Экоклав Порошок, флакон, 25 г, 125 мг + 31.25 мг / 5 мл, для приготовления суспензии, для взрослых, +12 лет, Порошок д/пригот. сусп, антибиотик, цвет белый

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Амоксициллин – полусинтетический антибиотик широкого спектра; действует бактерицидно, угнетая синтез белка клеточной стенки чувствительных бактерий на стадии роста."}},{"type":"paragraph","data":{"text":"Клавулановая киcлота обладает высоким сродством к бактериальным бета-лактамазам и образует с ними стабильный комплекс. Таким образом, биодеградация амоксициллина бета-лактамазами предотвращается, а бактерицидная активность антибиотика сохраняется. Клавулановая киcлота ингибирует бета-лактамазы II-V типа по классификации Ричмонда-Сайкса и не активна в отношении бета-лактамаз I типа, продуцируемых Pseudomonas aeruginosa, Serratia spp., Acinetobacter spp."}},{"type":"paragraph","data":{"text":"Комбинированный препарат амоксициллина и клавулановой кислоты по результатам испытаний in vitro и клинических исследований активен в отношении следующих микроорганизмов:"}},{"type":"paragraph","data":{"text":"Грамположительные аэробные микроорганизмы: "}},{"type":"paragraph","data":{"text":"Staphylococcus aureus (штаммы, продуцирующие и не продуцирующие бета-лактамазы);"}},{"type":"paragraph","data":{"text":"Грамотрицательные аэробные микроорганизмы:"}},{"type":"paragraph","data":{"text":"Enterobacter spp. (несмотря на то, что большинство штаммов Enterobacter устойчивы in vitro, клинически доказана эффективность препарата при лечении вызванных этим возбудителем инфекционных заболеваний мочевыделительного системы);"}},{"type":"paragraph","data":{"text":"Escherichia coli (штаммы, продуцирующие и не продуцирующие бета-лактамазы);"}},{"type":"paragraph","data":{"text":"Haemophilus influenzae (штаммы, продуцирующие и не продуцирующие бета-лактамазы);"}},{"type":"paragraph","data":{"text":"Klebsiella spp. (все известные штаммы продуцируют бета-лактамазы);"}},{"type":"paragraph","data":{"text":"Moraxella catarrhalis (штаммы, продуцирующие и не продуцирующие бета-лактамазы)."}},{"type":"paragraph","data":{"text":"По результатм исследований in vitro показана чувствительность к комбинации амоксициллина и клавулановой кислоты следующих микроорганизмов:"}},{"type":"paragraph","data":{"text":"Грамположительные аэробные микроорганизмы:"}},{"type":"paragraph","data":{"text":"Enterococcus faecalis**;"}},{"type":"paragraph","data":{"text":"Staphylococcus epidermidis (штаммы, продуцирующие и не продуцирующие бета-лактамазы);"}},{"type":"paragraph","data":{"text":"Staphylococcus saprophyticus (штаммы, продуцирующие и не продуцирующие бета-лактамазы);"}},{"type":"paragraph","data":{"text":"Streptococcus pneumoniae** (бета-лактамаз не продуцирует);"}},{"type":"paragraph","data":{"text":"Streptococcus pyogenes** (бета-лактамаз не продуцирует);"}},{"type":"paragraph","data":{"text":"Грамотрицательные аэробные микроорганизмы:"}},{"type":"paragraph","data":{"text":"Eikenella corrodens (штаммы, продуцирующие и не продуцирующие бета-лактамазы);"}},{"type":"paragraph","data":{"text":"Neisseria gonorrhoeae** (штаммы, продуцирующие и не продуцирующие бета-лактамазы);"}},{"type":"paragraph","data":{"text":"Proteus mirabilis** (штаммы, продуцирующие и не продуцирующие бета-лактамазы). Анаэробные микроорганизмы:"}},{"type":"paragraph","data":{"text":"Bacteroides spp., включая Bacteroides fragilis (штаммы, продуцирующие и не продуцирующие бета-лактамазы);"}},{"type":"paragraph","data":{"text":"Fusobacterium spp. (штаммы, продуцирующие и не продуцирующие бета-лактамазы);"}},{"type":"paragraph","data":{"text":"ПРИМЕЧАНИЕ: ** - (клинически доказана эффективность амоксициллина при лечении ряда инфекций, вызванных этими возбудителями)."}},{"type":"paragraph","data":{"text":"Лактулоза, входящая в состав Экоклавав качестве бифидогенного фактора, является синтетическим дисахаридом, молекула которого состоит из остатков галактозы и фруктозы. Лактулоза в желудке и верхних отделах кишечника не всасывается и не гидролизуется."}},{"type":"paragraph","data":{"text":"Высвобождающаяся из таблеток Экоклавалактулоза в качестве субстрата ферментируется нормальной микрофлорой толстого кишечника, стимулируя рост бифидобактерий и лактобацилл. В результате гидролиза лактулозы в толстом кишечнике образуются органические кислоты - молочная, уксусная и муравьиная, подавляющие рост патогенных микроорганизмов и уменьшающие вследствие этого продукцию азотсодержащих токсических веществ."}},{"type":"paragraph","data":{"text":"Таким образом, лактулоза в составе Экоклаваснижает повреждающее действие антибиотика на нормальную микрофлору кишечника и риски побочных эффектов, связанные с дисбиозами."}},{"type":"paragraph","data":{"text":"\u003cb\u003eФармакокинетика\u003c/b\u003e"}},{"type":"paragraph","data":{"text":"\u003ci\u003eВсасывание \u003c/i\u003e"}},{"type":"paragraph","data":{"text":"  После приема внутрь оба компонента препарата быстро всасываются из желудочно-кишечного тракта. Абсорбция активных ингредиентов препарата оптимальна в случае его приема в начале еды."}},{"type":"paragraph","data":{"text":"После приема внутрь в дозе 125 мг+31.25 мг:"}},{"type":"paragraph","data":{"text":"- Cmax амоксициллина – 1.96 мкг/мл, клавулановой кислоты – 0.77 мкг/мл;"}},{"type":"paragraph","data":{"text":"- Tmax амоксициллина – 1.5 ч, клавулановой кислоты – 1.0 ч;"}},{"type":"paragraph","data":{"text":"- AUC амоксициллина – 9.19 мг ч/л, клавулановой кислоты – 2.69 мг ч/л."}},{"type":"paragraph","data":{"text":"При применении препарата концентрации амоксициллина в сыворотке крови сходны с таковыми при пероральном приеме эквивалентных доз одного амоксициллина."}},{"type":"paragraph","data":{"text":"\u003ci\u003eРаспределение \u003c/i\u003e"}},{"type":"paragraph","data":{"text":"  Оба компонента препарата характеризуются хорошим объемом распределения – терапевтические концентрации амоксициллина и клавулановой кислоты создаются в различных органах и тканях, интерстициальной жидкости: легких, среднем ухе, органах брюшной полости, органах малого таза (предстательной железе, матке, яичниках), коже; жировой, костной и мышечной тканях; плевральной, синовиальной и перитонеальной жидкостях; плазме, желчи, гнойном отделяемом, мокроте, бронхиальном секрете."}},{"type":"paragraph","data":{"text":"Амоксициллин и клавулановая кислота обладают умеренной степенью связывания с белками плазмы, соответственно, на 18 % и 25%."}},{"type":"paragraph","data":{"text":"Оба компонента препарата проникают через плацентарный барьер, однако данных о негативном влиянии на плод не опубликовано."}},{"type":"paragraph","data":{"text":"Амоксициллин и клавулановая кислота в низких концентрациях обнаруживаются в грудном молоке."}},{"type":"paragraph","data":{"text":"\u003ci\u003eМетаболизм, выведение \u003c/i\u003e"}},{"type":"paragraph","data":{"text":"  Примерно 60-70% амоксициллина выводится почками: путем канальцевой секреции и клубочковой фильтрации. Клавулановая кислота активно метаболизирует в печени и выводится путем клубочковой фильтрации (40-65%), частично в виде метаболитов. Меньшая часть выводится кишечником."}},{"type":"paragraph","data":{"text":"При почечной недостаточности клиренс амоксициллина с клавулановой кислотой уменьшается, поэтому требуется коррекция дозы."}},{"type":"paragraph","data":{"text":"Лактулоза, входящая в состав Экоклава, не оказывает влияние на основные фармакокинетические параметры, характеризующие биодоступность амоксициллина и клавулановой кислоты."}}]},{"id":8,"name":"Показания к применению","slug":"indications","body":[{"type":"paragraph","data":{"text":"Инфекционно-воспалительные заболевания, вызванные чувствительными к препарату возбудителями:"}},{"type":"list","data":{"style":"ordered","items":["инфекции нижних дыхательных путей (бронхит, пневмония);","инфекции ЛОР-органов (синусит, тонзиллит, средний отит);","инфекции мочеполовой системы и органов малого таза (пиелонефрит, пиелит, цистит, уретрит, бактериальный простатит, цервицит, сальпингит, сальпингоофорит, эндометрит, бактериальный вагинит, септический аборт, мягкий шанкр, гонорея);","инфекции кожи и мягких тканей (рожа, импетиго, вторично инфицированные дерматозы, абсцесс, флегмона, раневая инфекция);","инфекции костей и суставов (остеомиелит)"]}}]},{"id":9,"name":"Противопоказания","slug":"contraindications","body":[{"type":"list","data":{"style":"ordered","items":["гиперчувствительность (в т.ч. к цефалоспоринам и другим бета-лактамным антибиотикам);","инфекционный мононуклеоз;","эпизоды желтухи или нарушение функции печени в результате применения амоксициллина/клавулановой кислоты в анамнезе;","детский возраст до 12 лет или при массе тела менее 40 кг (для данной лекарственной формы);","фенилкетонурия (содержит аспартам) для суспензии."]}}]},{"id":10,"name":"С осторожностью","slug":"cautions","body":[{"type":"paragraph","data":{"text":"тяжелая печеночная недостаточность, заболевания желудочно-кишечного тракта (в т.ч. колит в анамнезе, связанный с применением пенициллинов), хроническая почечная недостаточность."}}]},{"id":11,"name":"Применение при беременности и в период грудного вскармливания","slug":"pregnancy_warnings","body":[{"type":"paragraph","data":{"text":"Комбинированный препарат амоксициллина и клавулановой кислоты при беременности рекомендуется назначать только в случаях, когда ожидаемая польза от его приема для матери превышает потенциальный риск для плода."}},{"type":"paragraph","data":{"text":"Препарат можно применять во время грудного вскармливания."}},{"type":"paragraph","data":{"text":"За исключением риска сенсибилизации, связанного с проникновением в грудное молоко следовых количеств активных ингредиентов этого препарата, никаких других неблагоприятных эффектов у младенцев, находящихся на грудном вскармливании, выявлено не было."}}]},{"id":12,"name":"Способ применения и дозы","slug":"dosage","body":[{"type":"paragraph","data":{"text":"Суспензию принимают внутрь. Режим дозирования устанавливают индивидуально в зависимости от массы тела пациента, тяжести течения и локализации инфекционного процесса, а также чувствительности возбудителя."}},{"type":"paragraph","data":{"text":"Минимальный курс антибактериальной терапии - от 5 дней. Лечение не следует продолжать дольше 14 дней без пересмотра клинической ситуации. Продолжительность лечения острого неосложненного среднего отита составляет 5-7 дней, у детей до 2 лет – 7-10 дней."}},{"type":"paragraph","data":{"text":"Разовая доза устанавливается в зависимости от возраста и массы тела (расчет по амоксициллину):"}},{"type":"paragraph","data":{"text":"Дети до 3 месяцев - 30 мг/кг/сут в 2 приема;"}},{"type":"paragraph","data":{"text":"Дети от 3 месяцев и старше:"}},{"type":"paragraph","data":{"text":"— низкие дозы (для лечения инфекций кожи и мягких тканей, а также хронического тонзиллита) – 20 мг/кг/сут в 3 приема;"}},{"type":"paragraph","data":{"text":"— высокие дозы (для лечения среднего отита, синусита, инфекций нижних дыхательных путей, инфекций мочевыводящих путей) – 40 мг/кг/сут в 3 приема."}},{"type":"paragraph","data":{"text":"Детям массой тела 40 кг и более следует назначать дозы, как взрослым."}},{"type":"paragraph","data":{"text":"Рекомендуемый режим дозирования для взрослых: 20 мл суспензии в дозировке 125 мг+31.25 мг/5 мл или 10 мл суспензии в дозировке 250 мг+62.5 мг/5 мл 2-3 раза/сут."}},{"type":"paragraph","data":{"text":"Максимальная суточная доза амоксициллина для взрослых и детей старше 12 лет - 6 г, для детей до 12 лет - 45 мг/кг массы тела."}},{"type":"paragraph","data":{"text":"Максимальная суточная доза клавулановой кислоты для взрослых и детей старше 12 лет - 600 мг, для детей до 12 лет - 10 мг/кг."}},{"type":"paragraph","data":{"text":"Пациенты с нарушением функции почек:"}},{"type":"paragraph","data":{"text":"Коррекция доз основана на максимальной рекомендуемой дозе амоксициллина и значении клиренса креатинина."}},{"type":"paragraph","data":{"text":"Дети: Клиренс креатинина более 30 мл/мин коррекция дозы не требуется;"}},{"type":"paragraph","data":{"text":"Клиренс креатинина 10-30 мл/мин – 15 мг/3.75 мг/кг 2 раза/сут, максимальная доза 500 мг+125 мг (20 мл суспензии в дозировке 125 мг+31.25 мг/5 мл или 10 мл суспензии в дозировке 250 мг+62.5 мг/5 мл) 2 раза/сут;"}},{"type":"paragraph","data":{"text":"Клиренс креатинина менее 10 мл/мин – 15 мг/3.75 мг/кг 1 раз/сут, максимальная суточная доза 500 мг+125 мг (20 мл суспензии в дозировке 125 мг+31.25 мг/5 мл или 10 мл суспензии в дозировке 250 мг+62.5 мг/5 мл);"}},{"type":"paragraph","data":{"text":"Взрослые: Клиренс креатинина более 30 мл/мин коррекция дозы не требуется;"}},{"type":"paragraph","data":{"text":"Клиренс креатинина 10-30 мл/мин – 500 мг+125 мг (20 мл суспензии в дозировке 125 мг+31.25 мг/5 мл или 10 мл суспензии в дозировке 250 мг+62.5 мг/5 мл) 2 раза/сут;"}},{"type":"paragraph","data":{"text":"Клиренс креатинина менее 10 мл/мин – 500 мг+125 мг (20 мл суспензии в дозировке 125 мг+31.25 мг/5 мл или 10 мл суспензии в дозировке 250 мг+62.5 мг/5 мл) 1 раз/сут;"}},{"type":"paragraph","data":{"text":"Пациенты, находящиеся на гемодиализе: Коррекция доз основана на максимальной рекомендуемой дозе амоксициллина"}},{"type":"paragraph","data":{"text":"Дети– 15 мг/3.75 мг/кг 1 раз/сут."}},{"type":"paragraph","data":{"text":"Перед сеансом гемодиализа следует принять одну дополнительную дозу 15 мг/3.75 мг/кг. Для восстановления концентраций активных компонентов препарата в крови вторую дополнительную дозу 15 мг/3.75 мг/кг следует принять после сеанса гемодиализа."}},{"type":"paragraph","data":{"text":"Взрослые – 500 мг+125 мг (20 мл суспензии в дозировке 125 мг+31.25 мг/5 мл или 10 мл суспензии в дозировке 250 мг+62.5 мг/5 мл) однократно каждые 24 часа."}},{"type":"paragraph","data":{"text":"Дополнительно 1 доза во время сеанса диализа и еще одна доза в конце сеанса диализа (для компенсации снижения сывороточных концентраций амоксициллина и клавулановой кислоты)"}},{"type":"paragraph","data":{"text":"Способ приготовления суспензии: Суспензия приготавливается непосредственно перед применением. Порошок во флаконе предварительно встряхивают, затем, добавляя небольшое количество кипяченой и охлажденной до комнатной температуры воды, перемешивают, получая однородную суспензию, затем добавляют воду до метки на флаконе. Для точного дозирования суспензии следует пользоваться дозировочной двухсторонней ложкой, которую нужно хорошо споласкивать водой после каждого применения. После разведения суспензию следует хранить не более 7 дней в холодильнике, но не замораживать."}}]},{"id":13,"name":"Побочное действие","slug":"side_effects","body":[{"type":"paragraph","data":{"text":"Препарат хорошо переносится. Побочные эффекты возникают редко, бывают преимущественно слабовыраженными и носят транзиторный характер."}},{"type":"paragraph","data":{"text":"Со стороны пищеварительной системы: тошнота, рвота, диарея, гастрит, стоматит, глоссит, холестатическая желтуха, гепатит, печеночная недостаточность (чаще у пожилых, мужчин, при длительной терапии), колит (включая псевдомембранозный), черный \"волосатый\" язык, потемнение зубной эмали, повышение активности \"печеночных\" трансаминаз, увеличение содержания билирубина и активности щелочной фосфатазы."}},{"type":"paragraph","data":{"text":"Со стороны органов кроветворения: обратимое увеличение протромбинового времени и времени кровотечения, тромбоцитопения, тромбоцитоз, эозинофилия, лейкопения, агранулоцитоз, гемолитическая анемия."}},{"type":"paragraph","data":{"text":"Со стороны центральной нервной системы: головокружение, головная боль, гиперактивность, тревога, изменение поведения, судороги."}},{"type":"paragraph","data":{"text":"Аллергические реакции: крапивница, эритематозные высыпания, мультиформная экссудативная эритема, анафилактический шок, ангионевротический отек, эксфолиативный дерматит, злокачественная экссудативная эритема (синдром Стивенса-Джонсона), аллергический васкулит, синдром, сходный с сывороточной болезнью, острый генерализованный экзантематозный пустулез."}},{"type":"paragraph","data":{"text":"Со стороны почек и мочевыводящих путей: интерстициальный нефрит, кристаллурия, гематурия."}},{"type":"paragraph","data":{"text":"Прочие: кандидоз, развитие суперинфекции."}}]},{"id":14,"name":"Передозировка","slug":"overdose","body":[{"type":"paragraph","data":{"text":"Симптомы: нарушение функции желудочно-кишечного тракта и водно-электролитного баланса."}},{"type":"paragraph","data":{"text":"Лечение: симптоматическое. Гемодиализ эффективен."}}]},{"id":15,"name":"Взаимодействие с другими лекарственными средствами","slug":"drugs_interaction","body":[{"type":"paragraph","data":{"text":"Не рекомендуется применять комбинированный препарат амоксициллина и клавулановой кислоты одновременно с пробенецидом. Пробенецид снижает канальцевую секрецию амоксициллина, поэтому их совместное применение может приводить к повышению и персистенции концентрации амоксициллина в сыворотке, при этом сывороточная концентрация клавулановой кислоты не изменяется."}},{"type":"paragraph","data":{"text":"Диуретики, аллопуринол, фенилбутазон, нестероидные противовоспалительные препараты и другие лекарственные средства, блокирующие канальцевую секрецию, повышают концентрацию амоксициллина (клавулановая кислота выводится в основном путем клубочковой фильтрации)."}},{"type":"paragraph","data":{"text":"Антациды, глюкозамин, слабительные средства замедляют и снижают абсорбцию амоксициллина; аскорбиновая кислота - повышает."}},{"type":"paragraph","data":{"text":"Аллопуринол повышает риск возникновения кожной сыпи."}},{"type":"paragraph","data":{"text":"Как и другие антибиотики широкого спектра действия, комбинированный препарат амоксициллина и клавулановой кислоты может снижать эффективность пероральных контрацептивов, и пациенток необходимо информировать об этом."}},{"type":"paragraph","data":{"text":"В литературе описываются редкие случаи увеличения международного нормализованного отношения (МНО) у пациентов при совместном применении аценокумарола или варфарина и амоксициллина."}},{"type":"paragraph","data":{"text":"При необходимости одновременного применения комбинированного препарата амоксициллина и клавулановой кислоты с непрямыми антикоагулянтами протромбиновое время или МНО должны тщательно мониторироваться при назначении или отмене препарата."}}]},{"id":16,"name":"Особые указания","slug":"","body":[{"type":"paragraph","data":{"text":"Выраженность желудочно-кишечных симптомов уменьшается при приеме препарата в начале еды."}},{"type":"paragraph","data":{"text":"При курсовом лечении необходимо проводить контроль состояния функции органов кроветворения, печени и почек."}},{"type":"paragraph","data":{"text":"Возможно развитие суперинфекции за счет селекции резистентных форм возбудителя."}},{"type":"paragraph","data":{"text":"Могут быть выявлены ложноположительные результаты при определении содержания глюкозы в моче. В этом случае рекомендуется применять глюкозооксидазный метод определения концентрации глюкозы в моче."}},{"type":"paragraph","data":{"text":"У пациентов, имеющих повышенную чувствительность к пенициллинам, возможны перекрестные аллергические реакции с цефалоспориновыми антибиотиками."}},{"type":"paragraph","data":{"text":"В случае подозрения на инфекционный мононуклеоз препарат не следует применять, поскольку у пациентов с этим заболеванием амоксициллин может вызывать кореподобную кожную сыпь, что затрудняет диагностику заболевания."}},{"type":"paragraph","data":{"text":"Влияние на способность управлять транспортными средствами и другими механизмами, требующими повышенной концентрации внимания"}},{"type":"paragraph","data":{"text":"Учитывая вероятность развития побочных эффектов со стороны центральной нервной системы, следует соблюдать осторожность при управлении транспортными средствами и работе с движущимися механизмами."}}]},{"id":17,"name":"Влияние на способность управлять автомобилем и движущимися механизмами","slug":"","body":[{"type":"paragraph","data":{"text":"Учитывая вероятность развития побочных эффектов со стороны центральной нервной системы, следует соблюдать осторожность при управлении транспортными средствами и работе с движущимися механизмами."}}]},{"id":18,"name":"Форма выпуска","slug":"","body":[{"type":"paragraph","data":{"text":"Порошок для приготовления суспензии для приема внутрь"}}]},{"id":19,"name":"Условия хранения","slug":"storage","body":[{"type":"paragraph","data":{"text":"В сухом, защищенном от света месте, при температуре не выше 25 °C"}}]},{"id":20,"name":"Срок годности","slug":"expiry_date","body":[{"type":"paragraph","data":{"text":"2 года"}}]},{"id":21,"name":"Условия отпуска","slug":"release_condition","body":[{"type":"paragraph","data":{"text":"по рецепту"}}]},{"id":22,"name":"Производитель","slug":"","body":[{"type":"paragraph","data":{"text":"\u003ca href=\"https://www.eapteka.ru/goods/manufacturer/avva_rus/\"\u003eАВВА РУС, Россия\u003c/a\u003e"}}]}],"source":null},"description_toggle":false,"short_description":"Экоклав - комбинированный препарат амоксициллина и клавулановой кислоты - ингибитора бета-лактамаз. Амоксициллин – полусинтетический антибиотик широкого спектра; действует бактерицидно, угнетая синтез белка клеточной стенки чувствительных бактерий на стадии роста. Клавулановая киcлота обладает высоким сродством к бактериальным бета-лактамазам и образует с ними стабильный комплекс. Таким образом, биодеградация амоксициллина бета-лактамазами предотвращается, а бактерицидная активность антибиотика сохраняется. Клавулановая киcлота ингибирует бета-лактамазы II-V типа по классификации Ричмонда-Сайкса и не активна в отношении бета-лактамаз I типа, продуцируемых Pseudomonas aeruginosa, Serratia spp., Acinetobacter spp. Комбинированный препарат амоксициллина и клавулановой кислоты по результатам испытаний in vitro и клинических исследований активен в отношении следующих микроорганизмов: Грамположительные аэробные микроорганизмы: Staphylococcus aureus (штаммы, продуцирующие и не продуцирующие бета-лактамазы); Грамотрицательные аэробные микроорганизмы: Enterobacter spp. (несмотря на то, что большинство штаммов Enterobacter устойчивы in vitro, клинически доказана эффективность препарата при лечении вызванных этим возбудителем инфекционных заболеваний мочевыделительного системы); Escherichia coli (штаммы, продуцирующие и не продуцирующие бета-лактамазы); Haemophilus influenzae (штаммы, продуцирующие и не продуцирующие бета-лактамазы); Klebsiella spp. (все известные штаммы продуцируют бета-лактамазы); Moraxella catarrhalis (штаммы, продуцирующие и не продуцирующие бета-лактамазы). По результатм исследований in vitro показана чувствительность к комбинации амоксициллина и клавулановой кислоты следующих микроорганизмов: Грамположительные аэробные микроорганизмы: Enterococcus faecalis**; Staphylococcus epidermidis (штаммы, продуцирующие и не продуцирующие бета-лактамазы); Staphylococcus saprophyticus (штаммы, продуцирующие и не продуцирующие бета-лактамазы); Streptococcus pneumoniae** (бета-лактамаз не продуцирует); Streptococcus pyogenes** (бета-лактамаз не продуцирует); Грамотрицательные аэробные микроорганизмы: Eikenella corrodens (штаммы, продуцирующие и не продуцирующие бета-лактамазы); Neisseria gonorrhoeae** (штаммы, продуцирующие и не продуцирующие бета-лактамазы); Proteus mirabilis** (штаммы, продуцирующие и не продуцирующие бета-лактамазы). Анаэробные микроорганизмы: Bacteroides spp., включая Bacteroides fragilis (штаммы, продуцирующие и не продуцирующие бета-лактамазы); Fusobacterium spp. (штаммы, продуцирующие и не продуцирующие бета-лактамазы); ПРИМЕЧАНИЕ: ** - (клинически доказана эффективность амоксициллина при лечении ряда инфекций, вызванных этими возбудителями). Лактулоза, входящая в состав Экоклавав качестве бифидогенного фактора, является синтетическим дисахаридом, молекула которого состоит из остатков галактозы и фруктозы. Лактулоза в желудке и верхних отделах кишечника не всасывается и не гидролизуется. Высвобождающаяся из таблеток Экоклавалактулоза в качестве субстрата ферментируется нормальной микрофлорой толстого кишечника, стимулируя рост бифидобактерий и лактобацилл. В результате гидролиза лактулозы в толстом кишечнике образуются органические кислоты - молочная, уксусная и муравьиная, подавляющие рост патогенных микроорганизмов и уменьшающие вследствие этого продукцию азотсодержащих токсических веществ. Таким образом, лактулоза в составе Экоклаваснижает повреждающее действие антибиотика на нормальную микрофлору кишечника и риски побочных эффектов, связанные с дисбиозами.ФармакокинетикаВсасываниеПосле приема внутрь оба компонента препарата быстро всасываются из желудочно-кишечного тракта. Абсорбция активных ингредиентов препарата оптимальна в случае его приема в начале еды. После приема внутрь в дозе 125 мг+31.25 мг: - Cmax амоксициллина – 1.96 мкг/мл, клавулановой кислоты – 0.77 мкг/мл; - Tmax амоксициллина – 1.5 ч, клавулановой кислоты – 1.0 ч; - AUC амоксициллина – 9.19 мг ч/л, клавулановой кислоты – 2.69 мг ч/л. При применении препарата концентрации амоксициллина в сыворотке крови сходны с таковыми при пероральном приеме эквивалентных доз одного амоксициллина.РаспределениеОба компонента препарата характеризуются хорошим объемом распределения – терапевтические концентрации амоксициллина и клавулановой кислоты создаются в различных органах и тканях, интерстициальной жидкости: легких, среднем ухе, органах брюшной полости, органах малого таза (предстательной железе, матке, яичниках), коже; жировой, костной и мышечной тканях; плевральной, синовиальной и перитонеальной жидкостях; плазме, желчи, гнойном отделяемом, мокроте, бронхиальном секрете. Амоксициллин и клавулановая кислота обладают умеренной степенью связывания с белками плазмы, соответственно, на 18 % и 25%. Оба компонента препарата проникают через плацентарный барьер, однако данных о негативном влиянии на плод не опубликовано. Амоксициллин и клавулановая кислота в низких концентрациях обнаруживаются в грудном молоке.Метаболизм, выведениеПримерно 60-70% амоксициллина выводится почками: путем канальцевой секреции и клубочковой фильтрации. Клавулановая кислота активно метаболизирует в печени и выводится путем клубочковой фильтрации (40-65%), частично в виде метаболитов. Меньшая часть выводится кишечником. При почечной недостаточности клиренс амоксициллина с клавулановой кислотой уменьшается, поэтому требуется коррекция дозы. 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