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 | Alimentatie | Asistenta sociala | Frumusete | Medicina | Medicina veterinara | Retete |
I. Diagnostic
ex. sumar urina
hemoleucograma
VSH, CRP
urocultura
hemocultura
identificare factori favorizanti
ecografie renala si pelvina
glicemie
sarcina (test sarcina, ecografie, consult ginecologic)
obstacol (UIV)
II. Tratament in functie de forma clinica
|
Forma clinica |
Etiologie |
Tratament de prima intentie |
Alternative terapeutice |
Durata tratament |
|
PNA necomplicata severa |
BGN (E. coli, Proteus, Klebsiella) Staphilococcus saprophyticus Enterococ |
AminoPen / AminoPen+ +inhib.βlactamaza +Aminoglicozid Fluorochinolone |
Cefalosporine gen III / gen. IV ±aminoglicozid Carbapeneme |
14 zile* |
|
PNA complicata severa |
BGN (E. coli, Proteus, Klebsiella) Staphilococcus saprophyticus Enterococ Piocianic Serratia |
Βlactamina antipiocianic +inhib.βlactamaza ( Timentin / Tazocin ) |
Cefalosporine gen III (antipiocianic ) ± aminoglicozid Carbapeneme |
14 - 21 zile * |
|
PNA la gravida |
BGN (E. coli, Proteus, Klebsiella) Staphilococcus saprophyticus Enterococ |
AminoPen / AminoPen+ +inhib.βlactamaza |
Cefalosporine gen III / gen. IV |
14 zile* |
|
ITU Nosocomiala |
BGN (E. coli, Proteus, Klebsiella) Piocianic Acinetobacter Fungi |
Βlactamina antipiocianic +inhib.βlactamaza ( Timentin / Tazocin ) + Fluorochinolone / aminoglicozid antifungic (Fluconazol) |
Cefalosporine gen III (antipiocianic ) + Fluorochinolone / aminoglicozid Carbapeneme Voriconazol / Caspofungin |
14 - 21 zile * |
* tratament iv pana are minim 48 ore de afebrilitate, apoi poate primi tratament po (AminoPen+inhib.βlactamaza sau Fluorochinolone)
|
Forma clinica |
Etiologie |
Tratament de prima intentie |
Alternative Terapeutice |
Durata tratament |
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Abces intrarenal cortical |
Staphilococcus aureus -meti sensibil |
Oxaclina + aminoglicozid |
Fluorochinolone |
10 - 14 zile inj. apoi 2 - 4 sapt trat. po |
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Staphilococcus aureus -meti rezistent |
Glicopeptide |
Linezolid Carbapeneme |
10 - 14 zile |
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Abces intrarenal cortico-medular* |
Staphilococcus aureus BGN |
Βlactamina +inhib.βlactamaza ± Fluorochinolone / aminoglicozid Fluorochinolone inj |
Cefalosporine gen III ± aminoglicozid Carbapeneme |
10 - 14 zile inj. apoi 2 - 4 sapt trat. po |
*Drenaj chirurgical percutan (in caz de esec al terapiei cu antibiotice / abces mare / urosepsis / uropatie obstructiva )
III. Supravegherea eficientei terapiei
- afebrilitate dupa 48 ore de tratament antibiotic - continua tratamentul
- febra dupa 48 ore de tratament antibiotic - repeta urocultura
+ antibiograma
- ecografie
- consult urologic
- UIV
IV. Tratament asociat in ITU
hidratare 2-3 l lichide/zi ( solutii cristaloide, solutii macromoleculare in soc, ser glucozat, saruri de rehidratare orala)
AINS
HHC (urosepsis, soc)
Antiseptice urinare
Combaterea constipatiei (laxative)
V. Durata spitalizarii
ITU necomplicate = 7-10 zile
ITU complicate = 10 - 21 zile
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