Antifungal bakeng sa aspergillosis
Phekolo ea mafu a fungal e ka hlalosoa ka mokhoa o pharaletseng ho ea ka lihlopha tse tharo tsa li-antifungal. Li-echinocandins, li-azoles le polyenes.
Lipalene
Amphotericin B hangata e sebelisoa ka methapo ho phekola mafu a fungal systemic. E sebetsa ka ho tlama karolo ea fungal cell lebota e bitsoang ergosterol. Amphotericin B ho ka etsahala hore ebe ke sethibela-maqhubu se pharalletseng sa intravenous antifungal se fumanehang. E na le ts'ebetso khahlanong le Aspergillus, Blastomyces, Candida (mefuta eohle ntle le tse ling tsa Candida krusei le Candida lusitania), Coccidioides, Cryptococcus, Histoplasma, Paracoccidiodes le boholo ba mahlahana a zygomycosis (Mucorales), Fusarium le li-fungus tse ling tse sa tloaelehang. Ha e sebetse ka ho lekaneng khahlanong le Scedosporium apiospermum, Aspergillus terreus, Trichosporon spp., boholo ba mefuta e bakang mycetoma le mafu a tsamaiso ka lebaka la Sporothrix schenkii. Ho hanyetsa ha amphotericin B ho 'nile ha hlalosoa ka linako tse ling, hangata ka mor'a phekolo ea nako e telele ho latela endocarditis, empa ke ntho e sa tloaelehang. Amphotericin B e ka baka litla-morao tse ngata tseo maemong a mang li ka bang matla haholo.
Amphotericin e ka boela ea fanoa ka nebuliser. Sheba video mona.
Li-Echinocandins
Hangata li-Echinocandins li sebelisoa ho phekola tšoaetso ea fungal ho bakuli ba nang le bokooa ba ho itšireletsa mafung - lithethefatsi tsena li thibela motsoako oa glucan e leng karolo e itseng ea lerako la lisele tsa fungal. Li kenyelletsa micafungin, caspofungin le anidulafungin. Li-echinocandin li tsamaisoa hantle ka ho sebelisa methapo ka lebaka la ho se monye hantle.
Caspofungin e sebetsa haholo khahlanong le mefuta eohle ea Aspergillus. Ha e bolaee Aspergillus ka ho feletseng ka har'a tube ea teko. Ho na le palo e fokolang haholo ea ts'ebetso khahlanong le Coccidioides immitis, Blastomyces dermatitidis, Scedosporium mefuta, Paecilomyces varioti le Histoplasma capsulata empa ho ka etsahala hore mosebetsi ona ha oa lekana bakeng sa tšebeliso ea meriana.
Triazoles
Itraconazole, fluconazole, voriconazole le posaconazole - mokhoa oa ts'ebetso oa itraconazole o ts'oana le li-antifungal tse ling tsa azole: e thibela fungal cytochrome P450 oxidase-mediated synthesis ea ergosterol.
Fluconazole e sebetsa khahlano le mefuta e mengata ea Candida, ntle le Candida krusei le mokhelo o sa fellang oa Candida glabrata, le palo e nyane ea Candida albicans, Candida tropicalis, Candida parapsilosis le mefuta e meng e sa tloaelehang. E boetse e sebetsa khahlanong le bongata bo boholo ba Cryptococcus neoformans e itšehla thajana. E sebetsa khahlano le litomoso tse ling tse ngata ho kenyelletsa Trichosporon beigelii, Rhodotorula rubra, le li-fungus tsa dimorphic endemic ho kenyelletsa Blastomyces dermatitidis, Coccidioides immitis, Histoplasma capsulatuand Paracoccidioides brasiliensis. Ha e sebetse ho feta itraconazole khahlanong le li-fungus tsena tsa dimorphic. Ha e sebetse khahlanong le Aspergillus kapa Mucorales. E sebetsa khahlano le li-fungus tsa letlalo joalo ka Trichophyton.
Keketseho ea khanyetso ho Candida albicans ho bakuli ba AIDS e tlalehiloe. Mefuta e tloaelehileng ea ho hanyetsa ho Candida albicans sepetleleng se akaretsang ke 3-6%, ho Candida albicans AIDS 10-15%, Candida krusei 100%, Candida glabrata ~ 50-70%, Candida tropicalis 10-30% le mefuteng e meng ea Candida e ka tlase ho 5%.
"Itraconazole" ke e 'ngoe ea li-antifungal tse pharaletseng ka ho fetisisa tse fumanehang' me e kenyelletsa ts'ebetso khahlanong le Aspergillus, Blastomyces Candida (mefuta eohle e kenyeletsang li-isolates tse ngata tse hanyetsanang le fluconazole) Coccidioides, Cryptoccocus, Histoplasma, Paracoccidioides, Scedosporium apiospermum le Sporothrix schenkii. E boetse e sebetsa khahlanong le li-fungus tsohle tsa letlalo. Ha e sebetse khahlanong le Mucorales kapa Fusarium le li-fungus tse seng kae tse sa tloaelehang. Ke moemeli ea molemo ka ho fetisisa khahlanong le hlobo e ntšo, ho akarelletsa le Bipolaris, Exserohilum joalo-joalo Ho hanyetsa itraconazole ho hlalosoa ho Candida, le hoja hangata ho feta ka fluconazole le ho Aspergillus.
Voriconazole e na le ponahalo e pharaletseng haholo. E sebetsa khahlano le bongata bo boholo ba mefuta ea Candida, Cryptococcus neoformans, mefuta eohle ea Aspergillus, Scedosporium agiospermum, libaka tse ling tsa Fusarium le bongata ba likokoana-hloko tse sa tloaelehang. Ha e sebetse khahlano le mefuta ea Mucorales joalo ka Mucor spp, Rhizopus spp, Rhizomucor spp, Absidia spp le tse ling. Voriconazole e fetohile ea bohlokoa haholo kalafong ea aspergillosis e hlaselang.
Posaconazole e na le letoto le pharaletseng haholo la ts'ebetso. Li-fungus tseo khōlo ea tsona e thibeloang ke posaconazole li kenyelletsa Aspergillus, Candida, Coccidioides, Histoplasma, Paracoccidioides, Blastomyces, Cryptococcus, Sporothrix, mefuta e sa tšoaneng ea Mucorales (e bakang Zygomyetes) le mefuta e meng e mengata e ntšo e kang Bipolaris le Exserohilum. Bongata ba li-isolate tsa Aspergillus li bolaoa ke posaconazole maemong a amanang le bongaka. Ho hanyetsa posaconazole ho etsahala ho Aspergillus fumigatus le Candida albicans empa ha e fumanehe hangata.
Litla-morao tsa lithethefatsi tsa azole li khetholloa hantle 'me ho boetse ho na le litšebelisano tsa bohlokoa tsa lithethefatsi le lithethefatsi tse sa kenyelletseng tšebeliso ea ho laela lithethefatsi tse itseng ka nako e le' ngoe. Bakeng sa kutloisiso e felletseng ea litaba tsena sheba lipampitšana tsa tlhaiso-leseling ea mokuli (PIL) bakeng sa moriana ka mong (ka tlase ho leqephe).
Ho ikhethela
Tse ling tsa lithethefatsi tsa antifungal (mohlala itraconazole) li nkoa ka molomo 'me ho ka ba thata ho li monya, haholo-holo haeba u ntse u le teng antacid meriana (moriana o sebelisetsoang ho alafa ho se sile hantle, liso tsa ka mpeng kapa ho nyeheloa ke pelo). Lebaka ke hobane acid e ka mpeng ea hlokahala ho qhaqha li-capsules le ho lumella ho monya.
Ebang itraconazole keletso e tloaelehileng ke ho etsa bonnete ba hore ho na le asiti e ngata ka mpeng ka ho noa seno-mapholi se kang cola le meriana (carbon dioxide e bakang fizz le eona e etsa hore seno se be asiti haholo). Batho ba bang ha ba rate lino tse tahang, kahoo ba nkela lero la litholoana sebaka, mohlala. lero la lamunu.
Li-capsules tsa Itraconazole li nkoa ka mor'a lijo le lihora tse 2 pele u nka li-antacid. Tharollo ea Itraconazole e nkoa hora e le 'ngoe pele sejo ka ha se monyela ha bobebe.
Ho bohlokoa ho bala buka ea Pampitšana ea Boitsebiso ba Bakuli e tletse meriana ea hau kaha sena se u fa lintlha tsohle tseo u li hlokang ho li boloka le ho li sebelisa. Re fana ka lethathamo la litlhare tse atileng botlaaseng ba leqephe lena, le likhokahano tsa li-PIL tsa tsona.
Esita le ka mor'a ho latela litaelo tsohle tsa bahlahisi, ho monya ha lithethefatsi tse ling ho ke ke ha lebelloa. U ka fumana hore ngaka ea hau e tla nka lisampole tsa mali ho hlahloba hore na 'mele oa hau o monya antifungal hantle hakae
Litla-morao
Lithethefatsi tsohle li na le litla-morao ('litlamorao tse mpe') 'me baetsi ba lithethefatsi ba tlameha ho li ngola lethathamong la Litaba tsa Mokuli (PIL). Bongata ke ba banyenyane, empa tsohle li bohlokoa ho bua le ngaka ea hau ketelong ea hau e latelang. Litla-morao li ka ba tse fapaneng haholo 'me hangata li sa lebelloa ka ho feletseng. Haeba u ikutloa u sa phele hantle ho bohlokoa hore u hlahlobe lethathamo la litla-morao ho PIL kaha ho ka etsahala hore ebe sethethefatsi seo u se noang se baka bothata. Haeba u na le lipelaelo kamehla batla keletso ea ngaka ea hau.
Steroids li na le tšekamelo ea ho baka litla-morao tse ngata tse sa thabiseng. Ho na le tlhahisoleseding e tobileng ho litla-morao tsa steroid le mokhoa oa ho nka li-steroid ka ho fetisisa Mona.
Bakuli ba nang le litla-morao ba fuoa likeletso tse ngata - e ka 'na eaba ho phehella ho noa moriana ho baka hore bothata bo nyamele, kapa mohlomong mokuli o lokela ho emisoa ho noa moriana. Ka linako tse ling sethethefatsi se seng se tla laeloa ho loantša phello e mpe.
Ntle le maemong a boima ka ho fetisisa ha ho bohlale hore mokuli a khaotse ho noa lithethefatsi ntle le ho buisana le ngaka ea bona.
Ho na le litšebelisano tse ngata lipakeng tsa litlhare tse fapaneng tseo batho ba bangata ba lokelang ho li noa tse ka bakang litlamorao tse matla. Sheba litšebelisano pakeng tsa lithethefatsi tsa antifungal le meriana leha e le efe eo u ka e nkang ka ho e batla ho rona Database ea litšebelisano tsa antifungal.
Voriconazole le squamous cell carcinoma: Tlhahlobo ea 2019 ea batho ba 3710 ba fumaneng phetisetso ea mats'oafo kapa transplant ea lisele tsa hematopoietic ba fumane kamano e kholo lipakeng tsa ts'ebeliso ea voriconazole le squamous cell carcinoma ho bakuli bana. Nako e telele le litekanyetso tse phahameng tsa voriconazole li ne li amahanngoa le kotsi e eketsehileng ea SCC. Phuputso e tšehetsa tlhokahalo ea kamehla ea dermatologic surveillance bakeng sa bakuli ba LT le HCT ka voriconazole, le tlhahiso ea hore mekhoa e meng ea phekolo e nkoe, haholo-holo haeba mokuli a se a ntse a le kotsing e eketsehileng ea SCC. Bangoli ba hlokomela hore data e ne e lekanyelitsoe mme ho hlokahala lipatlisiso tse ngata ho tsoela pele ho hlahloba khokahano ena. Bala pampiri mona.
Ho tlaleha litla-morao tsa lithethefatsi:
UK: UK, MHRA e na le Karete e putsoa sekema moo o ka tlalehang litla-morao le liketsahalo tse mpe tsa meriana, liente, liphekolo tse tlatselletsang le lisebelisoa tsa bongaka. Ho na le foromo e fumanehang marang-rang e bonolo ho e tlatsa - ha ho hlokahale hore u etse sena ka ngaka ea hau. Haeba u hloka thuso ka foromo, ikopanye le motho e mong ho NAC kapa u botse motho e mong sehlopheng sa tšehetso sa Facebook.
US: Naheng ea Amerika, o ka tlaleha litla-morao ka kotloloho ho FDA ka tsona MedWatch moralo.
Ho fumaneha ha Antifungal:
Ka bomalimabe ha se litlhare tsohle tsa antifungal tse fumanehang naheng e 'ngoe le e' ngoe lefatšeng ka bophara, 'me leha li le teng, theko e ka fapana haholo ho ea ka linaha. Global Action Fund for fungal Infections (GAFFI) e hlahisitse sehlopha sa limmapa tse bonts'ang boteng ba litlhare tsa bohlokoa tsa antifungal lefatšeng ka bophara.
Tobetsa mona ho sheba 'mapa oa GAFFI oa ho fumaneha ha li-antifungal
Lintlha tse ling hape
Lithethefatsi tse atileng haholo tse behiloeng bakeng sa tšebeliso ea nako e telele bakeng sa batho ba nang le aspergillosis li thathamisitsoe ka lintlha tse qaqileng ka tlase. Ho boetse ho na le lethathamo la lintlha tse nolofalitsoeng bakeng sa boholo ba meriana ena Mona.
Ho bohlokoa ho bala lipampitšana tsa litaba tsa mokuli (PIL) bakeng sa meriana eo u seng u tla qala ho e noa le ho ela hloko litemoso, litla-morao le lenane la meriana e sa lumellaneng. Hape mona ke sebaka se setle sa ho bala tataiso e tobileng mabapi le mokhoa oa ho noa meriana ea hau. Re fana ka likopi tsa morao-rao ka tlase:
(PIL – Leaflet Information Leaflet) (BNF – British National Formulary)
steroid:
-
- Prednisolone (PIL)
- Hydrocortisone (BNF)
Ho se lekane ha adrenal e ka ba litlamorao tsa tšebeliso ea steroid.
Antifungal:
- 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)
Litla-morao - bona lipampitšana tsa PIL & VIPIL tse thathamisitsoeng ka holimo empa hape u bone litlaleho tse felletseng tse tsoang ho EU MRHA Karete e Sehla tsamaiso ea litlaleho mona