Beta-lactam mishonga: mashandiro chiito uye kupatsanura

Mishonga - boka zvinodhaka Etiotropic mashandiro nezvaaiita. Mune mamwe manzwi, zvinodhaka izvi vanoita zvakananga pamusoro mhaka chirwere (ichi zvazvingava, microorganism ndiye causative mumiririri) uye kudaro nenzira mbiri: kuparadza tupukanana (microbicides - penicillins, cephalosporins) kana tunodzivisa kubereka yavo (bacteriostatic - tetracyclines, sulfonamides).

Pane rakakura uwandu zvinodhaka nemishonga, asi zvikuru kwazvo boka vavo - iri Beta-lactams. Zviri pamusoro pavo uye ichakurukurwa munyaya ino.

Kupatsanura inorwisa mabhakitiriya

Musi mashandiro chiito zvinodhaka izvi vanokamurwa muzvikwata huru nhanhatu:

1. Mishonga kuti tunodzivisa kwetunhu muchitokisi Kamudzira zvinoriumba: penicillins, cephalosporins, uye vamwe.
2. Medicines kuti kudzivisa dzose kushanda sero rusvingo: polyenes polymyxins.
3. Zvinodhaka kuti tunodzivisa mapuroteni usage: macrolides, tetracyclines, aminoglycosides, uye vamwe.
4. Inhibitory RNA usage panguva danho chiito RNA polymerase: rifamycins, sulphonamides.
5. Inhibitory RNA usage panguva danho chiito DNA polymerase: actinomycins, et unto.
6. DNA reongororo blockers: anthracyclines, nitrofurans nevamwe.

Zvisinei, kupatsanura ichi hachisi nyore chaizvo. In kurapwa tsika, akaita zvinotevera weboka tupukanana:

1. Penicillins.
2. Cephalosporins.
3. Macrolides.
4. Aminoglycosides.
5. Polymyxin uye polyenes.
6. Tetracyclines.
7. Sulfonamides.
8. Aminohinolonov nomukaka.
9. Nitrofurans.
10. Fluoroquinolones.

Beta-lactam inorwisa mabhakitiriya. Marongerwo mashandiro chiito

boka iri zvinodhaka bactericidal kushanda uye zvakakwana akasiyana mazita zvairatidza kuti kushandiswa. Beta-lactam nemishonga zvinosanganisira penicillins, cephalosporins, carbapenems, monobactams. Vose vari inozivikanwa mukuru Kushanda uye vashoma shoma toxicity, akaaita mishonga anowanzodanwa nachiremba kurapa zvirwere zvakawanda.

The mashandiro chiito kuti Beta-lactam mishonga nokuda maumbirwo yavo. Yakawandisa akadzama pano chinhu, zvinokosha kutaura chete pamusoro kupfuura chinokosha, randakapiwa zita rose boka zvinodhaka. Zvinosanganisirwa mamorekuru iri Beta-lactam mhete uye inopa raidudzwa bactericidal Chaizvoizvo iyo kunoratidzwa rakavhara kwetunhu sero rusvingo zvinoumba nayo utachiona. Zvisinei, mabhakitiriya akawanda kubereka chaiyo enzayemu, izvo anotyora sechivako chindori nokudaro nokunyima mushonga wayo chombo chikuru. Ndokusaka kushandiswa kwezvinodhaka pakurapa vasina kudzivirira Beta-lactamases, haushandi.

Zvino kuramba vachiwanda mishonga Beta-lactam boka, yakadzivirirwa kubva chiito kwemabhakitiriya makemikari. sezvamunoita dzavo zvinosanganisira zvinhu kuti adzikatidza kwetunhu Beta-lactamase, akadai clavulanic acid. akadzivirira Beta-lactam mishonga (yakadai se "Amoxiclav") akasika kuti nzira. Zvimwe FIs of kwemabhakitiriya enzayemu zvinosanganisira "Sulbactam" uye "tazobactam."

Medicines kubva boka penicillins: Historical Background

Kugadzirira mune dzino vaiva nemishonga wokutanga kuchirapa mugumisiro aizivikanwa kuvanhu. Kwenguva refu vave kushandiswa chaizvo pakurapa zvirwere zvakasiyana-siyana uye makore okutanga chikumbiro vari vanenge mushonga. Zvisinei, munguva pfupi zvakava pachena kuti kushanda kwavo zvishoma nezvishoma pakugumburwa, sezvo mhindumupindu wenyika utachiona hakuiti mira. Micro-zvinenge anogona kuchinja nokukurumidza kune dzakasiyana-siyana kunzwisisa mamiriro ezvinhu aripo, achipa pave chiedza chizvarwa mushonga nemishonga kwemabhakitiriya.

Kuwanda kuti penicillin kwakaita kuti kukurumidza kukura vasiri nyore okuva utachiona kwavari, saka zvayo yakachena chimiro zvino zvinodhaka muboka iri hadzibatsiri uye haana kushandiswa. Vari zvakanakisisa ikashandiswa pamwe zvinhu izvo tiwedzere dzavo bactericidal zvazviri, uye kuchititadzisa kwemabhakitiriya unodzivirira zvigadziriswe.

Kugadzirira kuti penicillin

Uyu Beta-lactam nemishonga, kuti kupatsanura pakati iri zvikuru rakakura:

1. The dzinongoitika penicillins (semuenzaniso, "Penicillin").
2. Anti-staphylococcal ( "Oxacillin").
3. Penicillins, kwenguva-chakarondedzera ( "Ampicillin" "Amoxicillin").
4. Pseudomonas ( "azlocillin").
5. Kudzivirirwa penicillins (pamwe clavulanic asidhi "sulbactam", "tazobactam").
6. Zvinodhaka, kusanganisira nhengo dzaro mashoma inorwisa mabhakitiriya penicillin.

Muchidimbu zvinodhaka kuva penicillin boka

Zvinhu, penicillins angabudirira vamise basa vose giremu-akanaka uye giremu negative tusingaoneki. Neyokupedzisira, chinonyanya nehanya boka iri Beta-lactam mishonga Streptococcus uye zvinokonzera yomumuzongoza. Utachiona yasara zvevakomana yakawanikwa kudzivirira zvigadziriswe. Natural penicillins vanobudirira pamusoro anaerobes :. Clostridial peptokokki, peptostreptokokkov etc. zvinodhaka ava zvishoma chepfu uye kuva vashomanana nemigumisiro, mazita iyo ipfupi kuchitendero neutachiona, kunyange zvazvo ovhadhozi zvinokwanisika uye pave nezvipusha, uye chitarisiko zviratidzo nomuchetura ne kuti nhengo iri zvomudumbu hurongwa.

Kubva Anti-staphylococcal penicillins ukoshi mukuru ndiko Beta-lactam mushonga se "Oxacillin". Izvi kugadzirira yakatetepa chikumbiro, sezvo Mwari akaronga kunyanya kurwisa S. aureus. Zviri pamusoro utachiona hwakakura iyi (kusanganisira penitsillinrezistentnyh utachiona) "Oxacillin" zvinonyatsoshanda. Marwadzo akafanana vaya vemamwe nhengo boka iri nezvinodhaka.

Penicillins, kwenguva-chakarondedzera kuwedzera giremu positive giremu negative uye anaerobic kasvisto tiri kushingaira pamusoro causative vaishandira intestinal zvirwere. Nemishonga haana kusiyana kubva apa, pedyo zvishoma yepamusoro ndingangokuvara zvinetso zviri zvomudumbu ezvinhu kunyange zvinodhaka izvi dzinoratidzwa.

Beta-lactam asingaurayiwi "azlocillin" (mumiririri boka rechina penicillins) rakagadzirirwa kukurira Pseudomonas aeruginosa. Zvisinei, muna nguva nayo utachiona yakaratidza kudzivisa mishonga iri dzino, izvo zvinoita dzavo kushandiswa hakusi inoshanda kudaro.

About Kudzivirirwa penicillins ataurwa pamusoro. Nokuti kuti zvinodhaka izvi zvinosanganisira ayo sezvamunoita zvinhu kuti tunodzivisa Beta-lactamase inobereka utachiona, ivo tibudirire kuti mishonga yezvirwere zhinji.

The wokupedzisira boka - iri mubatanidzwa vamiririri anoverengeka kuti penicillin, wezvikamu muedzo nemumwe chiito.

Zvizvarwa zvina mabhakitiriya evadzimi

Beta-lactam kwemishonga inorwisa mabhakitiriya cephalosporins vari. zvinodhaka izvi, akaita kuti penicillin, mhare dzine yavo kwazvo chakarondedzera chiito uye vashoma nemishonga.

Kune mana mapoka (chizvarwa) cephalosporins:

1. Zvikuru vamiririri vechizvarwa yokutanga - "Cefazolin" uye "Cephalexin". Vari anonyanya yakagadzirirwa kurwisa staphylococci, streptococci, meningococci uye gonococci, uyewo vamwe giremu negative zvinenge.
2. Chizvarwa chechipiri - ndiye "Cefuroxime" Beta-lactam mushonga. nzvimbo yake basa rinosanganisira kunyanya giremu negative zvigare.
3. "Cefotaxime", "Ceftazidime" - vamiririri boka kupatsanura rechitatu. Vane chaizvo pamusoro enterobacteria uye zvinogona kuparadza nemiti nosocomial (hospital utachiona zvigare).
4. rudzi rwechina huru chigadzirwa - ". Cefepime" Rine zvose zvakanakira pamusoro zvinodhaka, uyezve, zvikuru kugadzikana kuti Beta-lactamases utachiona uye ane basa pamusoro Pseudomonas aeruginosa.

Cephalosporins uye Beta-lactam mishonga seboka iri dzinoratidzwa raidudzwa bactericidal kushanda.

Nekuti nenjodzi kuti vatarisire zvinodhaka vakawanda nzeve inoda mashoko siyana neutachiona (okusafunga kubva zviduku muupenyu-kuvatyisidzira, akadai anaphylactic kuvhunduka), mune zvimwe zviitiko kunyongana ari zvomudumbu nadzo.

chengetedza mari

"Imipenem" - mumwe Beta-lactam mushonga kungova carbapenem boka. Iye, uyewo hapana zvishoma akakurumbira "Meropenem" mabasa kukanganisa kurwisa kune dzimwe zvinodhaka ari microflora anogona kupa kusakundika kunyange rwechitatu norwechina chizvarwa cephalosporins.

Beta-lactam mushonga kubva boka carbapenems - mushonga rinoshandiswa zvikuru kwazvo nguva apo utachiona havasi amenable kurapwa nedzimwe zvinodhaka.

Tsigiro zvinoreva nhamba mbiri

"Aztreonam" - mumiriri akakurumbira kupfuura monobactams, zviri dzinoratidzwa hwakanyatsorwisa yakatetepa chakarondedzera chiito. Izvi Beta-lactam mushonga zvinonyatsoshanda pamusoro giremu negative Kurovedza. Zvisinei, zvinofanira kucherechedzwa kuti sezvo "Imipenem" "Aztreonam" substantially basa Beta-lactamases, izvo zvinoita kuti mushonga kusarudza kuti kwazvo siyana zvirwere kunokonzerwa utachiona izvi, kunyanya kana kurapwa kukundikana dzimwe inorwisa mabhakitiriya.

The chakarondedzera kuitwa Beta-lactam mishonga

Mukupfupikisa, zvinofanira kucherechedzwa kuti kugadzirira mapoka aya kuva nezvahunoita zhinji mhando utachiona. The mashandiro chiito kuti Beta-lactam mishonga yakadaro ichisiya pasina mukana yokupona tupukanana: Sero rusvingo usage blockade - rufu nokuda utachiona.

Giremu-akanaka uye giremu negative Utachiona, Kurovedza uye anaerobic ... vamiririri vose ava pathogenic kasvisto pane zvikuru anobudirira zvinodhaka. Chokwadi, pane pakati nemishonga iyi uye zvikuru kushandiswa maturusi asi vakawanda vavo vakagadzirira kurwa wandei rwarisa nevamiririri. Beta-lactam mishonga vanokwanisa kutsungirira kunyange vamiririri nosocomial kasvisto, ndivo kupfuura husingakwanisi kurapwa.

Chii okuva kuchipatara?

Tiri kutaura Micro-zvipenyu zviri munyika zvokurapa masangano. Zvinotisimbisa chitarisiko chavo kushumira kuvarwere uye vanachiremba. Zvikurukuru ngozi akavanzika, usimbe mhando zvirwere. Hospital - nzvimbo yakakwana kuunganidza zvose zvinobvira vatakuri zvirwere. A kutyora utsanana mitemo uye dzemunharaunda vari yakaorera pokutangira Maruva ichi yakazviwanira niche chokuvapo, uko aigona kurarama, erudzi uye wana kuramba zvinodhaka.

High nemishonga muchipatara utachiona anonyanya nokuti kuti, kubudikidza kwavo dzinogarisana zvipatara, bacteria vanogona kukurukura siyana nezvinodhaka. Sezvingatarisirwa, zvinokonzerwa zvinodhaka pamusoro zvipenyu kunoitika netsaona, asina kuparadza nangananga uye mishonga diki, uye zvinoita kuti chokwadi kuti vamiririri muchipatara microflora vanogona kuva kudzivirira nzira inoparadza kuti vadzidze kuzviramba. Uye utachiona sokuti kurwisana kuti zvakaoma chaizvo, uye dzimwe nguva zvinoita sokuti hazvibviri.

Beta-lactam mishonga munyika dzakawanda nzira imwe kana mumwe vari kuedza kugadzirisa dambudziko iri yakaoma. Pakati pavo vane vamiririri anogona zvikuru kubudirira kukurira kunyange basa zvinodhaka utachiona. Izvi chengetedza zvinodhaka. Kushandiswa yavo ishoma, sezvo vanogadzwa chete kana chaizvo. Kana mishonga iyi anoshandiswa buda kakawanda, ipapo, zvichida, ichagumisa kuwa kubudirira kwavo, nekuti ipapo utachiona mukana kushamwaridzana mishonga duku zvinodhaka izvi, kudzidza navo uye vave nzira yokudzivirira.

Kana achiita Beta-lactam nemishonga?

Zvairatidza kuti kushandisa boka iri mishonga yakafanira zvikurukuru avo chakarondedzera chiito. Zvingava zvakanaka kugadza Beta-lactam mushonga ari chirwere, apo nayo utachiona inonyatsoziva zviito zvinodhaka.

Penicillins vari zvakanaka yakasimbiswa pakurapa pharyngitis, tonsillitis, mabayo, nezvitsvuku fivha, yomumuzongoza kwemabhakitiriya endocarditis, actinomycosis, anaerobic zvirwere, leptospirosis, salmonellosis, shigellosis, zvirwere ganda uye akapfava munyama. Usakanganwa pamusoro mishonga anogona kuzorwa Pseudomonas aeruginosa.

Cephalosporins vane zvakafanana chakarondedzera basa saka zvinoratidza kuti vari rinenge zvakafanana kuti penicillins. Zvisinei, zvinofanira kutaurwa kuti kubudirira cephalosporins, kunyanya okupedzisira zvizvarwa maviri, kwete muenzaniso kumusoro.

Monobactams uye carbapenems akagadzirirwa kurwisa zvakakura uye havaratidzi rinorapika chirwere, kusanganisira avo kunokonzerwa kuchipatara utachiona. Vanodawo kubudirira sepsis uye septic kuvhunduka.

sadikanwa migumisiro

Sezvo kare akataura, kuti Beta-lactam mishonga (zvinodhaka yomumwe boka iri dzakarongwa pamusoro) vari kusiyaniswa vashomanana anokuvadza migumisiro kuti muviri. Rare nokugwinha uye zviratidzo nomudumbu havasi kukanganisa upenyu. The ngozi here anogona kuva kwakakura sema maitiro kuti mishonga pakati Beta-lactam inorwisa mabhakitiriya.

Mapundu, pruritus, rhinitis uye conjunctivitis haisi chinouraya, kunyange kusingafadzi chaizvo. Chii chaizvoizvo anofanira kutyiwa, nokuti zvakadai zvikuru siyana sezvo angioedema (kunyanya munzvimbo yacho dokeriro, izvo pamwe zvikuru dyspnea kusvikira nekusagona fema) uye anaphylactic kuvhunduka. Saka, mushonga dzinogona kusumwa chete pashure kuita nemiedzo kuti chisimbwa.

Possible muchinjikwa-siyana. Beta-lactam nemishonga, kuti kupatsanura zvinoreva kuvapo vakawanda mapoka zvinodhaka, kusimba zvikuru kufanana mumwe, izvo zvinoreva kuti kana asingashiviriri mumwe wavo, munhu wose achange panoonekwa muviri sechinhu allergen.

A mashoko mashoma pamusoro zvinhu kuti vawedzere kurwisa utachiona

The zvishoma nezvishoma kuderera kubudirira antibacterial zvinodhaka (kusanganisira Beta-lactam mishonga) nokuda kutarisira kugara uye kakawanda zvisiri nokuda kushanda. An kukwana yawapiwa, kushandisa duku kuchirapa mishonga zvinoita kuti apore, asi kudzivirira tusingaoneki mukana "chitima", kugadzira uye vave nzira kudzivirira zvinodhaka. Saka zvinoshamisa here kuti ekupedzisira kuva basa pamusoro nguva?

Kunyange iye zvino mishonga uye havasi asunungurwa kubva Pharmacies pasina mushonga kuti vose muchikwanisa. Izvi zvinoreva kuti kuzvida uye nechokuita matambudziko (kushandisa zvose nguva imwe chinodhaka, benzi chidzivaidzo yokurapa, sizvo chipimo chemushonga uye zvichingodaro.) Vacharamba, ndinosika mamiriro ezvinhu kurima zvahunoitwa nemishonga utachiona.

Zviri pano kugara mu-chipatara kasvisto, vane mukana vachishingaira kukurukura zvinodhaka zvakasiyana-siyana uye wekuvamba itsva nzira kukurira navo.

Zvokuita? Regai kuzvidzora medicate, ezvidzidzo kunenge ari kupinda chiremba: kutora mushonga semazuva zvaida, uye zvakarurama mishonga. With nosocomial kasvisto kurwa, Chokwadi, zvakaoma, asi zvakadaro zvinoita. The tightening zvinodiwa utano hwavo kunyatsoomerera Implementation kuti kuderedza mikana rakasikwa mamiriro ezvinhu akanaka nokuda maberekero kuti nemishonga kasvisto.

Mashoko mashoma mhedziso

A yakafara chaizvo nyaya - beta-lactam inorwisa mabhakitiriya. Pharmacology (science mishonga yavo simba pamusoro muviri) akakumikidza pavo zvitsauko zvakawanda zvinosanganisira kwete chete zvayo chakanangana boka, asi dzinewo rondedzero zvakanakisisa inozivikanwa wevamiriri vayo. Nyaya iyi hachisi chokutsanangura kuva nzwisisika, asi oedza kuzozivisa huru, kuziva mishonga izvi zvinokosha.

Garai utano uye musakanganwe: asati kushandisa ichi kana kuti mushonga kuverenga kunyatsoteerera mirayiridzo iyi uye mukanyatsochengeta kutevera kunenge, kana nani asi, bvunza nyanzvi.