Taageerada Bukaanka & Daryeelaha Aspergillosis

Waxaa bixisa NHS National Aspergillosis Center

Antifungals ee aspergillosis

Daawaynta caabuqa fangasku waxa si balaadhan loogu sifayn karaa marka la eego saddex qaybood oo ah antifungals. Echinocandins, azoles iyo polyenes.

Polyenes

Amphotericin B waxaa inta badan loo isticmaalaa xididada si loo daweeyo caabuq fangas habaysan. Waxay u shaqeysaa iyadoo lagu xirayo qayb ka mid ah gidaarka unugyada fangas ee loo yaqaan ergosterol. Amphotericin B waxay u badan tahay inay tahay antifungal-ka-xididka ee ugu ballaadhan ee la heli karo. Waxay leedahay dhaqdhaqaaq ka dhan ah Aspergillus, Blastomyces, Candida (dhammaan noocyada marka laga reebo qaar ka mid ah go'doominta Candida krusei iyo Candida lusitania), Coccidioides, Cryptococcus, Histoplasma, Paracoccidiodes iyo inta badan wakiilada zygomycosis (Mucorales), Fusarium iyo fangaska kale ee dhif ah. Si ku filan uguma dhaq-dhaqaaqo Scedosporium apiospermum, Aspergillus terreus, Trichosporon spp., Inta badan noocyada keena mycetoma iyo caabuqyada habdhiska sababtoo ah Sporothrix schenkii. Caabbinta la helay ee amphotericin B ayaa lagu sifeeyay go'doonno marmar ah, badanaa ka dib daawaynta muddada dheer ee macnaha guud ee endocarditis, laakiin waa dhif. Amphotericin B waxay keeni kartaa waxyeelooyin badan oo xaaladaha qaarkood aad u daran.

Amphotericin sidoo kale waxaa lagu kala bixin karaa nebulizer. Halkan ka daawo muuqaalka.

Echinocandins

Echinocandins ayaa inta badan loo isticmaalaa in lagu daaweeyo caabuqyada fangas ee nidaamka difaaca ee bukaannada difaaca yar - daawooyinkani waxay joojiyaan isku-darka glucan oo ah qayb gaar ah oo ka mid ah darbiga unugyada fangas. Waxaa ka mid ah micafungin, caspofungin iyo anidulafungin. Echinocandins waxaa sida ugu fiican loo maamulaa habka xididada sababtoo ah nuugista liidata.

Caspofungin wuxuu aad ugu firfircoon yahay dhammaan noocyada Aspergillus. Si buuxda uma dilo Aspergillus tuubada tijaabada. Waxaa jira xaddi aad u xaddidan oo ka dhan ah Coccidioides immitis, Blastomyces dermatitis, noocyada Scedosporium, Paecilomyces varioti iyo Histoplasma capsulata laakiin waxay u badan tahay in hawshu aysan ku filneyn isticmaalka kiliinikada.

Triazoles 

Itraconazole, fluconazole, voriconazole iyo posaconazole - habka ficilka itraconazole waa la mid ah antifungals kale ee azole: waxay joojisaa fangas-cytochrome P450 oxidase-dhexdhexaadinta ergosterol.

Fluconazole waa firfircoon ka dhanka ah inta badan noocyada Candida, iyadoo gabi ahaanba laga reebo Candida krusei iyo qayb ka mid ah marka laga reebo Candida glabrata, iyo tiro yar oo go'doomin ah Candida albicans, Candida tropicalis, Candida parapsilosis iyo noocyo kale oo dhif ah. Waxa kale oo ay ka soo horjeedaa inta badan ee Cryptococcus neoformans go'doominta. Waxay si firfircoon uga hortagtaa khamiiro kale oo badan oo ay ku jiraan Trichosporon beigeli, Rhodotorula rubra, iyo fungi dimorphic endemic oo ay ku jiraan Blastomyces dermatitis, Coccidioides immitis, Histoplasma capsulatum iyo Paracoccidioides brasiliensis. Way ka firfircoon tahay itraconazole lidka ku ah fangaskan dimorphic. Ma aha mid firfircoon oo liddi ku ah Aspergillus ama Mucorales. Waxay si firfircoon uga hortagtaa fangaska maqaarka sida Trichophyton.

Kordhinta caabbinta Candida albicans ee bukaannada qaba AIDS-ka ayaa la soo sheegay. Heerarka caadiga ah ee iska caabinta Candida albicans ee cisbitaalka guud waa 3-6%, Candida albicans ee AIDS 10-15%, Candida krusei 100%, Candida glabrata ~ 50-70%, Candida tropicalis 10-30% noocyada kale ee Candida in ka yar 5%.

Itraconazole waa mid ka mid ah antifungal-yada ugu ballaaran ee la heli karo waxaana ka mid ah waxqabadyada ka dhanka ah Aspergillus, Blastomyces Candida (dhammaan noocyada oo ay ku jiraan go'doomin badan oo fluconazole u adkaysta) Coccidioides, Cryptoccocus, Histoplasma, Paracoccidioides, Scedosporium apiospermum iyo Sporothrix schenkii. Waxa kale oo ay si firfircoon uga hortagtaa dhammaan fangaska maqaarka. Ma aha mid firfircoon oo ka dhan ah Mucorales ama Fusarium iyo fangaska kale ee dhifka ah. Waa wakiilka ugu fiican ee ka dhanka ah caaryada madow, oo ay ku jiraan Bipolaris, Exserohilum iwm. Iska caabbinta itraconazole waxaa lagu sifeeyaa Candida, in kasta oo in ka yar inta lagu jiro fluconazole iyo sidoo kale Aspergillus.

Voriconazole waxay leedahay muuqaal aad u ballaadhan. Waxay ka hortagtaa inta badan noocyada Candida, Cryptococcus neoformans, dhammaan noocyada Aspergillus, Scedosporium agiospermum, qaar ka mid ah go'doominta Fusarium iyo tiro badan oo ah cudur-sidaha dhifka ah. Ma aha mid firfircoon oo ka dhan ah noocyada Mucorales sida Mucor spp, Rhizopus spp, Rhizomucor spp, Absidia spp iyo kuwa kale. Voriconazole waxay noqotay mid qiimo leh daawaynta aspergillosis invasive.

Posaconazole waxa uu leeyahay falgal aad u balaadhan. Fangaska ay koritaankooda ka hortagto posaconazole waxaa ka mid ah Aspergillus, Candida, Coccidioides, Histoplasma, Paracoccidioides, Blastomyces, Cryptococcus, Sporothrix, noocyada kala duwan ee Mucorales (sabanaya Zygomyytes) iyo kuwo kale oo badan oo madow sida Bipolaris iyo Exserohilum. Inta badan go'doominta Aspergillus waxaa dila posaconazole marka la eego qiyaasta bukaan socodka. Caabbinta la helay ee posaconazole waxay ku dhacdaa Aspergillus fumigatus iyo Candida albicans laakiin haddii kale waa dhif.

Dhibaatooyinka soo raaca daawooyinka azole ayaa si fiican loo sifeeyay sidoo kale waxaa jira isdhexgalka daroogada iyo daroogooyinka qaarkood oo ka reebaya isticmaalka daawooyinka qaarkood isku mar. Si aad u fahanto arrimahan ka fiirso macluumaadka bukaan-socodka shakhsi ahaaneed (PIL) ee dawo kasta (ee bogga hoose ee bogga).

Dheecaan

Qaar ka mid ah daawooyinka fangas-ka (sida itraconazole) afka laga qaato wayna adkaan kartaa in la nuugo, gaar ahaan haddii aad ku jirto antacid daawo (daaw loo isticmaalo daawaynta dheefshiidka, boogaha caloosha ama laabjeexa). Tani waa sababta oo ah qaar ka mid ah aashitada caloosha ayaa loo baahan yahay si ay u milmaan kaabsoosha una ogolaato nuugista.

In the case of itraconazole Talada caadiga ah waa in la hubiyo in caloosha ay ku badan tahay aashitada iyadoo la qaadanayo cabbitaan qallafsan sida koolada oo leh dawada (kaarboon-ogsaydhuq ee sababa fiska sidoo kale waxay ka dhigtaa cabitaanka mid acidic ah). Dadka qaarkiis ayaan jeclayn cabbitaannada qalafsan si ay ugu beddelaan casiirka khudradda tusaale. cabitaan liin.

Itraconazole kaabsal ayaa la qaataa ka dib cunto iyo 2 saacadood ka hor qaadashada antacids. Itraconazole waxaa la qaataa hal saac ka hor cunto maadaama si fudud loo nuugo.

Waxaa habboon in la akhriyo Warqada Macluumaadka Bukaanka ka buuxa dawadaada maadaama ay tani ku siinayso dhammaan macluumaadka aad u baahan tahay si aad u kaydsato oo aad isticmaasho. Waxaan dhanka hoose ee boggan ku bixinaa liiska daawooyinka ugu caansan, iyo isku xirka PILs-yadooda.

Xitaa ka dib marka la raaco dhammaan tilmaamaha soo-saarayaasha, nuugista daawooyinka qaarkood lama saadaalin karo. Waxaa laga yaabaa inaad ogaato in dhakhtarkaagu kaa qaadi doono shaybaar dhiig si uu u eego sida fiican ee jidhkaagu u nuugo antifungal

Waxyaabaha kale ee saameynaya

Dhammaan dawooyinka waxay leeyihiin waxyeelooyin kale ('saameyn xun') iyo soo saarayaasha daroogada waxaa looga baahan yahay inay ku qoraan warqadda macluumaadka bukaanka (PIL). Badankoodu waa yar yihiin, laakiin dhammaantood waa ay mudan yihiin in loo sheego dhakhtarkaaga booqashadaada xigta. Waxyeellooyinka soo raaca aad bay u kala duwanaan karaan oo inta badan gebi ahaanba lamafilaan. Haddii aad dareento caafimaad darro, had iyo jeer waxaa habboon in aad hubiso liiska dhibaatooyinka soo raaca ee PIL sababtoo ah waxaa laga yaabaa in dawada aad qaadanayso ay dhibaato keento. Haddi aad shaki ku jirto mar walba raadso talada dhakhtarkaaga.

Steroids waxay si gaar ah ugu nugul yihiin inay keenaan waxyeelooyin badan oo aan fiicnayn. Waxaa jira macluumaad gaar ah oo ku saabsan waxyeellooyinka steroids iyo sida ugu wanaagsan ee loo qaato steroids halkan.

Bukaan-socodka ay la kulmaan dhibaatooyinka soo raaca waxaa la siiyaa talooyin kala duwan - waxaa laga yaabaa in ku adkeysiga qaadashada daawada ay keento dhibaatada inay meesha ka baxdo, ama waxaa laga yaabaa in bukaanka laga joojiyo qaadashada daawada. Mararka qaarkood daawo kale ayaa loo qori doonaa si looga hortago waxyeelada.

Marka laga reebo xaaladaha ugu daran, kuma habboona in bukaanku joojiyo qaadashada daawada isaga oo aan la tashan dhakhtarkooda.

Waxa jira is dhexgal badan oo ka dhexeeya dawooyinka kala duwan ee ay dad badani ku qasban yihiin inay qaataan taasoo keeni karta waxyeelo daran. Hubi isdhexgalka ka dhexeeya dawooyinka fangas-ka-hortagga ah iyo dawooyinka kale ee aad qaadan karto adiga oo ka raadinaya annaga Xogta isdhexgalka antifungal

Voriconazole iyo kansarka unugyada squamous: Dib u eegis 2019 lagu sameeyay 3710 qof oo helay mid ka mid ah xubinta taranka sambabada ama xubinta taranka unugyada hematopoietic ayaa laga helay xiriir muhiim ah oo ka dhexeeya isticmaalka voriconazole iyo kansarka unugyada squamous cell ee bukaannadan. Muddada dheer iyo qiyaasta sare ee voriconazole ayaa lala xiriiriyay khatarta sii kordheysa ee SCC. Daraasadu waxay taageertaa baahida loo qabo ilaalinta maqaarka joogtada ah ee bukaanada LT iyo HCT ee voriconazole, iyo soo jeedinta in daaweyn kale la qaato, gaar ahaan haddii bukaanku horeyba ugu jiray khatarta sii kordheysa ee SCC. Qorayaashu waxay xuseen in xogtu ay ahayd mid xaddidan oo loo baahan yahay cilmi-baaris dheeraad ah si loo sii sahamiyo xiriirkan. Halkaan ka akhri warqadda.

Ka warbixinta waxyeelada daawada:

UK: Gudaha UK, MHRA waxay leedahay a Kaarka Jaallaha Nidaam aad ka sheegi karto waxyeellooyinka iyo dhacdooyinka xun ee daawooyinka, tallaalada, daawaynta dhameystiran iyo qalabka caafimaadka. Waxaa jira foom online ah oo sahlan oo lagu buuxiyo - uma baahnid inaad tan ku sameyso dhakhtarkaaga. Haddii aad u baahan tahay in lagaa caawiyo foomka, la xidhiidh qof jooga NAC ama weydii qof ka tirsan kooxda taageerada Facebook.

US: Dalka Maraykanka, waxaad si toos ah ugu wargalin kartaa waxyeelada soo raaca FDA adigoo isticmaalaya MedWatch nidaam

Helitaanka Antifungal:

Nasiib darro dhammaan dawooyinka fangas-ka-hortagga ah lagama heli karo waddan kasta oo adduunka ah, xitaa haddii ay jiraan, qiimuhu aad buu u kala duwanaan karaa waddan ilaa waddan. Sanduuqa Waxqabadka Caalamiga ah ee Caabuqa Fungal (GAFFI) ayaa soo saaray khariidado muujinaya helitaanka dawooyinka fangas-ka-hortagga ee muhiimka ah adduunka oo dhan.

Riix halkan si aad u aragto khariidadda helitaanka GAFFI antifungal

Wixii macluumaad dheeraad ah

Daawooyinka ugu caansan ee loo qoro isticmaalka muddada-dheer ee dadka qaba aspergillosis waxay ku taxan yihiin macluumaad faahfaahsan hoos. Waxa kale oo jira liiska macluumaadka la fududeeyay ee badi daawooyinkan halkan.

Waxaa aad u wanaagsan in aad akhrido buug-yaraha macluumaadka bukaanka (PIL) ee dawada aad bilaabi doonto inaad qaadato iyo inaad ogaato wixii digniin ah, waxyeellooyin iyo liiska daawooyinka aan iswaafaqayn. Tani sidoo kale waa meel fiican oo lagu akhriyo hagitaan gaar ah oo ku saabsan sida loo qaato daawadaada. Waxaan hoos ku siinnaa nuqullo cusub:

(PIL – Xaashiyaha Macluumaadka Bukaanka) 

steroids:

Antifungals:

  • Amphotericin B (Abelcet, Ambiosome, Fungizone) (BNF)
  • Anidulafungin (ECALTA) (PIL)
  • Caspofungin (CANCIDAS) (PIL)
  • Fluconazole (Diflucan) (PIL)
  • Flucytosine (Ancotil) (BNF)
  • Mikafungin (Mycamine) (PIL)
  • Posaconazole (Noxafil) (PIL)
  • Voriconazole (VFEND) (PIL)

Dhibaatooyinka ay keento - eeg warqadaha PIL & VIPIL ee kor ku taxan laakiin sidoo kale arag warbixino dhamaystiran oo ka socda Midowga Yurub MRHA Kaarka Jaallaha nidaamka warbixinta halkan