Ко-тримоксазол Суспензия, флакон, 125 г, 240 мг / 5 мл, для приема внутрь

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Сульфаметоксазол сходный по строению с парааминобензойной кислотой нарушает синтез дигидрофолиевой кислоты в бактериальных клетках препятствуя включению парааминобензойной кислоты в ее молекулу. Триметоприм усиливает действие сульфаметоксазола нарушая восстановление дигидрофолиевой кислоты в тетрагидрофолиевую - активную форму фолиевой кислоты ответственную за белковый обмен и деление микробной клетки."}},{"type":"paragraph","data":{"text":"Является бактерицидным препаратом широкого спектра действия активен в отношении следующих микроорганизмов: Streptococcus spp. (гемолитические штаммы более чувствительны к пенициллину) Staphylococcus spp. Streptococcus pneumoniae. Neisseria meningitidis Neisseria gonorrhoeae Escherichia coli (включая энтеротоксогенные штаммы) Salmonella spp. (включая Salmonella typhi и Salmonella paratyphi) Vibrio cholerae Bacillus anthracis Haemophilus influenzae (включая ампициллиноустойчивые штаммы) Listeria spp. Nocardia asteroides Bordetella pertussis Enterococcus faecalis Klebsiella spp. Proteus spp. Pasteurella spp. Francisella tularensis Brucella spp. Mycobacterium spp. (в т.ч. Mycobacterium leprae) Citrobacter Enterobacter spp. Legionella pneumophila Providencia некоторые виды Pseudomonas (кроме Pseudomonas aeruginosa) Serratia marcescens Shigella spp. Yersinia spp. Morganella spp. Pneumocystis carinii Chlamydia spp. (в т.ч. Chlamydia trachomatis Chlamydia psittaci); простейшие: Plasmodium spp. Toxoplasma gondii патогенные грибы Actinomyces israelii Coccidioides immitis Histoplasma capsulatum Leishmania spp."}},{"type":"paragraph","data":{"text":"Устойчивы к препарату: Corynebacterium spp. Pseudomonas aeruginosa Mycobacterium tuberculosis Treponema spp. Leptospira spp. вирусы."}},{"type":"paragraph","data":{"text":"Угнетает жизнедеятельность кишечной палочки что приводит к уменьшению синтеза тиамина рибофлавина никотиновой кислоты и др. витаминов группы В в кишечнике. Продолжительность терапевтического эффекта составляет 7 ч."}},{"type":"paragraph","data":{"text":"Фармакокинетика:"}},{"type":"paragraph","data":{"text":"При пероральном приеме абсорбция - 90%. Время достижения максимальной концентрации препарата в плазме - 1-4 ч терапевтический уровень концентрации сохраняется 7 ч после однократного приема. Хорошо распределяется в организме. Проникает через гематоэнцефалический барьер плацентарный барьер и в грудное молоко. В легких и моче создает концентрации превышающие содержание в плазме. В меньшей степени накапливается в бронхиальном секрете влагалищных выделениях секрете и ткани предстательной железы жидкости среднего уха (при его воспалении) спинно-мозговой жидкости желчи костях слюне водянистой влаге глаза грудном молоке интерстициальной жидкости. Связь с белками плазмы - 66% у сульфаметоксазола у триметоприма - 45%."}},{"type":"paragraph","data":{"text":"Оба компонента метаболизируются с образованием ацетилированных производных сульфаметоксазол в большей степени. Метаболиты не обладают противомикробной активностью."}},{"type":"paragraph","data":{"text":"Выводится почками в виде метаболитов (80% в течение 72 ч) и в неизмененном виде (20% сульфаметоксазола 50% триметоприма); незначительное количество - через кишечник. Период полувыведения препарата сульфаметоксазола - 9-11 ч триметоприма - 10-12 ч у детей - существенно меньше и зависит от возраста: до 1 года - 7-8 ч 1-10 лет - 5-6 ч. У пожилых и пациентов с нарушением функции почек период полувыведения препарата увеличивается."}}]},{"id":8,"name":"Показания к применению","slug":"indications","body":[{"type":"paragraph","data":{"text":"- Инфекции мочеполовых органов: уретрит цистит пиелит пиелонефрит простатит эпидидимит гонорея мягкий шанкр венерическая лимфогранулема паховая гранулема;"}},{"type":"paragraph","data":{"text":"- инфекции дыхательных путей: бронхит (острый и хронический) бронхоэктатическая болезнь крупозная пневмония бронхопневмония пневмоцистная пневмония;"}},{"type":"paragraph","data":{"text":"- инфекции ЛОР-органов: средний отит синусит ларингит ангина; скарлатина; инфекции желудочно-кишечного тракта: брюшной тиф паратиф сальмонеллоносительство холера дизентерия холецистит холангит гастроэнтериты вызванные энтеротоксичными штаммами Escherichia coli;"}},{"type":"paragraph","data":{"text":"- инфекции кожи и мягких тканей: акне фурункулез пиодермия раневые инфекции;"}},{"type":"paragraph","data":{"text":"- остеомиелит (острый и хронический) и др. остеоартикулярные инфекции бруцеллез (острый) южноамериканский бластомикоз малярия (Plasmodium falciparum) токсоплазмоз (в составе комплексной терапии)."}}]},{"id":9,"name":"Противопоказания","slug":"contraindications","body":[{"type":"paragraph","data":{"text":"Гиперчувствительность (в т.ч. к сульфаниламидам) печеночная и/или почечная недостаточность (клиренс креатинина менее 15 мл/мин) апластическая анемия В 12-дефицитная анемия агранулоцитоз лейкопения дефицит глюкозо-6-фосфатдегидрогеназы беременность период лактации детский возраст (до 3 мес) гипербилирубинемия у детей."}},{"type":"header","data":{"text":"С осторожностью:","level":3}},{"type":"paragraph","data":{"text":"Дефицит фолиевой кислоты бронхиальная астма заболевания щитовидной железы."}}]},{"id":12,"name":"Способ применения и дозы","slug":"dosage","body":[{"type":"paragraph","data":{"text":"Режим дозирования индивидуальный в зависимости от тяжести заболевания чувствительности и вида возбудителя возраста больного. При неосложненных инфекциях назначают:"}},{"type":"paragraph","data":{"text":"от 3 месяцев до 6 месяцев по 25 мл суспензии 2 раза в сутки;"}},{"type":"paragraph","data":{"text":"от 6 месяцев до 6 лет по 25 - 5 мл суспензии 2 раза в сутки;"}},{"type":"paragraph","data":{"text":"от 6 до 12 лет по 5 -10 мл суспензии 2 раза в сутки;"}},{"type":"paragraph","data":{"text":"старше 12 лет и взрослым по 10-20 мл суспензии 2 раза в сутки"}},{"type":"paragraph","data":{"text":"Продолжительность курса лечения от 5 до 14 дней."}},{"type":"paragraph","data":{"text":"Препарат принимают во время или после еды. В процессе лечения рекомендуется обильное питье."}},{"type":"paragraph","data":{"text":"В случае продления курса лечения более 5 дней и/или увеличения дозы необходимо проводить гематологический контроль; в случае изменения картины крови необходимо назначение фолиевой кислоты по 5-10 мг в сутки."}}]},{"id":13,"name":"Побочное действие","slug":"side_effects","body":[{"type":"paragraph","data":{"text":"Со стороны нервной системы: головная боль головокружение; в отдельных случаях - асептический менингит депрессия апатия тремор периферические невриты."}},{"type":"paragraph","data":{"text":"Со стороны дыхательной системы: бронхоспазм легочные инфильтраты."}},{"type":"paragraph","data":{"text":"Со стороны пищеварительной системы: тошнота рвота снижение аппетита диарея гастрит боль в животе глоссит стоматит холестаз повышение активности \"печеночных\" трансаминаз гепатит гепатонекроз псевдомембранозный энтероколит."}},{"type":"paragraph","data":{"text":"Со стороны органов кроветворения: лейкопения нейтропения тромбоцитопения агранулоцитоз мегалобластная анемия."}},{"type":"paragraph","data":{"text":"Со стороны мочевыделительной системы: полиурия интерстициальный нефрит нарушение функции почек кристаллурия гематурия повышение концентрации мочевины гиперкреатининемия токсическая нефропатия с олигурией и анурией."}},{"type":"paragraph","data":{"text":"Со стороны опорно-двигательного аппарата: артралгия миалгия."}},{"type":"paragraph","data":{"text":"Аллергические реакции: зуд фотосенсибилизация сыпь мультиформная экссудативная эритема (в т.ч. синдром Стивенса-Джонсона) токсический эпидермальный некролиз (синдром Лайелла) эксфолиативный дерматит аллергический миокардит повышение температуры тела ангионевротический отек гиперемия склер."}},{"type":"paragraph","data":{"text":"Местные реакции: тромбофлебит (в месте венопункции) болезненность в месте введения. Прочие: гипогликемия."}}]},{"id":14,"name":"Передозировка","slug":"overdose","body":[{"type":"paragraph","data":{"text":"Симптомы: тошнота рвота кишечная колика головокружение головная боль сонливость депрессия обморочные состояния спутанность сознания нарушение зрения лихорадка гематурия кристаллурия; при продолжительной передозировке - тромбоцитопения лейкопения мегалобластная анемия желтуха."}},{"type":"paragraph","data":{"text":"Лечение: промывание желудка подкисление мочи увеличивает выведение триметоприма прием жидкости внутрь в/м - 5-15 мг/сут кальция фолината (устраняет действие триметоприма на костный мозг) при необходимости - гемодиализ."}}]},{"id":15,"name":"Взаимодействие с другими лекарственными средствами","slug":"drugs_interaction","body":[{"type":"paragraph","data":{"text":"\n\nУвеличивает антикоагулянтную активность непрямых антикоагулянтов а также действие гипогликемических лекарственных средств и метотрексата."}},{"type":"paragraph","data":{"text":"Снижает интенсивность печеночного метаболизма фенитоина (удлиняет его период полувыведения на 39%) и варфарина усиливая их эффект"}},{"type":"paragraph","data":{"text":" Снижает надежность пероральной контрацепции (угнетает кишечную микрофлору и уменьшает кишечно-печеночную циркуляцию гормональных соединений)."}},{"type":"paragraph","data":{"text":"Рифампицин сокращает период полувыведения триметоприма. Пириметамин в дозах превышающих 25 мг/нед увеличивает риск развития мегалобластной анемии."}},{"type":"paragraph","data":{"text":"Диуретики (чаще тиазиды) увеличивают риск развития тромбоцитопении. Снижают эффект бензокаин прокаин прокаинамид (и др. лекарственные средства в результате гидролиза которых образуется парааминобензойная кислота). Между диуретиками (тиазиды фуросемид и др.) и пероральными гипогликемическими лекарственными средствами (производные сульфонилмочевины) с одной стороны и противомикробными сульфаниламидами - с др. возможно развитие перекрестной аллергической реакции."}},{"type":"paragraph","data":{"text":"Фенитоин барбитураты парааминобензойная кислота усиливают проявления дефицита фолиевой кислоты."}},{"type":"paragraph","data":{"text":"Производные салициловой кислоты усиливают действие."}},{"type":"paragraph","data":{"text":"Аскорбиновая кислота гексаметилентетрамин (и др. лекарственные средства закисляющие мочу) увеличивают риск развития кристаллурии."}},{"type":"paragraph","data":{"text":"Колестирамин снижает абсорбцию поэтому его следует принимать через 1 ч после или за 4-6 ч до приема ко-тримоксазола."}},{"type":"paragraph","data":{"text":"Лекарственные средства угнетающие костномозговое кроветворение увеличивают риск миелосупресси.\n\n"}}]},{"id":16,"name":"Особые указания","slug":"","body":[{"type":"paragraph","data":{"text":"В случае продления курса лечения более 5 дней и/или увеличения дозы необходимо проводить гематологический контроль; в случае изменения картины крови необходимо назначение фолиевой кислоты по 5-10 мг в сутки."}},{"type":"paragraph","data":{"text":"При длительных (свыше месяца) курсах лечения необходимы регулярные анализы крови поскольку существует вероятность возникновения гематологических изменений (чаще всего асимптоматических). Эти изменения могут быть обратимы при назначении фолиевой кислоты (3-6 мг/сут) что существенно не нарушает противомикробной активности препарата. Особая осторожность должна проявляться при лечении пожилых больных или больных с подозрением на исходную нехватку фолатов. Назначение фолиевой кислоты целесообразно также при длительном лечении в высоких дозах. Для профилактики кристаллурии рекомендуется поддерживать достаточный объем выделяемой мочи. Вероятность токсических и аллергических осложнений сульфаниламидов значительно увеличивается при снижении фильтрационной функции почек. Следует избегать чрезмерного солнечного и УФ-облучения."}}]},{"id":19,"name":"Условия хранения","slug":"storage","body":[{"type":"paragraph","data":{"text":"Хранить при температуре не выше 15 °С. Хранить в недоступном для детей месте."}}]},{"id":20,"name":"Срок годности","slug":"expiry_date","body":[{"type":"paragraph","data":{"text":"2 года. После окончания срока годности препарат использоваться не должен."}}]}],"source":null},"description_toggle":false,"short_description":"Фармакотерапевтическая группа: противомикробное комбинированное средство Код АТХ: J01EE01 Фармакодинамика: Комбинированный противомикробный препарат состоящий из сульфаметоксазола и триметоприма. Сульфаметоксазол сходный по строению с парааминобензойной кислотой нарушает синтез дигидрофолиевой кислоты в бактериальных клетках препятствуя включению парааминобензойной кислоты в ее молекулу. Триметоприм усиливает действие сульфаметоксазола нарушая восстановление дигидрофолиевой кислоты в тетрагидрофолиевую - активную форму фолиевой кислоты ответственную за белковый обмен и деление микробной клетки. Является бактерицидным препаратом широкого спектра действия активен в отношении следующих микроорганизмов: Streptococcus spp. (гемолитические штаммы более чувствительны к пенициллину) Staphylococcus spp. Streptococcus pneumoniae. Neisseria meningitidis Neisseria gonorrhoeae Escherichia coli (включая энтеротоксогенные штаммы) Salmonella spp. (включая Salmonella typhi и Salmonella paratyphi) Vibrio cholerae Bacillus anthracis Haemophilus influenzae (включая ампициллиноустойчивые штаммы) Listeria spp. Nocardia asteroides Bordetella pertussis Enterococcus faecalis Klebsiella spp. Proteus spp. Pasteurella spp. Francisella tularensis Brucella spp. Mycobacterium spp. (в т.ч. Mycobacterium leprae) Citrobacter Enterobacter spp. Legionella pneumophila Providencia некоторые виды Pseudomonas (кроме Pseudomonas aeruginosa) Serratia marcescens Shigella spp. Yersinia spp. Morganella spp. Pneumocystis carinii Chlamydia spp. (в т.ч. Chlamydia trachomatis Chlamydia psittaci); простейшие: Plasmodium spp. Toxoplasma gondii патогенные грибы Actinomyces israelii Coccidioides immitis Histoplasma capsulatum Leishmania spp. Устойчивы к препарату: Corynebacterium spp. Pseudomonas aeruginosa Mycobacterium tuberculosis Treponema spp. Leptospira spp. вирусы. Угнетает жизнедеятельность кишечной палочки что приводит к уменьшению синтеза тиамина рибофлавина никотиновой кислоты и др. витаминов группы В в кишечнике. Продолжительность терапевтического эффекта составляет 7 ч. Фармакокинетика: При пероральном приеме абсорбция - 90%. Время достижения максимальной концентрации препарата в плазме - 1-4 ч терапевтический уровень концентрации сохраняется 7 ч после однократного приема. Хорошо распределяется в организме. Проникает через гематоэнцефалический барьер плацентарный барьер и в грудное молоко. В легких и моче создает концентрации превышающие содержание в плазме. В меньшей степени накапливается в бронхиальном секрете влагалищных выделениях секрете и ткани предстательной железы жидкости среднего уха (при его воспалении) спинно-мозговой жидкости желчи костях слюне водянистой влаге глаза грудном молоке интерстициальной жидкости. Связь с белками плазмы - 66% у сульфаметоксазола у триметоприма - 45%. Оба компонента метаболизируются с образованием ацетилированных производных сульфаметоксазол в большей степени. Метаболиты не обладают противомикробной активностью. Выводится почками в виде метаболитов (80% в течение 72 ч) и в неизмененном виде (20% сульфаметоксазола 50% триметоприма); незначительное количество - через кишечник. Период полувыведения препарата сульфаметоксазола - 9-11 ч триметоприма - 10-12 ч у детей - существенно меньше и зависит от возраста: до 1 года - 7-8 ч 1-10 лет - 5-6 ч. 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