Антибиотикорезистентность - Приказ МЗ РБ 1301 от 29.12.2015

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4t
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o
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que ryru
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Q
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r eparl nrrltuu/ ras o 6 alcrard
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ry
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6
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JIeKapcrBeHHoe cpeAcrBo (rercapcrBennbre cpe4crna), ncroJrb3oB€urue Koroporo(rx)
rpeArotlTrlTeJrbuee B cnfrae rffx(enoro rz^rrw 6rrcrpo nporpeccnpyrouero reqeHras ceflcnca
(nanuuura y nilIIdeHTa rffxeJroro cerrcnca, ceflTraqecKoro ItroKa, cI,IHApoMa flonr4oprannuofi
HeAocrarouuocrn).
2
- ssfiflorct o6ssareJrbHblMl,r JreKapcrBeHHbrMr,r cpeAcrBar\drr npn pa3 Bvrrukr cerrcnca na Qone
3aTgxHbD( I{ XpOHI{qeCKI,IX CTTHyCHTOB, OTLTTOB, OCTpOTO U XpOHIITTeCKOTO MaCTOTTAHTA.
' - tBrrlorcff o6ssarenbHbrMrr neKapcrBeuHbrMrr cpeAcrBaMn rpn roAo3penru (namawrr Qarcropon
pucra) Ha Jrerl,IoHenne3uyro grrroJrorruo sa6ores artrz's,. Ee cJreAyer rpeAroJrararb rpn
Bo3HI.rKHoBeHuI,t ceficuca na QoHe rtxejloro reqenus sHe6orbnr{rrHoft nnesiuoHr,ru npr{ HaJr?rvtrv y
raIIueHToB Hl,IxecneAyroqnx QarropoB pr,rcKa: Bo3Hr{KHoBeHLre sa6orenanfifl, B Terrnoe BpeMs roAa,
Bo3pacr crapme 40 rer, MylxcKofi uoro rryreruecrBr,re BHyrpr,r crpanbr rriln 3apy6ex B TerreHr,r e 2-10
Aueft Ao HarIaJIa KJII,IHI,IqecKIrx ttpotBneuufi ga6oJreBifruff, KypeH[re, 3noyflorpe6neHr{e arrKoroJreM,
car<apnrrft \wa6er, r,rMMyHoae$firlrlrrr (r r.-rr. Ha Qone rpueMa rnroKoKoprr,rKocreporrAoB rrJrr,r rrHbrx
JreKapcrBeHHbrx cpeAcrB, o6naAarorqux r{MMyHo cyrpec crrBubrM Aefi crnneM).
o
- ttp" prBBI{Tr{I{ cencrca 6eg BbrpaKeHHbrx (r r.u. iby"rq"onirrrbHbrx) oprannbrx ropa:Kenufi, npr
ycnoBl,Iu yAarleHl,rs opl'aHa (.racru opraHa), trBJrsBruerocff [epBr,rrrHbrM oqarorr,r r,rHQeKrIllH.
I - tp" pa3Brrrrr cercr{ca 6eg BbrptDKeHHbx (n r.u. rpyHrrluoHtrrrbHbrx) opraHHbrx nopiDr enuft.
o
- ttp" Htuluqlru B aHaMHe3e aHTLIMLrKpo6xoft Tepam,ru vurvr npe6nnanur B crtul]roHape 6es
r,ruBffrr,rBHbrx BMetuareJrbcrB B TerreHr.re nocJreAnnx 90 nHeft, a raKxe y [arIueHToB flo)Kr.rJroro
Bo3pacra (>65 rer) rur6o y [arIreHToB, rrMeroulux BbrptDKeHHbre (nrur MHo)KecrnenHue)
corryrcrByroqne sa6ore g anvrfr.
' - ncronrcyercff [pr4 ypoBue pe3r,rcreHTHocrr{ K aMoKcnqunnr,rnylwranyna*ary MeHee 30Yo s
perProHe.
8
nnQerqnft y
Mr,rKpoopraHpr3MoB, rrpoAyrlupyrorqux 6era-raxtaMa3br
- a*arbr, BKJrroqaroruue oprarreneM, flBJrrrorc.tr Teparruefi nu6opa B cnfrae pa3Brrrux
[arlrdeHToB c Qaxroparnrr.r pucKa lnaJrv.rrnfr,
pacmrpeHHoro creKrpa Aeftcrnur @nPC).
' - Krr,rHAilMr{qun coxptmrer 3HarreHr{e B cxeMil( Teparu,ru un$eruufi tusml[x rKaIIefi (oco6eHno
HeKporr,r3rrpyroque nnQerquu), rpu Koropbx cyrqecrBeHHa poJlb KJlocrpl{gIazutrnofi Qnoprr,
Ttuorce ocreoMr.relura c freroM xopouero rrpoHrrKHoBeHur anna6uorrrKa B KocrHylo rKaub. B
ocraJrbHbrx cJryqurx flpn cMerrraHHbrx un$erqurx B KaqecrBe arlTrlaHagpo6noro cpeAcrBa
rlp e.{il o qTI,ITe JIbH O I,I CII Onb3 O B arb M erp O HLrAa3 On.
l0 [crorIHI,IK cettclilca cql,ITaercg HeI,I3BecrHbIM, ecJILr flpn o6cneAoBalr4w naqueHTa He 6rrn
o6uapyxen [epBrI.IHHfi oqar.
OnrnuaJrbHafl 3Tr.rorporrHafl Tepanrrfl nHe6o.rrrHrrrrHoro ceflcrlca B 3aBrrcrrMocrrr or
BbI,UeJIeHHOTO
AIITEJIf
Tepanns nrr6opa
Murpooprau[r3M
qeQenurr,r nnu qe$oraKclrM unu qeQrpuarcoH
Enterobacteriaceae
aMoKcrrrlurwrn/ruaByJraHar
spp. (BJIPC-)
quupo0noKcarlun, nero6noKcarlrrn
Enterobacteriaceae
SpraIIeHeM
spp. (BIIPC+)
MeruuururuHrIyBcTBrrTeJrbHbIe
m,r[epaq u:lriru*I raso 6 axtaM + arr,runaquH'
aMoKcrrqurrnu/ruanynanar
KJII,I HAf ii\d
S.aureus
urM o
Anaspo6rr
I,I
qI,IH
Kcr.rqurnuH/xraBynaH ar
MerpoHI,IAUB OJI I,IJILT KJIT,IuAaUIAqU'
I
rraorcnQnoKcalrlaH
SpraleHeM
S.pneumoniae,
ueSrpuaxcou, ueSoraxcr/rM, aMoKcr,ilIurman/xranynanat*MaKpoJlrrA
(arnrpouuqlru uJlrr KJIapurpoMnIII,IH)'
nenoQloKcalllau, rr,rorcn(f JIoKcaIITIH
gpra[eHeutuaxponrlA (asurporvrrIllrlH I{JIrI KJrapI,ITpoMI,IqrIH)3
KJraprlTpoMrIIIrIH, a3u'!poMurIlIH
Legionella spp.
reno6roKcalllln, uoxcn$JIoKc€uInH
- Krr[HA8lr\4trqr,rH coxpaHffer 3HaqeHI,Ie B cxeMax repam{E uHQerqnft Msmux TKaHefi (oco6eHHo
HeKporr,r3rrpyroqne nnserqnu), rpu Koropbx cyqecrBenHa ponb KJlocrpuAnaurnoft Qnopu,
TaKxe ocreoMr{eJrr{Ta c freroM xopouero [poHr,rKnoBeHrIfl antw6uorl,IKa B KocrHylo rKaHb. B
ocrarrbubrx cnyqa;rx rtpn cMeruaHHbrx un(perqurx B KarlecrBe arTuanaspo6noro cpsAcrBa
[peAlorITI,ITeJrbHo lrcrloJlb3oBarb MerpoHllAtBon.
2 HannarreHr,Ie aMLrKauI,IHa B correraHlr[ c m,I[epaIII,IJIJrI,IHoM/rago6aKraMoM o6ocHogarrHo c
IJAJIPTqId'N Y
YqETOM HTTIIEIIIIS CUHEPIU3MA ME)KAY AByI!{ff NEKAPCTBEHHbIMI{ CPEACTBAMU B CJITIAE
InoKa,
(nanuuux
ceflTl{qecKoro
rtxeJloro cerrcuca,
niul14egTa rsxe;roro reqeHlrs sa6orenannfi.
pe3rrcrgHTHocTrr K
ypoBHff
HeAocrarounocru),
norropraHnofi
cr,rHApoMa
ycnoBl,Iu orcyrcrBl'Is
rpu
perr{oHe,
raKxe
a
fiHrepaqunnvtrtyhaeo6arranay cBbrrrre 30% B
Bbrpa6ennoro Hapymennr (rnlrpeHc Kpearr,rHI,IHa Menee 50 iran/runn) Oy"*qtla rloqeK. B cnyrae
Hanrr4q{us. raroJroruu rorreK (napyrueHur Synrqnu no.rer) uenecooopasno paccMoTperb
Bo3MoxHocrb LrcnoJrb3oBaHlrf, usofi cxeMbr reparu{u. llpn orcytcrBrlu raxoft Bo3MoxHocrrl rpe6yerct KoppeKrlrt Ao3br rleKapcrBeHHbtx cpeAcrB.
r
- rou6uHupoBanHiu{ Teparu,rq B-narrarr,r + MaKpoJII,IA peKoMeHAoBaHa [au[eHTaMI'I c
ce[TI,IrIecKr,IM IrIoKoM na Qone rIHeBMoKoKKoBofo ceilcraca.
SrvrunpllqecKas repa[lrfl Brryrprrdo.nrnurrHoro cencuca B 3aBrrcrrMocrrr or JroKaJrrr3arlu[
ITIIHOTO OqATA IIHQEKIIHH
II
oJraraeMoro II
H.influenzae
flpe4noraraeirnrtfr
SruorporlH€ul Teparu{t
t*
T,ICTOIIHI,IK CENCUCA
Helrgsecrrrrrfi
KarerepaccoqullpoBaHHilI
unQeruuff KpoBoroKa
Panuss
BAII (< 4 anefi)
ruauegoJmA uIrvI BaHKoMTIuI'IH
rip6aneseurt
AHrucu"ettroft
H vrIrri,IIa[ToMrIurI H
uru r eirKo rr JI itrrtl""te
I{e(poueparon/cynr6arrau + nr,rHe3onl,IA uJTvr BaHKoM}IIIIIH rrltrt
t3
reftronraHl,IH r,tlrr4 AanroMLIIII,IHl4 + rolptct""2'
* anrncuueruoftHble rap6aneneMbl
@
+
JIIaHesorI,IA aHTucI{HerH ofi nrre xap6 aneH eMbr
B anrounql,IH * anrucunerHofi HbIe rap6 aneHeMbl
TefirounaHuH * anrucunernofiHble rap6aneueMbl
t xonuc rvrt2'13
* npouanorpu6roBoe reKapcrBenHoe cpeAgTEq3
I{eifanocropl,IHbl III-N TIoKoJIeHI{t 6es aHTr{cr{Heruoftuofi
aKTI{BHocna (ueQrpl,Iaxcou, qe$ orarcurr,r)
PecnnparopHble
rraoxcnQnorcaqran)
SropxuHoJIoHLI
Vlttrulurop-3iluulqeuHble 6era-larraMbr
r.ltaeynaHar)
3
(renoQrroKcaIII,IH,
(anaorcn\unnvla/
flogAnsr BAII (Z 5 anen)
IQpCaneHeM 6es anrrcr{HerHoft noft ar(Tr,rBHocrn (epraneHeu)a
Anrr,lcranerHoft nrre rap6aleueMbr * nuneg onnA fiJrr,r Banroi*rraqnns
I{eQouepaaoH/cynr6axrarrr * nuuegonr,rA urrr4 Baurornrqnrs
* ronuc rr4r2'l3
Vnrpaa6AoMr,rHarrbHbre
uH$erqnu vr un$erquu
opraHoB MaJrofo Ta3a
AHrrcnHernoftHr-,re xap6aneHeMbr
f
rrutesonr,rA raml reft KonJraHnH
IIJII,I BaHrOUnqI,rHo
I{e0onepason/cynr6arrau
nilv
ru,rrepaqunnwylraso6axrard +
JII,IHe3oJInIfi trrrtefi ronlamvrr:r.rlrvBalrouuunn6
* xoructl,IH2'13
I,lnQerquu
MorreBbrBoAsrqrx nyreft (n
Antucunernoftnrre rap6aneHeMbr
nororenufi
TIIACJIE
TOM
L{e$onepason/cynr6axrau
accoqlrr4poBaHHbre c * ronprcrr ''t3
*
+
aMnHoilruKo3trAbr II-UI
aruunornr4Ko3r{Abr II
-n
norolenr,rfi
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MoqeBbrx
rarerepos)
llnSerquu Ko)rc{
u
MfffKI,Ix rranefi, rocrefi u
JlnnesornA ulrvr AarrroMr,ru[H prnn refironnaHnu
BaHKoMIIIIIIHT * anrncranernofi Hbre rap6aneHeMbr
cycTaBoB
Jlnuesoma4
BaHKoMLIIII{H7
r4lrfi
AarrroMr,ruuH
ullvr
reftroulanlrn
VIJIN
VTIII"i
+ Ile0onepasoH/cym6axranr
TureuprxrprH
u
I,InQerquu
UHC Anru uu erHo ft nrrft rap au en eiu + lun onI4 A vrJrvr BalE.KoM r,rql,I H
(rnoftnsrft MeHnHrrlT, I{eQ onepas on/cynr6axrau * mlnegonnA r,rJrr4 BarrKoMr,rqr,rn
a6cqecc Mo3ra v r.a.) * rolnc rr4r''
c
t
6
e3
13
IIocJIe
uefi poxnpyprr,rqecKr,[x
BMEIuATEJIbCTB
OnrnuaJrbHafl STr.rorponHafl Tepanl{fl BHyrprr6o.nrnnrrHoro cencnca B 3aBrrcrrMocrrr or
BbrAeJreHHofo nor6 AIITEJIfl
MnrpoopraHrrsM
Tepauur rrr6opa
EJIPC- E.coli, K.pneumoniae,
I{eQanocnoplrHbr III-IV roKoJreur.r.f, 6es arrrnc}ruenroftnoft
P.mirabilis
AIOI,IBHOCTI,I
flun epaq utmuvI rag o 6 arraM r,r Jrr,r u e Q o n ep ar on/cyn r 6 arrau
OtopxnHoJroHbr II-I[ uoroneHnfi
BJIPC+ E.coli, K.pneumoniae,
Kap6aueHeMEI 6es auT[cuHernoftHoft ru(rrrBHocrr.r
(epranenerra)
P.mirabilis
ouepason/cyns6axrau
Tnreuraxnun8
Korucrnng' 13
I{e
Enterobacter spp., Citrobacter
spp., Seruatia spp., Providencia
spp., Morganella spp.
P.aeruginosa
Q
Kap6aneHeMbr
I{eQ onepasoH/cynr6arm^u
Tureuuruun8
13
KoructuHg'
Kap6aneueMbr
c
xol"cruul3
firrn
17.
aHTlrcr,ruernofinoft al(Tr,rBHocrbro +
qunpoQnoKcauun/nenoQJroKcarlriu +
KOJrrrcTI,IH-- (B CJIrIae TIyBCTBI,ITeJIbHbIX TOJTbKO K KOIIUCTI,IHy
rsonxron)
Kap6aneHeMbr
c
aHTucuHernofinofi
ar(TnBuocrbro
(aopnneHeM, MepolreHeM, rrMlrneHerr,r)
I{e<[anocilopr,rnbr
III-IV
rroKoJreHrrfl
c
aHrucrrnernofiroft
ar0r,rBHocrbrc
*
II-ilI norolennfi
arrlIaHorilnKo3llau
Ilunpo$noKcaquu/nenoQnoKcallun
* arrlngogx1Ko3u,qbl II-m
v
IIOKOJICHNU
Kap6aneueMbl c aHTucrrHernofiuoft ar(TrlBnocrbro +
cyru6axtau
IleQonepason/cynr6axrau + aMrrnornlilKo3rlAbr II-m
Acinetobacter spp.
troKoJIeHttit"
Arunuqunwtu/cynr 6 armu
+
al\dl,InorfluKo3rrAbr
II-m
rroKoJrenutrrrz
aHT[ICI,IHernOfinOfi aKTI'IBHOCTrIO +
C
Kap6aneHeMbl
aMuHoruII{Ko3tI.IIbI II-
ru
n oKoJIeH
uirr2
Tureqnrrtnn
Konncrnnl3+xap6aneneMbrcarrrrlcrluernofinofi
IUCTuBHOCTrIO (n Cnflae qyBCTBuTeJIbHbx TOJIrKO K
KOJIUCTIHy I,I3On
flron)
Konucrunl3 +
ueQonepason/cynr6artau
BCTBlrrgiIbHbx roJIbKO K KOiIUCTfi Hy
Stenotr ophomonas malt oPhila
crBI'ITelurufi
S.aureus (MSSA)
cJrrrae
I',I3OJISTOB
Ko-tplttttoKcff!orI
Tra
MernquJIJII,IH - qyB
(n
rapuurtrruur/ru aByn
OrcauunuuH
*
aH
ar
aI\,ILIHoilII,IKo3I'IArI
I{eifalocropl,Igbl
nororenufi
I-II
II-m norolenufi
noroJIeHI,It
*
auunorJll'IKo3l{nrr
II-[I
I4nrufiuTOp-3aIUuUIeHHbIeIeHI,IqUJIJILIHII*aruranOilI[IKO3I'IAbI
U-III norolenuft
JlunrosardrlAbr
MetrnqnnJIrrH -pegncrenrnrrfi
JIuHesonI,IA
S.aureus (MRSA)
,{anrorvr"u"nto
Tnreuurrtun
BanrounqrrH
Teftronnil{I,IH
Enterococcus faecalis
AunuuuJIJrrIH
* ctpeuroMrlul{H/renrauuullg
Banrorruqun * crpentoMrlql'In/reurau[ulrn
TefironlaHI,IH
Enterococcus faecium
B
asrouuqlln
* crpeuroMllql'Iu/resmuuqlru
JIHHesonur,rr
t'
Aanrorran qro"t
to
Tnreunnm,lnll
MerpouI,IAa3on
Kap6aueHeMbr
MorcuQJIoKcaIIrrH
KrurnAauI{qlrH
SxunoraHALIHbI (necra6uJlbHoe cOcTOtHIIe naqIIeHTa' BIIA
candida He orrpeAeJreg, paHee [prrMeH flrrr11cb asorru)
onyrona3oJr (cra6lrJrbHoe cocToffHlle
6OnbIrOrO,
r4cIIoJrb3oBnJrcff)
Bopurou€Bon (craOulrnoe cocrof,Hr{e 6olruoro,
nos6y4nreJrb pe3r,rcrenTeH x Qlyxonasorry)
ArraQorepuqr,rH B (onmuanrno JunocoMamnrrft) (np"
HenepeHocr{MocTr{
pTrrr4 HeAocTy[HocTra Apyr[x
AIIT}IMI,IKOTIIKOB
- AuulcrauernoftHbre rap6aneneMbr -
rap6aneHeMbr, o6na,Aarorqne ar(Tr.rBHocrbro B orHorrreHr.rlr
rpaMorpl,IllareilbHbD( neQeprr,reHrlrpyroqux 6axrepuft: P.aeruginosa, Acinetobacter spp.
(uuuueueM, MepoleneM, 4opznenerr,r).
paSBkrrnfr Ho3oKoMl{arlbnoro ceficuca B orAeneHrrflx c pac[pocrpaHenHocrbro
lryBcrBl,rreJlbHbrx roJrbKo K Konr{cr}rny P.aeuruginosa u A.baumannii rro AilrrHbrM JroKarrbrroro
rr,rraxpo6uoJlofrqecKoro MoHtrropuHra > 20yo erwr \pvr HaJrurqlvu QaxropoB pr{cKa nHonqnpoBaHrrt
rlpe3Bbrlafiuo yctoft.rnBbrMl,I [aroreHaMu (nocrynnenr4e r43 Apyroro crarlraoHapa, [oBTopHoe
BbIICJIEHIIE IIATOTEHA B TEKYIIIYIO TOCIILIT€IIIIrcAIIUrc, I{MMYHOCYIIPECCVIfl, AJIIITENbHA'I
rocnl,ITaJln3arrws, B <npobneMHbleD orAeJreur,rr, flpeArrrecrByroqiur anru6arrepr{alrbuaff Teparrnq
autu6uoruK€lMla lurrpoKol'o crleKTpa, Bbr[oJrnenr,re uHBtts]rBnbrx BMerrrareJrbcrB n <upo6JreMHbrp)
' - B cnrrae
a"
orAeneHrdf,x).
i^
u
- 9runnpntlecKafi TepaflI{ff KareTep-accoqunponauuofi KarrAnAeuwr AoDKHa Hff}HaqaTbcr B
cnyqae HarIHtIIf[t nrc6oro LI3 cneAylolllux SaxropoB pr,rcKa: noJrHoe rapeHTepaJrbHoe rrrirraHrre,
AillrreilbHoe [cfloJrb3oBtur[e aHTrI6raoturoB rur,rpoKoro c[eKTpa Aeficrsur, onKoreMaroJrornqecKoe
sa6oresanvIe, peqnnuenT KocrHoro Mo3ra lrJur AoHopcKr{x opraHoB, Karerepr,r3arl[ff 6e4pennofi
BeHbI IaJII{ KoJloHr,r3arlrs Candida spp. AByx n 6oree noKycoB opraHra3ir,ra. @rryKouiltoJr Moxer 6um
LrcrIoJIb3oBaH B cnfrae orcyrcrBriff flpeArrrecrByroqefi TeptlrruIa a3onaMr,r B rrpeAbrAyrq[e 3 iuecsqa
r.r B ycJroBvrflx) KorAa prrcK uHQerqrnu C.glabtatautu C.krusei orreHb nrsxrft.
4 - Kap6aner{eM, He o6nalaroqufi
uu(TuBHocrbro B orHorueHrrr,r rpaivrorprrrlarenbnbrx
(epranenenr).
eprraeHrr4pyroulux
daxrepuft
Ier[
B cryrae cerrcrrca Ha Qone nogAnefi BAII HiBHarrenr{e nr,rHe3oJrr{ Ea vrrr4 rJmKo[errrr4oB
(ranrour{rlr{Ha, TefiKo[nanzua) peKoMeHAoBaHo rnr(eJrbrM rrarlrrenTaM c secra6nmnofi
reMoAr,rHauurofi H floJruoprannofi HeAocrarorrHocrbo, & TaK)r(e B cJrfrae :elarrur{ufi. QarropoB prrcKa
MRSA (npe4ruecrByrouiu anrn6arrepr,rurirbHuur reparufl, BbrcoKarr rracrora pacrpocrpaHenuff
MRSA B or4eJreHr{n ro AaHHbrM nanrpo6uororuqecKoro MoHr,rropvrnra, AJII{TeJIbHttff
rocrlrrzrJrkrsaps, r{MMyHocyupeccrax). llpeanoqrenr,re AonxHo orAaBarbcr JII{He3oJI}rAy
BcJreAcrsue 6oree Bbrcoroft uuHrarrecKoft eQQexu.rBHocrrr ro cpaBHeHr,rro c Drr.rKorrenrlrAillupr rtpri
uH Q erqur,r AaHHoft roran nsa\nn.
6 - HagHa.reHlre anru6norr,rKoB, tu(TrrBHbD( B ornorrreHnr,r MRSA, peKoMeHAoBzuIo B cJrfrae
AoKWeHTT{poBaHnoft upeArtrecrByroqefi KoJronrr3aLluvr [iuIEeHTa AaHHbrM MI,IKpoopraH]r3MoM, o
raKxe B cnyrrae neeQ$eruaBHocrpr rpeArrrecmyroqefi anru6norl,IKoreparrur 6eg anrn-MRSA
AKTI{BHOCTII.
' - B cJryqae ceucllca K€u( pe3ynbrara ranQerqnfi xoxrr I{ MflrKl,rx rKarrefi, rocreft u cycraBoB
7^tvvv
rpeAroqreHrre cneAyer orAaBarb JrrHe3onprAy rr AarroMr,rqrrHy Kiu( Harl6onee eQSerrnBHbIM B
cJrfrae nxQerquft Aarrnofi loralvlcapfl rro AaHHbrM KJrr{HurrecKr{x EccneAosanntrT.
8 - Ilpupoanoft ycroftvr,rBocrbro K rr{reqr,rKJrrrHy o6naAaror P.aeruginosa, cnnxennofi
rryBcrBrrreJrbHocrbro - Proteus spp., Providencia spp., Morganella spp.
9Mr,rKpoopraHrr3Mbr, Bce anaspo6ubre Mr,rKpoopraHu3Mbr, HeKoropbre rpalvlorpnllarenbHble
Mr,rKpoopraHu3Mbr (Neisseria spp., Proteus spp., Serratia spp., Providencia spp., Morganella spp.,
Brucella spp., Edwardsiella spp., Aeromonas spp., Vibrio spp., Pseudomonas mallei, Burkholderia
cepacia).
l0 B cJrfrae un(ferqufi I{HC peKoMeHAoBaHo npr{MeHeHrre roJrbKo MeponeHeMa, r.K. rIMI,IreHeM
o6naAaer npocyAopoxHofi iu(Tr,rBHocrbro v [porI,IBorIoKa3aH B groM cnfrae, a y6egureJlbHbre
,{aHHbIe o Krl,InrqecKoft eQQerrnBuocrr4 Aopr{reneMa
orcyTcrByror.
rpu nnQerqurx groft JroKaJrr{3 arrvrtr
IIpn nu6ope nro6ofi repBoHarrzurruoft
cxeMbr anrra6uoTrrKorepannn [peAroJraraercff
rrncre
fiepexoA rro Bo3Mo)r(Hocrrr Ha xap6aneHeMbr 6es
AeocKaJraquonnrrfi rroAxoA, B ToM
arrrllcl,Inenroftnoft axtusnocrrr npla BbrAeJreHr.rn norby,uurerefi, qyBcrBnreJrbnbrx r rap6aneHeMaM
ra orJnrqHbrx or rpaMorplrrlarenbHbx neQepnaeHrrpyrorqrx 6axreprafi .
tt
- I""e3oJMA, Aa[ToMI,IqI{H I,I Tr{reuI,IKJrI,IH gBJrf,rorct JIeKapcrBeHHbrMI,I cpe4crBaMl{ nrr6opa 4nr
gHTepoKoKK€lMrr.
lepamm Ho3oKoMlrarrbHbrx r,rn$erunfto rrnrarrnbrx BarrKoMr,rqr{H-pe3rrcreHTHbrMrr
" - PeKoMeHAoBaHo npr{MeHrrb cneAyroqne aMlrHornrrKo3vr4br II-III noKoJreHnit: sernnMrIurlH UJrll
aN,I[rKaIII,IH.
13
- Onruuamnrrft pexr.rM Ao3rrpoB altnfl, KoJurcrprHa ocHoBaH Ha pacqere sarpysounofi w
noAAepxnBarorqeft .qos. Pacraem 3o?pysottuoil dosar (o4uHaKoBa .unt Bcex Kareropuft uaqHeHToB,
He3aBr,rcr,rMo or Harrnrmr noqeqnofi HeAocraroqnocrr,r): 3arpysorrgilI Ao3a (rrann ME) - Macca reJla
(rr)* I 7,5 (naaxcrarraaJrbHo 10 rrann ME) B Br.{e BHytpl,IBennofi HnQysnra B retlenue 30-120 unn.
flocle BBeAeHus sarpyso.urofi Ao3br KoJrprcrr,rHa rrocneAylolqee BBeAeHIde ueprofi
rogepxr.rBttrorqefi Aosrt ocyqecrBrltercff qepes 24 q.
*Macca reJra - 9To Mr,rur,rMtlrrbHoe 3HaqeHHe Beca, nrr6upaeMoe npu cpasHeHuv peanrcnofi nrnr
nAearrbuoft (n cnfrae HirJrrrrrr{ff oxorpeHr,rr) uaccrr reJla [aIIrIeHTa.Ans pacqera lrAearlbnoft uaccrr
reJra (I,IMT) Bo3MoxHo ncroJIb3oBaHI,Ie cneAylounx Qopnnyl:
( I ) rurs B3pocJlbrx Myxrlrru : I4MT(rr) : 52+l 9X(0. 3 94Xpocr(cu)-60)
(2) ans nspocnbrx xeHIrIrIH: I4MT(rr) : 49+1.7x(0.394Xpocr(cu)-60)
(3) anq Aerefi Ao l8 let: I,IMT(rr) : pocr(cna)'Xl,65/1000
P ac.tem cymottHoil no d d epucus arct4eit d osut.
a) y rarILreHToB, He HrxoAflrrluxc{ Ha reMoAI{tuIiI3e, roAAepxI,IBaIoutuI Ao3a (rrann ME) - (KK
(nrn/rvruH)ll0)+2 B 2-3 ssexeur,rr exeAHeBHo. Krupenc KpearI,IHLIHa (KK) orpeAeJrfiercfl c
roMorqbrc upo6u Pe6epra (npeanoqrurerburui MeroA y rrarlueHroB B KpLIrtrrIecKoM cocrofiruu)
unu paccqr,IrblBaerct ro (p opnryne KorpoQra-f onm.
PeroueHAyeMbre r.rHTepB€urbr BBeAeHLrfl pa3oBbx Ao3, Ha Koropbre Aenlarcs cyrorlHaff
[ogepxr,rB4rorqtur Ao3a,3aBr,rcrr or KJrr{perca Kpearr{Hrrma14 cocraBntror npn KK < 10 un/unn KiDKAbre 12.r, KK : l0 rran/ruvr vr 6oree - KaxAbIe 12 nwl KaxArre 8 qacoB;
6) y [aqrreHToB, H€D(oprqr,rxc fr, Ha xponr,rqecKoM reMoAuaJrr{3e, [oAAep)KrlBilrouztfl Ao3a (nnnu ME)
: 2 uln ME n 2 nneAeru4r exeAHeBHo + 30yo noMepxr,rBirroruefi AogH B AeHb IOCJIe IIpOBeAeHUt
oqepeAuofi ceccuu reMoAvruru3a;,
s) y [arIueHToB, HaxoAffrrluxc s, Ha [ocroflHHoft sardecrl,ITenrsofi floqeqHofi rcpaunu: 12 MJIH ME s
2-3 nselenvfi, exeAHeBHo ;
r) npu HapyrrreHufix OyHKrIr.ru nerreHr,r r,r3Mgneunfl pexuMa Ao3npoBaHI'It ue tpe6yerct.
t4
--" cqrqua Ha3Haqeqvrs, [a[ToMr,rqlrHa [aqueHTy c cencucoM, BII3BaHHrIM Enterococcus faecium
vrJru MernrIunJMH-p$IrcreHTHbrM rrrraMMoM Staphylococcus antreus, KpI{[ToreHHbIM ceflc]IcoM,
oco6eguo flpu HaJrrrqura KruHuqecKu o6ocHosaHHoro rroAo3peunfl o BoBreqeHHI'I B rlpoqecc
KJra[aHoB cepAqa, Ao3r,rpoBKa neKapcrBennoro cpeAcrBa Moxer 6rtrr yBerl'IqeHa Ao 8'12
.
rur/rr/cymu.
TIHOEKIIIIU IIHC.
grvrnnpr.rqecKafl anrn6arreprraJrbnafl Tep afiwfl rHofinoro MeHnHrrlra B 3aBrlcrrMocrlr
B.
acnoJrafaroqux
HAJIIITIIIfl TI
IIpeapacroJIararcuufi
Sarrop
Bogpatt
Beporrnue
sos6yAI,ITeJII,I
Auru6arteplr
ulJIbH
M T epafivfl
or
0-4 neAenu
4-12 HeAeirr'r
qe$oril(cllM;
S.agalactiae, E.coli,
L.monocytogenes, K.
pneumoniae,
Enterococcus spp.,
Salmonella spp.
aMlr,ruuJrJrrrH +
E.coli,
aMlr,rquJrJIrIH + qe$otaKcrlM
aMTII,IqnJIJITIH
*
renrarr,uql{H
L.monocytogenes,
3uec-5rer
5-50 irer
H.influenzee,
S.pneumoniae,
N.meninsrtidis
H.influenzae,
S.pneumoniae,
N.meningitidis
S.pneumoniae,
N.meningitidis
6engr,rrneHuql,IJrnun (npenapar rrr6opa upu
MEHLIHTOKOKKOBOM MEHI,IHTUTE) ;
qe$rpraaxcon
6eHsurneHllqunJmn (npenapat srr6opa
MeHrrHroKoKKoBoM Meunnrute) ;
qeQorarcrartr nnu qeQrpu€uccou;
qe$ orarcl,IM
LIJII,I
rpll
xnopaMOeHrIKoJI
crapme 50
rer
S.pneumoniae,
qe$oraxcl,IM TIJIII qe$rpuaxcon + aMrrl'IqtanJllrH;
N.meningitidis,
xroparraQeHuKon
*
aunuqI,IJIJIIaH.
L.monocytogenes,
Enterobacteriaceae
S.pneumoniae,
flepenorrn o cHoBaHI,Iff
qepena, JrI,IKBopefl
H.influenzae,
S.pyogenes
.IIDyrOrO reHe3a
S.aureus,
HefipoxnpyprnqecKl,Ie
S.epidermidis,
BMEIIIATEJIbCTBA
Enterobacteriaceae,
P.aeruginosa
Jharn op oAuH aM I,Itle c KId e S.epidermidis,
S.aureus,
myHTbI
Enterobacteriaceae,
P.aeruginosa, P.acnes
qe(poraxcl,IM
I,IJII,I
qe$rpnaxcoH
BturKoMtrIIrIH nnu refironlanun lrJIrI JrrrregonrlA +
qe(brasnAl,IM unrl MepouelreM
BaHKoMI,IqI,IH tIrII{ refi
ronlaul'IH }IJIlr JIlrHe3oJMA +
qeQrasu4rlM tlrlu MeporeHeM
SnrnupllqecKarr anru6arrepnaJrbrrafl Tepa[rrfl a6cqecca roJroBHoro Mo3rar SnrrAypaJrbHoro
rnoft SMrIrIeMbr.
abcuecca, cy6,qy
Anru 6 axrepn aJIb H as, T epafirts
Bepomuue
llpegpacrloJlararcqufi
sos6yALrreJILI
6artoP
qe Q ano croprlnbl III - IV roKoJIeHIar (uerp oral(cl{M,
Streptococcus spp.,
Cpeaxufi orI,IT I,IJItr
qe(f rpuarcon, qe$enurrl) + MerpoHrIAa3oJI
Bacteroides spp.,
MacTor{,4rIT
Prevotella spp.,
Enterobacteriaceae
ueQ arocil optIHbI III - IV roKonenus (qeab oral(clrM'
Streptococcus spp.,
(no6uoft
u
Cunycur
qe$rpuarcou, qe(fenurr,r) + MerponnAasor *
Bacteroides spp.,
KJrIHoBI,IAnoft rocur)
B aH Ko M I,IqI,IH Ia1114 tefi ronlaHl'I H I'I JI]r JII{ H e3 oiILrA
Enterobacteriaceae,
(upra IroAo3peHW Ha M
S.aureus, H.influenzae
6eHsfiffi eHrlqllnnran * MerpoHrIAa3on
OAourorenHrfr cencl{c Fusobacterium sPP.,
Prevotella spp.,
Bacteroides spp.,
Streptococcus spp.
BaHKoMTIIITIH uJIII tefironnanun vlrn ImTHegoTrlIA +
S.aureus,
flponnrarcuffI rIMT,
HeftpoxupypruqecKne
oreparlnlr
A6cqecc, gMrr,ireMa
JIerKrIX,
6ponxoeKTarr{rrecKaf,
6onegHr
Eaxtepnanrurrft
sHAOKapArrT
BpoxaeHubre [opoKr,r
cepArla
Hosororus
IIH(D
BeporrHue
III-N
qe$anocnopr,rnbr
Streptococcus spp.,
Enterobacteriaceae,
Clostridium spp.
Fusobacterium spp.,
Actinomyces spp.,
Bacteroides spp.,
Prevotella spp.,
Streptococcus spp.,
Nocardia spp.
S.aureus,
Streptococcus spp.
Streptococcus spp.,
Haemophilus spp.
roKoJreHr.rt
[enuqr,rnnr,rH + MerponuAruon
BuurKoMI,rqnH uJnI
*
ro-tplrMoKcul3oJr
tefironraHr,Iu prlm ilune3oflrtA +
TIMI,IHOrJIIIKO3IIA
arocroplrHbr III - IV roKoJrenras (qeQ or€u(cuM,
qe$rpnaxcou, qe$euuru)
ueQ
ITYTEfr.
MOTIEBbIBO
AHrn6arrepuaJrbHrul Teparuu
sos6yAureJru
Ocrpufi
HeocJroxnennrrfi
IIrICTI,IT
E. coli,
Enterobacteriaceae,
S. saphrophyticus
Ocryrrfi ocnoxueuurrft
uI,ICTnr, Ha[FIrIe
0axropoB pr.rcKa
EeccnunroMH€uI
6arrepnpvrfl ocrprtfi
qrrcrrrr y 6eperrreHHbrx
Ia
E. coli,
Enterobacteriaceae,
S. saphrophyticus
flueroue$p"t remofi u E. coli
cpe,uneft crerIeHI,I
Enterobacteriaceae
TflXECTI,I
Tsxerufi u
ce[TI,Iqecrnft
rrr,reJroHeQpur
E. coli
Enterobacteriaceae (no
cponHeHup c 6onee
treeKuJvtu Qopuantu
nueroHeQpuma
eos1ydumennMu qat4e
OcroxueHHag
unSerurar
MoqeBbrBoAslqux nyrefi
fl&rflrcmcn
K.pneumoniae,
P.mirabilis u m.d.)
E. coli
Enterobacteriaceae
P. aeruginosa
SropxunoJronbr per os (upeuaparrr srr6opa, He
[oKa3aHbr AersM Ao 18 rer, 6eperr,renHblM [r
KopMrrqrM MarepffM)
irM o Kcr,rq ututur' I xn aByrIaH ar
repopamHbre rleQarocropl{Hbl II-III noKoteHrafi
(qeQypoKclrM aKc erI,IJI, qe Quxclarr,r)
Qocr[onrnul{Ha rpoMeraMon
uurpoQypaHror,rH
,UnumenbHocmb AET 3-5 dneit
Ilpu*teunomcfl me crce npenapambt, qmo u npu
ocmpo\vt HeocroltcHeHHoM qucmume, oduarco
dnumenuHocmb AET ygenuqunaemcfl do 7-14 duett
ipocif ounul{Ha rpoMeraMon
aM oKcprqnrrun/ruaBynaHar
nHrpo<[ypaHrorrH
nnumenbHocmb AET 7-14 dueit
repopalrbHble QropxuHoJroHbr
aM o Kcrrq nn:riunI KnaByn aH ar
repopaffi HbIe IIe$ aro cropI,IHbI II- III uoKoneunfi
(qeQypoKcrlM aKcerur, qe$urcnrvr)
.nnumenbHocmb AET 10-14 dueit
Qropxr.rHoJIoHbr
nnru6urop-3turglrleHnble 6era-narraMbl
ue$arocropl,Inbr II-IV roKoJren utrt +
AM I,IH
O
TJII,I KO3
I,IAbI
rap6aueHeMbI
IrI c n o na syn m c myne Hq amyn m ep anuo
(napeumeparlbHo AB eeodumcn do ucqesHoaeHun
nuxopadKu u wtuHuqecKo?o ytryqweHun cocmoflHun
nauueHma), dnumenbHocma AET 14-21 deuu
(propxunoJloHbl
* auunoilI[Ko3tlAbl,
unru6urop-3alqulqeHHble 6era-narral\{bl,
9
(nocne Ka.rerepr{3arluu,
na Qone o6crpyrt18tr,
per[nrorca, XIIH,
ca(apHoro Aua6erao
rpaHcrrJranrarlun r{ Ap.)
Enterococcus spp.
S. saprophyticus
II-ry
ueQanocropuubr
!
roKorrenwft
tlMlrHorJII{K03}rAbr,
xap6aueHeMbr
anup
(napeumepclnbHo AE eeodumcn do ucqesHoneHun
Irlcnonu syrcm cmyneHtt amyrc mep
nuxopadKu u KnuHwtecKozo ynyqueHun cocmoflHuz
naqueHma), dnumenbHocma AET 2I deua u 6onee
flueroxer[pur y
E. coli
Enterobacteriaceae
6epeueHHbrx
II o JIycI,IHTeTI,Iqe
C
KI{
e II e HIIIIIIIJITTHbI
(auoxcuqrrJrJrrrH, arvrrrrlqunnun) +
aMHHOrurI4KO3rIAbI,
Kap6ynryr
(ropruranrnrrfi
S. aureus (e 90%
usrndnrop-3€uryrueHHbre 6era-laxraMbr,
ueQanocropr,rHbr II-I[ nororennfi ,
rap6aneHeMbr (rpoue uMrrneHeua)
.AnumenbHocmb AET He MeHee 14 dueil
qeQasonnn,
cnyvaee)
BarrKoMrrIInH
a6cuecc) uoqrra
4,6cuecc
Enterobacteriaceae
E.coli,
Klebsiella spp.,
Proteus spp.,
P. aeruginosa
nnumenbHocmb AET 4-6 uedenu
QropxuHoJroHbr,
nnrn6nrop-3arquruennble 6era-raxraMbr,
qeQanocropr,rHbr II-IV noronexufi ,
BerrlecTBa,
rap6aneHeMbI
arrocreMarognrrfi
nr,reJroHedpur
.[[numenbHocmb AET 4-6 uedenu
K ifaxropaM pucKa pa3Bvrrr4fl. ocJroxueHuoro / peuraal{Bl,Ipyrouero qucrl{ra ornocffTcff Bo3pacr
craprfle 65 ler, qlrcrr,rr y Myxqr,rH, coxpauenr{e cl,IMnroMon 6onee 7 Ar'efi, peuuAlar nHQeKuI{Ilt,
rrcrroJrb3oBanr,re BJraraJrurrlHbrx graaQparu u cnepMlIrIHAoB, caxapnruZ Ana6er.
MeAyJrJrspHoro
MflTKITX TKAHEfr. KOCTETI
ITHO
Vrpeaar cbmb
Anru 6 aKtepr
Beporurrte
I,IgQeruur
nos6yAureJIIr
P.acnes
II CYCTABOB.
arlbH afl T epailnfr
gprrrpoMr{rll,IH-Il[nrosrfr KoMrrneK c ulrn
KJII,IHAtIMI4III,IH
M eCTH O,
MerpoHr,rAa3on MecrHo,
TerpaquKJprHbl per os
@ypynryr,
S. aureus
QypynrynEs,
rap6ynryn, a6cqecc,
I-II noro lrenr4s,
unru6nrop-3alqnqenHbre 6era-narraMbl,
ue(f anocroprlHbl
KJII,IHA€IN,II1ITTI1'.H',
(propxranoJloubl III-ry norolennfi ,
rrp]r BbrAeJIeH[[ MRSA - JII,IHe3om'rA, Aa[ToMLrquH
rr,rApaAeHr{T
VIJTVT
Poxa
S.
pyogenes
rr
BAHKOMI,IIIIH
enrrrlr{
JIJITI H
bI
(
6 e ns
nnrreHrlrlrr
JI
rrtrr^,
aMoKcl,Iqnnnun)o
ueQanocuopl,IHbl I uorolenprfr.)
KJIUHATIMLIULTH'
Mar(ponI,IAbI
I{ennronut, Qreruona
S. pyogenes
S. aureus
Enterobacteriaceae
ptrrn6nrop-3al4{IqeuHbleneHI,IqI,IJIrIIitHbI,
(pecrce)
SropxunoJloubl
qeQanocropllubl I-II noro lrelrtvls,
KNIIHAEII\{TIIIIIH,
III-N norolenufi
lplr BbIAeJIeHrIu MRSA LIJIII BTIIIKOMIIIIIIH
10
,
JrrIHe3oJMA, AarrroMlluuH
I4unernro
pyogenes
S. aureus
S.
wnru6urop-3arrlr4rrleHnbre[eH]rrlr{JrJrlrHbr,
KJrIHAtIM]IIIIIH,
MaKponuAbr
Herpoua.recrufi
S.
rleJrmonrar, $acqrnur
S. aureus
nororeruafi,
Auaepo6ut
Enterobacteriaceae
Pecrce: S. pyogenes,
+ KJrr{HAaMr{rIr.rH,
unrra6nrop-3arqnilIeunbre rreur.rqunJrrlnbr,
rap6aneHeMbr,
rpu pucKe r,rJrr{ BbrleJreHnn MRSA - ruure3oJrr{A,
Aa[ToMrrrIId H, B aH KoMr,I qI,I H trillr tefi ronl aHuH
uHrra6urop-3arquqeHHbre [eur,rqnnnrrHbr,
KJILIHAaMTIIInH + IleQarocropl{Hu III-IV
Enterobacteriaceae
nororenuft,
flroMrosrr
pyogenes
S. aureus
KJIUHAaI\{uqnH
+ Ile0arocropr,rHu III-IV
neno QnoKcarlr,rH
qeSarocropr,rnbr I noronenrag
renoQnoKcarlr,rH,
rap6aneHeMbr,
rpu pucKe lrJru BbrAeneHuu MRSA - nnne3oJrr{A,
Aarrro M Ii rItr H, B aHKoMI{qr,rH wtu r eitKo Ir Jlarrprn
Muonerpos
Clostridium
perfringens
KJIr{HAaMr{IITIH
*
KJIIIHAAMI.TUIIH
+ IIEoMPIAKCOH
Hercnocmpuduaaauan
xap6aneHeMbr,
Qnopa
nero QnoKcarlr,ru + KJrrrHAaMr{rIr{H,
Jrnue3oJrrr4 * nnnepuuunn wwha3o6ar(T€lM r{Jrrr
6eHgLrJmeHI,IUnJIJrI{H,
qunpo(f rroKcarlrdH,
KJrr,rHAaMr,rur,rH + ueQuoclopr,rHrr
flporexxu
LIHQerurn rocJre yKyca
TIEIOBEKOM ITJIII
)K}IBOTHbIM
I4n0uunpoBarrHbre
oxoru
Enterobacteriaceae,
P. aeruginosa,
S. aureus,
auaepo6at
Streptococcus spp.,
S. epidermidis,
S. aureus,
Corynebacterium spp.,
E. corcodens,
P. multocida,
Bacteroides spp.,
Peptostreptococcus
spp.
S. aureus,
Enterobacteriaceoe,
Pseudomonas spp.,
S. pyogenes
III-IV
nororeuufi,
rtpll pucKe LrJrrr BbrAeneHrar,r MRSA - rurHe3oJrr,rA,
AarITo M I,I IItrH, B aHKoMr,IuuH ulu r eirKo tt JItur]rH
ueQarocnopr,rHbr III- IV rroKoJreH wtrt +
MeTpoHLTAUu}OJT,
qunpoQnoKcarlnH rJtlt nenoQnorcaqnn
*
MeTpoHrIA€t3OJr,
uutw6utop-3ar4,rrqeHubre 6era-raxraMbr,
qe6agorr,ru + aMlrKarlun * uerpoHr,rAa3oJr
nntudulop-3arqfirqeHHbre 6era-naxr€lrvrbr,
nenoQnoKcarlr{H + MerponuAff}oJr,
naoxcnQJroKcarIrrH,
+ rleQarocropr.rHrr III roKoJleHr4t
qulpoSnorcarluu,
KJrrrHAar\,ruqnH
r,rJrr,r
rap6aueHeMbr,
rpra BbrreJreHr{r{ MRSA
-
JrnHe3o rrur4,
A€lrrroMLIIItrH,B€uIKoMrrrIvrHkrnn4reft
xonltauvr
as onrlH + aMI,IHorJItIKo3lIAbI II-m rroKoJrerrltt,
qeQuocropr,rubr III-N roKoJrennfl. c
anTr,r cr,rH ertr o ft H oft arfla sHo crbro (q e $m3r,r,u,rM,
ueS
ue(ponepa3oH, ueQennrra),
(p ropxun o Jr o H br * n an roMrrrlr,rH vrrrLr Jrune3 onr,IA
vnu AarrroMurlr,rH unu t eitKonJrarrrrH,
rap6 aneg eMbr +
TL
B aH
Ko
Mrrurrn urrvr nrur.ego
Irr4A
ulrn
AaIITOMI,IUHH I,IJII,I Teft KOnJIaHI{H
[ua6erurrecKffr crona
S. aureus,
S. pyogenes,
Enterococcus spp.,
P. aeruginosa,
Enterobacteriaceae.
auaepo6at
EoresHr roua.rreft
qaparrHbr
B. henselae
B. quintana
H HBre 6era-laxraM br,
qe(prpnaxcoH
+ MerpourrArnon
ueQoraxcr.rM rrirr{
tlJrrl KJII,THAaMnUIIH,
UeQasonl,rH + aMrrKaqnn * uerpoHrrA€t3oJr,
SropxrnoJroHbr + MerpoHrrga3oJr,
xap6aneHeMbr * sauroMlrrlrrH vrlrr4 rrvrne3onlrA r.rJM
AaTITOMI,IqI{H LIJIIr refi rOnn Alalala
Mar(ponu4rr (epnrpoMr4rlr,rn, annrponruqran) +
pu$auuLrrrvrn,
unrudprrop
-3
arqrrule
AOKCI,IqUKJIIIH
BaBdopogileHue qacmo npoucxodum 6eg AET
HnQerqnonnrfr aprpnr
S. aureus,
qe$otarcl{M,
qe (p asonI,IH + aMI{HoDIuKo3tIA II -m noKoJleHrrt,
nnru6nrop-3arquqeHHble 6era-raxr€tn,tbl,
BaHKoMu uu:g^ I reft ronl agtnr * arrlranorillrKo3l,IA IIIII noroJreHut
ueSanocroptlHbr II-m roKoneHus, *
H. influenzae,
aMrrHorJrr,rKo3[A
Streptococcus spp.,
Enterobacteriaceae
unrn6rarop-3arq[IqeHnble 6eta-laxraMbl,
KJILTHAaMTIIITIH * aunnorJruKo3rla II-il noKoJIeHLIf, ,
uerfrpuaxcoH + BiuIKoMrrIIpIH / rcftronJIaHI,IH (upn
S. aureus,
Honopox4eHHbre
Enterobacteriaceae,
CmpenmoKoKKtt ?p.8,
Ir{. gonorrhoeae
,{erra Ao 6
rer
S. aureus,
83pOCJrbre
S.
B osi\,Ioxna-a ran Q
eKII[s,
pyogenes
N. gonorrhoeae
repeAaroulaflct
loJroBbrM
[oKoJIeH[ff
,
MRSA)
rroAo3penkrv Ha
,{eru crapme 6 ner u
II-il
qe$asonuu,
nHrra6urop-3 alryrlqeHnbre neHlrqllnnnnbr,
nenoQnoKcalluH IIJII{ MoKcu(pnorcaquH,
BarIKoMn\wHnnvrrefi rounaHI,IHkrIrttllralae3oJrllA
ueQryuaxcoH I,IJILT ueQoraxcrM,
QropxranoJIoHbI
[yreM
llocre onepaquft,
BHyrpucycraBHbrx
unrexquft, c
LrcKyccrBeHHbIM
+
ueS asonlilH
Enterobocteriaceae,
P. aeruginosa
II-m noronennfio
B
AHKO M
I,I
II-ru noronenufi
aMI{H orJlrrKo3trAbl
S. epidermidis,
S. aureus,
UIIH I,INU
qeQanocropl,IHbr
JIU H E3
III-N
OJIIIA
+
AI\I}IH
noKorleH
t
KJTpTHAaMpIIITIH
TJII,IKO3I,IAII
uit nttu
aunnorJII{Ko3I,Ia
puSaunuqrH
+
6ropxprnoJloHbl
cycraBoM
O
,
II-il
[oKoJIeHI'It,
OcreouueJIrIT
feuarorennrrfi y .qerefi
H. influenzae,
uH vrlru ueQyporcrnu * aMrrH oHIrIKo3lIAbI
[-III noKoJleHrrt,
qeQanocroprlnbr III-N norolenufi ,
unrra6urop-3iuryIqeHHble 6eta-laxttubl,
Enterobacteriaceae
KJII{HAaMLIqIIH,
S. aureus,
S. pyogenes,
CmpenmoKoKKu zp.B,
ue(p asor
I{MI{IIeHeM,
B[uIKoMI{
uun I reft ronlaHl{H
*
fenaaroreuuufi y
S. aureus (vat4e eceeo),
ue$
B3pOCrlbIx
Enterobacteriaceae,
auaepo6at
KJILIHAAMLIIII.IH
as
onran
aMTIHoTJII{Ko3IIArI II
*
-
ATUUTTOrJIUKO3IIAU
m TIoKoJIeHI{q,
II-[I
rIoKoJIeHrIt,
BaHKoMr{u}rH
t2
TTJILI
nrIHe3oJIvrL
!
aMnHorJIlIKo3rIAbr
II-m
flocreoueparluoHnrrfi
6ropxuuoJroHbr
qeQasorlrH + aMprHoumKo3[Abr II-m rroKoJreHns,
qeQ zurocnoplrubr III- ry noKoJreHuft t BaIIKoMIIIITTH
tuwl Iil4IJe3OJIrIA,
S. aureus,
Enterobacteriaceae
Pseudomonas spp.
IdTTI4
nocrpasN,tarIa.lecxraft
noKoJrenufl,
I{MrIfIeHeM,
6topxuHoJloHbr + pu0arrarr?Iql{H
OCTPbIE KI,IUEIIIIbIE IIHOEKIUtr,I.
Sunnprvecrar arru6arcneprra:rbHalr reparu.rr B crryqae ctropa,ryrvecrofi ro wsncrlofr wapu 6eg rnrxopa,q<x
fi [pr.BHaKoB Boclarreur{rr K[EerrHura a (leranurx He rrora3arra. B cnyqae ocrpofi rumewrofi un$erqwr
neyrowrennofi sruonortru c JrmopagSoi u npurnararr,rrr Bocrralreru B ([exanzxx upenaparannr rr,r6opa gnr
sunupruecxofi ABT rrrlxorcr r[ropxunoronn (o$norcaqnn, qunpo(lnorcaqnn, nop([norcaurr) r
reqegre 3-5 ,u{efi.
BbI 6o
tErra
Bos6yaureJIb
Shigella spp.,
SrepounBa3r,rBHbr e E. c ol i,
Aeromona.s spp.,
Plesiomonas spp.
Salmonella spp.
Campylobacter spp.
v
I[3BECTHOII STIIOJIOTIIU.
Aflfl JIEqEHIIfl AHA
Anru 6 axrepu arrbH afl, T epalrnfl
QropxunoJIoHbI,
cropnubl III n oro lrenns. (qe$ omKcI,iIM, IIeSrpIaaKcoH)
,[numenbHocmb AET 3-5 dneil.
qe
(b
aro
QropxnHoJroHbI,
ueQanocroplrHbr III nororlennt (qe(borarcuM, ue$rpuaxcoH)
,[numenbHocmb AET 5-7 dueil. AumufiaKmepuclJtbHctfl mepanun noKo3aHa
monbKo 6 cnyttaflx 6ptowuozo muba u napamuQoe A, B, C, mfl:Hcenbtx
Qopu ccrnbMoHenne3a, y nuq c ttJt4JvtyHocynpeccueit u cepbsHoil
c o nym c m6wo u e il nam o n o zue it.
gpI,ITp oMI,IqI,IH * xo -rpuMoKca3oJl,
QropxuHoJIoHbI
.[lnumenbHocmb AET 5-7 dneit.
V.cholerae
QtopxnnoJIoHbI,
AOKCITqUKJIpTH,
KO-TPIIMOKCfI3OJI
Y.enterocolitica
E.coli OI57:H7
C.
dfficile
(aumu1uomurc-
ac c oLtuup o 6 aHH
afl duap e n)
QropxunoJIoHbI,
rIe0TpuaxcoH
,InumenbHocmb AET 5 dueil.
Aumu6 aKm epualtbH cm mep anun H e noKct3
cocmonHuf nawueHma.
MerpoHr,rA8on (per os),
BauKoMr,rqun (per os)
aH
a,
6o
3M
o
ctcH
o ycyd weHue
9TIIOTPOIIIIA^fl TEpAIMfl, C.DIFFICILE-ACCOqUIPOBAHHOrI IHOEKIIIIII.
C.difficile ssrsercfl BeAyilInrvr nos6y.uureJreM, Bbr3brBarorquM Ho3oKoMHuIJIbHbIe \vapepl". creKTp
KJrnnurrecKnx rrporBneHnfi roropbrx Bapbupyer or carvroorp€lHrrtll,IB€lroruefics lerrofi \napevr Ao
TrxeJroro, 3arracryro QynrrrauHaHTHoro, ilceBAoir,renr6parro3Horo KoJIrITa.
nIIII
MbI
bIe
CranAa
pexI,IMbI
Tepam,Ild
ble
P
erouenAyeM
a\ufl
cury
KruHu.recKulf,
MerpoHllAa3on 500 nrr X 3 paea B AeHb per os 10-14 Aneft
fleparrft gnI,I3oA lemoft nlu
cpeAHernxeroft KIAI4 (neftrouurbl
nlprarbepn.recxoft KpoBn < 15Xl }eln,
13
Kpearr{Hr,rn
<
l 15 sna.renufi
or nepxnefi
rpaHI{IIbI noprvrrr)
flepnrrfi err.r3o.{ rgxelofi KAAI4
(reftrour{rbr nepnQepraqecrofi KpoBE >
15X10'/1, Kpearl,rHns ) 1,5 sna.reHufi or
sepxueft rpaHuubr uopurr)
flepnrrfi err.r3oA rsxeroft KAAI4,
corpoBoxAzuotqefi cr pasnr{rrreM
Bauxonuurru 125-250 nar X 4 par, B AeHb per os I4IIU
refironnaHprH 400 rvrr 2 pasa B AeHb per os 10-14 ,qnefi
ociroxHenraft (runoreH3r,rr rirJrr{ rtroK,
KuilreqHffr HenpoxoAraMocrb,
Banxourquu 500 ur X 4 pasaB AeHb per os unu qepe3
3oHA UJM reftxon.naurrn 400 nrr X2 paza B AeHb per os +
Merponr,rA€Bon 500 nrr X3-4 pa3a B AeHb s/s t peKrarrbnbre
HHcrr{JrJrfrr1upr BaHKoMr{rIr.rHa (500 Mr B 100 rrrl 0,9yo NaCl
ToKcuqecrufi nnerarolou)
KtDKAbre 4-12 uacon) WlIldrefironnamr4ma (400 Mr B 100 rvrn
NaCl KalKArIe 4-12 uacon)
flpenapar I4 pexrrM Tepanrur rarc,re xe, KaK v Nrfl fiepBoro
0,9Yo
flepnrrf
peqrrAr.rB
3rr430Aa
Btopofi
r
rocne.4yroIqnft peqr,rAlrBbr
MoauQnrl?rpoB€tuubre pexr,rMhr [pr,rMeH enfifr. BturKoMnrlr{Ha
(nynrc-repalrvrfl, nocrereHuoe cHnxeHne Ao3br): 125 Mr per
os KzDKArre 6'r14 Aneft, KrDKAbre 12.r7 Atteit, KCIKAbre 24q
7 gueft, KiDKAbre 48.r 8 anefi (rcero 4 Aosrr), KiDKAbIe 72q
l 5 anefi (scero 5 aos)
[ls
ycreruHoro r,r3rerreHr,rr C.difficile-accoquuporannofi Tepanrr peKoMeHAyercr KaK Moxno
paHbrue (ecru [o3BoJrser KJurHrrrrecKar curyauur) flperparrrrb npoBo.q[Myro clrcreMHylo
aurr6axrepuaJrbuyro repanurc.
IlporunorroKa3aHo Ha3narreHne ireKapcrBeHHbrx cpeAcTB, rroAaBJrsrotqnx [eplrcraJrbrtrr(y
KrrruerrnrrKa (.rroneparvruAa)r TaK KaK 9To gHarrrrreJrbHo yBeJrrrqrrBaer prrcr pa3Brrrrrfl
ToKcnrrecKoro MeraKoJrona rr KnmerrHofi nenpoxoAr.rMocrb.
B cocraBe rou6unuponannofi Tepanprri anru6uornK-accoqu[poBarrHbx gnapeft, BrBBaTIHrD(
C.difficile, roK€xlauo rprrMeHeHlre npo6uorrrrKoB, coAeplrarqux Saccharomyces boulardii
(lerapcrBeHuoe cpeAcrBo oHTepol), uosnonsrcrqrx BMecre co craHAaprnofi reparuIeft corparurs
Anr,rreJrbHocrb sa6oresanufi, pr BoccraHoBrarb ir,rraxpo6raory )KenyAoquo-Ktrllerruoro rptuoa.
HEirrP OTIEHAIIE CKA' JITIXOPMKA
HefirpoueHnrrecKiur Jrnxop4,qra - rroBbrrrreHrre reMreparypbl TeJra Bbrrrre 38,0oC B TeqeHnpr
oAnoro qaca u 6oree y narlue"tb" c nefirponenraefi (ronu.recrBo uefirporpl{JloB Menee 0,5x l09ln
r4lru 1,0 x l}e h c rporHo3lrpyeMbrM rraAeupreM Hl,rxe 0,5 x l}e ln B lnuxaitmee npenax),
o6ycnornennofi sa6oregaHr,reM r{nr4 rrpoBeAenneM xI,IMtIo- urv nyrenofi Teparruu.
llpusuaxn JroKarrbHoro unQerquoHHoro rpoqecca y raIIpIeHToB c neftrpoueuueft qacro
orcyrcrByror, vr eAr,rHcrBeHHbrM crrMlroMoM unQerquu sBJltercf, Jltrlrrb JII{xopaAKa,
coxpaHffrorquucs B TerreHue 2-3 rracoB, He cBff3aHHffI c BBeAeHueM nI,IporeHHbD( npelaparoB,
eft spgAbl,
ttstluit VTTIT ycnoBIItMII OKpy)Katorqclc
BeAeHI,IeM A[raf HocraEIecKI,Ix lI reqe6H bIx
[penaparbl
A.rrrrepHarrrBHbre
lpeuaparbl srrbopa
OcHonnrre nog6yArrreJrrr
plMrrrreHeM LTJIII MepOIreHeM UJII,I
qeQeuurr,r I,u[I qeQ Tagvrwru vrlrur
Staphylococcus spp.,
Enterococcus spp.,
Enterobacteriaceae,
Pseudomonas spp.,
qrnpoQJloKctilIlrH
AOpI,IrIeHeM I,IJIlr
crpe[ToKoKK]I,
urutunI tas o 6 axraM LrJrIi
qeSonepasou/cynr6axrant
* lunegonrrA LrJrI,I BaHKoMTIIITIH
puu refiKolJI€lHI{H IIJIU
rpu6rt
AarrToMrIIII{H
((3eiIeH.flIUI,IeD
m{ fi ep aq
Lrlrrr
nenoSroKcaIII,rH
*rranesoJrl,IA vrlrn
BaHKoMITIILTH
krlrvr refironnaurIn
ulrvr
AaTTToMIIIILIH
AMLIKAIIUH
IIpu
omcymcmeua eQQeKma om adexeamnofr om adexeamnofi
arumuflaKmepuqJrottofi mepanuu c me.teHue 5 druefi uJtu npu
useecmHoil unfuexUutt/xonoHwaquu
L4
dpotrccrcenodeQ4btlwu
- do6aeuma npomusoepufixoeotfr npenapam K
sbrraeyKolannofi meponuu (clt. pazden <<Tepanun epufixoeou
UH
ufi>
Anru6arrepuarlbHylo repanurc ilpoAonxarcT Ao 7 lneft rocJre ucrre3HoBeHrrr nnxopaAKrr
u4u Ao gpaAlrKallnu sog6yrurens ll ncqe3HoBeHr,rr crrM[ToMon unQeKrILrH. XenarelbHo, .no6rr r
MoMeHTy orMeHbI anru6norrrKoB rrr.rcJro neftrpor[r,rJroB npeBbrrrralo 0,5 x 109/n.
zpuduvtu
Jlorca.rrn3aurrfl
uHdercqnu
fnofinotfr
nepuKapdum
(npu
I,IHOE
Ocnonnrre
u cocynoB
CEP
A.nrreprrarrrBHbre
npenaparbl
Ilpenaparbr nu6opa
nor6yAnreJrrr
S.aureus,
S.pneumoniae,
sprareHeM
S.pyogenes,
BaHKOMr.IqlrH rrJII,I
Enterobacteriaceae
NrIHE3ONI,IA
* AauroMr,rrIHH LrJrlr
LrMr{[eHeM r.rJrr{ Mepo[eHeM
rrnr{ Aopr{neHeM
+ AanroMI,IqrrH rrJrr{
BaHKOMI,IUI{H lIJrfi
reftronlanvr^ LrIftr
qeQenurra unu
eudorcapdume,
nuHe3onrrA
qnupoQnoKcaqnH
nocmmposMa-
muvecxuil,
nocneonepatluouuafi)
HJrrir
(npu
H
o3o
K
o JvtuanbH o Jvt
nenoQnoKcaur,IH
+ AanroMI,IqI,IH I,Inu
zeHe3e sa6onesaHur
BaHKOMI,IqLIH I,IiIl4
mepanuu)
refirorr.nalrvrr
np e d novmume nbH
ca
cx
e
Ma
LrIrLr
JII,IHE3ONI,IA
,I[nurenrHocrb reparruu 4-6 neAenr
S.aureus,
9praIIeHeM
H.influenzae,
rle Qrpr,raxcon r,rJrrr
qeQoraxcnrr,r
S.pyogenes,
ru{ rep aq
ur'nunI rag o 6 aK-
+OKCTUIHJIJII{H
TTIM
aMoKcnqnmun/rraBynaHAT
Tpom6ot
I{MI{NEHEM
KA6epHOSHOeO
cuHyca
MepoIIeHeM
[arlPreHTbr c
caxapHbrM
To xe + arr,rQoreprrluu B unu BoprIKoHiBon
Ana6erou,
HefirponeHuefi
+Aspergillus,
Mucor, Rhizopus
am c enmaqe cxuil
cBr3aHnrrft c s/s S.aureus,
S.epidermidis
KarerepaMrI,
Tn om6 o frne 6
undysusi\dI,I
cBff3arrurrfi c
TO x(E
napeHTepalrb-
+ Candida spp.
oKcaqrIJrJIuH
Jrr.rHe3oJruA
qeQaaonnH
BarrKoMI,IqI{H
refirouraHI,IH
To xe +SrryroHiBoJI nnrn arra0orepnqnn B
HbIM TIUTAHI,IEM
cBff3aHHrrfi c
oxor€lMl{, c
uefirponenuefi
S.epidermidis,
PrMrrfreHeM nJru MeporleHeM
S.antreus,
LrJrlr AopIIIIeHeM UJILI
Enterobacteriaceae
Pseudomonos spp.,
onepason/cynr6 artarvt
+ AaIrroMnIItIH rlJrI,I
11eQ
15
qeQennu
qunpo(bnoKcallrr urm
nenoQnoKctulllH rInE
qe0ragrArIM
JIora.uularIrIfl
nn6eruun
Ocnonnrre
nog6yAureJrrr
Aspergillus spp.
A.rrrrepHarrrBHbre
Ilpenaparbr nrr6opa
IIpenaparbr
*orcaqnJrJII,IH
BaHKOMLIqI,IH I,IIU
reftronlanur
vrlrpr
NI{HE3ONI,IA
Bacteroides spp.,
Enterobacteriaceae
Clostridium spp.,
Streptococcus spp.
aM o
Kcrrq
nnnnnI rctaByna-
rfiun wmn/ cy ttr 6 axraira
qeQeur,ru I{JII,I ue$TpHaIC3praneHeM
ueS oueparon/cynr6 arrana
ragoguft, rrocJle
poAoB I{JII{
rrocJre
al,r
HAT
con rrJrn qeQorarcnM uJlra
nero QnoKctuu,IH I,IJnr
qnnpoQnoKcaIII{H
*uerponula3olr priln
KJII,IHAIIM}IUI,IH
a6opta
EMHIIEHEM
MepoIIeHeM
AOplrneHeM
7nd o xap d um un d exquonnotil
Harunnrre KJIanaHbI
Streptococcus
6es nopoKoB 14
viridans,
cepAe.nrofi
Enterococcus spp.,
HeAOCTarOqHocTI4
S.aureus
[eHrrIIlrJIrIvlH wwl
AANTOMI,Iq}IH
I,I
JII,I
AMIINUUJIJIIIH IJILI
BaHKOMI,IqITH I,IJM
qeQrpnarcoH
* reuraruuUl,IH
refironnaHI,IH
*renraruilrlvrrr unvl
HETHJIMIIIIIIH
S.aureus,
Enterococcus spp.,
OKCAUIIJIJIVIH VTJII4
qeQarorutt
* renrauflIll{H
AAITOMI,IqI{H
I,I
JII,I
BtUIKOMTIUITH I,IJII
reftronnaHI,IH
*renrarr,rvrry4llr4IlPT
a/r naproMaHbl
HETIIJIM}IUI{H
,ft utemuo crb repailalr ulI\{I'IH oruIuKo3rlAal\'r u -
2
H
gA.
r
ocr€trlbHblMrI ulrrrl,IMrlKpo6nrntn nP
IrlcryccrBeHHble KJrarlaHbr
S.aureus,
BaHKOMII\nY
I
S.epidermidis,
Enterobacteriaceae
refirounaHI,IH
+pnrfauurIIIaH
,{uQrepoIdAbI
*renraufiulIH
pauuufi
JIIT
refironnaHI,IH
+qe$oraxcl,IM I{JItr
qe$rpuaxcoH IIJII{
quupoabJIoKcaIIrH
quonnrrfi
+pr,I6arra[I,IqrIH
sHAOKapALrr
6-8 Hea.
4-6 sel,.
gMrrupuqecKffI
Y KtDKAoro
Tepanus'
craproBgrf;
Yragana
[aqueHTa O6sgateJILHO IIpOBeAeHI,Ie rr,rrarpO6uoJlgndtlegKO1O uCCneAOBa1ufi. yr .4alrneftflIafi n,1OAraQ14KaIIut
Tepanrnu B 3aBrrcHMocrI'I
uonnrul
I,I
neno QnoKcarII,IH IIJII,I
nocJreorepa-
nogAnnfi
rrocJreoIIepaq-
,IAIITOMI,IqI,IH
BaHKOMI4UI'IH I4JITI
Streptococcus spp.,
Enterococcus spp.,
S.epidermidis,
oKcarIunJILrH lrJIlI
qeQagolur vrrm
qe6rpnaxcon
t6
or Bo36yAl{Tenff.
,IAITOMIIIIIIH I{JILI
BaTIKOMTIIITIH lIJIlr
refironnaHI.rH
Ocnonnrre
JIorca.nu3arlrlr
nndenuun
nos6yAnreJrrr
S.aureus
9HAOKapAr,rr
Ilpenaparbr nrr6opa
I
*nanrouutryru
refirounaHuH
*renrarrlnurrH
A.nnrepHarIrBHbIe
IIpenaDarbr
*renrarrrvrulau filfi4
HET}IJIMIIUIIH
Yrcasana gMilupnqecKarl craproBzul Tepar ns. Y KarKAoro
rrarlu eHT a o6 sgareJlbHo rrpoBeAenl{e Mrllq)o6uoloruqecKoro uccJleAoBaHlrfl I,I AiIJIbHefi ulas rr,ro4ra SuKtilIuq.
.IlnuremHocrb reparu,M orrpeAen frercs. I,IHAtrBtrAyarIBHo.
7nd oxaodum
undexauonaufr
rueacruofi smuoJtozttu
BIuIKOMI,IUUY
I
refironraHLrH
*reurauuUrIH
BagKoMrruun I
reftronraHLrH
HATI,IBHbIE KJIAIAIIbI
[rcKyccrBeHHble KJruuriurbl
+prarparuruql,IH
*rentauuUI,IH
IIHTPAAE.IIOMIIHAJIbHbIE IIH(DE
JIora.nu3aurrfl
uudercuuu
Ilepeawtotfi
(cnonmanruuit
6axmepuunb-
Ocnonnrre
nog6yAureJrrI
Enterobacteriaceae
S.pneumoniae,
S.pyogenes
A.nrrepnarrrBHbre
Ilpenaparbr nrrdopa
9pTarleHeM
rrrr
ep aq unrunI ras o 6aK -
nperaparbr
qe$rpuarcoH LTJILT
ueQ oraxclrM I'IJII,I qeS
enurra
*naetpour,rAanon
TAM
ttrv{ o Kcr,ruurunru/ru aByn a-
nufi)
HAT
nepumowum
naoxcn6noKcaIIIrH
Enterobacteriaceae
Enterococcus spp.,
Bacteroides spp.
Bmopuvnottt
ene6onoHurtHotrt
nepumoHum
sprareHeM
r r4 r ep aq wr.nun
rIeQrpI,I axcoH I,IJII,I
l'rag o 6 aK-
+MerpoHr.rAtr|on
TiIM
aM o
KcrII unnuttI rcnaByn aqeQ
HAT
rr,r
o
ueS orarcl,IM trJILr ue0enlarr,r
rcu
Q
onepasor/cynr6 axtarrn
rlo Kc aIII,IH
I,IMI,IIEHEM I,IJM
MeporleHeM
pIJILI
AOpI,IIIeHeM
Bmopuvnotrt
HOS0KOMUAnb-
Enterobacteriaceae
P.aeruginosa
S.aureus
Enterococcus spp.,
Bacteroides spp.,
Candida spp.
ttttfi
I,IMI4IEHEM lIJrI{
MeponeHeM
ruruepaqunlunhago6aKTAM
qe0 onepason/cynr6 arrana
llp" noBTopHbrx flarlaporoMrltx I4rrI4 KoJIoHTBaIITIIa
Apoxxeu oAo 6urruu rpu6 arra u >2 JIoKycoB Ao 6anurs
nepamoHum
SnyronasoJl I/IJII,I arraQorepnqr'In B.
srrcoxofi qacrore MRSA-nn(perUufi B opIturgaIIIIH
3ApaBooxpaneHrls * nrHe3onrlA IIJrlr BaHKoMIIUTIH
qeS on epas on/cynr6axrarra
9pTarreHeM
flp"
Xonaneum
I,IJIT{
AOpr,IneHeM
ueiprpnarcon LrJllt
qeQomrcr M vrnrn qeQeunnr
*uerpouI4Aanon
Enterobacteriaceae
t7
JIora.nn3arIun
nndenunn
Ocnonnrre
nos6ylrreJrrr
Enterococcus spp.,
Bacteroides spp.,
Clostridium spp.
A.nrrepHaruBHbre
npenaparbr
Ilpeuaparbr nrrdopa
m'rr
ep aq
qeQenuu uru
qnnpoQnoKcarlrrn
*uerporu{Aa3oJr
ruorcuSnoKc€uIrrH
unnnnI ras o 6 aK -
TfIM
NMIINEHEM UJII4
Mepo[eHeM
LrJrr,[
AopnrreHena (upn
HO3oKOMrrttrrbHoM reHe3e
Enterobacteriaceae
Enterococcus spp.,
Bacteroides spp.,
Entamoeba
hystolytica
Adcqecc neqeHu
repnaparrr srr6opa)
urM o Kc r,r q umturrI KnaByna-
nrn epau ututun/ rag o 6 arTAM
HAT
qeQonepa3oH
Spra[eHeM
raJrr,r
qe0orarcuM rJrH ue0enrla
ranr{ uuupoQnorcarluH
*uerponrrAa3on
qeQ onepasoH/cynr6axrau
I|IMI4IEHEM UJI}I
MepoIIeHeM lrJrr{
AOpurreHeM
rr,rorcu6noKcaIII,rH
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ttttfi
naHRpeoHeKpos,
a6c4ecc
noducenydo"ttofi ucenezu
A6cqecc
Enterobacteriaceae
Enterococcus spp.,
Bacteroides spp.,
Clostridium spp.
I,IMIIIIEHEM ITJIII
Mepo[eHeM
ueS
oueparon/cynr6axtau
I,IJrrr
ueQonepa3oH HJII{
AOpr{reHeM
ueQeunrra Iama
quupoQnoKcaqI,IH
Streptococcus spp.,
S.aureus,
Salmonella spp.,
Bacteroides spp.
*uerporu.rAa3on
n 14 r ep aq un,liuH hag o 6 ax-
SpTaneHeM
TIIM
€rM o
Kcrrq unnu:nI waByJI a-
ue$ otax cuM rrlru qeQenrarr,r
HAT
r,rJrr ireBoQnorcaqnn
ceneSeHKa
*uerpoHI,IAa3oJI
nrorcudnoKcauuH
Ilpo,uonxureJrbnocrb auTr,rMtrKpo6noft Teparu,Irr ilpu HeocJroxHenHbx ifoprtra:r
unrpaa6AoMrrHaJrbHbx r,rnQerunfi fipu orcyrcrBl,In Ao[oJIHrITenbHbx Qarropon p[cKa
unsexuuonnbrx ocloxnesufi AJrrreJrbHrul I4BJI, coryrcrByloruue ga6oresannfl JIerKax,
3HatrlrTeJrbHar KpoBo[oTepff Bo BpeMr ollepallufi, Apyrne I{HTpaonepaquoHHbre ocJloxHeH.ns.,
rrMMynocyrpeccvrfr.- He flpeBbrrrraer 5-7 wtefio flptr ocJlox(HeHHbrx - orpeAeJlflerct Lrn4LrBkr[yturbHo
B 3aBucuMocrlr or ee KJrr,rnr,rrrecrofi e0r[errnBlrocrrr. KpureputMn KJuHtltlecrofi eQSerrnBHocrl.r
cJryxar: 1) croftroe cHlrxenne reMneparypbr reJra Ao HopMiulbubrx IIrQp, coxpanf,rolqeecfl He
MeHee 2 cyrox; 2) crotrtK[u perpeccvrs, Apyrux rpLr3HaKoB crlcrerrauofi Bocrttnrlrenrnofi peilclluu;
3) epaanKarlur nos6yAnrenefi, BbrAeJrenHbrx n3 orrara uHSerqnn; 4) nonoxrrreJlbnu AnnarrtrKa
{ynrqnoHanbHoro cocro.flHuq XKT; 5) pa:}petueHue sKcrpaa6AounH€ulbHbrx JIoKycoB unQerqnn.
I,IH OE
KlJJiln AbIXATE JIb HbIX
18
rlyr E lI
Jfona.rrn3arllrfl
u oco6enHocrrr
nndercuulr
,{uQmepun
Ocnonnrre
nos6yAureJrr.r
Jaacmoadum
Xporuuvecxufi
Macmoudum
nperaparbr
IIn hexuuu I epxuux dowamarbHbrx nymefr
C.diphtheriae
AMOKCHUI{JIJII,IH
6eHsErueHlIuunnI,IH
pz0arr,rnuqr{H
SPI4TPOMIIIII,IH
S.pneumoniae,
Ocmpofi
A.nrrepHarrrBHbre
Ilpenaparbr nrr6opa
S.pyogenes,
H.influenzae,
S.aureus
floruuurcpo6nax:
S.aureus,
Pseudomonas spp.,
Enterobacteriaceae
*aHaspo6u
ar\,r o
Kc[rqurrus/rllaByJr a-
nenoQnoKcaIIrH
reuuQnoKcarlr,rH
HAT
il|rrrpoMtrrlnlt vrIlx
UeQrpnarcon
ue6oraxcnu
KJIAPI,ITPOMUUI,IH
Ocuony cocraBnfler xl{pypruqecKoe retleu}re. Ilepea
oilepauneft u rocJle Hee - qeQomxcuM, qe$rpuaxcoH,
neno QnoKcarlrrH. O 6rqat rpoAonxl{reJlbHocrb repar nv
-
3 ,unff.
O6gsareJlbH o nrnrpo6noJloruqecKoe I,IccneAoBaHLIe. flp"
neo6xoAr,rMocrlr - KoppeKllnt repanl{ff, ocuoBbrBaf,cb Ha
efo pe3yJlbrarix.
Omum ruapvucttotfi
S.aureus,
P.aeruginosa,
Octpufi
Enterobacteriaceae
Ar{00ysnnft
rHofturul orI,IT
(<yxo nnonqu)
6rr.ruo cl,IcreMHoe [prIMeHeHI{e aHru6arrep[uurbHbrx
npeuapaToB He [oKa3aHo.
llpu ocrpoM rerleHurl c BblptDrenuofi nrxopaArofi aMoKcr{uutnnrtlxnaByrlaHarunuqeQa3olrurrrlrrr
O
oKcaIILrJrJII,IH.
llprl rflxeJloM
Oypyuryit
HapyxHoro
cJryxoBoro
IIpoxoAa
Xponu.recrnfi
HapYXHbIft
S.aureus,
nrrft orllr (npu
cAu
-
rreao$noKcauuH rI44 IIgQgg4!!
KcHurallnn/rnaByna-
Streptococcus spp.
HA,T
npu ce6opee
O 6 rr.nr
otur
3nora.recrBeH-
aMo
rerIeHI,In
qeSaronun
OKCAUIIJUIIIH
o
cI{ creMg as,
artudtucrep I,I iulbu ilf; Teparu'Is H e
TIOKA3AHA.
Pseudomonas spp.,
S.antreus,
Streptococcus spp.
qe(fenrarr,r
taruuraIIun
neno SroKcaIIrIH tIJrlI
qnupoQJIoKciullrH
taT,IuKalllrH
LrMMyHOCyrpec-
cnn)
Ocmpofi cpednufr omum
Honopoxgen-
Enterobacteriaceae
qeSoraxcunr
itM o KcI,I q
ull.nuI KnaByna-
HAT
HbI9
S.pneumoniae,
llpoAomKrlreJlbuocrb reparurrl 7-1 0 rutefi
uttrlo Kcrlqr.rllnr/ruaByJraAMOKC}IUIIJIJIIIH
HAT
H.influenzae,
M.catarrhalis
a3I,ITpOMLIq[H I,IIU
KIIapU TpOMI,IqI,IH
,{eru, B3pocnble
reno QroKcuuII,IH LITIII
rerr,ru(pnoKcaIIlIH
qedmuarcon (3 AHt)
npeduecmeynqu[t
npueM aumu6uomuKo*, ueeQQerc-
aMoKcrlqnnnun/rrlaByrla-
nenoQnoKcarluH
trJI?I
rerr,rn(pnoKcaql,Iu
HAT
uedmnaxcoH (3 AHs)
mu6Hocmb
19
A.rrrrepHarrrBHbre
llpenaparbr nrr6opa
Pseudomonas spp.,
9ngorpaxeailbHarr uHry6aquff
>48 .racoB
Klebsiella spp.,
Enterobacter spp.
S.aureus,
Pseudomonas spp.,
S.pyogenes+
nnpnufi
adcqecc
*aruurauun
qunpo(bnoKcturr
r4lrw
lrMI,IngHeM UJII{ MepOIIeHeM
rtlru
nenoQnoKcaIII,IH
aMoKclrqunrtnn/ruaByJIaHAT
rIeSenr'rrra
Enterobacteriaceae
flormaurpo6nar:
IlapamoHsun-
qeQtarnALIM rann qe(peruM
qe(p ou epason/cynr6axrau
*arunraqun
florprruurpo6xar:
Omum cpednufi
xpoHuqecxufi
nperaparbl
S.aureus*
anaspo6u:
Prevotella spp.,
Fusobacterium
aM o
Kclrqurmnr/rrt
ueQyporcl,IM trJllr
qeQarorcl,IM I,IJII,I
aBy nra-
HAT
ueQtpuarcon
tMerpoHr{Aa3oJI
O6ssatenrHo
,upenraposaHlae a6cuecc?
!
KJIlrHAardI,IqI,IH
spp.,
Peptostreptococcus
Punoc
Ocrpufi, 6es OP
aM o
IIIJIJII,IH
S.pneumoniae,
UIN,I O
H.influenzae,
M.catarrhalis,
anaspo6rt
a3lrrpoMu\nH wwr
KCI,I
Kclrq
wutunI ruasyna-
HAT
neroQnoKcaIII{H rIiIrI
KJIapLTTpoMTIIII,IH
reuu0loKcaUI,IH
aM o KcI,I
qutlun/xlaBYJI
aH
ar
Octpufi, c @P
JIOKCAUIH }IJI}I TEMI,IQNOKCAUIIH
@pI,IcKa-[peAIIIecTByIoqufinpnenaaHur6noTlIKoBBTeIIeHLIeupeAmecTByIoqnx
6 neAelr, HeeQQeKTI,IBHocrb aMoKcl{uu{Iru{Ha
florutunrpo6nar:
S.pneumoniae,
O6ocrpeuue
xpoHnqecKoro
H.influenzoe
*auaspo6rt:
Bacteroides spp.,
Peptostreptococcus
spp.'
Fusobacterium
S.pneumoniae,
H.influenzae,
Ha Sone C[,
ueiltpoueHl{lI
M.catarrhalis
aMoKctrqunlun/ruaBYiIa-
KJII{HAAMI,IqIAH UJTU
JINHKOMI,IUIIH
HAT
nenoQnoKcarll{H I'Inu
rerr,rra (p no Kc aIII,I
H
I,I
ltlr
rr,rorcuQJIoKCaqI,IH
ar\doKcI,Iqunnuu/ruaBYnaTIAT
reno(pnoKcalll{H urm
rerrru
Q
I o Kc aIILIH I'I JII'I
uorcuSJIoKcaIII'IH
*aHaspo6st
+rpu6rr:
Rhizopus spp.,
Mucor SFF.,
+ arta6orepuutrH B unu BoprlKoHa3on (ronxo upu
Jlona.rrusaqnfl
H oco6enHocrrr
undenunn
Ocnonnrre
nos6yAnreJrr.r
Aspergillus spp.
Hogorouuarrbsufi (na Sone
T4BTI, saAneft
TaMIIOHaAbr
Enterobacteriaceae
P.aeruginosa,
S.aureus,
Acinetobacter
baumannii
A.nrrepHarrrBHbre
npenapaTbr
Ilpenaparbr nrrdopa
BbrAeneHuurpn6oBI{JrraHaJwrrtr4ungnecrxofi
KoJroHrr3 arlurpr 6onee AByx noKycoB r{nra
nesQQerrr,rBuocrr,r aAeKBarnofi anru6axrepualruoft
reparu.ru 6onee 5 aneft)
I,IMIIIEHEM I4JIII
ue0enurra
*aruuraUun
Mepo[eHeM
I,IJII,I
AOpureHeM
ir,rorcuQnoKcarIr,IH
ue (f
onepason/cynr6axranr
O6ssaremna n-vlrrllnq
cunyca!
Hoca)
S.pyogenes,
aM o Kc u q
6ensurmeHrIrIrIJIJrrIH
HAT
603MOJ|CHO
C.diphtheriae,
N.gonorrhoeae
AIdOKCIIULIJIJILIH
ueQanercun
npu C.diphtheriae
Ocmpufi
-
ili}HTpOMlrIIlrH l{Jrlr
KJrapr,ITp oMrrquH I,TJII,I
9plrTpoMrIIIuH
moHSuJLnum
umtuw I KilaBy na-
c[npaMI{qI,IH
npn N.gonorrhoeae
Ue(prpuarcon
(oaHorpatno)
Pequdueupyrot4ufr
movsuJLnum/
Qapuneum
S.pyogenes
aM o Kcr{q
-
w:l.ltuuI xttaByn a-
HAT
I,IJIlr
A)KO3tlMIIIIIIH
qeQrpraaxcon EJII{
qe6orarcunt
qe(foraxcrM rJllr
qeSrpnarcon
KJIII HA€lI\{nqI,IH
I,I
JI}I
JI[IHKOM}IUIIH
?nuutommum
S.pyogenes,
,,{ern
S.pneumoniae,
S.aureus,
H.influenzae
€lr\{ o
Kcrrqranrlrn/rll aByna-
aMrn qunnrn/cynr
6
axrau
HAT
KO-TpI,IMOKCtBOJI
qeQorarcrrM
LIJIIT
uedmuarcoH
S.pyogenes,
H.influenzae
Brpocnrte
aMoKcr,rqunrun/ruaBynaHAT
ueQorarcl,IM
qeQrpuarcoH
HJTI,I
reno QnoKcarllrn I,IJItr
uorcra(pnoKcaIIuH
spTaneHeM
ru.ru ep aq
nwtn:nhas
o 6 aK
-
TTIM
A6cqecc
neeKozo u
acnupauuoHHUn nHeSMOHAn
IInfr exuuu Hucrcuux dotxamenbHbu nymeil
3pTarreHeM
ueQomxcl,IM T,IJII,I
Bacteroides spp.,
ueQrpnaxcoH TIJITI
Peptostreptococcus
q e Q eu uu*ur,ruAarrauqLI
aM o Kc I{ unlrytH/rrt aBynaspp.,
vllrvr ITI.'I}JKOMIIUUI{ IdJrVt
TIAT
Fusobacterium
MCTPOHITAZl:}ON
spp.,
2t
H
JIona.nu3arIrrfl
n oco6enHocrr.l
Ocnonnrre
undercunu
A.rrrreprrarrrBHbre
rpenapaTbr
Ilpenaparbr nrr6opa
nor6yAureJrrr
Sreptococcus spp.,
Enterobacteriaceae
m,r
r
ep arl
ur,nn:aI rag
o6
aK-
TAM
PIMI,IIICHEM I{JIrI
Mepo[eHeM
EJIr,r
AOpnIIeHeM
Ocmpufi fiporuum
Bnpycrr: PCB,
IIapafprrilna,
,{erra Ao 5 ner
aAeHoBr{pycbr
ra
AP.
(6poxuonnr)
Bupycrr
S.pneumoniae,
,{eru crapure 5
JIeT I,I B3pocnbre
H.influenzae,
M.catarrhalis,
C.pneumoniae,
M.pneumoniae,
B.pertussis
Anrn6uorrrKrr K€uc [paBuJro He HtrHaqarcT, ecJrn Her
co rryrcrayro qeff rrH e BM o H vrv[- orvrr a wrrn plrn o c r,rHy cnr a.
Anrr6zorr,rKoTe parrvfr, Ha3naqaercr nppr orcyrcrBr,rr4
KJrlrHrrrrecKoro ynfrurenufr B Teqeur,re I HeAeln:
aM o Kcr,r qunnnn/u aByJraH ar
qeO orax cnu vrJru qe6rpuaxcon
Anrn6axrepuarrbHafl Tepanns rroKixlana Jr[rI€lM c
T.flxeJrbrM o6ulprnr cocrorulreM, c qacrbrM [poAyKTr{BHbrM
KamJIeM B AHeBHOe BpeMr, TTMeTOUIUM BbrpiDKeHHyrO
coryrcrByroqyro [aroJrornrc, craprue 55 ner.
aM o
Kcrrqulwur/rrtaByn
aH aT
il3rrTpoMrrrlrrHrrJrHKJrapr,rTpoMnqvEurJrrlSpr,rTpoMrarlr{H
(ans B.pertussis
- npenaparbr nrr6opa)
nenoQnoKcarlrrn uJrrr reMuQlorcaqnn
qe6 orax cvrv. wlrv
OflocmpeHue
rle0rprarco n
XOEII
Bupycu
6es (faxropoB
a3I,rTpoMwInH vlrn
AMOKCI{UITJIJII,IH
H.influenzae,
S.pneumoniae,
M.catarrhalis,
M.pneumoniae
KnaplrTpoMrilIrrH
ar\d o
Kcrrq
nr'nunI rcttaByJla-
HAT
pI,ICKa
neno QrroKcarlr,rH rrJrlr
rerrau$noKcaIII{H
tr,rolccu6noKcauuH
oAlrn n 6oree
H.influenzae,
S.pneumoniae,
Enterobacteriaceae
SamopoB pl4cKa
aM o
Kcrrqnnnnn/ru
aBy
lra-
nenoQroKcuulrlH rrJrl{
reurQroKcaIIuH
HAT
{eQoraxcl{M I,IJIu
qeQrpuaxcoH
rr,rorcrnQnoKctulr{H
9praneHeM
roxe*
P.aeruginosa
MHOXECTBEH.
Hbre
neno QnoKcaIII,IH I.rnlr
quupoQnoKcaur,IH
*anauraqun
Qarropu
pncKa
ue(beuuu
*auurarluH
22
rrnrepaqururunhago6aKTfIM
IIMI{IEHEM I{JII{
MeporreHeM I,IJITI
AOpr.rreHeM
JIona.nn3aurrfl
n oco6eHnocrrr
nnOenunu
OcnonHrre
A.rrrrepHarrrBHbre
Ilpeuaparbr nrrdopa
nor6y,uureJrr.r
nperaparbr
qe0 onepar on/cynr6axrau
pncra:
Oaxroprr
OOBr<SIYI,>4 o6ocrpeuuft n roA, rflxeJraf, raroJrorr,rff cepArla, neo6xoAl{Mocrb
B oKcnreHorepannfir rrpvrerra arnu6rlorr,rKoB B [pe.4rrrecrByroque 3 Mec.nrla, Bo3pacr >65 net.
ff ne enoH ufl en e 6 onuu u.tH an
qeQoraxcuu
E.coli,
aMIII{qUJIJIIIH
+AMnltultJIJII,IH
(napenreparrbHo)
unu
S.agalactiae,
(uapenrepanrrro)
unnnln
L.monocytogenes
o
Kcr,rq
I
rctaByJraH
ar
7
aM
rur.
,{erur.uo
+aMI,IKtuIrrH uIrr4
reHTaI\{I{IItrH
,,{eru
7 lrn. - 6 naec.
E.coli,
S.agalactiae,
ueQoraxcnrra
* gp urp o M I,I qI,I H
L.monocytogenes,
a3HTpOMrIIII,rH
oKcaIIunnnH
*renrarrlLrqI,IH
+ spurpoMrrqrrH
I,IJII,I
C.trachomatis,
Bnpycbr
rrJrI,I
a3lITpoMLIIIT{H
aM o
Kcr,rqnnnuH/ru
aBy rra-
HAT
t
3pI,ITpoMI{III'IH
I,IJIIa
0i|rlrpouuquH
Bnpycu
,{eua
6uec.-5ner
.{ern
craprre 5 ner
(au6ynaropno)
,{eur
craprre 5 net (n
craqr,roHape)
ue(potarcvM vrlru
qeQrpnarcon
aMoKcrIquJIJrrlH
S.pneumoniae,
H.influenzae,
S.aureus
S.pneumonise,
M.pneumoniae,
C.pneumoniae
S.pneumoniae,
M.pneumoniae,
C.pneumoniae,
Legionella spp.
aM o KcrarlrarwrH/u aBy rlre.-
it3rITpoMIIIIlIH
HAT
iIN,l O KC I,I
q
I,I
aM o Kc
JIJII,IH
r,r
uunrurr/rllaByna-
HAT
KJIapUTpOMT,IqI{H
a3rrTpoMI{IITIH
aMoKcraqurrur/xraByna-
ueQoraxcl,IM I{Jru
qeSrpuarcon
+ a3I,ITpoMpIIIrIH [JII{
HaT I,IJIn aMIII{qI'IJIJII,IH
(napenrepanuro)
+ a3I,ITpoMI,Iq[H nnll
KJraprrTpoMrIIII,IH
KJIapUrpoMlIIIr{H
Bspocnarc:
S.pneumoniae,
Au6ynarcpHo
6eg OP
Arr,r6yratopHo c
OP
M.pneumoniae,
C.pneumoniae,
H.influenzae
S.pneumoniae,
H.influenzae,
S.aureus,
Enterobacteriaceae
cIII4paM]rIIrIH
aI\4OKCLIqLIJIJII,IH
il3
trrp oMIaIIlrH
neno QnoKcaIII{H I,IJII,I
JIlr
I,I
renau6norcaIIIdH
KJIapI,ITpOMI,IqUH
arvr o
Kcrrqurruu/Kn aByrlaH ar
nenoQnoKcarlnn
TIJITI
reMnQrorcaqnH
uorcu6JIoKctuIHH
OP - (paxropu prrcKa - rpeAruecrByroquft upneu anru6rlortlKoB B rerlenrle rpeArrrecrByloqux
6 neAelr, neeQQerrnnHocrb aMoKcrrqr4rrrrvtna, H€IJII{rILre corlyrcrByloqrx sa6orenannfr, u
cocroguuft (XOBJI, caxapHrrfi 4na6er, cepAerlHult HeAocrarorlnocrb, 3rroyrrorpe6reHue
airKoroJleM, HapKonaanur)
focuurarugwpoB€lrlHbIe
(nne OPIIT)
S.pneumoniae,
H.influenzae,
C.pneumoniae,
S.aureus,
itM o Kcrrqrarrnn/ru aBy naHar rrJrlr ue$rpuarcoH HJII{
ue0 orarcl,IM IIJITI ueSenr'rrr,r
+a3nrpoMtIIIpIH
23
I,IJITI
9pra[eHeM rIJII{
fluqu r,nnn/ cy ttr 6 axtarra
aM
+a3I,ITpoMrIIIlIH rIJIrr
KJraprrTpoMlrIIEH I,IJM
Jlorca.nn3aurrfl
u oco6ennocrrr
nndercunu
Ocnonnrre
nor6yAureJrrr
Enterobacteriaceae
A.nrrepHarr.rBHbre
npenapaTbr
Ilpenaparbr nrr6opa
KJrapurpoM[rlrrH rrJM
9pr,rTpoMrrllrrH
9pprTpoMlrrlr,rH
reso6roKcarlrrH
S.pneumoniae,
focuurzurnsvpoBarrHbre,
gpTaueHeM I,IJII
Legionella spp.,
m,r rr ep
S.aureus,
*as nrp
Enterobacteriaceae
P.aeruginosa
KJr ap I,ITp
aq
aM o Kcr,rqumrun/rnaByna-
nntmn hag o 6 aKra]d
oM I,IqI,I
O
M
H
I,I
JII{
I,IUI{H r{Ipr
Har
vrrrvr
qe$rpuaxcoH
r{Jrr,r
ueSorarcr,rM r,rJI[ qeQenunr
vrlfi[
aMrnquwmilcynr6axmnr
cIIrrpaMLrIIr,rH
TgXEJIOE
+a3rITpoMrIrIrIH trJlu
TEqEHI,IE
KJrap HTp
(n OPZT)
oM[rur.rH
r,r
Jrr{
crIHpaMI,IqI,IH
neaoQnoKcauuH rrJrr
nrorcu6noKcaqI,IH
Bupycu rpr,rffra
fpann
o3eJrbraMLlBrtp
3aHaMrIBr4p
AUB
If ne emou un Hos o KoM u&nb H un
Yraumarccrnt go3moctcHocmb
cwecmgoqaHufl pa3nuquit e cmpyxmype u aumufiuomuKop%ucmeHmpasnuqHbtx
Hocmu uufuercquil a
cmaquoHapffi, eut6op eMnupuvecrcoit mepanuu s nepryto ovepeda
doncrceu 3a6ucemb om noKarbHoti cumyaquu. Hucrce npueedeHHwe peKoueHdaquu paspa6omaHbt
Ha ocHoeaHuu o6u.tttx meudeuoruil.
PanHss (rraenee 4
Asefi
npe6rrnauufl,
B
crarluouape), y
ruulfieHTos 6eg
OP
S.pneumoniae,
H.influenzae,
S.aureus,
Enterobacteriaceae
spraIIeHeM
ai\d o Kcr,r
qunrun/rlt
nenoQnoKcaqI,IH
aByn a-
rraorcu$JroKcarlr,IH
HAT
rIeSrpEaKcoH r{Jr}r
qe$ orarcr,rM r,rJrlr qeQenlarr,r
pe3r{cTeHTHbD(
sog6yAr,rrereft
flosAnrs (6oree
5 anefi
npe6rruantrfl,
B
crarllloHape), y
narlrreHTos c OP
P.aeruginosa,
Enterobacteriaceae
S.aureus (.rarue
MRSA),
A.baumannii,
S.maltophilia
r,rMn[eHeM I{JII{ MepOrIeHeM rJII,I AOp[IIIeHeM
LrJrI4
rle$onepasoH/cynr6artau nnu
ru{ rr ep aq unnunI ^rag o 6 axrarr,t
tlun e g o JTLII\ uIrtr B aHKoMtIrIlIH
*arrauraUun
*upu roAo3penuvr ua L.pneumophilia
-
resoSnorcaqr,rn
pe3I,ICTeHTHbtx
ros6y.urareneft
flpu BbrleneHnv S.maltophilia
-
xo-''rDr{MoKctl3on
prrcKa - rpoBeAeHrre aHrn6arrepuanbHofi tepanfivIB TeqeHue 3 rr,rec. Ao
roclr.rrttrrvaaTrtTvr; BbrcoKar rracrora pe3r,rcreHTHocrll cpeALI ocuoBHbrx nos6y.unreleft B pernoHe
ulunn orAgJreHr,rfi; rocnl{Tulrlrl3tulus,>2 Anefi 3a flpeAlrlecrBylorque 3 Mecf,Ila; npe6unanrle B
AJrrrreJrrHoro yxoAa; xpoHr,rqecxzft EvrurLrg; HIIIITITMe trrleHa ceMbl{ c sa6oreBaHrleM,
OP
-
Sarropu
frpexAeHr,rffx
Bbr3BaHHbrM [oJrrrp$rrcreHTHbrM Mr,rKpoopraHrr3MoM, rlMMynole$nqrIT, B T.tI. Ha Sone
IaMMyH o cyrrpeccusrroft TeparII4I,I
7unuetwa wrespbt
qe6orarcur"t
aM o Kc rr qnnruur/xr aByJI aS.aureus,
.Ilerpr to 7 Anefi
24
JIora.nu3aurrfl
n oco6enHocrrr
nH0ercqnn
Ocnonnrre
nor6yAnreJrrr
A.urrepHarrrBHbre
rpenapaTbr
Ilpenaparbr nrr6opa
S.agalactiae
HAT
i
E.coli
* renrauprrlvrr ulrkr
TIMIIKTIIIIIH
renrarrlkr\vrrkrlrla
aMrIKaIIEH
S.aureus,
S.pneumoniae,
xn,-
ueQtpuaxcoH IIJIII
qeQoraxcrrra
HAT
H.influenzae
,{etu
7
Apgnnpolranne
rrJreBpalrrsofi norocru !
€rMoKcHrlunnun/xnaByna-
KJTI,IH.qaMIdTIVTHIIIIVT
5 ner
JII{HKOMI{IIIIH
.4IleHrposaHue
S.pneumoniae,
S.pyogenes,
* renlaunrlvrr
uresparrHofi norocrlr!
aM o Kc r,r q unnnnI xnaByJra-
AMI{KAU}IH
HAT
qe
qeQrpraaxcoH
(p
orar cpru
prlru
HJrrr
vrJrkr r1e (p
enurr,r
S.aureus,
,{eru craprue
5
H.influenzae
neno$noKcaurru I{JIu
9prarreHeM
rraorcnQJroKcaur,rH
JreT I,I B3pOCJIbIe
(ocryar)
Apenr,IposaHLIe
(ronrro craprre 14 ner)
uespanrHofi uorocru!
rrr r epaq unnunI rag
o6
aK-
TZIM
Peptostreptococcus
spp.,
S.milleri,
Bacteroides spp.,
Enterobacteriaceae
M.tuberculosis
.{ern cmprue
5
aM o Kc
H
rI
nnnunI rcsraByn a-
urutuw hag o 6 aK-
TAM
HAT
sprarreHeM
aMn
.4pennposaHI,Ie
nrtenpzururoft
norocrr!
r,r
qu wmw/ cy
rle$TpraxcoH
r'16
arcrau
I{JILI
qe S o rar cvrv' vrlrtt q e $ ennrrr
+MerponlrAa3oJl I,IJM
JIeT I,I B3pocnbre
(uogocrpar/
xpoHrrrecrax)
ru,rrr ep aq
Heo 6xo.uraM o u crrnow{tr
ry6epryres r qHroromrc
(6uoncns unesprr)!
KJrrHAaMI,IqrH
UJII,I
JI}IHKOMIIUI{H
aMlr
r,r
qu nrtunI cy
ttr 6 axra*t
I,IMHTIEHEM I,IJIfl
Mepo[eHeM rIrIH
AOpureHeM
flpolonxr,rreJrbnocrb reparu{n r,rH$erqnft nepxnnx AbrxareJlbHbx nyreft cocraBJlter 5'7
gneft, Tou3r,rnJrkrra - 10 aneft. I4crnrorreHrie flpeAcraBirser Hff]HatIeHI,Ie repafir4r4 tl3tITpoMIlqI,IHoM,
Anr,rreJrbnocrb roropofi cocraBnffer 3 AHfl BBLIAy ero nrrcorofi cnoco6nocrl{ Har€IrJILIBarbc.f, B
TKAHfiX.
flpogonxr,rreJrbHocrb repanvrpr sne6omur,rrrnbrx ranQeruuft nnxru{x AbD(areJlbHbrx uyreft
6es QarropoB prrcKa u rsxeroft conyrcrByroqefi naronorur -7-10 rutefi.
,{nurelrHocrb repanuu Ho3oKoMr{€urbnbrx raHQerquft o[peAeJlterct prntruBvr/iyttrlbHo vr
3 aBlrcprr or KJrr,rHnqecrofi s$ rf erruBHo crI,I aHTrIMrIKp o 6nofi Tepam,Ilr .
25
TEPAIITM TPI,IEKOBbIX I{HO
Ocnonnrre
IlnQercqnn
IlpenapaTbr nrr6opa
nos6yAureJrrr
A.nrrepHarrrBHbre
NDENADATbI
Acnepeutmet
Arneprn.recxrafi
6ponxo-
rero.nrrrfi
Aspergillus
fumigatus,
Aspergillus
terreus,
Aspergillus flavus,
Aspergillus niger
n I.p.
JlerKr,re Soprvrrr ne
BOplrKoHa3on
rpe6yror retreuus
I,rTpaKoHa3on
IIo3aKoHa3oJr
(ao t 6 ne4enr)
IIpu xpoHr{rrecKoM
TeqeHr,ru - xupyprnrrecKoe
IEIIEHI,IE
xerpypllaqecKuur pe3 eKrlr{f,
AcnepruJrJroMa
I,ITpar(oHaBoJI
BOplrKoHa3oJr
BOpI,IKOHa3On
Xponn.recruft
arr,r$orepraqran
B
(nunocorr,rzurrnrul)
HeKpoTI,I3I,I-
xEpypruqecKoe rerreHfi e
pyroIuzfi
racuoSyurun
no3aKoHa30Jr
arr,rQorepnqus B
(nunocorvranrHrrft)
BOpprKoHa3on
Ocrpuft
LIHBi|:}I,IBNUfi
racnoQynrnn
reroqHrrft
Annepru.recruft
JrerKr4e Qopnru He
acIIeprurnne3-
no3il(oHa30Jr
rpe6yrcT rerrenlrs
I,ITpaKOHtr|On
nrrfi
PI,IHOCI,IHYCLIT
x[pypr[qecKoe reqeHr,re
XpoHra.recrufi
nepcucrnpyro-
ufifi cI,IHoHa-
a:r,rQorepEIIIaH
ganrnrrfi
arr,rQorepnqnn B
(nunocorraamuuft)
B, sarent
AnraTenbHarr cy[peccr,rBHzur
ac[epil.rJrJre3,
T
eparfilfl , r,rrp axo H il| onoM
HopMilJrbnrrft
trMMyHrrrer
Ocrpuft
BOpI,IKOHAnOn
r{HBa3uBnufi
cr{HoH&}zuturrrfi
ac[epruJlJle3,
r,rMMyHoAeOu-
UIIT
xupyprfi rrecKoe rerleHrle
IlapanasarrbHafl
rpaHyneMa
UTPAKOHA:}OJI
Kandudos
opor[apnHrearlb-
urrft
MoqeBbrx
uyreft
C.albicans,
C.parapsilosis,
C.glabrata,
C.crusei,
C.tropicalis
ra
III,IUIeBOAa
KaHAuAerans 6es
Ap.
HI,IcrarI,IH
(uecrno)
nTpar(oHa3oJI
KJrorpr,rMa3 o Jr (ruecrrro)
racnoQynrun
6nyroHagor
6nyronagon
$nyronason
racnoQyrrnH
rro3tucoHa30n
arra6orepuqun B
BOprrKoHa3oJI
IIo3ar(oHa30JI
rrrpiu(oHa3oJI
arradorepraqun B
6ryronagon
26
arradorepuruan B
Ocnonnrre
IInQercqnr
nos6vA[TeJrrr
ueftrponelatrur
Ilpenaparbr nrr6opa
racnoQyHrran
A.nrtepHarrrBHbIe
npenaDarbr
(nnnocorr,ranrHufi)
BOprrKoHa3oJr
KaHAI,IAeM[g
C
racuoSynrnH
arr,rQorepnquu B
(nnnocorrramsrrfi)
HefimoneHuefi
Qnyronason
ana$orcpuqnn B
arvrQotepuqun B
xpoHuqecrnfi
(nuuocorr,rzurrHrrft)
AI,ICCEMI,IHI,I.
ponanurrfi
[ocJre ct afnnu3alrvrtr
cocroflHtts, noAAepxrBflrollliur reparr{ff
SnyronasoJroM
fiocJre cralunu3€lulrrr
cocToflHvtfr,
-
roAAepxrrBaroqa.fl repam{s
6rryxonagoJroM
NEPI,ITOHIIT
racno0ynrnH
anr6orcpprqnn B
Qnyrconaror (rorrrKo npn
arr'rQorepuqnn B
MCHrIHTI,IT
(runocouarurufi)
HenepeHocI,IMocrr,r
+ipnyuuro3l,In, 3areM
QnyronasoJr Ao 4 nel,.
[ocJre JrEKBlrAau[Lr
arrr([orepuquxa B)
BOpI,IKOHtr|OJI
CIIMIITOMOB
yAaIIeHI,Ie BCeX
r{HopoltHbrx Teir
alaQotepuunn B
(wruoconranrrrufi)
+$nyuurbsnH
Qrryronasor (ronrKo rpu
HenepeHocrIMocTlI
arvrQorepnqnHa B
BbrleneHI4E
run
IIYBCTBI,ITENTUOfi
arraSorepnIIHH
rynrrypu)
+Qryrlraro3LrH
9HAOKapAr,rr
racnoQyurnn
yAarreHr.re KJrarraH a, fipvr
HEBO3MO)KHOCTII
-
AnETeJrbHaf, Teparu,Iff
6nyroHasoJroM
anr$otepuqnn B
+Qryuuro3rrH
en4oQmrbMI,IT
a*r$orepuqun B
(nnnoconranrnrrfi)
(fnyronaror
BOprrKoHtt:}oJI
xupyprI,IrIecKoe
racno(pyHrun
BMEIuATEJIbCTBO
QnyroHasoJl
ocreoMl,I elutl
aprpI,IT
uJrI,I
racnoQytrrun
arr,r(potepuqnn B
(nunocorr,ranurrrfi)
yAaJIeHr{e
27
airaQotepplqras B
fiocJre cra6unnga\firr
OcnosHrre
nor6yAureJrrr
HnQercunn
Ilpenaparbr nrr6opa
He
Kp orr,r3r{p o
B
aHH
brx
A.nrrepHarrrBHbre
IIpenaparbr
co croff H vrfl. - ([nyronason
rxanefi u r,rnopo4nbx ren
flocJre cra6urtu3aul{n
cocrosHufi
arr,rdorcppruuu B
racuo6yurr,rH
racuoQynrran
nnderutus, C.glabrata
nnQerqns, C.crusei
arvrQorepnunu B
BOpr4KOHa30n
arr,r(porcpnqun B
(nnnocorraanrnrrfi)
arr,r(fotepuqun B
Absidia
3ueotwuxos
(twyxoptwuxoz)
- Snyronason
corymbifera,
Rhizopus spp.,
Rhizomucor spp.,
Mucor spp.
14 trp.
xupyprrqecKar o6pa6orra
no3aKoHa30JI
Cnopompuxog
roxHufi/
lrrpaKoHt|:|on
Sporothrix
schenckii
Qnyronasorr
KO)KHO-
nnnriparuqecruft
anr$orcprql,IH B
rrrpaKoHa3on
v
IETOIIHbIII
lo
KoHIIeHrpuponannrui
pacrBop I,IoAI,IAa Kafing
(l r na I nan soAH)
o6rqefi Ao3br 1,5-2,5 r, 3areM
xfipyprnqecKoe lleqeHlre
anrQoreprqun B ao o6rqefi
Ao3br 2-3 r,3areM
qHC
LrTpaKoHtr|oJI UnU
(f
nyronaroJl noxu3HeHHo
r,rrpaKoHa3oJI
KOCTHO.
arr,riporeprul{H B ao o6qeft
cycrannofi
Ao3br 1.,5-2,5
cr a6uru3 allnu co croff HI4s,
3areM I,ITpaI(OHaIloJI I{JIlr
dnyronagoJl rroxll3HenHo
Qnyronason
(npu HenepeHocrrMocrrl
rpenaparon nu6opa)
r
a:r,r$orepuql,In B .qo o6rqeft
Ao3br 1,5-2,5 r
ArrcceMrIHPIpo-
arrrQoteprqnu B
(ruanocoMtulbHblft) ao
Qryronaron
saHHrrfi
r4Tpiu(oHa3oJI
MuKo3,rLIcToIIJI€l3Mo3'KoKIILIAlIoI,IAo3[[apaKoKIIlIAIIoI,IAo3cM.
pa3AeJr
<Bl49-nn$eruns).
Penicillium
marnffii
I,ITptU(oHa3o JI lrJII,I Kero KoHa3 oJI
(npu JIerKoM rcueuun)
IlenuuututuHog
a1a$Orepuqug B, Sareu HTpaKOHa3OJI nJIu KeTOKoHa3on
(upu rrx(eJloM
(Dywpuot
F.solanii,
F.oxysporttm,
F.proliferatum
TetIeHpIu)
arrn(forepuqun B
BOpLTKOHa3OJI
anafrorepuunn B
IIO3AICOHA3OJI
28
-
llnQercunr
Ocnonnrre
nos6y,ullTeJrrr
u Ap.
Ilpenaparbr nu6opa
A.rrrtepHarrlBHbre
npeIIapaTbr
(nnnocorr,rarurnft)
Snyuurosun (y
pe6parrepHbrx rauueHros)
Ilceedoqnttetaepuos
(cqedocnopuduos)
XpotwotwuKos u
MUUemOMA
(DeoeuQoMUKOSb'
P.boydii
(S.apiospermum),
BOplrKoHtl:}on
xfipypr[rrecKoe reqeHue
S.prolificans
Fonsecaea
pedrosoi,
Exophiala
spinifera,
Phialophora
verrucosa w ]J.p.
Cladophialophora
bantiana,
Bipolaris spinifera,
Exophiala
dermatitidis,
Lrrpar(oHtr|on
arr,rQorepuqun B
HTpar(oHa3on
yAiureHr,re IIopa)KeHHbrx
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qunpoQJroKcarluu / neno(fnorcaquH
xnoparr,rQeHraKoJr
noJrr4MI,IKcr,IH
B / uorrrMlrKcrrn E (ronncrnn)
t[ocQorr,rrdrlr,rn
uurpoQypaHrordH
ro-rPrMoKctti}on
Pseudomonas spp.
m,r n ep
iu[rJrJIr,IH - Tas
o6
aKra]d
qe0rasrAlrM
qeQennrra
I,IMUIIEHEM
MeponeHeM
AOpnrreHeM
reHTaMuIIrIH
ro6parrrnqrrH
HETI,IJIMI,IUIIH
aMlrKarILrH
qnnpoQnoKciulrrH
nenoSroKcarlr,rH
[oJrrdMI,rKcLrH B / noruruurcnx E (rorrracrnn)
6oc6onanullH
Acinetobacter spp.
rrep aqu JrJrr{H -Tas o 6 aKmra
ue$ragraArrM / ueQouep€BoH
ru,r
qe S o n ep a:i o H - cynr 6 armu
qeSenurr,r
I,IMI,INEHEM
Meponenena / aopureHeM
fEHTtIMIIUIIH
I avrnurrr{Jl
JIU H -
cyrr 6 arrau
ro6paldLrrInH
HETI,IJIMI{II14 H
aMr4KarlrIH
AOKCLIUI4 KJII,IH
TI,ITEqUKJIHH
qurpoQJroKcarlnn / resoQnorcaqun
floJrr{Mr.rKcr,ru B / uonprMr,rKcrrH E (xonucrnn)
0oc0onruqnn
Stenotrophomonas
maltophilia
KO-TpI,IMOKCtl3OJT
qeQrarnAr,rM
xropairaQeHuKon
nenoSnoKcaqr4H
Tr,r
Kapqu
JrJrr4 H -
KJraByJraH aT
TI,IrequKJIrlH
Staphylococcus spp.
I oKcauuJrJII,IH
9pI,ITpOMIIIII,IH
KJrlIHAar\{uur{H
nenoSnoKc[ilIrrn / rvrorcusnoKcarluu
BarrKoMlr tluln I refi ronlaHr,rH
NI,IHE3ONIIA
AaIITOMr{rltrH
TI,ITCUPIKNI,IH
KO-Tpr{MOKCTl3On
reHTaMLrrIUH
xroparr,rQeHLrKoJr
Qysn4HeBUr Kr{cJrora
rerparl[KJrr{H / AorcnqrKJrr,rH
pudarrrnur{un
Enterococcus spp.
aMnI{qEJTJII,IH
aMIII,rqLIJIJI[IH-CyJIb6aKTarr,r
/
arraorcnqprnJrr4H-KJraByJlzurar
I{MI,IIIEHEM
reuTaMra
\us I cTpe[ToMr{rIr{H
BaHKOM14rInH
reftxonraHraH
TI,I[ EIIIIKJII,IH
AanToMprIII,IH
JrlrHe3onr{A
numodypaHroLrH
S.pneumoniae
6eHg[rnenlaur,IJrn nn
I
aMttfi uuJrJII,rH
ueQypor cuv' / qeSorax cnv' / qeQrpraxcon
r,rMr,rreHeu / MeporeHev. I eprareneu lAopureHeM
neno SloKcarlrrn / naorcuQnoKcarluH
3prITpoMI,IqI,IH
KnI,IHAaMnIILTH
pu$ananuqr,rH
xnoparra$eHr,rKoJr
TerparIHKJrr4H / AorcnqrrKJrprH
nEHe30nI,I.{
BaHKOMITIILTH
KO-Tpr,rMOKc[I3OJr
CmpenmoKoKKtt epynn A,
6 e ns r,urn eH
B,CUG
reso Srorcarlng / r\dorcnQnoxcaquH
HrIr,rrrJMH
2
BAHKOMEIII,IH
sprrrpoMrIrInH
KJItTHAaMI,IqpIH
TerpaII[KJrr{H / Aorcuqr,rKJrr{H
TI,ITCUI{KJII,IH
xroparvrSeHr{KoJr
AaIITOMI,TUIdH
JIPIHe3Onllt.[
nnrpoQypanror,rH
pnQa:ranrqr,rH
KO-TpI,TMOKC€l3On
B
oAHy crpoKy, p*AenerrHbre 3Hau(oM
o[peAeJIeHI{e
d>
nepeqr{cJre'"t
K OAHOMy rI3 B3arrMo3aMeHreMbrx cpeAcrB
rryBcrBl,ITeJrbnocrr{ Mr,rKpoopr€u{r,r3Ma K
ApyrI,rM cpeAcrBaM ra3
TTyBcTBLITeJIbHOCTpI MI,IKpOOpraHrSMa
AocrarorlHo, qro6rr cyAI4Tb
AaHHOTO neperrHff.
o
BxruoqeHlle B na6op Ans olpeAenenl,I n aurulrlorr.rKorryBcTBr,rreJrbnocrrr Bcex flepeqrcJreHgbrx
BBITIIO cPeAcB HelleJrecoo6pasno v gKoHoMI,IqecKLr Heo[paBAaHHo. Brr6op
KoHKperubrx
fipe[aparoB onpeAenflercfr cnequQmoft f{pexAeHnf, 3ApaBooxpagegr.rr, Harrnqr{eM B
nnuxpo6noronaqecroft na6oparopuu orpeAeneHnbn< 4ncron/E-recron/pasneAegrft
antpr6uoruros/xapr
.qJrfl
[onyaBToMarlrqecruft 6arrepnororuqecK1rx itHturrparopoB.