I-Cefixime ye-gonorrhea ingumgwaqo wokubuyela emuva, hhayi isikhundla sokudutshulwa. Indlela yezinye zezikhungo ze-CDC ingu-800 mg ngomlomo, njengomthamo owodwa, esetshenziswa kuphela lapho i-ceftriaxone ingatholakali noma ingenzeki, futhi kuphela kulokugxila emalundwini, emgudwini womchamo noma emgudwini. Akufanele umphimbo.
TL;DR: Izinto Eziyinhloko Ezibalulekile
- I-Ceftriaxone 500 mg ngokujova emgqeni iwukuphela kwendlela yomgwaqo wokuqala we-gonorrhea engazinzile.
- Indlela yamanje yokubuyela emuva ngomlomo ingu-800 mg we-cefixime njengomthamo owodwa, wokugxila emgudwini womlomo nomgudu womchamo nanokugxila emgudwini.
- Uma ikhasi libhala i-cefixime 400 mg ye-gonorrhea, likubika iziqondiso ezashintsha ngo-2012.
- I-Cefixime ayithembekile ekugxileni komphimbo, ngakho-ke umlando wokuthi ubanquniwe uhlale uphambi kwamehlo ngaphambi kokuba umuntu akunike iphilisi.
- Indlela yezinye izindlela iletha izibopho ezingeziwe: mhlawumbe i-doxycycline, ukuhlolwa kokwelashwa, nokuhlolwa kabusha emva kwezinyanga ezintathu.
I-Cefixime ye-gonorrhea ingumgwaqo wokubuyela emuva, hhayi inguqulo yepilisi yokudutshulwa
I-Cefixime ye-gonorrhea yindlela yezinye zezikhungo ze-CDC: 800 mg ngomlomo, umthamo owodwa. Igcinelwe isimo lapho i-ceftriaxone ingeke yasetshenziswa, futhi ihlanganisa kuphela ukugxila emgudwini womlomo nomgudu womchamo. I-Ceftriaxone 500 mg njengomthamo owodwa wokujova emgqeni (1 g uma unesidingo esingaphezu kuka-150 kg) ihlale iyona kuphela indlela yokwelashwa yokuqala ye-gonorrhea engazinzile emalundwini, emgudwini womchamo nanokugxila emgudwini.
Lolo hlelo lwezokwelapha, hhayi ubudala. Iziqondiso ze-CDC zango-2021 ze-STI Treatment Guidelines zicacisa ukuthi i-cefixime yomlomo ayifinyeleli amazinga egazi aphezulu noma ahlala njalo njengomthamo owodwa we-500 mg wokujova emgqeni we-ceftriaxone. Umndeni ofanayo wezidakamzo, ukubeka kahle kancane endaweni yokugxila.
Ngakho-ke lapho abantu befuna ukwelashwa kwe-gonorrhea ngomlomo bethemba ukushintsha umjovo ngepilisi, impendulo eqotho ukuthi lesi sikhundla siyatholakala kodwa akusona isimo esingenabo ubungozi. I-Cefixime yileso osisebenzisayo lapho ukujova kungabizi, hhayi leso osicela ngoba ungathanda ukugwinya into.
I-Cefixime yalahlekelwa isikhundla sayo sokuqala ngo-2012, futhi umlando lowo usalawula indlela eyabelwa ngayo
Uma uhlola isizukulwane se-cefixime, i-cephalosporin yomlomo yesizukulwane sesithathu, okuyiso isizukulwane se-cephalosporin esifanayo nesomjovo we-ceftriaxone, kodwa ethathwa ngomlomo. Ngelinye ilanga yayiyeyokuqala. Bese ayisiyo.
Phakathi kuka-2010 no-2012, i-cefixime yakhishwa ngokuphelele njengendlela ye-CDC enconywayo yokwelashwa kwe-gonorrhea ngemuva kokubuyela kwama-resistance nokuhluleka kokwelashwa okubikiwe, futhi yabuya njengendlela eyimikhawulo, eyokusebenzisa kancane. Kuyindaba yayo yonke leyo into ekuwo namuhla.
I-CDC iphinde ixwayise ngokuthi amazinga aphezulu we-cefixime minimum inhibitory concentrations (MICs) phakathi kwama-gonococcal isolates angabonisa isigaba sokuqala sama-resistance, nokuthi ukuncika ku-cefixime kungashesha i-resistance ku-ceftriaxone, okuyilona okusasebenza njengomthamo owodwa kuphela othembekile kuyo yonke indawo yokugxila. Wonke umthamo we-cefixime ongagwenywa uyisikweletu esincane kuleyo akhawunti, okuyikho okuyikho okuyikho okubangela ukwesaba nge-super gonorrhea.
Ukuqhathanisa kwe-NEJM ka-1991 komthamo owodwa we-cefixime ne-ceftriaxone kubike amazinga okuphulukisa acishe abe ngu-95% kuya ku-98%. Lezi izinombolo zangempela ezivela kubantu abangakabi nama-resistance, futhi zichaza ibhaktheriya elingasafani ngendlela efanayo.
Izimo ezine kuphela ezidinga ngempela ukwelashwa kwe-gonorrhea ngaphandle kokujova
Ukwelashwa kwe-gonorrhea ngaphandle kokujova kugcinwe, akukhethwa. Umusho we-CDC "ongatholakali noma ongabizi" uhlala ohlwini olufushane:
- Ukushoda kwe-ceftriaxone noma ukuphazamiseka kokuhlinzekwa endaweni yokwelashwa.
- Awukwazi ukubekezelela noma ngeke uvume ukujova emgqeni, okuhlanganisa ukwesaba imijovo nezinkinga zokopha.
- Awekho izindawo zezokwelapha ezitholakalayo ukuze zinikeze umjovo, njenge-telehealth, ukunakekelwa ngokushesha, noma ukufinyelela kuphela ekhemisi.
- I-Expedited partner therapy, lapho iziqondiso zezokwelapha ze-CDC zivumela umthamo owodwa we-cefixime onemithamo engu-800 mg kumlingani ongakwazi ukuhlolwa ngokushesha emtholampilo. Uma ukutheleleka nge-chlamydial kungakhishiwe, lowo mlingani udinga futhi i-doxycycline 100 mg ngomlomo kabili ngosuku izinsuku ezingu-7 kanye ne-cefixime.
Zintathu ezine kulokhu ziyi-logistics, hhayi ukukhetha kwezokwelapha. Isizathu sesine abantu abasibeka, ukubika ukungezwani kahle kwe-ceftriaxone noma i-penicillin, kuyona eyokugcina eyizinga eliphansi kakhulu: cishe 10% yabantu base-US babika ukungezwani kahle kwe-penicillin kanti ngaphansi kuka-1% bane-allergy eqinisekisiwe yangempela, futhi ukuhlangana okungahambisani ne-cephalosporins yesizukulwane sesithathu kunqabe.
Nansi into ezokutshela amakhasi amaningi: ukuthandwa kokwelashwa kwe-gonorrhea ngomlomo ngokuvamile kuyalula, futhi ukulula kuyisona sizathu esingavunyelwe yiziqondiso. Uma uzama ukuthola ukwelashwa kwe-gonorrhea online, lindela ukuthi izindlela eziningi zizoqeda ngokujova ubuso nobuso.
Ukuvakashelwa okungabonakali kusenezinto ezibalulekile lapho ukufinyelela kuyisithiyo. Ukuvakashelwa kwe-August okungu-R39 online urgent care kukuxhumanisa nomdlali wezokwelapha onelayisensi yase-US ongahlola izimpawu nomlando wokuthi ubunqunywe yini futhi akubhalele lapho kufanele, nomdlali enquma ukuthi yini efanele. Okungeke kwenziwe wukugunyaza ukujova i-ceftriaxone, futhi ayikwazi ukuqoqa ama-swabs akhombisa ukuthi yisiphi isidakamzo esifanele.
Umphimbo yilapho i-cefixime ne-ceftriaxone ziyeka ukuba zifane
Noma yikuphi ukuqhathanisa okuyiqiniso kwe-cefixime vs ceftriaxone kuyaphela emqaleni. I-CDC ibeka izinga lokwelashwa le-cefixime le-gonorrhea yomphimbo ngo-92.3% (95% CI 74.9% to 99.1%), futhi lelo banga lokwethembana libanzi ngokwanele ukuhlanganisa amazinga okuhluleka angathandwa yilutho. I-Ceftriaxone, hhayi i-cefixime, kufanele isetshenziswe noma nini lapho ukugxila komphimbo kutholwa noma kungaqinisekiswa.
Le eyodwa kancane ngawe. I-gonorrhea yomphimbo ivame ukuba ingabi nezimpawu, ngakho-ke "umphimbo wami uzizwa kahle" awuqinisekisi lutho. Ngaphambi kokuba uvume inketho yomlomo, tshela udokotela mayelana nanoma yikuphi ukudakwa kwezitho zangasese zomlomo bese ubuza ngokuqondile ukuthi ngabe ama-swab omphimbo ayaqoqwa yini. Uma impendulo ithi cha, ipilisi akusona isinqumo esifanele okwamanje.
Uma umthombo ukutshela u-400 mg, ukubika isiqondiso esashintsha
Amakhasi abika i-cefixime 400 mg ye-gonorrhea aphinda aqala iziqondiso ze-CDC zangaphambi kuka-2012, hhayi iziqondiso zamanje. Indlela yezinye zezikhungo zamanje iyi-cefixime 800 mg ngomlomo njengomthamo owodwa, ngokuya ngeziqondiso ze-STI zango-2021.
Isibalo esingu-400 mg sasingumthamo owodwa wokuqala wokuqala kanye nomthamo osetshenziswe ezincwadini eziyisisekelo zocwaningo zango-1991, yingakho usaphila kumakhasi agciniwe, izifundo ezindala nezinye iziqondiso ezingezona zase-US. Akuyona enye inketho evumelekile. Kuyi-fossil.
Ngokuhlukile, i-cefixime 400 mg kanye noma kabili ngosuku iyingeyezinye izifo, okuhlanganisa izindlela zokuphefumula nezomgudu womchamo. Ungalokothi ubuyekeze umthamo we-gonorrhea kusuka kuresiphi esele, futhi ungaze uhlukanise, uphinde, noma uzilalele umthamo. Qinisekisa inombolo ngqo ebhalwe kuresiphi yakho nomdokotela noma ikhemisi, futhi ufunde imiyalelo ephelele yomuthi we-cefixime uma ilebula neziqondiso zibonakala zingafani.
Umthamo owodwa akuyona yonke imithi, futhi izinyathelo ezimbili ezingeziwe ziyimpoqo
Uma uke wafunda ukuthi i-cefixime kanye ne-azithromycin yindlela yokwelashwa ye-gonorrhea, lokho kuhlangana kudlulile. Ukwelashwa okubili kwakuyinto evamile kusuka ngo-2015 kuya ku-2020, futhi i-CDC yayo kuhlanganise ngo-2020 nango-2021 phezu kokukhula kwe-azithromycin resistance nokuphendula ngokusekelwe emitholampilo. Okuyingena esikhundleni sayo kuyinto emincane: i-doxycycline 100 mg ngomlomo kabili ngosuku izinsuku ezingu-7, futhi kuphela lapho ukutheleleka nge-chlamydial kungakhishiwe. I-Azithromycin 2 g ngomlomo manje ivele ikakhulukazi ne-i-gentamicin 240 mg IM yokungezwani kahle ngempela kwe-cephalosporin, indlela yokwelashwa ephilisa cishe u-80% wokugxila emqaleni.
Bese izinyathelo ezimbili ezingeyona zokukhetha. Ukuhlolwa kokwelashwa cishe ezinsukwini eziyi-7 kuya kweziyi-14 ngemuva kokwelashwa kulindeleke lapho kusetshenziswa indlela yezinye izindlela njenge-cefixime, ngqo ngoba imithi yesibili iyahluleka kaningi. Yeka ucansi imihla engu-7 ngemuva kokwelashwa nasele abalingani sebaphelisiwe, futhi uhlele ukuhlolwa kabusha ngemuva kwezinyanga ezintathu.
Lezi zinsuku kulula ukuzikhohlwa. Uhlelo lokusebenza lomsizi wezempilo olufana ne-August AI lungakusiza ukuba ubhalise usuku lokwelashwa, usuku lwesi-7, nokuqokwa kwe-test-of-cure, futhi ubuzwe imibuzo elula phakathi kokuvakasha. Kuyisengezo kunakekelo, akusona isinqumo esinqumayo. August AI ayisishintshi isikhungo esayala ukuhlolwa.
Ezinye izimpawu kusho ukuthi ipilisi akusona isinyathelo esifanele nhlobo
Shayela u-911 noma uye egumbini lezimo eziphuthumayo manje uma:
- Ukuvuvukala kobuso noma komphimbo, ubunzima bokuphefumula, noma ama-hives asakazekile ngemuva kwe-cefixime noma i-ceftriaxone.
- Umkhuhlane kanye nobuhlungu bamalungu, ukuvuvukala kwamalungu noma i-rash esakazekayo, okungakwenza kube yi-disseminated gonococcal infection.
- Ubuhlungu obunzima besisu esingezansi noma esingasebhola kanye nomkhuhlane, okungakwenza kube yi-pelvic inflammatory disease.
- Ubuhlungu obusha emithondweni noma ukuvuvukala, okungakwenza kube yi-epididymitis, futhi ukushesha kungcono.
- Ukuphuma noma ubuhlungu kusengabikho emva kwezinsuku ezingu-3 kuya kwezi-5 ngemuva kokwelashwa, okudinga ukuhlolwa kabusha kanye nendlela yokwelashwa ehlukile kunomthamo ophindwe kabili.
- Ayikho i-test-of-cure appointment ehleliwe.
- Uke waba nezitho zangasese zomlomo kusukela ekuhlolweni kwakho kokugcina, noma umphimbo wakho ungazange uqoqwe.
- Watshelwa ukuthi awuzwani kahle ne-penicillin noma i-cephalosporins kodwa awuzange uhlolwe ngokusemthethweni.
- Ukhulelwe.
- Unikezwa i-cefixime kuphela ngoba umtholampilo uphelelwe yi-ceftriaxone.
Imibuzo Evame Ukubuzwa
Ingabe i-cefixime iyatholakala ngaphandle kweresiphi ye-gonorrhea?
Cha. I-Cefixime ingumuthi wokubhalisa kuphela e-United States, futhi akukho ndlela yokuphulukisa ye-gonorrhea ethengiswa ngaphandle kweresiphi lapha. Amaphilisi athengwe phesheya noma online ngaphandle kweresiphi angozi wangempela: umthamo ongalungile, umkhiqizo ongakaqinisekisiwe, futhi akukho kuhlolwa ukuqinisekisa ukuthi iziphi izindawo zomzimba ezigxile. Ukuxilonga nokwaziswa komlingani kuyingxenye yokwelashwa, hhayi okokukhetha.
Ngingasebenzisa iresiphi ye-cefixime esele kusuka ku-UTI noma ukugxila komkhuhlane?
Cha. Amaphakethe asele avame ukuba amaphilisi e-cefixime angu-400 mg anomthamo wansuku zonke kwezinye izifo, ngakho-ke uzobe uqagela kokubili umthamo nenani lemithamo. Umthamo ongagcwalisiwe noma ongaphansi komthamo uyisona isimo esikhulisa i-gonorrhea ehlala isikhashana. Uphinde udinge ukuhlolwa okubhalisiwe, isinqumo mayelana nokuhlanganiswa kwe-chlamydia, nokwelashwa komlingani, okungekho okunye okuhlinzekwa yibhodlela elisele.
Kufanele ngigweme utshwala ngenkathi ngisebenzisa i-cefixime ye-gonorrhea?
Ngokuvamile akunjalo. I-Cefixime ayisiyo yezinye izidakamzo ezidinga ukugwema utshwala ngokukhawuleza, futhi indlela yokwelashwa ye-gonorrhea ingumthamo owodwa kunomzila wamasonto onke. Buza ikhemisi lakho uma usebenzisa eminye imithi. Isivimbelo esiwusizo kakhudlwana sokuziphatha: akukho ucansi imihla engu-7 ngemuva kokwelashwa nasele abalingani sebaphelisiwe, okwenza kube lula ukukhohlwa utshwala.
Ingabe i-cefixime iphephile ukuyisebenzisa i-gonorrhea ngenkathi ukhulelwe?
Ngokuvamile ayiyona inketho yokuqala. Ukukhulelwa yisizathu sokuba nengxoxo kunokwamukela indlela yomlomo njengokungagwegwesi, njengoba ukujova kuhlale kuyinto yokuqala futhi umuthi womlingani osetshenziselwa ukuhlanganisa i-chlamydia uhlukile ngenkathi ukhulelwe. Ungathathi i-antibiotic yomthamo owodwa enikezwe umlingani wakho. Buza udokotela wakho wezitho zangasese noma wezinsana ngaphambi kwanoma yimuphi umthamo.
Kungaba khona nini izimpawu zithuthuka ngemuva komthamo owodwa we-cefixime?
Ngokuvamile phakathi nezinsuku zokuqala. Ukuphuma kuvame ukuba buthakathaka bese kuyama, futhi ukushisa lapho uchama kuncipha kancane kunokunyamalala ubusuku bonke. Ukucasuka okuncane kungahlala isikhashana ngemuva kokuba amagciwane acoceka. Okubalulekile yindlela: izimpawu kufanele zibuthuntu, hhayi ukuhlala zinjalo noma ziyanda. Uma zingashintshi, shayela umtholampilo esikhundleni sokulinda usuku lwe-test-of-cure.
Iphuzu Lokugcina ekukhetheni ipilisi esikhundleni sokudutshulwa
I-Cefixime ye-gonorrhea ingumgwaqo wokubuyela emuva, hhayi ukukhetha. Kuyi-800 mg ngomlomo njengomthamo owodwa, wokugxila emgudwini womlomo nanokugudla emgudwini kuphela, futhi kuphela lapho i-ceftriaxone ingeke yasetshenziswa ngempela. Qinisekisa izinto ezintathu nodokotela wakho ngaphambi kokuba uzamukele: yiziphi izindawo ezihloliwe, kuhlanganise nomphimbo; umthamo oqondile nokuthi ngabe kukhona yini umuthi womlingani ohambisana nawo; nosuku lwe-test yakho yokwelashwa.
Isitatimende: Lesi sihloko senzelwe izinhloso zolwazi kuphela futhi asisho ukuba yeluleko kwezokwelapha. Hlala uthintana nomhlinzeki wezempilo oqeqeshiwe wezinqumo zokuxilonga nokwelashwa. Uma ubhekene nesimo esiphuthumayo sezokwelapha, shayela u-911 noma uye egumbini lezimo eziphuthumayo eliseduze ngaso leso sikhathi.
