Cefepim: Malangizo ntchito > Chithandizo ndi kupewa

Mfundo yofunika kwambiri ikufuna kuwonongedwa kwa cell khoma la tizilombo tating'onoting'ono, mankhwalawa amachita bactericidal.

Mankhwalawa akuwonetsa ntchito yapamwamba kwambiri yolimbana ndi tizilombo tosiyanasiyana tomwe timagwiritsa ntchito zaka 3 za cephalosporins, aminoglycosides. Chithandizo chogwira msanga chimalowa mu cell yamagalamu osavomerezeka, pomwe chikukhudzidwa kwambiri ndi hydrolysis ya ambiri a beta-lactamases. Cholinga chachikulu chomwe chimakhala mkati mwa selo ndi nthawi ya pulicillin.

Cefepim yoletsa antibayotiki imagwira pamafakiteriya okhala ndi gramu-gram komanso mabakiteriya osavomerezeka mu vitro ndi vivo: streptococci, enterobacteria, Escherichia coli, Klebsiella, clostridia, proteina, etc.

Zisonyezero zogwiritsa ntchito cefepime

Mankhwala ochepetsa mphamvu amtundu wa antibayotiki amatchulidwa kuti apite patsogolo kwambiri. chibayochifukwa cha streptococci, enterococci, Klebsiella ndi tizilombo tina tomwe timayang'ana machitidwe a mankhwalawa.

Malangizo ogwiritsira ntchito Cefepima ali ndi zotsatirazi zomwe zikugwiritsira ntchito mankhwalawa: zotupa zapamimba za kwamikodzo (mitundu yovuta komanso yosavuta), febrile neutropenia, matenda opatsirana osavuta a pakhungu ndi pafupi ndi minofu yofewa.

Mankhwalawa amathandizidwa kuti azigwiritsidwa ntchito pazovuta zamkati pamatumbo opatsirana (pamodzi ndi metronidazole).

Zotsatira zoyipa

Cepepime imatha kuyambitsa thupi kugundana, kutentha, zotupa zotupa pakhungu, poyizoni wa epidermal necrolysis, exudative erythema multiforme, anaphylactoid zimachitika.

Potengera momwe mankhwalawo amathandizira kuti asamamwe mankhwala, ndikotheka kulembetsa zomwe Coombs zimachita.

Mothandizidwa ndi intramuscular, soreness ndi redness mu jakisoni wothandizila amadziwika, phlebitis samakonda kukhala pambuyo kulowetsedwa kwa kulowetsedwa.

Thirakiti: zosokoneza mu magwiridwe antchito a aimpso.

Matumbo: Zizindikiro zam'maso pseudomembranous colitis, kudzimbidwa, kupweteka kwa epigastric, kusanza, nseru.

Ziwalo za Hematopoietic: magazi osachepera magazi,kuchepa magazi, leukopenia, kuchepa kwa chiwerengero cha mapulosi, neutrophils.

Kuchokera ku kupuma pali chifuwa.

Matenda a mtima: zotumphukira edema, palpitations, kufupika kwa mpweya.

Zowonetsa njira zakufufuzira zasayansi ndi zothandiza:hypercalcemiakuchuluka kwa prothrombin time, hyperbilirubinemia, kuchuluka kwa urea, michere ya chiwindi ndi phosphatase ya alkal, kulembetsa hypercreatininemia.

Poyerekeza ndi chithandizo cha mankhwala, kukula kwa oropharyngeal candidiasis, asthenia, kupweteka pachifuwa ndikotheka, kupambanapamwambakupweteka kumbuyo ndi mmero.

Cefepim, malangizo ogwiritsira ntchito (Njira ndi Mlingo)

Mankhwalawa amathandizira kulowetsedwa kudzera m'mitsempha (nthawi ya kulowetsedwa iyenera kukhala theka la ola). Nthawi zina, kuyamwa kwa mankhwalawa amaloledwa (matenda a genitourinary system oyambitsidwa ndi E. coli).

Chithandizo cha chibayo: mtsempha wa magazi makonzedwe a 1-2 gm a antiotic kawiri pa tsiku kwa masiku 10.

Mankhwala othandizira febrile neutropenia: Idziwitsani 2 magalamu a mankhwalawa kudzera maola 8 aliwonse, mankhwalawa amachitika mpaka matendawa atathetsedweratu (pafupifupi masiku 10).

Chithandizo cha zotupa zamtundu wa genitourinary thirakiti: kulowetsamo mtsempha wa 0,5-1 magalamu a mgonthi pa maola 12 aliwonse, njira ya antibacterial imapangidwira masiku 7-10.

Woopsa matenda opezeka pamwambapa, kuchuluka kwa mankhwalawa kumawonjezereka mpaka magalamu awiri, mankhwalawa amapangidwira masiku 10.

Patsiku loyamba la antibacterial, odwala omwe amalandila hemodialysis amapatsidwa gramu imodzi ya cefepime, ndiye kuti 0,5 gramu imathiridwa tsiku lililonse (kwa febrile neutropenia, mlingo umakulitsidwa 1 gramu). Mankhwala tikulimbikitsidwa kuti akaperekedwe atangomaliza gawo la hemodialysis.

Momwe mungasungire nthawi yam'mimba ya jekeseni: ufa umasungunuka musanayambe kulowetsedwa mu 5% yankho la dextrose (sodium chloride solution ya 0.9% ndikutheka) mpaka kuthe kwathunthu. Pamaso jakisoni wa mu mnofu, mankhwalawa amadzipaka m'madzi apadera kuti apangidwe jakisoni wa benzyl kapena paraben. Mwina kugwiritsa ntchito yankho la lidocaine wa ndende ya 0,5 ndi 1%.

Kuchita

Cefepime imatha kuchuluka ototoxicity ndi kuwonjezera zovuta pa aimpso dongosolo mankhwala ndi aminoglycosides.

Mankhwala othandizira sagwirizana ndi heparin ndi mankhwala ena oyambitsa matenda. Mankhwala sayenera kuperekedwa limodzi ndi yankho la metronidazole.

Malangizo apadera

Cepepime pamapiritsi sapezeka.

Mankhwala amathetsedwa ndikupanga matenda a pseudomembranous colitis okhala ndi matenda am'mimba a nthawi yayitali (tikulimbikitsidwa kusinthira ku metronidazole ndi vancomycin).

Odwala omwe ali ndi mbiri yokhudzana ndi mayankho a penicillin, mapangidwe a mitsempha yokhala ndi matupi a hypersensitivity amatha.

Odwala omwe ali ndi matenda a hepatic dongosolo ndi impso amafunika kuwunika pafupipafupi momwe amagwiritsidwira ntchito m'magazi (kuwongolera kwa mankhwalawa kumachitika molingana ndi mulingo wa QC).

Ndi mitundu yosakanikirana ya matenda a anaerobic-aerobic, mankhwala owonjezera a antibacterial amalimbikitsidwa mpaka chizindikiritso chokwanira cha tizilombo toyambitsa matenda.

Poyerekeza ndi chithandizo cha mankhwalawa, ndikotheka kulembetsa zotsatira zoyipa mukamayesa mayesero a mkodzo.

Ntchito ya antibacterial ya mankhwala siyitayika pamene mtundu wa yankho lakonzedwa wasintha.

Mlingo

Ufa wa yankho la jakisoni 0,5 g ndi 1.0 g

Botolo limodzi lili

ntchito yogwira - cefepime hydrochloride (malinga ndi cefepime) 0,5 g kapena 1.0 g,

wokonda - arginine.

Mu mawonekedwe osakaniza a cefepime hydrochloride ndi arginine.

Zoyera, pafupifupi zoyera kapena zachikasu ufa, hygroscopic.

Mankhwala

Pharmacokinetics

Nthawi yofika pazigawo zambiri za cefepime m'magazi a seramu ndi jakisoni wamitsempha pa 0,5 ga ndi maola 1-2, ndi ma intravenous makonzedwe a 0,5 g - kumapeto kwa kulowetsedwa. Ambiri plasma woipa wa cefepime pamene kutumikiridwa m`nsinga pa 0,25 g, 0,5 g, 1 g ndi 2 g ndi 18, 39, 82, ndi 164 μg / ml, motero, ndi jekeseni imodzi mu mnofu pa mlingo wa 0,5 g, 1 g ndi 2 g - 14, 30 ndi 57 μg / ml, motsatana. Nthawi yofikira pakati pa achire a plasma ndende ndi maola 12. Ambiri achire ndende ndi mtsempha wa magazi makonzedwe a 0,7 μg / ml, ndi mu mnofu makonzedwe - 0,2 μg / ml. Zochizira zozama za cefepime zimatheka mu mkodzo, bile, peritoneal fluid, bronchial mucosa, sputum, Prostate, zowonjezera komanso chikhodzodzo. Kugawa voliyumu 0,25 l / kg, ana kuyambira miyezi iwiri mpaka zaka 16 - 0,3 l / kg. Amapukusidwa m'chiwindi ndi impso ndi 15% ndikupanga N-methylpyrrolidine, yomwe imasandulika kukhala N-oxide. Pafupifupi 80% ya cefepime imachotsedwa mu mkodzo, makamaka chifukwa cha kusefera kwamadzi, osakwana 1% ya mankhwala omwe amaperekedwa amapezeka mumkodzo monga mawonekedwe a N-methylpyrrolidine. Kumangiriza kwa cefepime ku mapuloteni a seramu kumakhala kochepera 19% ndipo sikudalira kuchuluka kwa maantibayotiki m'magazi. 85% imapukusidwa ndi impso ndi kusefera kwa glomerular kosasinthika. Ma pharmacokinetic magawo a cefepime mu ana pambuyo mtsempha wa magazi makonzedwe a 50 mg / kg ali ofanana kukhudzana ndi achikulire pambuyo pakuchitika kwa jekeseni ya 2 g. Mtheradi wa bioavailability wa cefepime mwa odwala 8 pambuyo pa jekeseni wamitsempha pa 50 mg / kg anali 82.3 (± 15)%. Imalowa mkaka wa m'mawere.

Chilolezo chokwanira cha mankhwalawa ndi 120 ml / min. Chiyeretso cha nthawi yayitali cefepime ndi 110 ml / min. Pharmacokinetics ya cefepime sasintha kwambiri mwa odwala omwe ali ndi vuto la chiwindi kapena cystic fibrosis (kusintha kwa mlingo sikofunikira). Ndi kulephera kwa aimpso, theka la moyo wa cefepime limakulanso, pomwe pali mgwirizano wamgwirizano pakati pa kuvomerezeka kwathunthu kwa cefepime ndi chilolezo cha creatinine. Hafu ya moyo wa cefepime ndi maora 2, pa hemodialysis - maola 13, mosalekeza ambulatitis dialysis - maora 19. Sizimadziunjikira m'thupi.

Mankhwala

Cephalosporin IV m'badwo wa antiotic. Amagwira bactericidal, akusokoneza kapangidwe ka khungu lamoyo la tizilombo tating'onoting'ono. Ili ndi mitundu yambiri yochitira. Yogwira polimbana ndi mabakiteriya okhala ndi gramu komanso gram-negative, kuphatikiza mitundu ingapo yotsutsana ndi aminoglycosides kapena mankhwala amtundu wachitatu wa cephalosporin. Cepepime imalephera kwambiri machitidwe a β-lactamases ambiri, ali ndi mgwirizano wotsika wa beta-lactamases womangidwa ndi majini a chromosomal, ndipo amalowera mosavuta mabakiteriya opanda gramu. Kuwerengera kwa MBC (ochepera bactericidal ndende) / MIC (osachepera cholepheretsa ndende) ya cefepime ndi yochepera 2 chifukwa kupitirira 80% ya otalikirana onse a gram-positive ndi gram-hasi tizilombo.

Mankhwalawa amagwira ntchito pothana ndi tizilombo tosiyanasiyana tating'onoting'ono.

Mabakiteriya olimbitsa thupi aerobic: Staphylococcusaureus,Staphylococcuskhungu (kuphatikiza zingwe zopanga beta-lactamase), zovuta zina za staphylococci, kuphatikiza Staphylococcushominis,Staphylococcussaprophyticus,Streptococcuspyogenes (gulu A streptococci),Streptococcusagalactiae (Gulu la Streptococcus B),Streptococcuschibayo (kuphatikiza tizilombo ta penicillin odziletsa - MIC kuchokera 0,1 mpaka 0,3 μg / ml), ena beta hemolytic streptococci (magulu C, G, F),Streptococcusbovis (gulu D),Streptococcusma viridan.

Mitundu yambiri ya enterococci, mwachitsanzo Enterococcusfaecalis ndi sticylococci yogonjetsedwa ndi methicillin imagwirizana ndi nyengo ya kuphwanya.

Cepepime ndiyosagwira ntchito zina Xanthomonas maltpphilia (Pseudomonas maltophilia).

Anaerobes: Prevotella spp. (kuphatikiza Prevotella melaninogenicus) Bacteroides spp., kuphatikiza Bacteroides melaninogenicus ndi tizilombo tina tating'onoting'ono tomwe timagwira pakamwa Mabakiteriya, Clostridium perfringens, Fusobacterium spp., Mobiluncus spp., Peptostreptococcus spp., Veilonella spp.. Cepepime ndiyosagwira Bacterioides fragilisndiClostridium Hardile.

Mlingo ndi makonzedwe

Mankhwalawa amaperekedwa kudzera m'mitsempha (pang'onopang'ono kuposa mphindi 3-5) ndi intramuscularly (kulowa mkati mwa minofu). Mlingo wothandizirana umakhazikitsidwa payekhapayekha, poganizira zovuta za matendawa, mtundu wa pathogen komanso chidwi chake cha nthawi ya kuphwanya. Njira yolowerera yoyendetsera imakonda odwala omwe ali ndi matenda oopsa kapena oopsa, makamaka ndi chiopsezo chodzidzimutsa.

Akuluakulu ndi ana olemera oposa 40 kg omwe ali ndi matenda amkodzo - 0.5-1 g katatu patsiku,

ndi matenda a malo ena - 1 g kudzera mu intravenly kapena mwamitsempha maola 12 aliwonse, ndimatenda owopsa, mlingo umakulitsidwa mpaka 2 g 2 pa tsiku,

kwa matenda oopsa omwe amakhala m'magazi awiri, 2 g tsiku lililonse kwa masiku 7, kubweretsa mlingo wa tsiku lililonse wa 12 g,

ndi febrile neutropenia - 2 ga mtsempha wamaola 8 aliwonse masiku 7,

popewa matenda opatsirana opaleshoni isanayambike komanso nthawi yogwira ntchito - 2 g kudzera m'mitsempha kwa mphindi 30 (kumapeto kwa makonzedwe, metronidazole 500 mg imaperekedwanso kwa ola limodzi) ola limodzi isanachitike opareshoni, pakachitika ntchito yayitali, mobwerezabwereza pambuyo pa maola 12 pa mlingo womwewo , kutsatiridwa ndi kuyambitsidwa kwa metronidazole.

Mu zovuta kwamkodzo thirakiti matenda (kuphatikizapo pyelonephritis), chibayo, ndi mphamvu mankhwala a neutropenic fever ana osachepera 40 kg - 50 mg / kg maola 12 aliwonse.

Ndi neutropenic fever, mabakiteriya a meningitis mwa ana olemera zosakwana 40 makilogalamu - 50 mg / kg maola 8 aliwonse.

Pankhani ya kuwonongeka kwa impso, mlingo uyenera kusintha. Ndi creatinine chilolezo cha 30-60 ml / mphindi, kutengera kuwopsa kwa matendawa - 0,5, 1 kapena 2 g kawiri pa tsiku, ndi creatinine chilolezo cha 10-30 ml / mphindi - 0,5, 1 kapena 2 g nthawi imodzi patsiku. chilolezo

Kutulutsa mawonekedwe ndi kapangidwe kake

Mlingo wamitundu:

ufa pakukonzekera njira yothetsera makonzedwe a mu mnofu (IM): kuchokera kwa oyera mpaka oyera ndi tint wachikasu, 0,5 g kapena 1 g iliyonse pambale: mu bokosi lamatoni la Mbale 10 kapena 50 (ku chipatala), m'bokosi lamatabwa 1 mu chikatoni mtolo 1 wa botolo lodzaza ndi zosungunulira (1 galasi yokwanira 3.5 ml iliyonse ndi yankho la lidocaine wa jakisoni 10 mg / ml), pamatoni 1 a botolo 1 la 3,5 ml yodzadza ndi solventine jakisoni 10 mg / ml ndi 1 ampoule wa 5 ml ndi madzi a jekeseni, 1 g mu mbale, mu katoni mauthenga ndi mbale 5 kapena 30
ufa pakakonzedwe ka yankho la intravenous (iv) ndi intramuscular (i / m): yoyera yokhala ndi tint yachikasu ya 0,5 g mu botolo, pabokosi lamatabwa 1 pamabokosi a makompyuta 10, 50, 270 kapena 300 (kuchipatala), 0,5 g kapena 1 g m'mabotolo, m'matumba a mabotolo amtundu umodzi kapena asanu, mukatoni mtolo umodzi 1 wokwanira magalasi 1 kapena 5 ndi chosungunulira (madzi a jekeseni), 1 g iliyonse mabotolo, mkatoni mtolo 1 botolo, mu makatoni 10, 14, 25, 50, 270, 300 kapena 1000 mabotolo (ku chipatala), 2 g mu botolo, mu makatoni 1 botolo paketi, mu katoni 50 kapena 300 Mbale (kwa chipatala).

M'mabotolo 1 okhala ndi ufa wa i / m makonzedwe ali ndi:

chogwira ntchito: cefepime hydrochloride monohydrate malinga ndi nthawi ya cefepime - 0,5 g kapena 1 g,
othandizira gawo: arginine.

M'mabotolo 1 okhala ndi ufa wa iv ndi v / m makulitsidwe ali ndi:

yogwira mankhwala: cefepime hydrochloride malinga ndi cefepime - 0,5 g, 1 g kapena 2 g,
othandizira gawo: arginine.

Pharmacokinetics

The bioavailability wa cefepime ndi 100%.

Kuzindikira kwakukulu (C_max) mankhwala omwe amapezeka m'madzi am'magazi ndi kukokoloka kamodzi kwa 1000 mg ya cefepime kwa maola 0.5 ndi 0,0787 mg / ml 0,5 maola atatha kulowetsedwa. Pambuyo maola 12, mankhwala omwe amapezeka m'magazi a m'magazi a 0.0006 mg / ml. Ndende yonse (AUC) yamankhwala omwe amapezeka m'madzi opitirira ola limodzi ndi 0.1485 mg / ml.

Pambuyo poyang'anira i / m, mayamwidwe a cefepime amapezeka kwathunthu. C_max ndi kuyambitsa / m, 1000 mg ya mankhwalawa imafikira 0,0263 mg / ml pambuyo pa maola awiri. AUC - 0,137 mg / ml / h.

Voliyumu yogawa pakati pa akuluakulu ndi 0,25 l / kg, mwa ana - 0,33 l / kg.

Pafupifupi 20% ya mlingo womwe umayendetsedwa umagwira kumapuloteni a plasma.

Cefepime mu yozama kwambiri imatsimikizika mu peritoneal fluid, mkodzo, bile, chikhodzodzo, sputum, bronchial mucosa, bludate blland, gland ya Prostate.

Hafu ya moyo ndi maola 2, ndi hemodialysis - maola 13, ndi peritoneal dialysis kosatha - maola 19.

Pafupifupi 15% ya mankhwalawa imaphatikizidwa m'chiwindi ndi impso, pafupifupi 85% imachotsedwa mu mkodzo.

Ufa pakukonzekera njira yothetsera utsogoleri wa iv ndi / m

chibayo chapakati komanso choopsa chochitika ndi Pseudomonas aeruginosa, Streptococcus pneumoniae (kuphatikiza milandu yomwe imakhudzana ndi concomitant bacteremia), Klebsiella pneumoniae, Enterobacter spp.
pyelonephritis ndi zina zosavuta komanso zovuta kufalitsa matenda a kwamikodzo chifukwa cha Klebsiella pneumoniae, Escherichia coli, Proteus mirabilis,
febrile neutropenia - mankhwala othandizira,
matenda ophatikizika am'mimba omwe amayamba chifukwa cha Enterobacter spp., Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae, Bactero>

Mimba komanso kuyamwa

Kugwiritsa ntchito nthawi ya mphiri kumatheka pokhapokha pokhapokha ngati chithandizo chamankhwala chotsatira cha mayi chikuchuluka kwambiri zomwe zingawopseze mwana wosabadwayo:

mu mawonekedwe a ufa wa IV ndi IM makonzedwe - mu II ndi III trimesters of mimba (I trimester ndi mtheradi wotsutsana ndi fomu iyi),
mu mawonekedwe a ufa wa i / m kayendetsedwe - nthawi yonse ya mimba.

Kugwiritsa ntchito mankhwalawa pa mkaka wa m`mawere ndi contraindicated. Pazowonetsa zamankhwala zofunikira kukhazikitsidwa kwa nthawi ya kuphika, kuyamwitsa kuyenera kuyimitsidwa kwakanthawi.

Kuyanjana kwa mankhwala osokoneza bongo

Pogwiritsa ntchito nthawi yomweyo ya cefepime:

aminoglycosides, okodzetsa, polymyxin B amachititsa kuchepa kwa katulutsidwe katulutsidwe ka cefepime, kukweza theka la moyo ndikuchulukitsa ndende yake m'magazi, kuonjezera nephrotoxicity,
mankhwala omwe si a anti-steroidal anti-yotupa amathandizira kuchepetsa kuchepa kwa cephalosporins, kuonjezera ngozi ya kutuluka magazi,
macrolides, chloramphenicol, tetracyclines amawonetsa kukondana ndi mankhwalawo,
aminoglycosides ndi synergistic.

Mankhwala sayenera kusakaniza mu syringe yomweyo ndi yankho la metronidazole, boreamicin, vancomycin, tobramycin, aminophylline kapena netilmicin. Ngati ndi kotheka, kupezeka kwa munthawi yomweyo kwa aliyense kuyenera kuperekedwa payokha.

Ampicillin ndi cefepime zothetsera zimatha kusakanikirana mu syringe imodzi pachilichonse cha osaposa 40 mg pa 1 ml.

Mitu yanthawi ya mapiri ndi: Maksipim, Ladef, Movizar, Tsepim, Efipim.

Contraindication

Asanayambe chithandizo ndi Cefepim, odwala ayenera kuphunzira mosamala malangizo omwe akupatsirana. Jekeseni sichimaperekedwa ngati wodwala ali ndi vuto limodzi kapena zingapo:

msinkhu wa ana mpaka miyezi iwiri (yolumikizira mafupa) - izi zimachitika chifukwa cha kusazindikira kwa ntchito ndi chitetezo chosavomerezeka,
zaka mpaka 12 zaka jakisoni wa mankhwala
kusalolera pakumwa mankhwala,
milandu ya thupi lawo siligwirizana mankhwala a gulu la cephalosporins,
Hypersensitivity ku penicillin - kuthekera kwodutsa kwa cephalosporins,
pseudomembranous colitis, kuphatikizapo mbiri ya
mimba ndi nthawi yoyamwitsa.

Zokhudza kuponderezedwa kwa jekeseni ya Cefepim ndi matenda opweteka a chiwindi, zilonda zam'mimba zam'mimba, odwala azaka zopitilira 65.

Kugwiritsa ntchito mankhwala pa mimba ndi mkaka wa m`mawere

Munthawi yoyamba kubereka, jakisoni wa cefepim sanalembedwe kwa amayi oyembekezera, popeza kuti mankhwala othandizira omwe amapezeka m'magaziwo amatha kulowa m'matumbo a placental ndipo angayambitse kukula kwa zipsinjo ndi zodukiza mwa mwana wosabadwayo.

Munthawi yachiwiri ndi yachitatu yomwe mayi ali ndi pakati, kugwiritsa ntchito maantibayotiki ndikotheka pokhapokha ngati phindu lomwe likuyembekezeredwa kwa mayi likupereka chiwopsezo kwa mwana wosabadwayo. Chithandizo chimachitika kuchipatala moyang'aniridwa ndi madokotala.

Kugwiritsa ntchito jekeseni ya Cefepim nthawi yoyamwitsa nthawi zina kumafuna kufafaniza mkaka wa m'mawere, popeza chinthu chomwe chikuthandizidwa ndikuchotseredwa chimayamwa mkaka ndikulowa m'thupi la mwana.

Zotsatira zoyipa

Pa mankhwala a Cefepim, odwala omwe ali ndi hypersensitivity kwa cephalosporins amatha kukumana ndi zovuta zomwe zimawonetsedwa mwanjira iyi:

Kuchokera kwamanjenje - kupweteka mutu, kugona, kufoka, kusayenda bwino, kusokonezeka kwa chikumbumtima, kupsinjika, encephalopathy,
Kuchokera kugaya chakudya - zotupa zam'minyewa zam'mimba, glossitis, chivomerezo chowoneka mkamwa ndi lilime, kutentha pa chifuwa, kupindika, nseru, kusowa chilimbikitso, kusanza, kutsegula m'mimba, kukula kwa colitis, chiwindi ntchito, ,
thupi lawo siligwirizana - urticaria, pruritus, dermatitis, poermal necrolysis poizoni, kukula kwa angioedema, anaphylactic mantha,
Kuchokera kwa ziwalo za hemopoietic - leukopenia, kuchepa kwa maselo, agranulocytopenia, kuchepa kwa magazi kwa hemolytic, kusintha kwa nthawi ya prothrombin mtsogolo,
Kuchokera ziwalo za kwamikodzo - kuwonongeka aimpso ntchito, Kukula kwa nephritis, kukula kwa aimpso kulephera,

Kuchokera pakubala - dysbiosis, maliseche, kutupa, mawonekedwe a zotulutsa kumaliseche ndi fungo losasangalatsa,
mbali yamkati yopuma - chifuwa, kupweteka pachifuwa pakamapuma, bronchospasm, kupuma movutikira, kumva kuti mulibe mpweya,
Kuchokera pamtima - kupuma kwamtima, kupuma movutikira, kutupa kwa malekezero,
magawo a labotale - kuchepa kwa hematocrit, kuchuluka kwa kuchuluka kwa urea, kuchuluka kwa calcium ndi creatinine m'magazi,
zimachitika komweko - kupweteka kwapakhosi, kupangika kwa hematoma, kupsa ndi kupweteka m'mitsempha popanga mankhwala, phlebitis, thromboembolism, ndi intramuscular dongosolo la mankhwala opatsirana, kulowetsedwa kopweteka, redness, komanso kuyabwa kwa khungu pakhungu.

Ngati chizungulire, kupuma movutikira, thukuta kwambiri kapena kusadetsedwa m'maso pakukonzekera mankhwalawa mwachidziwitso, muyenera kudziwitsa dokotala wanu za izi ndikuletsa kulowetsedwa.

Bongo

Mankhwala osokoneza bongo amatha kuchitika ngati wodwalayo atatenga jakisoni kwa nthawi yayitali kapena mwadala kupitirira muyeso wa mankhwala. Pafupipafupi, zizindikiro za mankhwala osokoneza bongo zimawonetsedwa ndi kuwonjezeka kwa zovuta zomwe tafotokozazi, kukula kwa impso, mtima ndi chiwindi kulephera, encephalopathy.

Chithandizo cha bongo kumachitika mu kuthetseratu mankhwala, hemodialysis kwa wodwalayo ndi kuthetsa zizindikiritso za antixication.

Analogs a cefepim jakisoni

Mndandanda wa mankhwala a Cefepim ndi:

Timapaka ufa pakakonzedwe kake ka jakisoni,
Ladef ufa pakukonzekera njira yovalira jakisoni,
Cefomax ufa,
Movizar ufa wokonzekera njira.

Mukasinthanitsa ndi mankhwala omwe adayikidwa ndi analogue, muyenera kuyang'anitsitsa mulingo wa antiotic.

Tchuthi ndi malo osungira

Cefepim ufa umaperekedwa kuchokera ku pharmacies ndi mankhwala. Ndikulimbikitsidwa kuti tisunge mankhwala osavomerezeka mufiriji kapena m'malo ozizira. Pewani kufikira ana.

Njira yothetsera jakisoni imakonzedwa nthawi isanakwane. Osasunga yankho lomalizira mpaka jakisoni wotsatira!

Alumali moyo wa ufa ndi zaka 2, osagwiritsa ntchito mankhwalawa ndi moyo wa alumali womwe watha.

Malangizo ogwiritsira ntchito cefepime, mlingo

Ufa wa jekeseni wa mu mnofu

Njira yotsirizidwa imagwira okhazikika a makonzedwe amkati.

Momwe mungachepetse nthawi yam'mimba ya cefepus? Ma sol sol otsatirawa angagwiritsidwe ntchito kupukuta ufa: madzi osabala a jakisoni, 5% njira ya jekeseni, 0,9% sodium kolorayidi jekeseni, madzi a bacteriostatic ya jakisoni wa benzyl mowa kapena paraben, 0,5% kapena 1% yankho la lidocaine hydrochloride . Poyambitsa 0,5 g wa ufa, uyenera kusungunuka mu 1,3 ml, kuti pakhale 1 g mu 2.4 ml ya zosungunulira.

Dokotalayo ndi amene amawona kuti ali ndi mankhwalawa motani komanso nthawi yanji ya mankhwalawa malinga ndi kuchuluka kwa matendawa, kuopsa kwa matendawa, komanso magwiridwe ake a impso.

Mlingo wa cefepime wolimbikitsidwa ndi malangizo ogwiritsira ntchito ndi 0.5-1 g maola 12 aliwonse, njira ya mankhwalawa ndi masiku 7-10. Ndi vuto laimpso kuwonongeka ndi creatinine chilolezo (CC) zosakwana 30 ml / min, odwala ayenera kusintha njira. Mlingo woyambirira ndi mtundu wa mankhwalawa.

Kukonzekera kwa yankho la iv ndi mu mnofu makonzedwe

Njira yokhazikika yopangidwa ndi Cefepime imapangidwira makonzedwe amkati (pokhapokha ngati pali zovuta kuwumitsa matenda a kwamikodzo modekha komanso mwamphamvu kwambiri chifukwa cha Escherichia coli) kapena kupanikizana kwa ndege.

Kukonzekera yankho la jekeseni wa iv, ndikofunikira kuwonjezera 10 ml ya sol sol imodzi 1 g yokonzekera: madzi osabala a jakisoni, 5% dextrose (glucose) yankho, 0,9% sodium chloride solution. Njira yotsirizidwa imaperekedwa mkati mwa mphindi 3-5.

Kukonzekera yankho la iv drip, mutha kugwiritsa ntchito njira imodzi mwazosungunulira: 0.9% sodium chloride solution, sodium lactate solution, 5% kapena 10% dextrose (glucose) solution, osakaniza a Ringer's lactate ndi 5% dextrose solution, osakaniza 5 % dextrose yankho ndi 0.9% sodium chloride solution. Zomwe zili mu vial (1 g ya ufa) zimasungunuka koyamba mu 5-10 ml ya imodzi mwa mayankho omwe atchulidwa, kenako osakanikirana ndi thanki ya kulowetsedwa ndi yankho lomwelo, ndikubweretsa 50 ml kapena 100 ml. Kutalika kwa kulowetsedwa ndi mphindi 30.

Kukonzekera yankho la jakisoni wa mu mnofu, mutha kugwiritsa ntchito madzi osalala a jakisoni, yankho la 0.9% ya sodium kolorayidi kapena njira ya 0.5-1% ya lidocaine hydrochloride. Pa 1 g ya ufa, 2.4 ml ya zosungunulira ziyenera kuwonjezeredwa pambale. Jekeseni wam'magazi uyenera kuchitika pambuyo poyambitsidwa kuti tisatengere mu singano ndikuyambitsa yankho mu magazi (makamaka lidocaine)! Njira yothetsera vutoli imalowetsedwa mkatikati mwa minofu yakumtunda kwakunja kwa thako.

Munjira iliyonse yomwe mwakonzekera, kupezeka kwa tinthu tambiri sikuloledwa!

Chithandizo cha chibayo: mtsempha wa magazi makonzedwe a 1-2 magalamu a antibayotiki kawiri pa tsiku kwa masiku 10.

Empirical mankhwala a febrile neutropenia: aliyense 2 hours, kutumikiridwa 2 magalamu a mankhwala mtsempha wa magazi, mankhwala ikuchitika mpaka matenda atathetsedwa (pafupifupi masiku 10).

Chithandizo cha matenda opatsirana amtundu wa genitourinary thirakiti: kulowetsedwa kwa 0,5-1 magalamu a kuphomola maola 12 aliwonse, njira ya antibacterial imapangidwira masiku 7-10.

Woopsa matenda opezeka pamwambapa, kuchuluka kwa mankhwalawa kumawonjezereka mpaka magalamu awiri, mankhwalawa amapangidwira masiku 10.

Malangizo apadera

Ngati pseudomembranous colitis yokhala ndi matenda otsekula m'mimba, siyani kumwa ndikupereka vancomycin (pakamwa) kapena metronidazole.

Mtanda-hypersensitivity ndiwotheka kwa odwala omwe sayanjana ndi penicillin.

Kuphatikizika kwakukulu kwa aimpso ndi kwa hepatic, kuchuluka kwa plasma kwa mankhwala kuyenera kutsimikiziridwa pafupipafupi (kusintha kwa mlingo kumachitika molingana ndi CC).

Ndi chithandizo cha nthawi yayitali ndi Cefepim, kuwunika pafupipafupi magazi, chiwindi ndi impso zimagwira ntchito mdziko.

Mu matenda osakanikirana aerobic-anaerobic, kuzindikira kwa tizilombo toyambitsa matenda amafunika kuphatikiza ndi mankhwala omwe amagwiritsidwa ntchito motsutsana ndi anaerobes.

Odwala omwe ali ndi vuto loti atha kufalitsa kuchokera kumadera akutali omwe akudwala matendawa akuwakayikira kapena kuti akuwatsimikizira kuti ali ndi vuto la meningitis, njira yothandizira maantibayotiki yotsimikizika chifukwa cha vutoli iyenera kukhazikitsidwa.

Kuyesedwa kwa kuyesa koyesa kwa Coombs, kuyesa kwabwino kwa shuga mu mkodzo.

Sungani njira yophikiratu ya kuphwandaku kwa maola opitilira 24 kapena kutentha mufiriji. Kusintha kwamtundu sikukhudza ntchito ya mankhwala.

Zotsatira zoyipa

Malangizowa amachenjeza za mwayi wokhala ndi zotsatirapo zoyipa mukamapereka Cefepim:

Thupi lawo siligwirizana: zotupa pakhungu (kuphatikizapo erythematous totupa), kuyabwa, kutentha thupi, kusintha kwa anaphylactoid, kuphatikiza poyambira, eosinophilia, erythema multiforme exudative (kuphatikizapo Stevens-Johnson syndrome), kawirikawiri - poizoni wa epidermal necrolysis (syndrome Lyella).
Zotsatira zam'deralo: ndi iv makonzedwe - phlebitis, ndi makonzedwe a intramuscular - hyperemia ndi ululu pamalowa.
Kuchokera kwamanjenje: mutu, chizungulire, kusowa tulo, paresthesia, nkhawa, chisokonezo, kupweteka.
Kuchokera ku genitourinary system: vaginitis.
Kuchokera kwamikodzo dongosolo: kuwonongeka kwa impso.
Kuchokera pamimba: kukanika, kusanza, kusanza, kudzimbidwa, kupweteka pamimba, dyspepsia, pseudomembranous colitis.
Kuchokera hemopoietic ziwalo: magazi, thrombocytopenia, leukopenia, neutropenia, pancytopenia, hemolytic kuchepa magazi, magazi.
Kuchokera pakupuma dongosolo: chifuwa.
Kuchokera ku CCC: tachycardia, kupuma movutikira, zotumphukira edema.
Zizindikiro zasayansi: kuchepa kwa hematocrit, kuchuluka kwa prothrombin nthawi, kuchuluka kwa urea ndende, hypercreatininemia, hypercalcemia, kuchuluka kwa ntchito ya hepatic transaminases ndi alkaline phosphatase, ndi hyperbilirubinemia.
Zina: zilonda zapakhosi, kupweteka pachifuwa, thukuta, kupweteka m'mbuyo, asthenia, kukula kwa superinitness, oropharyngeal candidiasis.

Contraindication

Amakanizidwa kuti apange nthawi ya kuphika mu milandu iyi:

msinkhu wa ana mpaka miyezi iwiri (yolumikizira mafupa) - izi zimachitika chifukwa cha kusazindikira kwa ntchito ndi chitetezo chosavomerezeka,
zaka mpaka 12 zaka jakisoni wa mankhwala
kusalolera pakumwa mankhwala,
milandu ya thupi lawo siligwirizana mankhwala a gulu la cephalosporins,
Hypersensitivity ku penicillin - kuthekera kwodutsa kwa cephalosporins,
pseudomembranous colitis, kuphatikizapo mbiri ya
mimba ndi nthawi yoyamwitsa.

Zokhudza kuponderezedwa kwa jekeseni ya Cefepim ndi matenda am chiwindi, zilcerative colitis, odwala azaka zopitilira 65.

Bongo

Pali kuwonjezeka kwa mavuto. Zizindikiro za bongo ndi chisokonezo, kuyerekezera zinthu m'magazi, stupor, chikomokere, myoclonia.

Chithandizo cha Zizindikiro. Hemodialysis ndiyothandiza.

Cefepim analogs, mtengo pama pharmacies

Ngati ndi kotheka, mutha kusintha Cefepim ndi analogue yogwira - awa ndi mankhwala:

Posankha analogi, ndikofunikira kumvetsetsa kuti malangizo ogwiritsira ntchito Cepepim, mtengo ndi ndemanga sizigwira ntchito kwa mankhwala omwewo. Ndikofunikira kupeza upangiri wa dokotala komanso kuti usasinthe popanda mankhwala.