抗生素简介演示教学.ppt

1st generation Nalidixic acid, Cinoxacin Enterobacteriaceae: E. coli, K. pneumonia. P. mirabilis 易產生抗藥性 用於單純下泌尿道感染 Negacid(500mg) 1-2#bid-qid 2nd generation Norfloxacin, ciprofloxacin, ofloxacin 抗菌範圍 G(-) bacilli, 包括P. aeruginosa Some G(+): S. aureus Mycoplasma, Rickettesia, Mycobacterium, Legionella Norfloxacin UTI, acute prostatitis, travel diarrhea Less anti-pseudomonas effect Baccidial(100mg) 2# bid Ciprofloxacin 對P. aeruginosa效力最強的Quinolone For osteomyelitis, UTI, Pneumonia 200-400mg q12hrs 2#-3# bid po (1#=250mg) 空腹服用 3rd generation Levofloxacin, sparfloxacin, gatifloxacin 加強對Gram(+)的作用，尤其是S. pneumoniae Levofloxacin Oflxacin的新一代產品 Cravit(100mg):5#QD 4th generation Moxifloxacin, Trovafloxacin Moxifloxcin Pathogen Avelox MIC 90 (mg/l) Gram positives Streptococcus pneumoniae (penicillin-sensitive) 0.06 Streptococcus pneumoniae (penicillin-resistant) 0.12 Streptococcus aureus (methicillin-sensitive) 0.12 Gram negatives Haemophilus influwnzae(beta-lactamase-negative) 0.03 Haemophilus influwnzae(beta-lactamase-positive) 0.06 Moraxella catarrhalis 0.12 Moxifloxcin ? Pathogen Avelox MIC 90 (mg/l) Atypicals Mycoplasma pneumoniae 0.06-0.12 Legionella neumoniae 0.015 Chlamydia neumoniae 0.03-1 Moxifloxcin 健保規定 　 1. 現用於成人(十八歲以上)之慢性支氣管炎的急性惡化或社區性肺炎。　 2. 每日限使用一粒(400mg)，使用期間以不超過十天為原則。 Side effects Gastrointestinal symptoms: 5% such as nausea and vomiting Allergic reactions: rash, urticaria, and phototoxicity: 1-2% Lomefloxacin and sparfloxacin had higher rate of phototoxicity. CNS symptoms: can occur in 1-4% patients headache, slight dizziness, mild sleep disturbance, alteration of mood with agitation,  anxiety, or depression. Seizures had been reported The use NSAID and enoxacin had increase CNS side effect In Psychotic pt and convulsion should be avoided QT prolongation wih orsades de pointes: sparfloxacin, grepafloxacin and moxifloxacin. Tendon rupture: achilles tendon most common followed by hand and shoulder. more common in 50y/o age with steroi