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Dab tsi yog gentamicin-sulfate-siv-rau

Gentamicin sulfate siv rau dab tsi?

Muab lo rau  Hlis ntuj nqeg 21, 2020, Kho los ntawm Jason, Qeb  

Gentamicin sulfate yog dab tsi?

1. Lus txhais

Gentamicin sulfate hmoov yog aminoglycoside broad-spectrum tshuaj tua kab mob, uas muaj cov tshuaj tua kab mob thiab tua kab mob rau ntau yam gram-negative thiab cov kab mob zoo. Nws muaj qhov ua tau zoo ntawm cov kab mob Gram-negative xws li Pseudomonas aeruginosa, Aerobacter, Pneumoniae, Salmonella, Escherichia coli thiab Proteus, thiab Staphylococcus aureus.

BALLYA muab rau gentamicin kuaj los qhia koj yog tias muaj gentamicin seem hauv cov khoom siv mis uas koj noj txhua hnub.

gentamicin-sulfate-xeem
gentamicin-sulfate-xeem

2. Cov Tshuaj thiab Toxicology

Cov khoom no yog tshuaj tua kab mob aminoglycoside. Nws muaj cov tshuaj tua kab mob zoo rau ntau yam kab mob gram-negative thiab kab mob gram-positive. Nws muaj cov tshuaj tua kab mob zoo rau ntau yam Enterobacteriaceae xws li Escherichia coliKlebsiella, Proteus, Salmonella, Shigella, Enterobacter, Serratia, thiab Pseudomonas aeruginosa.

Neisseria thiab Haemophilus influenzae muaj kev nkag siab me ntsis rau cov khoom no. Nws kuj tseem muaj qee yam cuam tshuam rau Brucella, Yersinia pestis, Acinetobacter thiab Campylobacter fetus. Nws muaj cov tshuaj tua kab mob zoo txog li 80% ntawm cov kab mob methicillin-sensitive hauv Staphylococcus (suav nrog Staphylococcus aureus thiab coagulase-negative Staphylococcus), tab sis feem ntau ntawm cov kab mob methicillin-resistant tiv taus cov khoom no.

Cov txiaj ntsig ntawm Streptococcus thiab Streptococcus pneumoniae tsis zoo, thiab feem ntau ntawm Enterococcus tiv taus cov khoom. Thaum cov khoom no tau siv ua ke nrog Cov kws kho mob pom zoo kom noj cov khoom noj uas muaj lactam hauv cov ntshav, feem ntau ntawm lawv tuaj yeem tau txais cov tshuaj tiv thaiv kab mob sib kis.

Cov txheej txheem ntawm kev ua ntawm cov khoom no yog ua ke nrog 30S subunit ntawm cov kab mob ribosome txhawm rau tiv thaiv kab mob protein synthesis. Xyoo tsis ntev los no, tus naj npawb ntawm gram-negative bacilli tiv taus gentamicin tau nce ntau.

3. Pharmacokinetics

Tom qab txhaj tshuaj intramuscular, cov khoom tau nqus sai thiab ua tiav, mus txog qhov siab tshaj plaws plasma concentration (Cmax) tsis pub dhau 0.5 txog 1 teev. Kev tshem tawm cov ntshav ib nrab-lub neej (t1/2b) yog kwv yees li 2 txog 3 teev, thiab nws tuaj yeem txuas ntxiv mus ntev hauv cov neeg mob uas txo qis lub raum ua haujlwm. Tus nqi khi cov protein tsawg.

Nws tuaj yeem faib tawm hauv ntau cov ntaub so ntswg thiab cov kua dej hauv lub cev, sib sau ua ke hauv lub raum cortex, thiab tseem tuaj yeem nkag mus rau hauv menyuam hauv plab los ntawm kev tso pa tawm, tab sis tsis tuaj yeem nkag mus rau lub hlwb cov ntaub so ntswg thiab cov kua dej hauv lub cev los ntawm cov ntshav-cerebrospinal kua. Nws tsis yog metabolized hauv lub cev, thiab tau tso tawm hauv cov zis raws li tus qauv dhau los ntawm kev pom glomerular, thiab tshem tawm 50% txog 93% ntawm cov tshuaj hauv 24 teev tom qab kev tswj hwm.

Hemodialysis thiab lim ntshav peritoneal tuaj yeem tshem tawm cov tshuaj ntau los ntawm cov ntshav thiab ua kom luv ib nrab ntawm lub neej.

Gentamicin sulfate siv rau dab tsi?

1. siv

Cov txheej txheem ntawm kev ua ntawm cov khoom no yog txhawm rau khi rau cov protein tshwj xeeb ntawm cov kab mob riboprotein lub cev subunit, cuam tshuam nrog kev ua haujlwm ntawm lub cev riboprotein, tiv thaiv cov protein synthesis, thiab ua rau yuam kev ntawm cov cai ntawm kev txhais lus xa xov ribonucleic acid (mRNA) ) los ua ke cov protein tsis ua haujlwm.

Nws tau siv hauv tsev kho mob rau tus mob sepsis, ua pa rau tus kab mob, kis kab mob hauv lub cev, mob peritonitis, ua rau mob hauv plab, tso zis tso zis los ntawm Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, Shigella, Klebsiella, Proteus thiab lwm yam kab mob rhiab heev Kab mob xws li kis kab mob thiab mob plab.

2. indications

  • Nws yog qhov tsim nyog rau kev kho mob hnyav tshwm sim los ntawm cov kab mob gram-negative bacilli, xws li Escherichia coli, Klebsiella, Enterobacter, Proteus, Serratia, Pseudomonas aeruginosa thiab Staphylococcus methicillin cov kab mob rhiab, xws li sepsis, kab mob ua pa qis, mob plab, Kab mob hauv plab, kis kab mob hauv plab, tawv nqaij thiab kab mob mos mos, ua rau cov kab mob tso zis nyuaj, thiab lwm yam Kev kho mob plab thiab mob plab yuav tsum tau ua ke nrog tshuaj tiv thaiv kab mob, gentamicin thiab lwm yam tshuaj tua kab mob feem ntau siv hauv kev kho mob. Penicillin (lossis ampicillin) nrog gentamicin sulfate hmoov tuaj yeem kho tus kab mob Enterococcus.
  • Rau cov kab mob hauv nruab nrab hauv nruab nrog cev ua los ntawm cov kab mob rhiab, xws li mob meningitis thiab ventriculitis, txhaj tshuaj intrathecal ntawm cov khoom no tuaj yeem siv ua kev kho mob ntxiv.

3. Kev Siv thiab Dosage

  • Cov neeg laus txhaj tshuaj lossis txhaj tshuaj tom qab dilution, 80 mg (80,000 units) ib zaug, lossis 1 ~ 1.7 mg/kg raws li lub cev hnyav ib zaug, ib zaug txhua 8 teev; lossis ib zaug 5 mg/kg, ib zaug txhua 24 teev. Lub sijhawm kho yog 7 txog 14 hnub. Thaum lub sijhawm txhaj tshuaj, ntxiv tshuaj 50 ~ 200ml ntawm 0.9% sodium chloride txhaj lossis 5% txhaj tshuaj qab zib. Tus nqi ntawm cov kua ntxiv thaum txhaj tshuaj ib hnub ib zaug yuav tsum tsis pub tsawg dua 300ml yog li cov tshuaj ntawm cov tshuaj tsis pub ntau tshaj 0.1 %, kev daws teeb meem yuav tsum tau ua kom maj nrawm tsis pub dhau 30 txog 60 feeb kom tsis txhob muaj cov hlab ntshav txhaws.
  • Kev txhaj tshuaj intramuscular rau menyuam yaus lossis tso dej tom qab dilution, 2.5 mg/kg ib zaug, ib zaug txhua 12 teev; lossis 1.7 mg/kg ib zaug, ib zaug txhua 8 teev. Hoob kho yog 7 txog 14 hnub, lub sijhawm uas yuav tsum tau saib xyuas cov ntshav ntau li ntau tau, tshwj xeeb yog rau menyuam mos lossis menyuam mos.
  • Intrathecal thiab intracerebroventricular thawj koob tshuaj yog 4-8 mg ib zaug rau cov neeg laus, thiab 1-2 mg ib zaug rau menyuam yaus (dhau 3 hlis), ib zaug txhua 2 rau 3 hnub. Thaum lub sijhawm txhaj tshuaj, ua kom cov tshuaj sib tov sib xyaw kom tsis txhob ntau dua 0.2%, thiab tso nws mus rau hauv 5ml lossis 10ml lub raj mis uas tsis muaj menyuam. Tom qab lumbar puncture, ua ntej txiav txim siab ntau npaum li cas ntawm cov kua dej cerebrospinal ntws mus rau hauv lub raj mis thiab thawb thaum tso tawm kom tshem tag nrho cov tshuaj maj mam txhaj hauv 3 mus rau 5 feeb.
  • Kev noj tshuaj rau cov neeg mob uas lub raum tsis ua haujlwm: ib zaug txhua 8 teev rau cov neeg mob uas lub raum ua haujlwm tsis zoo, ib koob ib txwm yog 1 ~ 1.7 mg/kg, thiab tus nqi creatinine tshem tawm ntawm 10 ~ 50ml/min, ib zaug txhua 12 teev Nws yog 30 rau 70% ntawm cov tshuaj ib txwm muaj; thaum qhov kev tshem tawm creatinine tsawg dua 10ml/min, 20-30% ntawm qhov ib txwm tau muab rau txhua 24 txog 48 teev.
tshuaj gentamicin-sulfate
tshuaj gentamicin-sulfate

Cov kev mob tshwm sim ntawm gentamicin sulfate cuam tshuam dab tsi?

1. Gentamicin Sulfate Side Effects

  • Zoo ib yam li kanamycin, nws muaj kev cuam tshuam ntau dua ntawm lub vestibule ntawm pob ntseg, tab sis tsawg dua kev puas tsuaj rau cochlea. Cov tsos mob tseem ceeb yog kiv taub hau thiab tinnitus. Rau cov neeg uas lub raum tsis zoo lossis menyuam yaus, yuav tsum tau saib xyuas ntau ntxiv rau cov tshuaj lom. Hauv cov mob hnyav, nws tuaj yeem ua rau hnov ​​lus tsis hnov ​​lus lossis txawm tias lag ntseg.
  • Vim tias cov khoom lag luam muaj qhov cuam tshuam rau ntawm kev sib txuas ntawm neuromuscular, nws tsis haum rau kev txhaj tshuaj los yog txhaj tshuaj sai sai rau hauv cov hlab ntshav kom tiv thaiv kev ua pa nyuaj siab. Cov neeg uas ua xua rau cov khoom no lossis lwm yam aminoglycosides yuav tsum txwv cov tshuaj no.

2. Teeb meem tsis haum

  • Cov tshuaj yuav ua rau hnov ​​pob ntseg, hnov ​​pob ntseg, lossis pob ntseg puv thiab lwm yam kev cuam tshuam ototoxic. Kev taug kev tsis khov thiab kiv taub hau tuaj yeem tshwm sim thaum lub cev ua haujlwm raug cuam tshuam. Cov tshuaj tiv thaiv kab mob nephrotoxic xws li hematuria, txo qis ntau zaus thiab tso zis, tsis qab los, thiab nqhis heev kuj tseem tuaj yeem tshwm sim. Cov uas muaj qhov xwm txheej qis dua muaj qhov ua tsis taus pa, qaug zog, thiab tsis muaj zog vim muaj kev cuam tshuam los ntawm cov leeg hlwb lossis nephrotoxicity. Qee zaum, tawv nqaij ua pob, xeev siab, ntuav, ua rau daim siab tsis ua haujlwm, leukopenia, neutropenia, ntshav tsis txaus, hypotension tuaj yeem pom.
  • Ob peb tus neeg mob tuaj yeem hnov ​​cov tsos mob ototoxic xws li hnov ​​pob ntseg, hnov ​​pob ntseg lossis hnov ​​pob ntseg tag nrho tom qab siv tshuaj, yog li yuav tsum tau them nyiaj mloog.
  • Kev tswj xyuas cov txheej txheem ua ke nrog kev txhaj tshuaj intrathecal tuaj yeem ua rau ceg txav, tawv nqaij ua npaws, ua npaws, thiab ua rau lub cev txhaws.

3. Ceev faj

  • Cov khoom lag luam tuaj yeem hla dhau qhov teeb meem hauv plab thiab nkag mus rau hauv cov nqaij mos hauv plab, uas tuaj yeem ua rau menyuam yaus hnov ​​lus tsis zoo. Cov poj niam cev xeeb tub yuav tsum ntsuas qhov zoo thiab qhov tsis zoo ua ntej siv cov khoom. Cov khoom lag luam tau zais me ntsis hauv cov mis, tab sis feem ntau cov poj niam pub niam mis yuav tsum tso tseg niam mis thaum lub sijhawm siv tshuaj.
  • Gentamicin yog aminoglycoside. Nws yuav tsum tau siv nrog ceev faj hauv menyuam yaus, tshwj xeeb tshaj yog rau menyuam mos thiab menyuam mos yug tshiab. Vim tias lawv lub raum cov ntaub so ntswg tsis tau tsim kho tag nrho, ib nrab ntawm lub neej ntawm hom tshuaj no tau ncua ntev, thiab nws yooj yim mus rau hauv lub cev thiab ua rau muaj tshuaj lom lom.
  • Lub raum ua haujlwm ntawm cov neeg mob laus muaj qee qib ntawm lub cev poob qis. Txawm hais tias ntsuas tus nqi ntawm lub raum ua haujlwm nyob hauv qhov ib txwm muaj, yuav tsum tau kho me me. Cov neeg mob laus dua yuav muaj ntau yam tshuaj lom tshwm sim tom qab siv cov khoom no, thiab cov tshuaj ntshav siab yuav tsum tau saib xyuas ntau li ntau tau thaum lub sijhawm kho.
  • Cov dej txaus yuav tsum tau muab rau cov neeg mob txhawm rau txo kev puas tsuaj rau lub raum tubules.
  • Daim ntawv thov mus sij hawm ntev tuaj yeem ua rau muaj cov kab mob tiv taus.
  • Tsis haum rau kev txhaj tshuaj subcutaneous.
  • Cov khoom lag luam muaj cov txiaj ntsig ntawm kev tiv thaiv kev ua pa, yog li tsis txhaj tshuaj txhaj tshuaj.
  • Cov khoom lag luam yuav tsum tau siv nrog ceev faj hauv cov xwm txheej hauv qab no: cov neeg mob lub cev qhuav dej, ua rau lub paj hlwb puas, myasthenia gravis lossis Parkinson tus kab mob thiab lub raum tsis zoo.
  • Hla kev ua xua. Cov neeg mob uas ua xua rau aminoglycoside tshuaj tua kab mob xws li tshuaj streptomycin thiab amikacin yuav ua xua rau cov khoom no.
  • Kev tso zis thiab tso zis tsis tu ncua yuav tsum tau ua tas li ua ntej thiab thaum siv tshuaj kom tiv thaiv kev mob nephrotoxic loj. Yog tias tsim nyog, ua qhov ntsuas hluav taws xob lossis duab hluav taws xob, tshwj xeeb tshaj yog ntsuas qhov ntsuas hluav taws xob ntau thiab ntsuas kev ntsuas kub, txhawm rau txheeb xyuas cov tshuaj lom hauv lub cev.

4. Tshuaj Kev Sib Thoob

  • Kev siv ua ke nrog lwm cov aminoglycosides lossis kev siv hauv ib cheeb tsam lossis cov txheej txheem ua haujlwm tuaj yeem ua rau muaj peev xwm ua rau ototoxicity, nephrotoxicity thiab neuromuscular blockade.
  • Kev siv ua ke nrog cov tshuaj tiv thaiv kab mob neuromuscular tuaj yeem ua rau cov hlab ntsha tawg tsis zoo, ua rau cov leeg tsis muaj zog, ua pa nyuaj siab thiab lwm yam tsos mob.
  • Ua ke nrog capreomycin, cisplatin, ethanilic acid, furosemide, lossis vancomycin tshuaj (lossis norvancomycin), lossis ua tiav daim ntawv thov hauv cheeb tsam lossis cov txheej txheem, tuaj yeem ua rau ototoxicity thiab nephrotoxicity.
  • Hauv zos lossis kev sib xyaw ua ke nrog cefalotin thiab cefazolin tuaj yeem ua rau kom muaj cov kab mob nephrotoxicity.
  • Kev siv ua ke nrog kev txhaj tshuaj polymyxin lossis kev siv hauv ib cheeb tsam lossis cov txheej txheem ua haujlwm tuaj yeem ua rau kom muaj cov kab mob nephrotoxicity thiab neuromuscular blockade.
  • Lwm yam tshuaj nephrotoxic thiab ototoxic yuav tsum tsis txhob siv ua ke nrog cov khoom no lossis thov ua ntu zus, thiaj li tsis ua rau nephrotoxicity lossis ototoxicity hnyav.
  • Aminoglycosides thiab β lactams (cephalosporins thiab penicillins) tuaj yeem ua rau muaj kev tsis sib haum xeeb thaum sib xyaw. Cov khoom no yuav tsum tau muab tso rau hauv cov fwj cais thaum ua ke nrog cov tshuaj tua kab mob saum toj no.

xaus

Gentamicin sulfate hmoov tsim nyog rau ntau yam kab mob sib kis thiab kab mob hauv nruab nrab lub paj hlwb, tab sis nws muaj kev cuam tshuam loj rau kev hnov ​​lus thiab lub raum. Cov neeg mob yuav tsum ua raws li kws kho mob tau npaj thaum siv cov tshuaj no, tshwj xeeb yog poj niam cev xeeb tub thiab poj niam pub niam mis.

References

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