Beta-lactam tshuaj tua kab mob: mechanism ntawm qhov kev txiav txim thiab kev faib

Tshuaj tua kab mob - ib pab pawg neeg ntawm cov tshuaj nrog Etiotropic mechanism ntawm qhov kev txiav txim. Nyob rau hauv lwm yam lus, cov tshuaj ua ncaj qha rau ntawm qhov ua rau ntawm tus kab mob no (nyob rau hauv cov ntaub ntawv no, lub microorganism yog lub causative tus sawv cev) thiab ua li ntawd nyob rau hauv ob txoj kev: puas microbes (microbicides - penicillins, cephalosporins) los yog inhibit lawv tu tub tu kiv (bacteriostatic - tetracyclines, sulfonamides).

Muaj ib tug lossis loj npaum li cas ntawm cov tshuaj yog tshuaj tua kab mob, tiam sis feem ntau nws kim heev pab pawg neeg ntawm lawv - qhov no yog ib tug beta-lactams. Nws yog hais txog lawv thiab yuav tsum tau tham nyob rau hauv no tsab xov xwm.

Ib suam ntawm tshuaj tua kab mob

Nyob rau lub mechanism ntawm qhov kev txiav txim ntawm cov tshuaj yog muab faib ua rau lub ntsiab pawg:

1. Tshuaj tua kab mob uas inhibit qhov kev synthesis ntawm cell daim nyias nyias Cheebtsam: penicillins, cephalosporins, thiab lwm tus neeg.
2. Tshuaj uas tiv thaiv lub cev tau hauj lwm ntawm lub cell phab ntsa: polyenes polymyxins.
3. Cov tshuaj uas inhibit protein synthesis: macrolides, tetracyclines, aminoglycosides, thiab lwm tus neeg.
4. Inhibitory RNA synthesis ntawm kauj ruam kev txiav txim ntawm RNA polymerase: rifamycins, sulphonamides.
5. Inhibitory RNA synthesis ntawm kauj ruam kev txiav txim ntawm DNA polymerase: actinomycins li al.
6. DNA synthesis blockers: anthracyclines, nitrofurans thiab lwm tus neeg.

Txawm li cas los, qhov no faib tsis yog yooj yim heev. Nyob rau hauv soj ntsuam xyaum, ua raws li nram no sib faib ntawm antimicrobials:

1. Penicillins.
2. Cephalosporins.
3. Macrolides.
4. Aminoglycosides.
5. Polymyxin thiab polyenes.
6. Cov tshuaj tetracyclines.
7. Sulfonamides.
8. Aminohinolonov derivatives.
9. Nitrofurans.
10. Fluoroquinolones.

Beta-lactam tshuaj tua kab mob. Tus qauv thiab mechanism ntawm qhov kev txiav txim

Qhov no pab pawg neeg ntawm cov tshuaj nrog bactericidal nyhuv thiab txaus wide daim ntawv teev cov indications rau siv. Beta-lactam tshuaj tua kab mob muaj xws li penicillins, cephalosporins, carbapenems, monobactams. Tag nrho cov ntawm lawv yog yus muaj los ntawm high efficiency thiab kuj tsis tshua muaj toxicity, uas ua rau lawv cov tshuaj feem ntau kws kho rau cov kev kho mob ntawm ntau cov kab mob.

Lub mechanism ntawm qhov kev txiav txim ntawm beta-lactam tshuaj tua kab mob vim lawv cov qauv. Ntau dhau lawm nthuav dav ntawm no rau txhua yam uas, yog tsim nyog hais txog cov feem ntau lub caij tseem ceeb, uas tau muab lub npe rau tag nrho cov pab pawg neeg ntawm cov tshuaj. Muaj nyob rau hauv lub lwg me me ntawm lub beta-lactam nplhaib thiab muab ib tug qhia bactericidal nyhuv, uas yog manifested los thaiv cov hlab lub synthesis ntawm cell phab ntsa Cheebtsam ntawm lub pathogen. Txawm li cas los, muaj ntau yam kab mob muaj peev xwm ua tsim ib tug tshwj xeeb enzyme, uas lov cov qauv ntawm lub nplhaib, li no depriving lub tshuaj tua kab mob yog nws cov ntsiab riam phom. Uas yog vim li cas txoj kev siv cov tshuaj nyob rau hauv cov kev kho mob uas tsis muaj kev tiv thaiv tiv thaiv beta-lactamases, tawg paj txi txiv.

Yog tam sim no ua ntau ntau tshuaj tua kab mob beta-lactam pab pawg neeg, kev tiv thaiv los ntawm qhov kev txiav txim ntawm cov kab mob enzymes. Lawv muaj pes tsawg leeg muaj xws li tshuaj uas thaiv lub synthesis ntawm beta-lactamase, xws li clavulanic acid. kev tiv thaiv beta-lactam tshuaj tua kab mob (xws li "Amoxiclav") tsim hais tias txoj kev. Lwm yam inhibitors ntawm tus kab mob enzyme xws li "Sulbactam" thiab "tazobactam."

Tshuaj los ntawm cov pab pawg neeg ntawm penicillins: Keeb kwm Tom qab

Npaj nyob rau hauv no series yog thawj tshuaj tua kab mob, cov kho nyhuv ntawm uas lub npe hu rau tib neeg. Rau ib ntev lub sij hawm lawv tau lug siv rau kev kho mob ntawm ntau yam kab mob thiab cov thawj xyoo ntawm daim ntawv thov no yuav luag ib tug panacea. Txawm li cas los, nws sai sai no los ua tseeb hais tias lawv cov hauj lwm zoo yog maj ntog, raws li cov evolution ntawm lub ntiaj teb no ntawm cov kab mob tsis sawv tseem. Micro-kab yuav tau hloov sai sai mus rau ib tug ntau yam ntawm txoj tej yam kev mob ntawm lub neej, muab sawv mus rau lub teeb ntawm cov tshuaj tua kab mob-resistant cov kab mob.

Lub loj heev ntawm penicillin coj mus rau kev loj hlob sai ntawm uas tsis yog-raug kab mob los ntawm microbes rau lawv, yog li nyob rau hauv nws cov ntshiab daim ntawv no yog tam sim no cov tshuaj nyob rau hauv pab pawg neeg no yog ices thiab yog tsis siv. Lawv zoo tshaj plaws siv nyob rau hauv ua ke nrog nrog cov tshuaj uas txhim khu lawv bactericidal nyhuv, thiab kuj cheeb kab mob tiv thaiv mechanisms.

npaj penicillin

Qhov no yog ib tug beta-lactam tshuaj tua kab mob, cov kev faib ntawm uas yog heev kim heev:

1. Lub ntuj penicillins (e.g., "penicillin").
2. Anti-staphylococcal ( "Oxacillin").
3. Penicillins, ncua-spectrum ( "Ampicillin" "Amoxicillin").
4. Pseudomonas ( "azlocillin").
5. Kev tiv thaiv penicillins (nrog rau clavulanic acid "sulbactam", "tazobactam").
6. Yeeb siv tshuaj, xws li nyob rau hauv nws cov tswv cuab ib tug ob peb tshuaj tua kab mob penicillin.

Ib tug txheej txheem cej luam ntawm cov tshuaj teej tug mus rau lub penicillin pab pawg neeg

Lub ntuj penicillins yuav ntse suppress cov kev ua ntawm ob gram-zoo thiab gram-tsis zoo microorganisms. Ntawm lub yav tas, feem ntau rhiab rau qhov no pab pawg neeg ntawm beta-lactam tshuaj tua kab mob Streptococcus thiab ua rau daim npog hlwb. Qhov seem kab mob rau hnub tim mas yuav kis tau tiv thaiv mechanisms. Ntuj penicillins yog zoo tiv thaiv anaerobes :. Clostridial peptokokki, peptostreptokokkov etc. Cov tshuaj yog tsawg yam tshuaj lom thiab muaj ib tus me naj npawb ntawm cov phiv los, daim ntawv teev cov uas yog txo mas kev tsis haum tshuaj, txawm hais tias overdose yog tau thiab cov kev loj hlob ntawm qaug dab peg, thiab cov tsos ntawm cov tsos mob ntawm lom los ntawm lub nruab nrog cev ntawm lub digestive system.

Los ntawm cov anti-staphylococcal penicillins loj tshaj tus nqi yog ib yam uas lub beta-lactam tshuaj tua kab mob raws li "Oxacillin". Qhov no kev npaj rau nqaim daim ntawv thov, vim nws yog npaj mas rau tshwj kom txhob S. aureus. Nws yog tiv thaiv no yav (xws li penitsillinrezistentnyh hom) "Oxacillin" yog feem ntau zoo. Sab los yog zoo ib yam li cov uas nyob hauv lwm cov neeg ntawm no pab pawg neeg ntawm cov tshuaj.

Penicillins, ncua-spectrum sib nrug los ntawm ib tug kab-zoo, gram-tsis zoo thiab co muaj yog tseem dhia tiv thaiv cov causative ua hauj lawm ntawm plab hnyuv kab mob. Sab los tsis txawv los ntawm cov saum no, txawm hais tias cov tshuaj yog yus muaj los ntawm ib tug me ntsis ntau dua qhov muaj tseeb mob ntawm lub digestive system.

Beta-lactam tshuaj tua kab mob "azlocillin" (ib tug sawv cev ntawm cov plaub pab pawg neeg ntawm penicillins) no yog tsim los nrog Pseudomonas aeruginosa. Txawm li cas los, nyob rau hauv lub sij hawm ntawm lub pathogen qhia kam mus rau lub tshuaj nyob rau hauv no series, uas ua rau lawv siv yog tsis yog li ntawd zoo.

Hais txog kev tiv thaiv penicillins hais saum toj no. Vim lub fact tias cov tshuaj muaj xws li nyob rau hauv nws muaj pes tsawg leeg tshuaj uas inhibit beta-lactamase cov kab mob, lawv muaj ntau txoj kev uas cov kev kho mob ntawm ntau cov kab mob.

Lub xeem pab pawg neeg - nws yog ib tug ua ke ntawm ob peb cov neeg sawv cev ntawm penicillin, nrog txhawb lwm tus txoj kev txiav txim.

Plaub tiam ntawm cov kab mob tua hluav taws

Beta-lactam tshuaj tua kab mob thiab cephalosporins yog. Cov tshuaj, xws li penicillin, zoo nyob rau hauv lawv cov dav spectrum ntawm kev txiav txim thiab tsawg phiv.

Muaj plaub pab pawg (tiam) cephalosporins:

1. Lub ceeb tshaj plaws yog cov neeg sawv cev ntawm cov thawj tiam - "Cefazolin" thiab "Cephalexin". Lawv feem ntau tsim los tshwj kom txhob staphylococci, streptococci, meningococci thiab gonococci, raws li zoo li ib co gram-tsis zoo tus kab mob no.
2. Qhov thib ob tiam - yog "Cefuroxime" beta-lactam tshuaj tua kab mob. Nws cheeb tsam ntawm lub luag hauj lwm muaj xws li mas gram-tsis zoo microorganisms.
3. "Cefotaxime", "Ceftazidime" - cov neeg sawv cev ntawm peb pab pawg neeg ntawm cov cais. Lawv yog cov zoo heev tiv thaiv enterobacteria thiab yuav ua kom puas tus muaj ntawm nosocomial (tsev kho mob kab mob los ntawm kab mob).
4. cov plaub tiam ntawm lub ntsiab khoom - "Cefepime." Nws muaj tag nrho cov zoo ntawm cov saum toj no cov tshuaj, tshaj tej ntawm, yog tsis tshua muaj ruaj khov rau beta-lactamases kab mob thiab muaj ib qho kev ua tiv thaiv Pseudomonas aeruginosa.

Cephalosporins thiab beta-lactam tshuaj tua kab mob raws li ib tug tag nrho yog yus muaj los ntawm ib tug qhia tau bactericidal nyhuv.

Vim hais tias phiv tshuaj thawj coj ntawm cov tshuaj feem ntau xim tsim nyog cov ntaub ntawv muaj ntau haiv neeg tsis haum tshuaj loj (cov pob liab liab ntawm me mus rau lub neej-hem, xws li anaphylactic poob siab), nyob rau hauv tej rooj plaub lub mob ntawm lub digestive kabmob.

cia nyiaj

"Imipenem" - ib tug beta-lactam tshuaj tua kab mob teej tug mus rau lub carbapenem pab pawg neeg. Nws, raws li zoo raws li rau qhov tsis muaj tsawg tus naas ej "Meropenem" kev kawm tej yam nyob rau hauv kuj mus rau lwm cov tshuaj nyob rau hauv lub microflora yuav muab yuav muaj tseeb txawm peb thiab thib plaub tiam cephalosporins.

Beta-lactam tshuaj tua kab mob los ntawm cov pab pawg neeg ntawm carbapenems - ib tug yeeb tshuaj siv nyob rau hauv tshwj xeeb yog mob loj, thaum pathogens yog tsis amenable rau kev kho mob los ntawm lwm yam tshuaj.

Thaub qab txhais tau tias muaj pes tsawg tus ob

"Aztreonam" - lub feem ntau tseem ceeb sawv cev ntawm monobactams, nws yog yus muaj los ntawm ib tug kuj nqaim spectrum ntawm kev txiav txim. Qhov no beta-lactam tshuaj tua kab mob yog feem ntau zoo tiv thaiv kab-tsis zoo aerobic. Txawm li cas los, nws yuav tsum tau muab sau tseg hais tias raws li lub "Imipenem" "Aztreonam" tshuam insensitive rau beta-lactamases, uas ua rau nws cov tshuaj uas koj xaiv loj ntaub ntawv ntawm cov kab mob ntxias los ntawm cov pathogens, tshwj xeeb tshaj yog thaum kho mob tsis ua hauj lwm lwm yam tshuaj tua kab mob.

Lub spectrum ntawm kev txiav txim ntawm beta-lactam tshuaj tua kab mob

Nyob rau hauv txoj kev, nws yuav tsum tau muab sau tseg tias npaj ntawm cov pab pawg muaj feem rau ib tug zoo xov tooj ntawm cov tsiaj ntawm pathogens. Lub mechanism ntawm qhov kev txiav txim ntawm beta-lactam tshuaj tua kab mob xws li hais tias yoojyim tsis muaj caij nyoog ntawm tseem muaj sia nyob microbes: cell phab ntsa synthesis blockade - ib tug tuag kab lus rau cov kab mob.

Gram-zoo thiab kab-tsis zoo tus kab mob no, aerobic thiab co ... Tag nrho cov neeg sawv cev ntawm pathogenic muaj muaj yog ib tug zoo heev tshuaj. Ntawm cov hoob kawm, muaj cov no tshuaj tua kab mob thiab mas tshwj xeeb cov cuab yeej, tiam sis feem ntau ntawm lawv npaj txhij mus tua nrog ob peb kab nrog. Beta-lactam tshuaj tua kab mob yuav muaj peev xwm los mus tiv txawm tus neeg sawv cev ntawm nosocomial muaj, yog cov feem ntau resistant rau kev kho mob.

Yuav ua li cas yog lub tsev kho mob kab mob los?

Peb yuav tau tham txog micro-kab uas muaj nyob rau hauv kev kho mob hauv tsev. Lub qhov chaw ntawm lawv cov tsos pab cov neeg mob thiab kev kho mob cov neeg ua haujlwm. Tshwj xeeb yog txaus ntshai thaum, indolent ntaub ntawv ntawm cov kab mob. Tsev Kho Mob - lub zoo meej qhov chaw sib sau ua ke tag nrho cov tau muaj ntawm kis kab mob. Ib tug ua txhaum ntawm tsis muaj kab mob kev cai thiab kev cai yog fertile av rau no muaj tau pom ib tug niche rau hav zoov, qhov chaw uas nws yuav ua neej nyob, yug thiab tau kuj mus tshuaj.

High kuj tsev kho mob hom feem ntau vim lub fact tias, los ntawm lawv cov vaj tse tsev kho mob, cov kab mob yuav tau sib txuas lus nrog ib tug ntau yam ntawm cov tshuaj. Lawm, lub los ntawm cov tshuaj nyob rau hauv cov kab mob tshwm sim los ntawm lub caij nyoog, tsis muaj puas ntsoog lub hom phiaj, thiab nyob rau hauv me me koob tshuaj, thiab qhov no txhawb rau lub fact tias cov neeg sawv cev ntawm lub tsev kho mob microflora muaj peev xwm tsim ib tug tiv thaiv tawm tsam tug mechanisms rau lawv mus kawm kom tau thaum nws lawv. Thiab hom tshwm sim tawm tsam nrog uas yog heev yooj yim, thiab tej zaum nws nkawd hais tias nws yog tsis yooj yim sua.

Beta-lactam tshuaj tua kab mob nyob rau hauv ib tug xov tooj ntawm ib txoj kev los sis lwm yuav ua kom daws tau qhov complex teeb meem. Ntawm lawv yog cov neeg sawv cev uas yuav heev ntse nrog txawm lub feem ntau loog tshuaj kab mob. Qhov no cia cov tshuaj. Lawv siv xwb, raws li lawv yog tsa thaum nws yog tiag tiag uas yuav tsum tau. Yog hais tias cov tshuaj tua kab mob siv tsis tas feem ntau, ces, feem ntau yuav, nws yuav xaus lub caij nplooj zeeg ntawm cov hauj lwm zoo, vim hais tias ces cov kab mob muaj lub sij hawm mus koom nrog me me koob tshuaj ntawm cov tshuaj, kawm lawv thiab tsim txoj kev ntawm kev tiv thaiv.

Thaum muab beta-lactam tshuaj tua kab mob?

Indications rau kev siv ntawm no pab pawg neeg ntawm cov tshuaj vim feem ntau mus rau lawv spectrum ntawm kev txiav txim. Yuav zoo tshaj plaws rau appoint ib tug beta-lactam tshuaj tua kab mob nyob rau hauv cov kab mob, uas yav rhiab rau qhov kev txiav txim ntawm cov tshuaj.

Penicillins yog zoo tsim nyob rau hauv cov kev kho mob ntawm pharyngitis, tonsillitis, mob ntsws, kub taub hau, meningitis kab mob endocarditis, actinomycosis, co kab mob, leptospirosis, salmonellosis, shigellosis, mob cov kab mob ntawm daim tawv nqaij thiab nqaij mos mos. Tsis txhob hnov qab txog cov tshuaj uas muaj peev xwm sib ntaus sib tua nrog Pseudomonas aeruginosa.

Cephalosporins muaj ib tug zoo spectrum ntawm kev ua si, thiab yog li ntawd indications rau lawv yog yuav luag tib yam li ntawd rau penicillins. Txawm li cas los, nws yuav tsum tau hais tias cov hauj lwm zoo ntawm cephalosporins, tshwj xeeb yog cov ob tiam, tsis nyob rau hauv cov piv txwv saum toj no.

Monobactams thiab carbapenems yog tsim los tshwj kom txhob lub loj tshaj plaws thiab tsis zoo kho tau tus kab mob, nrog rau cov tshwm sim los ntawm lub tsev kho mob kab mob los. Lawv kuj yuav pab tau nyob rau hauv sepsis thiab lub taub dej khawb poob siab.

undesirable los

Raws li twb tau hais, lub beta-lactam tshuaj tua kab mob (tshuaj teej tug mus rau qhov no pab pawg neeg teev tseg saum toj) yog distinguished los ntawm ib tug tus me naj npawb ntawm cov teeb meem los rau hauv lub cev. Tsis tshua muaj convulsions thiab cov tsos mob ntawm digestive mob yog tsis yog lub neej-sia. Lub yeej txaus ntshai yuav ua tau ib tug loj heev kev tsis haum cov tshuaj tiv thaiv rau cov tshuaj cov beta-lactam tshuaj tua kab mob.

Ntse, pruritus, txhaws ntswg thiab conjunctivitis yog tsis yog lub neej-tuag, txawm hais tias heev tsis kaj siab. Yuav ua li cas ua tau yog yuav tsum tau ntshai tsam, vim hais tias nws yog xws li mob hnyav tshua ua angioedema (tshwj xeeb tshaj yog nyob rau hauv lub cheeb tsam ntawm lub suab, uas yog nrog los ntawm yam mob loj heev dyspnea kom txog thaum tsis muaj peev xwm rau kev ua pa) thiab anaphylactic poob siab. Yog li ntawd, cov tshuaj yuav tsum tau qhia tsuas yog tom qab ua kev ntsuam xyuas rau kev tsis haum tshuaj.

Tau tus ntoo khaub lig-tshua. Beta-lactam tshuaj tua kab mob, cov kev faib uas implies lub xub ntiag ntawm ib tug loj tus naj npawb ntawm cov pab pawg ntawm cov tshuaj, structurally zoo heev rau txhua tus lwm yam, uas txhais tau tias nyob rau hauv cov ntaub ntawv ntawm intolerance rau ib tug ntawm lawv, txhua leej txhua tus lwm tus yuav tsum ntaus nqi los ntawm lub cev raws li ib tug allergen.

Ob peb lo lus hais txog cov yam tseem ceeb uas ua rau kom cov kuj ntawm cov kab mob

Lub gradual poob nyob rau hauv cov hauj lwm zoo ntawm antibacterial tshuaj (xws li beta-lactam tshuaj tua kab mob) vim txhob txwm nquag thiab feem ntau tsis yog rau hauv daim ntawv thov. Ib tug ua tsis tiav cov hoob kawm ntawm kev kho mob, kev siv ntawm me me koob tshuaj kho yog tsis conducive mus rov qab, tab sis tiv thaiv kab mob ib lub sij hawm mus rau "lub tsheb ciav hlau", mus txua thiab tsim txoj kev tiv thaiv tawm tsam cov tshuaj. Li ntawd, yog nws muaj zem uas rau tom kawg ua tawg paj txi txiv thaum lub sij hawm?

Txawm tias tam sim no tshuaj tua kab mob thiab yog tsis tau tso tawm los ntawm cov chaw muag tshuaj tsis muaj ib tug tshuaj kom tau lawv tag nrho cov uas koj ua tau. Qhov no txhais tau hais tias nws tus kheej thiab cov kab teeb meem (siv tag nrho lub sij hawm tib lub siv yeeb tshuaj, tsis tsim nyog kev cuam tshuam ntawm txoj kev kho, tsis yog ntau npaum thiab thiaj li nyob.) Yuav nyob twj ywm, tsim lub tej yam kev mob rau cov sau qoob rau tshuaj-resistant hom.

Nws yog qhov no mus nyob thiab nyob rau hauv-lub tsev kho mob muaj, muaj lub sij hawm los mus sib txuas lus nrog rau ntau yam tshuaj thiab txua txoj kev tshiab rau counter lawv.

Yuav ua li cas? Tsis txhob self-medicate, siv lub tswv yim pom zoo ntawm cov kws kho mob: muab cov tshuaj kom ntev li ntev raws li yuav tsum tau, thiab nyob rau hauv txoj cai koob tshuaj. Nrog nosocomial muaj sib ntaus, ntawm chav kawm, ntau yooj yim, tab sis tseem ua tau. Lub zawm ntawm cov qauv kev kawm thiab lawv nruj siv yuav txo qhov yuav ua ntawm kev tsim paaj tej yam kev mob rau yug me nyuam ntawm resistant muaj.

Ob peb lo lus nyob rau hauv xaus

Ib tug heev sab npe - beta-lactam tshuaj tua kab mob. Pharmacology (science ntawm cov tshuaj thiab lawv lub hwj tus kab mob) dedicates lawv ob peb tshooj uas hais tias tsis yog ib tug general cov yam ntxwv ntawm cov pab pawg neeg, tab sis kuj muaj ib tug piav qhia ntawm qhov zoo tshaj plaws lub npe hu ntawm nws cov neeg sawv cev. Qhov tsab xov xwm no tsis yog yuav tsum tau qhia ntawv, tab sis npaj siab yuav ua kom paub cov highlights, paub uas cov tshuaj yog tsim nyog.

Nyob twj ywm noj qab nyob zoo thiab tsis txhob hnov qab: ua ntej siv qhov no los yog hais tias tshuaj tua kab mob nyeem cov lus qhia no zoo zoo thiab nruj me ntsis raws li cov tswv yim pom zoo, los yog zoo dua tsis tau, tham nrog ib tug tshwj xeeb.