Anju Goel, MD, MPH, yog ib tus kws kho mob uas muaj ntawv pov thawj tshwj xeeb hauv kev noj qab haus huv pej xeem, kab mob sib kis, ntshav qab zib, thiab txoj cai noj qab haus huv.
Penicillin yog ib hom tshuaj tua kab mob siv los kho qee yam kab mob kab mob.Cov kev mob tshwm sim feem ntau muaj xws li raws plab thiab mob plab, thiab qee tus neeg yuav muaj kev fab tshuaj rau penicillin - cov teebmeem muaj xws li mob me mus rau hnyav.
Penicillin tuaj yeem muab los ntawm qhov ncauj, lossis txhaj tshuaj txhaj (IV, mus rau hauv cov hlab ntsha), lossis intramuscularly (IM, hauv cov leeg nqaij loj).Thiab muaj ntau hom penicillins nrog ntau yam kev ua haujlwm.
Txhua hom tshuaj penicillin tau muab los, tsawg kawg ntawm ib feem, los ntawm cov kab mob hu ua fungusPenicilliumchrysogenum.
Tus kws tshawb fawb Scottish Alexander Fleming tau tshawb pom penicillin hauv xyoo 1929 thaum nws paub tias kab lis kev cai kab mob kis tau nrog "cov kua txiv hmab txiv ntoo" raug tua los ntawm cov kab mob fungus. tus neeg mob, ushering nyob rau hauv lub era ntawm tshuaj tua kab mob.
Los ntawm xyoo 1960, cov kws tshawb fawb muaj peev xwm tsim thawj cov tshuaj semisynthetic penicillin uas muaj peev xwm kho tau ntau yam kab mob ntawm cov kab mob. Nyob ib ncig ntawm lub sijhawm, lawv pib paub txog qhov kev hem thawj ntawm penicillin tsis kam, uas cov kab mob mutant resistant rau cov tshuaj tua kab mob pib tshwm sim. thiab kis thoob plaws hauv cov pejxeem.
Niaj hnub no, cov kab mob ntau zuj zus tuaj yog tag nrho lossis ib nrab tiv thaiv cov tshuaj penicillin qub, suav nrog Neisseria gonorrhoeae (gonorrhea) thiab methicillin-resistant Staphylococcus aureus (MRSA).
Streptococcus pneumoniae, ib hom kab mob ntsws, nrog rau qee hom Clostridium thiab Listeria kuj ua rau cov tshuaj tua kab mob tsawg dua.
Kev siv tshuaj tua kab mob ntau dhau los txhawb kev loj hlob ntawm cov tsiaj nyeg yog paub tias yuav ua rau muaj kev pheej hmoo ntawm cov kab mob tiv thaiv kab mob, suav nrog cov kab mob superbugs, thoob plaws hauv cov khoom noj khoom haus.Vim qhov kev txhawj xeeb thoob ntiaj teb no zuj zus, Tebchaws Meskas txwv tsis pub siv cov tshuaj tua kab mob los txhawb cov tsiaj loj hlob hauv xyoo 2017.
Penicillinsbelongs rau ib tsev neeg loj ntawm cov tshuaj hu ua beta-lactam tshuaj tua kab mob.Cov tshuaj no muaj ib tug zoo xws li cov qauv molecular, muaj ib lub nplhaib ntawm plaub atoms hu ua beta-lactams.Txhua hom penicillin muaj ntxiv sab chains uas txiav txim nws cov dej num.
Penicillin ua haujlwm los ntawm kev khi rau cov molecules ntawm phab ntsa ntawm cov kab mob hu ua peptidoglycan.Thaum cov kab mob sib faib, penicillin tiv thaiv kev hloov pauv ntawm cov protein nyob rau hauv cov phab ntsa ntawm tes, ua rau cov kab mob ua kom tawg thiab tuag sai.
Ntuj penicillins yog cov muab rho tawm ncaj qha los ntawm P. chrysogenum fungus.Nws muaj ob yam tshuaj penicillins.
Semi-synthetic penicillin yog tsim nyob rau hauv lub chaw soj nstuam thiab zoo ib yam li cov tshuaj muaj nyob rau hauv P. chrysogenum.Nws muaj plaub chav kawm ntawm semisynthetic penicillins, nrog rau cov tshuaj uas nquag siv xws li amoxicillin thiab ampicillin.
Txhua hom no muaj cov qauv molecular sib txawv me ntsis thiab tej zaum yuav raug tswj hwm txawv dua li lwm hom.
Qee cov tshuaj penicillins tsis muaj cov tshuaj tua kab mob ncaj qha.Lawv tau siv hauv kev sib xyaw ua ke los pab kov yeej penicillin tsis kam.Piv txwv li, clavulanic acid thaiv cov enzyme secreted los ntawm cov kab mob tiv thaiv kab mob (beta-lactamase) uas inhibits kev ua ntawm beta-lactam tshuaj tua kab mob.
Penicillins yog siv los kho cov kab mob - lawv tsis kho cov kab mob viral, fungal los yog parasitic kab mob.Cov tshuaj no feem ntau zoo tiv thaiv kab mob Gram-positive, ib chav ntawm cov kab mob uas muaj peptidoglycan nyob rau sab nraud ntawm lawv cov phab ntsa ntawm tes.Rau cov kab mob Gram-negative. , peptidoglycan txheej yog faus rau hauv ib txheej ntawm lipid hlwb, ua rau nws nyuaj rau cov tshuaj nkag mus rau cov molecule.
Cov kab mob Gram-zoo uas tuaj yeem kho nrog penicillin muaj xws li Clostridium, Listeria, Neisseria, Staphylococcus, thiab Streptococcus.
Ntuj penicillins - penicillin G thiab penicillin V - tseem siv niaj hnub no rau kev kho mob ntawm qee yam kab mob thiab tsis tshua muaj kab mob.
Hauv qhov sib piv, cov tshuaj tua kab mob semisynthetic zoo li amoxicillin - ib qho tshuaj tua kab mob feem ntau siv niaj hnub no - yog siv los kho ntau yam kab mob ua pa, tawv nqaij thiab kab mob xws li H. pylori, kab mob Lyme thiab mob otitis media.
Kev siv tshuaj tua kab mob penicillin feem ntau tshwm sim, txawm hais tias cov tshuaj xws li amoxicillin thiab ampicillin muaj ntau dua li ntuj.penicillin.Off-label siv suav nrog kev kho mob ntawm cov neeg mob hnyav uas muaj tus kab mob sepsis lossis neonates nrog mob ua pa nyuaj.Txawm li cas los xij, cov tshuaj no tau siv rau lub hom phiaj no, tab sis lawv feem ntau suav tias tsim nyog thaum tsis muaj lwm txoj kev kho mob.
Penicillin G yog qee zaum siv off-label los kho cov kab mob prosthetic leeg, kab mob Lyme, thiab leptospirosis.Penicillin V yog qee zaus siv off-label los kho tus kab mob Lyme thiab otitis media, los yog tiv thaiv kev kis kab mob hauv cov neeg tau txais kev hloov cov qia cell.
Penicillin tuaj yeem ua tau zoo heev thaum siv kom raug.Txawm li cas los xij, qee zaum, cov tshuaj tsis zoo ntawm kev tshem tawm tus kab mob.Qhov no, kev kuaj tshuaj tua kab mob (tseem hu ua tshuaj tua kab mob tiv thaiv kab mob) tuaj yeem siv los txiav txim seb tus neeg mob puas yog. teb rau penicillin.
Qhov kev sim pib los ntawm culturing kab mob coj los ntawm swabs ntawm lub cev kua thiab ces kis cov kab mob ncaj qha mus rau ntau hom penicillin nyob rau hauv lub laboratory.Antibiotic susceptibility test feem ntau yog siv rau cov neeg mob uas muaj mob ntsws ntsws uas muaj mob hnyav los yog muaj kev pheej hmoo siab ntawm tuag.
Penicillin yog contraindicated yog tias koj yav tas los ua xua rau ib qho tshuaj twg hauv tsev neeg penicillin.Koj yuav tsum ceev faj yog tias koj tau muaj cov tshuaj tiv thaiv kab mob hnyav dhau los, suav nrog anaphylaxis, Stevens-Johnson syndrome (SJS), lossis tshuaj lom epidermal necrosis. (TEN).
Yog tias koj tau muaj kev fab tshuaj rau penicillin G lossis penicillin V yav dhau los, koj tuaj yeem (tab sis tsis tas) yuav ua xua rau penicillins semi-synthetic xws li amoxicillin lossis ampicillin.
Cov neeg ua xua rau penicillin yuav tsum tau siv lwm cov tshuaj tua kab mob beta-lactam nrog ceev faj vim tias muaj kev pheej hmoo ntawm kev ua xua ntawm cross-reactive, txawm tias qhov kev pheej hmoo me me.Qhov no suav nrog cov tshuaj tua kab mob cephalosporin xws li Keflex (cephalexin), Maxipime (cefepime), Rocephin (ceftriaxone), thiab Suprax (cefixime).
Yog tias koj muaj kev txhawj xeeb tias koj tuaj yeem ua xua rau penicillin, koj tuaj yeem kuaj tawv nqaij kom pom tias koj muaj kev cuam tshuam rau cov tshuaj me me hauv qab koj cov tawv nqaij.
Penicillin kuj yuav tsum tau siv nrog ceev faj heev yog tias koj muaj mob raum (mob raum) tsis ua haujlwm.Penicillin feem ntau yog tawm los ntawm ob lub raum, thiab lub raum tsis ua haujlwm tuaj yeem ua rau cov tshuaj tsub zuj zuj mus rau qib tshuaj lom.Qhov kev siv tshuaj penicillin ntau dhau tuaj yeem ua rau cov tsos mob. ntawm agitation, tsis meej pem, coma, txawv txav convulsions, thiab, nyob rau hauv tsawg zaus, coma.
Cov koob tshuaj pom zoo ntawm penicillin G thiab penicillin V tuaj yeem sib txawv nyob ntawm tus kab mob thiab hnub nyoog ntawm tus neeg raug kho.
Nyob ntawm daim ntawv qhia, koob tshuaj yog ntsuas nyob rau hauv ntau txoj kev sib txawv. Hauv cov neeg laus, cov tshuaj feem ntau yog ntsuas hauv units lossis milligrams (mg).Rau cov menyuam yaus, cov koob tshuaj tuaj yeem suav tau hauv milligrams ib kilogram ntawm lub cev hnyav ib hnub (mg / kg / ib hnub) lossis hauv units ib kilogram ntawm lub cev hnyav ib hnub (units/kg/day).
Yog tias koj muaj kab mob raum, koj yuav tsum tau txo koj cov koob tshuaj penicillin kom tsis txhob muaj tshuaj toxicity.Thaum creatinine tshem tawm (kev ntsuas ntawm lub raum ua haujlwm) poob qis dua 10 milliliters ib feeb (mL / min), kev txo koob tshuaj feem ntau yog pom zoo.
Ntawm qhov tod tes, yog tias koj nyob rau hauv hemodialysis, koj yuav xav tau koob tshuaj ntau dua vim tias hemodialysis tuaj yeem ua kom tshem tawm penicillin ntawm koj cov ntshav.
Penicillin G yog muaj nyob rau hauv cov tshuaj premixed los yog ua hmoov rau reconstitution nrog Sterile Dej rau Txhaj.Premixed daws yuav muab khaws cia rau hauv lub tub yees los yog lub freezer, thaum hmoov formulations yuav khaws cia zoo nyob rau hauv chav tsev kub.
Penicillin V yog muaj nyob rau hauv lub qhov ncauj ntsiav tshuaj los yog raws li ib tug cherry-flavored hmoov tov nrog dej.Ob leeg muaj kev ruaj ntseg cia nyob rau hauv chav tsev kub.Thaum cov hmoov tau reconstituted, nws yuav tsum muab cia rau hauv lub tub yees thiab muab pov tseg tom qab 14 hnub.
Penicillin V yuav tsum tau noj ntawm lub plab khoob kom ntseeg tau tias qhov nqus tau siab tshaj plaws.Nws yuav tsum tau noj tsawg kawg ib teev ua ntej lossis ob teev tom qab noj mov.
Yog tias koj tsis tau koob tshuaj penicillin V, noj kom sai li sai tau thaum koj nco qab.Yog tias ze rau lub sijhawm rau koj cov koob tshuaj ntxiv, hla qhov koob tshuaj ntxiv thiab ntxiv nws li qub.Tsis txhob muab ob npaug rau qhov koob tshuaj.
Yuav tsum noj tshuaj penicillin raws li tau qhia thiab ua tiav.Tsis txhob tso tseg vim tias nws zoo nkaus li zoo.Koj yuav tsum ua kom tiav tag nrho cov kab mob kom tshem tawm tag nrho cov kab mob.Thaum kev kho mob lawm, cov kab mob me me tuaj yeem sib ntxiv.
Feem ntau cov kev mob tshwm sim ntawm penicillin yog me me thiab tsis tu ncua thiab daws lawv tus kheej yam tsis muaj kev kho mob.Tab sis qee zaum cov kev mob tshwm sim tuaj yeem ua rau mob hnyav, txawm tias muaj kev phom sij rau lub neej, thiab xav tau kev kho mob sai.
Ib qho teeb meem loj tshaj plaws uas cuam tshuam nrog kev siv penicillin yog qhov muaj feem cuam tshuam txog kev ua rau lub neej tsis zoo hu ua anaphylaxis. Cov tshuaj tsis haum rau penicillin tseeb cuam tshuam txog li 1 txog 5 tus neeg hauv 100,000.
Kev tsis haum tshuaj tuaj yeem ua rau muaj kev phom sij loj yog tias tsis kho.Nws tuaj yeem ua rau poob siab, coma, ua pa lossis lub plawv tsis ua haujlwm, thiab txawm tuag.
Nrhiav kev kho mob xwm txheej ceev yog tias koj muaj qee lossis tag nrho cov tsos mob ntawm kev tsis haum tshuaj tom qab noj tshuaj penicillin:
Muaj tsawg zaus, penicillin tuaj yeem ua rau mob nephritis interstitial, kab mob raum mob feem ntau tshwm sim los ntawm kev tiv thaiv lub cev tsis zoo rau cov tshuaj. Cov tsos mob muaj xws li xeev siab, pob liab liab, kub taub hau, qaug zog, tso zis qis, tso kua dej, thiab ntuav. mob me, tab sis qee qhov tuaj yeem ua rau mob hnyav thiab ua rau mob raum raug mob.
Zoo li txhua yam tshuaj tua kab mob, penicillin muaj feem cuam tshuam nrog kev pheej hmoo ntawm C. difficile raws plab.Qhov no tshwm sim los ntawm cov kab mob uas ib txwm muaj nyob hauv lub plab raug rhuav tshem los ntawm cov tshuaj tua kab mob, yog li tso cai rau cov kab mob C. difficile ntau ntau.Feem ntau yog mob me thiab kho tau yooj yim. , tab sis C. difficile paub tias ua rau mob hnyav fulminant colitis, toxic megacolon, thiab tuag tsawg zaus.
Penicillin feem ntau suav hais tias muaj kev nyab xeeb thaum cev xeeb tub thiab pub niam mis. Cov ntaub ntawv pov thawj hauv tib neeg tsis muaj, tab sis kev tshawb fawb tsiaj pom tias tsis muaj kev pheej hmoo ntawm tus menyuam hauv plab.
Yog tias koj cev xeeb tub, npaj cev xeeb tub, lossis pub niam mis, tham nrog koj tus kws kho mob kom nkag siab txog cov txiaj ntsig thiab kev pheej hmoo ntawm kev siv penicillin.
Ntau cov tshuaj kuj tuaj yeem cuam tshuam nrog penicillin, feem ntau yog los ntawm kev sib tw rau lub raum tshem tawm.Qhov no ua rau cov tshuaj penicillin ntau ntxiv hauv cov ntshav thiab kev pheej hmoo ntawm kev phiv tshuaj thiab tshuaj toxicity.Lwm cov tshuaj tuaj yeem ua kom tshem tawm penicillin ntawm lub cev thiab txo cov tshuaj ua haujlwm.
Txhawm rau kom tsis txhob muaj kev sib cuam tshuam, nco ntsoov qhia rau koj tus kws kho mob paub txog txhua yam tshuaj uas koj noj, txawm tias daim ntawv xaj, khw muag khoom, khoom noj khoom haus, tshuaj ntsuab, lossis kev ua si.
Sau npe rau peb cov ntawv xov xwm qhia txog kev noj qab haus huv txhua hnub thiab tau txais cov lus qhia txhua hnub los pab koj ua neej nyob zoo tshaj plaws.
Lobanovska M, Pilla G. Penicillin nrhiav pom thiab tshuaj tua kab mob: cov lus qhia rau yav tom ntej?Yale Journal of Biomedical Sciences.2017;90(1):135-45.
Founou LL, Founou RC, Essack SY.Antibiotic resistance in the food chain: a developing country perspective.pre-microbes.2016;7:1881.doi:10.3389/fmicb.2016.01881
Post lub sij hawm: Mar-25-2022