medea gegia

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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