抗菌药物的临床合理应用剖析.pptVIP

整合概念：优化抗菌治疗 Right Patient （有指征的病人） Right Antibiotic （合适的抗生素） Dose （剂量及其分配，即方案） Duration （疗程、包括开始时间） Miximal Clinical Outcome （尽可能好的临床结果） Minimal Resisitance （尽可能低的耐药） 2R+2D+2M 2RDM 抗菌药物干预治疗 替换使用 抗生素的循环使用 抗菌药物应用的多样化 (使用各种类别的抗生素作为一线治疗) 疗效 安全性 患者 副作用、附加损害 多种选择 ？ 选择抗生素的“安全性”考虑 抗菌新药研发周期10-12年 费用10亿美元 idea medicine 10 -12 years Basic research Pre-clinical and clinical development Phase I Phase II Phase III 0 15 5 10 Pre-clinical pharmacology Pre-clinical safety Testing and optimizing substances 1 - 2 products Clinical pharmacology and safety 100 research projects 耐药菌产生周期2年 细菌耐药性的控制策略 政府： 药房，畜牧业，宣传 医院： 加强细菌耐药性检测， 合理应用抗菌药物的培训和监督 实行抗菌药物的三线划分 限制某些抗菌药物的使用 药企： 加强抗菌新药的研制 预防药物耐药的12项措施 预防传播 合理应用抗菌药物 有效的诊断和治疗 预防感染 Campaign to Prevent Antimicrobial Resistance in Healthcare Settings 12 遏制医务工作者传播 11 隔离患者 9 严格掌握万古霉素应用指证 1 接种疫苗 2 拔除导管 6 专家会诊 7 治疗感染，而非污染 3 针对性病原治疗 8 治疗感染，而非寄殖 4 控制抗菌药物应用 5 应用当地资料 10 及时停用抗菌药物 谢 谢！ * * * * By some estimates, half of all hospitalized patients receive an antibiotic and 50% of antibiotic use may be inappropriate. The potential consequences of inappropriate us include toxicity, antimicrobial resistance, other HAI such as C. difficile colitis, increased morbidity and mortality, prolonged LOS, and increased costs. Antimicrobial resistance is no longer confined to the hospital. MRSA has recently emerged as an important cause of infections outside of hospitals. Community-acquired MRSA is now the leading cause of identifiable skin and soft tissue infections seen in U.S. emergency departments. Changes in antimicrobial use are paralleled by changes in the prevalence of antimicrobial resistance. Bacterial resistance will continue to worsen if this problem is not addressed. IN the past several years there have been some new compounds devel