U-Anju Goel, MD, MPH, ngugqirha oqinisekisiweyo webhodi okhethekileyo kwimpilo yoluntu, izifo ezithathelwanayo, isifo sikashukela, kunye nomgaqo-nkqubo wezempilo.
I-Penicillin sisibulali-zintsholongwane esisetyenziselwa ukunyanga iintlobo ezithile zosulelo lwebhaktiriya.Iziphumo ebezingalindelekanga ezixhaphakileyo ziquka urhudo kunye nokuphazamiseka kwesisu, kwaye abanye abantu basenokungavisisani nepenicillin - iziphumo ziqala kancinci ukuya kobukhali.
I-Penicillin inokunikwa ngomlomo, okanye ifakwe nge-intravenously (IV, kwi-vein), okanye i-intramuscularly (IM, kwi-muscle enkulu) .Kwaye kukho iindidi ezahlukeneyo ze-penicillin ezineendlela ezahlukeneyo zesenzo.
Zonke iintlobo zepenicillin zithatyathwa, ubuncinane ngokuyinxenye, kwifungus ebizwa ngokuba yi-Ipenicilliumikhrisogenum.
Isazinzulu saseSkotlani uAlexander Fleming wafumanisa ipenicillin ngo-1929 xa wafumanisa ukuba amasiko ebhaktiriya angcoliseke ngengozi “ngejusi yokungunda” ayebulawa yifungus. Kwaye kwada kwangowe-1941 apho izazinzulu zazikwazile ukwahlula ngempumelelo, ukulicoca kunye nokuvavanya iyeza okokuqala ngqa. isigulana, singenisa ixesha le-antibiotics.
Ngeminyaka yoo-1960, izazinzulu zazikwazi ukuphuhlisa iyeza lokuqala le-penicillin elikwaziyo ukunyanga uluhlu olubanzi losulelo lwebhaktheriya. Ngelo xesha, baqala ukuqaphela isoyikiso sokunganyangeki kwe-penicillin, apho iintlobo eziguquguqukayo ezichasene neyeza zaqala ukuvela. kwaye yasasazeka kubo bonke abantu.
Namhlanje, inani elonyukayo losulelo lwebhaktiriya luxhathisa ngokupheleleyo okanye ngokuyinxenye kumayeza e-penicillin okuqala, aquka iNeisseria gonorrhoeae (igonorrhea) kunye ne-methicillin-resistant Staphylococcus aureus (MRSA).
IStreptococcus pneumoniae, uhlobo lwenyumoniya yebhaktiriya, kunye nezinye iintlobo zeClostridium kunye neListeria nazo ziye zingasabeli kakuhle kula mayeza okubulala iintsholongwane.
Ukusetyenziswa ngokugqithiseleyo kwe-antibiotics ukukhuthaza ukukhula kwemfuyo kuyaziwa ngokunyusa umngcipheko we-bacterial-resistant-resistant bacteria, kubandakanywa ne-superbugs, kulo lonke i-chain chain.Ngenxa yolu kukhathazeka kwehlabathi jikelele, i-United States yavala ukusetyenziswa kwe-antibiotics ukukhuthaza ukukhula kwezilwanyana kwi-2017.
Iipenicillinsngamalungu osapho olukhulu lwamachiza abizwa ngokuba yi-beta-lactam antibiotics.La machiza anesakhiwo esifanayo semolekyuli, equlathe isangqa seeathom ezine ezibizwa ngokuba yi-beta-lactams.
I-Penicillin isebenza ngokuzibophelela kwiimolekyuli ezikudonga lwebhaktiriya olubizwa ngokuba yi-peptidoglycan.Xa ibhaktheriya isahlula, i-penicillin ithintela ukulungelelaniswa okuqhelekileyo kweeprotheni kudonga lweseli, okubangela ukuba iiseli zebhaktheriya ziqhekeke kwaye zife ngokukhawuleza.
Iipenicillin zendalo zezo zikhutshwe ngokuthe ngqo kwi-P. chrysogenum fungus. Kukho iipenicillin ezimbini zendalo.
I-Semi-synthetic penicillin iveliswa kwilabhoratri kwaye iyafana nekhemikhali efumaneka kwi-P. chrysogenum. Kukho iiklasi ezine ze-semisynthetic penicillins, kubandakanywa amayeza okubulala iintsholongwane asetyenziswa ngokuqhelekileyo afana ne-amoxicillin kunye ne-ampicillin.
Ngalunye kwezi ntlobo lunolwakhiwo lwemolekyuli olwahluke kancinane kwaye lunokulawulwa ngokwahlukileyo kunezinye iindidi.
Ezinye penicillins akukho ngqo antibacterial activity.Zisetyenziswa kunyango oludityanisiweyo ukunceda ukoyisa ukumelana penicillin.Ngokomzekelo, clavulanic acid iibhloko enzyme secreted ibhaktiriya antibacterial-resistant (beta-lactamase) ukuba inqanda umsebenzi beta-lactam antibiotics.
Iipenicillin zisetyenziselwa ukunyanga usulelo lwebhaktiriya – azilunyangi usulelo lwentsholongwane, lomngundo okanye lweparasitic.La machiza adla ngokusebenza ngokuchasene neebhaktheriya zeGram-positive, udidi lweebhaktheriya ezinepeptidoglycan ngaphandle kweendonga zazo zeeseli. Kwibhaktheriya yeGram-negative , umaleko we-peptidoglycan ungcwatywe phantsi koluhlu lweeseli ze-lipid, okwenza kube nzima ukuba amachiza afikelele kwi-molecule.
Iibhaktheriya ezinegram-positive ezinokunyangwa ngepenicillin ziquka iClostridium, iListeria, iNeisseria, iStaphylococcus, kunye neStreptococcus.
Iipenicillin zendalo - penicillin G kunye nepenicillin V - zisasetyenziswa nanamhlanje kunyango lwezinye izifo ezixhaphakileyo nezingaqhelekanga.
Ngokwahlukileyo, i-antibiotics ye-semisynthetic efana ne-amoxicillin-enye ye-antibiotics esetyenziswa ngokuqhelekileyo namhlanje-isetyenziselwa ukuphatha uluhlu olubanzi lwezifo zokuphefumula, ulusu kunye ne-bacterial ezifana ne-H. pylori, isifo se-Lyme kunye ne-acute otitis media.
Ukusetyenziswa kwe-penicillin ngaphandle kweleyibhile kuxhaphakile, nangona amachiza afana ne-amoxicillin kunye ne-ampicillin zixhaphake kakhulu kunendalo.ipenicillin.Ukusetyenziswa ngaphandle kweleyibhile kubandakanya unyango lwezigulane ezixinzelelekileyo kunye ne-sepsis okanye i-neonates ene-acute breath distress.Ayikho imeko, la mayeza asetyenziselwa iinjongo ezinjalo, kodwa ngokuqhelekileyo abonwa njengemfuneko xa kungekho ezinye iindlela zonyango ezikhoyo.
I-Penicillin G ngamanye amaxesha isetyenziselwa ukunyanga izifo ezidibeneyo ze-prosthetic, isifo se-Lyme, kunye ne-leptospirosis.I-Penicillin V ngamaxesha athile isetyenziselwa ukunyanga isifo se-Lyme kunye ne-otitis media, okanye ukukhusela izifo kubantu abafumana i-stem cell transplants.
Ipenicillin inokusebenza kakhulu xa isetyenziswa kakuhle.Nangona kunjalo, kwezinye iimeko, ichiza alisebenzi ekosuleni usulelo. Kule meko, uvavanyo lwe-antibiotic susceptibility testing (ekwabizwa ngokuba luvavanyo lwe-antibiotic susceptibility test) lunokusetyenziswa ukufumanisa ukuba usulelo lomntu ukusabela kwi-penicillin.
Uvavanyo luqala ngokuvelisa iintsholongwane ezithathwe kwiiswabs zolwelo lomzimba kwaye emva koko ziveze iibhaktheriya ngokuthe ngqo kwiintlobo ezahlukeneyo zepenicillin elabhoratri. ukufa.
I-Penicillin iyachaswa ukuba ubukhe wachasana naso nasiphi na ichiza kwintsapho yepenicillin. Kufuneka ulumke kwakhona ukuba ukhe waba ne-hypersensitivity kwiziyobisi kwixesha elidlulileyo, kuquka i-anaphylaxis, iStevens-Johnson syndrome (SJS), okanye i-epidermal necrosis enetyhefu. (SHUMI).
Ukuba ngaba uye wachasana ne-penicillin G okanye i-penicillin V kwixesha elidlulileyo, unokuthi (kodwa kunganyanzelekanga) ukwalane ne-semi-synthetic penicillins ezifana ne-amoxicillin okanye i-ampicillin.
Abantu abangahambisani ne-penicillin kufuneka basebenzise ezinye ii-antibiotics ze-beta-lactam ngononophelo ngenxa yomngcipheko wokwaliwa kwe-cross-reactive, nangona umngcipheko umncinci.Oku kubandakanya antibiotics e-cephalosporin njenge-Keflex (cephalexin), i-Maxipime (cefepime), i-Rocephin (ceftriaxone), kunye neSuprax (cefixime).
Ukuba unenkxalabo yokuba unokungadibani nepenicillin, unokuba novavanyo lokwaliwa lusu ukuze ubone ukuba uyasabela na kwisixa esincinci sechiza esibekwe phantsi kwesikhumba sakho.
I-Penicillin kufuneka isetyenziswe ngononophelo olukhulu ukuba une-renal ebukhali (izintso) failure.Penicillin ngokuyintloko ikhutshwa yizintso, kunye nokuncipha komsebenzi wezintso kunokukhokelela ekuqokeleleni kweyeza kwizinga eliyityhefu.Isiphumo sokugqithiswa kwepenicillin kunokukhokelela kwiimpawu ukungcangcazela, ukubhideka, isiqaqa, ukuxhuzula okungaqhelekanga, kwaye, kwiimeko ezinqabileyo, isiqaqa.
Iidosi ezicetyiswayo zepenicillin G kunye nepenicillin V zinokuhluka ngokuxhomekeke kwisifo kunye neminyaka yomntu onyangwayo.
Ngokuxhomekeke kwiresiphi, idosi ilinganiswa ngeendlela ezininzi ezahlukeneyo.Kubantu abadala, iziyobisi zivame ukulinganiswa kwiiyunithi okanye ii-milligrams (mg) .Kubantwana, iidosi zingabalwa ngeemiligram ngekhilogram yobunzima bomzimba ngosuku (mg / kg / ngosuku) okanye kwiiyunithi ngekhilogram yobunzima bomzimba ngosuku (iiyunithi/kg/ngosuku).
Ukuba unesifo sezintso, unokufuna ukunciphisa umthamo wakho we-penicillin ukukhusela ubuthi beziyobisi.Xa imvume ye-creatinine (umlinganiselo we-kidney function) iwela ngaphantsi kwe-10 milliliters ngomzuzu (mL / min), ukunciphisa umthamo kuyacetyiswa.
Kwelinye icala, ukuba ukwi-hemodialysis, unokufuna idosi ephezulu kuba i-hemodialysis inokukhawulezisa ukususwa kwepenicillin egazini lakho.
I-Penicillin G ifumaneka njengesisombululo se-premixed okanye njengepowder yokubuyisela kwakhona kunye naManzi aNyimbileyo kwi-Injection.I-Premixed solutions ingagcinwa kwifriji okanye efrijini, ngelixa i-powder formulations ingagcinwa ngokukhuselekileyo kwiqondo lokushisa.
I-Penicillin V ifumaneka njengepilisi yomlomo okanye i-cherry-flavored powder exutywe namanzi.Zombini zikhuselekile ukugcina kwindawo yokushisa kwegumbi.Emva kokuba i-powder ibuyiselwe, kufuneka igcinwe efrijini kwaye ilahlwe emva kweentsuku ze-14.
I-Penicillin V kufuneka ithathwe kwisisu esingenalutho ukuqinisekisa ukufunxa okuphezulu. Kufuneka ithathwe ubuncinane iyure enye phambi okanye kwiiyure ezimbini emva kokutya.
Ukuba uphose ithamo le-penicillin V, yithathe ngokukhawuleza xa ukhumbula. Ukuba kusondele ixesha ledosi yakho elandelayo, tsiba idosi kwaye uqhubeke uyithatha njengesiqhelo. Ungaze uyiphinde kabini idosi.
Soloko uthatha ipenicillin njengoko uyalelwe kwaye uyenzile.Ungayeki nje kuba ivakala ilungile.Kufuneka ugqibezele ikhosi ukuze utshabalalise zonke iintsholongwane.Xa unyango luyekiwe, inani elincinci lebhaktheriya eseleyo lingaphindaphindeka.
Uninzi lweziphumo ebezingalindelekanga ze-penicillin zithambile kwaye zidlula kwaye zizisombulule ngokwazo ngaphandle konyango.Kodwa ngamanye amaxesha iziphumo ebezingalindelekanga zinokumandundu, kwaye zibeke esichengeni ubomi, kwaye zifuna ukhathalelo olungxamisekileyo.
Enye yeengxaki ezinzulu ezinxulunyaniswa nokusetyenziswa kwe-penicillin kumngcipheko wenkqubo enokuba yingozi ebomini ebizwa ngokuba yi-anaphylaxis.I-Allergic reactions kwi-penicillin yokwenyani ichaphazela malunga nomntu om-1 ukuya kwaba-5 kwi-100,000.
Ukwalana kunokubangela ingozi enkulu ukuba ayinyangwa. Inokubangela ukothuka, isiqaqa, ukuphefumla okanye ukusilela kwentliziyo, kunye nokufa.
Funa unyango olungxamisekileyo ukuba ufumana ezinye okanye zonke iimpawu zokungaphenduli emva kokuthatha idosi yepenicillin:
Kwiimeko ezinqabileyo, ipenicillin inokubangela i-acute interstitial nephritis, isifo sezintso esidumbayo esidla ngokubangelwa kukusabela okungaqhelekanga komzimba kwichiza. ithambile, kodwa ezinye zinokuba nzima kwaye zikhokelele kumonzakalo wezintso.
Njengazo zonke ii-antibiotics, i-penicillin inxulunyaniswa nomngcipheko okhulayo we-C. difficile diarrhea.Oku kubangelwa ibhaktheriya ehlala ikhona emathunjini etshatyalaliswa ngamayeza okubulala iintsholongwane, ngaloo ndlela ivumela i-C. difficile bacteria ukuba iphindaphinde.Iimeko ezininzi zincinci kwaye zinyangeka ngokulula. , kodwa uC. difficile waziwa ngokubangela i-fulminant colitis enzima, i-megacolon eyityhefu, kunye nokufa kwiimeko ezinqabileyo.
I-Penicillin ngokuqhelekileyo ithathwa njengekhuselekile ngexesha lokukhulelwa kunye nokuncancisa.Ubungqina ebantwini abukho, kodwa uphando lwezilwanyana lubonisa ukuba akukho mngcipheko wokwenzakala kumntwana.
Ukuba ukhulelwe, uceba ukukhulelwa, okanye ukuncancisa, thetha nomboneleli wakho wezempilo ukuze uqonde ngokupheleleyo izibonelelo kunye nobungozi bokusebenzisa ipenicillin.
Amachiza amaninzi angakwazi ukusebenzisana ne-penicillin, ngokuqhelekileyo ngokukhuphisana ne-renal clearance.Oku kwandisa ukugxila kwe-penicillin egazini kunye nomngcipheko wemiphumo emibi kunye ne-toxicity yeziyobisi.Amanye amachiza anokukhawuleza ukususwa kwe-penicillin emzimbeni kunye nokunciphisa ukusebenza kweyeza.
Ukunqanda ukusebenzisana, hlala uvumela umboneleli wakho wezempilo ukuba azi malunga nawo nawaphi na amayeza owathathayo, nokuba ngummiselo, i-over-the-counter, isondlo, i-herbal, okanye ukuzonwabisa.
Bhalisela incwadana yethu yengcebiso yezempilo yemihla ngemihla kwaye ufumane iingcebiso zemihla ngemihla ukukunceda uphile obona bomi busempilweni.
U-Lobanovska M, uPilla G. Ukufumanisa i-Penicillin kunye nokuxhathisa i-antibiotic: izifundo zexesha elizayo? Yale Journal ye-Biomedical Sciences.2017; 90 (1): 135-45.
I-Founou LL, i-Founou RC, i-Essack SY.Ukunganyangeki kwe-Antibiotic kwikhonkco lokutya: umbono welizwe eliphuhlayo.
Ixesha lokuposa: Mar-25-2022