Anju Goel, MD, MPH, ni umuganga wemejwe ninama yinzobere mubuzima rusange, indwara zandura, diyabete, na politiki yubuzima.
Penisiline ni antibiyotike ikoreshwa mu kuvura ubwoko bumwe na bumwe bwandura za bagiteri. Ingaruka zisanzwe zirimo impiswi no kuribwa mu gifu, kandi abantu bamwe bashobora kugira allergique kuri penisiline - ingaruka ziva ku bworoherane bukabije.
Penisiline irashobora gutangwa kumunwa, cyangwa guterwa mumitsi (IV, mumitsi), cyangwa mumitsi (IM, mumitsi minini) .Kandi hariho ubwoko butandukanye bwa penisiline hamwe nuburyo butandukanye bwibikorwa.
Ubwoko bwose bwa penisiline ikomoka, byibuze igice, uhereye mugihumyo cyitwaPenicilliumchrysogenum.
Umuhanga mu bya siyansi witwa Scottish Alexander Fleming yavumbuye penisiline mu 1929 ubwo yamenyaga ko imico ya bagiteri yanduye ku buryo butunguranye n '“umutobe w’ibumba” yicwaga n’agahumyo. Mu 1941 ni bwo abahanga mu bya siyansi bashoboye gutandukanya, kweza no gupima ibiyobyabwenge ku ncuro yabo ya mbere. ihangane, itangiza mugihe cya antibiotique.
Kugeza mu myaka ya za 1960, abahanga bashoboye gukora imiti ya semisintetike ya penisiline yambere ishobora kuvura indwara nyinshi ziterwa na bagiteri.Mu gihe kimwe, batangiye kumenya iterabwoba rya penisiline, aho imitekerereze ya mutant irwanya antibiyotike. no gukwirakwira mu baturage.
Muri iki gihe, umubare munini w’ubwandu bwa bagiteri urwanya byimazeyo cyangwa igice kimwe imiti ya penisiline, harimo Neisseria gonorrhoeae (gonorrhea) na methicilline irwanya Staphylococcus aureus (MRSA).
Streptococcus pneumoniae, ubwoko bwa pneumoniya ya bagiteri, kimwe na Clostridium na Listeria nabyo ntibigenda byitabira iyo antibiyotike.
Kurenza urugero rwa antibiyotike kugirango iteze imbere ubworozi bizwiho kongera ibyago bya bagiteri zirwanya ibiyobyabwenge, harimo na superbugs, murwego rwibiribwa. Kubera iyi mpungenge zikomeje kwiyongera ku isi, Amerika yabujije ikoreshwa rya antibiyotike kugirango iteze imbere inyamaswa muri 2017.
Penisilineni mumuryango munini wibiyobyabwenge byitwa antibiotique ya beta-lactam.Iyi miti ifite imiterere isa na molekile, igizwe nimpeta ya atome enye bita beta-lactams. Buri bwoko bwa penisiline bufite iminyururu yinyongera igena ibikorwa byayo.
Penicillin ikora ihuza molekile kurukuta rwa bagiteri yitwa peptidoglycan.Iyo bagiteri igabanije, penisiline irinda kuvugurura poroteyine zisanzwe kurukuta rw'akagari, bigatuma bagiteri ziturika zipfa vuba.
Penisiline isanzwe niyo yakuwe muri fungus ya P. chrysogenum.Hari penisiline ebyiri.
Semi-syntetique penisiline ikorerwa muri laboratoire kandi isa n’imiti iboneka muri P. chrysogenum.Hariho ibyiciro bine bya penisiline ya semisintetike, harimo antibiyotike ikoreshwa nka amoxicillin na ampicilline.
Buri bwoko bwubwoko bufite molekulire itandukanye gato kandi burashobora gutangwa muburyo butandukanye nubundi bwoko.
Penisiline zimwe na zimwe zidafite ibikorwa bya antibacterial itaziguye.Bikoreshwa muguhuza imiti kugirango bifashe gutsinda penisiline.Urugero, aside clavulanic ihagarika enzyme isohorwa na bagiteri irwanya antibiyotike (beta-lactamase) ibuza ibikorwa bya antibiotike ya beta-lactam.
Penisiline ikoreshwa mu kuvura indwara ziterwa na bagiteri - ntabwo zivura virusi, fungal cyangwa parasitike.Iyi miti ubusanzwe igira ingaruka nziza kuri bagiteri ya Gram-positif, icyiciro cya bagiteri zifite peptidoglycan hanze yinkuta zabo. Kuri bagiteri ya Gram-negative , peptidoglycan igashyingurwa munsi ya selile ya lipide, bigatuma ibiyobyabwenge bigora molekile.
Indwara nziza ya bagiteri ishobora kuvurwa na penisiline harimo Clostridium, Listeria, Neisseria, Staphylococcus, na Streptococcus.
Penisiline isanzwe - penisiline G na penisiline V - iracyakoreshwa muri iki gihe mu kuvura indwara ziterwa na bagiteri zisanzwe kandi zidasanzwe.
Ibinyuranye na byo, antibiyotike ya semisintetike nka amoxicillin - imwe muri antibiyotike ikoreshwa cyane muri iki gihe - ikoreshwa mu kuvura indwara zitandukanye z’ubuhumekero, uruhu na bagiteri nka H. pylori, indwara ya Lyme hamwe n’itangazamakuru rikabije rya otitis.
Gukoresha ibirango bya penisiline birasanzwe, nubwo ibiyobyabwenge nka amoxicillin na ampisilline bikunze kugaragara kuruta ibisanzwepenisiline.Off-label ikoreshwa harimo kuvura abarwayi bafite uburwayi bukomeye bwa sepsis cyangwa neonates bafite ibibazo byubuhumekero bukabije.Ntabwo bimeze bityo, iyi miti ikoreshwa mubikorwa nkibi, ariko mubisanzwe bifatwa nkibikenewe mugihe ntayindi nzira yo kuvura ihari.
Penicillin G rimwe na rimwe ikoreshwa hanze ya label kugirango ivure indwara zifata prostate, indwara ya Lyme, na leptospirose.
Penicilline irashobora kuba ingirakamaro cyane iyo ikoreshejwe neza.Nubwo bimeze bityo, mubihe bimwe na bimwe, imiti ntigikora neza mugukuraho ubwandu.Muri iki gihe, hashobora gukoreshwa ibizamini byo kwanduza antibiyotike (nanone bita antibiotic susceptibility test) kugirango hamenyekane niba kwandura umuntu ari yitabira penisiline.
Ikizamini gitangirana no guhuza za bagiteri zavanywe mu mazi menshi hanyuma zigahita zitera bagiteri mu bwoko butandukanye bwa penisiline muri laboratoire. Kwipimisha kwa antibiyotike bikunze gukoreshwa mu barwayi bafite umusonga wanduye abaturage bafite uburwayi bukomeye cyangwa bafite ibyago byinshi byo kurwara. urupfu.
Penicillin irabujijwe niba warigeze kuba allergique kumiti iyo ari yo yose mumuryango wa penisiline.Ugomba kandi kwitonda niba ufite imiti ikabije yibiyobyabwenge, harimo anaphylaxis, syndrome ya Stevens-Johnson (SJS), cyangwa necrosis toxic toxic epidermal (ICUMI).
Niba ufite allergie reaction kuri penisiline G cyangwa penisiline V mubihe byashize, urashobora (ariko ntabwo byanze bikunze) kuba allergique kuri penisiline ya sintetike nka amoxicillin cyangwa ampisilline.
Abantu allergique kuri penisiline bagomba gukoresha antibiyotike ya beta-lactam bitonze kubera ibyago byo kwandura allergie, nubwo ibyago ari bike.Ibi birimo antibiyotike ya cephalosporin nka Keflex (cephalexin), Maxipime (cefepime), Rocephin (ceftriaxone), na Suprax (cefixime).
Niba ufite impungenge ko ushobora kuba allergique kuri penisiline, urashobora kwipimisha allergie y'uruhu kugirango urebe niba ufite reaction ku gipimo gito cyibiyobyabwenge gishyizwe munsi yuruhu rwawe.
Penicilline nayo igomba gukoreshwa mubwitonzi bukabije niba ufite ikibazo cyimpyiko zikomeye (impyiko ).Penicilline isohoka cyane nimpyiko, kandi imikorere yimpyiko igabanuka bishobora gutuma ibiyobyabwenge byiyongera kurwego rwuburozi.Ibisubizo birenze urugero bya penisiline bishobora gutera ibimenyetso yo guhagarika umutima, urujijo, koma, guhungabana bidasanzwe, kandi, mubihe bidasanzwe, koma.
Ingano isabwa ya penisiline G na penisiline V irashobora gutandukana bitewe n'indwara n'imyaka umuntu avurwa.
Ukurikije resept, ibipimo bipimwa muburyo butandukanye.Mu bantu bakuru, ibiyobyabwenge bipimirwa mubice cyangwa miligarama (mg) .Mu bana, dosiye irashobora kubarwa muri miligarama kuri kilo yuburemere bwumubiri kumunsi (mg / kg / umunsi) cyangwa mubice kuri kilo yuburemere bwumubiri kumunsi (ibice / kg / kumunsi).
Niba ufite uburwayi bwimpyiko, urashobora gukenera kugabanya urugero rwa penisiline kugirango wirinde uburozi bwibiyobyabwenge.Iyo gukuraho creinine (igipimo cyimikorere yimpyiko) bigabanutse munsi ya mililitiro 10 kumunota (mL / min), mubisanzwe birasabwa kugabanya ibipimo.
Ku rundi ruhande, niba uri kuri hemodialyse, urashobora gukenera urugero rwinshi kuko hemodialyse ishobora kwihutisha gukuramo penisiline mumaraso yawe.
Penicillin G iraboneka nkigisubizo cyateganijwe cyangwa nkifu yokwiyubaka hamwe namazi ya Sterile yo gutera inshinge. Ibisubizo bivanze birashobora kubikwa muri firigo cyangwa firigo, mugihe ifu ishobora kubikwa neza mubushyuhe bwicyumba.
Penicillin V iraboneka nkibinini byo munwa cyangwa nkifu ya cheri itoshye ivanze namazi.Bombi bafite umutekano kubika ubushyuhe bwicyumba. Iyo ifu imaze kongera kwiyubaka, igomba kubikwa muri firigo hanyuma ikajugunywa nyuma yiminsi 14.
Penisiline V igomba gufatwa mu gifu cyuzuye kugirango yinjire neza.Bigomba gufatwa byibuze isaha imwe mbere cyangwa amasaha abiri nyuma yo kurya.
Niba wabuze igipimo cya penisiline V, fata ukimara kubyibuka.Niba igihe cyegereje cya dose ikurikira, simbuka ikinini hanyuma ukomeze kugifata nkuko bisanzwe.Ntukigere wikuba kabiri.
Buri gihe ufate penisiline nkuko byateganijwe kandi bikozwe.Ntugahagarike gusa kuko byunvikana neza. Ugomba kurangiza amasomo yose kugirango urandure mikorobe zose. Iyo imiti imaze guhagarikwa, umubare muto wa bagiteri zisigaye zirashobora kugwira.
Ingaruka nyinshi za penisiline ziroroshye kandi zigihe gito kandi zigakemura ubwazo zitavuwe.Ariko rimwe na rimwe ingaruka zirashobora gukomera, ndetse zikangiza ubuzima, kandi bisaba ubuvuzi bwihutirwa.
Kimwe mu bibazo bikomeye bifitanye isano no gukoresha penisiline ni ibyago byo guhitana ubuzima bwa sisitemu ya allergique yitwa anaphylaxis. Imyitwarire ya allergique kuri penisiline nyayo igira ingaruka kubantu bagera kuri 1 kugeza kuri 55.000.
Imyitwarire ya allergique irashobora guteza ingaruka zikomeye iyo itavuwe.Bishobora gutera ihungabana, koma, guhumeka cyangwa kunanirwa k'umutima, ndetse no gupfa.
Shakisha ubutabazi bwihuse niba uhuye nibimenyetso cyangwa ibimenyetso byose byerekana allergie nyuma yo gufata ikinini cya penisiline:
Mubihe bidakunze kubaho, penisiline irashobora gutera neprite ikaze, indwara yimpyiko ikongora akenshi iterwa nubudahangarwa budasanzwe bwibiyobyabwenge. Ibimenyetso birimo isesemi, guhubuka, umuriro, gucika intege, kugabanuka kwinkari, kugumana amazi, no kuruka. byoroheje, ariko bimwe birashobora gukomera bikagutera gukomeretsa bikabije.
Kimwe na antibiyotike zose, penisiline ifitanye isano no kongera ibyago byo kurwara C. difficile diarrhea.Ibi biterwa na bagiteri zisanzwe ziboneka munda zirimburwa na antibiotique, bityo bigatuma bagiteri C. diffile igwira.Ibibazo byinshi biroroshye kandi birashobora kuvurwa byoroshye. , ariko C. diffile izwiho gutera colitis ikabije, megacolon yuburozi, nurupfu mubihe bidasanzwe.
Ubusanzwe Penicilline ifatwa nkumutekano mugihe cyo gutwita no konsa.Ibimenyetso byabantu ntibibuze, ariko ubushakashatsi bwinyamaswa bwerekana ko nta ngaruka zo kwangiza umwana.
Niba utwite, uteganya gusama, cyangwa konsa, vugana nushinzwe ubuzima kugirango wumve neza inyungu ningaruka zo gukoresha penisiline.
Imiti myinshi irashobora kandi gukorana na penisiline, mubisanzwe muguhatanira kuvanaho impyiko.Ibi byongera penisiline mumaraso hamwe ningaruka ziterwa nuburozi bwibiyobyabwenge.Ibindi biyobyabwenge birashobora kwihutisha gukuramo penisiline mumubiri kandi bikagabanya imikorere yibiyobyabwenge.
Kugira ngo wirinde imikoranire, buri gihe umenyeshe abashinzwe ubuvuzi kumenya imiti iyo ari yo yose ufata, yaba iyandikirwa, kurenza kuri konte, imirire, ibyatsi, cyangwa imyidagaduro.
Iyandikishe kumakuru yubuzima bwa buri munsi kandi wakire inama za buri munsi zagufasha kubaho ubuzima bwiza.
Lobanovska M, Pilla G. Penicillin kuvumbura no kurwanya antibiyotike: amasomo y'ejo hazaza? Yale Journal of Biomedical Science.2017; 90 (1): 135-45.
Founou LL, Founou RC, Essack SY. Kurwanya antibiyotike murwego rwibiryo: icyerekezo cyiterambere ryigihugu.pre-mikorobe.2016; 7: 1881.doi: 10.3389 / fmicb.2016.01881
Igihe cyo kohereza: Werurwe-25-2022