猫抗生素应用缺陷与问题翻译feline antibiotic therapy

Pitfallsandproblemsusingantibioticsincats猫的抗生素应用缺陷与Pitfallsandproblemsusingantibioticsincats猫的抗生素应用缺陷与问Dr.BiankaSchulzDipl.ECVIM-CAAntibiotictherapy–basic••••indicationAntibiotictherapy–basic••••indicationfortherapydetectionofpathogensentitivitytestingchoiceofantibiotic••Distributiondose/durationofsideeffects•Antibiotictherapy–basic••••indicationfordetectionofsentitivityAntibiotictherapy–basic••••indicationfordetectionofsentitivitychoiceof••dose/durationof•sideIndicationsfor治疗的适应•therapyofdiagnosedbacterial治疗已经确诊为细菌感Indicationsfor治疗的适应•therapyofdiagnosedbacterial治疗已经确诊为细菌感->baseduponcultureandsensitivity基于细菌培养和药敏试empiricaltherapy:suspected经验疗法：怀疑感•->发烧/低体->leukocytosis/leukopeniawithleft白细胞增多/白细胞减少并伴随核左signsofsepsis败血症征•Antibiotictherapy–basic••••indicationfordetectionAntibiotictherapy–basic••••indicationfordetectionofsentitivitychoiceof••dose/durationof•sideDetectionofbacterial病原菌的发•samplingbeforestartofantibioticDetectionofbacterial病原菌的发•samplingbeforestartofantibiotic••pleuraleffusionpulmonaryaspirate•••assessmentofcultureincorrelationwithcytologyspecialculturemediaforcertainMycoplasmaspp.,Chlamydophilafelis支原体，衣LRTculturesofwithrespiratory呼吸道症状猫的系呼吸道培Neg革兰氏阴Bord.博得特Strep链球菌Staph.葡萄球E.ColiLRTculturesofwithrespiratory呼吸道症状猫的系呼吸道培Neg革兰氏阴Bord.博得特Strep链球菌Staph.葡萄球E.Coli大肠杆Past.巴斯德%0(n=(n=(n=(n=(n=(n=BacterialisolatesfromlowerrespiratorytractofhealthyBacterialisolatesfromlowerrespiratorytractofhealthyStreptococcusspp.MicrococcusE.PasteurellaKlebsiellaspp.EnterobacterProteusHaemophilusGreene,Whendowetreatinapatientwithpositiveculture?培养结果阳性时我们Whendowetreatinapatientwithpositiveculture?培养结果阳性时我们该做什么•LRTnotbacterialconcentration<104colonyformingunits/mlhealthy健康猫的细菌集落形成浓度104单位signsoforopharyngealassessinformationfromhistory,PE,laboratorywork,radiographs,cytologyandculturetomakedecisionBAL支气管肺泡灌洗液细胞BAL支气管肺泡灌洗液细胞courtesyofDr.I.Oropharyngeal口咽部感••epithelialSimonsiellaspp.Oropharyngeal口咽部感••epithelialSimonsiellaspp.courtesyofDr.I.Antibiotictherapy–basic抗生素疗法-基本考••••indicationfordetectionAntibiotictherapy–basic抗生素疗法-基本考••••indicationfordetectionofsentitivitychoiceof••dose/durationof•sideSensitivity药敏试•resistancepatternoftenfrequentlyresistantSensitivity药敏试•resistancepatternoftenfrequentlyresistantbacteriaPseudomonasspp.,Enterobacterspp.,EcoliProteus*•*Papich,2001;Oluochetal.,Whentosuspectresistant什么时候怀疑细菌Whentosuspectresistant什么时候怀疑细菌耐药••••recurringinfectionschronicunderlyingdiseasenosocomialinfectionscatheterassociatedinfections••poorhealingwoundspre-treatmentwithinsufficientantibioticdoseanddurationSensitivity药敏试••agardiffusiontestMICtestingSensitivity药敏试••agardiffusiontestMICtestingantibiotictarget-orientedantibioticAntibiotictherapy–basic抗生素疗法-基本考••••indicationfordetectionAntibiotictherapy–basic抗生素疗法-基本考••••indicationfordetectionofsentitivitychoiceof••dose/durationof•sideAntibiotic•ifavailable,basedoncultureandsensitivity•Antibiotic•ifavailable,basedoncultureandsensitivity•ifnot:whichpathogendoIexpect我该怀疑哪种病->gram->gram->->Antibioticexamplecephalosporinsgram+--Antibioticexamplecephalosporinsgram+--+++AntibioticbactericidalorbactericidalordependingonimmunestatusofBactericidalAntibioticbactericidalorbactericidalordependingonimmunestatusofBactericidalBacteriostatic抑菌Penicillines青霉Cephalosporines头孢SulfonamidesAminoglycosidesChloramphenicol氯霉Fluoroquinolonesmacrolides(dose-dependentBacterialisolatesfromcatswithnasalNeg阴性菌Bord.StaphE.ColiPast巴氏杆菌0SchulzetBacterialisolatesfromcatswithnasalNeg阴性菌Bord.StaphE.ColiPast巴氏杆菌0Schulzetal,VetRec(n=(n=(n=(n=(n=(n=LRTculturesofcatswithrespiratory(n=Neg阴(n=(n=Staph(n=LRTculturesofcatswithrespiratory(n=Neg阴(n=(n=Staph(n=(n=E.Coli大肠杆(n=Past.%0Schulzetal,VetRecResultssensitivitytesting结果-overallefficacyin94.6Enrofloxacinn205)恩诺沙89.6Cephalexin(n48)Gentamicinn205)庆大霉85.9Amoxicillin/Clav.acid(n=Resultssensitivitytesting结果-overallefficacyin94.6Enrofloxacinn205)恩诺沙89.6Cephalexin(n48)Gentamicinn205)庆大霉85.9Amoxicillin/Clav.acid(n=83.8阿莫西林/克拉81.5Chloramphenicol(n205)氯霉81.3Kanamycin(n176)Doxycycline(n200)强力霉73.0Trimethoprim/Sulfon.(n=磺胺甲71.2Ampicillin/Amoxicillin(n=氨苄青霉素/68.3Schulzetal.,VetRecFelinepyothoraxwhatdoweknowfrom•••Felinepyothoraxwhatdoweknowfrom•••polymicrobialinfectionssimilartooropharyngealfloraobligateandfacultativeanaerobic•<20%ofbacteriaotherthan<20%的细culturemediaforantibiotictherapyshouldbedirectedagainstanaerobicbacteria抗生素治疗直接选择针对厌氧菌AntibioticsfortreatmentoffelinePenicillinGpotassium/sodium20,000–40,000AntibioticsfortreatmentoffelinePenicillinGpotassium/sodium20,000–40,000IU/kgIVq6青霉素G/钾/纳20,000–40,000IU/kgIVq6Ampicillin20–40mg/kgIVq6–8h氨苄青霉素20–40mg/kgIVq6–8hAmoxicillin10–20mg/kgIVq12h10–20mg/kgIVq12hTicarcillin–clavulanicacid40–50mg/kgIVq6–8h替卡西林-克拉维酸40–50mg/kgIVq6–8Ampicillin–sulbactam50mg/kg(combined)IVq8阿莫西林-舒巴坦50mg/kg(联合使用)IVq8hAmoxycillin–clavulanicacid12–20mg/kg/SC/IM/IVq12h阿莫西林克拉维酸acid12–20mg/kg/SC/IM/IVq12Antibiotic抗生素选•combinationtherapyindicatedin(pneumonia,联合疗法适用于严重的感染（肺炎，败血症•usefulcombinationsß-Antibiotic抗生素选•combinationtherapyindicatedin(pneumonia,联合疗法适用于严重的感染（肺炎，败血症•usefulcombinationsß-ßß-ßAntibiotictherapy–basic抗生素疗法-基本考••••indicationfordetectionAntibiotictherapy–basic抗生素疗法-基本考••••indicationfordetectionofsentitivitychoiceof••dose/durationof•sideDistribution分布标•dependingoncharge,size,lipophiliccharacteristicsofantibioticanatomicalDistribution分布标•dependingoncharge,size,lipophiliccharacteristicsofantibioticanatomicalbarriers•bloodbrainbarrierProstate前列Eye眼tracheobronchial-pulmonaryepithelialliningfluidEpithelialliningfluidtototalplasmaconcentrationratiosofantibioticsinhumansELF/P-ratio1ELF/PEpithelialliningfluidtototalplasmaconcentrationratiosofantibioticsinhumansELF/P-ratio1ELF/PAminoglycosides,ß-lactams,glycopeptides(e.g.氨基糖苷类，ß-内酰胺类，糖肽类（万古霉素••ELF/P-ratioELF/Pmacrolides,azithromycin,ELF/P-ratiohighlyvariableinß-lactams(penicillins,cephalosporins,carbapenemsRodvoldetal.,JClinPharmacokinet•Distribution分布标Distribution分布标fluoroquinolonesmacrolidesazithromycin普多沙••newgenerationfluoroquinolonelicensed普多沙••newgenerationfluoroquinolonelicensedfordogsandapprovedforFURTI(pyoderma,••improvedefficacyagainstStreptococcusspp.andanaerobescomparedtoolderfluoroquinolonesonlymildgastrointestinalsideeffects25mg/mlsuspension(dose:5mg/kgq2425mg/ml悬浮液（5mg/kgq24hr15mgtablets(dose:3mg/kgq24•阿奇霉•goodefficacyagainstgram-pos.andMycoplasmafair阿奇霉•goodefficacyagainstgram-pos.andMycoplasmafairefficacyagainstgram-neg.andhighoralbioavailabilityaccumulationinmacrophages200-在巨噬细胞中的积累浓度可达到200-500••••••longhalflifeincatsdosingevery2nd/3rddaypossible每2-3天调整剂量welltoleratedinlongtermtreatment长期治疗耐受性较chronicinfections(rhinitis,pneumonia)慢性感染(鼻炎,肺炎Antibiotictherapy–basic抗生素疗法-基本考••••indicationfordetectionAntibiotictherapy–basic抗生素疗法-基本考••••indicationfordetectionofsentitivitychoiceof••dose/durationof•sideAntibiotic抗生素剂•timedependentefficacy->ß-lactams,Antibiotic抗生素剂•timedependentefficacy->ß-lactams,ß-increaseintervalforbetter•concentration-dependentefficacy->fluoroquinolones,increasedoseforbetterefficacy(withintherapeutic增加剂量以产生更好的疗效(在治疗加量范围内Routeof给药途oralorparenteralRouteof给药途oralorparenteralparenteralapplicationif:以下情况肠外poorgeneralconditionfeverdehydratationvomiting/diarrhea呕吐/lowenteralabsorption(e.g.肠内吸收差（如氨基糖苷类Durationof治疗持续时•uncomplicatedURTI:7Durationof治疗持续时•uncomplicatedURTI:710daysusuallysufficient一般7-10pneumoniapyothorax•3–4clinical,radiographicalre-antibiotictherapyatleast1weekcontinuedafterdisappearanceofclinicalsignsGismo,DSH,4y,Gismo,DSH4Gismo,DSH,4y,Gismo,DSH4y雄性去Antibiotictherapy–basic抗生素疗法-基本考••••indicationfordetectionAntibiotictherapy–basic抗生素疗法-基本考••••indicationfordetectionofsentitivitychoiceof••dose/durationof•sideSide副作•••ownereducationageofthepatientSide副作•••ownereducationageofthepatient(tetracyclines动物年龄（四环素laboratoryre-checks(sulfonamides,实验室复查（磺胺类药物，多西环素inhaledapplicationofaminoglycosidestoreducesystemictoxicity•enrofloxacinin•Reductionofside减少副作•nephro/ototoxicityReductionofside减少副作•nephro/ototoxicityreducedifgivenonlyoncepatientmustberehydratedbeforestartof•tetracyclines:decreasedGIirritationifgivenwithHowtopilla怎样给猫Howtopilla怎样给猫喂药丸PickupcatandcradleitinPickupcatandcradleitinthecrookofyourleftarmasifholdingaPositionrightforefingerandthumboneithersideofcat'smouthandgentlyapplypressuretocheekswhileholdingpillinrighthand.Ascatopensmouth,poppillintomouth.AllowcattoclosemouthandRetrievepillfromfloorandcatfrombehindsofa.Cradlecatinleftarmandrepeatprocess.Retrievecatfrombedroom,andthrowsoggypillTakenewpillfromfoilwrap,cradlecatinleftarm,holdingrearpawstightlywithlefthand.Forcejawsopenandpushpilltobackofmouthwithrightforefinger.Holdmouthshutforacountoften.Retrievepillfromgoldfishbowlandcatfromtopofwardrobe.CallspouseinfromKneelonfloorwithcatwedgedfirmlybetweenknees,holdfrontandrearpaws.Ignorelowgrowlsemittedbycat.Getspousetoholdheadfirmlywithonehandwhileforcingwoodenrulerintomouth.Droppilldownrulerandrubcat'sthroatvigorously.Retrievecatfromcurtainrail.Getanotherpillfromfoilwrap.Makenotetobuynewrulerandrepaircurtains.Carefullysweepshatteredfigurinesandvasesfromhearthandsettoonesideforgluinglater.Wrapcatinlargetowelandgetspousetolieoncatwithheadjustvisiblefrombelowarmpit.Putpillinendofdrinkingstraw,forcemouthopenwithpencilandblowdowndrinkingstraw9.Checklabeltomakesurepillnotharmfultohumansanddrinkonebeertotaketasteaway.Applyband-aidtospouse'sforearmandremove9.Checklabeltomakesurepillnotharmfultohumansanddrinkonebeertotaketasteaway.Applyband-aidtospouse'sforearmandremovebloodfromcarpetwithcoldwaterandRetrievecatfromneighbor'sshed.Getanotherpill.Openanotherbeer.Placecatincupboard,andclosedoorontoneck,toleaveheadshowing.Forcemouthopenwithdessertspoon.Flickpilldownthroatwithelasticband.Fetchscrewdrive