"Amphotericin B": kurayirirwa, nzira yekuita. Mhinduro dzevarwere pamusoro pemishonga

Fungal ganda rezvipembenene rinounza kuvhiringidza kukuru kumurwere. Uyezve, zvirwere zvakadaro zvinopararira. Saka, apo zviratidzo zvekutanga zvefungus zvinoonekwa, iwe unofanira kugara uchingosangana nemumwe nyanzvi. Mushure mokunge kuendeswa kuongororwa kwezvokurapa uye zvimwe zviongorori chiremba anofanirwa kuisa mishonga inoshanda kumurwere.

Kazhinji, mafuta anosiyana uye mapiritsi anoshandiswa kurapa zvirwere zvefungal. Asi zvakadaro, vanachiremba vazhinji vanoti chirwere chakadaro chinotapurirwa zviri nani nemajekiseni epachivharo. Mushure mokunge majekiseni, mushonga wacho uchangotanga kuchinja ma microorganisms, anoratidza kusanzwisisika kwahwo.

Nzira dzakanakisisa uye dzinoshanda dzekubvisa zvirwere zvefungal dzinosanganisira mushonga we "Amphotericin B". Mafambiro, mafomu ekubudisa uye kuongororwa pamusoro pemishonga iyi ichaiswa pasi apa.

Fomu, kuumbwa, tsanangudzo uye kuiswa kwemishonga inorwisa mabhakitiriya

Iwe unogona kutenga mishonga iri mumhando inotevera:

• Lphiphilisate "Amphotericin B". Idzodzo dzinoti chimiro chechirwere ichi chinonzi porous, hygroscopic, masikati machena pasina chinyorwa chinonhuwira. Iyo yakagadzirirwa kugadzirira sarudzo yekugadzirisa. Icho chinoshanda chechirwere ichi ndiAmphotericin B. Sezvipo zvekubatsira, zvinhu zvakadai sa monosodium phosphate uye desoxycholic acid zvinoshandiswa. Pakutengesa mishonga iyi inouya mu 10 ml mhepo uye mapepa emakadhibhodi.

• Mafuta "Amphotericin B". Kushandiswa kwemuenzi uyu kunoratidzwa sechimwe chirwere mumishonga yakaoma. Mafuta antifungal anoshandiswa chete kunze. Iine ruvara rwezuva uye rine chinhu chakafanana chinoshanda. Kana zviri zvezvikamu zvinowedzera, vanoshandisa vaseline mafuta, Vaseline yezvehutano uye polysorbate 80. Vanogona kutengwa mumatope ane 30 kana 15 g.

Icho chinogadzirisa chiito chechirwere chinoshandiswa

Chii chinonzi "Amphotericin B"? Mirayiridzo yekushandiswa (mahwendefa ane chinhu chimwe chete chinoshanda chinowanikwa zvakaoma) inoshuma kuti iyo macrocyclic polyene antibiotic ine basa rekuita. Iyo inobudiswa neStptomyces nodosus, uye inewo fungistatic uye fungicidal effect (inobva mukufungidzira kwechirwere muzvinhu zvinokonzerwa nehupenyu uye kushushikana kwepathogen).

Mushure mokunge muwana mushonga muropa remvura, unosunga kune sterols iri muchitokisi chemukati memushuvha iyo inofanirwa nemishonga. Somugumisiro wekukanganisa kwakadaro, kukwana kwavo kunokanganiswa uye inhengo ye-intracellular inodzingwa kune imwe nzvimbo yekushambadzira.

Iyo mishonga "Amphotericin B" inoshanda mukurwisana nematambudziko akawanda uye inonyatsoshanda mukurwisa fungi nyore.

Uye zvakare zvinofanira kuonekwa kuti Fusarium spp. Uye Pseudallescheria boydii. Mukuwedzera, ichi chirwere hachibatsiri kurwisa rickettsia, mabhakitiriya uye mavairasi.

Kinetic zvinhu zvechirwere

Iye zvino unoziva kuti chii chinonzi mishonga inopisa, yakadai se "Amphotericin B". Iyo nzira yekuita kweiyo mujeri yakatsanangurwa pamusoro apa.

Mushure mekutengesa kwepachirwere kwechirwere mune imwe nhengo muropa rinokurumidza kusimbisa kukanganisa kwayo, iyo inopfuurira zuva rose. Iine mapuroteni eplasma, ichi chinodhaka chinosunga kusvika 90 muzana.

Mishonga iri mubvunzo inoparidzirwa muropa, mapapu, itsvo, spleen, mishonga, adrenal glands uye mune dzimwe nhengo uye mishonga. Iyo yakanyanyogadziriswa muchishuvo chekunyengera, synovial uye peritoneal fluids, pamwe chete nehutu hwemhepo inosvika 2/3 yekushungurudzwa muropa.

Nzira dze metabolism yemujaira uyu hazvizivikanwi. Mumuginha uye bile, anenge 98 kubva muzana yemishonga iripo mune maitiro e metabolites. Iyo inobviswa zvishoma nezvishoma, kuburikidza neitsvo. Chikamu chokutanga-hupenyu hwechirwere muvanhu vakuru maawa makumi maviri nemaviri, muvana vana maawa makumi matanhatu nemaawa makumi mana, uye mumangwana maawa 20-60. Chikamu chokupedzisira-hupenyu mazuva gumi nemashanu.

Zviratidzo zvemishonga inorwisa mabhakitiriya

Ndezvipi zvirwere zvinobata chirwere ichi Amphotericin B? Iyo inorayirwa kuenderera mberi, kutyisa hutachiona hwehutachiona hunokonzerwa nehutachiona husingaoneki:

• Histoplasmosis, kuparadzirwa cryptococcosis, coccidioidosis;
• Cryptococcal meningitis, paracoccidioidosis, chromomycosis;
• Meningitis inokonzerwa nemamwe fungi, North America blastomycosis;
• Kuparidzirwa uye kusapisa aspergillosis, fikomycosis (zygomycosis);
• Kuparidzirwa maitiro e candidiasis, hyalogomycosis;
• Fungal mycosis, chronic mycetoma;
• Yakaparadzirwa sporotrichosis, zvirwere zvepamuviri (kusanganisira peritonitis);
• Endophthalmitis, endocarditis, fungal sepsis;
• Visceral leishmaniasis, fungal zvirwere zveurinary tract;
• American skin-visceral leishmaniasis.

Contraindications antifungal agents

Funga kuti chii chinorambidza kushandiswa kwechirwere Amphotericin B (mahwendefa kubva fungi ane zita rakafanana haana kubudiswa). Maererano nemirayiridzo, mhinduro iyi inopesana:

• Nekukundikana kusingaperi kwetsva;
• Ne hypersensitivity;
• Munguva yenguva yekuyamwisa.

Nekuchenjerera iyi mishonga inoshandiswa kune zvirwere zvepfungwa (kusanganisira glomerulonephritis), amyloidosis, chiropa chinonzi cirrhosis, hepatitis, anemia, agranulocytosis, pamuviri uye chirwere cheshuga.

Amphotericin B lyophilizate: mirayiridzo yekushandiswa

Kugadzirira mushonga wegadziriro, iko kugadzirira kunoshandiswa nekutangira kwema 5 mg / ml. Uchishandisa sirinete yakasviba, 10 ml yemvura yejojo inowanikwa muchirwere ichi nemishonga. Uyezve, zviri mukati maro zvinodengenyeka kusvikira zvakajeka, colloidal liquid forms.

Intravenously, zvinodhaka zvinotarisirwa mukati mehafu yeawa pasi pekutongerwa kweropa, kupisa kwemuviri uye kurwara kwemurwere. Kana mushonga wacho wakanyatsorambidzwa, chirongwa chacho chezuva nezuva chinonzi 0.25-0.3 mg pa kg yehutatu hwehuviri (zvichienderana nekuoma kwechirwere).

Nemwoyo uye zvirwere zvevascular, hypersensitivity uye kusagadzikana kwepfungwa, mushonga unotanga nemikana shoma (5-10 mg), iyo inowedzera zvishoma nezvishoma ne5-10 mg pazuva uye yakashandurwa kusvika kune 0.5-0.7 mg nekg.

Ne sporotrichosis, chirongwa chechirwere chechirwere chiri 2.5 g, uye nguva yerapi inenge mwedzi 9.

MuAperpergillosis, muyero wacho ndewe 3.6 g, uye nguva yekurapa inenge mwedzi gumi nemana.

Vana pavanotanga kurapa vanopiwa 0.25 mg nekg yehutemi hwezuva nezuva, uye zvishoma nezvishoma kuwedzera kusvika pakuwandisa kwero (1 mg nekg).

Mafuta "Amphotericin B": mirayiridzo yekushandiswa

Matethe pasi pezita rakafanana rekutengeserana mu pharmacy haritengeswi. Saka, kutora mishonga iyi iwe unofanirwa kubvunza chiremba.

Kana iwe uchida kushandisa "Amphotericin B" mafuta, shandisa uwandu hwakatsetseka kune nzvimbo dzakabatwa kaviri pazuva. Nzira yekurapa inobva pane zvinoratidzwa:

• Ne candidiasis mapepa eganda - anenge masvondo matatu;
• Nekumhanya kwevana mudiki-mazuva manomwe kusvika ku14;
• Pa paronychia uye zvipembenene zvezvivako zvemukati - mavhiki 2-4.

Zvikanganiso

Iyo mishonga "Amphotericin B" inogona kukonzera zvinotevera migumisiro inotevera:

• Musoro, kuputika, purogiramu yeuropathy, transitory vertigo, encephalopathy;
• Kuderedza kudya kudya, kurutsa, dyspepsia, nausea, gastralgia, diarrhea, hepatotoxicity, hepatic insufficiency, jaundice, hepatitis, melena, hemorrhagic gastroenteritis;
• Normochromic normocytic anemia, leukopenia, kuvhara mhirizhonga, thrombocytopenia, agranulocytosis, hemolytic anemia, eosinophilia, leukocytosis;
• Kuora mwoyo, kurasikirwa kwekunzwa, diplopia, tinnitus;
• Tachypnea, dyspnea, pulmonary edema, arrhythmia uye allergenic pneumonitis;
• Kuderedza kana kuwedzerwa muropa, kuchenesa, kuchinja mu ECG zviratidzo, kusungwa kwemoyo, kushungurudzika, kukanganisa mwoyo;
• Kugadziriswa kweAnaphylactoid, kupopota, nephrogenic diabetes insipidus, bronchospasm, nephrocalcinosis, rash, exfoliative dermatitis, chepidermal necrolysis
• Renal kushandeka, hypokalemia, hypostenuria, renal tubular acidosis, Stevens-Johnson syndrome, kusagadzikana kwemazino, oliguria, anuria;
• Thrombophlebitis uye kupisa panzvimbo yejojo;
• Fever, myalgia, kuora muviri, arthralgia, kushaya simba.

Mhosva yekudarika

Paunenge uchitakura maitiro makuru emishonga, murwere anogona kumira pakufema uye mwoyo kusakundikana. Nokudaro, panguva yerapi iyo inofanira kunyatsoteerera kudii inorayirwa. Izvo zvinodiwawo kuongorora basa rekupumha uye chiitiko chemoyo, tsvete uye chiropa chinoshanda, mufananidzo wehutachiona ropa, pamwe nehuwandu hwe electrolytes mauri.

Kubatana nemimwe mishonga

Mushonga we "Amphotericin B" unogona kusimbisa kana kuderedza kushanda kwemamwe madhiragi, uyewo kuwedzerwa kuora. Panyaya iyi, iyi mishonga ine kungwarira inorayirwa mune zvakaoma kurapa.

Pakugadza mushonga uyu, murwere anofanira kuva nechokwadi chekuudza chiremba wake nezvekutora mamwe mishonga. Kana zvisina kudaro, kushandiswa kwe "Amphotericin B" (kukanganisa) kungakanganisa hutano uye hupenyu hune hupenyu hwomunhu.

Mazano Anokosha

• Iyo mishonga "Amphotericin B" inofanira kushandiswa chete kuraramisa hupenyu hunotyisa uye zvirwere zvinopfuurira zvirwere.
• Nekushandisa kwenguva refu, mukana wekuvandudza dambudziko rinowedzera.
• Kana chirwere chinopera simba chichiitika, kushandiswa kwemishonga kunofanira kubviswa.

Ongororo

Iye zvino unoziva kuti mushonga uyu "Amphotericin B" unoshanda sei. Kusimudzirwa nezita iri mune pharmacy hakutengeswi. Nokudaro, pakunyorera mumuromo, iwe unofanirwa kusarudza imwe mishonga nemigumisiro yakafanana.

Maererano nevarwere vazhinji, izvi zvinoreva kubudirira kubata nemabasa. Iyo inobata zvakakwana fungal yezvipembenene zveganda, kubvisa kusagadzikana kwomuviri uye kwepfungwa.

Iko kutsvaga kukuru kwechirwere ichi ndiko kuvapo kwenhamba yakawanda yemigumisiro. Mukati yekurapa newayi mumiririri, kupindura kusingadikanwi kunogona kuratidzirwa nhengo dzese uye zvirongwa. Saka, inofanira kushandiswa chete pane zviratidzo zvakasiyana.