抗生素（英文ppt）

Coventry and Warwickshire Pathology Antibiotics James Clayton Consultant Microbiologist Coventry and Warwickshire Pathology Antibiotic groups -Lactams Penicillins Penicillin, Amoxicillin, Flucloxacillin PO/IV Penicillins + -lactamase inhibitor Co-amoxiclav (Amoxicillin + clavulanate) PO/IV Tazocin (Piperacillin + tazobactam) IV Cephalosporins PO/IV Carbapenems Meropenem, Ertapenem IV Coventry and Warwickshire Pathology Other antibiotics: Aminoglycosides Gentamicin, (Amikacin) IV Macrolides Erythromycin, Clarithromycin PO/IV Glycopeptides Vancomycin, (Teicoplanin) IV Tetracyclines Doxycycline PO Others Trimethoprim, Nitrofurantoin PO Rifampicin, Clindamycin PO/IV Ciprofloxacin PO Coventry and Warwickshire Pathology Coventry and Warwickshire Pathology Coventry and Warwickshire Pathology Coventry and Warwickshire Pathology Coventry and Warwickshire Pathology Coventry and Warwickshire Pathology Streptococci Group A streptococci Skin & soft tissue infection Necrotising fasciitis Tonsillitis Toxic shock, sepsis Group B streptococci Neonatal infection, UTI Other streptococci Endocarditis, abscess Coventry and Warwickshire Pathology Streptococci & Enterococci Strep. pneumoniae URTI, pneumonia Enterococcus faecalis / E.faecium UTI, endocarditis Coventry and Warwickshire Pathology Staphylococcus Staph. aureus Skin & soft tissue infection Abscess Bone & joint infection Line infections Severe pneumonia Remember MRSA (Meticillin resistant S.aureus) Coventry and Warwickshire Pathology E.coli & coliforms E.coli, Klebsiella, Proteus UTIs Intra-abdominal infection E.g. cholangitis, sepsis Hospital-acquired infection Remember ESBLs Coventry and Warwickshire Pathology Neisseria & Haemophilus N. meningitidis Meningitis N. gonorrhoeae Gonorrhoea H. influenzae Respiratory tract infection Meningitis (rare) Coventry and Warwickshire Pathology Pseudomonas P. aeruginosa UTIs (usually complicated / catheter) Hospital acquired infections Anaerobes Intra-abdominal infections Skin & soft tissue infections Abscess Coventry and Warwickshire Pathology 7 cases Coventry and Warwickshire Pathology Case 1 John, 18 yrs old Sore throat for 2 days, feverish Exudate on tonsils when examined by GP Tonsillitis diagnosed. What organisms cause tonsillitis? What antibiotics are appropriate? Coventry and Warwickshire Pathology Coventry and Warwickshire Pathology Coventry and Warwickshire Pathology Coventry and Warwickshire Pathology Coventry and Warwickshire Community Antibiotic Guidelines Coventry and Warwickshire Pathology Tonsillitis Majority caused by Group A streptococci Group A streptococci Penicillin susceptibility 100% Erythromycin susceptibility 80% Penicillin preferred to Amoxicillin as: Narrower spectrum EBV / glandular fever reaction Oral antibiotics in a community setting Coventry and Warwickshire Pathology Case 2 Bob, 70 years old COPD. 60 pack year smoking history. Retired engineer. 3 day history of cough, green sputum, malaise, raised temperature o/e crepitations, reduced air entry CXR extensive consolidation CURB-65 = 2 No allergies Coventry and Warwickshire Pathology And Atypicals! Coventry and Warwickshire Pathology Coventry and Warwickshire Pathology Coventry and Warwickshire Pathology Coventry and Warwickshire Treatment Guidelines (Hospital) Coventry and Warwickshire Pathology Community acquired pneumonia Strep. pneumoniae 30 - 40% Haemophilus influenzae 5 - 10% Staph. aureus 0.5 - 5% Severity of infection (CURB-65 score) Determines need for IV or oral treatment Determines need for broad vs narrow cover Coventry and Warwickshire Pathology Dont forget atypicals in CAP! Legionella pneumophila 1 - 5% Mycoplasma pneumoniae 1 - 10% Chlamydophila pneumoniae 10% ? Chlamydia psittaci, Coxiella 2% Viruses including Influenza 15% Addition of Macrolide e.g. erythromycin or clarithromycin Tetracycline e.g. doxycycline (Ciprofloxacin) Coventry and Warwickshire Pathology Case 3 Katie, 25 years old Presents to A&E with history of dysuria, frequency Previously well Coventry and Warwickshire Pathology Coventry and Warwickshire Pathology Do all antibiotics get into urine? These do: Penicillins (most) Amoxicillin, co-amoxiclav Cephalosporins Carbapenems Gentamicin Trimethoprim Nitrofurantoin Ciprofloxacin Vancomycin These dont: Penicillins (few) Flucloxacillin (poorly only) Macrolides Erythro & Clarithromycin Tetracyclines Doxycycline Clindamycin Coventry and Warwickshire Pathology Coventry and Warwickshire Pathology Coventry and Warwickshire Pathology Coventry and Warwickshire Treatment Guidelines (Hospital) Coventry and Warwickshire Pathology UTI Usually Gram-negatives as a cause E.coli Other coliforms (proteus, klebsiella) Less commonly enterococci, staphylococci Pseudomonas Mainly in catheterised patients or those with underlying urinary tract disorders Coventry and Warwickshire Pathology Case 4 Stephen, 17 years old Admitted through A&E Lethargic, drowsy, unwell High fever Photophobia & stiff neck No allergies Coventry and Warwickshire Pathology Coventry and Warwickshire Pathology Coventry and Warwickshire Pathology Coventry and Warwickshire Pathology Coventry and Warwickshire Treatment Guidelines (Hospital) Coventry and Warwickshire Pathology Meningitis Neisseria menigitidis (meningococcus) Strep. pneumoniae (pneumococcus) Haemophilus influenzae (HiB) Listeria (extremes of age, immunocompromise) Need IV therapy Need antibiotics with good meningeal penetration Coventry and Warwickshire Pathology Case 5 Albert, 82 years old Had total hip replacement 5 days ago On review today, unwell, coughing mucky sputum Poor Oxygen sats, febrile WCC 18, CRP 280 CXR widespread opacity No allergies, no previous microbiology samples Coventry and Warwickshire Pathology Coventry and Warwickshire Pathology Coventry and Warwickshire Pathology Coventry and Warwickshire Pathology Coventry and Warwickshire Treatment Guidelines (Hospital) Coventry and Warwickshire Pathology Case 6 Ivy, 82 year old #neck of femur Had a DHS 3 days ago. Now has some erythema around the wound Tender and wound feels hot. Well otherwise Determined to be non-severe wound infection Recent MRSA screen negative Penicillin allergic (previous rash) Coventry and Warwickshire Pathology Coventry and Warwickshire Pathology Coventry and Warwickshire Pathology Coventry and Warwickshire Treatment Guidelines (Hospital) Coventry and Warwickshire Pathology Case 7 Rose, 75 year old Has been on medical ward for 2 weeks Diabetic, hypertensive Catheterised to measure urine output Today, unwell, high temperature, hypotensive, MEWS score = 7. No obvious cause chest OK, abdo normal. No known allergies Coventry and Warwickshire Pathology Coventry and Warwickshire Pathology Coventry and Warwickshire Pathology Coventry and Warwickshire Treatment Guidelines (Hospital) Coventry and Warwickshire Pathology Blood cultures are returned positive: MRSA grown after 24 hours Flucloxacillin Resistant Erythromycin Resistant Gent