Gentamicin ntsiav tshuaj: cov lus qhia rau kev siv

Kev piav qhia cuam tshuam rau 09.06.2016

Lub npe Latin: Gentamicin
ATX Code: S01AA11
Yam tshuaj muaj sia: Gentamicin (Gentamicin)
Chaw tsim tshuaj paus: Belmedpreparaty RUE (Republic of Belarus), Warsaw Tshuaj Ua Hauj Lwm Polfa (Poland), Moscow Endocrine cog, NIZHFARM, Sintez OAO, Microgen NPO FSUE, Pharmstandard-UfaVITA (Russia), thiab lwm yam.

Tsim ntawm kev daws rau kev tswj hwm ntawm cov leeg thiab intramuscularly muaj cov khoom xyaw dhia gentamicin sulfatentxiv rau ntau lub ntsiab lus ntxiv: sodium metabisulfite, disodium ntsev ntawm ethylenediaminetetraacetic acid, dej.

Qhov muag tee muaj cov tshuaj ua kom nquag plias gentamicin sulfatentxiv rau cov khoom siv ntxiv: sodium dihydrogen phosphate monohydrate, sodium chloride, sodium hydrogen phosphate dodecahydrate, benzalkonium chloride tov, dej.

Pharmacological kev txiav txim

Gentamicin yog tshuaj tua kab mob, uas qhia txog cov teebmeem dav, nyob ntawm pawg aminoglycosides. Hauv lub cev, nws khi rau 30S subunit ntawm ribosomes, vim tias cov protein synthesis cuam tshuam, kev tsim khoom ntawm cov nyom ntawm kev thauj thiab cov ntaub ntawv RNA raug muab ncua. Cov lus nyeem tsis raug ntawm RNA tau sau tseg thiab cov protein tsis ua haujlwm yog tsim los. Cov kab mob muaj txiaj ntsig yog pom - nyob rau hauv qhov xwm txheej ntawm qhov muaj zog ntau ntawm cov tshuaj, nws txo qis cov kev ua haujlwm ntawm cytoplasmic cov qog ua, vim tias cov kab mob me me tuag.

Lub siab rhiab heev rau cov tshuaj tua kab mob no los ntawm qee cov kab mob g-tsis zoo yog raug sau tseg.

Kuj tseem sau tseg yog qhov rhiab heev rau cov tshuaj ntawm tus lej ntawm cov kab mob gram-zoo.

Siv tshuaj tua kab mob ua kom pom tseeb los ntawm: Neisseria meningitidis, Providencia rettgeri, Clostridium spp., Treponema pallidum, Bacteroides spp., Streptococcus spp.

Yog gentamicin xyaw nrog tshuaj penicillins, nws cov haujlwm nyob rau hauv ntsig txog Enterococcus faecium, Enterococcus faecalis, Enterococcus avium, Enterococcus durans, Streptococcus faecium, Streptococcus durans, Streptococcus faecalis.

Cov tshuaj tiv thaiv ntawm cov kab mob me me mus rau cov tshuaj no loj hlob qeeb, tab sis cov kab mob uas pom tias qhov pib tiv taus neomycin thiab kanamycinkuj yuav tiv taus gentamicin. Cov nceb, protozoa, kab mob tsis ua.

Pharmacokinetics thiab cov chaw muag tshuaj

Tom qab kev coj noj coj ua, kev nqus sai thiab ua tiav ntawm cov khoom tshwm sim intramuscularly. Qhov siab tshaj plaws hauv lub cev tom qab tswj hwm intramuscularly tiav tom qab 0.5-1.5 teev. Tom qab siv sijhawm li 30 feeb, tso ntshav qab haus huv, tom qab 30 feeb, tom qab 60 feeb tshuaj mob, tom qab 15 feeb.

Nws khi tsawg dua rau cov protein plasma - txog 10%. Kev kho kom haum xeeb ntawm cov tshuaj muaj nyob rau hauv lub raum, mob siab, ntsws, thiab hauv lub cev ntawm cov dej - peritoneal, ascitic, synovial, pericardial, pleural, lymphatic, pom nyob rau hauv pus, ua rau los ntawm cov qhov txhab, txhab, hauv cov zis.

Kev tsis tshua muaj ntau ntawm cov tshuaj pom muaj nyob hauv cov nqaij, adipose cov ntaub so ntswg, kua mis niam, kua tsib, pob txha, hnoos qeev, txha caj qaum, zais kua qaub, thiab kua muag.

Los ntawm BBB, hauv cov neeg mob cov neeg laus, nws yuav luag tsis nkag rau hauv, nkag rau hauv lub qhov tso quav.

Qhov kev tso siab hauv cerebrospinal kua hauv cov menyuam yug tshiab yog siab dua rau cov neeg laus.

Cov kab mob rog hauv lub cev tsis raug nthuav tawm. Ib nrab-lub neej nyob rau hauv cov neeg laus yog 2-4 teev, hauv cov menyuam yaus hnub nyoog qis dua 6 hli - 3-3,5 teev.

Nws yog tsuas yog tawm hauv lub cev los ntawm lub raum, hloov pauv tsis tau, qhov tsis txaus ntseeg ntawm cov tshuaj tua kab mob tau tawm hauv cov kua tsib. Yog hais tias tus neeg mob lub raum lub luag haujlwm yog li qub, ces 70-95% ntawm cov tshuaj tau tawm hauv lub sijhawm thawj hnub. Hauv qhov no, qhov siab ntau tshaj 100 100g / ml yog teev hauv cov zis. Cumulation thaum tswj xyuas dua yog sau tseg.

Kev ntsuas rau siv

Kev taw qhia rau kev siv cov tshuaj yog kab mob ntawm kev sib kis-mob uas tau cuam tshuam los ntawm cov kab mob me me rau lub cev gentamicin.

Niam txiv kev siv tshuaj (4% daws) yog qhia rau cov kab mob zoo li no:

Gynecology txhaj tshuaj yog siv rau cov txheej txheem mob hnyav.

Kev siv sab nraud ntawm cov tshuaj (Gentamicin ointment) yog qhia rau cov kab mob zoo li no:

folliculitis dag dag xwb,
pyoderma,
furunculosis,
seborrheic dermatitis mob
paronychia,
mob sycosis,
pob txuvmob
lub manifestation ntawm theem nrab kab mob kis tus kab mob kis thiab fungal ntawm daim tawv nqaij,
qhov txhab ntawm keeb kwm sib txawv (tom, hlawv, mob txhab, thiab lwm yam),
varicose mob rau sab hauv muaj tus kab mob.

Kev siv cov tshuaj Gentamicin (tshuaj pleev qhov muag) yog qhov zoo rau cov kab mob zoo li no:

blepharoconjunctivitis,
blepharitis,
pom mob pob txha
meibomite,
keratitis,
keratoconjunctivitis,
dacryocystitis.

Cov Yuav Tsum Tau Ua

Cov tshuaj no yuav tsum tsis txhob siv nyob rau hauv cov xwm txheej zoo li no:

siab rhiab heev rau cov tshuaj tua kab mob no thiab lwm yam aminoglycosides,
hnov ntawm lub paj hlwb neuritis,
uremia
mob raum tsis zoo,
cev xeeb tub thiab lactation.

Hauv kev siv cov tshuaj no, nws yog ib qho tsim nyog los soj ntsuam raum lub raum ua haujlwm.

Sab sij huam

Hauv cov txheej txheem ntawm kev pub nkag, qee yam kev mob tshwm sim tuaj yeem sau tseg:

lub plab zom mov: hyperbilirubinemia, xeev siab thiab ntuav, nce kev ua ntawm "mob siab" transaminases,
hematopoiesis: leukopenia, mob ntshav liab, thrombocytopenia, granulocytopenia,
cov leeg hlab hlwb: paresthesiamob taub hau, mob leeg, leeg, loog, chua leeg, tsaug zogtej zaum yuav tshwm sim kev mob hlwb rau menyuam yaus,
hnov qhov muag plab hnyuv siab raum: tinnitus, kev hnov lus tsis zoo, lub labyrinth thiab vestibular ntshawv siab, lag ntseg,
tso zis: nephrotoxicity nrog lub raum tsis ua haujlwm, tsis tshua muaj - hlaus tubular necrosis,
ua xua: tawv nqaij ua pob, npaws, pruritus, eosinophilia, angioedema,
kuaj ntsuas: hypokalemia, hypocalcemia, hypomagnesemia - nyob rau hauv cov menyuam yaus,
lwm yam kev qhia: pom meej.

Noj ntau dhau

Nrog kev noj tshuaj tshaj plaws ntawm Gentamicin hauv ampoules lossis lwm yam tshuaj, txo qis ntawm neuromuscular conduction mus txog kev ua pa rau kev ua pa tuaj yeem raug sau tseg.

Yog tias muaj ntau tshaj ntawm cov neeg mob cov neeg laus, nws yog qhov tsim nyog yuav tau qhia cov tshuaj anticholinesterase (Prozerin), calcium npajCov. Ua ntej cov kev paub ntawm proserin, tus neeg mob tau siv tshuaj 0.5-0.7 mg Atropineintravenously, lawv tos kom txog thaum lub plawv dhia sai, tom qab ntawd 1.5 mg ntawm proserin muab tshuaj. Yog tias tsis muaj cov txiaj ntsig tom qab kev siv tshuaj ntawm lub koob tshuaj ntawd, tus nqi qub prozerin raug muab rov ua dua. Nrog txoj kev loj hlob bradycardiaua ib qho kev txhaj tshuaj ntxiv ntawm atropine.

Nyob rau hauv rooj plaub ntawm kev noj haus ntau tshaj nyob rau hauv cov menyuam yaus, kev qhia txog cov poov tshuaj npaj yog tsim nyog. Gentamicin sulfate raug tawm ntawm lub cev los ntawm hemodialysis thiab peritoneal lim ntshav.

Kev sib txuam

Yog tias cov tshuaj Gentamicin txhaj los yog siv lwm cov tshuaj noj coj los sim ua ke nrog Vancomycin, aminoglycosides, cephalosporins,ethacrylic acid, oto- thiab cov teebmeem nephrotoxic tuaj yeem ua kom zoo dua.

Yog tias cov khoom siv nrog Indomethacin, tom qab ntawd qhov kev tshem tawm ntawm Gentamicin poob qis, nws cov concentration hauv cov ntshav nce ntxiv thiab, raws li, cov nyhuv tshuaj lom muaj zog.

Thaum siv Gentamicin nrog opioid tshuaj loog, tshuaj rau tshuaj loogqhov ntxim nyiam ntawm neuromuscular blockade nce, kev loj hlob yog ua tau apnea.

Qhov concentration ntawm gentamicin hauv cov ntshav nce ntxiv yog noj ib txhij nrog“Voj” diuretics.

Cov lus qhia tshwj xeeb

Ceev faj koj yuav tsum tau thov cov tshuaj no rau cov neeg uas raug kev txom nyem myasthenia, parkinsonism, tsis hnov mob raum muaj nuj nqiCov. Hauv cov neeg muaj kev tsis zoo lub raum, nrog rau lub sijhawm ntev ntawm kev siv ntau dua ntawm cov tshuaj, qhov pheej hmoo ntawm nephrotoxicity nce. Thaum kho, nws yog ib qho tseem ceeb los saib xyuas cov xwm txheej ntawm tes tsho thiab pob ntseg, thiab lub raum ua haujlwm. Nws tseem yog qhov tseem ceeb los txiav txim siab ntawm lub rooj sib hais. Yog tias qhov ntsuas kev ntsuas tsis zoo, kev kho mob tsis ua tiav.

Nws yuav tsum tau yug hauv siab tias nrog lub sijhawm ntev ntawm kev siv tshuaj ntawm sab nraud, ib qho kev ntxim ntxub yog ua tau, ntawm cov tshuaj pleev no Gentamicin Akos thiab lwm hom tshuaj ntawm cov tshuaj sab nraud yuav tsum tau siv nyob hauv kev tswj hwm.

Vim tias muaj qhov sib xyaw ua ke ntawm kev daws teeb meem hauv ampoulessodium bisulfiteqhov ntxim nyiam ntawm kev txhim kho kev tsis haum lub cev nce ntxiv, tshwj xeeb tshaj yog cov neeg muaj keeb kwm kev tsis haum.

Cov tib neeg uas tau noj tshuaj pab rau kev kho mob ntawm kev mob kis thiab mob ntawm cov mob txeeb zig yog qhia kom haus dej ntau thaum lub sijhawm kho.

Hauv chav kawm ntawm kev kho, kev txhim kho ntawm kev tawm tsam ntawm cov kab mob me me yog ua tau.

Hauv cov khw muag tshuaj, muaj ntau yam tshuaj noj ntawm Gentamicin. Cov no yog cov tshuaj Garamycin, Gentamicin Akos, Gentamicin-Teva, Gentamicin K, Ceev, Qhoos, Gentacycolthiab lwm yam. Cov lus qhia thiab contraindications rau cov analogues yuav luag zoo li qub, tab sis tus kws kho mob yuav tsum ua qhov kawg xaiv kev siv tshuaj. Tseem muaj ib tug xov tooj ntawm cov tshuaj uas nws cov tshuaj nquag Betamethasone + Gentamicin + Clotrimazole.

Me nyuam yaus yog kws kho mob rau txoj kev noj qab haus huv xwb. Nws yog ib qho tseem ceeb kom ua raws li cov txheej txheem kho tau kom zoo thiab ua kom tus kws kho mob saib xyuas tus neeg mob lub sijhawm.

Thaum cev xeeb tub thiab lactation

Thaum cev xeeb tub, Gentamicin yuav tsum tsis txhob siv. Nws tsis pom zoo kom noj cov tshuaj no thaum tseem noj niam mis. Nws tau sau tseg tias aminoglycosides dhau mus rau hauv niam cov kua mis hauv cov khoom me me. Tab sis lawv tsis zoo los ntawm lub plab zom mov, yog li ntawd, cov teeb meem hauv cov menyuam tsis tau pauv.

Thaum twg kuv tuaj yeem siv

Raws li cov lus qhia, gentamicin sulfate 4% ntawm kev taw qhia rau kev siv tej zaum yuav muaj cov hauv qab no:

Mob txeeb zig.
Cov kab mob sib kis ntawm cov tawv nqaij sab nraud, nrog rau kev hlawv thiab daim ntaub mos muag.
Tso quav.
Kev mob ntsws pob txha.
Kev kis tus kab mob ENT plab hnyuv siab thiab mob siab ntsws.
Kev kis mob ntawm lub plab zom plab.
Cov kab mob uas tshwm sim tawm tsam keeb kwm ntawm kev tiv thaiv kab mob tsawg.

Kev siv tshuaj tua kab mob hauv ib daim ntawv tshuaj twg tsis pom zoo rau:

Cev xeeb tub thiab lactation.
Cov me nyuam qis dua 3 xyoos.
Mob raum lossis mob rau daim siab.

Kev txhaj tshuaj: qhov twg los nkaug thiab ntau npaum li cas

Kev noj tshuaj ntawm Gentamicin hauv kev txhaj tshuaj thiab lub sijhawm ntawm kev siv sijhawm yog txiav txim los ntawm tus kws kho mob uas koom nrog. Muab tshuaj rau koob tshuaj lossis koob tshuaj ntawm Getnamycin sulfate 4% kev daws, uas yog muag hauv ampoules ntawm 2 ml, No. 10. Qhov tshuaj tiv thaiv kab mob tau txiav txim siab raws tus neeg mob lub cev. Cov qauv yog qhov sib piv ntawm 3 mg ntawm cov tshuaj rau 1 kg ntawm tus neeg mob qhov hnyav. Hauv 1 ml ntawm kev txhaj tshuaj (hno tshuaj) muaj 40 mg ntawm cov tshuaj nquag, koob tshuaj txhua hnub rau tus neeg mob uas hnyav 50 kg yuav yog 150 mg = 4 ml (2 ampoules ntawm 2 ml) ntawm 4% kev daws. Nws raug nquahu kom txhaj 80 mg 2-3 zaug ib hnub.

Qhov ntau thiab tsawg ntawm cov tshuaj yog txiav txim los ntawm tus kws kho mob.

Kev kho mob ntawm urological kab mob

Cov tshuaj tua kab mob yog siv rau hauv urology, tshwj xeeb hauv kev kho mob ntawm prostatitis thiab cystitis. Cov ntau npaum li cas ntawm cov tshuaj rau prostatitis lossis kab mob cystitis yog txiav txim siab raws li cov txheej txheem qauv, suav nrog qhov hnyav ntawm pawg neeg mob. Qhov nruab nrab, nws yog 80 mg 2-3 zaug ib hnub tom qab 6-12 teev. Cov foos nyuaj ntawm cov kab mob yuav xav tau kev siv tshuaj ntau dua - txog li 80 mg rau ib phaus ntawm qhov hnyav, tab sis ua ntej pib kho, nws yog qhov yuav tsum tau kawm tus kws kho mob daim ntawv yuav tshuaj thiab cov lus pom zoo. Thaum txhaj cov tshuaj Gentamicin 4% daws, nws yog txwv tsis pub sib xyaw nrog ntau yam tshuaj hauv ib leeg. Nrog mob prostatitis thiab cystitis, chav kawm ntawm kev siv tshuaj tua kab mob kav 7-10 hnub.

Hauv kev kho tus mob prostatitis, nws yog ib qho tsim nyog yuav tsum ua cov kev ntsuam xyuas yooj yim ntawm qhov rhiab ntawm tsob ntoo rau cov tshuaj. Tom qab ib lub sijhawm dhau los ntawm kev txhaj tshuaj tiv thaiv kab mob, ib tus txiv neej yuav tsum nco ntsoov tias tsuas yog tom qab 4-6 lub hlis tuaj yeem xeeb menyuam tau. Nrog rau cystitis thiab prostatitis thaum kho, nws yog ib qho tsim nyog yuav tsum tso tseg txoj kev haus cawv kom tsis txhob mob nephrotoxicity.

Cov lus qhia rau kev siv pom zoo kom koj khaws cov tshuaj nyob rau hauv qhov kub tsis tshaj 25 ° C. Cov lus qhia rau kev siv hais tias lub txee lub neej yog 3 xyoo txij li hnub pib. Yog li cov lus qhia rau kev siv los ntawm cov tsim khoom lag luam tsis ploj thaum lub sijhawm no, nws yog qhov zoo tshaj kom cov tshuaj nyob rau hauv nws lub ntim thawj, kom deb ntawm cov menyuam yaus. Tshuaj pleev thiab cov tee khaws cia lawv qhov zoo rau 3 xyoo txij li hnub tso tawm. Txhawm rau yuav tshuaj nyob rau hauv lub tsev muag tshuaj, nws txaus los noj tshuaj uas muaj qhov pom zoo ntawm cov tshuaj tua kab mob thiab lub sijhawm kho mob.

Tshwj xeeb cov xwm txheej

Hauv kev kho mob rau cov menyuam yaus, gentamicin sulfate yog tau sau tseg yog tias muaj qhov tseem ceeb thaum tus menyuam muaj txiaj ntsig zoo tshaj qhov txaus ntshai ntawm cov kev mob tshwm sim. Txog kev kho mob kis rau cov menyuam yaus mus txog ib xyoos, kev siv tshuaj txhua hnub yog xam raws qhov feem ntawm 1 mg rau 1 kg ntawm qhov hnyav, rau cov menyuam hnub nyoog 3 txog 5 xyoos, qhov koob tshuaj yuav ua 1.5 mg rau 1 kg, rau cov menyuam muaj hnub nyoog 6 xyoo - 3 mg rau 1 kg ntawm qhov ceeb thawj. Cov menyuam yaus raug txhaj tshuaj nrog cov tshuaj intramuscularly 2 zaug hauv khob tom qab 12 teev.

Cov tshuaj yuav siv tau rau menyuam yaus.

Nrog kev mob plab hnyuv hauv qee kis uas tsis tshua muaj, Gentamicin raug xaj rau menyuam yaus. Cov lus qhia rau kev siv - qhov rhiab ntawm lub pathogen nkaus xwb rau cov tshuaj tua kab mob no. Hauv thawj 2-3 hnub, kev siv cov gentamicin rau cov plab hnyuv pathology yog nqa tawm ntawm txoj leeg, tom qab uas txhaj tshuaj yog ua intramuscularly hauv lub pob tw (80 mg 2-3 zaug ib hnub tom qab 6-12 teev).

Nrog kev mob ntev ntev, tus kws kho mob yuav pom zoo kom tso quav ntau rau hauv lub qhov ntswg rau cov menyuam yaus thiab cov laus. Rau lawv cov kev npaj, koj yuav tsum muab daim ntawv yuav tshuaj los ntawm kws kho mob mus rau lub tsev muag tshuaj. Gentamicin sulfate 4% feem ntau muaj nyob rau hauv daim ntawv qhia, raws li kev sib xyaw ua ke uas tso rau hauv lub qhov ntswg tau npaj, ua cov kab mob bactericidal. Cov kev tso quav nyuaj tau hu ua yog li, vim tias qhov kev nqis tes ntawm lawv cov khoom siv ib txhij muaj ob peb qhov kev qhia: antiallergic, bactericidal, vasoconstrictor, decongestant. Nws tsis tsim nyog los npaj cov tee ua tsis yooj yim rau koj tus kheej, txawm tias koj muaj daim ntawv qhia, lawv suav nrog ntau qhov sib xyaw, yog tias sib xyaw tsis yog, tuaj yeem muaj kev phiv tshuaj. Tus kws kho mob yuav sau ntawv tshuaj thiab cov tshuaj ntxiv rau txhua tus neeg mob ib tus zuj zus, suav txog qhov mob hnyav thiab hom mob.

Thaum cev xeeb tub, kev siv cov tshuaj hauv thiab sab nraud yog txwv, txawm tias muaj pov thawj. Cov tshuaj tsis zoo cuam tshuam rau cov neeg tsis hnov suab thiab ua kom haum ntawm tus me nyuam hauv plab, vim tias nws nkag mus rau hauv qhov tso ntshav. Txawm tias cov kev tuaj yeem tsis pom zoo thaum lub cev xeeb tub los kho kab mob rhinitis.

Tshuaj noj rau lwm yam mob

Hauv ophthalmology, Dex Gentamicin tshuaj tua kab mob qhov muag ntawm 5 ml tau siv rau hauv lub raj mis, cov khoom ntim qub yog ntsuab, zoo li hauv daim duab. Daim ntawv ntawm cov tshuaj tua kab mob tau ua pov thawj nws tus kheej hauv kev kho purulent conjunctivitis, blepharitis, dacryocystitis, keratitis. Cov tshuaj tau poob rau hauv lub hnab lacrimal rau 1-2 tee, thaum txav daim tawv muag qis dua. Koj tseem tuaj yeem yuav cov tshuaj pleev qhov muag 2.5 g, uas tau pw dua pob muag qis thiab tusyees faib thoob plaws hauv lub qhov muag.

Cov cuab yeej yog siv hauv ophthalmology.

Purulent lossis kab mob kis tau ntawm ENT cov kabmob (purulent otitis media) kuj tseem kho nrog cov tshuaj tua kab mob no, daim ntawv tso tawm yog pob ntseg pob ntseg thiab hno tawm. Rau kev kis mob ntawm caj pas lossis nasopharynx, cov kws kho mob sau ntawv rau gentamicin sulfate 4% kev daws rau kev nqus pa hauv lub qhov ntswg thiab lub qa, siv nws ua cov tshuaj tua kab mob hauv zos. Hom kev kho no yog qhov tshwj xeeb tshaj yog hais rau thaum cov menyuam tsis nyiam txhaj tshuaj. Lub tshuab tshuaj muaj zog yuav pab tshuaj tsuag rau cov khoom lag luam. Kev daws tau nchuav mus rau hauv lub cev tshuaj tua kab mob, ua rau nqus pa hauv qhov ntswg thiab caj pas 2-3 zaug hauv ib hnub tom qab 3-4 teev. Rau kev siv yooj yim, lub cav txhaj tshuaj tawm los nrog lub tog raj tsis muaj qhov ntswg, hauv caj pas thiab nrog lub npog ntsej muag.

Gentamicin yog ib feem ntawm cov kab ke ua ke rau kev kho mob ntawm cov kabmob pob txha. Kev taw qhia rau kev siv - eczema, tshuaj tiv thaiv kab mob dermatitis, kab mob tua kab mob, neurodermatitis.Qhov sib xyaw ua ke ntawm cov tshuaj pleev no suav nrog betamethasone, clotrimazole, nws yog muag npaj-tsim, koj tsis tas yuav tshuaj rau nws cov khoom lag luam. Thaum cev xeeb tub, nws tsis pom zoo kom siv cov liniment no. Daim ntawv ntawm gentamicin ntsiav tshuaj rau kev tswj hwm qhov ncauj yog qhov txaus siab rau txhua tus neeg mob. Cov tshuaj tsis muaj nyob hauv daim ntawv ntawm cov ntsiav tshuaj, hauv cov ntsiav tshuaj koj tuaj yeem yuav lwm cov tshuaj ntawm tib pawg tshuaj tua kab mob.

Muaj teeb meem tshwm sim

Nrog rau siv ntev, nrog rau nrog ib tus neeg tsis qaug rau cov tshuaj los yog nws cov tshuaj, cov tshuaj tuaj yeem ua rau muaj kev mob tshwm sim. Yog tias tus neeg mob muaj tshuaj phiv, koj yuav tsum qhia koj tus kws kho mob txog lawv. Nws tuaj yeem yog:

Xeev siab, ntuav, raws plab.
Proteinuria, azotemia, oliguria.
Kev ua txhaum ntawm daim ntaub thaiv lub ntsej muag, qhov ua kom tsis zoo rau hauv lub rooj sib hais.
Kev txhaj tshuaj Intramuscular tuaj yeem ua rau nyuaj los ntawm kev liab, mob.

Kws Tshuaj

Nws khi rau 30S subunit ntawm ribosomes thiab cuam tshuam kev cuam tshuam protein synthesis, tiv thaiv kev tsim ntawm txoj kev thauj mus los thiab kev xa xov RNA, thiab cov caj ces yog nyeem yuam kev thiab cov keeb ua haujlwm tsis ua haujlwm tau tsim. Nyob rau hauv qhov muaj zog ntau, nws ua txhaum lub nruas kev ua haujlwm ntawm cytoplasmic membrane thiab ua rau kev tuag ntawm cov kab mob me me.

Ua tau zoo tiv thaiv ntau cov kab mob gram-zoo thiab gram-tsis zoo. Gram-negative microorganisms paub zoo heev rau gentamicin (MPC tsawg dua 4 mg / l) - Proteus spp. (suav nrog indole-positive thiab indole-negative hom), Escherichia coli, Klebsiella spp., Salmonella spp., Shigella spp., Campylobacter spp., Cov kab mob zoo gram - Dab Tsi Staphylococcus spp. (suav nrog penicillin-resistant), nkag siab nrog IPC 4-8 mg / l - Serratia spp., Klebsiella spp., Pseudomonas spp. (suav nrog Pseudomonas aeruginosa), Acinetobacter spp., Citrobacter spp., Prov> suav nrog nrog benzylpenicillin, ampicillin, carbenicillin, oxacillin), ua rau ntawm kev sib txuas ntawm cov xovtooj ntawm phab ntsa ntawm cov kab mob me me, yog tawm tsam Enterococcus faecalis, Enterococcus faecium, Enterococcus durans, Enterococcus avum, yuav luag tag nrho cov leeg Streptococcus faecalis thiab lawv ntau yam (suav nrog Streptococcus faecalis liguifaciens, Streptococcus faecalis zymogenes), Streptococcus faecium, Streptococcus durans. Qhov kev cuam tshuam ntawm cov kab mob me me mus rau gentamicin kev loj hlob qeeb, txawm li cas los xij, cov kab mob tsis haum nrog neomycin thiab kanamycin kuj tseem tuaj yeem tiv taus gentamicin (tsis tiav ua tiav khaub lig-tsis kam). Tsis cuam tshuam rau anaerobes, kab mob fungi, kab mob, protozoa.

Nyob rau hauv lub plab zom mov, nws tsis zoo nqus, yog li ntawd, nws yog siv parenterally rau kev ua haujlwm ntawm lub cev. Tom qab i / m tswj hwm, nws yog nqus tau sai thiab tag nrho. T_max nrog ib / m taw qhia - 0.5-1.5 teev, nrog a / hauv kev qhia, lub sijhawm ncav cuag C_max yog: tom qab 30 feeb tso cov tshuaj infusion - 30 feeb, tom qab 60 feeb ib qho kev tso dej ntawm lub plab - 15 feeb, tus nqi ntawm C_max tom qab i / m lossis iv txhaj tshuaj ntawm koob tshuaj 1.5 mg / kg yog 6 μg / ml. Plasma protein khi yog tsawg (txog 10%). Qhov ntim ntawm kev faib tawm hauv cov laus yog 0.26 l / kg, hauv cov menyuam yaus - 0.2-0.4 l / kg. Nws muaj nyob hauv kev kho mob ntau hauv lub siab, ob lub raum, lub ntsws, nyob rau hauv pleural, pericardial, synovial, peritoneal, ascitic thiab lymphatic kua, tso zis, hauv qhov mob sib cais, pus, granulation. Kev tsis tshua muaj siab pom muaj nyob rau hauv cov ntaub so ntswg adipose, cov leeg, pob txha, bile, niam mis, aqueous kev lom zem ntawm lub qhov muag, lub ntsej muag bronchial, hnoos qeev thiab kua dej cerebrospinal. Feem ntau, hauv cov neeg laus, nws xyaum tsis nkag mus rau hauv BBB, nrog rau cov mob txha caj qaum, nws cov concentration hauv cov kua hlwb cerebrospinal nce ntxiv. Hauv cov menyuam tshiab, ntau dua nyob hauv cov kua dej ua kom tiav cerebrospinal tau tiav ntau dua li cov neeg laus. Cais tau los ntawm lub hno. Tsis yog metabolized. T_1/2 nyob rau hauv cov neeg laus - 2-4 teev. Nws yog tawm los tsuas yog los ntawm ob lub raum hauv daim ntawv hloov pauv, hauv me me - nrog cov tsib. Hauv cov neeg mob uas muaj lub raum ib txwm muaj, 70-95% yog tawm thaum thawj hnub, thaum muaj ntau tshaj 100 μg / ml tsim hauv cov zis. Hauv cov neeg mob uas txo qis glomerular pom, kev nthuav dav tau txo qis. Nws raug tawm hauv lub sijhawm hemodialysis (txhua 4-6 teev, qhov kev txiav txim siab poob qis 50%). Peritoneal lim ntshav ua kom zoo dua qub (hauv 48 2572 teev 25% ntawm koob tshuaj yog tawm). Nrog kev hno rov qab, nws nthuav tawm, feem ntau yog nyob rau hauv qhov chaw lymphatic ntawm lub pob ntseg sab hauv thiab hauv qhov ze rau lub raum tubules.

Thaum ua ntawv thov topically rau hauv daim ntawv ntawm lub qhov muag, nqus tau yog negligible.

Thaum ua ntawv thov sab nraud, nws yog xyaum tsis tau yaim, tab sis los ntawm thaj chaw loj ntawm daim tawv nqaij puas (qhov txhab, hlawv) los yog npog nrog cov ntaub so ntswg granulation, kev nqus tau tshwm sim sai.

Gentamicin nyob rau hauv ntau npaum li cas daim ntawv nyob rau hauv daim ntawv ntawm daim txhuam cev (daim hlau ntawm collagen daim txhuam cev tsau nyob rau hauv kev daws ntawm gentamicin sulfate) yog tus cwj pwm los ntawm lub cev ua kom ntev zog. Rau kev kis kab mob ntawm cov pob txha thiab cov nqaij mos (osteomyelitis, abscess, phlegmon, thiab lwm yam), ntxiv rau kev tiv thaiv cov teeb meem purulent tom qab kev ua haujlwm ntawm pob txha, cov tshuaj nyob rau hauv daim ntawv ntawm cov phaj yog txhaj rau hauv cov kab noj hniav thiab cov qhov txhab, thaum lub siab muaj peev xwm ntawm gentamicin hauv qhov chaw cog tshuaj yog tswj rau 7 for 15 hnub. Kev sib zog ntawm gentamicin nyob rau hauv cov ntshav thaum thawj hnub tom qab cog cov hnoos qeev sib haum rau cov uas tsim los ntawm kev tswj hwm hauv tsoomfwv; tom qab ntawd, ib qho tshuaj tua kab mob hauv cov ntshav tau tshawb pom hauv kev suav daws. Ua kom tiav cov resorption los ntawm cheeb tsam cog pob tshuaj yog cai tsis pub dhau 14-20 hnub.

Ntawv thov kev txwv

Txog qhov siv tag nrho: myasthenia gravis, parkinsonism, botulism (aminoglycosides tuaj yeem ua rau kev ua txhaum ntawm cov mob neuromuscular, uas ua rau cov leeg pob txha tsis muaj zog), lub cev qhuav dej, lub raum tsis ua haujlwm, lub sijhawm tsis muaj hnub nyoog, lub hnub nyoog yug menyuam ntxov, lub hnub nyoog laus.

Rau siv sab nraud: yog tias tsim nyog, siv rau ntawm ntau qhov chaw ntawm daim tawv nqaij - hnov pob ntseg ntawm cov leeg mob neuritis, myasthenia gravis, parkinsonism, botulism, lub raum tsis ua haujlwm (suav nrog kev mob raum tsis ua haujlwm nrog azotemia thiab uremia), cov menyuam mos thiab cov menyuam yug ntxov (kev ua haujlwm lub raum tsis muaj peev xwm tsim tau, uas tuaj yeem ua rau nce T_1/2 thiab kev nthuav qhia ntawm kev ua kom lub cev tsis zoo), cov laus lub neej.

Sab sij huam

Cov kev qhia ceeb toom pom tau tias muaj peev xwm tsim cov kev mob tshwm sim hauv qab no thaum sau ntawv rau Gentamicin:

xeev siab, ntuav,
anemia, leukopenia, granulocytopenia, thrombocytopenia,
oliguria
proteinuria
tsom kwm,
lub raum tsis ua hauj lwm
mob taub hau
tsaug zog
hnov lus
tsis paub kev lag ntseg
daim tawv nqaij ua pob
khaus
urticaria
npaws
Quincke's edema.

Cov Yuav Tsum Tau Ua

Gentamicin yog sib kis hauv cov xwm txheej hauv qab no:

Cov tib neeg tsis kam txais lossis tso tshuaj tiv thaiv tsis haum rau gentamicin thiab lwm tus neeg sawv cev ntawm pawg aminoglycosides.
Azotemia (kev nce ntxiv ntawm theem ntawm cov nitrogen nyob hauv cov ntshav) tiv thaiv keeb kwm yav dhau los los sis mob raum tsis ua haujlwm.
Neuritis (o) ntawm lub paj hlwb pob ntseg.
Myasthenia gravis yog cov leeg tsis muaj zog.
Txhua pathological tej yam kev mob ntawm lub pob ntseg sab hauv thiab pob ntseg vestibular.

Cev xeeb tub ntawm kev siv cov tshuaj yog tau tsuas yog rau kev noj qab haus huv yog tias qhov kev cia siab muaj txiaj ntsig rau leej niam tshaj qhov ua rau muaj qhov pheej hmoo rau tus me nyuam hauv plab.

Cov lus qhia tshwj xeeb

Siv nrog ceev faj hauv parkinsonism, myasthenia gravis, lub raum tsis ua haujlwm. Thaum siv cov txheej txheem Gentamicin, cov haujlwm ntawm lub raum, mloog lus thiab cov cuab yeej ua haujlwm yuav tsum tau saib xyuas.

Rau kev siv sab nraud ntev ntev rau ntawm thaj chaw loj ntawm daim tawv nqaij, nws yog qhov tsim nyog yuav tsum coj mus rau hauv qhov muaj peev xwm ua rau muaj kev tshem tawm, tshwj xeeb tshaj yog rau cov neeg mob uas mob raum tsis ua haujlwm.

Kev Sib Sau thiab daim ntawv ntawm tso tawm

Muaj plaub daim ntawv loj tshaj tawm ntawm Gentamicin, nws tsis yog tsim hauv cov ntsiav tshuaj. Lawv qhov sib txawv ntawm kev muaj pes tsawg leeg, sib xws thiab kev ntim khoom:

Kev daws rau kev txhaj tshuaj

Cov kua dej ntshiab ua kua ntsuab

Cov kua ntshiab ntshiab daj

Dawb dawb ua npuas ncauj

Qhov concentration ntawm gentamicin sulfate, mg

80 rau 1 ampoule (2 ml)

Dej, sodium metabisulfite, Trilon B

Dej, benzalkonium chloride, sodium chloride, sodium hydrogen phosphate, sodium dihydrogen phosphate

Kev sib xyaw ntawm tawv, kua, mos thiab dawb paraffins

Roj sib tov, dej

Pob ntawm 10 ampoules

5 ml dej tshuaj

Aerosol fwj 140 g

Pharmacodynamics thiab pharmacokinetics

Tom qab kev tswj hwm intramuscular, cov tshuaj tiv thaiv kom nquag plias nqus los ntawm qhov chaw txhaj tshuaj thiab nce mus txog qhov siab tshaj plaws tom qab 30-60 feeb, khi rau cov ntshav plasma 10%, yog pom nyob rau hauv tag nrho cov ntaub so ntswg ntawm lub cev, nkag mus rau qhov tus me nyuam. Kev txiav txim siab ua txhaum cai ntawm cov tshuaj tsis tshwm sim, rau 4-8 teev nws tawm hauv plab los yog zis. Thaum ua ntawv thov saum toj, cov tshuaj yuav nqus ntawm qhov tawv nqaij los ntawm tsuas yog 0.1%, nrog cov tawv nqaij puas lawm - sai dua thiab ntau dua kev xav. Tom qab siv sab nraud, cov khoom lag luam kav ntev li 8-12 teev, tso tawm los ntawm lub raum.

Tsuas tshuaj thiab tswj hwm

Ntawm dab tsi feem ntawm lub cev muaj kev cuam tshuam los ntawm kev kis tus kab mob, tus kab mob hnyav npaum li cas, kev xaiv ntawm daim ntawv ntawm kev tso tawm cov khoom lag luam muaj tshuaj nyob ntawm. Nrog kev puas tsuaj rau qhov muag, tso kua muag tau xaiv, nrog kev kis mob ntawm daim tawv nqaij thiab cov nqaij mos - cov tshuaj pleev lossis aerosol, rau cov mob hnyav uas yuav tsum muaj kev kho mob, txhaj tshuaj Gentamicin yog kho. Qhov ntau npaum li cas, hom thiab ntau zaus ntawm kev siv yog tsim los ntawm tus kws kho mob.

Yeeb tshuaj sib cuam tshuam

Thaum lub caij cov thawj coj ntawm Gentamicin nrog rau lwm cov tshuaj, cov tsos mob tsis zoo yog ua tau. Kev pheej hmoo ua ke:

aminoglycosides, vancomycin, cephalosporins, ethacrynic acid txhim kho ototoxicity thiab nephrotoxicity,
Indomethacin txo qhov kev ua kom tshem tawm ntawm cov tshuaj nquag, nce nws cov tshuaj lom neeg plasma thiab ua rau lom,
txhais tau hais tias rau inhalation tshuaj loog, opioid analgesics nce kev pheej hmoo ntawm neuromuscular blockade, mus txog rau apnea,
voj diuretics, Furosemide nce qhov kev kub siab ntawm gentamicin hauv cov ntshav, ua kom qhov kev pheej hmoo ntawm kev tshwm sim tsis zoo.

Cov nqe lus ntawm kev muag khoom thiab kev cia khoom

Txhua hom tshuaj yog tshuaj, khaws cia hauv qhov kub txog 15-25 degrees rau tee thiab daws, 8-15 degrees rau tshuaj pleev thiab aerosol. Lub txee lub neej ntawm cov tee yog peb xyoos, tshuaj pleev thiab aerosol yog ob, cov tshuaj yog tsib. Tom qab qhib lub raj mis ntawm cov tee, nws yuav tsum tsis pub ntev tshaj ib hlis.

Cov tshuaj analogues tseem ceeb yog cov tshuaj uas muaj tib yam tshuaj lom neeg ua ke. Indirect hloov nyiaj yog cov nyiaj nrog qhov sib txawv, tab sis nrog cov ntsuas thiab ua tau zoo tib yam. Xws li cov qauv:

Candiderm - lub qab zib raws li cov khoom siv tib yam nrog beclomethasone, clotrimazole,
Garamycin yog qhov yuav luag tiav ntawm cov tshuaj yeeb yaj kiab, hauv kev sib tov, tshuaj pleev,
Celestoderm - muaj cov tshuaj qub qub ntxiv nrog betamethasone, muaj nyob hauv cov tshuaj pleev.

Koj tuaj yeem yuav cov tshuaj hauv online platform lossis khw muag tshuaj kiosks ntawm tus nqi uas yog nyob ntawm daim ntawv ntawm cov tshuaj, cov npoo pauv. Kwv yees tus nqi ntawm cov tshuaj hauv cov khw muag tshuaj hauv Moscow:

Cev xeeb tub thiab lactation

Thaum cev xeeb tub, nws tsuas ua tau rau kev mob nkeeg (kev tshawb fawb kom txaus thiab tswj hwm tib neeg tsis tau ua tiav. Muaj cov ntaub ntawv hais tias lwm cov aminoglycosides ua rau muaj pob ntseg hauv menyuam hauv plab). Thaum lub sijhawm kev kho mob, nws yog ib qho tsim nyog kom tsum tsis txhob pub niam mis (nkag mus rau hauv niam mis).