{"id":218,"date":"2024-11-08T05:27:06","date_gmt":"2024-11-08T04:27:06","guid":{"rendered":"https:\/\/symbivita.cz\/rovnovaha-zivota\/?p=218"},"modified":"2024-11-08T05:27:07","modified_gmt":"2024-11-08T04:27:07","slug":"co-delat-s-rezistenci-na-antibiotika-a-antivirotika","status":"publish","type":"post","link":"https:\/\/symbivita.cz\/rovnovaha-zivota\/2024\/11\/08\/co-delat-s-rezistenci-na-antibiotika-a-antivirotika\/","title":{"rendered":"Co d\u011blat s\u00a0rezistenc\u00ed na antibiotika a antivirotika"},"content":{"rendered":"\n

Z historie <\/strong><\/strong><\/p>\n\n\n\n

se dozv\u00edd\u00e1me, jak ve sv\u011bt\u011b prob\u00edhaly infek\u010dn\u00ed epidemie. V\u017edy s sebou p\u0159in\u00e1\u0161ely zk\u00e1zu, utrpen\u00ed a \u00fabytek po\u010dtu obyvatel. S p\u0159\u00edchodem antibiotik lidstvo zaj\u00e1salo, \u017ee se dok\u00e1\u017ee vypo\u0159\u00e1dat s bakteri\u00e1ln\u00edmi nemocemi. Hlavn\u00ed rozvoj antibiotik za\u010dal Flemingov\u00fdm objevem penicilinu r. 1929. Jeho pou\u017e\u00edv\u00e1n\u00ed se dost\u00e1valo do praxe v pr\u016fb\u011bhu II. sv\u011btov\u00e9 v\u00e1lky a pot\u00e9 se na trhu objevovala dal\u0161\u00ed a dal\u0161\u00ed antibiotika. O rezistenci se tehdy nev\u011bd\u011blo. Lid\u00e9 nev\u011bd\u011bli, \u017ee patogenn\u00ed bakterie, na kter\u00e9 jsou antibiotika pod\u00e1v\u00e1na, postupn\u011b mutovaly. Ta bakterie, kterou p\u016fvodn\u011b antibiotikum zab\u00edjelo, za\u010dala b\u00fdt v\u016f\u010di n\u011bmu odoln\u00e1. J\u00e1s\u00e1n\u00ed pominulo, proto\u017ee se uk\u00e1zalo, \u017ee se bakterie st\u00e1vaj\u00ed odoln\u011bj\u0161\u00edmi a antibiotika jsou st\u00e1le \u010dast\u011bji ne\u00fa\u010dinn\u00e1 a st\u00e1vaj\u00ed se op\u011bt pro l\u00e9ka\u0159e no\u010dn\u00ed m\u016frou. Odhaduje se, \u017ee v roce 2050 budou bakteri\u00e1ln\u00ed infekce zab\u00edjet asi 10 milion\u016f lid\u00ed ro\u010dn\u011b. <\/p>\n\n\n\n

Posun<\/strong><\/strong><\/p>\n\n\n\n

P\u0159ed t\u0159iceti lety, kdy\u017e jsem za\u010d\u00ednal svou praxi, jsme m\u011bli p\u00e1r z\u00e1kladn\u00edch antibiotik a k dispozici byla tzv. antibiotika vz\u00e1cn\u00e1, je\u017e byla pod\u00e1v\u00e1na jen u v\u00e1\u017en\u00fdch stav\u016f, v\u011bt\u0161inou p\u0159i hospitalizaci. V sou\u010dasnosti jsou ona vz\u00e1cn\u00e1 antibiotika v seznamu antibiotik prvn\u00ed linie, prvn\u00ed volby, a to ji\u017e u d\u011bt\u00ed<\/u><\/em>\u2026 A b\u011bhem t\u00e9 doby p\u0159ich\u00e1zela na seznam antibiotika druh\u00e9 generace, potom t\u0159et\u00ed generace atd.<\/p>\n\n\n\n

Bakterie <\/strong><\/strong><\/p>\n\n\n\n

si vytvo\u0159\u00ed rezistenci, v\u011bdci proto vyvinou nov\u00e9 antibiotikum, na kter\u00e9 si bakterie \u010dasem zvyknou. Reklamn\u00ed kampa\u0148 vyzved\u00e1 p\u0159\u00edchoz\u00ed nov\u00e9 antibiotikum a uji\u0161\u0165uje lidi, \u017ee mohou b\u00fdt v klidu, nebezpe\u010d\u00ed je za\u017eehn\u00e1no. No, nen\u00ed d\u016fvodu k oslav\u00e1m, nov\u00e9 antibiotikum nen\u00ed v\u00fdhra; do\u010dasn\u011b zap\u016fsob\u00ed, ale pak op\u011bt za\u010dne v\u00edt\u011bzit bakterie. V odborn\u00e9 l\u00e9ka\u0159sk\u00e9 literatu\u0159e se st\u00e1le v\u00edce p\u00ed\u0161e o tzv. antibiotick\u00e9 krizi<\/em><\/strong>. A sou\u010dasn\u011b se mno\u017e\u00ed pr\u00e1ce o vyu\u017eit\u00ed bakteriof\u00e1g\u016f.<\/p>\n\n\n\n

Bakteriof\u00e1g<\/strong><\/p>\n\n\n\n

je virus, kter\u00fd infikuje bakterie. N\u011bkter\u00fd druh tohoto mal\u00e9ho viru v bakterii pouze p\u0159e\u017e\u00edv\u00e1 a neubl\u00ed\u017e\u00ed j\u00ed. Jin\u00e9 druhy v\u0161ak mohou zp\u016fsobit l\u00fdzu bu\u0148ky, tedy zp\u016fsobit rozklad \u010di destrukci vn\u011bj\u0161\u00ed membr\u00e1ny napaden\u00e9 bu\u0148ky, a to navod\u00ed smrt bakterie.  <\/p>\n\n\n\n

Kr\u00e1tk\u00e1 filozofick\u00e1 \u00favaha<\/strong><\/strong><\/p>\n\n\n\n

Patogenn\u00ed bakterie je nep\u0159\u00edtelem nemocn\u00e9ho \u010dlov\u011bka, je zde tedy snaha naj\u00edt nep\u0159\u00edtele patogenn\u00ed bakterie. Bakteriof\u00e1g se m\u00e1 st\u00e1t nep\u0159\u00edtelem nep\u0159\u00edtele, a t\u00edm vlastn\u011b p\u0159\u00edtelem nemocn\u00e9ho \u010dlov\u011bka.<\/p>\n\n\n\n

Tato \u201ef\u00e1gov\u00e1 terapie\u201c je v\u0161ak zat\u00edm hodn\u011b komplikovan\u00e1. Nen\u00ed snadn\u00e9 naj\u00edt spr\u00e1vn\u00e9ho f\u00e1ga, kter\u00fd je schopen infikovat bakterii zp\u016fsobuj\u00edc\u00ed infekci. P\u0159\u00edprava je zdlouhav\u00e1 a n\u00e1kladn\u00e1, p\u0159esto jsou ji\u017e zaznamen\u00e1ny \u00fasp\u011bchy t\u00e9to nov\u00e9 l\u00e9\u010dby v jednotliv\u00fdch p\u0159\u00edpadech u pacient\u016f s komplikovan\u00fdmi multirezistentn\u00edmi infekcemi. Pr\u016fkopnick\u00e9 zpr\u00e1vy p\u0159ich\u00e1zej\u00ed z Austr\u00e1lie a z USA. \u017del, bakterie si mohou<\/u><\/em> vytvo\u0159it tak\u00e9 v\u016f\u010di f\u00e1gov\u00e9 terapii rezistenci, nap\u0159. modifikac\u00ed sv\u00fdch povrchov\u00fdch receptor\u016f.<\/p>\n\n\n\n

Z\u00e1kladn\u00ed probl\u00e9m<\/strong>, kter\u00fd trv\u00e1 a st\u00e1le plat\u00ed, je v tom, \u017ee si jedinec sv\u00fdm zp\u016fsobem \u017eivota v t\u011ble tvo\u0159\u00ed podm\u00ednky, aby se bakterii da\u0159ilo.<\/p>\n\n\n\n

A v okam\u017eiku, kdy si svou imunitu oslab\u00ed n\u011bkter\u00fdm stresov\u00fdm faktorem, se bakterie uplatn\u00ed. Antibiotikum takovou situaci \u0159e\u0161\u00ed, tedy \u0159e\u0161\u00ed a\u017e n\u00e1sledek, \u0159e\u0161\u00ed to za<\/u><\/em> vlastn\u00ed imunitn\u00ed syst\u00e9m. Jeho probl\u00e9m nen\u00ed vy\u0159e\u0161en, l\u00e9\u010dba po ukon\u010den\u00ed antibiotika nekon\u010d\u00ed, ale m\u00e1 vlastn\u011b za\u010d\u00edt, proto\u017ee doty\u010dn\u00fd m\u00e1 d\u00e1t do po\u0159\u00e1dku to, co zp\u016fsobilo, \u017ee \u00fatok bakterie nezvl\u00e1dl. A to vy\u017eaduje zcela z\u00e1sadn\u00ed a tot\u00e1ln\u00ed zm\u011bnu \u017eivota. Toto je bod, kter\u00fd se v\u0161eobecn\u011b ned\u011bje<\/em>. Jakmile se d\u00edky antibiotiku doty\u010dn\u00e9mu ulev\u00ed, zapomene na podstatu nebo si ji ani neuv\u011bdom\u00ed \u010di nep\u0159ipou\u0161t\u00ed ji, je nucen<\/em> se co nejrychleji zapojit do koloto\u010de povinnost\u00ed, kter\u00e9 mus\u00ed plnit k udr\u017een\u00ed \u017eivota rodiny, ba co v\u00edc, ani kdy\u017e u\u017e\u00edval antibiotika, nebyl v klidu, chodil do pr\u00e1ce, a to nejhor\u0161\u00ed, co mohl ud\u011blat, bylo, \u017ee nasazen\u00e9 antibiotikum nedobral, ale s \u00fastupem pot\u00ed\u017e\u00ed je odlo\u017eil\u2026 T\u00edm vytvo\u0159il podm\u00ednky pro bakterii, aby si na antibiotikum vytvo\u0159ila rezistenci (odolnost). Je logick\u00e9, \u017ee ca. za 14 dn\u00ed se mu nemoc vr\u00e1t\u00ed, a pak nastane je\u0161t\u011b hor\u0161\u00ed situace, kdy\u017e si doty\u010dn\u00fd znovu s\u00e1m nasad\u00ed ono odlo\u017een\u00e9 antibiotikum\u2026 Dal\u0161\u00ed koment\u00e1\u0159 nen\u00ed nutn\u00fd, \u017ee? Nepom\u016f\u017ee ani \u010dtvrt\u00e1, ani p\u00e1t\u00e1 generace antibiotik. (https:\/\/theconversation.com\/phage-therapy-could-treat-some-drug-resistant-superbug-infections-but-comes-with-unique-challenges-207025)<\/p>\n\n\n\n

V lidsk\u00e9 novodob\u00e9 historii si cel\u00fd sv\u011bt b\u011bhem epidemie covidu p\u0159ipomn\u011bl hrozbu ztr\u00e1ty \u00fa\u010dinnosti antibiotik, i kdy\u017e \u0161lo nejprve o p\u016fsoben\u00ed viru – a na virus antibiotikum nem\u00e1me\u2026 A m\u00edsto toho nastupuje \u00e9ra antivirotik\u2026<\/p>\n\n\n\n

Antivirotikum<\/strong><\/p>\n\n\n\n

p\u016fsob\u00ed uvnit\u0159 bu\u0148ky, kdy\u017e u\u017e se do n\u00ed virus dostal. Zde virus pou\u017e\u00edv\u00e1 prote\u00e1zu – enzym, kter\u00fd pot\u0159ebuje, aby roz\u0161t\u011bpil specifickou b\u00edlkovinu a zformoval se do t\u00e9 podoby, ve kter\u00e9 pak bu\u0148ku opust\u00ed a napadne dal\u0161\u00ed bu\u0148ky. Krom\u011b toho virus navod\u00ed tzv. v<\/em><\/strong>irovou imunosupresi<\/em><\/strong>: V proveden\u00e9m laboratorn\u00edm testu zaznamen\u00e1me n\u00edzk\u00fd po\u010det lymfocyt\u016f. K tomu doch\u00e1z\u00ed velmi brzy a virus se v t\u011bch lymfocytech pomno\u017e\u00ed, a t\u00edm je ni\u010d\u00ed. V\u00fdzkum a v\u00fdvoj antivirotik se to\u010d\u00ed kolem tohoto bodu s c\u00edlem zabr\u00e1nit popsan\u00e9mu procesu t\u00edm, \u017ee bude onen enzym brzdit, tlumit, a t\u00edm zpomalovat ne\u017e\u00e1douc\u00ed aktivitu viru. To je tedy bod, na kter\u00fd m\u00e1 antivirotikum p\u016fsobit. A pou\u017e\u00edv\u00e1 se ji\u017e v boji proti HIV nebo viru hepatitidy B. Ale v\u0161imn\u011bte si toho podstatn\u00e9ho: Antivirotikum p\u016fsob\u00ed uvnit\u0159 bu\u0148ky, kdy\u017e u\u017e se do n\u00ed virus dostal\u2026<\/p>\n\n\n\n

Proto v\u011bdci vedou v\u00fdzkum l\u00e9\u010dby sm\u011brem k o\u010dkov\u00e1n\u00ed monoklon\u00e1ln\u00edmi protil\u00e1tkami, kter\u00e9 maj\u00ed virus zastavit je\u0161t\u011b p\u0159ed t\u00edm, ne\u017e se do bun\u011bk dostane. D\u00e1vaj\u00ed tomuto zp\u016fsobu nad\u011bji, ale co se t\u00fdk\u00e1 \u00fa\u010dinnosti, jsou zat\u00edm ob\u011b metody srovnateln\u00e9, je pozorov\u00e1n jen mal\u00fd rozd\u00edl.<\/p>\n\n\n\n

Po prod\u011blan\u00e9 epidemii ji\u017e mohou v\u011bdci srovn\u00e1vat statistick\u00e9 \u00fadaje o \u00fa\u010dinnosti. A to hlavn\u011b s tzv. rizikovost\u00ed pacienta. Co je t\u00edm m\u00edn\u011bno? Samoz\u0159ejm\u011b je to stejn\u00e1 situace, jak jsem v\u00fd\u0161e uvedl u podstaty, pro\u010d \u010dlov\u011bk podlehne nemoci.<\/p>\n\n\n\n

Pokud je pacient rizikov\u00fd a t\u0159eba byl o\u010dkov\u00e1n jenom jednou d\u00e1vkou, nedostal posiluj\u00edc\u00ed d\u00e1vku, pak imunita proti nemoci postupn\u011b vyhasne a dost\u00e1v\u00e1 se t\u00e9m\u011b\u0159 do stavu, jako kdyby o\u010dkov\u00e1n nebyl. O\u010dkovan\u00fd pacient s posiluj\u00edc\u00ed d\u00e1vkou se viru snadn\u011bji ubr\u00e1n\u00ed a antivirotikum ani nebude pot\u0159ebovat, proto\u017ee nemoc prob\u00edh\u00e1 jen m\u00edrnou formou. Ale pokud bude pacient neo\u010dkovan\u00fd nebo ji\u017e kv\u016fli jeho chronick\u00e9 nemoci u\u017e\u00edv\u00e1 l\u00e9ky a t\u0159eba i l\u00e9ky, kter\u00e9 imunitu potla\u010duj\u00ed (imunosupresiva), tak p\u0159esto\u017ee je o\u010dkovan\u00fd, imunitu proti viru nem\u00e1. O\u010dkov\u00e1n\u00ed mu m\u016f\u017ee sn\u00ed\u017eit riziko, \u017ee skon\u010d\u00ed na JIP, ale tak\u00e9 nemus\u00ed, je to individu\u00e1ln\u00ed.<\/p>\n\n\n\n

V on\u00e9 situaci neslavn\u011b prob\u00edhaj\u00edc\u00ed epidemie se medi\u00e1ln\u011b zd\u016fraz\u0148ovala pot\u0159eba ur\u010dit\u00e9 proo\u010dkovanosti k pos\u00edlen\u00ed tzv. kolektivn\u00ed imunity, ale je t\u0159eba dodat, \u017ee imunita po o\u010dkov\u00e1n\u00ed \u010dasem vyhas\u00edn\u00e1, a uk\u00e1zalo se tak\u00e9, \u017ee u nov\u00fdch variant viru kles\u00e1 rychleji. Vis\u00ed tedy otazn\u00edk nad my\u0161lenkou, zda lze vytvo\u0159it funk\u010dn\u00ed kolektivn\u00ed imunitu. Zn\u00e1me z historie, \u017ee t\u0159eba spalni\u010dky zanech\u00e1vaj\u00ed imunitu po prod\u011bl\u00e1n\u00ed nemoci nebo i po vakcinaci del\u0161\u00ed dobu, a kdy\u017e proo\u010dkovanost poklesla, za\u010daly se spalni\u010dky zase \u0161\u00ed\u0159it. Z pohledu epoch\u00e1ln\u00edho m\u00e1 proo\u010dkovanost proti ur\u010dit\u00e9 nemoci \u010dasov\u011b omezenou p\u016fsobnost.<\/p>\n\n\n\n

Faktory budou odhaleny a\u017e podrobn\u00fdm rozborem<\/strong><\/strong><\/p>\n\n\n\n

Ve sv\u00e9 praxi v\u017edy zd\u016fraz\u0148uji hloubkov\u00fd rozbor, jen\u017e m\u00e1 odhalit rizikov\u00e9 faktory, kter\u00e9 na jednotlivce p\u016fsob\u00ed, a ty jsou individu\u00e1ln\u00ed. A ka\u017ed\u00fd si je m\u00e1 vyhodnotit, m\u00e1 pochopit podstatu sv\u00e9 nemoci, tu mus\u00ed p\u0159ijmout a m\u00e1 neodkladn\u011b pracovat na odstran\u011bn\u00ed faktor\u016f. Bez tohoto kroku se pl\u00ed\u017eiv\u00fdm zp\u016fsobem dost\u00e1v\u00e1 pr\u00e1v\u011b do t\u00e9 situace, kdy jsou v jeho t\u011ble vytvo\u0159eny pro nemoc podm\u00ednky, a tedy \u00fatok bakterie nebo viru na imunitu je snadn\u00fd.<\/p>\n\n\n\n

Kdy\u017e vytvo\u0159\u00edme rozbor situace nemocn\u00e9ho \u010dlov\u011bka, m\u00e1me snadn\u011bj\u0161\u00ed pohled na \u0159e\u0161en\u00ed jeho probl\u00e9mu.<\/p>\n\n\n\n

Rizikov\u00e9 skupiny<\/strong><\/strong><\/p>\n\n\n\n

V\u011bdci obecn\u011b vyhodnotili statistiku tzv. rizikov\u00fdch skupin. Sem pat\u0159\u00ed p\u0159edev\u0161\u00edm v\u0161ichni lid\u00e9 star\u0161\u00ed 65 let, rizikem je tedy v\u011bk<\/strong>. Ka\u017ed\u00fd, kdo m\u00e1 vysok\u00fd BMI<\/strong> (je ob\u00e9zn\u00ed) nebo m\u00e1 vysok\u00fd krevn\u00ed tlak<\/strong>, trp\u00ed chronickou nemoc\u00ed ledvin, jater, chronick\u00fdm plicn\u00edm onemocn\u011bn\u00edm<\/strong> \u2013 CHOPN, plicn\u00ed fibr\u00f3zou<\/strong>. Diabetici <\/strong>i takov\u00ed, kte\u0159\u00ed u\u017e\u00edvaj\u00ed \u201ejen\u201c peror\u00e1ln\u00ed antidiabetika<\/strong>. Nemocn\u00ed s nedostate\u010dnou imunitou<\/strong> r\u016fzn\u00e9ho p\u016fvodu a jsou na terapii kortikosteroidy, na biologick\u00e9 l\u00e9\u010db\u011b<\/strong> a mohou b\u00fdt i o\u010dkovan\u00ed. Choroby s poruchou sr\u00e1\u017elivosti krve, neurologick\u00e9 nemoci<\/strong> a mnoho dal\u0161\u00edch.<\/p>\n\n\n\n

Vyj\u00e1d\u0159il jsem sv\u016fj n\u00e1zor na t\u00e9ma u\u017e\u00edv\u00e1n\u00ed antibiotik a antivirotik se zd\u016frazn\u011bn\u00edm individu\u00e1ln\u00edho p\u0159\u00edstupu p\u0159i jejich pou\u017e\u00edv\u00e1n\u00ed, kter\u00fd m\u00e1 vych\u00e1zet z hloubkov\u00e9ho rozboru situace jedince p\u0159edt\u00edm, ne\u017e se pou\u017eij\u00ed.<\/p>\n\n\n\n

MUDr. P. \u0160\u00e1cha<\/p>\n\n\n\n

<\/p>\n","protected":false},"excerpt":{"rendered":"

Z historie se dozv\u00edd\u00e1me, jak ve sv\u011bt\u011b prob\u00edhaly infek\u010dn\u00ed epidemie. V\u017edy s sebou p\u0159in\u00e1\u0161ely zk\u00e1zu, utrpen\u00ed a \u00fabytek po\u010dtu obyvatel. S p\u0159\u00edchodem antibiotik lidstvo zaj\u00e1salo, \u017ee se dok\u00e1\u017ee vypo\u0159\u00e1dat s bakteri\u00e1ln\u00edmi nemocemi. Hlavn\u00ed rozvoj antibiotik za\u010dal Flemingov\u00fdm objevem penicilinu r. 1929. Jeho pou\u017e\u00edv\u00e1n\u00ed se dost\u00e1valo do praxe v pr\u016fb\u011bhu II. sv\u011btov\u00e9 v\u00e1lky a pot\u00e9 se na trhu objevovala dal\u0161\u00ed a … <\/p>\n","protected":false},"author":1,"featured_media":219,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4],"tags":[],"_links":{"self":[{"href":"https:\/\/symbivita.cz\/rovnovaha-zivota\/wp-json\/wp\/v2\/posts\/218"}],"collection":[{"href":"https:\/\/symbivita.cz\/rovnovaha-zivota\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/symbivita.cz\/rovnovaha-zivota\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/symbivita.cz\/rovnovaha-zivota\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/symbivita.cz\/rovnovaha-zivota\/wp-json\/wp\/v2\/comments?post=218"}],"version-history":[{"count":1,"href":"https:\/\/symbivita.cz\/rovnovaha-zivota\/wp-json\/wp\/v2\/posts\/218\/revisions"}],"predecessor-version":[{"id":220,"href":"https:\/\/symbivita.cz\/rovnovaha-zivota\/wp-json\/wp\/v2\/posts\/218\/revisions\/220"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/symbivita.cz\/rovnovaha-zivota\/wp-json\/wp\/v2\/media\/219"}],"wp:attachment":[{"href":"https:\/\/symbivita.cz\/rovnovaha-zivota\/wp-json\/wp\/v2\/media?parent=218"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/symbivita.cz\/rovnovaha-zivota\/wp-json\/wp\/v2\/categories?post=218"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/symbivita.cz\/rovnovaha-zivota\/wp-json\/wp\/v2\/tags?post=218"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}