斯沃在颅脑感染的应用ppt课件.ppt

* 11. The choice of treatment for resistant staphylococcal infections in special patient populations In considering the patient perspective in the choice of appropriate initial antibiotic therapy for the management of resistant staphylococcal infections, this slide uses a “traffic light” approach to weigh up the relative suitability of various antibiotics. Whilst the difference between red and green is usually reasonably clear-cut, and the choice between red and orange is rather more subjective, this approach allows an overview of the relative merits of the 4 antibiotics that may be used for the treatment of resistant staphylococcal infections. Organ dysfunction is a common issue in many patients with critical illness. The need to monitor drug levels or conduct regular laboratory tests to check organ function as a result of drug choice, or the need to calculate dosage reduction can be an added inconvenience in the management of patients with an already complex management programme. Vancomycin should be used with care in patients with renal insufficiency; the dose should be reduced, and serum levels and renal function tests monitored regularly.1 For teicoplanin, dosage reduction is recommended from the fourth day of treatment for patients with renal insufficiency2; caution is advised when using quinupristin and dalfopristin in these patients.3 For linezolid, however, no dose adjustment is required for patients with renal insufficiency.4 With regard to liver function, the use of quinupristin and dalfopristin is contraindicated in patients with severe hepatic impairment.3 ?In the elderly, dosage reduction of vancomycin may be necessary to a greater extent than expected due to decreased renal function.1 Regular monitoring of serum levels is advised, together with tests for auditory function.1 Elderly patients with renal insufficiency will require dosage reduction with teicoplanin.2 No dosage adjustment is required for the elderly with linezolid4 or quinupristin and da