Cephalosporins raug cais ua tshuaj beta-lactam. Lawv sawv cev rau ib pawg loj tshaj plaws ntawm cov tshuaj tua kab mob.
cov ntaub ntawv dav dav
4th tiam cephalosporins suav tias yog qhov tshiab. Tsis muaj daim ntawv hais lus hauv pab pawg no. Qhov peb seem yog qhov ncauj thiab parenteral. Cephalosporins muaj kev ua haujlwm siab thiab tsis tshua muaj tshuaj lom. Yog li ntawd, lawv yog ib qho ntawm feem ntau siv hauv kev kho mob ntawm tag nrho cov tshuaj tua kab mob.
Cov lus qhia rau kev siv rau txhua tiam ntawm cephalosporins nyob ntawm lawv cov tshuaj pharmacokinetic thiab cov tshuaj tua kab mob. Cov tshuaj muaj cov qauv zoo ib yam li penicillins. Qhov no ua ntej txiav txim siab txog ib qho kev ua haujlwm ntawm cov tshuaj tiv thaiv kab mob, nrog rau kev ua xua hauv cov neeg mob.
Kev ua spectrum
Cephalosporins muaj cov kab mob bactericidal. Nws yog txuam nrog kev ua txhaum ntawm kev tsim cov kab mob ntawm cov phab ntsa ntawm tes. Nyob rau hauv lub series los ntawm thawj mus rau lub thib peb tiam, muaj ib tug nyiam mus nthuav lub spectrum ntawm kev ua thiab nce. Antimicrobial kev ua ub no ntawm gram-tsis zoo microbes nrog me ntsis txo cov nyhuv ntawm cov kab mob gram-zoo. Cov cuab yeej cuab tam rau txhua qhov txhais tau tias yog qhov tsis muaj qhov cuam tshuam tseem ceeb ntawm enterococci thiab qee qhov microbes.
Ntau tus neeg mob xav paub yog vim li cas 4 tiam cephalosporins tsis muaj nyob hauv cov ntsiav tshuaj? Qhov tseeb yog tias cov tshuaj no muaj cov qauv molecular tshwj xeeb. Qhov no tsis tso cai rau cov active Cheebtsam nkag mus rau hauv lub cell lug ntawm cov hnyuv mucosa. Yog li ntawd, 4th tiam cephalosporins tsis muaj nyob rau hauv cov ntsiav tshuaj. Txhua yam tshuaj nyob rau hauv pab pawg no yog npaj rau kev tswj xyuas parenteral. 4 tiam cephalosporins muaj nyob rau hauv hnyav ampoules.
4th tiam cephalosporins
Tshuaj ntawm pab pawg no yog tshwj xeeb los ntawm cov kws tshaj lij. Qhov no yog ib pawg tshiab ntawm cov tshuaj. Cephalosporins 3, 4 tiam muaj qhov cuam tshuam zoo sib xws. Qhov sib txawv yog tsawg dua cov kev mob tshwm sim hauv pawg thib ob. Cov tshuaj "Cefepime", piv txwv li, yog ze rau cov tshuaj thib peb hauv ntau qhov tsis muaj. Tab sis vim muaj qee qhov tshwj xeeb hauv cov qauv tshuaj, nws muaj peev xwm nkag mus rau sab nrauv phab ntsa ntawm cov kab mob gram-tsis zoo. Tib lub sijhawm, Cefepime kuj tiv taus hydrolysis los ntawm beta-lactamases (chromosomal) ntawm C-chav kawm. Yog li ntawd, ntxiv rau cov yam ntxwv yam ntxwv ntawm 3 tiam cephalosporins (Ceftriaxone, Cefotaxime), cov tshuaj muaj xws li.nta xws li:
- cuam tshuam rau microbes-hyperproducers ntawm beta-lactamase (chromosomal) C-class;
- kev ua haujlwm siab txheeb ze rau cov kab mob uas tsis yog fermenting;
- siab dua rau hydrolysis ntawm ncua-spectrum beta-lactamases (lub ntsiab lus ntawm cov yam ntxwv no tsis to taub tag nrho).
Inhibitorprotected tshuaj
Pab pawg no suav nrog ib qho tshuaj "Cefoperazone / Sulbactam". Hauv kev sib piv nrog cov tshuaj mono, cov tshuaj sib xyaw ua ke muaj kev ua haujlwm ntev. Nws muaj kev cuam tshuam rau cov kab mob anaerobic, feem ntau cov kab mob enterobacteria muaj peev xwm ua tau beta-lactamase.
YPharmacokinetics
3rd thiab 4th tiam parenteral cephalosporins tau nqus tau zoo heev thaum txhaj rau hauv cov leeg. Cov tshuaj rau kev tswj qhov ncauj yog absorbed heev nyob rau hauv lub plab zom mov. Bioavailability yuav nyob ntawm seb cov tshuaj twg. Nws txawv ntawm 40-50% (rau Cefixime, piv txwv li) rau 95% (rau Cefaclor, Cefadroxil, Cefalexin). Kev nqus ntawm qee cov tshuaj hauv qhov ncauj yuav ua rau qeeb los ntawm kev noj zaub mov. Tab sis xws li cov tshuaj xws li "Cefuroxime asketil" ua rau hydrolysis thaum nqus. Kev tso tawm sai dua ntawm cov khoom xyaw nquag tau yooj yim los ntawm cov zaub mov.
4th tiam cephalosporins tau muab faib zoo hauv ntau cov ntaub so ntswg thiab kabmob (tshwj tsis yog rau cov prostate), nrog rau cov zais zis. Nyob rau hauv high concentrations, tshuaj muaj nyob rau hauv lub peritoneal thiab synovial, pericardial thiab pleural.kua, pob txha thiab tawv nqaij, cov nqaij mos, daim siab, cov leeg, ob lub raum thiab lub ntsws. Kev muaj peev xwm dhau BBB thiab tsim cov kev kho mob ntau hauv cov kua cerebrospinal tau tshaj tawm hauv cov tshuaj thib peb xws li Ceftazidime, Ceftriaxone, thiab Cefotaxime, thiab tus neeg sawv cev ntawm plaub, Cefepime.
Metabolism thiab excretion
Feem ntau ntawm cov cephalosporins tsis degraded. Ib qho kev zam yog cov tshuaj "Cefotaxime". Nws biotransforms nrog rau tom qab tsim ntawm cov khoom nquag. 4 tiam cephalosporins, zoo li tus so, yog tawm los ntawm ob lub raum. Thaum tawm hauv cov zis, pom muaj ntau ntau ntau.
Tshuaj "Cefoperazone" thiab "Ceftriaxone" yog qhov txawv los ntawm ob txoj kev ntawm kev tso tawm - los ntawm lub siab thiab lub raum. Rau feem ntau cephalosporins, ib nrab-lub neej yog nyob rau hauv ib mus rau ob teev. Lub sijhawm ntev dua yog xav tau rau Ceftibuten, Cefixime (3-4 teev), thiab Ceftriaxone (txog 8.5 teev). Qhov no ua rau nws muaj peev xwm muab lawv ib hnub ib zaug. Tawm tsam keeb kwm yav dhau los ntawm lub raum tsis ua haujlwm, qhov ntau npaum ntawm cov tshuaj yuav tsum tau hloov kho.
Side effects
Tshuaj tua kab mob - 4 tiam cephalosporins - ua rau muaj ntau yam tsis zoo, tshwj xeeb:
- Kev tsis haum. Cov neeg mob tuaj yeem tshwm sim nrog erythema multiforme, tawm pob, urticaria,mob ntshav qab zib, eosinophilia. Cov kev mob tshwm sim hauv pawg no kuj suav nrog anaphylactic shock thiab kub taub hau, Quincke's edema, bronchospasm.
- Hematological cov tshuaj tiv thaiv. Ntawm lawv, nws tsim nyog hais txog qhov zoo Coombs kuaj, leukopenia, eosinophilia (tsis tshua muaj), hemolytic anemia, neutropenia.
- Ntshai tsam mob. Kev qaug dab peg tau raug tshaj tawm ntawm koob tshuaj ntau dua hauv cov neeg mob lub raum tsis ua haujlwm.
- Los ntawm lub siab: nce kev ua haujlwm ntawm transaminases.
- Digestive disorders. Ntawm qhov tshwm sim tsis zoo, raws plab, pseudomembranous colitis, ntuav thiab xeev siab, thiab mob plab yog qhov ntau heev. Yog tias cov quav xoob nrog cov ntshav tawg, cov tshuaj raug tso tseg.
- Cov tshuaj tiv thaiv hauv zos. Cov no muaj xws li infiltration thiab mob ntawm qhov chaw txhaj tshuaj intramuscular thiab phlebitis nrog txhaj tshuaj intravenous.
- Lwm cov teebmeem tshwm sim raws li qhov chaw mos thiab qhov ncauj candidiasis.
Indications thiab contraindications
4th tiam cephalosporins yog tshuaj rau mob hnyav, feem ntau cov kab mob qis uas tshwm sim los ntawm ntau yam kab mob microflora. Cov no muaj xws li pleural empyema, ntsws abscess, pneumonia, sepsis, pob qij txha thiab pob txha. 4th tiam cephalosporins tau qhia rau cov kab mob nyuaj hauv cov zis, tawm tsam keeb kwm ntawm neutropenia thiab lwm yam kev tiv thaiv kab mob. Cov tshuaj tsis raug sau tseg rau tus neeg intolerance.
Kev Tiv Thaiv
Kev ua xua sib txawv tau sau tseg thaum siv. Hauv cov neeg mobNrog intolerance rau penicillins, zoo ib yam li cov tshuaj tiv thaiv rau thawj tiam cephalosporins tau sau tseg. Kev ua xua sib txawv nrog kev siv thib ob lossis thib peb yog tsawg dua (hauv 1-3% ntawm cov neeg mob). Yog tias muaj keeb kwm ntawm cov tshuaj tiv thaiv tam sim ntawd (piv txwv li, anaphylactic shock lossis urticaria), cov tshuaj thawj tiam tau sau nrog ceev faj. Cov tshuaj nyob rau hauv pawg hauv qab no (tshwj xeeb yog plaub) muaj kev nyab xeeb dua.
Lactation thiab cev xeeb tub
Cephalosporins raug tshuaj rau lub sijhawm ua menyuam tsis muaj kev txwv tshwj xeeb. Txawm li cas los xij, kev tswj xyuas txaus ntawm kev nyab xeeb ntawm cov tshuaj tsis tau ua. Hauv cov ntsiab lus qis, cephalosporins tuaj yeem nkag mus rau hauv cov mis nyuj. Tawm tsam keeb kwm yav dhau los ntawm kev siv cov tshuaj thaum lub sij hawm lactation, kev hloov hauv plab hnyuv microflora, candidiasis, daim tawv nqaij ua pob liab vog, thiab rhiab heev ntawm tus me nyuam yuav muaj.
Thaum siv rau hauv cov menyuam mos, qhov nce hauv ib nrab-lub neej yog qhov yuav tawm tsam keeb kwm ntawm lub raum tsis ua haujlwm qeeb. Hauv cov neeg mob laus, muaj qhov hloov pauv ntawm lub raum ua haujlwm, thiab yog li ntawd qhov kev txo qis hauv kev tshem tawm cov tshuaj yuav tshwm sim. Qhov no yuav xav tau kev hloov kho ntawm daim ntawv thov lub sijhawm thiab ntau npaum li cas.
raum tsis ua haujlwm
Vim tias feem ntau cov cephalosporins raug tso tawm los ntawm lub raum system feem ntau nyob rau hauv daim ntawv nquag, cov tshuaj noj yuav tsum tau kho kom haum rau lub cev. Thaum siv cov koob tshuaj ntau, tshwj xeeb tshaj yog ua ke nrog lub voj diuretics lossisaminoglycosides, cov nyhuv nephrotoxic zoo li.
siab tsis ua haujlwm
Qee cov tshuaj tau tawm hauv cov kua tsib, thiab yog li ntawd rau cov neeg mob uas muaj kab mob siab heev, cov tshuaj yuav tsum raug txo. Hauv cov neeg mob zoo li no, muaj kev pheej hmoo siab los ntshav thiab hypoprothrombinemia thaum siv Cefoperazone. Vitamin K tau pom zoo rau kev tiv thaiv.
