希刻劳抗感染创新.pptVIP

希刻劳在感染性疾病中的临床应用 天津市第一中心医院 杨文杰 WHO于90年代的统计资料表明，感染仍是人类健康的主要杀手，占世界人口死因的32.7%，其中急性呼吸道感染（主要是肺炎）列居诸感染之首，年发病率为2-16/1000人。 轻中症感染的合理用药 覆盖可能的病原、早期开始 宿主因素：基础疾病、免疫状态、 既往用药 (评估病原、调整药物、剂量) 药物因素：组织浓度、安全性、依从性(PK/PD) 适当的抗菌素疗程 门诊治疗的轻、中度患者不必行病原学检查，只有当初始经验性治疗无效时才进行。 CLSI文件提示：阿莫西林/棒酸、头孢克罗、头孢丙烯、阿奇霉素等口服制剂可用于社区呼吸道感染的经验用药而不需每个病人都做药敏，只在流行病研究时进行药敏试验 观念误区 以过强的广谱抗菌药治疗轻度感染 Third-generation cephalosporin was associated with the increased occurrence of K. pneumoniae producing ESBLs 哌拉西林他唑巴坦增加耐药铜绿假单胞菌比例 常见社区获得性呼吸道感染病原菌菌种分布 　卫生部2009 38号文件 （一）对主要目标细菌耐药率超过30%的抗菌药物，应及时将预警信息通报本机构医务人员。（二）对主要目标细菌耐药率超过40%的抗菌药物，应慎重经验用药。（三）对主要目标细菌耐药率超过50%的抗菌药物，应参照药敏试验结果选用。（四）对主要目标细菌耐药率超过75%的抗菌药物，应暂停该类抗菌药物的临床应用，根据追踪细菌耐药监测结果，再决定是否恢复其临床应用 口服抗菌药对肺炎链球菌的抗菌活性 口服抗菌药对流感嗜血杆菌的抗菌活性 口服抗菌药对呼吸道感染其它常见菌的抗菌活性 我国PNSSP发生率(CHINET) 对厌氧菌的抗菌活性 Although the majority of Fusobacterium strains were resistant to erythromycin,azithromycin, and telithromycin, but cefaclor, cefuroxime, penicillin, cefdinir, and minocycline demonstrated a high level ofantimicrobial activity. P. micros and Porphyromonas species exhibited high susceptibility to all antibiotics tested in this study. Susceptibility of Prevotella strains to cefaclor, cefuroxime, penicillin, cefdinir, erythromycin, azithromycin, and minocycline was found to correlate with amoxicillin susceptibility. 希刻劳被对机体免疫反应的影响 希刻劳体内增效抗菌特性 头孢克罗体内增效抗菌活性 希刻劳临床疗效  多中心，随机单盲研究  (与头孢地尼比较) The cure rate of cefdinir and cefaclor was 84.8% and 77.4% respectively and the overall efficacy rate was 93.9% and 87.1%. The bacterial eradication rates of the two groups were 80.7% and 88%. The adverse drug reaction rate were 3% in cefdinir group and 6.5% in cefaclor group. There was no statistical significant difference between the two groups for the above results (P 0.05). The time of given medicine of cefdinir and cefaclor was (10.8 +/- 1.6) d and (12.1 +/- 1.7) d (P 0.01) . 临床总有效率 小 结 头孢克洛对常见社区获得性感染主要致病菌抗菌活性高 具有免疫调节作用 对轻中度呼吸道、泌尿道、皮肤软组织感 染临床疗效肯定