Antibiotics and Neutropenia课件.ppt

Antibiotics and Neutropenia 報告者 : 呂俊德 2002/11/11 Definite 1.Neutropenia : ANC(absolute neutrophil count ) 500-1000/mm3 2.ANC1000/mm3 : susceptibility to infectious diseases increases . 3.ANC500 /mm3 : noraml microbial flora pathogen Causes of Neutropenia Decreased Production Peripheral Destruction Peripheral Pool Decreased Production Drug-induced-alkylating agents Hematologic diseases Tumor invasion Nutritional deficiency-vitamin B12, folate (especially alcoholics) Infection Periperal Destruction Antineutrophil antibodies and/or splenic or lung (alveolar macrophage) trapping Autoimmune disorders- Drugs as haptens- Wegeners granulomatosis Peripheral Pool Overwhelming bacterial infection (acute endotoxemia) Hemodialysis Cardiopulmonary bypass Common Antibiotics 1.Penicillin 2.Cephem 3.Monobactam 4.Carbapenem 5.Aminoglycoside 6.Fluoroquinolone 7.Macrolide 8.Glycopeptide 9.sulfa drug 10.others Penicillin 類抗生素 1.PENICILLIN 2.AMOXICILLIN/CLAVULANIC ACID (Augmentin) 3.TICARCILLIN/CLAVULANIC ACID (Timentin) 4.PIOERACILLIN/TAZOBACTAM (Tazocin)-6% 1.Penicillin G induced neutropenia 1.Incidence : rare 2.Onset : 20 million units daily for 2 week 3.Recover : within 3 days 4.Suggest : intensive monitoring of patients with SBE receiving high dose penicillin therapy 2.Augmentin ? induced neutropenia 1.Incidence : rare 2.Onset :1.5 g Augmentin daily for 45 days 3.Recover : within 6 days 4.Suggest : WBC monitor 3.Timentin? induced neutropenia 1.Incidence : rare 2.Onset : 9 days of treatment with 3.1 gram every 6 hours for pneumonia. 3.Recover : within 4 days 4.Suggest : monitor of WBC 4.Tazocin? induced neutropenia 1.Incidence : 6 % 2.Onset : 200 to 300 mg/kg piperacillin developed neutropenia 15-23 days 3.Recover : 3-8 days 4.Suggest : be careful used in child Cephem類抗生素 1. Cephalexin 2.Cefoxitin 3.Ceftriaxone,Cefoperazone 4.Cefep