[临床医学]抗菌药物临床合理使用WXD20110316-1远程.ppt

不合理使用原因 不合理原因 病例数 百分率 围术期预防使用 10 52.6% 超适应症使用 4 21.1％ 细菌对同类药耐药 3 15.8％ 无感染出院带药 2 10.5% 氟喹诺酮类药使用合理性PDCA 预　祝 贵院在等级医院审评中 取得理想成绩！！ 王选锭 答案就在于MDR，也就是非发酵菌产生了多重耐药。 * * * For drugs where the kill rate is highly dependent on concentration, such as HMR 3647 and azithromycin, AUC/MIC is generally considered the best predictor of efficacy. For b-lactam antibiotics and the macrolides erythromycin and clarithromycin, the kill rate is not highly concentration-dependent, and so time over MIC is the best predictor of in vivo efficacy. For b-lactams, animal and clinical studies show that outcome depends on time above MIC. For maximum activity, time above MIC must exceed 40%, 50% and 67% for carbapenems, penicillins and cephalosporins, respectively. This is also the PK / PD variable most closely linked to outcome for erythromycin and clarithromycin (Drusano and Craig. 1997). Where the bacterial kill rate is very dependent on drug concentration, the AUC/MIC tends to be closely linked to outcome. This is the case for both HMR 3647 and azithromycin (Drusano and Craig.1997; Vesga et al. 1997). Since both these agents concentrate in phagocytes, the presence of neutrophils substantially reduces the dose required for survival in animal models. Interestingly, peak concentration/MIC is linked to outcome for fluoroquinolones in both animal models and clinical studies. This finding is explained by the fact that a peak concentration 10 x MIC is sufficient to kill the small number of resistant organisms that occur by spontaneous mutation of Gyr A (at a frequency of 10-8–10-9. When the peak concentration is 10 x MIC, AUC/MIC is the PK / PD variable that best predicts outcome with fluoroquinolones. Drusano and Craig. J Chemother 1997;9(suppl 3):38–44. Drusano et al. Clin Microbiol Infect 1998;4(suppl 2):S27–41 Vesga et al. 37th ICAAC 1997 * ? 青霉素类 ? 头孢菌素类 ? 非典型β-内酰胺类 头孢美唑、安曲南、亚胺培南、美罗培南、拉氧头孢、氟氧头孢 β-内酰胺类抗生素的分类 类 别 主要品种 青霉烷类 青霉素类、舒巴坦、他唑巴坦 头孢烯类 第一、二、三、四代头孢菌素 青霉烯类 Faropenem