抗生素PPT课件(英文精品)-Review-of-Antibiotics.ppt

1、抗生素PPT课件(英文精品)-Review-of-Antibiotics Gram+1st GenerationAncefKeflex lTiming of pre op antibiotic is key Gram+1st Generation2nd Generation AncefCefuroxime Keflex CefamandoleCefotetan+/-anaerobeCefoxitinH Flu Gram+Gram-1st Generation2nd Generation3rd GenerationAncefCefuroximeCeftriaxoneKeflex Cefamand

2、oleCefotaximeCefotetanCeftazidimeCefoxitin Gram-Gram-Coverage*3rd GenerationAcinetobacterSerratia Ceftriaxone(CNS penetration,gram neg.alternative to amnioglycosides)CefotaximeCeftazidimePseudomonas Aeruginosa*not for enterobacter Penicillin AmpicillinCloxacillin AmoxillinOxacillinNafcillinMethicill

3、in CoverageAmpicillinEnterococcusAmoxicillinEcoliKlebsiellaProteusH.Flu Clavulin=amoxicillin+clavulinic acidlPiperacillin(Pipracil)lPiperacillin/Tazobactam(Tazocin)lTicarcillin(Ticar)lTicarcillin/Clavulante(Timentin)Gram+/-(including Pseudomonas a.)*anaerobic coverage+RRlCloxacillinlOxacillinlNafcil

4、linlMethicillinlImipenem+Cilastatin(Primaxin)lMeropenem(Merrem)lErtapenem(Invanz)lVery broad spectrumlGram negative including pseudomonasl gram positive including staph and enterococcus lAnaerobeslIndicated for“high-severity”intra-abdominal infectionslReplaced imipenem/cilastatin at HHS 5 7 15 30 FA

5、ILUREA.P.A.C.H.E.ImipenemAA+AMGChristou&Solomkin,1990(Intra-abdominal sepsis)BacteriaTobramycinMICImipenemMIC90Resistant90ResistantE.ColiEnterobacterKlebsiellaProteusPseudomonas a.Citrobacter sp.Other Gram Negative BreakpointTobramycin 4 Imipeneim 44.01.01.01.04.016.02.050001200.251.01.04.02.00.54.0

6、0001000BacteriaClindamycinMICImipenemMIC90Resistant90Resistant.FragilisBacteroides sp.Clostridia sp.EnterococciBreakpintClindamycin 2 Imipenem 416.016.04.0-?4-0.500.502.04.00000lTraumatic and iatrogenic enteric perfn operated on within 12hlGastroduodenal perfn operated on within 24hlAcute/gangrenous

7、 appendicitis without perfnlAcute/gangrenous cholecyswtitis without perfnlTransmural bowel necrosis from embolic,thrombotic or obsstructive vascular occlusion without perfn or established peritonitis or abcesslNalidixic acid(NegGram)lCiprofloxacin(Cipro)lNorfloxacin(Noroxin)lLevofloxacin(Levaquin)lG

8、atifloxacin(Tequin)lMoxifloxacin(Avelox)lCiprofloxacin(Cipro)-Ps.a.lNorfloxacin(Noroxin)lLevofloxacin(Levaquin)lGatifloxacin(Tequin)lMoxifloxacin(Avelox)CAPStrep.+other gram neg atypicalslAdvantages(Bioavailability,IV/PO,tissue penetration)lDrug Interactions(Calcium,Iron,Magnesium)(Theophylline,Meth

9、ylxanthines)lSide EffectslGentamicin lTobramycinlAmikacinAminoglycosides MIC Serratia(Pseudomonas a.)Gentamicin .5 2Tobramycin2.5lVancomycinlLinezolidlSeptra PRINCIPLES:lFor empiric therapy,reassess at day 4,consult IDlNarrow spectrum when bacteria identifiedlConvert to oral therapy when possiblelCl

10、inical Pulmonary Infection Score(CPIS)lTakes into account temperature,wbc,secretions,ventilation,xrayl6(bronch and treat with 8 dayslBENEFITS:lReduced use of broad spectrum agentslReduced resistancelReduced LOSlReduced fungal infectionslReduced costs$200,000Pugin J.Am Rev Respir Dis.1991;143:1121-9.

11、Pugin J.Minerva Anestesiol.2002;68(4):261-5.1 12 23 34 45 56 67 7lInclusion Criteria:Clinical Pulmonary infection score(CPIS)6Ventilated or non-ventilatedlExclusion Criteria:Infected with HIV18 years of ageSingh N,et al.Am J Respir Crit Care Med.2000;162:505-511.1 12 23 34 45 56 67 7Singh N,et al.Am

12、 J Respir Crit Care Med.2000;162:505-11.CPIS calculated at 3 days1 12 23 34 45 56 67 7Experimental Therapy (n=39)Standard Therapy (n=42)p ValueDeaths at 3 days0%(0/39)7%(3/42)NSCPIS 6 at 3 days21%(8/39)23%(9/39)NSExtrapulmonary infections18%(7/39)15%(6/39)NSAntibiotic continuation 3 days28%(11/39)97

13、%(38/39)0.0001lData for patients with entry CPIS 6 subject to standard and experimental therapySingh N,et al.Am J Respir Crit Care Med.2000;162:505-511.1 12 23 34 45 56 67 7Experimental Therapy (n=39)Standard Therapy (n=42)p ValueAntibiotic continuation 3 days0%(0/25)96%(24/25)0.0001Mean duration of

14、 antibiotics,day39.80.0001Mean cost$259$6400.0001lData for patients with CPIS 6 at the 3-day evaluation point and no extrapulmonary infectionsSingh N,et al.Am J Respir Crit Care Med.2000;162:505-511.1 12 23 34 45 56 67 7lProlonged(i.e.3 days)use of antibiotics in patients with an initial CPIS 6 may

15、be unnecessary and inappropriateSingh N,et al.Am J Respir Crit Care Med.2000;162:505-511.1 12 23 34 45 56 67 7lRISK FACTORSlTPNlSteroidslBroad spectrum antibioticslAbdominal involvementlImmunosuppressionlPolyenes:Amphotericin B(binds to sterols and disrupts barrier resulting in leakage of intracellu

16、lar contentslFor hemodynamically unstable,systemic infectionslAdverse effects may limit treatmentlAzoles:Fluconazole,voriconazole,itraconazole(inhibit p450-mediated 14-alpha demethylase in the sterol)lGood activity vs C.albicans,resistance to Krusei,GlabratalNumerous drug interactionslEchinocandins:Caspofungen(inhibit fungal cell wall synthesis)lActive against C.albicans,krusei,glabratalcost