抗生素的选择（英文）ANTIBIOTICS .pptVIP

ANTIBIOTICS Selection of Antibiotics Identification of Infecting organism Empirical treatment Prior to Identification of Organism 1.The Acutely Ill patient 2. Selecting a Drug C.Determining the Antimicrobial Susceptibility of the Organism Bacteriostatic vs Bacteriocidal MIC MBC D. Effect of Site of Infection on Therapy: Blood Brain Barrier Lipid solubility of drug Mol wt Protein Binding E. Patient Factors Immune system Renal dysfunction Hepatic dysfunction Poor perfusion Age Pregnancy Lactation F. Drug Safety G. Cost of therapy SITES OF MICROBIAL ACTION DRUG RESISTENCE 1.Genetic alteration Spontaneous mutation DNA transfer of drug resistence 2. Altered expression of proteins in drug resistant organisms Modification of target sites Decreased accumulation Enzyme inactivation PROPHYLACTIC ANTIBIOTICS Rheumatic heart disease Dental work in pts with valves, prosthesis TB Surgery Pregnant mother - zidovudine COMPLICATIONS OPF ANTIBIOTIC THERAPY Hypersensitivity Direct toxicity Superinfections Inhibitors of Cell Wall Synthesis PENICILLIN PENICILLIN G Extended Penicillins ORAL - Amoxycillin IV -Ampicillin Wider range Broken down by penicillinase Combined with penicillinanse (BETA LACTAMASE) inhibitors - Clavulanic acid Sulbactam Tazobactam Augmentin- Amoxy+sulbactam Anti Staphylococcal Penicillins Oral Not inactivated by penicillinases (BETA LACTAMASE)? Cloxacillin Dicloxacillin Flucloxacillin ADVERSE EFFECTS OF PENICILLINS CEPHALOSPORINS OTHER BETA LACTAM ANTIBIOTICS-CARBAPENEMS MONOBACTAMS OTHER CELL WALL INHIBITORS- VANCOMYCIN SIDE-EFFECTS * The selection of antibiotic therapy for an infection requires a knowledge of: 1The infecting organism, including the pathogen most likely to be present in given clinical or geographical circumstances 2The local patterns of antimicrobial resistance in common pathogens 3 An understanding of the pharmacokinetics of the antimicrobials selected 4 The physiology of the patient, metabolic upset, renal or hepa