Page 19 - วารสารกรมการแพทย์แผนไทยฯ ปีที่ 10 ฉบับที่ 3

Journal of Thai Traditional & Alternative Medicine Vol. 10 No. 3 September-December 2012 169

‡´≈≈å¢Õ߬“Õ“®„™âæ≈—ßß“πÀ√◊Õ‰¡à„™âæ≈—ßß“π°Á‰¥â phenical ‡ªìπμâπ PmrA ¢Õß Streptococcus

™àÕß∑“ß ”§—≠∑’ˬ“ªØ‘™’«π–®–‡¢â“‡´≈≈å¢Õß pneumoniae ´÷Ëß®–¢—∫ fluoroquinolones ·≈– LfrA
·∫§∑’‡√’¬§◊Õ∑’Ë outer membrane protein ´÷Ë߇ªìπ ¢Õß Mycobacterium smegmatis ´÷Ëß®–¢—∫ qua-
‚ª√μ’π∑’Ë¡’≈—°…≥–‡ªìπ™àÕß ”À√—∫¢π àß‚¡‡≈°ÿ≈ºà“π ternary amine compounds, acriflavin, ·≈–

lipid bilayer membranes ‡ªìπ permeability fluoroquinolones ‡ªìπμâπ (¢) the small multidrug
”À√—∫‚¡‡≈°ÿ≈∑’Ë≈–≈“¬πÈ”‰¥â (hydrophillic solutes) resistance family (SMR) ‡ªìπ MDRp ∑’Ë°≈ÿࡇ≈Á°
°≈‰°°“√¥◊ÈÕ¬“¢Õß·∫§∑’‡√’¬‚¥¬°“√≈¥°“√ – ¡ ∑’Ë ÿ¥ “¡“√∂¢—∫ “√ÕÕ°‰¥âπâÕ¬™π‘¥ ‚¥¬ à«π„À≠à
¢Õ߬“¿“¬„π‡´≈≈å·∫§∑’‡√’¬Õ“®‡°‘¥¢÷Èπ‚¥¬°≈‰° ®–‡ªìπ “√‡§¡’∑’Ëπ‘¬¡„™â¶à“‡™◊ÈÕ‡™àπ benzalkonium

À≈—° 2 °≈‰° §◊Õ °“√≈¥°“√´÷¡ºà“π¢Õ߬“‡¢â“ Ÿà‡´≈≈å chloride À√◊Õ cetyltrimethylammonium bro-
(decreased permeability) ·≈–°“√¢—∫¬“ÕÕ°®“° mide ·μà®–‰¡à‡°’ˬ«¢âÕß°—∫°≈‰°°“√¥◊ÈÕμàÕ¬“

‡´≈≈å (active efflux) πÕ°®“°π’È°“√≈¥°“√𔬓 ªØ‘™’«π– ‡™àπ Smr „π S. aureus ‡ªìπμâπ (§) re-
‡¢â“ Ÿà‡´≈≈å·∫§∑’‡√’¬Õ“®‡°‘¥®“°ªí®®—¬∑’ˉ¡à‡°’ˬ«¢âÕß sistance-nodulation-division family (RND) ‡ªìπ
°—∫·∫§∑’‡√’¬‚¥¬μ√ß ‡™àπ °“√ √â“ß biofilm „π MDRp °≈ÿà¡∑’Ë¡’§«“¡ ”§—≠¡“°„π·∫§∑’‡√’¬·°√¡
coaglase-negatie Staphylococcus spp. À√◊Õ ≈∫ ‡™àπ E. coli, P. aeruginosa ·≈– A. baumannii

ªí®®—¬∑’ˇ°’ˬ«°—∫¬“ ‡™àπ ¢π“¥‚¡‡≈°ÿ≈∑’Ë„À≠à ¡’ ‡ªìπμâπ ∑”Àπâ“∑’Ë¢—∫ “√ÕÕ°‰¥âÀ≈“¬°≈ÿà¡ ‰¥â·°à ‚≈À–
ª√–®ÿ‰øøÑ“‰¡à‡À¡“– ¡ °“√‰¡à≈–≈“¬πÈ” (hydropho- ‡™àπ cobalt, zinc, cadmium, ·≈– nickel ¬“
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bicity) ‡ªìπμâπ ªØ‘™’«π– ‡™à𠬓°≈ÿà¡ beta-lactam, ¬“°≈ÿà¡
°“√æ—≤π“¢Õß°“√¥◊ÈÕμàÕ¬“ªØ‘™’«π–¥â«¬°“√ fluoroquinolones, chloramphenical, erythromy-
‡√àß°√–∫«π°“√¢—∫ÕÕ°πÕ°‡´≈≈å (multidrug resis- cin, aminocoumarins ·≈– tetracycline ‡ªìπμâπ
tant pump; MDRp) ‡ªìπ°√–∫«π°“√ªÑÕß°—π “√‡§¡’∑’Ë„™â¶à“‡™◊ÈÕ ‡™àπ sodium dodecylsulfate ·≈–

‡´≈≈å¢Õß·∫§∑’‡√’¬ ‚¥¬°“√≈¥°“√ – ¡¢Õß “√ triclosan π—∫‡ªìπ°≈ÿà¡¢Õß MDRp ∑’ˉ¥â√—∫§«“¡
μâ“π·∫§∑’‡√’¬¿“¬„π‡´≈≈å °“√¢—∫¬“ÕÕ°πÕ°‡´≈≈å π„®»÷°…“«‘®—¬‡ªìπÕ¬à“ß¡“° ‡π◊ËÕß®“°‡ªìπ°≈‰°

„™âæ≈—ßß“π®“° ATP hydrolysis ·≈– ion gradi- À≈—°∑’Ë∑”„À⇰‘¥°“√¥◊ÈÕ¬“„π·∫§∑’‡√’¬·°√¡≈∫ (ß)
ent ‚¥¬ “¡“√∂·∫àß°≈ÿà¡¢Õß MDRp ÕÕ°‰¥â‡ªìπ 5 ATP-binding cassette family (ABC) ‡ªìπ°≈ÿà¡
42,43
°≈ÿà¡„À≠àÊ (√Ÿª∑’Ë 3°) §◊Õ (°) the major fa- ¢Õß MDRp ∑’Ë¡’§«“¡·μ°μà“ß®“°∑ÿ°°≈ÿà¡¢â“ßμâπ
cilitator superfamily (MFS) ‡ªìπ™àÕß∑“ßπ” ‡π◊ËÕß®“°°≈ÿà¡π’È„™âæ≈—ßß“π®“°°“√ ≈“¬ ATP „π

¢π àß “√∑’Ë¡’§«“¡À≈“°À≈“¬¡“° “¡“√∂¢π àß °“√¢—∫ “√À√◊Õ¬“ªØ‘™’«π–ÕÕ°®“°‡´≈≈å μ—«Õ¬à“ß∑’Ë
“√‰¥âÀ≈“¬°≈ÿà¡ ‡™àπ °√¥Õ–¡‘‚π πÈ”μ“≈™π‘¥μà“ßÊ ”§—≠„π°≈ÿà¡π’ȉ¥â·°à LmrA „π Lactococcus lactis
·≈–¬“ªØ‘™’«π–À≈“¬™π‘¥ MDRp ∑’Ë ”§—≠Ê ∑’ËÕ¬Ÿà ∑”Àπâ“∑’Ë¢—∫ ethidium bromide ·≈– daunomy-

„π°≈ÿà¡π’ȉ¥â·°à NorA ·≈– QacA ¢Õß S. aureus cin ‡ªìπμâπ (®) multidrug and toxic compound
´÷Ëß®–¢—∫ quaternary amine compounds, chlor- extrusion family (MATE) ‡ªìπ MDRp ªí®®ÿ∫—π
hexidine, fluoroquinolones ·≈– chloram- æ∫√“¬ß“π‡©æ“–„π·∫§∑’‡√’¬·°√¡≈∫ μ—«Õ¬à“߇™àπ