Vancomycin

Chiyambi: Kodi Vancomycin ndi chiyani?

Vancomycin ndi mankhwala amphamvu opha tizilombo omwe amagwiritsidwa ntchito makamaka pochiza matenda akuluakulu a bakiteriya. Ndi m'gulu la maantibayotiki otchedwa glycopeptides ndipo amagwira ntchito bwino kwambiri polimbana ndi mabakiteriya okhala ndi Gram-positive, kuphatikizapo mitundu yolimbana ndi maantibayotiki ena. Vancomycin nthawi zambiri imasungidwa ku matenda oopsa, makamaka omwe amayamba chifukwa cha methicillin-resistant Staphylococcus aureus (MRSA). Itha kuperekedwa makamaka kudzera m'mitsempha kapena pakamwa, kutengera mtundu wa matenda omwe akuchiritsidwa.

Ntchito za Vancomycin

Vancomycin yavomerezedwa kuti igwiritsidwe ntchito m'njira zosiyanasiyana zachipatala, kuphatikizapo:

• Matenda Oopsa: Kawirikawiri amagwiritsidwa ntchito pochiza matenda akuluakulu omwe amayamba chifukwa cha mabakiteriya a Gram-positive, makamaka MRSA.
• Endocarditis: Vancomycin nthawi zambiri imagwiritsidwa ntchito pochiza endocarditis, matenda a valve ya mtima.
• Matenda a mafupa: Ikhoza kukhala yothandiza pochiza osteomyelitis, matenda a mafupa.
• Matenda a pakhungu: Vancomycin imagwiritsidwa ntchito pa matenda ovuta a pakhungu ndi minofu yofewa.
• Matenda a Clostridium difficile: Mankhwala oletsa kutsegula m'mimba oyambitsidwa ndi C. difficile ndi oyamba kugwiritsidwa ntchito pochiza matenda otsegula m'mimba.
• Chibayo: Ingagwiritsidwe ntchito ngati chibayo chopezeka kuchipatala kapena chogwirizana ndi mpweya wopumira chomwe chimayambitsidwa ndi mabakiteriya a Gram-positive omwe sagonjetsedwa.

Kodi Ntchito?

Vancomycin imagwira ntchito poletsa kupanga makoma a maselo a bakiteriya. Mwachidule, imaletsa mabakiteriya kumanga gawo lawo lakunja loteteza, lomwe ndi lofunika kwambiri kuti apulumuke. Popanda khoma lolimba la maselo, mabakiteriya sangasunge mawonekedwe awo kapena umphumphu wawo, zomwe zimapangitsa kuti afe. ​​Njira imeneyi imapangitsa vancomycin kukhala yothandiza kwambiri polimbana ndi mabakiteriya omwe sagonjetsedwa ndi maantibayotiki ena.

Mlingo ndi Utsogoleri

Mlingo wa vancomycin umasiyana malinga ndi mtundu wa matenda, zaka za wodwalayo, kulemera kwake, ndi momwe impso zake zimagwirira ntchito.

Akuluakulu:

Mlingo wamba wa 15-20 mg/kg maola 8-12 aliwonse, ndipo mlingo wotsogozedwa ndi cholinga cha AUC/MIC cha 400-600 mg?h/L kuti muchepetse poizoni. Pakumwa, mlingo wa matenda a C. difficile nthawi zambiri umakhala 125-500 mg kanayi patsiku kwa masiku 10.

Zachipatala:

Kwa ana, mlingo nthawi zambiri umakhala 15 mg/kg maola 6 aliwonse (osapitirira 2 g/tsiku); sinthani kwa akhanda/makanda.

Vancomycin ikhoza kuperekedwa kudzera mu jakisoni mu mitsempha (IV) kapena kumwedwa m'mapiritsi kapena madzi omwa. Njira yoperekera mankhwalawa imadalira mtundu wa matenda omwe akuchiritsidwa.

Zotsatirapo za Vancomycin

Zotsatira zoyipa zomwe zimapezeka chifukwa cha vancomycin ndi izi:

• nseru
• kusanza
• kutsekula
• ululu m'mimba
• Rash
• malungo

Zotsatira zoyipa zingaphatikizepo:

• Kuvulala kwa impso mwachangu (kuopsa kwa impso)
• Kumva kutayika
• Zotsatira zoyipa kwambiri (anaphylaxis)
• Matenda a Red Man (kutuluka thukuta, ziphuphu, ndi kuyabwa, nthawi zambiri kumachitika chifukwa cha kulowetsedwa mwachangu), komwe kungapeweke mwa kulowetsedwa pang'onopang'ono kwa mphindi 60 ndikupatsidwa mankhwala oletsa antihistamines.
• Neutropenia (yosowa)

Odwala ayenera kufotokoza zizindikiro zilizonse zoopsa kapena zachilendo kwa wothandizira zaumoyo wawo mwamsanga.

Kuyanjana kwa Mankhwala

Vancomycin imatha kuyanjana ndi mankhwala angapo, zomwe zingawonjezere chiopsezo cha zotsatirapo zoyipa kapena kuchepetsa mphamvu ya mankhwala aliwonse. Kuyanjana kwakukulu kwa mankhwala ndi monga:

• Aminoglycosides: Kuwonjezeka kwa chiopsezo cha kuwonongeka kwa impso.
• Mankhwala oletsa kumva (monga furosemide): Angawonjezere chiopsezo cha poizoni m'thupi (kuwonongeka kwa kumva).
• Zotsitsimula minofu: Zingayambitse kutsekeka kwa mitsempha ya mitsempha.
• Maantibayotiki ena: Angasinthe momwe mankhwala amagwirira ntchito.
• Piperacillin-tazobactam: chiopsezo chowonjezeka cha nephrotoxicity.

Nthawi zonse dziwitsani dokotala wanu za mankhwala onse omwe mukumwa kuti mupewe kuyanjana ndi mankhwala ena.

Ubwino wa Vancomycin

Ubwino wa mankhwala ogwiritsira ntchito vancomycin ndi monga:

• Kuchita Bwino Polimbana ndi Mabakiteriya Osamva: Ndi imodzi mwa maantibayotiki ochepa omwe amagwira ntchito bwino polimbana ndi MRSA ndi mitundu ina yolimbana ndi matendawa.
• Yogwira ntchito motsutsana ndi mabakiteriya ambiri a Gram-positive.
• Utsogoleri Wosiyanasiyana: Ikhoza kuperekedwa kudzera m'mitsempha kapena pakamwa, zomwe zimapangitsa kuti ikhale yoyenera matenda osiyanasiyana.
• Mbiri Yachitetezo Yokhazikitsidwa: Vancomycin yakhala ikugwiritsidwa ntchito kwa zaka zambiri, zomwe zikusonyeza kuti chitetezo ndi mphamvu zake zili bwino.

Zotsutsana ndi Vancomycin

Anthu ena ayenera kupewa kugwiritsa ntchito vancomycin, kuphatikizapo:

• Azimayi Oyembekezera: Gulu C; gwiritsani ntchito pokhapokha ngati phindu likuposa chiopsezo (deta yochepa ikusonyeza chiopsezo chochepa cha mwana wosabadwayo).
• Odwala ndi Impso: Anthu omwe ali ndi vuto la impso akhoza kukhala pachiwopsezo chachikulu cha zotsatirapo zoyipa.
• Zomwe Zingachitike: Anthu omwe ali ndi vuto lodziwika bwino la kusagwirizana ndi vancomycin kapena chilichonse mwa zigawo zake sayenera kugwiritsa ntchito mankhwalawa.

Kusamala ndi machenjezo

Odwala asanayambe kumwa vancomycin ayenera kuyesedwa mayeso ena a labu, kuphatikizapo:

• Kuyeza Ntchito ya Impso: Kuwunika momwe impso zimagwirira ntchito, chifukwa vancomycin imachotsedwa makamaka ndi impso.
• Mayeso akumva: Ngati pali mbiri ya mavuto a kumva, vancomycin ingayambitse poizoni wa ototoxicity.
• Kuwunika mankhwala ochizira (TDM) kofunikira: Kufikira 10-20 mg/L pa matenda akuluakulu (musanayambe kusinthira ku AUC/MIC).

Odwala ayeneranso kuyang'aniridwa kuti awone ngati ali ndi zizindikiro za ziwengo komanso ngati impso sizikugwira ntchito bwino panthawi ya chithandizo.

Ibibazo

• Kodi vancomycin imagwiritsidwa ntchito pa chiyani? Vancomycin imagwiritsidwa ntchito pochiza matenda akuluakulu a bakiteriya, makamaka omwe amayamba chifukwa cha MRSA ndi C. difficile.
• Kodi vancomycin imaperekedwa bwanji? Ikhoza kuperekedwa kudzera m'mitsempha kapena pakamwa, kutengera mtundu wa matenda.
• Zotsatira zoyipa zomwe zimachitika nthawi zambiri ndi zotani? Zotsatira zodziwika bwino ndi monga nseru, kusanza, kutsekula m'mimba, ndi zidzolo.
• Kodi ndingatenge vancomycin ngati ndili ndi pakati? Iyenera kugwiritsidwa ntchito panthawi ya mimba pokhapokha ngati pakufunika kutero, chifukwa deta ya nyama imasonyeza chiopsezo cha mwana wosabadwayo koma deta ya anthu ndi yochepa.
• Kodi vancomycin imagwira ntchito bwanji? Zimalepheretsa kupanga makoma a mabakiteriya, zomwe zimapangitsa kuti mabakiteriya afe.
• Kodi ndingatani ndikaphonya mlingo? Imwani mwamsanga mukangokumbukira koma musaigwiritse ntchito ngati nthawi yatsala pang'ono kuyamba kumwa mankhwala ena. Musawirikize kawiri mlingo. Funsani dokotala ngati muli ndi matenda oopsa.
• Kodi vancomycin ingayambitse kuwonongeka kwa impso? Inde, zimatha kuwononga impso, makamaka kwa odwala omwe ali ndi vuto la impso.
• Kodi vancomycin imagwira ntchito polimbana ndi mabakiteriya onse? Ayi, imagwira ntchito bwino kwambiri polimbana ndi mabakiteriya okhala ndi Gram-positive.
• Kodi ndiyenera kupewa chiyani ndikamamwa vancomycin? Pewani mankhwala ena omwe angawononge impso pokhapokha ngati dokotala wanu wakupatsani malangizo.
• Kodi ndiyenera kumwa vancomycin kwa nthawi yayitali bwanji? Kutalika kwa chithandizo kumadalira mtundu ndi kuopsa kwa matendawa, nthawi zambiri kuyambira masiku 7-21 kapena kupitirira apo pa matenda ozama kwambiri monga osteomyelitis/endocarditis.

Mayina A Brand

Vancomycin imapezeka pansi pa mayina angapo a makampani, kuphatikizapo:

• Vancocin
• Vancoled
• Firvanq (mankhwala omwa)

Kutsiliza

Vancomycin ndi mankhwala opha tizilombo ofunikira kwambiri polimbana ndi matenda akuluakulu a bakiteriya, makamaka omwe amayamba chifukwa cha mitundu yosagonja. Kugwira ntchito kwake bwino, kusinthasintha kwake popereka mankhwala, komanso chitetezo chake chokhazikika zimapangitsa kuti ikhale chida chofunikira kwambiri mu zamankhwala amakono. Komabe, monga mankhwala onse, imabwera ndi zotsatirapo zoyipa komanso kuyanjana komwe kuyenera kusamalidwa mosamala. Nthawi zonse funsani dokotala wanu kuti akupatseni upangiri ndi njira zina zochiritsira.