Qhov tshwm sim ntawm cov khw muag tshuaj ntawm cov tshuaj tua kab mob tshiab nrog ntau yam teebmeem, xws li fluoroquinolones, cephalosporins, tau ua rau qhov tseeb tias cov kws kho mob tau dhau los tsis tshua muaj tshuaj aminoglycosides (cov tshuaj). Cov npe tshuaj muaj nyob rau hauv pab pawg no yog qhov dav heev, thiab suav nrog cov tshuaj zoo li Gentamicin, Amikacin, Streptomycin. Streptomycin, los ntawm txoj kev, suav hais tias keeb kwm yog thawj aminoglycoside. Nws kuj yog tus thib ob paub tshuaj tua kab mob tom qab penicillin. Aminoglycosides, lossis theej, kev npaj aminoglycoside, tseem nyob rau hnub no qhov xav tau tshaj plaws hauv kev saib xyuas mob hnyav thiab chaw phais mob.
piav qhia luv ntawm pab pawg
Aminoglycosides yog cov tshuaj (cov npe tshuaj yuav tau tham hauv qab no) uas txawv ntawm semi-synthetic lossis natural origin. Cov tshuaj tua kab mob no muaj cov kab mob bactericidal sai thiab muaj zogkab mob.
Tshuaj muaj ntau yam kev ua. Lawv cov tshuaj tiv thaiv kab mob tau tshaj tawm tawm tsam cov kab mob gram-tsis zoo, tab sis txo qis hauv kev tawm tsam cov kab mob gram-zoo. Thiab aminoglycosides tsis muaj txiaj ntsig zoo rau anaerobes.
Cov tshuaj no ua rau muaj cov kab mob bactericidal zoo heev vim muaj peev xwm tiv thaiv tsis tau cov protein synthesis hauv cov kab mob rhiab heev ntawm qib ribosomes. Cov tshuaj muaj active nyob rau hauv kev sib raug zoo rau ob leeg multiplying thiab so hlwb. Qib ntawm kev ua ntawm cov tshuaj tua kab mob yog nyob ntawm lawv cov concentration hauv tus neeg mob cov ntshav ntshav.
Cov pab pawg ntawm aminoglycosides tam sim no siv rau qhov txwv. Qhov no yog vim lub siab toxicity ntawm cov tshuaj no. Lub raum thiab lub cev hnov lus feem ntau cuam tshuam los ntawm cov tshuaj no.
Ib qho tseem ceeb ntawm cov nyiaj no yog qhov ua tsis tau ntawm lawv txoj kev nkag mus rau hauv lub cell nyob. Yog li, aminoglycosides tsis muaj zog kiag li hauv kev tawm tsam cov kab mob hauv lub cev.
Qhov zoo thiab qhov tsis zoo
Cov tshuaj tua kab mob no tau siv dav, raws li tau hais los saum no, hauv kev xyaum phais. Thiab nws tsis yog coincidence. Cov kws kho mob hais txog ntau yam txiaj ntsig uas aminoglycosides muaj.
Cov tshuaj ntawm lub cev yog qhov txawv ntawm qhov zoo li no:
- siab tshuaj tua kab mob;
- tsis muaj qhov mob tshwm sim (thaum txhaj tshuaj);
- tsis tshua muaj tshwm sim ntawm kev ua xua;
- muaj peev xwm ua kom puas tsuajyug kab mob;
- ua kom cov txiaj ntsig kho tau zoo thaum ua ke nrog cov tshuaj tua kab mob beta-lactam;
- kev ua haujlwm siab hauv kev tawm tsam kev kis kab mob txaus ntshai.
Txawm li cas los xij, nrog rau qhov zoo uas tau piav qhia saum toj no, pawg tshuaj no kuj muaj qhov tsis zoo.
Qhov tsis zoo ntawm aminoglycosides yog:
- kev ua haujlwm tsawg ntawm cov tshuaj thaum tsis muaj oxygen lossis nyob rau hauv ib puag ncig acidic;
- kev nkag mus tsis zoo ntawm cov khoom tseem ceeb rau hauv lub cev (cov kua tsib, kua cerebrospinal, hnoos qeev);
- ntau yam phiv.
Kev faib cov tshuaj
Muaj ntau yam kev faib tawm.
Yog li, muab cov kab ke ntawm kev qhia txog aminoglycosides rau hauv kev kho mob, tiam tom ntej no txawv:
- thawj cov tshuaj siv los tua cov kab mob sib kis yog Streptomycin, Monomycin, Neomycin, Kanamycin, Paromomycin.
- tiam thib ob suav nrog ntau cov aminoglycosides niaj hnub (cov tshuaj). Cov npe tshuaj: Gentamycin, Tobramycin, Sizomycin, Netilmicin.
- pab pawg no suav nrog cov tshuaj ib nrab tshuaj xws li Amikacin, Isepamycin.
Aminoglycosides raug cais qee qhov sib txawv raws li qhov spectrum ntawm kev ua thiab qhov tshwm sim ntawm kev tawm tsam.
Tam sim tshuaj muaj raws li hauv qab no:
1. Pawg 1 suav nrog cov tshuaj xws li: Streptomycin, Kanamycin, Monomycin, Neomycin. Cov tshuaj no tso cai rau koj los tua cov kab mob ua rau mob ntsws thiab qee qhovkab mob atypical. Txawm li cas los xij, lawv tsis muaj zog tiv thaiv ntau cov kab mob gram-tsis zoo thiab staphylococci.
2. Tus neeg sawv cev ntawm tiam thib ob ntawm aminoglycosides yog cov tshuaj "Gentamicin". Nws yog qhov txawv los ntawm kev siv tshuaj tua kab mob zoo heev.
3. Cov tshuaj zoo dua. Lawv muaj antibacterial kev ua haujlwm siab. Siv tawm tsam Klebisiella, Enterobacter, Pseudomonas aeruginosa yog lub cim thib peb ntawm aminoglycosides (cov tshuaj). Cov npe tshuaj yog raws li nram no:
- "Sizomycin";
- Amikacin;
- "Tobramycin";
- Netilmicin.
4. Cov pab pawg plaub suav nrog cov tshuaj "Isepamycin". Nws yog qhov txawv ntawm qhov muaj peev xwm ntxiv los tua Cytobacter, Aeromonas, Nocardia.
Hauv kev kho mob, lwm qhov kev faib tawm tau tsim. Nws yog raws li kev siv tshuaj nyob ntawm qhov chaw kho mob ntawm tus kab mob, qhov xwm ntawm tus kab mob, nrog rau txoj kev siv.
Qhov kev faib tawm ntawm aminoglycosides yog raws li hauv qab no:
- Tshuaj rau cov kab mob hauv lub cev, ua rau parenterally (los ntawm kev txhaj tshuaj). Rau kev kho mob ntawm cov kab mob purulent kab mob tshwm sim nyob rau hauv cov ntaub ntawv hnyav, provoked los ntawm opportunistic anaerobic kab mob, cov tshuaj hauv qab no yog muab: Gentamicin, Amikacin, Netilmicin, Tobramycin, Sizomycin. Kev kho mob ntawm cov kab mob txaus ntshai monoinfections, uas yog raws li cov kab mob sib kis, yog siv tau thaum cov tshuaj "Streptomycin", "Gentomycin" suav nrog hauv kev kho. Zoo heev rau mycobacteriosisCov tshuaj Amikacin, Streptomycin, Kanamycin.
- Tshuaj uas yog siv los ntawm qhov ncauj tshwj xeeb. Cov no yog: Paromycin, Neomycin, Monomycin.
- Tshuaj rau kev siv hauv zos. Lawv yog siv los kho cov kab mob purulent kab mob hauv otorhinolaryngology thiab ophthalmology. Rau kev ua hauv zos, kev npaj "Gentamicin", "Framycetin", "Neomycin", "Tobramycin" tau tsim.
Indications for prescription
Kev siv aminoglycosides tsim nyog rau kev puas tsuaj ntawm ntau yam aerobic Gram-negative pathogens. Cov tshuaj tuaj yeem siv ua monotherapy. Lawv feem ntau ua ke nrog beta-lactams.
Aminoglycosides tshuaj rau kev kho mob:
- tsev kho mob kis ntawm ntau qhov chaw;
- purulent postoperative teeb meem;
- kab mob hauv plab;
- sepsis;
- kab mob endocarditis;
- pyelonephritis tshwm sim hauv cov ntaub ntawv hnyav;
- mob kub hnyiab;
- kab mob purulent meningitis;
- tuberculosis;
- kab mob txaus ntshai (plague, brucellosis, tularemia);
- kab mob septic tshwm sim los ntawm kab mob Gram-negative;
- kab mob urinary tract;
- kab mob ophthalmic: blepharitis, kab mob keratitis, conjunctivitis, keratoconjunctivitis, uveitis, dacryocystitis;
- otorhinolaryngological kab mob: otitis externa, nasopharyngitis, rhinitis, sinusitis;
- protozoan kab mob.
Sibteebmeem
Hmoov tsis zoo, thaum kho nrog cov tshuaj no, tus neeg mob yuav ntsib ntau yam tsis xav tau. Lub ntsiab tsis zoo ntawm cov tshuaj yog siab toxicity. Yog li ntawd tsuas yog ib tus kws kho mob yuav tsum tau sau cov aminoglycosides rau tus neeg mob.
Cov kev mob tshwm sim tuaj yeem tshwm sim:
- Ototoxicity. Cov neeg mob yws yws tsis hnov lus, suab nrov, suab nrov. Feem ntau lawv qhia tias mob pob ntseg. Feem ntau, cov kev tshwm sim no tau pom nyob rau hauv cov neeg laus, nyob rau hauv cov neeg uas pib raug kev txom nyem los ntawm tsis hnov lus. Cov kev tshwm sim zoo sib xws tshwm sim nyob rau hauv cov neeg mob uas muaj kev kho mob mus sij hawm ntev los yog koob tshuaj ntau.
- Nephrotoxicity. Tus neeg mob tsim muaj kev nqhis dej ntau, cov zis hloov pauv (nws tuaj yeem nce thiab txo qis), qib ntawm creatinine hauv cov ntshav nce, thiab glomerular pom txo qis. Cov tsos mob zoo sib xws yog cov yam ntxwv ntawm cov neeg uas muaj lub raum ua haujlwm tsis zoo.
- Neuromuscular thaiv. Qee zaum thaum kho, ua pa nyuaj siab. Qee zaum, cov leeg tuag tes tuag taw ntawm cov leeg ua pa tseem pom. Raws li txoj cai, cov tshuaj tiv thaiv no yog cov yam ntxwv ntawm cov neeg mob uas muaj kab mob hauv lub paj hlwb lossis lub raum tsis ua haujlwm.
- Vestibular disorders. Lawv tshwm sim los ntawm kev tsis sib haum xeeb, kiv taub hau. Feem ntau, cov kev mob tshwm sim tshwm sim thaum tus neeg mob tau txais cov tshuaj Streptomycin.
- Kev mob hlwb. Paresthesia, encephalopathy tuaj yeem tshwm sim. Qee lub sij hawm kev kho mob nrog rau kev puas tsuaj rau lub paj hlwb.
NyobTsis tshua muaj aminoglycosides ua rau muaj kev tsis haum tshuaj xws li pob khaus tawv nqaij.
YContraindications
Cov tshuaj tau piav qhia muaj qee qhov kev txwv rau lawv siv. Feem ntau, aminoglycosides (uas cov npe tau muab saum toj no) yog contraindicated nyob rau hauv xws pathologies los yog tej yam kev mob:
- tus neeg siab phem;
- ua haujlwm tsis zoo ntawm lub raum;
- hnov tsis hnov lus;
- txhim kho cov tshuaj tiv thaiv neutropenic hnyav;
- vestibular mob;
- Ymyasthenia gravis, botulism, parkinsonism;
- ua pa nyuaj, ntxhov siab.
Tsis tas li ntawd, lawv yuav tsum tsis txhob siv rau kev kho mob yog tias tus neeg mob keeb kwm muaj qhov tsis zoo rau cov tshuaj los ntawm pab pawg no.
Cia peb saib cov aminoglycosides nrov tshaj plaws.
Amicacin
Cov tshuaj muaj cov tshuaj bacteriostatic, bactericidal thiab anti-tuberculosis nyhuv ntawm tib neeg lub cev. Nws muaj zog heev tiv thaiv ntau Gram-positive thiab Gram-negative kab mob. Yog li ua pov thawj rau cov tshuaj "Amikacin" cov lus qhia rau kev siv. Kev txhaj tshuaj muaj txiaj ntsig zoo hauv kev kho mob ntawm staphylococci, streptococci, pneumococci, salmonella, Escherichia coli, mycobacterium tuberculosis.
Cov tshuaj tsis tuaj yeem nqus tau los ntawm txoj hnyuv. Yog li ntawd, nws tsuas yog siv intravenously los yog intramuscularly. Qhov siab tshaj plaws ntawm cov tshuaj nquag tau pom hauv cov ntshav ntshav tom qab 1 teev. Cov nyhuv kho tau zoo nyob rau 10-12 teev. Vim yog cov cuab yeej no, txhaj tshuajua ob zaug ib hnub.
Thaum twg cov lus qhia rau kev siv pom zoo siv tshuaj "Amicacin"? Kev txhaj tshuaj yog qhia rau cov kab mob hauv qab no:
- pneumonia, bronchitis, ntsws abscesses;
- kab mob sib kis ntawm peritoneum (peritonitis, pancreatitis, cholecystitis);
- kab mob ntawm cov kab mob urinary (cystitis, urethritis, pyelonephritis);
- daim tawv nqaij pathologies (ulcerative lesions, burns, bedsores, kis mob);
- osteomyelitis;
- meningitis, sepsis;
- kab mob TB.
Ntau qhov kev kho no yog siv rau cov teeb meem tshwm sim los ntawm kev phais.
Kev siv tshuaj hauv kev xyaum menyuam yaus raug tso cai. Qhov tseeb no lees paub cov lus qhia rau kev siv tshuaj "Amikacin". Rau cov menyuam yaus txij li thawj hnub ntawm lub neej, cov tshuaj no tuaj yeem sau tau.
Cov tshuaj yog txiav txim los ntawm tus kws kho mob nkaus xwb, nyob ntawm tus neeg mob lub hnub nyoog thiab lub cev hnyav.
Cov lus qhia muab cov lus qhia hauv qab no:
- Rau 1 kg ntawm tus neeg mob qhov hnyav (ob leeg laus thiab menyuam yaus) yuav tsum yog 5 mg ntawm cov tshuaj. Nrog rau cov tswv yim no, txhaj tshuaj thib ob yog muab tom qab 8 teev.
- Yog tias noj 7.5 mg ntawm cov tshuaj ib 1 kg ntawm lub cev hnyav, ces lub sijhawm ntawm kev txhaj tshuaj yog 12 teev.
- Ua tib zoo saib seb nws pom zoo siv cov tshuaj "Amikacin" rau cov menyuam yug tshiab cov lus qhia rau kev siv. Rau cov menyuam yaus uas nyuam qhuav yug los, cov koob tshuaj suav nrog hauv qab no: ib 1 kg - 7.5 mg. Nyob rau tib lub sijhawm, lub sijhawm ntawm kev txhaj tshuaj yog 18teev.
- Lub sijhawm kho mob tuaj yeem yog 7 hnub (nrog txhaj tshuaj IV) lossis 7-10 hnub (nrog rau kev txhaj tshuaj IM).
Netilmicin
Cov tshuaj no zoo ib yam hauv nws cov tshuaj tiv thaiv kab mob rau Amikacin. Nyob rau tib lub sijhawm, muaj cov xwm txheej thaum "Netilmicin" tau zoo tiv thaiv cov kab mob uas cov tshuaj saum toj no tsis muaj zog.
Cov tshuaj muaj txiaj ntsig zoo dua lwm cov aminoglycosides. Raws li cov lus qhia rau kev siv qhia rau cov tshuaj "Netilmicin", cov tshuaj muaj tsawg nephro- thiab ototoxicity. Cov tshuaj no tsuas yog siv rau niam txiv xwb.
"Netilmicin" cov lus qhia rau kev siv pom zoo tshuaj:
- rau septicemia, bacteremia,
- rau kev kho mob ntawm tus kab mob Gram-negative;
- rau cov kab mob ntawm cov kab mob ua pa, kab mob urogenital, tawv nqaij, ligaments, osteomyelitis;
- menyuam mos thaum muaj tus kab mob staphylococcal hnyav (sepsis lossis mob ntsws);
- rau qhov txhab, ua ntej thiab kab mob hauv plab;
- nyob rau hauv rooj plaub ntawm kev pheej hmoo ntawm kev mob tom qab phais hauv cov neeg mob phais;
- rau cov kab mob kis kab mob hauv plab.
Cov koob tshuaj pom zoo tsuas yog txiav txim los ntawm tus kws kho mob xwb. Nws tuaj yeem muaj li ntawm 4 mg mus rau 7.5 mg. Nyob ntawm qhov ntau npaum, tus neeg mob thiab nws lub hnub nyoog, 1-2 txhaj tshuaj tau pom zoo thaum nruab hnub.
Tshuaj "Gentamicin"
Tau ua tshuaj pleev, txhaj tshuaj thiab ntsiav tshuaj. Cov tshuaj muaj pronounced bactericidal zog. Nws muab cov txiaj ntsig tsis zoo rau ntau cov kab mob gram-tsis zoo, Proteus, Campylobacter, Escherichia, Staphylococcus, Salmonella, Klebsiella.
Cov tshuaj "Gentamicin" (cov ntsiav tshuaj lossis cov tshuaj), nkag mus rau hauv lub cev, rhuav tshem cov kab mob ntawm qib cellular. Zoo li txhua aminoglycoside, nws muab kev ua txhaum ntawm cov protein synthesis ntawm cov kab mob. Yog li ntawd, cov kab mob no poob lawv lub peev xwm los tsim dua tshiab thiab tsis tuaj yeem kis thoob plaws lub cev.
Tshuaj tua kab mob yog tshuaj rau cov kab mob sib kis uas cuam tshuam rau ntau lub cev thiab kab mob:
- meningitis;
- peritoneal;
- prostat;
- gonorrhea;
- osteomyelitis;
- cystitis;
- Ypyelonephritis;
- endometritis;
- pleural empyema;
- bronchi, mob ntsws;
Gentamicin yog qhov xav tau hauv cov tshuaj. Nws tso cai rau koj los kho cov neeg mob ntawm cov kab mob hnyav ntawm cov pa ua pa thiab tso zis. Txoj kev kho no raug pom zoo rau cov txheej txheem sib kis uas cuam tshuam nrog peritoneum, pob txha, cov ntaub so ntswg lossis tawv nqaij.
Aminoglycosides tsis yog npaj rau kev kho tus kheej. Tsis txhob hnov qab tias tsuas yog ib tus kws kho mob tsim nyog tuaj yeem xaiv cov tshuaj tua kab mob tsim nyog. Yog li ntawd, tsis txhob kho tus kheej. Cia siab rau koj txoj kev noj qab haus huv rau cov kws tshaj lij!
