Hlavní téma – Moderní trendy antibiotické léčby

Pavel Dlouhý, Marek Štefan

Vnitr Lek 2024, 70(5):371  

Antibiotic therapy for the most common infections in outpatient practice

Milan Trojánek, Marek Štefan, Ludmila Bezdíčková, Michal Prokeš, Helena Žemličková

Vnitr Lek 2024, 70(5):276-283 | DOI: 10.36290/vnl.2024.056  

The World Health Organization (WHO) has identified antimicrobial resistance as one of the leading risks to global health. In 2019, antibiotic resistance led to 4.95 million deaths worldwide. The primary cause is the exposure of bacteria to antibiotics, especially in human medicine. There is evidence that improving antibiotic prescriptions can reduce antimicrobial resistance. Most antibiotics are prescribed to outpatients, often for respiratory infections, where they are frequently overused. To improve clinical practice, it is necessary to influence not only the quantity of prescribed antibiotics but also to prefer antibiotics with a lower potential...

Duration of antibiotic therapy of the most common bacterial infections

Marek Štefan

Vnitr Lek 2024, 70(5):284-288 | DOI: 10.36290/vnl.2024.057  

The duration of antibiotic therapy is a controversial topic, as historically, recommendations for treatment duration were based on traditional concepts, empirical experience and concerns about the recurrence of inadequately treated infections. However, in the last few decades, a large amount of data has accumulated in the scientific literature, allowing for the safe shortening of antibiotic therapy duration for many bacterial infections. Compared to longer treatment regimens, shorter therapy duration has been shown in multiple randomized controlled trials to be equally effective, with the advantage of less antibiotic exposure, resulting in a lower...

Sequential antibiotic therapy

Pavel Dlouhý

Vnitr Lek 2024, 70(5):289-294 | DOI: 10.36290/vnl.2024.058  

The article summarizes information on sequential antibiotic therapy, i.e. the transition from parenteral to oral administration of antibiotics. The aim of this approach is to improve patient comfort, reduce the length of hospital stay, limit complications associated with intravenous access, and decrease costs, all while achieving the same treatment outcomes as in parenteral antibiotic therapy. The review also outlines the conditions on the patient's side, suitable clinical situations, and available oral antibiotics.

Current recommendations for antibiotic dosing in obese patients

Jan Strojil

Vnitr Lek 2024, 70(5):295-302 | DOI: 10.36290/vnl.2024.059  

Obesity is a growing societal and population health problem the prevalence of which has increased significantly in the recent decades. Pathophysiological changes associated with obesity can alter the pharmacokinetics (PK) of antiinfective drugs and result in subtherapeutic levels and treatment failure. Due to complex changes in distribution volume and elimination functions, a simple correction based on total body weight would often lead to overdosing and risk of toxicity. Thanks to a number of PK studies evaluating antibiotic doses in the critically ill and thanks to dedicated studies in the obese we have gained new insights into adequate dosing in...

Specifics of antibiotic treatment in intensive care

Hynek Bartoš

Vnitr Lek 2024, 70(5):303-307 | DOI: 10.36290/vnl.2024.060  

Antibiotics are one of the most frequently administered groups of drugs in intensive care. The treatment of critically ill patients with community and nosocomial infections has some significant specifics compared to the treatment of outpatients or patients hospitalized in wards. Septic patients must be treated in a timely manner with an appropriately chosen empiric antibiotic treatment in a sufficient dose and at adequately selected dosing intervals. Compared to less serious conditions, these patients cannot wait to start antibiotic therapy. Pharmacokinetics is very often changed in critically ill patients, and it also changes dynamically during the...

Percutaneous coronary angioplasty for chronic coronary syndrome: the antithrombotic therapy

Ivo Varvařovský, Roman Miklík

Vnitr Lek 2024, 70(5):308-313 | DOI: 10.36290/vnl.2024.061  

Percutaneous coronary angioplasty (PCI) is an established method of treating chronic coronary syndrome, the safety of which is fundamentally increased by properly administered antithrombotic treatment. The actual performance of PCI is ensured by a combination of anticoagulant treatment and acetylsalicylic acid. Platelet P2Y12 receptor inhibitors have been shown to be crucial for the safe use of coronary stents both in the perioperative period and in long-term treatment after PCI. The choice of a P2Y12 inhibitor and the duration of its administration are governed primarily by the risk of bleeding.

Adrenal incidentalomas

Ivana Ságová

Vnitr Lek 2024, 70(5):E9-E15 | DOI: 10.36290/vnl.2024.066  

Adrenal incidentalomas (AI) include all adrenal lesions ≥ 1 cm in diameter found incidentally during radiological examinations indicated for other than adrenal pathologies. Based on hormonal activity, AI are divided into hormonally non-functional and hormone active (functional). Nonfunctional AI and those with mild hormonal secretion can remain asymptomatic. However, AI that exhibit significant hormonal activity often present with characteristic symptoms of Cushing syndrome, primary hyperaldosteronism, or hyperandrogenism. Evaluation of AI requires a comprehensive approach involving hormonal examinations as well as imaging examinations to accurately...

Growth hormone secretion disorders and their impact on bone quality

Juraj Payer, Peter Jackuliak, Peter Vaňuga, Martin Kužma

Vnitr Lek 2024, 70(5):E16-E20 | DOI: 10.36290/vnl.2024.067  

In this article, we address endocrine-mediated osteoporosis caused by disorders of growth hormone (GH) secretion; growth hormone deficiency in adults and acromegaly. GH and insulin-like growth factor-1 (IGF-1) stimulate linear bone growth through complex hormonal interactions and activate epiphyseal prechondrocytes. GH stimulates the production of osteoprotegerin and its accumulation in the bone matrix through the receptor activator of nuclear factor-kappaB (RANK), its ligand (RANK-L) and the osteoprotegerin system. Incorrect function of this mechanism can lead to specific bone damage. The primary problem of bone involvement in disorders of GH secretion...

Pilot analysis of insulin pump (CSII) utilization for the treatment of seniors with diabetes in the Czech Republic

Martina Nováková, Klára Benešová, Jiří Jarkovský, Ladislav Dušek, Iva Holmerová, Milan Kvapil

Vnitr Lek 2024, 70(5):E3-E8 | DOI: 10.36290/vnl.2024.065  

Introduction: Good glucose control is the optimal goal of antidiabetic therapy in most patients. CSII improves results and does not increase the risk of hypoglycemia in patients with type 1 and type 2 diabetes mellitus; it reduces cardiovascular mortality in type 1 diabetics. Objectives: evaluation of the use of CSII in the therapy of elderly treated with insulin in the Czech Republic. Methodology: An anonymized set of patients with DM from the data of the National Register of Paid Health Services (NRHZS) in the years 2010-2021 (patients for whom an insulin pump, accessories or consumables were reported in the given year) was used for the analysis....

Periprocedural care, bleeding control and rules for the use of antithrombotics in patients with haemostatic disorders in liver disease

MUDr. Jaromír Gumulec

Vnitr Lek 2024, 70(5):326-334 | DOI: 10.36290/vnl.2024.064  

Prevention and treatment of bleeding or thrombosis in patients with liver cirrhosis is associated with a number of pitfalls, perceived ideas and established stereotypes. A false paradigm persists in the professional community that changes in haemostasis accompanying liver cirrhosis are a priori bleeding. In fact, a new haemostatic balance develops along with liver disease. The problem is that it is fragile and easily disrupted by internal drives or external interventions. The result can be bleeding as well as thrombosis. Inadequate medical interventions conducted in an attempt to correct pathological coagulation abnormalities or thrombocytopenia may...

OPAT - ambulantní parenterální antimikrobiální terapie

Marek Štefan, Pavel Dlouhý

Vnitr Lek 2024, 70(5):E21-E26 | DOI: 10.36290/vnl.2024.068  

Arterial hypertension - chronic disease which needs an active and dynamic approach

Pavel Rutar

Vnitr Lek 2024, 70(5):314-317 | DOI: 10.36290/vnl.2024.062  

Cardiovascular diseases are 80 % preventable. One of the main risk factors of cardiovascular diseases which can be controlled easily is arterial hypertension. There are two main conditions which influences our chance to reach the therapeutic target - active role of a physician and a patient's adherence to the therapy. Early treatment, the proper choice of the drug, periodic check-up of results and fortification of the therapy if it's necessary, encouraging patient's adherence by a simple therapeutic schema with using a polypill and a control of other important cardiovascular risk factors as hypercholesterolaemia - these are characteristics which bring...

Profesor Kršek oslavil významné životní jubileum

Prof. MUDr. Richard Češka, CSc., FACP, FEFIM

Vnitr Lek 2024, 70(5):E28-E29  

Výsledky léčby hypertenze v České republice v letech 1972-2022

Arian Taniwall, Jan Brož, Michala Lustigová, Lucia Fačkovcová, Jana Urbanová

Vnitr Lek 2024, 70(5):E27  

News in gastroenterology, hepatology and digestive endoscopy

Dana Ďuricová, Ivana Mikoviny Kajzrlíková, Kateřina Košťálová, Lucie Zdrhová, Ondřej Urban, Václav Šmíd, Přemysl Falt, Ilja Tachecí

Vnitr Lek 2024, 70(5):318-325 | DOI: 10.36290/vnl.2024.063  

Gastroenterology, digestive endoscopy, and hepatology are dynamically developing fields that bring many interesting and clinically important innovations and findings every year. The aim of this article is to provide an overview of these developments. The discussed topics include oesophageal diseases (specifically the treatment of eosinophilic esophagitis and reflux oesophageal disease) and the surveillance of patients at high risk of pancreatic cancer. In hepatology, much attention has been paid in recent years to the metabolic dysfunction-associated steatotic liver disease (MASLD), which is one of the most common chronic liver diseases. The last part...