Mankhwala Amikacin 500: malangizo ntchito

Semi-yopanga yotakata sipekitiramu yothandizira ndi bactericidal ntchito. Mwa kumangiriza ku 30un subunit ya ribosomes, imalepheretsa mapangidwe azovuta kuyendetsa ndi mthenga RNA, imalepheretsa kuphatikizika kwa mapuloteni, ndikuwonongeranso nembanemba ya ma cytoplasmic a bacteria.

Imagwira kwambiri motsutsana ndi aerobic gram-hasi tizilombo - Pseudomonas aeruginosa, Escherichia coli, Klebsiella spp., Serratia spp., Providencia spp., Enterobacter spp., Salmonella spp., Shigella spp. ), tizilombo tating'onoting'ono ta gramu - Staphylococcus spp. (kuphatikiza zomwe sizigwirizana ndi penicillin, cephalosporins ena), agagment yolimbana ndi Streptococcus spp.

Ndi munthawi yomweyo makonzedwe a benzylpenicillin, imakhala ndi mgwirizano m'magulu a Enterococcus faecalis tizilombo ta.

Zosakhudzana ndi anaerobic tizilombo.

Amikacin sataya ntchito mothandizidwa ndi ma enzymes omwe amachititsa ma amino glycosides ena ndipo amatha kukhalabe achangu ndi tizilombo ta Pseudomonas aeruginosa wogwirizana ndi tobramycin, gentamicin ndi netilmicin.

Pharmacokinetics

Pambuyo pa makonzedwe a intramuscular (IM), imagwidwa mwachangu komanso mokwanira. The ndende kwambiri (Stax) ndi / m makonzedwe pa mlingo wa 7.5 mg / kg ndi 21 μg / ml. Nthawi yakukwanira ndende yayikulu (TSmax) ili pafupifupi maola 1.5 pambuyo poyang'anira i / m. Kuyankhulana ndi mapuloteni a plasma - 4-11%.

Imagawilidwa bwino mu madzi akunja kwama cell (zomwe zimapezeka mu ma abscesses, ma phenation, ascitic, pericardial, synovial, lymphatic ndi peritoneal

madzimadzi), mwakuya kwambiri wopezeka mu mkodzo, otsika - mu ndulu, mkaka wa m'mawere, nthabwala yamadzimadzi, kutsekeka kwa bronchial, sputum ndi cerebrospinal fluid (CSF). Imalowerera mu ziwalo zonse za thupi momwe imadziunjikira mwachisangalalo, kutsika kwakukulu kumadziwika m'magulu omwe ali ndi magazi abwino: mapapu, chiwindi, myocardium, ndulu, komanso impso, komwe zimasonkhana mu cortical wosanjikiza, kutsika kozama - minofu, adipose minofu ndi mafupa.

Mankhwala akamagwiritsa ntchito muyezo achire akulu, amikacin samalowa mu magazi ndi zotchinga zamagazi, ndikutupa kwa mankhwalawa, kupezeka kwamankhwala kumawonjezeka pang'ono. Mu akhanda, kutsata kwakakulu mu CSF kumatheka kuposa achikulire, kudutsa placenta - imapezeka m'magazi a mwana wosabadwayo ndi amniotic fluid. Kugawa kuchuluka kwa akuluakulu - 0,26 l / kg, mu ana - 0-0-0.4 l / kg, mwa makanda - obadwa osakwana sabata 1 komanso kulemera kwa thupi kosakwana 1.5 makilogalamu - mpaka 0,68 l / kg osakwana sabata 1 ndipo kulemera kwa thupi kupitilira 1.5 makilogalamu - mpaka 0,58 l / kg, odwala ndi cystic fibrosis - 0,3-0.39 l / kg. Ambiri achire ndende ndi i / m makonzedwe amasungidwa kwa maola 10-12.

Osapukusidwa. Hafu ya moyo (T1 / 2) mwa achikulire ndi maola 2-4, mwa ana obadwa kumene - maola-5-8, mwa ana okulirapo - maola 2 mpaka 2,5. Mtengo wotsiriza wa T1 / 2 ndi maola opitilira 100 (kumasulidwa ku ma depracellular depots) .

Imadziwitsidwa ndi impso ndi kusefera kwa glomerular (65-94%), yosasinthika. Kuchotsera kwina - 79-100 ml / min.

T1 / 2 mwa anthu akuluakulu omwe ali ndi vuto la impso zimasiyanasiyana malinga ndi kuchuluka kwa kuwonongeka - mpaka maora 100, odwala omwe ali ndi cystic fibrosis - 1-2 maola, odwala omwe akumwa ndi matenda oopsa, T1 / 2 amatha kufupikirapo kuposa momwe amachepera chifukwa cha kuchuluka kwawoko .

Amachotseredwa pa hemodialysis (50% mu maola 4-6), peritoneal dialysis siyothandiza (25% mu maola 48-72).

Zizindikiro zogwiritsidwa ntchito

Amapangidwira zochizira matenda opatsirana komanso otupa omwe amayamba chifukwa cha maikulosin: kupuma thirakiti (bronchitis, chibayo, pleural empyema, mapapu am'mimba, sepsis, septic endocarditis, chapakati mantha amthupi (kuphatikizapo meningitis), ndi m'mimba. peritonitis), genitourinary thirakiti (pyelonephritis, cystitis, urethritis), khungu ndi zofewa zimakhala (kuphatikizapo kupsa koyambitsidwa ndi zilonda zam'mimba ndi zilonda zamitundu yosiyanasiyana), matenda amitsempha, mafupa ndi mafupa (kuphatikizapo osteomyelitis) bala infe ktsiya, matenda a postoperative.

Contraindication Hypersensitivity (kuphatikizapo mbiri ya aminoglycosides ena), mtima wamitsempha wamitsempha, kulephera kwambiri kwaimpso (CRF) ndi azotemia ndi uremia, kutenga pakati, kuyamwa.

Mosamala. Myasthenia gravis, parkinsonism, botulism (aminoglycosides angayambitse kuphwanya kwa mitsempha, yomwe imabweretsa kufooka kwa minofu yamafupa), kufooka kwa thupi, kulephera kwa impso, nthawi yaubongo, kusakhazikika kwa ana, ukalamba.

Mimba komanso kuyamwa

. Kugwiritsidwa ntchito kwa amikacin kumadzipakati pakati. Aminoglycosides amatha kusokoneza kukula kwa mluza akaperekedwa kwa mayi woyembekezera. Aminoglycosides amadutsa placenta; chitukuko cha ugonthi wapakati mwa ana omwe amayi awo adalandira streptomycin panthawi yapakati. Ngakhale zovuta zoyipa m'makutu kapena zatsopano sizinapezeke pomwe aminoglycosides ena amaperekedwa kwa amayi apakati, vuto lomwe lingakhalepo limakhalapo. Kuwerengera kubala kwa amikacin mu makoswe ndi mbewa sizinawonetse vuto la chonde kapena vuto la fetal lomwe limakhudzana ndi kutenga amikacin.

Sizikudziwika ngati amikacin amadutsa mkaka wa m'mawere. Pogwiritsa ntchito amikacin, kuyamwitsa sikulimbikitsidwa.

Mlingo ndi makonzedwe

Kwa matenda ambiri, makonzedwe a mu mnofu amalimbikitsidwa. Pankhani ya matenda owopsa m'moyo kapena ngati kukhazikika kwa mnofu ndikosatheka, amawayikidwa pang'onopang'ono mumtsuko (mphindi 2-3), kapena kulowetsedwa (0.25% yankho kwa mphindi 30).

Intramuscular and intravenous management

Amikacin imatha kutumikiridwa kudzera mu intramuscularly komanso kudzera m'mitsempha. Mankhwala atafotokozedwa mu Mlingo woyenera wa matenda osavuta omwe amayamba chifukwa cha tizilombo tating'onoting'ono, yankho la mankhwalawa limatha kupezeka mkati mwa maola 24-48.

Ngati palibe mayankho azachipatala omwe amapezeka mkati mwa masiku 3-5, muyenera kugwiritsa ntchito njira zochiritsira zosagwiritsidwa ntchito masiku onse.

Musanalembe amikacin, muyenera:

- kuwunika ntchito ya impso poyesa kuchuluka kwa seramu creatinine kapena kuwerengera kuchuluka kwa mapangidwe a creatinine (ndikofunikira kuwunika ntchito ya impso nthawi yogwiritsira ntchito amikacin),

Ngati ndi kotheka, serum amikacin ndende iyenera kutsimikizika (pazambiri komanso zochepa za seramu nthawi nthawi

Pewani kuchuluka kwapadera kwa seramu ya amikacin (mphindi 30-90 pambuyo pa jakisoni) woposa 35 μg / ml, ndende ya seramu yocheperako (yomweyo isanachitike mlingo wotsatira) wa 10 μg / ml.

Odwala omwe ali ndi vuto laimpso, amikacin amatha kutumikiridwa nthawi 1 patsiku, motere, kuchuluka kwambiri kwa seramu kumatha kupitirira 35 μg / ml. Kutalika kwa mankhwalawa ndi masiku 7-10.

Mlingo wokwanira, mosasamala kanthu za njira yoyendetsera, sayenera kupitirira 15-20 mg / kg / tsiku.

Mu matenda opanikizika, pamene njira yothandizira mankhwalawa yoposa masiku 10 ikufunika, ntchito ya impso, makina ndi ma vestibular sensory system, komanso serum amikacin ayenera kuyang'aniridwa mosamala.

Ngati pakalibe kusintha kwachipatala mkati mwa masiku 3-5, kugwiritsa ntchito amikacin kuyenera kuyimitsidwa, ndipo kumva kwa tizilombo toyambitsa matenda ku amikacin kuyenera kuwunikidwanso.

Akuluakulu ndi ana opitirira zaka 12 zakubadwa - ndi matenda abwinobwino a impso (creatinine chilolezo> 50 ml / min) i / m kapena iv 15 mg / kg / tsiku 1 nthawi patsiku kapena 7.5 mg / kg maola 12 aliwonse. Mankhwala okwanira tsiku lililonse sayenera kupitirira 1.5 g. Pa endocarditis ndi febrile neutropenia, mlingo wa tsiku ndi tsiku uyenera kugawidwa pawiri. zosakwanira pakulandila 1 pa tsiku.

Ana 4 milungu - 12 zaka - ndi yachilendo aimpso ntchito (creatinine chilolezo> 50 ml / mphindi) i / m kapena i / v (kulowetsedwa pang'onopang'ono) 15-20 mg / kg / tsiku 1 nthawi patsiku kapena

7.5 mg / kg maola 12 aliwonse. Ndi endocarditis ndi febrile neutropenia, tsiku ndi tsiku mlingo uyenera kugawidwa mu 2 waukulu, chifukwa zosakwanira pakulandila 1 pa tsiku. Makanda obadwa kumene - mlingo woyamba wa kukweza ndi 10 mg / kg, ndiye 7.5 mg / kg maola 12 aliwonse.

Makanda oyambira asanakwane - 7.5 mg / kg maola 12 aliwonse.

Malangizo apadera okhudza kulowetsedwa kwa magazi. Kwa akulu ndi ana, yankho la amikacin nthawi zambiri limapatsidwa kwa mphindi 30-60.

Ana osakwana zaka 2 azilumikizidwa kwa ola limodzi mpaka awiri.

Amikacin sayenera kusakanizika ndi mankhwala ena, koma amayenera kuperekedwa mosagwirizana malinga ndi mlingo ndi njira yoyendetsera.

Amalemba okalamba. Amycacin amuchotseredwa ndi impso. Ntchito yamkati iyenera kuyesedwa ndi mlingo womwe umayikidwa ngati vuto la impso likulephera.

Kuwopseza moyo ndi / kapena kuyambitsidwa ndi Pseudomonas. Doz okalamba amatha kuchulukitsidwa mpaka 500 mg maola 8 aliwonse, koma amikacin sayenera kutumikiridwa pa mlingo wowonjezera

1.5 g patsiku, ndipo osaposa masiku 10. Mlingo wonse wokwanira maphunziro sayenera kupitilira 15 g.

Tizilombo ta Urinary thirakiti (tina osati chifukwa cha Pseudomonas). Mlingo wofanana

7.5 mg / kg / tsiku logawidwa mu 2 Mlingo wofanana (womwe mu akulu ndi wofanana ndi 250 mg kawiri pa tsiku).

Kuwerengedwa mlingo wa amikainin pui mkhutu aimpso ntchito (creatinine chilolezo

Bongo

Zizindikiro: kuzungulira kwa poizoni (kutaya khutu, kutulutsa tulo, chizungulire, kusokonekera kwam'mimba, ludzu, kusungulumwa, kusanza, kusanza, kulira kapena kumva kuti muli ndi vuto m'makutu, kulephera kupuma).

Chithandizo: kuchotsa blockade ya kufalikira kwa mitsempha ndi zotulukapo zake - hemodialysis kapena peritoneal dialysis, mankhwala a anticholinesterase, mchere wamkati, mpweya wabwino, zina zothandizira komanso zothandizira.

Kuchita ndi mankhwala ena

Kugwiritsa ntchito limodzi kapena munthawi yomweyo kugwiritsa ntchito mankhwala ena a nephrotoxic kapena ototoxic kuyenera kupewedwa chifukwa chowonjezera pazowonjezera. Kuwonjezeka kwa nephrotoxicity kumachitika ndi kuphatikizika kwa aminoglycosides ndi cephalosporins. Kugwiritsa ntchito limodzi ndi cephalosporins kumatha kukulitsa zabodza la seramu ngati atatsimikiza. Chiwopsezo cha ototoxicity chimawonjezeka ndi munthawi yomweyo kugwiritsa ntchito amikacin pogwiritsa ntchito okodzetsa, makamaka pamene okodzetsa amathandizidwa kudzera m'mitsempha. Ma diuretics amatha kuonjezera kawopsedwe ka aminoglycosides mpaka osasinthika ototoxicity chifukwa cha kusintha kwa kuchuluka kwa ma antibayotiki m'magazi a seramu ndi zimakhala. Awa ndi furosemide ndi ethaconic acid, yomwe palokha ndi mankhwala osokoneza bongo.

Intraperitoneal makonzedwe a amikacin osavomerezeka chifukwa cha mankhwala oletsa kupweteka kapena minyewa yopumitsa minofu (kuphatikizapo ether, halothane, D-tubocurarine, succinylcholine ndi decametonium), neuromuscular blockade ndi kupuma kwaposachedwa kwamatenda. ,

Indomethacin ingakulitse kuchuluka kwa amikacin mu plasma mu makanda.

Odwala omwe ali ndi vuto laimpso, kuchepa kwa ntchito za aminoglycoside kumatha kuchitika pogwiritsa ntchito mankhwala a penicillin.

Chiwopsezo chowonjezeka cha hypocalcemia limodzi ndi aminoglycosides omwe ali ndi ma phosphonates.

Chiwopsezo chowonjezeka cha nephrotoxicity komanso mwina ototoxicity ndi othandizira aminoglycosides okhala ndi platinamu.

Chenjezo ndi kusamala mwapadera

Gwiritsani ntchito mosamala odwala omwe ali ndi vuto la aimpso, kapena kuwonongeka kwa makutu kapena zida zapakhosi. Odwala ayenera kuyang'aniridwa bwino chifukwa cha ototoxicity ndi nephrotoxicity ya aminoglycosides. Chitetezo kwa nthawi yopitilira masiku 14 sichinakhazikitsidwe. Mlingo wa kusamala ndi kukhathamiritsa okwanira kuyenera kuonedwa.

Odwala omwe ali ndi vuto la impso kapena kuchepa kwa kusefera kwa khungu, ntchito yaimpso iyenera kuwunikidwa ndi njira zamwambo zisanachitike chithandizo komanso nthawi yamankhwala. Mlingo watsiku ndi tsiku uyenera kuchepetsedwa komanso / kapena pakati pakulingo uyenera kukulitsidwa molingana ndi ndende ya serum creatinine kuti mupewe kudzikundikira kwamphamvu kwambiri m'magazi ndikuchepetsa chiopsezo cha ototoxicity. Kuwunikira pafupipafupi kwa seramu yogwiritsira ntchito mankhwalawa komanso ntchito yaimpso ndikofunika kwambiri kwa okalamba omwe kuchepa kwa impso kumatheka, zomwe sizingakhale zodziwikiratu pazotsatira zoyeserera pafupipafupi monga urea wamagazi ndi seramu creatinine.

Ngati mankhwalawa atenga masiku asanu ndi awiri kapena kuposerapo mwa odwala omwe ali ndi vuto la impso, kapena masiku 10 mwa odwala ena, zowonjezera za audiogram ziyenera kupezedwa ndikuwunikidwanso panthawi yamankhwala. Mankhwala a Amikacin ayenera kusiyidwa ngati lingaliro lamphamvu la tinnitus kapena kutaya kwa makutu litayamba, kapena ngati makilogalamu omvera akuwonetsa kuchepa kwakukulu pakuwona kwa mapangidwe apamwamba.

Ngati pali zizindikiro zosokoneza minyewa ya impso (mwachitsanzo, albuminuria, maselo ofiira am'magazi kapena ma lymphocyte), hydration iyenera kuchuluka ndipo mulingo wa mankhwalawa uyenera kuchepetsedwa. Mavutowa nthawi zambiri amatha pamene chithandizo chatha. Komabe, ngati azotemia ndi / kapena kuchepa kwapang'onopang'ono kwa mkodzo kumachitika, chithandizo chikuyenera kutha.

Neuro / Ototoxicity. Neurotoxicity, yowonetsedwa mwa mawonekedwe a vestibular ndi / kapena mayiko ovomerezeka, amatha kumachitika mwa odwala omwe amalandila aminoglycosides. Chiwopsezo cha aminoglycoside-indoses ototoxicity ndiochulukirapo mwa odwala omwe ali ndi vuto laimpso, komanso mukalandira mlingo waukulu, kapena nthawi yayitali ya masiku oposa 7. Chizungulire chomwe chitha kuwonetsa kuwonongeka kwa vestibular. Zina zomwe zimawonetsa kuphatikiza mitsempha imatha kuphatikizira dzanzi, kumva kutopa kwa khungu, kupindika minofu, komanso kupindika. Chiwopsezo cha ototoxicity chimawonjezeka ndi chiwopsezo chowonjezeka cha chiwonetsero chambiri kapena chotsalira cha seramu. Kugwiritsa ntchito amikacin mwa odwala omwe ali ndi ziwengo kuti aminoglycosides, kapena subclinical aimps, , cephaloridine, kapena viomycin) ziyenera kuganiziridwa mosamala, chifukwa kuopsa kungapangidwe. Mwa odwalawa, amikacin amagwiritsidwa ntchito ngati, malinga ndi dokotala, zochizira zimaposa zoopsa zomwe zingakhalepo.

Neuromuscular kawopsedwe. Neuromuscular blockade ndi kupunduka ziwalo akuti pambuyo pa makonzedwe a makolo, kuphunzitsidwa (mu mafupa, kuthilira kwam'mimba, chithandizo cha mankhwala am'kati), komanso pambuyo pamlomo makonzedwe a aminoglycosides. Kuthekera kwa kupuma ziwalo kuyenera kuganiziridwanso pakukhazikitsidwa kwa aminoglycosides mwanjira iliyonse, makamaka kwa odwala omwe amalandira opaleshoni, minyewa yopuma (tubocurarine, desinylcholine, decametonium), kapena mwa odwala omwe amalandiridwa magazi owonjezereka a citrate-anticoagulated. Ngati mitsempha ya blockomus imachitika, mchere wa calcium umachotsa kupuma ziwalo, koma mpweya wabwino ungafunike. Aminoglycosides ayenera kugwiritsidwa ntchito mosamala kwa odwala omwe ali ndi vuto la minofu (myasthenia gravis kapena parkinsonism), chifukwa amatha kukulitsa kufooka kwa minofu chifukwa cha kufalikira kwa kupindika kwa mitsempha.

Zoopsa. Aminoglycosides amatha kukhala nephrotoxic. Chiwopsezo chokhala ndi nephrotoxicity ndiwokwera kwambiri kwa odwala omwe ali ndi vuto laimpso, komanso mukalandira mlingo waukulu komanso chithandizo cha nthawi yayitali. Kuthira manyowa koyenera pakufunika pakuthandizidwa; Kuchiza kuyenera kusiyidwa ndi kuwonjezeka kwa azotemia kapena kuchepa kwapang'onopang'ono mu mkodzo.

Kwa odwala okalamba, kuchepa kwa ntchito yaimpso ndikotheka, komwe sikungakhale kwodziwikiratu pakuwunika mayeso (serum nitrogen urea kapena serum feathein). Kudziwa chilolezo cha creatinine kumatha kukhala kothandiza muzochitika zotere. Kuwunikira ntchito yaimpso okalamba odwala pakumwa mankhwala a aminoglycosides ndikofunikira kwambiri.

Ntchito yamkati ndi ntchito yachisanu ndi chitatu yamitsempha yamagazi imagwira ntchito imafuna kuwunika kwa odwala omwe amadziwika kapena akuwoneka kuti aimpso kulephera koyambirira kwamankhwala, komanso odwala omwe ali ndi vuto laimpso, koma ali ndi vuto laimpso pantchito. Kuzunzidwa kwa Amikacin kuyenera kuwunikidwa kuti muwonetsetse wokwanira Mlingo komanso kupewa matenda oopsa. Mitsempha iyenera kuyang'aniridwa chifukwa chachepetsa mphamvu inayake yokoka, kuchuluka kwa mapuloteni, ndi erythrocyturia. Urea wamagazi, seramu creatinine, kapena chilolezo cha creatinine amayenera kuwunika nthawi ndi nthawi. Ma audi audiograms amayenera kupezeka mwa odwala okalamba, makamaka odwala omwe ali pachiwopsezo chachikulu. Zizindikiro za ototoxicity (chizungulire, tinnitus, tinnitus ndi kutaya kwa makutu) kapena nephrotoxicity zimafuna kusiya kwa mankhwala kapena kusintha kwa mankhwala.

Kugwiritsa ntchito munthawi yomweyo komanso / kapena kugwiritsa ntchito mitundu inanso ya neurotoxic kapena nephrotoxic (bacitracin, cisplatin, amphotericin B, cephaloridin, paromomycin, viomycin, polymyxin B, colistin, vancomycin, kapena aminoglycosides). Zina zomwe zimawonjezera chiopsezo cha zakumwa zaukalamba ndi ukalamba komanso kusowa madzi m'thupi.

Zolakwika Aminoglycosides amafulumira msanga komanso pafupifupi odzipereka kwathunthu akaphatikizidwa, komanso opaleshoni. Kusagontha kosasinthika, kulephera kwa impso, ndi kufa chifukwa cha kufooka kwa mitsempha zanenedwapo nthawi yothirira minda yayikulu ndi yaying'ono.

Monga maantibayotiki ena, kugwiritsa ntchito amikacin kungayambitse kukula kwambiri kwa tizilombo tating'onoting'ono. Pankhaniyi, chithandizo choyenera chikuyenera kuperekedwa.

Milandu yakuwonongeka kosasinthika yawonekera pambuyo pobayidwa wa amikacin mu vitreous of eye.

Kutulutsa mawonekedwe ndi kapangidwe kake

Mankhwala amaperekedwa ngati:

• Njira yothetsera i / m ndi utsogoleri wa iv, 1 ml yomwe ili ndi 250 mg ya amikacin, m'mapiritsi a 2 ndi 4 ml,
• Ufa womwe njira yothetsera jakisoni wakonzedwera, mu botolo limodzi (10 ml) momwe mumakhala 250 mg, 500 mg kapena 1 gramu ya amikacin.

Contraindication

Malinga ndi zomwe zidanenedwa kwa mankhwalawa, kugwiritsa ntchito Amikacin kumatsutsana:

• Amayi oyembekezera
• Ndi mitsempha yam'mitsempha,
• Odwala omwe ali ndi vuto lalikulu laimpso limodzi ndi uremia ndi / kapena azotemia,
• Pamaso pa hypersensitivity kuti amikacin, mankhwala othandizira aliwonse, mankhwala ena aminoglycosides (kuphatikizapo mbiri).

Amikacin adalembedwa, koma mosamala kwambiri komanso moyang'aniridwa ndi achipatala:

• Ndikusowa kwamadzi,
• Azimayi nthawi yoyamwa
• Ndi myasthenia gravis,
• Odwala omwe ali ndi parkinsonism
• Ndi kulephera kwa aimpso,
• Makanda ndi ana akhanda osabadwa,
• Anthu okalamba
• Ndi botulism.

Mlingo ndi makonzedwe Amikacin

Njira yothetsera vutoli (kuphatikizapo yokonzedwa kuchokera ku ufa) Amikacin, malinga ndi malangizo, iyenera kutumikiridwa kudzera m'mitsempha kapena m'mitsempha.

Mlingo wa akulu ndi ana opitirira zaka 6 ndi 5 mg pa kilogalamu ya thupi, yomwe imayendetsedwa pakapita maola 8, kapena 7.5 mg / kg maola 12 aliwonse. Ndi mabakiteriya osavuta a genitourinary thirakiti, n`zotheka kuti mupereke mlingo wa 250 mg maola 12 aliwonse. Ngati mukufuna gawo la hemodialysis pambuyo pake, mutha kupanganso jakisoni wina pamlingo wa 3-5 mg pa 1 kg yolemera.

Mlingo wovomerezeka tsiku lililonse kwa akulu ndi 15 mg / kg, koma osaposa magalamu 1.5 patsiku. Kutalika kwa chithandizo, monga lamulo, ndi masiku 3-7 - ndi / pakubweretsa, masiku 7-10 - ndi / m.

Amikacin adalembera ana motere:

• Makanda oyambira asanabadwe: mlingo woyamba ndi 10 mg pa kg, ndiye 7.5 mg / kg maola 18-18 aliwonse,
• Kwa akhanda ndi makanda mpaka zaka 6: mlingo woyamba ndi 10 mg / kg, ndiye 7.5 mg / kg maola 12 aliwonse.

Ngati mankhwalawa ayaka, chifukwa cha kufupika kwa theka la moyo wa amikacin m'gulu ili la odwala, mlingo wa mankhwalawa nthawi zambiri umakhala wa 5,5 mg / kg, koma pafupipafupi maulamuliro amawonjezeka - maola 4-6 aliwonse.

Amikacin amachilitsidwa mkati mwamitsempha kwa mphindi 30-60. Ngati pakufunika thandizo mwachangu, jekete la jet limaloledwa kwa mphindi ziwiri.

Kwa kukapanda kuleka kwamkati, mankhwalawa amamuthandizira ndi 0,9% sodium kolorayidi kapena 5% dextrose yankho kuti ntchito yogwiritsa ntchito isapitirire 5 mg / ml.

Kuchepetsa mlingo kapena kuwonjezera nthawi pakati pa jakisoni amafunikira kwa odwala omwe ali ndi vuto la impso.

Zotsatira zoyipa za Amikacin

Malinga ndi ndemanga ya odwala omwe amachitiridwa chithandizo ndi Amikacin, mankhwalawa atha kukhala ndi zovuta zina:

• Kupumira, nseru, kusokoneza chiwindi,
• Leukopenia, thrombocytopenia, kuchepa magazi, granulocytopenia,
• Kugona, kupweteka mutu, kukomoka kwamitsempha yamafinya (mpaka kumanga kupuma), kukula kwa mphamvu ya m'mitsempha ya m'mimba (kugunda, dzanzi, kupindika kwa minofu, khunyu),
• Kumva kutayika, ugonthi womwe sungasinthe, labyrinth ndi zovuta zam'mimba,
• Oliguria, micromaturia, proteinuria,
• Zotsatira zoyipa: hyperemia yapakhungu, totupa, malungo, kuyabwa, edema ya Quincke.

Kuphatikiza apo, ndi intravenous makonzedwe a Amikacin, malinga ndi ndemanga, kukulitsa kwa phlebitis, dermatitis ndi periphlebitis, komanso kumva kupweteka pamalo a jekeseni, ndizotheka.

Malangizo apadera

Musanagwiritse ntchito mankhwalawa, ndikofunikira kudziwa kuthamanga kwa tizilombo toyambitsa matenda kwa iwo.

Mankhwalawa ndi Amikacin, kamodzi pa sabata, ntchito za impso, zida zamagetsi ndi mitsempha yamagazi ziyenera kuyang'aniridwa.

Amikacin ndi mankhwala omwe sagwirizana ndi mavitamini a B ndi C, cephalosporins, penicillins, nitrofurantoin, potaziyamu kloride, erythromycin, hydrochlorothiazide, capreomycin, heparin, amphotericin B.

Odwala omwe akulandira chithandizo cha matenda opatsirana komanso otupa a kwamikodzo amafunika kumwa madzi ambiri (operewera diuresis).

Tiyenera kukumbukira kuti kugwiritsa ntchito nthawi yayitali kwa Amikacin, kukulitsa tizilombo toyambitsa matenda ndikotheka. Chifukwa chake, pakalibe mphamvu yazachipatala, ndikofunikira kusiya mankhwalawa ndikuchita zoyenera.

Amikacin analogues

Ma analogi a Amikacin ndi Amikacin-Ferein, Amikacin-Vial, Amikacin Sulfate, Amikin, Amikabol, Selemicin, Hemacin.

Mwa gulu limodzi la pharmacological ndi kufanana kwa machitidwe a zochita, mankhwalawa angatengedwe ngati fanizo la Amikacin: Bramitob, Gentamicin, Kanamycin, Neomycin, Sisomycin, Florimycin sulfate, ndi ena.

Migwirizano ndi magwiritsidwe akusungidwa

Amikacin ndi gulu B la ma antibayotiki lomwe limafalitsidwa kuchokera ku mankhwala opangidwa ndi mankhwala. Moyo wa alumali ndi zaka 2 mukumvera malamulo osungira omwe amalimbikitsidwa ndi wopanga - kutentha 5-25 ºº, malo owuma komanso amdima.

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

Kutulutsa mawonekedwe, ma CD ndi mapangidwe Amikacin

Njira yothetsera kuphatikizira kwamitsempha yamaubongo ndi yowonekera, yopanda utoto kapena pang'ono.

Othandizira: sodium disulfite (sodium metabisulfite), sodium citrate d / i (sodium citrate pentasesquihydrate), sulfuric acid kuchepetsedwa, madzi d / i.

2 ml - magalasi okhala ndi magalasi (5) - matumba otupa (1) - mapaketi a makatoni.
2 ml - galasi ampoules (5) - matumba otupa (2) - mapaketi a makatoni.
2 ml - galasi ampoules (10) - matumba otupa (1) - mapaketi a makatoni.
2 ml - galasi ampoules (10) - makatoni.

Njira yothetsera kuphatikizira kwamitsempha yamaubongo ndi yowonekera, yopanda utoto kapena pang'ono.

Othandizira: sodium disulfite (sodium metabisulfite), sodium citrate d / i (sodium citrate pentasesquihydrate), sulfuric acid kuchepetsedwa, madzi d / i.

4 ml - galasi ampoules (5) - matumba otupa (1) - mapaketi a makatoni.
4 ml - galasi ampoules (5) - matumba otupa (2) - mapaketi a makatoni.
4 ml - galasi ampoules (10) - matumba otupa (1) - mapaketi a makatoni.
4 ml - galasi ampoules (10) - makatoni.

The ufa pakukonzekera njira yothetsera kuphatikizira kwamitsempha yama cell oyera kapena pafupifupi oyera ndi a hygroscopic.

Mabotolo okhala ndi 10 ml (1) - mapaketi a makatoni.
Mabotolo okhala ndi mphamvu ya 10 ml (5) - mapaketi a makatoni.
Mabotolo okhala ndi mphamvu ya 10 ml (10) - mapaketi a makatoni.

Mafotokozedwe a magulu a nosological

Mitengo mumaofesi a mankhwala ku Moscow

Siyani ndemanga yanu

Chidziwitso Chaposachedwa Chosowa Chidziwitso, ‰

Amalembetsa Mankhwala Ovuta Komanso Ofunika

Zikalata zolembetsa ku Amikacin

• P N001175 / 01

• LP-003317

• LP-004398

• LP-003391

• LSR-002156/09

• LSR-002348/08

• LS-000772

• LSR-006572/09

• P N003221 / 01

• S-8-242 N008784

• S-8-242 N008266

Webusayiti yovomerezeka ya kampani RLS ®. Ensaikulopediya yayikulu ya mankhwala osokoneza bongo ndi katundu wa assortment yaku Russia. Ndondomeko yamankhwala Rlsnet.ru imapatsa ogwiritsa ntchito malangizo, mitengo ndi mafotokozedwe a mankhwala, zowonjezera pazakudya, zida zamankhwala, zida zamankhwala ndi zina. Maupangiri a pharmacological akuphatikiza chidziwitso cha kapangidwe ndi mawonekedwe amamasulidwe, zochitika zamankhwala, zisonyezo zogwiritsidwa ntchito, contraindication, zotsatira zoyipa, kuyanjana kwa mankhwala, njira yogwiritsira ntchito mankhwala, makampani opanga mankhwala. Ndondomeko ya mankhwala ili ndi mitengo yamankhwala ndi mankhwala ku Moscow ndi mizinda ina ya Russia.

Sizoletsedwa kufalitsa, kukopera, kufalitsa zambiri popanda chilolezo cha RLS-Patent LLC.
Mukamagwiritsa ntchito zidziwitso zofalitsidwa pamasamba a webusayiti ya www.rlsnet.ru, kulumikizana ndi gwero lachidziwitso ndikofunikira.

Zinthu zina zambiri zosangalatsa

Maumwini onse ndi otetezedwa.

Kugwiritsa ntchito malonda pazinthu sikuloledwa.

Chidziwitsochi cholinga chake ndi akatswiri azachipatala.

Mankhwala

Pharmacokinetics

Pambuyo pa makonzedwe a intramuscular (IM), imagwidwa mwachangu komanso mokwanira. Kuzindikira kwakukulu (Cmax) kokhala ndi i / m pa mlingo wa 7.5 mg / kg ndi 21 μg / ml. Nthawi yakukwanira ndende kwambiri (TCmax) ili pafupifupi maola 1.5 pambuyo poyang'anira i / m. Kuyankhulana ndi mapuloteni a plasma - 4-11%.

Imagawidwa bwino mu madzi am'madzi am'mimba (zomwe zimapezeka mu ma abscesses, pleural effusion, ascitic, pericardial, synovial, lymphatic and peritoneal fluid), zimapezeka kwambiri poyerekeza mkodzo, m'munsi - mu ndulu, mkaka wamawere, kuseka kwakumaso kwa diso, kubisala kwa sponchial madzimadzi (CSF). Imalowa bwino mu ziwalo zonse za thupi momwe imadziunjikira mwachisangalalo, kutsekemera kwakukulu kumawonedwa mu ziwalo zokhala ndi magazi abwino: mapapu, chiwindi, myocardium, ndulu, komanso impso, momwe zimadziunjikira mu cortical wosanjikiza, kutsika kwapang'onopang'ono - minofu, adipose minofu ndi mafupa .

Mankhwala akamagwiritsa ntchito muyezo pakati pa akulu, amikacin samalowa mu zotchinga zamagazi (BBB), ndikutupa kwa mankhwalawa, kuvomerezedwa kumawonjezeka pang'ono. Mu akhanda, kutsata kwakakulu mu CSF kumatheka kuposa achikulire, kudutsa placenta - imapezeka m'magazi a mwana wosabadwayo ndi amniotic fluid. Kugawa kuchuluka kwa akuluakulu - 0,26 l / kg, mwa ana - 0,2 - 0,4 l / kg, mwa akhanda - osakwana sabata 1. ndipo kulemera kwa thupi kosakwana 1.5 makilogalamu - mpaka 0,68 l / kg, wazaka zosakwana sabata 1. ndipo kulemera kwa thupi kupitilira 1.5 makilogalamu - mpaka 0,58 l / kg, odwala omwe ali ndi cystic fibrosis - 0,3 - 0,39 l / kg. Ambiri achire ndende ndi mtsempha wa magazi kapena mu mnofu makonzedwe amasungidwa kwa maola 10-12.

Osapukusidwa. Hafu ya moyo (T1 / 2) mwa achikulire ndi maola 2-4, mwa ana obadwa kumene ndi maola 5-8, mwa ana achikulire ndi maola 2,5.The T1 / 2 yomaliza ndi maola opitilira 100 (kumasulidwa ku malo owoneka bwino kwambiri )

Amadzipukusa ndi impso ndi kusefedwa kwamafuta (65 - 94%), osasinthika. Kuchotsera kwina - 79-100 ml / min.

T1 / 2 mwa anthu akuluakulu omwe ali ndi vuto la impso zimasiyanasiyana malinga ndi kusokonekera - mpaka maola 100, odwala omwe ali ndi cystic fibrosis - 1 - 2 maola, odwala omwe ayaka ndi matenda oopsa, T1 / 2 amatha kufupikirapo kuposa pafupifupi chifukwa chovomerezeka .

Amachotseredwa pa hemodialysis (50% mu maola 4 - 6), peritoneal dialysis siyothandiza (25% mu maora 48 - 72).

Mankhwala

Semi-yopanga yotakata sipekitiramu yothandizira ndi bactericidal ntchito.Mwa kumangiriza ku 30un subunit ya ribosomes, imalepheretsa mapangidwe azovuta kuyendetsa ndi mthenga RNA, imalepheretsa kuphatikizika kwa mapuloteni, ndikuwonongeranso nembanemba ya ma cytoplasmic a bacteria.

Wokangalika kwambiri motsutsana ndi aerobic gram-hasi tizilombo - Pseudomonas aeruginosa, Escherichia coli, Klebsiella spp., Serratia spp., Providencia spp., Enterobacter spp., Salmonella spp., Shigella spp, Ena gram-tizilombo tating'ono - Staphyloccusp spp. (kuphatikiza zomwe sizigwirizana ndi penicillin, ena cephalosporins), wogwira ntchito motsutsana ndi Streptococcus spp.

Ndi munthawi yomweyo makonzedwe a benzylpenicillin, imakhala ndi mgwirizano pakulimbana ndi Enterococcus faecalis tizilombo ta.

Zosakhudzana ndi anaerobic tizilombo.

Amikacin sataya ntchito mothandizidwa ndi ma enzyme omwe amachititsa kuti ena azikhala aminoglycosides, ndipo amatha kukhalabe olimbana ndi mavuto a Pseudomonas aeruginosa osagwirizana ndi tobramycin, gentamicin ndi netilmicin.

Zochita zamankhwala

Ndiosagwirizana ndi ma penicillin, heparin, cephalosporins, capreomycin, amphotericin B, hydrochlorothiazide, erythromycin, nitrofurantoin, mavitamini B ndi C, ndi potaziyamu chloride.

Zimawonetsa synergism mukamayanjana ndi carbenicillin, benzylpenicillin, cephalosporins (odwala omwe ali ndi vuto lalikulu laimpso, akaphatikizidwa ndi mankhwala a beta-lactam, mphamvu ya aminoglycosides ingachepe). Nalidixic acid, polymyxin B, chisplatin ndi vancomycin zimawonjezera chiopsezo cha oto- ndi nephrotoxicity.

Ma diuretics (makamaka furosemide, ethaconic acid), cephalosporins, penicillins, sulfonamides komanso mankhwala osapatsa mankhwala a anti-yotupa, kupikisana ndi katulutsidwe kake mu nephron tubules, kutseka kuchotsedwa kwa aminoglycosides ndikuwonjezera kuchuluka kwawo mu seramu ya magazi, kukulitsa nephro- komanso neurotoxicity.

Kugwiritsa ntchito munthawi yomweyo ndi mankhwala ena omwe angakhale a nephrotoxic kapena ototoxic osavomerezeka chifukwa chowopsa cha mavuto.

Kuwonjezeka kwa nephrotoxicity kunanenedwa pambuyo pamakomedwe anthawi yomweyo a makina aminoglycosides ndi cephalosporins. Kugwiritsanso ntchito kwa cephalosporins kungawonjezere zabodza la seramu creatinine.

Imawonjezera kupuma kwamphamvu kwa mankhwala a curariform.

Methoxyflurane, polymyxins ya makolo, capreomycin ndi mankhwala ena omwe amatseketsa kupatsirana kwa ma neuromuscular (ma halogenated hydrocarbons ngati inhalation anesthetics, opioid analgesics), ndikuwonjezereka kwa magazi ndi ma cell a citrate kumawonjezera chiopsezo chakumangidwa.

Parenteral makonzedwe a indomethacin kumaonjezera ngozi ya zotsatira za aminoglycosides (kuchuluka kwa theka la moyo ndikuchepera chilolezo).

Imachepetsa mphamvu ya anti-myasthenic mankhwala.

Pali chiwopsezo chowonjezereka cha hypocalcemia ndi mgwirizano wama aminoglycosides okhala ndi bisphosphonates. Chiwopsezo chowonjezeka cha nephrotoxicity komanso mwina ototoxicity ndizotheka ndi kuphatikiza kwa aminoglycosides okonzekera platinamu.

Ndi munthawi yomweyo makonzedwe a thiamine (Vitamini B1), gawo lomwe limagwiritsidwa ntchito popanga sodium bisulfite mu amikacin sulfate.

Tulutsani mawonekedwe ndi ma CD

500 mg yogwira mumabotolo omwe adasindikizidwa ndi ma block ya mphira, wolumikizidwa ndi zisoti za aluminium ndikugulitsa zigawo za "FLIPP OFF".

Cholembedwera chopangidwa ndi zilembo kapena cholembera chimaduliridwa pa botolo lililonse, kapena ngati cholembera chodzikongoletsera chimatumizidwa kunja.

Botolo lirilonse, limodzi ndi malangizo ovomerezeka ogwiritsira ntchito zachipatala m'boma ndi zilankhulo zaku Russia, zimayikidwa pakatoni.

Zisonyezero za mankhwala Amikacin

Matenda opatsirana komanso otupa omwe amayamba chifukwa cha gram-hasi tizilombo toyambitsa matenda (kugonjetsedwa ndi glamicin, sisomycin ndi kanamycin) kapena mayanjano a gram-virus komanso gram-hasi:

• matenda kupuma thirakiti (bronchitis, chibayo, empural, kupweteka kwa mapapo),
• sepsis
• septic endocarditis,
• Matenda a CNS (kuphatikizapo meningitis),
• matenda am'mimba, kuphatikizapo peritonitis,
• matenda a kwamkodzo thirakiti (pyelonephritis, cystitis, urethritis),
• matenda opatsirana oyipa a pakhungu ndi zimakhala zofewa (kuphatikiza zilonda zamatenda, zilonda zoyambitsidwa ndi zilonda zamphamvu zamayendedwe osiyanasiyana),
• biliary matenda opatsirana
• matenda am'mafupa ndi mafupa (kuphatikizira osteomyelitis),
• matenda opweteka
• matenda opatsirana.

Mlingo

Mankhwala chikuyendetsedwera intramuscularly, m`mitsempha, kwa mphindi 2 kapena kukapanda kuleka, kwa akulu ndi ana a zaka zopitilira 6 - 5 mg / kg maola 8 aliwonse kapena 7.5 mg / kg maola 12 aliwonse. zosavuta) - 250 mg maola 12 aliwonse, atatha gawo la hemodialysis, mlingo wina wa 3-5 mg / kg ukhoza kutumikiridwa.

Mlingo waukulu wa akuluakulu ndi 15 mg / kg / tsiku, koma osapitirira 1.5 g / tsiku kwa masiku 10. Kutalika kwa mankhwalawa ndi / m'mawu oyamba ndi masiku 3-7, ndi / m - masiku 7-10.

Kwa akhanda osabereka, gawo limodzi lokha ndi 10 mg / kg, ndiye 7.5 mg / kg maola 18-18 aliwonse, kwa ana akhanda ndi osakwana zaka 6, mlingo woyambira ndi 10 mg / kg, ndiye 7.5 mg / kg aliyense 12 h kwa masiku 7-10.

Pootcha kachilombo, muyeso wa 5-7.5 mg / kg maola aliwonse a 4-6 ungafunike chifukwa cha kufupika kwa T 1/2 (maola 1-1.5) m'gululi.

Mu / amikacin imayendetsedwa kwa mphindi 30-60 ngati ndi kotheka, ndi ndege.

Mwa iv (drip), mankhwalawa amathandizidwa kale ndi 200 ml ya 5% dextrose (glucose) kapena 0,9% sodium chloride solution. Kuchuluka kwa amikacin mu njira yothetsera utsogoleri wa iv sayenera kupitirira 5 mg / ml.

Ngati vuto la kuwonongeka kwa aimpso, kuchepetsedwa kwa mlingo kapena kuwonjezeka kwapakati pakati pa kayendetsedwe ndikofunikira. Pankhani yowonjezereka pakadali pakati pa oyang'anira (ngati phindu la QC silikudziwika, komanso momwe wodwalayo alili), nthawi yapakati pakukhazikitsidwa kwa mankhwala imakhazikitsidwa ndi njira yotsatirayi:

nthawi (h) = seramu creatinine ndende × 9.

Ngati kuchuluka kwa seramu creatinine ndi 2 mg / dl, ndiye kuti mlingo umodzi wovomerezeka (7.5 mg / kg) uyenera kutumikiridwa maola aliwonse a 18. Ndi kuwonjezeka kwa nthawi, gawo limodzi silinasinthidwe.

Pakakhala kuchepa kwa mlingo umodzi ndi regimen yosasinthika, gawo loyamba la odwala omwe ali ndi vuto la aimpso ndi 7.5 mg / kg. Kuwerengera Mlingo wotsatira kumachitika potsatira njira zotsatirazi:

Mlingo wotsatira (mg), womwe umaperekedwa kwa maola 12 aliwonse = KK (ml / mphindi) mwa wodwala × mlingo woyambayo (mg) / KK ndi wabwinobwino (ml / min).

Zotsatira zoyipa

Kuchokera mmimba dongosolo: nseru, kusanza, chiwindi ntchito (kuchuluka kwa hepatic transaminases, hyperbilirubinemia).

Kuchokera ku hemopoietic dongosolo: kuchepa magazi, leukopenia, granulocytopenia, thrombocytopenia.

Kuchokera kumbali ya chapakati mantha dongosolo ndi zotumphukira mantha dongosolo: mutu, kugona, neurotoxic zotsatira (minyewa, kugona, dzanzi, kumva kugwedezeka, khunyu).

Kuchokera pamalingaliro am'mimba: ototoxicity (kusamva kwa makutu, vuto la maselo ndi labrinth, kusamva kosagwirizana), zotsatira zoyipa pazida za vestibular (kuzindikira kusuntha, chizungulire, kusanza, kusanza).

Kuchokera kwamikodzo dongosolo: nephrotoxicity - mkhutu aimpso ntchito (oliguria, proteinuria, microcaluria).

Thupi lawo siligwirizana: zotupa pakhungu, kuyabwa, kutentha kwa khungu, kutentha thupi, edema ya Quincke.

Zomwe zimachitika m'deralo: kupweteka kwa malo a jakisoni, dermatitis, phlebitis ndi periphlebitis (yolamulira ndi iv).

Mimba komanso kuyamwa

Mankhwala ndi contraindicated pa mimba.

Pamaso pazisonyezo zofunika, mankhwalawa angagwiritsidwe ntchito pokonza akazi. Tiyenera kudziwa kuti aminoglycosides amathandizidwa mkaka wa m'mawere ochepa. Samatengeka bwino m'mimba, ndipo mavuto okhudzana ndi makanda sanalembetsedwe.

Kuyanjana kwa mankhwala

Zimawonetsa synergism mukamayanjana ndi carbenicillin, benzylpenicillin, cephalosporins (odwala omwe ali ndi vuto lalikulu laimpso, akaphatikizidwa ndi mankhwala a beta-lactam, mphamvu ya aminoglycosides ingachepe).

Nalidixic acid, polymyxin B, chisplatin ndi vancomycin zimawonjezera chiopsezo cha oto- ndi nephrotoxicity.

Ma diuretics (makamaka furosemide), cephalosporins, penicillin, sulfanilamides ndi NSAIDs, kupikisana mwachangu mu tubules la nephron, kuletsa kuchotsedwa kwa aminoglycosides, kuonjezera kuyika kwawo mu seramu yamagazi, kukulira nephro- ndi neurotoxicity.

Amikacin imathandizira minofu kumasuka kwa mphamvu ya curariform mankhwala.

Mukamagwiritsidwa ntchito ndi amikacin, methoxyflurane, ma polymyxins, capreomycin ndi mankhwala ena omwe amatseketsa kupatsirana kwa ma neuromuscular (halogenated hydrocarbons - inhalation anesthetics, opioid analgesics), kuthiridwa magazi kwakukulu ndi citrate kosungirako kumawonjezera chiopsezo chomangidwa.

Parenteral makonzedwe a indomethacin amawonjezera chiopsezo cha zotsatira za aminoglycosides (kuchuluka kwa T 1/2 ndi kuchepa kwa chilolezo).

Amikacin amachepetsa mphamvu ya anti-myasthenic mankhwala.

Ndiosagwirizana ndi ma penicillin, heparin, cephalosporins, capreomycin, amphotericin B, hydrochlorothiazide, erythromycin, nitrofurantoin, mavitamini B ndi C, ndi potaziyamu chloride.