抗生素(英文精品) Review of Antibiotics方案说明.pptVIP

CPIS Antibiotic Study: Trial Design CPIS≤6 Standard Therapy (antibiotics for 10-21 days) Experimental Therapy Ciprofloxacin for 3 days CPIS 6 Treat as pneumonia Singh N, et al. Am J Respir Crit Care Med. 2000;162:505-11. CPIS ≤6 Discontinue treatment CPIS calculated at 3 days 1 2 3 4 5 6 7 Next Back Review of Antibiotics Zagorka Popovski, Pharm.D. Clinical Pharmacist, Intensive Care Cephalosporins Gram + 1st Generation ?Ancef ?Keflex LESS IS MORE!!! Timing of pre op antibiotic is key POPOVSKI and TEOHSCCM 1993 SAN DIEGO CA REDUCTION OF POST-OP ANTIBIOTICS FROM 72 HR TO 48HR ADMINISTER PRE-OP ANTIBIOTIC IN OR WOUND INFECTION RATE REDUCED FROM 2% TO 0.6% Cephalosporins Gram - Gram - Coverage *3rd Generation Acinetobacter Serratia ?Ceftriaxone (CNS penetration, gram neg. alternative to amnioglycosides) ?Cefotaxime ?Ceftazidime ?Pseudomonas Aeruginosa *not for enterobacter Penicillins Penicillin Ampicillin Cloxacillin Amoxillin Oxacillin Nafcillin Methicillin ? Penicillins Coverage ?Ampicillin ?Enterococcus ?Amoxicillin ?Ecoli ?Klebsiella ?Proteus ?H. Flu Clavulin?=amoxicillin+clavulinic acid Antipseudomonal Penicillins Piperacillin (Pipracil) Piperacillin/Tazobactam (Tazocin) Ticarcillin (Ticar) Ticarcillin/Clavulante (Timentin) Gram +/- (including Pseudomonas a.) *anaerobic coverage + R R Penicillins Cloxacillin Oxacillin Nafcillin Methicillin Carbapenems Imipenem + Cilastatin (Primaxin) Meropenem (Merrem) Ertapenem (Invanz) Meropenem Very broad spectrum Gram negative including pseudomonas gram positive including staph and enterococcus Anaerobes Indicated for “high-severity” intra-abdominal infections Replaced imipenem//cilastatin at HHS 5 7 15 30 F A I L U R E A.P.A.C.H.E. Imipenem AA + AMG Christou Solomkin, 1990 (Intra-abdominal sepsis) Activity of Study Ag