抗生素英文课件精品Antibiotics Principles and Illustrative .pptVIP

Antibiotics: Principles and Illustrative Cases Jake Nania, M.D. Pediatric Infectious Diseases February 2, 2006 Making wise antibiotic choices #1 Know what you’re targeting! Send appropriate diagnostic studies before antibiotics are started Empiric Rx based on likely organisms at suspected site of infection e.g. Bacterial Meningitis… READ UP and SEE MORE PATIENTS Adjust Rx based on info from the Micro Lab Gram Stain: should never narrow, only broaden Rx Culture and susceptibilities Making wise antibiotic choices #2 Pathogen-specific factors Know (or look up) susceptibility patterns for suspected organisms: Best: Hospital Antibiogram, Pt’s previous cultures Good: Regional Data (e.g.CDC) Okay: Published Series of Susceptibility Data (including the Sanford Guide) Least Helpful: The guy bringing breakfast to morning report Know agents likely active against bacteria for which susceptibilities are not usually done e.g. oral anaerobes… e.g. Mycoplasma pneumoniae… Making wise antibiotic choices #3 Host-specific factors How sick or vulnerable = how aggressive Previous antibiotic history and other risk factors for resistant organisms Renal and Hepatic Function, GI absorption Ensuring therapeutic levels Avoiding toxicity Previous Allergy or other adverse reactions Age Fluoroquinolones (FQ), if 18 years Erythromycin, if 2 weeks Making wise antibiotic choices #3 Host-specific factors (continued) Site of infection Meningitis: clindamycin, macrolides, 1st/2nd gen ceph, aminoglycosides (AG) not good choices Endocarditis: bacteriocidal agent(s) needed Abscesses: AG less active Biliary tract: PCNs, doxycycline, ceftriaxone, FQs have high excretion Bone: FQ, Clinda PCNs, Ceph, Vanc AG Bloodstream: Azithromycin tissue blood levels Making wise antibiotic choices Other important factors Toxicity (e.g. AG ? oto- and nephrotoxicity) Cost (someone is paying for it!) Ease of administration (frequency, palatability, parenteral vs. oral) Avoiding selection of resistance Narrowest spectrum a