Documente Academic
Documente Profesional
Documente Cultură
.
.
Tratarnent compler<
L Etiologic
, Antimicrobierc
Boli Infectioase
CURS 3
,
.
hf.il" flu&i,lq.
3. Patogeqic
4. Imwrcrnodulator
5. Simptornatic (febra, durerga)
Unive r s itatea " Dunare a de,Io s
a.
" - Facaltatea
6. Igieno-dietetic
de
Medicina si Farmacie
7.
kgrijiri
de nursing
lmunoprofilaxie
lmunoprofilaxie
Pasiva
)se aplica
Indicatii:
Ig pmane polivalente:
- i.m. (standard) 16'5%io: prevenirea rujeolei dupa contact
- I v 0.05g/nrl: deficite imune, infectii bacteriene severe, sd.
Kawasaki
Ig pmane specilice
- .Anti-tetanos: plagi la nevaccinati
Anti-botulinic
de
origine animala);
b.Activa
F protectie dezvoltata rnai lent, dar de durata (- 5-10 ani)
)in
.
Vaccinuri
g,
tetanos
ztzstzu15
Vaccinuri- clasificare
Tip
lndicatii
Avantaje
Ilezavantaje
Viu, atenuat
Rujeola,
R. lmun putemic
rubeola,oreion,
polio, febra
Necesita
refrigerare
Risc revenire
oalbena
varulenta
hactivat,
'omorat'
Toxoid
Holera, gripa,
hep.A, polio, rabie,
encef. Japoneza
Difterie. tetanos
'lnvata" 3l sa lupte,cu
FFrr
rarsta
tagm.
Subunitati
vaccinale
Conjugate
Hib, pneumococ
Permite
recunoasterea unor
de Sl al copilului
Teste clinice
R. Umoral si celular
puternic
Recombinant
Teste clinice
,{edio de t'amilie
)TPa-VPI-lIib, RRO
ledic de familie
4 luni
dedic de familie
aniira
heumo co,niumtr
)TPa
)TPa'VPI
LRO
tlodic de familie
ledic de familie
lompmie scolara
/PI
)mmie slua
.Iunlor/
Adtdt
Fluerlx
Hawtx lunlor/
Hlberlx
Rotarlx
Synnodx
Typherlx
Varllrtx
Adult
lnfanrlx He)(r
llnfanrlxlPV-Hlb
Prlorix
.*
Prlorlx-Tetra
UE
{optionale in Romania)
.
.
I
I
.
B
r*
dedic de familie
Engerlx
n matemltote
tcG
6 aili si 8 mi mi{*+r
, oni /^toe4 0 l/Iil
DNA
--omentarii
2luni
Difcil de realizat
Ib.
rhccinul
Iep B
Fhftl
)TPa-VPI-Hib-Hep B
repetate
m. specifice
ledic de familie
luni
luni
ani
Tinteste
Calendar de Vaccinare
iome
tot+rtd.r
toxinele
Hep.B, perhFis,
pneumococ
ruommdatr
'rimele 24 de ore
-7 zlle
luni
[S,
Anti-rotavirus: Austria
lTwlnrixAdult
TEMAI
Comparati schema vaccinala din Romania si Fganta
{vezi Bulletin epidemiologique hebdomadaire - calendrier vaccinal 2014:
httpr//ufiw.vidal.frlactualites/13732/les nouveautes du calendrier
vaccinal 2014/ J
2t23t2015
Terapia antimicrobiana
Clasificari
Terapia a ntimicrobia na
Antrbiotice : precizari
Antiparazitare
Antivirale
Antifungice
Antibiotice
.
.
patogene:
-cide: efect distructiv
Las
phare
pha.e
bacteth
popuLlion
slart lo
grow
doublet ery
Sens
Conccntrallon
ph*e
: Dedh
' b&tria die fder
20 minute6
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o
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o
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E
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Tlmc (h)
DP Nicofau. Citical Carc2008 l2(Suppl 4):S2
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Alegerea corecta a
2. "Right DOSE"
3. "Right DURATION"
Administrararea
dozei corecte
Administrararea
duratei suficiente
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lnhibllo ol
nueblc acid
tunclion or
b*
coot{
ztzatzv15
A. Betalactamine
A. Betalactamine
II. Dibactami
Meropenem
1. Penami
Penicilina clasica
3. Cefalosporine
Izoxalipenicilinele: oxacilina
Carboxipenicilina: Ticarcilina
tJreidopenicilinele: Azlocilina, Mezlocilina,
Piperacilina
*Penami + inhibitori de plactamaze
d.
e.
Cefoperazona, Ceftizoxima
Cf.lV: Cefpiroma, Cefepima
Cf.V:
Ceftarolin4 Ceftobiprole
M.
pylory
C.
jejuni, Legionella
E. rhusiopathie,
Ketolide: Telitromicina
zt
Glicilcicline:
T ig
eqtcl i na
L.
z5t 2915
Nitrofurani:
Urinari: N i trofu ra nto i n
Digestivi (nerezorbabili): Furazolidon, Nifurzide
M. A.: alterarea proteinelo4 ac. nucleici si lipidelor
Cotimoxazol=Sullamaoxazot+trlmetoprtm
Fonsidor--.tufadoxlna + Plrlrnetamlna
- Chinina
-* Clorochina, Mefloquin4 Tafenoquina, Halofrantina
Artemisina gi derivafii acesteia
- Primaquina
- Atovaquona
- Sulfadoxina+ Pirimetamina (FansidarJ
zt23tzv15
Antiparazitare (2)
rotozoa re
. Cestode
- Tenia cisticercus - NiclosamiP
T Echinoqocus - Praziquantef, Albendazol
. Nematode
- Ascaris l. - Mebendazol, Piperazina
- Oxiuris ox - Mebendazol, Pyrantel pamoat,
- Larva migrans - Mebendazol, Thiabendazol
sp. - Thiabendazol, Mebendazol,
- ltichinella
Diethycarbazin
- Filarii [BppeciiJ - Ivermectin
- Oncocerci - Ivermectin
p. malariae
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Antivirale
l. Vl'd
R.
"Tintele'hntivi ralelor
Ciclul de replicare virala
ltcnrt D(} v,tRtE6
Ttematode
Fasciola - Praziquantel
Schistostoma - Niclosamid
Il
II{.
ry.
V,
V{.
Interfero4i=citokineantivirale,antitumorale,
imunomodulatoare; secretat de celulele infectate, se
fixeaza pe membrana celulelor neinfectate inducand
proteine qare se opun replicarii virale; amplifica
activitatea LT-c si NK
Antiherpetice: ArycloviX, Valacyclovi4, Brivurdinp,
Famryclovi4 Gancycloviq, Foscarnet Cdofovir
2t2312015
ANTIHERPETICE
Indicatii terapeutice
1. Mecanism de acliune:
2. Reprezentanti:
3.
Cidofovir
: rv,
2, Ganciclovir (valganciclovir)
-retinita CMV
topic
Foscamet (CMV):iv
Fomivirsen (oligonucleotid "antisens): intravineal
ANTIGRIPALE
a
1 . Aciclovir (valachlovir):
-fl erpes genital, lqbial (primoinfectie, recurente)
-ncefalita herpe{ci (doar iv)
-.varicele, herpes foster
Inhlbltorll ppotelnel M2
*amantadina (po)
* rimantadin4 (po)
Se poate recurge
fgmivirsen topic
N.a
Inhibitori de neuramlnidazi
Mecanism: lmpiedic6 eliberarea virionilor nou formati din
celulele infectate
Indicatii: activi pe virusuri gripale A6i B
Oselta mivir (po) tb 75me X2/ zi
Reduce severitatea 9i durata bolii
Reduce a psenteismul profegional
Indicat la copii > 1 an gi adulfi
Zanamivir (intra4azal) pulbere pentru inhalatii (5 mg I doza)
Terapeutic (primele 48 h de ila debut) 2 x 2 inhqlatii/zi
Indicat la copii peste 7 ani 9i la adulti
Probleme:
- reactii adverne: digestive, rareprize de bronhospqsm la
zanamivir (1/10000) + contraindicat astmatici, BPO
-
tulburiri
psihice
2t23t2015
Ribavirina
Antivira le
Analog nucleozidic
* Spectru larg:
IV.
- virusuri (para)gripale
- Virus sincitial respirator
- virus hepatitic C
- Hantavirusuri
- v. febrei de Lassa
.
-
Antiretrovirale
1.
2.
3.
4.
5.
6.
Indicafii
hepatita cronici (acutd?J cu VHC (po, 1000-120Amg/zi)
brongiolita cu virus sincitial respirator (aerosoli, 3-7 zilel
Febre hemoragice (iv,2,4-7,2 g/zitn 3 prize, 10 zile)
Inhibitori
Inhibitori
Inhibitori
Inhibitori
Inhibitori
lnhibitori
nucleozidici de RT
non-nucleozidici de
RT
de proteaza
de fuziune
de integraza
de coreceptori
&r,u
{H;*'
A
N
T
I
R
E
T
R
o
V
I
A
L
E
ergosteroli
Azoli: Imidazoli (Mico4azol, Ketoconazol),
Triazoli (ltracongzol, Fluconazol Voriconazol,
Posaconazol)
MA: lnpiedica sinteza grgosterolului- constituent al
ryrembranei fungice
Fluorp-pirimidind: Flucitozina
M.A.: inhiba sinteza acizilor nucleici
Alilaryrine: Tebinafina
Derivat de Penicilium: Criseofu lvina
M.A.: lnhiba sinteza acizilor nucleici, a\Eercaza peretele
celular (antagonizgaza sinteza chitinei)
Echinocandin: Caspofungin, Anidulafungin, Micafungin
M.A.: inhiba Bglucan sintetaza fperete celular)
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lnfectii
fungle lnvadve:
CLASA
POLIENI,]
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ll-cd*tnalhfsr
indicatli
tw = 7M i Aspcrglllus sw = ,M
ntele" antifungicelor
candida
DCI
SPECTRU
*cmdse
"gsrb&psnws
l,Sngkg/z x
mtifiugioelu"
Ncfrotoxicitste, &@ie,
trmbsilopnic, flcbite
Cahdida spp
Criptococow
2-3 mpt
,INAI,OGI
NUCLEOZID
5-flumcitozirc po, iv
IVOLI
KetGWo[
p0
200400 mr/z
C:andidd sl2p
Flucowol
Candida spp
{Nrgofil''d bi0.Y&ut*tai}
R.
Amfotuioim B, iv 0,5-
gincmestio, mlpl.ii
po. iv
100-800 mg/zi
Criptoc@Lw
B16toilic)za
Itt.mwol,po
AsperEilw spp,
200-600 ng/zi
l{ittapksma sW,
JKaie, hipo-TA
EP
Blatomyces spp
L:Ncidioidis sW
Asperyillu spp
tulburui virulc,
Candida spp
I{epelotoxiaitatc,
Candida spp
Aspe@llw
anfilsie
IicHtNo-
Caspoft ngin, iv
CANDINE
Anidubfungi4 iv
XO0+100m/z
7 0+50m9/
folmsfri
Rezistenta la antibiotice
Definitie: capacitatea unor germeni patogeni de a supravietuiy'
multiplica in prezenta atb.
Cauze: antibioterapia excesiva/ inadecvata
Diagnostic: testarea sensibilitatii germenilor la atb.
Clasificare:
Genetica
. Naturala (fixa genetic)
. Dobandita
- Cromozomiala: mutatii,
- Extracromozomiala: plasmide (fragmente ADN
Dismicrobisme
Vmimazol po, iv
PM(J@olpo
Biochimica
10
2t23t2015
mai puternici!
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Lipsa testelor de diagnostic rapid si precis care sa
diferentieze infectiile virale de cele bacteriene
a
a
11
2t23t2015
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irri Nillgctiile sc.ot. lslru t apMia cf cidnF sBpici ntrliinf*-lion$e
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domlc:ilnkr ridkate.
La
hercdinmit su ls cri h
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comDni$tr
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de ttuNliatft
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1.
Criturii d* rrdurrr*
a tcrrrpiei
t
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uumulatiw
lcnoroe
atcrgicc i
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auliLirtlr:r
Eflclooti
.
.
.
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rjt
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i lnamrc
i hepatotoxicitai!
.
.
Tses clinic
op!rexre
rcmi5ie iiodrom infl smalor
nurmlire
hernognml
sBs
EicrobiolDgio
oeg&ivftr culu.i
puiti|c itriliol
.
.
.
12
2t23t2415
2.
Alegerea atb:
3.
contraindicat bolnavului
Sa fie mai putin costisitor (dar cu eficienta optima)
*
-
Asocierile atb:
Sa
7. Durata
B.
Controlul tratamentului
Eficacitatea sterilizanta
Puterea b6ida [seq, LCR, urina)
13