Amphotericin B ni iki: Ibyo ikoreshwa, urugero rwo gufata, ingaruka zayo n'ibindi

Amphotericin B ni umuti ukomeye uvura indwara ziterwa n'imvuvu ukoreshwa mu kuvura indwara zikomeye ziterwa n'imvuvu zishobora kwica. Uyu muti ukora urwanya urukuta rw'uturemangingo tw'imvuvu, mu buryo bwo kubisenya kugira ngo bahagarike ikwirakwizwa ry'iyo ndwara. Nubwo ari umwe mu miti ikora neza cyane mu kuvura indwara zikomeye ziterwa n'imvuvu, bisaba gukurikiranwa neza bitewe n'imbaraga zayo n'ingaruka zishobora guterwa.

Amphotericin B ni iki?

Amphotericin B ni umuti wica imvuvu, abaganga bakoresha mu kurwanya indwara zikomeye ziterwa n'imvuvu mu mubiri wawe wose. Uyu muti ubarirwa mu cyiciro cy'imiti yitwa polyene antifungals, ikora ikora igifatanya ku turemangingo tw'imvuvu maze ikabacamo icyuho.

Uyu muti umaze imyaka myinshi ukoreshwa mu kuvura indwara ziterwa n'imvuvu. Ni ingenzi cyane kuko ushobora kuvura indwara indi miti ivura imvuvu itashobora kuvura neza.

Ubusanzwe uzahabwa amphotericin B unyuze mu muyoboro wa IV (intravenous) mu bitaro. Uyu muti uza mu buryo butandukanye, harimo amphotericin B isanzwe n'uburyo bushya bushingiye ku lipid bushobora gutera ingaruka nke.

Amphotericin B ikoreshwa mu kuvura iki?

Amphotericin B ivura indwara zikomeye ziterwa n'imvuvu zishobora kwica iyo zitavuwe. Ubu burwayi bukunze kuboneka ku bantu bafite ubudahangarwa bw'umubiri butameze neza, nubwo rimwe na rimwe bushobora kwibasira n'abantu bafite ubuzima bwiza.

Aha hari indwara nyamukuru uyu muti ufasha kuvura, kuva ku ndwara zisanzwe kugeza ku ndwara zitagaragara kenshi:

• Kandidiyase ya sisitemike (iyo indwara ziterwa na mikorobe zikwirakwira mu mubiri wawe)
• Asperjilosi (indwara z'ibihaha ziterwa na fungi ya Aspergillus)
• Meningite ya Cryptococcal (indwara ikomeye yo mu bwonko)
• Histoplasmose (indwara akenshi ifata ibihaha)
• Blastomycosis (indwara y'ibihaha ishobora gukwirakwira mu zindi ngingo)
• Coccidioidomycosis (umuriro wa Valley uba mubi)
• Mucormycosis (indwara idasanzwe ariko ikaze iterwa na fungi)
• Leishmaniasis (indwara iterwa na parasite, nubwo iyi ikoreshwa mu buryo butemewe)

Muganga wawe azemeza niba amphotericin B ikwiriye icyo gihe ukurikije ubwoko bw'indwara, ubuzima bwawe muri rusange, n'uburyo ushobora kwihanganira ubuvuzi.

Amphotericin B ikora ite?

Amphotericin B ikora yerekeza ku kintu cyihariye mu nkuta z'uturemangingo twa fungi kitwa ergosterol. Tekereza ergosterol nk'igice cy'ingenzi cyubaka kigumisha uturemangingo twa fungi turiho kandi dukora neza.

Iyo amphotericin B yifatanye na ergosterol, ituma habaho imyenge cyangwa imyobo mu gice cy'uturemangingo twa fungi. Ibi bituma uturemangingo tudashobora gukomeza imiterere yabo y'imbere, bigatuma ibintu by'ingenzi biva hanze hanyuma bigica fungi.

Ibi bifatwa nk'umuti ukomeye cyane urwanya fungi. Akenshi yitwa "gold standard" yo kuvura indwara zikomeye ziterwa na fungi kubera imikorere yayo yagutse ku bwoko bwinshi bwa fungi.

Uyu muti ushobora no kugira ingaruka ku turemangingo tw'abantu ku rugero runaka, niyo mpamvu bishobora gutera ingaruka ziterwa n'imiti. Ariko, fungi iroroshye cyane kuri amphotericin B kurusha uturemangingo tw'abantu, bituma iba uburyo bwiza bwo kuvura nubwo hari izo mpungenge.

Nkwiriye gufata amphotericin B nte?

Uzahabwa amphotericin B unyuze mu muyoboro wa IV, akenshi mu bitaro cyangwa ikigo cyihariye cy'ubuvuzi. Uyu muti uvangwa n'umuti wera kandi ugahabwa buhoro buhoro mu masaha menshi kugirango ugabanye ingaruka ziterwa n'imiti.

Mbere yo gutera urushinge, ikipe yawe y’ubuzima ishobora kuguha imiti kugira ngo ifashe kwirinda ibibazo. Iyi miti ishobora kuba irimo acetaminophen (Tylenol) yo kugabanya umuriro, imiti irwanya allergie nka diphenhydramine (Benadryl) yo kurwanya allergie, rimwe na rimwe na corticosteroids kugira ngo igabanye umubyimbire.

Uburyo bwo gutera urushinge mubisanzwe bufata amasaha 4 kugeza kuri 6, nubwo ibi bishobora gutandukana bitewe n’uburyo bwihariye bwawe n’urugero. Ikipe yawe y’abaganga izagukurikiranira hafi muri iki gihe, ikagenzura ibimenyetso byawe by’ingenzi kandi ikareba ibibazo byose biteye inkeke.

Ntabwo ukeneye guhangayika kubijyanye n’ibiribwa byategetswe na amphotericin B kuko itangwa mu maraso yawe. Ariko, kuguma ufite amazi ahagije ni ingenzi, bityo ikipe yawe y’ubuzima ishobora kuguha amazi yinyongera mbere cyangwa mugihe cyo kuvurwa.

Nzamara Igihe Kingana Iki Ndafatira Amphotericin B?

Igihe cyo kuvurwa na amphotericin B gitandukana cyane bitewe n’ubwandu bwawe bwihariye n’uburyo wemera imiti. Abantu benshi bakira ubuvuzi mu byumweru byinshi kugeza kumyaka.

Kubwandu bumwe nka systemic candidiasis, ushobora gukenera kuvurwa mu byumweru 2 kugeza kuri 6. Ubwandu bugoye nka cryptococcal meningitis bushobora gusaba amezi menshi yo kuvurwa, akenshi bitangirana na amphotericin B hanyuma bagahindukirira imiti irwanya fungus yo kunywa.

Muganga wawe azakurikirana iterambere ryawe binyuze mumizamini y'amaraso isanzwe no gukoresha amashusho. Bazareba ibimenyetso byerekana ko ubwandu burimo gukira mugihe kandi bareba ko impyiko zawe n'izindi ngingo zikoresha neza imiti.

Umubare wose wa amphotericin B uzakira akenshi ubara hashingiwe kuburemere bwawe n’ubwandu bwihariye burimo kuvurwa. Ikipe yawe y’ubuzima izahindura gahunda yo kuvura uko bikwiye bitewe n’uburyo wabyakiriye n’ingaruka zose zikubaho.

Ni Iyihe Mbereko ya Amphotericin B?

Amphotericin B ishobora gutera ingaruka ziterwa n'imiti, nubwo abantu benshi bayihanganira neza bafashijwe no gukurikiranwa neza no kwitabwaho. Kumenya ibyo witegura bishobora kugufasha kumva witeguye neza kuvurwa.

Dore ingaruka ziterwa n'imiti zisanzwe zishobora kukubaho mugihe cyangwa nyuma yo kuvurwa:

• Urubura n'ubukonje (bikunda kubaho mugihe cy'ubwinjizwe bwa mbere)
• Isesemi no kuruka
• Umutwe
• Uburibwe mu mikaya no mu ngingo
• Igabanuka ry'umuvuduko w'amaraso
• Impinduka mu mikorere y'impyiko (muganga wawe azabikurikirana neza)
• Urwego ruto rwa potasiyumu cyangwa magineziyumu mu maraso yawe
• Anemiya (umubare muto w'uturemangingo dutukura tw'amaraso)

Abantu bamwe bashobora guhura n'ingaruka zikomeye ariko zitabaho cyane zisaba ubufasha bwihuse bw'abaganga:

• Urugero rukomeye rwo kwibasirwa n'umubiri hamwe no guhumeka bigoranye cyangwa kubyimba
• Ibibazo bikomeye by'impyiko
• Umutima utera nabi
• Imikorere mibi ikomeye ya elctrolyte
• Ibibazo byo kumva cyangwa guhinda mumutwi
• Kwigana (bitabaho ariko bishoboka)

Itsinda ryawe ry'abaganga rizateza imbere uburyo bwo kugabanya izi ngaruka ziterwa n'imiti kandi rizakurikirana neza mugihe cyose uvurwa. Ingaruka nyinshi ziterwa n'imiti zishobora guhangana nazo neza hamwe n'imiti ifasha no gukurikiranwa neza.

Ninde utagomba gufata Amphotericin B?

Mugihe amphotericin B ikunda kuba ngombwa kubera indwara zikomeye ziterwa n'ibihumyo, abantu bamwe bakeneye kwitonda cyane cyangwa ntibashobora kuba abakandida beza kuri ubu buvuzi. Muganga wawe azagereranya neza inyungu n'ibibazo mubibazo byawe byihariye.

Abantu basanzwe bakeneye kwitabwaho by'umwihariko cyangwa ubuvuzi busimburwa harimo:

• Abafite indwara zikomeye z'impyiko (umuti ushobora gutuma imikorere y'impyiko irushaho kuba mibi)
• Abantu bafite ibibazo bikomeye by'umwijima
• Abantu bafite indwara zimwe na zimwe z'umutima cyangwa umutima utera nabi
• Abantu bagiye bagira allergie zikomeye kuri amphotericin B mu bihe byashize
• Abantu bafite ibibazo bikomeye bya electrolyte bitashobora gukosorwa
• Abantu bafite ibibazo byo kumva (umuti ushobora gutuma kutumva birushaho kuba bibi)

Kuba utwite no konsa bisaba kubitekerezaho byihariye, nubwo amphotericin B ishobora gukoreshwa niba icyorezo giteje akaga gakomeye kurusha umuti. Muganga wawe azaganira kuri ibi bintu nawe niba bireba uko ubuzima bwawe bumeze.

Amazina y'ubwoko bwa Amphotericin B

Amphotericin B iboneka mu mazina y'ubwoko butandukanye, buri rimwe rikaba ryerekana uburyo butandukanye bw'uyu muti. Itandukaniro rikuru riri mu buryo umuti utegurwamo kandi ukanazanwa kugirango ugabanye ingaruka mbi.

Uburyo busanzwe bukunda kwitwa Fungizone, naho uburyo bushya bushingiye ku lipid harimo AmBisome (liposomal amphotericin B), Abelcet (amphotericin B lipid complex), na Amphotec (amphotericin B colloidal dispersion). Ubu buryo bushingiye kuri lipid bugenewe korohereza impyiko zawe mugihe zigifite ubushobozi bwo kurwanya indwara ziterwa n'imvange.

Muganga wawe azahitamo uburyo bukwiye bushingiye ku cyorezo ufite, imikorere y'impyiko zawe, n'ubuzima bwawe muri rusange. Uburyo bushya bukunda gukundwa niba bishoboka kubera imiterere yabo y'umutekano yongerewe.

Uburyo bwo gusimbuza Amphotericin B

Imiti myinshi isimbura imiti irwanya imvange ishobora gukoreshwa mu mwanya wa cyangwa hamwe na amphotericin B, bitewe n'icyorezo ufite n'uko ubuzima bwawe bumeze. Iyi miti isimbura ishobora guhitwamo niba udashobora kwihanganira amphotericin B cyangwa niba ikwiye kurushaho kubera uko ubuzima bwawe bumeze.

Izindi nzira zikoreshwa harimo fluconazole (Diflucan) ku buryo bwo kuvura indwara ziterwa na mikorobe yitwa yeast, voriconazole (Vfend) ku buryo bwo kuvura aspergillosis, n'imiti mishya nka isavuconazole (Cresemba) cyangwa posaconazole (Noxafil) ku buryo bwo kuvura indwara ziterwa na mikorobe zitandukanye zifata umubiri.

Zimwe mu ndwara zishobora kuvurwa hakoreshwa imiti ivanze, hakoreshwa amphotericin B hamwe n'indi miti irwanya mikorobe yitwa fungi nka flucytosine. Muganga wawe azagena uburyo bwiza bushingiye ku bwoko bw'umwanda wa fungi utera indwara yawe n'ubuzima bwawe bwite.

Ese Amphotericin B iruta Fluconazole?

Amphotericin B na fluconazole bifite uruhare rutandukanye mu kuvura indwara ziterwa na fungi, kandi nta na rimwe riruta irindi. Guhitamo biterwa n'ubwoko bw'indwara yawe, ubukana bwayo, n'ibintu byose birebana n'ubuzima bwawe.

Amphotericin B akenshi ikoreshwa mu kuvura indwara zikomeye, ziteye ubuzima bw'umuntu akaga cyangwa igihe indi miti irwanya fungi itagize icyo ikora. Ifite ubushobozi bwo kurwanya fungi zitandukanye kandi akenshi ikoreshwa mu kuvura indwara zirwanya indi miti.

Fluconazole akenshi ikoreshwa mu kuvura indwara zitari zikomeye cyangwa nk'uburyo bwo gukomeza kuvura nyuma yo kuvurwa bwa mbere hakoreshejwe imiti ikomeye. Byoroshye kuyifata (iboneka mu buryo bw'ibinini), ifite ingaruka nke, kandi ikora neza ku bwoko bwihariye bw'indwara ziterwa na fungi nka zimwe mu bwoko bwa Candida.

Muganga wawe azahitamo umuti ukwiriye cyane ubuzima bwawe, rimwe na rimwe agatangira na amphotericin B ku ndwara zikomeye hanyuma akimukira kuri fluconazole mu kuvura igihe kirekire.

Ibibazo bikunze kubazwa kuri Amphotericin B

Q1. Ese Amphotericin B irakwiriye ku bantu barwaye indwara z'impyiko?

Amphotericin B ishobora kugira ingaruka ku mikorere y'impyiko, bityo abantu barwaye indwara z'impyiko basabwa gukurikiranwa cyane. Muganga wawe azagereranya ubukana bw'indwara yawe iterwa na fungi n'ibishobora guteza akaga ku mpyiko zawe.

Niba ufite ibibazo by'impyiko, muganga wawe ashobora guhitamo umuti wa amphotericin B ukoresha amavuta, ukunda kugirira neza impyiko. Bazanakurikirana imikorere y'impyiko zawe neza bakoresheje ibizamini by'amaraso bya buri gihe kandi bashobora guhindura urugero rwawe cyangwa gutanga amazi yinyongera kugirango barinde impyiko zawe.

Q2. Nkwiriye gukora iki niba mbonye umuti mwinshi wa amphotericin B ku buryo butunguranye?

Kubera ko amphotericin B itangwa n'abakora mu buvuzi ahantu havurirwa, guhabwa umuti mwinshi ku buryo butunguranye ntibikunda kubaho. Ariko, niba ubonye ibimenyetso bikomeye mugihe cyangwa nyuma yo guterwa umuti, bimenyeshe ikipe yawe y'ubuvuzi ako kanya.

Ibimenyetso byo guhabwa umuti mwinshi birimo isesemi ikabije, kuruka, ibibazo by'impyiko, cyangwa impinduka ziteje akaga mu rwego rwawe rw'amazi. Ikipe yawe y'ubuvuzi izagukurikiranira hafi kandi itange ubufasha bwo guhangana n'ingorane zose zigaragara.

Q3. Nkwiriye gukora iki niba nciwe urugero rwa amphotericin B?

Kubera ko amphotericin B itangirwa mu bitaro cyangwa ikigo cy'ubuvuzi, gucikanwa n'urugero bisobanura gusubika gahunda yawe. Vugana n'ikipe yawe y'ubuvuzi vuba bishoboka kugirango usubize gahunda yo guterwa umuti.

Ni ngombwa kutareka urugero, kuko ibi bishobora koroshya indwara y'imvuvu cyangwa bishobora guteza ubudahangarwa bw'umuti. Muganga wawe ashobora gukenera guhindura gahunda yawe yo kuvurwa bitewe n'igihe cyari hagati y'urugero.

Q4. Nshobora guhagarika ryari gufata amphotericin B?

Ugomba guhagarika gusa kuvurwa na amphotericin B mugihe muganga wawe yemeje ko ari byiza kubikora. Iyi myanzuro ishingiye ku buryo indwara yawe isubiza neza ku kuvurwa no kunozwa kwawe muri rusange.

Muganga wawe azakoresha ibizamini by'amaraso, amasomo yo gushushanya, n'ibimenyetso byawe kugirango amenye igihe indwara yasohotse bihagije. Guhagarika kare bishobora koroshya indwara gusubira, bishobora kuba mu buryo bukomeye.

Q5. Nshobora gufata indi miti mugihe mfata amphotericin B?

Imiti myinshi irashobora gufatwa neza hamwe na amphotericin B, ariko hariho uburyo bumwe bwo guhura. Buri gihe bwire abaganga bose imiti, ibyongerera imbaraga, n'ibicuruzwa by'ibyatsi urimo gufata.

Imiti imwe igira ingaruka ku mikorere y'impyiko cyangwa urwego rwa electrolyte ishobora gukenera guhindurwa cyangwa gukurikiranwa neza iyo ikoreshejwe hamwe na amphotericin B. Itsinda ryawe ry'abaganga rizasuzuma urutonde rwawe rwuzuye rw'imiti hanyuma rigakora impinduka zose zikenewe kugirango ugumane umutekano mugihe cyo kuvurwa.