Akademik

Противоглистные средства
I Противогли́стные сре́дства (antihelminthica, синоним антигельминтные средства)
химиотерапевтические средства для лечения заболеваний, вызываемых паразитическими червями и их личинками.
В современной медицинской практике в качестве П. с. используют главным образом синтетические вещества, относящиеся к разным классам химических соединений, например к производным фенола (дифезил, фенасал и др.), пиперазина (пиперазина адипинат), хлорированным углеводородом (хлоксил) и др. Из препаратов растительного происхождения в качестве П. с. используют в основном экстракт мужского папоротника густой, семя тыквы и эметина гидрохлорид.
Механизмы действия на гельминтов отдельных П. с. различны. Так, многие П. с. например ниридазол (амбильгар), дитразина цитрат, празиквантель (билтрицид), левамизол, влияют на разные стадии углеводного обмена в тканях гельминтов. Некоторые противоглистные средства, например битионол, нафтамон, пиперазин и др., вызывают паралич нервно-мышечной системы гельминтов. При приеме фенасала не только развивается паралич нервно-мышечной системы плоских червей, но и разрушаются их покровные ткани. Празиквантель нарушает обмен гликогена и вызывает спастический паралич мышц гельминтов, а экстракт мужского папоротника густой парализует мышечную систему гельминтов, очевидно вследствие разобщения процессов окислительного фосфорилирования. Механизмы действия ряда П. с. (серы очищенной, медамина) не изучены.
Эффективность П. с. при разных гельминтозах различна и определяется прежде всего биологическим видом паразитических червей и их локализацией в организме хозяина. Классификация П. с. основана на видовой чувствительности гельминтов к отдельным препаратам данной группы. В соответствии с этим среди П. с. выделяют препараты, применяемые преимущественно для лечения нематодозов (Нематодозы), цестодозов (Цестодозы) и трематодозов (Трематодозы), а также П. с. широкого спектра действия, которые эффективны в отношении разных видов гельминтов. Кроме того, П. с. иногда подразделяют на препараты, применяемые при гельминтозах пищеварительного тракта, и препараты, используемые для терапии тканевых гельминтозов.
Противоглистные средства, применяемые преимущественно при нематодозах. К этой группе относятся соли пиперазина, левамизол, нафтамон, пирантел, тиабендазол, медамин, кислород, дитразина цитрат и др. Из солей пиперазина в качестве П. с. используется главным образом пиперазина адипинат, который широко применяется для массовой дегельминтизации при аскаридозе и энтеробиозе, т.к. не требует предварительной подготовки больного, т.е. назначения соответствующей диеты, слабительных средств и др., а также отличается низкой токсичностью для человека и редко вызывает побочные эффекты. Такими же свойствами обладает левамизол, применяемый главным образом при аскаридозе. Кроме того, этот препарат действует как иммуностимулятор. Пирантел по спектру противоглистного действия превосходит пиперазин и отличается эффективностью не только при аскаридозе и энтеробиозе, но также при трихоцефалезе, анкилостомидозах и трихостронгилидозах. Нафтамон применяют главным образом при анкилостомозе. При отсутствии других П. с. этот препарат используют также при аскаридозе и трихоцефалезе. При трихоцефалезе более эффективен дифезил, близкий к нафтамону по химической структуре и свойствам. Тиабендазол назначают при некаторозе и стронгилоидозе, а также при трихинеллезе (одновременно с десенсибилизирующими средствами). Особенно эффективен тиабендазол в ранних стадиях трихинеллеза, т.к. он подавляет репродуктивную способность кишечных трихинелл. Этот препарат используют и для терапии ларвальных нематодозов, в частности токсокароза. Дитразина цитрат применяют преимущественно при филяриатозах, т.к. при аскаридозе и других кишечных нематодозах он мало эффективен. Относительно редко для лечения энтеробиоза используют серу очищенную, т.к. по эффективности она уступает, например, пиперазину, мебендазолу (вермоксу) и др. Кислород в качестве П. с. применяют также относительно редко. При введении в желудок он эффективен при аскаридозе, а при введении в прямую кишку — при трихоцефалезе.
Противоглистные средства, применяемые преимущественно при цестодозах. До появления синтетических П. с. для лечения цестодозов широко использовали экстракт мужского папоротника, отличающийся высокой токсичностью и требующий тщательной специальной подготовки больного (диета, назначение слабительных средств и др.). В современной медицинской практике для лечения цестодозов кишечника применяют в основном фенасал, обладающий высокой эффективностью при этих гельминтозах и не требующий специальной подготовки больных. Другие П. с. данной группы (семя тыквы, аминоакрихин) по эффективности при цестодозах значительно уступают фенасалу, поэтому их назначают реже.
Противоглистные средства, применяемые преимущественно при трематодозах. Препараты данной группы, исходя из особенностей их применения, можно условно разделить на П. с., используемые в терапии трематодозов печени (описторхоза, клонорхоза и фасциолеза), к которым относится хлоксил, и П. с., применяемые при шистосомозах, — антимонила-натрия тартрат и эметина гидрохлорид. Лечение препаратами этой группы проводится только в условиях стационара под тщательным врачебным контролем, т.к. в процессе применения таких препаратов требуются дополнительные лечебные мероприятия (например, после окончания приема хлоксила необходимо назначение желчегонных средств и проведение повторного дуоденального зондирования) или возможно развитие тяжелых побочных эффектов (например, при назначении антимонила-натрия тартрата и эметина гидрохлорида). В связи с этим для лечения трематодозов печени и шистосомозов используют в основном П. с. широкого спектра действия, отличающиеся не только высокой активностью при таких гельминтозах, но и относительно низкой токсичностью.
Противоглистные средства широкого спектра действия. К данной группе П. с. относятся ниридазол (амбильгар), битинол, мебендазол и празиквантель. Ниридазол эффективен при гельминтозах, вызываемых всеми видами шистосом, а также при дракункулезе. Битонол применяют при цестодозах и парагонимозе легких. Празиквантель назначают при шистосомозах и других трематодозах, а также при цестодозах и цистицеркозе. Мебендазол показан при нематодозах пищеварительного тракта. Он эффективен во всех стадиях развития трихинеллеза, при дракункулезе, ларвальных нематодозах. Некоторой эффективностью он обладает и при цестодозах кишечника, а также трематодозах печени.
Сравнительная клинико-фармакологическая характеристика основных П. с. приводится в таблице.
Таблица
Клинико-фармакологическая характеристика основных противоглистных средств
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| Название              | Возможные механизмы | Показание к               | Способы               | Побочные           | Противопоказания | Формы              |
| препарата,           | противоглистного          | применению              | применения, дозы | эффекты            |                             | выпуска,           |
| основные             | действия                       |                                  |                              |                           |                             | условия             |
| синонимы             |                                      |                                  |                              |                           |                             | хранения           |
|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| 1                          | 2                                   | 3                               | 4                           | 5                        | 6                           | 7                       |
|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Битионол,             | Парализует                   | Парагонимоз,            | Внутрь взрослым  | Понос, боли в     | Не установлены    | Порошок            |
| Bitionolum;            | двигательную               | тениидозы,                | по 40—60 мг/кг в   | животе,              |                             |                          |
| синоним актамер  | активность плоских       | дифиллоботриоз       | сутки при              | тошнота, рвота,  |                             |                          |
| и др.                    | червей                          |                                  | парагонимозе в     | крапивница         |                             |                          |
|                             |                                      |                                  | течение 10 дней    |                           |                             |                          |
|                             |                                      |                                  | подряд или с         |                           |                             |                          |
|                             |                                      |                                  | интервалами в      |                           |                             |                          |
|                             |                                      |                                  | 1—3 дня, при        |                           |                             |                          |
|                             |                                      |                                  | цестодозах           |                           |                             |                          |
|                             |                                      |                                  | однократно с         |                           |                             |                          |
|                             |                                      |                                  | последующим       |                           |                             |                          |
|                             |                                      |                                  | назначением         |                           |                             |                          |
|                             |                                      |                                  | слабительного       |                           |                             |                          |
|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Дитразина            | Нарушает начальные    | Филяриатозы             | Внутрь взрослым  | Кашель,             | Поражения глаз    | Порошок,           |
| цитрат,                 | стадии гликолиза          |                                  | из расчета 2 мг/кг  | головная боль,   | при онхоцеркозе   | таблетки по       |
| Ditrazinum            | путем угнетения            |                                  | 3 раза в день в     | бессонница,       |                             | 0,05 и 0,1 г.       |
| citricum; синоним  | активности                    |                                  | течение 10 дней.   | аллергические    |                             | Хранение:         |
| локсуран и др.      | фосфорилазы               |                                  | Имеются и другие | реакции              |                             | список Б; а        |
|                             |                                      |                                  | схемы                   |                           |                             | хорошо              |
|                             |                                      |                                  | применения.          |                           |                             | укупоренной      |
|                             |                                      |                                  | Суточная доза не  |                           |                             | таре                  |
|                             |                                      |                                  | должна                 |                           |                             |                          |
|                             |                                      |                                  | превышать 0,4 г    |                           |                             |                          |
|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Кислород             | Усиливает процессы     | Аскаридоз                 | Взрослым по         | Тяжесть в          | Язвенная              |                          |
|                             | аэробного дыхания в     |                                  | 1250—1500 мл;     | области              | болезнь,               |                          |
|                             | тканях гельминтов        |                                  | детям до 10 лет    | желудка             | беременность,      |                          |
|                             |                                      |                                  | по 100 мл на 1 год |                           | менструация         |                          |
|                             |                                      |                                  | жизни, 10—12 лет  |                          |                             |                          |
|                             |                                      |                                  | по 1000—1100 мл, |                           |                             |                          |
|                             |                                      |                                  | 13—14 лет по        |                           |                             |                          |
|                             |                                      |                                  | 1250 мл через       |                           |                             |                          |
|                             |                                      |                                  | зонд в желудок     |                           |                             |                          |
|                             |                                      |                                  | (порциями по         |                           |                             |                          |
|                             |                                      |                                  | 100—200—250 мл  |                          |                             |                          |
|                             |                                      |                                  | с интервалами в    |                           |                             |                          |
|                             |                                      |                                  | 1—2 мин)              |                           |                             |                          |
|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Левамизол,          | Подавляет анаэробное  | Аскаридоз                 | Внутрь                  | Боли в животе,   | Беременность       | Таблетки по       |
| Levamisolum;        | дыхание, блокируя        |                                  | однократно           | понос, рвота       |                             | 0,15 г                |
| синоним декарис  | восстановление            |                                  | взрослым 0,15 г;   |                           |                             |                          |
| и др.                    | фумарата вследствие   |                                  | детям по 2,5 мг/кг |                           |                             |                          |
|                             | угнетения активности    |                                  |                              |                           |                             |                          |
|                             | сукцинатдегидрогеназы |                                  |                              |                           |                             |                          |
|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Мебендазол,        | Нарушает                      | Аскаридоз,                | Внутрь                  | Не установлены  | Беременность      | Таблетки по       |
| синоним вермокс, | пищеварение у              | энтеробиоз,               | однократно при     |                           |                             | 0,1 г                  |
| Vermox                 | гельминтов, действуя   | трихоцефалез,          | энтеробиозе          |                           |                             |                          |
|                             | на субклеточные           | анкилостомидозы,     | взрослым и           |                           |                             |                          |
|                             | органеллы и вызывая    | трихинеллез              | подросткам по      |                           |                             |                          |
|                             | дистрофические           |                                  | 0,1 г, детям от 2    |                           |                             |                          |
|                             | изменения в                  |                                  | до 10 лет по          |                           |                             |                          |
|                             | цитоплазме                   |                                  | 0,025—0,05 мг.      |                           |                             |                          |
|                             |                                      |                                  | При                       |                           |                             |                          |
|                             |                                      |                                  | трихоцефалезе и   |                           |                             |                          |
|                             |                                      |                                  | смешанных           |                           |                             |                          |
|                             |                                      |                                  | инвазиях               |                           |                             |                          |
|                             |                                      |                                  | взрослым и           |                           |                             |                          |
|                             |                                      |                                  | подросткам по      |                           |                             |                          |
|                             |                                      |                                  | 0,1 г 2 раза в         |                           |                             |                          |
|                             |                                      |                                  | день, а при           |                           |                             |                          |
|                             |                                      |                                  | полиинвазии по     |                           |                             |                          |
|                             |                                      |                                  | 0,1 г в день 3 дня  |                           |                             |                          |
|                             |                                      |                                  | подряд                  |                           |                             |                          |
|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Нафтамон,           | Угнетает способность   | Аскаридоз,                | Внутрь натощак    | Тошнота, рвота,  | Нарушения           | Таблетки           |
| Naphyhammonum; | митохондрий нематод   | анкилостомидозы,     | (за 2 ч до              | частый стул       | функции печени    | нафтамона        |
| синоним алкпар и | окислять декарбоновые | трихостронгилидозы, | завтрака)              |                           |                             | «К», покрытые   |
| др.                       | кислоты в цикле            | трихоцефалез,          | взрослым и детям |                           |                             | оболочкой         |
|                             | Кребса и тем самым     | энтеробиоз                | старше 10 лет по   |                           |                             | (Tabulettae         |
|                             | ограничивают                |                                  | 5 г; детям 3—5      |                           |                             | Naphthamoni K   |
|                             | обеспечение энергией   |                                  | лет по 2—2,5 г,     |                           |                             | obductae), и       |
|                             | процессов мышечного   |                                  | 6—7 лет по 3 г,     |                           |                             | таблетки            |
|                             | сокращения                  |                                  | 8—9 лет по 4 г в    |                           |                             | нафтамона,       |
|                             |                                      |                                  | течение 3—5         |                           |                             | растворимые в  |
|                             |                                      |                                  | дней. При              |                           |                             | кишечнике         |
|                             |                                      |                                  | трихоцефалезе     |                           |                             | (Tabulettae         |
|                             |                                      |                                  | назнанают только  |                           |                             | Naphthamoni      |
|                             |                                      |                                  | таблетки               |                           |                             | enterosolubiles), |
|                             |                                      |                                  | нафтамона,           |                           |                             | содержащие по |
|                             |                                      |                                  | растворимые в      |                           |                             | 0,5 г                  |
|                             |                                      |                                  | кишечнике, при     |                           |                             | нафтамона.       |
|                             |                                      |                                  | прочих                  |                           |                             | Хранение:         |
|                             |                                      |                                  | гельминтозах,       |                           |                             | список Б; в        |
|                             |                                      |                                  | чувствительных к  |                           |                             | защищенном от |
|                             |                                      |                                  | препарату,            |                           |                             | света месте      |
|                             |                                      |                                  | применяют            |                           |                             |                          |
|                             |                                      |                                  | таблетки               |                           |                             |                          |
|                             |                                      |                                  | нафтамона «К»,    |                           |                             |                          |
|                             |                                      |                                  | покрытые              |                           |                             |                          |
|                             |                                      |                                  | оболочкой             |                           |                             |                          |
|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Ниридазол,           | Нарушает углеводный   | Шистосомозы,           | Внутрь во время   | Диспептические  | Психические        | Таблетки по       |
| синоним               | обмен за счет               | дракункулез              | еды взрослым по  | расстройства,     | заболевания,        | 0,25 г                |
| амбильгар            | угнетения активности    |                                  | 0,025 г/кг в сутки   | боли в мышцах,  | органические        |                          |
|                             | глюкозо-6-                     |                                  | в 3 приема. Курс   | костях,               | заболевания         |                          |
|                             | фосфатдегидрогеназы  |                                  | лечения 5—7         | суставах,           | сердечно-             |                          |
|                             |                                      |                                  | дней                     | психические       | сосудистой           |                          |
|                             |                                      |                                  |                              | расстройства     | системы, печени,  |                          |
|                             |                                      |                                  |                              |                           | почек,                   |                          |
|                             |                                      |                                  |                              |                           | преклонный           |                          |
|                             |                                      |                                  |                              |                           | возраст,                |                          |
|                             |                                      |                                  |                              |                           | истощение            |                          |
|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Пиперазина          | Парализует мышечную  | Аскаридоз,                | Внутрь в течение  | Тошнота, боли в | Органические        | Таблетки по 0,2 |
| адипинат,             | систему нематод          | энтеробиоз                | 2 дней за 1 ч до    | животе,              | заболевания ц. н.  | и 0,5 г; 5%         |
| Piperazini              |                                      |                                  | или через 1/2—1 ч  | головная боль    | с.                          | раствор (для     |
| adipinasв;             |                                      |                                  | после еды 2 раза  |                           |                             | детей) в            |
| синоним энтацил, |                                      |                                  | в день взрослым   |                           |                             | склянках по       |
| пипераскат и др.  |                                      |                                  | по 1,5—2 г на        |                           |                             | 100 мл.              |
|                             |                                      |                                  | прием; детям до 1 |                           |                             | Хранение:         |
|                             |                                      |                                  | года по 0,2 г, 2—3 |                           |                             | таблетки в         |
|                             |                                      |                                  | лет по 0,3 г, 4—5   |                           |                             | обычных            |
|                             |                                      |                                  | лет по 0,5 г, 6—8   |                           |                             | условиях,          |
|                             |                                      |                                  | лет по 0,75 г, 9—   |                           |                             | раствор в          |
|                             |                                      |                                  | 12 лет по 1 г, 13— |                           |                             | прохладном,      |
|                             |                                      |                                  | 15 лет по 1,5 г       |                           |                             | защищенном от |
|                             |                                      |                                  |                              |                           |                             | света месте      |
|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Пирантел;             | Деполяризует                | Аскаридоз,                | Внутрь 1 раз в      | Тошнота, рвота,  | Беременность      | Таблетки по       |
| синоним               | мышечные мембраны    | энтеробиоз,               | день (после           | боли в животе,   |                             | 0,25 г.               |
| комбантрин          | нематод и                     | анкилосгомидозы,     | завтрака)              | понос, головная  |                             | Суспензия,        |
|                             | вследстствие этого       | трихостронгилидозы, | взрослым по 10     | боль,                  |                             | содержащая по |
|                             | вызывает контрактуру   | трихоцефалез           мг/кг (при              | головокружение  |                             | 50 мг в 1 мл, во |
|                             | их мышц                       |                                  | аскаридозе и         |                           |                             | флаконах по      |
|                             |                                      |                                  | энтеробиозе          |                           |                             | 15 мл.               |
|                             |                                      |                                  | однократно, при    |                           |                             | Хранение:         |
|                             |                                      |                                  | сочетании             |                           |                             | список Б           |
|                             |                                      |                                  | некатороза с         |                           |                             |                          |
|                             |                                      |                                  | аскаридозом в      |                           |                             |                          |
|                             |                                      |                                  | той же дозе в        |                           |                             |                          |
|                             |                                      |                                  | течение 3 дней      |                           |                             |                          |
|                             |                                      |                                  | или по 20 мг/кг в   |                           |                             |                          |
|                             |                                      |                                  | течение 2 дней);    |                           |                             |                          |
|                             |                                      |                                  | детям 1—2 лет по |                           |                             |                          |
|                             |                                      |                                  | 0,125 г, 2—6 лет    |                           |                             |                          |
|                             |                                      |                                  | по 0,25 г, 6—12     |                           |                             |                          |
|                             |                                      |                                  | лет по 0,5 г в 1—2 |                           |                             |                          |
|                             |                                      |                                  | приема                  |                           |                             |                          |
|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Семя тыквы,         | Не установлен              | Тениаринхоз, тениоз  | Внутрь в виде      | Тошнота             | Не установлены    | В пакетах и       |
| Semen Cucurbitae |                                      |                                  | отвара взрослым   |                           |                             | коробках по       |
|                             |                                      |                                  | из 500 г                 |                           |                             | 130 г                 |
|                             |                                      |                                  | неочищенных        |                           |                             |                          |
|                             |                                      |                                  | измельченных       |                           |                             |                          |
|                             |                                      |                                  | семян; детям до 5 |                           |                             |                          |
|                             |                                      |                                  | лет из 100—150 г,  |                          |                             |                          |
|                             |                                      |                                  | 5—7 лет из 200 г,  |                           |                             |                          |
|                             |                                      |                                  | 8—9 лет из 250 г,  |                           |                             |                          |
|                             |                                      |                                  | 10 лет из 300 г.     |                           |                             |                          |
|                             |                                      |                                  | Через 2 ч дают     |                           |                             |                          |
|                             |                                      |                                  | солевое                |                           |                             |                          |
|                             |                                      |                                  | слабительное.       |                           |                             |                          |
|                             |                                      |                                  | Возможны и          |                           |                             |                          |
|                             |                                      |                                  | другие схемы        |                           |                             |                          |
|                             |                                      |                                  | применения           |                           |                             |                          |
|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Сера очищенная,  | Не установлен              | Энтеробиоз               | Внутрь 3 раза в     | Не установлены  | Не установлены   | Порошок.           |
| Sulfur depuratum   |                                      |                                  | день во время       |                           |                             | Храненение: в   |
|                             |                                      |                                  | еды в течение 5    |                           |                             | хорошо              |
|                             |                                      |                                  | дней взрослым по |                           |                             | укупоренных     |
|                             |                                      |                                  | 0,8—1 г на прием; |                           |                             | банках в сухом  |
|                             |                                      |                                  | детям на прием     |                           |                             | месте                |
|                             |                                      |                                  | из расчета по        |                           |                             |                          |
|                             |                                      |                                  | 0,05 г на 1 год       |                           |                             |                          |
|                             |                                      |                                  | жизни. Всего         |                           |                             |                          |
|                             |                                      |                                  | проводят от 3 до   |                           |                             |                          |
|                             |                                      |                                  | 5 циклов лечения  |                           |                             |                          |
|                             |                                      |                                  | с перерывами по   |                           |                             |                          |
|                             |                                      |                                  | 4 дня                    |                           |                             |                          |
|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Тиабендазол,       | В тканях гельминтов     | Стронгилоидоз          | Внутрь взрослым  | Тошнота, рвота,  | Нарушения           | Таблетки по       |
| Tiabendazolum,     | проявляет свойства      |                                  | из расчета по 25   | боли в области   | функции печени и | 0,1 г                  |
| синоним               | конкурентного               |                                  | мг/кг в сутки в 2— | сердца               | почек,                   |                          |
| минтезол и др.     | антагониста                  |                                  | 3 приема в            |                           | беременность       |                          |
|                             | имидазола, связывает   |                                  | течение 2—3         |                           |                             |                          |
|                             | АТФ                              |                                  | дней. При              |                           |                             |                          |
|                             |                                      |                                  | необходимости     |                           |                             |                          |
|                             |                                      |                                  | через 2 нед.          |                           |                             |                          |
|                             |                                      |                                  | лечение можно      |                           |                             |                          |
|                             |                                      |                                  | повторить             |                           |                             |                          |
|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Фенасал,              | Парализует нервно-       | Тениаринхоз,            | После                   | Не установлены  | Не установлены   | Порошок.           |
| Phenasalum;         | мышечную систему и    | дифиллоботриоз,      | соответствующей  |                          |                             | Хранение:         |
| синоним:              | разрушает покровные    | гимеволепидоз          | подготовки            |                           |                             | список Б; в        |
| йомезан,              | ткани плоских червей    |                                  | (диета,                  |                           |                             | сухом месте      |
| никлосамид и др.  |                                     |                                  | слабительное)       |                           |                             |                          |
|                             |                                      |                                  | внуть однократно  |                           |                             |                          |
|                             |                                      |                                  | взрослым 2 г;        |                           |                             |                          |
|                             |                                      |                                  | детям до 3 лет      |                           |                             |                          |
|                             |                                      |                                  | 0,5 г, 3—6 лет 1 г, |                           |                             |                          |
|                             |                                      |                                  | 6—9 лет 1,5 г,       |                           |                             |                          |
|                             |                                      |                                  | старше 9 лет 2 г.   |                           |                             |                          |
|                             |                                      |                                  | За 15 мин до         |                           |                             |                          |
|                             |                                      |                                  | приема фенасала  |                           |                             |                          |
|                             |                                      |                                  | дают 1—2 г           |                           |                             |                          |
|                             |                                      |                                  | натрия                  |                           |                             |                          |
|                             |                                      |                                  | гидрокарбоната.    |                           |                             |                          |
|                             |                                      |                                  | При                       |                           |                             |                          |
|                             |                                      |                                  | гименолепидозе    |                           |                             |                          |
|                             |                                      |                                  | лечение                |                           |                             |                          |
|                             |                                      |                                  | фенасалом           |                           |                             |                          |
|                             |                                      |                                  | состоит из 3          |                           |                             |                          |
|                             |                                      |                                  | семидневных        |                           |                             |                          |
|                             |                                      |                                  | циклов с                |                           |                             |                          |
|                             |                                      |                                  | интервалами 7      |                           |                             |                          |
|                             |                                      |                                  | дней                     |                           |                             |                          |
|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Хлоксил,              | Вызывает деструкцию   | Описторхоз,              | Внутрь взрослым  | Головная боль,   | Заболевания         | Порошок.           |
| Chloxylum             | нуклеопротеидов в        | клонорхоз,                | в суточной дозе    | чувство легкого  | печени и сердца,  | Хранение:          |
|                             | клетках кишечного        | фасциолез                | из расчета по        | опьянения, боли | беременность       | список Б           |
|                             | эпителия и паренхимы  |                                  | 0,15 г/кг в течение | в области           |                             |                          |
|                             | трематод и угнетает      |                                  | 2 дней; по 0,1 г/кг  | печени,              |                             |                          |
|                             | углеводный обмен         |                                  | в течение 3 дней   | аллергические    |                             |                          |
|                             |                                      |                                  | или по 0,06 г/кг в   | реакции              |                             |                          |
|                             |                                      |                                  | течение 5 дней.     |                           |                             |                          |
|                             |                                      |                                  | Суточную дозу      |                           |                             |                          |
|                             |                                      |                                  | принимают по 2 г  |                           |                             |                          |
|                             |                                      |                                  | каждые 10 мин.     |                           |                             |                          |
|                             |                                      |                                  | Через 2 ч после    |                           |                             |                          |
|                             |                                      |                                  | приема хлоксила   |                           |                             |                          |
|                             |                                      |                                  | дают                     |                           |                             |                          |
|                             |                                      |                                  | желчегонные         |                           |                             |                          |
|                             |                                      |                                  | средства и 1—2    |                           |                             |                          |
|                             |                                      |                                  | раза в неделю       |                           |                             |                          |
|                             |                                      |                                  | проводят               |                           |                             |                          |
|                             |                                      |                                  | дуоденальное       |                           |                             |                          |
|                             |                                      |                                  | зондирование (в    |                           |                             |                          |
|                             |                                      |                                  | течение 1 мес.)     |                           |                             |                          |
|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Экстракт              | Парализует нервно-       | Тениидозы,               | Внутрь после        | Тошнота, рвота,  | Сердечная           | В склянках и в   |
| мужского              | мышечную систему       | дифиллоботриоз,      | соответствующей  | понос,                | недостаточность,  | капсулах по       |
| папоротника         | плоских червей,            | гименолепидоз          | подготовки            | головокружение, | болезни печени и  | 0,5 г. Хранение: |
| густой, Extractum | разобщает процессы     |                                  | (диета, солевое     | головная боль,   | почек, язвенная    | список Б. в        |
| Filicis maris          | окислительного             |                                  | слабительное        | иногда                | болезнь, острые    | плотно               |
| spissum                | фосфорилирования       |                                  | однократно при     | судорога,           | заболевания         | укупоренных     |
|                             |                                      |                                  | тениидозах и         | угнетение           | желудочно-           | склянках в         |
|                             |                                      |                                  | дифиллоботриозе) | дыхания,            | кишечного тракта, | защищенном от |
|                             |                                      |                                  | взрослым 4—7 г    | коллапс,             | беременность,      | света месте      |
|                             |                                      |                                  | (по 0,5 г каждые    | атрофия             | резкое                  |                          |
|                             |                                      |                                  | 3 мин); детям 2     | зрительного        | истощение,           |                          |
|                             |                                      |                                  | лет 1 г, 3 лет 1,5   | нерва,                | анемия,                |                          |
|                             |                                      |                                  | г, 4 лет 2 г, 5—6    | дистрофические | туберкулез            |                          |
|                             |                                      |                                  | лет 2—2,5 г, 7—9  | изменения          |                             |                          |
|                             |                                      |                                  | лет 3—3,5 г, 10—  | печени               |                             |                          |
|                             |                                      |                                  | 12 лет 3,5 г, 13—   |                           |                             |                          |
|                             |                                      |                                  | 16 лет 4 г. Детям   |                           |                             |                          |
|                             |                                      |                                  | до 2 лет препарат  |                          |                             |                          |
|                             |                                      |                                  | не назначают.       |                           |                             |                          |
|                             |                                      |                                  | Через 1—2 ч         |                           |                             |                          |
|                             |                                      |                                  | дают солевое        |                           |                             |                          |
|                             |                                      |                                  | слабительное.       |                           |                             |                          |
|                             |                                      |                                  | При                       |                           |                             |                          |
|                             |                                      |                                  | гименолепидозе    |                           |                             |                          |
|                             |                                      |                                  | препарат               |                           |                             |                          |
|                             |                                      |                                  | назначают             |                           |                             |                          |
|                             |                                      |                                  | однократно в         |                           |                             |                          |
|                             |                                      |                                  | следующих           |                           |                             |                          |
|                             |                                      |                                  | дозах: детям 2      |                           |                             |                          |
|                             |                                      |                                  | лет 0,2 г, 3—4 лет |                           |                             |                          |
|                             |                                      |                                  | 0,3 г, 5—6 лет 0,5  |                           |                             |                          |
|                             |                                      |                                  | г, 7—8 лет 0,6 г,    |                           |                             |                          |
|                             |                                      |                                  | 9—10 лет 0,7 г,     |                           |                             |                          |
|                             |                                      |                                  | 11—12 лет 0,9 г,    |                           |                             |                          |
|                             |                                      |                                  | 13—14 лет 1 г, 15  |                           |                             |                          |
|                             |                                      |                                  | лет и старше 1,5   |                           |                             |                          |
|                             |                                      |                                  | г. В указанных      |                           |                             |                          |
|                             |                                      |                                  | дозах лечение       |                           |                             |                          |
|                             |                                      |                                  | препаратом           |                           |                             |                          |
|                             |                                      |                                  | проводят тремя     |                           |                             |                          |
|                             |                                      |                                  | однодневными      |                           |                             |                          |
|                             |                                      |                                  | циклами с             |                           |                             |                          |
|                             |                                      |                                  | перерывами          |                           |                             |                          |
|                             |                                      |                                  | между ними 7       |                           |                             |                          |
|                             |                                      |                                  | дней. Высшая       |                           |                             |                          |
|                             |                                      |                                  | разовая доза для  |                           |                             |                          |
|                             |                                      |                                  | взрослых внутрь   |                           |                             |                          |
|                             |                                      |                                  | 8 г (однократно)    |                           |                             |                          |
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Библиогр.: Лекарственные препараты, применяемые при паразитарных заболеваниях, под ред. А.И. Кротова, с. 85, М., 1979; Озерецковская Н.Н., Зальнова Н.С. и Тумольская Н.И. Клиника и лечение гельминтозов. Л., 1985; Озерецковская Н.Н. и др. Новый отечественный антигельминтик медамин, Мед. паразитол., № 5, с. 7, 1986.
II Противогли́стные сре́дства (antihelminthica; син.: антигельминтики, антигельминтные средства)
лекарственные средства, применяемые для лечения глистных инвазий человека и животных (пиперазин, экстракт мужского папоротника, хлоксил и др.).

1. Малая медицинская энциклопедия. — М.: Медицинская энциклопедия. 1991—96 гг. 2. Первая медицинская помощь. — М.: Большая Российская Энциклопедия. 1994 г. 3. Энциклопедический словарь медицинских терминов. — М.: Советская энциклопедия. — 1982—1984 гг.