抗菌药物的临床合理应用推荐.pptVIP

（二）用什么？ 选用恰当的抗菌药物： 熟悉致病菌的致病特点和耐药现状 熟悉抗菌药物的适应证、抗菌活性、药动学 和不良反应 根据病人的生理、病理及免疫状态选择用药 * （三）怎么用 1.选用恰当的给药方法： 给药途径： 剂量达有效范围 给药次数：剂量依赖性/时间依赖性 疗程：一般感染应在体温正常、症状消退3～4天时停药； 更换或调整用药指征：急性细菌感染用药48～72小时无明显疗效时再作考虑 * 2．正确认识药敏试验的价值 根据细菌学检查结果，结合临床选用或调整抗菌药物 如临床上治疗反应良好，不论培养和药敏试验结果如何，治疗方案原则上不变 3．重视综合性治疗措施 避免“重药轻人”的倾向 改善全身状况；稳定内环境；增强抵抗力； 处理局部病灶 * 目的：提高疗效，减低不良反应 治疗浓度与中毒浓度接近的药物： 万古霉素、氨基糖苷类等 特殊个体： 新生儿——氯霉素 肾功能减退者——氟胞嘧啶、SMZ等 4．血药浓度监测 * 联合应用抗菌药物的指征： 病因未明的严重感染 单一药物不能控制的严重感染 （败血症、细菌性心内膜炎、化脓性脑膜炎） 多种细菌引起的混合感染 （需氧菌+厌氧菌，G+球菌+G-杆菌） 二重感染（细菌+真菌） 需长期用药且细菌易产生耐药的感染（结核病） 以两联为宜，且相互间具协同或相加作用 * 细菌耐药性的控制策略 政府： 药房，畜牧业，宣传 医院： 加强细菌耐药性检测， 合理应用抗菌药物的培训和监督 实行抗菌药物的三线划分 限制某些抗菌药物的使用 药企： 加强抗菌新药的研制 * 谢 谢 ！ * * * Various antifungal agents target different parts of fungal cells as illustrated here. The antifungal agents in yellow are those currently approved by the FDA; those in white are in varying stages of development. The polyenes, amphotericin B, its lipid formulations, and nystatin interfere with membrane function. They are derived from Streptomyces species, are fungicidal, and have a broader range of action than other types of antifungal agents. They bind to membrane sterols causing increased membrane leakage and cell death. Those that are clinically useful have a higher affinity for ergosterol than for its mammalian equivalent, cholesterol, thereby limiting their toxicity in mammalian cells. Amphotericin B is the only polyene used to treat deep mycoses in severely immunocompromised patients, but its effectiveness is limited by its toxic side effects. Delivery of this agent in lipid formulations helps to reduce the toxicity. They can be used for patients unable to tolerate amphotericin B’s toxicity. The azole agents are synthetic compounds with a broad antifungal activity that encompasses more yeasts and filamentous fungi. Azoles are classified as imidazoles or triazoles, depending on whether the azole has 2 or 3 nitrogens in the 5-membered azole ring.