Tshuaj Cefepim: cov lus qhia rau kev siv > Kev khomob thiab kev tiv thaiv

Lub hauv paus ntsiab lus ntawm cov nyhuv loj yog tsom rau kev puas tsuaj ntawm phab ntsa cell ntawm microbial cell, cov tshuaj ua rau cov kab mob bactericidal.

Cov tshuaj ua rau pom cov kab mob siab ua haujlwm tiv thaiv cov kab mob uas muaj peev xwm tiv taus qhov kev txiav txim ntawm 3rd tiam cephalosporins, aminoglycosidesCov. Cov tshuaj nquag muaj txaus sai nkag rau hauv cov cell-negative microbial cell, thaum muaj lub siab tiv thaiv cov hydrolysis ntawm ntau yam beta-lactamases. Lub hom phiaj tseem ceeb hauv lub cell rau cefepime yog penicillin-binding protein.

Cov tshuaj tua kab mob Cefepim ua rau cov kab mob gram-positive thiab cov kab mob gram-tsis zoo hauv vitro thiab hauv vivo: streptococci, enterobacteria, Escherichia coli, Klebsiella, clostridia, protea, thiab lwm yam.

Kev taw qhia rau kev siv cefepime

Ib qho tshuaj tua kab mob tau raug samfwm kom tua mob hnyav rau ib nrab. mob ntswstshwm sim los ntawm streptococci, enterococci, Klebsiella thiab lwm yam kab mob me me nkag siab rau kev ua ntawm cov tshuaj.

Cov lus qhia rau kev siv Cefepima muaj cov cim qhia hauv qab no rau kev siv tshuaj: kis mob txhab ntawm mob txeeb zig (mob nyuaj thiab tsis yooj yim), febrile neutropenia, mob tsis yooj yim rau cov kis kab mob ntawm daim tawv nqaij thiab cov mos mos uas nyob ib sab.

Cov tshuaj yog raug pom zoo rau kev siv rau hauv kev mob siab mob hauv plab - mob plab (hauv kev sib xyaw ua ke nrog metronidazole).

Sab sij huam

Cepepime tuaj yeem ua rau muaj kev tsis haum ntawm cov qauv ua npaws, khaus, erythematous ua pob ntawm daim tawv nqaij, tshuaj lom epidermal necrolysis, exudative erythema multiforme, anaphylactoid kev tsis haum.

Tawm tsam keeb kwm ntawm kev siv tshuaj tua kab mob, nws muaj peev xwm rau npe rau Coombs cov tshuaj tiv thaiv zoo.

Nrog kev tswj hwm intramuscular, mob thiab liab ntawm thaj chaw txhaj tshuaj yog sau tseg, phlebitis tsis tshua muaj kev txhim kho tom qab kev mob txeeb zig.

Cov mob txeeb zig: kev ntxhov siab hauv kev ua haujlwm ntawm kev ua haujlwm rov qab.

Digestive huam: Cov tsos mob dyspeptic pseudomembranous mob plab, cem quav, mob epigastric, ntuav, xeev siab.

Hematopoietic kabmob: tsis tshua muaj ntshav nrog kev siv tshuaj tua kab mob,anemia, leukopenia, txo qis hauv cov platelets, neutrophils.

Los ntawm lub tshuab ua pa nws muaj qhov hnoos.

Mob plawv: peripheral edema, palpitations, txog siav.

Qhov ntsuas pom ntawm qhov chaw kuaj thiab twj qhia kev tshawb fawb:hypercalcemiance prothrombin lub sijhawm, hyperbilirubinemia, nce qib ntawm urea, daim siab enzymes thiab alkaline phosphatase, sau npe hypercreatininemia.

Tawm tsam keeb kwm ntawm kev kho mob, kev txhim kho oropharyngeal candidiasis, asthenia, mob hauv siab yog tau, superinfectionmob mob qaum thiab qa.

Cefepim, cov lus qhia rau kev siv (Txoj kev thiab ntau npaum li cas)

Cov tshuaj yog muab tshuaj noj rau txoj kev lis ntshav hauv qhov dej ntawm lub cev (lub sijhawm ntawm Txoj kev lis ntshav yuav tsum yog tsawg kawg ib nrab ib teev). Hauv qee kis, kev tswj hwm intramuscular ntawm cov tshuaj raug tso cai (rau kab mob ntawm cov kab mob genitourinary los ntawm E. coli).

Kev kho mob ntsws: Kev tso dej tso tshuaj rau 1-2 gram tshuaj tua kab mob ib hnub ob zaug rau 10 hnub.

Kev kho kho qhov tseeb febrile neutropenia: Qhia 2 gram ntawm cov tshuaj cia txhua 8 teev, kev kho yog nqa tawm kom txog rau thaum tus kab mob tiav tag (kwv yees li 10 hnub)

Kev kho mob ntawm qhov mob txhab ntawm tus mob genitourinary: Txoj kev ua kom ntshav ntawm 0,5-1 gram ntawm cov khoom noj siav txhua 12 teev, ib chav kawm ntawm kev siv tshuaj tua kab mob yog tsim rau 7-10 hnub.

Nyob rau hauv cov mob hnyav ntawm cov kab mob saum toj no, cov tshuaj noj tau nce rau 2 grams, kev kho yog tsim rau 10 hnub.

Nyob rau thawj hnub ntawm kev siv tshuaj tua kab mob, cov neeg mob tau txais hemodialysis tau muab 1 gram ntawm cefepime, tom qab ntawd 0.5 gram yog nchuav txhua hnub (rau febrile neutropenia, qhov koob tshuaj tau nce rau 1 gram). Cov tshuaj raug pom zoo kom tau txais kev tswj hwm tam sim ntawd tom qab ua tiav ntawm kev kho mob hemodialysis.

Yuav ua li cas thiaj yug me nyuam rau me nyuam kom txhaj tshuaj: cov hmoov ua kom yaj ua ntej infusion hauv kev daws 5% ntawm dextrose (sodium chloride tov ntawm 0.9% yog ua tau) kom txog thaum ua tiav kev sib xyaw. Ua ntej txhaj cov tshuaj intramuscular, cov tshuaj tau yaj hauv dej tshwj xeeb rau kev txhaj nrog benzyl cawv lossis paraben. Tej zaum siv cov tshuaj ntawm kev daws ntawm lidocaine concentration ntawm 0.5 thiab 1%.

Kev sib txuam

Cefepime muaj peev xwm nce ntxiv ototoxicity thiab txhim kho cov kev mob tshwm sim rau lub raum thaum tau kho nrog aminoglycosides.

Cov tshuaj tua kab mob yog sib xyaw nrog heparin thiab lwm yam tshuaj tua kabmob. Cov tshuaj yuav tsum tsis txhob muab nrog ua ke nrog kev daws teeb meem ntawm metronidazole.

Cov lus qhia tshwj xeeb

Cepepime hauv cov ntsiav tshuaj tsis muaj.

Cov tshuaj tshem tawm nrog kev txhim kho pseudomembranous colitis nrog mob raws plab mus ntev (nws tau pom zoo hloov mus rau metronidazole thiab vancomycin).

Hauv cov neeg mob uas muaj keeb kwm ua xua los ntawm penicillin, kev tsim cov tshuaj tiv thaiv khaub thuas sib chwv muaj peev xwm ua tau.

Cov neeg mob uas muaj cov kab mob ntawm cov kab mob hepatic thiab lub raum xav tau kev soj ntsuam tas li ntawm kev saib xyuas ntawm cov khoom tseem ceeb hauv cov ntshav (kho cov tshuaj ntau npaum li cas yog ua raws li qib QC).

Nrog cov tshuaj sib xyaw ua ke ntawm cov kab mob anaerobic-aerobic, cov tshuaj ntxiv ntawm cov tshuaj tua kab mob tau pom zoo kom txog thaum ua tiav cov cim ntawm cov kab mob tseem ceeb.

Tawm tsam tom qab ntawm kev kho mob, nws muaj peev xwm rau npe qhov cuav qhov tsis zoo thaum ua qhov ntsuas cov ntshav qab zib.

Cov haujlwm ua haujlwm ntawm txoj kev ua kom tsis txhob ploj thaum cov xim ntawm cov npaj tau hloov.

Dosage daim ntawv

Hmoov rau kev daws rau kev txhaj tshuaj 0.5 g thiab 1.0 g

Ib fwj muaj

cov tshuaj heev - txoj cai cefepime hydrochloride (hais txog cefepime) 0.5 g lossis 1.0 g,

tus zam - arginine.

Hauv daim foos tov sib xyaw ntawm cefepime hydrochloride thiab arginine.

Dawb, yuav luag dawb lossis daj ua hmoov, hygroscopic.

Cov chaw muag tshuaj

Cov Tshuaj Pharmacokinetics

Lub sijhawm kom ncav cuag lub siab tshaj plaws ntawm cov kab mob cefepime hauv cov ntshav ntshav nrog kev txhaj tshuaj intramuscular ntawm ib koob li 0.5 g yog 1-2 teev, nrog kev tswj hwm ntshav ntawm ib koob ntawm 0.5 g - tom kawg ntawm Txoj kev lis ntshav. Qhov nruab nrab plasma qhov ntau ntawm cefepime thaum muab tso ncaj rau ntawm ib koob tshuaj 0.25 g, 0.5 g, 1 g thiab 2 g yog 18, 39, 82, thiab 164 μg / ml, feem, nrog ib leeg txhaj tshuaj intramuscular ntawm koob tshuaj 0.5 g, 1 g thiab 2 g - 14, 30 thiab 57 μg / ml, feem. Lub sijhawm kom mus txog qhov nruab nrab kho ntshav plasma concentration yog 12 teev. Cov tshuaj nruab nrab hauv nruab nrab nrog kev tswj hwm ntawm 0.7 μg / ml, nrog kev tswj hwm intramuscular - 0.2 μg / ml. Kho cov tshuaj muaj zog ntawm cov zaub mov tiav tom qab tso zis, kua tsib, kua peritoneal, bronchial mucosa, hnoos qeev, prostate, hnyuv tws thiab lub zais zis. Kev faib khoom ntim 0.25 l / kg, hauv cov menyuam yaus txij li 2 hlis txog 16 xyoo - 0.33 l / kg. Nws yog metabolized hauv daim siab thiab lub raum los ntawm 15% nrog kev tsim ntawm N-methylpyrrolidine, uas sai hloov mus rau qhov sib thooj N-oxide. Li ntawm 80% ntawm cov zaub mov yug ntses tau nthuav tawm tsis hloov pauv hauv lub tso zis, feem ntau vim yog cov txha caj qaum glomerular, tsawg dua 1% ntawm kev muab tshuaj yog pom nyob hauv cov zis hauv daim ntawv ntawm N-methylpyrrolidine. Kev khi ntawm cov nqaij nruab deg rau cov tshuaj protein tsawg dua 19% thiab tsis nyob ntawm qhov kev saib xyuas ntawm cov tshuaj tua kab mob hauv cov ntshav. 85% yog tawm los ntawm lub raum los ntawm glomerular pom tsis hloov pauv. Kev txiav txim tsis pub noj zaub mov rau cov menyuam yaus tom qab noj tshuaj nrog 50 mg / kg piv rau cov neeg laus tom qab txhaj koob tshuaj 2 g Lub cev tsis txaus noj ntawm cefepime hauv 8 tus neeg mob tom qab txhaj tshuaj rau 50 mg / kg yog 82.3 (± 15)%. Ua kom muaj kua mis.

Kev tshem tawm tag nrho ntawm cov tshuaj yog 120 ml / min. Qhov nruab nrab lub raum tshem tawm ntawm cov zaub mov noj yog 110 ml / min. Cov chaw muag tshuaj ntawm cefepime tsis hloov pauv ntau hauv cov neeg mob uas lub siab tsis ua hauj lwm los yog mob cystic fibrosis (kev kho tshuaj tsis tas yuav tsum tau). Nrog lub raum tsis ua haujlwm, ib nrab-lub neej ntawm cefepime nce, thaum muaj ib txoj kab sib txuas ntawm tag nrho cov kev ua kom huv si ntawm cefepime thiab kev tshem tawm ntawm creatinine. Ib nrab-lub neej ntawm cefepime yog 2 teev, lub sijhawm mob hemodialysis - 13 teev, nrog kev txuas ntxiv ntawm lub tsheb thauj neeg mob peritoneal lim ntshav - 19 teev. Nws tsis nthuav tawm hauv lub cev.

Cov Tshuaj Hauv Tshuaj

Cephalosporin IV tiam tshuaj tua kab mob. Nws ua rau cov kab mob, cuam tshuam rau kev sib txuas ntawm cov xovtooj ntawm phab ntsa ntawm cov kab mob me me. Nws muaj qhov kev ua kom dav. Nquag ua tawm tsam cov kab mob gram-positive thiab gram-tsis zoo, suav nrog feem ntau cov kab mob tiv taus aminoglycosides lossis peb cov tshuaj tua kab mob cephalosporin. Cepepime muaj kev tiv thaiv zoo rau kev ua ntawm feem ntau β-lactamases, muaj kev sib txuam qis rau beta-lactamases encoded los ntawm cov keeb kwm chromosomal, thiab nkag mus sai sai rau cov kab mob gram-negative. Qhov piv ntawm MBC (tsawg kawg yog cov kab mob bactericidal concentration) / MIC (cov tshuaj tiv thaiv kab mob tsawg kawg nkaus) rau cov kab noj hniav yog qhov tsawg dua 2 rau ntau dua 80% ntawm kev cais tawm ntawm tag nrho cov tshuaj tiv thaiv kab mob siab-zoo thiab cov gram tsis zoo.

Cov tshuaj yog nquag tawm tsam feem ntau cov kab mob ntawm cov kab mob me me.

Aerobic gram-cov kab mob zoo: Dab Tsi Staphylococcusaureus,Dab Tsi Staphylococcusphaum mob daim tawv nqaij (suav nrog kev siv cov kabmob uas ua cov beta-lactamase), lwm yam txawv ntawm staphylococci, suav nrog Dab Tsi Staphylococcushom,Dab Tsi Staphylococcussaprophyticus,Streptococcuspyogenes (pawg A streptococci),Streptococcusagalactiae (Cov kab mob Streptococcus pawg B),Streptococcusmob ntsws (suav nrog cov neeg mob uas muaj penicillin ua hauj hnyav - MIC ntawm 0.1 mus rau 0.3 μg / ml), lwm cov beta hemolytic streptococci (pawg C, G, F),Streptococcusbovis (pawg D),Streptococcusviridans.

Piv txwv feem ntau ntawm enterococci, piv txwv li Enterococcusfaecalis thiab methicillin-resistant staphylococci tiv taus cefepime.

Cepepime tsis nyob ntev rau qee qhov txawv Xanthomonas maltpphilia (Pseudomonas maltophilia).

Anaerobes: Prevotella sppCov. (suav nrog Prevotella melaninogenicus) Cov ntsiab lus Bacteroides spp., suav nrog Bacteroides melaninogenicus thiab lwm yam kab mob me me ntawm lub qhov ncauj kab noj uas cuam tshuam nrog Bacteroides, Clostridium perfringens, Fusobacterium spp., Mobiluncus spp., Peptostreptococcus spp., Veilonella spp.Cov. Cepepime tsis tawm tsam Cov kab mob bactericide fragilisthiabClostridium difficile.

Tsuas tshuaj thiab tswj hwm

Cov tshuaj yog muab rau dej tshuaj (maj mam dhau 3-5 feeb) thiab intramuscularly (tob rau hauv cov leeg). Kev noj tshuaj ntau dua tau teeb tsa ua ib qho zuj zus, noj mus rau hauv tus account qhov mob hnyav, hom kab mob thiab nws qhov rhiab heev rau zaub mov noj. Kev mob siab rau txoj kev tswj hwm yog pom zoo rau cov neeg mob uas muaj kab mob hnyav lossis ua rau muaj sia, tshwj xeeb nrog kev pheej hmoo ntawm kev poob siab.

Cov neeg laus thiab menyuam yaus hnyav dua 40 kg nrog lub rwj mob txeeb zig - 0.5-1 g 2 zaug ib hnub,

nrog kev kis mob ntawm qhov chaw sib txawv - 1 g sib zog lossis intramuscularly txhua 12 teev, nrog rau kis mob hnyav, qhov koob tau nce rau 2 g 2 zaug hauv ib hnub,

txhawm rau muaj kev mob kev phom sij rau lub neej, 2 g tso ntshav txhua 8 teev rau 7 hnub, nqa tag nrho cov tshuaj txhua hnub rau qhov siab tshaj plaws ntawm 12 g,

nrog febrile neutropenia - 2 g tso rau txhua 8 teev rau 7 hnub,

rau kev tiv thaiv kev kho mob phais mob ua ntej thiab tom qab sijhawm - 2 g ncau rau 30 feeb (thaum kawg ntawm kev tswj hwm, metronidazole 500 mg tseem ntxiv txhaj tshuaj rau lub sijhawm) 1 teev ua ntej kev ua haujlwm, thaum lub sijhawm ua haujlwm ntev, rov qab siv dua tom qab 12 teev ntawm tib lub koob tshuaj , ua raws cov lus qhia ntawm metronidazole.

Hauv qhov tsis yooj yim tso zis mob (suav nrog pyelonephritis), mob ntsws, thiab qhov muaj peev xwm kho neutropenic ua npaws rau cov menyuam uas hnyav dua 40 kg - 50 mg / kg txhua 12 teev.

Nrog rau cov mob neutropenic ua npaws, cov kab mob ua paug rau cov menyuam yaus uas hnyav dua 40 kg - 50 mg / kg txhua 8 teev.

Yog tias tsis muaj teeb meem lub raum, lub cev yuav tsum tau kho. Nrog creatinine tshem tawm ntawm 30-60 ml / min, nyob ntawm qhov mob hnyav - 0.5, 1 lossis 2 g 1-2 zaug hauv ib hnub, nrog creatinine tshem ntawm 10-30 ml / min - 0.5, 1 lossis 2 g 1 zaug hauv ib hnub kev tshem tawm tswv yim

Tso tawm daim ntawv thiab muaj pes tsawg leeg

Dosage cov ntaub ntawv ntawm cefepime:

hmoov rau qhov kev npaj ntawm kev daws rau kev tswj hwm intramuscular (IM): los ntawm dawb mus dawb nrog lub daj zas, 0.5 g lossis 1 g txhua qhov hauv vials: hauv thawv ntawv thawv ntawm 10 lossis 50 vials (rau lub tsev kho mob), hauv daim ntawv thawv los ntawm 1 lub raj mis, nyob rau hauv cov duab los ua pob 1 lub raj mis ua kom tiav nrog cov kuab tshuaj (1 iav ampoule ntawm 3.5 ml txhua nrog kev daws ntawm lidocaine rau txhaj tshuaj 10 mg / ml), hauv ib daim ntawv pov thawj 1 lub raj mis ua tiav nrog cov kuab tshuaj (1 iav ampoule txhua 3.5 ml nrog kev daws ntawm lidocaine rau kev txhaj tshuaj 10 mg / ml thiab 1 ampoule ntawm 5 ml nrog dej rau txhaj), 1 g hauv vials, hauv lub thawv ntawv thawv e yog 5 los yog 30 vials
hmoov rau kev npaj cov tshuaj rau cov tshuaj pleev (iv) thiab tshuaj intramuscular (i / m) tswj hwm: dawb nrog lub daj tint ntawm 0.5 g hauv lub raj mis, hauv daim ntawv thawv ntawv 1 lub raj mis, hauv ib daim ntawv thawv ntawm 10, 50, 270 lossis 300 lub raj mis (rau tsev kho mob), 0.5 g lossis 1 g txhua qhov hauv hwj, hauv cov hlwv ntim ntawm 1 lossis 5 lub raj mis, hauv pob ntawv qhwv 1 pob ua tiav nrog 1 lossis 5 iav ampoules nrog cov kuab tshuaj (dej rau txhaj), 1 g txhua cov lam fwj, hauv ib daim ntawv qhwv ib leeg 1 lub raj mis, hauv ib daim ntawv thawv ntawv 10, 14, 25, 50, 270, 300 lossis 1000 fwj (rau tsev kho mob), 2 g hauv ib lam fwj, hauv cardboard 1 raj mis pob, nyob rau hauv ib tug thawv 50 los yog 300 vials (rau lub tsev kho mob).

Hauv 1 lub raj mis nrog lub hmoov rau i / m tswj hwm muaj:

cov tshuaj nquag: cefepime hydrochloride monohydrate hais txog cefepime - 0.5 g lossis 1 g,
ntu ntu: arginine.

Hauv 1 lub raj mis nrog hmoov rau iv thiab v / m tswj hwm muaj:

cov tshuaj nquag: cefepime hydrochloride hais txog cefepime - 0.5 g, 1 g lossis 2 g,
ntu ntu: arginine.

Cov Tshuaj Pharmacokinetics

Lub bioavailability ntawm cefepime yog 100%.

Kev siab tshaj plaws (C_max) ib cov tshuaj hauv cov ntshav ntshav nrog ib leeg ntshav nrog ntawm 1000 mg ntawm cefepime rau 0.5 teev yog 0.0787 mg / ml 0.5 teev tom qab ua tiav ntawm Txoj kev lis ntshav. Tom qab 12 teev, cov tshuaj nyob rau hauv cov ntshav plasma nruab nrab 0.0006 mg / ml. Qhov kev xav ntau tag nrho (AUC) ntawm cov tshuaj hauv plasma dhau ib teev yog 0.1485 mg / ml.

Tom qab i / m tswj hwm, cefepime absorption tshwm sim kiag li. C_max nrog ib / m taw qhia, 1000 mg ntawm cov tshuaj nce mus txog 0.0263 mg / ml tom qab 2 teev. AUC - 0.137 mg / ml / h.

Qhov faib tawm ntawm qhov nruab nrab hauv cov neeg laus yog 0.25 l / kg, hauv cov menyuam yaus - 0.33 l / kg.

Kwv yees li 20% ntawm cov koob tshuaj tau muab khi rau cov protein ntshav.

Cefepime hauv ntau qhov kev txiav txim siab yog txiav txim siab peritoneal kua, tso zis, kua tsib, zais zis, hnoos qeev, bronchial mucosa, exudate blister, prostate caj pas thiab appendix.

Ib nrab-lub neej yog 2 teev, nrog hemodialysis - 13 teev, nrog txuas ntxiv peritoneal lim - 19 teev.

Kwv yees li 15% ntawm qhov koob tshuaj yog metabolized hauv lub siab thiab ob lub raum, kwv yees li 85% raug nteg tawm hauv cov zis.

Hmoov rau qhov npaj ntawm kev daws rau iv thiab / m tswj hwm

mob ntsws dej ib nrab thiab mob hnyav los ntawm Pseudomonas aeruginosa, Kab mob Streptococcus pneumoniae (suav nrog rau kev kis mob nrog cov mob ua pa), Klebsiella pneumoniae, Enterobacter spp.,
pyelonephritis thiab lwm yam tsis yooj yim thiab cov kab mob sib kis ntawm cov mob txeeb zig ua rau mob Klebsiella pneumoniae, Escherichia coli, Proteus mirabilis,
febrile neutropenia - kev kho mob tiag tiag,
muaj kev nyuaj rau mob plab plab uas tshwm sim los ntawm tus kab mob Enterobacter spp., Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae, Bactero>

Cev xeeb tub thiab lactation

Kev siv cov zaub mov noj yog ua tau tsuas yog muaj qhov tshwj xeeb, thaum qhov kev xav pom ntawm kev kho rau leej niam muaj txiaj ntsig zoo tshaj qhov kev hem thawj rau cov menyuam hauv plab:

nyob rau hauv daim ntawv ntawm hmoov rau IV thiab IM tswj hwm - nyob rau hauv II thiab III trimesters ntawm cev xeeb tub (Kuv trimester yog ib qho meej contraindication rau daim ntawv no tsuas tshuaj),
nyob rau hauv daim ntawv ntawm hmoov siv rau i / m tswj hwm - lub sijhawm tagnrho ntawm cev xeeb tub.

Kev siv cov tshuaj thaum lub sijhawm lactation yog contraindicated. Rau kev ntsuas kev kuaj mob uas xav tau kev tswj hwm zaub mov noj, kev pub mis rau menyuam yuav tsum tsis pub mus ib ntus.

Yeeb tshuaj sib cuam tshuam

Nrog rau kev siv khoom noj ua ke zoo ib yam:

aminoglycosides, diuretics, polymyxin B ua rau kev txo qis ntawm tubular tso rau ntawm cov zaub mov nqaij, ua kom ntev li ntawm ib nrab-lub neej thiab nce nws cov peev xwm hauv cov ntshav, nce nephrotoxicity,
non-steroidal anti-inflammatory tshuaj pab qeeb qeeb txo cov cephalosporins, nce ntawm kev pheej hmoo los ntshav,
macrolides, chloramphenicol, tetracyclines qhia kev thaiv kev rau cov tshuaj,
aminoglycosides yog synergistic.

Cov tshuaj yuav tsum tsis txhob sib xyaw nrog cov koob txhaj ib yam nrog kev daws ntawm metronidazole, gentamicin, vancomycin, tobramycin, aminophylline lossis netilmicin. Yog tias tsim nyog, tib lub sijhawm teem tseg ntawm txhua cov tshuaj yuav tsum tau muab nyias.

Cov tshuaj Ampicillin thiab cov tshuaj nplawm ntxaws yuav tov nrog ib lub koob txhaj tshuaj ntawm ib qho twg ntawm lawv tsis siab tshaj 40 mg rau 1 ml.

Cov lus qhia ntawm cov zaub mov noj yog: Maksipim, Ladef, Movizar, Tsepim, Efipim.

Cov Yuav Tsum Muaj

Ua ntej pib txoj kev kho nrog Cefepim, cov neeg mob yuav tsum ua tib zoo kawm cov lus qhia nyob nrog. Kev txhaj tshuaj tsis raug txwv yog cov neeg mob muaj ib lossis ntau yam mob:

lub hnub nyoog ntawm cov menyuam yaus txog 2 hlis (rau kev tswj hwm txoj haujlwm) - qhov no yog vim tsis muaj kev paub txog kev siv thiab tsis muaj kev nyab xeeb,
hnub nyoog txog 12 xyoos rau kev txhaj tshuaj intramuscular,
tus neeg tsis qaug rau yeeb tshuaj,
cov mob uas muaj kev fab loj rau cov tshuaj tua kab mob los ntawm pab pawg ntawm cephalosporins,
hypersensitivity rau penicillins - ua tau hla intolerance rau cephalosporins,
pseudomembranous mob plab, nrog rau keeb kwm ntawm
cev xeeb tub thiab lub sijhawm pub mis.

Cov tshuaj tiv thaiv sib kis rau kev coj noj coj ua ntawm Cefepim yog cov mob rau daim siab ntev, mob plab, tus neeg mob hnub nyoog tshaj 65 xyoos.

Kev siv cov tshuaj thaum cev xeeb tub thiab lactation

Hauv thawj peb lub hlis thaum cev xeeb tub, cefepim txhaj tsis tau rau cov niam uas tseem muaj lub cev, vim tias cov tshuaj tiv thaiv cov tshuaj tiv thaiv tau yooj yim nkag mus rau hauv qhov chaw tiv thaiv kab mob thiab tuaj yeem ua rau muaj kev txhim kho ntawm cov tsis xws luag thiab txawv txav hauv menyuam hauv plab.

Hauv kev cuam tshuam thib ob thiab thib peb ntawm kev xeeb tub, kev siv tshuaj tiv thaiv kab mob tsuas yog siv tau yog tias xav tias yuav muaj txiaj ntsig rau leej niam tshaj qhov ua rau muaj kev pheej hmoo rau tus menyuam hauv plab. Txoj kev kho yog nqa tawm hauv tsev kho mob los ntawm kev saib xyuas nruj ntawm cov kws kho mob.

Kev siv Cefepim kev txhaj tshuaj thaum pub mis niam hauv qee kis yuav tsum muaj kev tshem tawm kev lactation, txij li cov tshuaj yeeb dej caw ntawm cov tshuaj tau tawm hauv cov mis thiab mus rau hauv lub cev ntawm tus menyuam.

Kev phiv tshuaj

Thaum kho nrog Cefepim kev txhaj tshuaj, cov neeg mob uas lub siab tsis tshua zoo rau cephalosporins yuav muaj kev cov nyom uas tshwm sim los ntawm kev kuaj mob raws li hauv qab no:

los ntawm cov leeg hlwb - mob taub hau, tsaug zog, qaug zog, nkees, nkees, tsis nco qab, tsis nco qab, nriaj, mob caj dab,
los ntawm lub plab zom mov - kev mob ncauj plab ntawm lub qhov ncauj mucosa, glossitis, mob plab tawg, mob siab rau hauv lub qhov ncauj thiab tus nplaig, kub siab, nkees, nkees, tsis qab los noj mov, ntuav, mob plab tsis txaus, kev loj hlob ntawm lub plab, ua kom lub siab ua haujlwm tsis zoo, kev loj hlob ntawm lub siab tsis ua haujlwm. ,
kev ua xua - urticaria, pruritus, dermatitis, mob ua paug epidermal necrolysis, kev txhim kho mob ntawm kev mob hlwb, mob anaphylactic,
los ntawm cov ntshav hemopoietic plab hnyuv siab raum - leukopenia, txo qis hauv platelet suav, agranulocytopenia, mob ntshav qab zib tsis txaus, kev hloov pauv prothrombin lub sijhawm dhau los,
los ntawm cov plab hnyuv siab raum tso zis - lub raum tsis ua haujlwm, kev txhim kho interstitial nephritis, kev txhim kho ntawm lub raum tsis ua haujlwm,

los ntawm kev muaj me nyuam - qhov chaw mos dysbiosis, khaus ntawm qhov chaw mos, qhov chaw tawm mus, qhov tshwm sim ntawm chaw mos nrog qhov tsis hnov tsw,
nyob rau ntawm cov pa ua pa - hnoos, mob hauv siab thaum nqus pa, bronchospasm, ua pa nyuaj, zoo li tsis muaj huab cua,
los ntawm cov hlab plawv system - lub plawv palpitations, ua tsis taus pa, o ntawm qhov kawg,
kev kuaj ntsuas - qhov txo qis ntawm hematocrit, qhov nce ntawm cov paug ntawm urea, nce ntxiv hauv cov qib calcium thiab creatinine hauv cov ntshav,
cov tshuaj tiv thaiv hauv zos - cov leeg txha caj ntshav, mob ntshav txhaws, kub hnyiab thiab mob raws txoj leeg thaum lub sijhawm tswj kev siv tshuaj, phlebitis, thromboembolism, nrog kev siv tshuaj intramuscular ntawm cov tshuaj tua kab mob, mob ua paug, liab thiab ua pob khaus ntawm daim tawv nqaij ntawm qhov chaw txhaj tshuaj.

Thaum tsaus muag, ua tsis taus pa, nce tawm hws lossis tsaus muag hauv qhov muag thaum tswj hwm cov tshuaj cia, koj yuav tsum qhia koj tus kws kho mob tam sim no txog qhov no thiab nres lub infusion.

Noj ntau dhau

Kev noj tshuaj ntau dhau ntawm kev siv tshuaj tua kab mob yog muaj peev xwm ua tau yog tias tus neeg mob siv tshuaj ntev lossis ntev dua qhov kev mob siab tshaj qhov pom zoo ntawm cov tshuaj. Clinically, cov cim ntawm kev txhaj tshuaj ntau dua yog pom los ntawm kev nce ntxiv hauv cov kev mob tshwm sim saum toj no, kev txhim kho lub raum, lub plawv thiab lub siab tsis ua haujlwm, encephalopathy.

Kev kho mob ntawm kev siv tshuaj ntau dhau yog suav nrog kev kho mob sai, kev kho mob me me rau tus neeg mob thiab tshem tawm cov tsos mob ntawm cov tshuaj tua kab mob.

Cov qauv ntawm cov tshuaj cefepim

Analogues ntawm cov tshuaj Cefepim yog:

Peb lo cov hmoov rau qhov kev npaj ntawm qhov kev daws rau kev txhaj tshuaj,
Ladef hmoov rau kev npaj cov tshuaj rau hno,
Cefomax hmoov,
Movizar hmoov rau kev npaj daws.

Thaum hloov cov tshuaj noj nrog cov tshuaj tiv thaiv kab mob sib xyaw, koj yuav tsum tau mloog zoo rau kev haus tshuaj ntawm cov tshuaj tua kab mob.

So haujlwm thiab chaw mob

Cefepim hmoov yog faib los ntawm cov chaw muag tshuaj los ntawm cov tshuaj noj. Nws raug nquahu kom muab cov tshuaj vials tso rau hauv tub yees lossis hauv qhov chaw txias. Khaws tsis ncav cuag ntawm cov menyuam yaus.

Ib qho kev daws rau kev txhaj tshuaj yog npaj tam sim ua ntej tswjhwm. Tsis txhob tso cov tshuaj tiav kom txog thaum txhaj tshuaj tom ntej!

Lub txee lub neej ntawm cov hmoov yog 2 xyoos, tsis txhob siv cov tshuaj nrog lub txee ncua sij hawm.

Cov lus qhia rau kev siv cefepime, ntau npaum li cas

Hmoov rau kev txhaj tshuaj intramuscular

Cov tshuaj tiav tau npaj rau tsuas yog rau kev tswj hwm intramuscular.

Yuav ua li cas txhawm rau cefepime rau kev tswj hwm intramuscular? Cov tshuaj ntxuav hauv qab no tuaj yeem siv cov hmoov yaj: cov dej tsis huv rau kev txhaj tshuaj, 5% kua nplaum tov rau kev txhaj tshuaj, 0.9% sodium chloride tov rau kev txhaj tshuaj, bacteriostatic dej rau kev txhaj nrog benzyl cawv lossis paraben, 0.5% lossis 1% daws ntawm lidocaine hydrochloride Cov. Rau kev qhia txog 0.5 g ntawm hmoov, nws yuav tsum tau yaj nyob rau hauv 1.3 ml, rau kev qhia ntawm 1 g hauv 2.4 ml ntawm cov kuab tshuaj.

Tus kws kho mob txiav txim qhov koob tshuaj thiab lub sijhawm ntawm kev kho mob raws li cov cim qhia tau, cov mob hnyav, thiab kev ua haujlwm ntawm lub raum.

Qhov ntau npaum ntawm cefepime pom zoo los ntawm cov lus qhia rau kev siv yog 0.5-1 g txhua 12 teev, chav kawm ntawm kev kho mob yog 7-10 hnub. Nrog lub raum tsis ua haujlwm nrog creatinine tshem tawm (CC) tsawg dua 30 ml / min, cov neeg mob yuav tsum kho cov tshuaj ntau dua. Thawj koob tshuaj yog thawj zaug ib txwm siv.

Npaj kev daws rau iv thiab intramuscular tswj hwm

Kev npaj daws ntawm Cefepime yog npaj rau kev tswj hwm intramuscular (tsuas yog kho cov mob tsis yooj yim thiab nyuaj tso zis ntawm cov mob sib khuav thiab mob hnyav los ntawm Escherichia coli) lossis rau dav hlau thiab dej nrog kev tswj hwm.

Txhawm rau npaj cov tshuaj rau iv txhaj, nws yog ib qho tsim nyog yuav ntxiv 10 ml ntawm ib qho ntawm cov kuab tshuaj rau 1 g ntawm kev npaj: dej tsis huv rau kev txhaj, 5% dextrose (kua nplaum) tov, 0.9% sodium chloride tov. Cov tshuaj tiav tau muab tshuaj rau hauv 3-5 feeb.

Txhawm rau npaj cov tshuaj rau iv kua, koj tuaj yeem siv ib qho ntawm cov kev daws teebmeem hauv qab no: 0.9% sodium chloride tov, sodium lactate tov, 5% lossis 10% dextrose (kua nplaum) tov, kev sib xyaw ntawm Ringer's lactate thiab 5% dextrose tov, sib tov 5 % dextrose kev daws thiab 0.9% kev daws sodium chloride. Cov ntsiab lus ntawm lub vial (1 g ntawm hmoov) yog thawj zaug yaj hauv 5-10 ml ntawm ib qho ntawm cov kev daws teeb meem, tom qab ntawd sib xyaw rau hauv lub taub hau infusion nrog tib cov kev daws teeb meem, nqa nws mus rau 50 ml lossis 100 ml. Lub sijhawm tiv thaiv ntawm Txoj kev lis ntshav yog 30 feeb.

Txhawm rau npaj cov tshuaj rau kev txhaj tshuaj rau intramuscular, koj tuaj yeem siv dej tsis huv rau kev txhaj tshuaj, 0.9% kev daws teeb meem ntawm sodium chloride lossis 0.5-1% ntawm lidocaine hydrochloride. Rau 1 g ntawm hmoov, 2.4 ml ntawm cov tshuaj lom yuav tsum tau ntxiv rau qhov vial. Intramuscular txhaj tshuaj yuav tsum tau ua tom qab kev xav ua ntej kom tsis txhob tau txais rab koob rau hauv lub nkoj thiab qhia qhov kev daws teeb meem rau hauv cov ntshav (tshwj xeeb tshaj yog lidocaine)! Kev daws yog txhaj tob rau hauv cov leeg nqaij hauv qhov siab ntawm lub pob tw.

Hauv txhua qhov ntawm cov kev npaj daws teeb meem, qhov nyob ntawm ib qho lus me me tsis raug tso cai!

Kev kho mob ntawm mob ntsws: ua haujlwm tso ntshav ntawm 1-2 grams tshuaj tua kabmob ob zaug ib hnub rau 10 hnub.

Kev kho qhov tseeb ntawm febrile neutropenia: txhua 2 teev, tswj 2 grams ntawm cov tshuaj cia, kev kho yog nqa tawm kom txog thaum tus kab mob tiav tag (hauv nruab nrab 10 hnub).

Kev kho mob ntawm qhov mob txhab mob ntawm qhov mob ua kom yuv: ua kom nqus ntshav ntawm 0.5-1 gram ntawm cov zaub mov noj txhua 12 teev, ib chav kawm ntawm kev siv tshuaj tua kab mob yog tsim rau 7-10 hnub.

Nyob rau hauv cov mob hnyav ntawm cov kab mob saum toj no, cov tshuaj noj tau nce rau 2 grams, kev kho yog tsim rau 10 hnub.

Cov lus qhia tshwj xeeb

Yog tias mob pseudomembranous mob nrog rau mob plab zawv ntev tshwm sim, tsum tsis txhob noj thiab muab tshuaj vancomycin (ntawm qhov ncauj) lossis metronidazole.

Kev mob khaub thuas sib deev muaj peev xwm ua tau rau cov neeg mob ua xua ntawm kev siv penicillins.

Nrog rau cov teeb meem ua mob raum thiab ntshav siab tsis txaus, ntshav plasma concentration ntawm cov tshuaj yuav tsum tau txiav txim siab tsis tu ncua (kev hloov kho koob tshuaj yog nyob ntawm CC).

Nrog kev kho mob ntev nrog Cefepim, kev soj qab xyuas txhua zaus ntawm cov ntshav, mob siab thiab lub raum ua haujlwm yog qhov tsim nyog.

Hauv kev sib xyaw aerobic-anaerobic, kev txheeb xyuas cov kab mob yuav tsum muaj kev sib xyaw nrog cov tshuaj nquag tawm tsam anaerobes.

Cov neeg mob uas muaj mob txha caj qaum los ntawm qhov chaw nyob deb ntawm tus kab mob tau xav tias muaj mob hlwb los yog kuaj pom tus mob meningitis tau lees paub, lwm txoj kev siv tshuaj tua kab mob nrog cov chaw kho mob tau txais kev pom tseeb rau qhov xwm txheej no yuav tsum tau kho.

Kev kuaj pom ntawm txoj kev kuaj pom zoo Coombs, kuaj tsis muaj tseeb rau cov piam thaj hauv cov zis.

Khaws cov tshuaj txhuam hniav tov rau tsis pub tshaj li 24 teev ntawm chav sov lossis rau 7 hnub hauv tub yees. Kev hloov xim tsis cuam tshuam rau cov kev ua ntawm cov tshuaj.

Sab sij huam

Cov kev qhia ceeb toom txog qhov ua tau los ntawm kev muaj cov kev mob tshwm sim tom qab thaum sau ntawv Cefepim:

Kev tsis haum tshuaj: ua pob khaus tawv nqaij (suav nrog ua pob ua pob ua paug), khaus, ua npaws, anaphylactoid, Coombs cov tshuaj tiv thaiv zoo, eosinophilia, erythema multiforme exudative (suav nrog Stevens-Johnson syndrome), tsis tshua muaj - lom neeg muaj peev xwm ua paug (syndrome) Lyella).
Cov tshuaj tiv thaiv hauv zos: nrog rau kev tswj hwm iv - phlebitis, nrog kev tswj hwm intramuscular - hyperemia thiab mob ntawm qhov chaw txhaj tshuaj.
Los ntawm cov leeg hlwb: mob taub hau, kiv taub hau, pw tsaug zog, pliaj plab, ntxhov siab, tsis meej pem, nriaj.
Los ntawm cov kab mob genitourinary: vaginitis.
Los ntawm cov kab mob txeeb zis: mob raum tsis zoo.
Los ntawm lub plab zom mov: raws plab, xeev siab, ntuav, cem quav, mob plab, dyspepsia, pseudomembranous mob plab.
Los ntawm cov ntshav hemopoietic plab hnyuv siab raum: anemia, thrombocytopenia, leukopenia, neutropenia, pancytopenia, hemolytic anemia, los ntshav.
Los ntawm kev ua pa: hnoos.
Los ntawm CCC: tachycardia, ua pa siav, peripheral edema.
Qhov ntsuas pom: qhov txo qis ntawm hematocrit, kev nce sijhawm hauv prothrombin sijhawm, nce ntawm urea concentration, hypercreatininemia, hypercalcemia, kev nce siab hauv cov haujlwm ntawm hepatic transaminases thiab alkaline phosphatase, thiab hyperbilirubinemia.
Lwm yam: mob caj pas, mob hauv siab, tawm hws, mob nraub qaum, asthenia, kev txhim kho superinfection, oropharyngeal candidiasis.

Cov Yuav Tsum Muaj

Nws yog contraindicated rau sau tshuaj cfepime nyob rau hauv rooj plaub no:

lub hnub nyoog ntawm cov menyuam yaus txog 2 hlis (rau kev tswj hwm txoj haujlwm) - qhov no yog vim tsis muaj kev paub txog kev siv thiab tsis muaj kev nyab xeeb,
hnub nyoog txog 12 xyoos rau kev txhaj tshuaj intramuscular,
tus neeg tsis qaug rau yeeb tshuaj,
cov mob uas muaj kev fab loj rau cov tshuaj tua kab mob los ntawm pab pawg ntawm cephalosporins,
hypersensitivity rau penicillins - ua tau hla intolerance ntawm cephalosporins,
pseudomembranous mob plab, nrog rau keeb kwm ntawm
cev xeeb tub thiab lub sijhawm pub mis.

Cov tshuaj tiv thaiv sib kis rau kev coj noj coj ua ntawm Cefepim yog cov mob rau daim siab ntev, mob plab, tus neeg mob hnub nyoog tshaj 65 xyoos.

Noj ntau dhau

Muaj kev nce ntxiv hauv cov kev mob tshwm sim. Cov tsos mob ntawm ib qho kev noj qab haus huv yog qhov tsis meej pem, pom kev tsis meej, tsis hnov qab, hnov qab, myoclonia.

Kev kho mob yam mob. Hemodialysis siv tau.

Cefepim analogs, tus nqi hauv cov chaw muag tshuaj

Yog tias tsim nyog, koj tuaj yeem hloov Cefepim nrog cov tshuaj tiv thaiv ntawm cov tshuaj nquag - cov no yog cov tshuaj:

Thaum xaiv cov analogues, nws yog ib qho tseem ceeb kom nkag siab tias cov lus qhia rau kev siv Cepepim, nqe thiab tshuaj xyuas tsis siv rau cov tshuaj ntawm cov nyhuv zoo sib xws. Nws yog ib qho tseem ceeb kom kws kho mob sab laj thiab tsis txhob hloov pauv cov tshuaj ywj siab.