Antifungals ye aspergillosis
Kurapa kwehutachiona hwefungal kunogona kutsanangurwa zvakanyanya maererano nemakirasi matatu eantifungals. Iyo echinocandins, azoles uye polyenes.
Polyenes
Amphotericin B inowanzo shandiswa intravenously kurapa systemic fungal infections. Inoshanda nekusunga kune fungal cell wall component inonzi ergosterol. Amphotericin B ingangove ndiyo yakanyanya kupamhama spectrum intravenous antifungal iripo. Iine chiitiko chinopesana neAspergillus, Blastomyces, Candida (marudzi ese kunze kwemamwe akaparadzana eCandida krusei neCandida lutania), Coccidioides, Cryptococcus, Histoplasma, Paracoccidiodes uye mazhinji evamiririri vezygomycosis (Mucorales), Fusarium uye imwe isingawanzo fungi. Haina kunyatsoshanda kurwisa Scedosporium apiospermum, Aspergillus terreus, Trichosporon spp., Zvizhinji zvezvipenyu zvinokonzera mycetoma uye systemic zvirwere nekuda kweSporothrix schenkii. Kuwana kuramba kune amphotericin B kwakatsanangurwa mune dzimwe nguva kuparadzaniswa, kazhinji mushure menguva refu kurapwa mumamiriro endocarditis, asi isingawanzo. Amphotericin B inogona kukonzera akawanda maside effects ayo mune dzimwe nguva anogona kuve akanyanya.
Amphotericin inogona zvakare kupihwa kuburikidza nebuliser. Ona vhidhiyo pano.
Echinocandins
Echinocandins inowanzoshandiswa kurapa systemic fungal zvirwere muvarwere vasina simba rekudzivirira zvirwere - mishonga iyi inhibit synthesis yeglucan iyo inhengo chaiyo yefungal cell wall. Zvinosanganisira micafungin, caspofungin uye anidulafungin. Echinocandins inonyatso kurongerwa nemutsinga nekuda kwekusabatwa zvakanaka.
Caspofungin inoshanda zvakanyanya kurwisa marudzi ese eAspergillus. Haiurayi Aspergillus zvachose mu test tube. Pane huwandu hushoma hwekuita hunopesana neCoccidioides immitis, Blastomyces dermatitidis, Scedosporium species, Paecilomyces varioti uye Histoplasma capsulata asi zvingangoita kuti basa racho harina kukwana kushandiswa kwechipatara.
Triazoles
Itraconazole, fluconazole, voriconazole uye posaconazole - nzira yekuita nayo itraconazole yakafanana nedzimwe azole antifungals: inodzivisa fungal cytochrome P450 oxidase-mediated synthesis yeergosterol.
Fluconazole iri kushingaira kurwisana nemhando dzakawanda dzeCandida, pamwe chete kunze kweCandida krusei uye kunze kweCandida glabrata, uye nhamba shomanana yeCandida albicans, Candida tropicalis, Candida parapsilosis nedzimwe mhuka dzisingawanzoitiki. Inoshanda zvakare kurwisa ruzhinji rweCryptococcus neoformans inotsaura. Inoshanda kurwisa dzimwe mbiriso dzakawanda dzinosanganisira Trichosporon beigelii, Rhodotorula rubra, uye dimorphic endemic fungi inosanganisira Blastomyces dermatitidis, Coccidioides immitis, Histoplasma capsulatuma uye Paracoccidioides brasiliensis. Iyo isinganyanyi kushanda pane itraconazole kurwisa idzi dimorphic fungi. Haisi kurwisa Aspergillus kana Mucorales. Inoshanda kurwisa fungi dzeganda seTrichophyton.
Kuwedzera kuramba muCandida albicans mune varwere vane AIDS kwakataurwa. Maitiro ekupikisa muCandida albicans muchipatara chevanhu 3-6%, muCandida albicans muAIDS 10-15%, muCandida krusei 100%, muCandida glabrata ~ 50-70%, muCandida tropicalis 10-30% uye mune mamwe marudzi Candida asingasviki 5%.
Itraconazole ndeimwe yeakanyanya kupararira antifungals iripo uye inosanganisira basa rinopesana neAspergillus, Blastomyces Candida (marudzi ese anosanganisira akawanda fluconazole resistant isolate) Coccidioides, Cryptoccocus, Histoplasma, Paracoccidioides, Scedosporium apiospermum uye Sporothrix schenkii. Inoshandawo kurwisa fungi dzose dzeganda. Haisi kurwisa Mucorales kana Fusarium uye mamwe mashoma asingawanzo fungi. Ndiyo yakanakisa mumiriri kurwisa zviumbwa zvitema, zvinosanganisira Bipolaris, Exserohilum etc. Kupokana ne itraconazole kunotsanangurwa muCandida, kunyangwe kashoma pane fluconazole uye zvakare muAspergillus.
Voriconazole ine chitarisiko chakanyanyisa. Inoshanda kurwisa huwandu hwakawanda hwemhando dzeCandida, Cryptococcus neoformans, marudzi ese eAspergillus, Scedosporium agiospermum, mamwe ari ega eFusarium uye huwandu hwehutachiona husingawanzoitiki. Haisi kushanda kurwisa Mucorales marudzi akadai Mucor spp, Rhizopus spp, Rhizomucor spp, Absidia spp nevamwe. Voriconazole yakave yakakosha mukurapa kwe invasive aspergillosis.
Posaconazole ine zvakawanda zvakasiyana-siyana zvekuita. Iyo fungus iyo kukura kwayo inodziviswa ne posaconazole inosanganisira Aspergillus, Candida, Coccidioides, Histoplasma, Paracoccidioides, Blastomyces, Cryptococcus, Sporothrix, marudzi akasiyana-siyana eMucorales (anokonzera Zygomyetes) uye mamwe akawanda matema matema akadai Bipolaris uye Exserohilum. Ruzhinji rweAspergillus isolates inouraiwa neposaconazole panguva dzakakosha dzekiriniki. Kuwana kuramba posaconazole kunoitika muAspergillus fumigatus neCandida albicans asi hazviwanzo kuwanikwa.
Migumisiro yemishonga yeAzole inonyatsozivikanwa uye kunewo mamwe maitiro anokosha emishonga-zvinodhaka asingabatanidzi kushandiswa kwekunyora mamwe mishonga panguva imwe chete. Kuti uwane kunzwisisa kwakadzama kwenyaya idzi tarisa ruzivo rwemurwere wega wega (PIL) mapepa emushonga wega wega (pazasi pepeji).
Kubvisa
Mamwe emishonga inorwisa fungal (semuenzaniso itraconazole) inotorwa nemuromo uye inogona kunetsa kunwa, kunyanya kana uri pa antacid mushonga (mushonga unoshandiswa kurapa kuzvimba, maronda emudumbu kana chirungurira). Izvi zvinodaro nekuti imwe asidhi mudumbu inodiwa kunyungudutsa macapsules uye kubvumira kunyura.
Kana itraconazole zano rakajairwa nderekuva nechokwadi chekuti mudumbu mune acid yakawanda nekutora chinwiwa chinopisa senge cola nemushonga (iyo carbon dioxide inokonzeresa fizz inoitawo kuti chinwiwa chive acidic). Vamwe vanhu havafarire zvinwiwa zvine muto saka tsiva muto wemuchero eg. chinwiwa cheranjisi.
Itraconazole capsules inotorwa pashure kudya uye maawa maviri asati atora antacids. Itraconazole solution inotorwa awa imwe chete pamberi chikafu sezvo chiri nyore kunyura.
Zvakakodzera kuverenga iyo Ruzivo rweMurwere rakazara nemishonga yako sezvo izvi zvinokupa ruzivo rwese rwaunoda kuchengeta nekuishandisa. Isu tinopa runyoro rwemishonga yakajairika pazasi peji rino, uye zvinongedzo kune avo vakasiyana PILs.
Kunyangwe mushure mekutevera mirairo yese yevagadziri, kumwa kwemimwe mishonga hakugoneki. Unogona kuona kuti chiremba wako achatora sampuli dzeropa kuti atarise kuti muviri wako uri kutora sei antifungal
Migumisiro Yechiri
Mishonga yese ine maside effects ('adverse effects') uye vagadziri vezvinodhaka vanosungirwa kuinyora muPatient Information Leaflet (PIL). Ruzhinji ruduku, asi zvose zvakakodzera kutaura kuna chiremba wako pakushanya kwako kunotevera. Migumisiro inogona kunge yakasiyana-siyana uye kazhinji isingatarisirwi zvachose. Kana usiri kunzwa zvakanaka zvinogara zvakakodzera kuti utarise rondedzero yemhedzisiro paPIL sezvo zvingave kuti mushonga wauri kutora uri kukonzera dambudziko. Kana usina chokwadi nguva dzose tsvaka mazano echiremba wako.
Steroids zvinonyanya kukurumidza kukonzera akawanda asingafadzi mhedzisiro. Pane ruzivo rwakananga kune steroid mhedzisiro uye maitiro ekutora steroid pano.
Varwere vari kusangana nemigumisiro yechirwere vanopiwa mazano akasiyana-siyana - zvingave kuti kutsungirira mukutora mushonga kunoita kuti dambudziko ripere, kana kuti zvingave kuti murwere anofanira kumiswa kutora mushonga. Dzimwe nguva mumwe mushonga unozorongerwa kurwisa mhedzisiro.
Kunze kwemuzviitiko zvakanyanya kuipa hazvikurudzirwe kuti murwere arege kutora mushonga asina kubvunza chiremba wavo.
Kune kudyidzana kwakawanda pakati pemishonga yakasiyana-siyana iyo vanhu vazhinji vanofanira kutora iyo inogona kukonzera mhedzisiro yakaoma. Tarisa kupindirana pakati pemishonga yeantifungal uye chero mimwe mishonga yaungatora nekuitsvaga pane yedu Antifungal interactions database.
Voriconazole uye squamous cell carcinoma: Ongororo ya2019 yevanhu 3710 vakagamuchira kuisirwa mapapu kana hematopoietic cell transplant vakawana hukama hwakakosha pakati pekushandiswa kwevoriconazole uye squamous cell carcinoma muvarwere ava. Kureba kwenguva refu uye madosi epamusoro evoriconazole akabatanidzwa nenjodzi yakawedzera yeSCC. Chidzidzo ichi chinotsigira kudiwa kwenguva dzose dermatologic surveillance yeLT neHCT varwere pavoriconazole, uye pfungwa yokuti dzimwe nzira dzokurapa dzitorwe, kunyanya kana murwere atova panjodzi yakawedzerwa yeSCC. Vanyori vanocherekedza kuti data raive rakaganhurirwa uye kutsvagisa kwakawanda kunodiwa kuti uwedzere kuongorora kubatana uku. Verenga bepa riri pano.
Kuzivisa zvinodhaka zvinokonzerwa nemishonga:
UK: MuUK, MHRA ine a Yero Kadhi chirongwa apo iwe unogona kutaurira mhedzisiro uye yakashata chiitiko chemishonga, majekiseni, ekuwedzera marapirwo nemidziyo yekurapa. Pane fomu repamhepo riri nyore kuzadza - haufanire kuita izvi kuburikidza nachiremba wako. Kana muchida rubatsiro nefomu, svikai kune mumwe munhu kuNAC kana kubvunza mumwe ari muboka revatsigiri veFacebook.
US: MuUS, unogona kutaura mhedzisiro yakananga kuFDA kuburikidza neyavo MedWatch chirongwa.
Antifungal Kuwanikwa:
Nehurombo haisi yese mishonga inorwisa fungal inowanikwa munyika dzese pasirese uye, kunyangwe ikadaro, mutengo unogona kusiyanisa zvakanyanya kubva kunyika nenyika. Global Action Fund yeFungal Infections (GAFFI) yakagadzira seti yemamepu anoratidza kuwanikwa kweakakosha antifungal mishonga pasi rese.
Kuwedzera mamwe mashoko
Mishonga inonyanyozivikanwa inonyorerwa kushandiswa kwenguva refu kune vanhu vane aspergillosis yakanyorwa ine ruzivo rwakadzama pazasi. Pane zvakare rondedzero yeruzivo rwakareruka rwemizhinji yemishonga iyi pano.
Zvakakodzera kuverenga mapepa eruzivo rwemurwere (PIL) emushonga wauri kuda kutanga kutora uye kucherechedza chero yambiro, mhedzisiro uye runyorwa rwemishonga isingaenderane. Ino zvakare inzvimbo yakanaka yekuverenga chaiyo nhungamiro yekuti ungatora sei mushonga wako. Isu tinopa makopi emazuva ano pazasi:
(PIL – Patient Information Leaflet) (BNF – British National Formulary)
Steroids:
-
- Prednisolone (PIL)
- Hydrocortisone (BNF)
Adrenal kusakwana inogona kuva mhedzisiro yekushandisa steroid.
Antifungals:
- Amphotericin B (Abelcet, Ambiosome, Fungizone) (BNF)
- Anidulafungin (ECALTA) (PIL)
- Caspofungin (CANCIDAS) (PIL)
- Fluconazole (Diflucan) (PIL)
- Flucytosine (Ancotil) (BNF)
- Micafungin (Mycamine) (PIL)
- Posaconazole (Noxafil) (PIL)
- Isavuconazole (BNF)
- Voriconazole (VFEND) (PIL)
Zvikanganiso - ona PIL & VIPIL mapepa akanyorwa pamusoro asi zvakare ona mishumo yakazara kubva kuEU MRHA Yellow Card reporting system pano