I-Vancomycin

Isingeniso: Iyini i-Vancomycin?

I-Vancomycin iyi-antibiotic enamandla esetshenziswa kakhulu ekwelapheni izifo ezibangelwa amagciwane ezinkulu. Iyingxenye yeqembu lama-antibiotic aziwa ngokuthi ama-glycopeptides futhi isebenza kahle kakhulu ngokumelene namagciwane ane-Gram-positive, okuhlanganisa izinhlobo ezimelana namanye ama-antibiotic. I-Vancomycin ivame ukugcinelwa izifo ezibangelwa amagciwane ezinzima, ikakhulukazi lezo ezibangelwa yi-methicillin-resistant Staphylococcus aureus (MRSA). Inganikezwa ngokuyinhloko ngemithambo yegazi noma ngomlomo, kuye ngohlobo lokutheleleka okwelashwayo.

Ukusetshenziswa kwe-Vancomycin

I-Vancomycin ivunyelwe ukusetshenziswa kwezokwelapha eziningana, okuhlanganisa:

• Amagciwane Amakhulu: Ngokuvamile isetshenziselwa ukwelapha izifo ezinkulu ezibangelwa amagciwane ane-Gram-positive, ikakhulukazi i-MRSA.
• I-Endocarditis: I-Vancomycin ivame ukusetshenziswa ekwelapheni i-endocarditis, ukutheleleka kwama-valve enhliziyo.
• Ukutheleleka Kwamathambo: Kungasebenza kahle ekwelapheni i-osteomyelitis, ukutheleleka kwamathambo.
• Amagciwane Esikhumba: I-Vancomycin isetshenziselwa izifo zesikhumba eziyinkimbinkimbi kanye nezicubu ezithambile.
• Ukutheleleka kweClostridium difficile: I-vancomycin yomlomo iyindlela yokuqala yokwelapha isifo sohudo esihambisana ne-C. difficile.
• Inyumoniya: Ingasetshenziswa ezimweni ze-pneumonia etholakala esibhedlela noma ehlobene nokuphefumula ebangelwa amagciwane ane-Gram-positive amelana nayo.

Isebenza kanjani?

I-Vancomycin isebenza ngokuvimbela ukwakheka kwezindonga zamaseli ebhaktheriya. Kalula nje, ivimbela amabhaktheriya ekwakheni ungqimba lwawo lwangaphandle oluvikelayo, olubalulekile ekusindeni kwawo. Ngaphandle kodonga lwamaseli oluqinile, amabhaktheriya awakwazi ukugcina isimo sawo noma ubuqotho bawo, okuholela ekufeni kwawo. Le ndlela yenza i-vancomycin isebenze kahle kakhulu ngokumelene namabhaktheriya amelana namanye ama-antibiotic.

Isilinganiso nokuphathwa

Umthamo we-vancomycin uyahlukahluka kuye ngohlobo lokutheleleka, ubudala besiguli, isisindo, kanye nokusebenza kwezinso.

Abantu abadala:

Umthamo ojwayelekile wokufakwa emthanjeni u-15-20 mg/kg njalo emahoreni angu-8-12, kanti umthamo uqondiswa yi-AUC/MIC target engu-400-600 mg?h/L ukuze kuncishiswe ubuthi. Uma kuthathwa ngomlomo, umthamo wokutheleleka kwe-C. difficile uvame ukuba ngu-125-500 mg izikhathi ezine ngosuku izinsuku eziyi-10.

Izingane:

Ezinganeni, umthamo ngokuvamile u-15 mg/kg njalo emahoreni ayi-6 (ubuningi obungu-2 g/ngosuku); lungisa izingane ezisanda kuzalwa/izinsana.

I-Vancomycin inganikezwa ngomjovo emithanjeni (IV) noma ithathwe ngomlomo ngama-capsule noma ngesixazululo somlomo. Indlela yokunikezwa incike ohlotsheni lokutheleleka okwelashwayo.

Imiphumela Engemihle ye-Vancomycin

Imiphumela emibi evamile ye-vancomycin ihlanganisa:

• I-nausea
• Ukuvota
• Uhudo
• Ubuhlungu besisu
• Rash
• Fever

Imiphumela emibi kakhulu ingase ihlanganise:

• Ukulimala kwezinso okubukhali (ukungazweli kahle kwe-nephrogenicity)
• Ukuzwa ukulahlekelwa
• Ukungezwani komzimba okukhulu (anaphylaxis)
• I-Red Man Syndrome (ukushaqeka, ukuqubuka, nokulunywa, ngokuvamile okubangelwa ukumuncwa okusheshayo), ingavinjelwa ngokumuncwa kancane isikhathi esingaphezu kwemizuzu engama-60 kanye nokwelashwa kusengaphambili ngama-antihistamine.
• I-Neutropenia (engavamile)

Iziguli kufanele zibike noma yiziphi izimpawu ezinzima noma ezingajwayelekile kumhlinzeki wazo wezempilo ngokushesha.

Ukusebenzisana kwezidakamizwa

I-Vancomycin ingasebenzisana nemithi eminingana, okungase kwandise ingozi yemiphumela emibi noma kunciphise ukusebenza kahle kwanoma yimuphi umuthi. Ukusebenzisana okukhulu kwemithi kufaka phakathi:

• Ama-Aminoglycosides: Ingozi eyengeziwe yokulimala kwezinso.
• Ama-diuretics e-Loop (isb., i-furosemide): Angandisa ingozi yokuba yingozi yokuzwa (ukulimala kokuzwa).
• Iziphumuli zemisipha: Zingaholela ekuvinjweni okukhulu kwemisipha yezinzwa.
• Amanye ama-antibiotic: Angashintsha ukusebenza kahle kokwelashwa.
• I-Piperacillin-tazobactam: ingozi yokwanda kwe-nephrotoxicity.

Njalo yazisa umhlinzeki wakho wezempilo ngayo yonke imithi oyiphuzayo ukuze ugweme ukuhlangana okungenzeka.

Izinzuzo zeVancomycin

Izinzuzo zezokwelapha zokusebenzisa i-vancomycin zifaka:

• Ukusebenza Ngokumelene Namagciwane Angazweli: Ingenye yama-antibiotic ambalwa asebenza kahle ekulweni ne-MRSA nezinye izinhlobo ezimelana nayo.
• Isebenza kahle ngokumelene namagciwane amaningi ane-Gram-positive.
• Ukuphatha Okuhlukahlukene: Inganikezwa ngemithambo noma ngomlomo, okwenza ifanelekele izinhlobo ezahlukene zezifo.
• Isungulwe Iphrofayela Yokuphepha: I-Vancomycin ibilokhu isetshenziswa amashumi eminyaka, inikeza irekhodi elibhalwe kahle lokuphepha nokusebenza kahle.

Ukuphikisana kwe-Vancomycin

Abantu abathile kufanele bagweme ukusebenzisa i-vancomycin, okuhlanganisa:

• Abesifazane Abakhulelwe: Isigaba C; sebenzisa kuphela uma inzuzo idlula ingozi (idatha elinganiselwe iphakamisa ingozi ephansi yomntwana osanda kuzalwa).
• Iziguli ezinesifo sezinso: Labo abanenkinga yokusebenza kwezinso bangase babe sengozini enkulu yemiphumela emibi.
• I-Alergic: Abantu abanokungezwani komzimba ne-vancomycin noma ezinye zezingxenye zayo akufanele basebenzise lo muthi.

Ukuqapha Nezexwayiso

Ngaphambi kokuqala i-vancomycin, iziguli kufanele zenze izivivinyo ezithile zelebhu, okuhlanganisa:

• Ukuhlolwa Kokusebenza Kwezinso: Ukuhlola ukusebenza kwezinso, njengoba i-vancomycin ikhishwa kakhulu yizinso.
• Ukuhlolwa kokuzwa: Uma kunomlando wezinkinga zokuzwa, i-vancomycin ingabangela ubuthi obungangeni emzimbeni.
• Ukuqapha imithi yokwelapha (TDM) kubalulekile: Umthamo ongaba ngu-10-20 mg/L wezifo ezingathi sína (ngaphambi kokushintshela ku-AUC/MIC).

Iziguli kufanele futhi ziqashwe ukuze zibone izimpawu zokungezwani komzimba kanye nokusebenza kwezinso ngesikhathi sokwelashwa.

Imibuzo Evame Ukubuzwa

• Isetshenziselwani i-vancomycin? I-Vancomycin isetshenziselwa ukwelapha izifo ezibangelwa amagciwane ezinkulu, ikakhulukazi lezo ezibangelwa yi-MRSA kanye ne-C. difficile.
• Isetshenziswa kanjani i-vancomycin? Inganikezwa ngemithambo noma ngomlomo, kuye ngohlobo lokutheleleka.
• Yimiphi imiphumela emibi evamile? Imiphumela emibi evamile ihlanganisa isicanucanu, ukuhlanza, isifo sohudo, nokuqubuka.
• Ngingayithatha yini i-vancomycin uma ngikhulelwe? Kufanele isetshenziswe kuphela ngesikhathi sokukhulelwa uma kudingeka ngokucacile, njengoba idatha yezilwane ibonisa ingozi engaba khona yombungu kodwa idatha yabantu ilinganiselwe.
• Isebenza kanjani i-vancomycin? Ivimbela ukwakheka kodonga lwamaseli ebhaktheriya, okuholela ekufeni kwamagciwane.
• Yini okufanele ngiyenze uma ngiphuthelwa umthamo? Yithathe ngokushesha nje lapho ukhumbula kodwa yeqa uma sekuyisikhathi somthamo olandelayo. Ungaphindi kabili umthamo. Xhumana nomhlinzeki wezempilo uma unesifo esibucayi.
• Ingabe i-vancomycin ingadala umonakalo wezinso? Yebo, kungabangela ukulimala kwezinso, ikakhulukazi ezigulini ezinenkinga yezinso esele zikhona.
• Ingabe i-vancomycin iyasebenza kuwo wonke amagciwane? Cha, isebenza kahle kakhulu ekulweni namagciwane ane-Gram-positive.
• Yini okufanele ngiyigweme lapho ngithatha i-vancomycin? Gwema eminye imithi engalimaza izinso ngaphandle kokuthi udokotela wakho akutshele.
• Kuyoze kube nini ngidinga ukuthatha i-vancomycin? Isikhathi sokwelashwa sincike ohlotsheni kanye nobukhali bokutheleleka, ngokuvamile kusukela ezinsukwini ezingu-7-21 noma ngaphezulu kwezifo ezijulile njenge-osteomyelitis/endocarditis.

Amagama Omkhiqizo

I-Vancomycin itholakala ngaphansi kwamagama emikhiqizo eminingana, okuhlanganisa:

• I-Vancocin
• I-Vancoled
• I-Firvanq (isixazululo somlomo)

Isiphetho

I-Vancomycin iyi-antibiotic ebalulekile ekulweni nokutheleleka okukhulu kwamagciwane, ikakhulukazi lawo abangelwa izinhlobo ezingamelana nayo. Ukusebenza kwayo kahle, ukuguquguquka ekusetshenzisweni kwayo, kanye nephrofayili yokuphepha eqinisekisiwe kuyenza ibe ithuluzi elibalulekile kwezokwelapha zanamuhla. Kodwa-ke, njengayo yonke imithi, iza nemiphumela emibi engaba khona kanye nokusebenzisana okumele kulawulwe ngokucophelela. Njalo xhumana nomhlinzeki wakho wezempilo ukuze uthole iseluleko esiqondene nawe kanye nezinketho zokwelapha.