课件：糖尿病溃疡抗生素治疗.ppt

*INVANZ? (ertapenem sodium) is indicated for the treatment of moderate to severe complicated skin/skin structure infections, including diabetic foot infections without osteomyelitis, due to Staphylococcus aureus (methicillin-susceptible isolates only), Streptococcus agalactiae, Streptococcus pyogenes, Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Bacteroides fragilis, Peptostreptococcus species, Porphyromonas asaccharolytica, or Prevotella bivia. INVANZ has not been studied in diabetic foot infections with concomitant osteomyelitis. Piperacillin/Tazobactam (Zosyn) is indicated for the treatment of moderate to severe complicated and uncomplicated skin and skin structure infections, including cellulitis, cutaneous abscesses and ischemic/diabetic foot infections caused by piperacillin-resistant, beta-lactamase producing strains of Staphylococcus aureus.1 INVANZ is a registered trademark of Merck Co., Inc. Zosyn is a registered trademark of Wyeth Pharmaceuticals. Reference: 1. Zosyn [package insert]. Philadelphia, Pa: Wyeth Pharmaceuticals; 2004. 7.4　药物动力学作用（１） 糖尿病肾病对药物的影响（疾病影响药物） 7.4　药物动力学作用（2） 糖尿病血管病变对药物的影响： 　　　在脓液、骨组织分布较高的抗生素 7.5　药源性疾病 影响肾功的抗生素（药物不良反应） 　　　　氨基糖苷 　　　　万古霉素 　　　　两性霉素 　　　　磺胺类 　　　　与部分头孢类与肝药酶抑制剂合用 7.6　用药教育 减负 有氧与无氧锻炼 血糖控制 Observational study Population Glucose cutoff mmol/l Risks Pomposelli et al 1998 Post-op spot 12.2 on post-op Day 1 ↑2.7x nosocomial infection Latham et al 2001 Cardiothoracic post-op hyperglycemia in first 48 hrs ↑2x surgical site infection Capes et al 2001 ischemic stroke with no hx of DM admission glucose 6.1 ↑3x in-hospital or 30-day mortality and poor functional outcome Umpierrez GE et al 2002 newly diagnosed DM vs known DM vs normal FBS7.0 or random11.1 ↑mortality 16% vs 3% vs 1.7% Hyperglycaemia associated with Increased infection Mortality Interventional Study Populations Target glucose level (mmol/l) Outcomes Comments Furnary et al 1999 Post cardiothoracic surgery 8.3-11.1 24 hours post-op ↓deep sternal