Tshuaj tua kab mob "tshuaj": cov lus qhia rau kev siv, tiag tiag counterparts

Tam sim no kev kho mob ntawm cov kab dab, yog tsis yooj yim sua yam uas tsis tau siv antibacterial tshuaj. Lub puas tau nce kuj kab mob ua rau cov kev tshawb fawb rau cov tshuaj tshiab los yog kev siv ntawm ob peb ua ke ntawm cov laus, pov thawj tshuaj tua kab mob. Tsis nyob rau hauv dej siab ntawm tus muaj kuab siv ntawm antimicrobials yog evidenced los ntawm lub sij hawm ntawm uncontrolled broad-spectrum tshuaj tua kab mob, es tsis txhob ntawm lub ntsuam xyuas thawj zaug ntawm lub rhiab heev ntawm muaj rau cov tshuaj nyob rau hauv pab pawg neeg no. Tshuaj "tshuaj", muaj teeb meem loj pharmacokinetic thiab pharmacodynamic zoo nyob rau hauv ib tug xov tooj ntawm fluoroquinolones yog nce siv rau cov kev kho mob ntawm kis kab mob ntawm txawv etiologies.

Clinico-pharmacological yam ntxwv

Lub medicament "tshuaj" los yog "levofloxacin" (International Nonproprietary lub npe) yog ib qho tshuaj tua kab mob los ntawm cov series fluoroquinolones, npaj rau enteral thiab parenteral kev ntawm koom haum saib xyuas.

Los ntawm nws cov xwm heev "tshuaj" (phau ntawv qhia muab raws nraim tej ntaub ntawv) yog monoftorhinolonom - isomer ntawm ofloxacin, thiab nyob rau hauv kev sib piv nrog rau lwm cov tshuaj, muaj teeb meem loj pharmacokinetic zoo:

• qhov ncauj bioavailability yog 100%, cov neeg kawm ntawv ntawm kev sib raug zoo nrog ntshav cov nqaijrog raws li high school raws li 40%;
• nyiaj pab ntau tshaj cov ntshav ntshiab tshuaj no yog cai 1-2 teev tom qab qhov ncauj thawj coj yog piv rau tias tom qab tso dej thawj coj;
• "Tshuaj" yog yus muaj los ntawm ib tug muaj zog lub ntim ntawm faib nyob rau hauv lub cev, vim lub intensive allergic rau hauv cov ntaub so ntswg;
• Nws muaj ib tug ntev ib nrab-lub neej ntawm tus kab mob uas ua rau tsuas muaj ib zaug xwb koob tshuaj ntawm cov tshuaj ib hnub twg.

Muab hais tias ib tug tseem ceeb kho nyhuv fluoroquinolones ua sai npaum li cas ntawm sawv nyob rau hauv cov ntshav concentration ntawm cov tshuaj siv yeeb tshuaj, lub aforementioned pharmacokinetic tsis muab paaj tej yam kev mob rau tag nrho tshem tawm ntawm microorganisms.

Raws li lawv hom ntawm kev txiav txim nyob rau hauv txoj kev loj hlob thiab tu tub tu kiv ntawm cov kab mob, "tshuaj" muaj ib tug bactericidal nyhuv, impacting tsis tsuas yog nyob rau hauv lub active ntaub ntawv ntawm pathogenic cov kab mob, tab sis kuj nyob rau hauv lub vegetative thiab tsaug zog.

Metabolism hauv ntawm ib co tshuaj tshwm sim nyob rau hepatocytes los ntawm deacetylation los yog oxidation. Txawm li cas los, hais txog 5% ntawm cov tshuaj no yog tas los ntawm ob lub raum li metabolites, thiab tseem yuav tshuav yog tso tawm los ntawm glomerular filtration thiab tubular secretion. Nws yuav tsum tau muab sau tseg tias tom qab qhov ncauj thawj coj ntawm ib tug tseem ceeb feem ntawm cov tshuaj (txog 70%) yog tas los rau ntawm lub cev tsis pub dhau 24 teev los ntawm cov zis, thiab hais txog 80% ntawm cov tshuaj yog tshem tawm tom qab 48 teev. Cov qhia tawm ntawm feem ntawm cov tshuaj los ntawm tus mob huam yog tsawg tsawg thiab yog tsuas hais txog 4%.

Thaum siv cov tshuaj nyob rau hauv koob tshuaj tshaj 1000 mg ib hnub twg (ob zaug-txhua hnub ntsiav tshuaj ntawm 500 mg) muaj me ntsis yuav ua rau muaj kev loj hlob loj zus nyhuv.

mechanism ntawm qhov kev txiav txim

Lub mechanism ntawm yeeb tshuaj txiav txim raws li inhibition ntawm tej enzyme hu ua DNA gyrase, uas yog muab kev koom tes nyob rau hauv lub replication kev ntawm kev tshuaj ntsuam genetic khoom los ntawm stitching zoo coils nyob rau hauv tsis zoo helix DNA. Raws li ib tug tshwm sim ntawm inhibition ntawm cov enzyme ua txhaum dab ntawm DNA replication, cell division, cell tuag tshwm sim.

"Tshuaj": cov lus qhia rau kev siv thiab indications

Rau hnub tim, lub ntsiab indications rau tshuaj dab yog kis kab mob etiology, tshwm sim los ntawm raug kab mob los ntawm kab mob mus rau lub tshuaj tua kab mob nyob rau hauv cov neeg mob laus tshaj 18 xyoo.

Kev npaj "tshuaj" txoj kev zoo muaj pov thawj nyob rau hauv cov kev kho mob ntawm kev ua pa kab mob kab mob ntawm lub Upper thiab qis pa zig xws li mob ntsws, sinusitis, inflammatory kab mob ntawm lub ntsws cov ntaub so ntswg. Qhov no yog vim, saum toj no tag nrho, ib qho zoo heev cov tshuaj allergic rau hauv lub epithelium ntawm lub bronchi thiab lub ntsws nyob qhov twg txawm tom qab thawj zaug tshuaj thawj coj tsim zoo concentration.

Cov tib formulation ntse siv los kho mob txeeb zig (pyelonephritis, cystitis, urethritis, etc.), biliary ib ntsuj av tau kab mob, prostatitis, daim tawv nqaij kab mob, intraabdominal kab mob thiab sepsis.

Nyob rau hauv thiaj li yuav kho kis kab mob ntawm cov hlab pas "tshuaj" yog muab (nyob ntawm seb tus kab mob heev) 1-2 lub sij hawm ib hnub twg nrog 500 mg rau ib ntsiav tshuaj, los yog tshuaj npaj.

Rau cov kev kho mob ntawm mob txeeb zig yog txaus koob tshuaj ntawm kev npaj 1, 250 mg ib hnub ib zaug, thiab nyob rau hauv loj heev zaum, txhua hnub koob tshuaj yuav ua tau 500 mg ( "tshuaj 500"). Cov lus qhia rau kev siv hais tias ob zaug-txhua hnub koob tshuaj ntawm 250 mg yuav hloov los ntawm ib tug 500 mg nyob ntawm tus kab mob no heev.

Rau cov kev kho mob ntawm kis kab mob ntawm daim tawv nqaij thiab qog ua kua "tshuaj" yog muab nyob rau hauv ib tug ntau npaum ntawm 250 mg ib hnub ob zaug.

Contraindications

Tsis contraindication tau txais tshuaj yog npau taws me ntsis thiab kev tsis haum tshuaj nyob rau hauv lub xub ntiag ntawm ib tug keeb kwm ntawm cov tshuaj fluoroquinolones.

Tseem cov ntaub ntawv hais txog cov thawj coj ntawm lub tshuaj thaum lub sij hawm cev xeeb tub, tsis, raws li kev kawm ntawm teratogenic los yog embryotoxic nyhuv tsis tau ua.

Nyob rau hauv view ntawm no lub sij hawm "tshuaj" rau cev xeeb tub cov poj niam yuav tsum tau zam, tsuas yog nyob rau hauv tus neeg mob qhov twg lub peev xwm uas yuav muaj thawj coj ntawm lub substance yog qis dua qhov kev pab cuam los ntawm nws.

Nyob rau hauv cov ntaub ntawv ntawm cov tshuaj nyob rau hauv cov neeg mob kev txom nyem los ntawm porphyria, tej zaum yuav ua rau aggravation ntawm tus kab mob.

Nrog tshwj xeeb ceev faj Txoj kev lis ntshav tov yuav tsum tau ua ntawv thov rau cov neeg mob nrog ua ntej txhab ntawm lub hauv paus poob siab system (stroke, plawv tawm tsam, puas hlwb raug mob), vim lub high yuav ua rau muaj convulsive lub xeev.

Rau cov neeg mob uas ua hauj lwm nrog complex mechanisms ntawm kev ua hauj lwm los yog tsav ib lub tsheb, muaj yog tsis muaj tshwj xeeb cov lus qhia, tiam sis xav txog lub tseem phiv nyob rau hauv lub central lub paj hlwb nyob rau hauv daim ntawv ntawm cov tsaug zog, tsis meej pem, thiab lwm tus neeg. Vim li no yuav tsum caiv txhob los ntawm no hom ntawm kev ua hauj lwm.

phiv

Ib tug ntawm cov tseem ceeb tshaj plaws kev phiv uas tsim nyob rau hauv cov neeg mob uas tau txais fluoroquinolones, yog ib tug teeb meem ntawm cov pob txha mos puas tsuaj vim epiphyseal chondrocytes thiab cov ntaub so ntswg xwb. Nyob rau hauv view ntawm cov tshuaj no yog ua rau cov neeg nyob rau hauv 18 lub xyoos ntawm hnub nyoog thiab cev xeeb tub cov poj niam. Nws yuav tsum tau muab sau tseg tias nyob rau hauv cov neeg mob tshaj 18 xyoo ntawm lub hnub nyoog tawm tsam lub backdrop ntawm ntev-lub sij hawm kev siv ntawm cov tshuaj muaj cai tshwm sim ntawm arthralgia los yog tsis ua hauj lwm ntawm cov pob qij txha. Cov lwm sab los yog cov nram qab no.

Nyob rau hauv ib feem ntawm tus mob huam - xeev siab, ntuav, poob qab los noj mov, cov tsos ntawm seeb ncus nyob rau hauv lub epigastric cheeb tsam, tej zaum koj yuav muaj kev hnyuv los ntshav thiab kev loj hlob ntawm Gastroenteritis; nce nyob rau transaminases nyob rau hauv cov ntshav ntshav.

Nyob rau hauv ib feem ntawm lub hauv paus poob siab system - cov kev loj hlob ntawm encephalopathy cov tsos mob, mob taub hau, kiv taub hau, tsis nco qab, pw tsis taus, thiab nquag hloov nyob rau hauv ob peb vas, cov tsos ntawm paresthesias, hallucinations thiab delusions.

Nyob rau hauv ib feem ntawm lub cev - kev loj hlob ntawm kev tsis haum tshuaj xws li daim tawv nqaij sawv pob, khaus, thiab muaj peev xwm tsim photodermatitis muab siab insolation.

Los ntawm cov urinary system - txoj kev loj hlob ntawm crystalluria.

Cov pa system yuav tshwm sim ntawm bronchospasm thiab los ntawm cov circulatory system - cov ntse txo nyob rau hauv cov ntshav siab, hypoglycemia txoj kev loj hlob tshuaj tiv thaiv los ntawm tus xovtooj ntawm hemostasis (nyob rau hauv daim ntawv ntawm cov thrombocytopenia, etc.).

Sis nrog lwm yam tshuaj

fluoroquinolone tshuaj tsis muab ua ke nrog antacids, raws li qhov no ho thiaj li haum thiab bioavailability ntawm tshuaj tua kab mob. Tsis pom zoo simultaneous daim ntawv thov "tshuaj" nrog hlau npaj, raws li zoo raws li cov tshuaj uas cuam tshuam rau kev haumxeeb kev ua ntawm lub hauv paus poob siab system. Tsis tas li ntawd, muaj pov thawj hais txog cov nyhuv ntawm probenecid thiab cimetidine rau lub feem ntawm cov tshuaj (cov tshuaj yog tau txo tshem tawm ntawm tshuaj tua kab mob).

Unambiguous hais txog ntawm cov tshuaj cov kev sib tshuam nrog levofloxacin tsis. Nyob rau hauv view ntawm cov uas tsis muaj cov metabolism hauv cov yeeb tshuaj nyob rau hauv lub hepatic cov ntaub so ntswg thiab cov tsis muaj kev sis raug zoo nrog enzymes ntawm cov pab pawg neeg ntawm cytochrome P450 «tshuaj" tsis hloov lub xeem, tiam sis txawm qhov no, ib yam li lwm cov tswv cuab ntawm fluoroquinolone, cov tshuaj yuav tsum tsis txhob ua ke nrog tshuaj teofilinovogo series thiab indirect anticoagulants, vim ib tug ua tau nce nyob rau hauv lawv cov concentration hauv cov ntshav.

Cov kev siv ntawm cov tshuaj thaum lub sij hawm kev pub niam mis

Rau hnub tim yog tsis muaj cov lus qhia txog cov kev muaj peev xwm ntawm cov tshuaj mus txeem leej niam lub mis. Yog hais tias muaj yog ib tug tseem ceeb ntawm tshuaj tua kab mob thaum lub sij hawm lub mis noj, kawg nres rau lub sij hawm pom zoo (lub caij nyob rau hauv lub heev ntawm tus kab mob thiab yuav tsum ntev ntawm tshuaj tua kab mob kev kho mob). Yog hais tias tsim nyog nyob rau hauv thiaj li yuav muaj lactation tsim periodic siv los yog tso tseg lactation nkaus los ntawm kev kho mob txhais tau tias.

Nyob rau hauv huab, mis-feeding thiab tshuaj tua kab mob tej zaum yuav nyob rau hauv lub soj ntsuam rau tus me nyuam thiab leej niam.

Tso daim ntawv thiab ntau npaum

"Tshuaj" yog ua nyob rau hauv ob hom: rau enteral thiab parenteral thawj coj. Rau qhov ncauj thawj coj muaj ntsiav tshuaj daim ntawv uas muaj 250 los yog 500 mg ntawm cov tshuaj (feem nyob rau hauv cov lag luam tawm cov npe ntawm cov "tshuaj 250" thiab "500 tshuaj"). Rau parenteral thawj coj muaj Txoj kev lis ntshav tov.

"Tshuaj" Ntsiav tshuaj yog npaum li cas 1-2 lub sij hawm ib hnub twg ua ntej noj mov los yog nyob rau hauv nruab nrab ntawm nws txoj kev tsis yog kua, squeezed nrog txaus dej. Nyob rau hauv cov kev tshwm sim ntawm qhov yuav tsum tau mus rau faib lub koob nyob rau hauv ib nrab ntawm cov yeeb tshuaj, cov ntsiav tshuaj yuav txhaum rau ntawm daim ntawv lo rau hauv ob qhov chaw.

Rau parenteral cov thawj coj, cov tshuaj cov kev txhaj tshuaj yog muaj nyob nrog active ingredient ntau ntawm 500 mg / 100 ml ntawm cov kua ( "tshuaj 500"). Nyob rau hauv cov ntaub ntawv ntawm tso dej txhaj tshuaj, cov kev taw qhia ntawm cov tshuaj yog tsis ceev tshaj li 1 teev.

ntxiv txoj kev hloov mus rau lub ntsiav tshuaj daim ntawv no yog pom zoo tom qab Txoj kev lis ntshav thawj coj. Xav ntev nyob rau hauv lub heev ntawm kab mob thiab rhiab heev ntawm pathogenic microorganisms mus rau lub tshuaj tua kab mob. Therapy (txawm yog yus daim ntawv ntawm cov thawj coj) yog xav kom mus ntxiv rau 3-4 hnub tom qab normalization ntawm lub cev kub. Cais kev kho mob thiab thaum ntxov txiav ntawm cov tshuaj yog tsis pom zoo vim hais tias ntawm lub high school uas yuav muaj sab tshua thiab tau txoj kev loj hlob ntawm kuj mus rau yeeb tshuaj microflora.

ceev faj

Ua ntej txoj kev kho siv "tshuaj" phau ntawv qhia obliges tuav kuaj rau microbial hom rhiab heev mus rau yeeb tshuaj. Txawm li cas los, txij li thaum ib tug broad spectrum ntawm kev txiav txim, kev kho mob tej zaum yuav pib tsis muaj kev tus qauv, ua raws li los ntawm kev txiav txim ntawm qhov zoo tshaj tshuaj.

Muab ib tug kho "tshuaj", tshwj xeeb mloog yuav tsum tau them mus rau lub tsom xam tswj ntsuam xyuas lub raum ntshav txaus, txij li thaum lub ib thooj ntawm cov tshuaj yog tas los ntawm ob lub raum nws. Thaum ua txhaum ntawm cov tshuaj kawg koob muaj nuj nqi yuav tsum tau tom nyob rau hauv raws li qhov clearance ntawm endogenous creatinine.

Txoj kev lis ntshav npaj daim ntawv txwv tsis pub mixed nrog kev daws rau tshuaj, uas muaj ib tug alkaline ras txog (sodium bicarbonate), thiab nrog heparin. Rau lub hom phiaj ntawm Txoj kev lis ntshav dilutions rasvor "tshuaj" tau tshaj isotonic sodium tshuaj dawb tov, isotonic zib tov "Ringers".

Thaum lub sij hawm txais tos, "tshuaj" yuav tsum tsis txhob haus dej cawv, hais tias nws pab tau lom nyhuv ntawm levofloxacin rau lub hauv paus poob siab system thiab ntau pronounced manifestation ntawm cov kev phiv.

Yog hais tias, txawm li cas los, txiav txim siab rau lawv tus kheej mus thov cov "tshuaj", cov lus qhia rau kev siv, analogues, yuav tsum tau soj ntsuam zoo zoo, vim hais tias nws yog ib lub fullness ntawm cov ntaub ntawv thiab tso siab rau txaus paub txog cov kev npaj yuav tsum tsis txhob blunders.

Cia thiab mov ntawm cov chaw muag tshuaj

Tshwj xeeb cia tej yam kev mob cov tshuaj tsis yog yuav tsum tau. Nws muaj kev ruaj ntseg yog xyuas kom muaj ambient kub rau 25 degrees Celsius. Los ntawm cov "tshuaj" cov chaw muag tshuaj (tshuaj tua kab mob) tshuaj.

Thaum yuav ib yam khoom yog tsim nyog kiag li them sai sai rau lub sam xeeb thiab kev ruaj ntseg ntawm lub ntim, ntau lawm hnub thiab txee lub neej. Yuav tsum tam sim no nyob rau hauv cov tshuaj box "tshuaj" phau ntawv qhia. Ntsiav tshuaj yuav tsum yog nyob rau hauv high-zoo ntim. Koj yuav nrhiav tau cov tactile kev xav ntawm nws (raws li nws tej zaum yuav zoo li coj txawv txawv). Qhov no yog vim lub fact tias ntau thiab ntau ntau nyob rau hauv tus kws ua lag luam muaj cov counterfeits thiab fakes, uas nyob rau zoo tshaj plaws yog tsis tau muab txaus antibacterial nyhuv thaum noj ntawm ncauj, thiab rau ntawm phem tshaj - ua mob loj heev tshwm sim. Yog li ntawd, tau txais cov tshuaj, tsis txhob yuav tub nkeeg mus nug tus kws muab tshuaj txog cov muaj ib tug zoo daim ntawv pov thawj, lees tias lub keeb kwm ntawm cov tshuaj, "tshuaj" (ntsiav tshuaj). Cov lus qhia rau kev siv (tshuaj muas) yuav tsum muaj ntaub ntawv hais txog lub hauv paus chiv keeb ntawm cov nyiaj.

overdose

Nyob rau hauv cov ntaub ntawv yog tsis muaj kev antidote overdose. Symptomatology nyob rau hauv excess ntawm cov tshuaj yog vim mas tus ntawm lub yav tas rau hauv lub haumxeeb kev ua ntawm lub hauv paus poob siab system. Nyob rau hauv cov ntaub ntawv no muaj cov kev puas hlwb tsis meej pem, kiv taubhau, kiv taub hau, thiab cov tsos mob ntawm lub excitation ntawm poob siab system nyob rau hauv daim ntawv ntawm psychosis, qaug dab peg, thiab lwm tus neeg.

Kev kho mob yog aimed ntawm lub pab feem ntawm cov tshuaj. Muab lub siab bioavailability thiab tis ntawm cov tshuaj thoob plaws hauv lub cev, hemodialysis detoxification txoj kev yog tsis zoo. Nws yog tsim nyog mus lawm ndlwg ntawm cov tshuaj rau hauv lub cev thiab mus nqa tawm symptomatic kev kho mob.

Vim hais tias ntawm cov loj tshem tawm ntawm "tshuaj" los ntawm pom nyob rau hauv lub raum glomeruli zoo txoj kev detoxifying nws yog siv aqueous ntsev daws thiab Txoj kev lis ntshav ntawm diuretic tshuaj voj hom kev txiav txim.

Xyuas ntawm kev npaj

Yeej cai zoo lus teb rau cov tshuaj vim hais tias ntawm nws cov high efficiency rau cov kev kho mob ntawm kis kab mob los ntawm ntau yam etiology. Raws li tau teev nyob rau hauv lub "tshuaj" cov lus qhia rau kev siv ntawm cov tshuaj xyuas yog tshuav tsis tau tsuas yog cov neeg mob, tab sis kuj cov kws kho mob, uas sau tseg rau nws cov high efficiency, mus txog cov kev kho mob ntawm nosocomial thiab nosocomial kab mob.

Tsis zoo xyuas thiab siab cov tshuaj nyob rau hauv lub ntsiab tus neeg mob. Qhov no yog vim txoj kev loj hlob ntawm lawv phiv los yog siv tsis raws cai ntawm "tshuaj". Kev qhia ntawv, txawm li cas los, muab ib tug heev tej ntaub ntawv rau cov khoom no. Tsis zoo xyuas yog vim txoj kev siv cov tshuaj nyob rau hauv tus neeg mob qhov twg nws yog ices vim tsis raws kev cai ntawm lub spectrum ntawm antibacterial kev txiav txim ntawm ib tug microbial kab mob. Nws yuav tsum tau muab sau tseg tias tseem ceeb heev xav feem ntau tawm cov neeg mob rau nws tus kheej-medicate thiab coj nws tus kheej-taw, los yog nyob rau qhov kev pom zoo ntawm cov phooj ywg los yog "tshuaj" cov phooj ywg (qhia nyob rau tib lub sij hawm yog feem ntau tsis quav ntsej li, uas tsis heev pom zoo). Tsis zoo tswv yim los ntawm tus kws kho cov tub txawg yog xyaum tsis cai. Qhov no yog vim qhov tseeb thiab meej pem ntawm kev noj tshuaj (cov lus qhia txog tus "tshuaj 500" phau ntawv muaj txaus cov ntaub ntawv rau kev siv ntawm cov tshuaj).

Drug analogues "tshuaj"

Rau kev npaj "tshuaj" qhia analogs piav raws li nram no: txij li thaum cov tshuaj yog ib tug fluoroquinolone tshuaj tua kab mob levofloxacin, high-qib analogues yuav suav hais tias zoo tag nrho cov tshuaj uas zoo xws li muaj pes tsawg leeg. nws yuav tsum tau muab sau tseg ua ntej ntawm tag nrho cov "Levofloxacin", "huab", "os dej dawb", "Levoksimed" Cov no, thiab ntau lwm tus neeg. Rau "tshuaj" (ntsiav tshuaj) Tus neeg siv daim ntawv thov muab analogs ntawm cov tshuaj xws li "Leflok", "Floksium" thiab lwm tus neeg.

xaus

Lub active tivthaiv "tshuaj" tshuaj - ib tug tshuaj tua kab mob levofloxacin. Nws yog ib qho zoo heev antibacterial neeg sawv cev nrog broad-spectrum bactericidal nyhuv. Vim cov uas tsis muaj cov xwm txheej ntawm cov kev phiv thiab tsis muaj kev kuj mus rau ib qho tshuaj tua kab mob sib txawv kab mob kab mob los, muaj tau ntse thov nyob rau hauv cov kev soj ntsuam xyaum "tshuaj". Cov lus qhia rau kev siv muab heev tej ntaub ntawv hais txog cov kev ua ntawm cov tshuaj.