U-Anju Goel, MD, MPH, ungudokotela oqinisekisiwe webhodi onguchwepheshe kwezempilo yomphakathi, izifo ezithathelwanayo, isifo sikashukela, kanye nenqubomgomo yezempilo.
I-Penicillin iyimithi elwa namagciwane esetshenziselwa ukwelapha izinhlobo ezithile zezifo ezibangelwa amagciwane. Imiphumela engemihle evamile ihlanganisa isifo sohudo nokuphatheka kabi kwesisu, futhi abanye abantu bangase babe nokungezwani ne-penicillin - imiphumela isukela emincane iye kobi kakhulu.
I-Penicillin inganikezwa ngomlomo, noma ijovwe ngomthambo (IV, emthanjeni), noma nge-intramuscularly (IM, emsipha omkhulu). Futhi kunezinhlobo ezahlukene zama-penicillin anezinqubo ezahlukene zokusebenza.
Zonke izinhlobo ze-penicillin zitholakala, okungenani ingxenye, kukhunta okuthiwaI-Penicilliumi-chrysogenum.
Usosayensi waseScotland u-Alexander Fleming wathola i-penicillin ngo-1929 lapho eqaphela ukuthi amasiko ebhaktheriya angcoliswe ngephutha “ngejusi yesikhunta” ayebulawa ukhunta. isiguli, siqala inkathi yama-antibiotic.
Ngawo-1960, ososayensi bakwazi ukwenza umuthi wokuqala we-penicillin we-semisynthetic okwazi ukwelapha uhla olubanzi lwezifo ezibangelwa amagciwane. Ngaso leso sikhathi, baqala ukubona usongo lokumelana ne-penicillin, lapho kwaqala ukuvela izinhlobo eziguqukayo ezimelana nemithi elwa namagciwane. futhi yasabalala kubo bonke abantu.
Namuhla, inani elikhulayo lezifo ezibangelwa amagciwane amelana ngokugcwele noma kancane nemithi ye-penicillin yokuqala, okuhlanganisa i-Neisseria gonorrhoeae (igonorrhea) kanye ne-Staphylococcus aureus (MRSA) engamelana ne-methicillin.
I-Streptococcus pneumoniae, uhlobo lwenyumoniya yebhaktheriya, kanye nezinye izinhlobo ze-Clostridium ne-Listeria nazo ziyancipha ukusabela kulawa ma-antibiotic.
Ukusetshenziswa ngokweqile kwama-antibiotics ukukhuthaza ukukhula kwemfuyo kuyaziwa ukwandisa ingozi yamagciwane aphikisana nezidakamizwa, kuhlanganise nama-superbugs, kulo lonke uchungechunge lokudla.Ngenxa yalokhu kukhula kokukhathazeka komhlaba wonke, i-United States yavala ukusetshenziswa kwama-antibiotics ukukhuthaza ukukhula kwezilwane ku-2017.
Amapenicillinabomndeni omkhulu wezidakamizwa ezibizwa ngokuthi i-beta-lactam antibiotics.Le mithi inokwakheka kwamangqamuzana okufanayo, okuhlanganisa indandatho yama-athomu amane okuthiwa ama-beta-lactam.Uhlobo ngalunye lwe-penicillin lunamaketanga engeziwe aseceleni anquma umsebenzi wawo.
I-penicillin isebenza ngokubophezela kuma-molecule odongeni lwebhaktheriya olubizwa ngokuthi i-peptidoglycan.Lapho amagciwane ehlukana, i-penicillin ivimbela ukuhlelwa kabusha okuvamile kwamaprotheni odongeni lwamaseli, okubangela ukuthi amangqamuzana ebhaktheriya aqhume futhi afe ngokushesha.
Ama-penicillin emvelo yilawo akhishwa ngokuqondile kufungus we-P. chrysogenum. Kunama-penicillin emvelo amabili.
I-semi-synthetic penicillin ikhiqizwa elabhorethri futhi ifana nekhemikhali etholakala ku-P. chrysogenum. Kunezigaba ezine zama-penicillin e-semisynthetic, okuhlanganisa ama-antibiotic avame ukusetshenziswa njenge-amoxicillin ne-ampicillin.
Ngalunye lwalezi zinhlobo lunesakhiwo samangqamuzana esihluke kancane futhi singase siphathwe ngendlela ehlukile kunezinye izinhlobo.
Amanye ama-penicillin awanawo umsebenzi oqondile wokulwa namagciwane.Asetshenziswa ekwelapheni okuhlanganisiwe ukusiza ukunqoba ukumelana ne-penicillin.Isibonelo, i-clavulanic acid ivimba i-enzyme ekhiqizwe amagciwane amelana nama-antibiotic (beta-lactamase) avimbela umsebenzi we-beta-lactam antibiotics.
Ama-penicillin asetshenziselwa ukwelapha izifo ezibangelwa amagciwane - awalaphi izifo ezibangelwa amagciwane, isikhunta noma izimuncagazi. Le mithi ivamise ukusebenza ngempumelelo ngokumelene nama-bacteria e-Gram-positive, isigaba samagciwane ane-peptidoglycan ngaphandle kwezindonga zamangqamuzana awo. Ngamagciwane angenayo i-Gram-negative. , ungqimba lwe-peptidoglycan lungcwatshwa ngaphansi kongqimba lwamaseli e-lipid, okwenza kube nzima ukuthi izidakamizwa zifinyelele i-molecule.
Amagciwane ane-Gram-positive angelashwa nge-penicillin ahlanganisa i-Clostridium, i-Listeria, i-Neisseria, i-Staphylococcus, ne-Streptococcus.
Ama-penicillin emvelo - i-penicillin G kanye ne-penicillin V - asasetshenziswa nanamuhla ekwelapheni izifo ezivamile nezingajwayelekile zamagciwane.
Ngokuphambene nalokho, ama-antibiotic e-semisynthetic afana ne-amoxicillin-enye yemithi elwa namagciwane esetshenziswa kakhulu namuhla-isetshenziselwa ukwelapha izifo eziningi zokuphefumula, isikhumba kanye ne-bacterial ezifana ne-H. pylori, isifo se-Lyme kanye ne-acute otitis media.
Ukusetshenziswa kwe-penicillin ngaphandle kwelebula kuvamile, nakuba izidakamizwa ezifana ne-amoxicillin ne-ampicillin zivame kakhulu kunemvelo.i-penicillin.Ukusetshenziswa ngaphandle kwelebula kuhlanganisa ukwelashwa kweziguli ezigula kakhulu ezine-sepsis noma izingane ezisanda kuzalwa ezinokucindezeleka kokuphefumula okukhulu.Kunoma yikuphi, le mithi isetshenziselwa izinjongo ezinjalo, kodwa ngokuvamile ibhekwa njengedingekile uma zingekho ezinye izindlela zokwelapha ezitholakalayo.
I-Penicillin G ngezinye izikhathi isetshenziswa ngaphandle kwelebula ukwelapha izifo ezihlangene ze-prosthetic, isifo se-Lyme, ne-leptospirosis.I-Penicillin V ngezikhathi ezithile isetshenziswa ngaphandle kwelebula ukwelapha isifo se-Lyme kanye ne-otitis media, noma ukuvimbela izifo kubantu abathola ukufakelwa kwe-stem cell.
I-penicillin ingasebenza kahle kakhulu uma isetshenziswa ngendlela efanele.Noma kunjalo, kwezinye izimo, umuthi awuphumeleli ekuqedeni ukutheleleka.Kulokhu, ukuhlolwa kokuzwela kwama-antibiotic (okubizwa nangokuthi ukuhlolwa kokuzwela kwama-antibiotic) kungasetshenziswa ukuthola ukuthi ukutheleleka komuntu isabela ku-penicillin.
Ukuhlola kuqala ngokuhlakulela amagciwane athathwe ku-swabs oketshezi lomzimba bese kuvezwa amagciwane ngokuqondile ezinhlotsheni ezihlukahlukene ze-penicillin elabhorethri.Ukuhlola ukuthi kungenzeka yini ukuthi amagciwane e-antibiotic susceptibility testing asetshenziswa ezigulini ezinenyumoniya etholwa umphakathi ezigula kakhulu noma ezisengozini enkulu yokugula. ukufa.
I-Penicillin iyavinjelwa uma ngaphambilini ubukade uguliswa yinoma yisiphi isidakamizwa emndenini we-penicillin.Kufanele futhi uqaphe uma uke waba nokusabela okunamandla kwezidakamizwa esikhathini esidlule, okuhlanganisa i-anaphylaxis, i-Stevens-Johnson syndrome (SJS), noma i-epidermal necrosis enobuthi. (ISHUMI).
Uma uke waba nokungezwani ne-penicillin G noma i-penicillin V esikhathini esedlule, ungase (kodwa hhayi ngempela) ungazwani nama-semi-synthetic penicillin njenge-amoxicillin noma i-ampicillin.
Abantu abangazwani ne-penicillin kufanele basebenzise amanye ama-antibiotic e-beta-lactam ngokuqapha ngenxa yengozi yokungezwani komzimba ne-cross-reactive, nakuba ingozi incane.Lokhu kuhlanganisa ama-antibiotic e-cephalosporin afana ne-Keflex (cephalexin), i-Maxipime (cefepime), i-Rocephin (ceftriaxone), kanye ne-Suprax (cefixime).
Uma ukhathazekile ngokuthi ungase ungezwani ne-penicillin, ungaba nokuhlolwa kokungezwani komzimba nesikhumba ukuze ubone ukuthi unokusabela yini enanini elincane lomuthi obekwe ngaphansi kwesikhumba sakho.
I-Penicillin kufanele futhi isetshenziswe ngokuqapha okukhulu uma unokwehluleka okukhulu kwezinso (izinso).I-Penicillin ikhishwa ngokuyinhloko yizinso, futhi ukuncipha kokusebenza kwezinso kungaholela ekuqongeleleni komuthi emazingeni anobuthi.Ukweqisa okuwumphumela we-penicillin kungaholela ezimpawu yokuyaluza, ukudideka, ukuqhanyelwa, ukudlikizeka okungavamile, futhi, ezimweni ezingavamile, ikhoma.
Imithamo enconyiwe ye-penicillin G kanye ne-penicillin V ingahluka kuye ngesifo kanye neminyaka yomuntu owelashwayo.
Kuye ngeresiphi, umthamo ulinganiswa ngezindlela eziningana ezahlukene.Kubantu abadala, izidakamizwa zivame ukulinganiswa ngamayunithi noma ama-milligrams (mg).Ezinganeni, imithamo ingabalwa ngama-milligram ngekhilogremu ngayinye yesisindo somzimba ngosuku (mg/kg/ ngosuku) noma ngamayunithi ngekhilogremu yesisindo somzimba ngosuku (amayunithi/kg/ngosuku).
Uma unesifo sezinso, kungase kudingeke wehlise umthamo wakho we-penicillin ukuze uvimbele ubuthi bezidakamizwa.Lapho imvume ye-creatinine (isilinganiso sokusebenza kwezinso) iwela ngaphansi kwamamililitha ayi-10 ngomzuzu (mL/min), ukuncishiswa komthamo kuvame ukutuswa.
Ngakolunye uhlangothi, uma usebenzisa i-hemodialysis, ungase udinge umthamo ophezulu ngoba i-hemodialysis ingasheshisa ukukhishwa kwe-penicillin egazini lakho.
I-Penicillin G iyatholakala njengesixazululo esixutshwe ngaphambili noma njengempushana yokuhlanganiswa kabusha naManzi Ayinyumba Yomjovo.Izixazululo ezixubile zingagcinwa esiqandisini noma efrijini, kuyilapho ukwakheka kwempushana kungagcinwa ngokuphepha ekamelweni lokushisa.
I-Penicillin V itholakala njengethebhulethi yomlomo noma njengempushane enambitheka ye-cherry exutshwe namanzi.Zombili ziphephile ukuthi zigcinwe ekamelweni lokushisa.Uma impushana isihlanganisiwe, kufanele igcinwe esiqandisini futhi ilahlwe ngemva kwezinsuku ezingu-14.
I-Penicillin V kufanele iphuzwe esiswini esingenalutho ukuze kuqinisekiswe ukumuncwa okuphezulu. Kufanele iphuzwe okungenani ihora elilodwa ngaphambi noma amahora amabili ngemva kokudla.
Uma weqa umthamo we-penicillin V, yiphuze ngokushesha uma ukhumbula. Uma sekusondela isikhathi somthamo wakho olandelayo, yeqa umthamo bese uqhubeke ukuwudla njengenjwayelo. Ungalokothi uphindwe kabili umthamo.
Ngaso sonke isikhathi phuza i-penicillin njengoba uyaliwe futhi wenze.Ungayeki ngoba nje izwakala kahle.Kudingeka uqedele isifundo ukuze uqede wonke amagciwane.Uma ukwelashwa sekuyekiwe, inani elincane lamagciwane asele lingaphindaphindeka.
Imiphumela eminingi engemihle ye-penicillin imnene futhi iyadlula futhi iyazixazulula ngokwayo ngaphandle kokwelashwa.Kodwa ngezinye izikhathi imiphumela engemihle ingase ibe mibi, ibeke ngisho nokuphila engozini, futhi idinga ukunakekelwa okuphuthumayo.
Enye yezinkinga ezinkulu kakhulu ezihambisana nokusetshenziswa kwe-penicillin ingozi yokungezwani komzimba okungaba yingozi empilweni ebizwa ngokuthi i-anaphylaxis.Ukungezwani komzimba ne-penicillin yeqiniso kuthinta cishe abantu aba-1 kuya kwabahlanu kwabayi-100,000.
Ukungezwani komzimba kungase kubangele umonakalo omkhulu uma kungelashwa. Kungabangela ukushaqeka, ukukoma, ukuhluleka kokuphefumula noma kwenhliziyo, ngisho nokufa.
Funa usizo oluphuthumayo uma uthola ezinye noma zonke izimpawu zokungezwani komzimba ngemva kokuthatha umthamo we-penicillin:
Ezimweni ezingavamile, i-penicillin ingabangela i-acute interstitial nephritis, isifo sezinso esivuvukalayo esivame ukubangelwa ukusabela okungavamile kokuzivikela komzimba emuthini. imnene, kodwa eminye ingaba nzima futhi iholele ekulimaleni kwezinso okukhulu.
Njengawo wonke ama-antibiotics, i-penicillin ihlotshaniswa nengozi eyengeziwe yohudo lwe-C. difficile. Lokhu kubangelwa amagciwane avame ukuba khona emathunjini abhujiswa ama-antibiotics, ngaleyo ndlela avumele amagciwane i-C. difficile ukuthi aziphindaphinde.Izimo eziningi zithambile futhi zelapheka kalula , kodwa i-C. difficile yaziwa ngokubangela i-fulminant colitis enzima, i-megacolon enobuthi, nokufa ezimweni ezingavamile.
I-penicillin ngokuvamile ibhekwa njengephephile phakathi nokukhulelwa nokuncelisa. Ubufakazi kubantu abukho, kodwa ucwaningo lwezilwane lubonisa ukuthi ayikho ingozi yokulimala kwengane.
Uma ukhulelwe, uhlela ukukhulelwa, noma ukuncelisa, khuluma nomhlinzeki wakho wezempilo ukuze uqonde ngokugcwele izinzuzo nezingozi zokusebenzisa i-penicillin.
Izidakamizwa eziningi zingasebenzisana ne-penicillin, ngokuvamile ngokuncintisana ngokuvunyelwa kwezinso.Lokhu kwandisa ukugxila kwe-penicillin egazini kanye nengozi yemiphumela emibi kanye nobuthi bezidakamizwa.Eminye imithi ingasheshisa ukukhishwa kwe-penicillin emzimbeni futhi yehlise ukusebenza komuthi.
Ukuze ugweme ukusebenzisana, hlala wazisa umhlinzeki wakho wokunakekelwa kwezempilo nganoma yimiphi imithi oyiphuzayo, kungaba incwadi kadokotela, esitolo esidayisa ukudla, ukudla okunomsoco, okokwelapha, noma ezokungcebeleka.
Bhalisela iphephandaba lethu lansuku zonke lamathiphu ezempilo futhi uthole amathiphu nsuku zonke angakusiza uphile impilo yakho enempilo.
U-Lobanovska M, u-Pilla G. Ukutholakala kwe-Penicillin kanye nokumelana nama-antibiotic: izifundo zesikhathi esizayo?Yale Journal of Biomedical Sciences.2017;90(1):135-45.
I-Founou LL, i-Founou RC, i-Essack SY.Ukumelana nemithi elwa namagciwane ochungechungeni lokudla: umbono wezwe elisathuthuka.pre-microbes.2016;7:1881.doi:10.3389/fmicb.2016.01881
Isikhathi sokuthumela: Mar-25-2022