Cov tshuaj Amikacin 500: cov lus qhia rau kev siv

Semi-hluavtaws dav-tshuaj tua kab mob nrog cov kab mob bactericidal. Los ntawm kev khi rau 30S subunit ntawm ribosomes, nws tiv thaiv qhov tsim los ntawm kev thauj khoom thiab kev xa xov RNA, thaiv cov protein synthesis, thiab tseem ua rau cytoplasmic membranes ntawm cov kab mob.

Nws yog qhov tshwj xeeb tawm tsam aerobic gram-tsis zoo microorganisms - Pseudomonas aeruginosa, Escherichia coli, Klebsiella spp., Serratia spp., Providencia spp., Enterobacter spp., Salmonella spp., Shigella spp., Indole-positive thiab indole-negative Acinotea strain Proteus ), qee cov kab mob gram-zoo - Staphylococcus spp. (suav nrog cov tshuaj tiv thaiv penicillin, qee cov cephalosporins), muaj kev sib xyaw ib qho qis ntawm Streptococcus spp.

Nrog rau kev tswj hwm ib txhij nrog benzylpenicillin, nws muaj cov nyhuv synergistic nrog kev hwm rau Enterococcus faecalis hom.

Tsis cuam tshuam rau tus kab mob anaerobic microorganisms.

Amikacin tsis plam cov haujlwm hauv qhov kev ua ntawm cov enzymes uas tsis ua haujlwm ntawm lwm cov amino glycosides thiab tuaj yeem ua haujlwm tiv thaiv kab mob ntawm Pseudomonas aeruginosa tiv taus tobramycin, gentamicin thiab netilmicin.

Cov Tshuaj Pharmacokinetics

Tom qab kev tswj hwm intramuscular (IM), nws yog nqus tau sai thiab tag nrho. Qhov siab tshaj plaws (Stax) nrog ib tug / m tswj hwm ntawm ib koob tshuaj 7,5 mg / kg yog 21 μg / ml. Lub sijhawm kom mus txog qhov siab tshaj plaws (TSmax) yog li 1.5 teev tom qab i / m tswj hwm. Kev sib txuas lus nrog plasma protein - 4-11%.

Nws tau faib zoo nyob rau hauv cov kua dej ntxiv (cov ntsiab lus ntawm qog ntshav, pleural effusion, ascitic, pericardial, synovial, lymphatic thiab peritoneal)

kua), nyob rau hauv cov ntsiab lus ntau nyob hauv cov zis, hauv qis - hauv cov kua tsib, kua mis, aqueous kev lom zem ntawm lub qhov muag, lub ntsej muag bronchial, hnoos qeev thiab cerebrospinal kua (CSF). Nws nkag mus rau hauv cov ntaub so ntswg hauv lub cev uas nws tau tsim tawm ntxiv, muaj ntau qhov kev pom nyob rau hauv cov kabmob uas muaj ntshav txaus: mob ntsws, mob siab, myocardium, tus txha caj qaum, thiab tshwj xeeb tshaj yog hauv lub raum, qhov twg nws nthuav tawm hauv cortical txheej, qis ntau - nyob hauv cov leeg, adipose nqaij thiab pob txha.

Thaum kho nyob rau hauv nruab nrab kho cov tshuaj rau cov neeg laus, amikacin tsis nkag rau hauv cov ntshav-hlwb teeb meem, nrog kev o ntawm cov kab mob meninges, permeability nce me ntsis. Hauv cov menyuam mos yug tshiab, cov ntsiab lus siab dua hauv CSF yog ua tiav ntau dua li cov neeg laus, dhau los ntawm qhov tso ntshav - nws pom nyob hauv cov ntshav ntawm cov menyuam hauv plab thiab cov kua dej amniotic. Kev faib khoom ntim hauv cov neeg laus - 0.26 l / kg, hauv cov menyuam yaus - 0.2-0.4 l / kg, hauv cov menyuam tshiab - hnub nyoog qis dua 1 lub lis piam thiab lub cev hnyav dua li 1.5 kg - txog 0.68 l / kg tsawg dua 1 lub lim tiam thiab lub cev hnyav dua li 1.5 kg - txog 0.58 l / kg, hauv cov neeg mob cystic fibrosis - 0.3-0.39 l / kg. Qhov nruab nrab kho qhov nruab nrab nrog kev tswj hwm i / m tswj hwm tau 10-12 teev.

Tsis yog metabolized. Ib nrab-lub neej (T1 / 2) hauv cov neeg laus yog 2-4 teev, hauv cov menyuam mos -5-8 teev, nyob rau cov menyuam loj dua - 2.5-4 teev. Tus nqi kawg ntawm T1 / 2 yog ntau dua 100 teev (tso tawm ntawm qhov tso rau hauv intracellular) Cov.

Nws yog tawm los ntawm lub raum los ntawm glomerular pom (65-94%), feem ntau tsis hloov. Kev kho kom lub raum - 79-100 ml / min.

T1 / 2 nyob rau cov neeg laus uas lub raum lub raum tsis ua haujlwm txawv nyob ntawm qhov sib txawv ntawm qhov tsis taus - txog li 100 teev, nyob rau hauv cov neeg mob cystic fibrosis -1-2 teev, nyob rau hauv cov neeg mob kub thiab hyperthermia, T1 / 2 tej zaum yuav luv dua li qhov nruab nrab vim yog nce ntxiv. Cov.

Nws raug nthuav tawm thaum mob hemodialysis (50% hauv 4-6 teev), peritoneal dialysis tsawg dua (25% hauv 48-72 teev).

Kev ntsuas rau siv

Nws yog npaj rau kev kho mob ntawm kev kis mob hnyav thiab mob tshwm sim los ntawm cov kab mob me me mus rau amikacin: lub ntsws ua pa (mob ntsws, mob ntsws, pleural empyema, mob ntsws ua paug), mob sepsis, mob septic endocarditis, lub hauv nruab nrab lub paj hlwb (suav nrog rau cov leeg mob), thiab lub plab hauv plab (suav nrog mob rau daim tawv (peritonitis), mob raum (pyelonephritis, cystitis, urethritis), tawv nqaij thiab cov nqaij mos (nrog rau qhov mob ua paug, mob rau sab hauv thiab mob tawm ntawm ntau yam noob), mob plab, cov pob txha thiab pob qij txha (suav nrog osteomyelitis) qhov txhab infe ktsiya, postoperative mob.

Cov Yuav Tsum Tau Ua Hypersensitivity (nrog rau keeb kwm ntawm lwm cov aminoglycosides), hnov ​​mob neuritis, mob raum tsis ua haujlwm (CRF) nrog azotemia thiab uremia, cev xeeb tub, lactation ..

Nrog ceev faj. Myasthenia gravis, parkinsonism, botulism (aminoglycosides tuaj yeem ua rau kev ua txhaum ntawm cov mob neuromuscular, uas ua rau cov nqaij pob txha tsis muaj zog ntxiv), lub cev qhuav dej, lub raum tsis ua haujlwm, lub sijhawm neonatal, ua ntej menyuam yaus, hnub nyoog siab dua.

Cev xeeb tub thiab lactation

Cov. Kev siv tshuaj amikacin yog sib kis hauv kev xeeb tub. Aminoglycosides tuaj yeem cuam tshuam nrog kev tsim kho ntawm embryo thaum muab rau tus poj niam cev xeeb tub. Aminoglycosides hla lub cev nqaij daim tawv; kev loj hlob ntawm ob sab lag ntseg lag ntseg hauv cov menyuam yaus uas leej niam tau txais tus mob streptomycin thaum cev xeeb tub. Txawm hais tias muaj kev mob tshwm sim loj nyob rau hauv cov ntshav lossis yug menyuam tshiab tsis pom thaum lwm tus aminoglycosides tau muab rau cov poj niam cev xeeb tub, muaj kev phom sij muaj. Kev tshawb fawb kev muaj me nyuam ntawm amikacin hauv nas thiab nas pom tsis muaj cov cim ntawm kev tsis taus lossis kev muaj mob ua rau muaj me nyuam hauv kev noj cov tshuaj amikacin.

Kuj tsis paub meej tias seb amikacin kis tau rau niam mis. Lub sijhawm siv tshuaj amikacin, kev noj niam mis tsis pom zoo.

Tsuas tshuaj thiab tswj hwm

Rau feem ntau cov mob, kev tswj hwm intramuscular yog kev pom zoo. Thaum muaj mob tuag los yog kev siv tshuaj ntxiv rau hauv lub cev tsis tuaj yeem ua tau, lawv tau maj mam tso rau hauv lub dav hlau (2-3 feeb), lossis infusion (0.25% daws rau 30 feeb).

Intramuscular thiab leeg kev tswj hwm

Amikacin tuaj yeem muab tshuaj intramuscularly thiab intravenously. Thaum tau txhaj tshuaj pom zoo muab koob tshuaj pom zoo rau kev kis tus mob tsis txaus ntseeg los ntawm cov kab mob tshwm sim yooj yim, kev kho mob tuaj yeem tau txais hauv 24-48 teev.

Yog tias tsis muaj cov lus teb kho mob tau txais nyob rau hauv 3-5 hnub, lwm txoj kev kho yuav tsum raug kho.

Ua ntej sau ntawv qhia txog amikacin, koj yuav tsum:

• ntsuas raum kev ua haujlwm los ntawm kev ntsuas cov tshuaj creatinine lossis los ntawm kev txiav txim siab creatinine qib kev txiav tawm (nws yog qhov yuav tsum tau ntsuas qee lub raum ua haujlwm thaum siv amikacin),

Yog tias ua tau, cov tshuaj amikacin concentration yuav tsum raug txiav txim siab (ntau kawg thiab qhov tsawg kawg ntawm ntshav ntau nyob rau qee zaum

Txav deb ntawm qhov kev xav ntau tshaj plaws ntawm amikacin (30-90 feeb tom qab txhaj tshuaj) ntau dua 35 μg / ml, qhov tsawg kawg nkaus ntawm qhov kev xav (tam sim ntawd ua ntej koob tshuaj ntxiv) ntau dua 10 μg / ml.

Hauv cov neeg mob uas lub raum tsis ua haujlwm, amikacin tuaj yeem kho 1 zaug nyob rau ib hnub, qhov no, qhov siab tshaj plaws qhov siab yuav tshaj 35 μg / ml. Lub sijhawm kho yog 7-10 hnub.

Tag nrho cov koob tshuaj, tsis hais txog txoj kev ntawm kev coj noj coj ua, tsis pub tshaj 15-20 mg / kg / hnub.

Hauv kev kis mob nyuaj, thaum ib chav kho mob ntau dua 10 hnub yog tsim nyog, lub raum kev ua haujlwm, kev hnov ​​lus thiab vestibular cov lus piav qhia, nrog rau cov theem amikacin yuav tsum tau ua tib zoo saib xyuas.

Yog tias tsis muaj kev txhim kho hauv chaw kho mob tsis pub dhau 3-5 hnub, kev siv tshuaj amikacin yuav tsum raug tso tseg, thiab qhov mob rhiab ntawm cov kab mob me me mus rau amikacin yuav tsum tau kuaj xyuas dua.

Cov neeg laus thiab menyuam yaus hnub nyoog 12 xyoos tshaj saud - nrog lub raum kev ua haujlwm zoo (tshem tawm tus kheej> 50 ml / min) i / m lossis iv 15 mg / kg / hnub 1 zaug hauv ib hnub lossis 7.5 mg / kg txhua 12 teev. Tag nrho cov koob tshuaj txhua hnub yuav tsum tsis pub ntau tshaj 1.5 g. Rau cov kab mob endocarditis thiab febrile neutropenia, koob tshuaj txhua hnub yuav tsum tau faib ua 2 koob, vim tias cov ntaub ntawv tsis txaus ntawm kev nkag mus 1 zaug hauv ib hnub.

Cov menyuam hnub nyoog 4 lub hlis - 12 xyoos - nrog lub raum ua haujlwm zoo (tshem tawm tus kheej> 50 ml / min) i / m lossis i / v (tso ntshav qeeb qeeb) 15-20 mg / kg / hnub 1 zaug hauv ib hnub lossis

7.5 mg / kg txhua 12 teev. Nrog endocarditis thiab febrile neutropenia, koob tshuaj txhua hnub yuav tsum tau muab faib ua 2 koob tshuaj, vim tias cov ntaub ntawv tsis txaus ntawm kev nkag mus 1 zaug hauv ib hnub. Cov menyuam yug tshiab - qhov pib thauj khoom yog 10 mg / kg, tom qab ntawd 7.5 mg / kg txhua 12 teev.

Cov me nyuam yug ntxov - 7.5 mg / kg txhua 12 teev.

Cov lus qhia tshwj xeeb rau kev tswj hwm ntawm cov leeg. Rau cov neeg laus thiab menyuam yaus, cov tshuaj amikacin feem ntau yog ua rau dhau 30-60 feeb.

Cov menyuam yaus hnub nyoog qis dua 2 xyoos yuav tsum tau siv tshuaj 1 mus rau 2 teev.

Amikacin yuav tsum tsis txhob xyaw ua ntej nrog lwm cov tshuaj, tab sis yuav tsum tau muab cais tshwj xeeb raws li kev pom zoo koob tshuaj thiab txoj kab ke ntawm kev tswj hwm.

Daim ntawv teev kev laus. Amycacin ua tawm los ntawm lub raum. Cov raum muaj nuj nqi yuav tsum raug ntsuas thiab cov koob tshuaj raws li ua rau lub raum khiav tsis zoo.

Kev phom sij txog lub neej thiab / lossis tshwm sim los ntawm Pseudomonas. Dtus neeg laus oz tuaj yeem tau nce txog 500 mg txhua 8 teev, tab sis amikacin yuav tsum tsis txhob siv ntau dua ib koob ntxiv

1.5 g ib hnub, thiab tsis pub ntau tshaj 10 hnub. Tag nrho cov chav kawm ntau kawg yuav tsum tsis pub tshaj 15 grams.

Cov kab mob txeeb zig (lwm qhov tsis yog los ntawm Pseudomonas). Vaj huam sib luag

7.5 mg / kg / hnub muab faib ua 2 koob tshuaj sib npaug (uas rau cov laus yog sib npaug 250 mg 2 zaug hauv ib hnub).

Kev suav ntawm cov koob tshuaj ntawm amikainin pui ntuag ua rau lub raum tsis ua haujlwm zoo (creatinine tshem tawm)

Noj ntau dhau

Cov tsos mob: hnov ​​mob lom (hnov pob ntseg, ataxia, kiv taub hau, tso zis tsis txaus, nqhis dej, tsis qab los, xeev siab, ntuav, lub suab nrov lossis hnov ​​zoo li hauv pob ntseg, ua pa tsis ua haujlwm).

Kev Kho Mob: txhawm rau tshem tawm qhov thaiv ntawm neuromuscular kis thiab nws lub txim - hemodialysis lossis peritoneal dialysis, tshuaj anticholinesterase, calcium ntsev, kev kho cua tshuab, lwm yam tsos mob thiab txhawb kev kho mob.

Kev cuam tshuam nrog lwm yam tshuaj

Kev siv cov txheej txheem hauv ib puag ncig lossis hauv zos nrog rau lwm cov tshuaj nephrotoxic lossis ototoxic yuav tsum zam vim muaj peev xwm ntxiv tau cov txiaj ntsig. Kev nce nephrotoxicity tshwm sim nrog kev sib koom tes ntawm aminoglycosides thiab cephalosporins. Kev siv qhov tseeb nrog cephalosporins yuav dag cov tshuaj creatinine tsis tseeb thaum txiav txim siab. Txoj kev pheej hmoo ntawm ototoxicity nce nrog kev siv tib lub sijhawm ntawm amikacin nrog kev coj ua sai sai, tshwj xeeb tshaj yog thaum siv cov diuretic yog tso ntshav tshuaj. Diuretics tuaj yeem ua rau kom muaj tshuaj lom ntau ntawm aminoglycosides txog kev hloov pauv ototoxicity vim qhov hloov pauv ntawm cov tshuaj tua kab mob hauv cov ntshav cov ntshav thiab cov nqaij mos. Cov no yog furosemide thiab ethacrylic acid, uas nyob rau hauv nws tus kheej yog ib qho tshuaj ototoxic.

Kev tswj hwm ntawm cov tshuaj amikacin tsis pom zoo rau cov neeg mob nyob hauv qab ntawm kev ua kom loog lossis mob rau cov leeg nqaij (nrog rau ether, halothane, D-tubocurarine, succinylcholine thiab decametonium), kev tiv thaiv neuromuscular thiab kev nyuaj siab ua pa ntawm lub ntsws tom qab. ,

Indomethacin yuav nce qhov siab ntawm amikacin hauv plasma hauv cov menyuam yug tshiab.

Hauv cov neeg mob uas mob raum tsis zoo, qhov txo qis ntawm aminoglycoside kev ua haujlwm yuav tshwm sim nrog kev siv cov tshuaj penicillin ntau heev.

Kev pheej hmoo ntawm hypocalcemia nrog kev sib koom tes ntawm aminoglycosides nrog bisphosphonates.

Ua rau muaj kev pheej hmoo ntawm nephrotoxicity thiab muaj peev xwm ototoxicity nrog kev sib koom tes ntawm aminoglycosides nrog platinum tebchaw.

Cov lus ceeb toom tshwj xeeb thiab cov kev ceev faj

Siv nrog ceev faj hauv cov neeg mob raum tsis ua haujlwm, los yog kev puas tsuaj rau lub rooj sib hais lossis cov khoom siv vestibular. Cov neeg mob yuav tsum tau saib xyuas kom zoo vim qhov muaj peev xwm ototoxicity thiab nephrotoxicity ntawm aminoglycosides. Kev nyab xeeb rau lub sijhawm kho mob ntau dua 14 hnub tsis tau tsim. Dosage ceev faj thiab muaj dej txaus yuav tsum tau pom.

Hauv cov neeg mob uas lub raum tsis ua hauj lwm los yog txo qis txhaws txhaws, kev ua haujlwm lub raum yuav tsum raug soj ntsuam los ntawm cov txheej txheem sib xyaw ua ntej kev kho mob thiab tsis tseg thaum kho. Kev noj tshuaj txhua hnub yuav tsum tau txo qis thiab / lossis qhov sib nrug ntawm cov koob tshuaj yuav tsum tau txuas ntxiv raws li qhov kev tsim cov tshuaj lom neeg lub cev kom tsis txhob muaj kev txuam nrog cov ntshav siab tsis zoo hauv cov ntshav thiab txo qis kev pheej hmoo ntawm ototoxicity. Kev tshuaj xyuas tsis tu ncua ntawm cov tshuaj thiab lub raum muaj nuj nqi tshwj xeeb tshaj yog tseem ceeb rau cov neeg laus hauv cov neeg mob raum ua haujlwm, qhov no yuav tsis pom tseeb hauv cov txiaj ntsig kev soj ntsuam ib txwm muaj xws li ntshav urea thiab serum creatinine.

Yog tias kev kho mob yuav ntev li xya hnub lossis ntau dua ntawm cov neeg mob uas mob raum tsis ua haujlwm, lossis 10 hnub hauv lwm tus neeg mob, cov ntaub ntawv xov xwm ua ntej yuav tsum tau txais thiab rov ntsuas dua thaum kho. Kev siv tshuaj Amikacin yuav tsum tsis ua ntxiv yog tias ib qho kev hnov ​​ntawm tinnitus lossis hnov ​​lus tsis hnov ​​qab, lossis yog hais tias hnov ​​cov ntsiab lus tomqab ntawd pom qhov tseem ceeb txo qis ntawm qhov kev nkag siab ntawm qhov muaj ntau.

Yog tias muaj cov cim qhia kev ua haujlwm ntawm lub raum (piv txwv li, albuminuria, qe ntshav liab lossis lymphocytes), kev haus dej yuav tsum tau nce thiab qhov ntau npaum ntawm cov tshuaj yuav tsum tau txo. Cov kev tsis zoo no feem ntau ploj thaum kho tiav. Txawm li cas los xij, yog tias azotemia thiab / lossis ib qho kev nce zuj zus hauv cov zis tshwm sim, kev kho yuav tsum tsis ua mus ntxiv.

Neuro / Ototoxicity. Neurotoxicity, ua pov thawj nyob rau hauv daim ntawv ntawm vestibular thiab / lossis ob tog auditory ototoxicity, tuaj yeem tshwm sim hauv cov neeg mob tau txais aminoglycosides. Txoj kev pheej hmoo ntawm aminoglycoside-induced ototoxicity yog ntau dua nyob rau hauv cov neeg mob uas lub raum tsis ua haujlwm, zoo li thaum tau txais kev txhaj tshuaj siab, lossis lub sijhawm kho mob ntau dua 7 hnub. Kiv taub hau uas tej zaum yuav qhia ua kev puas tsuaj. Lwm qhov kev qhia ntawm neurotoxicity kuj muaj xws li loog, tingling ntawm daim tawv nqaij, ua kom lub cev, thiab mob. Txoj kev pheej hmoo ntawm ototoxicity nce nrog nce qib ntawm kev sib raug zoo rau ib qho kev ua siab ntev ntawm lub siab los yog lub siab cov ntshav siab. Kev siv amikacin hauv cov neeg mob uas muaj kev tsis haum rau aminoglycosides, lossis subclinical lub raum tsis ua haujlwm, lossis kev puas tsuaj rau yim qhov mob tshwm sim los ntawm kev tswj hwm ua ntej ntawm nephrotoxic thiab / lossis ototoxic tshuaj (streptomycin, dihydrostreptomycin, gentamicin, tobramycin, kanamycin, kanamycin B polyinomy) , cephaloridine, lossis viomycin) yuav tsum tau txiav txim siab nrog ceev faj, txij li muaj tshuaj lom yuav ua kom zoo. Hauv cov neeg mob no, amikacin siv yog tias, raws li tus kws kho mob, cov txiaj ntsig kho tau ntau dua cov kev pheej hmoo txaus ntshai.

Neuromuscular toxicity. Neuromuscular blockade thiab ua pa tuag tes tuag taw tau tshaj tawm tom qab kev tswj hwm kev coj noj coj ua, kev tsim kho (nyob rau hauv kev coj ua orthopedic, kev tso dej ntawm lub plab hauv plab, kev kho mob hauv zos ntawm empyema), thiab tom qab kev tswj hwm ntawm aminoglycosides. Lub sijhawm ua pa tuag tes tuag taw yuav tsum tau txiav txim siab nrog kev qhia ntawm aminoglycosides hauv txhua txoj kev, tshwj xeeb tshaj yog nyob rau cov neeg mob tau txais tshuaj loog, mob leeg (tubocurarine, succinylcholine, decametonium), lossis hauv cov neeg mob tau txais ntshav ntau ntawm citrate-anticoagulated cov ntshav. Yog tias neuromuscular blockade tshwm sim, muaj ntsev ntsev tshem tawm ua pa tuag tes tuag taw, tab sis kev siv lub tshuab ua pa yuav tsim nyog. Aminoglycosides yuav tsum tau siv nrog kev ceev faj hauv cov neeg mob uas muaj cov leeg mob (myasthenia gravis lossis parkinsonism), vim tias lawv tuaj yeem ua rau cov leeg tsis muaj zog vim yog qhov cuam tshuam los ntawm kev cuam tshuam los ntawm neuromuscular kis tau.

Lub raum toxicity. Aminoglycosides yog qhov ua rau nephrotoxic. Txoj kev pheej hmoo ntawm kev txhim kho nephrotoxicity yog siab dua hauv cov neeg mob uas lub raum tsis ua haujlwm, zoo li thaum tau txais kev txhaj tshuaj siab thiab kev kho mob ntev. Kev haus dej tau zoo yog xav tau thaum kho, lub raum kev ua haujlwm yuav tsum raug ntsuas uas siv cov txheej txheem sib xyaw ua ntej thiab thaum kho. Kev kho yuav tsum tsis ua mus ntxiv nrog kev nce ntshav ntxiv lossis tso zis tsawg zuj zus.

Hauv cov neeg laus cov neeg mob, qhov ua kom lub raum khiav qis dua yog qhov ua tau, uas tej zaum yuav tsis pom tseeb hauv kev tshuaj ntsuam xyuas (ntshav ntshiab urea lossis ntshav ntshiab). Kev txiav txim siab txog kev tsim creatinine tshem tawm tej zaum yuav pab tau ntau dua li ntawd. Saib xyuas lub raum kev ua haujlwm hauv cov neeg laus laus thaum kho nrog aminoglycosides yog qhov tshwj xeeb tshaj yog.

Cov raum ua haujlwm thiab yim lub cranial cov hlab ntsha muaj nuj nqi xav tau kev soj ntsuam hauv cov neeg mob uas paub los yog xav tias lub raum tsis ua haujlwm thaum pib kho, nrog rau cov neeg mob uas lub raum ua haujlwm thawj zaug, tab sis nrog cov cim ntawm lub raum tsis ua haujlwm thaum kho. Amikacin concentration yuav tsum kuaj kom ntseeg tau tias qhov tshuaj ntau txaus thiab zam kom tsis txhob muaj cov tshuaj lom ntau. Cov zis yuav tsum raug saib xyuas rau kev txo qis kev nqus, muaj protein ntau ntxiv, thiab erythrocyturia. Ntshav urea, ntshav dej creatinine, lossis kev ntshiab si creatinine yuav tsum tau ntsuas ntsuas tsis tu ncua. Yuav tau txais cov kab xev kaw hauv cov neeg laus, tshwj xeeb yog cov neeg mob pheej hmoo. Cov tsos mob ntawm ototoxicity (kiv taub hau, tinnitus, tinnitus thiab hnov ​​lus tsis zoo) lossis nephrotoxicity yuav tsum tsis ua ntxiv lawm ntawm kev siv tshuaj lossis tshuaj kho kom haum.

Kev siv tib txhij thiab / lossis siv ntau yam ntawm lwm cov tshuaj neurotoxic lossis nephrotoxic (bacitracin, cisplatin, amphotericin B, cephaloridin, paromomycin, viomycin, polymyxin B, colistin, vancomycin, lossis lwm yam aminoglycosides) yuav tsum tau zam. Lwm yam uas ua rau muaj kev phom sij ntxiv yog cov muaj hnub nyoog thiab lub cev qhuav dej.

Txooj. Aminoglycosides nrawm nrawm thiab yuav luag txhua qhov kev xav thaum siv cov ntsiab lus, hauv kev sib xyaw nrog kev phais mob. Irreversible lag ntseg, lub raum tsis ua haujlwm, thiab kev tuag vim neuromuscular blockade tau raug tshaj tawm thaum lub sij hawm kev cog qoob loo ntawm thaj chaw loj thiab me phais.

Zoo li lwm yam tshuaj tua kab mob, kev siv cov amikacin tuaj yeem ua rau muaj kev loj hlob ntau ntawm cov kab mob tsis haum. Hauv qhov no, txoj kev kho tsim nyog yuav tsum tau kho.

Cov neeg mob uas tsis tuaj yeem rov qab tsis pom kev tau tshaj tawm tom qab txhaj tshuaj amikacin mus rau hauv vitreous ntawm lub qhov muag.

Tso tawm daim ntawv thiab muaj pes tsawg leeg

Ib qho tshuaj yog muab tawm hauv daim ntawv ntawm:

• Ib qho kev daws teeb meem rau i / m thiab iv kev tswj hwm, 1 ml ntawm uas muaj 250 mg ntawm amikacin, hauv ampoules ntawm 2 thiab 4 ml,
• Lub hmoov los ntawm cov tshuaj uas tov rau kev txhaj tshuaj yog npaj, hauv ib lub raj mis (10 ml) ntawm cov uas yuav muaj 250 mg, 500 mg lossis 1 gram ntawm amikacin.

Cov Yuav Tsum Tau Ua

Raws li cov lus piav qhia rau cov tshuaj, kev siv cov Amikacin yog contraindicated:

• Cov poj niam cev xeeb tub
• Nrog neuritis ntawm auditory hlab ntsha,
• Cov neeg mob uas mob raum ua mob tsis zoo los yog mob uremia thiab / lossis azotemia,
• Nyob rau hauv lub xub ntiag ntawm hypersensitivity rau amikacin, ib yam koom ua ke ntawm cov tshuaj, lwm yam aminoglycosides (suav nrog hauv keeb kwm).

Amikacin raug xaj, tab sis nrog kev saib xyuas zoo thiab hauv qab kev saib xyuas mob tas li:

• Nrog rau lub cev qhuav dej,
• Cov poj niam thaum lub sijhawm lactation
• Nrog myasthenia gravis,
• Cov neeg mob nrog parkinsonism
• Nrog raum tsis ua hauj lwm,
• Cov menyuam mos yug tshiab thiab cov menyuam yug ua ntej,
• Neeg laus
• Nrog botulism.

Kev noj tshuaj thiab kev tswj hwm Amikacin

Txoj kev daws teeb meem (suav nrog npaj los ntawm hmoov) Amikacin, raws li cov lus qhia, yuav tsum tau muab tshuaj intramuscularly lossis intravenously.

Qhov tshuaj rau cov neeg laus thiab menyuam yaus hnub nyoog dhau 6 xyoo yog 5 mg rau ib phaus ntawm lub cev qhov hnyav, uas tau txhaj tshuaj nyob rau ncua sijhawm 8 teev, lossis 7.5 mg / kg txhua 12 teev. Nrog rau cov kab mob tsis yooj yim ntawm cov mob ntsig txog tus kab mob genitourinary, nws muaj peev xwm sau ntawv rau ib koob ntawm 250 mg rau txhua 12 teev. Yog tias koj xav tau kev kho mob hemodialysis tom qab nws, koj tuaj yeem ua lwm qhov kev txhaj tshuaj ntawm qhov nqi ntawm 3-5 mg rau 1 kg ntawm qhov hnyav.

Qhov nyiaj siab pub rau txhua hnub rau cov neeg laus yog 15 mg / kg, tab sis tsis pub ntau tshaj 1.5 grams tauj ib hnub. Lub sijhawm ntawm kev kho mob, raws li txoj cai, yog 3-7 hnub - nrog a / hauv kev qhia, 7-10 hnub - nrog a / m.

Amikacin yog tseg rau cov menyuam raws li hauv qab no:

• Cov menyuam yug ua ntej: qhov kev muab thawj zaug yog 10 mg rau ib kg, tom qab ntawd 7.5 mg / kg txhua 18-24 teev,
• Rau cov menyuam mos thiab menyuam mos txog 6 xyoo: thawj koob yog 10 mg / kg, tom qab ntawd 7.5 mg / kg txhua 12 teev.

Thaum kis mob kub hnyiab, vim lub sijhawm luv luv ntawm ib nrab ntawm lub neej ntawm amikacin nyob rau hauv pawg no ntawm cov neeg mob, cov tshuaj ntawm cov tshuaj feem ntau yog 5-7.5 mg / kg, tab sis qhov ntau zaus ntawm kev tswj hwm nce - txhua 4-6 teev.

Amikacin yog raug mob rau ib pliag li 30-60 feeb. Yog tias muaj mob hnyav, yuav tsum tau txhaj dav hlau ob feeb.

Rau kev tswj hwm kev poob dej, cov tshuaj yog kho nrog 0.9% sodium chloride tov lossis 5% dextrose cov tshuaj kom cov tshuaj lom ntawm lub cev tsis tshaj 5 mg / ml.

Txo cov koob tshuaj lossis nce ntxiv ntawm kev txhaj tshuaj yog qhov yuav tsum tau ua rau cov neeg mob uas lub raum tsis ua haujlwm lub raum.

Phiv los ntawm Amikacin

Raws li kev tshuaj xyuas ntawm cov neeg mob uas tau txais kev kho mob nrog Amikacin, cov tshuaj no yuav muaj kev mob tshwm sim, xws li:

• Ntuav, xeev siab, ua kom lub siab ua haujlwm tsis zoo,
• Leukopenia, thrombocytopenia, anemia, granulocytopenia,
• Kev nkees nkees nkees, mob taub hau, mob tsis zoo ntawm neuromuscular (txog kev ntes ua pa), kev txhim kho ntawm cov nyhuv neurotoxic (tingling, loog, mob leeg, tw khi, mob qaug dab peg),
• Hnov tsis hnov ​​lus, tsis hnov ​​lus zoo, lag ntseg thiab lub ntsej muag tsis sib xws,
• Oliguria, microhematuria, proteinuria,
• Ua xua: tawv nqaij hyperemia, tawm pob, ua npaws, ua pob, khaus, Quincke's edema.

Ntxiv rau, nrog kev tswj hwm ntawm Amikacin, raws li kev txheeb xyuas, kev txhim kho phlebitis, dermatitis thiab periphlebitis, nrog rau kev hnov ​​mob ntawm qhov chaw txhaj tshuaj, yog qhov ua tau.

Cov lus qhia tshwj xeeb

Ua ntej siv cov tshuaj, nws yog qhov yuav tsum tau txiav txim siab qhov rhiab ntawm cov xaiv pathogens rau nws.

Lub sijhawm kho mob nrog Amikacin, tsawg kawg ib zaug ib lub lim tiam, cov haujlwm ntawm lub raum, lub tsho ua pa thiab cov leeg hnov ​​qab yuav tsum kuaj xyuas.

Amikacin yog tshuaj tsis haum nrog B thiab C vitamins, cephalosporins, penicillins, nitrofurantoin, potassium chloride, erythromycin, hydrochlorothiazide, capreomycin, heparin, amphotericin B.

Cov neeg mob tseem tab tom kho kab mob kev kis mob ntawm cov mob txeeb zig yuav tsum haus dej ntau (muab tshuaj rau kom txaus).

Nws yuav tsum tau yug hauv siab tias nrog kev siv sijhawm ntev ntawm Amikacin, kev txhim kho ntawm cov kab mob tiv taus yog qhov ua tau. Yog li ntawd, thaum tsis muaj cov chaw kuaj mob zoo lawm, nws yog qhov yuav tsum tso tseg cov tshuaj no thiab kev kho kom tsim nyog.

Amikacin analogues

Amikacin cov qauv sib piv yog Amikacin-Ferein, Amikacin-Vial, Amikacin Sulfate, Amikin, Amikabol, Selemicin, Hemacin.

Los ntawm tib pab pawg pharmacological thiab kev sib thooj ntawm cov txheej txheem ntawm kev nqis tes ua, cov tshuaj hauv qab no tuaj yeem suav hais tias yog cov tshuaj analogue ntawm Amikacin: Bramitob, Gentamicin, Kanamycin, Neomycin, Sisomycin, Florimycin sulfate, thiab lwm yam.

Cov lus thiab cov xwm txheej ntawm kev cia

Amikacin yog pawg B tshuaj tua kab mob tso tawm los ntawm cov chaw muag tshuaj los ntawm cov ntawv sau tshuaj. Txee lub neej yog 2 xyoos raug rau ua raws li cov cai khaws cia pom zoo los ntawm cov chaw tsim khoom - qhov chaw sov 5-25 ºС, qhov chaw qhuav thiab tsaus.

Pom qhov yuam kev hauv cov ntawv nyeem? Xaiv nws thiab nias Ctrl + Enter.

Tso tawm daim ntawv, ntim thiab muaj pes tsawg Amikacin

Kev daws rau kev saib xyuas ntawm qhov ncaj thiab intramuscular yog pob tshab, xim tsis muaj xim lossis me ntsis xim.

Tshwjxeeb: sodium disulfite (sodium metabisulfite), sodium citrate d / i (sodium citrate pentasesquihydrate), sulfuric acid diluted, dej d / i.

2 ml - iav ampoules (5) - hlwv pob (1) - pob khoom los ntawm cardboard.
2 ml - iav ampoules (5) - hlwv pob (2) - pob khoom los ntawm cardboard.
2 ml - iav ampoules (10) - hlwv pob (1) - pob khoom los ntawm cardboard.
2 ml - iav ampoules (10) - cov thawv ntawv thawv.

Kev daws rau kev saib xyuas ntawm qhov ncaj thiab intramuscular yog pob tshab, xim tsis muaj xim lossis me ntsis xim.

Tshwjxeeb: sodium disulfite (sodium metabisulfite), sodium citrate d / i (sodium citrate pentasesquihydrate), sulfuric acid diluted, dej d / i.

4 ml - iav ampoules (5) - hlwv pob (1) - pob khoom los ntawm cardboard.
4 ml - iav ampoules (5) - hlwv pob (2) - pob khoom los ntawm cardboard.
4 ml - iav ampoules (10) - hlwv pob (1) - pob khoom los ntawm cardboard.
4 ml - iav ampoules (10) - cov thawv ntawv thawv.

Lub hmoov rau kev npaj daws ntawm cov tshuaj rau cov tshuaj dawb thiab intramuscular ntawm dawb lossis yuav luag dawb xim yog hygroscopic.

Fwj nrog ntim muaj 10 ml (1) - ntim khoom ntawm thawv ntawv.
Cov raj mis nrog lub peev xwm ntawm 10 ml (5) - ntim ntawm cardboard.
Fwj nrog ntim muaj 10 ml (10) - ntim khoom ntawm thawv ntawv.

Cov ntsiab lus ntawm nosological pawg

Cov nqi hauv cov khw muag tshuaj hauv Moscow

Tso koj saib

Cov Ntaub Ntawv Tam Sim No Xav Tau Index, ‰

Sau npe Cov Tshuaj Tseem Ceeb thiab Tseem Ceeb

Amikacin cov ntawv pov thawj rau npe

• P N001175 / 01

• LP-003317

• LP-004398

• LP-003391

• LSR-002156/09

• LSR-002348/08

• LS-000772

• LSR-006572/09

• P N003221 / 01

• S-8-242 N008784

• S-8-242 N008266

Lub vev xaib raug cai ntawm lub tuam txhab RLS ®. Lub encyclopedia tseem ceeb ntawm cov tshuaj thiab cov khoom muag ntawm cov khw muag tshuaj assortment ntawm Lavxias Internet. Daim ntawv teev cov tshuaj Rlsnet.ru muab cov neeg siv kev nkag mus rau cov lus qhia, tus nqi thiab cov lus piav qhia txog cov tshuaj, khoom noj tshuaj, khoom siv kho mob, khoom siv kho mob thiab lwm yam khoom lag luam. Cov lus qhia ntawm pharmacological suav nrog cov ntaub ntawv ntawm kev sib xyaw thiab daim ntawv tso tawm, kev nqis tes ua pharmacological, kev taw qhia rau kev siv, contraindications, kev phiv tshuaj, cuam tshuam tshuaj, hom kev siv tshuaj, cov tuam txhab tshuaj. Daim ntawv qhia cov tshuaj muaj nqi rau tshuaj thiab cov khoom lag luam tshuaj hauv Moscow thiab lwm lub nroog Lavxias.

Nws yog txwv tsis pub xa, theej, tshaj tawm cov ntaub ntawv yam tsis tau txais kev tso cai los ntawm RLS-Patent LLC.
Thaum hais cov ntaub ntawv xov xwm luam tawm nyob rau ntawm nplooj ntawv ntawm lub xaib www.rlsnet.ru, qhov txuas mus rau qhov chaw ntawm cov ntaub ntawv xav tau.

Ntau ntau yam nthuav

Qoob loo.

Kev ua lag luam siv cov ntaub ntawv tsis raug tso cai.

Cov ntaub ntawv yog npaj rau cov kws kho mob.

Cov chaw muag tshuaj

Cov Tshuaj Pharmacokinetics

Tom qab kev tswj hwm intramuscular (IM), nws yog nqus tau sai thiab tag nrho. Qhov siab tshaj plaws siab (Cmax) nrog i / m tswj hwm ntawm ib koob tshuaj 7,5 mg / kg yog 21 μg / ml. Lub sijhawm kom mus txog qhov siab tshaj plaws (TCmax) yog li 1.5 teev tom qab i / m tswj hwm. Kev sib txuas lus nrog plasma protein - 4-11%.

Nws tau txais kev faib zoo nyob rau hauv cov kua dej ntxiv (cov ntsiab lus ntawm qog, pleural effusion, ascitic, pericardial, synovial, lymphatic thiab peritoneal kua), yog pom muaj nyob rau hauv siab ntau hauv cov zis, hauv qis - hauv cov kua tsib, kua mis, aqueous lom zem ntawm lub qhov muag, hnoos qeev, hnoos qeev thiab txha caj qaum. kua dej (CSF). Nws nkag mus rau hauv cov ntaub so ntswg hauv lub cev uas nws ntau zuj zus, ntau qhov kev tso cai rau hauv cov kabmob uas muaj ntshav txaus: mob ntsws, mob siab, myocardium, tus txha caj qaum, thiab tshwj xeeb tshaj yog nyob hauv lub raum, qhov twg nws nthuav tawm hauv cortical txheej, qis ntau - nyob hauv cov leeg, adipose nqaij thiab pob txha Cov.

Thaum raug coj los kho hauv nruab nrab txoj kev kho mob (ib txwm) rau cov neeg laus, amikacin tsis nkag rau hauv cov ntshav-hlwb lub hlwb (BBB), nrog kev mob ntawm cov mob meninges, permeability nce me ntsis. Hauv cov menyuam mos yug tshiab, cov ntsiab lus siab dua hauv CSF yog ua tiav ntau dua li cov neeg laus, dhau los ntawm qhov tso ntshav - nws pom nyob hauv cov ntshav ntawm cov menyuam hauv plab thiab kua dej. Kev faib khoom ntim hauv cov neeg laus - 0.26 l / kg, hauv cov menyuam yaus - 0.2 - 0.4 l / kg, hauv cov menyuam mos - thaum muaj hnub nyoog qis dua 1 lub lis piam. thiab lub cev hnyav tsawg dua 1.5 kg - txog 0.68 l / kg, hnub nyoog qis dua 1 lub lis piam. thiab lub cev hnyav dua li 1.5 kg - txog 0.58 l / kg, hauv cov neeg mob cystic fibrosis - 0.3 - 0.39 l / kg. Qhov nruab nrab kho cov tshuaj lom neeg nrog cov tshuaj mob siab lossis tshuaj khov kho tau raug tswj tseg li 10-12 teev.

Tsis yog metabolized. Ib nrab-lub neej (T1 / 2) hauv cov neeg laus yog 2-4 teev, hauv cov menyuam yug tshiab yog 5-8 teev, cov menyuam loj dua 2.5-4 teev, T1 / 2 kawg yog ntau dua 100 teev (tso tawm los ntawm cov khoom tso rau hauv intracellular )

Nws yog tawm los ntawm lub raum los ntawm glomerular pom (65 - 94%), feem ntau tsis hloov. Kev kho lub raum - 79-100 ml / min.

T1 / 2 nyob rau cov neeg laus uas lub raum lub raum tsis ua haujlwm txawv nyob ntawm qhov sib txawv ntawm qhov tsis taus - txog li 100 teev, rau cov neeg mob cystic fibrosis - 1 - 2 teev, nyob rau hauv cov neeg mob kub thiab hyperthermia, T1 / 2 tej zaum yuav luv dua li qhov nruab nrab vim yog nce ntxiv Cov.

Nws raug tawm hauv lub sijhawm hemodialysis (50% hauv 4 - 6 teev), peritoneal dialysis tsawg dua (25% hauv 48 - 72 teev).

Cov Tshuaj Hauv Tshuaj

Semi-hluavtaws dav-tshuaj tua kab mob nrog cov kab mob bactericidal.Los ntawm kev khi rau 30S subunit ntawm ribosomes, nws tiv thaiv qhov tsim los ntawm kev thauj khoom thiab kev xa xov RNA, thaiv cov protein synthesis, thiab tseem ua rau cytoplasmic membranes ntawm cov kab mob.

Muaj kev ua haujlwm zoo los tiv thaiv aerobic gram-tsis zoo microorganisms - Pseudomonas aeruginosa, Escherichia coli, Klebsiella spp., Serratia spp., Providencia spp., Enterobacter spp., Salmonella spp., Shigella spp., Qee yam kab mob me me - Staphyloccus spp. (suav nrog cov tshuaj tiv thaiv penicillin, qee cov cephalosporins), nquag tiv thaiv Streptococcus spp.

Nrog rau kev tswj hwm tib lub sijhawm nrog benzylpenicillin, nws muaj cov nyhuv synergistic tiv thaiv Enterococcus faecalis leeg.

Tsis cuam tshuam rau tus kab mob anaerobic microorganisms.

Amikacin tsis plam cov haujlwm hauv qhov kev nqis tes ua ntawm cov enzymes uas inactivate lwm aminoglycosides, thiab tuaj yeem ua haujlwm tiv thaiv kab mob ntawm Pseudomonas aeruginosa uas tiv taus tobramycin, gentamicin thiab netilmicin.

Cov tshuaj sib cuam tshuam

Nws yog cov tshuaj tsis sib haum nrog penicillins, heparin, cephalosporins, capreomycin, amphotericin B, hydrochlorothiazide, erythromycin, nitrofurantoin, vitamins B thiab C, thiab potassium chloride.

Nws qhia cov synergism thaum muaj kev cuam tshuam nrog carbenicillin, benzylpenicillin, cephalosporins (hauv cov neeg mob uas muaj mob raum tsis ua haujlwm, thaum ua ke nrog cov tshuaj tua kab mob beta-lactam, cov tshuaj aminoglycosides kuj yuav txo qis). Nalidixic acid, polymyxin B, cisplatin thiab vancomycin nce kev pheej hmoo ntawm oto- thiab nephrotoxicity.

Diuretics (tshwj xeeb tshaj yog furosemide, ethacrylic acid), cephalosporins, penicillins, sulfonamides thiab cov tshuaj tsis-steroidal los tiv thaiv kev sib tw, sib tw rau kev ua kom muaj kev tso pa hauv nephron tubules, thaiv kev tshem tawm ntawm aminoglycosides thiab nce lawv cov kev mob siab hauv cov ntshav, nce nephro- thiab neurotoxicity.

Siv tib lub sijhawm nrog lwm cov tshuaj nephrotoxic lossis ototoxic tsis pom zoo vim tias kev pheej hmoo ntawm kev mob tshwm sim.

Kev nce ntxiv ntawm nephrotoxicity tau tshaj tawm tom qab concomitant parenteral administration ntawm aminoglycosides thiab cephalosporins. Kev siv cephalosporins ntau heev yuav ua rau kom cov ntshav creatin tsis muaj tseeb.

Txhim kho cov leeg ua kom lub zog ua kom cov tshuaj curariform nce ntxiv.

Methoxyflurane, parenteral polymyxins, capreomycin, thiab lwm yam tshuaj uas thaiv neuromuscular kis tau (halogenated hydrocarbons raws li kev nqus tshuaj loog, opioid analgesics), thiab ntau cov ntshav ntxiv nrog rau cov tshuaj tiv thaiv citrate ua kom muaj kev phom sij rau kev ua pa.

Kev tswj hwm hauv tsoomfwv ntawm indomethacin nce kev pheej hmoo ntawm kev phiv los ntawm aminoglycosides (nce ntxiv hauv ib nrab-lub neej thiab txo qhov pom tseeb).

Txo cov nyhuv ntawm cov tshuaj tiv thaiv myasthenic.

Muaj kev pheej hmoo ntxiv ntawm hypocalcemia nrog kev tswj hwm ntawm aminoglycosides nrog bisphosphonates. Kev pheej hmoo ntawm nephrotoxicity thiab muaj peev xwm ototoxicity yog ua tau nrog kev tswj hwm ntawm aminoglycosides nrog platinum npaj.

Nrog rau kev tswj hwm tib lub sij hawm ntawm thiamine (vitamin B1), cov tshuaj tiv thaiv kev hloov ntawm sodium bisulfite hauv amikacin sulfate muaj pes tsawg leeg tuaj yeem rhuav tshem.

Daim ntawv tso tawm thiab ntim khoom

500 mg ntawm cov tshuaj yeeb dej caw hauv lub raj mis hermetically kaw nrog roj hmab stoppers, crimped nrog txhuas hau thiab txawv teb "FLIPP OFF" kaus mom.

Daim ntawv lo ntawm daim ntawv lo ntawm daim ntawv lossis ntawv sau yog lo rau txhua lub raj mis, lossis daim ntawv lo rau tus kheej lo rau tus kheej.

Txhua lub raj mis, ua ke nrog cov lus qhia pom zoo rau kev siv kho mob hauv lub xeev thiab Lavxias lus, muab tso rau hauv pob ntawv los qhia.

Kev taw qhia ntawm cov tshuaj Amikacin

Cov kab mob sib kis thiab mob tshwm sim los ntawm cov kab mob g-tsis zoo (tiv taus gentamicin, sisomycin thiab kanamycin) lossis cov koom haum ntawm cov kab mob gram-positive thiab gram-tsis zoo:

• mob ntsws ua pa (mob ntsws, mob ntsws, pleural empyema, mob ntsws ntsws),
• sepsis
• mob hlab ntsha hlwb
• Cov mob CNS (suav nrog rau tus mob meningitis),
• muaj kab mob hauv lub plab (nrog rau mob rau daim tawv),
• mob txeeb zig (pyelonephritis, cystitis, mob tso zis),
• cov kab mob purulent ntawm daim tawv nqaij thiab cov nqaij mos (nrog rau qhov mob sib kis, mob sib kis thiab mob siab ntawm ntau lub hauv paus pib),
• biliary huam mob
• mob ntawm cov pob txha thiab pob qij txha (suav nrog osteomyelitis),
• qhov txhab mob
• postoperative kis tau tus mob.

Kev noj tshuaj ntxiv

Cov tshuaj no tau txais koob tshuaj intramuscularly, rau hauv ntshav (hauv dav hlau, rau 2 feeb lossis nqus dej) rau cov neeg laus thiab menyuam yaus hnub nyoog dhau 6 xyoo - 5 mg / kg txhua 8 teev lossis 7.5 mg / kg txhua 12 teev. tsis yooj yim) - 250 mg txhua 12 teev, tom qab kev kuaj mob hemodialysis, ib koob tshuaj ntxiv 3-5 mg / kg tuaj yeem kho tau.

Qhov siab tshaj plaws rau cov neeg laus yog 15 mg / kg / hnub, tab sis tsis ntau tshaj 1.5 g / hnub rau 10 hnub. Lub sijhawm ntawm kev kho nrog a / hauv kev taw qhia yog 3-7 hnub, nrog rau / m - 7-10 hnub.

Rau cov menyuam mos thaum yug ntxov, qhov pib ib zaug yog 10 mg / kg, tom qab ntawd 7.5 mg / kg txhua 18-24 teev, rau cov menyuam yug tshiab thiab menyuam hnub nyoog qis dua 6 xyoo, thawj koob tshuaj yog 10 mg / kg, tom qab ntawd 7.5 mg / kg txhua 12 h rau 7-10 hnub.

Hauv cov mob kub hnyiab, qhov koob tshuaj 5-7.5 mg / kg txhua 4-6 teev yuav tsum muaj vim muaj luv T 1/2 (1-1.5 teev) ntawm pawg neeg mob no.

Hauv / hauv amikacin raug tswj hwm dropwise rau 30-60 feeb, yog tias tsim nyog, los ntawm dav hlau.

Rau kev tswj hwm iv (kua txau), cov tshuaj tau muab tshuaj ua ntej nrog 200 ml ntawm 5% dextrose (kua nplaum) lossis 0.9% sodium chloride tov. Qhov siab ntawm amikacin hauv kev daws rau iv kev tswj hwm yuav tsum tsis pub ntau dua 5 mg / ml.

Yog tias muaj teeb meem lub raum tsis ua haujlwm zoo, yuav tsum tau txhaj tshuaj ntau dua lossis ncua sij hawm nruab nrab ntawm kev tswj hwm. Nyob rau hauv qhov kev hloov ntawm lub sijhawm nruab nrab ntawm kev tswj hwm (yog tias QC tsis muaj nuj nqis, thiab tus neeg mob tus mob tseem ruaj khov), lub sijhawm nruab nrab ntawm kev tswj hwm tshuaj tau tsim los ntawm cov qauv hauv qab no:

luv (h) = ntshiab si creatinine concentration × 9.

Yog hais tias qhov kev sib txuam ntawm cov tshuaj creatinine yog 2 mg / dl, tom qab ntawd qhov kev pom zoo ib koob (7.5 mg / kg) yuav tsum tau siv txhua 18 teev. Nrog rau qhov nce ntxiv ntawm qhov sib nrug, qhov kev kho ib zaug tsis pauv.

Thaum poob qis hauv ib qho kev noj nrog ib koob tshuaj tsis hloov pauv, thawj koob tshuaj rau cov neeg mob raum tsis ua hauj lwm yog 7.5 mg / kg. Kev suav ntawm cov koob tshuaj tom qab yog nqa tawm raws li cov qauv hauv qab no:

Cov koob tshuaj tom qab (mg), muab txhua 12 teev = KK (ml / min) hauv tus neeg mob × thawj koob tshuaj (mg) / KK yog li qub (ml / min).

Sab sij huam

Los ntawm lub plab zom mov: xeev siab, ntuav, ua tsis tau zoo nyob hauv daim siab ua haujlwm (nce kev ua haujlwm ntawm hepatic transaminases, hyperbilirubinemia).

Los ntawm cov kab mob hemopoietic: ua haujlwm ntshav, leukopenia, granulocytopenia, thrombocytopenia.

Los ntawm sab hauv nruab nrab ntawm lub hauv nruab nrab lub paj hlwb thiab lub paj hlwb ntawm lub paj hlwb: mob taub hau, tsaug zog, cov nyhuv neurotoxic (mob leeg, loog, tingling, qaug dab peg), tsis hnov ​​qab neuromuscular kis (ua pa ntes).

Los ntawm cov kab mob hauv lub cev: ototoxicity (hnov lus tsis zoo, pob ntseg thiab pob txha loog, qhov tsis hnov ​​lus tsis zoo), muaj teeb meem rau lub cev vestibular (tsis meej pem ntawm kev txav, kiv taub hau, xeev siab, ntuav).

Los ntawm cov kab mob urinary: nephrotoxicity - lub raum khiav tsis zoo (oliguria, proteinuria, microhematuria).

Kev ua xua rau: tawv nqaij ua pob khaus, khaus, ua pob rau ntawm daim tawv nqaij, ua npaws, Quincke's edema.

Cov tshuaj tiv thaiv hauv zos: qhov mob ntawm qhov chaw txhaj tshuaj, kab mob dermatitis, phlebitis thiab mob periphlebitis (nrog rau kev tswj hwm iv).

Cev xeeb tub thiab lactation

Cov tshuaj yog contraindicated nyob rau hauv cev xeeb tub.

Nyob rau hauv qhov muaj qhov tseem ceeb qhia, cov tshuaj yeeb yaj kiab yuav siv tau rau hauv cov pojniam muaj pojniam. Nws yuav tsum tau yug hauv lub siab tias aminoglycosides yog tawm hauv cov kua mis hauv cov khoom me me. Lawv ua tsis tau zoo los ntawm kev mob plab, thiab teeb meem cuam tshuam hauv cov menyuam tsis tau sau npe.

Yeeb tshuaj sib cuam tshuam

Nws qhia cov synergism thaum sib cuam tshuam nrog carbenicillin, benzylpenicillin, cephalosporins (hauv cov neeg mob uas mob raum tsis zoo, thaum ua ke nrog cov tshuaj tua kab mob beta-lactam, cov tshuaj aminoglycosides kuj yuav txo qis).

Nalidixic acid, polymyxin B, cisplatin thiab vancomycin nce kev pheej hmoo ntawm oto- thiab nephrotoxicity.

Diuretics (tshwj xeeb tshaj yog furosemide), cephalosporins, penicillins, sulfanilamides thiab NSAIDs, kev sib tw rau kev ua kom zoo nyob rau hauv cov tubules ntawm nephron, thaiv kev tshem tawm ntawm aminoglycosides, nce lawv cov peev xwm hauv cov ntshav, nce nephro- thiab neurotoxicity.

Amikacin txhim kho cov leeg ua kom cov leeg txhim kho ntawm cov tshuaj curariform.

Thaum siv nrog amikacin, methoxyflurane, niam txiv polymyxins, capreomycin thiab lwm yam tshuaj uas thaiv neuromuscular kis tau tus mob (halogenated hydrocarbons - inhalation anesthesia, opioid analgesics), ntau cov ntshav ntxiv nrog cov tshuaj tiv thaiv citrate ua rau muaj kev phom sij ntau ntxiv.

Kev tswj hwm hauv tsoomfwv ntawm indomethacin nce kev pheej hmoo ntawm kev phiv los ntawm aminoglycosides (nce hauv T 1/2 thiab txo qis hauv kev tshem tawm).

Amikacin txo cov kev ua haujlwm ntawm tshuaj los tiv thaiv myasthenic.

Nws yog cov tshuaj tsis sib haum nrog penicillins, heparin, cephalosporins, capreomycin, amphotericin B, hydrochlorothiazide, erythromycin, nitrofurantoin, vitamins B thiab C, thiab potassium chloride.