【医学精品课件】抗生素正確使用原則.pptVIP

First Generation Cefazolin Cefadroxil Ceflexin Cephradine Streptococcus Staphylococcus (methicillin-susceptible) E. coli P. mirabilis K. pneumoniae Second Generation Cefmetazole Cefuroxime Cefalor Cefuroxime above the diaphragm: cefuroxime. below the diaphragm: cefmetazole (cephamycins, B. fragilis) Cefmatazole : ESBL-producing Enterobacteriaceae Third generation Cefoperazone Cefotaxime Ceftazidime Ceftriaxone Flumarin Cefixime Cefpodoxime ceftibuten Resistant Gram-negative microorganisms（Nosocomial infections） : Serratia, Citrobacter, Enterobacter, Pseudomonas, β-lactamase producing H. influenzae. Better BBB penetration among cephalosporins (except cefoperazone) Indication: nosocomial infections (mainly GNB), GNB meningitis Fourth Generation Cefepime Cefpirome Good anti-pseudomonal effect Good CNS penetration Preserve antimicrobial effect to G(+) bacteria Adverse effects of cephalosporins Cefamandole, cefmetazole, cefoperazone, cefotetan? vitamin K-dependent clotting factor metabolism Monobactam (Aztreonam) Only gram-negative aerobes Alternative in penicillin- and cephalosporin- allergic patients Sulfonamides and trimethoprim Inhibit folic acid metabolism Treatment of PCP, Nocardia, Toxaplasma, Sternotrophomonus Aderverse effect: cholestatic jaudice, bone marrow suppression, severe hypersensitivity (Stevens-Johnson syndrome) Carbapenem Group Classification Group 1 Broad-spectrum carbapenems, with limited activity against non-fermentative Gram-negative bacilli (NFGNB, e.g. Pseudomonas, Acinetobacter) , that are particularly suitable for community-acquired infections (e.g. ertapenem) Group 2 Broad-spectrum carbapenems, with activity against non- fermentative Gram-negative bacilli (e.g. Pseudomonas, Acinetobacter), that are particularly suitable for nosocomial infections (e.g. imipenem and meropen