Anju Goel, MD, MPH, ndi dokotala wodziwika bwino wa zaumoyo, matenda opatsirana, matenda a shuga, ndi ndondomeko ya thanzi.
Penicillin ndi mankhwala omwe amagwiritsidwa ntchito pochiza mitundu ina ya matenda a bakiteriya. Zotsatira zake zoyipa ndi monga kutsekula m'mimba komanso kukhumudwa m'mimba, ndipo anthu ena sangagwirizane ndi penicillin - zotsatira zake zimakhala zochepa kwambiri.
Penicillin atha kuperekedwa pakamwa, kapena kubayidwa kudzera m'mitsempha (IV, mumtsempha), kapena kudzera m'mitsempha (IM, mumnofu waukulu). Ndipo pali mitundu yosiyanasiyana ya penicillin yokhala ndi machitidwe osiyanasiyana.
Mitundu yonse ya penicillin imachokera ku bowa lotchedwaPenicilliumchrysogennum.
Wasayansi waku Scottish Alexander Fleming adapeza penicillin mu 1929 pomwe adazindikira kuti chikhalidwe cha mabakiteriya omwe adayipitsidwa mwangozi ndi "madzi a nkhungu" anali kuphedwa ndi bowa. Sizinafike mpaka 1941 pomwe asayansi adakwanitsa kudzipatula, kuyeretsa ndikuyesa mankhwalawo koyamba. odwala, kuyambitsa nthawi ya maantibayotiki.
Pofika zaka za m'ma 1960, asayansi adatha kupanga mankhwala oyamba a semisynthetic penicillin omwe amatha kuchiza matenda osiyanasiyana a bakiteriya. Pafupifupi nthawi yomweyo, adayamba kuzindikira kuwopsa kwa penicillin kukana, momwe mitundu yosinthira yosamva maantibayotiki idayamba kutuluka. ndi kufalikira mwa anthu onse.
Masiku ano, kuchuluka kwa matenda obwera chifukwa cha mabakiteriya kumalimbana kwathunthu kapena pang'ono ndi mankhwala oyamba a penicillin, kuphatikiza Neisseria gonorrhoeae (chinzonono) ndi Staphylococcus aureus (MRSA) yolimbana ndi methicillin.
Streptococcus pneumoniae, mtundu wa chibayo cha bakiteriya, komanso mitundu ina ya Clostridium ndi Listeria nawonso akuyamba kusalabadira maantibayotikiwa.
Kugwiritsa ntchito mopitirira muyeso kwa maantibayotiki pofuna kulimbikitsa kukula kwa ziweto kumadziwika kuti kumawonjezera chiopsezo cha mabakiteriya osamva mankhwala, kuphatikizapo superbugs, panthawi yonse ya chakudya.
Penicillinali m'gulu lalikulu la mankhwala otchedwa beta-lactam antibiotics. Mankhwalawa ali ndi mawonekedwe ofanana a maselo, omwe ali ndi mphete ya ma atomu anayi otchedwa beta-lactams. Mtundu uliwonse wa penicillin uli ndi maunyolo owonjezera omwe amatsimikizira ntchito yake.
Penicillin amagwira ntchito pomanga mamolekyu pa khoma la bakiteriya lotchedwa peptidoglycan. Bakiteriya akagawikana, penicillin imalepheretsa kukonzanso kwabwino kwa mapuloteni mu khoma la cell, zomwe zimapangitsa kuti ma cell a bakiteriya aphwanyike ndi kufa mwachangu.
Ma penicillin achilengedwe ndi amene amatengedwa kuchokera ku bowa wa P. chrysogenum. Pali mapenicillin awiri achilengedwe.
Semisynthetic penicillin imapangidwa mu labotale ndipo ndi yofanana ndi mankhwala omwe amapezeka mu P. chrysogenum. Pali magulu anayi a penicillin a semisynthetic, kuphatikiza maantibayotiki omwe amagwiritsidwa ntchito kwambiri monga amoxicillin ndi ampicillin.
Iliyonse mwa mitundu iyi ili ndi mawonekedwe a mamolekyu osiyana pang'ono ndipo amatha kuperekedwa mosiyana ndi mitundu ina.
Ma penicillin ena alibe antibacterial zochita mwachindunji. Amagwiritsidwa ntchito pophatikizana kuti athe kuthana ndi kukana kwa penicillin.Mwachitsanzo, clavulanic acid imatchinga puloteni yotulutsidwa ndi mabakiteriya osamva maantibayotiki (beta-lactamase) omwe amalepheretsa ntchito ya beta-lactam maantibayotiki.
Ma penicillin amagwiritsidwa ntchito pochiza matenda a bakiteriya - sachiza matenda a virus, mafangasi kapena parasitic. Mankhwalawa nthawi zambiri amagwira ntchito motsutsana ndi mabakiteriya a Gram-positive, gulu la mabakiteriya omwe ali ndi peptidoglycan kunja kwa ma cell awo. , wosanjikiza wa peptidoglycan amakwiriridwa pansi pa maselo a lipid, zomwe zimapangitsa kuti zikhale zovuta kuti mankhwala apeze molekyulu.
Mabakiteriya a gram-positive omwe amatha kuchiritsidwa ndi penicillin akuphatikizapo Clostridium, Listeria, Neisseria, Staphylococcus, ndi Streptococcus.
Ma penicillin achilengedwe - penicillin G ndi penicillin V - amagwiritsidwabe ntchito masiku ano pochiza matenda obwera chifukwa cha bakiteriya odziwika komanso osadziwika bwino.
Mosiyana ndi zimenezi, maantibayotiki a semisynthetic monga amoxicillin-imodzi mwa mankhwala omwe amagwiritsidwa ntchito kwambiri masiku ano-amagwiritsidwa ntchito pochiza matenda osiyanasiyana a kupuma, khungu ndi mabakiteriya monga H. pylori, matenda a Lyme ndi acute otitis media.
Kugwiritsa ntchito penicillin popanda chizindikiro ndikofala, ngakhale mankhwala monga amoxicillin ndi ampicillin amapezeka kwambiri kuposa chilengedwe.penicillin.Kugwiritsidwa ntchito kwapadera kumaphatikizapo kuchiza odwala omwe ali ndi vuto lalikulu la sepsis kapena ana akhanda omwe ali ndi vuto la kupuma movutikira.Palibe, mankhwalawa amagwiritsidwa ntchito pazinthu zotere, koma nthawi zambiri amaonedwa kuti ndi ofunikira ngati palibe njira zina zothandizira.
Penicillin G nthawi zina amagwiritsidwa ntchito pochiza matenda a prosthetic olowa, matenda a Lyme, ndi leptospirosis.Penicillin V nthawi zina amagwiritsidwa ntchito pochiza matenda a Lyme ndi otitis media, kapena kuteteza matenda mwa anthu omwe akulandira tsinde cell transplants.
Penicillin amatha kugwira ntchito bwino akagwiritsidwa ntchito moyenera.Ngakhale zili choncho, nthawi zina, mankhwalawa sangathetse matendawo.Panthawiyi, kuyezetsa kwa ma antibiotic susceptibility test (kotchedwanso antibiotic susceptibility test) kungagwiritsidwe ntchito kuti adziwe ngati munthu ali ndi matenda. kuyankha kwa penicillin.
Kuyezetsako kumayamba ndi kupanga mabakiteriya omwe amatengedwa m'madzi am'madzi am'thupi ndikuyika mabakiteriyawo mwachindunji ku mitundu yosiyanasiyana ya penicillin mu labotale. Kuyezetsa magazi kumagwiritsidwa ntchito kwambiri kwa odwala omwe ali ndi chibayo chopezeka m'madera omwe akudwala kwambiri kapena omwe ali pachiwopsezo chachikulu chotenga kachilomboka. imfa.
Penicillin amaletsedwa ngati munali ndi mankhwala osagwirizana ndi mankhwala aliwonse amtundu wa penicillin. Muyeneranso kusamala ngati mudakhalapo ndi vuto la hypersensitivity m'mbuyomu, kuphatikizapo anaphylaxis, Stevens-Johnson syndrome (SJS), kapena toxic epidermal necrosis. (KUMI).
Ngati mudakhalapo ndi zosagwirizana ndi penicillin G kapena penicillin V m'mbuyomu, mutha (koma osati kwenikweni) kukhala matupi a penicillin opangidwa ndi semisynthetic monga amoxicillin kapena ampicillin.
Anthu omwe samamva ndi penicillin ayenera kugwiritsa ntchito maantibayotiki ena a beta-lactam mosamala chifukwa cha chiopsezo chokhala ndi ziwengo, ngakhale chiopsezo chake ndi chaching'ono. Izi zikuphatikizapo mankhwala a cephalosporin monga Keflex (cephalexin), Maxpime (cefepime), Rocephin (ceftriaxone), ndi Suprax (cefixime).
Ngati mukuda nkhawa kuti mungakhale ndi matupi a penicillin, mukhoza kuyezetsa khungu kuti muwone ngati mukukhudzidwa ndi mankhwala ochepa omwe amaikidwa pansi pa khungu lanu.
Penicillin ayenera kugwiritsidwa ntchito mosamala kwambiri ngati muli pachimake aimpso (impso) kulephera. Penicillin makamaka excreted ndi impso, ndi utachepa aimpso ntchito kungachititse kudzikundikira kwa mankhwala poizoni misinkhu. The motsatira bongo wa penicillin kungayambitse zizindikiro. kugwedezeka, chisokonezo, chikomokere, kukomoka kwachilendo, ndipo, mwa apo ndi apo, chikomokere.
Mlingo wovomerezeka wa penicillin G ndi penicillin V ukhoza kusiyanasiyana malinga ndi matenda komanso zaka za munthu amene akulandira chithandizocho.
Malingana ndi maphikidwe, mlingo umayesedwa m'njira zosiyanasiyana.Kwa akuluakulu, mankhwala nthawi zambiri amayesedwa mu mayunitsi kapena milligrams (mg) tsiku) kapena mayunitsi pa kilogalamu ya kulemera kwa thupi patsiku (mayunitsi/kg/tsiku).
Ngati muli ndi matenda a impso, mungafunike kuchepetsa mlingo wanu wa penicillin kuti muteteze kuopsa kwa mankhwala.Pamene chilolezo cha creatinine (chiwerengero cha ntchito ya impso) chikutsika pansi pa 10 milliliters pamphindi (mL/min), kuchepetsa mlingo kumalimbikitsidwa.
Komano, ngati muli pa hemodialysis, mungafunike mlingo wokulirapo chifukwa hemodialysis imatha kufulumizitsa kuchotsedwa kwa penicillin m'magazi anu.
Penicillin G imapezeka ngati yankho losakanikirana kapena ngati ufa wokonzanso ndi Sterile Water for Injection.Mayankho osakaniza amatha kusungidwa mufiriji kapena mufiriji, pamene mapangidwe a ufa akhoza kusungidwa bwino kutentha.
Penicillin V imapezeka ngati piritsi la pakamwa kapena ngati ufa wonyezimira wa chitumbuwa wosakaniza ndi madzi. Zonsezi ndi zotetezeka kuti zisungidwe kutentha kutentha.Ufa ukangokonzedwanso, uyenera kusungidwa mufiriji ndikutayidwa pakatha masiku 14.
Penicillin V ayenera kumwedwa m'mimba yopanda kanthu kuti azitha kuyamwa kwambiri. Ayenera kumwedwa ola limodzi musanadye kapena maola awiri mutadya.
Ngati mwaphonya mlingo wa penicillin V, imweni mukangokumbukira. Ngati yatsala pang'ono kuti mutenge mlingo wina, dumphani mlingowo ndipo pitirizani kumwa monga mwanthawi zonse. Osawirikiza mlingowo.
Nthawi zonse imwani penicillin monga mwaneneratu komanso momwe mwachitira. Osayimitsa chifukwa akumva bwino. Muyenera kumaliza maphunziro onse kuti muthe majeremusi onse. Mankhwala akaletsedwa, mabakiteriya otsala pang'ono amatha kuchulukana.
Mavuto ambiri a penicillin amakhala ochepa komanso osakhalitsa ndipo amatha okha popanda mankhwala.
Limodzi mwavuto lalikulu lomwe limakhudzana ndi kugwiritsa ntchito penicillin ndi chiopsezo chokhala ndi vuto loyika moyo pachiwopsezo chotchedwa anaphylaxis. Kusagwirizana ndi penicillin weniweni kumakhudza pafupifupi munthu mmodzi kapena asanu mwa anthu 100,000.
Kusamvana kungayambitse vuto lalikulu ngati sikunachiritsidwe. Kungayambitse mantha, chikomokere, kupuma kapena kulephera kwa mtima, ngakhale imfa.
Pezani chithandizo chadzidzidzi ngati mukukumana ndi zina kapena zizindikiro zonse zakuti simunagwirizane nazo mutamwa mlingo wa penicillin:
Nthawi zambiri, penicillin imatha kuyambitsa pachimake interstitial nephritis, matenda otupa a impso omwe nthawi zambiri amayamba chifukwa cha kulephera kwa chitetezo chamthupi kumankhwala. Zizindikiro zake ndi monga nseru, totupa, kutentha thupi, kuledzera, kuchepa kwa mkodzo, kusungidwa kwamadzi, komanso kusanza. zofatsa, koma zina zimatha kukhala zowopsa ndikupangitsa kuvulala kwa impso.
Mofanana ndi maantibayotiki onse, penicillin imagwirizana ndi chiopsezo chowonjezereka cha matenda otsekula m'mimba a C. difficile. Izi zimachitika chifukwa mabakiteriya omwe amapezeka m'matumbo akuwonongeka ndi maantibayotiki, motero amalola kuti mabakiteriya a C. difficile achuluke.Nkhani zambiri zimakhala zochepa komanso zochiritsidwa mosavuta. , koma C. difficile amadziwika kuti amayambitsa matenda a fulminant colitis, megacolon yapoizoni, ndi imfa nthawi zina.
Penicillin amaonedwa kuti ndi abwino pa nthawi yapakati komanso yoyamwitsa. Umboni wa anthu ulibe, koma kafukufuku wa zinyama akusonyeza kuti palibe chiopsezo chovulazidwa ndi mwana.
Ngati muli ndi pakati, mukukonzekera kutenga pakati, kapena mukuyamwitsa, lankhulani ndi achipatala kuti amvetsetse ubwino ndi kuipa kogwiritsa ntchito penicillin.
Mankhwala ambiri amatha kuyanjananso ndi penicillin, nthawi zambiri popikisana ndi chilolezo cha aimpso.Izi zimawonjezera kuchuluka kwa penicillin m'magazi ndi chiopsezo cha zotsatirapo komanso kuopsa kwa mankhwala.
Kuti mupewe kuyanjana, nthawi zonse muzidziwitsa dokotala za mankhwala omwe mukumwa, kaya ndi mankhwala, ogula, zakudya, zitsamba, kapena zosangalatsa.
Lembetsani ku nkhani zamalangizo azaumoyo watsiku ndi tsiku ndikulandila malangizo atsiku ndi tsiku okuthandizani kukhala ndi moyo wathanzi.
Lobanovska M, Pilla G. Penicillin anapeza ndi kukana maantibayotiki: maphunziro amtsogolo?Yale Journal of Biomedical Sciences.2017;90(1):135-45.
Founou LL, Founou RC, Essack SY. Antibiotic resistance in the foodchain
Nthawi yotumiza: Mar-25-2022