Ƙungiyar Cututtuka ta Amurka a halin yanzu tana ba da shawarar amoxicillin da ampicillin, maganin rigakafi na aminopenicillin (AP), a matsayin magungunan zaɓi don magani.enterococcusUTIs.2 Yaduwar enterococcus mai jurewa ampicillin yana ƙaruwa.

Musamman, abubuwan da suka faru na vancomycin-resistantenterococci(VRE) ya kusan ninka sau biyu a cikin 'yan shekarun nan, tare da 30% na asibiti interococcal keɓewa da aka ruwaito a matsayin resistant zuwa vancomycin.3 Dangane da halin yanzu Clinical and Laboratory Standards Institute,Enterococcusnau'in da ke da ƙananan ƙwayar inhibitory (MIC) ≥ 16 μg/ml ana ɗaukar ampicillin-resistant.

Dakunan gwaje-gwajen microbiology suna amfani da wannan wurin karyewa ba tare da la'akari da wurin kamuwa da cuta ba. Pharmacokinetic, pharmacodynamics, da bayanan gwaji na asibiti suna goyan bayan yin amfani da maganin rigakafi na aminopenicillin a cikin maganin enterococcus UTIs, ko da lokacin da keɓaɓɓen ke da MIC wanda ya zarce alamar rashin lafiya.4,5

Saboda ana kawar da maganin rigakafi na AP ta hanyar kodan, za mu iya samun yawa mafi girma a cikin fitsari fiye da na jini. Ɗaya daga cikin binciken ya sami damar nuna matsakaicin adadin fitsari na 1100 μg/ml wanda aka tattara sama da sa'o'i 6 bayan kashi ɗaya na amoxicillin na baki 500 MG.

Wani binciken kuma yayi nazari akan maganin ampicillinenterococcus faecium(E. Faecium) fitsari ya ware tare da rahoton MICs na 128 μg/mL (30%), 256 μg/mL (60%), da 512 μg/mL (10%).4 Yin amfani da bayanai daga waɗannan gwaje-gwajen, yana da kyau a faɗi cewa ƙididdigar AP kai isassun matsuguni a cikin magudanar fitsari don magance cututtuka da yawa da aka ruwaito.

A wani binciken kuma, an gano cewa ampicillin yana jurewaE. faciumwarewar fitsari yana da MICs daban-daban, tare da matsakaicin MIC na 256 μg/mL5. Keɓancewar 5 ne kawai ke da ƙimar MIC> 1000 μg/mL, amma kowane ɗayan waɗannan keɓe yana cikin dilution 1 na 512 μg/mL.

Magungunan maganin rigakafi na penicillin suna nuna kisa mai dogaro da lokaci kuma mafi kyawun amsa zai faru muddin yawan fitsarin ya kasance sama da MIC na aƙalla kashi 50 cikin ɗari na tazara. bi daEnterococcusnau'in, amma kuma yana jure wa ampicillinenterococcusware a cikin ƙananan UTIs, idan dai an yi amfani da su a hankali.

Ilimantar da masu rubutawa ita ce hanya ɗaya da za mu iya rage yawan adadin maganin rigakafi da ake amfani da su don magance waɗannan cututtuka, irin su linezolid da daptomycin. Wata hanya ita ce haɓaka ƙa'ida a cibiyoyi ɗaya don taimakawa jagorar masu rubutawa zuwa ga rubutaccen jagora.

Ɗaya daga cikin mafi kyawun hanyoyin magance wannan matsala yana farawa a cikin dakin gwaje-gwaje na microbiology. Ƙayyadaddun wuraren hutu na musamman na fitsari zai ba mu ƙarin amintattun bayanai masu lahani; duk da haka, wannan ba a ko'ina a wannan lokaci.

Yawancin asibitocin sun dakatar da gwajin cutar su na yau da kullun donenterococcusfitsari ya ware kuma ya ba da rahoton duk a matsayin mai saurin kamuwa da aminopenicillins.6 Wani bincike ya kimanta sakamakon jiyya tsakanin marasa lafiya da aka yi wa VRE UTI tare da maganin rigakafi na AP idan aka kwatanta da waɗanda aka yi da maganin rigakafi marasa beta-lactam.

A cikin wannan binciken, an ɗauki maganin AP yana aiki a kowane yanayi, ba tare da la'akari da raunin ampicillin ba. A cikin rukunin AP, wakili na yau da kullun da aka zaɓa don ingantaccen magani shine amoxicillin wanda ke biye da ampicillin na ciki, ampicillin-sulbactam, da amoxicillin-clavulanate.

A cikin rukunin da ba na beta-lactam ba, wakili na yau da kullun da aka zaɓa don ingantaccen magani shine linezolid, sannan daptomycin da fosfomycin suka biyo baya. Adadin maganin asibiti shine 83.9% marasa lafiya a cikin rukunin AP da 73.3% a cikin rukunin marasa beta-lactam.

An lura da magani na asibiti tare da maganin AP a cikin 84% na duk lokuta kuma a cikin 86% na marasa lafiya tare da keɓe masu tsayayya da ampicillin, ba tare da wani bambanci na ƙididdiga da aka gano tsakanin sakamako ga waɗanda aka yi musu magani tare da β-lactams ba.