Yebo, i-Augmentin ye-UTI ingasebenza, kodwa iyinye yama-antibiotic esigaba sesibili. I-FDA ikubhalela ukuthi i-amoxicillin/clavulanate iyasebenza ezifweni zamathumbu omchamo ezibangelwa amagciwane akhiqiza i-beta-lactamase, futhi imihlahlandlela yezifo ezithathelwanayo isabeka i-nitrofurantoin, i-trimethoprim-sulfamethoxazole ne-fosfomycin ngaphambi kwayo ezifweni ezijwayelekile zesinye. Izindlela ezejwayelekile zabantu abadala ziphela izinsuku ezingu-5 kuye kwezi-7.

TL;DR: Okubalulekile

  • I-Augmentin ipholisa ama-UTI, kodwa i-IDSA ne-ESCMID bayibeka njengenye indlela, hhayi njengenketho yokuqala, yama-cystitis angadluliselwa kalula.
  • Emini yedatha yophenyo ngemuva kwalokho kokuqeqeshwa, isigamu sezinsuku ezingaba ngu-3 se-amoxicillin/clavulanate sapholisa abesifazane abangu-58% ngokomtholampilo uma kuqhathaniswa no-77% we-ciprofloxacin.
  • Cishe u-43% wabantu abaphandle abane-UTI engadluliselwa kalula i-E. coli iyachitha imithi yeqembu le-penicillin, uma kuqhathaniswa nokungaphansi kuka-1% we-nitrofurantoin.
  • Iba inketho efanele ngenkambiso egugile, ukungezwani komzimba ne-sulfa, lapho i-nitrofurantoin ikhutshaziwe, noma ekukhulelweni, lapho ama-beta-lactam eyiqembu elithandwayo.
  • Umthamo wabantu abadala ohlwini olusemthethweni ungama-mg angama-500 njalo ngehora eli-12 noma ama-mg angama-250 njalo ngehora eli-8, ngokuvamile izinsuku ezingu-5 kuye kwezi-7 ku-cystitis. Udokotela wakho ubeka umthamo.

Yebo, i-Augmentin ye-UTI iyasebenza, kodwa ayiyona i-antibiotic ongayithola kuqala.

Ingabe i-Augmentin iphatha i-UTI? Yebo, kunesidingo. I-amoxicillin/clavulanate ibhalwe yi-FDA ngezifo zamathumbu omchamo ezibangelwa izinhlobo ezikhiqiza i-beta-lactamase ze-E. coli, i-Klebsiella ne-Enterobacter, futhi iyaphilisa izifo zesinye. Kodwa imihlahlandlela ibeka ngaphansi kwezinye izidakamizwa ezintathu zama-cystitis avamile, ngakho-ke iyimpendulo efanele ikakhulukazi lapho kukhona okubavimbela.

I-Clavulanate ayiyona i-antibiotic eyodwa. Ivimbela i-enzyme ye-beta-lactamase esetshenziswa amagciwane aphikisayo ukuze achithe i-amoxicillin, okuyinto kanye kanye indlela inhlanganisela efika ngayo ezinhlotsweni amoxicillin ayikwazi ukufinyelela kuzo. Leso sifunda esibanzi singokoqobo, futhi asanele ukwenza lesi sidakamizwa sibe yinto yokuqala: i-IDSA ne-ESCMID zibeka i-amoxicillin/clavulanate njengenye indlela yesigaba sesibili ye-acute uncomplicated cystitis. Ingxenye elandelayo uyofakaza.

Isigaba Sesibili Ngoba: I-Augmentin ipholisa ama-UTI ambalwa kunemithi esikhundla sayo

I- 2011 IDSA/ESCMID guidelines ye-acute uncomplicated cystitis ibeka izinto ezine ezithandwayo: i-nitrofurantoin, i-trimethoprim-sulfamethoxazole, i-fosfomycin, kanye ne-pivmecillinam lapho itholakala khona eYurophu. I-amoxicillin/clavulanate ihlala esigabeni sezindlela ezihlukile, igcinelwe lapho izidakamizwa ezithandwayo zingasetshenziswa. Leso yisikhundla, hhayi ukukhansela.

Amanani angemuva kwesikhundla awavuni kahle. Kophenyo oluqhathanayo olucashunwe kuleyo mpendulo, i-amoxicillin/clavulanate ku-mg angama-500/125 kabili ngosuku izinsuku ezingu-3 yenza ukwelashwa okuphumelelayo okungama-58% uma kuqhathaniswa no-77% we-ciprofloxacin, nokwelashwa kwe-microbiologic okungu-76% kuya ku-95%. Qaphela isikhathi. Kwakuyisigamu sezinsuku ezingaba ngu-3, esingaphansi kwalokho okwamanje okuphakanyiswayo kwe-cystitis.

Ukumelana kwandisa umehluko nakakhulu. Kudatha enkulu yabantu abadala e-U.S. eshicilelwe ku- Open Forum Infectious Diseases ngo-2023, i-E. coli ye-UTI engadluliselwa kalula yayiphikisa cishe u-43% ezidakamizweni zeqembu le-penicillin, iqembu elihlanganisa ne-amoxicillin/clavulanate, uma kuqhathaniswa nokungaphansi kuka-1% ephikisana ne-nitrofurantoin.

Nansi into iningi lamakhasi eliyithola lingabasho: akukho kulokhu okwenza i-Augmentin ibe yi-antibiotic embi. Kuyidakamizwa elihle kakhulu lezifo zamakhala, izindlebe, ukulunywa, kanye nezokuphefumula. Isibalo sika-43% siyisamba sikazwelonke, futhi isimo sakho sokumelana sendawo kanye nesimo sakho singcono kunanoma yisiphi isilinganiso esishicilelwe. Ingxoxo imayelana nezinga lohlu lwesifo esithile esisodwa, akukho okunye.

Izimo Eziyine Eziphendula Ukukhetha Ku-Augmentin

I-Augmentin ye-UTI ekukhulelweni ingenye yezimo ezine lapho isidakamizwa sesigaba sesibili siba umuthi ofanele. Ezinye izintathu yilezi: isimo esiqinisekiswe yisimo, ukungezwani komzimba kwe-sulfa, kanye nenkinga yezinso noma indawo yesifo eyenza i-nitrofurantoin ingasebenzi.

  • Isimo siyakuveza. Isimo somchamo nombiko wokumelana ukhombisa igciwane elikhiqiza i-beta-lactamase eliphikisa umuthi wokuqala owawuzama.
  • I-Sulfa ayikho. Ukungezwani komzimba ne-sulfa noma ukungabekezelelani kukuvimbela ngokuphelele i-trimethoprim-sulfamethoxazole.
  • I-Nitrofurantoin ayikho. Ukuncipha komsebenzi wezinso, noma isifo esibanjwa phezulu kunama-bladder, kwenza kube yithuluzi elingalungile.
  • Ukukhulelwa. Uphando lwango- 2025 JAMA Network Open lwabesifazane abangaphezu kuka-71,000 abakhulelwe isigamu sokuqala sabonisa ukuthi i-trimethoprim-sulfamethoxazole ingeyona into enengozi enkulu kunama-beta-lactam (ingcuphe engu-1.35), ngenkathi i-nitrofurantoin nama-fluoroquinolones afana nama-beta-lactam.

Funda leso sihloko sesine ngokucophelela. Sisekela isitatimende sokuthi ama-beta-lactam ayiqembu elithandwayo ekuqaleni kokukhulelwa, hhayi isitatimende sokuthi i-Augmentin "iphephile ekukhulelweni." Udokotela wakho kanye nesigamu sakho sokukhulelwa kuyona. Futhi qaphela ukuthi izinto ezintathu kwezine zincike embhalweni wesimo, okusho ukuthi lolu uhlu lokulubeka noluhlu lwakho, hhayi uhlu lokuzihlola.

Uma unezimpawu futhi akukho nhlelo okwamanje, ukuvakashelwa okungabizi kwi-inthanethi okungu-$39 no-August kukuxhumanisa nomqeqeshi onelayisense e-US ongahlola izimpawu zakho, acele ukuhlolwa, futhi anikeze umuthi uma kufanelekile. Umqeqeshi unquma ukuthi ngabe i-antibiotic iyadingeka yini nokuthi iyiphi, ngakho-ke akukho ukuvakashelwa okungaqinisekisa umuthi. Ukuvakashelwa futhi akukwazi ukubhekana nesifo sezinso esibanjisiwe noma ukungena esikhundleni sokuhlolwa komuntu lapho kukhona izimpawu eziyingozi.

Umthamo Uhhafu kuphela Womuthi. Isikhathi singuhhafu wesinye.

Umthamo we-Augmentin UTI ku-ilebula le-FDA labantu abadala uyisibhamu esingu-mg angama-500 njalo ngehora eli-12 noma isibhamu esingu-mg angama-250 njalo ngehora eli-8, ngezigaba eziphakeme kakhulu zama-mg angama-875 njalo ngehora eli-12 ezilondoloziwe ngezifo ezinzima kakhulu.

Umshwana okufanele uphindwe kumakhemisi wakho uhlanganisa umthamo nesikhathi: i-cystitis engadluliselwa kalula, ama-mg angama-500/125 njalo ngehora eli-12 (noma ama-mg angama-875/125 njalo ngehora eli-12 uma udokotela wakho ecabanga ukuthi isifo siphansi kakhulu) izinsuku ezingu-5 kuye kwezi-7, hhayi isigamu sezinsuku ezingaba ngu-3 esingasebenzi kahle emiphumeleni. Uma ufuna ukwazi ngesizathu esingemuva kwesikhathi osithatha ngaso i-Augmentin, kuncike endaweni yesifo kanye nobunzima bayo.

Ukusebenza kwezinso kushintsha izibalo. Ngokwelebula, isibhamu sama-mg angama-875 akufanele sisetshenziswe lapho i-creatinine clearance ingaphansi kuka-30 mL/min, futhi umthamo uncipha ube cishe ama-mg angama-250 kuye kwangama-500 njalo ngehora eli-12 nge-creatinine clearance engu-10 kuye ku-30 mL/min kanye njalo ngehora eli-24 ngaphansi kuka-10. Lolo shintsho lungolodokotela. Akulona ukuzishintshela.

Amanqaku amabili asebenzayo athinta ukuthi umthamo we-Augmentin UTI ubekezeleka kangakanani. I-MedlinePlus incoma ukuyithatha njalo ngehora eli-8 kuye kweli-12 nesidlo noma isnack ukuze kuncishiswe ukuphazamiseka esiswini, futhi ixwayisa ukuthi i-amoxicillin/clavulanate inganciphisa ukusebenza kwamakhondomu asebenzayo, ngakho sebenzisa indlela yokuqinisekisa ngesikhathi sokwelashwa.

Ngokumelene neMacrobid kanye neBactrim, i-Augmentin iyahlulwa kulo lonke uhlangothi ngaphandle kolunye

I-Augmentin vs Macrobid ye-UTI kanye ne-Augmentin vs Bactrim ye-UTI yizimbambalo ezimbili abantu abazenzayo, futhi ziyafana kakhulu kunokwehlukana. I-Nitrofurantoin iyinto yokuqala, ngokungamela u-1% we-E. coli resistance kudatha ka-2023, kodwa igxila emchameni futhi ayifinyeleli amazinga ezicubu ezisebenzayo ngaphandle kwesinye. Phatha lokho njengomthetho oqinile: ayanele i-pyelonephritis. I-Trimethoprim-sulfamethoxazole nayo iyinto yokuqala lapho ukumelana kwendawo kungaphansi, futhi ukungezwani komzimba kwe-sulfa kuvala lowo mnyango ngokuphelele. I-Fosfomycin iqedela isigaba esithandwayo njengenketho yesigamu esisodwa. Ukuqhathanisa kwethu iBactrim vs Macrobid kuyahamba kakhulu kulaba ababili.

Ukunqoba kwangempela kwe-Augmentin kuyimfushane kodwa kungokoqobo: kuyinketho ye-beta-lactam lapho ukungezwani komzimba, ukukhulelwa, noma isimo esiqinisekisiwe sivale ezinye, siqhathaniswa nokumelana kwezigaba ze-penicillin ezicishe zibe ngu-43%.

Nansi imfihlo ayisho umbhalo. Ukubandakanyeka kwezinso kuvala i-nitrofurantoin, kodwa akukhuphuli i-Augmentin ngokuzenzakalela. I-i-IDSA efanayo ithi ama-beta-lactam asebenzayo angasebenzi kangako kunezinye izinto ze-pyelonephritis, futhi uma esetshenziswa, kufanele alandelwe umthamo wokuqala we-intravenous we-ejenti yesikhathi eside njenge-ceftriaxone noma i-aminoglycoside.

Umkhuhlane kanye nobuhlungu emhlane kusho ukuthi umbuzo we-antibiotic usushintshile

Ezinye izimpawu zenza ingxoxo ye-Augmentin-noma-hhayi ingabaluleki, ngoba zishintsha indawo yokunakekelwa kunokukhetha ibhodlela.

Shayela u-911 noma uye egumbini lezimo eziphuthumayo manje uma:

  • Ukudideka, ukuphefumula ngokushesha, ukushaya kwenhliziyo okusheshayo noma umfutho wegazi ophansi nge-UTI ebukhuni, okungase kubonise i-urosepsis
  • Ukuvuvukala kobuso, umphimbo, ulimi, izindebe noma amehlo, ukushodelwa yimphefumulo noma ukugwinya, noma ukukhwehlela, okungase kubonise ukusabela okunzima kokungezwani komzimba
  • Ukuphuzi kwesikhumba noma amehlo, umchamo omnyama, noma ubuhlungu esingxenyeni engenhla yesisu sakwesokudla, okungase kubonise ukulimala kwesibindi

Isigaba esilandelayo akusona isimo esiphuthumayo, kodwa futhi akusona isimo sokulinda nokubona. Noma yiziphi izimpawu ze-UTI kanye nomkhuhlane ngesikhathi sokukhulelwa kudinga ukuhlolwa okusheshayo.

Bhuka ukuvakasha phakathi nesonto elizayo uma:

  • Umkhuhlane, ukudlikizela, ubuhlungu emhlane noma emhlane ongezansi, noma isicanucanu nokugabha kanye nezimpawu ze-UTI, okubonisa isifo sezinso futhi kudinga ukuhlolwa okusheshayo noma ngaphambili
  • Izimpawu zakho azithuthuki ku-antibiotic
  • Ukuhlanza noma ukopha esitokisini ngokuhlanganiswa nezinyoka noma umkhuhlane ngesikhathi sokwelashwa noma kuze kube izinyanga ezimbili noma ngaphezulu ngemuva kokuqeda, okuyinto i-MedlinePlus ikuqinisekisa njenge-C. difficile colitis engenzeka. Lokho ukulibazisa kungokoqobo, ngakho-ke shilo ama-antibiotics asanda kwenziwa noma ngisho nenyanga eziningi kamuva.

Futhi kunezinye izinto okufanele kuxoxwe ngazo ngaphambi kwesibhamu sokuqala, kanye nezimpawu ezijwayelekile zezimpawu ze-Augmentin.

Khuluma nomqeqeshi ngaphambi kokuba uqale uma:

  • Une-allergy ye-penicillin noma ukusabela kwesibindi okudala kwe-amoxicillin/clavulanate
  • Unezinso ezingasebenzi kahle
  • Ukhulelwe noma uncancisa, noma usebenzisa ama-contraceptives asebenzayo

Imibuzo Evame Ukubuzwa

Ngingasebenzisa i-Augmentin esele kusukela kumuthi wangaphambili we-UTI?

Cha. Ibhodlela eliyingxenye ngencazelo yalo liyisigamu, futhi lalihambisana nesifo esihlukile futhi mhlawumbe nezinye izinhlobo. Ukuthatha izinsuku ezimbalwa ze-beta-lactam esingase singamelana namagciwane akho akhethela ukumelana okuningi, kuhlanganise nesimo somchamo uma usithola kamuva, futhi kungalibazisa ukwelashwa okuphumelelayo. Thola isifo samanje sihlolwe futhi sinikezwe umuthi.

I-Augmentin kufanele iqale ukusebenza cishe nini ku-UTI?

Ngokuvamile phakathi kwamahora angama-24 kuye kwangama-48, ukushisa kanye nesidingo kufanele kube kuncipha ngokucacile. Uma kungakho lutho oluthuthukisiwe kuze kube amahora angama-48 kuye kwangama-72, noma izimpawu ziba zimbi nganoma yisiphi isikhathi, xhumana nodokotela wakho kunokulinda ibhodlela. Lolo hlobo lungavame ukusho ukuthi igciwane liyamelana futhi isimo kufanele siqondise ushintsho. Qedela isigamu esiphelele njengoba kukhonjisiwe noma ngisho nalapho uzizwa ungcono.

Kungani ukubuyekezwa kwabantu abakwi-inthanethi kwe-Augmentin kubantu abane-UTI kuxubene kakhulu?

Ngezinye izikhathi imithi ayizange ihambisane nenhlanzeko. Ukubuyekezwa kwehlukaniswa cishe ngokulinganayo ngoba imiphumela incike ekutheni yini i-E. coli eyayihambisana nayo, futhi ukumelana kwezinhlobo ze-penicillin ezimpahleni ze-UTI eziphuma ngaphandle kusondele ku-43%. Kunqunywa kusukela embhalweni wokumelana, kusebenza kahle. Kunqunywa ngokungaboni, isabelo esibalulekile sabantu abatholi inzuzo futhi bayabhala ngayo.

Ngabe i-amoxicillin ecacile ingcono njenge-Augmentin ye-UTI?

Cha. Lezi ezimbili azifani. Isibambiso se-FDA sihlanganisa izinhlobo ezikhiqiza i-beta-lactamase, futhi lawo magciwane akhiqiza i-enzyme echitha i-amoxicillin esetshenziswe yodwa. I-Clavulanate ikhona ukuze ivimbe leyo enzyme. I-Amoxicillin eyedwa isilele kakhulu ekuthembekeni kuyo nge-urinary E. coli kangangokuthi ayiyona inketho eyi-guideline-preferred ye-empiric cystitis treatment.

Ngabe i-Augmentin iyasebenza kuma-UTI emadodeni noma kubantu abane-catheter?

Ngezinye izikhathi, kodwa lezi zihlanganisa konke okungenhla. Ama-UTI emadodeni, kubantu abane-catheter, nasemadodeni anama-abnormalities ezicubu noma ezisebenzayo omchamo achazwa njengezinkimbinkimbi, okuvame ukusho ukuthi isimo somchamo sibalulekile, izigamu ziphela isikhathi eside, futhi i-catheter ingase kudingeke ukuthi ishintshwe noma ikhishwe. Umthamo nesikhathi esikuleli khasi ngokuvamile yizingqinamba ze-cystitis engadluliselwa kalula.

Isiphetho nge-Augmentin kanye nama-UTI

I-Augmentin iyasebenza ezifweni zamathumbu omchamo futhi isengumuthi wesigaba sesibili we-uncomplicated cystitis, ngemuva kwe-nitrofurantoin, i-trimethoprim-sulfamethoxazole kanye ne-fosfomycin. I-Augmentin ye-UTI iba umuthi ofanele lapho umphumela wesimo, ukungezwani komzimba kwe-sulfa, ukusebenza kwezinso, noma ukukhulelwa kuhlanganisa iminyango yezinto zokuqala. Lapho ikhethwa, ukuhlanganiswa okubalulekile kungumthamo nesikhathi: ama-mg angama-500/125 njalo ngehora eli-12 izinsuku ezingu-5 kuye kwezi-7 ku-uncomplicated cystitis, njengoba udokotela wakho eyala. Ukunikeza imithi okuhanjiswa ngumphumela wesimo yilokho okuhlukanisa imiphumela emihle naleyo emibi abantu abayichazayo ezibuyekezweni.

Isitatimende: Lesi sihloko siyeyolwazi kuphela futhi akusona iseluleko sezokwelapha. Njalo thintana nomhlinzeki wezempilo onokwethenjelwa ukuze uthole ukuxilongwa nezinqumo zokwelashwa. Uma ubhekene nesimo esiphuthumayo sezokwelapha, shaya u-911 noma uye esikhungweni sezimo eziphuthumayo esiseduze ngaso leso sikhathi.