. . . . . . . . "004.002" . . . "4.2 D\u00E1vkov\u00E1n\u00ED a zp\u016Fsob pod\u00E1n\u00ED"@cs . . . . . . . . "Piperacilin/tazobaktam lze pod\u00E1vat pomalou intraven\u00F3zn\u00ED injekc\u00ED (trvaj\u00EDc\u00ED nejm\u00E9n\u011B 3 a\u017E 5 minut) nebo pomalou intraven\u00F3zn\u00ED infuz\u00ED (doba pod\u00E1n\u00ED infuze v\u00EDce ne\u017E 20 a\u017E 30 minut).\nRekonstituovan\u00FD roztok m\u00E1 b\u00FDt pou\u017Eit jen tehdy, pokud je \u010Dir\u00FD a bez \u010D\u00E1stic. Pokyny k\u00A0rekonstituci viz bod 6.6.\nL\u00E9\u010Dba sm\u00ED\u0161en\u00FDch infekc\u00ED, zp\u016Fsoben\u00FDch organizmy citliv\u00FDmi na piperacilin a organizmy produkuj\u00EDc\u00EDmi betalaktam\u00E1zu citliv\u00FDmi na kombinaci piperacilin/tazobaktam, obecn\u011B nevy\u017Eaduje p\u0159id\u00E1n\u00ED dal\u0161\u00EDho antibiotika.\nU pacient\u016F s nozokomi\u00E1ln\u00ED pneumoni\u00ED a u infekc\u00ED neutropenick\u00FDch pacient\u016F lze kombinaci piperacilin/tazobaktam pou\u017E\u00EDt spolu s aminoglykosidem. Pokud je pou\u017Eit\u00ED aminoglykosidu v\u00A0kombinaci s piperacilin/tazobaktamem pot\u0159ebn\u00E9, mus\u00ED se jak kombinace piperacilin/tazobaktam, tak aminoglykosid pou\u017E\u00EDt v\u00A0pln\u00FDch terapeutick\u00FDch d\u00E1vk\u00E1ch.\nNeutropenick\u00FDm pacient\u016Fm s\u00A0projevy infekce (nap\u0159. hore\u010Dka) je zapot\u0159eb\u00ED podat okam\u017Eitou empirickou antibiotickou l\u00E9\u010Dbu je\u0161t\u011B p\u0159ed z\u00EDsk\u00E1n\u00EDm laboratorn\u00EDch v\u00FDsledk\u016F.\nDosp\u011Bl\u00ED a d\u011Bti nad 12 let s\u00A0norm\u00E1ln\u00ED funkc\u00ED ledvin\nObvykl\u00E9 d\u00E1vkov\u00E1n\u00ED piperacilin/tazobaktamu u dosp\u011Bl\u00FDch a d\u011Bt\u00ED nad 12 let je 4000/500 mg pod\u00E1van\u00FDch ka\u017Ed\u00FDch 8 hodin.\nCelkov\u00E1 denn\u00ED d\u00E1vka piperacilin/tazobaktamu z\u00E1vis\u00ED na z\u00E1va\u017Enosti a lokalizaci infekce, p\u0159i\u010Dem\u017E se m\u016F\u017Ee pohybovat od d\u00E1vky piperacilin/tazobaktamu 2000/250 mg do d\u00E1vky piperacilin/tazobaktamu 4000/500 mg pod\u00E1van\u00E9 ka\u017Ed\u00FDch 6 a\u017E 8 hodin.\nP\u0159i neutropenii je doporu\u010Den\u00E1 d\u00E1vka piperacilin/tazobaktamu 4000/500 mg pod\u00E1van\u00E1 ka\u017Ed\u00FDch 6 hodin v\u00A0kombinaci s aminoglykosidem.\nStar\u0161\u00ED pacienti s norm\u00E1ln\u00ED funkc\u00ED ledvin\nPiperacilin/tazobaktam lze pou\u017E\u00EDvat ve stejn\u00FDch d\u00E1vk\u00E1ch jako u dosp\u011Bl\u00FDch s\u00A0v\u00FDjimkou p\u0159\u00EDpad\u016F poruchy funkce ledvin (viz n\u00ED\u017Ee):\nRen\u00E1ln\u00ED insuficience u dosp\u011Bl\u00FDch, star\u0161\u00EDch pacient\u016F a d\u011Bt\u00ED (v\u00E1\u017E\u00EDc\u00EDch v\u00EDce ne\u017E 40 kg), kte\u0159\u00ED jsou l\u00E9\u010Deni d\u00E1vkou pro dosp\u011Bl\u00E9:\nU pacient\u016F s\u00A0ren\u00E1ln\u00ED insuficienc\u00ED m\u00E1 b\u00FDt intraven\u00F3zn\u00ED d\u00E1vka upravena podle stupn\u011B aktu\u00E1ln\u00EDho posti\u017Een\u00ED ledvin. Doporu\u010Den\u00E9 denn\u00ED d\u00E1vky jsou n\u00E1sleduj\u00EDc\u00ED:\n\uFFFD\n\tClearance kreatininu (ml/min)\n\tDoporu\u010Den\u00E1 d\u00E1vka piperacilin/tazobaktamu\n\t\n\tCelkov\u00E1\n\tJednotliv\u00E9 d\u00E1vky\n\t20 - 80\n\t12/1,5 g/den\n\t4000/500 mg ka\u017Ed\u00FDch 8 hodin\n\t< 20\n\t8/1 g/den\n\t4000/500 mg ka\u017Ed\u00FDch 12 hodin\nU pacient\u016F na hemodial\u00FDze je maxim\u00E1ln\u00ED denn\u00ED d\u00E1vka piperacilin/tazobaktamu 8 g/1 g. Jeliko\u017E hemodial\u00FDzou se odstran\u00ED 30-50% piperacilinu za 4 hodiny, je t\u0159eba podat dodate\u010Dnou d\u00E1vku 2000/250 mg piperacilin/tazobaktamu po ka\u017Ed\u00E9 dial\u00FDze. \nU pacient\u016F se selh\u00E1n\u00EDm ledvin a insuficienc\u00ED jater poskytnou dodate\u010Dn\u00E9 \u00FAdaje pro \u00FApravu d\u00E1vky v\u00FDsledky m\u011B\u0159en\u00ED s\u00E9rov\u00FDch hladin piperacilin/tazobaktamu.\nD\u011Bti ve v\u011Bku 2 - 12 let s\u00A0norm\u00E1ln\u00ED funkc\u00ED ledvin \nPiperacilin/tazobaktam se doporu\u010Duje pouze k\u00A0l\u00E9\u010Db\u011B d\u011Bt\u00ED s neutropeni\u00ED.\nNeutropenie\nU d\u011Bt\u00ED v\u00E1\u017E\u00EDc\u00EDch m\u00E9n\u011B ne\u017E 40 kg m\u00E1 b\u00FDt d\u00E1vka upravena na 90 mg/kg (80 mg piperacilinu/10 mg tazobaktamu), pod\u00E1van\u00FDch ka\u017Ed\u00FDch 6 hodin v\u00A0kombinaci s aminoglykosidem, p\u0159i\u010Dem\u017E nesm\u00ED p\u0159es\u00E1hnout d\u00E1vku 4000/250 mg piperacilinu/tazobaktamu ka\u017Ed\u00FDch 6 hodin.\nRen\u00E1ln\u00ED insuficience u d\u011Bt\u00ED ve v\u011Bku 2 - 12 let (nebo v\u00E1\u017E\u00EDc\u00EDc\u00EDch m\u00E9n\u011B ne\u017E 40 kg)\nU d\u011Bt\u00ED s\u00A0ren\u00E1ln\u00ED insuficienc\u00ED m\u00E1 b\u00FDt intraven\u00F3zn\u00ED d\u00E1vka upravena podle stupn\u011B aktu\u00E1ln\u00EDho posti\u017Een\u00ED ledvin n\u00E1sledovn\u011B:\n\tClearance kreatininu (ml/min)\n\tDoporu\u010Den\u00E9 d\u00E1vkov\u00E1n\u00ED piperacilin/tazobaktamu\n\tFrekvence\n\tMaxim\u00E1ln\u00ED denn\u00ED d\u00E1vka\n\t\u226540\n\t\u00DAprava d\u00E1vkov\u00E1n\u00ED nen\u00ED pot\u0159ebn\u00E1\n\t20 - 39\n\t90 mg (piperacilin/tazobaktam 80/10 mg) /kg\n\tka\u017Ed\u00FDch 8 hodin\n\t12/1,5 g/den\n\t< 20\n\t90 mg (piperacilin/tazobaktam 80/10 mg) /kg\n\tka\u017Ed\u00FDch 12 hodin\n\t8/1 g/den\nU d\u011Bt\u00ED na hemodial\u00FDze v\u00E1\u017E\u00EDc\u00EDch <50 kg je doporu\u010Den\u00E1 d\u00E1vka 45 mg/kg (40 mg piperacilinu/5 mg tazobaktamu) ka\u017Ed\u00FDch 8 hodin.\nV\u00FD\u0161e uveden\u00E9 \u00FApravy d\u00E1vkov\u00E1n\u00ED jsou pouze p\u0159ibli\u017En\u00E9. Ka\u017Ed\u00FD pacient mus\u00ED b\u00FDt pe\u010Dliv\u011B sledov\u00E1n s\u00A0ohledem na projevy l\u00E9kov\u00E9 toxicity. D\u00E1vka l\u00E9ku a interval jeho pod\u00E1v\u00E1n\u00ED by podle toho m\u011Bly b\u00FDt upraveny.\nD\u011Bti do 2 let\nPou\u017Eit\u00ED piperacilin/tazobaktamu se u d\u011Bt\u00ED do 2 let s\u00A0ohledem na nedostatek \u00FAdaj\u016F o bezpe\u010Dnosti nedoporu\u010Duje.\nPorucha funkce jater\n\u00DAprava d\u00E1vky nen\u00ED nutn\u00E1.\nTrv\u00E1n\u00ED l\u00E9\u010Dby\nTrv\u00E1n\u00ED l\u00E9\u010Dby se m\u00E1 \u0159\u00EDdit z\u00E1va\u017Enost\u00ED infekce, klinick\u00FDm pr\u016Fb\u011Bhem a v\u00FDsledky bakteriologick\u00E9ho vy\u0161et\u0159en\u00ED pacienta.\nP\u0159i akutn\u00EDch infekc\u00EDch m\u00E1 l\u00E9\u010Dba piperacilin/tazobaktamem trvat je\u0161t\u011B 48 hodin po odezn\u011Bn\u00ED klinick\u00FDch p\u0159\u00EDznak\u016F nebo hore\u010Dky.\n"@cs . . .