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\pard\li6453\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li6453\ri0\sl-213\slmult0 \fs
18\cf0\par\pard\li6453\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li6453\ri0\sl-213\s
lmult0 \fs18\cf0\par\pard\li6453\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li6453\ri
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\li6453\ri0\sl-386\slmult0 \fs16\cf0\f0\charscalex100 {Rev Cubana Farm 2003;37(1
):38-52}\par\pard\li4293\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li4293\ri0\sl-213
\slmult0 \fs18\cf0\par\pard\li4293\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li4293\
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rd\li4293\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li4293\ri0\sl-386\slmult0 \fs24\
cf0\f0\charscalex100\b {Farmacodivulgacin}\b0 \par\pard\li4266\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li4266\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {Centro
para el Desarrollo de la Farmacoepidemiologa}\par\pard\li1853\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li1853\ri0\sl-320\slmult0 \fs24\cf0\f0\charscalex100\b {GUA P
ARA LA PRCTICA CLNICA DE LAS INFECCIONES}\b0 \par\pard\li1853\ri0\sl-293\slmult0 \
fs24\cf0\f0\charscalex100\b {VAGINALES}\b0 \par\pard\li2933\ri0\sl-213\slmult0 \
fs18\cf0\par\pard\li2933\ri0\sl-213\slmult0 \fs16\cf0\f0\charscalex100 {Miriam C
ires Pujol,}\fs8\cf0\f0\charscalex100 {1}{ }\fs16\cf0\f0\charscalex100 {Elsie Fr
eijoso Santiesteban,}\fs8\cf0\f0\charscalex100 {2}\fs16\cf0\f0\charscalex100 {Lza
ro Silva Herrera,}\fs8\cf0\f0\charscalex100 {3}\fs16\cf0\f0\charscalex100 {Eduar
do Vergara}\par\pard\li2933\ri0\sl-186\slmult0 \fs16\cf0\f0\charscalex100 {Fabin,
}\fs8\cf0\f0\charscalex100 {3}{ }\fs16\cf0\f0\charscalex100 {Eduardo Cuti Len,}\fs
8\cf0\f0\charscalex100 {4}\fs16\cf0\f0\charscalex100 { Mirna Ortega Blanco,}\fs8
\cf0\f0\charscalex100 {5}\fs16\cf0\f0\charscalex100 { Flix Sanso Soberat,}\fs8\cf
0\f0\charscalex100 {6}\fs16\cf0\f0\charscalex100 { Wilfredo}\par\pard\li2933\ri0
\sl-200\slmult0 \fs16\cf0\f0\charscalex100 {Francisco Martnez}\fs8\cf0\f0\charsca
lex100 {7}\fs16\cf0\f0\charscalex100 { y Mara Isela Lantero Abreu,}\fs8\cf0\f0\ch
arscalex100 {8}\par\pard\li2213\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2213\ri0
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alex100\b {Lmite de la gua:}\b0 { }\fs20\cf0\f0\charscalex100 {paciente del sexo f
emenino de cualquier edad que consulta por}\par\pard\li1853\ri0\sl-240\slmult0 \
fs20\cf0\f0\charscalex100 {sntomas y signos de infeccin vaginal.}\par\pard\li1853\
ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-266\slmult0 \fs18\cf0\f0\cha
rscalex100\b {Objetivos de la gua}\b0 \par\pard\li2040\ri0\sl-213\slmult0 \fs18\c
f0\par\pard\li2040\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {- Establecer r
ecomendaciones para el manejo teraputico adecuado de pacientes con}\par\pard\li22
53\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {infeccin vaginal.}\par\pard\li2
040\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {- Contribuir al enfoque multi
disciplinario de pacientes con infeccin vaginal.}\par\pard\li1853\ri0\sl-213\slmu
lt0 \fs18\cf0\par\pard\li1853\ri0\sl-266\slmult0 \fs18\cf0\f0\charscalex100\b {C
lasificacin de las evidencias cient-ficas y de las recomendaciones teraputicas}\b0
\par\pard\li2213\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2213\ri0\sl-266\slmult0
\fs18\cf0\f0\charscalex100 {Las evidencias se clasifican en: nivel I (datos pro
cedentes de ensayos clnicos controlados}\par\pard\li1853\ri0\sl-240\slmult0 \fs20
\cf0\f0\charscalex100 {y aleatorizados, metanlisis y revisiones sistemticas); nive
l II (resultados de estudios de}\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f0
\charscalex100 {cohortes o casos y controles) y nivel III (informacin basada en e
studios no controlados o}\par\pard\li1853\ri0\sl-240\slmult0 \fs18\cf0\f0\charsc
alex100 {concenso de expertos). Las recomendaciones (Rec.) se clasifican en:}{ }
\fs18\cf0\f0\charscalex100\b {Buenas (Rec. A):}\b0 { }\fs20\cf0\f0\charscalex100
{basada}\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {en la c
ategora I de evidencia;}{ }\fs18\cf0\f0\charscalex100\b {Regular (Rec. B):}\b0 {
}\fs18\cf0\f0\charscalex100 {basada directamente en la categora II de la}\par\par
d\li1853\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {evidencia o extrapolada
de la categora I;}{ }\fs20\cf0\f0\charscalex100\b {Baja (Rec. C):}\b0 { }\fs20\cf
0\f0\charscalex100 {basada directamente en la categora}\par\pard\li1853\ri0\sl-24
0\slmult0 \fs20\cf0\f0\charscalex100 {III o extrapolada de las categoras II y III
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alex100\b {Especialista de I Grado en Pediatra.}\b0 \par\pard\li1853\ri0\sl-200\s
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00\b {Especialista de I Grado en Medicina General Integral.}\b0 \par\pard\li1853
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Hernndez".}\b0 \par\pard\li1853\ri0\sl-186\slmult0 \*\tx1986\fs8\cf0\f0\charscale
x100\b {5}\b0 \tab \fs16\cf0\f0\charscalex100\b {Profesora Auxiliar en Ginecologa
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alex100\b {7}\b0 \tab \fs16\cf0\f0\charscalex100\b {Especialista en Medicina Gen
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sl-200\slmult0 \*\tx1986\fs8\cf0\f0\charscalex100\b {8}\b0 \tab \fs16\cf0\f0\cha
rscalex100\b {Especialista en Higiene y Epidemiologa. Direccin de Epidemiologa, MIN
SAP}\b0 \par\pard\li5320\ri0\sl-426\slmult0 \fs22\cf0\f0\charscalex100\b {38}\b0
\par\pard\sect\sectd\sbkpage\pgwsxn12240\pghsxn15840\marglsxn666\margrsxn133\ma
rgtsxn666\margbsxn520\pard\li2213\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2213\r
i0\sl-213\slmult0 \fs18\cf0\par\pard\li2213\ri0\sl-213\slmult0 \fs18\cf0\par\par
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-333\slmult0 \fs20\cf0\f0\charscalex100 {Las secreciones vaginales normales se c
aracterizan por ser: inodoras, claras, viscosas,}\par\pard\li1853\ri0\sl-240\slm
ult0 \fs16\cf0\f0\charscalex100 {pH cido menor que 4,5, no contienen neutrfilos y
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8\cf0\f0\charscalex100 {La flora vaginal est constituida por lactobacillus spp .
La mucosa vaginal de la nia, a}\par\pard\li1853\ri0\sl-226\slmult0 \fs18\cf0\f0\c
harscalex100 {diferencia de la mujer adulta, es delgada con ausencia de glucgeno
y lactobacilos acidfilos}\par\pard\li1853\ri0\sl-240\slmult0 \fs18\cf0\f0\charsca
lex100 {de Doderlein, pH neutro (7 a 8), medio que favorece el cultivo de microo
rganismos.}\par\pard\li1853\ri0\sl-226\slmult0 \fs18\cf0\f0\charscalex100 {Anatmi
camente la cercana del ano a la uretra y vagina favorece la contaminacin fecal y}\
par\pard\li1853\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {urinaria.1 En las
nias puede existir una secrecin vaginal fisiolgica en el momento del}\par\pard\li1
853\ri0\sl-226\slmult0 \fs18\cf0\f0\charscalex100 {nacimiento y premenarquia, y
en la mujer durante algunas etapas del ciclo menstrual,}\par\pard\li1853\ri0\sl-
240\slmult0 \fs20\cf0\f0\charscalex100 {relacionado con el coito, durante el emb
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8\cf0\f0\charscalex100 {caracterizado por uno o ms de los siguientes sntomas: fluj
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0\f0\charscalex100 {disuria, dispareunia y fetidez vaginal, determinados por la
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alex100 {cualquier microorganismo en la vagina y como resultado de un disbalance
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{ecosistema vaginal. Se presenta en las mujeres cuando tienen infeccin en la vagi
na. (tambin}\par\pard\li1853\ri0\sl-226\slmult0 \fs18\cf0\f0\charscalex100 {llama
da vaginitis) o en el cuello del tero (cervicitis), siendo esta ltima ms severa y q
ue}\par\pard\li1853\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {puede ocasion
ar complicaciones graves.}{\super \fs10\up2\cf0\f0\charscalex100 {2,3}}\fs18\cf0
\f0\charscalex100 { En algunos pases se han producido cambios en}\par\pard\li1853
\ri0\sl-226\slmult0 \fs18\cf0\f0\charscalex100 {los patrones de infeccin como con
secuencia de la modificacin de los comportamientos}\par\pard\li1853\ri0\sl-240\sl
mult0 \fs20\cf0\f0\charscalex100 {sexuales.}{ }\fs20\cf0\f0\charscalex100\i {La
Chlamydia}\i0 \fs20\cf0\f0\charscalex100 {, el herpes genital y el papiloma huma
no son ahora ms frecuentes}\par\pard\li1853\ri0\sl-226\slmult0 \fs18\cf0\f0\chars
calex100 {que la gonorrea y la sfilis. Solo en los Estados Unidos se reportan cad
a ao de 4 a 8 millones}\par\pard\li1853\ri0\sl-240\slmult0 \fs18\cf0\f0\charscale
x100 {de casos nuevos de Chlamydia. Se han generalizado las cepas de Neisseria g
onorrhoeae}\par\pard\li1853\ri0\sl-226\slmult0 \fs18\cf0\f0\charscalex100 {resis
tentes a la penicilina y a la tetraciclina, adems se ha modificado la resistencia
de la}\par\pard\li1853\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100\i {Trichom
onas vaginalis}\i0 \fs20\cf0\f0\charscalex100 { al metronidazol.}{\super \fs12\u
p2\cf0\f0\charscalex100 {4}}\par\pard\li2213\ri0\sl-240\slmult0 \fs16\cf0\f0\cha
rscalex100 {En la prctica mdica las infecciones vaginales representan un problema
de salud frecuente}\par\pard\li1853\ri0\sl-226\slmult0 \fs18\cf0\f0\charscalex10
0 {ya que el 95 % de las pacientes consultan por flujo vaginal. Las infecciones
genitales en la}\par\pard\li1853\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {
infancia y premenarquia constituyen la causa ginecolgica ms frecuente en este grup
o de}\par\pard\li1853\ri0\sl-226\slmult0 \fs18\cf0\f0\charscalex100 {edad. En lo
s servicios de atencin primaria de salud, estas afecciones en adolescentes, se}\p
ar\pard\li1853\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {encuentran entre l
as 3 primeras causas de consulta, teniendo una incidencia mucho mayor}\par\pard\
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sexual activa, aunque tambin se ha encontrado entre}\par\pard\li1853\ri0\sl-240\
slmult0 \fs20\cf0\f0\charscalex100 {adolescentes vrgenes.}{\super \fs12\up2\cf0\f
0\charscalex100 {5}}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li185
3\ri0\sl-266\slmult0 \fs18\cf0\f0\charscalex100\b {Situaciones que favorecen las
infecciones vaginales}\b0 \fs12\cf0\f0\charscalex100\b {6}\b0 \par\pard\li2040\
ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2040\ri0\sl-266\slmult0 \*\tx2253\fs20\c
f0\f1\charscalex100 {-}\tab \fs20\cf0\f0\charscalex100 {Deficiente higiene gnito-
anal}\par\pard\li2040\ri0\sl-240\slmult0 \*\tx2253\fs20\cf0\f1\charscalex100 {-}
\tab \fs20\cf0\f0\charscalex100 {Nuevo o mltiples parejas sexuales}\par\pard\li20
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253\fs20\cf0\f1\charscalex100 {-}\tab \fs20\cf0\f0\charscalex100 {Embarazo}\par\
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\cf0\f0\charscalex100 {Diabete}\par\pard\li2040\ri0\sl-240\slmult0 \*\tx2253\fs2
0\cf0\f1\charscalex100 {-}\tab \fs20\cf0\f0\charscalex100 {Parasitosis}\par\pard
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ab \fs20\cf0\f0\charscalex100 {Malformaciones congnitas}\par\pard\li2040\ri0\sl-2
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53\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par
\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs
18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\s
lmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri
0\sl-333\slmult0 \fs18\cf0\f0\charscalex100\b {Formas de presentacin ms frecuentes
de la infeccin vaginal}\b0 {\super \fs12\up2\cf0\f0\charscalex100\b {7-9}\b0 }\p
ar\pard\sect\sectd\sbknone\pgwsxn12240\pghsxn15840\marglsxn666\margrsxn133\cols2
\colno1\colw5253\colsr-0\colno2\colw6186\pard\li1853\ri0\sl-213\slmult0 \fs18\cf
0\par\pard\li1853\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100\b {Cuadro clnico}
\b0 \par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-266\slm
ult0 \fs20\cf0\f0\charscalex100 {Flujo blanquecino escaso, pH<4,5}\par\pard\li18
53\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {Prurito vulvar y/o irritacin, e
ritema}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-266\
slmult0 \fs20\cf0\f0\charscalex100 {Flujo amarillo profuso, pH>5 }\par\pard\li
1853\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {prurito vulvar}\par\pard\li1
853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-266\slmult0 \fs20\cf0\f0
\charscalex100 {Flujo ftido blanco-grisceo, pH>4,5}\par\pard\li1853\ri0\sl-240\slm
ult0 \fs20\cf0\f0\charscalex100 {Olor a aminas (pescado)}\par\pard\li1853\ri0\sl
-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-266\slmult0 \fs20\cf0\f0\charscale
x100 {Despus de la adicin de hidrxido}\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0
\f0\charscalex100 {de potasio 10 % presencia de clulas}\par\pard\li1853\ri0\sl-24
0\slmult0 \fs20\cf0\f0\charscalex100 {guas (criterios de Amsel)}\par\pard\li1853\
ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pa
rd\li1853\ri0\sl-293\slmult0 \fs20\cf0\f0\charscalex100 {Flujo anormal, sangrami
ento poscoital}\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {/
intermenstrual, dolor abdominal bajo,}\par\pard\li1853\ri0\sl-240\slmult0 \fs20\
cf0\f0\charscalex100 {ardor al orinar}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\
cf0\par\pard\li1853\ri0\sl-253\slmult0 \fs20\cf0\f0\charscalex100 {Flujo purulen
to,}\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {dolor y difi
cultad al orinar,}\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100
{fiebre escasa}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri
0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {Flujo, ardor o sensacin}\par\pard\li
1853\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {quemante genital y}\par\pard
\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {perineal, dolor y}\par\pa
rd\li1853\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {lesiones vesiculares y}
\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {pstulas Herpes ge
nital}\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {fiebre e i
nflamacin}\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {perinea
l}\par\column\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-266\slmu
lt0 \fs18\cf0\f0\charscalex100\b { }\b0 \fs18\cf0\f0\charscalex100\b {Agente
 causal}\b0 \par\pard\li160\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li160\ri0\sl-2
66\slmult0 \fs20\cf0\f0\charscalex100\i {Candida albicans}\i0 \par\pard\li160\ri
0\sl-213\slmult0 \fs18\cf0\par\pard\li160\ri0\sl-213\slmult0 \fs18\cf0\par\pard\
li160\ri0\sl-293\slmult0 \fs20\cf0\f0\charscalex100\i {Trichomonas vaginalis}\i0
\par\pard\li160\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li160\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li160\ri0\sl-293\slmult0 \fs20\cf0\f0\charscalex100\i {Gadner
ella vaginalis }\i0 \par\pard\li160\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li16
0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li160\ri0\sl-293\slmult0 \fs20\cf0\f0\ch
arscalex100 {Anaerobios (bacteroides,}\par\pard\li173\ri0\sl-240\slmult0 \fs20\c
f0\f0\charscalex100 {peptoestreptococos, porphyromonas)}\par\pard\li160\ri0\sl-2
40\slmult0 \fs20\cf0\f0\charscalex100\i {Mobiluncus spp}\i0 \par\pard\li160\ri0\
sl-240\slmult0 \fs20\cf0\f0\charscalex100\i {Mycoplasma hominis}\i0 \par\pard\li
160\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li160\ri0\sl-213\slmult0 \fs18\cf0\par
\pard\li160\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li160\ri0\sl-320\slmult0 \fs20
\cf0\f0\charscalex100\i {Chlamydiatrachomatis}\i0 \par\pard\li160\ri0\sl-213\slm
ult0 \fs18\cf0\par\pard\li160\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li160\ri0\sl
-213\slmult0 \fs18\cf0\par\pard\li160\ri0\sl-306\slmult0 \fs20\cf0\f0\charscalex
100\i {Neisseria gonorrhoeae}\i0 \par\pard\li160\ri0\sl-213\slmult0 \fs18\cf0\pa
r\pard\li160\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li160\ri0\sl-213\slmult0 \fs1
8\cf0\par\pard\li160\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li160\ri0\sl-213\slmu
lt0 \fs18\cf0\par\pard\li160\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li160\ri0\sl-
213\slmult0 \fs18\cf0\par\pard\li160\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li160
\ri0\sl-200\slmult0 \fs20\cf0\f0\charscalex100 {Herpes genital}\par\pard\sect\se
ctd\sbknone\pgwsxn12240\pghsxn15840\marglsxn666\margrsxn133\pard\li2213\ri0\sl-2
13\slmult0 \fs18\cf0\par\pard\li2213\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li221
3\ri0\sl-280\slmult0 \fs20\cf0\f0\charscalex100 {Teniendo en cuenta, que en una
misma mujer pueden coexistir ms de una forma clnica}\par\pard\li1853\ri0\sl-226\sl
mult0 \fs18\cf0\f0\charscalex100 {(vaginitis y/o cervicitis), y si el examen gin
ecolgico no permite afirmar la presencia de un}\par\pard\li1853\ri0\sl-226\slmult
0 \fs18\cf0\f0\charscalex100 {agente causal en particular, el tratamiento deber s
er enfocado de forma sindrmica (vase}\par\pard\li1853\ri0\sl-240\slmult0 \fs18\cf0
\f0\charscalex100 {anexo), a las 3 infecciones ms frecuentemente asociadas con el
sndrome de flujo vaginal:}\par\pard\li1853\ri0\sl-226\slmult0 \fs18\cf0\f0\chars
calex100 {trichomoniasis, candidiasis y vaginosis bacteriana. Con menor frecuenc
ia estas infecciones}\par\pard\li1853\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex
100 {son producidas por N. gonorrhoeae y C. trachomatis.}\par\pard\li1853\ri0\sl
-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-253\slmult0 \fs18\cf0\f0\charscale
x100\b {Objetivos del tratamiento:}\b0 \par\pard\li2026\ri0\sl-213\slmult0 \fs18
\cf0\par\pard\li2026\ri0\sl-253\slmult0 \*\tx2253\fs20\cf0\f1\charscalex100 {-}\
tab \fs20\cf0\f0\charscalex100 {Brindar un alivio rpido de los sntomas y signos de
infeccin.}\par\pard\li2026\ri0\sl-240\slmult0 \*\tx2253\fs20\cf0\f1\charscalex10
0 {-}\tab \fs20\cf0\f0\charscalex100 {Tratar las infecciones adecuadamente.}\par
\pard\li5320\ri0\sl-333\slmult0 \fs22\cf0\f0\charscalex100\b {40}\b0 \par\pard\s
ect\sectd\sbknone\pgwsxn12240\pghsxn15840\marglsxn666\margrsxn133\pard\sect\sect
d\sbkpage\pgwsxn12240\pghsxn15840\marglsxn666\margrsxn133\margtsxn666\margbsxn52
0\pard\li2040\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2040\ri0\sl-213\slmult0 \f
s18\cf0\par\pard\li2040\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2040\ri0\sl-213\
slmult0 \fs18\cf0\par\pard\li2040\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2040\r
i0\sl-213\slmult0 \fs18\cf0\par\pard\li2040\ri0\sl-213\slmult0 \fs18\cf0\par\par
d\li2040\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2040\ri0\sl-333\slmult0 \*\tx22
53\fs20\cf0\f1\charscalex100 {-}\tab \fs20\cf0\f0\charscalex100 {Erradicar los a
gentes patgenos de la vagina.}\par\pard\li2040\ri0\sl-240\slmult0 \*\tx2253\fs20\
cf0\f1\charscalex100 {-}\tab \fs20\cf0\f0\charscalex100 {Prevenir el desarrollo
de complicaciones del tracto genital superior.}\par\pard\li2040\ri0\sl-226\slmul
t0 \*\tx2253\fs20\cf0\f1\charscalex100 {-}\tab \fs20\cf0\f0\charscalex100 {Preve
nir futuras infecciones de transmisin sexual en el paciente individual y en la}\p
ar\pard\li2253\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {comunidad.}\par\pa
rd\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-253\slmult0 \fs18\
cf0\f0\charscalex100\b {Recomendaciones generales}\b0 \fs12\cf0\f0\charscalex100
\b {8,10,11}\b0 \par\pard\li2040\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2040\ri
0\sl-240\slmult0 \*\tx2253\fs20\cf0\f1\charscalex100 {-}\tab \fs20\cf0\f0\charsc
alex100 {No utilizar ducha vaginal, geles y agentes antispticos locales (Rec.C)}\
par\pard\li2040\ri0\sl-226\slmult0 \*\tx2253\fs20\cf0\f1\charscalex100 {-}\tab \
fs20\cf0\f0\charscalex100 {Practicar una tcnica adecuada de higiene vulvo-vaginal
(Rec.C)}\par\pard\li2040\ri0\sl-226\slmult0 \*\tx2253\fs20\cf0\f1\charscalex100
{-}\tab \fs20\cf0\f0\charscalex100 {Corregir anomalas anatomo-funcionales asocia
das (Rec. C)}\par\pard\li2040\ri0\sl-240\slmult0 \*\tx2253\fs18\cf0\f1\charscale
x100 {-}\tab \fs18\cf0\f0\charscalex100 {Comenzar tratamiento en presencia de si
gnos y sntomas de infeccin vaginal mientras}\par\pard\li2253\ri0\sl-226\slmult0 \f
s20\cf0\f0\charscalex100 {se espera por la confirmacin diagnstica (Rec. C)}\par\pa
rd\li2040\ri0\sl-226\slmult0 \*\tx2253\fs18\cf0\f1\charscalex100 {-}\tab \fs18\c
f0\f0\charscalex100 {El uso de estrgenos intravaginales durante la posmenopausia
puede prevenir}\par\pard\li2253\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {i
nfecciones recurrentes (Rec. C)}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\pa
r\pard\li1853\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100\b {Criterios teraputi
cos por grupos de pacientes}\b0 \par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\pa
r\pard\li1853\ri0\sl-253\slmult0 \fs20\cf0\f0\charscalex100 {I.}{ }\fs18\cf0\f0\
charscalex100\b {Vaginosis bacteriana (VB)}\b0 \par\pard\li2120\ri0\sl-213\slmul
t0 \fs18\cf0\par\pard\li2120\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100\b {a)
Nias}\b0 \par\pard\li2440\ri0\sl-226\slmult0 \fs18\cf0\f0\charscalex100 {El uso
de medicamentos por va vaginal en estas pacientes se reservar para aquellos}\par\p
ard\li2440\ri0\sl-226\slmult0 \fs18\cf0\f0\charscalex100 {casos con una amplia a
bertura himeneal y siempre precedido de una adecuada}\par\pard\li2440\ri0\sl-240
\slmult0 \fs20\cf0\f0\charscalex100 {explicacin a los familiares.}{\super \fs12\u
p2\cf0\f0\charscalex100 {5}}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pa
rd\li1853\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100\b {Tratamiento de primer
a eleccin (Rec. C}\b0 \fs12\cf0\f0\charscalex100\b {11,16,17}\b0 \fs20\cf0\f0\cha
rscalex100\b {)}\b0 \par\pard\sect\sectd\sbknone\pgwsxn12240\pghsxn15840\marglsx
n666\margrsxn133\cols2\colno1\colw7520\colsr-0\colno2\colw3920\pard\li2120\ri0\s
l-213\slmult0 \fs18\cf0\par\pard\li2120\ri0\sl-253\slmult0 \*\tx3560\fs20\cf0\f0
\charscalex100 {Metronidazol}\tab \fs18\cf0\f0\charscalex100 {40mg/kg oral(mx
2g)}\par\pard\li3560\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {15mg/kg/da
cada 8 h (mx 1 g)}\par\pard\li3560\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100
{gel vaginal 0,75 %, 1 aplic 2 veces al da}\par\pard\li1853\ri0\sl-213\slmult0 \f
s18\cf0\par\pard\li1853\ri0\sl-253\slmult0 \fs20\cf0\f0\charscalex100\b {Alterna
tiva}\b0 \par\column\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-2
53\slmult0 \fs20\cf0\f0\charscalex100 {una sola dosis}\par\pard\li0\ri0\sl-226\s
lmult0 \fs20\cf0\f0\charscalex100 {7 }\fs20\cf0\f0\charscalex100 {das}\par\pard\l
i0\ri0\sl-226\slmult0 \fs20\cf0\f0\charscalex100 {7 das}\par\pard\sect\sectd\sbkn
one\pgwsxn12240\pghsxn15840\marglsxn666\margrsxn133\cols3\colno1\colw3560\colsr-
0\colno2\colw3960\colsr-0\colno3\colw3920\pard\li1853\ri0\sl-213\slmult0 \fs18\c
f0\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {Clindamicina}\
par\column\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-240\slmult0
\fs20\cf0\f0\charscalex100 {8 a 20 }\fs20\cf0\f0\charscalex100 {mg/kg/da oral ,
2 veces al das}\par\column\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0
\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {7 das}\par\pard\sect\sectd\sbknone\pg
wsxn12240\pghsxn15840\marglsxn666\margrsxn133\cols2\colno1\colw7520\colsr-0\coln
o2\colw3920\pard\li2120\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2120\ri0\sl-253\
slmult0 \fs18\cf0\f0\charscalex100\b {b) Mujer no embarazada}\b0 \par\pard\li18
53\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-240\slmult0 \fs18\cf0\f0\
charscalex100\b {Tratamiento de primera eleccin (Rec. C16-20)}\b0 \par\pard\li185
3\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-253\slmult0 \fs20\cf0\f0\c
harscalex100 {Metronidazol}{\super \fs12\up2\cf0\f0\charscalex100 {*}}\fs18\cf0\
f0\charscalex100 {500 mg oral, 2 veces al da }\par\pard\li1853\ri0\sl-226\s
lmult0 \*\tx3560\fs18\cf0\f0\charscalex100 { o }\tab \fs20\cf
0\f0\charscalex100 {gel vaginal 0,75 %, 1}\par\pard\li3560\ri0\sl-226\slmult0 \f
s20\cf0\f0\charscalex100 {aplicacin 2 veces/da}\par\pard\li1853\ri0\sl-240\slmult0
\fs20\cf0\f0\charscalex100 {Alternativas}\par\pard\li1853\ri0\sl-213\slmult0 \f
s18\cf0\par\pard\li1853\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {Clindamic
ina 300 mg oral, 2 veces al da }\par\column\pard\li13\ri0\sl-21
3\slmult0 \fs18\cf0\par\pard\li13\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li13\ri0
\sl-213\slmult0 \fs18\cf0\par\pard\li13\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li
13\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li13\ri0\sl-320\slmult0 \fs20\cf0\f0\ch
arscalex100 {7 das}\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl
-240\slmult0 \fs20\cf0\f0\charscalex100 {5das}\par\pard\li0\ri0\sl-213\slmult0 \f
s18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-266\slmult
0 \fs20\cf0\f0\charscalex100 {7 das}\par\pard\sect\sectd\sbknone\pgwsxn12240\pghs
xn15840\marglsxn666\margrsxn133\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\par
d\li1853\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {Nota: se deber aconsejar
a las pacientes que eviten el consumo de alcohol durante el}\par\pard\li1853\ri0
\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {tratamiento con metronidazol y en la
s 24 h posteriores.}\par\pard\li5320\ri0\sl-426\slmult0 \fs22\cf0\f0\charscalex1
00\b {41}\b0 \par\pard\sect\sectd\sbknone\pgwsxn12240\pghsxn15840\marglsxn666\ma
rgrsxn133\pard\sect\sectd\sbkpage\pgwsxn12240\pghsxn15840\marglsxn666\margrsxn13
3\margtsxn666\margbsxn520\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li18
53\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par
\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs
18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\s
lmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri
0\sl-346\slmult0 \fs18\cf0\f0\charscalex100\b {c) Mujer embarazada}\b0 \par\pard
\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-253\slmult0 \fs20\cf
0\f0\charscalex100 {Se dispone de pocos datos acerca de los preparados vaginales
para uso tpico en la gestante,}\par\pard\li1853\ri0\sl-240\slmult0 \fs18\cf0\f0\
charscalex100 {por lo que se prefiere emplear la va oral.15 No se recomienda el u
so de la crema vaginal de}\par\pard\li1853\ri0\sl-240\slmult0 \fs18\cf0\f0\chars
calex100 {clindamicina porque existen estudios clnicos controlados que indican un
incremento en el}\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100
{nmero de partos pretrminos en gestantes tratadas con este preparado.}{\super \fs
12\up2\cf0\f0\charscalex100 {7}}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\pa
r\pard\li1853\ri0\sl-266\slmult0 \fs18\cf0\f0\charscalex100\b {Tratamiento de pr
imera eleccin (Rec. C}\b0 \fs12\cf0\f0\charscalex100\b {16-32}\b0 {\sub \fs20\cf0
\f0\charscalex100\b {)}\b0 }\par\pard\sect\sectd\sbknone\pgwsxn12240\pghsxn15840
\marglsxn666\margrsxn133\cols3\colno1\colw3746\colsr-0\colno2\colw3560\colsr-0\c
olno3\colw4133\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-2
66\slmult0 \fs20\cf0\f0\charscalex100 {Metrodinazol*}\par\pard\li1853\ri0\sl-240
\slmult0 \fs18\cf0\f0\charscalex100 { o}\par\pard\li1853\ri0\sl-240\slmu
lt0 \fs20\cf0\f0\charscalex100 {Alternativa}\par\pard\li1853\ri0\sl-240\slmult0
\fs20\cf0\f0\charscalex100 {Clindamicina}\par\column\pard\li0\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {250 mg, va
oral, 3 veces al da}\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\
sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-293\slmult0 \fs18\cf0\f0\charscalex
100 {300 mg, va oral, 2 veces al da }\par\column\pard\li0\ri0\sl-213\slmu
lt0 \fs18\cf0\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {7 das}\
par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\
cf0\par\pard\li0\ri0\sl-293\slmult0 \fs20\cf0\f0\charscalex100 {7 das}\par\pard\s
ect\sectd\sbknone\pgwsxn12240\pghsxn15840\marglsxn666\margrsxn133\pard\li1853\ri
0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-266\slmult0 \fs20\cf0\f0\chars
calex100 {* El metronidazol se iniciar a partir del segundo trimestre de la gesta
cin.}\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {** El metron
idazol 2 g por va oral en dosis nica no es tan efectivo como un curso de 7 das}\pa
r\pard\li2120\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100 {de duracin. En pacie
ntes incumplidores de esquemas de tratamiento mltiples, esta}\par\pard\li2120\ri0
\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {pudiese ser una alternativa.}\par\pa
rd\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-200\slmult0 \fs18\
cf0\f0\charscalex100\b {II. Candidiasis vulvovaginal}\b0 \fs12\cf0\f0\charscalex
100\b {11,16-18,35}\b0 \par\pard\li2040\ri0\sl-240\slmult0 \fs20\cf0\f0\charscal
ex100 {a) Nias}\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\
sl-266\slmult0 \fs18\cf0\f0\charscalex100\b {Tratamiento de primera eleccin (Rec.
C}\b0 { }\fs12\cf0\f0\charscalex100\b {11,16,17}\b0 {\sub \fs20\cf0\f0\charscal
ex100\b {)}\b0 }\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri
0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\f0\chars
calex100\b {Medicamento Dosis
Duracin}\b0 \par\pard\sect\sectd\sbknone\pgwsxn12
240\pghsxn15840\marglsxn666\margrsxn133\cols3\colno1\colw4640\colsr-0\colno2\col
w2613\colsr-0\colno3\colw4186\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\
li1853\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {Nistatina}\par\pard\li1853
\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-266\slmult0 \fs18\cf0\f0\ch
arscalex100 {Fluconazol }\par\pard\li2213\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li2213\ri0\sl-266\slmult0 \fs18\cf0\f0\charscalex100\b {Alter
nativas (Rec. C}\b0 \fs12\cf0\f0\charscalex100\b {11,16-17}\b0 \fs20\cf0\f0\char
scalex100\b {)}\b0 \par\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853
\ri0\sl-266\slmult0 \fs18\cf0\f0\charscalex100 {Violeta de genciana
}\par\pard\li1853\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {(solucin ac
uosa al 1 %)}\par\pard\li2253\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li2253\ri0\s
l-266\slmult0 \fs20\cf0\f0\charscalex100 {b) Mujer no embarazada}\par\column\par
d\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\
charscalex100 {1 tab vaginal 100 000 UI}\par\pard\li0\ri0\sl-240\slmult0 \fs20\c
f0\f0\charscalex100 {o crema}\par\pard\li0\ri0\sl-240\slmult0 \fs20\cf0\f0\chars
calex100 {3 a 6 }\fs20\cf0\f0\charscalex100 {mg/kg/da, oral dosis nica}\par\pard\l
i13\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li13\ri0\sl-213\slmult0 \fs18\cf0\par\
pard\li13\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li13\ri0\sl-320\slmult0 \fs18\cf
0\f0\charscalex100 {1 aplicacin al da }\par\column\pard\li0\ri0\sl-213\sl
mult0 \fs18\cf0\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {14 da
s}\par\pard\li0\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {14 das}\par\pard\l
i0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pa
rd\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\pa
r\pard\li0\ri0\sl-346\slmult0 \fs20\cf0\f0\charscalex100 {14 das}\par\pard\sect\s
ectd\sbknone\pgwsxn12240\pghsxn15840\marglsxn666\margrsxn133\pard\li1853\ri0\sl-
213\slmult0 \fs18\cf0\par\pard\li1853\ri0\sl-266\slmult0 \fs18\cf0\f0\charscalex
100\b {Tratamiento de primera eleccin (Rec. C}\b0 \fs12\cf0\f0\charscalex100\b {1
6-18,35}\b0 \fs20\cf0\f0\charscalex100\b {)}\b0 \par\pard\li1853\ri0\sl-213\slmu
lt0 \fs18\cf0\par\pard\li1853\ri0\sl-266\slmult0 \fs18\cf0\f0\charscalex100\b {M
edicamento Dosis
Duracin}\b0 \par\pard\sect\sectd\sbknone\pgwsxn12240\pghsxn15
840\marglsxn666\margrsxn133\cols3\colno1\colw4640\colsr-0\colno2\colw2613\colsr-
0\colno3\colw4186\pard\li1853\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1853\ri0\s
l-266\slmult0 \fs20\cf0\f0\charscalex100 {Clotrimazol}\par\column\pard\li0\ri0\s
l-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex1
00 {100 mg tab vaginal}\par\pard\li0\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex1
00 {100 mg 2 veces al da }\par\pard\li680\ri0\sl-213\slmult0 \fs18\cf0\par\p
ard\li680\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li680\ri0\sl-413\slmult0 \fs22\c
f0\f0\charscalex100\b {42}\b0 \par\column\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\
par\pard\li0\ri0\sl-266\slmult0 \fs20\cf0\f0\charscalex100 {7 das o}\par\pard\li0
\ri0\sl-240\slmult0 \fs20\cf0\f0\charscalex100 {3 das}\par}