抗生素概论Review in .pptVIP

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 plus: 1st Generation ?Ecoli ?Ancef ?Proteus ?Keflex ?Klebsiella Cephalosporins Gram + 1st Generation 2nd Generation ?Ancef ?Cefuroxime ?Keflex ?Cefamandole ?Cefotetan +/- anaerobe ?Cefoxitin Cephalosporins Gram + Gram - 1st Generation 2nd Generation 3rd Generation ?Ancef ?Cefuroxime ?Ceftriaxone ?Keflex ?Cefamandole ?Cefotaxime ?Cefotetan ?Ceftazidime ?Cefoxitin 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 + 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 Activity of Study Agents Agains