《基础医学各论3》资料：yunbi_chemotherapeutic Drugs.pptVIP

* * * * Acid-Fast Bacteria * 不动的，无孢子形成，需氧杆菌 对生存环境十分苛求 * lipoarabinomannan (LAM)阿拉伯糖甘露糖 Arabinogalactan 阿拉伯半乳聚糖 * 烟酰胺腺嘌呤二核苷酸 （辅酶，NAD）flavin 核黄素 * slow acetylators 70 min rapid acetylators 3h * Aliphatic * 橘红色的尿液、粪便、唾液、泪液。 * 动物致畸作用 流感综合征（寒战、头痛、发热、肌肉痛等） * 不宜用于5岁以下儿童 * 1 1 * 13 13 Nasopharyngeal * 全球的麻风病患者人数已经由1985年的520万降至去年的21.3万。麻风病仍困扰着一些国家——比如，2009年的新发病例有超过一半在印度。 1957年的全国流行病学调查总共网罗30万个病例，到上世纪七十年代初期，一大批被称作“赤脚医生”乡村卫生工作者协助相关的专业人士一道，寻找麻风病人并把他们送往麻风院。麻风病患病率从1966年的每10万人中23.5人患病的峰值降至2009年的万分之0.5，在中国的1464个县中92%实现了“消除”麻风病。——“这是一个伟大的成就！”中国麻风防治协会会长张国成表示。 在过去十年中中国每年的新发病例保持在1600例左右，主要分布在在贵州、四川、云南等三个西南省份的农村贫困地区; 中国其他地方的病例，绝大多数都来自1800万到东部和南部寻找工作的迁徙人群. * 2 2 当全球范围患病率连续十年低于万分之一时，方能认为这种疾病已经被“消除”并不再对公众健康构成威胁。 * 7 7 Hypopigmentation(色素减少) * 8 8 * 12 12 * Antimicrobial agents are frequently used before the pathogen responsible for a particular illness or the susceptibility to the particular antimicrobial agents is known. This use of antimicrobial is called empirical therapy. * Clinical Uses of Antimicrobial Agents 1. Formulating a pathogenic diagnosis early, which depends on clinical diagnosis, microbiologic diagnosis and testing results in vitro. 2. Choiceness of antimicrobial agents depends on pharmacological factors and host factors. 3. The uses of antimicrobial agents is strictly controlled in some situations. Basic principles Empiric Therapy Vast majority of all antimicrobial therapy Should be approached rationally Syndrome Likely pathogens Known resistance patterns Host factors Identification of Infecting Organism Staining of clinical specimens Gram stain, Acid-fast stain, silver stains… Antigen detection (e.g. ELISA) Nucleic acid detection (e.g. PCR) Culture methods Obtain culture material prior to antimicrobial therapy, if possible in broth pharmacological factors include: kinetics of absorption, distribution, and elimination; Bacteriostatic vs bactericidal activity concentration-dependent killing (eg. aminoglycosides and quinolones) time-dependent killing (