Léčba mykózy

8.4.2012 , Lucia Hlavatá

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lecba-mykozy.jpg - kopie
K léčbě mykózy se dnes používají léčiva zvaná antimykotika. K léčbě mykózy se používají v lehčích případech masti, u těžších infekcí jsou již potřeba tablety či nitrožilní léky. Léčba mykózy by i přes velké množství volně prodejných antimykotik měla být stále v rukou kožního lékaře, protože při nesprávném léčení hrozí riziko recidivy, tedy znovuobjevení onemocnění.

Léčba mykózy

Mykózy čili plísně jsou onemocnění způsobena houbami, plísněmi či kvasinkami. K léčbě mykóz se používají léčiva zvaná antimykotika. Pokud se diagnóza mykózy potvrdí, její léčba se odvíjí od citlivosti odebraného vzorku k antimykotickým látkám, od spektra účinků léků nebo častěji od zkušeností lékaře. V současnosti se u povrchových forem infekcí dermatofyty nebo kvasinkami užívá specifických antimykotik se širokým spektrem účinku. Zevní léčba mykóz je u většiny těchto onemocnění dostačující, ale u rozsáhlých infekcí a také u jedinců s oslabenou imunitou je již nutná léčba celková. Volba antimykotik a jejich forem je vždy individuální a přizpůsobená jednotlivým infekcím. K zevní léčbě se užívají masti, při těžších a celkových onemocněních se podávají antimykotika v tabletové formě nebo injekčně do žíly. K léčbě vaginální mykózy jsou pak k dispozici poševní čípky.

Typy léčby mykózy

Nejstaršími přípravky pro léčbu mykóz jsou antimykotika polyenová, která jsou poměrně toxická. Z nich jsou nejčastěji používány amfotericin B, který se podává nitrožilně, natamycin a nystatin, které se podávají zevně. Tyhle preparáty jsou účinné hlavně proti kvasinkám. Dále se v léčbě mykóz používají antimykotika imidazolová, která působí proti dermatofytům i kvasinkám a užívají se lokálně zevně jako krémy, pasty, masti nebo čípky. Patří k nim například clotrimazol, ekonazol či oxikonazol. Ketokonazol je dostupný i v tabletové formě nebo v podobě šamponu na vlasy. Triazolová antimykotika mají široké spektrum účinku. Působí proti většině původců mykotických infekcí. Flukonazol a itrakonazol se podávají u celkových a těžkých mykóz v tabletové nebo nitrožilní formě. Poslední skupinou jsou antimykotika alylaminová, která jsou účinná zejména u dermatofytóz kůže a nehtů. Sem patří terbinafin, který je ale méně účinný na kvasinky. Mezi další antimykoticky působící látky pro léčbu mykózy patří griseofulvin, flucytosin, ciklopiroxolamin, genciánová violeť nebo echinokandiny (kaspofungin).

Léčba dermatofytózy

K léčbě mykózy nohou způsobené dermatofyty, tedy k léčbě dermatofytózy nohou, obyčejně stačí několika týdenní užívání lokálních antimykotik v podobě krémů. Jsou to krémy jako Myfungar, Imazol, Batrafen či Canesten. Jako součást léčby mykóz a též jako jejich prevence, se doporučuje denní výměna bavlněných ponožek a dezinfekce obuvi, dodržování hygieny a pečlivé vysušení míst vlhké zapářky. Léčba mykózy při postižení ostatních částí těla je stejná, jen při hlubokých formách se vyžaduje i léčba celková a to pomocí léčiv jako je ketokonazol, itrakonazol nebo terbinafin. Onychomykóza, tedy postižení nehtů, se léčí obtížněji vzhledem k častým návratům nemoci. Kromě zevní léčby se doporučuje i terapie celková a při postižení jen několika nehtů je možné chemické snesení nehtu v kombinaci s antimykotiky. Léčba mykóz postihujících kůži v místech vlhké zapářky se provádí pomocí lokálních antimykotik. U těžkých stavů jsou opět nutná antimykotika celková. Důležitá je pravidelná hygiena, vzdušný oděv a úprava případné cukrovky. U kandidózy dutiny ústní se používá roztok genciánové violeti a zevní antimykotika, při těžkých infekcích i celková. K léčbě nekomplikované vaginální mykózy se podávají poševní čípky, tablety a krémy s nystatinem, natamycinem nebo azoly, případně jednorázová dávka flukonazolu v tabletě. U komplikované formy kvasinkové infekce a v těhotenství je léčba mykózy delší.

Léčba mykózy v rukou kožního lékaře

V dnešní době je k dispozici množství volně prodejných antimykotik, která se dají použít k léčbě již časných stadií mykózy. Nevhodně zvolená léčba mykózy však může komplikovat diagnostiku nemoci a navíc prodlužovat její průběh. Aby byla léčba mykózy úspěšná, je třeba správně určit původce nemoci a nasadit tak cílenou léčbu. Léčba mykózy musí být dostatečně dlouhá a musí se v ní pokračovat i po vymizení příznaků. Při nedostatečném přeléčení totiž houbovité mikroorganismy mohou přetrvávat v těle a při oslabení organismu infekce propukne znovu. Průběh léčby mykózy by měl být také průběžně kontrolován. Diagnostika a léčba mykózy proto patří do rukou specialisty, kterým je kožní lékař.

 

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