Clindamycin: cov lus qhia rau kev siv, analogues thiab tshuaj xyuas, tus nqi hauv cov khw muag tshuaj hauv Lavxias

Kev piav qhia cuam tshuam rau 13.03.2016

• Lub npe Latin: Clindamycin
• ATX Code: J01FF01
• Yam tshuaj muaj sia: Clindamycin (Clindamycin)
• Chaw tsim tshuaj paus: Hemofarm (Serbia), VERTEX (Russia)

Cov muaj pes tsawg leeg clindamycin tsiav tshuaj nquag tivthaiv nrog clindamycin(hydrochloride daim ntawv), kuj tseem muaj cov khoom xyaw ntxiv: talc, lactose monohydrate, pob kws hmoov txhuv nplej siab, magnesium stearate.

Tshuaj muaj cov nquag xyaw clindamycin (ib daim ntawv ntawm phosphate), thiab ntxiv rau cov khoom xyaw: benzyl cawv, disodium edetate, dej.

Clindamycin Cov Tshuaj Nplaum Cov tshuaj muaj pes tsawg leeg muaj cov khoom ua ub ua no clindamycin (ib hom phosphate), thiab ntxiv rau cov khoom xyaw pabcuam: macrogol 1500, roj taum castor, sodium benzoate, propylene glycol, emulsifier No.

Daim ntawv tso tawm

Cov twj yog tsim nyob rau hauv daim ntawv ntawm tsiav tshuaj, kev daws thiab pojniam paum.

Nkaws tsiav tshuaj muaj lub cev liab doog thiab lub hau liab. Sab hauv muaj cov hmoov, uas yuav muaj xim dawb lossis dawb-daj. Cov tshuaj ntsiav tau ntim rau hauv cov hlwv ntawm 8 pcs., Hauv ib pob ntawv los qhia rau 2 yam ntawd lub hlwv.

Txoj kev daws teeb meem, uas tau tswj hwm qhov quav lossis intramuscularly, yog pob tshab, nws tuaj yeem tsis muaj xim lossis daj me ntsis. Muaj nyob hauv ampoules ntawm 2 ml. Hauv cov hlwv qhwv ntawm 5 ampoules, hauv daim npav cardboard ntawm 2 pob.

Lub paum ntawm qhov paum 2% tej zaum yuav muaj xim dawb, daj-dawb, qab zib. Nws muaj lub zog uas tsis muaj ntxhiab tsw. Nws muaj nyob hauv cov kav hlau txhuas ntawm 20 g lossis 40 g, tus neeg thov nkag nrog hauv pob.

Pharmacological kev txiav txim

Cov tshuaj clindamycin belongs rau cov pab pawg ntawm cov tshuaj tua kab mob-lincosamides. Nws muaj cov txiaj ntsig dav, yog tus mob bacteriostatic.

Hauv lub cev, nws khi rau 50S ntu ntawm ribosome thiab inhibits protein synthesis hauv microorganisms. Nws tseem nquag in relation to Dab Tsi Staphylococcus spp., Streptococcus spp. (tsis suav yog Enterococcus spp.), Kab mob ntsws dej liab, anaerobic thiab microaerophilic gram-zoo cocci, Clostridium tetani, Clostridium perfringens, Corynebacterium diphtheriae, Mycoplasma spp., Bacteroides spp. (suav nrog Bacteroides melaningenicus thiab Bacteroides fragilis) Nws tseem ua kom pom kev ua haujlwm tawm tsam anaerobic gram-zoo, tsis yog-spore sib sau, bacilli.

Feem ntau cov neeg tseem muaj lub siab xav txog cov khoom no. Clostridium perfringens, tab sis lwm yam ntau yam ntawm clostridia (tshwj xeeb Clostridium tertium, Clostridium sporogenes) qhia kev tawm tsam rau cov tshuaj no. Hauv qhov no, nrog rau cov kab mob provoked Clostridium spp.Nws raug nquahu kom siv tshuaj tiv thaiv kab mob ua ntej pib kho.

Tus txheej txheem ntawm kev ua ntawm cov tshuaj no thiab nws cov tshuaj tua kab mob ze ntawm lincomycin.

Daim ntawv ntawm cov tshuaj clindamycin phosphate yog qhov ua tsis tiav hauv vitro, txawm li cas los xij, nws tau nrawm nrawm rau hauv vivo, thiab clindamycin tau tsim, uas ua kom pom cov dej num.

Pharmacokinetics thiab cov chaw muag tshuaj

Clindamycin yog kiag li thiab sai sai los ntawm kev mob hauv txoj hnyuv, thaum noj mov, kev nqus poob qis, thaum lub siab ntawm cov tshuaj hauv plasma tseem tsis hloov. Ua kom nkag mus rau hauv lub cev nqaij thiab dej, kis tsis zoo los ntawm BBB, tab sis yog tias muaj mob ntawm cov leeg ntawm lub hlwb, permeability nce.

Qhov siab tshaj plaws hauv ntshav nws tau sau tseg thaum noj ntawm qhov ncauj tom qab 0.75-1 teev, yog tias ua tus thawj coj intramuscular, tom qab 1 teev hauv cov neeg laus thiab tom qab 3 teev hauv cov menyuam yaus. Thaum muab tshuaj rau lub cev, qhov siab tshaj plaws yog pom ntawm qhov kawg ntawm Txoj kev lis ntshav.

Muaj tshuaj kho mob nyob rau hauv cov ntshav rau 8-12 teev. Ib nrab-lub neej yog 2.4 teev. Kev zom zaub mov tshwm sim hauv daim siab, thaum lub cev nquag thiab lub cev tsis ua haujlwm metabolitesCov. Kev tshem tawm yuav siv sij hawm dhau 4 hnub los ntawm lub raum thiab los ntawm txoj hnyuv.

Thaum muab cov tshuaj rau hauv intravaginally, li ntawm 3% ntawm cov koob tshuaj muab rau siv cov txheej txheem kev nqus.

Kev ntsuas rau siv

Clindamycin kev daws teeb meem thiab cov ntsiav tshuaj yog siv rau cov kab mob zoo li no:

• cov kis mob thiab mob uas tau tshwm sim los ntawm kev ua ntawm cov kab mob me me nkag siab clindamycin,
• kis kab mob ntawm ENT plab hnyuv siab raum, nrog rau cov kab mob sib kis ntawm cov pa sab saud thiab hauv cov pa ua pa qis,
• mob ntsws o, caws pliav taub,
• urogenital mob
• kis ntawm lub qhov ncauj kab noj hniav, kho lub plab,
• cov nqaij mos thiab cov tawv nqaij sib kis,
• septicemia (feem ntau anaerobic),
• osteomyelitismob thiab ntev
• endocarditis cov kab mob
• tso cai rau kev tiv thaiv kev ua mob ntawm kev mob ntawm tus mob intraperitoneal thiab peritonitis tom qab perforation ntawm txoj hnyuv lossis tom qab kev mob tshwm sim (ua ke nrog aminoglycosides).

Cov tshuaj nplaum thiab gel Clindamycin yog siv rau cov kab mob ua paug.

Cov lus qhia rau kev siv cov tshuaj tiv thaiv kev mob nrog clindamycin:

• cov kab mob vaginosis, provoked los ntawm microorganisms rhiab rau cov tshuaj.

Cov Yuav Tsum Tau Ua

Kev siv cov cuab yeej no yog contraindicated:

• ntawm bronchial hawb pob,
• ntawm myasthenia gravis,
• nrog ulcerative cem,
• nrog cov kab mob tsis tshua muaj ntawm qhov muaj keeb (tsis muaj lactase, galactose tsis kam lees, qabzib-galactose malabsorption),
• ntawm ntawm cev xeeb tub thiab kev pub niam mis,
• nyob rau lub hnub nyoog ntawm ib tug menyuam nyob rau hauv 3 xyoos, kev tso tshuaj thiab tshuaj intramuscular yog contraindicated, thaum muaj hnub nyoog 8 xyoo, tshuaj ntsiav tshuaj yog contraindicated,
• siab rhiab heev rau cov tshuaj ntawm cov tshuaj.

Xyuam xim yog kho rau cov neeg uas muaj mob raum lossis siab mob siab tsis txaus, cov neeg laus laus.

Sab sij huam

Thaum noj tshuaj, cov neeg mob tuaj yeem ntsib qee qhov kev mob tshwm sim:

• lub plab zom mov: Cov tsos mob dyspeptic, mob daj ntseg, mob caj pas, hlab ntsws, pseudomembranous enterocolitis, hyperbilirubinemia, dysbiosislub siab ua tsis taus haujlwm,
• musculoskeletal system: Hauv qee qhov tsis tshua muaj tshwm sim, tej zaum yuav muaj kev ua txhaum ntawm neuromuscular conduction,
• hematopoiesis: leukopenia, neutropenia, agranulocytosis, thrombocytopenia,
• kev ua xua tshwm simua pob khaus tawv, urticaria, qee zaum - dermatitis, anaphylactoid manifestations, eosinophilia,
• lub plawv thiab cov hlab ntshav: thaum kev daws yog muab tshuaj rau thiab sai-txo ntshav siabtsis muaj zog kiv taub hau,
• qhov kev qhia hauv zos: mob thiab thrombophlebitis(ntawm qhov chaw txhaj tshuaj), voos,
• lwm cov kev mob tshwm sim: superinfection.

Thaum siv Clindamycin lee, cov kev mob tshwm sim tuaj yeem txhim kho:

• tso zis: voos ntawm lub paum ntawm lub paum thiab lub paum, candidiasispaum ntawm qhov paum, mob vulvovaginitis, trichomonas vaginitis, mob paum ntawm qhov chaw mos, mob ncig mus los txhua hli, kev tso tawm ntshav ntawm lub tsev menyuam, qhov mob ntawm qhov paum, mob plab, qhov pom ntawm kev tso quav, endometriosisglucosuria proteinuria,
• hom tshwm sim: mob plab thiab cramps, tsam plab, fungal thiab kab mob, mob taub hauua pa tsw phem o tuaj o, mob nyob rau hauv qab plab, sab sauv, mob duav, mob nrob qaum, kev tsis haum,
• lub plab zom mov: xeev ntuav zawv plab, cem quavntuav flatulence, dyspepsia, mob plab zom mov,
• daim tawv nqaij integument: daim tawv nqaij khaus, erythema, tawm pob, candidiasis, urticaria,
• endocrine system: hyperthyroidism,
• CNS: kiv taub hau,
• cov kab mob ua pa: ntswg.

Noj ntau dhau

Yog tias kev noj tshuaj ntau dhau ntawm cov tshuaj tau tshwm sim, qhov cuam tshuam tsis zoo piav qhia saum toj no tuaj yeem siv zog ntxiv. Tshwj xeeb tshuaj tiv thaiv kab mob tsis muaj, nyob rau hauv cov ntaub ntawv ntawm overdose, tsos mob kev kho mob yog ua.

Tsis muaj ntaub ntawv hais txog kev siv cream dhau hwv lawm. Yog tias kev noj tshuaj tsis xwm yeem, kev cuam tshuam rau lub cev yuav tshwm sim uas tshwm sim tom qab kev noj cov tshuaj ntawm qhov ncauj.

Kev sib txuam

Muaj qhov nce ntawm qhov nqis tes ntawm streptomycin aminoglycosides, Gentamicin, Rifampicin thaum noj nrog clindamycin.

Nws ua kom muaj txiaj ntsig zoo ntawm kev sib tw ntawm cov leeg sib tw, thiab ntxiv rau cov leeg ua kom ib ce, uas ua rau n-anticholinergics.

Antagonism nrog chloramphenicol thiab Erythromycin.

Nws tsis pom zoo kom noj ib txhij nrog kev daws teeb meem uas muaj cov nyom cov vitamins pawg B, phenytoins, aminoglycosides.

Clindamycin thiab antidiarrheal tshuaj tsis tuaj yeem muab tshuaj nyob rau tib lub sijhawm, vim tias qhov muaj feem ua rau mob pseudomembranous mob plab ntau dua.

Thaum siv tib lub sijhawm nrog opioid analgesics cov nyhuv ntawm kev mob ntsws yuav nce ntxiv, mus txog kev txhim kho apnea.

Kev tiv thaiv sib kis tau pom ntawm lincomycin thiab clindamycin. Kuj muaj kev tawm tsam ntawm erythromycin thiab clindamycin kuj tau ua pov thawj.

Nws tsis pom zoo kom siv nrog lwm cov tshuaj rau kev tswj hwm hauv intravaginal.

Cov lus qhia tshwj xeeb

Qhov pom ntawm pseudomembranous mob plab yog ua tau ob qho tib si hauv kev siv tshuaj, thiab 2-3 lub lis piam tom qab ua tiav ntawm kev kho. Hauv cov mob no, ib tug neeg tsim nws tus kheej zawv plab, npaws, leukocytosismob plab.

Yog tias cov tsos mob tshwm sim, koj yuav tsum tso tseg cov tshuaj thiab noj cov ion-txauv resins. Hauv qhov mob plab nyhav, nws yog qhov tsim nyog los them rau cov kua dej uas ploj lawm, protein thiab electrolytes, kom sau tshuaj rau ntawm Vancomycin lossis Metronidazole.

Thaum kho, koj tsis tuaj yeem noj cov tshuaj uas ua kom muaj plab hnyuv plab zom mov.

Yog tias siv sijhawm ntev los siv cov tshuaj tau xyaum los ntawm menyuam yaus, koj yuav tsum tau saib xyuas lub mis tas li ntshav thiab tus neeg mob lub siab. Thaum noj ntau dua ntawm cov tshuaj, clindamycin yuav tsum raug tswj ntshav ntshav.

Cov neeg uas kuaj pom tias lub siab ua haujlwm tsis zoo yog lub siab ua haujlwm daim siab.

Ua ntej noj cov tshuaj intravaginally, koj yuav tsum cais tawm chaw kuaj Tus mob chlamydia trachomatis, Trichomonas vaginalis, Neisseria gonorrhoeae, Candida albicans, Herpes yooj yim, uas feem ntau heev ua rau kev txhim kho ntawm vulvovaginitis.

Thaum siv clindamycin intravaginally, tej zaum yuav muaj kev nce kev txhim kho ntawm cov kab mob tsis haum, tshwj xeeb tshaj yog cov poov xab zoo li fungi.

Txij li thaum muaj qhov ua tau ntawm kev siv tshuaj me me rau kev quav tshuaj, raws plab tuaj yeem txhim kho nrog kev siv cov tshuaj suppositories lossis cream. Hauv qhov no, lub twj tso tseg.

Nws yuav tsum raug sau tseg tias thaum lub sijhawm kho koj yuav tsum caiv tsis txhob sib deev thiab tsis txhob siv lwm yam tshuaj rau kev siv intravaginal.

Qhov sib xyaw ntawm cov tshuaj no muaj cov khoom sib xyaw uas tuaj yeem ua cov khoom siv roj hmab, latex tsis ruaj. Yog li, nws tsis pom zoo kom siv cov hnab looj qau, diaphragms thiab lwm yam kev tiv thaiv kom txhob los ntawm cov looj.

Tsis cuam tshuam rau lub peev xwm tsav lub tsheb lossis koom nrog lwm yam dej num uas xav tau kev mloog zoo.

Thaum cev xeeb tub thiab lactation

Koj tuaj yeem siv cov tshuaj intravaginally rau cov poj niam hauv kev txiav thib ob thiab thib peb ntawm kev xeeb tub. Hauv thawj lub hlis ntawm cev xeeb tub, nws tau sau tseg tsuas yog tias cov txiaj ntsig kev cia siab dhau qhov yuav muaj kev phom sij nrog kev siv tshuaj qab zib los yog tshuaj tiv thaiv. Thaum lub sijhawm lactation, koj yuav tsum ua tib zoo ntsuas qhov txiaj ntsig uas xav pom thiab muaj kev phom sij. Siv cov khoom tsuas yog saib xyuas los ntawm tus kws kho mob.

Sab sij huam

Cov kev qhia ceeb toom txog kev muaj peev xwm tsim cov kev mob tshwm sim hauv qab no thaum muab tshuaj clindamycin:

• tsis kaj siab xim hlau tsis zoo nyob rau hauv lub qhov ncauj, phlebitis (nrog kev tswj hwm hauv qhov siab),
• xeev siab, ntuav, raws plab, mob plab,
• tshwm sim ntawm esophagitis (nrog rau kev siv clindamycin ntsiav tshuaj),
• nce bilirubin thiab hepatic transaminase kev ua si,
• kiv taub hau, tsis muaj zog, poob ntshav siab (nrog kev tswj hwm ceev),
• mob plab pseudomembranous,
• candidiasis.

Hauv cov xwm txheej cais, nws tuaj yeem ua rau mob nqaij daj thiab mob siab, thiab thim rov qab mob thrombocytopenia, mob leukopenia, neutropenia thiab agranulocytosis.

Qee qhov tsis tshua muaj, kev cuam tshuam hauv zos muaj peev xwm ua tau (ua haujlwm ntawm chaw txhaj tshuaj, kev txhim kho ntawm qog lossis infiltrate).

Clindamycin gel tuaj yeem ua rau tsis haum nyob rau ntawm qhov chaw ntawm kev thov, ntxiv rau qhov kev txhim kho ntawm cov tawv nqaij sib chwv. Nrog siv ntev, cov kab mob hauv lub cev yuav tshwm sim.

Cov tshuaj pleev (suppositories thiab lee) muaj cov kev mob tshwm sim xws li vaginitis, cervicitis thiab vulvovaginal voos.

Nrog rau tus kheej rhiab, kev ua xua tuaj yeem txhim kho - urticaria, erythema multiforme, ua npaws, Quincke's edema, lossis anaphylactic shock.

Kev mob pseudomembranous tuaj yeem tshwm sim ob qho tib si thaum noj clindamycin, thiab 2-3 lub lis piam tom qab txiav kev kho mob (3-15% ntawm cov neeg mob). Nws ua tawm nws tus kheej li mob raws plab, mob leukocytosis, ua npaws, mob plab (qee zaum nrog los ntawm kev nthuav tawm nrog quav quav pawg hauv cov ntshav thiab cov quav).

Cov Yuav Tsum Tau Ua

Nws yog contraindicated rau muab tshuaj clindamycin nyob rau hauv rooj plaub no:

• myasthenia gravis
• bronchial hawb pob,
• ulcerative colitis (keeb kwm)
• tsis tshua muaj cov kab mob muaj keeb, xws li galactose intolerance, lactase deficiency lossis glucose-galactose malabsorption (rau tshuaj ntsiav),
• cev xeeb tub thiab lactation,
• cov menyuam yaus lub hnub nyoog txog 3 xyoos - rau kev daws teebmeem rau kev tswj hwm kev quav dej thiab tshuaj (vim tias tsis muaj cov ntaub ntawv qhia txog kev nyab xeeb ntawm kev siv benzyl cawv),
• cov menyuam hnub nyoog txog 8 xyoo rau tsiav tshuaj (qhov nruab nrab tus me nyuam qhov hnyav dua 25 kg),
• kev tiv thaiv tsis haum.

Clindamycin yog siv nrog kev ceev faj rau cov neeg mob uas muaj mob rau daim siab hnyav thiab / lossis lub raum tsis ua haujlwm, hauv cov neeg laus.

Thaum kho, koj tsis tuaj yeem noj cov tshuaj uas ua kom muaj plab hnyuv plab zom mov.

Noj ntau dhau

Yog hais tias noj ntau dhau, ua rau cov kev mob tshwm sim tuaj yeem sib zog tuaj.

Cov kev mob tshwm sim yog nqa tawm, tsis muaj ib qho tshuaj tua kab mob tshwj xeeb. Hemodialysis thiab peritoneal lim ntshav tsis ua haujlwm.

Kws Tshuaj

Nws khi rau 50S ribosomal subunit ntawm microbial cell thiab inhibits synthesis ntawm protein ntawm cov kab mob me me. Nws muaj cov kab mob bacteriostatic, nyob rau hauv ntau qhov chaw siab thiab nrog rau kev lees paub txog cov tsiaj mob me me nws yuav ua rau pom cov nyhuv bactericidal. Raws li cov txheej txheem ntawm kev ua thiab cov tshuaj tua kab mob sib kis, nws yog ze rau lincomycin (hauv kev sib raug rau qee yam kab mob me me nws yog 2-10 zaug ua haujlwm ntau dua).

Thaum clindamycin noj ntawm qhov ncauj, hydrochloride nrawm thiab zoo nqus los ntawm lub plab zom mov (zoo dua li lincomycin), bioavailability yog 90%, kev sib txig kev sib xyaw ntawm cov zaub mov ua rau qis kev nqus, tsis hloov pauv ntawm kev nqus. Kev khi cov protein yog 92–94%. Nws yooj yim nkag rau cov kua roj ntsha, hauv nruab nrog cev thiab cov nqaij hauv lub cev, suav nrog tonsils, nqaij thiab pob txha nqaij (kwv yees li 40% ntawm cov ntshav tsom), bronchi, ntsws, pleura, kua pleural (50-90%), kua tsib lub plab, hnyuv tws, txoj hlab qe ntshav, lub caj pas prostate, kua synovial (50%), qaub ncaug hnoos qeev (30-75%), tawm ntawm qhov txhab. Nws kis tau tsis zoo dhau ntawm BBB (nrog rau cov mob ua paug, tus kab mob BBB permeability nce). Kev faib tawm hauv cov neeg laus yog kwv yees li 0.66 l / kg, hauv cov menyuam yaus - 0.86 l / kg. Nws kis tau sai heev los ntawm tus kab mob no, yog pom nyob rau hauv cov ntshav ntawm tus menyuam (40%), kis mus rau niam mis (50-100%).

Clindamycin palmitate thiab clindamycin phosphate yog cov tsis muaj zog, lawv tau sai sai ntawm lub cev mus rau hauv lub cev kom nquag ua haujlwm clindamycin.

C_max hauv qhov ncauj tawm, nws tiav tom qab 0.75–1 h, tom qab i / m tswj hwm - tom qab 3 h (neeg laus) lossis 1 h (menyuam yaus), nrog iv infusion - los ntawm qhov kawg ntawm kev tswj hwm. Nws yog cov tshuaj tiv thaiv hauv lub siab nrog kev tsim cov kev ua kom nquag plias (N-dimethylclindamycin thiab clindamycin sulfoxide) thiab cov metabolites tsis muaj zog. Nws raug tawm hauv 4 hnub nrog cov zis (10%) thiab los ntawm cov hnyuv (3.6%) raws li kev ua feem, tus so yog cov tshuaj tiv thaiv metabolites. T_1/2 nrog lub raum kev ua haujlwm hauv cov neeg laus yog 2.4–3 teev, hauv cov menyuam mos thiab cov menyuam loj dua - 2.5– teev, hauv cov menyuam mos thaum ntxov - 6.3-8.6 teev. kev ua rau cov leeg tsis muaj zog ntau, ua rau kev txo qis tua kab qeeb qeeb (T_1/2 hauv cov laus - 3-5 teev). Tsis cumulate.

Nrog kev tswj hwm ntawm intravaginal ntawm 100 mg ntawm clindamycin phosphate nyob rau hauv daim ntawv ntawm 2% lub paum ntawm lub paum 1 zaug hauv ib hnub rau 7 hnub hauv 5 tus poj niam uas muaj tus kab mob vaginosis, qhov kev nqus tau muaj kwv yees li 5% (hauv thaj tsam ntawm 2-8%) ntawm kev muab tshuaj. C qhov tseem ceeb_max nyob rau thawj hnub - txog 13 ng / ml (los ntawm 3 mus rau 34 ng / ml), nyob rau hnub xya - nruab nrab ntawm 16 ng / ml (los ntawm 7 txog 26 ng / ml), T_max - kwv yees li 16 teev (hauv thaj tsam ntawm 8-24 teev) tom qab thov. Nrog kev siv dua ntawm kev siv intravaginal, mub nrawm tsis tuaj yeem lossis tsis tuaj yeem. T_1/2 nrog rau muaj txoj kev nqus - 1.5-2.6 teev

Thaum siv clindamycin phosphate intravaginally nyob rau hauv daim ntawv ntawm cov tshuaj tiv thaiv kev noj tshuaj ntawm ib koob ntawm 100 mg ib hnub ib zaug rau 3 hnub, kwv yees li 30% (6-70%) ntawm kev muab koob tshuaj yog nqus rau hauv cov kab ke, uas muaj qhov nruab nrab ntawm AUC ntawm 3.2 μg / h / ml (0.42–11 μg / h / ml). C_max ua tiav kwv yees li 5 teev (1-10 teev) tom qab saib xyuas lub paum ntawm qhov paum.

Thaum siv los ua cov gel rau kev siv sab nraud ntawm clindamycin, phosphate tau nrawm dua los ntawm phosphatases hauv cov ducts ntawm cov qog sebaceous nrog kev tsim cov clindamycin. Cov gel tuaj yeem nqus tau nyob rau hauv cov nyiaj uas ua rau muaj kev cuam tshuam rau lub cev.

Rhiab rau clindamycin hauv vitro cov kab mob hauv qab no: aerobic gram-zoo cocci, suav nrog Staphylococcus aureus, Staphylococcus ep> suav nrog cov leeg ntshav uas tsim thiab tsis tsim cov penicillinase ( hauv vitro kev loj hlob sai ntawm clindamycin tsis kam hauv qee qhov staphylococcal erythromycin tiv thaiv kab mob tau sau tseg),, Streptococcus spp. (tshwj tsis yog Streptococcus faecalis), Pneumococcus spp., anaerobic gram-tsis zoo bacilli, suav nrog Bactero> suav nrog cov pab pawg B. ua kom puas thiab pab pawg B. melaninogenicus), Fusobacterium spp.,. non-spore anaerobic gram-positive bacilli, suav nrog Propionibacterium spp., Eubacterium spp., Actinomyces spp.,. anaerobic thiab microaerophilic gram-zoo cocci, suav nrog Peptococcus spp.,Peptostreptococcus spp., Microaerophilic Streptococcus spp., Clostridia spp. (clostridia tiv taus ntau dua clindamycin ntau dua lwm cov anaerobes). Feem Ntau Clostridium perfringens rhiab rau clindamycin, tab sis lwm hom, piv txwv C. Cov Tshuaj Ntsaws Zoo thiab C. tertium, feem ntau tiv taus clindamycin, yog li ntawd, qhov kev kuaj qhov tseeb yog qhov tsim nyog.

Hauv siab kawg, nws ua haujlwm ntawm qee qhov protozoa (Plasmodium falciparum).

Kab mob sib kis ntawm clindamycin thiab lincomycin thiab antagonism ntawm clindamycin thiab erythromycin tau pom tias.

Hauv cov xwm txheej hauv vitro clindamycin nquag tawm tsam feem ntau ntawm cov kab mob hauv qab no uas ua rau muaj kab mob vaum: Gardnerella vaginalis, Mobiluncus spp., Mycoplasma hominis, Bacteroides spp., Peptostreptococcus spp. Clindamycin rau kev siv intravaginal yog qhov tsis muaj txiaj ntsig rau kev kho mob ntawm vulvovaginitis los ntawm Trichomonas vaginalis,Chlamydia trachomatis,Neisseria gonorrhoeae, Candida albicans lossis tus kab mob Herpes yooj yim.

Cov nyhuv los tiv thaiv pob txuv rau kev siv sab nraud yog vim muaj qhov tseeb tias clindamycin txo cov tshuaj ntawm cov roj khov dawb ntawm daim tawv nqaij thiab inhibits kev rov tsim tawm. Propionibacterium acnes - Tus anaerobic pom nyob hauv cov qog sebaceous thiab cov hauv paus. Qhov rhiab heev ntawm txhua qhov kev tshawb nrhiav pom muaj qhia tau. P. Acnes rau clindamycin hauv vitro (MIC 0.4 μg / ml).

Carcinogenicity, mutagenicity, muaj kev cuam tshuam ntawm kev muaj menyuam

Kev tshawb nrhiav tsiaj ntev ntev los soj ntsuam qhov muaj peev xwm carcinogenicity ntawm clindamycin tseem tsis tau ua. Mutagenic kev ua haujlwm hauv Ames kuaj thiab kuaj micronuclear hauv cov nas tsis tau kuaj. Qhov tshwm sim tsis zoo ntawm kev muaj peev xwm thiab kev sib raug zoo ntawm kev muaj peev xwm hauv cov nas kho nrog clindamycin ntawm qhov ncauj ntawm koob tshuaj txog 300 mg / kg / hnub (kwv yees li 1.6 npaug ntawm MPDs ntawm mg / m 2) tsis tau pom.

Cev xeeb tub Hauv kev kawm txog kev tsim cov tsiaj txhu (nas, nas) siv qhov ncauj ntawm clindamycin txog 600 mg / kg / hnub (3.2 thiab 1.6 zaug siab dua MPDs txog mg / m 2, ntsig txog) lossis sc hauv koob tshuaj kom txog 250 mg / kg / hnub (1.3 thiab 0.7 lub sijhawm siab dua MPDC hais txog mg / m 2, feem) tsis muaj tshuaj teratogenic pom tau. Hauv kev sim rau cov nas, ib lub khoob ntawm lub palate tau sau tseg rau hauv tus me nyuam hauv plab (qhov txiaj ntsig no tsis tau lees paub hauv kev sim rau lwm cov tsiaj thiab ntawm lwm cov kab ntawm nas).

Cev xeeb tub thiab lactation

Thaum cev xeeb tub, nws muaj peev xwm yog tias qhov xav pom ntawm kev kho mob ntau dua qhov muaj feem ua rau muaj menyuam hauv plab (tsis muaj cov kev tshawb fawb txaus thiab nruj me ntsis hauv cov poj niam cev xeeb tub, clindamycin dhau los ntawm cov kab mob thiab tuaj yeem mloog zoo hauv lub plab hauv plab, tab sis tsis muaj teeb meem tshwm sim hauv tib neeg). Cov kev tshawb fawb tseem tsis tau tsim kho seb puas muaj kev kho tus kab mob vaginosis txo qhov kev pheej hmoo ntawm qhov tshwm sim ntawm cev xeeb tub xws li kev puas tsuaj ntawm lub qog ua ntej, kev pib mob lub sijhawm ua ntej, lossis kev yug menyuam ntxov.

FDA Fetal Action Qeb - Kwv.

Kev ceev faj yuav tsum tau siv thaum siv thaum lub sijhawm pub niam mis (nws tsis paub meej tias clindamycin xa mus rau niam mis tom qab kev siv sab nraud thiab intravaginal, tab sis pom nyob rau hauv niam mis tom qab hais tawm lossis tswj hwm kev coj noj coj ua).

Pharmacodynamics thiab pharmacokinetics

Clindamycin nkag mus rau hauv txhua cov kua dej, cov ntaub so ntswg ntawm lub cev thiab pob txha. Cov tshuaj inhibits lub synthesis ntawm cov protein nyob rau hauv lub hlwb ntawm pathogenic microorganisms, sauv ib bacteriostatic thiab bactericidal nyhuv. Muaj ntau cov kab mob tiv taus cov tshuaj tua kab mob no:

Cov kab mob los ntawm cov kab mob no

unicellular flagellar cov kab mob

mob rau daim npluag qhwv, bacteremia, dysbiosis

botulism, tetanus, gas gangrene, clostridial zaub mov kis

Qhov siab tshaj plaws ntawm kev tso tshuaj rau hauv cov ntshav nrog lub qhov ncauj tswj hwm tau pom sai dua nrog kev tswj hwm intramuscular. Cov tshuaj nquag nkag rau hauv cov ntshav 1-3 teev tom qab noj (tswj hwm) cov tshuaj. Tau mus txog thaj chaw muaj kabmob, nws tau khaws cia hauv lub cev ntev li 12 teev, thaum yuav luag 90% ntawm cov khoom sib txuas rau cov protein ntawm cov kab mob pathogenic. Cov kev tshawb fawb soj ntsuam tsis tau qhia tawm cov kev txuam nrog ntawm cov tshuaj nquag ntawm cov tshuaj. Nws yog ua los ntawm daim siab. Metabolites tas mus tom qab 4 hnub uas muaj zis, bile thiab quav.

Tsuas tshuaj thiab tswj hwm

Cov tshuaj tua kab mob kho yog ua raws li kev kho mob los ntawm tus kws kho mob. Qhov kev xaiv ntawm daim ntawv ntawm cov tshuaj, nws ntau npaum li cas thiab lub sijhawm ntawm kev tswj hwm, nyob ntawm:

• tus neeg mob hnub nyoog
• nws kev nyob zoo
• thaj tsam ntawm tus kab mob ntawm lub cev,
• mob hnyav ntawm cov chav kawm ntawm tus kab mob,
• Qhov rhiab ntawm cov pathogen rau cov tshuaj nquag.

Rau cov mob txeeb chaw mos, cov tshuaj tua kab mob hauv daim ntawv los ntawm cov tshuaj nplaum yog tsim rau kev siv intervaginal. Tus ntsuas ntsuas pov tseg (suav nrog) tso rau ntawm lub raj roj nplaum thiab ntim nrog nws. Txhawm rau ua qhov no, nias lub raj tsis thawb rub lub piston ntawm tus thov. Ib koob tshuaj (5 mg) raug txhaj rau hauv qhov chaw mos ib hnub ib zaug ua ntej yuav mus pw. Lub sijhawm tiv thaiv yog 7 hnub.

Rau cov neeg laus, txoj kev daws teeb meem rau kev txhaj tshuaj rau cov leeg plab (intravenous) yog siv 2 zaug hauv ib hnub, 300 mg ib koob. Nrog txoj kev mob hnyav ntawm tus kabmob, kev nce ntxiv ntawm cov tshuaj txhua hnub rau 2700 mg yog ua tau. Nws faib ua 3-4 koob. Hauv qhov no, ib txoj kev tswj hwm ib leeg yuav tsum tsis pub ntau tshaj 600 mg. Cov menyuam yaus txij thaum muaj 3 xyoos raug xaj 15-25 mg rau 1 kg ntawm qhov hnyav thiab tau muab faib ua feem sib luag rau 3-4 koob. Hauv kev kis mob hnyav, noj ntau ntxiv ntawm cov menyuam yaus tau nce txog 40 mg ib hnub twg.

Rau kev siv cov tshuaj, cov tshuaj yaj yog diluted nrog kev daws ntawm 0.9% sodium chloride lossis 5% dextrose rau ib qho tshuaj uas tsis ntau tshaj 6 mg / ml. Txoj kev daws teeb meem yog muab nqis rov qab los ntawm 10 mus rau 60 feeb (nyob ntawm seb qhov koob tshuaj). Qhov siab tshaj plaws tau tso cai ntawm ib qho kev tswj hwm ib leeg yog 1.2 g. Yog tias pom 8 teev nyob nruab nrab ntawm cov hnoos qeev, cov neeg mob raum (hepatic) tsis txaus yuav tsum tau noj ntau npaum li cas ntawm cov tshuaj tua kab mob no.

Cov me nyuam tsis tau muaj 12 xyoos tsis raug tseev kom noj tshuaj tua kab mob. Cov tshuaj rau cov neeg mob ntawm lwm cov hnub nyoog muaj raws li nram no:

Cov naj npawb ntawm cov txais tos ib hnub

Qhov nruab nrab ntawm qhov mob hnyav, tus naj npawb ntawm cov tshuaj ntsiav (pcs.)

Muaj mob hnyav kis, cov naj npawb ntawm cov tshuaj ntsiav (pcs.)

Clindamycin cov tshuaj tiv thaiv yog siv los kho 1 lub sijhawm ib hnub ua ntej yuav mus pw. Hauv txoj haujlwm supine, nws yog ib qhov tsim nyog los ua kom lub qe me me nkag mus rau hauv qhov chaw mos. Qhov kev kawm yog 3-7 hnub.

Cov txheej txheem o ntawm daim tawv nqaij nrog cov kab mob kis nrog cov pob khaus ua pob. Rau cov kab mob ntawm daim tawv nqaij, tus kws kho mob tuaj yeem sau tshuaj tua kab mob thiab cov gel rau kev kho mob ua ke. Cov tshuaj pleev zoo li gel nrog clindamycin yog siv rau kev siv sab nraud. Cov dej pleev tau ua ntawv thov nyob rau hauv txheej txheej nyias nyias ntawm cov ntxau thiab thaj chaw nrog yaum yuag tom qab ntxuav daim tawv.

Hauv thaum yau

Cov menyuam yaus hnub nyoog qis dua 8 xyoo tau muab tshuaj tiv thaiv kab mob rau hauv lub ntsej muag ua cov kua ntoo. Kev npaj ua tiav yog npaj rau tus kheej npaj cov kua qab (kev ncua). Lub vial nrog granules yuav tsum tau ntim nrog 60 ml ntawm dej thiab shaken kom zoo. Xam xyuas ntawm cov koob tshuaj ntawm cov tshuaj raws li lub cev qhov hnyav thiab hnub nyoog ntawm tus me nyuam. Cov koob tshuaj txhua hnub rau cov menyuam yaus hnub nyoog ntau dua 1 hlis yog 8-25 mg rau ib qhov hnyav ntawm qhov hnyav, muab faib ua 4 koob. Qhov koob tshuaj tsawg kawg nkaus rau cov menyuam yaus uas hnyav dua 10 kg yog 37 mg (1/2 me nyuam diav) txhua 8 teev.

Cov tshuaj tua kab mob no yog muab rau cov niam txiv rau cov menyuam:

Yeeb tshuaj sib cuam tshuam

Clindomycin, thaum sib cuam tshuam nrog lwm cov tshuaj, qee zaum muaj qhov tsis zoo rau tus neeg mob lub cev. Qhov no yuav tsum tau txiav txim siab thaum sau tshuaj rau hauv cov kev kho mob nyuaj:

• Tsis sib haum nrog barbiturates. Kev sib koom tes ntawm cov tshuaj yog txwv tsis pub.
• Txhim kho qhov ua kom cov leeg so tshwm sim los ntawm n-anticholinergic blockers.
• Nws yog antagonistic rau erythromycin thiab chloramphenicol.
• Kev sib koom tes nrog Fortum muaj cov tshuaj lom rau hauv lub raum.
• Txhim kho qhov kev txiav txim ntawm aminoglycosides.
• Nrog rau cov tshuaj tiv thaiv kab mob siab tuaj yeem ua rau mob ua paug rau mob pseudomembrane.
• Nws ua rau lub zog ua pa (txog apnea) thaum siv nrog kev ua kom haum rau ua ntu zus ntawm opium.
• Tsis sib haum nrog lwm yam ntawm lub paum npaj.

Cov nqe lus ntawm kev muag khoom thiab kev cia khoom

Clindamycin nyob rau txhua daim foos tuaj yeem yuav ntawm chaw muag tshuaj los ntawm cov tshuaj noj. Muab cia rau qhov chaw qhuav thiab tsaus uas ncav tsis cuag ntawm cov menyuam. Txee lub neej ntawm cov tshuaj no hauv daim ntawv ntawm:

• kev daws rau kev saib xyuas kev mob siab thiab intramuscular - 2 xyoos txij li hnub kev tsim khoom (qhia ntawm txhua ampoule thiab ntawm pob),
• tsiav tshuaj - 3 xyoos,
• cream - 2 xyoos,
• tswm ciab - 3 xyoos.

Yog tias siv clindamycin yog qhov tsis yooj yim vim qee yam, tus kws kho mob tau sau nws cov analogues:

• Klindatop. Topical gel rau kev kho mob ntawm cov ntawv me me mus rau mob ntxaws.
• Klimitsin. Muaj nyob rau hauv daim ntawv ntawm granules rau kev npaj ntawm cov menyuam mos thiab kev txhaj tshuaj.
• Dalacin. Muaj nyob rau hauv daim ntawv ntawm tshuaj ntsiav, txhaj tshuaj, granules, gel, paum qhov paum thiab cov tshuaj ntsiag to.
• Zerkalin. Cov tshuaj rau kev kho mob ntxau.