Nystatin - one of the first antifungal antibiotics. For many years, it is used to treat fungal infections, but despite the presence today of more effective antifungal agents, nystatin are still widely used.

Mechanism of action

Nystatin belongs to the group of polyene antibiotics having antifungal activity. It is a natural antibiotic that is produced by several types of fungi, actinomycetes.

The mechanism of action nistatitna is that it violates the permeability of the cell membranes of fungi that cause the suspension of their life and especially breeding. This happens due to the fact that nystatin in its structure tends to fungal cell membrane sterols. As a result of fungal cells destroyed by the high osmotic pressure outside it, which membrane can no longer resist.

Nystatin inhibits the vital functions of yeast and yeast-like fungi. He shows the most active against yeast fungi genus Candida, causing a disease called candida or candidiasis. Thus bacteria, protozoa and viruses are not susceptible to nystatin. Getting used to nystatin fungus develops very slowly.

When administered nystatin is not well absorbed in the gastrointestinal tract, the blood enters only a small portion of it. It shows a therapeutic effect mainly in the gastrointestinal tract does not accumulate in the body and almost all derived from the faeces from the intestine intact. When using nystatin in the form of suppositories and ointments it is practically not absorbed through the skin and mucous membranes and enters the bloodstream.

Dosage

Dosing Nystatin Nystatin - help with candidiasis   in terms of action - ED. The 1 mg contains about 4000 IU. It is produced in the form of tablets of different dosages (at 250,000 and 500,000 units), vaginal and rectal suppositories (in varying doses - at 250,000 and 500,000 units) and nystatin ointment, which contains one gram of 100,000 units.

Indications and contraindications

Nystatin is shown at various fungal infections caused by fungi which exhibit sensitivity to it.

Inside nystatin tablets prescribed:

• candidiasis of the mucous membrane in the mouth and throat;
• when kandidomikoz skin;
• kandidomikoz in the gastrointestinal tract, broncho-pulmonary, urinary systems, and other internal organs;
• for the prevention of candidiasis in the background of prolonged courses of treatment with antibacterial agents, especially in patients with reduced immunity.

Topically as an ointment nystatin is used:

• when candidiasis of the skin and mucous membranes;
• in the treatment of yeast infections in women Thrush in women - the relevance of the problem   (treat both her sexual partner, even if he does not have signs of disease).
• Topically in the form of vaginal suppositories:
• for vaginal candidiasis (thrush - treatment is given to both partners, men Nystatin appointed as an ointment); during menstruation treatment is not interrupted;
• in order to prevent fungal infections by topical application of antibiotics.

Note that when using vaginal suppositories may impair the strength of latex condoms.

Topically in the form of rectal suppositories:

• at the end kandidomikoz intestine (sigmoid colon and rectum);
• for the prevention of fungal infections pre- and postoperative pelvic and final intestine.

With simultaneous use of Nystatin and other antifungal drug - clotrimazole reduced effectiveness of the latter.

Contraindications for use nystatin:

• Nystatin idiosyncrasy of the body of the patient;
• liver disease in violation of its functions;
• inflammation of the pancreas (acute and chronic pancreatitis);
• gastric ulcer and duodenal ulcer;
• Pregnancy and breast-feeding Breastfeeding - a personal choice   feeding.

Side effects

Nystatin is a non-toxic drug, and is generally well tolerated but side effects are still possible. For example, when administered to change the taste and appetite, nausea, vomiting, diarrhea, abdominal pain Abdominal pain: Types and Symptoms . Allergic reactions can occur in the form of itching, various rashes (including in the form of urticaria), fever, chills.

In the application of nystatin in the form of suppositories and ointments as allergic reactions, as well as the emergence and proliferation of non-sensitive to nystatin fungus - in this case, the Nystatin should be lifted immediately.

Nystatin is certainly not the most effective antifungal drug, but it is well tolerated and provides few side effects.

Galina Romanenko

TB dispensary carries not only the treatment of all forms of tuberculosis, but also the main coordinator of the work on the identification and prevention of tuberculosis Tuberculosis prevention: how to prevent infection   among all segments of the population attached to it. Modern TB dispensary - is a specialized medical institution has the necessary equipment and trained staff to perform all its tasks.

Clinical examination of patients with tuberculosis

Tuberculosis is an infectious disease that creates a series of social problems. To solve these problems, and treatment of TB patients in the country has a network of specialized hospitals - tuberculosis dispensaries (more correctly - TB - PDD). All patients specialized care is provided free by the state. Treatment is voluntary, but if a patient with active TB The open form of tuberculosis - to be treated in hospital   Lung refuses treatment, it can bring it to the court decision.

The objective of the tuberculosis dispensary is early detection and staging on a clinical record of all patients suffering from tuberculosis. With timely initiated adequate treatment of patients with tuberculosis, as a rule, it is possible to manage and control of follow-up after the patient is removed from the register. If the patient has an irreversible change in the nature of tuberculosis in different organs, it is at the dispensary until the end of life.

Tuberculosis Clinic has in its structure ambulatory (outpatient) department, hospital, day care, physiotherapy services (including inhalation). Diagnostic base dispensary must be submitted clinical diagnostic and microbiological laboratory rentgenkabinetom, cabinets endoscopic and functional diagnostics. The structure of the clinic may also include employment workshops and sanatorium.

Groups dispensary for tuberculosis

Properly organized medical examination for tuberculosis enables TB doctors promptly examine all the contingents of patients, assign them to appropriate treatment as an outpatient and inpatient, as well as the rehabilitation in a sanatorium establishments. Dividing the patients in the dispensary group allows time to remove cured patients with dispensary. Total release seven groups of follow-up of tuberculosis.

• Group Zero (0) of follow-up includes individuals with unspecified active TB of the respiratory process. The group is divided into groups A and B. The group of follow-up 0-A includes patients who require clarification of the activity of tuberculosis. The group 0-B includes patients with unspecified diagnosis of tuberculosis, which require further examination to confirm it.
• The first group (I) of follow-up includes patients with active TB, that is, the presence of a tubercular inflammation of the respiratory system. This group of patients is divided into three groups - I-A, I-B, and IB. The Group IA include patients with newly diagnosed tuberculosis, a group I-B - with exacerbation of tuberculous process, which lasts more than two years. In both groups always distinguish patients with active TB, that is, those that are MbT and possible sources of infection of healthy people: IA - BK +, IA - BK-; I-B - BC +, I-B - BK-. In Group IB include patients who discontinued treatment or were not tested at the end of treatment.
• The second group (II) of follow-up - Patients with active tuberculosis subsides respiratory system. It includes two subgroups II-A and II-B. In subgroup II-A includes patients who as a result of intensive treatment can be achieved clinical cure. In subgroup II-B includes patients with advanced tuberculosis process that can not be cured completely, but who need an anti, restorative treatment, as well as the recurrence of TB therapy.
• The third group (III) clinical supervision - control. It consists of patients cured of TB of the respiratory system.
• The fourth group (IV) of follow-up - persons who are in contact with patients with open tuberculosis (MbT) or animals suffering from tuberculosis.
• The fifth group (V) of follow-up - Patients with extrapulmonary tuberculosis Extrapulmonary tuberculosis - many forms   and heal him.
• The sixth group (VI) of follow-up - children and adolescents at increased risk of TB were selected to monitor the results of Mantoux test.
• The seventh group (VII) of follow-up - Patients with residual symptoms after treatment of pulmonary tuberculosis, with an increased risk of disease recurrence.

Treatment of tuberculosis in domestic TB dispensaries and abroad

Today, the treatment of tuberculosis Treatment of tuberculosis - a lengthy process and requires constant monitoring   around the world carried out by a single scheme. Therefore, treatment of tuberculosis in Germany, is not different from the treatment of domestic PDD (except, of course, the conditions in the hospitals and to the patient medical staff). Treatment of tuberculosis in Israel also built on conventional circuits in the world. The advantage of treatment in Israel can be the rehabilitation of patients in the clinic, located on the Dead Sea, with its dry climate healing.

Galina Romanenko