抗菌疗法的原则（英文PPT）Foundationsin .pptVIP

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Considerations in Selecting an Antimicrobial Drug Identify the microorganism causing the infection Test the microorganism’s susceptibility (sensitivity) to various drugs in vitro when indicated The overall medical condition of the patient * Identifying the Agent Identification of infectious agent should be attempted as soon as possible Specimens should be taken before antimicrobials are initiated * Testing for Drug Susceptibility Essential for groups of bacteria commonly showing resistance Kirby-Bauer disk diffusion test E-test diffusion test Dilution tests – minimum inhibitory concentration (MIC) – smallest concentration of drug that visibly inhibits growth Provide profile of drug sensitivity * * * * The MIC and Therapeutic Index In vitro activity of a drug is not always correlated with in vivo effect If therapy fails, a different drug, combination of drugs, or different administration must be considered Best to chose a drug with highest level of selectivity but lowest level toxicity – measured by therapeutic index – the ratio of the dose of the drug that is toxic to humans as compared to its minimum effective dose High index is desirable * * * * * * * * * * * * * * * * * * * * * * * Non Beta-lactam Cell Wall Inhibitors Vancomycin – narrow-spectrum, most effective in treatment of Staphylococcal infections in cases of penicillin and methicillin resistance or if patient is allergic to penicillin; toxic and hard to administer; restricted use Bacitracin – narrow-spectrum produced by a strain of Bacillus subtilis; used topically in ointment Isoniazid (INH) – works by interfering with mycolic acid synthesis; used to treat infections with Mycobacterium tuberculosis Antibiotics That Damage Bacterial Cell Membranes Polymixins, narrow-spectrum peptide antibiotics with a unique fatty acid component Treat drug resistant Pseudomonas aeruginosa and severe UTI * Drug