Puas yog vancomycin yog tshuaj tua kab mob muaj zog?

• Nreeb Navigation
• Vancomycin yog dab tsi?
  1. Lus txhais
  2. Keeb kwm
  3. Cov Tshuaj thiab Toxicology
  4. Pharmacokinetics
• Vancomycin siv
  1. Kev pab them nqi Vancomycin
  2. siv
  3. ntau npaum
• Vancomycin phiv los
  1. Teeb meem tsis haum
  2. taboo
  3. Teeb meem xav tau mloog
• Vancomycin xwm txheej
• xaus

Vancomycin yog dab tsi?

1. Lus txhais

Vancomycin's molecular formula yog C66H74ClN9O24. Vancomycins yog cov tshuaj tua kab mob glycopeptide, suav nrog vancomycin tshuaj, tshuaj norvancomycin thiab teicoplanin ua. Vancomycin khi rau alanine thaum kawg ntawm peptidoglycan, uas yog lub hauv paus ntawm cov xovtooj ntawm phab ntsa ntawm cov kab mob rhiab heev nrog kev sib raug zoo, thaiv qhov sib xyaw ua ke ntawm qhov hnyav molecular hnyav peptidoglycan uas ua rau cov phab ntsa ntawm cov cell, ua rau cov phab ntsa tsis xws luag thiab tua cov kab mob, tshwj xeeb tshaj yog rau cov kab mob uas tab tom loj tuaj. Ib qho ntxiv, nws tseem txwv tsis pub RNA sib xyaw hauv cytoplasm.

Vancomycins tsuas yog muaj cov kab mob tua kab mob zoo rau cov kab mob gram-positive, suav nrog cov kab mob staphylococci thiab methicillin-resistant Staphylococcus aureus (MRSA) thiab methicillin-resistant Staphylococcus epidermidis (MRSE). Norvancomycin thiab Teicoplanin muaj kev cuam tshuam zoo rau feem ntau Staphylococcus aureus ntau dua vancomycin, thiab nws cov txiaj ntsig ntawm Staphylococcus epidermidis zoo ib yam li vancomycin; norvancomycin yog cov tshuaj tua kab mob anaerobic uas muaj zog tshaj tiv thaiv Bacteroides fragilis, thiab muaj qhov muaj zog tshaj plaws ntawm cov hnyuv thiab muaj zog rau cocci ntau dua li teicoplanin.

Vancomycin ib nrab-lub neej: 4 ~ 8 teev, 9 hnub rau lub raum tsis ua haujlwm, tsis muaj txiaj ntsig tiv thaiv kab mob anaerobic thiab kab mob gram-negative, hemodialysis yuav tsis tshem Vancomcin. Vancomycin muaj lub zog muaj zog thiab nephrotoxicity. Nws yuav siv thaum lwm cov tshuaj tua kab mob tsis muaj txiaj ntsig rau kab mob. Nws yog cov tshuaj hu ua kab kawg. Xyoo tsis ntev los no, vim muaj kev siv tshuaj tua kab mob ntau dhau, cov kab mob tiv taus vancomycin, xws li vancomycin-resistant enterococcus (VRE), tau tshwm sim, ua rau muaj kev txhawj xeeb txog kev tiv thaiv thiab kho kab mob sib kis.　　

Nws tuaj yeem tiv thaiv kev sib txuas ntawm cov phab ntsa ntawm cov kab mob, muaj kev cuam tshuam zoo rau Staphylococcus aureus, Streptococcus pyogenes, Streptococcus pneumoniae, thiab lwm yam, thiab muaj txiaj ntsig zoo rau Bacillus difficile, Bacillus anthracis, thiab Bacillus diphtheria. Tsis muaj kev tiv thaiv khaub thuas mus rau lwm cov tshuaj tua kab mob thiab ob peb hom kab mob uas tiv taus tau zoo. Vancomycin tsis tau nqus ntawm qhov ncauj, nws yuav tsum tau yaj nrog dej rau kev txhaj tshuaj ua ntej tso ntshav, thiab lub sijhawm tso ntshav yuav tsum tsis pub tsawg dua 1 teev. Kev txhaj tshuaj sai sai tuaj yeem ua rau cov tawv nqaij cuam tshuam, thiab siab ntau dhau tuaj yeem ua rau thrombophlebitis; txhaj tshuaj intramuscular tuaj yeem ua rau mob hnyav, yog li tsis txhaj tshuaj intramuscular; nws muaj ototoxicity hnyav thiab nephrotoxicity, yog li nws yuav tsum tsuas yog siv rau kev cawm lub sijhawm luv.

2. Keeb kwm

Vancomycin thawj zaug sib cais los ntawm EC Kornfeld (Lilly cov neeg ua haujlwm) los ntawm cov av sib sib zog nqus hauv hav zoov Borneo sau los ntawm cov tub txib. Cov kab mob ua vancomycin thaum kawg hu ua Amycoplasma orientalis. Lub hom phiaj tseem ceeb ntawm kev siv vancomycin yog los kho kab mob los ntawm penicillin-resistant Staphylococcus aureus.

Tsis ntev, qhov zoo ntawm vancomycin tau tshwm sim: txawm hais tias muaj ntau tiam neeg ntawm subculture ntawm qhov nruab nrab uas muaj vancomycin, staphylococci tseem tsis tau qhia pom kev tiv thaiv tshuaj. Lub sijhawm ntawd, ntau thiab ntau tus staphylococci tau tiv taus tshuaj penicillin tshuaj tua kab mob, uas ua rau vancomycin tau txais kev pom zoo los ntawm FDA sai sai hauv xyoo 1958. Eli Lily xub tsim thiab muag vancomycin nyob hauv qab lub npe Vancocin (ruaj khov thiab ntseeg tau).

Txawm li cas los xij, vancomycin tsis tau dhau los ua thawj kab tshuaj rau kev kho mob ntawm Staphylococcus aureus, vim tias vancomycin yuav tsum tau txhaj tshuaj txhaj ncaj qha thiab tsis tuaj yeem nqus tau qhov ncauj. Kev loj hlob sai ntawm kev tiv thaivbeta-lactamase cov cov tshuaj penicillin ib nrab hluavtaws, xws li methicillin (thiab nws cov khoom ua tiav xws li ethoxynaphthalene (amine) penicillin, o-chloropenicillin, thiab lwm yam) tuaj yeem tiv thaiv penicillin tiv thaiv kab mob. Qhov qis purity vancomycin siv hauv kev sim thaum ntxov muaj zog ototoxicity thiab nephrotoxicity. Yog li ntawd, vancomycin tsuas yog siv rau methicillin thiab lwm yam tiv thaiv kab mob Staphylococcus aureus.

Xyoo 2004, Eli Lilly tau tso cai Vancocin lub cim lag luam rau Viro Pharma hauv Tebchaws Meskas, Flynn Pharma hauv tebchaws Askiv thiab Aspen Pharmacare hauv Australia. Daim ntawv patent vancomycin tau tas sijhawm thaum xyoo 1980s, tab sis FDA tsis tso cai vancomycin tsim los ntawm ib ntawm peb lub tuam txhab kws muag tshuaj muag hauv Tebchaws Meskas. Muaj ntau lub chaw tsim tshuaj nyob hauv Suav teb uas tsim cov tshuaj vancomycin generic, cov npe lag luam uas yog Fangkerin thiab Wanxun (norvancomycin).

3. Cov Tshuaj thiab Toxicology

Vancomycin muaj cov tshuaj tua kab mob zoo rau feem ntau cov kab mob gram zoo xws li Staphylococcus aureus thiab coagulase-negative Staphylococcus methicillin-sensitive thiab tiv taus kab mob, ntau yam Streptococcus, Streptococcus pneumoniae thiab Enterococcus.

4. Pharmacokinetics

Vancomycin tsis nqus ntawm qhov ncauj, nrog ib koob ntawm 400 mg tso rau hauv cov hlab ntshav, cov ntshav siab tshaj plaws (Cmax) ntawm 25.18 mg/L yuav mus txog tom qab kev tso ntshav, qhov nruab nrab cov ntshav siab hauv 8 teev yog 1.90 mg/L, thiab ua tau zoo ntshav siab tuaj yeem tswj tau li 6 txog 8 teev.

Ib qhov tso dej tawm ntawm 800 mg, qhov nruab nrab cov ntshav siab tshaj yog 50.07 mg/L. Cov khoom no tuaj yeem nthuav dav hauv ntau cov ntaub so ntswg thiab kua dej ntawm lub cev, tab sis nws tsis yooj yim nkag mus rau hauv lub hlwb cov ntaub so ntswg, thiab cov nyiaj hauv cov kua tsib me me. Tom qab txhaj tshuaj tiv thaiv kab mob, nws tsuas yog tso tawm los ntawm ob lub raum. Kev txhaj tshuaj ib leeg nkaus xwb ntawm 400 mg ua rau qhov nruab nrab 24 teev cov zis tso zis ntawm 81.1%; ib txoj hlab ntshav tso rau ntawm 800 mg, qhov nruab nrab tso zis 24 teev nyob rau ntawm 85.9%.

Vancomycin siv

1. Kev pab them nqi Vancomycin

Vancomycin txwv tsis pub muaj kab mob sib kis los ntawm methicillin-resistant Staphylococcus aureus (MRSA) thiab mob plab hnyuv thiab kab mob sib kis los ntawm Clostridium difficile; penicillins or cephalosporins yuav tsum tsis txhob siv tshuaj tua kab mob penicillin rau cov neeg mob uas muaj tus kab mob staphylococcal hnyav uas tsis kho nrog cov tshuaj tua kab mob saum toj no, norvancomycin tuaj yeem siv tau. Vancomycin kuj tseem siv rau kev kho mob enterococcal endocarditis thiab corynebacterium (diphtheria-like) endocarditis hauv tib neeg ua xua rau penicillin.

2. siv

• Tua cov kab mob los ntawm kev txwv lawv txoj kev loj hlob thiab kev tsim dua tshiab. Vancomycin cuam tshuam nrog kev sib txuas ntawm cov phab ntsa ntawm tes los ntawm kev cuam tshuam nrog cov khoom tseem ceeb ntawm cov kab mob ntawm cov kab mob ntawm tes, peptidoglycan, thiab txwv tsis pub tsim cov phospholipids thiab polypeptides hauv phab ntsa ntawm tes.
• Vancomycin feem ntau yog siv los kho kev kis kab mob hauv plaub yam: ua ntej, kev kho mob ntawm cov tshuaj tiv thaiv kab mob rau kab mob; ib qho ntxiv, nws kuj tseem siv rau hauv kev kho kab mob pseudomembranous enteritis los ntawm Clostridium difficile.
• Vancomycin kuj tseem tuaj yeem siv los kho mob plab thiab mob plab; vancomycin kuj tseem siv los tiv thaiv kev kis tus kab mob thaum txhim kho lub plawv catheters, cov raj tso pa tso pa thiab lwm yam khoom siv. Vancomycin tuaj yeem siv ib leeg lossis ua ke.
• Nws tuaj yeem tiv thaiv kev sib txuas ntawm cov phab ntsa ntawm cov kab mob, muaj kev cuam tshuam zoo rau Staphylococcus aureus, Streptococcus pyogenes, Streptococcus pneumoniae, thiab lwm yam, thiab muaj txiaj ntsig zoo rau Bacillus difficile, Bacillus anthracis, thiab Bacillus diphtheria.
• Tsis muaj kev tiv thaiv khaub thuas mus rau lwm cov tshuaj tua kab mob thiab ob peb hom kab mob uas tiv taus tau zoo. Feem ntau siv rau endocarditis, sepsis, pseudomembranous enteritis, thiab lwm yam.
• Cov tshuaj tsis nqus los ntawm kev tswj qhov ncauj. Nws yuav tsum tau yaj nrog dej rau kev txhaj tshuaj ua ntej tso ntshav, thiab lub sijhawm tso ntshav yuav tsum tsis pub tsawg dua 1 teev. Kev txhaj tshuaj sai sai tuaj yeem ua rau cov tawv nqaij cuam tshuam, thiab siab ntau dhau tuaj yeem ua rau thrombophlebitis; txhaj tshuaj intramuscular tuaj yeem ua rau mob hnyav, yog li tsis txhaj tshuaj intramuscular; nws muaj ototoxicity hnyav thiab nephrotoxicity, yog li nws yuav tsum tsuas yog siv rau kev cawm lub sijhawm luv.

3. ntau npaum

Vancomycin hydrochloride feem ntau siv 2g ib hnub (titer), uas tuaj yeem faib ua 500mg txhua 6 teev lossis 1g txhua 12 teev. Txhua txoj kev txhaj tshuaj yuav siv sijhawm ntau dua 60 feeb. Nws tuaj yeem nce lossis txo qis raws hnub nyoog, qhov hnyav, thiab cov tsos mob.

Rau cov neeg laus, 500 mg txhua 12 teev lossis 1 g txhua 24 teev, txhaj tshuaj ntau tshaj 60 feeb txhua lub sijhawm. Cov menyuam yaus thiab menyuam mos tau muab tso rau ntawm 40mg/kg ib hnub 2-4 zaug, txhua lub sijhawm ntau dua 60 feeb. Cov koob tshuaj rau cov menyuam yug tshiab yog 10-15 mg/kg txhua lub sijhawm, tus menyuam yug tshiab hauv ib lub limtiam ntawm kev yug menyuam tau muab ib zaug txhua 12 teev, tus menyuam yug los ntawm ib lub limtiam mus rau ib lub hlis yug tau muab ib zaug txhua 8 teev, thiab txhua txoj kev txhaj tshuaj ntau tshaj 60 feeb.

Txoj kev npaj yog txhawm rau ntxiv 10mL dej rau kev txhaj tshuaj rau hauv lub vial uas muaj 0.5g ntawm vancomycin kom yaj, dilute nrog tsawg kawg 100mL ntawm cov ntsev lossis 5% kev txhaj tshuaj qab zib, thiab lub sijhawm tso ntshav ntau tshaj 60 feeb.

Vancomycin phiv los

1. Teeb meem tsis haum

• Cov tawv nqaij ua pob, xeev siab, phlebitis, thiab lwm yam tuaj yeem tshwm sim.
• Vancomycin kuj tseem tuaj yeem ua rau hnov ​​pob ntseg, hnov ​​pob ntseg, thiab lub raum puas.
• Qee cov neeg mob tseem tseem tuaj yeem muaj cov ntshav nyob ib ncig ntawm lub cev leukopenia thiab cov ntshav siab aminotransferase.
• Kev txhaj tshuaj sai tuaj yeem ua rau muaj kev tsis haum tshuaj, txo ntshav siab, thiab txawm tias lub plawv nres, nrog rau hawb pob, ua tsis taus pa, tawv nqaij pob liab liab, liab ntawm lub cev sab saud (mob caj dab liab), hauv siab thiab nraub qaum nqaij ntshiv, thiab lwm yam.

2. taboo

Cov neeg uas ua xua rau tshuaj tua kab mob vancomycin tsis raug tso cai siv vancomycin.

3. Teeb meem xav tau mloog

• Vancomycin tsis tuaj yeem txhaj tshuaj intramuscularly lossis txhaj tshuaj.
• Qhov ceev ntawm cov tshuaj txau dej yuav tsum tsis txhob nrawm dua. Txhua koob tshuaj (0.4 ～ 0.8g) yuav tsum tau maj mam ntws tom qab yaj tsawg kawg 200ml 5% kev txhaj tshuaj qab zib lossis txhaj tshuaj sodium chloride. Lub sijhawm tso dej yuav tsum ntau dua 1 teev.
• Cov neeg mob uas lub raum tsis zoo yuav tsum siv vancomycin nrog ceev faj. Yog tias muaj cov cim qhia rau siv, nws yuav tsum tau siv nyob rau hauv kev saib xyuas cov tshuaj kho tshuaj (TDM) raws li qib kev ua haujlwm ntawm lub raum poob.
• Cuam tshuam nrog kev kuaj mob: ntshav urea nitrogen tuaj yeem nce ntxiv.
• Thaum lub sijhawm kho, kev hnov ​​lus, cov zis protein, pov tseg, tus xov tooj ntawm tes thiab cov zis ntom ntom ntom ntom yuav tsum tau tshuaj xyuas tas li.

Vancomycin xwm txheej

"Superbug" NDM-1 uas tau tshwm sim nyob rau South Asia lub tebchaws xws li Is Nrias teb tau kis mus rau tebchaws Askiv, Tebchaws Asmeskas, Canada, Australia, Netherlands thiab lwm lub tebchaws, thiab 170 tus neeg tau kis mob thoob ntiaj teb. Raws li Asmeskas kev tshuaj xyuas xov xwm, txawm hais tias qhov kab laum loj no txaus ntshai, nws tsis muaj peev xwm tswj tsis tau nws txoj kev sib kis. Cov kws tshaj lij hauv tsev kuj ntseeg tias cov kab mob super yuav tsis ua rau muaj mob hnyav li tus mob khaub thuas A, thiab tsis tas yuav ntshai.

Nws Jianfeng, tus thawj coj ntawm Lub Tsev Haujlwm Saib Xyuas Kab Mob, Guangdong Lub Xeev Lub Chaw Tiv Thaiv thiab Tiv Thaiv Kab Mob, hais tias superbug NDM-1 yeej yog kev hloov pauv caj ces ntawm cov enzyme, uas yooj yim sib xyaw nrog cov kab mob thiab dhau los ua cov kab mob, uas tuaj yeem yuav rov ua dua thiab nthuav tawm. Superbugs tiv taus ntau yam tshuaj tua kab mob, tab sis raws li kev tshawb nrhiav pom, vancomycin tseem muaj txiaj ntsig zoo rau nws. Cov tsev kho mob loj muaj cov peev txheej thiab tuaj yeem siv nws thaum tsim nyog. Txawm li cas los xij, txawm hais tias vancomycin muaj txiaj ntsig zoo rau kev kho mob ntau yam tshuaj tiv thaiv kab mob, nws tsis paub tias nws muaj txiaj ntsig zoo li cas.

Raws li kws tshaj lij, cov kab mob super tuaj yeem tiv taus yuav luag txhua cov tshuaj tua kab mob, thiab cov tshuaj tua kab mob zoo tshaj plaws yog tigcycline thiab vancomycin. Yog tias tus kab mob kis tau tiag tiag, cov khoom lag luam kws tshuaj yuav tau txais txiaj ntsig los ntawm nws.

Kev lig kev cai, vancomycin tau siv los ua "kab kawg ntawm kev tiv thaiv" rau tshuaj tua kab mob, thiab feem ntau tau muab cais ua "tertiary antibiotic", siv los kho mob hnyav uas tsis muaj txiaj ntsig zoo rau txhua yam tshuaj tua kab mob, suav nrog txiv hmab daj daj uas tiv taus methicillin.

Xyoo tsis ntev los no, vim kev siv tshuaj tua kab mob ntau dhau, cov kab mob uas tuaj yeem tiv taus vancomycin, xws li vancomycin-resistant enterococcus (VRE), tau tshwm sim, ua rau muaj kev txhawj xeeb txog kev tiv thaiv thiab kho kab mob sib kis. Nws cov xwm txheej tau maj mam txo qis los ntawm cov tshuaj tshiab mus rau "tshuaj kab kawg" tiv thaiv kev kis mob.

Vancomycin tau ntev tau suav tias yog "tshuaj kawg". Nws khi rau cov protein tawg ua lub cell phab ntsa-peptides los tiv thaiv kab mob los ntawm kev tsim cov phab ntsa cell thiab ua rau lawv tuag. Txawm li cas los xij, cov kab mob kuj tseem nce ntxiv lawv cov tshuaj tiv thaiv kab mob, txo qhov peev xwm ntawm vancomycin los khi rau lub hom phiaj.

Niaj hnub no, kev pheej hmoo kis mob nrog vancomycin-resistant enterococci thiab Staphylococcus aureus tau nce zuj zus. Raws li cov ntaub ntawv los ntawm Asmeskas Lub Chaw Tiv Thaiv thiab Tiv Thaiv Kab Mob, kwv yees li 23,000 tus neeg Asmeskas tuag los ntawm 17 tus kab mob tiv thaiv kab mob tiv thaiv kab mob txhua xyoo.

xaus

Vancomycin, ib polypeptide tshuaj tua kab mob zoo ib yam li polymyxin IB, feem ntau siv los ua kab kawg ntawm kev tiv thaiv kab mob sib kis, thiab feem ntau tsis siv hauv kev kho mob.

BALLYA muab rau ballya-vancomycin-xeem qhia rau koj yog tias muaj vancomycin tshuaj seem hauv cov khoom noj thiab pub.

References

• MedlinePlus: Vancomycin
• DRUGBANK: Vancomycin