Azithromycin rau cov menyuam yaus muaj qee yam kev kho mob ntawm cov kab mob tso zis, tab sis ntau tus neeg mob tsis paub txaus txog kev kis kab mob tso zis, thiab lawv tsis nkag siab qhov ua tau zoo ntawm Azithromycin. Tam sim no kuv yuav teb cov lus nug hauv qab no.
Azithromycin ntsiav tshuaj, qhov taw qhia rau cov khoom no haum rau cov kab mob hauv qab no tshwm sim los ntawm cov kab mob rhiab: mob ntsws, mob ntsws thiab lwm yam kab mob ua pa hauv qab; kab mob ntawm daim tawv nqaij thiab cov nqaij mos; mob otitis media; sinusitis, pharyngitis, tonsillitis thiab lwm yam kab mob ua pa sab saud Azithromycin tuaj yeem tshem tawm oropharyngeal Streptococcus tau zoo, tab sis tsis muaj cov ntaub ntawv qhia txog kev ua tau zoo ntawm Azithromycin hauv kev kho thiab tiv thaiv kev kub taub hau.
Azithromycin tuaj yeem siv rau kev kis kab mob yooj yim los ntawm Chlamydia trachomatis hauv kev sib deev kis kab mob ntawm txiv neej thiab poj niam. Azithromycin kuj tseem tuaj yeem siv rau kev kis kab mob yooj yim los ntawm kev tsis muaj tshuaj ntau yam tiv thaiv Neisseria gonorrhoeae thiab chancroid tshwm sim los ntawm Haemophilus duke.
Mob txeeb zis kab mob sib kis (UTI) hais txog cov kab mob uas nkag mus rau hauv cov hlab zis ncaj qha, loj hlob thiab ua ntau ntxiv hauv cov zis, thiab ua rau cov hlab zis tso zis los yog cov ntaub so ntswg ua rau puas tsuaj. Raws li qhov sib txawv ntawm cov kab mob kev cuam tshuam, nws tau muab faib ua pyelonephritis, cystitis, thiab urethritis.
Pyelonephritis kuj tseem hu ua kab mob sib kis hauv cov hlab ntshav, thaum cov kab mob cystitis thiab urethritis tau sau ua ke qis dua mob txeeb zig kab mob. Vim tias kev kis tus kab mob tsawg tsawg rau qee qhov ntawm cov zis thaum menyuam yaus, thiab nws nyuaj rau nrhiav nws hauv tsev kho mob, nws feem ntau hu ua UTI yam tsis muaj qhov txawv. Raws li cov tsos mob ntawm tus mob, nws tuaj yeem faib ua cov tsos mob ntawm cov kab mob tso zis (UTI) thiab asymptomatic bacteriuria.
Raws li kev tshawb fawb hauv tebchaws tau ua nyob hauv Suav teb xyoo 1982, cov kab mob tso zis muaj txog 8.5% ntawm cov kab mob hauv cov kab ke no. Xyoo 1987, raws li kev txheeb cais ntawm cov menyuam yaus kuaj zis hauv 21 lub xeev thiab nroog thoob plaws tebchaws, UTI suav txog 12.5% ntawm cov menyuam yaus tso zis tso zis. Txawm hais tias yog neeg laus lossis menyuam yaus, qhov tshwm sim ntawm poj niam UTIs feem ntau siab dua li txiv neej, tab sis qhov xwm txheej ntawm txiv neej yog siab dua li poj niam hauv cov menyuam yug tshiab lossis menyuam mos ntxov.
A. Mob kis
B. Rov tshwm sim thiab rov kho dua
Kev rov qab los txhais tau tias cov kab mob bacteriuria dhau los ua qhov tsis zoo ib ntus tom qab kho, thiab cov kab mob tshwm sim thawj zaug tshwm sim nyob rau lub sijhawm luv (6 lub lis piam) tom qab siv tshuaj, thiab cov tsos mob rov tshwm sim. Kev rov kis mob yog hais txog kev kis tus kab mob uas tau kho tom qab kho tas thiab tshwm sim los ntawm lwm yam kab mob nkag mus rau hauv cov hlab zis ntev (feem ntau 6 lub lis piam) tom qab siv tshuaj.
C. Mob kis
Lub sijhawm ntawm tus kabmob yog ntau dua 6 lub hlis. Pyuria lossis bacteriuria tuaj yeem tshwm sim tsis tu ncua. Cov neeg uas muaj kab mob ntev yuav muaj ntshav tsis txaus, qaug zog, thiab ncua kev loj hlob.
Txhua yam kab mob hauv lub cev tuaj yeem ua rau UTI, tab sis feem ntau ntawm lawv yog Gram-negative bacilli, xws li Escherichia coli, Para Escherichia coli, Proteus, Klebsiella, Pseudomonas aeruginosa, thiab ob peb yog Enterococcus thiab Staphylococcus. Escherichia coli yog kab mob ntau tshaj plaws hauv UTI, kwv yees li 60%-80%. Rau cov menyuam yug tshiab raug kev txom nyem los ntawm UTI thawj zaug, cov menyuam ntxhais ntawm txhua lub hnub nyoog thiab cov tub hluas muaj hnub nyoog qis dua ib xyoos, cov kab mob tseem ceeb tseem yog Escherichia coli, thaum nyob hauv cov tub hluas hnub nyoog tshaj ib xyoos, cov kab mob tseem ceeb feem ntau yog Proteus. Rau cov menyuam ntxhais hnub nyoog 10-16, Staphylococcus albicans kuj tseem muaj, thiab Klebsiella thiab Enterococcus muaj ntau dua rau cov menyuam yug tshiab.
Lub hom phiaj ntawm kev kho mob yog tswj hwm cov tsos mob, tshem tawm cov kab mob, tshem tawm cov yam ntxwv ua ntej, thiab tiv thaiv kev rov tshwm sim.
Cov hauv paus ntsiab lus rau xaiv cov tshuaj tua kab mob:
Azithromycin yog lub cim tshiab ntawm macrolide tshuaj tua kab mob. Nws cov kab mob tua kab mob yog dav dua erythromycin tshuaj. Nws muaj cov tshuaj tua kab mob muaj zog tiv thaiv kab mob gram-negative xws li Neisseria gonorrhoeae ntau dua li erythromycin. Nws kuj tseem muaj txiaj ntsig zoo rau Chlamydia trachomatis thiab Ureaplasma urealyticum. Yog tias koj haus mis nyuj hauv tsev, Ballya kuj tuaj yeem ua tau macrolides kuaj qhia rau koj paub yog tias muaj macrolides seem hauv cov mis koj haus.
Azithromycin tau nqus tau zoo ntawm qhov ncauj, nrog kev mob siab rau hauv cov ntaub so ntswg, lub neej ib nrab ntev (2 txog 3 hnub), thiab muaj kev nkag siab siab hauv cov kab mob urogenital, prostate thiab lwm cov ntaub so ntswg. Yog li, nws nquag siv hauv tsev kho mob los kho tus mob Neisseria gonorrhoeae, Chlamydia trachomatis thiab Urea Urogenital kis los ntawm lub cev qub.
Azithromycin ntsiav tshuaj tau siv los kho kab mob sib kis. Feem ntau, cov tsos mob yuav raug tshem tawm tom qab peb hnub sib law liag, thiab ntxiv dag zog rau peb hnub tom ntej. Cov txheej txheem kho thiab siv txoj hauv kev yog raws li hauv qab no: faib cov dej thiab nqos nws qhov ncauj.
Cov neeg laus: Rau kev sib deev kis kab mob los ntawm Chlamydia trachomatis lossis Neisseria gonorrhoeae, tsuas yog 1.0g ntawm cov khoom no yuav tsum tau noj qhov ncauj ib zaug. Kev kho mob lwm yam kab mob: tag nrho koob tshuaj yog 1.5g, faib ua peb koob; 0.5g ntawm cov khoom no tau noj ib zaug ib hnub. Los yog tag nrho cov tshuaj yog tib yam, tseem yog 1.5g, noj 0.5g ntawm thawj hnub, tom qab ntawd siv 0.25g ntawm cov khoom no ib hnub ib hnub txij li hnub thib ob txog rau hnub thib tsib.
Tus neeg mob uas raug tus kab mob tso zis yuav tsum tau kho lub sijhawm, tab sis ua tib zoo saib xyuas cov tshuaj raws li kev qhia ntawm kws kho mob, thiab tsis txhob siv tshuaj yam tsis tau kev tso cai, uas yuav ua rau muaj kev phom sij. Haus dej kom ntau thiab yaug cov zis kom txo qhov mob.
Txawm li cas los xij, qee tus kws kho mob qhia tias azithromycin tsis muaj txiaj ntsig zoo los kho cov kab mob tso zis. Nws yog qhov zoo tshaj los noj cephalosporins thiab levofloxacin. Yog tias koj tsis xis nyob, koj yuav tsum mus rau tom tsev kho mob kom kuaj koj cov zis li niaj zaus thiab ua raws koj tus kws kho mob cov lus qhia. Ib txwm haus dej ntau thiab tso zis ntau ntxiv.
Cov tshuaj tua kab mob hauv qab no feem ntau yog siv los kho tus kab mob UTI yooj yim (mob cystitis): nitrofurantoin tshuaj, fosfomycin, sulfamethoxazole-trimethoprim. Cov kws kho mob yuav tsum xaiv tshuaj tua kab mob raws li tus neeg mob keeb kwm kev kho mob, hom UTI, cov ntaub ntawv tiv thaiv tshuaj hauv ib cheeb tsam, thiab tus nqi. Thawj cov tshuaj feem ntau tau xaiv los ntawm nitrofurantoin, fosfomycin, thiab sulfamethoxazole-trimethoprim. Thaum siv thawj cov tshuaj tsis tuaj yeem siv, amoxicillin/clavulanic acid thiab qee yam cephalosporins xws li cefpodoxime, cefdinir lossis cefaclor tuaj yeem siv tau.
Fluoroquinolones, Xws li ciprofloxacin ua thiab levofloxacin, kuj tseem siv rau UTI yooj yim. Txawm li cas los xij, FDA (Asmeskas Khoom Noj thiab Tshuaj Yeeb Tshuaj) pom zoo kom siv cov tshuaj zoo li no rau kev kis mob hnyav dua thiab yuav tsum tsuas yog siv thaum cov tshuaj tua kab mob ib txwm tsis muaj.
Kev tshuaj xyuas kev nyab xeeb los ntawm FDA pom tias qhov ncauj thiab txhaj tshuaj Cov tshuaj fluoroquinolones (tseem hu ua "quinolones") cuam tshuam nrog qhov hnyav thiab muaj peev xwm ua rau muaj kev cuam tshuam tsis zoo, cuam tshuam nrog cov leeg, leeg, pob qij txha, paj hlwb, thiab lub hauv nruab nrab lub paj hlwb. Cov kev phom sij tsis zoo no tuaj yeem tshwm sim sai tom qab siv ob peb lub lis piam tom qab kis tau, thiab tej zaum yuav nyob mus ib txhis.
Qee qhov ncauj fluoroquinolones tuaj yeem tsim nyog rau cov kab mob tso zis ntau ntxiv, suav nrog pyelonephritis thiab UTI nyuaj nrog kev koom tes nrog prostate. Rau kev kho mob sab nrauv ntawm pyelonephritis yooj yim, cov quinolones hauv qab no tuaj yeem siv tau: ciprofloxacin ua thiab levofloxacin. Nyob ntawm tus qauv tiv thaiv (> 10%), thawj koob tshuaj tiv thaiv kab mob tiv thaiv kab mob ntev (xws li ceftriaxone) lossis yuav tsum tau txhaj tshuaj aminoglycoside 24 teev.
Ampicillin thiab amoxicillin, uas tau siv los kho mob cystitis (E. coli infection), muaj cov tshuaj tiv thaiv kab mob siab ntau. Lwm yam tshuaj hauv qhov ncauj nrog nce tus nqi tiv thaiv suav nrog sulfamethoxazole thiab trimethoprim thiab Cov tshuaj fluoroquinolones. Qhov tsis kam ntawm cephalosporins qhov ncauj thiab amoxicillin/clavulanate potassium feem ntau tsawg dua 10%, thiab amoxicillin/clavulanate potassium tseem tuaj yeem siv ua tshuaj xaiv.
Yuav ua li cas txog kev rov tshwm sim ntau dua ntawm cov kab mob tso zis? Tsis pub dhau ib xyoos ntawm qhov pib muaj cov kab mob tso zis, kwv yees li 1/4 txog 1/2 ntawm cov poj niam yuav kis tus kab mob UTI dua. Rau cov poj niam zoo li no, nws raug nquahu kom siv tshuaj tua kab mob prophylactically, thiab ua cov kab lis kev cai tso zis lossis kuaj cov duab rau kev tshuaj xyuas ntxiv. Kev xaiv tshuaj tua kab mob yuav tsum yog ua raws cov kab mob tso zis dhau los, muaj cov tshuaj, thiab cov neeg mob (xws li kev tsis haum tshuaj tua kab mob thiab tus nqi). Tshuaj tua kab mob feem ntau siv rau rov UTI suav nrog sulfamethoxazole-trimethoprim, nitrofurantoin, cefaclor lossis cephalexin.
Rau cov poj niam tom qab cev xeeb tub uas muaj cov kab mob tso zis rov tshwm sim los ntawm qhov chaw qhuav ntawm qhov chaw mos, cov tshuaj estrogen tuaj yeem siv los ua kev kho mob zoo. Cov kev kho mob pom zoo suav nrog: cov tshuaj estrogen hauv qhov chaw mos, cov ntsiav tshuaj hauv qhov chaw, lossis cov tshuaj estrogen hauv qhov chaw mos.
Kev kho UTI yam tsis muaj tshuaj tua kab mob feem ntau tsis pom zoo. Cov kab mob tso zis thaum ntxov (xws li cystitis) tuaj yeem ua rau lub sijhawm hnyav zuj zus, ua rau mob raum ntau ntxiv (pyelonephritis). Yog tias koj muaj cov tsos mob ntawm mob txeeb zig kis kab mob, nws yog qhov zoo tshaj los mus nrhiav kev kho mob. Yog tias poj niam cev xeeb tub xav tias lawv muaj tus kab mob tso zis, lawv yuav tsum mus ntsib kws kho mob sai li sai tau, txwv tsis pub muaj kev pheej hmoo ntawm kev yug me nyuam hnyav lossis yug menyuam ntxov yuav ntau dua.
Qee tus neeg mob tuaj yeem siv cranberry lossis kua txiv cranberry ua tshuaj kho mob hauv tsev rau cov kab mob tso zis. Txawm li cas los xij, kua txiv cranberry rau siv tseem tsis tau muaj pov thawj los kho cov kab mob hauv lub zais zis lossis lub raum. Feem ntau, tshuaj tua kab mob yog kev kho mob zoo tshaj plaws rau cov kab mob tso zis. Raws li cov ntaub ntawv txwv, nce cov kua dej ntau ntxiv (xws li dej), zam kev tua cov phev thiab tso zis tom qab sib deev tuaj yeem pab tiv thaiv UTI.
Ntxiv dag zog rau lub cev yog ib qho tseem ceeb los tiv thaiv kab mob tso zis.
Azithromycin rau cov menyuam yaus yog qhov ua tau zoo, tab sis nws cov txiaj ntsig yuav tsis zoo li qhov peb xav. Thiab azithromycin belongs rau macrolide tshuaj tua kab mob, yog li nws cov kev mob tshwm sim loj heev. Thaum muaj UTI, koj yuav tsum nrhiav kev kho mob kom raws sijhawm thiab noj tshuaj tua kab mob pom zoo los ntawm koj tus kws kho mob.
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