"Meropenem": mirayiridzo yekushandisa, kuongorora. Drug analogues

Synthetic antibiotics inosanganisira boka remakumbo, iro mumiririri ndiye mishonga "Meropenem" yepamusoro pekutonga. Nokuda kwebhakitiriya uye chiito chechigteriostatic chechigadzirwa chinoshanda, mushonga unokwanisa kukanganisa kukura nekuwedzera kwebhakitiriya inokonzera zvirwere zvakasiyana-siyana zvinopisa.

Tsanangudzo yemishonga

Mushonga uyu "Meropenem" inonzi inofanana nemishonga inorwisa mabhakitiriya uye inenge yakachena kana yakachena pfupa ine shadhi yemazuva ekugadzirira mhinduro. Kutarisira intravenously bolus kana kuvharwa.

Ibudise iyo mumavals ne volume 10 uye 20 ml. Nhamba ye lyophilizate i 0.5 g kana 1 g yemudhi Meropenem. Mapiritsi uye injectable mhinduro yejojo yegumbo uchishandisa mishonga inorwisa mabhakitiriya haigoni kubudiswa. Kune imwe chete nzira yekusunungurwa.

Maitiro ekugadzirira

Sezvo inoshandiswa inoshandiswa inowanikwa musimboti mumhando ye trihydrate. Mutsanangudzo yekuumbwa, yakarongerwa 1 bhodhoro, chiyero chezvinhu zvinoshandiswa zvinoratidzwa: meropenem trihydrate pa 0.570 g, kana kuti 1.140 g, uye nenzira yekusununguka, 0.5 g kana 1 g. Zvinhu zvinobatsira zvehupfu zvinosanganisira sodium carbonate.

Main analogues uye varimi vavo

Chirwere chepakutanga chakavakirwa pamusangano we "meropenem" chinonzi "Meronem" muchimiro cheupfu we 0.5 g. Inoshandiswa kugadzira chirongwa chinoshandiswa, chinotarisirwa mukati. Iyi antibiotic inobudiswa nekambani yeBritish Astra Zeneca Ltd, iyo inokonzerwa nekuumbwa uye kuyerwa kwemishonga yakagadzirirwa, zvipembenene uye zvipatara zvakaedzwa. Izvo zvakasara zvigadziriswa ne-meropenem zvinotorwa sezviripo uye zvinowanikwa zvakare muchimiro chepakutanga.

Mazwi anonzi "Meropenem" anogadzirwa ose pasi pezita rekutengeserana, rinoenderana nevepasi rose risina kodzero, uye pasi pebhizimisi, rakasiyana neyakagamuchirwa INN. Mhando yekusunungurwa, kuyerwa uye kuumbwa kwemishonga yose yakabudiswa muchimiro che "Meronem" pamwe chete, iyo inoratidza kuchinja kwavo.

Mishonga ine zita rekutengeserana "Meropenem" inobudiswa nemiti yakawanda yemishonga pasi rose. Somuenzaniso, kambani yeIndia "M. J. Biofarm Pvt. Ltd. inogadzira mishonga, uye kugovera kunoitwa mubazi reRussia CJSC BIOTEK MIPPDK. Makambani eKukraine "Lekhim", "Pharma Life" inoberekawo ma antibiotic "Meropenem". Nhoroondo dzinogonawo kuva nezita remugadziri muzita ravo. Kune mienzaniso yakawanda munyika yemishonga yepasi. Kunyanya, mushonga we "Meropenem-Vero" unozivikanwa. Ichi ndicho chibereko chekambani yeChina Shenzhen Heibin Pharmaceutical Co. Ltd. ".

Mishonga "Meropenem Jodas" inyanzvi yeIndia yemishonga inorwisa mabhakitiriya yakaitwa naJodas Expo. Yakagadzirwa nenzira yehupfu yekugadzira injection solutions 500 mg uye 1000 mg.

Imwe kambani yeRussia LLC "ABOLmed" inobereka mushonga we "Meropenabol" pachishandiswa antibacterial agent anofarira. Mhinduro yekugadziriswa kwemukati yakagadzirwa kubva muhupfu.

Mushonga we "Meropenem Spencer"

Ichi chishandiso mumwe muIndia anokonzerwa naChristian Pharma kwaSpencer Pharma Yukey Limited, India. Iyo inobudiswa pamusana pekugadzirisa mune maitiro e-trihydrate uye ndeyeboka revanhu vanodhakwa. Mishonga inorwisa mabhakitiriya Meropenem Spencer ine chirwere chinorwisa mabhakitiriya kune britamine gram-positive uye gram-negative muzvirwere zvinopisa uye zvinotapukira. Shandisa parenteral administration.

Pharmacological properties

Izvo zvinokonzera kugadziriswa kwezvinhu zvinoshandiswa pamitemo yekushandiswa zvinoratidzira chiito chebhakitiriki chechidimbu chakawanda, chinosanganiswa nekuderedza kwekuumbwa kwebhakitiriya membrane. Kukwanisa kukonzera kufa kweaerobes uye anaerobes kunokonzerwa nekupinda kwemaantibhakitiriya kuburikidza nemadziro e microorganism, kusatendeseka maererano ne beta-lactamases uye ukama hunokosha nemaitiro eprotini anosunga penicillin.

Nokusungira mapuroteni receptors pamakumbo e-cytoplasm yebhakitiriya, kuderedza peptidoglycan danda mumusero wechitini, uye kubvisa transpeptidase, maitiro ezvimoto mumasero emasero anosunungurwa, achiparadza sarudzo yaro uye kutungamirira kurufu rwechirwere.

Ndezvipi zvipembenene zvinoshandiswa nemishonga inorwisa mabhakitiriya?

Nokuti mushonga we "Meropenem" mirayiridzo yekushandisa inopa kushandiswa kurwisana ne gram-positive aerobes, iyo inosanganisira Enterococcus fecalis, Staphylococcy aureus, Streptococcus agalactia, Streptococcus pneumonia nekunzwisisika
Penicillin, Streptococcus pyogenesis, Streptococcus viridance.

Mishonga inorwisa mabhakitiriya inonyanya kurwisana ne-gram-negative aerobes, pakati peiyo E. coli, Hemofilus influenza, Klebsiella pneumonia, Neisseria meningitis, Pseudomonas auruginosa, Proteus mirabilis inosarudzwa.
Iko kunobvumirana nevanaerobic mabhakitiriya akadai se: Bacteroid flagylis, Peptostreptococcus spp.

Kubudirira kwechirwere kunosimbiswa kupikisa mabhakitiriya anotevera chete ne in vitro zvidzidzo, asi hapana humwe humwe hwehutachiona hunobudirira.
Gram-positive aerobes dzinosanganisira Staphylococcus epidermidis ne-methicillin sensivity, uye Gram-negative aerobes: Acinetobacter spp., Aeromonas hydrophilus, Campylobacter jediuni, Citrobacter diversia, Citroobacter freundi, Enterobacter cloaci, Hafnieh, Klebsiella psitta, Morakella katarrhalis, Morganella Morgani, Pasterella multocida, Proteus vulgaris , Salmonella spp., Serratia marcesens, Shigella spp., Ursina enterocolitis.

Ezvokunambira kunze kwomuviri waamai achirwira anaerobic bacteria :. Bakteroides distasonis, Bakteroides ovatus, Bakteroides uniformis, Bakteroides ureolitikus, Bakteroides vulgaris, Clostridium difficile, Clostridium perfringens, Eubakterium lentum, Fuzobakterium spp, Prevotella bivia, Prevotella intermedia, Prevotella melaninogenika, Porfiromonas asaharolitika, Propionibakterium aknes.

Zvinoshandiswa nemishonga iyi

Pamusana pehuwandu hwemabasa ehushandi hunoshandiswa hunobvumirana, mirayiridzo yekushandiswa inokurudzirwa kuti ishandiswe mune zvirwere zvakasiyana-siyana zvinotapukira uye zvinoputira semishonga yakasiyana kana sechikamu chekubatanidza kurapa.

Izvi zvinosanganisira kuve nehanya nehutachiona hwehutachiona hunoita kuti:

• Maturakiti ekumusoro anoputika, anoratidzwa nepineumonia, kusanganisira chipatara pneumonia;
• Urinary system inomirira pyelonephritis, pyelitis;
• Ganda uye zvinyoro zvinyoro zvinyorwa nenzira ye erysipelas, pyoderma, yechipiri yakakonzerwa nedermatosis;
• Nhengo dziri muduku duku, kusanganisira kuvhiringidza kweutterine mucosa;
• Nhengo dziri mudumbu, kusanganisira mamiriro ezvinhu akaoma appendicitis, peritonitis, pelvioperitonitis.

Mishonga iyi inoshanda muBacterial meningitis uye kuwedzerwa ropa. Vanhu vane febrile neutropenia vanoshandisa iyi antibiotic pamwe chete nemishonga inorwisa maitiro kana maitiro antifungal.

Mirairo yegadziriro yekugadzirisa

Kusagadzikana kwechirwere kunoda kutenderwa ne aseptic uye antiseptic kuchengetedza zviyero. Vivha mabhodhoro ane mhinduro anoshandiswa kamwe chete, haabvumirwi kusanganiswa nemishonga inorwisa mabhakitiriya nemimwe mishonga panguva imwecheteyo.

Antibiotic "Meropenem" nenzira yehupfu yakasvibiswa neisina kuvhara mvura inoshandiswa kuti iwedzere kuwedzera muhutano hutungamiri. Kuti iparadze 1 g yemuviri, 20 ml yemvura inoshandiswa, iyo inofananidzwa nehuwandu hwe 50 mg pam ml. Mvura yakagadzirirwa inowanzojeka, isina ruvara kana kuti yakatsvuka tinge.

Sezvakagadziriswa kumushonga we "Meropenem" unogona kushandisa 50-200 ml yemusanganisi wekodzero yekuenderana. Zvinosanganisira:

• Solution ye sodium chloride 0,9%;
• Mhinduro ye dextrose 5% kana 10%.

Pamberi pehutungamiri hwekutengesa, mvura yakanatswa inozununguswa.

Nhamba yechirwere

Kuvanhu vakuru, mishonga "Meropenem" mirayiridzo yekushandisa inopa mazamu e 500 mg, iyo inodzokororwa mushure memaawa masere. Maererano nechirongwa ichi, pneumonia, zvirwere zvekuvhota, zvirwere zvinotapukira uye zvinoputika zvezvikamu zviri muduku duku, zvirwere zveganda uye mishonga inoshandiswa inobatwa.

Chipatara chinonzi pneumonia, peritonitis, septicemia, zviratidzo zvekutapukirwa kwebhakitiriya kune varwere vane neutropenia febrile vanoda antibiotic katatu pazuva pazuva 1 g.Kubata menititis, chirwere che 2g mushure maawa 8 chinokurudzirwa.

Zvichienderana nehuwandu hwomukati uye rudzi rwezvirwere zvinotapukira zvemuurwere, kuisa uye nguva yehutano kunosarudzwa nachiremba.

Kazhinji, nguva yezvinoshandiswa zvinoenderana nenzira yekugadzirisa. Intravenous bolus kudya kwechinonzi diluted solution inogadzirirwa kwemaminitsi mashanu, uye kuvharirwa kwemukati-kubva pamaminitsi 15 kusvika ku30. Mishonga "Meropenem" haisi iyo inogadziriswa.
Kukanganiswa kwemazuva ekupedzisira kunoda kugadziriswa kwekuita maererano nekusununguka kwekusika :

• Pa 26-50 ml paminiti, chirwere chacho chinobva 500 mg kusvika 2 g, maawa gumi nemaviri;
• Pa 10-25 maminitsi neminiti, chirwere chinobva 250 mg kusvika 1 g, maawa gumi nemaviri;
• Pasingapfuuri 10 maminitsi neminiti, muyero wacho unotanga kubva pa 250 mg kusvika ku 1 g, maawa makumi mana nemaviri.

Varwere vakwegura vane hutano hwemazuva ose uye kubwinya kwechiremera kupfuura mamiriyoni makumi mashanu neminomwe hazvidi kudiwa. Kukundikana kwehepatic haisi chikonzero chekugadzirisa mazai.

Munguva ye hemodialysis, kubviswa kwema-meropenem kunoitika, saka mishonga inotarisirwa pamagumo eitiro. Izvi zvinonyanya kukosha pakurapa kwenguva yakareba kudzorera kushanda kwakasimba kwemishonga inorwisa mabhakitiriya muropa.
Muhuduku kubva pamwedzi mitatu kusvika pamakore gumi nemaviri, 10-20 mg yemishonga pa kg yehutatu hwemuviri inoshandiswa intravenously panguva dzemaawa masere. Chiyero chinoenderana ne causative agent wehutachiona, hunova nehutano kumishonga inorwisa maitiro uye chirwere chechirwere chacho.
Kana vana vane makore pasi pemakore gumi nemaviri vane nzara inopfuura 50 kg, ivo vanorayirwa vakuru maitiro emishonga.

Therapy inobatsira vana vasina kusimba basa rekuita basa risina kudzidza.
Mukurapa kwemainiritis, 40 mg nekg yehutatu hwemuviri inoshandiswa mushure memaawa masere.

Kune avo vanopesana nehutano

Zvakakosha kuziva kuti havasi vose vanogona kushandisa mushonga uyu, kunyanya apo pane kuwedzera hypersensitivity kune iyi antibiotic kana zvakafanana beta-lactam antibacterial agents munguva yakapfuura.

Vana vaduku vasiri pasi pemwedzi mitatu havasi kurongerwa mushonga "Meropenem." Zvipupuriro zvevarwere zvinopupurira mutsika yekuishandisa nemishonga ine zvinokonzera tsvina paitsvo uye zvirwere zvegomba rekudya.
Panguva yekuzvitakura, chirwere hachina kushandiswa, kunze kwematambudziko apo kubatsirwa kwemishonga inorwisa mabhakitiriya kunokunda kukanganisa kwekuvandudza mwana asati aberekwa. Kuberekwa panguva yekurapa hakukurudzirwi navanachiremba.

Zvikanganiso

Pamusoro pezvinodhaka "Meropenem" kuongororwa kunoratidza kuve nekugadzirwa kwezvinhu zvisingadikanwi mumativi akasiyana emuviri.

Nzira yekutya uye nhengo dzemuviri dzinogona kugadzirisa kune remishonga inorwisa mabhakitiriya ine kuratidzwa kwemusoro, chizivo, manzwiro ekushaya simba munharaunda yacho, manzwiro ekudengenyeka uye kusvetuka, kusimba kwakasimudzika mupfungwa, kutyora kwekuziva, kuora mwoyo kweropa, kukanganisa.

Pamusoro pemagetsi emwoyo, nhengo dze hematopoiesis mishonga ine uipi hwakasanganiswa nezvose kuwedzera kwemazana eosinophils uye maplatelet mu plasma yeropa reropa, uye nekuderera kweplatelet uye leukocyte masero, hemoglobin level, kuderera kwehukuru hwehematocrit uye nhamba yeeutrophils inotungamirira ku agranulocytosis, Thromboplastin uye prothrombin nguva.

Vamwe varwere vakaona kuchinja kunobatanidza nhengo dzechipfuva chemuviri, kuratidzwa nemarwadzo mudumbu remuviri, kushungurudza, kusuruvara, chirwere chekuda, kuvhara muviri, kusagadzikana kwekudya, jaundice. Zvinogonawo kuwedzera huwandu hwebilirubin mu plasma yeropa, kuwedzera basa re enzymes alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase uye lactate dehydrogenase. Muzviitiko zvisingawanzoitiki, mamiriro epseudomembranous colitis inokura, kana zvipembenene zve candidiasis zvinowanikwa mumuchengetedze wemumuromo.

Pane zviitiko zvekuputsa kunokonzera genitourinary system. Zvinosanganisira: kuoma kunyorera, kuora kwemamiriro ezvinyoro zvishoma, kusakanganiswa kweeitsvo zvinosanganiswa ne hyperkreatininemia, kuwedzerwa kweurea muropa, hematuria, thrush.

Chiito chemishonga inorwisa mabhakitiriya inogona kukonzera zviratidzo zvakasiyana-siyana zvehutano. Zvinoratidzwa nekutsvaira, kuputika, urticaria, multiforme exudative erythema, Stevens-Johnson syndrome, inouraya epidermal necrolysis, angioedema, anaphylactic shock.

Pakati pezvimwe zvinopikisa, kune mhinduro dze leaching potassium kubva mumuviri, kuwedzerwa kweropa muhuwandu hwemasvomhu, kushandiswa kwakananga kana kusanzwisisika antiglobulin muedzo weCoombs. Maitiro emunharaunda kubva pakubatanidzwa kwemasimba anosangana nekuputika, phlebitis, thrombophlebitis, kunzwa kunorwadza uye kupfugama panzvimbo yejojo.

Vamwe varwere vanoshamwaridzana nekufungidzira, kuora mwoyo, kuwedzerwa kusununguka, kusuruvara, mwoyo kusagadzikana, kusungwa kwemwoyo, tachycardia, bradycardia, mwoyo musikana infarction, kuwedzerwa kweropa, dyspnoea, kukanganisika uye kushungurudzika, kunyange pasina hunodikanwa hwekubatana mune zviratidzo izvi .