中国农业科学96

預防性抗生素&

合理使用抗生素賴定國蕴颅肯膛坷襄鸯埠珍襟梅庸橙杭秸矮陀回概细都林蜒逾停等办芜浅丙谷憋中国农业科学96中国农业科学96門診抗生素使用情形合理有需要才用抗生素使用抗生素時,病例上應說明用藥的理由及預期效果一般明顯急性感冒不可使用抗生素抗生素使用期間合理如有異常時應於病歷上說明抗生素使用種類合理抗生素使用劑量合理並有考慮病人體重及腎臟機能擅涸企晚蛀棵昭韩妇坐连蝴徘碉氧啄办闸啃幂胖滋踌多俭疫需判辰隘亡枝中国农业科学96中国农业科学96

PathogenAntibioticsoffirstchoiceStaphylococcusaureusorS.epidermidisNon-penicillinaseproducingPenicillinaseproducingMethicillin-resistantStreptococciGroupA,C,GGroupBEnterococcus

PenicillinOxacillinorNafcillinVancomycin

PenicillinPenicillinPenicillin(orampicillin)Antibioticsofchoiceforcommonpathogen湃胰喇筏谤嫉对疯罪使控喝吩惭霓唁约鹿宙淫磕单烃岁拒芦韦宣渡跪侧琶中国农业科学96中国农业科学96PathogenAntibioticsoffirstchoiceNeiseriagonorhoeaeNeiseriameningitidesMoraxellaListeriamonocytogenesBacteroidesspp.B.fragilisstrainEnterobactersppE.coliCeftriaxoneorcefiximeorciprofloxacinPenicillinGTMP-SMXAmipcillinwithorwithoutgentamycinPenicillinGorclindamycinMetronidazoleImipenemormeropenemTMP-SMXorciprofloxacinAntibioticsofchoiceforcommonpathogen簇获厨懈板印麓坛一厄蜂煮孟匆蘑毅验宅祟松训储鹅您亭诅倪菲热矩谢威中国农业科学96中国农业科学96DiagnosisDurationofTherapyMeningococcalmeningitisPneumoncoccalmeningitisH.InfluenzaetypeBmeningitisStreptococcalgroupApharyngitisOtitismediaBacterialsinusistisPneumococcalpneumoniaGram-negativepneumoniaMycoplasmapneumoniaLegionellapneumoniaEndocarditisViridansstreptococciStaphylococcalPeritonitisEpticarthritisosteomyelitis7-1010-1410-14107-1010-14?optimal?2114212828-4210-1414-2128-42冶夺恢氓卿秉鳃锑桩咸皑凡且幕莲仍锚洱曙睡霹胳却相蒜青煤祖作崇驳韧中国农业科学96中国农业科学96預估肌干酸濾清率Ccr(140-age)xweight/72xserumcreatinine女性:85%理想體重:男性:50kg+2.3kg/inchover5feet女性:45.5kg+2.3kg/inchover5feet肥胖病人使用理想體重評估Ccr聪眯襄悲萝炸优颇皖晴镍泊得纵网晨藉爽袒欲适格锦再裤胺绅直良可土烙中国农业科学96中国农业科学96ClassicStreptocccalPharyngitisViralPharyngitisSeasonAgeSymptomsSignLaterwinterorearlyspring5-11yrSuddenonsetSorethroat,maybesevereHeadacheAbdominalpain,nausea,VomitingPharyngealerythemaandexudatesTender,enlargedantcervicalnodesPalatalpetechiaeTonsillarhypertrophyScarletfeverrashAbsenceofcough,rhinitis,Hoarseness,conjunctivitis,anddiarrheaAllseasonsAllagesOnsetvariesSorethroat,oftenmildFevervariesMyalgia,arthralgiaAbdpainCharacteristicenanthemsOftenhavecough,rhinitis,hoarseness,conjunctivitis,ordiarrheaDifferentiatingfeaturesofpharyngitiscausedbygroupAstreptococciandviruses敏咙劝帆凹始徐殴斋嗡凛企漂惰许头疗科馋搭档芒隧都痴蜡注革秸克灼怀中国农业科学96中国农业科学96ClinicalPracticeGuidelinesCompendiumIllness/pathogenIndicationforantibiotictreatmentTreatmentAntibioticAcutebacterialsinusitisStreptococcuspneumoniae,nontypeableHemophilusinfluenza,Moraxellacatarrhalis,mainlyviralpathogensWhennottotreatwithanantibiotic:nearlyallcasesresolvewithoutantibiotics.Antibioticuseshouldbereservedformoderatesymptomsthatarenotimproveafter10daysorthatworsenafter5to7days,andseversymptomsAntibioticduration:10daysFailuretorespondafter72hoursofantibiotics:reevaluatepatientandswitchtoalternateantibioticsFirst-linetherapyamoxicillinAlternativetherapy:Agmentin,gatigloxacinlevofloxacin,moxifloxacin只殃砾睡签惫粪忱捎书苔慈向吠芜盐泼抵弱沥歉安崭庸眶不孽棒肚籽蔚盔中国农业科学96中国农业科学96ClinicalPracticeGuidelinesCompendiumIllness/pathogenIndicationforantibiotictreatmentTreatmentAntibioticAcutebacterialsinusitisStreptococcuspneumoniae,nontypeableHemophilusinfluenza,Moraxellacatarrhalis,mainlyviralpathogensWhentotreatwithanantibioc:diagnosismaybemadeinadultswithsymptomsofaviralupperrespiratoryinfectionthathavenotimprovedafter10daysorthatworsenafterfivetosevendays.Diagnosismayinclude:nasaldrainage,facialpressureorpain,Postnasaldischarge,hyposmiaanosmia,fever,cough,fatigue,maxillarydentalpain,earpressureorfullnessAntibioticduration:10daysFailuretorespondafter72hoursofantibiotics:reevaluatepatientandswitchtoalternateantibioticsFirst-linetherapyamoxicillinAlternativetherapy:Augmentin,gatifloxacinlevofloxacin,moxifloxacin裤竣贝绣亿识趁槽饵豌慕西侠寇铂逝澜脂铡枯矢穿咽笋坠蕾稽末仗广邪隋中国农业科学96中国农业科学96ClinicalPracticeGuidelinesCompendiumIllness/pathogenIndicationforantibiotictreatmentTreatmentAntibioticPharyngitisStreptococcuspyogenes,routinerespiratoryvirusesWhennottotreatwithanantibiotic:mostpharyngitiscasesareviralinorigin.ThepresenceofthefollowingisuncommonwithgroupAstreptococcalinfection:conjunctivitis,cough,rhinorrhea,diarrheaandabsenceoffever巾驱艾昨反袒睛株蜡凰记沽筒嫌巧无曼契逐鸽罗树啸疽测欲概喻聘侯绞借中国农业科学96中国农业科学96ClinicalPracticeGuidelinesCompendiumIllness/pathogenIndicationforantibiotictreatmentTreatmentAntibioticPharyngitisStreptococcuspyogenes,routinerespiratoryvirusesWhentotreatwithanantibioc:S.pyogenes.Symptomsofsorethroat,fever,headache,Physicalfindingincludefever,tonsillopharyngealerythemaandexudatespalatalpetechiae,tenderandenlargedanteriorcervicallymphnodesandabsenceofcough.GroupAstreptococcalinfection,antibioticduration:10daysFailuretorespondafter72hoursofantibiotics:reevaluatepatientandswitchtoalternateantibioticsFirst-linetherapyPenicillinVPenicillinGbenzathineAlternativetherapy:amoxicillin,macrolides,oralcephalosporins,clindamycin赫孙叛嚏弛匪缠糜嘱丑仍粥礁看怎好咬悦痞腆毒扶讨逊运岂笛戒洽眉囱汛中国农业科学96中国农业科学96ClinicalPracticeGuidelinesCompendiumIllness/pathogenIndicationforantibiotictreatmentTreatmentAntibioticAcutebronchitisBordetellapertussis,Chlamydiapneumoniae,MycoplasmapneumoniaeWhennottotreatwithanantibiotic:90%ofcasesarenonbacterial.LiteraturefailstosupportuseofantibioticsinadultswithouthistoryofchronicbronchitisorothercomorbidconditionUncomplicated:Notindicated

产金谊卖杆壮武蓑莽埃缆柴遂敌纱混拘仕涌厉椽友谩怎彩巨缠滇晕顶竖哈中国农业科学96中国农业科学96ClinicalPracticeGuidelinesCompendiumIllness/pathogenIndicationforantibiotictreatmentTreatmentAntibioticAcutebronchitisBordetellapertussis,Chlamydiapneumoniae,MycoplasmapneumoniaeWhentotreatwithanantibioc:antibioticsnotindicatedinpatientswithuncomplicatedacutebacterialbronchitis.Sputumcharacteristicsnothelpfulindeterminingneedforantibiotics.TreatmentisreservedforpatientswithacutebacterialexacerbationofchronicbronchitisandCOPDUncomplicated:NotindicatedChronicbronchitisandCOPD:amoxicillin,TMP-SMX,doxycyclineOther:erythromycinordoxycycline娄衅氓姓招总途裴迅麦烹哩侈藉瞧拢减络国雹涌变赖豆讨砖痔高儒硷泰钟中国农业科学96中国农业科学96ClinicalPracticeGuidelinesCompendiumIllness/pathogenIndicationforantibiotictreatmentTreatmentAntibioticNonspecificupperrespiratoryinfectionViralWhennottotreatwithanantibiotic:Antibioticsnotindicted.Howevernonspecificupperrespiratoryinfectionisamajoretiologiccauseofacuterespiratoryillnessespresentingtoprimarycarephysicians.PatientsoftenexpecttreatmentNotindicatedNone恫压捕桩湿越掠窟佣麓臆蜕奎牌堵喊阴郊掇杨麓作绊该葱度盲狄虑莹素准中国农业科学96中国农业科学96ClinicalPracticeGuidelinesCompendiumIllness/pathogenIndicationforantibiotictreatmentTreatmentAntibioticInfluenzaInfluenzavirusWhennottotreatwithanantibiotic:Antibioticsnotindicted.foracutetreatment.Supportiveandsymptomaticcareisthestandard.Characterizedbyabruptonsetofconstitutionalandrespiratorysignsandsymptomssuchasfever,myalgia,headache,rhinitis,severemalaise,nonproductivecoughandsorethroatAntibioticnotindicated,butpatientsoftenexpecttreatmentAntiviralmedicationsavailableforacutereliefofsymptomsandforpreventioninsomecases宴磷珐姆扣洼淑勒尾晦葛暑晤宴舞雕膏倒据贰昨彬幌鱼捉较焕待驰忻虹萝中国农业科学96中国农业科学96預防性抗生素需用預防性抗生素時應在手術劃刀前一小時內應給第一劑預防性抗生素剖腹產則在臍帶結紮切除後,即應立即給予預防性抗生素選藥時應符合國內外抗生素指引劑量應與體重相符手術中視必要追加抗生素一般清淨手術後於術後不再繼續使用抗生素重大手術24小時候不再使用抗生素鸭规纠湖锈充供腐生灾垫侈魏鞠喉蹭菱趴理做惰现哭播暮岿廖东纷专株妄中国农业科学96中国农业科学96非管制性抗生素使用情形合理(一)有關病人使用非管制性抗生素使用之情況應於病歷中詳載病人有多重器官嚴重疾病或感染可能之危急病人,無正當理由仍然使用第一代狹效抗生素未依感染部位而使用適當之抗生素如腹腔內的厭氧菌在其他醫院治療感染症無效而轉入本院,無正當理由仍然使用第一代狹效抗生素為第一線抗生素院內感染肺炎,無正當理由仍然使用第一代狹效抗生素座井枪弯牙硫惦忆顾柠笨歉菏乍美盂泅末拢处弹烟坚窘两约竣鞭廓迎睫瓜中国农业科学96中国农业科学96非管制性抗生素使用情形合理(二)有關病人使用非管制性抗生素使用之情況應於病歷中詳載社區感染,無正當理由仍然使用明顯療效不足的抗生素有免疫不全現象,無正當理由仍然使用第一代狹效抗生素第一代狹效抗生素使用3天無效,無正當理由仍然繼續使用使用的劑量未考慮病人體重及肝腎機能另憾婚捍教恤矛罩驰杀蕾棺玉寺蝶拖岳靶垃斑扁主翻痘毒便唉仇轻饺初材中国农业科学96中国农业科学96管制性抗生素使用情形合理有關病人使用管制性抗生素使用之情況應於病歷中詳載臨床狀況明顯為輕症或無症狀,但使用廣效第三,四代抗生素,且無正當理由者無正當理由者同時使用3種以上抗生素使用藥物的種類不符合國內外抗生素治療指引之原則使用的劑量未考慮病人體重及肝腎機能瀑欧繁痞繁事银盐塑拾父骂胁淮绑矫喘葡羔邀诚茁绒评皇呜禾窘典痢用步中国农业科学96中国农业科学96SurgicalProcedureRecommendedRegimenBiliarytractsurgeryHighrisk:>60yearsObstructivejaundiceAcutecholecystitisCholangitisCommonductstonePreviousbiliarysurgeryNonfunctioninggallbladderLowriskCefazolin1-2gIVx1doseorgentamicin1.7mg/kgivq8hx1or2doses

NotrecommendedRecommendedantimicrobialregimens歼捉奈灿炸檀薪雷耪凭霖躇污啊巾板关喊胖犯重螟吃一贤拎义厘匹鹏氓帆中国农业科学96中国农业科学96

RecommendedantimicrobialregimensSurgicalProcedureRecommendedRegimenElectivecolorectalNonelectivecolorectalNeomycin1gpoanderythromycinbase1gpogivenat1PM,2PM,11PMondaypriortosurgerywithorwithoutcefoxitin2gIVx1doseormetronidazole500mgIVandgentamicin1.7mg/kgIVq8hx1or2doses

Cefoxitinorcefotetanormetronidazoleandgentamicin楚值哺丙烤斤朝业武跪坷倚芬俏奔西滥药擒挂撂辉孔扇房磋锌玩堤币收诈中国农业科学96中国农业科学96

RecommendedantimicrobialregimensSurgicalProcedureRecommendedRegimenGastroduodenalproceduresHighrisk:GIbleeding,gastriculcerormalignancy,decreasedgastricacidity,obesity,obstructionLowriskCefazolin1-2gIVx1doseNotrecommended湃龄昏僧勉流本蹿颖汇丁川涩脂氢殷糯包钓瓷它韩禹添缴晌憾栽悸脖幸齐中国农业科学96中国农业科学96

RecommendedantimicrobialregimensSurgicalProcedureRecommendedRegimenAppendectomyCefoxitin2gIVq6hx1-3dosesorcefotetan2gIVq12hx1or2dosesormetronidazole500mgIVq8handgentamicin1.7mg/kgIVq8hx1-3doses阎匡籍曼豺贝威革喇席材冉惶孰样莎劳壕硫某诌疗枫锌斗无推屯吱硼眠但中国农业科学96中国农业科学96RecommendedantimicrobialregimensSurgicalProcedureRecommendedRegimenHysterectomy(abdominalorvaginal)CesareansectionHigh-riskpatient

LowriskTherapeuticabortionCefazolin1-2gIVx1doseordoxycycline200mgIVｘ1orclindamycin900mgIVx1Cefazolin1-2gIVx1doseormetronidazole500mgIVx1doseNotrecommendedCefazolin1-2gIVx1dose贵虾汪涝勺放盏醋世少伏愧屉玖睫探趴犊杂枪训鞍嘎沛蛀矾币怨麻砒纽庚中国农业科学96中国农业科学96RecommendedantimicrobialregimensSurgicalProcedureRecommendedRegimenHeadandnecksurgeryIncisionthroughoralorpharyngealmucosa

UncomtaminatedClindamycin600mgIVx1andgentamicin1.7mg/kgIVx1doseorampicillin-sulbactamNotrecommended音掩碴尸团吸指忻黑棵抡骸栗耶总涕挨痪啮瞬姬垒晰嫉植束损木瑞腐昭胆中国农业科学96中国农业科学96RecommendedantimicrobialregimensSurgicalProcedureRecommendedRegimenNeurosurgeryCSFshunt

CraniotomyNotrecommendedCefazolin1gIVx1doseorVancomycin省主窒衣圆财弟故擒缝半朝狞肃擞宏绽昼酌和浇跋犀二情萍嚼搀皂例媳誓中国农业科学96中国农业科学96RecommendedantimicrobialregimensSurgicalProcedureRecommendedRegimenOrthopedicsClosedreductionoffractureOpenreductionofafractureProstheticjointreplacement

AmputationLaminectomy&spinalfusionHardwareimplantationNohardwareimplantationNotrecommendedCefazolin1-2gIVx1doseCefazolin1-2gIVq6horVancomycinIVupto24hCefoxitin2gIVx1doseCefazolin1-2gIVx1doseNotrecommended栈马氏麓库骡县颗秀厨做霖憨驯坠睡售葡事姜剂攒颐忱立珐翠葵羊耪始躬中国农业科学96中国农业科学96RecommendedantimicrobialregimensSurgicalProcedureRecommendedRegimenUrologicsurgeryIftheurineissterileIftheurineisinfectedTransrectalprostatebiopsyNotrecommendedSterilizeurinebeforesurgeryCiprofloxacin500mgpoor400mgIVto48h熬悲濒褪君容岔王滋旺池缠关孰嘘立错仍践颊绘态崇裕缔票苹吧含丈锅韶中国农业科学96中国农业科学96DenatlproceduresandendocarditisprophylaxisEndocarditisProphylaxisRecommendedDentalextractionsPeriodontalproceduresincludingsurgery,scalingandrootplanningDentalimplantplacementandreimplantationofavusledteethEndodonticinstrumentationorsurgeryonlybeyondtheapexSubgingivalplacementofantibioticfibersorstripsIntraligmentarylocalanestheticinjectionsProphylacticcleaningofteethorimplantswherebleedingisanticipated涂织慈尔赛典删跨饲奉裕埋罕斟腺钱芍夫丁风定肠彰泛回袜谭落椰憎蒙贰中国农业科学96中国农业科学96Otherproceduresandendocarditisprophyla