Imithi elwa namagciwane isizukulwane yakamuva ezibanzi-spectrum

Phakathi kwezidakamizwa hlala ebalulekile isizukulwane wokugcina imithi elwa namagciwane asebenzayo ngokumelene amagciwane amaningi. Zisetshenziswa ekwelapheni pathologies ezithathelwanayo, okuyinto kakhulu ziyancipha lokufa kwezinsana weziguli ezivela banal samanje pneumonias futhi pyelonephritis. Ngenxa imithi lula futhi asheshisa yokuthola ukucinana kwemigudu yokuphefumula, sinusitis, futhi sebekwazi ukwenza izinqubo eziyinkimbinkimbi kuhlinzwa. izifo Ngisho nilimaza ziphathwa ngempumelelo ngemithi elwa namagciwane.

Imithi ebulala izinhlobonhlobo zamagciwane (ABSHS)

Lesi sigaba sihlanganisa ejenti elwa namagciwane asebenzayo ngokumelene igremu-negative futhi igremu-HIV eziphilayo. Eyokuqala kukhona causative ejenti izifo emathunjini, pathologies sokuvuvukala urogenital futhi izinhlelo zokuphefumula. Gram-HIV eziphilayo ngokuvamile abangela izilonda bese thobeka okuvela yezinkinga nasezinkingeni ezilandela ngemva kokuhlinzwa ekuhlinzeni.

Uhlu ABSHS ezahlukene ukukhululwa isikhathi

Ezinye ezibanzi spectrum-antibiotic isizukulwane yakamuva esebenza ngokukhuthala ukulwa protozoal izifo. Izibonelo zibandakanya nemikhiqizo nitroimidazole - tinidazole, metronidazole futhi ornidazole. Inqubo esetshenziswa kabanzi metronidazole ngenxa ukuyikhokhela. ikilasi lakhe Analogue - tinidazole - spectrum ezifanayo umsebenzi elwa namagciwane, kodwa parenterally akuzange kusetshenziswe. Ngokuvamile, wonke amaqembu imithi ebulala izinhlobonhlobo zamagciwane ethulwa ngale ndlela:

• penicillins yemvelo;
• ingibitorzaschischennye aminopenicillin;
• penicillins pseudomonas, kuhlanganise ingibitorzaschischennye;
• cephalosporins III isizukulwane cephalosporins IV isizukulwane ;
• aminoglycosides iqembu;
• imithi elwa namagciwane tetracycline ;
• imithi elwa namagciwane macrolide;
• inani carbapenem imithi elwa namagciwane;
• chloramphenicol;
• fosfomycin;
• rifampin;
• dioxidine;
• sulfonamides;
• quinolones, fluoroquinolones;
• iqembu nitrofurans;
• nitroimidazole imithi elwa namagciwane chungechunge.

Lolu hlu alinikwa amagama amaqembu ewumngcingo-spectrum antibiotic. Ziyakwazi sicaciselwe inombolo encane amagciwane futhi ngempumelelo ngokumelene nawo. izidakamizwa ewumngcingo-spectrum ayikwazi ukusetshenziswa for ekwelapheni superinfection futhi kungukuthi isicelo empirically. Zisetshenziswa njengoba imithi elwa namagciwane lokuqala umugqa lwegciwane ebekiwe.

Uhlu Ezizukulwaneni ezidlule ABSHS

Okungenhla ejenti elwa namagciwane basonta ezihlukahlukene izidakamizwa. Lolu uhlu oluphelele lwamaqembu izidakamizwa nomsebenzi ngokumelene igremu-HIV futhi igremu-negative amagciwane. Nokho, uhlu iqukethe kokubili isizukulwane yakamuva kwamaphilisi kanye nabamele ngaphambili leqembu. Of abamele izizukulwane zakamuva okungenhla yilezi ezilandelayo amaqembu izidakamizwa:

• aminopenicillin amelana beta-lactamase ( "Sulbactam", "Ampicillin", "clavulanate" "Amoxicillin");
• cephalosporins zezizukulwane III futhi IV ( "Cefotaxime" "Cefoperazone" "Ceftazidime" "ceftriaxone" "cefpirome" "Cefepime");
• isizukulwane III aminoglycoside ngezilapha magciwane ( "Amikacin" "Netilmicin");
• 14- futhi 15-membered semi zokwenziwa macrolides ( "Roxithromycin" "Clarithromycin," "Azithromycin");
• Yemvelo-16 membered imithi elwa namagciwane macrolide ( "midecamycin");
• fluoroquinolones III futhi IV izizukulwane ( "levofloxacin" "sparfloxacin" "Gatifloxacin" "Trovafloxacin" "moxifloxacin");
• carbapenems ( "meropenem" "Imipinem-cilastatin" "Ertapenem");
• nitrofurans ( "Nitrofurantoin" "Furazidin", "ersefuril").

Imithi elwa namagciwane ukuthi bayakhishwa ohlwini

Lezi ngaphambilini evikelwe penicillins antipseudomonal babe Nokho, spectrum ezibanzi umsebenzi, isicelo kuphela ngokumelene P. aeruginosa sicabangela isidingo ukunciphisa contact kungenzeka nge usuku zakamuva futhi imithi elwa namagciwane ezinamandla. Lokhu kuvimbela ingozi amagciwane amelana nemithi. Kusebenta enkulu ngokumelene Pseudomonas ukutheleleka ububonisa "tazobactam." Ngezikhathi ezithile "Piperacillin" futhi "clavulanate" lalisetshenziswa njengezaba isizukulwane yakamuva imithi inyumoniya kubangelwa esibhedlela zakulezi pathogen.

Futhi ohlwini Awekho iqembu imithi elwa namagciwane isizukulwane lokugcina penicillins yemvelo anti-staphylococcal. Lo mqeqeshi owake wapheka ayikwazi isetshenziswa ekwelashweni nesineke ngenxa isidingo yokuphathwa njalo emthanjeni noma esicutshini. Amafomu ukuthi ubavumele ukuthatha ngomlomo, alikho. Namuhla kunesimo esithi asifane nge cephalosporins. Nge bohlu efanayo umsebenzi njengoba penicillins, abakwazi esizosingathwa ngomlomo ngoba ukubhujiswa esiswini.

Cephalosporins futhi penicillins ukusetshenziswa parenteral - kungcono isizukulwane yakamuva kwamaphilisi eliphumelelayo nenyumoniya. ososayensi iNASB baye ngakwazi ukusungula uhlobo umthamo ekuphathweni enteral. Nokho, ucwaningo ongakabi bakwenze, futhi izinhlobo eziningi zezidakamizwa ingasetshenziswa kuze kube manje kuphela izikhungo zezempilo umile.

imithi elwa namagciwane kakhulu ngempumelelo izingane

Ukuhlaziya isizukulwane yakamuva kwamaphilisi, uhlu izidakamizwa Kunconywa izingane, ayisesemikhulu kakhulu. Ngo ebuntwaneni, kungenziwa kuphela esetshenziswa abamele aminopenicillins eziningana ( "Amoxicillin", "clavulanate"), cephalosporins ( "Ceftriaxone" "Cefepime"), macrolides ( "Azithromycin", "midecamycin" "Roxithromycin", "Clarithromycin"). Fluoroquinolone antibiotic, carbapenems futhi nitrofurans ayikwazi ukusetshenziswa ngenxa yokucindezelwa ukukhula amathambo, isibindi nezinso ubuthi.

nitrofurans System kungukuthi isicelo ngenxa yokuntuleka ubufakazi besayensi asekelayo ukuphepha ukwelashwa. Okuwukuphela "furatsillina", efanelekayo ukwelashwa wendawo amanxeba. amaphilisi anamuhla futhi esebenza kahle kakhulu isizukulwane lokugcina izingane kanje: macrolides, penicillins, cephalosporins (amagama izidakamizwa banikwa ngenhla). Iqembu asele ejenti elwa namagciwane akunconywa ngenxa umphumela anobuthi, neziyaluyalu lwamathambo.

ABSHS kwabesifazane abakhulelwe

Ngokusho FDA ngezigaba (US), kuphela ezimbalwa zakamuva isizukulwane imithi elwa namagciwane ingasetshenziswa ekwelapheni abesifazane abakhulelwe, okuyinto uhlu encane kakhulu. Bangabakhe izigaba A no-B, okungukuthi ingozi wabo ayiqinisekiswanga noma ayinayo imiphumela teratogenic ezifundweni isilwane.

Izinto ngemiphumela unproven embungwini, kanye nokuba khona umphumela anobuthi ingasetshenziswa kuphela uma yokudlanga kokuxhashazwa nomphumela oqabulayo phezu ohlangothini (isigaba C no-D). Amalungiselelo X isigaba kuhluke kungase kutholakale imiphumela teratogenic embungwini, uma kunesidingo, ngoba ukusetshenziswa yabo ngempela isisu.

Phakathi nenkathi yokukhulelwa, le antibiotic elandelayo isizukulwane wokugcina amaphilisi ezibanzi-spectrum: aminopenicillin evikelwe ( "Amoklav", "Amoxiclav"), cephalosporins ( "Cefazolin" "Ceftriaxone" "Cefepime"). Macrolides ( "Azithromycin", "Clarithromycin", "midecamycin" "Roxithromycin") abavunyelwe ukusebenzisa e senyanga yesithathu sokukhulelwa ngenxa yokuthi lokho yabo teratogenic engakaze wafunda ngokugcwele, kanye nokuntuleka asikwazi nangokunembile ukukhuluma. Futhi, abesifazane abakhulelwe zisebenzisa ngokuphepha penicillin akuzange kusize kwamaphilisi ukungabi komzimba.

Nokusetshenziswa kwamaphilisi ekwelapheni ukucinana kwemigudu yokuphefumula

Zonke imithi elwa namagciwane isizukulwane wokugcina ezibanzi-spectrum, ngemcondvo, ingasetshenziswa ukucinana kwemigudu yokuphefumula kanye nenyumoniya uma izici zabo pharmacodynamic eliphezulu lokhu. Nokho, kukhona izikimu elikhulu yokwelashwa okunengqondo izifo ezinjalo. Bona acabangele ukuhlukahluka inhlanganisela ngempumelelo antimicrobial kwenzelwe ukuqinisekisa ukufundiswa ububanzi amagciwane amagciwane abe nenkani.

Nitrofurans, nitroimidazole nemikhiqizo kanye sulfonamides ukusetshenziswa engenangqondo ku Izifo ukuvuvukala umgudu wokuphefumula. Inhlanganisela yimpumelelo kakhulu ukucinana kwemigudu yokuphefumula noma inyumoniya, iphaphu ukugeleza ivikelwe macrolide nge aminopenicillin ( "Amoklav" + "Azithromycin"). Ukucinana kwemigudu yomoya emaphashini engapheli eyayiqhutshwa zidinga ukuqashwa cephalosporin esikhundleni aminopenicillin ( "Ceftriaxone" + "Azithromycin"). Kulesi uhlelo, macrolide ingase ithathelwe indawo kwelinye ikilasi analog: I-"midecamycin" "Clarithromycin" noma "Roxithromycin".

Zonke alama-antibiotic zakamuva-isizukulwane for ukucinana kwemigudu yokuphefumula nethonya evelele, nakuba izimpawu zokwelapha lesi sifo angase aqhubeke khona. Umbandela ka ukuphumelela ukwelashwa - ukubukeka ukukhwehlela ne phlegm kancane kancane ukugeza impumuzo imfiva. Ngo COPD Kuwohloza dyspnea, isifiso ngcono, encishisiwe ukukhwehlela imvamisa izifiso.

ukwelashwa okuphumelelayo pneumonia

Isifo samaphaphu ka omnene iphathwa ngesisekelo ukucinana kwemigudu yokuphefumula, kodwa nokusetshenziswa cephalosporin futhi macrolide. Lapho ngokulinganisela inyumoniya ezinzima umphakathi atholwe Lokudabuka esimisiwe cephalosporin ( "Ceftriaxone" noma "Cefepime") nge eziningana fluoroquinolones ( "Ciprofloxacin" noma "Levofloxacin"). Lezi imithi elwa namagciwane yesizukulwane odlule ezibanzi-spectrum microflora kahle ukucindezela umphakathi aluthola, futhi umphumela ukusebenzisa kwabo lubonakale ngosuku ukwelashwa kwesibili.

isizukulwane sanamuhla yakamuva imithi pneumonia (igama letinikwe lapha ngenhla) kuthinte lwegciwane, imisebenzi yalo ebalulekile by abacindezela noma ukumbulala. I izinto zokuqala zibizwa ngokuthi bacteriostatic, amagciwane kanye nezidakamizwa yokugcina. Cephalosporins, futhi fluoroquinolones aminopenicillin - bactericides, futhi macrolides - bacteriostats. Ngaphezu kwalokho, inhlanganisela yemithi elwa namagciwane, okuhlose ukwandisa hhayi kuphela uhla imisebenzi, kodwa futhi ukuze uhambisane nemithetho yokuxuba eyodwa izidakamizwa nomunye amagciwane bacteriostatic.

Ukwelashwa pneumonia obukhulu HITD

Egunjini labagula kakhulu, lapho kungase kube iziguli samakhaza ezinzima nokucindezeleka syndrome ku ngemuva lokudakwa. Umnikelo main kobukhulu isimo iziguli ezinjalo kwenza microflora pathogenic ukuthi olumelana antimicrobial kakhulu. Ezimweni ezinjalo, isicelo carbapenems ( "Imipinem-cilastatin," "Tienam", "Meropenem"), awavumelekile ukusetshenziswa esimweni sinenkonzo yokunakekela iziguli emakhaya.

Ukwelashwa sinusitis futhi sinusitis

isizukulwane sanamuhla yakamuva imithi sinusitis noma itheku ezazivame ukubulala amagciwane. Ezimweni ezinjalo, ungase usebenzise ama-antibiotic amagciwane. Nokho, uma itheku nobunzima main ukufinyelela kwisayithi ukuvuvukala imithi elwa nawo. Ngakho-ke, ngokuvamile ezisetshenziswa izidakamizwa cephalosporin. Isibonelo "Ceftriaxone" noma "Cefepime." Lungase iqondiswa fluoroquinolone III isizukulwane - "Levofloxacin".

Ukwelashwa antimicrobial angina yesimanje

isizukulwane yakamuva imithi umphimbo obuhlungu aqokwa ngenjongo efanayo. Ngaphezu kwalokho, futhi itheku, futhi efanayo ejenti anti-microbial lingasetshenziswa at namathansela. Umahluko owokuthi ukuthi esimweni ukuvuvukala amalaka lungasetshenziswa futhi antiseptics, isibonelo, "furatsillina" - ukulungiswa eziningi nitrofurans. Nakuba aminopenicillins angina futhi ingasetshenziswa sulbactam evikelwe ngempumelelo noma clavulanic acid ( "Amoklav" "Amoksiklav" "Ospamoks"). Futhi imithi kufanele sinikezwe izinsuku 10-14.

Ukwelashwa nokuvikelwa pyelonephritis kanye nezifo kohlelo genitourinary

Ngenxa ukungcoliswa ngomgudu womchamo by nezilwanyana ezincanyana, isizukulwane yakamuva kwamaphilisi pyelonephritis ezidingekile imithi yabo. Okukhulu kunakho ukubaluleka zokwelapha nazi cephalosporins, fluoroquinolones futhi nitrofurans. Cephalosporins asetshenziswa pyelonephritis kuqhathaniswa kancane olunzima, futhi fluoroquinolones ( "Ciprofloxacin", "Levofloxacin", "Ofloxacin", "moxifloxacin") - at Ukuwohloka ngemuva babe yokwelapha.

Umuthi ngempumelelo kakhulu, efanelekayo zombili monotherapy futhi lihambisana "Ceftriaxone" imelele iyiphi inombolo nitrofurans - "FURAMAG"). Futhi quinolone ingasetshenziswa - "Nalidixic acid". Kwakamuva ukudala lokuhlala eliphezulu umchamo futhi bamatasa ngokumelene causative ejenti izifo urinary. Futhi, ngezinye izikhathi lapho gardnelleze emomozini dysbacteriosis futhi isetshenziswa "metronidazole".

Ukumelana Izidakamizwa nomphumela walo

Ngenxa yokushintsha njalo izinhlayiya eziyisisekelo zofuzo microorganism, ikakhulukazi ama-bacterium, ukusebenza eziningi elwa namagciwane is kakhulu ziyancipha. Ithola amandla okumelana nemithi, ama-bacterium okulungiselelwe ikhono ukusinda emzimbeni womuntu ngu ngumlamuli nokwehliswa kwesithunzi izifo ezithathelwanayo. Lokhu kudala abacwaningi ukubheka futhi bakwenze imithi emisha elwa namagciwane isizukulwane eledlule.

Ngesikhathi ukhona ejenti elwa namagciwane zenzelwe mayelana 7000 izinto ngendlela ethile kusetshenziswa imithi. Iningi lazo waphuma ukusetshenziswa ngenxa isifo ebaluleke side effects noma ngenxa yokufuna amagciwane abe nenkani kubo. Ngoba namuhla imithi isetshenziswa izidakamizwa mayelana 160. Abangaba ngu-20 - yisizukulwane yakamuva kwamaphilisi, esimagama ngokuvamile babonakala ngokweqile izincwadi zempilo ezingakhulumi yokwelapha elwa namagciwane yezifo ezithathelwanayo.