Maitiro Ekuita Kwemishonga Inorwisa Mabhakitiriya Mukuparadza Mabhakitiriya
Mishonga inorwisa mabhakitiriya ndeimwe yezvinhu zvakakosha zvakawanikwa munhoroondo yemishonga yemazuva ano. Mishonga iyi inoshandiswa kurapa hutachiona hunokonzerwa nemabhakitiriya, kungave hunokanganisa ganda, nzira yekufema, nzira yeweti, kana dzimwe nhengo dzemuviri. Kunyangwe ichiwanzonzi "mabhakitiriya anouraya zvipembenene," mishonga inorwisa mabhakitiriya haishande zvakafanana pakurwisa mabhakitiriya ese, uye haishande pakurwisa hutachiona hwakaita sefuruwenza kana COVID-19. Kuti tinzwisise kuti sei kushandiswa kwemishonga inorwisa mabhakitiriya kwakakosha, tinofanira kunzwisisa kuti mishonga inorwisa mabhakitiriya inoshanda sei kuparadza mabhakitiriya.
Mishonga inorwisa mabhakitiriya: inouraya kana kudzivirira mabhakitiriya
Kazhinji, mishonga inorwisa mabhakitiriya inoshanda nenzira mbiri huru. Chekutanga, inouraya mabhakitiriya zvakananga. Chechipiri, inorwisa mabhakitiriya, zvichireva kuti inodzivirira kukura nekuberekana kwemabhakitiriya, zvichibvumira masoja emuviri kuti abvise hutachiona. Musiyano uyu wakakosha nekuti mune mamwe mamiriro ezvinhu (akadai sehutachiona hwakaoma kana varwere vane masoja emuviri asina simba), mishonga inorwisa mabhakitiriya inowanzo shandiswa kubvisa mabhakitiriya nekukurumidza.
Zvisinei, pasinei nerudzi rwechirwere, mishonga inorwisa mabhakitiriya inoshanda chete nekutsvaga "nzvimbo isina simba" yebhakitiriya. Nzvimbo iyi isina simba inowanzova chimiro kana maitiro ehupenyu akasiyana nebhakitiriya uye haawanikwe mumasero evanhu. Ndokusaka mishonga inorwisa mabhakitiriya ichigona kurwisa mabhakitiriya pasina kukuvadza masero emuviri zvakanyanya.
1. Inodzivirira kuumbwa kwemadziro emasero ebhakitiriya
Chimwe chezvinhu zvinonyanya kufarirwa nemishonga inorwisa mabhakitiriya madziro emasero ebhakitiriya. Mabhakitiriya mazhinji ane madziro emasero anoumbwa nepeptidoglycan, chimiro chakaita semesh chinopa chimiro nesimba. Masero evanhu haana madziro emasero, zvichiita kuti chinangwa ichi chive chakanangana nemabhakitiriya.
Mishonga inorwisa mabhakitiriya yakaita sepenicillin, cephalosporins, carbapenems, uye monobactams ndeyeboka re beta-lactam. Inoshanda nekudzivisa enzyme inokonzera kuumba ma cross-links mu peptidoglycan. Izvi zvinoderedza simba remadziro esero uye zvinogona kukonzera kuti mabhakitiriya aputsike (lysis), kunyanya panguva yekukura nekupatsanurwa.
Kunze kwe beta-lactams, kunewo ma glycopeptides akaita se vancomycin anoshanda nenzira yakasiyana: anosunga kune chikamu che peptidoglycan, zvichikanganisa kubatanidzwa kwemadziro esero. Maitiro aya anoshanda zvakanyanya kurwisa mabhakitiriya ane Gram-positive.
2. Inokuvadza masero ebhakitiriya
Chinangwa chinotevera imembrane yesero, iyo inochengetedza kuenzana kwezviri mukati mesero. Kana membrane ikakuvara, zvinhu zvakakosha zviri mukati mesero zvinobuda, uye mabhakitiriya haagone kurarama.
Mienzaniso yemishonga inorwisa mabhakitiriya inoshanda ne membrane inosanganisira polymyxins (semuenzaniso, colistin), iyo inowanzoshandiswa kurwisa mamwe mabhakitiriya eGram-negative anoramba kushanda. Polymyxins inosangana nezvikamu zve membrane yekunze uye cytoplasmic membrane, zvichikonzera kubuda kwemvura. Daptomycin inogonawo kukuvadza membrane yesero yebhakitiriya reGram-positive nekuita kuti membrane depolarization ipararire, nokudaro ichimisa kugadzirwa kwesimba rebhakitiriya.
Nekuti ma membrane emasero aripowo muvanhu, rudzi urwu rwemishonga inorwisa mabhakitiriya runowanzova nenjodzi huru yemigumisiro uye runoda kungwarira kwakanyanya pakushandisa kwayo.
3. Inodzivirira kugadzirwa kwemapuroteni ebhakitiriya
Mabhakitiriya anoda mapuroteni kuti ararame, akure, agadzirise kukuvara, uye aite mabasa akasiyana-siyana ekugadzirisa muviri. Mapuroteni anogadzirwa nemichina inonzi ribosomes. Mabhakitiriya eribosome akasiyana nema ribosomes evanhu, zvichiita kuti mishonga inorwisa mabhakitiriya ikwanise kuarwisa.
Mamwe mapoka emishonga inorwisa mabhakitiriya inodzivirira kugadzirwa kwemapuroteni anosanganisira:
– Aminoglycosides (semuenzaniso, gentamicin, amikacin): inokanganisa kuverenga kwekodhi yemajini, zvichiita kuti mabhakitiriya agadzire mapuroteni asina kunaka. Mazhinji emaaminoglycosides anouraya mabhakitiriya.
– Tetracycline (semuenzaniso doxycycline): inodzivirira kupinda kwe "zvinhu zvakagadzirwa" zvekuumba mapuroteni muma ribosome, nokudaro ichimisa kugadzirwa kwemapuroteni.
– Macrolides (semuenzaniso erythromycin, azithromycin): inodzivisa kufamba kwe ribosome pamwe chete ne mRNA, ichimisa maitiro ekureba kweprotein chain.
– Chloramphenicol uye lincosamides (semuenzaniso, clindamycin): zvinokanganisa kuumbwa kwepeptide bond kana mamwe matanho akakosha mukugadzirwa kweprotein.
Kana mapuroteni akakosha asina kuumbwa, mabhakitiriya haagone kukura kana kufa zvichienderana nerudzi rwemushonga unorwisa mabhakitiriya uye mamiriro ehutachiona.
4. Inodzivirira kugadzirwa kweDNA neRNA
Zvinhu zvemajini zvebhakitiriya, zvinoti DNA neRNA, ndizvo zvinonyanya kudzora hupenyu hwemabhakitiriya. Mamwe maantibiotics anonyanya kurwisa maitiro ekudzokororwa kweDNA (kudzokororwa) kana kunyorwa kweRNA (kugadzira makopi eruzivo rwemajini ekugadzira mapuroteni).
MaFluoroquinolones (semuenzaniso, ciprofloxacin, levofloxacin) anodzivisa enzyme yeDNA gyrase, kana kuti topoisomerase, iyo inodiwa kuti DNA isununguke uye idzorerwe kumashure panguva yekudzokororwa. Kana maitiro aya akakanganiswa, mabhakitiriya haagone kupatsanurana uye pakupedzisira anofa.
Panguva iyi, rifampin inodzivisa enzyme yeRNA polymerase yebhakitiriya, ichidzivirira mabhakitiriya kuti asagadzire RNA. Mushonga uyu unokosha mukurapa TB nekuti unomisa mabhakitiriya kuti asagadzire zvinhu zvakakosha.
5. Inokanganisa kushandiswa kwe folate metabolism (antimetabolite)
Mabhakitiriya anoda folate kuti aumbe DNA nezvimwe zvinhu zvakakosha. Zvinofadza kuti vanhu vanowana folate kubva muchikafu, nepo mabhakitiriya mazhinji achifanira kugadzira folate yawo. Musiyano uyu unogadzira mukana wekuti mishonga inorwisa mabhakitiriya ishande.
Muenzaniso ndewe musanganiswa we trimethoprim-sulfamethoxazole. Sulfamethoxazole inodzivirira danho rekutanga pakuumbwa kwe folate, nepo trimethoprim ichidzivirira danho rinotevera. Nekuvharira matanho ese ari maviri panguva imwe chete, kugadzirwa kwe folate kunodzikira zvakanyanya, mabhakitiriya anoshaya zvekushandisa pakugadzira DNA, uye kukura kwawo kunomira kana kuti anofa.
Sei mishonga inorwisa mabhakitiriya isingashande nguva dzose?
Kunyangwe mishonga inorwisa mabhakitiriya iine nzira dzinoshanda, pane zvimwe zvinhu zvinoita kuti isakwanise kuuraya mabhakitiriya. Chimwe chezvikonzero zvikuru ikusagona kurapwa nemishonga inorwisa mabhakitiriya. Kusagona kurapwa kunoitika kana mabhakitiriya achichinja kusvika pakuti mishonga inorwisa mabhakitiriya haichashandi. Nzira dzacho dzakasiyana-siyana, semuenzaniso:
1. Gadzira ma enzymes anoparadza mabhakitiriya, akadai se beta-lactamase iyo inoparadza beta-lactam ring iri mu penicillin.
2. Kuchinja chinangwa chemushonga unorwisa mabhakitiriya, kuitira kuti mushonga usakwanise kubatana kana kushanda.
3. Inoderedza kupinda kwemishonga inorwisa mabhakitiriya kuburikidza nekuchinja kwemaburi eganda mubhakitiriya yeGram-negative.
4. Kupomba mishonga inorwisa mabhakitiriya uchishandisa pombi yemvura inobuda, kuitira kuti huwandu hwemushonga uri mumabhakitiriya husakwane kuuuraya.
5. Inogadzira biofilm, chikamu chinodzivirira chinoita kuti zviomere mishonga inorwisa mabhakitiriya kusvika kubhakitiriya.
Kusakwanisa kushandisa mishonga kunowanzowedzera nekuda kwekushandiswa zvisina kunaka kwemishonga inorwisa mabhakitiriya, semuenzaniso kutora mishonga inorwisa mabhakitiriya usina kunyorerwa nachiremba, kusapedza mushonga sezvakarairwa, kana kushandisa mishonga inorwisa mabhakitiriya pazvirwere zvinotapukira.
Penutup
Maitiro ekushanda kwemishonga inorwisa mabhakitiriya mukuparadza mabhakitiriya anotarisa pakurwisa zvinhu zvakakosha zvebhakitiriya: madziro esero, membrane yesero, ribosomes, DNA/RNA synthesis, uye nzira dze folate metabolism. Nekutarisa "nzvimbo dzisina simba" idzi, mishonga inorwisa mabhakitiriya inogona kuuraya kana kudzivirira mabhakitiriya zvinobudirira. Zvisinei, kurapa kunobudirira kunoenderana zvakanyanya nekusarudzwa kwemishonga inorwisa mabhakitiriya yakakodzera, chiyero chakakodzera, uye kutevedzera mirairo yemurwere. Munguva yekuwedzera kwekusagona kurwisa mishonga, kunzwisisa mashandiro anoita mishonga inorwisa mabhakitiriya kwakakosha kwete chete kune vezvekurapa asiwo kune veruzhinji kuitira kuti kushandiswa kwemishonga inorwisa mabhakitiriya kuve kwakaringana uye hutachiona hwebhakitiriya hugone kurapwa zvakachengeteka uye zvinobudirira.
