.jpg "Prof. dr Đorđe Jevtović - Specijalista infektologije")
Specijalista infektologije
Prof. dr Đorđe Jevtović, rođen 1953. godine u Beogradu, lekar-infektolog. Profesor je Medicinskog fakulteta i načelnik centra za HIV na Klinici za infektologiju i tropske bolesti u Beogradu. Dr Jevtović je objavio 208 publikacija kojima su obuhvaćene različite oblasti infektologije.
Prof. dr Đorđe Jevtović je u penziji.
Prof. dr Đorđe Jevtović, rođen 1953. godine u Beogradu, lekar-infektolog. Profesor je Medicinskog fakulteta i načelnik centra za HIV na Klinici za infektologiju i tropske bolesti u Beogradu. Dr Jevtović je objavio 208 publikacija kojima su obuhvaćene različite oblasti infektologije.
Prof. dr Đorđe Jevtović je u penziji.
Osnovne studije.
Profesor.
Načelnik centra za HIV.
klostridija koja sejavlja po treći put treba mi pomoć za adekvatno lečenje.pored vankomicina i bulardija već tri meseca ,suprug je ležeći pacijent ,fraksiparin 0,3 ujutro, 0,6 uveće,klosridija se vratila po treći put sa krvavim sluzavim stolicama jaki bolovi u stomaku i bolovi u želudcu, Dobili smo preporuku za VSL PROBIOTIK I ZA LACTICHOC LACTOBIANE,Molim Vas za pomoć i mišljenje
postoje preporuke dobre prakse za medikamntozno lečenje recidivantnog pseudomembranoznog kolitisa, koji ne podrazumevaju probiotike, koji se često prepisuju-javite se infektologu u nekoj univerzitetskoj bolnic
iz udžbenika:
Oral vancomycin or oral fidaxomicin
Oral vancomycin or oral fidaxomicin is recommended by the American College of Gastroenterology (1) for the treatment of a primary episode of nonsevere C. difficile–induced diarrhea.
Fidaxomicin 200 mg orally every 12 hours for 10 days is recommended by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) as first-line therapy for C. difficile infection (2). Fidaxomicin decreases the risk of recurrence more than vancomycin. Vancomycin 125 mg orally 4 times a day for 10 days is an alternative (2).
Metronidazole is no longer recommended as first-line therapy for C. difficile–induced diarrhea. However, oral metronidazole can be used if vancomycin or fidaxomicin is not available.
Vancomycin 500 mg orally or by nasogastric tube 4 times a day and metronidazole 500 mg IV every 8 hours are recommended by the ISDA/SHEA for fulminant disease without ileus.
If ileus is present, a retention enema can be given as a dosage of vancomycin 500 mg in 10 mL saline per rectum 4 times a day (1).
If possibly causative antibiotics are being used, they should be stopped as soon as possible, or patients should be switched to an antibiotic regimen less likely to cause C. difficile–induced diarrhea.
Cholestyramine resin, Saccharomyces boulardii yeast, and probiotics have not been proved to be beneficial but are frequently added.
Nitazoxanide appears to be comparable to oral vancomycin but is not commonly used in the United States.
A few patients require total colectomy for cure.
C. difficile–induced diarrhea recurs in 15 to 20% of patients, typically within a few weeks of stopping treatment. Recurrence often results from reinfection (with the same or different strain), but some cases may involve persistent spores from the initial infection. For patients with recurrent infections, the ISDA guidelines suggest fidaxomicin (standard or extended-pulsed regimen) rather than a standard course of vancomycin. Vancomycin in a tapered and pulsed regimen or as a standard course are alternatives for a first recurrence. For patients with multiple recurrences, vancomycin in a tapered and pulsed regimen, vancomycin followed by rifaximin, and fecal microbiota transplantation are options in addition to fidaxomicin (2).
Infusion of donor feces (fecal transplant, usually done via colonoscopy) increases the likelihood of resolution in patients who have frequent recurrences; presumably, the mechanism is restoration of normal fecal microbiota. About 200 to 300 mL of donor feces are used; donors are tested for enteric and systemic pathogens. Feces can be infused using a nasal-duodenal tube, colonoscope, or enema; the optimal method has not been determined.
Oral fecal microbiota transplant capsules and a fecal microbiota suspension for rectal administration are commercially available. They can be given a few days after antibiotic treatment of recurrent C. difficile infection to prevent recurrence.
A human monoclonal antibody, bezlotoxumab 10 mg/kg IV given once, binds to and neutralizes C. difficile toxin B; it can be used for prevention of recurrent C. difficile–induced diarrhea along with standard-of-care treatment in patients who have had a recurrence within the last 6 months.
Infection control measures are vital to reduce the spread of C. difficile among patients and health care workers.
1. Kelly CR, Fischer M, Allegretti JR, et al: ACG Clinical Guidelines: Prevention, diagnosis, and treatment of Clostridioides difficile infections. Am J Gastroenterol 116(6):1124–1147, 2021. doi: 10.14309/ajg.0000000000001278. Clarification and additional information. Am J Gastroenterol 117(2):358, 2022.
2. Johnson S, Lavergne V, Skinner AM, et al: Clinical practice guideline by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA): 2021 Focused update guidelines on management of Clostridioides difficile infection in adults. Clin Infect Dis 73(5):e1029–e1044, 2021. doi: 10.1093/cid/ciab549
Antibiotic therapy can cause intestinal overgrowth of toxin-secreting C. difficile, resulting in a pseudomembranous colitis that can be severe and difficult to cure.
Cephalosporins (particularly 3rd-generation), penicillins, clindamycin, and fluoroquinolones pose the highest risk.
Diagnose using a stool assay for C. difficile antigen and toxin and sometimes PCR testing for the toxin gene.
Treat with oral fidaxomicin or vancomycin.
Recurrence is common; re-treat with antibiotics, and consider fecal transplantation or bezlotoxumab for refractory recurrences.
The following English-language resources may be useful. Please note that THE MANUAL is not responsible for the content of these resources.
American College of Gastroenterology (ACG): ACG Clinical Guidelines: Prevention, diagnosis, and treatment of Clostridioides difficile infections (2021)
Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA): Clinical practice guideline: 2021 Focused update guidelines on management of Clostridioides difficile infection in adults (2021)
Bio u cetvrtak, uradjeni testovi, HCV PCR PCR 6874859 IU/ml, genotip HCV 3. Jetra normalne velicine , od 2022 hronicni pancreatitis. Doc dr. Nikolic mi je rekla da sacekam komisiju od 2-6 meseci da mi odobri terapiju. Inace sam u dobrom zdravstvenom stanju, ali ne bih cekao. Postoji li nacin da dodjem do terapije koja odgovara meni na drugi nacin, bez cekanja
neznam, od 2018 sam u penziji i nisu mi poznate novi propisi i birokratske procedure. Postoje vodiči dobre prakse koji preporučuje kda se započinje antivirusna trapija hrnične HCV infekcije i nadam seda se ikod nas, u univerzitetskim bolnicama, primenjuju
Profesore, javljam se opet, imao sam pre 25 god vise puta visokorizicni kontakt sa starijom devojkom koju sam upoznao nakon neke tehno zurke u klubu. Tada sam imao 20 god, nakon nekih 1o god 2010 nakon simptoma osipa po kozi i temperature od 37.3 koja je trajala mesec do dva meseca, javljam se kod doktorke koja me nakon antibiotika salje na Infektivnu u BG 2011 god gde me testiraju na sve bolesti i HIV, negativno. Osip prolazi i temperatura ali se ja osecam slabije od tada i kao da mi se promenila boja noktiju ka modroj boji. . 2024 naglo mrsavim i dobijam kandidu na jeziku koju sam imao malo ranije pozadi, doktor me salje opet na Infektivnu u BG gde me opet testiraju i obicnim testom i RNK PCR testom na HIV negativno, kao i na sve druge bolesti. Ja se i privatno testiram na Gradskom zavodu u BG obicnim testom na HIV i u Novom Sadu sa RNK PCR testom sve negativno, kao i u BEOLAB I AQUALAB pcr rnk hiv sve negativno. Mozete li mi reci posto je i moja supruga testirana negativno u bolnici tercijalnog nivoa nakon nekih analiza, zbog toga sto sam se u medjuvemenu naglo ugojio preko 30 kg kao i daljeg problema sa kandidom, da li postoji mozda jos neko testiranje ili je to konacno. Dodao bih da mi je hematolog rekao da su analize krvi u redu, ali je imunolog nasao da imam neku inflamaciju bez faktora autoimunih bolesti, osim HEP-2 ANA nucleus 1: 160. Kome dalje da se javim zbog velikog osecaja zamora i umora, kandide koja se javila i prekomerne tezine. Ne pijem nikakve lekove
javite se internisti, možda je potrebno proveriti i endokrinolške parametre
Hvala doktore, a dali moze seboroicni dermatitis da se izleči, ja koristim neku kremu koju mi je prepisao dermatilog, čim prestanem sa mazanjem počne ponovo iritacija I crvenilo
kombinacija dveju krema kortikosteroida(Sinoderm) i mikonazola(Dactanol), jedna ujutru , druga uveće i ketokonazol šampon za kosu mogu da postignu uspeh, no kako je to hronična bolest, nije uvek verovatno kompletno izlečenje
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Dobar dan,
Majstor koji mi je popravljao automobil je imao neku posekotinu/ogrebotinu iznad lakta, veličine možda pola centimetara. Mislim da nije aktivno krvarila, ali je delovalo kao da je krv na posekotini/ogrebotini sveža, tj. da je posekotina/ogrebotina skorija.
Ako je on ušao u automobil i seo na mesto vozača da ga isproba i prislonio taj deo ruke na sedište ili dotakao neku drugu površinu u automobilu (volan, menjač), i ako posle pet minuta ja sednem na to vozačevo mesto da vozim i dotaknem te iste površine (dlanovima, prstima, laktom) da li je moguće steći HIV, hepatitis (b, c)? Na prstima imam neke stare ogrebotine koje su zarasle i gde je koža mlada, pa se bojim da sam bio u riziku. Hvala.
nema razloga za brigu-nema rizika