Clindamycin gel: malangizo ogwiritsira ntchito

Kufotokozera kogwirizana ndi 13.03.2016

Dzina lachi Latin: Clindamycin
Code ya ATX: J01FF01
Chithandizo: Clindamycin (Clindamycin)
Wopanga: Hemofarm (Serbia), VERTEX (Russia)

The zikuchokera makapisozi a clindamycin yogwira pophatikizidwa clindamycin(hydrochloride mawonekedwe), ndi zina zowonjezera: talc, lactose monohydrate, wowuma chimanga, magnesium stearate.

Njira Zothetsera Muli yogwira pophika clindamycin (mtundu wa phosphate), komanso zinthu zina zothandiza: mowa wa benzyl, disodium edetate, madzi.

Clindamycin Kirimu Kapangidwe kake kamakhala ndi kaphikidwe kogwiritsa clindamycin (mtundu wa phosphate), komanso zina zothandiza: macrogol 1500, mafuta a castor, sodium benzoate, propylene glycol, emulsifier No. 1.

Kutulutsa Fomu

Chida chimapangidwa mwanjira ya makapisozi, yankho ndi ukazi wachikazi.

Makapisozi a Gelatin amakhala ndi thupi lofiirira komanso kapu yofiyira. Mkati mwake mumakhala ufa, womwe umatha kukhala ndi utoto woyera kapena wachikaso. Makapisozi amadzaza matuza a ma 8 ma PC., Phukusi la makatoni awiri matuza oterowo.

Njira yothetsera vutoli, yomwe imayendetsedwa kudzera m'mitsempha kapena intramuscularly, imatha kuwonekera, imatha kukhala yopanda utoto kapena chikaso pang'ono. Muli ma ampoules a 2 ml. M'matumba 5 a matuza, m'matayala okhala ndi mapaketi awiri.

Mafuta a Vaginal 2% amatha kukhala ndi mtundu woyera, wachikasu, kirimu. Imakhala ndi fungo linalake lofooka. Ili ndi machubu a aluminium a 20 g kapena 40 g, wolembetsa akuphatikizidwa ndi phukusi.

Zotsatira za pharmacological

Thupi clindamycin ndi gulu la mankhwala-lincosamides. Imakhala ndi zovuta zingapo, ndi bacteriostatic.

Mu thupi, limagwirizanitsa ndi 50S subunit ya nthiti ndipo limalepheretsa kaphatikizidwe ka mapuloteni mu tizilombo tating'onoting'ono. Imagwira pa Staphylococcus spp., Streptococcus spp. (kupatula ndi Enterococcus spp.), Streptococcus pneumoniae, anaerobic ndi microaerophilic gram zabwino cocci, Clostridium tetani, Clostridium perfringens, Corynebacterium diphtheriae, Mycoplasma spp., Bacteroides spp. (kuphatikiza Mabakiteriya melaningenicus ndi Bacteroides fragilis) Imawonetseranso zochitika motsutsana ndi gramu ya anaerobic yabwino, yopanda spore, bacilli.

Mitundu yambiri imakhudzidwanso ndi izi. Clostridium perfringens, koma mitundu ina ya clostridia (makamaka Clostridium tertium, Clostridium sporogenes) onetsani kukana mankhwalawa. Pankhaniyi, ndi matenda oyambitsa Clostridium spp.Ndikulimbikitsidwa kuti maantibayotiki atengedwe musanayambe mankhwala.

Limagwirira ntchito ya mankhwalawa ndi mawonekedwe ake antimicrobial ali pafupi ndi lincomycin.

Mawonekedwe a chinthu clindamycin phosphate sagwira ntchito mu vitro, komabe, amawongolera mwachangu mu vivo, ndipo clindamycin imapangidwa, yomwe imawonetsa ntchito ya antibacterial.

Pharmacokinetics ndi pharmacodynamics

Clindamycin kwathunthu ndipo mwachangu odzipereka kuchokera m'mimba thirakiti, pamene kudya, mayamwidwe amachepetsa, pomwe kugwiritsidwa ntchito kwa plasma sikunasinthe. Imalowa m'matumbi am'madzi ndi zamadzimadzi, zimadutsa bwino kudzera mu BBB, koma ikayamba kutupa m'mitsempha ya ubongo, kupezekanso kumawonjezeka.

Kuzindikira kwakukulu magazi zimadziwika akamamwa pakadutsa maola 0,75-1, ngati makonzedwe amtumbo amachitika, pambuyo pa ola limodzi mwa odwala akuluakulu komanso pambuyo maola atatu kwa ana. Mukaperekedwa kudzera m'mitsempha, chizindikiritso chapamwamba chimawonedwa kumapeto kwa kulowetsedwa.

Pali zochiritsira zozama m'magazi kwa maola 8-12. Hafu ya moyo ndi maola 2.4. Kupenda amapezeka m'chiwindi, pomwe akugwira ntchito komanso osagwira ntchito metabolites. Kutupa kumachitika masiku opitilira anayi kudzera mu impso komanso matumbo.

Mukamapaka intravaginally, pafupifupi 3% ya mankhwala omwe amapatsiridwa amayamba kuyamwa.

Zizindikiro zogwiritsidwa ntchito

Clindamycin yothetsera ndi mapiritsi amagwiritsidwa ntchito pa matenda ndi mikhalidwe:

matenda opatsirana komanso otupa omwe amayambitsidwa ndi zochita za tizilombo tating'ono clindamycin,
matenda a ziwalo za ENT, komanso matenda opatsirana am'mapapo apakati komanso kupuma kochepa,
diphtheria, malungo ofiira,
matenda a urogenital
matenda amkamwa, m'mimba,
minofu yofewa ndi khungu,
septicemia (makamaka anaerobic),
osteomyelitispachimake komanso chovuta
endocarditis bakiteriya
kuvomereza kupewa kupewa abscesses wa intraperitoneal ndi peritonitis pambuyo mafuta matumbo kapena pambuyo zoopsa matenda (kuphatikizapo aminoglycosides).

Kirimu ndi gel osakaniza Clindamycin amagwiritsidwa ntchito pa bacteric vaginosis.

Zisonyezero zogwiritsa ntchito ma suppositories omwe amakhala ndi clindamycin:

bakiteriya vaginosis, wokwiyitsidwa ndi tizilombo tomwe timayang'ana chinthu.

Contraindication

Kugwiritsa ntchito chida ichi ndi zotsutsana:

at mphumu ya bronchial,
at myasthenia gravis,
ndi zilonda zam'mimba tsabola,
Ndi matenda osowa a chibadwa (kusowa kwa lactase, galactose tsankho, shuga-galactose malabsorption),
at wa mimba ndi kuyamwitsa,
pa mwana wazaka zosakwana 3, kutsekeka kwa intravenous ndi intramuscular, ali ndi zaka 8, kapisozi wa kaperekedwe kamatsutsana,
kukhudzika kwakukulu pazigawo za mankhwala.

Chenjezo limaperekedwa kwa anthu omwe ali ndi vuto lalikulu laimpso kapena kwa chiwindi, odwala okalamba.

Zotsatira zoyipa

Mukamamwa mankhwalawa, odwala amatha kudwala:

m'mimba dongosolo: dyspeptic dalili, jaundice, esophagitis, pseudomembranous enterocolitis, hyperbilirubinemia, dysbiosischiwindi ntchito,
musculoskeletal system: Nthawi zina pamakhala kuphwanya kwa neuromuscular conduction,
hematopoiesis: leukopenia, neutropenia, agranulocytosis, thrombocytopenia,
ziwonetserozotupa Khungu, urticaria, nthawi zina - dermatitis, anaphylactoid mawonetseredwe, eosinophilia,
mtima ndi mitsempha yamagazi: pamene yankho limayendetsedwa kudzera m'mitsempha mwachangu komanso mwachangu - kuchepa kuthamanga kwa magazikufooka chizungulire,
mawonetsedwe apafupi: zilonda komanso thrombophlebitis(pamalo opangira jakisoni), mkwiyo,
zovuta zina: mwayi wapamwamba.

Mukamagwiritsa ntchito kirimu wa Clindamycin, mavuto omwe amakumana nawo:

pokodza: kuyimitsa khungu candidiasisukazi, vulvovaginitis, trichomonias vaginitis, matenda am'kati, kusokonezeka kwa mwezi, kutulutsa magazi mu chifuwa, kupweteka kwamkati, dysuria, mawonekedwe a kutulutsa kwamkati endometriosisglucosuria proteinuria,
mawonetseredwe wamba: kupweteka kwam'mimba komanso kukokana, kutulutsa, matenda oyamba ndi mabakiteriya, mutumpweya wabwino kutupa yotupa, kupweteka m'mimba, m'mimba kupweteka matenda, kupweteka kumbuyo, matupi awo sagwirizana,
m'mimba dongosolo: nseru kutsegula m'mimba, kudzimbidwakusanza chisangalalo, dyspepsia, matenda am'mimba am'mimba,
khungu mawonekedwe: kuyabwa pakhungu, erythema, zotupa, candidiasis, urticaria,
dongosolo la endocrine: hyperthyroidism,
CNS: chizungulire,
kupuma dongosolo: mphuno.

Bongo

Ngati mankhwala osokoneza bongo apezeka, zovuta zomwe zafotokozedwa pamwambapa zitha kukulira. Zapadera mankhwala ayi, ngati bongo, mankhwala opatsirana amachitidwa.

Palibe chidziwitso chokhudza kuchuluka kwa zonona. Ngati mwalowa mwangozi mankhwala, zotsatira zake zimatha kuchitika pambuyo poti timumenyeni.

Kuchita

Pali kuwonjezeka kwa zochita za streptomycin aminoglycosides, Gentamicin, Rifampicin mukumwa ndi clindamycin.

Imayendetsa zotsatira za kupumula kwa minofu, komanso kupumula kwa minofu, komwe kumayambitsa n-anticholinergics.

Kukopa ndi chloramphenicol ndi Erythromycin.

Simalimbikitsidwa kutengedwa nthawi yomweyo ndi mayankho omwe ali ndi zovuta mavitamini magulu B, phenytoins, aminoglycosides.

Mankhwala a Clindamycin ndi antidiarrheal sangathe kufotokozedwanso panthawi imodzi, chifukwa mwayi wokhala ndi pseudomembranous colitis ukuwonjezeka.

Mukamagwiritsa ntchito pamodzi ndi opioid analgesics zotsatira za kupuma kwapachulukidwe zitha kuchuluka, mpaka kukula ziphuphu.

Kutsutsa kwamtanda kumawonedwa pakati pa lincomycin ndi clindamycin. Kukopa pakati pa erythromycin ndi clindamycin kumawonetsedwanso.

Iwo ali osavomerezeka kuti agwiritse ntchito limodzi ndi mankhwala ena opaka intravaginal.

Malangizo apadera

Kuwonetsedwa kwa pseudomembranous colitis ndikotheka kumwa onse pakatha masabata awiri ndi atatu atatha kuthandizira. Ndi chikhalidwe ichi, munthu amadziwulula kutsegula m'mimba, malungo, leukocytosiskupweteka kwam'mimba.

Zizindikiro zotere zikayamba, muyenera kuletsa mankhwalawo ndikupanga ma resion a ion. Mu colitis yoopsa, ndikofunikira kulipiritsa madzi otayika, mapuloteni ndi ma elekitirodi, kuti apereke kudya kwa Vancomycin kapena Metronidazole.

Mankhwalawa, simungamwe mankhwala omwe amalepheretsa matumbo kuyenda.

Ngati kugwiritsa ntchito mankhwalawa kwa nthawi yayitali ndi ana, muyenera kuwunika kakhalidwe kamodzinthawi magazi komanso matenda a chiwindi. Mukamamwa mankhwala akuluakulu, clindamycin amayenera kuwongoleredwa magazi a m'magazi.

Anthu omwe adapezeka kuti ali ndi vuto lalikulu la chiwindi ayenera kukhala ndi chiwongolero chazomwe zimagwira.

Musanamwe mankhwala kudzera mu intravaginally, muyenera kupatula labotale Chlamydia trachomatis, Trichomonas vaginalis, Neisseria gonorrhoeae, Candida albicans, Herpes simplex, zomwe nthawi zambiri zimayambitsa chitukuko cha vulvovaginitis.

Mukamagwiritsa ntchito clindamycin kudzera m'mitsempha, pamatha kukulira vuto lina laling'ono, makamaka la yisiti.

Popeza pali kuthekera kwina kovomerezeka kwa mankhwalawa, kutsekula m'mimba kumatha kuphatikizidwa ndi suppositories kapena zonona. Pankhaniyi, chida sichitheka.

Tiyenera kudziwa kuti munthawi yamankhwala muyenera kupewa zogonana ndipo osagwiritsa ntchito mankhwala ena osokoneza bongo.

Kuphatikizika kwa mankhwalawa kumakhala ndi zinthu zomwe zimatha kupanga zinthu zamtundu wa rabara, latex osakhazikika. Chifukwa chake, sikulimbikitsidwa kugwiritsa ntchito makondomu, diaphragms ndi njira zina zolerera kuchokera ku latex.

Zisawonongeke kuyendetsa galimoto kapena kuchita nawo zinthu zina zomwe zimafuna kuti anthu azikumbukira.

Pa mimba ndi mkaka wa m`mawere

Mutha kugwiritsa ntchito mankhwalawa intravaginally mwa akazi wachiwiri ndi wachitatu trimesters wa mimba. M'miyezi yoyambirira ya pakati, imayikidwa pokhapokha phindu lomwe likuyembekezeredwa limaposa zovuta zomwe zingagwiritsidwe ntchito zonona kapena zowonjezera. Panthawi ya mkaka, muyenera kuyeza bwino phindu lomwe lingachitike ndikuvulaza. Gwiritsani ntchito mankhwalawo moyang'aniridwa ndi dokotala.

Zotsatira zoyipa

Malangizowa amachenjeza za mwayi wokhala ndi zotsatirapo zoyipa mukamapereka mankhwala a clindamycin:

kutsekemera kwazitsulo mkamwa, phlebitis (ndi makonzedwe amkati mwambiri),
mseru, kusanza, kutsegula m'mimba, kupweteka kwam'mimba,
phenomena wa esophagitis (ndi mapiritsi a clindamycin),
kuchuluka kwa bilirubin ndi hepatic transaminase ntchito,
chizungulire, kufooka, kutsika kwa magazi (mothandizidwa ndi mtsempha wamitseko),
pseudomembranous colitis,
candidiasis.

Pazinthu zakutali, zimatha kuyambitsa kukulitsa kwa matenda a jaundice ndi chiwindi, komanso thrombocytopenia, leukopenia, neutropenia ndi agranulocytosis.

Nthawi zina, zimachitika mdera ladzidzidzi (kukwiya pamalo opukusira jakisoni, kukula kwa chithupsa kapena kulowetsedwa).

Clindamycin gel ingayambitse kukwiya pamalo ogwiritsira ntchito, komanso kukula kwa dermatitis yolumikizana. Ndi kugwiritsa ntchito nthawi yayitali, zotsatira zoyipa zimayamba.

Mitundu yapamwamba ya mankhwalawa (suppositories ndi zonona) imakhala ndi mavuto monga vaginitis, cervicitis ndi vulvovaginal.

Ndi chidwi chamunthu payekha, zimatha kusintha zamatsenga - urticaria, erythema multiforme, malungo, edincke's edema, kapena anaphylactic.

Pseudomembranous colitis imatha kuchitika onse mutatenga clindamycin, ndipo patatha masabata awiri atasiya kumwa mankhwala (3-15% milandu). Imadziwoneka ngati kutsegula m'mimba, leukocytosis, kutentha thupi, kupweteka kwam'mimba (nthawi zina kumayendera limodzi ndi kupukusira kwa magazi ndi mafinya).

Contraindication

Amavomerezedwa kuti apereke clindamycin pazotsatirazi:

myasthenia gravis
Mphumu ya bronchial,
zilonda zam'mimba (mbiri)
Matenda obadwa nawo, monga galactose tsankho, kuchepa kwa lactase kapena glucose-galactose malabsorption (makapisozi),
Mimba ndi kuyamwa
zaka za ana mpaka zaka 3 - yankho la njira yodutsira khosi lamatumbo (chifukwa cha kusowa kwa chidziwitso pakugwiritsa ntchito mowa wa benzyl),
zaka za ana mpaka zaka 8 za makapisozi (pafupifupi ana kulemera kwa makilogalamu 25),
Hypersensitivity.

Clindamycin amagwiritsidwa ntchito mosamala odwala omwe ali ndi vuto lozungulira la hepatic komanso / kapena aimpso, odwala okalamba.

Mankhwalawa, simungamwe mankhwala omwe amalepheretsa matumbo kuyenda.

Bongo

Ngati mankhwala osokoneza bongo amakumana ndi mavuto ambiri.

Chithandizo cha Syndrome chimachitika, palibe mankhwala enaake. Hemodialysis ndi peritoneal dialysis sizothandiza.

Pharmacology

Amamangirira 50S ribosomal subunit ya tizilombo tating'onoting'ono ndipo timalepheretsa kaphatikizidwe kazinthu kena kakang'ono kwambiri. Imakhala ndi bacteriostatic kwambiri, mozama kwambiri komanso mokhudzana ndi tizilombo tating'ono kwambiri titha kuwonetsa bactericidal. Mwa magwiridwe antchito ndi makina owonera makina, ili pafupi ndi lincomycin (molingana ndi mitundu ina ya tizilombo, imakhala yogwira kawiri mpaka kawiri).

Clindamycin akatengedwa pakamwa, hydrochloride imatengedwa mwachangu komanso bwino kuchokera kugaya chakudya (bwino kuposa lincomycin), bioavailability ndi 90%, kudya munthawi yomweyo kumachepetsa mayamwidwe, osasintha mayamwidwe. Mapuloteni omanga ndi 92-94%. Imalowerera mosavuta zakumwa zam'madzi, ziwalo ndi ziwalo zathupi, kuphatikiza minofu, minofu ndi mafupa (pafupifupi 40% ya ndende yamagazi), bronchi, mapapu, pleura, madzi am'mimba (50-90%), ndulu za bile, zowonjezera, machubu a fallopian, gland sputum (30-75%), kumeta kwa mabala. Zimadutsa moyipa kudzera mu BBB (ndikutupa kwa meninges, kuchuluka kwa BBB kumakulanso). Kuchuluka kwa magawo akuluakulu kumakhala pafupifupi 0,66 l / kg, mwa ana - 0,86 l / kg. Imadutsa mwachangu kudutsa placenta, imapezeka m'magazi a mwana wosabadwayo (40%), imadutsa mkaka wa m'mawere (50-100%).

Clindamycin palmitate ndi phindamini wa clindamycin ndiwosagwira, amathamanga hydrolyze mthupi kuti azigwira clindamycin.

C_max mkamwa Seramu, zimatheka pambuyo 0.75-1 h, pambuyo i / m makonzedwe - pambuyo 3 h (akuluakulu) kapena 1 h (ana), ndi iv kulowetsedwa - kumapeto kwa makonzedwe. Zimapangidwa m'chiwindi ndikupanga yogwira (N-dimethylclindamycin ndi clindamycin sulfoxide) ndi metabolites yogwira. Imafukusidwa mkati mwa masiku anayi ndi mkodzo (10%) komanso matumbo (3.6%) ngati gawo lothandiza, ena onse ngati metabolites yogwira. T_1/2 ndi wabwinobwino aimpso ntchito akuluakulu ndi maola 2.4-3, makanda ndi ana okalamba - maola 2 mpaka 2-3, mu makanda osakwana - - maola 6.3-8.6. kwambiri kusokonezeka kwa chiwindi ntchito, kuperewera kwa clindamycin kumachepetsa (T_1/2 mwa akulu - maola 3-5. Sichikupanga.

Ndi intravaginal makonzedwe a 100 mg ya clindamycin phosphate mu 2% ya kirimu maliseche 1 nthawi patsiku kwa masiku 7 mwa amayi 5 omwe ali ndi bakiteriya wa m'magazi, mayamwidwe amtundu anali pafupifupi 5% (pamlingo wa 2-8%) ya mlingo womwe umayendetsedwa. Makhalidwe a C_max tsiku loyamba - pafupifupi 13 ng / ml (kuyambira 3 mpaka 34 ng / ml), patsiku la 7 - avareji ya 16 ng / ml (kuyambira 7 mpaka 26 ng / ml), T_max - pafupifupi maola 16 (pamtunda wa maola 8-24) mutatha kugwiritsa ntchito. Pogwiritsa ntchito mobwerezabwereza intravaginal, kuphatikiza kwadongosolo kunalibe kapena kunalibe. T_1/2 ndi mayamwidwe zokhudza zonse - maola 1.5-2.6

Mukamagwiritsa ntchito clindamycin phosphate kudzera m'mitsempha ya 100 mg kamodzi patsiku kwa masiku atatu, pafupifupi 30% (6-70%) ya mlingo womwe umayendetsedwa umalowetsedwa mu systemic kufalitsa, ndi AUC ya 3.2 μg / h / ml (0.42-11 μg / h / ml). C_max anakwanitsa pafupifupi maora 5 (maora 1-10) atayang'anira nyini yowonjezera.

Ikagwiritsidwa ntchito ngati gel osafunsira kunja kwa clindamycin, phosphate imathiriridwa mofulumira ndi ma phosphatases mu ma ducts a sebaceous glands ndikupanga clindamycin. Geluli imatha kumizidwa mu zochuluka zomwe zimayambitsa zotsatira zama systemic.

Omvera ku clindamycin mu vitro tizilombo totsatirazi: aerobic gram zabwino cocci, kuphatikiza Staphylococcus aureus, Staphylococcus ep> kuphatikiza Zomera zomwe zimapanga ndipo sizipanga penicillinase ( mu vitro Kukula msanga kwa kukokana kwa clindamycin mu ena a staphylococcal erythromycin kugonjetsedwa kwa zovuta kunkadziwika), Streptococcus spp. (kupatula Streptococcus faecalis), Pneumococcus spp., anaerobic gram-hasi bacilli, kuphatikiza Bactero> kuphatikiza gulu B. fragilis ndi gulu B. melaninogenicus), Fusobacterium spp., non-spore anaerobic gram-positive bacilli, kuphatikizapo Propionibacterium spp., Eubacterium spp., Actinomyces spp., anaerobic ndi microaerophilic gram zabwino cocci, kuphatikiza Peptococcus spp.,Peptostreptococcus spp., Microaerophilic Streptococcus spp., Clostridia spp. (Clostridia imalephera kugonjetsedwa ndi clindamycin kuposa anaerobes ena ambiri). Kwambiri Clostridium perfringens chidwi ndi clindamycin, koma mitundu ina, mwachitsanzo C. sporogenes ndi C. tertium, Nthawi zambiri kugonjetsedwa ndi clindamycin, kotero, kuyesa kwa kuzindikira ndikofunikira.

Mlingo wambiri, umagwira pa protozoa ina (Plasmodium falciparum).

Kutsutsana kwa mtanda pakati pa clindamycin ndi lincomycin ndi kutsutsana pakati pa clindamycin ndi erythromycin kwawonetsedwa.

M'mikhalidwe mu vitro clindamycin ikugwira ntchito motsutsana ndi zovuta zingapo zotsatirazi zomwe zimayambitsa bakiteriya vaginosis: Gardnerella vaginalis, Mobiluncus spp., Mycoplasma hominis, Bacteroides spp., Peptostreptococcus spp. Clindamycin yogwiritsira ntchito intravaginal sagwiritsa ntchito mankhwalawa a venvovaginitis amayamba Trichomonas vaginalis,Chlamydia trachomatis,Neisseria gonorrhoeae, Candida albicans kapena kachilombo Herpes simplex.

Mphamvu yotsutsa ziphuphu zakumaso yogwiritsa ntchito kunja mwina ndi chifukwa chakuti clindamycin imachepetsa kuchuluka kwa mafuta a pakhungu ndi kuletsa kubereka Propionibacterium acnes - An anaerobic opezeka mu sebaceous tiziwalo thunzi thunzi tating'onoting'ono. Kuzindikira kwa zovuta zonse zofufuzidwa kumawonetsedwa. P. acnes clindamycin mu vitro (MIC 0.4 μg / ml).

Carcinogenicity, mutagenicity, zimabweretsa chonde

Kafukufuku wazinyama wamtundu wowerengeka kuti awone kuyipa kwa clindamycin sanachitike. Zochita za Mutagenic pamayeso a Ames ndi mayeso a micronuclear m'makoma sizinapezeke. Zotsatira zoyipa pakubala komanso kukhwima zimawonedwa mu makoswe omwe amalandila clindamycin pamlomo waukulu mpaka 300 mg / kg / tsiku (pafupifupi 1.6 nthawi kuposa MPD molingana ndi mg / m 2).

Mimba Pakufufuza kwa kubereka mu nyama (makoswe, mbewa) pogwiritsa ntchito Mlingo wa pamlomo wa clindamycin mpaka 600 mg / kg / tsiku (3,2 ndi 1.6 pafupipafupi ma MPD molingana ndi mg / m 2, motsatira) kapena sc mu Mlingo mpaka mpaka 250 mg / kg / tsiku (1.3 ndi 0,7 nthawi zambiri kuposa MPDC malinga ndi mg / m 2, motsatana) palibe teratogenic zotsatira zomwe zapezeka. Poyeserera kamodzi pa mbewa, kanyumba kamkati kadadziwika kuti mwana wakhanda (zotsatira zake sizinatsimikizidwe poyesa nyama zina ndi mizere ina ya mbewa).

Mimba komanso kuyamwa

Pakati pa nthawi yayitali, ndizotheka ngati chiyembekezo chamankhwala chikuyembekezeka kupitilira chiwopsezo cha mwana wosabadwayo (panalibe maphunziro okwanira komanso okhwima mwamphamvu mwa amayi apakati, clindamycin imadutsa mwa placenta ndipo imatha kuyang'ana kwambiri m'chiwindi cha fetal, koma sipanakhale zovuta zina mwa anthu). Kafukufuku sanawone ngati chithandizo cha bakiteriya vaginosis chimachepetsa chiopsezo cha zotsatira zoyipa monga kupwetekedwa kwamkati, kumayambiriro kwa ntchito, kapena kubereka musanakwane.

FDA Fetal Action Gulu - B.

Chenjezo liyenera kugwiritsidwa ntchito mukamayamwitsa (sizikudziwika ngati clindamycin imadutsa mkaka wa m'mawere pambuyo pakugwiritsidwa ntchito kwakunja ndi intravaginal, koma imapezeka mkaka wa m'mawere pambuyo pakulankhula kwapakamwa kapena kwa makolo).

Pharmacodynamics ndi pharmacokinetics

Clindamycin imalowa bwino m'mawu onse amadzimadzi, zofewa za thupi ndi mafupa. Mankhwala amalepheretsa kuphatikiza kwa mapuloteni m'maselo a tizilombo tating'onoting'ono, ndikuwonetsa bacteriostatic ndi bactericidal. Pali mabakiteriya angapo omwe amalimbana ndi maantibayotiki:

Matenda oyambitsidwa ndi mabakiteriya

mabakiteriya a unicellular flagellar

meningitis, bacteremia, dysbiosis

botulism, kafumbata, gululi, chakudya cham'mimba

Pazipita kuchuluka kwa achire mu magazi ndi pakamwa makonzedwe amayang'aniridwa mwachangu kuposa ndi mu mnofu makonzedwe. Chithandizo chogwira ntchito chimalowa m'magazi pambuyo pake patatha maola atatu ndi atatu. Pofika m'dera lomwe muli kachilombo, limasungidwa m'thupi kwa pafupifupi maola 12, pomwe pafupifupi 90% ya chinthucho chimamangiriza mapuloteni a tizilombo tating'onoting'ono. Kafukufuku wazachipatala sanawululire kuchuluka kwa zomwe zimagwiritsidwa ntchito ndi mankhwalawa. Amakonzedwa ndi chiwindi. Ma metabolabol amapukusidwa kwathunthu pambuyo masiku 4 ndi mkodzo, bile ndi ndowe.

Mlingo ndi makonzedwe

Chithandizo cha antibiotic choyang'aniridwa ndi dokotala. Kusankhidwa kwa mawonekedwe a mankhwalawa, kuchuluka kwake ndi nthawi yoyang'anira, zimatengera:

zaka odwala
moyo wake
madera oyambitsa matenda,
kuopsa kwa matendawa.
kudziwa kwa tizilomboti kuti tigwire mankhwala.

Kwa matenda obwera ndi ukazi, maantibayotiki amtundu wa kirimu amathandizidwa kuti azigwiritsa ntchito. Wofunafuna woyezera (wophatikizidwa) umayikidwa pa chubu cha kirimu ndikudzaza nawo. Kuti muchite izi, kanikizani chubu popanda kukoka pisitoni ya wolemba. Mlingo umodzi wa mankhwalawa (5 mg) umalowetsedwa mu nyini kamodzi patsiku asanagone. Kutalika kwa chithandizo ndi masiku 7.

Kwa akulu, yankho la jakisoni wa intramuscular (intravenous) limagwiritsidwa ntchito kawiri pa tsiku, 300 mg aliyense. Ndi matenda oopsa a matendawa, kuchuluka kwa mankhwalawa tsiku lililonse kwa 2700 mg ndikotheka. Imagawidwa majekeseni atatu. Pankhaniyi, kasitomala amodzi sayenera kupitirira 600 mg. Ana kuyambira azaka 3 amafunsidwa 15-25 mg pa 1 makilogalamu kulemera kwake ndipo amagawidwa m'magawo ofanana kukhala jakisoni 3-4. Mu matenda oopsa, mlingo wa ana umakulitsidwa mpaka 40 mg patsiku.

Kuti mugwiritse ntchito intravenous, mankhwalawa amadzipaka ndi yankho la 0.9% sodium chloride kapena 5% dextrose kufikira ndende yoposa 6 mg / ml. Zotsatira zake zimayendetsedwa kuchokera kwa mphindi 10 mpaka 60 (kutengera mlingo). Mulingo wovomerezeka wa gawo limodzi la intravenous makonzedwe ndi 1.2 g. Ngati gawo la maola 8 pakati pa omwe akutsikira likuwoneka, odwala omwe ali ndi vuto la impso (hepatic) ndi omwe amapatsidwa mlingo woyenera wa antiotic.

Ana osakwana zaka 12 sagwiritsidwa ntchito ndi mankhwala a kapisozi. Mlingo wa odwala a misinkhu ina ndi motere:

Chiwerengero cha madyerero patsiku

Kuchuluka kwa matendawa, kuchuluka kwa makapisozi (ma PC).

Zambiri za matendawa, kuchuluka kwa makapisozi (ma PC).

Clindamycin suppositories amagwiritsidwa ntchito pochiza 1 nthawi patsiku asanagone. Mu supine udindo, ndikofunikira kusungitsa zowonjezera mkati mwa nyini. Maphunzirowa ndi masiku 3-7.

Njira zotupa pakhungu lokhala ndi mabakiteriya zimayendera limodzi ndi zotupa mu mawonekedwe a ziphuphu. Kwa matenda apakhungu, dokotala atha kukulemberani mankhwala othandizira ndi ma gel osakaniza a antibayotiki munthawi yomweyo. Mafuta onga ngati gel ali ndi clindamycin amagwiritsidwa ntchito panja. Gilal imayikidwa mu wochepa thupi pa ziphuphu zakumaso ndi malo okhala ndi zotupa pambuyo poyeretsa khungu.

Muubwana

Ana osakwana zaka 8 amapatsidwa mankhwala opaka pakamwa ngati madzi. Kukonzekera kwa granular kumapangidwira kudzikonzekera nokha kwa madzi (kuyimitsidwa). Vala yokhala ndi granules iyenera kudzazidwa ndi 60 ml ya madzi ndikugwedezeka bwino. Kuwerengera mlingo wa mankhwalawa kutengera kulemera kwa thupi ndi msinkhu wa mwana. Mlingo wa tsiku ndi tsiku wa ana wamkulu kuposa mwezi umodzi ndi 8-25 mg wa kilogalamu imodzi ya kulemera, wogawidwa mu 4 waukulu. Mlingo wochepera wa ana olemera osakwana 10 makilogalamu ndi 37 mg (1/2 supuni) maola 8 aliwonse.

Maantibayotiki amaperekedwa kwa kholo kwa ana:

Kuyanjana kwa mankhwala osokoneza bongo

Clindomycin, akamagwiritsa ntchito mankhwala ena, nthawi zina amakhala ndi zotsutsana ndi thupi la wodwalayo. Izi ziyenera kuganiziridwa popereka mankhwala osokoneza bongo:

Zosagwirizana ndi barbiturates. Kugwiritsa ntchito limodzi mankhwala kumaletsedwa.
Imakulitsa kupumula kwamatumbo chifukwa cha n-anticholinergic blockers.
Ndikotsutsana ndi erythromycin ndi chloramphenicol.
Kugwirizana ndi Fortum kumakhala ndi poizoni.
Imawonjezera zochita za aminoglycosides.
Ndi mankhwala a antidiarrheal angayambitse pseudomembrane colitis.
Zimachepetsa kupuma (mpaka pa ziphuphu) zikagwiritsidwa ntchito limodzi ndi ma analgesic kukonzekera kwa mndandanda wa opium.
Zosagwirizana ndi kukonzekera kwanyini.

Migwirizano yogulitsa ndikusunga

Clindamycin mu mitundu yonse akhoza kugulidwa ku pharmacies ndi mankhwala. Sungani pamalo owuma, amdima osawonekera kwa ana. Alumali moyo wa mankhwalawa mu mawonekedwe a:

Njira yothetsera kulowetsedwa kwa mtsempha - mnofu - zaka 2 kuyambira tsiku lopangira (zomwe zikuwonetsedwa pazokwera komanso phukusi),
makapisozi - zaka 3,
kirimu - zaka 2,
makandulo - zaka 3.

Ngati kugwiritsa ntchito clindamycin sikutheka pazifukwa zina, dokotala amafotokoza mitundu yake:

Klindatop. Topical gel osakaniza zochizira mitundu yosiyanasiyana ya ziphuphu.
Klimitsin. Amakhala mu mawonekedwe a granules pakukonzekera madzi a ana ndi jakisoni.
Dalacin. Amapezeka mu mawonekedwe a makapisozi, jakisoni, ma granules, gel, kirimu wa vaginal ndi suppositories.
Zerkalin. Mankhwala ochizira ziphuphu.