抗生素处方（英文PPT）Antibiotic.pptVIP

Antibiotic Prescribing Dr John Ferguson (ID Physician) Dr Robert Pickles (ID Physician) Kelly Cairns (ID Pharmacist) Today’s presentation The AIR program Ceftriaxone briefly Aminoglycosides Vancomycin Surgical Prophylaxis Card AIR Program - JHH Anti-Infective Registrations (AIR) Resistance Pathogens (eg C. difficile) Safety (eg. IV clindamycin) Cost Only 24 hours supply if not registered Reviewed by ID pharmacist daily and at ID meeting weekly “Registration” not “Approval” system Restricted Anti-infectives Require registration number at JHH: Aztreonam Cefepime Cefotaxime Ceftazidime Ceftriaxone Clindamycin IV Ticarcillin/clavulanate Vancomycin IV Requires direct approval from Infectious Diseases: Caspofungin Ciprofloxacin IV Flucytosine Linezolid Liposomal amphotericin Meropenem (except CF) Moxifloxacin Posaconazole Teicoplanin (except cardiac Surg) Tigecycline Voriconazole Restricted antibiotic indications See Sheet (available via AIR link) Note dosages Where in doubt, please contact ID Registrar, ID Physician or Clinical Microbiologist Ceftriaxone A few reminders: Ceftriaxone is not recommended as an empiric agent (excluding bacterial meningitis) Most adults only require ceftriaxone 1g daily (excluding bacterial meningitis) Aminoglycosides Gentamicin Tobramycin Amikacin Aminoglycosides Mechanisms of action: Outer cell membrane disruption Inhibit protein synthesis (binding to ribosome) Rapidly bactericidal: main value is as empiric agents (1 or 2 doses) for potential aerobic Gram negative sepsis Synergistic action with cell wall active agents such as beta-lactams Esp. of use for streptococcal and enterococcal endocarditis Poorly absorbed from the gastrointestinal tract Dosing Once daily dosing - suitable for most indications Exceptions include: Enterococcal and some streptococcal endocarditis Patients with altered volume of distribution (eg. burns, ascites, post-partum) Recommended gentamicin and tobramycin starting doses: