(精编)【医学精品课件之抗生素】上呼吸道感染抗生素使用原則教学课件.pptVIP

上呼吸道感染抗生素使用原則 小兒感染科 趙雁南醫師/ 邱南昌醫師,李聰明醫師 Antibiotic usage in primary care units in Taiwan (Chang SC et al Diag Micro Infect Dis 2001;40: 137-43) 1996 ~ 1999, collect prescriptions for 1 wk in March each year, sampled from 114~166 health stations with 40891 ~ 53992 physician-visits each year Antibiotic Tx in 13.4% of total visits Patients 11 y/o highest (38.2%) percentage Common cold most frequent (32%) diagnosis for antibiotic prescription Among patients with the Dx of common cold, antibiotic Tx in 31%, highest among 16 y/o (45.5%) Penicillin class 35%, cephalosporins 27%, macrolides 22%, others Six common diagnoses in which antibiotics were prescribed Chang SC et al Diag Micro Infect Dis 2001;40:137-43 Diagnosis No. of patients-visits with antibiotics prescribed % of total antibiotic prescriptions Common cold 13588 32.3 COPD or asthma 2408 5.7 Acute bronchitis 2127 5.1 Skin and soft tissue infections 1781 4.2 Acute tonsillitis 999 2.4 Cystitis 929 2.2 Guidelines for antimicrobial therapy of acute upper respiratory tract infection in Taiwan Seven acute URTI chosen: acute sinusitis, acute otitis media, acute pharyngotonsillitis, acute epiglotittis, acute bronchitis, common cold, influenza Principles of guidelines From the viewpoint of primary care physicians Antimicrobial agents suggested marketing in Taiwan Based on local epidemiologic data and antimicrobial resistant rate of pathogens Antimicrobial agents suggested mainly oral formulation Guidelines for antimicrobial therapy of acute URT in Taiwan 診　　斷 首　　選 另　　選 急性鼻竇炎 (Acute sinusitis) Amoxicillin (high dose) Ampicillin Amoxicillin/clavulanate Ampicillin/sulbactam 2o or 3o cephalosporins (oral) 急性中耳炎 (Acute otitis media) Amoxicillin (high dose) Ampicillin Amoxicillin/clavulanate Ampicillin/sulbactam 2o or 3o cephalosporins (oral) 急性咽扁桃腺炎 (Acute pharyngotonsillitis) Penicillin V Benzathine penicillin (IM) Clindamycin Macrolides 1o cephalosporins 急性支氣管炎(Acute bronchitis) --