхиальная астма . - умеренно нарушенная функция щитовидной железы и печени . - пожилые пациенты (требуется дополнительное назначение препаратов фолиевой кислоты). Ко-тримоксазол не является средством первого ряда при инфекциях, ассоциированных с бета-гемолитическим стрептококком группы А (при учете распространенности устойчивых штаммов)."]}}]},{"id":5,"name":"Применение при беременности и в период грудного вскармливания","slug":"pregnancy_warnings","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Противопоказан при беременности и в период лактации."}}]},{"id":6,"name":"Способ применения и дозы","slug":"dosage","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Таблетки предназначены для приема перорально, перерыв между принятием каждой из разовых доз – 12 часов. Рекомендуется максимально точно придерживаться указанного интервала между приемами (это позволяет поддерживать терапевтические уровни антибактериальных веществ в организме). Дозирование – индивидуальное (следует учитывать патогенную флору, тяжесть и динамику заболевания, а также возраст, вес и выделительную функцию почек). Средние рекомендованные разовые дозы (разовая доза принимается дважды в сутки): - лицам старше 12 лет – 2 таблетки . - пациентам 6-12 лет – 1 таблетка . - пациентам с 6 месяцев до 5 лет – 1/2 таблетки . - пациентам с 2 месяцев до 6 месяцев – 1/4 таблетки. Средняя продолжительность антибактериальной терапии средством Ко-тримоксазол – 5-7 дней. Не следует прерывать курс антибактериального лечения даже в случае исчезновения клинических признаков заболевания. При необходимости более продолжительной терапии (до 14 дней) взрослым, начиная с 7 дня терапии, рекомендуют прием 50% средней дозы. При острой форме бруцеллеза длительность приема антибактериальных средств должна составлять 3-4 недели, при паратифе и тифе – 1-3 месяца. Особые случаи дозирования: - Хронические формы инфекционных заболеваний мочевыделительной системы (в качестве профилактики) – взрослым 1 таблетка на ночь, детям до 12 лет 12 мг/кг веса в сутки на ночь (доза указана из расчета сульфаметоксазола). Продолжительность профилактики до 12 месяцев. - При цистите пациентам 7-16 лет назначают по 1 таблетке каждые 12 часов на протяжении 3 дней (всего 6 разовых доз). - При гонорее назначают 4-6 таблеток, которые делят на 3 приема с перерывами 12 часов. - При пневмонии, ассоциированной с Pneumocystis carinii, назначают 15-20 мг/кг веса триметоприма и 120 мг/кг веса сульфаметоксазола в сутки. Суточную дозу делят на 4 принятия (с перерывами по 6 часов). Курс – 14 дней. Функциональную активность почек, печени и системы кроветворения следует контролировать, если время лечения более 14 дней подряд. При назначении высоких (ударных) доз требуется обильное питье (для предупреждения кристаллурии). Ультрафиолетовое облучение может провоцировать развитие нежелательных реакций (светочувствительность) на фоне терапии. Пациент должен исключить солнечные ванны и солярий на период лечения."}}]},{"id":7,"name":"Побочное действие","slug":"side_effects","displayInMenu":true,"body":[{"type":"paragraph","data":{"text":"Нежелательные эффекты, которые регистрировались при исследовании препарата Ко-тримоксазол, рассортированы по системам организма: - ЖКТ: снижение аппетита, рвота, нарушения диспепсического характера, некротический и холестатический гепатит, панкреатит, глоссит, псевдомембранозный энтероколит, стоматит. - Кроветворение: лейкопения, тромбоцитопения, анемия гемолитическая и апластическая, эозинофилия, агранулоцитоз. - Мочевыделительная система: токсическая форма нефропатии, интерстициальный нефрит, кристаллурия (преимущественно при применении ударных доз), недостаточность функции почек. - Реакции аллергического характера: полиморфная эритема, крапивница, зуд и сыпь на коже, синдром Лайелла, аллергический миокардит, синдром Стивенса-Джонсона. - Прочие нежелательные эффекты, которые регистрировались у пациентов: периферический неврит, легочный инфильтрат, головная боль, гиперкалиемия, гипонатриемия, слабость, гипертермия, боль в суставах и мышцах, реакции светочувствительности. 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Немедленная отмена препарата требуется при развитии кашля, сыпи и боли в суставах, а также прочих выраженных побочных эффектов."}}]}],"source":{"title":"36.6","url":"https://366.ru"}},"description_toggle":false,"short_description":"Комбинированный противомикробный препарат, состоящий из сульфаметоксазола и триметоприма. Сульфаметоксазол, сходный по строению с пара-аминобензойной кислотой (ПАБК), нарушает синтез дигидрофолиевой кислоты в бактериальных клетках, препятствуя включению ПАБК в ее молекулу. Триметоприм усиливает действие сульфаметоксазола, нарушая восстановление дигидрофолиевой кислоты в тетрагидрофолиевую - активную форму фолиевой кислоты, ответственную за белковый обмен и деление микробной клетки. 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