抗生素与SFGH（英文PPT）Antibioticsat .pptVIP

Antibiotics at SFGH Clinical Pearls Treatment Recommendations Important Contacts and Info ID Fellow Pager 443-BUGS (ext 4114) Page for ID consults (and approval of restricted antimicrobials-weekends only) ID Pharmacist Pager 443-IDRX (ext 5574) Page for antibiotic questions and approval of restricted antimicrobials (weekdays only) UCSF/SFGH/VASF ID Website WWW.UCSF.EDU/IDMP Empiric treatment, Antibiotic Dosing, ID References Overview Beta-lactams Penicillins Cephalosporins Carbapenems Monobactams Fluoroquinolones Ciprofloxacin, Levofloxacin, etc. Glycopeptides Vancomycin Pneumonia CAP HAP/VAP S. aureus infections Bacteremia and Endocarditis Skin and soft tissue infections Osteomyelitis Beta-lactam antibiotics Beta-lactams: Overview Mechanism of action: inhibit transpeptidases (PBPs) responsible for cell wall synthesis Time-dependent, bactericidal activity versus most pathogens Spectrum of activity determined by: Affinity for target PBPs Ability to penetrate through porins in the gram-negative cell wall Stability to beta-lactamase degradation (carbapenemscephalosporinspenicillins) Penicillin generations Natural and anti-staphylococcal penicillins penicillin G V, nafcillin, oxacillin limited spectrum, mostly Gram-positive Aminopenicillins ampicillin, amoxicillin broader spectrum, some enteric Gram-negatives Carboxypenicillins carbenicillin, ticarcillin Activity against nosocomial Gram-negatives Ureidopenicillins piperacillin, mezlocillin Improved activity versus Pseudomonas Natural Penicillins Penicillin G V- use limited due to acquired resistance in S. aureus however they are active against: Beta-hemolytic streptococcus including Group A strep S. pneumoniae Viridans Strep (resistance effects empiric treatment of meningitis and endocarditis) Meningococcus Anaeobes: Clostridium, Peptostreptococcus, Actinomyces T.pallidum Commonly used penicillins Anti-staphylococcal penicillins Nafcillin, Oxacillin, Dicloxacillin Used almost exclusively for th