. "004.002" . . . . "4.2\tD\u00E1vkov\u00E1n\u00ED a zp\u016Fsob pod\u00E1n\u00ED"@cs . . . . . . . . . . . . . . "Gentamicin je l\u00E9k volby tak\u00E9 p\u0159i l\u00E9\u010Db\u011B t\u011B\u017Ek\u00FDch bakteri\u00E1ln\u00EDch infekc\u00ED vyvolan\u00FDch nezn\u00E1m\u00FDmi p\u016Fvodci a infekc\u00ED, kter\u00E9 vzplanou v\u00A0pr\u016Fb\u011Bhu chorob a situac\u00ED, z\u00E1va\u017Enou m\u011Brou sni\u017Euj\u00EDc\u00EDch odolnost organismu (nap\u0159. diabetu, leukemie, terapie glukokortikoidy). V\u00A0t\u011Bchto p\u0159\u00EDpadech se gentamicin obvykle pou\u017E\u00EDv\u00E1 v\u00A0kombinaci s\u00A0\u03B2-laktamov\u00FDmi antibiotiky.\nGentamicin je \u00FA\u010Dinn\u00FD zejm\u00E9na p\u0159i infekc\u00EDch vyvolan\u00FDch gramnegativn\u00EDmi mikroorganismy a stafylokoky. Je \u00FA\u010Dinn\u00FD tak\u00E9 p\u0159i z\u00E1va\u017En\u00FDch novorozeneck\u00FDch infekc\u00EDch. \nDosp\u011Bl\u00ED a d\u011Bti star\u0161\u00ED ne\u017E 12 let: Obvykl\u00E1 denn\u00ED d\u00E1vka gentamicinu b\u00FDv\u00E1 3 mg/kg, p\u0159\u00EDpadn\u011B a\u017E 5 mg/kg t\u011Blesn\u00E9 hmotnosti, podan\u00E1 intramuskul\u00E1rn\u011B nebo intraven\u00F3zn\u011B v 1 a\u017E 3 jednotliv\u00FDch d\u00E1vk\u00E1ch. Obvykl\u00E9 d\u00E1vkov\u00E1n\u00ED u pacient\u016F s\u00A0hmotnost\u00ED vy\u0161\u0161\u00ED ne\u017E 60 kg a s\u00A0norm\u00E1ln\u00ED funkc\u00ED ledvin je 80 mg ka\u017Ed\u00FDch 8 hodin. \nD\u011Bti ve v\u011Bku 1 \u2013 12 let: 4,5 mg/kg denn\u011B, intramuskul\u00E1rn\u011B nebo intraven\u00F3zn\u011B, v\u00A0jedn\u00E9 a\u017E t\u0159ech jednotliv\u00FDch d\u00E1vk\u00E1ch denn\u011B.\nNovorozenci star\u0161\u00ED ne\u017E 1 t\u00FDden a d\u011Bti do 1 roku v\u011Bku: 6 mg/kg denn\u011B, rozd\u011Bleno do 2 jednotliv\u00FDch d\u00E1vek ka\u017Ed\u00FDch 12 hodin.\nNovorozenci v 1. t\u00FDdnu \u017Eivota: 5 mg/kg denn\u011B, rozd\u011Bleno do 2 jednotliv\u00FDch d\u00E1vek ka\u017Ed\u00FDch 12 hodin.\nP\u0159ed\u010Dasn\u011B narozen\u00ED novorozenci, v 1. t\u00FDdnu \u017Eivota: Ve 28. t\u00FDdnu t\u011Bhotenstv\u00ED nebo d\u0159\u00EDve: 2,5 mg/kg ka\u017Ed\u00E9 24 hodiny. \u2013 Od 29. do 35. t\u00FDdne t\u011Bhotenstv\u00ED: 2,5 mg/kg ka\u017Ed\u00FDch 18 hodin.\nD\u00E1vkov\u00E1n\u00ED p\u0159i nedostate\u010Dn\u00E9 funkci ledvin\nPo\u010D\u00E1te\u010Dn\u00ED d\u00E1vka u dosp\u011Bl\u00FDch pacient\u016F s ledvinovou nedostate\u010Dnost\u00ED posta\u010Duj\u00EDc\u00ED k dosa\u017Een\u00ED maxim\u00E1ln\u00ED plazmatick\u00E9 koncentrace je 1.5 a\u017E 2 mg/kg bez ohledu na stupe\u0148 ledvinov\u00E9 nedostate\u010Dnosti.\nRen\u00E1ln\u00ED dysfunkce vy\u017Eaduje zm\u011Bn\u011Bn\u00E9 d\u00E1vkovac\u00ED sch\u00E9ma. Po\u010D\u00E1te\u010Dn\u00ED d\u00E1vka je podobn\u00E1 jako u pacient\u016F s norm\u00E1ln\u00ED funkc\u00ED ledvin. Pro pokra\u010Dov\u00E1n\u00ED l\u00E9\u010Dby existuj\u00ED dv\u011B mo\u017Enosti. Jednou z mo\u017Enost\u00ED pro \u00FApravu d\u00E1vkov\u00E1n\u00ED je prodlou\u017Een\u00ED intervalu mezi jednotliv\u00FDmi d\u00E1vkami. Jeliko\u017E je clearance aminoglykosid\u016F \u00FAzce v korelaci s clearance kreatininu, m\u016F\u017Ee b\u00FDt pot\u0159ebn\u00E1 d\u00E1vka vypo\u010D\u00EDt\u00E1na z hodnoty clearance kreatininu.\nN\u00E1sleduj\u00EDc\u00ED tabulka uv\u00E1d\u00ED doporu\u010Den\u00E9 d\u00E1vkovac\u00ED sch\u00E9ma pro pacienty s poruchou funkce ledvin:\n\tUrea\n(mmol/L)\n\tClearance kreatininu\n(ml/s)\n\tD\u00E1vka a interval mezi d\u00E1vkami\n\t ( 6.7\n\t> 1.2 \n\t80* mg ka\u017Ed\u00FDch 8 hodin\n\t6.7 - 16.7\n\t0.5 \u2013 1.2 \n\t80* mg ka\u017Ed\u00FDch 12 hodin\n\t16.7 \u2013 33.3\n\t0.2 \u2013 0.5\n\t80* mg ka\u017Ed\u00FDch 24 hodin\n\t > 33.3\n\t0.1 \u2013 0.2\n\t80* mg ka\u017Ed\u00FDch 48 hodin\n* u pacient\u016F v\u00E1\u017E\u00EDc\u00EDch m\u00E9n\u011B ne\u017E 60 kg m\u00E1 b\u00FDt d\u00E1vka 60 mg gentamicinu. \nSn\u00ED\u017Een\u00ED d\u00E1vky, stejn\u011B jako prodlou\u017Een\u00ED intervalu mezi d\u00E1vkami, jsou rovnocenn\u011B vhodn\u00FDm \u0159e\u0161en\u00EDm, nicm\u00E9n\u011B je pot\u0159eba vz\u00EDt v \u00FAvahu, \u017Ee takto stanoven\u00E9 d\u00E1vky jsou jen p\u0159ibli\u017En\u00E9 a \u017Ee stejn\u00E1 d\u00E1vka m\u016F\u017Ee v organismu r\u016Fzn\u00FDch pacient\u016F vy\u00FAstit v r\u016Fznou koncentraci. Proto je pot\u0159eba stanovit hladinu gentamicinu v s\u00E9ru a d\u00E1vku pro pacienta pak adekv\u00E1tn\u011B p\u0159izp\u016Fsobit. \nPo\u017Eadovan\u00E1 koncentrace gentamicinu za 30 a\u017E 60 minut po intraven\u00F3zn\u00EDm nebo intramuskul\u00E1rn\u00EDm pod\u00E1n\u00ED je 5 a\u017E 10 \u03BCg/ml.\n1 a\u017E 1,5 mg gentamicinu na kg t\u011Blesn\u00E9 hmotnosti m\u00E1 b\u00FDt pod\u00E1no na konci ka\u017Ed\u00E9 hemodial\u00FDzy. P\u0159i peritone\u00E1ln\u00ED dial\u00FDze m\u00E1 b\u00FDt do 2 l dialyza\u010Dn\u00EDho roztoku d\u00E1n 1 mg gentamicinu.\nU star\u0161\u00EDch pacient\u016F je prodlou\u017Een elimina\u010Dn\u00ED polo\u010Das gentamicinu vzhledem ke sn\u00ED\u017Een\u00E9 glomerul\u00E1rn\u00ED filtraci. Sn\u00ED\u017Een\u00ED glomerul\u00E1rn\u00ED filtrace u star\u00FDch pacient\u016F se neprojev\u00ED v\u017Edy zv\u00FD\u0161en\u00FDmi hladinami s\u00E9rov\u00E9ho kreatininu (jeliko\u017E je u star\u00FDch pacient\u016F sn\u00ED\u017Eena jeho produkce). Proto m\u00E1 b\u00FDt u star\u00FDch pacient\u016F stanovena clearance kreatininu, aby bylo mo\u017Eno vypo\u010D\u00EDtat clearance gentamicinu.\nIntraven\u00F3zn\u00ED pod\u00E1n\u00ED\nD\u00E1vky jsou stejn\u00E9 jako p\u0159i pod\u00E1n\u00ED intramuskul\u00E1rn\u00EDm. Gentamicin se aplikuje intraven\u00F3zn\u011B bu\u010F p\u0159\u00EDmo, anebo do zaveden\u00E9ho ven\u00F3zn\u00EDho kat\u00E9tru. Injekce sama trv\u00E1 2 a\u017E 3 minuty. Pod\u00E1v\u00E1-li se gentamicin v\u00A0kr\u00E1tkodob\u00E9 infuzi, je obvykl\u00FD objem rozpou\u0161t\u011Bdla (b\u011B\u017En\u00E9ho izotonick\u00E9ho roztoku chloridu sodn\u00E9ho anebo 5% roztoku glukosy) 100 ml pro dosp\u011Bl\u00E9; pro d\u011Bti je objem rozpou\u0161t\u011Bdla p\u0159im\u011B\u0159en\u011B men\u0161\u00ED. Infuze trv\u00E1 20 a\u017E 30 minut. Jestli\u017Ee se celodenn\u00ED d\u00E1vka p\u0159\u00EDpravku pod\u00E1v\u00E1 \u00A0jedinou infuz\u00ED za den, trv\u00E1 aplikace 30 a\u017E 60 minut. Koncentrace gentamicinu v\u00A0roztoku nem\u00E1 p\u0159estoupit 1 mg/ml (0,1 %). Gentamicin se nesm\u00ED m\u00EDsit s\u00A0jin\u00FDmi l\u00E9\u010Divy.\nMaxim\u00E1ln\u00ED denn\u00ED d\u00E1vka gentamicinu je 7,5 mg/kg, podan\u00E1 rozd\u011Blen\u011B ve t\u0159ech jednotliv\u00FDch d\u00E1vk\u00E1ch.\n"@cs . .