抗生素英語課件

AntibioticsAntibioticsQuestionsbeforeroutinelyusageofantibiotics

Isanantibioticindicated(viralinfection,fungalinfection,localinfectionHaveappropriatedspecimensobtained(Gramstain,acidfaststain,culture)Whatinfectionislikely;WhatorganismislikelyHandbookofantibiotics.Richard.ER

AntibioticsQuestionsbeforeroutinelyusageofantibioticsAntibiotics;Whatisbest;drugofchoice,pharmacokinetics,toxicology,cost,narrowspectrum,bactericidalorbacteriostaticCombinationtherapy(synergy,competition)Hostfactors(steroid,diabetes,HIV,uremia,livercirrhosis)Thebestrouteofadministration(oral,IV,IM,local)AntibioticsQuestionsbeforeroutinelyusageofantibioticsAppropriatedose(elder,renalfailure,livercirrhosis,lowbodyweight)Modificationafterculturedatareturned(pneumonia:pneumococcus,Staphylococcus,Klebsiella,Hemophilus)Theoptimaldurationoftreatment(urinarytractinfection,pyelonephritis,renalabscess)Resistanceofdrug(vancomycin;linezolid)AntibioticsGPCAntibioticsGPCAntibioticsGPBAntibioticsGNBAntibioticsGNBAntibioticsAntibioticsBeta-lactamPenicillinCephalosporinMonobactamCarbapenemCephamycinAminoglycosidesTetracyclinesFluoroquinolonesLincosaminesMacrolidesGlycopeptidesNitroimidazolesAzolesPolyenesAntibioticsBeta-lactamMonobactamAztreonamCarbapenemImipenemMeropenemCephamycinCefmetazoleFlomoxefBeta-lactamase-inhibitorClavunicacidAugmentinTimentinSulbactamUnasynTazobactamTazocinAntibioticsOtherantibioticsAminoglycosidesGentamicinTobramycinIsepamicinAmikacinTetracyclinesTetracyclineMinocyclineDoxycyclineFluoroquinolonesOfloxacinLevofloxacinNorfloxacinCiprofloxacinLomefloxacinLincosamineClindamycinAntibioticsOtherantibioticsMacrolidesErythromycinClarithromycinAzithromycinGlycopeptidesVancomycinTeicoplaninNitroimidazoleMetronidazoleAzolesKetoconazoleFluconazoleItraconazolePolyenesAmphotericinBNystatinAntibioticsOtherantibioticsChloramphenicolChloramphenicolGyraseinhibitorsNalidicacid,QuinolonesSulfonamidesTrimethoprim-sulfamethoxazoleOthersFlucytosineMupirocinFusidicacidFosfomycinLinezolidAntibioticsOtherantimicrobialagentsAntimycobacterialIsoniazidRifampicinEthambutolPyrazinamideStreptomycinDapsoneAntiviralAciclovirFamciclovirGanciclovirRibavirinAmantadineFoscarnetZidovudineLamivudineAntibioticsPneumonia

Community-acquiredpneumonia

Mostcommon:S.pneumoria(Tx:PCN,30%resistant)Elderlypeople&COPD:Pneumococcus&Hinfluenzae.(2ndPCNor2ndCepha)DM&Alcoholism:K.pneumoniae(Tx:3rdcephalosporin)AtypicalpneumoniaLegionella:1-15%(Macrolide)Youngpeople:mycoplasmaorchlamydiae.(Macrolide)AntibioticsHospitalacquiredpneumonia:P.aeruginosaAnti-PseudomonasMRSA.GlycopeptidesAntibioticsAspirationpneumonia90%anaerobic(B.melaninogenicus,fusobact.Anaerobicstrept.Tx:PCNorclindamycin.+-AminoglycosideAntibioticsUTI

E.coli:mostfreqinfectingorganism.S.saprophyticus:causeinfectioninyoung,sexuallyactivefemale.EnterobacteraciaeAdenovirus:causehemorrhagiccystitisAntibioticsSkin&softtissueinfection

Impetigo:GrAstrept.,S.aureus.S.S.S.:S.aureus.Charact.Bywidespreadbullae&exfoliation.Furuncle&carbuncle:S.aureus.Erysipela:GrAstrept.Cellulitis:GrAstrept,&S.aureus.AntibioticsSkin&softtissueinfectionAeromonashydrophilia:lacerationacquiredduringswimminginfreshwater,livercirrhosis,malignancy.Vibriovulnificus:Bullouscellulitis,traumaticwoundinsaltwater:,livercirrhosis,highmortality.AntibioticsOsteomyelitis

<1Y/O:S.aureus,Strept.Agalactiae,E.coli.>1Y/O:S.aureus.GAS,H.influenzae.Infectionoffootpuncturewound:95%causedbyP.aeruginosa.Adult:Traumatic:mostcommon,oftenmixedinfection.Hematogenous:vertebrae;S.aureusmostcommon.DMfoot:Limbnonthreatening:S.aureus(50%)Limbthreatening:multipleorganism:Txwithbroad-sprectrumATB+earlysurgicaldebridement.AntibioticsNosocomialInfectionPathogens:P.aeruginosae,S.aureus(esp.MRSA)mostcommonintaiwan.(A.baumanii)Commoninf:UTI:40%(urinarycatheter)Surgicalsiteinf:3-7daysfollowingsurgery.Pneumonia:leadingcauseofmortality.BloodstreaminfectionICU:2-10Xthannon-ICUwards.Antibiotics醫(yī)學(xué)中心評(píng)鑑標(biāo)準(zhǔn)之細(xì)項(xiàng)標(biāo)準(zhǔn)（一）醫(yī)院應(yīng)有抗生素使用管制措施及執(zhí)行情形記錄。(3分)（二）醫(yī)院應(yīng)有全院性臨床分離菌種及院內(nèi)感染致病菌之抗生素感受性統(tǒng)計(jì)報(bào)告，並分發(fā)給全院醫(yī)師參考。(2分)Antibiotics醫(yī)學(xué)中心評(píng)鑑標(biāo)準(zhǔn)之細(xì)項(xiàng)標(biāo)準(zhǔn)（三）抗生素使用應(yīng)合於治療所需及相關(guān)規(guī)定，包括預(yù)防性抗生素、門診抗生素及非第一線抗生素的使用。(12分)（四）醫(yī)院主要醫(yī)療科部應(yīng)設(shè)有專責(zé)醫(yī)師協(xié)助做好抗生素管制工作或定期檢討及改善該科部抗生素使用情形。(3分)Antibiotics本院抗生素管制方式進(jìn)藥管制（感管會(huì)抗生素小組審核→藥委會(huì)）資深醫(yī)師或感染科醫(yī)師核簽管制處方單之設(shè)定種類時(shí)效及劑量管制微生物室的管制Antibiotics抗生素使用管制處方單第一線藥物之管制（住院醫(yī)師開方）☆預(yù)防性---限量三天☆治療性---最多使用十四天第二線藥物之管制（主治醫(yī)師開方）第三線藥物之管制☆附culture（第一線藥物無效）☆照會(huì)感染科醫(yī)師Antibiotics第三聯(lián)：申請(qǐng)單位↓藥局↓感染管制↓藥局↓申請(qǐng)部門留底第二聯(lián)：申請(qǐng)單位↓藥局↓感染管制↓藥局↓感染管制留底第一聯(lián)：申請(qǐng)單位↓藥局↓感染管制↓藥局↓病歷聯(lián)上

聯(lián)：申請(qǐng)單位↓藥局↓感染管制↓藥局↓藥局聯(lián)□elective□emergency

請(qǐng)補(bǔ)相關(guān)資料

符合使用規(guī)範(fàn)

請(qǐng)照會(huì)感染科第二、三線抗微生物製劑使用申請(qǐng)單□初次申請(qǐng)□續(xù)用申請(qǐng)(月日申請(qǐng))病歷號(hào)碼:年齡:

姓名:□男

□女

床號(hào):

診斷：體重：過敏記錄：住院日期

□8am~4pm

□假日

身份別□保險(xiǎn)□自費(fèi)

項(xiàng)次處方類別處方內(nèi)容(藥名、用法、用量)首日量常備量開方醫(yī)師

NEWDCST

1

2

感染科?？漆t(yī)師

3

4

5

5

藥師

處方條件□第二線抗微生物製劑(表列如背面)(本單需由主治醫(yī)師核章)(限用14天)□對(duì)第一線抗生素?zé)o效者(下表請(qǐng)?zhí)钆囵B(yǎng)結(jié)果及日期)□感染病情嚴(yán)重或免疫不全已進(jìn)行微生物培養(yǎng)及藥物敏感試驗(yàn)□使用第一線藥物超過7天(或2個(gè)月-5歲使用72小時(shí))□自費(fèi)□第三線抗微生物製劑(表列如背面)(限用14天)□對(duì)第一線及第二線藥物無效者(附細(xì)菌培養(yǎng)報(bào)告)(本單需由□已照會(huì)感染專科醫(yī)師(本單需有感染?？漆t(yī)師核章)主治醫(yī)師核章)□自費(fèi)

批價(jià)

感染癥及相關(guān)診斷臨床診斷日期最近相關(guān)檢驗(yàn)值

□

pneumoniae(CXR如下)

BloodWBC：

N/L：BloodCreatinine：

Sputumculture：

PMN：

□UTI

Urineculture：

U/AWBC：

□neutropenicfever

BloodWBC：

neutrophil：

□

woundinfection

Woundculture：

Discharge：

□menigitis

CSFWBC：

N/L：

□other

使用特性□心肺復(fù)甦術(shù)後□免疫狀態(tài)不良患者□手術(shù)預(yù)防性使用

□敗血性休克（ＢＰ：／）

□感染科會(huì)診建議使用（會(huì)診日期：月日）□經(jīng)驗(yàn)性療法（請(qǐng)?zhí)顚懸咽褂弥股兀?.