抗生素英文课件精品Acute .pptVIP

Acute Pneumonia “The most widespread and fatal of all acute diseases, pneumonia is now Captain of the Men of Death.” The Principals and Practice of Medicine Sir William Oscar, 1901 Principles and Practice of Infectious Diseases Principals and Practice of Infectious Diseases Diagnosis of CAP Chest radiograph is the most important diagnostic tool Clinical presentation is not diagnostic of an etiology Yield of pathogens from Gram stain of expectorated sputum from patients with CAP is only 30%–40%. Diagnosis Chest Radiograph Gram Stain’s Role in CAP Diagnosis CAP Treatment Issues Causative pathogen frequently not found Treatment predominantly empiric Pneumococcal and atypical coverage important Increasing antibiotic resistance Clinical significance in question Use double-coverage for pneumococci? If outcomes are similar, which agent do we choose? CAP: Changing Presentation Aging of the population Increased number of nursing home beds Increased number of AIDS cases Increased number of organs transplanted Key Bacterial Pathogens in CAP The reported age-related mortality per 100,000 US population from pneumonia and influenza in individuals 15 yr, 1982-1990 ASCAP Guidelines for Outpatient Treatment of CAP Otherwise healthy patients (all ages) First-line Azithromycin PO Alternative first-line Moxifloxacin PO (preferred) or levofloxacin PO or clarithromycin PO or gatifloxacin PO Indications for Hospitalization Pulse 140, SBP 90 mm Hg, and/or respiratory rate 30/min Altered mental status Hypoxemia (PO? 60 mm Hg) Suppurative complication Metabolic abnormality ASCAP Guidelines for Inpatient Treatment of CAP Hospitalized, non-ICU First-line Ceftriaxone PLUS azithromycin IV Alternative first-line Moxifloxacin or levofloxacin IV or gatifloxacin ICU Patients First-line Ceftriaxone IV PLUS levofloxacin IV (±) aminoglycoside or ceftriaxone IV PLUS azithromycin IV (±) an antipseudomonal agent Alternative first-line Ciprofloxacin IV PLUS an aminoglycoside IV PLUS azithromy