Ntawm cov tshuaj, tshuaj tua kab mob ntawm cov tiam tshiab, nquag tawm tsam ntau cov kab mob, nyob hauv qhov chaw tseem ceeb. Lawv tau siv los kho cov kab mob sib kis, uas txo qis kev tuag ntawm cov neeg mob los ntawm mob ntsws thiab pyelonephritis, uas muaj niaj hnub no. Vim yog cov tshuaj tua kab mob, chav kawm tau yooj yim thiab rov qab los ntawm bronchitis, sinusitis tau nrawm dua, thiab nws kuj tau dhau los ua cov haujlwm phais nyuaj. Txawm tias cov kab mob kis tau zoo los ntawm cov tshuaj tua kab mob.
Broad Spectrum Antibiotics (ABSS)
Cov tshuaj tua kab mob no suav nrog cov tshuaj nquag tawm tsam Gram-negative thiab Gram-positive kab mob. Cov yav tas yog cov causative tus neeg sawv cev ntawm plab hnyuv kab mob, inflammatory pathologies ntawm lub genitourinary thiab ua pa systems. Cov kab mob gram-zoo feem ntau ua rau mob qhov txhab thiab kho qhov tshwm sim ntawm kev mob tom qab phais hauv kev phais.
Daim ntawv teev npe ntawm ABSS Lwm yamtso tawm hnub
Qee cov tiam tshiab ntawm cov tshuaj tua kab mob broad-spectrum kuj tseem muaj zog tiv thaiv kab mob protozoal. Piv txwv li yog nitroimidazole derivatives - tinidazole, ornidazole thiab metronidazole. Feem ntau siv metronidazole vim kev pheej yig. Nws cov chav kawm analogue, tinidazole, zoo ib yam nyob rau hauv nws spectrum ntawm antimicrobial kev ua si, tab sis tsis yog siv parenterally. Feem ntau, txhua pawg ntawm cov tshuaj tua kab mob dav dav tau nthuav tawm raws li hauv qab no:
- natural penicillins;
- inhibitorprotected aminopenicillins;
- tshuaj tiv thaiv kab mob penicillins, suav nrog cov tshuaj tiv thaiv inhibitor;
- III tiam cephalosporins, IV tiam cephalosporins;
- aminoglycoside pawg;
- tetracycline tshuaj tua kab mob;
- Y tshuaj tua kab mob macrolide;
- tshuaj tua kab mob ntawm ntau tus carbapenems;
- chloramphenicol;
- fosfomycin;
- rifampicin;
- dioxidine;
- sulfonamides;
- Yquinolones, fluoroquinolones;
- nitrofuran pawg;
- tshuaj tua kab mob ntawm nitroimidazole series.
Daim ntawv teev npe no tsis suav nrog cov npe ntawm cov tshuaj tua kab mob nqaim. Lawv yog cov tshwj xeeb rau cov microbes me me thiab muaj txiaj ntsig zoo rau lawv. Cov tshuaj nqaim-spectrum tsis tuaj yeem siv los kho cov kab mob superinfections thiab tsis siv rau qhov pom. Lawv tau siv los ua thawj kab tshuaj tua kab mob thaum hom kab mob tsim.
Daim npe ntawm cov tiam tshiab ntawm ABSS
Cov tshuaj tiv thaiv kab mob saum toj noyog broad spectrum tshuaj. Qhov no yog ib daim ntawv teev tag nrho ntawm pawg ntawm cov tshuaj nrog kev ua ub no tiv thaiv gram-positive thiab gram-negative microbes. Txawm li cas los xij, cov npe muaj cov tshuaj tua kab mob tiam tshiab thiab cov neeg sawv cev ua ntej ntawm pab pawg. Ntawm cov neeg sawv cev saum toj no ntawm cov tiam tshiab yog cov hauv qab no cov tshuaj:
- aminopenicillins tiv taus beta-lactamase ("Sulbactam", "Ampicillin", "Clavulanate", "Amoxicillin");
- III thiab IV tiam cephalosporins ("Cefotaxime", "Cefoperazone", "Ceftazidime", "Ceftriaxone", "Cefpirome", "Cefepime");
- 3rd tiam aminoglycoside tshuaj tua kab mob ("Amicacin", "Netilmicin");
- 14- thiab 15-tus tswvcuab semi-synthetic macrolides ("Roxithromycin", "Clarithromycin", "Azithromycin");
- 16-mer natural macrolide tshuaj tua kab mob ("Midecamycin");
- III thiab IV tiam fluoroquinolones (Levofloxacin, Sparfloxacin, Gatifloxacin, Trovafloxacin, Moxifloxacin);
- carbapenems ("Meropenem", "Imipinem-cilastatin", "Ertapenem");
- nitrofurans ("Nitrofurantoin", "Furazidin", "Ersefuril").
Tshuaj tua kab mob tso tseg
Kev tiv thaiv yav dhau losantipseudomonal penicillins muaj ntau yam kev ua ub no, txawm li cas los xij, lawv tsuas yog siv tawm tsam Pseudomonas aeruginosa vim qhov xav tau los txo qhov tshwm sim ntawm kev sib cuag tom kawg nrog cov tshuaj tua kab mob niaj hnub thiab muaj zog. Qhov no tiv thaiv kev pheej hmoo ntawm kev tsim tshuaj tiv thaiv kab mob. Qhov ua tau zoo tshaj plaws tiv thaiv Pseudomonas aeruginosa qhia "Tazobactam". Qee zaum, "Piperacillin" lossis "Clavulanate" yog siv los ua cov tshuaj tua kab mob tshiab tshiab rau kev mob ntsws los ntawm lub tsev kho mob ntawm cov kab mob.
Kuj nyob rau hauv daim ntawv teev npe no tsis muaj cov tshuaj tua kab mob ntawm cov tiam tshiab ntawm pab pawg neeg ntawm ntuj thiab tshuaj tiv thaiv staphylococcal penicillins. Cov qub tsis tuaj yeem siv rau hauv kev kho mob sab nraud vim qhov xav tau kev siv tshuaj intramuscular ntau zaus. Cov ntawv uas tso cai rau koj coj lawv ntawm qhov ncauj, tsis muaj nyob. Ib qho xwm txheej zoo sib xws tau tsim nrog cephalosporins. Muaj tib lub spectrum ntawm kev ua haujlwm xws li penicillins, lawv tsis tuaj yeem muab tshuaj rau qhov ncauj vim kev puas tsuaj hauv plab.
Cephalosporins thiab parenteral penicillins yog tiam tshiab ntawm cov tshuaj tua kab mob zoo rau mob ntsws. Cov kws tshawb fawb ntawm National Academy of Sciences ntawm lub koom pheej ntawm Belarus tau ua tiav hauv kev tsim daim ntawv ntau npaum rau lawv cov kev siv nkag. Txawm li cas los xij, cov txiaj ntsig ntawm kev tshawb fawb tseem tsis tau siv rau hauv kev xyaum, thiab cov tshuaj ntawm cov koob no tuaj yeem siv tau txog tam sim no tsuas yog hauv kev ua haujlwm ntawm cov chaw kho mob hauv tsev kho mob.
tshuaj tua kab mob zoo rau menyuam yaus
Tshawb nrhiav cov tshuaj tua kab mob tiam tshiab, ib daim ntawv teev npeCov tshuaj pom zoo rau cov menyuam yaus yog qhov nqaim heev. Hauv menyuam yaus, tsuas yog cov neeg sawv cev ntawm ntau cov aminopenicillins (Amoxicillin, Clavulanate), cephalosporins (Ceftriaxone, Cefepime), macrolides (Azithromycin, Midecamycin, Roxithromycin, Clarithromycin) tuaj yeem siv. Cov tshuaj tua kab mob Fluoroquinolone, carbapenems thiab nitrofurans tsis tuaj yeem siv vim yog cov pob txha loj hlob inhibition, siab thiab raum toxicity.
Systemic nitrofurans tsis siv vim tsis muaj cov ntaub ntawv tshawb fawb lees paub txog kev nyab xeeb ntawm kev kho mob. Qhov kev zam tsuas yog "Furacilin", tsim nyog rau kev kho mob hauv zos ntawm qhov txhab. Cov tshuaj tua kab mob niaj hnub thiab muaj txiaj ntsig zoo rau cov menyuam yaus ntawm tiam tshiab yog raws li hauv qab no: macrolides, penicillins, cephalosporins (cov npe ntawm cov tshuaj tau hais saum toj no). Lwm pawg ntawm cov tshuaj tua kab mob tsis raug pom zoo vim muaj cov tshuaj lom thiab ua rau lub cev tsis muaj zog.
ABS rau cov poj niam cev xeeb tub
Raws li kev faib tawm ntawm FDA (USA), tsuas yog qee cov tshuaj tua kab mob tiam tshiab tuaj yeem siv los kho cov poj niam cev xeeb tub, cov npe uas tsawg heev. Lawv raug cais raws li Qib A thiab B, txhais tau tias lawv tsis tau raug pov thawj tias muaj kev phom sij lossis tsis muaj qhov cuam tshuam teratogenic hauv kev tshawb fawb tsiaj.
Cov tshuaj uas tsis muaj pov thawj los ntawm tus menyuam hauv plab, nrog rau qhov muaj cov tshuaj lom, tsuas yog siv tau yog tias cov tshuaj kho tau zoo dua.by-products (Qeb C thiab D). Qeb X tshuaj muaj pov thawj teratogenic nyhuv ntawm tus me nyuam hauv plab, yog li ntawd, yog tias tsim nyog, lawv yuav tsum raug txiav.
Thaum cev xeeb tub, cov tshuaj tua kab mob dav dav hauv qab no ntawm cov tiam tshiab hauv cov ntsiav tshuaj tau siv: tiv thaiv aminopenicillins ("Amoclav", "Amoxiclav"), cephalosporins ("Cefazolin", "Ceftriaxone", "Cefepim"). Macrolides ("Azithromycin", "Clarithromycin", "Midecamycin", "Roxithromycin") raug tso cai siv rau peb lub hlis twg ntawm cev xeeb tub vim qhov tseeb tias lawv cov nyhuv teratogenic tseem tsis tau kawm tag nrho, thiab ib tus tsis tuaj yeem hais lus tsis meej txog. nws tsis muaj. Nws tseem muaj kev nyab xeeb rau cov poj niam cev xeeb tub siv cov tshuaj tua kab mob penicillin thaum tsis muaj kev fab tshuaj.
Kev siv tshuaj tua kab mob hauv kev kho mob bronchitis
Txhua tiam tshiab broad-spectrum tshuaj tua kab mob tuaj yeem siv rau kev mob ntsws ntsws thiab mob ntsws yog tias lawv cov tshuaj pharmacodynamic zoo rau qhov no. Txawm li cas los xij, muaj cov tswv yim zoo rau kev kho mob zoo li no. Lawv xav txog cov kev xaiv rau kev ua tiav kev sib xyaw ua ke ntawm cov tshuaj tua kab mob nrog lub hom phiaj ntawm kev pabcuam dav dav ntawm cov kab mob microbial.
Nitrofurans, nitroimidazole derivatives thiab sulfonamides tsis yog qhov tsim nyog siv rau cov kab mob ua pa ntawm cov pa. Kev sib xyaw ua ke zoo tshaj plaws rau kev mob ntsws ntsws lossis mob ntsws me yog kev tiv thaiv aminopenicillin nrog macrolide ("Amoclave" +"Azithromycin"). Kev mob ntsws ntev ntev yuav tsum tau teem sijhawm ntawm cephalosporin es tsis txhob siv aminopenicillin ("Ceftriaxone" + "Azithromycin"). Nyob rau hauv cov tswv yim no, cov macrolide tuaj yeem hloov nrog lwm chav kawm analogue: Midecamycin, Clarithromycin lossis Roxithromycin.
Tag nrho cov tshuaj tua kab mob tiam tshiab no rau kev mob ntsws ntsws muaj cov txiaj ntsig zoo, txawm hais tias cov tsos mob ntawm tus kab mob tuaj yeem txuas ntxiv mus. Cov txheej txheem rau kev ua tau zoo ntawm kev kho mob yog qhov tshwm sim ntawm hnoos nrog maj mam tshem cov hnoos qeev thiab pab ua npaws. Nrog COPD, ua tsis taus pa luv kuj txo, qab los noj mov zoo dua, thiab zaus hnoos qis.
kho mob ntsws zoo
mob ntsws me yog kho zoo li mob ntsws, tab sis nrog cephalosporin thiab macrolide. Rau cov neeg mob ntsws mob nruab nrab lossis mob hnyav hauv zej zog, ib qho cephalosporin (Ceftriaxone lossis Cefepime) tau muab tshuaj nrog ntau tus neeg sawv cev ntawm fluoroquinolones (Ciprofloxacin lossis Levofloxacin). Cov tshuaj tua kab mob dav dav ntawm cov tiam tshiab no txwv cov zej zog microflora zoo, thiab cov txiaj ntsig ntawm lawv siv tau pom zoo rau hnub thib ob ntawm kev kho mob.
Cov tshuaj tua kab mob niaj hnub ntawm tiam tshiab rau kev mob ntsws (cov npe tau hais saum toj no) ua rau cov kab mob, txo nws txoj haujlwm tseem ceeb lossis tua nws. Thawj cov tshuaj hu ua bacteriostatics, thiab thib ob kev npaj cov kab mob bactericidal. Cephalosporins,aminopenicillins thiab fluoroquinolones yog cov tshuaj tua kab mob, thiab macrolides yog bacteriostatics. Tsis tas li ntawd, kev sib xyaw ua ke ntawm cov tshuaj tua kab mob tsis yog tsuas yog nthuav tawm cov spectrum ntawm kev ua, tab sis kuj ua raws li cov cai ntawm kev sib xyaw ua ke: ib qho tshuaj tua kab mob nrog ib qho bacteriostatic.
Kev kho mob ntsws mob hnyav hauv ICU
Nyob rau hauv kev saib xyuas mob hnyav, qhov twg tej zaum yuav muaj cov neeg mob uas muaj mob ntsws hnyav thiab muaj kev nyuaj siab ntawm keeb kwm ntawm kev qaug dab peg. Lub luag haujlwm tseem ceeb rau qhov mob hnyav ntawm cov neeg mob no yog tsim los ntawm cov kab mob microflora uas tiv taus rau feem ntau cov tshuaj tiv thaiv kab mob. Hauv cov xwm txheej zoo li no, carbapenems raug siv ("Imipinem-cilastatin", "Tienam", "Meropenem"), uas tsis tuaj yeem siv rau hauv kev kho mob sab nraud.
Kev kho mob ntawm sinusitis thiab sinusitis
Cov tshuaj tua kab mob niaj hnub ntawm tiam tshiab rau sinusitis lossis sinusitis yog siv los rhuav tshem cov kab mob. Hauv cov xwm txheej zoo li no, ib qho tshuaj tua kab mob bactericidal tuaj yeem siv tau. Txawm li cas los xij, nrog sinusitis, qhov nyuaj tseem ceeb yog kev nkag mus rau cov tshuaj tiv thaiv kab mob mus rau qhov chaw mob. Yog li ntawd, cov tshuaj feem ntau siv yog cephalosporin series. Ib qho piv txwv yog "Ceftriaxone" lossis "Cefepime". Ib tiam thib peb fluoroquinolone, Levofloxacin, kuj tuaj yeem raug tshuaj.
Kev kho mob angina nrog cov tshuaj tua kab mob niaj hnub
Cov tshuaj tua kab mob tiam kawg rau angina tau muab rau tib lub hom phiaj. Ntxiv mus, ob qho tib si nrog sinusitis thiab tonsillitis, tib cov tshuaj tiv thaiv kab mob tuaj yeem siv tau. Qhov txawv tsuas yog nyob rau hauv cov ntaub ntawv ntawm otonsils, koj tuaj yeem siv tshuaj tua kab mob, piv txwv li, "Furacilin" - tshuaj ntawm ntau cov nitrofurans. Txawm hais tias angina tuaj yeem siv tau zoo aminopenicillins tiv thaiv los ntawm sulbactam lossis clavulanic acid (Amoclave, Amoxiclav, Ospamox). Ntxiv mus, cov tshuaj yuav tsum tau muab tshuaj rau 10-14 hnub.
Kho rau pyelonephritis thiab kab mob ntawm cov kab mob genitourinary
Vim muaj kev sib kis ntawm cov kab mob tso zis nrog cov kab mob microbes, cov tshuaj tua kab mob ntawm cov tiam tshiab hauv pyelonephritis yog qhov tsim nyog rau lawv txoj kev kho. Cephalosporins, fluoroquinolones thiab nitrofurans muaj txiaj ntsig zoo tshaj plaws ntawm no. Cephalosporins yog siv rau cov mob pyelonephritis me me, thiab fluoroquinolones ("Ciprofloxacin", "Levofloxacin", "Ofloxacin", "Moxifloxacin") - thaum tus mob hnyav dua tawm tsam keeb kwm ntawm kev kho mob tsis tu ncua.
Cov tshuaj muaj txiaj ntsig zoo tshaj plaws, haum rau kev kho mob monotherapy thiab kev sib xyaw nrog "Ceftriaxone", yog ib tus neeg sawv cev ntawm ntau tus nitrofurans - "Furamag"). Ib qho quinolone, Nalidixic Acid, kuj tuaj yeem siv tau. Cov tom kawg tsim muaj siab nyob rau hauv cov zis thiab ua active tiv thaiv kab mob ntawm genitourinary kab mob. Tsis tas li, qee zaus, nrog gardnellosis thiab qhov chaw mos dysbacteriosis, "Metronidazole" yog siv.
Tshuaj tiv thaiv thiab nws qhov cuam tshuam
Vim qhov hloov pauv tsis tu ncua ntawm cov caj cescov khoom siv ntawm cov kab mob, feem ntau yog cov kab mob, qhov ua tau zoo ntawm ntau cov tshuaj tua kab mob yog txo qis heev. Los ntawm kev nkag mus rau cov tshuaj tiv thaiv, cov kab mob muaj peev xwm ua kom muaj sia nyob hauv tib neeg lub cev, kho cov kab mob sib kis. Qhov no yuam cov kws tshawb fawb nrhiav thiab muab tso rau hauv cov tshuaj tua kab mob tshiab ntawm tiam tshiab.
Nyob rau hauv tag nrho, thaum lub sijhawm muaj cov tshuaj tiv thaiv kab mob, kwv yees li 7,000 cov tshuaj twb tau tsim los siv rau hauv cov tshuaj hauv ib txoj kev. Qee tus ntawm lawv tau raug muab tshem tawm vim qhov kev mob tshwm sim tseem ceeb hauv tsev kho mob lossis vim tias cov kab mob microbes tau ua rau lawv tiv taus. Yog li ntawd, niaj hnub no muaj txog 160 tshuaj siv nyob rau hauv cov tshuaj. Kwv yees li ntawm 20 ntawm lawv yog cov tshuaj tua kab mob tiam tshiab, uas nws cov npe feem ntau tshwm sim hauv cov txheej txheem kho mob rau kev kho cov kab mob sib kis.
