I-Aspergillosis Isiguli Nokusekelwa

Kuhlinzekwe yi-NHS National Aspergillosis Center

Ama-Antifungal e-aspergillosis

Ukwelashwa kwezifo zokukhunta kungachazwa kabanzi ngokwezigaba ezintathu zama-antifungal. Ama-echinocandins, ama-azoles nama-polyenes.

Ama-Polyenes

I-Amphotericin B ivame ukusetshenziswa emthanjeni ukwelapha izifo ze-fungal zesistimu. Isebenza ngokubophezela engxenyeni yodonga lwamaseli esikhunta okuthiwa i-ergosterol. I-Amphotericin B cishe iyi-spectrum ebanzi kakhulu ye-intravenous antifungal etholakalayo. Inomsebenzi omelene ne-Aspergillus, Blastomyces, Candida (zonke izinhlobo zezilwane ngaphandle kweCandida krusei ne-Candida lutania), i-Coccidioides, i-Cryptococcus, i-Histoplasma, i-Paracoccidiodes kanye nama-ejenti amaningi e-zygomycosis (Mucorales), i-Fusarium nezinye isikhunta esingavamile. Ayisebenzi ngokwanele ngokumelene ne-Scedosporium apiospermum, Aspergillus terreus, Trichosporon spp., iningi lezinhlobo ezibangela i-mycetoma kanye nezifo zesistimu ngenxa ye-Sporothrix schenkii. Ukumelana okutholiwe ku-amphotericin B kuye kwachazwa ezindaweni ezizimele ngezikhathi ezithile, ngokuvamile ngemva kokwelashwa kwesikhathi eside kumongo we-endocarditis, kodwa akuvamile. I-Amphotericin B ingabangela imiphumela emibi eminingi kwezinye izimo ingaba nzima kakhulu.

I-Amphotericin ingaphinda ikhishwe nge-nebuliser. Buka ividiyo lapha.

Echinocandins

I-Echinocandins ivame ukusetshenziselwa ukwelapha izifo ze-fungal zesistimu ezigulini ezintula amasosha omzimba - lezi zidakamizwa zivimbela ukuhlanganiswa kwe-glucan okuyingxenye ethile yodonga lwamaseli esikhunta. Zihlanganisa i-micafungin, i-caspofungin ne-anidulafungin. I-Echinocandins ilawulwa kahle kakhulu ngokusebenzisa i-intravenous ngenxa yokumuncwa kabi.

I-Caspofungin isebenza kakhulu kuzo zonke izinhlobo ze-Aspergillus. Ayibulali i-Aspergillus ngokuphelele epayipini lokuhlola. Kukhona inani elilinganiselwe kakhulu lomsebenzi ngokumelene ne-Coccidioides immitis, i-Blastomyces dermatitidis, izinhlobo ze-Scedosporium, i-Paecilomyces varioti ne-Histoplasma capsulata kodwa kungenzeka ukuthi umsebenzi awanele ukusetshenziswa emtholampilo.

I-Triazoles 

I-Itraconazole, i-fluconazole, i-voriconazole ne-posaconazole - indlela yokusebenza ye-itraconazole iyafana nezinye izidakamizwa ze-azole: ivimbela ukuhlanganiswa kwe-ergosterol kwe-cytochrome P450 oxidase-mediated synthesis.

Fluconazole iyasebenza ngokumelene nezinhlobo eziningi ze-Candida, ngaphandle ngokuphelele kwe-Candida krusei futhi ngaphandle kwengxenye ye-Candida glabrata, kanye nenani elincane lezinhlobo ze-Candida albicans, i-Candida tropicalis, i-Candida parapsilosis nezinye izinhlobo ezingavamile. Isebenza futhi ngokumelene neningi lama-Cryptococcus neoformans ahlukanisayo. Isebenza ngokumelene namanye ama-yeast amaningi okuhlanganisa i-Trichosporon beigelii, i-Rhodotorula rubra, kanye nesikhunta se-dimorphic endemic okuhlanganisa i-Blastomyces dermatitidis, i-Coccidioides immitis, i-Histoplasma capsulatuma kanye ne-Paracoccidioides brasiliensis. Isebenza kancane kune-itraconazole ngokumelene nalezi sikhunta se-dimorphic. Ayisebenzi ngokumelene ne-Aspergillus noma i-Mucorales. Isebenza ngokumelene nesikhunta sesikhumba njenge-Trichophyton.

Ukwanda kokungazweli kuma-Candida albicans ezigulini ezine-AIDS kuye kwabikwa. Amazinga ajwayelekile okumelana nama-albicans e-Candida esibhedlela esijwayelekile angu-3-6%, kuma-albicans e-Candida ku-AIDS 10-15%, e-Candida krusei 100%, e-Candida glabrata ~ 50-70%, e-Candida tropicalis 10-30% futhi kwezinye izinhlobo zeCandida ngaphansi kuka-5%.

I-Itraconazole ingenye yama-antifungal ebanzi kakhulu atholakalayo futhi ihlanganisa umsebenzi omelene ne-Aspergillus, Blastomyces Candida (zonke izinhlobo ezihlanganisa nezinhlobo eziningi ezikwazi ukumelana ne-fluconazole) I-Coccidioides, i-Cryptoccocus, i-Histoplasma, i-Paracoccidioides, i-Scedosporium apiospermum ne-Sporothrix schenkii. Iphinde isebenze ngokumelene nazo zonke isikhunta sesikhumba. Ayisebenzi ngokumelene ne-Mucorales noma i-Fusarium kanye nezinye isikhunta ezimbalwa ezingavamile. Kuyi-ejenti engcono kakhulu emelene nesikhunta esimnyama, okuhlanganisa i-Bipolaris, i-Exserohilum njll. Ukumelana ne-itraconazole kuchazwa ku-Candida, nakuba kuncane kakhulu kune-fluconazole kanye naku-Aspergillus.

I-Voriconazole inombono obanzi ngokwedlulele. Isebenza ngokumelene nenani elikhulu lezinhlobo ze-Candida, i-Cryptococcus neoformans, zonke izinhlobo ze-Aspergillus, i-Scedosporium agiospermum, ezinye iziqhingi ze-Fusarium kanye nenqwaba yamagciwane angatholakali kalula. Ayisebenzi ngokumelene nezinhlobo ze-Mucorales ezifana ne-Mucor spp, i-Rhizopus spp, i-Rhizomucor spp, i-Absidia spp nezinye. I-Voriconazole isibe wusizo ekwelapheni i-aspergillosis ehlaselayo.

I-Posaconazole inohlelo olubanzi kakhulu lwesenzo. Isikhunta okuvinjelwa ukukhula kwazo yi-posaconazole kuhlanganisa i-Aspergillus, Candida, Coccidioides, Histoplasma, Paracoccidioides, Blastomyces, Cryptococcus, Sporothrix, izinhlobo ezihlukahlukene zeMucorales (okubangela iZygomyetes) nezinye isikhunta esimnyama esiningi njenge-Bipolaris ne-Exserohilum. Iningi lama-Aspergillus isolate abulawa yi-posaconazole ezindaweni ezifanele zomtholampilo. Ukumelana okutholiwe ku-posaconazole kuyenzeka ku-Aspergillus fumigatus kanye ne-Candida albicans kodwa akuvamile.

Imiphumela emibi yezidakamizwa ze-azole ibonakala kahle futhi kukhona ukuxhumana okubalulekile kwezidakamizwa nezidakamizwa ezingafaki ukusetshenziswa kokunquma izidakamizwa ezithile ngesikhathi esifanayo. Ukuze uthole ukuqonda okubanzi kwalezi zinkinga buka amapheshana olwazi lwesiguli ngasinye (PIL) omuthi ngamunye (ngezansi kwekhasi).

Ukwamukela

Ezinye zezidakamizwa ze-antifungal (isb itraconazole) zithathwa ngomlomo futhi kungaba nzima ukumunca, ikakhulukazi uma uvuliwe i-antacid imithi (umuthi osetshenziselwa ukwelapha ukuqunjelwa, izilonda zesisu noma isilungulela). Lokhu kungenxa yokuthi enye i-asidi esiswini iyadingeka ukuze kuncibilike amaphilisi futhi kuvunyelwe ukumuncwa.

Uma kwenzeka kuba itraconazole iseluleko esijwayelekile siwukuqinisekisa ukuthi kune-asidi eningi esiswini ngokuphuza isiphuzo esishisayo njenge-cola nemithi (i-carbon dioxide ebangela i-fizz yenza isiphuzo sibe ne-asidi impela). Abanye abantu abazithandi iziphuzo ezinoshukela ngakho bashintsha ijusi yesithelo isb. ijusi yewolintshi.

Ama-capsules e-Itraconazole athathwa ngemuva ukudla kanye namahora ama-2 ngaphambi kokuthatha ama-antacid. Isixazululo se-Itraconazole sithathwa ihora elilodwa ngaphambi ukudla njengoba kudonswa kalula.

Kuyafaneleka ukufunda incwadi Ipheshana Lolwazi Lwesiguli igcwele imithi yakho njengoba lokhu kukunikeza lonke ulwazi oludingayo ukuze uyigcine futhi uyisebenzise. Sihlinzeka ngohlu lwemithi ejwayeleke kakhulu ezansi kwaleli khasi, kanye nezixhumanisi zama-PIL azo.

Ngisho nangemva kokulandela yonke imiyalelo yabakhiqizi, ukumunca kweminye imithi akubikezeleki. Ungathola ukuthi udokotela wakho uzothatha amasampula egazi ukuze ahlole ukuthi umzimba wakho ubamba kahle kangakanani i-antifungal

Okuqhamuka uma udla imishanguzo

Yonke imithi inemiphumela engemihle ('imiphumela emibi') futhi abakhiqizi bezidakamizwa kudingeka bayifake ohlwini Lwephepha Lolwazi Lwesiguli (i-PIL). Iningi lincane, kodwa konke kufanelekile ukusho kudokotela wakho ekuvakasheleni kwakho okulandelayo. Imiphumela engemihle ingahluka kakhulu futhi ngokuvamile ingalindelekile ngokuphelele. Uma uzizwa ungaphilile kuhle ngaso sonke isikhathi ukuhlola uhlu lwemiphumela engemihle ku-PIL njengoba kungenzeka ukuthi umuthi owuphuzayo udala inkinga. Uma ungabaza ngaso sonke isikhathi funa iseluleko sikadokotela wakho.

I-Steroids zivame ukubangela imiphumela eminingi engemihle eminingi. Kukhona ulwazi oluqondile ku-steroid side effects kanye nendlela engcono kakhulu yokuthatha ama-steroids lapha.

Iziguli ezithola imiphumela engemihle zinikezwa izeluleko eziningi - kungenzeka ukuthi ukuphikelela ekuphuzeni umuthi kubangela ukuthi inkinga iphele, noma kungenzeka ukuthi isiguli kufanele sinqandwe ukuthatha umuthi. Kwesinye isikhathi kuzobekwa omunye umuthi ukuze kuliwe nomphumela ongemuhle.

Ngaphandle kwezimo ezinzima kakhulu akukhuthazwa ukuthi isiguli siyeke ukuthatha umuthi ngaphandle kokubonisana nodokotela waso.

Kukhona ukusebenzisana okuningi phakathi kwemithi ehlukene abantu abaningi okufanele bayiphuze okungadala imiphumela emibi kakhulu. Hlola ukusebenzisana phakathi kwezidakamizwa ze-antifungal kanye nanoma yimiphi eminye imithi ongase uyithathe ngokuyicinga yethu Isizindalwazi sokusebenzisana kwe-Antifungal.

I-Voriconazole ne-squamous cell carcinoma: Ukubuyekezwa kwango-2019 kubantu abangama-3710 abathole ukufakelwa amaphaphu noma ukufakelwa kweseli legazi kwathola ukuxhumana okubalulekile phakathi kokusetshenziswa kwe-voriconazole kanye ne-squamous cell carcinoma kulezi ziguli. Ubude besikhathi eside kanye nemithamo ephezulu ye-voriconazole yayihlotshaniswa nengozi eyengeziwe ye-SCC. Ucwaningo lusekela isidingo sokubhekwa njalo kwe-dermatologic kweziguli ze-LT ne-HCT ku-voriconazole, kanye nesiphakamiso sokuthi kuthathwe ezinye izindlela zokwelapha, ikakhulukazi uma isiguli sesivele sisengozini eyengeziwe ye-SCC. Ababhali bayaqaphela ukuthi idatha ibinomkhawulo futhi ucwaningo olwengeziwe luyadingeka ukuze kuqhutshekwe nokuhlola lokhu kuxhumana. Funda iphepha lapha.

Ukubika imiphumela emibi yezidakamizwa:

UK: E-UK, i-MHRA ine- Ikhadi eliphuzi uhlelo lapho ungabika khona imiphumela emibi kanye nesigameko esibi semithi, imigomo, ukwelapha okuhambisanayo kanye nemishini yezokwelapha. Kunefomu eliku-inthanethi elilula ongaligcwalisa - awudingi ukwenza lokhu ngodokotela wakho. Uma udinga usizo ngefomu, xhumana nothile e-NAC noma ubuze othile eqenjini losekelo le-Facebook.

I-US: E-US, ungabika imiphumela emibi ngqo ku-FDA usebenzisa yabo I-MedWatch uhlelo.

Ukutholakala kwe-Antifungal:

Ngeshwa akuzona zonke izidakamizwa ze-antifungal ezitholakala kuwo wonke amazwe emhlabeni jikelele futhi, noma ngabe zikhona, intengo ingahluka kakhulu emazweni ngamazwe. I-Global Action Fund for fungal Infections (GAFFI) ikhiqize isethi yamamephu abonisa ukutholakala kwemithi ebalulekile ye-antifungal emhlabeni jikelele.

Chofoza lapha ukuze ubuke imephu yokutholakala kwe-GAFFI antifungal

Ulwazi olunzulu

Izidakamizwa ezivame kakhulu ezinqunyelwe ukusetshenziswa isikhathi eside kubantu abane-aspergillosis zibalwe ngolwazi oluningiliziwe ngezansi. Kukhona nohlu lolwazi olwenziwe lula lweningi lale mithi lapha.

Kuhle ukufunda amapheshana olwazi lwesiguli (i-PIL) ngomuthi osuzoqala ukuwuthatha futhi uqaphele noma yiziphi izixwayiso, imiphumela engemihle kanye nohlu lwemithi engahambisani. Lena futhi indawo enhle yokufunda iziqondiso ezithile zokuthi uyithatha kanjani imithi yakho. Sihlinzeka ngamakhophi akamuva ngezansi:

(PIL – Ipheshana Lolwazi Lwesiguli) (BNF – British National Formulary) 

Ukuphuza ama-steroid:

Ama-Antifungal:

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

Okuqhamuka uma udla imishanguzo - bona amapheshana e-PIL & VIPIL asohlwini olungenhla kodwa futhi ubone imibiko ephelele evela e-EU Ikhadi Eliphuzi le-MRHA uhlelo lokubika lapha