Tshuaj tua kab mob yog qhov tseeb tiam ntawm broad-spectrum

Ntawm cov tshuaj nyob ib qho tseem ceeb qhov chaw kawg tiam tshuaj tua kab mob active tiv thaiv ntau cov kab mob. Lawv yog siv rau cov kev kho mob ntawm cov kab pathologies, uas significantly txo lub neej no ntawm cov neeg mob los ntawm cov banal rau hnub tim pneumonias thiab pyelonephritis. Vim tshuaj tua kab mob rau thawm thiab ceev rov qab nyob rau hauv bronchitis, sinusitis, thiab nws tau los ua tau ua txoj kev phais cov txheej txheem. Txawm lub qhov txhab mob yog ntse kho nrog tshuaj tua kab mob.

Broad-spectrum tshuaj tua kab mob (ABSHS)

Qhov no muaj xws li qeb antimicrobial cov neeg ua hauj active tiv thaiv kab-tsis zoo thiab gram-zoo kab mob. Tus thawj yog cov causative ua hauj lawm ntawm plab hnyuv kab mob, inflammatory pathologies ntawm lub urogenital thiab ua pa tshuab. Gram-zoo kab mob feem ntau ua rau cov qhov txhab mob thiab kho qhov tshwm sim ntawm postoperative teeb meem nyob rau hauv kev phais.

Daim ntawv teev cov ABSHS txawv tso tawm sij hawm

Ib txhia sab spectrum tshuaj tua kab mob ntawm qhov tseeb tiam yog active tiv thaiv protozoal kab mob. Piv txwv li nitroimidazole derivatives - tinidazole, metronidazole thiab ornidazole. Cov feem ntau lug siv metronidazole vim hais tias ntawm affordability. Nws chav kawm ntawv analogue - tinidazole - uas zoo sib xws spectrum ntawm antimicrobial kev ua si, tab sis tsis tau thov parenterally. Nyob rau hauv Feem ntau, tag nrho cov pab pawg ntawm cov broad-spectrum tshuaj tua kab mob uas hais raws li nram no:

• tej yam ntuj tso penicillins;
• ingibitorzaschischennye aminopenicillin;
• Pseudomonas penicillins, xws li ingibitorzaschischennye;
• cephalosporins III tiam cephalosporins IV tiam ;
• aminoglycosides pab pawg neeg;
• tetracycline tshuaj tua kab mob ;
• macrolide tshuaj tua kab mob;
• tus naj npawb ntawm carbapenem tshuaj tua kab mob;
• chloramphenicol;
• fosfomycin;
• rifampin;
• dioxidine;
• sulfonamides;
• quinolones, fluoroquinolones;
• nitrofurans pab pawg neeg;
• nitroimidazole tshuaj tua kab mob series.

Qhov no daim ntawv teev yog tsis tau muab lub npe ntawm pawg neeg ntawm cov nqaim-spectrum tshuaj tua kab mob. Lawv yog cov hais rau ib tug me me muaj pes tsawg tus ntawm microbes thiab yog zoo tawm tsam lawv. nqaim-spectrum tshuaj yuav siv tsis tau rau cov kev kho mob ntawm superinfection thiab tsis tau thov empirically. Lawv yog siv raws li ib tug thawj-line tshuaj tua kab mob ntawm ib tug kws kho qhov pathogen.

Daim ntawv teev cov yav tag los tiam ABSHS

Qhov saum toj no antimicrobial agents yuav mus rau ib tug ntau yam ntawm cov tshuaj. Qhov no yog ib tug ua tiav daim ntawv teev cov pawg neeg ntawm cov tshuaj nrog ua si tiv thaiv kab-zoo thiab gram-tsis zoo kab mob. Txawm li cas los, rau hauv daim ntawv muaj ob qhov tseeb tiam ntawm tshuaj tua kab mob thiab ua ntej lawm cov neeg sawv cev ntawm cov pab pawg neeg. Ntawm cov neeg sawv cev ntawm qhov tseeb tiam ntawm lub saum toj no yog cov nram no pab pawg neeg ntawm cov tshuaj:

• aminopenicillin uas yog resistant rau beta-lactamase ( "Sulbactam", "Ampicillin", "clavulanate" "Amoxicillin");
• cephalosporins tiam III thiab IV ( "Cefotaxime" "Cefoperazone" "Ceftazidime" "ceftriaxone" "cefpirome" "Cefepime");
• tiam III aminoglycoside tshuaj tua kab mob ( "Amikacin" "Netilmicin");
• 14- thiab 15-membered semi-hluavtaws macrolides ( "Roxithromycin" "clarithromycin," "Azithromycin");
• Ntuj 16-membered macrolide tshuaj tua kab mob ( "midecamycin");
• fluoroquinolones III thiab IV tiam ( "levofloxacin" "sparfloxacin" "Gatifloxacin" "Trovafloxacin" "Moxifloxacin");
• carbapenems ( "meropenem" "Imipinem-cilastatin" "Ertapenem");
• nitrofurans ( "Nitrofurantoin" "Furazidin", "ersefuril").

Tshuaj tua kab mob uas yog cais los ntawm cov ntawv teev

Cov yav tas los tiv thaiv antipseudomonal penicillins muaj ib tug broad spectrum ntawm kev ua si, txawm li cas los, thov tsuas tiv thaiv P. aeruginosa nyob rau hauv view ntawm qhov yuav tsum tau kom txo tus tej zaum kev sib cuag nrog lub tseeb hnub thiab hwj chim tshuaj tua kab mob. Qhov no tiv thaiv kev pheej hmoo ntawm tshuaj-resistant cov kab mob. Qhov loj tshaj miv nyuas siv zug tiv thaiv Pseudomonas infection manifests "tazobactam." Qee zaus "Piperacillin" thiab "clavulanate" siv raws li qhov tseeb tiam ntawm tshuaj tua kab mob rau mob ntsws tshwm sim los ntawm lub tsev kho mob kab mob los ntawm lub pathogen.

Tsis tas li ntawd nyob rau hauv daim ntawv teev yog tsis muaj tshuaj tua kab mob kawg tiam pab pawg neeg ntawm ntuj thiab anti-staphylococcal penicillins. Cov yav tas los tsis tau siv nyob rau hauv tus neeg mob kev kho mob vim qhov yuav tsum tau ntawm heev tso dej los yog intramuscular thawj coj. Cov ntaub ntawv uas tso cai rau lawv coj hais lus, tsis muaj nyob. Ib tug zoo xws li cov teeb meem no tshwm sim nrog cephalosporins. Nrog tib spectrum ntawm kev ua si raws li lub penicillins, lawv yuav tsis tau xeem lus vim hais tias kev puas tsuaj nyob rau hauv lub plab.

Cephalosporins thiab penicillins parenteral siv - nws yog ib qhov tseeb tiam ntawm zoo tshuaj tua kab mob rau mob ntsws dej. NASB zaum tau ua tau zoo nyob rau hauv kev tsim ib tug ntau npaum daim ntawv ntawm enteral thawj coj. Txawm li cas los, kev tshawb fawb tau tseem tsis tau muab tso rau hauv kev xyaum, thiab ib tug xov tooj ntawm cov tshuaj yuav tsum tau siv kom deb li deb xwb nyob rau hauv lub ruaj ruaj kho mob hauv tsev.

Zoo heev tshuaj tua kab mob rau cov me nyuam

Kawm qhov tseeb tiam ntawm tshuaj tua kab mob, daim ntawv teev cov tshuaj pom zoo rau cov me nyuam, roj ho. Nyob rau hauv thaum yau, tsuas yog siv los ntawm cov neeg sawv cev ntawm ob peb aminopenicillins ( "Amoxicillin", "clavulanate"), cephalosporins ( "Ceftriaxone" "Cefepime"), macrolides ( "Azithromycin", "midecamycin" "Roxithromycin", "clarithromycin"). Fluoroquinolone tshuaj tua kab mob, carbapenems thiab nitrofurans yuav siv tsis tau vim hais tias ntawm kev tsim txom ntawm txoj kev loj hlob ntawm cov pob txha, daim siab thiab lub raum toxicity.

System nitrofurans yog tsis tau thov vim tsis muaj pov thawj scientific txhawb txoj kev ruaj ntseg ntawm cov kev kho mob. Lub tsuas kos yog "furatsillina", haum rau lub zos kev kho mob ntawm cov qhov txhab. Niaj hnub nimno thiab heev npaum tshuaj tua kab mob rau lub xeem tiam ntawm cov me nyuam raws li nram no: macrolides, penicillins, cephalosporins (npe ntawm cov tshuaj yog muab saum toj no). Qhov seem pab pawg neeg ntawm antimicrobial ua hauj lawm yog tsis pom zoo vim hais tias ntawm cov tshuaj lom nyhuv, thiab skeletal mob.

ABSHS rau cev xeeb tub cov poj niam

Raws li FDA kev faib (US), tsuas yog ib ob peb ntawm qhov tseeb tiam tshuaj tua kab mob yuav siv tau nyob rau hauv cov kev kho mob ntawm cev xeeb tub cov poj niam, uas yog heev me me daim ntawv teev. Lawv yuav mus rau pawg A thiab B, uas yog lub txaus ntshai ntawm lawv tsis paub tseeb hais tias los yog tsis muaj teratogenic los nyob rau hauv cov tsiaj cov kev tshawb fawb.

Tshuaj nrog meej los rau lub fetus, raws li zoo raws li nrog lub xub ntiag ntawm cov tshuaj lom nyhuv yuav tsuas yuav siv nyob rau hauv cov ntaub ntawv ntawm loj heev ntawm kho nyhuv tshaj ib sab (qeb C thiab D). Npaj X qeb txawv pov thawj teratogenic los rau hauv lub fetus, yog tias tsim nyog, vim hais tias ntawm lawv cov kev siv tas rho menyuam.

Thaum lub sij hawm cev xeeb tub, cov nram qab no tshuaj tua kab mob kawg tiam broad-spectrum tshuaj: kev tiv thaiv aminopenicillin ( "Amoklav", "Amoxiclav"), cephalosporins ( "Cefazolin" "Ceftriaxone" "Cefepime"). Macrolides ( "Azithromycin", "clarithromycin", "midecamycin" "Roxithromycin") muaj cai siv nyob rau hauv lub thib peb peb lub hlis ntawm hnub vim lub fact tias lawv teratogenic nyhuv tsis tau siab kawm, thiab cov tsis muaj nws yuav tsis tau unambiguously hais lus. Tsis tas li ntawd, cev xeeb tub cov poj niam yam xyuam xim siv penicillin tshuaj tua kab mob nyob rau hauv lub qhaj ntawv ntawm kev ua xua.

Kev siv cov tshuaj tua kab mob nyob rau hauv cov kev kho mob ntawm ntsws

Tag nrho cov tshuaj tua kab mob kawg tiam broad-spectrum, nyob rau hauv kev tshawb xav, yuav siv tau rau ntsws thiab mob ntsws muaj dej, yog hais tias lawv pharmacodynamic yam ntxwv pom rau qhov no. Txawm li cas los, muaj zoo schemes ntawm muaj kuab kev kho mob ntawm cov kab mob xws. Lawv coj mus rau hauv tus account variations kev vam meej ob peb ua ke ntawm antimicrobials los xyuas kom meej dav kev pab them nqi ntawm microbial hom.

Nitrofurans, nitroimidazole derivatives thiab sulfonamides irrational siv nyob rau hauv inflammatory kab mob ntawm lub pa system. Cov vam meej tshaj plaws ua ke ntawm ntsws los yog mob ntsws muaj dej, mob ntsws txaus yog kev tiv thaiv macrolide nrog aminopenicillin ( "Amoklav" + "Azithromycin"). Ntev ntsws yuav tsum tau lub sij hawm cephalosporin es tsis txhob aminopenicillin ( "Ceftriaxone" + "Azithromycin"). Nyob rau hauv no cov tswvyim, cov macrolide tej zaum yuav hloov nrog lwm analog chav kawm ntawv: rau "midecamycin" "clarithromycin" los yog "Roxithromycin".

Tag nrho cov latest-tiam tshuaj tua kab mob rau hlab ntsws muaj ib tug qhia tau cov nyhuv, txawm hais tias tus soj ntsuam tej yam tshwm sim ntawm tus kab mob tej zaum yuav tsum tam sim no. Lub rau ntawm kev hauj lwm zoo ntawm kev kho mob - lub tsos ntawm hnoos nrog phlegm maj ntxuav thiab kub ib ce nyem. Nyob rau hauv COPD kuj tsis muaj zog txog dyspnea, qab los noj mov zoo, txo hnoos zaus lub siab nyiam.

Pib kev kho mob ntawm mob ntsws

Mob Ntsws Txheem Dej me kho rau lub hauv paus ntawm bronchitis, tab sis, nrog rau kev siv ntawm cephalosporin thiab macrolide. Thaum hauj sim mus rau mob loj heev lub zej lub zos-kis tau mob ntsws los ntawm keeb kwm tsa cephalosporin ( "Ceftriaxone" los yog "Cefepime") nrog ib tug xov tooj ntawm fluoroquinolones ( "Ciprofloxacin" los yog "Levofloxacin"). Cov tshuaj tua kab mob ntawm lub xeem tiam broad-spectrum zoo suppress microflora zej zog-nrhiav, thiab cov nyhuv ntawm lawv cov kev siv yog hnov nyob rau hauv lub thib ob hnub ntawm kev kho mob.

Niaj hnub no tus tseeb tiam ntawm tshuaj tua kab mob rau mob ntsws (lub npe saum toj no) cuam tshuam rau pathogen, nws tseem ceeb heev functions ntawm suppressing los yog tua nws. Tus thawj yam yog hu ua cov bacteriostatic, bactericidal thiab rau tom kawg tshuaj. Cephalosporins, thiab fluoroquinolones aminopenicillin - bactericides, thiab macrolides - bacteriostats. Ntxiv mus, lub ua ke ntawm tshuaj tua kab mob los tsis tau tsuas yog nthuav cov ntau yam ntawm kev ua ub no, tab sis kuj yuav ua raws li cov kev cai ntawm combining ib cov tshuaj nrog bactericidal bacteriostatic ib.

Kev kho mob ntawm kev mob loj mob ntsws nyob rau hauv HITD

Nyob rau hauv intensive kev saib xyuas, nyob qhov twg muaj tej zaum yuav cov neeg mob uas muaj mob loj mob ntsws dej thiab nyuaj siab syndrome nyob rau tom qab ntawm intoxication. Lub ntsiab pab mus rau lub heev ntawm tus mob ntawm xws cov neeg mob ua rau pathogenic microflora uas yog resistant rau feem ntau antimicrobials. Nyob rau hauv tej lub sijhawm, thov carbapenems ( "Imipinem-cilastatin," "Tienam", "Meropenem"), yog siv tsis tau rau kev siv nyob rau hauv lub pw chaw.

Kev kho mob ntawm sinusitis thiab sinusitis

Niaj hnub no tus tseeb tiam ntawm tshuaj tua kab mob rau sinusitis los yog qhov ntswg uas siv los tua cov kab mob. Nyob rau hauv xws li mob, ib tug tej zaum yuav siv ib tug bactericidal tshuaj tua kab mob. Txawm li cas los, Yog hais tias qhov ntswg ntsiab teeb meem yog mus saib hauv internet ntawm antimicrobial o. Yog li ntawd, feem ntau siv tshuaj cephalosporin. Ib qho piv txwv yog tus "Ceftriaxone" los yog "Cefepime." Nws tej zaum kuj yuav muab fluoroquinolone III tiam - "Levofloxacin".

Kev kho mob ntawm angina niaj hnub antimicrobials

qhov tseeb tiam ntawm tshuaj tua kab mob rau mob caj pas tsa rau tib lub hom phiaj. Ntxiv mus, thiab nyob rau hauv lub qhov ntswg, thiab tib lub anti-microbial cov neeg ua hauj tej zaum yuav siv tau nyob rau tonsillitis. Qhov txawv tsuas yog tias nyob rau hauv cov ntaub ntawv ntawm o ntawm lub tonsils kuj yuav siv tau thiab antiseptics, piv txwv li, "furatsillina" - qhov kev npaj ntawm ib tug xov tooj ntawm nitrofurans. Txawm tias angina aminopenicillins kuj yuav siv ntse tiv thaiv sulbactam los yog clavulanic acid ( "Amoklav" "Amoksiklav" "Ospamoks"). Thiab cov tshuaj yuav tsum tau muab rau 10-14 hnub.

Kev kho mob ntawm pyelonephritis thiab kab mob ntawm lub genitourinary system

Vim kis ntawm cov mob txeeb zig los ntawm microbes, qhov tseeb tiam ntawm tshuaj tua kab mob nyob rau hauv pyelonephritis tsim nyog rau lawv kho. Qhov loj tshaj kho nqi no yog cephalosporins, fluoroquinolones thiab nitrofurans. Cephalosporins yog siv nyob rau hauv kuj tsis mob hnyav pyelonephritis, thiab fluoroquinolones ( "Ciprofloxacin", "Levofloxacin", "Ofloxacin", "Moxifloxacin") - nyob rau ntawm deterioration nyob rau hauv lub keeb kwm yav dhau muaj txoj kev kho.

Cov vam meej tshaj plaws tshuaj, haum rau ob qho tib si monotherapy thiab rau thaum lawv tseem nrog "Ceftriaxone" yog tus neeg sawv cev ntawm tej xov tooj ntawm nitrofurans - "FURAMAG"). Tsis tas li ntawd quinolone yuav siv tau - "Nalidixic acid". Tsis ntev los no tsim END nyob rau hauv cov zis thiab yog active tiv thaiv cov causative ua hauj lawm ntawm urinary kab mob. Tsis tas li ntawd, tej zaum thaum gardnelleze dysbacteriosis chaw mos thiab thov "Metronidazole".

Tshuaj kuj thiab nws cov nyhuv

Vim rau qhov kev hloov nyob rau hauv lub caj khoom ntawm kab mob, mas cov kab mob, muaj ntau yam antimicrobial hauj lwm zoo yog significantly txo. Kis kuj mus tshuaj, cov kab mob npaj muaj peev xwm ciaj sia nyob rau hauv tib neeg lub cev los ntawm mediating degradation ntawm kis kab mob. Qhov no forces soj ntsuam mus nrhiav thiab muab tso rau hauv kev xyaum tshiab tshuaj tua kab mob kawg tiam.

Thaum lub sij hawm lub sij hawm ntawm cov hav zoov ntawm antimicrobial agents tsim rau txog 7000 yam nyob rau hauv ib txoj kev yog siv nyob rau hauv cov tshuaj. Feem ntau ntawm lawv mus tawm ntawm kev siv vim muaj ib tug clinically tseem ceeb phiv los sis vim hais tias ntawm lub tshaaj ntawm microbial kuj mus rau lawv. Vim hais tias niaj hnub no nyob rau hauv cov tshuaj ua ntawv thov txog 160 tshuaj. Hais txog 20 ntawm lawv - yog qhov tseeb tiam ntawm tshuaj tua kab mob, nws lub npe feem ntau tshwm nyob rau hauv kev kho mob phau ntawv ntawm antimicrobial txoj kev kho ntawm kis kab mob.