如何充分发挥“抗菌药物应用指南”在指导临床合理用药中的价值教案.pptVIP

* Dr.HU Bijie * 谢谢大家 Thank you * * 1Comorbidities: COPD, ESRD, liver disease, RR30/min, SBP90mmHg, DBP60mmHg, PaO260mmHg or PaCO250mmHg 2If beta-lactam allergy: azithromycin 500mg IV q 24 hr; switch to oral therapy within 48 hours 3Review susceptibilities-S. pneumoniae resistance ranges from 2.4-6% 4Should switch to oral therapy once clinical improvement occurs 5If P. aeruginosa a consideration (ANC500/mcl or resident of chronic care facility), add tobramycin * 1Can switch to oral therapy once clinical improvement occurs 2If penicillin allergy use clindamycin or trimethoprim/sulfamethoxazole; if MRSA-use vancomycin 3Review susceptibilities-S. pneumoniae resistance ranges from 2.4-6% 4Substitute levofloxacin if gram negative bacilli are seen on Gram stain or if P. aeruginosa suspected. 5If multiresistant microorganism, consider aerosolized tobramycin * * The optimal method has not been determined. Publication in medical journals, especially general medical journals, has, to date, been the most commonly used strategy, but is regarded as a poor means of disseminating guidelines with a low likelihood of implementation.23 Direct mailing to relevant practitioners is seen as a more effective measure, but is still of limited efficacy, levels of awareness rarely increasing to 40%.7,24 The impact of this intervention can be enhanced by making the guidelines visually attractive and/or by staging their delivery in manageable ‘chunks’ of information.25,26 In general, however, the ability of passive methods such as written communications to achieve even a temporary change in behaviour is questionable. Grimshaw Russell23 claimed that the more overtly educational the dissemination strategy the greater the likelihood that guidelines will be adopted and the more lasting their impact, provided that dissemination is linked to an effective implementation strategy. * Dr.HU Bijie * 社区获得性呼吸道感染的常见病原体 肺炎链球菌 流感嗜血杆菌 卡他莫拉菌 军团菌 肺炎衣原体 肺炎支原体 病毒 金葡菌 革兰阴性杆菌 * Dr.HU Bijie * University of Pennsyl