Transcript axali rekomendaciis mixedviT
medea gegia
Zveli rekomendaciis mixedviT gamoiyeneboda SemTxvevaTa dayofa kategoriebad: I II III IV
axali rekomendaciis mixedviT, kategoriebad dayofa aRar gamoiyeneba
SemTxvevis klasificireba emyareboda Semdeg kriteriumebs:
daavadebis lokalizacia baqteriologiuri kvlevis monacemebi warsulis farmakologiuri anamnezi • daavadebis simZime
axali rekomendaciis mixedviT:
daavadebis lokalizacia baqteriologiuri kvlevis monacemebi warsulis farmakologiuri anamnezi • daavadebis simZime
daavadebis lokalizaciis mixedviT:
filtvis filtvgareSe miliaruli tuberkulozi klasificirdeba rogorc “filtvis” forma
adre arsebuli rekomendaciiT, pacientTan mgb (+) filtvis tuberkulozi diagnostirdeba, Tu: naxvelis nacxis mikroskopuli gamokvlevis erTi dadebiTi Sedegi da filtvis formis aqtiuri tuberkulozisaTvis damaxasiaTebeli rentgenologiuri cvlilebebi;
axali rekomendaciiT, mgb (+) SemTxveva klasificirdeba, im SemTxvevaSic ki Tu mxolod erTi nacxia dadebiTi, sxva klinikur/laboratoriuli kvlevis monacemebis arsebobis da/an ararsebobis SemTxvevaSi
adre arsebuli monacemebisgan gansxvavebiT, definicia
“sxva SemTxveva” Gar moicavs “qronikul formebs”.
ganmeorebiTi qimioTerapiis SemTxvevaSi pacients eniWeba definicia yvelaze axali wina qimioTerapiis kursis
Sedegis mixedviT:
(mag. ,,uSedego” ; “Sewyvetili”; relafsi)
moicavs: yvela im SemTxvevas, romelic ver Tavsdeba zemoT aRniSnul definiciebSi “warsulSi namkurnalev SemTxvevebs” ucnobi gamosavliT pacientebs, romelTac warsulSi ukve Caitares tubsawinaaRmdego mkurnaloba da amJamad daudgindaT mgb (-) filtvis tuberkulozis diagnozi
2.1. rifampicinis miRebis xangrZlivoba “axal SemTxvevebSi”
2HRZE/4 HR
Tu
2 HRZE/6 HE?
filtvis tuberkulozis “axali SemTxvevis” dros rifampicini iniSneba mkurnalobis mTeli kursis ganmavlobaSi 2 HRZE/4 HR alternatiuli sqema 2 HRZE / 6 HE aRar gamoiyeneba susti Terapiuli efeqtis gamo
M 2.2
. mkurnalobis xangrZlivoba F
igivea rogorc filtvis aseve filtvgareSe formebis dros
M 2.2
. mkurnalobis xangrZlivoba F
zogierTi eqspertis mixedviT, SesaZlebelia mkurnalobis kursis gaxangrZliveba Zval-saxsris da tubmeningitis SemTxvevaSi (9-12)
2. standartuli qimioTerapia
intensiuri/yoveldRiuri Tu intermitiuli reJimi?
,,axali SemTxvevebis” dros unda dainiSnos wamlebis miRebis yoveldRiuri reJimi mTeli samkurnalo kursis ganmavlobaSi
intensiur fazaSi:
wamlebis intermitiuli miReba rekomendebuli ar aris
gagrZelebis fazaSi: alternatiuli rekomendacia
wamlebis intermitiuli miReba (kviraSi 3-jer) SesaZlebelia mxolod im SemTxvevaSi, Tu TiToeuli dozis miRebaze xorcieldeba uSualo meTvalyureoba
gagrZelebis fazaSi
HRE
Tu
HR?
zogierTi eqspertis mixedviT:
gagrZelebis fazaSi HR –is nacvlad, SesaZlebelia dainiSnos alternatiuli sqema - HRE
iniSneba wamlebis miRebis yoveldRiuri reJimi mTeli samkurnalo kursis ganmavlobaSi mkurnalobis xangrZlivoba aiv (+) da aiv (-) pirebSi erTidaigivea
ramdenad efeqturia intensiuri fazis gaxangrZliveba relafsisa da uSedego mkurnalobis prevenciisaTvis?
Tu 2 HRZE is bolos, pacienti rCeba mgb (+) dadebiTi, mkurnaloba unda gagrZeldes 4HR samkurnalo reJimiT
aqedan gamomdinare, “damatebiTi intensiuri faza” saWiro aRar aris
Tu gamoiyeneba DST miiReba SedarebiT kvlevis tradiciuli meTodi Sedegi gvian da amitomac pasuxis miRebamde iniSneba empiriuli mkurnaloba, xolo Semdeg reJimi icvleba Sesabamisad
iniSneba Semdeg SemTxvevebSi: pirveli rigiT mkurnalobis Sedegi Sefasebul iqna rogorc “uSedego mkurnaloba” albaToba multirezistentobisa sakmaod maRalia magram wamlis mimarT gamZleobis testis Sedegi jer cnobili ar aris
Anti tuberculosis drug resistance in the world, WHO, 2008 - Data from 105 and 94 countries
“axali SemTxvevebis” dros:
Tu pacienti rCeba mgb (+) dadebiTi intensiuri fazis dasrulebis Semdeg, ganmeorebiTi baqterioskopia unda Catardes me-3 Tvis dasrulebis Semdegac
dadebiTi pasuxis SemTxvevaSi, damatebiT unda Cautardes kulturaluri gamokvleva da wamlis mimarT gamZleobis testi
“warsulSi namkurnalebi SemTxvevebis” dros:
Ymkurnalobis dawyebisTanave, unda Catardes kulturaluri gamokvleva da wamlis mimarT gamZleobis testi
intensiuri fazis Semdeg, Tu pacienti rCeba mgb (+) dadebiTi, unda Cautardes kulturaluri gamokvleva da wamlis mimarT gamZleobis testi
tuberkulozi da RviZlis daavadebebi
adre arsebuli samkurnalo reJimi 9RE Aaxali rekomendaciiT 9 HRE 2 HRSE/6HR 6 RZE 2 HES/10HE
tuberkulozi da Tirkmlis ukmarisoba
adre arsebuli samkurnalo reJimi 6HRE axali rekomendaciiT 6HREZ
wamlebi izoniazidi rifampicini etambutoli pirazinamidi adre arsebuli rekomendaciis mixedviT (mg/kg) 4 - 6 8 - 12 15 - 20 20 - 30
axali gaidlainis 10 - 15 10 - 20 15 - 25 30 - 40 mixedviT (mg/kg)
mkurnalobis xangrZlivoba ganisazRvreba kulturis konversiis mixedviT.
mkurnaloba grZeldeba minimum 18 Tve kulturis konversiis Semdeg. mkurnalobis kursis gaxangrZliveba –konversiidan 24 Tve naCvenebia mxolod garkveul SemTxvevebSi
mono da polirezistentuli tuberkulozis samkurnalo sqemebi mowodebulia mxolod kargad organizebuli programebisaTvis
rezistentobis profili H (±S) H da Z H da E R R da E (±S) R da Z (±S) H, E, Z (±S) rekomendirebuli reJimi R, Z da E R, E da ftorqinolonebi R, Z da ftorqinolonebi H, E, ftorqinolonebi plus Z sul mcire 2 Tve mkurnalobis minimaluri xangrZlivoba 6-9 Tve 9-12 Tve 9-12 Tve 12-18 Tve H, Z, ftorqinolonebi plus saineqcio preparati sul mcire pirveli 2-3 Tve 18 Tve H, E, ftorqinolonebi plus saineqcio preparati sul mcire pirveli 2-3 Tve 18 Tve R, ftorqinolonebi plus II rigis preparati, plus saineqcio preparati sul mcire pirveli 2-3 Tve 18 Tve
magaliTad: samkurnalo sqema 2.5 Tvis Semdeg : 2 HRZE DST Sedegi : R- HE ; S-R am SemTxvevaSi polirezistentuli tuberkulozis samkurnalo sqema ar unda iqnas gamoyenebuli.
zogadi wesi
masalis aRebis TariRi DST pasuxis miRebis TariRi mono/polirezistentuli tuberkulozis sqema ????
> 1 Tve
saineqcio medikamentis miReba grZeldeba minimum 6
Tve an sul mcire 4 Tve mas Semdeg rac pacienti gaxda da darCa kultura uaryofiTi.
ufro xangrZlivad saineqcio medikamentebis gamoyeneba unda eyrdnobodes sxva monacemebs
saineqcio medikamentebis kviraSi samjer miReba rekomendebulia mxolod gansakuTrebuli situaciebis dros.
samkurnalo kategoriebad dayofa aRar gamoiyeneba
axal SemTxvevebSi “damatebiTi intensiuri faza” ar gamoiyeneba
filtvis tuberkulozis “axali SemTxvevis” dros rifampicini iniSneba mkurnalobis mTeli kursis ganmavlobaSi 6 HE aRar gamoiyeneba susti Terapiuli efeqtis gamo
izoniazidze maRali rezistentobis SemTxvevaSi, SesaZlebelia dainiSnos HRE multirezistentuli tuberkulozis xangrZlivoba ganisazRvreba kulturiss konversiis mixedviT, minimum 18 Tve polirezistentuli tuberkulozis samkurnalo sqemis SerCevisas unda iqnas gaTvaliswinebuli pasuxis miRebis TariRi masalis aRebis da DST -is
gmadlob yuradRebisTvis