Amoklav-375: malangizo ogwiritsira ntchito

375 mg ndi mapiritsi okhala ndi mafilimu a 625 mg

Piritsi limodzi lili

ntchito: amoxicillin monga amoxicillin trihydrate 250 mg, clavulanic acid monga potaziyamu clavulanate 125 mg (kwa 375 mg) kapena amoxicillin ngati amoxicillin trihydrate 500 mg, clavulanic acid monga potaziyamu clavulanate 125 mg (kwa 625 mg),

obwera: colloidal silicon dioxide, crospovidone, croscarmellose sodium, magnesium stearate, talc, microcrystalline cellulose,

makanema ojambula: hydroxypropyl cellulose, ethyl cellulose, polysorbate, triethyl citrate, titanium dioxide (E 171), talc.

Mapiritsi, atakulungidwa ndi chipolopolo cha zoyera kapena pafupifupi zoyera, octagonal mawonekedwe okhala ndi biconvex kumtunda, olembedwa ndi "250/125" mbali imodzi ndi "AMS" mbali inayo (kwa mulingo wa 250 mg + 125 mg).

Mapiritsi, okhala ndi film, oyera kapena pafupifupi oyera, oval okhala ndi biconvex kumtunda (kwa mlingo wa 500 mg + 125 mg).

Mankhwala

Pharmacokinetics

Amoxicillin ndi clavulanic acid amasungunuka kwathunthu mu madzi amchere pH ya thupi. Zonsezi ndizoyamwa bwino pakamwa. Mulingo woyenera kumwa amoxicillin / clavulanic acid mukadzayamba kudya. Pambuyo pakamwa, bioavailability wa amoxicillin ndi clavulanic acid pafupifupi 70%. Mphamvu ya kuchuluka kwa mankhwalawa mu plasma ya zigawo zonse ziwiri ndi zofanana. Pazambiri za seramu ndizodziwikiratu zimafikira ola limodzi pambuyo pa kukhazikitsa.

Mphamvu ya amoxicillin ndi clavulanic acid mu seramu ya magazi mukamamwa mankhwala a amoxicillin / clavulanic acid ndi ofanana ndi omwe amadziwika ndi pakamwa pokhapokha ngati gawo limodzi la amoxicillin ndi clavulanic acid.

Pafupifupi 25% ya kuchuluka kwathunthu kwa clavulanic acid ndi 18% ya amoxicillin amamangiriza mapuloteni a plasma. Kuchuluka kwa magawa pakamwa pakumwa mankhwala pafupifupi 0.3-0.4 l / kg wa amoxicillin ndi 0,2 l / kg wa clavulanic acid.

Pambuyo pokonzekera mtsempha wamagazi, onse amoxicillin ndi clavulanic acid adapezeka mu chikhodzodzo, mafinya am'mimbamo, khungu, mafuta, minofu minofu, zotumphukira ndi zotumphukira zam'mimba, bile ndi mafinya. Amoxicillin amalowa bwino mu madzi a cerebrospinal.

Amoxicillin ndi clavulanic acid amawoloka placental zotchinga. Zinthu zonsezi zimadutsanso mkaka wa m'mawere.

Amoxicillin amachotsekera pang'ono mu mkodzo wofanana ndi penicillic acid wofanana ndi 10 - 25% ya mlingo woyambirira. Clavulanic acid imapangidwa m'thupi ndi kuponyera mkodzo ndi ndowe, komanso mpweya wa mpweya wothira mpweya.

Kuchulukitsa kwapakati theka la moyo wa amoxicillin / clavulanic acid ndi pafupifupi ola limodzi, ndipo kuvomerezeka kokwanira pafupifupi 25 l / h. Pafupifupi 60-70% ya amoxicillin ndi 40-65% ya clavulanic acid amachotsedwa mu mkodzo mkati mwa maola 6 atatha kumwa kamodzi pa mapiritsi a amoxicillin / clavulanic acid. Pa maphunziro osiyanasiyana, zidapezeka kuti 50-85% ya amoxicillin ndi 27-60% ya clavulanic acid amachotsedwa mkodzo mkati mwa maola 24. Kuchuluka kwacrosulanic acid kumachotsedwa pakatha maola 2 mutatha ntchito.

Kugwiritsa ntchito pamodzi kwa phenenecid kumachepetsa kutulutsidwa kwa amoxicillin, koma mankhwalawa samakhudza kutuluka kwa clavulanic acid kudzera mu impso.

Hafu ya moyo wa amoxicillin imakhala yofanana mwa ana a zaka zitatu mpaka ziwiri, komanso mwa ana achikulire ndi akulu. Popereka mankhwala kwa ana aang'ono kwambiri (kuphatikiza ana akhanda) m'milungu yoyamba ya moyo, mankhwalawa sayenera kuperekedwa kawiri patsiku, omwe amalumikizidwa ndi kusakhazikika kwa njira ya impso kwa ana. Chifukwa chakuti okalamba omwe ali ndi vutoli amatha kuvutika ndi vuto la impso, mankhwalawa ayenera kuyikidwa mosamala ku gulu la odwala, koma ngati kuli kotheka, kuyang'anira ntchito yaimpso kuyenera kuchitika.

Chilolezo chonse cha amoxicillin / clavulanic acid m'madzi am'magazi amachepetsa mwachindunji kuchepa kwa impso. Kuchepa kwa chilolezo cha amoxicillin kumanenedweratu poyerekeza ndi clavulanic acid, chifukwa kuchuluka kwa amoxicillin kumathandizidwa kudzera mu impso. Chifukwa chake, popereka mankhwala kwa odwala omwe amalephera aimpso, kusintha kwa mankhwalawa ndikofunikira kuti muchepetse kuchuluka kwa amoxicillin ndikukhalabe wofunikira clavulanic acid.

Popereka mankhwala kwa odwala omwe ali ndi vuto la chiwindi, muyenera kusamala posankha mlingo ndikuwonetsetsa ntchito ya chiwindi.

Mankhwala

Amoxicillin ndi mankhwala opanga ma cell kuchokera ku penicillin gulu (beta-lactam antiotic) lomwe limalepheretsa ma enzyme amodzi kapena angapo (omwe nthawi zambiri amatchedwa ma penicillin-binding protein) omwe amaphatikizidwa ndi biosynthesis ya peptidoglycan, yomwe ndi gawo lofunikira kwambiri mwa khoma la bakiteriya. Kuletsa kwa peptidoglycan synthesis kumayambitsa kufooka kwa khungu la cell, nthawi zambiri kumatsatiridwa ndi lysis l cell ndi cell cell.

Amoxicillin amawonongeka ndi beta-lactamases opangidwa ndi mabakiteriya osagwira, chifukwa chake zochitika za amoxicillin zokhazokha sizimaphatikizapo tizilombo tating'onoting'ono timene timatulutsa ma enzymes amenewa.

Clavulanic acid ndi beta-lactam mwapangidwe kogwirizana ndi penicillin. Imalepheretsa ma beta-lactamase, potero kuletsa kuyatsidwa kwa amoxicillin ndikukulitsa zochitika zake. Clavulanic acid yokha ilibe mphamvu yokhudza antibacterial.

Kuchulukitsa nthawi yopitilira muyeso wosachepera (T> IPC) imawerengedwa kuti ndiyo yofunika kwambiri pakuwonetsa mphamvu ya amoxicillin.

Njira ziwiri zomwe zingalimbane ndi amoxicillin ndi clavulanic acid ndi:

inactivation ndi bacteria beta-lactamases omwe saponderezedwa ndi clavulanic acid, kuphatikiza makalasi B, C ndi D.

kusintha kwa mapuloteni omangira penicillin, omwe amachepetsa kuyanjana kwa antibacterial wothandizila ku pathogen yomwe akufuna.

Kusakhudzidwa kwa mabakiteriya kapena njira ya pampu ya efflux (kayendedwe ka zinthu) kumatha kuyambitsa kapena kupitiliza kulimbana ndi mabakiteriya, makamaka mabakiteriya osagwiritsa ntchito gramu.

Mfundo za MIC zokhala amoillillin / clavulanic acid ndizomwe zimatsimikiziridwa ndi Komiti ya European for Testing of Antimicrobial Sensitivity (EUCAST).

Zizindikiro zogwiritsidwa ntchito

Amoklav akuwonetsedwa pochiza matenda otsatirawa mwa akulu ndi ana:

• pachimake bakiteriya sinusitis (wapezeka wokwanira)

• Kutupa kwa tinthu tating'onoting'ono

• Misozi yayikulu yam mano ndi kufalikira kwa kutukusira kwa minofu yaying'ono. Malangizo apadera ogwiritsira ntchito antibacterial mankhwala ayenera kuganiziridwanso.

Mlingo ndi makonzedwe

Mlingo umatchulidwa malinga ndi zomwe amamwaillillin / clavulanic acid pokonzekera, pokhapokha mulingo umayikidwa kutengera zomwe zili muzolemba zina.

Posankha mtundu wa Amoclav pochiza matenda amwini, izi ziyenera kuganiziridwa:

• Tizilombo toyambitsa matenda tosakayikitsa komanso chidwi chawo ndi mankhwala othandizira (onani "Precautions")

• kukula ndi kutengera kwa matenda

• Age, kulemera, ndi impso ntchito ya wodwalayo.

Ngati ndi kotheka, mungathe kugwiritsa ntchito Mlingo wina wa Amoklav (kuphatikizapo milingo yapamwamba ya amoxicillin ndi / kapena magawo ena a amoxicillin ndi clavulanic acid) (onani "Precautions").

Kwa akulu ndi ana olemera makilogalamu 40 kapena kupitirira apo, mlingo wa tsiku ndi tsiku wa Amoklav-375 ndi 750 mg wa amoxicillin / 375 mg wa clavulanic acid mukamagwiritsidwa ntchito molingana ndi malangizo omwe ali pansipa. Ngati ndi kotheka kugwiritsa ntchito mankhwala apamwamba tsiku ndi tsiku a amoxicillin, kugwiritsa ntchito njira zina za Amoklav tikulimbikitsidwa kuti musatenge mlingo waukulu wa clavulanic acid (onani "Precautions").

Akuluakulu ndi ana olemera makilogalamu 40 ndi piritsi limodzi 250 mg / 125 mg katatu patsiku.

Ana masekeli zosakwana 40 kg

Kwa ana omwe ali ndi thupi lolemera zosakwana 40 makilogalamu, mapiritsi a Amoklav-375 amatchedwa:

Odwala okalamba Kusintha kwa Mlingo sikofunikira.

Odwala ndi mkhutu aimpso ntchito

Kusintha kwa Mlingo wokhazikika pazotsatira zoyenera za amoxicillin.

Odwala omwe ali ndi creatinine clearance value (CrCl) yoposa 30 ml / min, kusintha kwa mankhwala sikofunikira.

Ana masekeli zosakwana 40 kg

Kwa ana omwe ali ndi thupi lolemera zosakwana 40 makilogalamu ndi mtundu wa creatinine chilolezo chochepera 30 ml / min, kuyang'anira Amoclav-375 ndi amoxicillin / clavulanic acid chiyezo cha 2: 1 osavomerezeka, popeza kuti palibe mwayi wa kusintha kwa mlingo. Kwa odwala oterewa, Amoclav yokhala ndi amoxicillin / clavulanic acid pazomwe 4: 1 ikulimbikitsidwa.

Odwala omwe ali ndi vuto la chiwindi

Chithandizo chimachitika mosamala; chiwindi chimayang'aniridwa nthawi zonse (onani "Contraindication" ndi "Precautions").

Amoklav anafuna kuti azigwiritsa ntchito pakamwa.

Ndikulimbikitsidwa kuti mumwe mankhwalawa koyambirira kwa chakudya kuti muchepetse kusokonezeka kwa m'mimba ndikuwongolera mayamwidwe a amoxicillin / clavulanic acid.

Bongo

Mwina kukula kwa zizindikiro kuchokera m'matumbo am'mimba, komanso kuphwanya kwamphamvu yamagetsi yamagetsi. Milandu yokhudzana ndi amoxicillin yokhudzana ndi crystalluria imawonedwa, nthawi zina imapangitsa kuti kulephera kwa impso.

Odwala omwe ali ndi vuto laimpso kapena amalandila mankhwala okwanira amatha kudwala. Kwa zizindikiro zam'mimba, chithandizo chamankhwala chimatha kuperekedwa pamodzi ndi kubwezeretsa bwino-electrolyte bwino. Amoxicillin ndi potaziyamu clavulanate amatha kuwonjezeranso ndi hemodialysis.

Kuchita ndi mankhwala ena

Milandu yowonjezera kuchuluka kwachulukidwe padziko lonse lapansi (INR) mwa odwala omwe amalandila chithandizo cham'mimba ndi acenocoumarol kapena warfarin motsutsana ndi njira yokhazikitsidwa ya amoxicillin akufotokozedwa. Ngati ndi kotheka, munthawi yomweyo makonzedwe a mankhwala amayang'anira mosamala nthawi ya prothrombin kapena INR koyambirira kwa chithandizo ndipo atamaliza kuthandizira ndi amoxicillin. Kusintha kwa mlingo wa anticoagulants pamlomo kungafunike.

Penicillins amatha kuchepetsa kuchulukitsidwa kwa methotrexate, komwe kumayendera limodzi ndi kawopsedwe.

Kugwiritsa ntchito pamodzi nthawi imodzi ya phenenecide sikulimbikitsidwa. Amachepetsa secretion wa amoxicillin mu aimpso tubules. Kugwiritsira ntchito pamodzi kwa phenenecid ndi Amoclav kungayambitse kuchuluka kwa magazi a amoxicillin (koma osati clavulanic acid) ndi kukonzanso kwawo kwakanthawi.

Njira zopewera kupewa ngozi

Musanayambe chithandizo ndi Amoclave, ndikofunikira kusanthula mwatsatanetsatane zamankhwala zokhudzana ndi zovuta zam'mbuyomu za penicillins, cephalosporins kapena kukonzekera kwina kwa beta-lactam.

Zoopsa komanso nthawi zina zowopsa za hypersensitivity reaction (anaphylactoid reaction) zimawonedwa pamankhwala a penicillin. Nthawi zambiri amakula mwa odwala omwe ali ndi vuto la hypersensitivity ku penicillin komanso mbiri ya atopy. Ngati matendawo apsa, mankhwala a Amoclav amachotsedwa ndipo mankhwala ena oyenera a antibacterial amadziwika.

Pankhani ya chiwopsezo cha matenda opatsirana ku amoxicillin, ayenera kuganiziranso za kusintha kuchokera ku Amoclav kupita amoxicillin malinga ndi malangizo a boma.

Mlingo wamtunduwu wa mankhwalawa ndi wosayenera kugwiritsidwa ntchito ngati pali chiopsezo chambiri kuti ma pathogen omwe akuwakayikira akukana mankhwala a beta-lactam osayanjanitsidwa ndi beta-lactamase omwe amawonetsetsa mphamvu ya clavulanic acid. Popeza palibe zambiri zachinsinsi za T> IPC (kuchuluka kwakanthawi kovomerezeka), ndipo zotsatira za kuwunika mitundu ya milomo yofananira ndizofunika kwambiri pamalire, fomu iyi ya Mlingo (wopanda amoxicillin) siyingakhale yoyenera kuchitira matenda omwe amayamba chifukwa cha penicillin-eSpheumoniae.

Odwala ndi mkhutu aimpso ntchito kapena angayambidwe. Amoclav chithandizo chikuwonetsa matenda opatsirana mononucleosis, popeza pambuyo poti matendawa agwiritse ntchito, mawonekedwe a chotupa chikuwoneka.

Kugwiritsanso ntchito kwa allopurinol pa mankhwala a amoxicillin mwina kumawonjezera mwayi wokhala khungu lomwe siligwirizana.

Kugwiritsa ntchito mankhwalawa kwa nthawi yayitali kumatha kupangitsa kuti pakhale michere yambiri.

Kukhazikika kwa erythema wamatenda oyambitsidwa ndi malungo ndi mapangidwe a ma pustule koyambirira kwa chithandizo cha mankhwala ndi chizindikiro champhamvu kwambiri ya puteulosis pustulosis (OGEP) (onani "Zotsatira zoyipa"). Kuchita kumeneku kumafuna kutha kwa chithandizo cha mankhwala ndi Amoclave ndipo kuphwanya kwa mapangidwe a amoxicillin wotsatira.

Chithandizo cha odwala omwe ali ndi vuto la chiwindi chimachitika mosamala.

Zochitika zolakwika kuchokera ku chiwindi zimawonedwa makamaka mwa abambo ndi odwala okalamba ndipo zimatha kuyanjana ndi chithandizo cha nthawi yayitali. Zochitika zoyipa izi zomwe zimachitika kawirikawiri zimawonedwa mwa ana.

M'magulu onse a odwala, zizindikiro ndi zizindikiro nthawi zambiri zimakhazikika pakanthawi kochepa chithandizo, koma nthawi zina zimawonekera pakangotha ​​masabata ochepa atasiya kulandira chithandizo. Nthawi zambiri amasinthidwa. Pali zovuta zingapo za chiwindi zomwe zimachitika, kawirikawiri kwambiri zomwe zimapha. Nthawi zambiri zimawonedwa pakati pa odwala omwe ali ndi matenda oopsa kapena kumwa mankhwala omwe angakhudze chiwindi (onani "Zotsatira Zotsatira").

Milandu ya colitis yokhudzana ndi maantibayotiki yomwe imapezeka pakumwa mankhwala pafupifupi mankhwala onse a antibacterial, kuphatikiza amoxicillin, imatha kusiyanasiyana kuyambira paukali kufikira pakuwopseza moyo (onani "Zotsatira zoyipa").

Ndikofunika kuunikira za matenda omwe ali ndi matenda otsegula m'mimba nthawi yomwe amamaliza kapena atamaliza. Pankhani ya kukula kwa colitis yokhudzana ndi maantibayotiki, chithandizo cha Amoclave chimayimitsidwa nthawi yomweyo, funsani dokotala ndikupereka chithandizo choyenera. Muno, kugwiritsa ntchito mankhwala omwe amaletsa peristalsis amatsutsana.

Pa chithandizo cha nthawi yayitali, kuwunikira kwakanthawi kachitidwe ka ziwalo zosiyanasiyana, kuphatikizapo impso, chiwindi ndi ziwalo zopanga magazi, ndikofunikira.

Nthawi zina, mukamamwa mankhwalawa, kuwonjezera kwa nthawi ya prothrombin kunadziwika. Ndi makonzedwe omwewo a anticoagulants, kuwunika koyenera kwa chizindikiro cha kuphatikizika ndikofunikira. Kusintha kwa mlingo wa anticoagulants pamlomo kungafunike kuti mukwaniritse gawo lomwe mukufuna.

Odwala omwe ali ndi vuto la impso, kusintha kwa mankhwalawa kumafunikira malinga ndi kuchuluka kwa kusakwanira (onani "Mlingo ndi Ulamuliro").

Odwala ochepetsedwa diuresis, crystalluria sichinkawonetsedwa kwenikweni, makamaka motsutsana ndi maziko a chithandizo cha makolo.Pa chithandizo chachikulu cha mankhwala a amoxicillin, kuthira madzi okwanira kumalimbikitsidwa kuti muchepetse mwayi wa mankhwala ogwirizana ndi amoxicillin. Odwala omwe ali ndi catheter woyika mu chikhodzodzo, ndikofunikira kuwunika nthawi zonse mawonekedwe ake. Pakupanga kwa shuga Kukhalapo kwa clavulanic acid ku Amoklava kumatha kuyambitsa kusakhazikika kwa IgG ndi albumin kumimba ya erythrocyte, zomwe zimatha kubweretsa zotsatira zabodza zabodza pa mayeso a Coombs.

Pakhala pali zochitika za enzyme yolumikizidwa modunosorbent assay (ELISA) ya Aspergillus odwala omwe amalandila mankhwalawa, omwe pambuyo pake adatsimikiza kusapezeka kwa matenda oyambitsidwa ndi Aspergillus. Zotsatira zamtanda ndi nonaspergillic

polysaccharides ndi polyfuranoses monga gawo la mayeso a ELISA pa Aspergillus. Zotsatira zabwino zoyeserera kwa odwala omwe amatenga Amoklav ziyenera kutanthauziridwa mosamala ndikutsimikiziridwa ndi njira zina zodziwira matenda.

Mlingo wa ana

Kwa odwala ang'onoang'ono, mlingo wa tsiku ndi tsiku wa Amoxiclav nthawi zonse umawerengeredwa potengera patebulo potsatira malangizo:

• mpaka miyezi itatu, Amoxiclav amawerengera kuchuluka kwa kulemera kwa 30 mg / 1 kg patsiku, logawidwa pazidutswa zitatu patsiku,
• kuyambira miyezi itatu mpaka zaka 12, mlingo wa tsiku ndi tsiku amawerengedwa malinga ndi formula 20 mg / 1 makilogalamu kulemera kwambiri, kapena 40 mg / 1 kg pa matenda oopsa, kuchuluka kwa mankhwalawo kumagawika magawo atatu ndikupatsidwa pafupipafupi,
• Kuyambira wazaka 12, ana amatha kumwa mankhwala akuluakulu.

Kutalika kwa mankhwala kwa ana nthawi zambiri sikuyenera kupitirira masiku 5-7. Ili ndi theka la achikulire. Ngati ndi kotheka, dokotalayo amatha kuwonjezera njira ya mankhwala opha maantibayotiki.

Ndemanga za Amoxiclav

Ndemanga zambiri za Amoxiclav ndizabwino. Pafupifupi mukangomwa mankhwalawo, zizindikiro zimafooka, mavuto ake amakhala ofatsa kapena osapezeka konse. Nthawi zina, odwala okalamba komanso odwala matenda a impso adandaula za edema, zomwe zikuwonetsa kuti ziwalo zake sizigwira bwino ntchito. Izi sizimawoneka ngati zabwinobwino, makamaka mukaganiza kuti iwo achulukitsa asidi wambiri. Nthawi yomweyo, mankhwalawa amawonjezera mphamvu yake, zizindikiro za mankhwala osokoneza bongo zitha kuonekera. Kuti izi zisachitike, njira zodzitetezera ziyenera kumwedwa - imwani madzi ambiri ndikuwona dokotala pafupipafupi.