Ciprofloxacin: malangizo ogwiritsira ntchito

Mapiritsi a Ciprofloxacin ndi othandizira antibacterial a gulu la fluoroquinolone. Amagwiritsidwa ntchito pochiza matenda osiyanasiyana opatsirana omwe amapezeka ndi mabakiteriya omwe amagwira ntchito pazomwe zimagwiritsidwa ntchito ndi mankhwalawa.

Mlingo mawonekedwe, zikuchokera

Mapiritsi a Ciprofloxacin amaphatikizidwa ndi filimu yophimba ndi enteric. Amakhala ndi mtundu woyera komanso wosalala. Chofunikira chachikulu pa mankhwalawa ndi chiprofloxacin. Zomwe zili mu piritsi limodzi ndi 250 ndi 500 mg. Komanso, momwe zimapangidwira zimaphatikizapo zinthu zothandiza, zomwe zimaphatikizapo:

Colloidal silicon anhydrite.
Povidone.
Methylene chloride.
Microcrystalline cellulose.
Magnesium wakuba.
Isopropyl mowa.
Hydroxypropyl methylcellulose.
Talc Wotsukidwa.
Sodium wowuma glycolate.

Mapiritsi a Ciprofloxacin amawaika mu paketi yolumikizana ya zidutswa 10. Phukusi la makatoni limakhala ndi chithuza chimodzi ndi mapiritsi, komanso malangizo ogwiritsira ntchito.

Zochizira

Gawo lalikulu la mapiritsi a profrofloxacin ndi a antibacterial othandizira a gulu la fluoroquinolone. Imakhala ndi bactericidal zotsatira, zomwe zimatsogolera ku kufa kwa mabakiteriya achilengedwe. Kuchita izi kumadziwika ndikumapondereza zochita za mabakiteriya enzyme ya DNA gyrase. Izi zimabweretsa kusokonezeka kwa kubwereza (kuwirikiza) kwa DNA ndi kufa kwa khungu la bakiteriya. Mankhwalawa ali ndi ntchito yokwanira yolimbana ndi magawo omwe amagwira ma cell mabacteria. Ili ndi bactericidal zotsatira zotsutsana ndi kuchuluka kwa gram-positive (staphylococci, streptococci) ndi gram-negative (E. coli, Pseudomonas aeruginosa, Proteus, Klebsiella, Yersinia, Salmonella, Shigella, Gonococcus). Komanso, mankhwalawa amatsogolera ku kufa kwa mabakiteriya ena omwe ali ndi majeremusi achiberekero (Mycobacterium tuberculosis, Legionella, Mycoplasma, Ureaplasma, Chlamydia). Zochitika za mapiritsi a Ciprofloxacin motsutsana ndi wotumbululuka treponema (the causative agent of syphilis) sizimamveka bwinobwino.

Mutatenga piritsi la profrofloxacin mkati, chigawo chogwira bwinocho chimatengeka bwino kwambiri ndikuzungulira ndikugawika mu minofu, momwe chimathandizira.

Mapiritsi a Ciprofloxacin amawonetsedwa chifukwa cha etiotropic mankhwala (chithandizo chofuna kupha munthu yemwe akupatsirana) matenda osiyanasiyana oyambitsidwa ndi mabakiteriya omwe amayang'ana mbali ya mankhwala:

Kugonjetsedwa kwa chapamwamba, cham'munsi kupumira.
Kutupa kwa mabakiteriya a ziwalo za ENT.
Zofooka za kapangidwe ka kwamikodzo ndi impso.
Matenda amtundu mwachindunji komanso osadziwika.
Matenda opatsirana a m'mimba, kuphatikiza mano ndi nsagwada.
Kutupa kutukusira kutulutsidwa mu ndulu ndi zina zopanda pake a hepatobiliary dongosolo.
Matenda ndi purulent-yotupa njira ya pakhungu, minofu subcutaneous ndi zofewa zimakhala zosiyanasiyana kutanthauzira.
Njira zoyipa zotupa za zotupa za masculoskeletal system, kuphatikizapo osteomyelitis.
Sepsis (kuwonongeka kwa bakiteriya) ndi peritonitis (njira yotupa mu peritoneum).

Mankhwala amagwiritsidwanso ntchito kupewa matenda opatsirana mwa odwala omwe ali ndi kuchepetsedwa kwa chitetezo cha m'thupi.

Contraindication

Mapiritsi a Ciprofloxacin amaponderezedwa pakati pa nthawi iliyonse yamaphunziro, nthawi yoyamwitsa (mkaka wa m'mawere), mwa ana osaposa zaka 18, komanso ngati sangalole ciprofloxacin kapena ena oimira gulu la fluoroquinolone. Asanapereke mapiritsi a ciprofloxacin, dokotala amaonetsetsa kuti palibe zotsutsana.

Mapiritsi a Ciprofloxacin amapangidwira kukonzekera pakamwa pamimba yopanda kanthu. Amameza athunthu, osafunafuna ndikutsukidwa ndi madzi okwanira. Mlingo komanso mtundu wa mankhwalawa zimatengera mtundu wa zovuta za matenda. Popanda zovuta za matenda opatsirana, mapiritsi a chiprofloxacin nthawi zambiri amagwiritsidwa ntchito pa mlingo wa 250 mg kawiri pa tsiku. Mwanjira yovuta kapena yowawa, komanso kuwonongeka kwa mafupa, ziwalo - 500 mg kawiri pa tsiku. Kwa odwala okalamba, komanso motsutsana ndi maziko a kuchepa kwa chizindikiro cha impso, kuchuluka kwa chiwindi kumachepetsedwa. Kutalika kwa nthawi ya maphunzirowa ndi masiku 7 mpaka 7, ndikamatenda kwambiri, matendawa amatha kukula. Nthawi zambiri, adotolo amakhazikitsa njira yodalirika, nthawi ndi nthawi ya maphunziridwe a wodwala aliyense payekhapayekha.

Zotsatira zoyipa

Poyerekeza ndi kutenga mapiritsi a profrofloxacin, kukulitsa zovuta zoyipa kuchokera ku ziwalo ndi machitidwe osiyanasiyana ndizotheka:

Matumbo dongosolo - nseru, limodzi ndi kusanza nthawi, kutsegula m'mimba, kupweteka pamimba, kukula kwa pseudomembranous colitis.
Mitsempha yam'mimba - kupweteka mutu, chizungulire chamtundu wina wosiyanasiyana, kumva kutopa, matenda osiyanasiyana osowa tulo, mawonekedwe a malodza, kukomoka, kusokonezeka kowoneka, kuwunika kapena kuwonera.
Mtima wamitsempha - kuchuluka kwa mtima (tachycardia) ndi kusokonezeka kwa mitsempha (arrhythmia), kutsika kwa magazi (kuchepa kwa magazi).
Njira ya kwamikodzo - kuphwanya kwamikodzo poyerekeza (dysuria, kusungika kwamikodzo), mawonekedwe amakristali (crystalluria), magazi (hematuria) ndi mapuloteni (albuminuria) mu mkodzo, njira zotupa mu impso (glomerulonephritis, interstitial nephritis).
Magazi ndi mafupa ofiira - kuchepa kwa chiwerengero cha leukocytes (leukopenia), mapulateleti (thrombocytopenia), neutrophils (neutropenia) m'magazi, kuchuluka kwa eosinophils (eosinophilia).
Musculoskeletal system - kupweteka kwa kuphatikizika (arthralgia), kunachepa mphamvu ya ma nyamakazi ndi ma tendon a zida za minofu ndi mafupa.
Laborator Zizindikiro - kuchuluka kuchuluka kwa creatinine, urea m'magazi, kuchuluka kwa chiwindi transaminase enzymes (ALT, AST).
Khungu ndi mawonekedwe ake - kukula kwa photosensitivity (kuchuluka kwa khungu kuti kuwala).
Thupi lawo siligwirizana - zotupa pakhungu, kuyabwa, kusintha kwa mawonekedwe ofanana ndi kuwotcha kwamatumbo (urticaria), kutupa kwambiri kwa minofu yofewa ya nkhope ndi ma genitalia akunja (angioedema, edema ya Quincke), zotupa za khungu la necrotic (Stevens-Johnson, matenda a Lyell).

Ngati zizindikiro zakukula kwa zovuta za m'maganizo zikuwoneka mutamwa mapiritsi a Ciprofloxacin, muyenera kulumikizana ndi katswiri.

Pharmacology

Imalepheretsa bakiteriya wa DNA gyrase (topoisomerases II ndi IV, omwe amachititsa kuti michere ya DNA ya chromosomal isazungulidwe ndi nyukiliya ya RNA, yomwe imafunika kuwerenga zambiri zamtunduwu, imasokoneza kaphatikizidwe ka DNA, kukula komanso magawikidwe a mabakiteriya, zimayambitsa kusintha kwamalingaliro (kuphatikiza maselo a cell ndi nembanemba) ndi kufa mwachangu kwa bakiteriya.

Imagwira ma bactericidal pa gram-hasi tizilombo panthawi yopuma komanso magawidwe (chifukwa samangokhala ndi gyrase ya DNA yokha, komanso imayambitsa kuyang'anitsitsa kwa khoma la cell), ndipo imagwira ntchito pazinthu zabwino za gramu pokhapokha panthawiyi.

Kuchepetsa kochepa m'maselo a macroorganism amafotokozedwa ndi kusowa kwa DNA gyrase mwa iwo. Poyerekeza ndi maziko a ciprofloxacin, palibe chitukuko chofanana ndi mankhwala ena a antibacterial omwe siali m'gulu la DNA gyrase inhibitors, omwe amathandiza kwambiri motsutsana ndi mabakiteriya omwe amalimbana, mwachitsanzo, aminoglycosides, penicillin, cephalosporins, tetracyclines.

Kukaniza mu vitro ku ciprofloxacin nthawi zambiri imayamba chifukwa cha masinthidwe amtundu wa bakiteriya topoisomerases ndi DNA gyrase ndipo imayamba pang'onopang'ono kudzera pakusintha kwamitundu yambiri.

Kusintha kwamtundu umodzi kumatha kuyambitsa kuchepa kwa chidwi kuposa kukula kwa kukana kwamankhwala, komabe, kusinthika kambiri kumayambitsa kukula kwa kukana kwamankhwala a ciprofloxacin komanso kutsutsana ndi mankhwala a quinolone.

Kukaniza ciprofloxacin, komanso mankhwala enanso ambiri okhala ndi antibacterial, kumatha kuchitika chifukwa chakuchepa kwa mphamvu ya khoma la bakiteriya (monga zimakhalira nthawi zambiri ndi Pseudomonas aeruginosa) ndi / kapena kutsegulira kwa chimbudzi kuchokera ku selo laling'ono (efflux). Kukula kwa kukana chifukwa cha mtundu wama coding wopezeka pamapasmids kwanenedwapo Qnr. Njira zotsutsa zomwe zimapangitsa kuti ma penicillin apangidwe, ma cephalosporins, aminoglycosides, macrolides, ndi ma tetracyclines mwina sasokoneza ntchito ya antibacterial ya ciprofloxacin. Ma microorganism omwe amalimbana ndi mankhwalawa amatha chidwi ndi ciprofloxacin.

Bactericidal concentration (MBC) nthawi zambiri sikhala yochepera pazomwe zimalepheretsa kwambiri (MIC) nthawi zopitilira 2.

Pansipa pali njira zothandiza kubwereketsa chidwi cha ciprofloxacin, chovomerezedwa ndi European Committee for the Determination of Sensitivity to Antibacterial Agents (Eucast) Mitengo ya malire a MIC (mg / l) imaperekedwa pansi pazovuta za chiprofloxacin: chiwerengero choyambirira ndi cha tizilombo tating'onoting'ono ta ciprofloxacin, chachiwiri ndi cha osagwira.

- Enterobacteriaceae ≤0,5, >1.

- Pseudomonas spp. ≤0,5, >1.

- Spinetobacter spp. ≤1, >1.

- Staphylococcus 1 spp. ≤1, >1.

- Streptococcus pneumoniae 2 2.

- Haemophilus influenzae ndi Moraxella catarrhalis 3 ≤0,5, >0,5.

- Neisseria gonorrhoeae ndi Nisseria meningitidis ≤0,03, >0,06.

- Malingaliro amtundu osagwirizana ndi mitundu ya tizilombo 4 ≤0.5,> 1.

1 Staphylococcus spp: Miyezo yamtengo wapatali ya ciprofloxacin ndi ofloxacin imagwirizanitsidwa ndi chithandizo chachikulu cha mankhwala.

2 Streptococcus pneumoniae: mtundu wamtchire S. chibayo Sichikulingaliridwa kukhala chokhudza ciprofloxacin ndipo, motero, ili m'gulu la tizilombo tokhala ndi mphamvu yapakatikati.

Matanda okhala ndi mtengo wa MIC pamwambapa mulingo wovutikira / wowonetsetsa ndiwosowa kwambiri, ndipo pakadali pano palibe malipoti aiwo. Kuyesedwa kwa kuzindikira ndi kuzindikira antimicrobial pakuzindikira madera oterowo kuyenera kubwerezedwa, ndipo zotsatira zake ziyenera kutsimikiziridwa ndikuwunika kwa madera omwe anali mu labotore. Mpaka umboni woyankha kuchipatala utapezeka wa zovuta zomwe zatsimikiziridwa za MIC zomwe zikupitilira zomwe zikutsalira, ziyenera kuonedwa ngati zosagwira. Haemophilus spp./Moraxella spp: chizindikiritso cha zovuta ndizotheka H. fuluwenza ndi chidwi chochepa cha fluoroquinolones (MIC ya ciprofloxacin - 0.125-0.5 mg / l). Umboni wa kufunikira kachipatala wa kukana kochepa mu matenda opumira omwe amayambitsidwa ndi H. fuluwenzaayi.

4 Mitengo yopanda malire yomwe siigwirizane ndi mitundu ya tizilombo tating'onoting'ono timayikidwa makamaka pamaziko a pharmacokinetics / pharmacodynamics ndipo sizimadalira pakugawidwa kwa MICs kwa mitundu yapadera. Zigwira ntchito kwa mitundu yokha yomwe gawo latsatanetsatane wamtundu silinadziwike, komanso osati kwa mitundu yomwe sikunayesedwe kudziwa zoyeserera. Kwa zovuta zina, kufalikira kwa kukhudzika komwe kumachitika kungasiyane ndi dera komanso nthawi. Pankhani imeneyi, ndikofunikira kukhala ndi chidziwitso chofunikira pokana kukana, makamaka pochiza matenda oopsa.

Otsatirawa ndi deta yochokera ku Institute of Clinical and Laboratory Standards (CLSI), kuyika miyezo yoberekera ya MIC values (mg / L) ndikuyesa mayendedwe (m'mimba mwake, mm) pogwiritsa ntchito ma disc omwe muli 5 μg ciprofloxacin. Mwa izi, tizilombo tosaoneka m'magulu tomwe timawagawa ngati owopsa, apakati komanso osagwira.

- MIC 1: tcheru - 4.

- Kuyesa koyerekeza 2: kovuta -> 21, kwapakatikati - 16-20, kugonjetsedwa - mabakiteriya ena omwe siabanja Enterobacteriaceae

- MIC 1: tcheru - 4.

- Kuyesa koyerekeza 2: kovutirapo -> 21, kwapakatikati - 16-20, kukana - 1: kokhazikika - 4.

- Kuyesa koyerekeza 2: kovutirapo -> 21, kwapakatikati - 16- 20, kugonjetsedwa - 3: kokhazikika - 4: kokhazikika -> 21, kwapakatikati - -, kukana - -.

- MIC 5: tcheru - 1.

- Kuyesa koyerekeza 5: kokhazikika -> 41, kwapakatikati - 28-40, kukana - 6: kokhazikika - 0.12.

- Kuyesa koyerekeza 7: kovuta -> 35, kwapakatikati - 33- 34, kugonjetsedwa - 1: kokhazikika - 3: tcheru - 1 Mulingo wokhazikitsidwa umagwiritsidwa ntchito pokhapokha msuzi pogwiritsa ntchito cationic wokonzedwa ndi Mueller-Hinton msuzi (SAMNV), yomwe imayatsidwa ndi mpweya kutentha kwa (35 ± 2) ° C kwa 16-20 h kwa tizilombo ta Enterobacteriaceae, Pseudomonas aeruginosamabakiteriya ena omwe siabanja Enterobacteriaceae, Staphylococcus spp., Enterococcus spp. ndi Bacillus anthracis, 20-24 h kwa Spinetobacter spp., 24 h kwa Y. pestis (ngati mukukula osakwanira, gwiritsani ntchito maola ena 24).

2 Mulingo wokhazikikanso umangogwiritsa ntchito mayeso obanika omwe amagwiritsa ntchito ma Muller-Hinton agar (SAMNV), yomwe imayatsidwa ndi mpweya kutentha kwa (35 ± 2) ° C kwa maola 16-18.

3 Mulingo wothandiza kubereka umangogwiritsa ntchito mayeso obanika omwe amagwiritsa ntchito ma disc kuti azindikire Haemophilus influenzae ndi Haemophilus parainfluenzae kugwiritsa ntchito msuzi pakuyesa kwa Haemophilus spp. (NTM), yomwe imayatsidwa ndi mpweya kutentha kwa (35 ± 2) ° C kwa maola 20-24.

Mulingo wokhazikikanso umagwira pakungoyesa mayeso pogwiritsa ntchito ma disc pomwe pali mayeso NTMyomwe imapangidwa mu 5% CO₂ pa kutentha kwa (35 ± 2) ° C kwa maola 16-18

5 Muyezo wobwezeretsanso ukugwira ntchito pongoyesa kumvetsetsa (mayeso obayira ogwiritsa ntchito ma disc m'magawo ndi njira ya agar ya MIC) pogwiritsa ntchito gonococcal agar ndi 1% yokhazikitsidwa pakukula pa kutentha kwa (36 ± 1) ° C (osapitirira 37 ° C) kwa 5 % CO₂ mkati mwa maola 20-24

Mulingo wokhazikikanso umangogwiritsa ntchito mayeso a msuzi pogwiritsa ntchito msuzi wa Mueller-Hinton.SAMNV) ndi kuwonjezera kwa 5% magazi a nkhosa, omwe amadzipika ndi 5% CO₂ pa (35 ± 2) ° C kwa maola 20-25

Mulingo wokhazikikanso umangogwiritsa ntchito mayeso pogwiritsa ntchito msuzi wa mu cellic Mueller-Hinton (SAMNV) ndi kuwonjezera kwa 2% yokha yowonjezera kukula, yomwe imapangidwa ndi mpweya pa (35 ± 2) ° C kwa maola 48.

Mphamvu yaku vitro ya ciprofloxacin

Kwa zovuta zina, kufalikira kwa kukhudzika komwe kumachitika kungasiyane ndi dera komanso nthawi. Pankhaniyi, poyesa kuzindikira kupsinjika, ndikofunikira kukhala ndi chidziwitso chokwanira pokana, makamaka pochiza matenda oopsa. Ngati kuchuluka kwa kukhudzidwa kwanuko ndikwakuti phindu logwiritsa ntchito chiprofloxacin kwa mitundu ingapo ya matenda ndikukaika, funsani katswiri. Mu vitro Ntchito ya ciprofloxacin motsutsana ndi zovuta zotsatirazi zamagulu ochepa adawonetsedwa.

Aerobic Gram-Posakhalitsa Zamoyo - Bacillus anthracis, Staphylococcus aureus (wodwala methicillin) Staphylococcus saprophyticus, Streptococcus spp.

Aerobic gram-hasi tizilombo tating'onoting'ono - Aeromonas spp., Moraxella catarrhal is, Brucella spp., Neisseria meningitidis, Citrobacter koseri, Pasteurella spp., Francisella tularensis, Salmonella spp., Haemophilus ducreyi, Shigella spp., Haemophilus influenzae, Vibo..

Ma tizilombo a Anaerobic - Mobiluncus spp.

Tizilombo tina tambiri - Chlamydia trachomatis, Chlamydia chibayo, Mycoplasma hominis, Mycoplasma pneumoniae.

Mitundu yosiyanasiyana yamphamvu ya ciprofloxacin yawonetsedwa pazinthu zotsatirazi: Acinetobacter baumanii, Burkholderia cepacia, Campylobacter spp. Pseudomonas fluorescens, Serratia marcescens, Streptococcus pneumoniae, Peptostreptococcus spp., Propionibacterium acnes.

Amakhulupirira kuti ciprofloxacin imagonjetsedwa mwachilengedwe. Staphylococcus aureus (methicillin zosagwira) Stenotrophomonas maltophilia, Actinomyces spp., Enteroccus faecium, Listeria monocytogene, Mycoplasma genitalium, Ureaplasma urealyticumtizilombo toyambitsa matenda a anaerobic (kupatula Mobiluncus spp., Peptostreptococus spp., Propionibacterium acnes).

Zogulitsa. Pambuyo iv makonzedwe a 200 mg a ciprofloxacin T_max ndi 60 min, C_max - 2.1 μg / ml, kulumikizana ndi mapuloteni a plasma - 20-40%. Ndi iv makina, pharmacokinetics of ciprofloxacin anali liniya mu 400 mg.

Ndi iv makonzedwe a 2 kapena katatu patsiku, kuchuluka kwa ciprofloxacin ndi metabolites ake sikunawonedwe.

Pambuyo pakukonzekera pakamwa, ciprofloxacin imatengedwa mwachangu kuchokera kumimba, makamaka mu duodenum ndi jejunum. Ndi_max mu seramu zimatheka pambuyo 1-2 mawola ndipo pakamwa 250, 500, 700 ndi 1000 mg wa ciprofloxacin 1.2, 2.4, 4.3 ndi 5.4 μg / ml, motero. Bioavailability pafupifupi 70-80%.

Makhalidwe a C_max ndi kuchuluka kwa AUC molingana ndi mlingo. Kudya (kuphatikiza mafuta a mkaka) kumachepetsa kuyamwa, koma sasintha C_max ndi bioavailability.

Pambuyo pophunzitsidwa mu conjunctiva kwa masiku 7, kuchuluka kwa ciprofloxacin m'madzi a m'magazi kumachokera ku kuperewera koyenera (C_max mu madzi am`magazi anali pafupifupi 450 nthawi zosakwana pambuyo pakamwa makonzedwe a 250 mg.

Kugawa. The yogwira popezeka amapezeka m'magazi makamaka osakhala ionized mawonekedwe. Ciprofloxacin imagawidwa mwaulere mu zimakhala ndi zithupi za mthupi. V_d m'thupi ndi 2-3 l / kg.

The ndende mu minofu ndi kawiri 2-12 kuposa plasma. Zochitika zochizira zimapezeka mu malovu, ma toni, chiwindi, chikhodzodzo, end, matumbo, m'mimba ndi ziwalo za m'mimba (endometrium, machubu a fallopian ndi thumba losunga mazira, chiberekero), madzi am'mimba, minofu ya prostate, impso ndi ziwalo zamkodzo, minofu yam'mapapo, bronchial katulutsidwe, minofu ya mafupa, minofu, kutulutsa kwamkati ndi kaphatikizidwe ka cartilage, madzimadzi a peritoneal, khungu. Imalowa m'magazi am'magazi ochepa, pomwe kulumikizika kwake kusanachitike chifukwa cha kutupa kwaminyewa ndi 6-10% ya m'magazi am'magazi, ndipo vuto likatupa ndi 14- 37%. Ciprofloxacin imalowanso kulowa mumagazi amaso, pleura, peritoneum, mwanabele, kudzera mwa placenta. Kuphatikizika kwa ciprofloxacin m'magazi a neutrophils ndiwokwera nthawi 2-7 kuposa madzi am'magazi.

Kupenda. Ciprofloxacin imapangidwa mu chiwindi (15-30%). Ma metabolites anayi a profrofloxacin m'magawo otsika amatha kupezeka m'magazi - diethylcycrofloxacin (M1), sulfociprofloxacin (M2), oxociprofloxacin (M3), formylcycrofloxacin (M4), formylcycrofloxacin (M4), atatu a (M1 - M3) amawonetsa zochita za antibacterial. mu vitro kufananizidwa ndi nalidixic acid ntchito. Ntchito za antibacterial mu vitro metabolite M4, yomwe ilipo pang'ono, imagwirizana kwambiri ndi ntchito ya norfloxacin.

Kuswana. T_1/2 ndi maola 3-6, ndi CRF - mpaka maola 12. Imafukusidwa makamaka ndi impso mwa kusefera kwa tubular ndi katulutsidwe kosasinthika (50-70%) komanso mawonekedwe a metabolites (10%), ena onse kudzera m'mimba. Pafupifupi 1% ya mankhwala omwe amathandizidwa amaperekedwa mu ndulu. Pambuyo pa kayendetsedwe ka iv, kuchuluka kwa mkodzo nthawi yoyamba ya 2 pambuyo pa kupangika kumakhala kambiri kuposa 100 m'magazi am'magazi, omwe amapitilira BMD chifukwa cha matenda amkodzo amkodzo.

Chilolezo cha renal - 3-5 ml / min / kg, chilolezo chokwanira - 8-10 ml / min / kg.

Kulephera kwa aimpso (Cl creatinine> 20 ml / min), kuchulukitsa kudzera mu impso kumatsika, koma kuwerengera kwamthupi sikumachitika chifukwa cha kuchuluka kwachulukidwe kagayidwe ka peprofloxacin ndi chimbudzi cha m'mimba.

Ana. Mu kafukufuku mu ana, zomwe C_max ndipo AUC anali azaka zodziyimira pawokha. Kuwonjezeka kowoneka bwino kwa C_max ndi AUC yothandizidwa mobwerezabwereza (pa 10 mg / kg katatu patsiku) sanawonedwe. Mwa ana 10 odwala sepsis osakwana chaka chimodzi, mtengo wa C_max kuchuluka kwa 6.1 mg / l (kuyambira 4,6 mpaka 8,3 mg / l) pambuyo kulowetsedwa kumatenga ola limodzi pa mlingo wa 10 mg / kg, ndi kwa ana a zaka 1 mpaka 5 - 7.2 mg / l (kuyambira 4,7 mpaka 11.8 mg / l). Makhalidwe a AUC m'magulu onse anali 17.4 (kuyambira 11,8 mpaka 32 mg · h / l) ndi 16.5 mg · h / l (kuyambira 11 mpaka 23,8 mg · h / l). Izi zimafanana ndi kuchuluka komwe kunanenedwa kwa odwala akuluakulu omwe amagwiritsa ntchito Mlingo wothandizira wa ciprofloxacin. Kutengera kusanthula kwa pharmacokinetic mwa ana omwe ali ndi matenda osiyanasiyana, zomwe zikutanthauza T_1/2 pafupifupi 4-5 maola

Zolemba zogwiritsira ntchito

Asanapereke mapiritsi a Ciprofloxacin, dokotala ayenera kuyang'anitsitsa magwiritsidwe ake a mankhwalawa olondola, omwe akuwonetsedwa muzowonjezera:

Mosamala kwambiri, mankhwalawa amagwiritsidwa ntchito kwa odwala omwe ali ndi vuto la khunyu, kupezeka kwa kukhudzika kosiyanasiyana kwa miyambo yosiyanasiyana, komanso motsutsana ndi zotupa za mitsempha ya mitsempha ya muubongo. Nthawi yomweyo, mapiritsi a profrofloxacin amalembedwa pokhapokha pazokhudza thanzi.
Kukula kwa kutsegula m'mimba kwakanthawi kwamankhwala ndikugwiritsa ntchito mankhwalawa ndiko maziko owonjezera kuti asankhe pseudomembranous colitis. Ngati matendawa atsimikiziridwa, mankhwalawo amathetsedwa.
Pakumva ululu m'mitsempha kapena ma tendon, mankhwalawa amathetsedwa, makamaka kwa odwala okalamba, omwe amakhudzidwa ndi chiopsezo cha kugundana kwa pathological.
Sitikulimbikitsidwa kuti mugwire ntchito yolemetsa ngati mumamwa mapiritsi a chiprofloxacin.
Ndikulimbikitsidwa kupewa kupewa kuwala pang'ono ndi dzuwa pakhungu panthawi yomwe mumalandira mankhwala.
Mukamamwa mapiritsi a Ciprofloxacin, muyenera kumwa madzi okwanira kuti muchepetse vuto la crystalluria.
Simumamwa mowa pakumwa mankhwala.
Gawo logwira la mapiritsi a profrofloxacin amatha kulumikizana ndi mankhwala am'magulu ena a mankhwala, kotero ngati agwiritsidwa ntchito, dokotala yemwe akupezekapo ayenera kuchenjezedwa za izi.
Panthawi yamankhwala, chisamaliro chapadera chikuyenera kuchitika mukamagwira ntchito yoopsa yomwe imafunikira chidwi chochulukirapo komanso kuthamanga kwa zochitika zama psychomotor.

Patsamba lamankhwala, maprofloxacin mapiritsi ndi mankhwala. Kudziyang'anira kwawo kokha sikumaperekedwa popanda mankhwala oyenera, chifukwa izi zimatha kubweretsa mavuto.

Bongo

Mufunika kuwonjezeranso kuchuluka kwa zochizira mapiritsi a profrofloxacin, mseru, kusanza, kupweteka mutu, chizungulire, kusokonezeka kwa kudziwa kosiyanasiyana kwa minyewa, kukokana minyewa, kuyembekezera zinthu. Pankhaniyi, m'mimba ndi matumbo zimatsukidwa, matumbo am'mimba amayikidwa, ndipo chithandizo chamankhwala chimachitidwanso ngati pakufunika, popeza palibe mankhwala enieni a mankhwalawa.

Mndandanda wa mapiritsi a profrofloxacin

Zofanananso ndizomwe zimapangidwira komanso zochizira zotsatira za mapiritsi a profrofloxacin ndi kukonzekera kwa Ecocifol, Ciprobay, Ciprinol, Ciprolet.

Moyo wa alumali wa mapiritsi a profrofloxacin ndi zaka 2 kuyambira tsiku lopangidwa. Ayenera kusungidwa mu phukusi losawonongeka, m'malo owuma, osawoneka ndi ana pamtunda wa mpweya wosaposa + 25 ° C.

Kutulutsa mawonekedwe ndi kapangidwe kake

Ciprofloxacin imapezeka m'mitundu iyi:

mapiritsi a 250, 500 kapena 750 mg, atakhala filimu. Mapiritsi ozungulira a Biconvex a 250 mg ali ndi pinki. Mapiritsi a 500 mg apamwamba otsekemera amakhala ndi chipolopolo ndipo amakhala pachiwopsezo mbali imodzi. Mapiritsi okhala ndi mapiritsi 750 mg ali ndi buluu. Mankhwalawa amatha kuikidwa m'matumba (mapiritsi 10 kapena 20) komanso m'matumba a makatoni (1, 2, 3, 4, 5, kapena 10 matuza). Komanso mapiritsi a ciprofloxacin amatha kumayikidwa m'matumba apulasitiki (30, 50, 60, 100, kapena zidutswa za 120), zomwe zimayikidwa payekhapayokha mumbale zamapulasitiki. Kuphatikiza apo, mankhwalawa amapezeka mumtsuko wa polyethylene (mapiritsi 10 kapena 20), omwe amaikidwa pabokosi la makatoni,
lingalira yankho la kulowetsedwa 10 mg / ml. Mafuta osayera kapena opaka chikasu. Mankhwalawa amadzaza m'mapaketi okhala ndi makatoni (mabotolo asanu aliyense),
Njira yothetsera kulowetsedwa 2 mg / ml. Transxpintent pale wachikasu kapena yopanda utoto umathiridwa m'mabotolo apulasitiki 100, omwe amadzaza m'matumba apulasitiki ndi makatoni (1 thumba lililonse).
khutu ndi diso likutsikira 0,3%. Madzi owonekera, opanda khungu kapena achikasu pang'ono amatsanuliridwa mumabotolo oyera a polymer oyera (5 ml iliyonse), omwe amadzaza m'mabokosi azikatoni (1 botolo lililonse).

Piritsi limodzi lili ndi:

yogwira mankhwala: ciprofloxacin - 250, 500 kapena 750 mg,
zotuluka: wowuma, microcrystalline cellulose, talc, magnesium stearate, colloidal silicon dioxide (aerosil), hydroxypropyl methyl cellulose 15 CPS, sodium starch glycolate, diethyl phthalate, titanium dioxide, chikasu cha dayamondi, phula wamoto.

Kamangidwe ka botolo limodzi lokhazikika pakukonzekera njira yothetsera kulowetsamo:

yogwira mankhwala: ciprofloxacin - 100 mg,
excipients: disodium edetate dihydrate, lactic acid, sodium hydroxide, hydrochloric acid, madzi a jakisoni.

Kapangidwe ka 100 ml yankho la kulowetsedwa kumaphatikizapo:

yogwira mankhwala: ciprofloxacin - 200 mg,
excipients: disodium edetate, sodium chloride, madzi a jakisoni.

The 1 ml ya makutu amaso ndi amaso akuphatikizira:

yogwira mankhwala: ciprofloxacin - 3 mg,
zotuluka: mannitol, sodium acetate trihydrate, benzalkonium chloride, disodium edetate dihydrate, glacial acetic acid, madzi oyeretsedwa.

Mapiritsi, kuganizira, njira yothetsera kulowetsedwa

Ciprofloxacin amagwiritsidwa ntchito pofuna kuchiza matenda otsatirawa ovuta komanso osavuta omwe amayamba chifukwa cha tizilombo tating'onoting'ono tomwe timagwira ntchito:

Matenda opatsirana a kupuma thirakiti, kuphatikiza ndi chibayo choyambitsa matenda a Enterobacter spp., Klebsiella spp., Escherichia coli, Proteus spp., Haemophilus spp., Pseudomonas aeruginosa, Legionella spp., Staphylococcus spp.
matenda a sinuses (makamaka, sinusitis) ndi khutu lapakati (mwachitsanzo, atitis media), makamaka ngati matendawa amayamba chifukwa cha gram-negative tizilombo, kuphatikizapo Staphylococcus spp. ndi Pseudomonas aeruginosa,
matenda amaso (kupatula miyala),
kwamikodzo thirakiti ndi matenda a impso
matenda amtundu, kuphatikizapo chinzonono, prostatitis, adnexitis,
bakiteriya matenda am'mimbamo (matenda am'mimba, matenda am'mimba, peritonitis),
sepsis
minofu yofewa ndi matenda akhungu (kupatula miyala),
kupewa matenda kapena matenda kwa odwala ochepetsedwa chitetezo (odwala omwe ali ndi neutropenia kapena odwala omwe akutenga ma immunosuppressants),
Chithandizo cha kusankha matumbo decontamination odwala ndi yafupika chitetezo chokwanira,
Chithandizo ndi kupewa kwa anthrax ya pulmonary chifukwa cha Bacillus anthracis (kupatula mapiritsi).

Khutu ndi diso likugwa

Mukamagwiritsa ntchito madontho amaso mu ophthalmology, mankhwalawa amagwiritsidwa ntchito pochiza matenda amtundu wa maso opatsirana komanso otupa:

subacute ndi pachimake conjunctivitis,
blepharoconjunctivitis,
blepharitis
keratoconjunctivitis,
keratitis
aakulu dacryocystitis
zilonda zam'magazi,
zotupa pambuyo matupi achilendo kapena kuvulala,
meibomite (barele).

Mukamagwiritsa ntchito madontho amaso mu opaleshoni ya ophthalmic, mankhwalawa amagwiritsidwa ntchito kupewetsa pambuyo pake komanso pambuyo pake pantchito yothandizira kupewa matenda opatsirana.

Mukamagwiritsa ntchito makutu a khutu mu otorhinolaryngology:

Chithandizo cha matenda opatsirana pambuyo pake,
otitis externa.

250, 500 kapena 750 mg mapiritsi

Mankhwala amaperekedwa pakamwa - pamimba yopanda kanthu, ndi madzi okwanira. Mlingo amasankhidwa malinga ndi kuopsa kwa matendawa, mkhalidwe wa thupi, mtundu wa matenda, kunenepa, ntchito ya impso komanso msinkhu wa wodwala. Mlingo wotsatira nthawi zambiri umalimbikitsidwa:

matenda osavuta a kwamikodzo ndi impso - 250 mg kawiri pa tsiku, komanso matenda ovuta - 500 mg,
ndi matenda olimbitsa a m'munsi kupuma thirakiti - 2 kawiri pa tsiku, 250 mg, ndipo kwambiri - 500 mg,
ndi chinzonono - kamodzi 250-500 mg,
ndi matenda a gynecological, colitis ndi enteritis (mawonekedwe owopsa, kutentha kwambiri), osteomyelitis, prostatitis - 2 kawiri pa tsiku, 500 mg aliyense. Ndi banal m'mimba, tikulimbikitsidwa kumwa mankhwala 250 mg kawiri pa tsiku.

Kutalika kwa mankhwalawa kumasankhidwa malinga ndi kuuma kwa matendawa, komabe, mankhwalawa amayenera kupitilizidwa kwa masiku osachepera masiku awiri chizindikirocho chitatha. Kutalika kwa nthawi yotalikirana ndi masiku 7-10.

Njira yothetsera kulowetsedwa 2 mg / ml

Mankhwala amaperekedwa kudzera m`mitsempha. Njira yothetsera imalowetsedwa pang'onopang'ono m'mitsempha yayikulu kuti muchepetse zovuta pakompyuta ya kulowetsedwa. Njira yothetsera vutoli imayendetsedwa yokhayo kapena kuphatikiza njira zowonjezera kulowetsedwa (yankho la Ringer, 0.9% sodium chloride solution, 10% kapena 5% dextrose solution, 10% fructose solution, 5% dextrose solution, 0,2525 kapena 0,45 sodium chloride solution) %).

Kutalika kwa kulowetsedwa pa mlingo wa 200 mg ndi mphindi 30, pa mlingo wa 400 mg - 60 Mphindi. Pafupipafupi kayendetsedwe ka katatu patsiku.

Kutalika kwa chithandizo kumatengera kuchipatala, zovuta komanso kuchira kwa matendawa. Mankhwalawa adapangidwanso masiku ena atatu atachotsedwa kwa zizindikiro zamatenda.

Kutalika kwakanthawi kachipatala:

ndi chinzonono chosavuta - 1 tsiku,
ndi matenda a impso, m'mimba, ziwalo zamkodzo - mpaka masiku 7,
ndi kufooka chitetezo chokwanira - nthawi yonse ya neutropenia,
ndi osteomyelitis - osaposa masiku 60,
ndi Chlamydia spp. kapena Streptococcus spp. matenda - osachepera masiku 10,
ndi matenda ena - masiku 7-14.

Mlingo wa mankhwalawa amasankhidwa kutengera mtundu wa matenda:

ndi matenda am`mapapo thirakiti - katatu patsiku, 400 mg aliyense,
mu matenda osakhazikika a genitourinary system - 2 pa tsiku, 200 kapena 400 mg,
ndi matenda ovuta a genitourinary system - katatu patsiku, 400 mg iliyonse,
ndi prostatitis, adnexitis, orchitis, epididymitis - katatu patsiku, 400 mg iliyonse,
ndi m'mimba - 2 kawiri pa tsiku, 400 mg aliyense,
ndi matenda ena - 2 kawiri pa tsiku, 400 mg aliyense,
wokhala ndi matenda oopsa oopsa (makamaka pamaso pa Staphylococcus spp., Streptococcus spp. ndi septicemia, peritonitis - katatu patsiku, 400 mg aliyense,
kupewa ndi kuchiza matenda am'mapapo - 2 pa tsiku, 400 mg.

Kukonzekera kwa kuganizira kulowetsedwa njira

Musanagwiritse ntchito, zomwe zili mu 1 vial of concentrate ziyenera kuchepetsedwa mpaka kuchuluka kwa osachepera 50 ml ndikuthira kokwanira kwa kulowetsedwa (yankho la Ringer, 0.9% sodium chloride solution, 10% kapena 5% dextrose solution, 10% yankho la fructose, 5% dextrose solution) , yankho la sodium chloride 0,2525 kapena 0,45%.

Njira yothetsera vutoli iyenera kugwiritsidwa ntchito mwachangu chifukwa cha kumva kwa ciprofloxacin kuti iwalikire, komanso kuti ikhalebe yolimba. Chifukwa chake, botolo liyenera kuchotsedwa m'bokosi lisanayambe kugwiritsidwa ntchito. Pakakhala dzuŵa mwachindunji, yankho limatsimikizika kukhala lokhazikika kwa masiku atatu. Mukasunga yankho pamatenthedwe ochepa, mpweya ungayambike, womwe umasungunuka firiji, motero sikulimbikitsidwa kuti uziwitsenso njira yothetsera kapena kuisunga mufiriji. Gwiritsani ntchito yankho lomveka bwino.

Ngati zikugwirizana ndi mayankho ena okonzekera / kukonzekera sikutsimikiziridwa, ciprofloxacin iyenera kutumikiridwa mosiyana. Zizindikiro zowoneka za kusayenerana: mpweya wabwino, kusinthasintha kwa mawonekedwe kapena mitambo.Mankhwalawa ndi osagwirizana ndi mayankho onse omwe amakhala osakhazikika pamankhwala kapena pH kuyambira pa 3,9 mpaka 4.5 (mwachitsanzo, zothetsera za heparin, penicillin), komanso ndi mayankho omwe amasintha pH kupita kumbali ya zamchere.

Diso ndi khutu

thupi lawo siligwirizana
kuyaka
kuyabwa
Hyperemia ndi kufatsa modekha kwa conjunctiva mwina m'chigawo cha membala wamkati wa tympanic ndi ngalande yapanja yapanja,
nseru
Photophobia
kutupa kwa matope,
kukhudzika kwa thupi lakunja
lacure
atangophunzitsidwa - mankhwala osasangalatsa pamlomo wamkamwa,
Odwala omwe ali ndi zilonda zam'mimba - oyera oyera makhwala,
kutsika kwamawonedwe owoneka,
keratopathy
keratitis
kulowetsedwa kwa ma corneal kapena kuwonekera kwa ma corneal mawanga,
kukula kwa umunthu wapamwamba.

Malangizo apadera

Ciprofloxacin sichikulimbikitsidwa pakuchiza matenda obwera chifukwa cha Streptococcus pneumoniae, popeza mankhwalawa sagwira ntchito polimbana ndi tizilomboti. Pankhani ya matenda ena, musanalembe Ciprofloxacin, muyenera kuonetsetsa kuti ikugwira ntchito pothana ndi zovuta za tizilombo tofanana.

Pakusamalidwa kwakanthawi kokwanira ndi mankhwalawa, kupenda magazi pafupipafupi, chiwindi ndi impso ndikulimbikitsidwa.

Pankhani ya kuperekera mankhwala munthawi yomweyo mankhwala a chiprofloxacin ndi mankhwala ochokera ku gulu la barbituric acid omwe amagwiritsidwa ntchito chifukwa cha opaleshoni yayikulu, ndikofunikira kuyang'anira kuthamanga kwa magazi, kugunda kwa mtima, komanso electrocardiogram.

Popewa kukula kwa crystalluria, sikovomerezeka kupitirira mlingo womwe umalimbikitsidwa tsiku lililonse. M'pofunikanso kuonetsetsa kuti acidic imachitika mu mkodzo komanso kuthira madzi okwanira.

Pali chiopsezo chokhala ndimaganizo chifukwa chogwiritsa ntchito ciprofloxacin koyamba. Nthawi zina, ma psychotic kapena kupsinjika mtima kumatha kupitilira pamaganizidwe ofuna kudzipha komanso kudzivulaza (mwachitsanzo, kuyesera kosapambana komanso kopambana). Pankhaniyi, muyenera kusiya kumwa mankhwalawo ndikuonana ndi dokotala. Odwala omwe ali ndi mbiri ya kukomoka komanso mbiri ya khunyu, kuwonongeka kwa ubongo, komanso matenda amitsempha chifukwa cha chiopsezo cha zovuta zoyipa, ciprofloxacin iyenera kuyikidwa pazifukwa zaumoyo.

Ciprofloxacin, monga fluoroquinolones ena, amatha kuchepetsa gawo kuti agwire bwino ntchito ndikuyambitsa kugwidwa. Zikachitika, muyenera kusiya kugwiritsa ntchito mankhwalawa.

Mankhwala a odwala omwe akutenga fluoroquinolones (kuphatikizapo ciprofloxacin), milandu ya sensorimotor kapena sensor polyneuropathy, dysesthesia, hypesthesia, ndi kufooka zalembedwa. Wina akakhala ndi zizindikiro monga kuwotcha, kupweteka, dzanzi, kudandaula, kufooka, wodwalayo ayenera kusiya kumwa mankhwalawo ndi kupita kwa dokotala.

Pogwiritsa ntchito ciprofloxacin, milandu yokhudzana ndi kapangidwe ka khunyu idanenedwapo.

Ngati yayitali, kutsegula m'mimba kumachitika pakatha masiku kapena chithandizo, ndikofunikira kupatula matenda a pseudomembranous colitis, omwe amafunika kuti mankhwala athetse msanga komanso kupatsidwa chithandizo chokwanira.

Panthawi ya chithandizo ndi Ciprofloxacin, milandu yovuta kwambiri yopulumutsa chiwindi ndi necrosis ya chiwindi idadziwika. Ngati muli ndi zizindikiro za matenda amchiwindi (anorexia, mkodzo wakuda, jaundice, kudekha kwam'mimba, kuyabwa), muyenera kusiya kumwa mankhwalawa.

Odwala omwe ali ndi matenda a chiwindi ndipo akutenga ciprofloxacin, alkaline phosphatase zochita, ma hepatic transaminases amatha kuwonjezeka kwakanthawi, kapena cholestatic jaundice. Odwala omwe ali ndi vuto lalikulu la gravis myasthenia gravis ayenera kutsegula ciprofloxacin mosamala, chifukwa zizindikiro zimatha kukulira.

Munthawi yamankhwala, ndikofunikira kuti musakhale padzuwa mwachindunji, komanso magwero ena a radiation ya ultraviolet.

Mukamamwa Ciprofloxacin kale masiku 2 atangoyamba kumene chithandizo, panali milandu ya tendonitis, komanso kupasuka kwa tendon (nthawi zambiri ma tendon Achilles, kuphatikiza pakati). Kutupa ndi kupindika kwa tendons zidalembedwanso patapita miyezi ingapo kuchokera ku chithandizo. Odwala okalamba, odwala omwe ali ndi matenda a tendon omwe amalandila chithandizo chothandizirana ndi glucocorticosteroids, pali chiopsezo chowonjezeka cha tendinopathy. Pankhani yodziwitsa zizindikiro zoyambirira za tendonitis (kutupa, kutupa kwakuphatikizika), kugwiritsa ntchito Ciprofloxacin kuyenera kuyimitsidwa, kupatula ntchito yolimbitsa thupi, popeza pamakhala chiopsezo chotumphukira kwa tendon. Mankhwala ayenera kugwiritsidwa ntchito mosamala pochiza odwala omwe ali ndi matenda a tendon omwe amagwiritsidwa ntchito ndi quinolones.

Pankhani ya matenda oyambitsidwa ndi matenda oopsa, matenda oyambitsidwa ndi bakiteriya wa anaerobic, ndi matenda a staphylococcal, ciprofloxacin iyenera kugwiritsidwa ntchito molumikizana ndi mankhwala oyenera a antibacterial. Kwa matenda omwe amayamba chifukwa cha fluoroquinolone zosagwira gonorrhoeae, zambiri zakudziko pokana zinthu zomwe ziyenera kugwira ntchito ziyenera kukumbukiridwa komanso kuzindikira kwa pathogen yotsimikiziridwa panthawi ya mayeso a labotale.

Ciprofloxacin imakhudza kuwonjezeka kwa gawo la QT. Popeza azimayi amakhala ndi nthawi yayitali ya QT poyerekeza ndi amuna, amamvera kwambiri mankhwala omwe amachititsa kuti pakhale nthawi yayitali ya QT. Odwala okalamba amadziwikanso ndi chidwi chowonjezereka cha mankhwala omwe amachititsa kuti pakhale nthawi yayitali ya QT. Pakugwirizana ndi zomwe tafotokozazi, ndikofunikira kugwiritsa ntchito ciprofloxacin mosamala pazotsatirazi:

pamodzi ndi mankhwala omwe amalimbikitsa nthawi ya QT (mwachitsanzo, mankhwala osokoneza bongo a kalasi III ndi IA, ma antiidepressants atatu, antipsychotic ndi macrolides),
mankhwalawa odwala omwe ali ndi mwayi wowonjezereka wa arrhythmias monga pirouette kapena kutalika kwa nthawi ya QT (mwachitsanzo, ndi vuto lobadwa nalo la kutalika kwa nthawi ya QT, kusalingalira bwino kwa ma elekitirodiya, kuphatikizapo hypomagnesemia ndi hypokalemia),
ndi matenda amtima ena mwa odwala omwe ali ndi vuto la mtima, bradycardia, myocardial infarction.

Pambuyo pakugwiritsa ntchito ciprofloxacin, kawirikawiri zochitika za anaphylactic, kuphatikizapo anaphylactic mantha, zalembedwa. Izi zimafuna kusiyiratu kumwa mankhwalawo ndi kulandira chithandizo choyenera.

Ndi mtsempha wa mtsempha wa yankho, zimachitika mderalo malo a jakisoni ndizotheka (kupweteka, kutupa). Izi zimachitika kawirikawiri ngati kutalika kwa kulowetsedwa kumakhala kochepera mphindi 30. Kumapeto kwa kulowetsedwa, zomwe zimachitika zimadutsa mwachangu, osakhala chosokoneza pakuyendetsedwera kwa Ciprofloxacin (ngati sikuyenda ndi njira yovuta).

Ciprofloxacin ndi cholepheretsa zolimbitsa thupi za CYP450 1A2 isoenzyme, chifukwa chake, kusamala kuyenera kugwiritsidwa ntchito ngati agwiritsidwa ntchito munthawi yomweyo ndi mankhwala omwe amaphatikizidwa ndi enzyme iyi (kuphatikizapo methylxanthin, theophylline, duloxetine, caffeine, ropinirole, clozapine, olanzapine chifukwa cha kuchuluka kwa magazi mu kuchuluka kwawo zochita zina zoyipa.

Mu mayeso a labotale mu vitro, ciprofloxacin imalepheretsa kukula kwa Mycobacterium spp. Izi zimatha kudzetsa vuto labodza pakupezeka kwa tizilombo toyambitsa matenda omwe ali ndi odwala omwe amapatsidwa ciprofloxacin.

Ndi kuchepa kwa glucose-6-phosphate dehydrogenase, mawonekedwe a hemolytic amawonekera mwa odwala omwe amalandira mankhwalawa. Kugwiritsa ntchito ciprofloxacin pochiza gululi ndizotheka kokha ndi maubwino omwe angapose chiopsezo chogwiritsa ntchito. Pankhaniyi, ndikofunikira kuonetsetsa kuwunika kwa wodwala.

Pochiza odwala ndi sodium choletsa (aimpso kulephera, mtima kulephera, nephrotic syndrome), ndikofunikira kuganizira za kuchuluka kwa sodium mankhwala enaake a Ciprofloxacin.

Madontho amaso samapangidwira jakisoni wa intraocular. Pankhani yogwiritsa ntchito ma ophthalmic, makonzedwe a mphindi 5 kapena kuposerapo akuyenera kuwonedwa. Kugwiritsa ntchito ciprofloxacin kuyenera kusiyidwa ngati pali zizindikiro za hypersensitivity. Wodwala ayenera kudziwitsidwa kuti ngati pali madontho, conjunctival hyperemia ikhoza kupezeka (mwanjira iyi, muyenera kusiya kugwiritsa ntchito mankhwalawa ndikupempha upangiri wa dokotala). Panthawi ya mankhwalawa ndi Ciprofloxacin akutsikira, tikulimbikitsidwa kukana kuvala magalasi ofewa. Pankhani yogwiritsa ntchito magalasi olimba musanakhazikitsidwe, amayenera kuchotsedwa ndikuvalanso mphindi 20 pambuyo pokhazikitsa mankhwala.

Mimba komanso kuyamwa

Pa nthawi yoyembekezera, mankhwalawa amaletsedwa.

Popeza ciprofloxacin imadutsa mkaka wa m'mawere, mankhwalawa sayenera kugwiritsidwa ntchito pochiza amayi oyamwitsa. Ngati ndi kotheka, poika ciprofloxacin pa mkaka wa m`mawere musanayambe chithandizo, muyenera kusiya kuyamwitsa.

Gwiritsani ntchito paubwana

Mankhwala saloledwa kugwiritsidwa ntchito pochizira ana osaposa zaka 18, kupatula pa milandu yotsatirayi:

mankhwalawa matenda a cystic fibrosis - katatu patsiku 10 mg pa 1 makilogalamu a thupi (mlingo waukulu wa mankhwalawo ndi 400 mg),
mankhwalawa ammapapo - 2 pa tsiku 10 mg pa 1 makilogalamu a thupi (pazipita mlingo wa mankhwalawo ndi 400 mg). Kutalika kwa mankhwala a ciprofloxacin ndi miyezi iwiri.

Kuchiza kuyenera kuyamba pokhapokha ngati mwatsimikizira kapena mwatsoka kachilombo. Pokhudzana ndi chiopsezo cha kusokonekera kwa mafupa ndi minyewa yozungulira, chithandizo chamankhwala chiyenera kuchitika ndi dokotala wodziwa bwino matenda opatsirana mwa ana. Mankhwala ayenera kuperekedwa pambuyo kuwunika chiopsezo ndi phindu.

Pogwiritsa ntchito ciprofloxacin mwa ana, kukula kwa arthropathy nthawi zambiri kunkajambulidwa.

Mu vuto laimpso

Odwala kwambiri aimpso kuwonongeka amapatsidwa hafu ya mankhwala.

Mukamamwa pakamwa, Mlingo wa ciprofloxacin umakhala motere:

ndi creatinine chilolezo choposa 50 ml / min, njira yofananira yamawonekedwe,
ndi creatinine chilolezo cha 30-50 ml / mphindi - maola 12 aliwonse, 250-500 mg aliyense,
ndi creatinine chilolezo cha 5-29 ml / mphindi - maola 18 aliwonse, 250-500 mg aliyense,
Kwa odwala omwe akudwala hemo- kapena peritoneal dialysis, pambuyo pa njirayi, 250-500 mg maola 24 aliwonse.

Ndi mtsempha wamkati, mlingo wa ciprofloxacin uli motere:

ndi kulephera kwapakati kwaimpso (CC 30-60 ml / mphindi / 1.73 m 2) kapena ndi ndende ya creatinine m'magazi am'magazi a 1.4-1.9 mg / 100 ml, mlingo wa tsiku ndi tsiku sayenera kupitirira 800 mg,
kulephera kwambiri kwa aimpso (CC mpaka 30 ml / mphindi / 1.73 m 2) kapena ndi ndende ya creatinine m'madzi am'madzi opitilira 2 mg / 100 ml, tsiku lililonse mankhwalawa sayenera kupitirira 400 mg.

Kwa odwala hemodialysis, ndi mtsempha wamitsempha, mulingo wofanana. Ciprofloxacin yokhala ndi dialysate imayendetsedwa mwachisawawa 50 mg pa 1 lita imodzi ya dialysate. Pafupipafupi - maola 6 aliwonse kanayi pa tsiku.

Kuyanjana kwa mankhwala osokoneza bongo

Kugwiritsa ntchito munthawi yomweyo ciprofloxacin ndi phenytoin kungayambitse kuchepa kapena kuwonjezeka kwa anthu omaliza m'magazi am'magazi, chifukwa chake ndikulimbikitsidwa kuwunikira kuchuluka kwa mankhwalawa. Chifukwa cha kuchepa kwa ntchito ya microsomal oxidation njira mu hepatocytes, mankhwalawa amatalikitsa theka la moyo ndikuwonjezera kuchuluka kwa theophylline ndi xanthines zina (kuphatikizapo caffeine).

Kafukufuku wokhudza odzipereka wathanzi awonetsa kuti kugwiritsa ntchito pamodzi nthawi yomweyo mankhwala a lidocoin ndi Ciprofloxacin ndi 22% kumachepetsa chilolezo cha lidocaine pakaperekedwa. Ngakhale lidocaine wa wololera bwino, kuphatikiza pamodzi ndi ciprofloxacin kumatha kukulitsa mavuto.

Pankhani yogwiritsidwa ntchito munthawi yomweyo ciprofloxacin ndi mankhwala amkamwa a hypoglycemic (nthawi zambiri kukonzekera kwa sulfonylurea, mwachitsanzo, glimepiride, glibenclamide), zotsatira zaotsiriza zimatha kupititsidwa patsogolo.

The munthawi yomweyo mtsempha wa ciprofloxacin ndi yosalunjika anticoagulants kumawonjezera prothrombin nthawi.

Kugwiritsa ntchito munthawi yomweyo ciprofloxacin okhala ndi mavitamini a K K (mwachitsanzo, acenocoumarol, warfarin, fluindone, fenprocoumone) kungalimbikitse zotsatira zawo zotsutsana. Kukula kwa izi kumakhudzidwa ndi matenda oyanjana, momwe wodwalayo alili komanso zaka zake, motero nkovuta kuyesa kuchuluka kwa mankhwalawa pakukula kwa INR. Ndikulimbikitsidwa kuti kuwunika pafupipafupi kwa INR kumachitika ngati anthu akugwiritsa ntchito njira za vitamini K motsutsana ndi Ciprofloxacin, komanso kwakanthawi kochepa kumapeto kwa kuphatikiza mankhwala.

Akaphatikizidwa ndi antimicrobials (aminoglycosides, metronidazole, clindamycin, mankhwala a beta-lactam), synergism nthawi zambiri imawonedwa. Ciprofloxacin itha kugwiritsidwa ntchito bwino limodzi ndi ceftazidime ndi azlocillin kuchiza matenda oyambitsidwa ndi Pseudomonas spp. Mukaphatikizidwa ndi mankhwala a beta-lactam (mwachitsanzo, azlocillin ndi meslocillin), mankhwalawa amatha kugwiritsidwa ntchito pa matenda a streptococcal. Pamodzi ndi vancomycin ndi isoxazolylpenicillins, Ciprofloxacin amagwiritsidwa ntchito pofalitsa matenda a staph. Mankhwala osakanikirana ndi clindamycin ndi metronidazole amathandizika kumatenda a anaerobic.

Mukamagwiritsa ntchito ciprofloxacin ndi cyclosporine, mphamvu ya lephrotoxic yotsirizira imatheka, ndipo kuwonjezeka kwa ndende ya serum creatinine kumadziwika. Pochiza odwala kawiri pa sabata, ndikofunikira kuwunika ntchito yaimpso.

Ndi kuphatikiza kwapoploloacacin komanso mankhwala osapweteka a antiidal (kuphatikiza acetylsalicylic acid), mwayi wa kugwidwa umawonjezeka. Kugwiritsa ntchito munthawi yomweyo mankhwala a uricosuric ndi ciprofloxacin kumachepetsa kuchotsa (mpaka 50%) ndikuonjezera plasma ndende yotsiriza.

Ciprofloxacin imachulukitsa kuchulukitsa kasanu ndi kawiri kuchuluka kwa tizanidine (Cmax) m'magazi am'magazi (masinthidwe amtunduwu ndi nthawi 421) ndipo imawonjezeka nthawi 10 m'dera lomwe lili nthawi ya mapiritsi a pharmacokinetic curve (AUC nthawi 6-24), zomwe zimawonjezera chiopsezo cha kugona komanso kutsitsa magazi. Chifukwa chake, kugwiritsa ntchito munthawi yomweyo mankhwala a tizanidin okhala ndi ciprofloxacin ndi otsutsana.

Njira yothetsera ya kulowetsedwa kwa mankhwala imagwirizana mosiyanasiyana ndi mankhwala komanso kulowetsedwa, komwe kumakhala kosakhazikika mwanjira yachilengedwe (pH ya Ciprofloxacin yankho la kulowetsedwa ndi 3,9-54.5). Sizoletsedwa kusakaniza iv ndi mayankho ndi pH pamwambapa 7. Mukamagwiritsa ntchito ciprofloxacin ndi mankhwala omwe amakulitsa nthawi ya QT (tricyclic antidepressants, antipsychotic mankhwala, antiarrhythmic mankhwala a kalasi ya III kapena IA, macrolides), kusamala kumafunika.

Kugwiritsa ntchito pamodzi kwa phenenecid ndi ciprofloxacin kumawonjezera kuchuluka kwa otsiriza m'magazi amwazi, popeza kuchuluka kwake kwa impso kumachepa.

Ndi munthawi yomweyo kugwiritsa ntchito omeprazole ndi ciprofloxacin, kuchuluka kwa mankhwala omwe amapezeka m'madzi am'magazi kungachepetse pang'ono, ndipo dera lomwe limaponderezedwa "nthawi yayitali" limachepa.

Kugwiritsa ntchito munthawi yomweyo ciprofloxacin ndi methotrexate kumachepetsa kuchepa kwa impso, komwe kumayendera limodzi ndi kuchuluka kwa plasma ya magazi ndi chiwopsezo chowopsa cha zotsatira za methotrexate. Sitikulimbikitsidwa kugwiritsa ntchito ciprofloxacin ndi methotrexate nthawi imodzi.

Pogwiritsa ntchito munthawi yomweyo kugwiritsa ntchito zoletsa zamphamvu za CYP450 1A2 isoenzyme (mwachitsanzo, fluvoxamine) ndi duloxetine, kuwonjezeka kwa Cmax ndi AUC kwa duloxetine. Ngakhale kusowa kwa chidziwitso pakukhudzana ndi duloxetine omwe ali ndi ciprofloxacin, kuyanjana kofananako ndikotheka kwambiri ngati kumagwiritsidwa ntchito imodzi.

Kugwiritsa ntchito munthawi yomweyo ciprofloxacin ndi ropinirole kumabweretsa kuwonjezeka kwa AUC ndi Cmax komaliza ndi 84 ndi 60%, motsatana. Ndikulimbikitsidwa kuwunika mavuto a ropinirole mukamagwiritsa ntchito ciprofloxacin, komanso kwakanthawi kochepa kumapeto kwa kuphatikiza mankhwala.

Kugwiritsa ntchito munthawi yomweyo ciprofloxacin (250 mg kwa masiku 7) ndi clozapine kumayambitsa chiopsezo cha kuchuluka kwa seramu komaliza ndi N-desmethylclozapine ndi 29 ndi 31%, motero. Ndikofunikira kusintha mankhwalawa a clozapine akagwiritsidwa ntchito pamodzi ndi ciprofloxacin, komanso kwakanthawi kochepa kumapeto kwa kuphatikiza mankhwala.

Kugwiritsa ntchito nthawi yomweyo ciprofloxacin (500 mg) ndi sildenafil (50 mg) kungapangitse kuwonjezeka kwa 2 kwa AUC ndi Cmax komaliza. Cholinga chophatikizira izi chimapangidwa pokhapokha kuwunika mgwirizano womwe ungakhalepo pakati pa zabwino zomwe zingachitike ndi zoopsa zomwe zingakhalepo.

Analogues wa Ciprofloxacin ndi Vero Ciprofloxacin, Basij, Betatsiprol, Kvintor, Infitsipro, Nirtsil, Oftotsipro, Tseprova, Rotsip, Protsipro, Tsiprobid, Tsiprobay, Tsiproksil, Tsiprodoks, Tsiprolet, Tsiprolaker, Tsipromed, Tsiprolon, Tsiprofloksabol, Tsiprolan, Tsifroksinal, Ekotsifol, Tsifratsid , Dijito.

Migwirizano ndi magwiritsidwe akusungidwa

Alumali moyo wa mapiritsi ndi zaka zitatu.

Mapiritsi amayenera kusungidwa pamalo owuma, amdima osafikira ana pamatenthedwe mpaka 30 ° C.

Alumali moyo wa kutsata ndi zaka 2.

Zowunikirazi ziyenera kusungidwa pamalo amdima osavomerezeka kwa ana kutentha mpaka 25 ° C. Osamawuma.

Alumali moyo wa yankho ndi zaka 3.

Njira yothetsera vutoli iyenera kusungidwa ndi ana kuti isamadutse mpaka 25 ° C. Osamawuma.

Nthawi yodonthetsa makutu ndi maso ndi zaka zitatu.

Mankhwalawa amatha kugwiritsidwa ntchito pakatha milungu 4 mutatsegula botolo.

Mtengo wa ciprofloxacin m'mafakisi

Mtengo wa Ciprofloxacin 250 mg (mapiritsi 10 pa paketi) ali pafupifupi ma ruble 20.

Mtengo wa Ciprofloxacin 500 mg (mapiritsi 10 pa paketi iliyonse) ndi ma ruble 40.

Mtengo wa ciprofloxacin mu mawonekedwe a njira yothetsera kulowetsedwa (100 ml) ndi pafupifupi ma ruble 35.

Mtengo wa ciprofloxacin mu mawonekedwe a madontho amaso (5 ml) ndi pafupifupi ma ruble 25.

Ndemanga pa Ciprofloxacin

Ndemanga za ciprofloxacin mwanjira ya mapiritsi ndizotsutsana: ogwiritsa ntchito ena amati mankhwalawa amagwira ntchito, ena samawona mfundo pakugwiritsa ntchito kwake. Ndemanga zambiri zimatchula zoyipa.

Ndemanga za madontho amaso ndizabwino.

Malinga ndi madokotala, ciprofloxacin ili ndi zotsatirazi:

kulekerera kwabwino
Kuthekera kogwiritsira ntchito kuchipatala mankhwala othandizira odwala kwambiri, komanso mankhwalawa atapezeka m'chipatala pafupi ndi malo aliwonse,
kwambiri bactericidal ndi antimicrobial ntchito,
Kutalika kwa theka la moyo komanso mankhwala a anti-antiotic (amakulolani kumwa kamodzi kokha patsiku).

Kodi mwapeza cholakwika m'mawuwo? Sankhani ndikusindikiza Ctrl + Lowani.

Kugwiritsa ntchito mankhwala amprofloxacin

Matenda osakhazikika komanso ovuta omwe amayamba chifukwa cha tizilombo tating'onoting'ono tokhudza chiprofloxacin.

Matenda a kupuma thirakiti, kuphatikizapo pachimake komanso matenda (pachimake siteji) bronchitis, bronchiectasis, matenda a cystic fibrosis, chibayo chifukwa Klebsiella spp., Enterobacter spp., Proteus spp., Esherichia coli. Pseudomonas aeruginosa, Haemophilus spp., Moraxella catarrhalis, Legionella spp. ndi staphylococci, matenda a ziwalo za ENT, kuphatikiza khutu lapakati (otitis media), paranasal sinuses (sinusitis, kuphatikizapo pachimake), makamaka yoyambitsidwa ndi tizilombo tating'onoting'ono ta gramu, kuphatikizapo Pseudomonas aeruginosa kapena staphylococci, matenda a genitourinary system (kuphatikizapo cystitis, pyelonephritis, adnexitis, bacterial prostatitis, orchitis, epididymitis, gonorrhea yosavuta, matenda amkati mwa m'mimba (kuphatikiza ndi metronidazole), kuphatikizapo peritonitis, gallbladder ndi biliary matenda opatsirana, khungu ndi zofewa matenda am'matumbo (zilonda zopatsirana, mabala, kupsa, zilonda zam'mimba, mafupa ndi matenda olowa (osteomyelitis, septic nyamakazi), sepsis, typhoid fever, campylobacteriosis, shigellosis, oyenda m'mimba, matenda kapena prophylaxis matenda opatsirana odwala immunocompromised (odwala omwe amatenga mankhwala a immunosuppress kapena odwala omwe ali ndi neutropenia), kusankha matumbo decontamination mu odwala a immunocompromised, kupewa ndi kuchiza anthrax ya pulmonary. zilonda rskoy (matenda Bacillus anthracis,, kupewa matenda owononga omwe amayambitsidwa ndi Nisseria meningitidis.

Chithandizo cha zovuta zomwe zimayambitsidwa Pseudomonas aeruginosa, ana kuyambira zaka 5 mpaka 17, okhala ndi pulmonary cystic fibrosis, kupewa ndi kuchiza matenda am'mapapo am'mimba Bacillus anthracis).

Chifukwa cha zovuta zomwe zimakhudzana ndi kulumikizana komanso / kapena minofu yoyandikana nayo (onani "Zotsatira zoyipa"), adotolo amayenera kuyamba kulandira chithandizo chodziwa bwino matenda a ana ndi achinyamata ndipo atawunika mosamala kuchuluka kwa chiwopsezo.

Ntchito ophthalmic. Chithandizo cha zilonda zam'mimba ndi matenda amkati mwa mbali yamaso ndi zowonjezera zake zomwe zimayambitsidwa ndi mabakiteriya omwe amamva kwambiri zauprofloxacin mwa akuluakulu, akhanda (kuyambira masiku 0 mpaka 27), makanda ndi makanda (kuyambira masiku 28 mpaka 23), ana (kuyambira 2 mpaka 11) wazaka) ndi achinyamata (wazaka 12 mpaka 18).

Zoletsa ntchito

Matenda oopsa amitsempha yamagazi, kuwonongeka kwa maselo, kuwonjezereka kwa kutalika kwa nthawi ya QT kapena kukulira kwa mtundu wa pirouette arrhythmias (mwachitsanzo, kutalika kwa nthawi yayitali ya QT, matenda amtima (kulephera kwa mtima, kulowetsedwa kwa myocardial, bradycardia), kusakhazikika kwa mtima (hyprosteia ), kuchepa kwa glucose-6-phosphate dehydrogenase, kugwiritsa ntchito munthawi yomweyo mankhwala omwe amakulitsa nthawi ya QT (kuphatikizapo mankhwala osokoneza bongo a antiarrhythmic mankhwala a makalasi IA ndi III, ma tridclic antidepressants, macrolides, mitsempha oleptics), yogwiritsidwa ntchito munthawi yomweyo ndi zoletsa za CYP1A 2 isoenzyme, kuphatikiza methylxanthines, kuphatikizapo theophylline, caffeine, duloxetine, clozapine, ropinirole, olanzapine (onani "Precautions"), odwala omwe ali ndi mbiri ya kuwonongeka kwa tendon yokhudzana ndi kugwiritsa ntchito quinolones, matenda amisala (kukhumudwa, psychosis), chapakati mantha dongosolo (matenda a khunyu, kuchepa khunyu (kapena mbiri ya khunyu), kuwonongeka kwa ubongo kapena kugunda, myasthenia gravis graviskulephera kwambiri kwaimpso ndi / kapena chiwindi, ukalamba.

Kuchita

Mankhwala omwe amachititsa kuti pakhale nthawi yayitali ya QT. Chenjezo liyenera kugwiritsidwa ntchito mukamagwiritsa ntchito chiprofloxacin, monga fluoroquinolones ena, mwa odwala omwe amalandila mankhwala omwe amachititsa kuti pakhale nthawi yayitali ya QT (mwachitsanzo, mankhwala a kalasi IA kapena III antiarrhythmic, triceclic antidepressants, macrolides, antipsychotic) (onani "Precautions").

Theofylline. Kugwiritsa ntchito munthawi yomweyo ciprofloxacin ndi mankhwala okhala ndi theophylline kungayambitse kuchuluka kosafunikira kwa theophylline m'magazi am'magazi ndipo, chifukwa chake, mawonekedwe a zovuta aophylline, m'malo osowa kwambiri, zotsatira zoyipa zimatha kukhala zowopsa kwa wodwala. Ngati kugwiritsa ntchito munthawi yomweyo ciprofloxacin ndi mankhwala okhala ndi theophylline ndiwosapeweka, tikulimbikitsidwa kuyang'anira kuchuluka kwa theophylline m'magazi am'magazi ndipo, ngati kuli kotheka, muchepetse mlingo wa theophylline.

Zotuluka zina za xanthine. Kugwiritsa ntchito munthawi yomweyo ciprofloxacin ndi caffeine kapena pentoxifylline (oxpthenillin) kungapangitse kuwonjezeka kwa kuchuluka kwa zotumphukira za xanthine mu seramu.

Phenytoin. Pogwiritsa ntchito munthawi yomweyo ciprofloxacin ndi phenytoin, kusintha (kuwonjezeka kapena kuchepa) kwapazinthu za phenytoin m'madzi a m'magazi kunawonedwa. Pofuna kupewa kupweteketsa mtima komwe kumakhudzana ndi kuchepa kwa ndende ya phenytoin, komanso kupewa zochitika zokhudzana ndi bongo wa phenytoin atasiya, tikulimbikitsidwa kuyang'anira phenytoin chithandizo kwa odwala omwe amatenga ciprofloxacin, kuphatikizapo kutsimikiza kwa zomwe zili phenytoin m'magazi a plasma nthawi yonseyi munthawi yomweyo kugwiritsa ntchito mankhwala mosakhalitsa.

NSAIDs. Kuphatikizidwa kwa milingo yayikulu ya quinolones (DNA gyrase inhibitors) ndi ena a NSAID (kupatula acetylsalicylic acid) kungayambitse kugwidwa.

Cyclosporin. Pogwiritsa ntchito munthawi yomweyo ciprofloxacin ndi mankhwala okhala ndi cyclosporine, kuwonjezeka kwakanthawi kochepa kwa plasma creatinine ndende kunawonedwa. Zikatero, ndikofunikira kudziwa kuchuluka kwa creatinine m'magazi 2 pa sabata.

Omvera a hypoglycemic othandizira ndi insulin. Pogwiritsa ntchito munthawi yomweyo ciprofloxacin ndi othandizira pakamwa. (Makamaka, glibenclamide, glimepiride), kapena insulin, kukulitsa kwa hypoglycemia mwina chifukwa chakuwonjezeka kwa zochita za hypoglycemic agents (onani "Zotsatira zoyipa"). Kuwunikira mosamala kuchuluka kwa shuga m'magazi kumafunika.

Khalid. Probenecid amachepetsa msanga kuchuluka kwa impso za improfloxacin ndi impso. Kugwiritsa ntchito munthawi yomweyo ciprofloxacin ndi mankhwala okhala ndi phenenecid kumabweretsa chiwopsezo cha chiprofloxacin mu seramu yamagazi.

Methotrexate. Ndi munthawi yomweyo kugwiritsa ntchito methotrexate ndi ciprofloxacin, aimpso zotsekemera za methotrexate zimachepetsa, zomwe zimatha kukhala limodzi ndi kuchuluka kwa methotrexate m'madzi a m'magazi. Potere, mwayi wokhala ndi zovuta za methotrexate ukhoza kuchuluka. Pankhaniyi, odwala omwe amalandira onse methotrexate ndi ciprofloxacin ayenera kuyang'aniridwa bwino.

Tizanidine. Zotsatira zakufukufuku wazachipatala wokhudzana ndi odzipereka athanzi pogwiritsa ntchito munthawi yomweyo ciprofloxacin ndi mankhwala okhala ndi tizanidine, kuwonjezeka kwa kuchuluka kwa tizanidine m'madzi a m'magazi - -_max Nthawi zokwanira 7 (kuyambira nthawi 4 mpaka 21) ndi AUC - maulendo 10 (kuyambira 6 mpaka 24). Ndi kuwonjezeka kwa kuchuluka kwa tizanidine mu seramu, hypotensive (kutsitsa kuthamanga kwa magazi) ndi kusinkhitsa (kugona, kuwonda) mavuto. Kugwiritsa ntchito munthawi yomweyo ciprofloxacin ndi mankhwala okhala ndi tizanidine ndizotsutsana.

Omeprazole Pogwiritsa ntchito mankhwala ophatikizika a ciprofloxacin ndi omeprazole, kuchepa pang'ono kwa C kungadziwike_max ciprofloxacin mu plasma ndi kuchepa kwa AUC.

Duloxetine M'mayeso azachipatala, zidawonetsedwa kuti kugwiritsa ntchito nthawi yomweyo duloxetine ndi potent inhibitors a CYP1A 2 isoenzyme (monga fluvoxamine) kungayambitse kuwonjezeka kwa AUC ndi C_max duloxetine. Ngakhale kusowa kwa chidziwitso cha chipatala pakuyanjana ndi chiprofloxacin, ndizotheka kulosera za kuyanjana kotereku ndi kugwiritsa ntchito munthawi yomweyo ciprofloxacin ndi duloxetine.

Ropinirol. Kugwiritsa ntchito nthawi yomweyo kwa ropinirole ndi ciprofloxacin, choletsa zolimbitsa thupi za isoenzyme CYP1A 2, kumabweretsa kuwonjezeka kwa C_max ndi ropinirole AUC ndi 60 ndi 84%, motsatana. Zotsatira zoyipa za ropinirole ziyenera kuyang'aniridwa ngati zimagwiritsidwa ntchito limodzi ndi ciprofloxacin komanso kwa nthawi yochepa mukamaliza kuphatikiza mankhwala.

Lidocaine. Pakafukufuku wokhudza odzipereka athanzi labwino, zidapezeka kuti kugwiritsa ntchito nthawi yomweyo mankhwala a lidocaine okhala ndi ciprofloxacin, choletsa chowonjezera cha isoenzyme CYP1A 2, kumabweretsa kutsika kwa lidocaine wa 22% wokhala ndi iv. Ngakhale kulekerera kwabwino kwa lidocaine, kugwiritsa ntchito munthawi yomweyo ndi ciprofloxacin, zotsatira zoyipa chifukwa chogwirizana zingalimbikitsidwe.

Clozapine. Pogwiritsa ntchito nthawi yomweyo ya clozapine ndi ciprofloxacin pa mlingo wa 250 mg kwa masiku 7, kuwonjezeka kwa seramu kozizira ndi N-desmethylclozapine kumawonedwa ndi 29 ndi 31%, motero. Momwe wodwala akuyenera kuwunikira ndikuwunika, ngati pakufunika kuthandizanso, muyezo wa dosing ya clozapine amagwiritsidwa ntchito limodzi ndi chiprofloxacin ndipo patangopita nthawi yochepa atamaliza kuphatikiza mankhwala.

Sildenafil. Pogwiritsa ntchito ciprofloxacin pa mlingo wa 500 mg ndi sildenafil pa mlingo wa 50 mg mwa odzipereka athanzi, kuchuluka kwa C kwadziwika._max ndi AUC ya sildenafil 2 nthawi. Motere, kugwiritsa ntchito kuphatikiza kumeneku ndizotheka pokhapokha kuwunika phindu / chiopsezo.

Vitamin K Antagonists Kugwiritsa ntchito koprofloxacin kuphatikizira ndi mavitamini a vitamini K (mwachitsanzo warfarin, acenocumarol, fenprocoumon, fluindione) kungawonjezere kuwonjezeka kwa mphamvu yawo ya anticoagulant. Kukula kwa izi kumatha kusiyanasiyana malinga ndi matenda omwe ali nawo, kuchuluka kwa odwala komanso momwe zinthu zilili kwa wodwalayo, kotero ndikovuta kuyesa zotsatira za ciprofloxacin pakuwonjezeka kwa INR. Nthawi zambiri zimakhala zokwanira kuyang'anira INR pogwiritsa ntchito akuprofloxacin ndi othandizira a vitamini K, komanso kwa nthawi yochepa mukamaliza kuphatikiza mankhwala.

Mankhwala a Cationic. The munthawi yomweyo kukonzanso kwa ciprofloxacin ndi mankhwala cationic - mchere zowonjezera calcium, magnesium, zotayidwa, chitsulo, sucralfate, maantacid, polymeric phosphate mankhwala (mwachitsanzo, sevelamer, lanthanum carbonate) ndi mankhwala okhala ndi gawo lalikulu la buffer (mwachitsanzo didanosine) calcium - amachepetsa mayamwidwe a ciprofloxacin. Muzochitika zotere, ciprofloxation iyenera kumwedwa mwina maola 1-2 musanadye kapena maola 4 mutamwa mankhwalawa.

Kudya ndi mkaka. Mankhwala munthawi yomweyo a ciprofloxacin komanso mkaka wa mkaka kapena zakumwa zomangidwa ndi mchere (mwachitsanzo mkaka, yogati, timadzi ta calcium) zimayenera kupewedwa, chifukwa kuperewera kwa ciprofloxacin kungachepe. Kashiamu yokhala ndi zakudya wamba sizimakhudza mayamwidwe a ciprofloxacin.

Kafukufuku wapadera wazokhudzana ndi mawonekedwe a ophthalmic mitundu ya ciprofloxacin sanachitike. Poganizira kuperewera kwa ciprofloxacin m'madzi a m'magazi pambuyo poti pakhale cholumikizira cham'magazi, kulumikizana kwa mankhwala omwe amagwiritsidwa ntchito limodzi ndi chiprofloxacin sikungatheke. Pankhani yogwiritsidwa ntchito palimodzi ndi zina zakumaso zakukonzekera, nthawi yomwe magwiritsidwe ntchito azikhala osachepera mphindi 5, ndipo mafuta odzola amayenera kugwiritsidwa ntchito komaliza.

Njira zopewera

Matenda owopsa, matenda a staphylococcal ndi matenda chifukwa cha gram-virus ndi anaerobic bacteria. Pochiza matenda oopsa, matenda a staph ndi matenda oyambitsidwa ndi bakiteriya wa anaerobic, ciprofloxacin iyenera kugwiritsidwa ntchito limodzi ndi othandizira antibacterial.

Zofooka chifukwa cha Streptococcus pneumoniae. Ciprofloxacin sichikulimbikitsidwa pochiza matenda oyambitsidwa ndi Streptococcus pneumoniae, chifukwa chakuchepa kwake polumikizana ndi tizilomboti.

Matenda amtundu wa genital. Pa matenda amtunduwu mwina omwe amayamba chifukwa cha zovuta Neisseria gonorrhoeaekugonjetsedwa ndi fluoroquinolones, chidziwitso chotsutsana ndi chiprofloxacin chakumalo chiyenera kukumbukiridwa ndipo chidwi cha pathogen chiyenera kutsimikiziridwa ndi mayeso a labotale.

Kusweka kwa mtima. Ciprofloxacin imakhudza kutalika kwa gawo la QT (onani "Zotsatira zoyipa"). Poganizira kuti azimayi amakhala ndi nthawi yayitali ya nthawi ya QT poyerekeza ndi amuna, amamvera kwambiri mankhwala omwe amayambitsa nthawi yayitali ya QT. Mwa odwala okalamba, pamakhalanso chidwi cha zochita za mankhwala, ndikupangitsa kuwonjezera kwa QT. Chifukwa chake, chiprofloxacin iyenera kugwiritsidwa ntchito mosamala kuphatikiza ndi mankhwala omwe amawonjezera nthawi ya QT (mwachitsanzo, mankhwala a IA ndi III antiarrhythmic mankhwala, anticepressants a tricyclic, macrolides ndi antipsychotic mankhwala (onani "Kuchita"), kapena kwa odwala omwe ali pachiwopsezo chowonjezera nthawi ya QT kapena kukulitsa. pirouette mtundu arrhythmias (mwachitsanzo, kubadwa kwa QT yopititsa patsogolo matendawa, kusasinthika kwa electrolyte, monga hypokalemia kapena hypomagnesemia, komanso matenda a mtima monga kulephera kwa mtima, inf myocardial artery, bradycardia).

Gwiritsani ntchito ana. Zinapezeka kuti ciprofloxacin, monga mankhwala ena amakalasi iyi, amachititsa arthropathy ya mafupa akulu a nyama.

Kuwunika kwa chitetezo chamakono pakugwiritsa ntchito ciprofloxacin mwa ana osaposa zaka 18, omwe ambiri mwa iwo ali ndi cystic fibrosis, sanakhazikitse mgwirizano pakati pa kuwonongeka kwa cartilage kapena mafupa okhala ndi ciprofloxacin. Sitikulimbikitsidwa kugwiritsa ntchito ciprofloxacin mwa ana a zaka 5 mpaka 17 pochiza matenda ena, kupatula zovuta za cystic fibrosis zomwe zimagwirizana ndi Pseudomonas aeruginosa, komanso kuthandizira komanso kupewa matenda am'mapapo a m'mapapo (atatha kukayikiridwa kapena kutsimikiziridwa matenda Bacillus anthracis).

Hypersensitivity. Nthawi zina mutatenga koyamba mlingo wa ciprofloxacin, hypersensitivity imatha kuphatikizira matupi awo sagwirizana, omwe amayenera kufotokozeredwa kwa asing'anga (onani "Zotsatira zoyipa"). Nthawi zina, mutagwiritsidwa ntchito koyamba, zimachitika kuti anaphylactic angadabwe. Muzochitika izi, kugwiritsa ntchito ciprofloxacin kuyenera kuyimitsidwa nthawi yomweyo ndipo chithandizo choyenera chikuyenera kuchitika.

Matumbo. Ngati kutsegula kwambiri kwa nthawi yayitali kumachitika pakatha kapena chithandizo cha ciprofloxacin, kuwunika kwa pseudomembranous colitis sikuyenera kuchotsedwa, komwe kumafunika kuchotsedwa kwaphiploxacin mwachangu ndi kupatsidwa chithandizo choyenera (pakamwa vancomycin pa mlingo wa 250 mg 4 pa tsiku) (onani "Zotsatira zoyipa").

Kugwiritsa ntchito mankhwala omwe amachepetsa matumbo athu kumatsutsana.

Machitidwe a heepatobiliary. Pogwiritsa ntchito ciprofloxacin, pakhala pali zochitika za chiwindi necrosis komanso kufooka kwa chiwopsezo cha moyo. Ngati pali zizindikiro za matenda a chiwindi monga anorexia, jaundice, mkodzo wakuda, kuyabwa, kupweteka pamimba, ciprofloxacin iyenera kusiyidwa (onani "Zotsatira zoyipa").

Odwala omwe amatenga ciprofloxacin komanso akudwala matenda a chiwindi, kuwonjezeka kwakanthawi kwa ntchito ya hepatic transaminases, alkaline phosphatase, kapena cholestatic jaundice kuonedwa (onani "Zotsatira zoyipa").

Dongosolo laumiseche. Odwala kwambiri myasthenia gravis ciprofloxacin iyenera kugwiritsidwa ntchito mosamala, chifukwa kuchuluka kwa zizindikiro ndizotheka.

Mukamamwa ciprofloxacin, pakhoza kukhala milandu ya tendonitis ndi tendon (makamaka Achilles), nthawi zina, mkati mwa maola 48 atangoyamba kumene chithandizo. Kutupa kwa Tendon ndi kupasuka kumatha kuchitika ngakhale miyezi ingapo pambuyo poti chiprofloxacin atayimitsidwa. Mwa odwala okalamba komanso odwala omwe ali ndi matenda a tendon omwe nthawi yomweyo amalandila chithandizo ndi corticosteroids, pali chiopsezo chowonjezeka cha tendinopathy.

Pazizindikiro zoyambirira za tendonitis (kutupa kwakupweteka pakulowa, kutupa), kugwiritsa ntchito ciprofloxacin kuyenera kuyimitsidwa, zolimbitsa thupi ziyenera kuthiridwa, chifukwa pali chiopsezo chotumphukira kwa tendon, ndikuwonana ndi dokotala. Ciprofloxacin iyenera kugwiritsidwa ntchito mosamala odwala omwe ali ndi mbiri ya matenda a tendon omwe amagwiritsidwa ntchito ndi quinolones.

Machitidwe amanjenje. Ziprofloxacin, monga mitundu ina ya fluoroquinolones, imatha kuyambitsa kupweteka komanso kuchepetsa chitseko chotsimikiza. Odwala omwe ali ndi khunyu komanso akudwala matenda oopsa amisempha (mwachitsanzo, kuchepa kwa njira yolumikizira, mbiri ya kukomoka, ngozi zam'magazi, kuwonongeka kwa ubongo, kapena sitiroko), chifukwa choopsa cha zotsatira zoyipa za CNS, ciprofloxacin iyenera kugwiritsidwa ntchito pokhapokha ngati zikuyembekezeredwa Matenda azachipatala amapitilira chiwopsezo cha mavuto.

Pogwiritsa ntchito ciprofloxacin, milandu yokhudzana ndi khunyu yapezeka (onani "Zotsatira zoyipa"). Ngati kukhumudwitsa kumachitika, kugwiritsa ntchito ciprofloxacin kuyenera kusiyidwa. Machitidwe amakhudzidwa amatha kuchitika ngakhale mutayamba kugwiritsa ntchito fluoroquinolones, kuphatikiza ciprofloxacin. Nthawi zina, kukhumudwa kapena ma psychotic zimatha kupitilira mpaka pakudzipha komanso kudzivulaza, monga kuyesa kudzipha, incl. odzipereka (onani "Zotsatira zoyipa"). Wodwala akayamba kupanga chimodzi mwazinthu izi, muyenera kusiya kumwa ciprofloxacin ndi kudziwitsa dokotala.

Odwala omwe akutenga fluoroquinolones, kuphatikizapo ciprofloxacin, afotokozapo milandu yam'mutu kapena sensorimotor polyneuropathy, hypesthesia, dysesthesia, kapena kufooka. Ngati zizindikiro monga kupweteka, kuwotcha, kumva, kugona, kufooka kumachitika, odwala ayenera kudziwitsa dokotala wawo asanapitirize ndi ciprofloxacin.

Khungu. Mukamamwa ciprofloxacin, zimachitika m'maso, motero odwala ayenera kupewa kulumikizana ndi dzuwa kapena kuwala kwa UV. Chithandizo ziyenera kusiyidwa ngati chizindikiro cha kupenyerera kwa khungu (mwachitsanzo, kusintha kwa khungu kukufanana ndi kutentha kwa dzuwa) (onani "Zotsatira zoyipa").

Cytochrome P450. Amadziwika kuti ciprofloxacin ndizoletsa zolimbitsa thupi za isoenzyme CYP1A 2. Chenjezo liyenera kugwiritsidwa ntchito mukamagwiritsa ntchito ciprofloxacin ndi mankhwala omwe amapangidwa ndi isoenzyme iyi methylxanthines, kuphatikizapo theophylline ndi tiyi kapena khofi, duloxetine, ropinirole, clozapine, olanzapine, monga kuwonjezeka kwa kuchuluka kwa mankhwalawa mu seramu yamagazi, chifukwa cha kuletsa kwa kagayidwe kake ka ciprofloxacin, kungayambitse zovuta zina.

Zomwe zimachitika mdera lanu. Ndi pa / pakubwera kwa ciprofloxacin, zotupa zakomweko zimatha kupezeka pamalo a jekeseni (edema, ululu). Izi zimachitika kawirikawiri ngati nthawi ya kulowetsedwa ndi mphindi 30 kapena kuchepera. Zomwe zimachitika mwachangu zimadutsa kutha kwa kulowetsedwa ndipo sikuti kuphwanya lamulo lotsatira, pokhapokha njira yake ili yovuta.

Popewa kukula kwa crystalluria, mlingo womwe umalimbikitsidwa tsiku lililonse sayenera kupitirira, kukhathamiritsa madzi okwanira ndikusunga mkodzo wa acid acid ndikofunikira. Ndi munthawi yomweyo iv ya ciprofloxacin komanso mankhwala oletsa kuwunika kuchokera ku gulu la barbituric acid, kuyang'anira kuchuluka kwa mtima, kuthamanga kwa magazi, ECG ndiyofunikira. Mu vitro ciprofloxacin ikhoza kusokoneza kuyesedwa kwa bacteria Chifuwa chachikulu cha mycobacterium, kuponderezera kukula kwake, komwe kungapangitse zotsatirapo zabodza pakupezeka kwa tizilombo toyambitsa matenda omwe ali ndi odwala omwe akutenga ciprofloxacin.

Kugwiritsa ntchito ciprofloxacin nthawi yayitali komanso mobwerezabwereza kumatha kuyambitsa matenda opatsirana kapena mabakiteriya oyamba ndi matenda oyamba ndi mafangasi.

Kukopa pa luso loyendetsa magalimoto ndi zida. Panthawi yamankhwala, muyenera kusamala mukamayendetsa magalimoto ndi ziwonetsero, komanso pochita zinthu zina zomwe zingakhale zowopsa zomwe zimafunikira chidwi chochulukirapo komanso kuthamanga kwa zochitika zama psychomotor. Ndi makulidwe osagwirizana a mantha a dongosolo (mwachitsanzo, chizungulire, kupweteka), munthu ayenera kupewa kuyendetsa galimoto ndi kuchita zinthu zina zomwe zimafuna kuti anthu azisamalira komanso azithamanga kwambiri.

Zochitika zamankhwala za chiprofloxacin mwa ana osakwana 1 chaka chochepa. Kugwiritsa ntchito ciprofloxacin mu ophthalmia kwa akhanda okhala ndi gonococcal kapena chlamydial etiology sikulimbikitsidwa chifukwa chosowa chidziwitso pakugwiritsa ntchito gulu ili la odwala. Odwala omwe ali ndi neonatal ophthalmia ayenera kulandira chithandizo choyenera cha etiotropic.

Pogwiritsa ntchito ophthalmic ya ciprofloxacin, kuthekera kwa kudutsa kwa ma rhinopharyngeal kuyenera kukumbukiridwa, zomwe zingapangitse kuwonjezeka kwa pafupipafupi komanso kuwonjezereka kwa kubwera kwa mabakiteriya.

Odwala omwe ali ndi zilonda zam'mimba, mawonekedwe a kristalo yoyera adadziwika, omwe ndi mabungwe a mankhwalawa. Mtengo sukusokoneza pakugwiritsidwanso ntchito kwa ciprofloxacin ndipo sizikhudza mphamvu yake yothandizira. Maonekedwe a mpweya amawonekera munthawi ya maola 24 mpaka masiku 7 chiyambireni chithandizo, ndipo kuyambiranso kwake kumatha kuchitika pokhapokha atapangidwa ndipo mkati mwa masiku 13 atangoyamba kumene chithandizo.

Kuvala magalasi osavomerezeka sikuthandizidwa.

Pambuyo pakugwiritsira ntchito kwa ophthalmic kwa ciprofloxacin, kuchepa kwa kumvetsetsa kwa mawonekedwe azowonekera ndikotheka, chifukwa chake, atangogwiritsa ntchito, sikulimbikitsidwa kuyendetsa galimoto ndikuchita zinthu zomwe zimafunikira chidwi chochulukirapo komanso kuthamanga kwa zochitika zama psychomotor.