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#1
15.09.2009, 16:51
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Лечение избыточного бактериального роста
Цитата:
 
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#2
16.09.2009, 14:00
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Цитата:
Насколько мне известно, авторитетных руководств по лечению СИБР еще нет (буду действительно благодарен если Вы мне укажите таковое  , так же как нет и четкого консенсуса о предпочтимости в том или ином случае того или иного противомикробного средства. Назначая нифуроксазид, я руководствовался тем, что предпочтение должно отдаваться несистемным средствам. [Ссылки доступны только зарегистрированным пользователям ] Лично мне и коллегам, с которыми я работаю, применение нифуроксазида казалось эффективным. Возможно, есть лучшие варианты, было бы очень интересно познакомиться с Вашим мнением.
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#3
20.09.2009, 10:12
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Цитата:
Treatment of bacterial overgrowth Authors Jon A Vanderhoof, MD Rosemary J Young, NP-C, MS, RN Section Editor J Thomas LaMont, MD Deputy Editor Peter A L Bonis, MD Last literature review version 16.3: September 2008*|*This topic last updated: August 18, 2008*(More) TREATMENT OF THE BACTERIAL OVERGROWTH*—*Most patients with bacterial overgrowth require treatment with antibiotics. The goal of therapy should not be to eradicate the flora but to alter it in a way that leads to symptomatic improvement. The selection of antimicrobial agents ideally should reflect the predominant organisms associated with bacterial overgrowth. Bacterial culture and sensitivity testing is often not helpful since various bacterial species with different antibiotic sensitivities coexist. (See "Pathogenesis, clinical manifestations, and diagnosis of bacterial overgrowth"). Effective antibiotic treatment should cover both aerobic and anaerobic enteric bacteria [6] , although, narrower coverage has been associated with clinical improvement in some series (see below). Traditionally, tetracycline 250 mg four times daily by mouth was considered effective. However, because of trends in microbial resistance, many patients do not respond adequately to monotherapy with this drug and it also cannot be used in young children. Adequate antimicrobial coverage can be achieved with the following combinations: Amoxicillin-clavulanate plus metronidazole [7] . A combination of a cephalosporin, such as cephalexin or trimethoprim-sulfamethoxazole with metronidazole. Norfloxacin [8] . Oral gentamicin and metronidazole. Rifaximin [9-11] . A single course of therapy for 7 to 10 days may improve symptoms and have an effect lasting for months. However, some patients require prolonged therapy (eg, one to two months) before a response is seen. It is usually unnecessary to repeat diagnostic testing if symptoms or objective measures of malabsorption respond to treatment. Recurrence is common after treatment. In a study involving 80 patients with bacterial overgrowth who were treated successfully with rifaximin, recurrence rates were 13, 28, and 44 percent, after three, six, and nine months, respectively [12] . Recurrence was more likely in older adults, those with a history of an appendectomy and with chronic PPI use. Most cases were heralded by a recurrence of gastrointestinal symptoms. Because of recurrent symptoms, some patients require repeated courses of therapy and others need treatment on a regular basis (such as the first 5 to 10 days out of every month or every other week). In the latter patients, rotating antibiotic regimens may help to prevent the development of resistance. На мой взгляд, нифуроксазидом у нас как-то избыточно интересуются.
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#4
20.09.2009, 18:14
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Цитата:
А Вы часто используете рифаксимин? Если да, какие впечатления? Каков он в сравнении с нифуроксазидом?
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Линейный вид
