抗生素英语课件

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醫學中心評鑑標準之細項標準（一）醫院應有抗生素使用管制措施及執行情形記錄。(3分)（二）醫院應有全院性臨床分離菌種及院內感染致病菌之抗生素感受性統計報告，並分發給全院醫師參考。(2分)Antibiotics醫學中心評鑑標準之細項標準（三）抗生素使用應合於治療所需及相關規定，包括預防性抗生素、門診抗生素及非第一線抗生素的使用。(12分)（四）醫院主要醫療科部應設有專責醫師協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藥管制（感管會抗生素小組審核→藥委會）資深醫師或感染科醫師核簽管制處方單之設定種類時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（住院醫師開方）☆預防性---限量三天☆治療性---最多使用十四天第二線藥物之管制（主治醫師開方）第三線藥物之管制☆附culture（第一線藥物無效）☆照會感染科醫師Antibiotics第三聯：申請單位↓藥局↓感染管制↓藥局↓申請部門留底第二聯：申請單位↓藥局↓感染管制↓藥局↓感染管制留底第一聯：申請單位↓藥局↓感染管制↓藥局↓病歷聯上

聯：申請單位↓藥局↓感染管制↓藥局↓藥局聯□elective□emergency

請補相關資料

符合使用規範

請照會感染科第二、三線抗微生物製劑使用申請單□初次申請□續用申請(月日申請)病歷號碼:年齡:

姓名:□男

□女

床號:

診斷：體重：過敏記錄：住院日期

□8am~4pm

□假日

身份別□保險□自費

項次處方類別處方內容(藥名、用法、用量)首日量常備量開方醫師

NEWDCST

1

2

感染科專科醫師

3

4

5

5

藥師

處方條件□第二線抗微生物製劑(表列如背面)(本單需由主治醫師核章)(限用14天)□對第一線抗生素無效者(下表請填培養結果及日期)□感染病情嚴重或免疫不全已進行微生物培養及藥物敏感試驗□使用第一線藥物超過7天(或2個月-5歲使用72小時)□自費□第三線抗微生物製劑(表列如背面)(限用14天)□對第一線及第二線藥物無效者(附細菌培養報告)(本單需由□已照會感染專科醫師(本單需有感染專科醫師核章)主治醫師核章)□自費

批價

感染症及相關診斷臨床診斷日期最近相關檢驗值

□

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□心肺復甦術後□免疫狀態不良患者□手術預防性使用

□敗血性休克（ＢＰ：／）

□感染科會診建議使用（會診日期：月日）□經驗性療法（請填寫已使用之抗生素）1.