Pre-ICU training (Antibiotics).ppt

Pre-ICU training (Antibiotics) 馬偕紀念醫院 感染科 郭建峯醫師 What organisms are most likely?何種致病菌是最可能造成此次感染的致病菌? 適當的經驗療法 臨床症候群(Clinical syndrome) 宿主因素(Host factor) 流行病學資料(Epidemiological data) If several antibiotics are available, which is best? (This question involves such factors as drugs of choice, pharmacokinetics, toxicology, cost, narrowness of spectrum, and bactericidal compared with bacteriostatic agents.) 對於一個最可能的致病菌，或是已確定的致病菌，可能有多種藥物可用來治療，何者才是最佳的選擇藥物? Staphylococcus aureus: Antibiotics Methocillin-sensitive S. aureus (MSSA): 首選藥物: oxacillin 替代藥物:第一代頭孢菌素 假如 penicillin allergic - Erythromycin, Clindamycin, Glycopeptide (Vancomycin, Teicoplanin) Methocillin-resistant S. aureus (MRSA) : 首選藥物:Glycopeptide (Vancomycin, Teicoplanin) 替代藥物: Linezolid Fusidic acid Rifampicin Treatment of S. pneumoniae Pneumonia Penicillin MIC (?g/ml) primary alternative ?1 penicillin 1st cephalosporins (S) ampicillin or amoxicillin 2 penicillin (high dose) 3rd or 4th cephalosporins (I) ampicillin or amoxicillin ?4 3rd or 4th cephalosporins vancomycin or teicoplanin (R) vancomycin or teicoplanin + rifampin or newer fluoroquinolones The infectious diseases society R.O.C. 2000 Treatment of Pneumococcal Meningitis MIC (?g/ml) dosage PCN CTX therapy adults children (/kg) 0.12 ?0.5 penicillin 300,000 u/kg/d 3-400,000 u q4-6h ?0.12 ?0.5 Cefotaxime or 2 g q6h 200-225 mg q6-8h Ceftriaxone 2 g q12h 100 mg q12-24h 1.0 Cefotaxime or 300 mg/kg/d (m.24g) 300 mg q6-8h Ceftriaxone 2 g q12h 100 mg q12-24h +Vancomycin 60 mg/kg/d (M.2g) 60 mg q6h ?2.0 Same as 1.0 + Rifampin 300 mg q12h 20 mg q12h Kaplan SL and mason EO jr. Clin microbiol rev 1998 Streptococcus pneumoniae 依CNS Infection和Non- CNS