抗生素(英文精品) Update on use of antibiotics in GP(66p)重点培训.pptVIP

How to assess the severity of patient with CAP? Severity assessment :adverse prognostic features “Core” clinical adverse prognostic factors (CRB-65/ CURB-65) Confusion (Urea: 7mmol/l) Respiratory rate 30/min BP: low BP (SBP 90mmHg and/or DBP 60mmHg) Age =/ 65 yo “Additional” clinical adverse prognostic factors Hypoxaemia (SaO2 92% or PaO2 8kpa) bilateral or multilobe involvement on the CXR Identifying those patients who can usually be safely treated at home CRB-65 score of 0 low risk of death and do not normally require hospitalisation for clinical reasons CRB-65 score of 1 or 2 at increased risk of death hospital referral and assessment should be considered, particularly with Score 2 CRB-65 score of 3 or more at high risk of death and require urgent hospital admission When deciding on home treatment, the patient’s social circumstances and wishes must be taken into account in all instances General management Patient with suspected CAP should be advised not to smoke, to rest and to drink plenty of fluids Pleuritic pain should be relieved using simple analgesia such as panadol Thos who fail to improved after 48h of treatment should be considered for hospital admission or CXR Antibiotic management Amoxicillin remains the preferred agent Macrolide as an alternative for hypersensitive to penicillin Combined oral therapy with amoxicillin and macrolide for patients who require hospital admission for clinical reasons When oral treatment is contraindicated: iv ampicillin or benzylpenicillin, together with erythromycin or clarithromycin Antibiotic management Oral monotherapy should be considered in the following circumstances: Amoxicillin monotherapy: Those previously untreated in the community Those admitted to hospital for non clinical reasons Macrolide monotherpay: may be suitable for patients who have failed to respond to an adequate course of amoxicillin prior to admission. Situation in Hong Kong high resistance rate of cotrimoxazole, erythromycin and tetr