孙钢-抗菌药物的合理应用.pptVIP

* 5 Professor Dagan will end his presentation by commenting that antibiotics should treat the whole patient, ie they should exert a positive influence at the site of infection and on the flora in the nasopharynx 规范的给药方式意味着足够的抗生素治疗，保证TMIC40-50%, 假如某种细菌感染了宿主，黄色的代表MIC值低的敏感菌，绿色的代表MIC值较高的耐药菌，规范的给药方式导致细菌学清除。细菌学清除意味着： 97% 临床治愈 临床感染的症状与体症迅速消退 防止耐药菌的传播 * * 照读幻灯片 * Professor Dagan will end his presentation by commenting that antibiotics should treat the whole patient, ie they should exert a positive influence at the site of infection and on the flora in the nasopharynx 不规范的给药方式意味着不足量的抗生素治疗，TMIC30-40%, 假如某种细菌感染了宿主，黄色的代表MIC值低的敏感菌，绿色的代表MIC值较高的耐药菌，不规范的给药方式导致敏感菌被清除，耐药菌持续存在并传播。 细菌学治疗失败： 63% 临床治愈 临床的症状与体症消退缓慢 临床治疗失败的危险性 增加临床并发症的危险 耐药菌的产生 耐药菌的传播 虽然有部分的病人也能临床治愈，但是临床治愈并不等于细菌学治愈，这些病人很可能是耐药菌的携带者。 * 强调对医生利益的损害。 照读幻灯片。 * 抗生素按杀菌活性可分成二类： 时间依赖型 浓度依赖型 * 时间依赖型的抗生素主要的一大类就是b -内酰胺类 (青霉素类、头孢菌素、氨曲南、碳烯类)，克林和大环(红、克、阿奇)、四环、链、万古，是目前临床上应用最多的一些抗生素 它有以下特点： 持续后效应-无或轻、中度 在MIC4-5倍时杀菌率即处于饱和 杀菌范围主要依赖于接触时间 血药浓度超过MIC时间是与临床疗效相关的主要参数 * 浓度依赖型的抗生素包括氨基糖苷类和喹诺酮类，甲硝唑 它有以下几个特点 投药目标达到最大药物接触，药物浓度越高，杀菌率及杀菌范围也越大 24小时AUC（浓度时间曲线下面积）/MIC、峰浓度/MIC是疗效相关的主要参数 * This slide represents key factors involved in antimicrobial therapy. Once the dose is administered, pharmacokinetic parameters then describe what happens to the drug once it enters the body. Absorption from the GI tract is essential for oral therapy. Once in the blood stream critical factors for success include distribution of the drug into the infected tissues. How long a drug remains in the blood stream is determined by half-life (metabolism or excretion) The distribution and metabolism of the drug can have an impact on safety (hepatic metabolites) or efficacy (urine excretion unchanged for UTI). The degree of protein binding can impact the microbiologic activity Pharmacodynamics represents the relationship between the pharmacologic activity (MIC) and pharmacokinetics (AUC or peak concentrations). The pharmacologic activity of an antibiotic can be defined by whet