«YTBEPJK)l:AlO» P)'KOBO ' Te11b ,[(enapTaMeHTa

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no Me)l,HUHHCKOMY npHMeHeHHIO npenapaTa

BABKOMIID;IIB-TEBA

ToproBoe Ha3BaHHe: BaHKOMI1UI1H-TeBa

Me~)l,YHapO)l,Hoe(HenaTeHToBaHHoe)Ha3BaHHe:BaHKOMI1UI1H

XHMH1.feCKOe Ha3BaHHe: TPI1UI1K11J11IeCKI1H f'J1I1KOnenTI1,llHhIH npl1pO,llHhlH aHTI16110TI1K.

JIeKapCTBeHHaSl liJopMa: JIl1oqm11113aT ,[(1151 npl1rOTOB11eHI151 pacTBopa ,111151 I1HCPY3l1H

CocTaB: AKTI1BHOe Belll,eCTBO - BaHKOMHUI1Ha rHAPOX110PI1A (B nepeC1.feTe Ha BaHKOMI1UI1H) - 500 Mr

1000 ML

OnHcaHHe: I101.fTI1 6e11hlH (c p030BaTh1M 111111 cBeT110-KOpl11.fHeBhIM orreHKoM) 11110CPI111113I1pOBaHHhIH

nopOlliOK.

<l>apMaKoTepaneBTH1.leCKaSl rpynna: AHTI16110TI1K, f'J1HKOnenTI1,ll.

KOA ATC: [JOIXAOl]. <l>apMaKo.rlOrHQeCKHe CBoucTBa

<l>apMaKoAHHaMHKa

BaHKOMI1UHH 51B1151eTC5I TPI1UI1K11I11.feCKI1M r11I1KOnenTI1,llHhIM aHTH6110TI1KOM, Bhl,lle11eHHhlM 113

Amycolatopsis orientalis. EaKTepl1UI1AHOe AeHCTBl1e BaHKOMI1UI1Ha np05lBlliIeTC5I B pe3Y11bTaTe

I1Hf'116I1pOBaHI151 6110Cl1HTe3a K11eT01.fHOH CTeHKI1 . KpOMe TOro, BaHKOMHUI1H MO)KeT 113MeH5ITh

npOHl1uaeMOCTh K11eT01.fHOH MeM6paHbi 6aKTepl1H 11 113MeH5ITb Cl1HTe3 PHK. I1epeKpeCTHa51 YCTOH1.fI1BOCTh

Me)K,llY BaHKOMI1UI1HOM 11 aHTl16110Tl1KaMl1 ,llPYf'I1X K11aCCOB OTCYTcTByeT.

In vitro BaHKOMHUI1H np05lBJI5IeT aKTI1BHOCTb B OTH 0 1lI eH 1111 rpaMno11Q)KI1TeJIhHhIX

MI1KpOOpraHI13MOB, BKJIlOLJa5I: Staphylococcus aureus 11 Staphylococcus epidermidis (BKJIlOLJa51

reTeporeHHhle MeTI1UI1JI11I1H-YCTOH1.fI1Bhle llITaMMbl), Streptococcus pyogenes, Streptococcus pneumoniae (BK11lOLJa51 neHI1UI1JIJIHH-YCTOHLJI1Bble llITaMMbl), Streptococcus agalactiae, f'pynny Bl1pl1,llaHC,

Streptococcus hovis 11 3HTepOKOKKl1 (HanpI1Mep, Enterococcusfaecalis); Clostridium difJicile (HanpI1Mep,

TOKCl1reHHble llITaMMbl, npl1HI1MalOllI,l1e YLJaCTHe B pa3BHTI1H nCeB,llOMeM6paH03Horo 3HTepOK011I1Ta) 11

,lll1cpTepOH,llbl. K ,llPYf'I1M MI1KpOOpraHI13MaM, KOTophle LJYBcTBI1Te11hHbl K BaHKOMI1UI1HY in vitro OTHOC5ITC5I Listeria monocytogenes, PO,llbl 6aKTepl1H Lactohacillus, Actinomyces, Clostridium 11 Bacillus.

In vitro HeKoTophle 1130JIl1pOBaHHhie llITaMMbl 3HTepoKoKKOB 11 cTacpl1110KOKKOB np05lB1151lOT

YCTOH1.fI1BOCTh K BaHKOMI1UI1HY. KOM6I1HaUI151 BaHKOMI1UI1Ha 11 aMI1HOr11I1K03I1AOB ,lleHcTByeT CI1HeprH,llHO

in vitro B OTHOllleHl111 MHOrHX llITaMMOB Staphylococcus aureus, cmpenmOKOKK06, He npl1Ha,llJIe)l(aIUI1X

3Hl11epO?pynne D, 3HmepOKoKK06 H 6aKTepl1H rpynnbI Streptococcus (f'pynna Bl1pl1,llaHC).

BaHKOMI1UI1H HeaKTI1BeH in vitro B OTHOllleHHI1 rpaMOTpl1uaTe11bHhlx MHKpOOpraHI13MOB,

MHK06aKTepl1H 11 rp1160B .

<l>apMaKoKHHeTHKa

Y 11I1U C HOPMallhHOH cpYHKUl1eH nOLJeK MHoroKpaTHoe BHYTpl1BeHHOe BBe,lleHl1e f'

BaHKOMHUHHa (15 Mf'/ Kf') (HHcpY31151 B TeLJeHHe 60 MHHYT) C03,llaBaJIO Cpe,llHl1e KOHueHTpaUl111 B n11a3Me

OK0110 63 Mf'/11 HenOCpe,llCTBeHHo nOC11e 3aBepllIeHI151 I1HCPy3HI1; 1.fepe3 2 LJaca nOC11e I1HCPy3l1H Cpe,llHl1e

KOHueHTpaUl111 B n11a3Me COCTaBJI5I1111 OK0110 23 Mf'/JI, a LJepe3 11 LJaCOB nOC11e I1HCPy3Hl1 - OK0110 8 Mf'/11.

MHoroKpaTHhle 11 Hcpy3 11 11 500 Mf', BBOAI1Mble B TeLJeHl1e 30 MI1HyT, C03,llaBa1111 Cpe,llHl1e KOHueHTpaUl111 B

n11a3Me OK0110 49 Mf'/11 nOCJIe 3aBepllIeHI151 I1HCPY31111; LJepe3 2 LJaca nOC11e HHcpy31111 Cpe,llHl1e

KOHueHTpaUHH B TI11a3Me COCTaBJI5I11H OK0110 19 Mf'/11, a LJepe3 6 LJaCOB - OK0110 10 Mf'/11. KOHueHTpaUHH B

nJIa3Me npH MHoroKpaTHoM BBe,lleHHH aHaJIOrl1'-IHbI KOHueHTpaUl15lM B nJIa3Me npH O,llHOKpaTHOM

BBe,lleHHH .

Cpe,llHHH nepHO,ll nOJIYBbIBe,lleHH}! BaHKOMHUHHa H3 nJIa3MbI COCTaBJI}{eT 4-6 I.J:aCOB Y 60JIbHbIX C

HOpMaJIbHOH (PYHKUHeH nOI.J:eK. OKOJIO 75% BBe,lleHHOH ,l103bI BaHKOMHUHHa BbIBO,llHTC}! C MOI.J:OH 3a CI.J:eT

KJIy6oI.J:KOBOH Q)J1JIbTpaUHH B nepBble 24 I.J:aca. Cpe,llHHH KJIHpeHC nm13MbI COCTaBJI}!eT OKOJIO 0,058 JIiKr/I.J:, a Cpe,llHHH nOI.J:eI.J:HbIH KJIHpeHC COCTaBJI}{eT OKOJIO 0,048 JI/Kr/I.J: . ITOI.J:eI.J:HbIH KJIHpeHC

BaHKOMHUHHa }!BJI}!eTC}! ,llOCTaTOI.J:HO nOCTO}!HHbIM H o6eCneI.J:HBaeT ero BbIBe,lleHHe Ha 70-80%. 06beM

pacnpe,lleJIeHH5I KOJIe6JIeTC5I OT 0,3 ,llO 0,43 JI/Kr. ITpenapaT npaKTHI.J:eCKM He MeTa6oJIM3MPYeTC5I . KaK

nOKa3aJIa YJIbTpacpHJIbTpaUM}!, npH KOHueHTpaUMM BaHKOMMUHHa B CbIBopOTKe OT 10 Mr/JI ,llO 100 Mr/JI,

55% BaHKOMMUHHa o6HaPY)l<MBaeTC}! B CB}!3aHHOMO 6eJIKOM COCT05lHMM . .

I10cJIe BHYTpHBeHHoro BBe,lleHH}! BaHKoMMUHHa rH,llPOXJIOPM,ll o6HapY)!(MBaeTC}! B nJIeBpaJIbHOH,

nepHKap,llHaJIbHOH, aCUHTMI.J:eCKOH, CMHOBHaJIbHOH )!(M,llKOCT5IX H B TKaHM YUlKa npe,llCep,llM}!, a TaK)!(e B

MOI.J:e H B nepMTOHHaJIbHOH )!(M,llKOCTM B KOHueHTpaUM}!X, HHrH6HpYlOml1X POCT MHKpoopraHM3MOB.

BaHKOMHUMH Me,llJIeHHO npOHI1KaeT B uepe6pOCnHHaJIbHYlO )!(M,llKOCTb. I1pH MeHI1HrMTe OTMe4aeTC}!

npOHHKHOBeHHe npenapaTa B Cnl1HHOM03rOBYlO )!(H,llKOCTb. BaHKOMI1UHH npOHHKaeT I.J:epe3

nJIaueHTapHblH 6apbep H B rpY,llHOe MOJIOKO.

HapyweHHe CPYHKUHH no I.J:e K 3aMe,llJI5IeT BbIBe,lleHHe BaHKOMHUHHa. Y 60JIbHbIX C

OTCyTCTBYlOmHMH n04KaMH Cpe,llHHH nepHO,ll nOJIYBbIBe,lleHH}! COCTaBJI}!eT 7,5 ,llHeH. 06mHH cHcTeMHbIH

H n04e4HbIH KJIHpeHC BaHKOMHUMHa MO)!(eT 6bITb CHM)!(eH Y nmKI1JIbIX 60JIbHbIX B pe3YJIbTaTe

eCTeCTBeHHOrO 3aMe,llJIeHH5I KJIy6oI.J:KOBOH cpI1JIbTpaUMM .

IIoKa3aHlui K npHMeHeHHIO 3HOOlWPOUl11

BaHKoMHUHH 3Q)cpeKTHBeH KaK npH MOHoTepanMH, TaK H B KOM6HHaUHM C aMMHOrJIHK03H,llaMH ,llJI}!

JIe4eHH5I 3 H,110Kap,llHTa, BbI3blBaeMoro Streptococcus viridans WIll S. hovis. ITPH 3H,llOKap,llHTe,

Bbl3BaHHbiM 3HTepoKoKKaMH (HanpHMep, E. Jaecalis), BaHKOMHUHH 3cpcpeKTHBeH TOJIbKO B C04eTaHHH C

aMHHOrJIHK03H,llaMH.

I1MeIOTC5I CBe,lleHH5I 0 TOM, I.J:TO BaHKOMHUHH 3cpcpeKTHBeH npH JIeI.J:eHHH ,llHcpTepOH,llHoro 3H,llOKap,llHTa.

BaHKOMHUHH ycnewHo npHMeH5IeTC5I B COI.J:eTaHHH C pHcpaMnHUI1HOM, aMHHOrJIMK03H,llaMH I1JIH C

060HMH aHTH6HOTHKaMH npH paHHeM 3H,llOKap,llHTe, 06YCJIOBJIeHHOM S. epidermidis WIU diphtheroids, nOCJIe npoTe3HpOBaHH5I KJIanaHa.

B OT,lleJIbHbIX cJIYI.J:a}!x BaHKOMHUHH nOKa3aH ,llJI5I npocpHJIaKTHKH 3H,llOKap,llHTa.

Cencuc lfUpeKl(lIl1 Kocmeij 11 cycma606 i1H(/Jef(1(111l HUJICTlUX OmOeJl06 Ob7,JG711ef lbHO?O mpaJ(nw

lfrf(peK1(1lU KOJ/ell U kffl?KUX I11KaHeii

BaHKoMHUHH MO)KeT TaK)!(e npHMeH5ITbC5I npH HHcpeKUH5IX, BbI3BaHHblX rpaMnOJIO)!(HTeJIbHbIMH

MHKpoopraHH3MaMH B cJIYI.J:a5lx:

- AJIJIeprHH K neHHUHJIJIHHY

- HenepeHocHMoCTH HJIH OTCYTCTBHH OTBeTa Ha JIeI.J:eHHe ,llpyrHMH aHTH6HoTHKaMH, BKJIlOI.J:a51

neHI1UHJIJ1HHbI HJII1 uecpaJIOCnOpl1HbI

- I1HcpeKUHH, BbI3bIBaHHblX MHKpOOpraHI13MaMI1, I.J:YBcTBI1TeJIbHbIMH K BaHKOMI1UHHY, HO YCTOHI.J:HBbIMI1 K

,llPYrHM aHTHMI1Kpo6HbIM npenapaTaM

flce600Mej1l6paU03Hblii KOflllln - KaK pacTBop ,llJI5I npl1eMa BHYTPb (CM . pa3,lleJ1 «cnoco6 npl1MeHeHI151 11

,l103bb».

IIpoTMBonoKa3aHHH

ryrnep4YBcTBHTeJIbHOCTb K BaHKOMHUyIHY, 6epeMeHHocTb (1 TpI1MecTp), nepHO,ll JIaKTaUHI1,

HeBpHT CJ1yxoBoro HepBa, nOI.J:eI.J:Ha51 He,llOCTaTOI.J:HOCTb.

C ocmOpOJ/cHocmblO npHMeH5ITb npH HapyweHI1M cJIyxa (B TOM 4HCJIe B aHaMHe3e),

6epeMeHHocTb (2 11 3 TpHMecTp).

Cnoco6 npuMeHeHHH H il:03bI I1pH BBe,lleHHH BaHKOMI1UHHa peKOMeH,llyeMa51 KOHueHYpaUH}! COCTaBJI5IeT He 60JIee 5 Mr/MJI H

CKOPOCTb BBe,lleHH5I He 60JIee 10 Mr/MHH . Y 60JIbHbIX; KOTOPbIM nOKa3aHO OrpaHHI.J:eHl1e nOTpe6JIeHI151

)KI1,llKOCTH, MO)!(eT npI1MeH5ITbC5I KOHueHTpaUI151 ,llO 10 Mr/MJI 11 CKOPOCTb BBe,lleHI151 He npeBblWalOma51 10 Mr/MHH. O,llHaKO, B cJIYI.J:ae TaKI1X KOHueHTpaUHH B03pacTaeT BepO}!THOCTb Pa3BHTI1}I n060I.J:HbIX 51BJIeHHH,

CB5I3aHHbIX C HHCPY3HeH.

B3pOC.7bJe:

- -------------------------- -

.ll.03a )],JI5I 60JIbHbIX C HOpMaJIbHOH CPYHKUHeH nO'-leK COCTaBJI5IeT 2 r BHYTpHBeHHo (no 500 Mr

Ka)l()],ble 6 '-IaCOB HJIH no 1 r Ka)l()],ble 12 '-IacoB). Ka)l()],YI{) )],03Y CJIe)]'yeT BBO)],HTb co CKOPOCTbIO He 60JIee

10 Mr/MHH H B Te'-leHHe He MeHee 60 MHHYT. B03pacT H HaJIH'-IHe O)lmpeHH5I Y naUHeHTa MorYT

nOTpe60BaTb H3MeHeHH5I 06bI'-IHOH )],03bI Ha OCHOBaHHH onpe)]'eJIeHH5I KOHueHTpaUHH BaHKOMHUHHa B

CbIBopoTKe.

J(emu:

06hI'-IHa51 )],03a COCTaBJI5IeT 10 Mr/Kr H BBO)],HTC5I BHYTpHBeHHo Ka)l()],ble 6 '-IaCOB. Ka)l()],YI{) }J,03Y

CJIe}J,yeT BBO}J,HTb B Te'-leHHe He MeHee 60 MHHYT.

J(emu pamte?o G03paCma u HOGOpOJIC()eHHble:

.ll.JI5I HOBOpO)l()]'eHHblx Ha'-laJIbHa51 )],03a )],OJI)I(Ha COCTaBJI5ITb 15 Mr/Kr, a 3aTeM 10 Mr/ Kr Ka)l(}J,ble 12

4aCOB B Te'-leHHe nepBoH He)],eJIH HX )KH3HH. Ha'-lHHa51 co BTOPOH He)],eJIH )l(H3HH - Ka)l()],ble 8 '-IaCOB )],0

)],OCTJ1)I<eHl151 B03pacTa O)],HOro MeC5Iua. Ka)K)],YI{) )],03Y cJIe)],YeT BBO)],HTb B Te4eHHe He MeHee 60 MHHYT.

EOflbHbte C HapyzuewlOil QJYHKllueil notleK u nOJICUflble 6oflbHble:

EOJIhHbIM C HapyweHHoH (PYHKUHeH n04eK He06xo}J,HMO l1H)],HBl1}J,yaJIbHO no)]'6HpaTh )],03y . .ll.JI5I

nO}J,60pa )],03bI BaHKOMHUHHa }J,JI5I 3TOH rpynnbI 60JIbHbIX MO)l(HO HCnOJIb30BaTb ypoBeHh KpeaTHHHHa

CbIBOpOTKH. Y nQ)KHJIbIX 60JIbHbIX BaHKOMHUHH HMeeT 60JIee HH3KHH KJIHpeHC H 60JIhWHH 06beM

pacnpe}J,eJIeHH5I. Y 3TOH rpynnbI no)]'60p )],03bI ueJIeC006pa3HO npoBo)],HTb Ha OCHOBaHHH KOHueHTpaUHH

BaHKOMHUHHa B CbIBopoTKe. Y He}J,OHoweHHbIX )],eTeH H y nQ)KHJIbIX 60JIbHbIX B pe3YJIbTaTe CHH)I(eHHOH

CPYHKUHH n04eK MO)l(eT nOTpe60BaTbC5I 3 Ha'-l HTeJIhHOe CHH)I(eHl1e )],03bI. CJIe}J,yeT peryJI5IpHO

KOHTPOJIHpOBaTb KOHueHTpaUHI{) BaHKOMHUHHa B CbIBopOTKe. B npHBe)]'eHHOH HH)I(e Ta6JIHue YKa3aHbI

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C HapyweHHoH cpYHKUHeH n04eK

KJIHpeHC KpeaTHHHHa MJI/MHH .ll.03a BaHKOMHUHHa Mr/24 4aca

100 1,545

90 1,390

80 1,235

70 1,080

60 925

50 770

40 620

30 465

20 310

10 155

3TY Ta6JIHUY HeJIb351 npHMeH5ITb }J,JI5I onpe)]'eJIeHH5I )],03bI npenapaTa npH aHypHH. TaKHM

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B HeCKOJIbKO }J,HeH (npH KK 10-50MJI/MHH - 1 r Ka)l(}J,bIe 3-7 }J,HeH, MeHee 10MJI/MHH - 1 r Ka)l()],hle 7-14

}J,HeH). TIpH aHypHH peKoMeH)],yeTc5I )],03a 1 r Ka)l()],ble 7-10 }J,Hei1.

HHcmpYKlf1.lU no npU?OmOGflemllO pacmGopa amI 6HympUGeHHO?O G6erJeflll>l

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P A3BE)J.EHl1E npl1rOTOBneHHoro pacTBopa.

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napeHTepaJIbHOrO BBe)],eHH5I CJ1e)],yeT npOBep5lTb BH3yaJIbHO, eCJIH 3TO B03MQ)KHO, Ha Hanwme

MeXaHI1'·leCKHX npHMeceH H H3MeHeHHe UBeTa.

--- - ----- ------- - - - -

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YJIYIfweHI151 BKyca pacTBopa K HeMY Mo)KHO 'z:{o6aBJI5ITb 06blIfHble nI1meBble CI1pOnbI.

IIPO'[(OJI)I(I1TeJIbHOCTb JIeIfeHI151 - 7 - 10 ,[(HeH.

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