肺部感染的抗生素治疗.pptVIP

这样够了吗？ 是否可以就此高枕无忧了呢？ 抗生素耐药潜能 抗生素根据诱导耐药的潜能区分： 高诱导耐药潜 低诱导耐药潜能? 亚胺培南 头孢他啶 环丙沙星 羧苄西林 马斯平 美罗培南 左氧氟沙星 两性霉素 ?低诱导耐药潜能：抗生素治疗某种细菌时，诱导耐药的可能性低。 Cunha BA. Crit Care Med 2007;35:1992-93 合理 优化 * Reference: /viewarticle/527862_print Scott T. Micek. Optimizing Antibiotic Treatment for Ventilator-Associated Pneumonia. Pharmacotherapy. ?2006;26(2):204-213. Cefepime (100%) vs ceftazidime (20%): Jason A, et al. Cefepime versus ceftazidime: considerations for empirical use in critically ill patients. International Journal of Antimicrobial Agents 29 (2007) 117–128 Amoxicillin (12.9%): Cook PJ. Concentration of amoxycillin and clavulanate in lung compartments in adults without pulmonary infection. Thorax. 1994 Nov;49(11):1134-8 Piperacillin (56.8%) Tazobactam (91.3%): Boselli E. Steady-state plasma and intrapulmonary concentrations of piperacillin/tazobactam 4 g/0.5 g administered to critically ill patients with severe nosocomial pneumonia. Intensive Care Med. 2004 May;30(5):976-9. Cefaclor: Mazzeit. New insight into the clinical pharmacokinetics of cefaclor: tissue penetration. J Chemother. 2000 Feb;12(1):53-62 Cefuroxime, Azithromycin, Clarithomycin, Ciprofloxacin. JOHN E. CONTE, Single-Dose Intrapulmonary Pharmacokinetics of Azithromycin, Clarithromycin, Ciprofloxacin, and Cefuroxime in Volunteer Subjects. AAC 1996;40:1617 Cefuroxime: Baldwin DR. Bronchoalveolar distribution of cefuroxime axetil and in-vitro efficacy of observed concentrations against respiratory pathogens. J Antimicrob Chemother. 1992 Sep;30(3):377-85 Meropenam: Allergenzi. Concentrations of single-dose meropenem (1 g iv) in bronchoalveolar lavage and epithelial lining fluid. J Antimicrob Chemother. 2000 Aug;46(2):319-22 * 2006年，斯科特等教授发表在药物治疗杂志上的文章中，比较了肺部感染常用抗生素在肺组织的穿透力。头孢他啶21％，哌拉西林57％，美罗培南17％，亚安培南60％，马斯平在肺组织的穿透力100％具有明显优势低浓度的抗生素更加容易诱导细菌产生耐药性，这也解释了为什么肺部感染更容易分离出耐药菌。而马斯平优越的穿透力不但确保了治疗感染的临床疗效，更可以有效的降低耐药菌的产生。因此我们从临床药理学角度确认马斯平更适合作为经验治疗的选择。 * * * * * * * * 表中所列为针对迟发性或具有MDR病原菌感染危险的 HAP, VAP 和 HCAP 患者初始经验性治疗药物