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Рациональная фармакотерапия основных заболеваний влагалища
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Аннотация
В статье изложены вопросы рациональной фармакотерапии у женщин с вульвовагинитами разной этиологии. С учетом патогенеза основных заболеваний влагалища дана обоснованная концепция местного применения современных комбинированных препаратов. Применение безопасной лекарственной формы метронидазола, миконазола и лидокаина (Нео-Пенотран® Форте Л) помогло быстро снять симптомы острых дискомфортных ощущений у пациенток с клиническими проявлениями вульвовагинитов. Хорошее купирование болевого синдрома, обычно проявляющегося в виде жжений, зуда, отечности, гиперемии преддверия влагалища и тканей промежности, позволило достигнуть максимальной комплаентности во время лечения и добиться не только клинического, но и патогенетического эффекта. Сочетание метронидазола и миконазола показало дозозависимую эффективность, обусловленную видом возбудителей и формой болезни влагалища, а также оказало положительное влияние на рецидивирующие формы болезни.
Ключевые слова: смешанные инфекции, трихомониаз, кандидозный вульвовагинит, метронидазол, миконазол, лидокаин.
Ключевые слова: смешанные инфекции, трихомониаз, кандидозный вульвовагинит, метронидазол, миконазол, лидокаин.
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This paper outlines the issues of rational pharmacotherapy for women with various vulvovaginal etiology. Taking into consideration the pathogenesis of major diseases of the vagina, the concept of therapy based on combined drugs. Implementation of safe dosage forms of metronidazole, mikоnazole and lidocaine (Neo-Penotran® Forte L) allowed to quickly relieve symptoms of acute discomfort sensations in patients with symptomatic vulvоvaginitov, relieving pain, usually manifested in the form of burning, itching, edema, hyperemia of the vestibule and perineal tissues, allowed to achieve maximal compliance during treatment and achieve not only clinically but also pathogenic effect.
The combination of metronidazole and mikоnazole showed a dose-dependance efficiency that depends on the type and form of the disease pathogens vagina, as this combination of drugs had a positive impact on the recurrent form of the disease.
Key words: mixed infections, trichomoniasis, candidiasis vulvovaginitis, metronidazole , miconazole, lidocaine.
Полный текст
Список литературы
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12. Kirjavainen P, Pautler S, Baroja ML et al. Aberrant vaginal microbiota and IL-12 skewed cytokine production by antigen-presenting cells are characteristic of women prone to urinary tract infections. Clin Vaccine Immunol 2008; 16 (1): 29–36.
13. Beerepoot MA, ter Riet G, Nys S et al. Lactobacilli vs antibiotics to prevent urinary tract infections: a randomized, double-blind, noninferiority trial in postmenopausal women. Arch Intern Med 2012; 172 (9): 704–12.
14. Ferris DG, Litaker MS, Woodward L et al. Treatment of bacterial vaginosis: a comparison of oral metronidazole, metronidazole vaginal gel, and clindamycin vaginal cream. J Fam Pract 1995; 41 (5): 443–9.
15. Johnson SR, Griffiths H, Humberstone FJ. Attitudes and experience of women to common vaginal infections. J Low Genit Tract Dis 2010; 14 (4): 287–94.
2. Sobel JD. Vulvovaginal candidosis. Lancet 2007; 369: 1961–71. Davies S, Johnson E, White D et al. How to Treat persistent vaginal yeast infection due to species other than Candida Albicans? J Sex Transm Infect 2013; 89 (2): 165–6.
3. Danby CS, Boikov D, Rautemaa-Richardson R et al. Effect of pH on in vitro susceptibility of Candida glabrata and Candida albicans to 11 antifungal agents and implications for clinical use. Antimicrob Agents Chemother 2012; 56: 1403–6.
4. Brown JM, Hess KL, Brown S et al. Intravaginal practices and risk of bacterial vaginosis and candidiasis infection among a cohort of women in the United States. Obstet Gynecol 2013; 121 (4): 773–80.
5. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions, 2011. http://www.cochrane-handbook.org/
6. Nyirjesy P, Peyton C, Weitz MV et al. Causes of chronic vaginitis: analysis of a prospective database of affected women. Obstet Gynecol 2006; 108: 1185–91.
7. Boughton B, Marten М. Chlamydia screening guidelines miss some high-risk groups. American congress of obstetricians and gynecologists (ACOG) 60th annual clinical meeting, 2012.
8. Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance, 2010. Atlanta, GA: US Department of Health and Human Services. Julian PT Higgins, Sally Green (Eds). Cochrane Handbook for Systematic Reviews of Interventions, 2011. http://www.cochrane-handbook.org/
9. Hummelen R, Fernandes AD, Macklaim JM et al. Deep sequencing of the vaginal microbiota of women with HIV. PLoS ONE 2010; 5 (8): e12078.
10. Ravel J, Gajer P, Abdo Z et al. Vaginal microbiome of reproductive-age women. Proc Natl Acad Sci USA 2011; 108 (Suppl. 1): 4680–7.
11. Brown JM, Hess KL, Brown S et al. Intravaginal practices and risk of bacterial vaginosis and candidiasis infection among a cohort of women in the United States. Obstet Gynecol 2013; 121 (4): 773–80.
12. Kirjavainen P, Pautler S, Baroja ML et al. Aberrant vaginal microbiota and IL-12 skewed cytokine production by antigen-presenting cells are characteristic of women prone to urinary tract infections. Clin Vaccine Immunol 2008; 16 (1): 29–36.
13. Beerepoot MA, ter Riet G, Nys S et al. Lactobacilli vs antibiotics to prevent urinary tract infections: a randomized, double-blind, noninferiority trial in postmenopausal women. Arch Intern Med 2012; 172 (9): 704–12.
14. Ferris DG, Litaker MS, Woodward L et al. Treatment of bacterial vaginosis: a comparison of oral metronidazole, metronidazole vaginal gel, and clindamycin vaginal cream. J Fam Pract 1995; 41 (5): 443–9.
15. Johnson SR, Griffiths H, Humberstone FJ. Attitudes and experience of women to common vaginal infections. J Low Genit Tract Dis 2010; 14 (4): 287–94.
________________________________________________
1. Marrazzo JM. Interpreting the epidemiology and natural history of bacterial vaginosis: are we still confused? Anaerobe 2011; 17: 186–90.
2. Sobel JD. Vulvovaginal candidosis. Lancet 2007; 369: 1961–71. Davies S, Johnson E, White D et al. How to Treat persistent vaginal yeast infection due to species other than Candida Albicans? J Sex Transm Infect 2013; 89 (2): 165–6.
3. Danby CS, Boikov D, Rautemaa-Richardson R et al. Effect of pH on in vitro susceptibility of Candida glabrata and Candida albicans to 11 antifungal agents and implications for clinical use. Antimicrob Agents Chemother 2012; 56: 1403–6.
4. Brown JM, Hess KL, Brown S et al. Intravaginal practices and risk of bacterial vaginosis and candidiasis infection among a cohort of women in the United States. Obstet Gynecol 2013; 121 (4): 773–80.
5. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions, 2011. http://www.cochrane-handbook.org/
6. Nyirjesy P, Peyton C, Weitz MV et al. Causes of chronic vaginitis: analysis of a prospective database of affected women. Obstet Gynecol 2006; 108: 1185–91.
7. Boughton B, Marten М. Chlamydia screening guidelines miss some high-risk groups. American congress of obstetricians and gynecologists (ACOG) 60th annual clinical meeting, 2012.
8. Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance, 2010. Atlanta, GA: US Department of Health and Human Services. Julian PT Higgins, Sally Green (Eds). Cochrane Handbook for Systematic Reviews of Interventions, 2011. http://www.cochrane-handbook.org/
9. Hummelen R, Fernandes AD, Macklaim JM et al. Deep sequencing of the vaginal microbiota of women with HIV. PLoS ONE 2010; 5 (8): e12078.
10. Ravel J, Gajer P, Abdo Z et al. Vaginal microbiome of reproductive-age women. Proc Natl Acad Sci USA 2011; 108 (Suppl. 1): 4680–7.
11. Brown JM, Hess KL, Brown S et al. Intravaginal practices and risk of bacterial vaginosis and candidiasis infection among a cohort of women in the United States. Obstet Gynecol 2013; 121 (4): 773–80.
12. Kirjavainen P, Pautler S, Baroja ML et al. Aberrant vaginal microbiota and IL-12 skewed cytokine production by antigen-presenting cells are characteristic of women prone to urinary tract infections. Clin Vaccine Immunol 2008; 16 (1): 29–36.
13. Beerepoot MA, ter Riet G, Nys S et al. Lactobacilli vs antibiotics to prevent urinary tract infections: a randomized, double-blind, noninferiority trial in postmenopausal women. Arch Intern Med 2012; 172 (9): 704–12.
14. Ferris DG, Litaker MS, Woodward L et al. Treatment of bacterial vaginosis: a comparison of oral metronidazole, metronidazole vaginal gel, and clindamycin vaginal cream. J Fam Pract 1995; 41 (5): 443–9.
15. Johnson SR, Griffiths H, Humberstone FJ. Attitudes and experience of women to common vaginal infections. J Low Genit Tract Dis 2010; 14 (4): 287–94.
Авторы
А.Г.Кедрова
ФГБОУ ДПО Институт повышения квалификации ФМБА России, Москва
ФГБОУ ДПО Институт повышения квалификации ФМБА России, Москва
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A.G.Kedrova
Цель портала OmniDoctor – предоставление профессиональной информации врачам, провизорам и фармацевтам.