Anju Goel, MD, MPH, ibhodhi-yakasimbiswa chiremba nyanzvi muhutano hweveruzhinji, zvirwere zvinotapukira, chirwere cheshuga, uye mutemo wehutano.
Penicillin mushonga unorwisa mabhakitiriya unoshandiswa kurapa mamwe marudzi ezvirwere zvinokonzerwa nemabhakitiriya. Zvinowanzoitika zvinosanganisira manyoka uye kugumbuka kwemudumbu, uye vamwe vanhu vanogona kusawirirana nepenicillin - mhedzisiro inosiyana kubva kune yakapfava kusvika yakanyanya.
Penicillin inogona kupihwa nemuromo, kana kubaiwa mutsinga (IV, mutsinga), kana intramuscularly (IM, mumhasuru hombe). Uye kune marudzi akasiyana epenicillin ane nzira dzakasiyana dzekuita.
Mhando dzose dzepenicillin dzinotorwa, pamwe muchidimbu, kubva kune howa inonziPenicilliumchrysogenum.
Sainzi weScottish Alexander Fleming akawana penicillin muna 1929 paakaona kuti tsika dzemabhakitiriya dzakasvibiswa netsaona ne "mold juice" dzaiurayiwa nefungus. Yakanga isiri kusvika 1941 apo masayendisiti akakwanisa kubudirira kuparadzanisa, kuchenesa uye kuedza mushonga pakutanga. murwere, achiunza nguva yemishonga inorwisa mabhakitiriya.
Pakazosvika makore ekuma1960, masayendisiti akakwanisa kugadzira mushonga wekutanga semisynthetic penicillin unokwanisa kurapa huwandu hwakakura hwehutachiona hwehutachiona. Panguva imwecheteyo, vakatanga kuona kutyisidzira kwekudzivirira kwepenicillin, umo mutant rudzi runopesana nemishonga yakatanga kubuda. ndokupararira pakati pavanhu.
Nhasi, nhamba inowedzera yehutachiona hwehutachiona hunopesana zvakakwana kana zvishoma kune mishonga yepakutanga yepenicillin, kusanganisira Neisseria gonorrhoeae (gonorrhea) uye methicillin-resistant Staphylococcus aureus (MRSA).
Streptococcus pneumoniae, rudzi rwemabayo ebhakitiriya, pamwe nemamwe marudzi eClostridium neListeria ari kuitawo kushomeka kumishonga iyi.
Kunyanya kushandiswa kwemishonga inorwisa mabhakitiriya kukurudzira kukura kwezvipfuyo kunozivikanwa kuwedzera njodzi yehutachiona hwehutachiona, kusanganisira superbugs, mukati mekudya kwekudya.Nekuda kwekunetseka uku kuri kukura kwepasirese, United States yakarambidza kushandiswa kwemishonga inorwisa mabhakitiriya kukurudzira kukura kwemhuka mu2017.
Penicillinsndewemumhuri yakakura yemishonga inonzi beta-lactam antibiotics.Mishonga iyi ine mamolecular structure, ine ring yeatomu ina inonzi beta-lactams.Rudzi rwepenicillin rumwe norumwe rune mamwe macheni ekumativi anotarisisa kushanda kwayo.
Penicillin inoshanda nekusunga kumamorekuru ari pamadziro ebhakitiriya anonzi peptidoglycan.Apo bhakitiriya rikaparadzana, penicillin inodzivirira kurongeka patsva kwemapuroteni ari mumadziro emadziro, zvichiita kuti masero ebhakitiriya atsemuke uye afe nekukurumidza.
Natural penicillins ndeaya akatorwa zvakananga kubva kuP. chrysogenum fungus.Kune mapenicillin maviri chaiwo.
Semi-synthetic penicillin inogadzirwa murabhoritari uye yakafanana nekemikari inowanikwa muP. chrysogenum.Kune makirasi mana esemisynthetic penicillin, kusanganisira mishonga inorwisa mabhakitiriya inowanzoshandiswa yakaita seamoxicillin neampicillin.
Imwe neimwe yemhando idzi ine mamorekuru akasiyana zvishoma uye anogona kupihwa zvakasiyana pane mamwe marudzi.
Mamwe mapenicillin haana zvakananga antibacterial activation.Anoshandiswa mumubatanidzwa kurapa kubatsira kukunda penicillin kuramba.Semuyenzaniso, clavulanic acid inovharira enzyme inoburitswa ne antibiotic-resistant bacteria (beta-lactamase) inotadzisa kushanda kwebeta-lactam antibiotics.
Penicillins anoshandiswa kurapa utachiona hwehutachiona - haabate mavhairasi, fungal kana parasitic infections.Mishonga iyi inowanzoshanda pakurwisa mabhakitiriya eGram-positive, boka remabhakitiriya ane peptidoglycan kunze kwemadziro emasero.Kune Gram-negative bacteria. , iyo peptidoglycan layer inovigwa pasi peiyo lipid masero, zvichiita kuti zvive zvakaoma kuti mishonga iwane molecule.
Gram-positive mabhakitiriya anogona kurapwa nepenicillin anosanganisira Clostridium, Listeria, Neisseria, Staphylococcus, uye Streptococcus.
Natural penicillins - penicillin G uye penicillin V - zvichiri kushandiswa nhasi pakurapa kwezvimwe zvinowanzoitika uye zvisingawanzo hutachiona hwehutachiona.
Kusiyana neizvi, semisynthetic antibiotics yakafanana neamoxicillin-imwe yemishonga inowanzoshandiswa mazuva ano-inoshandiswa kurapa zvirwere zvakasiyana-siyana zvekufema, ganda uye mabhakitiriya zvakadai seH. pylori, chirwere cheLyme uye acute otitis media.
Off-label kushandiswa kwepenicillin kwakajairika, kunyangwe zvinodhaka zvakaita seamoxicillin neampicillin zvakajairika pane zvakasikwa.penicillin.Off-label kushandiswa kunosanganisira kurapwa kwevarwere vakanyanya vane sepsis kana neonates vane acute breathing distress.Muzviitiko zvose, mishonga iyi inoshandiswa nokuda kwezvinangwa zvakadaro, asi inowanzoonekwa seyakakosha kana pasina dzimwe nzira dzokurapa dziripo.
Penicillin G dzimwe nguva inoshandiswa kure-label kurapa prosthetic joint infections, chirwere cheLyme, uye leptospirosis.Penicillin V dzimwe nguva inoshandiswa kure-label kurapa chirwere cheLyme uye otitis media, kana kudzivirira zvirwere muvanhu vanogamuchira stem cell transplants.
Penicillin inogona kushanda zvakanaka kana ikashandiswa zvakanaka.Kunyange zvakadaro, mune dzimwe nguva, mushonga haushande pakubvisa utachiona.Pakadai apa, antibiotic susceptibility testing (inonziwo antibiotic susceptibility testing) inogona kushandiswa kuona kuti utachiona hwemunhu inopindura kune penicillin.
Muedzo unotanga nekugadzira mabhakitiriya anotorwa kubva mumapubhu emvura yemuviri uyezve kuburitsa bhakitiriya kumarudzi akasiyana-siyana epenicillin murabhoritari.Antibiotic susceptibility testing inowanzoshandiswa muvarwere vane mabayo anowanikwa munharaunda vanorwara zvakanyanya kana kuti vari panjodzi huru rufu.
Penicillin inorambidzwa kana iwe wakambove nechirwere chero chipi zvacho chemushonga mumhuri yepenicillin.Unofanirawo kuchenjerera kana wakambove nechirwere chakanyanya hypersensitivity reaction munguva yakapfuura, kusanganisira anaphylaxis, Stevens-Johnson syndrome (SJS), kana toxic epidermal necrosis. (GUMI).
Kana wakambove neallergies kune penicillin G kana penicillin V munguva yakapfuura, unogona (asi kwete hazvo) kusawirirana nesemi-synthetic penicillins seamoxicillin kana ampicillin.
Vanhu vasingawirirani nepenicillin vanofanira kushandisa mamwe maantibiotic e beta-lactam nekuchenjerera nekuda kwenjodzi yekusawirirana kweropa, kunyangwe njodzi yacho iri diki.Izvi zvinosanganisira mishonga yecephalosporin yakadai seKeflex (cephalexin), Maxpime (cefepime), Rocephin (ceftriaxone), uye Suprax (cefixime).
Kana iwe uine hanya kuti iwe unogona kunge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge uchinge penicillin yepenicillin , unogona kuva neallergies yeganda bvunzo kuti uone kana iwe uine chekuita kune diki diki remushonga wakaiswa pasi peganda rako.
Penicillin inofanirawo kushandiswa nekuchenjerera kwakanyanya kana uine acute renal (itsvo) kukundikana.Penicillin inonyanya kubudiswa neitsvo, uye kuderera kwetsvo kunogona kutungamirira kuunganidzwa kwemushonga kusvika kune chepfu.Kunyanya kudarika kwepenicillin kunogona kutungamirira kune zviratidzo. yekuvhiringika, kuvhiringika, kukoira, kugwinha zvisina kujairika, uye, muzviitiko zvisingawanzo, coma.
Mishonga inokurudzirwa yepenicillin G nepenicillin V inogona kusiyana zvichienderana nechirwere uye zera remunhu ari kurapwa.
Zvichienderana neresipi, chiyero chinoyerwa nenzira dzakasiyana-siyana.Muvanhu vakuru, mishonga inowanzoyerwa mumayuniti kana mamilligrams (mg) .Muvana, mishonga inogona kuverengwa mumamirigiramu pakirogiramu yehuremu hwemuviri pazuva (mg/kg/ zuva) kana mumayuniti pakirogiramu yehuremu hwemuviri pazuva (mayuniti/kg/zuva).
Kana uine chirwere cheitsvo, ungada kuderedza penicillin yako kuti udzivise toxicity yezvinodhaka.Kana creatinine clearance (chiyero chekushanda kwetsvo) inowira pasi pe10 milliliters paminiti (mL / min), kuderedza dose kunowanzokurudzirwa.
Nekune rimwe divi, kana uri pahemodialysis, ungangoda muyero wepamusoro nekuti hemodialysis inogona kukurumidzisa kubviswa kwepenicillin muropa rako.
Penicillin G inowanikwa seyakagadziriswa mhinduro kana sehupfu hwekugadzirisa zvakare neSterile Water yeInjection.Premixed solutions inogona kuchengetwa mufiriji kana mufiriji, nepo hupfu hwehupfu hunogona kuchengetwa zvakachengeteka pakupisa kwekamuri.
Penicillin V inowanikwa sehwendefa remuromo kana se cherry-flavored powder yakavhenganiswa nemvura.Zvose zvakachengeteka kuti zvichengetedzwe mukamuri yekushisa.Kana poda yagadzirwazve, inofanira kuchengetwa mufiriji uye kuraswa mushure memazuva gumi nemana.
Penicillin V inofanira kutorwa mudumbu musina chinhu kuti ive nechokwadi chekusvira zvakanyanya.
Kana ukatadza kunwa mushonga wepenicillin V, inwe nekukasika.
Nguva dzose tora penicillin sezvaunenge waudzwa uye waita.Usamira nekuti inonzwa zvakanaka.Unofanira kupedza kosi yese kuti upedze utachiona hwose.Kana kurapwa kwangomiswa, utachiona hushoma hunenge hwasara hunogona kuwanda.
Mishonga yakawanda yepenicillin inopfava uye inopera uye inogadziriswa yega pasina kurapwa.
Rimwe rematambudziko akakomba ane chekuita nekushandiswa kwepenicillin injodzi yenjodzi inogona kuuraya hupenyu hwe systemic allergic reaction inonzi anaphylaxis.Allergic reactions to true penicillin inobata vanhu 1 kusvika vashanu mu100,000.
Kusawirirana nemuviri kunogona kukonzera kukuvadza kwakakomba kana kukasarapwa. Inogona kukonzera kuvhunduka, kukomoka, kutadza kufema kana moyo, uye kunyange kufa.
Tsvaka rubatsiro rwechimbichimbi kana ukaona zvimwe kana zvese zvezviratidzo zvekusawirirana nazvo mushure mekutora chipimo chepenicillin:
Muzviitiko zvisingawanzoitiki, penicillin inogona kukonzera acute interstitial nephritis, chirwere cheitsvo chinoputika chinowanzokonzerwa nekusagadzikana kwekudzivirira muviri kune mushonga. zvakapfava, asi zvimwe zvinogona kuve zvakanyanya uye zvinotungamira mukukuvara kwakanyanya kweitsvo.
Kufanana nemishonga yese inorwisa mabhakitiriya, penicillin inobatanidzwa nekuwedzera kwengozi yeC. difficile diarrhea.Izvi zvinokonzerwa nebhakitiriya rinowanzowanikwa muura richiparadzwa nemishonga inorwisa mabhakitiriya, zvichiita kuti utachiona hweC. difficile huwande.Zvizhinji zvinyoro uye zvinorapika nyore. , asi C. difficile inozivikanwa kuparira fulminant colitis yakakomba, megacolon ine chepfu, uye rufu muzviitiko zvisingawanzoitiki.
Penicillin inowanzonzi haina ngozi panguva yekuzvitakura nekuyamwisa. Humbowo muvanhu haupo, asi zvidzidzo zvemhuka zvinoratidza kuti hapana njodzi yekukuvadzwa kwe "fetus".
Kana uri nepamuviri, uchironga kuva nepamuviri, kana kuyamwisa, taura nemutarisiri wako wehutano kuti unzwisise zvizere mabhenefiti nenjodzi dzekushandisa penicillin.
Mishonga yakawanda inogonawo kupindirana nepenicillin, kazhinji nekukwikwidzana kwerenal clearance.Izvi zvinowedzera penicillin kuwedzera muropa uye njodzi yemigumisiro uye huturu hwezvinodhaka.Mimwe mishonga inogona kukurumidza kubviswa kwepenicillin kubva mumuviri uye kuderedza kushanda kwezvinodhaka.
Kuti udzivise kudyidzana, gara ita kuti mutarisiri wako wehutano azive nezve chero mishonga yauri kutora, ingave yekunyorerwa, pamusoro-the-counter, inovaka muviri, yemakwenzi, kana yekutandara.
Nyorera kune yedu yemazuva ese ehutano mazano enhau uye ugamuchire matipi emazuva ese ekukubatsira iwe kurarama hupenyu hune hutano.
Lobanovska M, Pilla G. Penicillin kuwanikwa uye kuramba kwemishonga inorwisa mabhakitiriya: zvidzidzo zveramangwana?Yale Journal of Biomedical Sciences.2017;90(1):135-45.
Founou LL, Founou RC, Essack SY.Antibiotic resistance mucheni yezvokudya: maonero enyika ari kusimukira.pre-microbes.2016;7:1881.doi:10.3389/fmicb.2016.01881
Nguva yekutumira: Mar-25-2022