Polymyxin B (EENT)
Jeneng merek: Casporyn HC
Kelas obat:
Agen Antineoplastik
Panganggone Polymyxin B (EENT)
Infeksi Ophthalmic Bakteri
Digunakake ing kombinasi tetep karo anti-infèksi liyane (yaiku, bacitracin; bacitracin lan neomycin; neomycin lan gramicidin; trimethoprim) kanggo perawatan topikal saka infèksi dangkal mripat (umpamane, konjungtivitis). , keratitis, keratoconjunctivitis, blepharitis, blepharoconjunctivitis) sing disebabake dening bakteri sing rentan.
Digunakake suBConjunctivally kanggo perawatan saka infèksi mripat sing disebabake dening rentan Pseudomonas aeruginosa. Senajan anti-infèksi ophthalmic topikal bisa nyepetake wektu kanggo resolusi lan nyuda keruwetan lan risiko komplikasi, supaya ora nggunakake anti-infèksi topikal kanthi sembarangan. Perawatan konjungtivitis bakteri akut umume empiris; nggunakake antibakteri ophthalmic topikal spektrum sing amba biasane dianjurake. Pewarnaan in vitro lan / utawa kultur bahan konjungtiva bisa dituduhake ing perawatan konjungtivitis purulen sing berulang, abot, utawa kronis utawa nalika konjungtivitis akut ora nanggapi perawatan topikal empiris awal.
Amarga keratitis bakteri bisa digandhengake karo mundhut sesanti sabanjure minangka akibat saka jaringan parut kornea utawa irregularities topografi lan amarga keratitis bakteri sing ora diobati utawa abot bisa nyebabake perforasi kornea kanthi potensial kanggo endophthalmitis lan bisa ilang mripat, Manajemen optimal kalebu evaluasi lan diagnosa kanthi cepet, wiwitan perawatan sing tepat, lan tindak lanjut sing cocog. Perawatan keratitis bakteri sing dipikolehi masyarakat umume empiris; nggunakake antibakteri ophthalmic topikal spektrum sing amba biasane dianjurake. Anti-infèksi subconjunctival bisa uga perlu yen scleral nyebar utawa perforasi wis cedhak. Pewarnaan in vitro lan / utawa kultur materi kornea dituduhake ing manajemen keratitis sing nglibatake infiltrat kornea sing tengah, gedhe, lan ngluwihi stroma tengah nganti jero; nalika keratitis kronis utawa ora responsif kanggo perawatan anti-infèksi topikal spektrum sing amba; utawa nalika fitur atipikal nuduhake infeksi jamur, amebik, utawa mikobakteri.
Infeksi Otik Bakteri
Digunakake ing kombinasi tetep karo neomycin lan kortikosteroid (yaiku, hidrokortison) kanggo perawatan topikal infeksi dangkal saluran pendengaran eksternal (otitis externa) sing disebabake dening bakteri sing rentan. Uga digunakake kanggo perawatan topikal infeksi mastoidectomy lan rongga fenestrasi sing disebabake dening bakteri sing rentan.
Otitis eksterna akut sing nyebar lan ora rumit ing pasien sing sehat biasane diobati wiwitane kanthi terapi topikal (contone, anti-infektif otik utawa antiseptik kanthi utawa tanpa kortikosteroid otik). Tambahan karo terapi anti-infektif sistemik yen pasien duwe kondisi medis sing bisa ngrusak pertahanan host (umpamane, diabetes mellitus, infeksi HIV) utawa yen infeksi wis nyebar menyang pinna, kulit gulu utawa rai, utawa menyang jaringan sing luwih jero kayata kedadeyan karo otitis eksterna maligna. Otitis externa ganas minangka infeksi invasif, sing bisa ngancam nyawa, utamane ing pasien immunocompromised, lan mbutuhake diagnosis lan perawatan kanthi cepet kanthi anti-infèksi sistemik.
Inflamasi Okular
Persediaan ophthalmic kombinasi tetep sing ngandhut polimiksin B, neomycin, lan deksametason utawa preparat ophthalmic kombinasi tetep sing ngemot polimiksin B, neomycin, bacitracin, lan hidrokortison utawa hidrokortison asetat digunakake kanggo perawatan topikal. kondisi okular responsif kortikosteroid nalika kortikosteroid dituduhake lan infèksi okular bakteri superfisial utawa risiko infèksi kuwi ana.
Sanajan pabrikan nyatakake yen nggunakake preparat ophthalmic kombinasi tetep sing ngemot anti-infektif lan kortikosteroid bisa dituduhake ing kondisi inflamasi okular nalika risiko infeksi okular superfisial dhuwur utawa nalika jumlah bakteri sing bisa mbebayani bakal ana ing mripat, para ahli nyatakake supaya ora nggunakake preparat kasebut ing pasien karo konjungtivitis bakteri amarga bisa nyebabake infèksi.
Elinga yen nggunakake preparat ophthalmic kombinasi tetep sing ngemot anti-infektif lan kortikosteroid bisa uga topeng tandha klinis infeksi bakteri, jamur, utawa virus; nyegah pangenalan ineffectiveness saka anti-infèksi; lan / utawa nambah IOP. (Deleng Panganggone Kombinasi Tetap sing Ngandhut Kortikosteroid miturut Ati-ati.)
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Carane nggunakake Polymyxin B (EENT)
Administrasi
Administrasi Oftalmik (Topik)
Kombinasi tetep polimiksin B lan bacitracin kanthi utawa tanpa neomycin: Olesake ing mripat minangka salep ophthalmic.
Kombinasi tetep saka polimiksin B, neomycin, lan gramicidin: Aplikasi topikal ing mripat minangka solusi ophthalmic.
Kombinasi tetep polimiksin B lan trimethoprim: Aplikasi topikal ing mripat minangka solusi ophthalmic.
Kombinasi tetep polimiksin B, anti-infeksi liyane (yaiku, neomycin kanthi utawa tanpa bacitracin), lan kortikosteroid (yaiku, deksametason, hidrokortison, utawa hidrokortison asetat): Aplikasi topikal ing mripat minangka salep ophthalmic utawa penundaan.
Mung kanggo panggunaan ophthalmic topikal; aja nyuntikake subconjunctivaly utawa langsung menyang kamar anterior mripat.
Aja nganti kontaminasi tip wadhah karo bahan saka mripat, tlapukan, driji, utawa sumber liyane.
Administrasi Ophthalmic (Subconjunctival)
Wis ditindakake kanthi injeksi subconjunctival.
Kanggo administrasi subconjunctival, reconstitute vial sing ngemot bubuk steril kanggo injeksi (500.000 unit polymyxin B ) kanthi nambahake 20-50 ml banyu steril kanggo injeksi utawa injeksi natrium klorida 0,9% kanggo nyedhiyakake solusi sing ngemot 10,000-25,000 unit / mL. Atur dosis larutan rekonstitusi sing cocog kanthi injeksi subconjunctival.
Administrasi Otik
Kombinasi tetep polimiksin B, neomycin, lan hidrokortison: Aplikasi topikal menyang saluran kuping minangka solusi otik utawa suspensi.
Persediaan otik mung kanggo panggunaan otik topikal; ora digunakake ing mripat.
Kali kuping sing resik lan garing sadurunge diombe.
Goyang suspensi otic sakdurunge digunakake.
Lungguh kanthi kuping sing kena munggah. Lebokake jumlah solusi otic utawa suspensi sing cocog menyang kuping; njaga posisi iki nganti 5 menit kanggo nggampangake penetrasi menyang saluran kuping. Baleni prosedur kanggo kuping ngelawan yen perlu.
Yen saluran kuping sempit utawa edematous lan ana kuwatir manawa pangiriman obat bisa diganggu, coba lebokake sumbu katun menyang saluran kuping lan jenuh karo persiapan otik. Produsen nyatakake supaya sumbu tetep lembab kanthi nambahake solusi otic utawa suspensi tambahan saben 4 jam lan ngganti sumbu saben 24 jam. Para ahli nyatakake yen sumbu sing ora perlu sawise busung saluran kuping suda, sing bisa kedadeyan sajrone 24 jam utawa sawetara dina sawise perawatan topikal diwiwiti.
Aja nganti kontaminasi tip wadhah kanthi bahan saka kuping, driji, utawa sumber liyane.
Dosis
Kasedhiya minangka polimiksin B sulfat; Potensi lan dosis sing dituduhake ing syarat-syarat aktivitas polimiksin B (unit polimiksin B).
Pasien Anak
Infeksi Ophthalmic Bakteri OphthalmicPolymyxin B lan trimethoprim ing bayi lan bocah-bocah umur ≥2 sasi (solusi ophthalmic): Pasang 1 tetes ing mripat sing kena pengaruh saben 3 jam (maksimal 6 dosis saben dina) kanggo 7-10 dina.
Durasi biasa perawatan anti-infèksi topikal kanggo konjungtivitis bakteri yaiku 5-10 dina; 5-7 dina biasane cukup kanggo konjungtivitis bakteri sing entheng.
Infeksi Otik Bakteri OtikPolymyxin B, neomycin, lan hydrocortisone ing bocah-bocah umur ≥2 taun (solusi otik utawa suspensi): Tetesake 3 tetes ing kuping sing kena pengaruh( s) 3 utawa 4 kaping saben dina nganti 10 dina.
Durasi optimal perawatan topikal otitis eksterna akut ora ditemtokake, nanging biasane dianjurake 7-10 dina. Pangobatan sing cocog kudu nambah gejala (otalgia, pruritus, fullness) sajrone 48-72 jam, sanajan resolusi gejala bisa nganti 2 minggu.
Ocular Inflammation OphthalmicPolymyxin B, neomycin, lan dexamethasone ing bocah-bocah umur ≥2 taun (suspensi ophthalmic): Lebokake 1 utawa 2 tetes ing kantong conjunctival saka mripat sing kena pengaruh nganti 4-6 kaping saben dina. Ing penyakit sing abot, nyemprotake 1 utawa 2 tetes saben jam ing wiwitan, banjur nyuda dosis kanthi nyuda frekuensi administrasi nalika inflamasi suda.
Yen ora ana perbaikan sawise 48 jam, evaluasi maneh pasien. (Waca Panganggone Kombinasi Tetep Ngandhut Kortikosteroid ing Ati-ati.)
Dewasa
Infeksi Ophthalmic Bakteri Ophthalmic (Topik)Polymyxin B lan bacitracin kanthi utawa tanpa neomycin (ophthalmic ointment): Aplikasi kanggo sing kena pengaruh. mripat (s) saben 3 utawa 4 jam kanggo 7-10 dina, gumantung saka keruwetan infèksi.
Polymyxin B, neomycin, lan gramicidin (solusi ophthalmic): Lebokake 1 utawa 2 tetes ing mripat sing kena pengaruh saben 4 jam suwene 7-10 dina. Bisa instill nganti 2 tetes saben jam kanggo infèksi abot.
Polymyxin B lan trimethoprim (solusi ophthalmic): Lebokake 1 tetes ing mripat sing kena pengaruh saben 3 jam (maksimal 6 dosis saben dina) suwene 7-10 dina.
Durasi biasa perawatan anti-infèksi topikal kanggo konjungtivitis bakteri yaiku 5-10 dina; 5-7 dina biasane cukup kanggo konjungtivitis bakteri entheng.
Ophthalmic (Subconjunctival)Nganti 100.000 unit saben dina nggunakake solusi reconstituted sing ngemot 10.000-25.000 unit / mL.
Yen digunakake bebarengan karo polimiksin B topikal, dosis total ora kudu ngluwihi 25.000 unit/kg saben dina.
Infèksi Otik Bakteri OtikPolymyxin B, neomycin, lan hidrokortison (larutan utawa suspensi otik): Lebokake 4 tetes ing kuping sing kena pengaruh 3 utawa kaping 4 saben dina nganti 10 dina.
Durasi optimal perawatan topikal otitis eksterna akut ora ditemtokake, nanging biasane dianjurake 7-10 dina. Pangobatan sing cocog kudu nambah gejala (otalgia, pruritus, fullness) sajrone 48-72 jam, sanajan resolusi gejala bisa nganti 2 minggu.
Ophthalmic Inflammation OcularPolymyxin B, neomycin, lan dexamethasone (salep ophthalmic): Lebokake salep kira-kira 1,25 cm (½ inci) ing kantong konjungtiva mata sing kena pengaruh nganti 3 utawa 4 kaping saben dina.
Polymyxin B, neomycin, lan dexamethasone (suspensi ophthalmic): Lebokake 1 utawa 2 tetes ing kantung konjungtiva mata sing kena pengaruh nganti 4-6 kaping saben dina. Ing penyakit sing abot, nyemprotake 1 utawa 2 tetes saben jam ing wiwitan, banjur nyuda dosis kanthi nyuda frekuensi administrasi nalika inflamasi suda.
Polymyxin B, neomycin, bacitracin, lan hydrocortisone utawa hydrocortisone acetate (ointment oftalmic): Aplikasi menyang mripat sing kena pengaruh saben 3 utawa 4 jam, gumantung saka keruwetan kondisi kasebut.
Yen ora ana perbaikan sawise 48 jam, evaluasi maneh pasien. (Deleng Panganggone Kombinasi Tetep Ngandhut Kortikosteroid ing Ati-ati.)
Watesan Resep
Pasien Anak
Infeksi Ophthalmic Bakteri OphthalmicPolymyxin B lan trimethoprim ing bayi lan bocah-bocah ≥ Umur 2 sasi (solusi ophthalmic): Maksimal 6 dosis sajrone 24 jam.
Infeksi Otik Bakteri OtikPolymyxin B, neomycin, lan hydrocortisone ing bocah-bocah umur ≥2 taun (solusi otik utawa suspensi): Maksimal 10 dina terapi berturut-turut.
Dewasa
Infeksi Ophthalmic Bakteri OphthalmicPolymyxin B lan trimethoprim (solusi ophthalmic): Maksimal 6 dosis ing 24 jam.
Infeksi Otik Bakteri OtikPolymyxin B, neomycin, lan hydrocortisone (solusi otik utawa suspensi): Terapi maksimal 10 dina berturut-turut.
Populasi Khusus
Ora ana rekomendasi dosis populasi khusus.
Pènget
Kontraindikasi
Pènget/PanandhapReaksi Sensitivitas
Reaksi Hipersensitivitas
Iritasi lokal lan reaksi alergi kacarita; reaksi hipersensitivitas sing luwih serius, kalebu anafilaksis, jarang dilapurake.
Anti-infektif topikal, utamane neomycin, bisa nyebabake sensitisasi kulit.
Sajrone nggunakake jangka panjang, priksa pasien kanthi periodik kanggo tandha-tandha sensitisasi.
Preparat oftalmik: Sensitisasi bisa katon minangka ruam, pruritus, edema konjungtiva lan kelopak mata, eritema konjungtiva, utawa ora bisa waras.
Persediaan otik: Sensitisasi bisa diwujudake minangka pembengkakan, scaling garing, pruritus, utawa gagal waras.
Yen ana pratandha utawa gejala sensitivitas, mandhegake obat kasebut. Gejala biasane suda kanthi cepet sawise persiapan mandheg.
Pasien alergi marang siji preparat kombinasi tetep kudu ngindhari preparat sing ngemot obat komponen apa wae. Cross-allergenicity ana ing antarane aminoglikosida; pasien alergi karo persiapan kombinasi tetep sing ngemot neomycin bisa uga alergi marang aminoglikosida liyane (contone, gentamicin, paromomycin, streptomycin).
Sensitivitas SulfitSawetara preparat otik kombinasi tetep ngandhut kalium metabisulfit, sawijining sulfit sing bisa nyebabake reaksi alergi (kalebu anafilaksis lan episode asma sing ngancam nyawa utawa kurang abot) ing individu tartamtu sing rentan.
Superinfeksi
Panganggone sing suwe bisa nyebabake kakehan organisme sing ora rentan, kalebu jamur. Yen superinfeksi kedadeyan, mula terapi sing cocog.
Resistensi kanggo polymyxin B utawa anti-infèksi liyane ing preparat kombinasi tetep bisa berkembang.
Pancegahan sing Gegandhengan karo Administrasi Ophthalmic
Keratitis bakteri wis dikembangake ing pasien sing ora sengaja kontaminasi wadhah pirang-pirang dosis persiapan ophthalmic; ing kasus paling kacarita, penyakit kornea bebarengan utawa gangguan saka lumahing epiteli ocular ana.
Aja nganggo lensa kontak yen ana tandha utawa gejala infeksi okular.
Produsen ngati-ati yen salep ophthalmic bisa nundha penyembuhan.
Pancegahan sing Gegandhengan karo Administrasi Otik
Aja nggunakake preparat otik kombinasi tetep sing ngemot polimiksin B, neomycin, lan hidrokortison ing pasien kanthi membran timpani perforasi.
Neomycin, utamane kanthi panggunaan sing dawa, bisa nyebabake gangguan pendengaran sensorineural permanen amarga karusakan koklea, utamane karusakan sel rambut ing organ Corti. Gunakake preparat otic sing ngemot neomycin mung ing pengamatan klinis sing cedhak; Aja nggunakake luwih saka 10 dina berturut-turut.
Yen infèksi otic ora apik sawise 1 minggu perawatan, entuk kultur kanggo nuntun perawatan.
Panganggone Kombinasi Tetep sing Ngandhut Kortikosteroid
Nalika preparat ophthalmic utawa otic sing ngemot polimiksin B ing kombinasi tetep karo anti-infèksi liyane lan kortikosteroid (yaiku, deksametason, hidrokortison, hidrokortison asetat) digunakake, nimbang ati-ati. , pancegahan, lan kontraindikasi sing ana gandhengane karo kortikosteroid EENT.
Nyedhiyakake resep awal kanggo preparat ophthalmic kombinasi tetep sing ngemot kortikosteroid utawa resep pembaharuan (luwih saka 8 g salep mata utawa luwih saka 20 ml suspensi ophthalmic) mung sawise mriksa pasien kanthi mikroskop lampu celah lan, yen perlu, pewarnaan fluorescein.
Evaluasi maneh pasien yen nyeri mata utawa inflamasi tetep nganti> 48 jam utawa saya tambah.
Panganggone preparat ophthalmic sing berpanjangan sing ngemot kortikosteroid bisa nyebabake glaukoma, kanthi karusakan saraf optik, cacat ing ketajaman visual lan bidang penglihatan, lan pembentukan katarak subkapsular posterior. Yen digunakake kanggo ≥10 dina, ngawasi IOP kanthi rutin, sanajan ngawasi bisa uga angel kanggo bocah-bocah lan pasien sing ora kooperatif. Gunakake kanthi ati-ati ing pasien glaukoma; mriksa IOP kerep ing pasien kasebut.
Gunakake sawise operasi katarak bisa nundha penyembuhan lan nambah insiden pembentukan bleb.
Penipisan kornea lan scleral dilapurake kanthi macem-macem penyakit okular lan kanthi nggunakake jangka panjang kortikosteroid ophthalmic topikal. Panggunaan ing pasien kanthi jaringan kornea lan scleral tipis bisa nyebabake perforasi.
Panganggone sing suwe bisa nyuda respon host lan nambah risiko infeksi okular sekunder. Gunakake ing pasien kanthi kondisi purulen akut ing mripat bisa nutupi infeksi utawa nambah infeksi sing ana.
Bisa ndawakake kursus lan nambah keruwetan akeh infeksi virus ing mripat (kalebu herpes simplex). Gunakake ati-ati banget ing pasien karo herpes simplex; mikroskopi lampu irisan asring dianjurake.
Coba kemungkinan infèksi jamur ing kornea sawise nggunakake dawa, utamané ing ulceration kornea terus-terusan. Nindakake kultur jamur yen cocok.
Populasi Spesifik
KandhutanOra dingerteni manawa preparat ophthalmic sing ngemot polymyxin B bisa nyebabake cilaka janin nalika diwenehake marang wanita ngandhut.
Polymyxin B lan bacitracin kanthi utawa tanpa neomycin (ophthalmic): Gunakake nalika meteng mung yen perlu.
Polymyxin B, neomycin, lan gramicidin (ophthalmic): Gunakake nalika meteng mung yen perlu.
Polymyxin B lan trimethoprim (ophthalmic): Gunakake nalika meteng mung yen keuntungan potensial mbenerake potensial risiko kanggo janin; trimethoprim bisa ngganggu metabolisme asam folat.
Polymyxin B, anti-infèksi liyane, lan dexamethasone, hidrokortison, utawa hidrokortison asetat (ophthalmic): Gunakake nalika meteng mung yen keuntungan potensial mbenerake potensial risiko kanggo janin.
Polymyxin B, neomycin, lan hydrocortisone (otic): Gunakake nalika meteng mung yen keuntungan potensial mbenerake potensial risiko kanggo janin.
LaktasiPolymyxin B lan anti-infèksi liyane (oftalmik): Gunakake kanthi ati-ati.
Polymyxin B, neomycin, lan dexamethasone (oftalmik): Gunakake kanthi ati-ati.
Polymyxin B, neomycin, bacitracin, lan hydrocortisone utawa hydrocortisone acetate (ophthalmic): Mungkasi nyusoni utawa obat kasebut, kanthi nganggep pentinge obat kasebut kanggo wong wadon.
Polymyxin B, neomycin, lan hydrocortisone (otik): Gunakake kanthi ati-ati.
Panggunaan PediatrikPolymyxin B lan bacitracin kanthi utawa tanpa neomycin (ophthalmic): Keamanan lan khasiat ora ditetepake ing pasien pediatrik.
Polymyxin B, neomycin, lan gramicidin (ophthalmic): Keamanan lan khasiat ora ditetepake ing pasien pediatrik.
Polymyxin B lan trimethoprim (ophthalmic): Keamanan lan khasiat ora ditetepake ing bayi <2 sasi.
Polymyxin B, neomycin, lan dexamethasone (ophthalmic): Keamanan lan khasiat saka suspensi ora ditetepake ing bocah-bocah <2 taun; safety lan khasiat salep ora ditetepake ing pasien pediatrik.
Polymyxin B, neomycin, bacitracin, lan hydrocortisone utawa hydrocortisone acetate (ophthalmic): Keamanan lan khasiat ora ditetepake ing pasien pediatrik.
Polymyxin B, neomycin, lan hydrocortisone (otik): Umume pabrikan nyatakake safety lan khasiat sing ora ditetepake ing bocah-bocah <2 taun amarga data sing ora cukup. Siji pabrikan nyatakake safety lan khasiat wis ditetepake ing pasien pediatrik lan ora nemtokake kisaran umur.
Panggunaan GeriatrikPolymyxin B, neomycin, lan gramicidin (ophthalmic): Data klinis ora cukup kanggo nemtokake manawa pasien geriatrik nanggapi kanthi beda. tinimbang wong diwasa luwih enom.
Polymyxin B lan trimethoprim (ophthalmic): Ora ana beda sakabèhé ing safety utawa khasiat relatif kanggo wong diwasa enom.
Polymyxin B, neomycin, lan dexamethasone (ophthalmic): Ora ana bedane sakabèhé ing safety utawa khasiat relatif kanggo pasien sing luwih enom.
Polymyxin B, neomycin, bacitracin, lan hydrocortisone acetate (oftalmik): Ora ana beda sakabèhé ing safety utawa khasiat relatif kanggo wong diwasa enom.
Polymyxin B, neomycin, lan hydrocortisone (otic) : Data klinis ora cukup kanggo nemtokake manawa pasien geriatrik nanggapi beda karo pasien sing luwih enom; pengalaman klinik liyane wis ora dikenali beda nanggepi.
Efek Samsaya Awon
Iritasi lokal lan reaksi alergi.
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