Tshuaj tua kab mob yog ib pawg tshuaj uas muaj etiotropic mechanism ntawm kev ua. Hauv lwm lo lus, cov tshuaj no ua ncaj qha rau qhov ua rau ntawm tus kab mob (qhov no, cov kab mob ua rau muaj kab mob) thiab ua rau ob txoj hauv kev: lawv rhuav tshem cov kab mob (cov tshuaj tua kab mob - penicillins, cephalosporins) lossis tiv thaiv lawv cov kev tsim tawm (bacteriostatic - tetracyclines, sulfonamides).
Muaj ntau cov tshuaj uas yog tshuaj tua kab mob, tab sis ntau pawg ntawm lawv yog beta-lactams. Nws yog hais txog lawv uas yuav tau tham hauv kab lus no.
Kev faib cov tshuaj tua kab mob
Raws li cov txheej txheem ntawm kev ua, cov tshuaj no tau muab faib ua rau pawg loj:
- Tshuaj tua kab mob uas cuam tshuam kev sib txuas ntawm cov cell membrane Cheebtsam: penicillins, cephalosporins, thiab lwm yam.
- Tshuaj uas cuam tshuam rau kev ua haujlwm ntawm cov phab ntsa ntawm tes: polyenes, polymyxins.
- Tshuaj uas inhibit protein synthesis: macrolides, tetracyclines, aminoglycosides, thiab lwm yam.
- Inhibiting RNA synthesis ntawm theem ntawm kev uaRNA polymerases: rifampicins, sulfonamides.
- inhibiting RNA synthesis ntawm theem ntawm DNA polymerase kev ua: actinomycins thiab lwm yam
- Blockers ntawm DNA synthesis: anthracyclines, nitrofurans, thiab lwm yam.
Txawm li cas los xij, qhov kev faib tawm no tsis yooj yim heev. Hauv kev kho mob, kev faib cov tshuaj tua kab mob hauv qab no raug lees txais:
- Penicillins.
- YCephalosporins.
- YMacrolides.
- Aminoglycosides.
- YPolymyxins thiab polyenes.
- Tetracyclines.
- YSulfanilamides.
- YAminoquinolone derivatives.
- Nitrofurans.
- YFluoroquinolones.
tshuaj tua kab mob beta-lactam. Qauv thiab mechanism ntawm kev txiav txim
Nov yog ib pawg tshuaj uas muaj cov kab mob bactericidal thiab cov npe dav dav ntawm cov lus qhia rau kev siv. Cov tshuaj tua kab mob beta-lactam muaj xws li penicillins, cephalosporins, carbapenems, monobactams. Tag nrho cov ntawm lawv yog tus cwj pwm los ntawm kev ua haujlwm siab thiab tsis tshua muaj tshuaj lom, uas ua rau lawv cov tshuaj feem ntau tau sau tseg rau kev kho mob ntau yam kab mob.
Lub tshuab ua haujlwm ntawm cov tshuaj tua kab mob beta-lactam yog vim lawv cov qauv. Cov ntsiab lus ntau dhau yog tsis muaj txiaj ntsig ntawm no, nws tsim nyog hais txog tsuas yog lub ntsiab lus tseem ceeb, uas tau muab lub npe rau tag nrho pawg ntawm cov tshuaj. Lub nplhaib beta-lactam, uas yog ib feem ntawm lawv cov molecules, muab cov nyhuv bactericidal, uas yog tshwm sim los ntawm kev thaiv cov synthesis ntawm cov kab mob ntawm cov phab ntsa ntawm cov kab mob. Txawm li cas los xij, ntau cov kab mob muaj peev xwm tsim tau cov enzyme tshwj xeeb uas cuam tshuam cov qauv ntawm lub nplhaib,li no depriving cov tshuaj tua kab mob ntawm nws cov riam phom tseem ceeb. Tias yog vim li cas kev siv tshuaj uas tsis muaj kev tiv thaiv beta-lactamase hauv kev kho mob tsis zoo.
Hnub no, tshuaj tua kab mob ntawm pab pawg beta-lactam, tiv thaiv los ntawm kev ua ntawm cov kab mob enzyme, tau dhau los ua ntau dua. Lawv suav nrog cov tshuaj uas thaiv cov synthesis ntawm beta-lactamase, piv txwv li, clavulonic acid. Qhov no yog qhov kev tiv thaiv beta-lactam tshuaj tua kab mob (xws li Amoxiclav) raug tsim. Lwm cov kab mob enzyme inhibitors suav nrog Sulbactam thiab Tazobactam.
Tshuaj los ntawm pawg penicillin: keeb kwm keeb kwm
Kev npaj ntawm cov koob no yog thawj cov tshuaj tua kab mob, cov tshuaj kho mob uas tau paub rau tib neeg. Rau ib ntev lub sij hawm lawv tau lug siv los kho ntau yam kab mob thiab nyob rau hauv thawj xyoo ntawm kev siv yog yuav luag ib tug panacea. Txawm li cas los xij, tsis ntev los no tau pom tseeb tias lawv cov txiaj ntsig tau maj mam poob qis, vim tias kev hloov pauv ntawm lub ntiaj teb cov kab mob tsis sawv ntsug. Cov kab mob muaj peev xwm hloov tau sai sai rau ntau yam kev nyuaj ntawm lub neej, muab yug rau tiam neeg ntawm cov kab mob tiv thaiv kab mob.
Qhov ntau ntawm penicillins tau ua rau muaj kev loj hlob sai ntawm cov kab mob microbes tsis hnov tsw rau lawv, yog li ntawd, hauv lawv daim ntawv ntshiab, kev npaj ntawm pab pawg no tam sim no tsis muaj txiaj ntsig thiab yuav luag tsis siv. Lawv yog cov zoo tshaj plaws siv nyob rau hauv ua ke nrog cov tshuaj uas ua rau kom lawv cov bactericidal nyhuv, nrog rau suppress lub tiv thaiv mechanisms ntawm cov kab mob.
Penicillin tshuaj
Cov no yog cov tshuaj tua kab mob beta-lactam, kev faib tawm uas yog qhov dav heev:
- Natural penicillins (zoo li "Benzylpenicillin").
- Antiphylococcal ("Oxacillin").
- Extended-spectrum penicillins ("Ampicillin", "Amoxicillin").
- YAntipseudomonal ("Azlocillin").
- Tiv thaiv penicillins (ua ke nrog clavulonic acid, Sulbactam, Tazobactam).
- Npaj muaj ntau yam tshuaj tua kab mob penicillin.
Cov ntsiab lus ntawm cov tshuaj muaj nyob hauv pawg penicillin
Natural penicillins tuaj yeem ua tiav cov haujlwm ntawm cov kab mob gram-positive thiab gram-negative microorganisms. Ntawm qhov kawg, streptococci thiab tus kab mob ua rau mob meningitis yog qhov nkag siab tshaj plaws rau pawg tshuaj tua kab mob beta-lactam. Tus so ntawm cov kab mob tam sim no tau txais cov txheej txheem tiv thaiv. Ntuj penicillins kuj muaj txiaj ntsig zoo tiv thaiv anaerobes: clostridia, peptococci, peptostreptococci, thiab lwm yam. Cov tshuaj no yog cov tshuaj lom tsawg tshaj plaws thiab muaj cov teebmeem me me, cov npe uas txo qis feem ntau yog qhov tshwm sim tsis haum, txawm hais tias nyob rau hauv cov ntaub ntawv ntawm overdose, txoj kev loj hlob ntawm convulsive syndrome thiab cov tsos mob ntawm cov tsos mob ntawm lom nrog ib sab ntawm digestive system.
Ntawm cov tshuaj tua kab mob tshuaj tua kab mob, tshuaj tua kab mob beta-lactam Oxacillin yog qhov tseem ceeb tshaj plaws. Qhov no yog ib qho tshuaj rau kev siv nqaim, txij li thaumNws yog npaj rau kev sib ntaus tawm tsam Staphylococcus aureus. Nws tawm tsam cov kab mob no (nrog rau cov kab mob penicillin-resistant) uas Oxacillin zoo tshaj plaws. Cov kev mob tshwm sim zoo ib yam li lwm tus neeg sawv cev ntawm pawg tshuaj no.
Extended-spectrum penicillins, ntxiv rau gram-positive, gram-negative flora thiab anaerobes, kuj tseem muaj zog tiv thaiv kab mob ntawm txoj hnyuv. Cov kev mob tshwm sim zoo ib yam li saum toj no, txawm hais tias cov tshuaj no feem ntau yuav ua rau digestive chim siab.
Beta-lactam tshuaj tua kab mob "Azlocillin" (tus sawv cev ntawm plaub pawg penicillins) yog tsim los tiv thaiv Pseudomonas aeruginosa. Txawm li cas los xij, tam sim no, tus kab mob no tau pom tias muaj kev tiv thaiv rau cov tshuaj ntawm cov koob no, uas ua rau lawv siv tsis zoo.
Cov tshuaj tiv thaiv penicillins tau hais los saum toj no. Vim tias cov tshuaj no muaj cov tshuaj tiv thaiv kab mob beta-lactamases, lawv muaj txiaj ntsig zoo hauv kev kho mob ntau yam.
Pab pawg kawg yog kev sib koom ua ke ntawm ntau tus neeg sawv cev ntawm cov tshuaj penicillin, kev sib koom tes txhawb nqa ib leeg.
Plaub tiam ntawm cov kab mob exterminators
tshuaj tua kab mob beta-lactam kuj yog cephalosporins. Cov tshuaj no, zoo li penicillins, txawv ntawm qhov dav ntawm qhov kev ua haujlwm thiab qhov tsis tseem ceeb ntawm cov kev mob tshwm sim.
Muaj plaub pawg (tiam) ntawm cephalosporins:
- Cov neeg sawv cev zoo tshaj plaws ntawm thawj tiam yog Cefazolin thiab Cefalexin. Lawv tau npaj rau kev tswj hwm ntawm staphylococci, streptococci, meningococci thiab gonococci, nrog rau qee cov kab mob gram-tsis zoo.
- tiam thib ob yog beta-lactam tshuaj tua kab mob Cefuroxime. Nws thaj tsam ntawm lub luag haujlwm suav nrog feem ntau yog gram-negative microflora.
- "Cefotaxime", "Ceftazidime" yog cov neeg sawv cev ntawm pawg thib peb ntawm qhov kev faib tawm no. Lawv muaj txiaj ntsig zoo tiv thaiv kab mob enterobacteria, thiab tseem muaj peev xwm ua kom puas cov kab mob nosocomial (cov kab mob hauv tsev kho mob ntawm cov kab mob).
- Cov tshuaj tseem ceeb ntawm tiam plaub yog Cefepime. Nws muaj tag nrho cov txiaj ntsig ntawm cov tshuaj saum toj no, ntxiv rau, nws muaj peev xwm tiv taus cov kab mob beta-lactamase thiab muaj kev ua haujlwm tawm tsam Pseudomonas aeruginosa.
Cephalosporins thiab tshuaj tua kab mob beta-lactam feem ntau yog tus cwj pwm los ntawm cov kab mob tshwm sim.
Ntawm cov kev phiv tsis zoo rau kev tswj hwm cov tshuaj no, ntau yam kev tsis haum tshuaj tsim nyog tau txais kev saib xyuas tshaj plaws (los ntawm cov pob me me mus rau qhov ua rau muaj kev phom sij rau lub neej, xws li kev poob siab anaphylactic), qee zaum, plab zom mov tuaj yeem ua tau.
Reserve facility
"Imipenem" yog tshuaj tua kab mob beta-lactam ntsig txogpawg carbapenems. Nws, raws li zoo raws li tsis muaj tsawg nto moo "Meropenem", nyob rau hauv cov nqe lus ntawm kev ua tau zoo ntawm cov kev cuam tshuam ntawm microflora resistant rau lwm yam tshuaj, muaj peev xwm muab qhov txawv txawm rau peb thiab plaub tiam ntawm cephalosporins.
Beta-lactam tshuaj tua kab mob los ntawm pawg carbapenems yog ib hom tshuaj siv tshwj xeeb tshaj yog cov kab mob hnyav thaum cov kab mob tsis tuaj yeem kho nrog lwm cov tshuaj.
Backup number two
"Aztreonam" yog tus neeg sawv cev tseem ceeb tshaj plaws ntawm monobactams, nws yog tus cwj pwm los ntawm qhov nqaim ntawm kev ua haujlwm. Cov tshuaj tua kab mob beta-lactam no zoo tshaj plaws tiv thaiv Gram-negative aerobes. Txawm li cas los xij, nws yuav tsum raug sau tseg tias, zoo li Imipenem, Aztreonam yog qhov ua tau zoo rau beta-lactamases, uas ua rau nws cov tshuaj xaiv rau cov kab mob hnyav los ntawm cov kab mob no, tshwj xeeb tshaj yog thaum kho nrog lwm cov tshuaj tua kab mob tsis zoo.
Spectrum of action of beta-lactam tshuaj tua kab mob
Raws li cov lus saum toj no, nws yuav tsum raug sau tseg tias cov tshuaj ntawm cov pab pawg no muaj kev cuam tshuam rau ntau hom kab mob. Cov txheej txheem ntawm kev ua ntawm cov tshuaj tua kab mob beta-lactam yog qhov uas tsis muaj txoj hauv kev rau cov kab mob kom muaj sia nyob: kev thaiv ntawm phab ntsa ntawm tes yog kab lus tuag rau cov kab mob.
Gram-positive thiab gram-negative kab mob, aerobes thiab anaerobes… Muaj cov tshuaj muaj txiaj ntsig zoo rau txhua tus neeg sawv cev ntawm cov kab mob pathogenic. Tau kawg, muaj cov tshuaj tshwj xeeb ntawm cov tshuaj tua kab mob no, tab sis feem ntau tseem tau npaj los tua ntau yam kab mob ntawm cov kab mob sib kis ib zaug. Cov tshuaj tua kab mob beta-lactam muaj peev xwm tiv taus txawm tias cov neeg sawv cev ntawm nosocomial flora, uas yog cov tshuaj tiv thaiv tshaj plaws.
tsev kho mob dab tsi?
Peb tab tom tham txog cov kab mob uas muaj nyob hauv cov tsev kho mob. Qhov chaw ntawm lawv cov tsos yog cov neeg mob thiab cov neeg ua haujlwm kho mob. Latent, sluggish cov ntaub ntawv ntawm cov kab mob yog tshwj xeeb tshaj yog txaus ntshai. Lub tsev kho mob yog qhov chaw zoo tshaj plaws uas cov neeg nqa khoom ntawm txhua hom kev kis kab mob sib sau ua ke. Thiab kev ua txhaum cai ntawm kev huv huv thiab kev tswj hwm yog qhov muaj txiaj ntsig zoo rau cov nroj tsuag no kom nrhiav tau lub niche rau lub neej, qhov twg nws tuaj yeem nyob, sib npaug thiab tau txais kev tiv thaiv tshuaj.
Qhov kev tiv thaiv siab ntawm tsev kho mob hom mob feem ntau yog vim qhov tseeb tias, tau xaiv lub tsev kho mob hauv tsev kho mob raws li lawv qhov chaw nyob, cov kab mob tau txais lub sijhawm los tiv thaiv ntau yam tshuaj. Lawm, cov nyhuv ntawm cov tshuaj ntawm cov kab mob tshwm sim random, tsis muaj lub hom phiaj ntawm kev puas tsuaj rau lawv, thiab nyob rau hauv me me koob tshuaj, thiab qhov no ua rau lub fact tias cov neeg sawv cev ntawm lub tsev kho mob microflora muaj peev xwm tsim kev tiv thaiv tiv thaiv kev puas tsuaj mechanisms rau lawv, kawm tiv thaiv lawv. Nov yog hom kab mob tshwm sim, uas nyuaj heev rau kev sib ntaus, thiab qee zaum zoo li tsis yooj yim sua.
Tshuaj tua kab mob ntawm beta-lactam series hauv ib txoj kev lossis lwm qhov sim daws qhov teeb meem nyuaj no. Ntawm lawv yog cov neeg sawv cevmuaj peev xwm ua tau zoo sib ntaus sib tua txawm tias feem ntau cov kab mob-insensitive tshuaj. Cov no yog cov tshuaj cia. Lawv siv yog txwv, thiab lawv tsuas yog muab thaum nws tsim nyog tiag tiag. Yog tias cov tshuaj tua kab mob no tau siv ntau yam tsis tsim nyog, feem ntau qhov no yuav xaus rau hauv lawv qhov kev ua tau zoo, vim tias tom qab ntawd cov kab mob yuav muaj sijhawm los cuam tshuam nrog cov tshuaj me me, kawm lawv thiab txhim kho txoj hauv kev tiv thaiv.
Thaum twg yog tshuaj beta-lactam tshuaj tua kab mob?
Cov lus qhia rau kev siv cov tshuaj no feem ntau yog vim lawv qhov kev ua haujlwm. Nws yog qhov zoo tshaj plaws los muab tshuaj tua kab mob beta-lactam rau tus kab mob uas nkag siab zoo rau qhov kev ua ntawm cov tshuaj no.
Penicillins tau ua pov thawj lawv tus kheej hauv kev kho mob pharyngitis, tonsillitis, mob ntsws, ua npaws liab, mob meningitis, kab mob endocarditis, actinomycosis, kab mob anaerobic, leptospirosis, salmonellosis, shigellosis, kis kab mob ntawm daim tawv nqaij thiab cov nqaij mos. Tsis txhob hnov qab txog cov tshuaj uas tuaj yeem tua Pseudomonas aeruginosa.
Cephalosporins muaj qhov zoo sib xws ntawm kev ua, yog li cov lus qhia rau lawv yuav luag zoo ib yam li penicillins. Txawm li cas los xij, nws yuav tsum tau hais tias qhov ua tau zoo ntawm cephalosporins, tshwj xeeb tshaj yog ob tiam dhau los, tsis yog piv txwv siab dua.
Monobactams thiab carbapenems yog tsim los tawm tsam cov kab mob hnyav tshaj plaws thiab nyuaj rau kev kho mob, suav nrog cov kab mob hauv tsev kho mob. Lawv yogkuj tseem siv tau rau sepsis thiab septic shock.
Tsis xav ua
Raws li twb tau hais lawm, cov tshuaj tua kab mob beta-lactam (cov tshuaj uas muaj nyob hauv pab pawg no tau teev tseg saum toj no) muaj cov teebmeem me me ntawm lub cev. Tsis tshua muaj tshwm sim convulsive syndrome thiab cov tsos mob ntawm kev tsis haum xeeb ntawm lub plab zom mov tsis ua rau muaj kev hem thawj rau lub neej. Kev ua xua rau cov tshuaj tua kab mob beta-lactam tuaj yeem ua rau muaj kev phom sij heev.
pob khaus, pruritus, rhinitis thiab conjunctivitis tsis ua rau muaj kev hem thawj rau lub neej, txawm tias lawv tsis kaj siab heev. Dab tsi tiag tiag yuav tsum ntshai yog qhov tshwm sim hnyav xws li Quincke's edema (tshwj xeeb tshaj yog nyob rau hauv lub caj pas, uas yog nrog los ntawm kev ua pa hnyav mus txog qhov ua tsis taus pa) thiab anaphylactic shock. Yog li, cov tshuaj tsuas yog siv tau tom qab kuaj kev ua xua.
Cross-reactions kuj ua tau. Cov tshuaj tua kab mob beta-lactam, kev faib tawm uas txhais tau hais tias muaj ntau pawg ntawm cov tshuaj, yog qhov zoo sib xws hauv cov qauv rau ib leeg, uas txhais tau hais tias yog ib tus ntawm lawv intolerant, tag nrho lwm tus kuj yuav pom los ntawm lub cev. ua allergen.
Ib ob peb lo lus hais txog yam uas ua rau cov kab mob ua kom muaj zog
Qhov kev txo qis hauv cov txiaj ntsig ntawm cov tshuaj tua kab mob (xws li tshuaj tua kab mob beta-lactam) yog vim lawv cov tshuaj tsis tsim nyog thiab feem ntau tsis raug. Kev kho tsis tiav, kev siv tshuaj me me tsis ua rau rov zoo, tab sismuab cov kab mob me me rau "kev cob qhia", tsim thiab tsim cov txheej txheem tiv thaiv tshuaj. Yog li puas yog qhov xav tsis thoob tias qhov kawg ua tsis tau raws sijhawm?
Txawm hais tias tam sim no cov tshuaj tua kab mob tsis tau muab tso rau hauv cov khw muag tshuaj yam tsis muaj tshuaj, koj tseem tuaj yeem tau txais lawv. Thiab qhov no txhais tau hais tias nws tus kheej noj tshuaj thiab cov teeb meem cuam tshuam nrog nws (kev siv cov tshuaj tib lub sijhawm, kev cuam tshuam tsis tsim nyog ntawm kev kho, xaiv cov tshuaj tsis raug, thiab lwm yam) yuav nyob twj ywm, tsim cov xwm txheej rau kev cog qoob loo ntawm cov kab mob resistant..
Lub tsev kho mob yuav tsis mus qhov twg los xij, muaj sijhawm los koom nrog ntau yam tshuaj thiab tsim txoj hauv kev tshiab los tiv thaiv lawv.
Yuav ua li cas? Tsis txhob noj tshuaj rau tus kheej, ua raws li cov lus pom zoo ntawm tus kws kho mob uas tuaj koom: noj cov tshuaj kom ntev li ntev tau, thiab cov koob tshuaj kom raug. Ntawm chav kawm, nws yog qhov nyuaj dua los tua cov nosocomial flora, tab sis nws tseem ua tau. Kev nruj nruj ntawm cov qauv kev huv huv thiab lawv cov kev siv nruj yuav txo qhov kev pheej hmoo ntawm kev tsim cov kev mob zoo rau kev yug me nyuam ntawm resistant flora.
Ib ob peb lo lus xaus
Lub ncauj lus dav dav - tshuaj tua kab mob beta-lactam. Pharmacology (kev tshawb fawb ntawm cov tshuaj thiab lawv cov nyhuv ntawm lub cev) devotes ob peb tshooj rau lawv, uas tsis tsuas yog ib tug general piav qhia ntawm pab pawg neeg, tab sis kuj muaj ib tug piav qhia ntawm nws cov neeg sawv cev nto moo tshaj plaws. Kab lus no tsis thov kom tiav, nws tsuas yog sim ua kom paub lub ntsiablub sijhawm koj yuav tsum paub txog cov tshuaj no.
Noj qab nyob zoo thiab tsis txhob hnov qab: ua ntej siv cov tshuaj no lossis cov tshuaj tua kab mob, ua tib zoo nyeem cov lus qhia thiab ua raws cov lus pom zoo, thiab tseem zoo dua, sab laj nrog kws kho mob.
