抗生素英文课件精品AntibioticUpdate .pptVIP

Antibiotic Update2009 Michael S. Bronze, MD Professor and Chair Department of Medicine, OUHSC Objectives To briefly review some of the current issues with antibiotics To discuss several newer agents To discuss several clinical situations in which newer agents may have an expanding role I have no conflicts of interest to report! Challenges in Antibiotic Design Drug No. Rx Worldwide World-wide Sales (Rx; 000s) (USD; 000s) Amox/clav 136,000 1,971,927 Cipro 80,217 877,718 Clarithro 74,689 1,495,006 Azithro 66,061 2,002,082 Levo 41,484 1,555,325 Cefuroxime 15,552 343,177 Coates and Hu, Drug RD, 2006 Challenges in Antibiotic Design “Hospital surveys indicate that: 1:3 patients receive at least one anti-infective during their hospital stay Nearly 25% of all adverse drug reactions are due to anti-infective drugs” Stein, GE. Clin Infect Dis, 2005 Challenges in Antibiotic Design Despite large sales volumes and dollars, many companies have withdrawn from development of new antibiotics. Reasons include Not considered profitable enough Fear of liability and litigation Growing world-wide antibiotic resistance MRSA, glycopeptide resistant SA (GISA, GRSA) ESBL-producing GNR (Klebsiella, E. coli) Acinetobacter, Pseudomonas VRE Coates and Hu, Drug RD, 2006 Challenges in Antibiotic Design:Newer Drugs Class Agent Phase Indications Lipopeptide daptomycin marketed cSSSI Oxazolidinone linezolid marketed RTI, cSSSI, VRE,BSI Glycopeptides televancin phase 3 cSSSI, HAP Glycylcycline tigecycline marketed cSSSI, CAP, HAP VRE, UTI Carbapenem doripenem phase 3 HAP, VAP, UTI Cephalosporin ceftibiprole, phase 3 CAP, cSSSI ceftaroline invest cSSSI Ceftobiprole Novel cephalosporin, bactericidal Acts thru PBP2A’(2a) Stable against Class A non-ESBL and inducible Class C β-lactamases, bactericidal Active against Gram Positives- MSSA, MRSA, E. faecalis, PSRP, VRE Gram Negative Rods-comparable to cefepime, ceftaz, pip/tazo