抗菌药(Clinical_Uses_of_AntimicrobialAgents——方三华.pptVIP

Empiric Therapy Vast majority of all antimicrobial therapy Should be approached rationally Syndrome Likely pathogens Known resistance patterns Host factors Identification of Infecting Organism Staining of clinical specimens Gram stain, Acid-fast stain, silver stains… Antigen detection (e.g. ELISA) Nucleic acid detection (e.g. PCR) Culture methods Obtain culture material prior to antimicrobial therapy, if possible Bactericidal vs Bacterostatic Host Factors Site of infection Adequate concentrations of antimicrobials must be delivered to the site of infection Local concentrations greater than MIC Excretion Urine Aminoglycosides, fluoroquinolones Bile Ceftriaxone(头孢曲松) Penetration into various sites Central nervous system Lung Bone Host Factors Age Gastric acidity low in young children and elderly Renal, hepatic function vary with age Dose adjustment for creatinine clearance and hepatic dysfunction is critical to avoid toxicities Developing bone and teeth Tetracyclines stain teeth Quinolones may impair bone and cartilage growth Host Factors Genetic and metabolic abnormalities Isoniazid acetylation varies greatly G-6-PD deficiency and risk of hemolysis Sulfonamides, nitrofurantoin Pregnancy Teratogenicity and other toxicity to the fetus Other toxic reactions (lactic acidosis, pancreatitis) Excretion in breast milk Immunocompromise Resistance Patterns Antibiograms Local patterns of susceptibility Hospital, state, country Two is better than one? Empiric therapy Polymicrobial infection Increase efficacy--synergism Prevent emergence of resistance Combination therapy Mycobacterium tuberculosis HIV Pseudomonas aeruginosa ? Invasive aspergillosis （侵入性曲霉菌病） * Clinical Uses of Antimicrobial Agents San-Hua Fang, PhD 方三华 Dept. of Pharmacology, School of Medicine, Zhejiang University fshfbzxhq@zju.edu.cn 1. Formulating a pathogenic diagnosis early, which depends on clinical diagnosis, mi