红霉素克拉霉素阿奇霉素.PPT

;;;;Macrolides(大环内酯类), Lincomycin(林可霉素类), and Vancomycin(万古霉素);History ;;;Erythromycin (红霉素);Mechanism of action;① Chloramphenicol ② Clindamycin Macrolides ③ Tertracyclines;Pharmokinetics ;Clinical uses;Mechanism of resistance;Adverse reactions;Second generation;Azithromycin (阿齐霉素,丽珠奇乐）;Roxithromycin （罗红霉素，严迪） ;Clarithromycin（甲红霉素,克拉霉素）;Third generation ;Part 3-2 Lincomycin (林可霉素)and Clindamycin（克林霉素）;;Clinical uses Severe anaerobic infection Acute or chronical suppurative osteomylitis（化脓性骨髓炎）, arthritis caused by susceptive organisms especially Staphylococci aureus（金黄色葡萄球菌） Adverse reactions Gastrointestinal effects: severe diarrhea and pseudomembranous enterocolitis caused by Clostridium difficile（难辨梭状芽孢杆菌）: vancomycin metronidazole(甲硝唑) Impaired liver function , neutropenia(中性粒细胞减少);;Vancomycin (万古霉素);Antimicrobial spectrum: Narrow spectrum, active only against gram-positive bacteria paticularly staphylococci Pharmacokinetics Poorly absorbed from intestinal tract, iv Excreted from glomerular filtration 90% ;Vancomycin(万古霉素);Teicoplanin(替考拉宁) ;Part 3-4 Oxazolidinones(恶唑烷酮类) Linezolid (利奈唑胺);Adverse reaction The principal toxicity of linezolid is hematologic—reversible and generally mild. Thrombocytopenia(血小板减少症) is the most common manifestation (seen in approximately 3% of treatment courses), particularly when the drug is administered for longer than 2 weeks. Neutropenia may also occur, most commonly in patients with a predisposition to or underlying bone marrow suppression. Pharmacokinetics Linezolid is 100% bioavailable after oral administration and has a half-life of 4–6 hours. It is metabolized by oxidative metabolism, yielding two inactive metabolites. It is neither an inducer nor an inhibitor of cytochrome P450 enzymes. Peak serum concentrations average 18 g/mL following a 600 mg oral dose. The recommended dose for most indications is 600 mg twice daily, either orally or intraveneously. Clinical uses vancomycin-resistant E faecium