I-Trimethoprim-Sulfamethoxazole

I-Trimethoprim-Sulfamethoxazole

I-Trimethoprim-sulfamethoxazole, inhlanganisela yama-antibiotic enamandla, ingalapha izifo eziningi ezibangelwa amagciwane. Lesi sidakamizwa esisebenza ngezindlela eziningi sidlala indima ebalulekile ekwelapheni izimo ezihlukahlukene, kusukela ukutheleleka kwe-urinary tract ku-pneumonia. Odokotela bavame ukuyinikeza ngenxa yokuphumelela kwayo ngokumelene namagciwane amaningi avamile.

Le bhulogi ihlola izinzuzo, umthamo, kanye nezinyathelo zokuphepha ze-trimethoprim-sulfamethoxazole. Sizobheka ukuthi uyini lo muthi, usetshenziswa kanjani, kanye nemiphumela yawo engemihle engaba khona. 

Iyini Ithebhulethi ye-Trimethoprim Sulfamethoxazole?

I-Trimethoprim-sulfamethoxazole, noma i-co-trimoxazole, imithi elwa namagciwane esetshenziselwa ukwelapha nokuvimbela izifo eziningi ezibangelwa amagciwane. Kuyinhlanganisela yomthamo ongashintshi wezithako ezimbili ezisebenzayo- i-trimethoprim ne-sulfamethoxazole, ehlanganiswe ngesilinganiso esingu-1:5.

Le nhlanganisela idala umphumela we-synergistic anti-folate, okuwenza ube omunye wezidakamizwa ezisebenza ngempumelelo ngokumelene nohlu olubanzi lwamagciwane.

Ukusetshenziswa kwethebhulethi ye-Trimethoprim ne-Sulfamethoxazole

I-Trimethon sulfamethoxazole iyimithi elwa namagciwane esebenza ngezindlela eziningi esetshenziselwa ukwelapha nokuvimbela izinhlobo eziningi zezifo ezibangelwa amagciwane. Izinkomba zayo ezigunyazwe yi-FDA zifaka:

• Acute infective exacerbation of izifo ezingamahlalakhona ezingapheli
• I-Otitis media (ukutheleleka kwezindlebe) kwezingane
• Isifo sohudo sabahambi sokwelashwa nokuvimbela
• Izifo ezithinta u-Urinary
• I-Shigellosis (isihudo sebhaktheriya)
• I-Pneumocystis jirovecii inyumoniya/I-Pneumocystis i-carinii pneumonia (PJP/PCP) yakho kokubili i-prophylaxis nokwelashwa
• I-Toxoplasmosis kokubili i-prophylaxis nokwelashwa
• I-Trimethoprim/sulfamethoxazole nayo iyasiza kulokhu:
• I-Prophylaxis kubantu abane-HIV
• Induna vulgaris
• Izifo ze-Listeria
• I-Meliondosis
• I-Pertussis (ukukhwehlela)
• Ukutheleleka kwe-Staphylococcus aureus, kuhlanganise ne-methicillin-resistant Staphylococcus aureus (MRSA)
• Isifo sofuba
• Isifo seWhipple
• I-Isosporiasis
• Umalaleveva
• Inyumoniya etholwe umphakathi

Isetshenziswa kanjani i-Trimethoprim-sulfamethoxazole

I-Trimethoprim-sulfamethoxazole itholakala ekwenziweni ngomlomo nange-intravenous. 

Amaphilisi e-Trimethoprim-sulfamethoxazole noma uketshezi kungathathwa ngomlomo ngokudla noma ngaphandle kokudla. Nokho, ukuwathatha okungenani nengilazi eyodwa yamanzi kungcono kakhulu. Ukuphuza inani eliphelele loketshezi ngenkathi uthatha lo muthi kuyasiza vimbela ukwakheka kwamatshe ezinso.

Ulwazi lwesilinganiso

Umthamo Wokutheleleka Kwamagciwane:

• Kubantu abadala kanye nezingane ezinesisindo esingama-40 kg (amakhilogremu angu-88) noma ngaphezulu, umthamo womlomo onconywayo uthi:
  • Ithebhulethi eyodwa engu-800 mg sulfamethoxazole/160 mg trimethoprim njalo emahoreni ayishumi nambili izinsuku eziyi-10 kuya kweziyi-14.
  • Ezinganeni ezinezinyanga ezimbili nangaphezulu, umthamo ulungiswa ngesisindo, ngokuvamile:
  • 40 mg/kg sulfamethoxazole & 8 mg/kg trimethoprim, ihlukaniswe ngemithamo emibili njalo emahoreni ayishumi nambili izinsuku eziyishumi.

I-Pneumocystis Pneumonia Ukwelashwa

Kubantu abadala kanye nezingane izinyanga ezimbili nangaphezulu, umthamo ulungiswa ngesisindo:

• 75-100 mg/kg sulfamethoxazole kanye 15-20 mg/kg trimethoprim nsuku zonke izinsuku 14-21.
• Isifo sohudo sabahambi
• Abantu abadala: 800 mg sulfamethoxazole/160 mg trimethoprim njalo emahoreni ayi-12 izinsuku ezinhlanu.

I-Bronchitis Engapheli

Ngokukhula okunamandla ngenxa yamagciwane athile:

• Ithebhulethi eyodwa engu-800 mg sulfamethoxazole/160 mg trimethoprim njalo emahoreni ayi-12 izinsuku eziyi-10-14.

Ukutheleleka Kwe-Urinary Tract

• I-Pyelonephritis: Ithebhulethi eyodwa engu-800 mg sulfamethoxazole/160 mg trimethoprim njalo emahoreni ayi-12 izinsuku eziyi-14.
• I-Prostatitis: Ithebhulethi eyodwa engu-800 mg sulfamethoxazole/160 mg trimethoprim njalo emahoreni ayi-12 izinsuku eziyi-14 noma izinyanga ezi-2-3 ngezifo ezingamahlalakhona.

I-Trimethoprim/sulfamethoxazole ayinconyelwe izingane ezingaphansi kwezinyanga ezimbili ubudala.

Imiphumela Emibi Yethebhulethi ye-Trimethoprim-sulfamethoxazole

I-Trimethoprim-sulfamethoxazole ngokuvamile ibekezelelwa kahle, kodwa ingabangela imiphumela emibi.

Imiphumela engemihle edinga ukunakwa ngokushesha:

• Ukungezwani komzimba - ukuqubuka kwesikhumba, ukulunywa, ukuqubuka, ukuvuvukala kobuso, izindebe, ulimi, noma umphimbo.
• I-Aplastic anemia- ubuthakathaka obungavamile noma ukukhathala, isiyezi, ikhanda elibuhlungu, ukuphefumula kanzima, ukopha okukhulu noma imihuzuko, imfiva, ukugodola, ukukhwehlela, noma umphimbo obuhlungu.
• Ukukhwehlela okomile noma ukuphelelwa umoya
• Izinga eliphezulu le-potassium- Ubuthakathaka bemisipha, ukushaya kwenhliziyo okusheshayo noma okungajwayelekile
• Ukulimala kwesibindi- Ubuhlungu besisu esingenhla kwesokudla, ukungakuthandi ukudla, isicanucanu, indle enombala okhanyayo, umchamo onsundu ngokumnyama noma onsundu, isikhumba esiba phuzi noma amehlo, ubuthakathaka obungavamile noma ukukhathala.
• Ushukela wegazi ophansi (i-hypoglycemia)- Ukuthuthumela noma ukuthuthumela, ukukhathazeka, ukujuluka, isikhumba esibandayo noma esinesikhumba esimhlophe, ukudideka, isiyezi, ukushaya kwenhliziyo okusheshayo
• Izinga le-sodium ephansi- Ubuthakathaka bemisipha, ukukhathala, isiyezi, ikhanda elibuhlungu, ukudideka
• Umkhuhlane, ukuqubuka, nokuvuvukala kwama-lymph nodes
• Ububomvu, ukuxebuka, noma amabhamuza esikhumbeni, okuhlanganisa nangaphakathi emlonyeni
• Uhudo olunzima, umkhuhlane.
• Amaqhubu amancane agcwele ubomvu esikhumbeni
• Ukuphuma komchamo okungajwayelekile, ukulunywa, noma iphunga
• Imiphumela emibi evamile engase ingadingi ukunakekelwa kwezokwelapha:
• Ukulahlekelwa kwesifiso
• I-nausea
• Ukuvota
• Eminye imiphumela engemihle evamile ihlanganisa ukuzwela kwesithombe (ukwanda kokuzwela ekukhanyeni kwelanga), i-anorexia, isiyezi, i-tinnitus, ukukhathala, ukuqwasha, nokuqubuka/i-urticaria.
• Ukuchayeka Elangeni: I-Trimethoprim-sulfamethoxazole ingase ikhulise ukuzwela kwakho ukukhanya kwelanga. 
• Uma unesifo sikashukela, i-trimethoprim-sulfamethoxazole ingase ithinte amazinga akho kashukela egazini. 
• Ukusabela okubucayi kakhulu kodwa okungajwayelekile kungase kuhlanganise i-Stevens-Johnson syndrome, i-anemia ehlukahlukene, i-agranulocytosis, isifo sohudo esihlobene ne-Clostridium difficile, i-myelosuppression, ukwehluleka kwezinso/i-interstitial nephritis, i-pancreatitis, kanye ne-hepatotoxicity. I-anemia ye-haemolytic ingenzeka ezigulini ezinokushoda kwe-glucose-6-phosphate-dehydrogenase (G6PD).

Ukuqapha

Ukulandela izinyathelo ezithile zokuphepha ngenkathi uthatha i-trimethoprim-sulfamethoxazole kubalulekile ukuze kuqinisekiswe ukwelashwa okuphephile nokusebenzayo. Nazi izinyathelo zokuphepha ezibalulekile okufanele uzikhumbule:

• Ukukhulelwa nokuncelisa
• Uma uguliswa yi-sulfamethoxazole, i-trimethoprim, noma eminye imithi ye-sulfa
• Yazisa udokotela wakho mayelana nanoma yikuphi ukungezwani komzimba okukhulu, isifuba somoya, noma umlando wokuphazamiseka kwegazi okubangelwa i-trimethoprim noma izidakamizwa ze-sulfa.
• Iziguli ezinengculazi 
• Abantu abanezifo ezithile zegazi (i-porphyria, i-folate deficiency anemia), isifo sezinso, isifo sesibindi, ukuntuleka kwamavithamini (i-folate noma i-folic acid), ukwehla komnkantsha wamathambo, ukuntuleka kwe-G6PD, i-thyroid engasebenzi, noma ukungalingani kwamaminerali (i-potassium ephezulu noma amazinga aphansi e-sodium).
• Yazisa udokotela wakho mayelana nokuthatha i-trimethoprim-sulfamethoxazole ngaphambi kokuthola noma imiphi imigomo noma imigomo.
• Ukusebenzisana kwezidakamizwa
• Imithi engase ihlanganyele ne-trimethoprim-sulfamethoxazole:
• I-Dofetilide 
• I-Leucovorin
• Ama-ACE inhibitors 
• I-Antiarrhythmics 
• I-Methotrexate
• Warfarin
• Phenytoin
• Digoxin
• I-Cyclosporine
• Imithi engadinga ukulungiswa komthamo:
• I-Sulfonylureas (izidakamizwa ezilwa nesifo sikashukela) 
• isisu 
• Imithi enganciphisa ukusebenza kwe-trimethoprim-sulfamethoxazole:
• Rifampin
• I-Methenamine

Isiphetho

I-Trimethoprim-sulfamethoxazole igqama njengethuluzi elinamandla ekulweni nezifo ezihlukahlukene ezibangelwa amagciwane. Ukuguquguquka kwayo ekwelapheni izimo ezisukela ezifweni zomgudu womchamo kuye kweyenyumoniya kwenza kube ukukhetha kodokotela abaningi. Indlela yokusebenza eyingqayizivele yomuthi, ehlanganisa izithako ezimbili ezisebenzayo ukuphazamisa ukuhlanganiswa kwe-folate yebhaktheriya, inikeza ukuzivikela okuqinile kuma-microorganisms ayingozi.

FAQ sika

1. Ingabe i-sulfamethoxazole iyi-antibiotic enamandla?

Nakuba i-sulfamethoxazole iyodwa ingathathwa njengemithi elwa namagciwane enamandla, umphumela wayo we-synergistic ne-trimethoprim wenza inhlanganisela ibe i-ejenti elwa namagciwane enamandla. Lapho ihlanganiswa ne-trimethoprim, i-sulfamethoxazole yakha inhlanganisela yama-antibiotic enamandla eyaziwa ngokuthi i-trimethoprim-sulfamethoxazole noma i-co-trimoxazole. Le nhlanganisela ibhekwa njenge-anti-spectrum antibiotic, ephumelelayo ngokumelene nezifo ezihlukahlukene zamagciwane. 

2. Kungani uthatha i-trimethoprim ebusuku?

Kunezizathu eziningana zokuthi kungani i-trimethoprim ivame ukunconywa ukuthi ithathwe ebusuku:

• Ukusebenza okuthuthukisiwe: Ukuthatha i-trimethoprim ngesikhathi sokulala kuvumela izinqubo ze-metabolic zomzimba ukuthi zisebenze ngokuphumelelayo ngokuhambisana namazinga womzimba wasebusuku.
• Ukumuncwa okungcono: Obunye ubufakazi bubonisa ukuthi i-trimethoprim ingase imunceke kangcono umzimba uma ithathwa ebusuku.
• Imiphumela emibi eyehlisiwe: Imiphumela ethile ye-trimethoprim, njenge isicanucanu, ingase ingaphinyiselwa kancane ngesikhathi sokulala.
• Okulula: Ukuthatha i-trimethoprim ebusuku kungaba lula kwabanye abantu, njengoba kulula ukukukhumbula futhi kufanelana nenqubo yabo yansuku zonke.

3. Zingaki izinsuku ongayithatha i-sulfamethoxazole?

Ubude besikhathi sokwelashwa kwe-sulfamethoxazole (kuhlanganiswe ne-trimethoprim) kuncike ohlotsheni lokutheleleka. Ngokuvamile, inqunyelwe izikhathi ezilandelayo:

• Ukutheleleka komgudu womchamo (UTIs): izinsuku eziyi-10-14
• Uhudo lwabahambi: izinsuku ezi-5
• I-Shigellosis (isihudo sebhaktheriya): izinsuku ezi-5
• Ukwelashwa kwe-Pneumocystis jiroveci pneumonia (PCP): izinsuku eziyi-14-21

4. Iyini imibi ye-trimethoprim-sulfamethoxazole?

Nakuba i-trimethoprim-sulfamethoxazole iyinhlanganisela esebenzayo yama-antibiotic, inakho ukungalungi okungase kube khona:

• Ukuphendula kwe-allergen
• Ukuntuleka kwe-folate
• Lo muthi ungandisa ukuzwela ekukhanyeni kwelanga, okwandisa ingozi yokushiswa yilanga nokusabela kwesikhumba.
• Ukuphazamiseka kwegazi, okuhlanganisa i-aplastic anemia, i-agranulocytosis, ne-thrombocytopenia (isibalo esiphansi seplatelet).
• Ubuthi bezinso nesibindi
• Ukusebenzisana neminye imithi, okungase kuguqule ukusebenza kwayo noma kwandise ingozi yemiphumela engemihle.

5. Ubani Ongakwazi ukuthatha i-trimethoprim?

I-Trimethoprim kufanele igwenywe noma isetshenziswe ngokuqapha kubantu abathile, okuhlanganisa:

• Omama abakhulelwe nabancelisayo
• Izingane ezingaphansi kwezinyanga ezimbili
• Abantu abanesifo esibi kakhulu sesibindi noma sezinso:
• Abantu abanokuntuleka kwe-folate noma i-anemia
• Abantu abanomlando wokungezwani okukhulu ne-trimethoprim noma i-sulfonamides
• Abantu ngabanye bathatha imithi ethile, njenge-dofetilide (isidakamizwa esilwa nokuvuvukala), i-leucovorin (esetshenziswa ekwelapheni umdlavuza), kanye ne-methotrexate (esetshenziselwa umdlavuza kanye nezifo ezizimele).