Post on 26-Dec-2015
抗生素正確使用原則
張恩本醫師 為恭醫院感染科
20100326
今日討論的主題
抗生素一般使用原則 抗生素 相關過敏反 應 常見的感染症致病菌 抗生素的分類 抗生素使用常見錯誤 抗素使用的適應症 常見感染症的抗生素療程
抗生素一般使用原則
Narrow spectrum 一種細菌用一種藥物治療 足量藥物治療 完整療程
使用抗生素之前應
用手取得檢體染色培養 用眼觀察染色特徵 用腦社區型感染或院內感染 想想看最可能的致病菌是什麼 藥物敏感性如何
理想的抗生素 Maximal damage to the bacteria minimal damage to the host ndashselective toxicity Single use High effectiveness Low cost No side-effect
Principles of antibiotic therapy Host factors Allergy history Age Body weight Renalliver function Immune status Site of infection pathogen route of
antibiotics Disease severity Pregnancy
Empirical therapy must be adjusted after culture become available
Definite antimicrobial therapy ndashchange broad- spectrum coverage to specific pathogen
De-escalating therapy
Pathogens of community-acquired infection Pulmonary
S pneumoniae H influenzae M catarrhalis Skin amp soft tissue Streptococci Staphylococci
Enterobacterioceae Intraabdomen Enterobacterioceae Anaerobes Enterococci CNS S pneumoniae H influenzae N meningitidis
Pathogens of community-acquired infection
Pulmonary S pneumoniae H influenzae M catarrhalis Skin amp soft tissue Streptococci Staphylococci
Enterobacterioceae Intraabdomen Enterobacterioceae Anaerobes Enterococci CNS S pneumoniae H influenzae N meningitidis
Pathogens of nosocmial infection
Pulmonary Enterobacterioceae Pseudomonas Acinetobacter MRSA Intraabdomen Enterobacterioceae Pseudomonas Anaerobes Enterococci Candida CNS MRSA Pseudomonas
Allergic reactions to antibiotics Fixed drug eruption Skin rash (maculopapular) Exfoliativedermatitis Stevens-Johnson Syndrome (Toxic epidermal necrolysis) Anaphylactic shock
Fixed rug eruption
Skin rash (maculopapular)
Stevens-Johnson Syndrome (Toxic epidermal necrolysis)
Antibiotics
Penicillins Beta-lactmase
inhibitors Cephalosporins Carbapenems Monobactams Sulfonamides amp
trimethoprim
Aminoglycosides Quinolones Tetracycline Metronidazole Macrolides Tigecycline Glycopeptide Colistimethate
sodium
Penicillins
Natural PCNsPenicillin G Penicillin V benzathine
PCN Penicillinase-resistant PCNs
Oxacillin Prostaphylin Amionopenicillins
Amoxicillin Ampicillin Anti-pseudomonal PCNs
Ticarcillin Piperacillin
Antimicrobial spectrum of Penicillin-G Streptococcus spp Anaerobes Neisseria spp (Meningococcus
Gonococcus) Actinomycosis Animal bite (Pasteurella multocida) 螺旋體 Syphilis Leptospirosis
Penicillinase-resistant Penicillins oxacillin Penicillinase (β-lactamase) inhibitor Anti-staphylococcal penicillins Less active than penicillin-G against
all other penicillin-susceptible microorganisms
Adverse effects-PCNs
Anaphylaxis anemia leukopenia Oxacillin hepatitis Ticarcillin coagulation abnormality
bleeding
Beta-lactambeta-lactamatase inhibitor
Sulbactam Ampicillin + Sulbactam
Clavulanic acid Amoxycillin + ClavulanateTicarcillin + Clavulanate
Tazobactam Piperacillin + Tazobactam
Antipseudomonal Penicillins Piptazo Ticarcillin + Clavulanate Pseudomonas species Many strains of Enterobacter Anaerobics except β-lactamase
producing Bacteroides species Less active against gram positive
isolates
Adverse effects of penicillin Anaphylaxis anemia leukopenia Oxacillin hepatitis Ticarcillin coagulation abnormality
bleeding
Sulbactam (Maxtam)
Sulbactam is an irreversible inhibitor of beta-lactamase
Combinations of sulbactam with beta-lactam antibiotics
Dose 05 ~ 10 gm 6 ~ 8 with other antibiotics not
gt 40 gmday Cefoperazonesulbactam Ampicillinsulbactam
Cephalosporins
First generation Second generation Third generation Fourth generation
Cephalosporins
Against GPC 1st gt 2nd gt cephamycins gt 3rd Against GNB 1st lt 2nd lt cephamycins lt 3rd
First Generation
Cefazolin Cefadroxil Ceflexin Cephradine
StreptococcusStaphylococcus (methicillin-susceptible)E coliP mirabilisK pneumoniae
Second Generation
Cefmetazole Cefuroxime
Cefalor Cefuroxime
above the diaphragm cefuroximebelow the diaphragm cefmetazole (cephamycins B fragilis) Cefmatazole ESBL-producing Enterobacteriaceae
Third generation
Cefoperazone Cefotaxime Ceftazidime Ceftriaxone Flumarin
Cefixime Cefpodoxime ceftibuten
Resistant Gram-negative microorganisms ( Nosocomial infections ) Serratia Citrobacter Enterobacter Pseudomonas β-lactamase producing H influenzaeBetter BBB penetration among cephalosporins (except cefoperazone)Indication nosocomial infections (mainly GNB) GNB meningitis
Fourth Generation
Cefepime Cefpirome
Good anti-pseudomonal effectGood CNS penetrationPreserve antimicrobial effect to G(+) bacteria
Adverse effects of cephalosporins
Cefamandole cefmetazole cefoperazone cefotetan vitamin K-dependent clotting factor metabolism
Monobactam Monobactam (Aztreonam(Aztreonam)) Only gram-negative aerobes Alternative in penicillin- and
cephalosporin- allergic patients
Sulfonamides and trimethoprim Inhibit folic acid metabolism Treatment of PCP Nocardia
Toxaplasma Sternotrophomonus Aderverse effect cholestatic jaudice
bone marrow suppression severe hypersensitivity (Stevens-Johnson syndrome)
CarbapenemGroup Classification
Group 1 Broad-spectrum carbapenems with limited activity against non-fermentative Gram-negative bacilli (NFGNB eg Pseudomonas Acinetobacter) that are particularly suitable for community-acquired infections (eg ertapenem)
Group 2 Broad-spectrum carbapenems with activity against non-
fermentative Gram-negative bacilli (eg Pseudomonas
Acinetobacter) that are particularly suitable for nosocomial infections (eg imipenem and meropenem)
Group3 Carbapenems with clinical activity against Methicillin-
Resistant Staphylococcus (eg In development)
J Antimicrob Chemotherapy
Side effect of Carbapenems Anaphylaxis Interstitial nephritis Anemia Leukopenia Precipitate seizure activity
especially old patients CRI preexisting seizure disorder or CNS pathology
AminoglycosidesAminoglycosides
Antimicrobial Spectrum Antimicrobial Spectrum - All Gram negative bacilli
- Staphylococcus aureus Dosage Dosage - Gentamicin loading ~ 2 mgkg maintenance ~ 3-5 mgkgday Amikacin loading ~ 75 mgkg maintenance ~ 5 mgkg Q8H or 75
mgkg q12H Exacin 8mgskgday Single daily (once-daily) dosing (SDD) Short course (3-5 days)
Adverse effects of Adverse effects of aminoglycosidesaminoglycosides Nephrotoxicity Ototoxicity Neuromuscular paralysis ~ High doseinfrequent administration
DECREASES the rate of tissue uptake mdash DELAY the onset
of toxicity doesnrsquot prevent it from happening ~ All patients if treated for a long enough time
will eventually develop toxicity
Fluoroquinolones
Group I
- Nalidixic acid
- Enteric or urinary tract infections Group II
- Ciprofloxacin Ofloxacin Levofloxacin
- GNR (P aeruginosa) S pneumoniae atypicals Group III
- Moxifloxacin Gemifloxacin
- GPB ( S pneumoniaeuarr) atypicals anaerobes GNR
(P aeruginosadarr)
- Respiratory tract infections
GlycopeptidesGlycopeptides
Vancomycin amp Teicoplanin
Non-β-lactam cell wall synthesis inhibitor
Spectrum GPC amp GPB
Avoid oral use except AAC (antibiotic-associated colitis)
Tetracyclines
STD
- Chlamydial
diseases
- Gonorrhea
(doxycycline +
ceftriaxone)
- Syphilis
Rickettsial diseases
Brucellosis
Tularemia
Relapsing fever
Tigecycline (a new class Glycylcyclines)Gram-positive BacteriaGram-positive Bacteria Staphylococcus MRSA
MRSE VRE E faecium E faecalis Streptococcus agalactiae S treptococcus anginosus
group Streptococcus pyogenes
AnaerobesAnaerobes B fragilis group Prevotella spp Peptostreptococcus spp C perfringensAtypicalAtypical Chlamydia pneumoniae Mycoplasma pneumoniae Legionella
Gram-negative BacteriaGram-negative Bacteria E coli (including ESBLs) Kl ebsiella pneumoniae (including ESBLs) K oxytoca Acinetobacter baumannii (Resistant strains)Resistant strains) Citrobacter freundii Enterobacter cloacae Enterobacter aerogenes Stenotrophomonas
maltophilia
Does not have good activity Does not have good activity againstagainst P aeruginosa Proteus Providencia
Colistimethate sodium Colistimethate sodium Pseudomonas
aeruginosa infections in cystic fibrosis multidrug-resistant Acinetobacter infection
E-coli Klebsiella sp ( ESBL) Enterobacter Colomycin 1000000 units = 80 mg
colistimethate 6 to 12 mgkg colistimethate sodium per
day 60 kg man recommended dose for
Colomycin is 240 to 480 mg of colistimethate sodium
Nephrotoxicity (damage to the kidneys) and neurotoxicity
抗生素使用常見的五大錯誤
Antibiotic = scanol (antipyretic) S vs R (susceptible vs resistant) 4 gt 3 gt2 gt 1 Treat colonization Vancomycin+ imipenem(atomic
bomb)
Colonization
Positive culture for sputum urine bile stool and skin swab without symptoms or signs of infection Not recommend for using antibiotics
Except asymptomatic bacteriuria before urological work up and in pregnancy should be treated
抗生素使用的適應症
明顯的細菌感染 極可能的細菌感染 敗血症 白血球過低合併發燒 懷疑急性心內膜炎 細菌性腦膜炎 壞死性筋膜炎
常見感染症之抗生素療程 ( 一 )
感染症療程 ( 天 )
菌血症 敗血症 14
肝膿瘍 21
軟組織感染 7-10
急性腎炎 14
細菌性腦膜炎 10
常見感染症之抗生素療程 ( 二 )感染症療程 ( 天 )
1048729
肺炎雙球菌肺炎 14 ()
革蘭氏陰性桿菌肺炎1048729
21 ()
退伍軍人協會症1048729
21
奴卡氏菌肺炎1048729
180-360
感染性心內膜炎 28-42
抗生素治療失敗之原因
選用藥物不恰當 藥物交互作用 降低療效 異異物阻塞或膿瘍未引流 病人免疫力太差 分離菌之判讀錯誤 新的院內感染
今日討論的主題
抗生素一般使用原則 抗生素 相關過敏反 應 常見的感染症致病菌 抗生素的分類 抗生素使用常見錯誤 抗素使用的適應症 常見感染症的抗生素療程
抗生素一般使用原則
Narrow spectrum 一種細菌用一種藥物治療 足量藥物治療 完整療程
使用抗生素之前應
用手取得檢體染色培養 用眼觀察染色特徵 用腦社區型感染或院內感染 想想看最可能的致病菌是什麼 藥物敏感性如何
理想的抗生素 Maximal damage to the bacteria minimal damage to the host ndashselective toxicity Single use High effectiveness Low cost No side-effect
Principles of antibiotic therapy Host factors Allergy history Age Body weight Renalliver function Immune status Site of infection pathogen route of
antibiotics Disease severity Pregnancy
Empirical therapy must be adjusted after culture become available
Definite antimicrobial therapy ndashchange broad- spectrum coverage to specific pathogen
De-escalating therapy
Pathogens of community-acquired infection Pulmonary
S pneumoniae H influenzae M catarrhalis Skin amp soft tissue Streptococci Staphylococci
Enterobacterioceae Intraabdomen Enterobacterioceae Anaerobes Enterococci CNS S pneumoniae H influenzae N meningitidis
Pathogens of community-acquired infection
Pulmonary S pneumoniae H influenzae M catarrhalis Skin amp soft tissue Streptococci Staphylococci
Enterobacterioceae Intraabdomen Enterobacterioceae Anaerobes Enterococci CNS S pneumoniae H influenzae N meningitidis
Pathogens of nosocmial infection
Pulmonary Enterobacterioceae Pseudomonas Acinetobacter MRSA Intraabdomen Enterobacterioceae Pseudomonas Anaerobes Enterococci Candida CNS MRSA Pseudomonas
Allergic reactions to antibiotics Fixed drug eruption Skin rash (maculopapular) Exfoliativedermatitis Stevens-Johnson Syndrome (Toxic epidermal necrolysis) Anaphylactic shock
Fixed rug eruption
Skin rash (maculopapular)
Stevens-Johnson Syndrome (Toxic epidermal necrolysis)
Antibiotics
Penicillins Beta-lactmase
inhibitors Cephalosporins Carbapenems Monobactams Sulfonamides amp
trimethoprim
Aminoglycosides Quinolones Tetracycline Metronidazole Macrolides Tigecycline Glycopeptide Colistimethate
sodium
Penicillins
Natural PCNsPenicillin G Penicillin V benzathine
PCN Penicillinase-resistant PCNs
Oxacillin Prostaphylin Amionopenicillins
Amoxicillin Ampicillin Anti-pseudomonal PCNs
Ticarcillin Piperacillin
Antimicrobial spectrum of Penicillin-G Streptococcus spp Anaerobes Neisseria spp (Meningococcus
Gonococcus) Actinomycosis Animal bite (Pasteurella multocida) 螺旋體 Syphilis Leptospirosis
Penicillinase-resistant Penicillins oxacillin Penicillinase (β-lactamase) inhibitor Anti-staphylococcal penicillins Less active than penicillin-G against
all other penicillin-susceptible microorganisms
Adverse effects-PCNs
Anaphylaxis anemia leukopenia Oxacillin hepatitis Ticarcillin coagulation abnormality
bleeding
Beta-lactambeta-lactamatase inhibitor
Sulbactam Ampicillin + Sulbactam
Clavulanic acid Amoxycillin + ClavulanateTicarcillin + Clavulanate
Tazobactam Piperacillin + Tazobactam
Antipseudomonal Penicillins Piptazo Ticarcillin + Clavulanate Pseudomonas species Many strains of Enterobacter Anaerobics except β-lactamase
producing Bacteroides species Less active against gram positive
isolates
Adverse effects of penicillin Anaphylaxis anemia leukopenia Oxacillin hepatitis Ticarcillin coagulation abnormality
bleeding
Sulbactam (Maxtam)
Sulbactam is an irreversible inhibitor of beta-lactamase
Combinations of sulbactam with beta-lactam antibiotics
Dose 05 ~ 10 gm 6 ~ 8 with other antibiotics not
gt 40 gmday Cefoperazonesulbactam Ampicillinsulbactam
Cephalosporins
First generation Second generation Third generation Fourth generation
Cephalosporins
Against GPC 1st gt 2nd gt cephamycins gt 3rd Against GNB 1st lt 2nd lt cephamycins lt 3rd
First Generation
Cefazolin Cefadroxil Ceflexin Cephradine
StreptococcusStaphylococcus (methicillin-susceptible)E coliP mirabilisK pneumoniae
Second Generation
Cefmetazole Cefuroxime
Cefalor Cefuroxime
above the diaphragm cefuroximebelow the diaphragm cefmetazole (cephamycins B fragilis) Cefmatazole ESBL-producing Enterobacteriaceae
Third generation
Cefoperazone Cefotaxime Ceftazidime Ceftriaxone Flumarin
Cefixime Cefpodoxime ceftibuten
Resistant Gram-negative microorganisms ( Nosocomial infections ) Serratia Citrobacter Enterobacter Pseudomonas β-lactamase producing H influenzaeBetter BBB penetration among cephalosporins (except cefoperazone)Indication nosocomial infections (mainly GNB) GNB meningitis
Fourth Generation
Cefepime Cefpirome
Good anti-pseudomonal effectGood CNS penetrationPreserve antimicrobial effect to G(+) bacteria
Adverse effects of cephalosporins
Cefamandole cefmetazole cefoperazone cefotetan vitamin K-dependent clotting factor metabolism
Monobactam Monobactam (Aztreonam(Aztreonam)) Only gram-negative aerobes Alternative in penicillin- and
cephalosporin- allergic patients
Sulfonamides and trimethoprim Inhibit folic acid metabolism Treatment of PCP Nocardia
Toxaplasma Sternotrophomonus Aderverse effect cholestatic jaudice
bone marrow suppression severe hypersensitivity (Stevens-Johnson syndrome)
CarbapenemGroup Classification
Group 1 Broad-spectrum carbapenems with limited activity against non-fermentative Gram-negative bacilli (NFGNB eg Pseudomonas Acinetobacter) that are particularly suitable for community-acquired infections (eg ertapenem)
Group 2 Broad-spectrum carbapenems with activity against non-
fermentative Gram-negative bacilli (eg Pseudomonas
Acinetobacter) that are particularly suitable for nosocomial infections (eg imipenem and meropenem)
Group3 Carbapenems with clinical activity against Methicillin-
Resistant Staphylococcus (eg In development)
J Antimicrob Chemotherapy
Side effect of Carbapenems Anaphylaxis Interstitial nephritis Anemia Leukopenia Precipitate seizure activity
especially old patients CRI preexisting seizure disorder or CNS pathology
AminoglycosidesAminoglycosides
Antimicrobial Spectrum Antimicrobial Spectrum - All Gram negative bacilli
- Staphylococcus aureus Dosage Dosage - Gentamicin loading ~ 2 mgkg maintenance ~ 3-5 mgkgday Amikacin loading ~ 75 mgkg maintenance ~ 5 mgkg Q8H or 75
mgkg q12H Exacin 8mgskgday Single daily (once-daily) dosing (SDD) Short course (3-5 days)
Adverse effects of Adverse effects of aminoglycosidesaminoglycosides Nephrotoxicity Ototoxicity Neuromuscular paralysis ~ High doseinfrequent administration
DECREASES the rate of tissue uptake mdash DELAY the onset
of toxicity doesnrsquot prevent it from happening ~ All patients if treated for a long enough time
will eventually develop toxicity
Fluoroquinolones
Group I
- Nalidixic acid
- Enteric or urinary tract infections Group II
- Ciprofloxacin Ofloxacin Levofloxacin
- GNR (P aeruginosa) S pneumoniae atypicals Group III
- Moxifloxacin Gemifloxacin
- GPB ( S pneumoniaeuarr) atypicals anaerobes GNR
(P aeruginosadarr)
- Respiratory tract infections
GlycopeptidesGlycopeptides
Vancomycin amp Teicoplanin
Non-β-lactam cell wall synthesis inhibitor
Spectrum GPC amp GPB
Avoid oral use except AAC (antibiotic-associated colitis)
Tetracyclines
STD
- Chlamydial
diseases
- Gonorrhea
(doxycycline +
ceftriaxone)
- Syphilis
Rickettsial diseases
Brucellosis
Tularemia
Relapsing fever
Tigecycline (a new class Glycylcyclines)Gram-positive BacteriaGram-positive Bacteria Staphylococcus MRSA
MRSE VRE E faecium E faecalis Streptococcus agalactiae S treptococcus anginosus
group Streptococcus pyogenes
AnaerobesAnaerobes B fragilis group Prevotella spp Peptostreptococcus spp C perfringensAtypicalAtypical Chlamydia pneumoniae Mycoplasma pneumoniae Legionella
Gram-negative BacteriaGram-negative Bacteria E coli (including ESBLs) Kl ebsiella pneumoniae (including ESBLs) K oxytoca Acinetobacter baumannii (Resistant strains)Resistant strains) Citrobacter freundii Enterobacter cloacae Enterobacter aerogenes Stenotrophomonas
maltophilia
Does not have good activity Does not have good activity againstagainst P aeruginosa Proteus Providencia
Colistimethate sodium Colistimethate sodium Pseudomonas
aeruginosa infections in cystic fibrosis multidrug-resistant Acinetobacter infection
E-coli Klebsiella sp ( ESBL) Enterobacter Colomycin 1000000 units = 80 mg
colistimethate 6 to 12 mgkg colistimethate sodium per
day 60 kg man recommended dose for
Colomycin is 240 to 480 mg of colistimethate sodium
Nephrotoxicity (damage to the kidneys) and neurotoxicity
抗生素使用常見的五大錯誤
Antibiotic = scanol (antipyretic) S vs R (susceptible vs resistant) 4 gt 3 gt2 gt 1 Treat colonization Vancomycin+ imipenem(atomic
bomb)
Colonization
Positive culture for sputum urine bile stool and skin swab without symptoms or signs of infection Not recommend for using antibiotics
Except asymptomatic bacteriuria before urological work up and in pregnancy should be treated
抗生素使用的適應症
明顯的細菌感染 極可能的細菌感染 敗血症 白血球過低合併發燒 懷疑急性心內膜炎 細菌性腦膜炎 壞死性筋膜炎
常見感染症之抗生素療程 ( 一 )
感染症療程 ( 天 )
菌血症 敗血症 14
肝膿瘍 21
軟組織感染 7-10
急性腎炎 14
細菌性腦膜炎 10
常見感染症之抗生素療程 ( 二 )感染症療程 ( 天 )
1048729
肺炎雙球菌肺炎 14 ()
革蘭氏陰性桿菌肺炎1048729
21 ()
退伍軍人協會症1048729
21
奴卡氏菌肺炎1048729
180-360
感染性心內膜炎 28-42
抗生素治療失敗之原因
選用藥物不恰當 藥物交互作用 降低療效 異異物阻塞或膿瘍未引流 病人免疫力太差 分離菌之判讀錯誤 新的院內感染
抗生素一般使用原則
Narrow spectrum 一種細菌用一種藥物治療 足量藥物治療 完整療程
使用抗生素之前應
用手取得檢體染色培養 用眼觀察染色特徵 用腦社區型感染或院內感染 想想看最可能的致病菌是什麼 藥物敏感性如何
理想的抗生素 Maximal damage to the bacteria minimal damage to the host ndashselective toxicity Single use High effectiveness Low cost No side-effect
Principles of antibiotic therapy Host factors Allergy history Age Body weight Renalliver function Immune status Site of infection pathogen route of
antibiotics Disease severity Pregnancy
Empirical therapy must be adjusted after culture become available
Definite antimicrobial therapy ndashchange broad- spectrum coverage to specific pathogen
De-escalating therapy
Pathogens of community-acquired infection Pulmonary
S pneumoniae H influenzae M catarrhalis Skin amp soft tissue Streptococci Staphylococci
Enterobacterioceae Intraabdomen Enterobacterioceae Anaerobes Enterococci CNS S pneumoniae H influenzae N meningitidis
Pathogens of community-acquired infection
Pulmonary S pneumoniae H influenzae M catarrhalis Skin amp soft tissue Streptococci Staphylococci
Enterobacterioceae Intraabdomen Enterobacterioceae Anaerobes Enterococci CNS S pneumoniae H influenzae N meningitidis
Pathogens of nosocmial infection
Pulmonary Enterobacterioceae Pseudomonas Acinetobacter MRSA Intraabdomen Enterobacterioceae Pseudomonas Anaerobes Enterococci Candida CNS MRSA Pseudomonas
Allergic reactions to antibiotics Fixed drug eruption Skin rash (maculopapular) Exfoliativedermatitis Stevens-Johnson Syndrome (Toxic epidermal necrolysis) Anaphylactic shock
Fixed rug eruption
Skin rash (maculopapular)
Stevens-Johnson Syndrome (Toxic epidermal necrolysis)
Antibiotics
Penicillins Beta-lactmase
inhibitors Cephalosporins Carbapenems Monobactams Sulfonamides amp
trimethoprim
Aminoglycosides Quinolones Tetracycline Metronidazole Macrolides Tigecycline Glycopeptide Colistimethate
sodium
Penicillins
Natural PCNsPenicillin G Penicillin V benzathine
PCN Penicillinase-resistant PCNs
Oxacillin Prostaphylin Amionopenicillins
Amoxicillin Ampicillin Anti-pseudomonal PCNs
Ticarcillin Piperacillin
Antimicrobial spectrum of Penicillin-G Streptococcus spp Anaerobes Neisseria spp (Meningococcus
Gonococcus) Actinomycosis Animal bite (Pasteurella multocida) 螺旋體 Syphilis Leptospirosis
Penicillinase-resistant Penicillins oxacillin Penicillinase (β-lactamase) inhibitor Anti-staphylococcal penicillins Less active than penicillin-G against
all other penicillin-susceptible microorganisms
Adverse effects-PCNs
Anaphylaxis anemia leukopenia Oxacillin hepatitis Ticarcillin coagulation abnormality
bleeding
Beta-lactambeta-lactamatase inhibitor
Sulbactam Ampicillin + Sulbactam
Clavulanic acid Amoxycillin + ClavulanateTicarcillin + Clavulanate
Tazobactam Piperacillin + Tazobactam
Antipseudomonal Penicillins Piptazo Ticarcillin + Clavulanate Pseudomonas species Many strains of Enterobacter Anaerobics except β-lactamase
producing Bacteroides species Less active against gram positive
isolates
Adverse effects of penicillin Anaphylaxis anemia leukopenia Oxacillin hepatitis Ticarcillin coagulation abnormality
bleeding
Sulbactam (Maxtam)
Sulbactam is an irreversible inhibitor of beta-lactamase
Combinations of sulbactam with beta-lactam antibiotics
Dose 05 ~ 10 gm 6 ~ 8 with other antibiotics not
gt 40 gmday Cefoperazonesulbactam Ampicillinsulbactam
Cephalosporins
First generation Second generation Third generation Fourth generation
Cephalosporins
Against GPC 1st gt 2nd gt cephamycins gt 3rd Against GNB 1st lt 2nd lt cephamycins lt 3rd
First Generation
Cefazolin Cefadroxil Ceflexin Cephradine
StreptococcusStaphylococcus (methicillin-susceptible)E coliP mirabilisK pneumoniae
Second Generation
Cefmetazole Cefuroxime
Cefalor Cefuroxime
above the diaphragm cefuroximebelow the diaphragm cefmetazole (cephamycins B fragilis) Cefmatazole ESBL-producing Enterobacteriaceae
Third generation
Cefoperazone Cefotaxime Ceftazidime Ceftriaxone Flumarin
Cefixime Cefpodoxime ceftibuten
Resistant Gram-negative microorganisms ( Nosocomial infections ) Serratia Citrobacter Enterobacter Pseudomonas β-lactamase producing H influenzaeBetter BBB penetration among cephalosporins (except cefoperazone)Indication nosocomial infections (mainly GNB) GNB meningitis
Fourth Generation
Cefepime Cefpirome
Good anti-pseudomonal effectGood CNS penetrationPreserve antimicrobial effect to G(+) bacteria
Adverse effects of cephalosporins
Cefamandole cefmetazole cefoperazone cefotetan vitamin K-dependent clotting factor metabolism
Monobactam Monobactam (Aztreonam(Aztreonam)) Only gram-negative aerobes Alternative in penicillin- and
cephalosporin- allergic patients
Sulfonamides and trimethoprim Inhibit folic acid metabolism Treatment of PCP Nocardia
Toxaplasma Sternotrophomonus Aderverse effect cholestatic jaudice
bone marrow suppression severe hypersensitivity (Stevens-Johnson syndrome)
CarbapenemGroup Classification
Group 1 Broad-spectrum carbapenems with limited activity against non-fermentative Gram-negative bacilli (NFGNB eg Pseudomonas Acinetobacter) that are particularly suitable for community-acquired infections (eg ertapenem)
Group 2 Broad-spectrum carbapenems with activity against non-
fermentative Gram-negative bacilli (eg Pseudomonas
Acinetobacter) that are particularly suitable for nosocomial infections (eg imipenem and meropenem)
Group3 Carbapenems with clinical activity against Methicillin-
Resistant Staphylococcus (eg In development)
J Antimicrob Chemotherapy
Side effect of Carbapenems Anaphylaxis Interstitial nephritis Anemia Leukopenia Precipitate seizure activity
especially old patients CRI preexisting seizure disorder or CNS pathology
AminoglycosidesAminoglycosides
Antimicrobial Spectrum Antimicrobial Spectrum - All Gram negative bacilli
- Staphylococcus aureus Dosage Dosage - Gentamicin loading ~ 2 mgkg maintenance ~ 3-5 mgkgday Amikacin loading ~ 75 mgkg maintenance ~ 5 mgkg Q8H or 75
mgkg q12H Exacin 8mgskgday Single daily (once-daily) dosing (SDD) Short course (3-5 days)
Adverse effects of Adverse effects of aminoglycosidesaminoglycosides Nephrotoxicity Ototoxicity Neuromuscular paralysis ~ High doseinfrequent administration
DECREASES the rate of tissue uptake mdash DELAY the onset
of toxicity doesnrsquot prevent it from happening ~ All patients if treated for a long enough time
will eventually develop toxicity
Fluoroquinolones
Group I
- Nalidixic acid
- Enteric or urinary tract infections Group II
- Ciprofloxacin Ofloxacin Levofloxacin
- GNR (P aeruginosa) S pneumoniae atypicals Group III
- Moxifloxacin Gemifloxacin
- GPB ( S pneumoniaeuarr) atypicals anaerobes GNR
(P aeruginosadarr)
- Respiratory tract infections
GlycopeptidesGlycopeptides
Vancomycin amp Teicoplanin
Non-β-lactam cell wall synthesis inhibitor
Spectrum GPC amp GPB
Avoid oral use except AAC (antibiotic-associated colitis)
Tetracyclines
STD
- Chlamydial
diseases
- Gonorrhea
(doxycycline +
ceftriaxone)
- Syphilis
Rickettsial diseases
Brucellosis
Tularemia
Relapsing fever
Tigecycline (a new class Glycylcyclines)Gram-positive BacteriaGram-positive Bacteria Staphylococcus MRSA
MRSE VRE E faecium E faecalis Streptococcus agalactiae S treptococcus anginosus
group Streptococcus pyogenes
AnaerobesAnaerobes B fragilis group Prevotella spp Peptostreptococcus spp C perfringensAtypicalAtypical Chlamydia pneumoniae Mycoplasma pneumoniae Legionella
Gram-negative BacteriaGram-negative Bacteria E coli (including ESBLs) Kl ebsiella pneumoniae (including ESBLs) K oxytoca Acinetobacter baumannii (Resistant strains)Resistant strains) Citrobacter freundii Enterobacter cloacae Enterobacter aerogenes Stenotrophomonas
maltophilia
Does not have good activity Does not have good activity againstagainst P aeruginosa Proteus Providencia
Colistimethate sodium Colistimethate sodium Pseudomonas
aeruginosa infections in cystic fibrosis multidrug-resistant Acinetobacter infection
E-coli Klebsiella sp ( ESBL) Enterobacter Colomycin 1000000 units = 80 mg
colistimethate 6 to 12 mgkg colistimethate sodium per
day 60 kg man recommended dose for
Colomycin is 240 to 480 mg of colistimethate sodium
Nephrotoxicity (damage to the kidneys) and neurotoxicity
抗生素使用常見的五大錯誤
Antibiotic = scanol (antipyretic) S vs R (susceptible vs resistant) 4 gt 3 gt2 gt 1 Treat colonization Vancomycin+ imipenem(atomic
bomb)
Colonization
Positive culture for sputum urine bile stool and skin swab without symptoms or signs of infection Not recommend for using antibiotics
Except asymptomatic bacteriuria before urological work up and in pregnancy should be treated
抗生素使用的適應症
明顯的細菌感染 極可能的細菌感染 敗血症 白血球過低合併發燒 懷疑急性心內膜炎 細菌性腦膜炎 壞死性筋膜炎
常見感染症之抗生素療程 ( 一 )
感染症療程 ( 天 )
菌血症 敗血症 14
肝膿瘍 21
軟組織感染 7-10
急性腎炎 14
細菌性腦膜炎 10
常見感染症之抗生素療程 ( 二 )感染症療程 ( 天 )
1048729
肺炎雙球菌肺炎 14 ()
革蘭氏陰性桿菌肺炎1048729
21 ()
退伍軍人協會症1048729
21
奴卡氏菌肺炎1048729
180-360
感染性心內膜炎 28-42
抗生素治療失敗之原因
選用藥物不恰當 藥物交互作用 降低療效 異異物阻塞或膿瘍未引流 病人免疫力太差 分離菌之判讀錯誤 新的院內感染
使用抗生素之前應
用手取得檢體染色培養 用眼觀察染色特徵 用腦社區型感染或院內感染 想想看最可能的致病菌是什麼 藥物敏感性如何
理想的抗生素 Maximal damage to the bacteria minimal damage to the host ndashselective toxicity Single use High effectiveness Low cost No side-effect
Principles of antibiotic therapy Host factors Allergy history Age Body weight Renalliver function Immune status Site of infection pathogen route of
antibiotics Disease severity Pregnancy
Empirical therapy must be adjusted after culture become available
Definite antimicrobial therapy ndashchange broad- spectrum coverage to specific pathogen
De-escalating therapy
Pathogens of community-acquired infection Pulmonary
S pneumoniae H influenzae M catarrhalis Skin amp soft tissue Streptococci Staphylococci
Enterobacterioceae Intraabdomen Enterobacterioceae Anaerobes Enterococci CNS S pneumoniae H influenzae N meningitidis
Pathogens of community-acquired infection
Pulmonary S pneumoniae H influenzae M catarrhalis Skin amp soft tissue Streptococci Staphylococci
Enterobacterioceae Intraabdomen Enterobacterioceae Anaerobes Enterococci CNS S pneumoniae H influenzae N meningitidis
Pathogens of nosocmial infection
Pulmonary Enterobacterioceae Pseudomonas Acinetobacter MRSA Intraabdomen Enterobacterioceae Pseudomonas Anaerobes Enterococci Candida CNS MRSA Pseudomonas
Allergic reactions to antibiotics Fixed drug eruption Skin rash (maculopapular) Exfoliativedermatitis Stevens-Johnson Syndrome (Toxic epidermal necrolysis) Anaphylactic shock
Fixed rug eruption
Skin rash (maculopapular)
Stevens-Johnson Syndrome (Toxic epidermal necrolysis)
Antibiotics
Penicillins Beta-lactmase
inhibitors Cephalosporins Carbapenems Monobactams Sulfonamides amp
trimethoprim
Aminoglycosides Quinolones Tetracycline Metronidazole Macrolides Tigecycline Glycopeptide Colistimethate
sodium
Penicillins
Natural PCNsPenicillin G Penicillin V benzathine
PCN Penicillinase-resistant PCNs
Oxacillin Prostaphylin Amionopenicillins
Amoxicillin Ampicillin Anti-pseudomonal PCNs
Ticarcillin Piperacillin
Antimicrobial spectrum of Penicillin-G Streptococcus spp Anaerobes Neisseria spp (Meningococcus
Gonococcus) Actinomycosis Animal bite (Pasteurella multocida) 螺旋體 Syphilis Leptospirosis
Penicillinase-resistant Penicillins oxacillin Penicillinase (β-lactamase) inhibitor Anti-staphylococcal penicillins Less active than penicillin-G against
all other penicillin-susceptible microorganisms
Adverse effects-PCNs
Anaphylaxis anemia leukopenia Oxacillin hepatitis Ticarcillin coagulation abnormality
bleeding
Beta-lactambeta-lactamatase inhibitor
Sulbactam Ampicillin + Sulbactam
Clavulanic acid Amoxycillin + ClavulanateTicarcillin + Clavulanate
Tazobactam Piperacillin + Tazobactam
Antipseudomonal Penicillins Piptazo Ticarcillin + Clavulanate Pseudomonas species Many strains of Enterobacter Anaerobics except β-lactamase
producing Bacteroides species Less active against gram positive
isolates
Adverse effects of penicillin Anaphylaxis anemia leukopenia Oxacillin hepatitis Ticarcillin coagulation abnormality
bleeding
Sulbactam (Maxtam)
Sulbactam is an irreversible inhibitor of beta-lactamase
Combinations of sulbactam with beta-lactam antibiotics
Dose 05 ~ 10 gm 6 ~ 8 with other antibiotics not
gt 40 gmday Cefoperazonesulbactam Ampicillinsulbactam
Cephalosporins
First generation Second generation Third generation Fourth generation
Cephalosporins
Against GPC 1st gt 2nd gt cephamycins gt 3rd Against GNB 1st lt 2nd lt cephamycins lt 3rd
First Generation
Cefazolin Cefadroxil Ceflexin Cephradine
StreptococcusStaphylococcus (methicillin-susceptible)E coliP mirabilisK pneumoniae
Second Generation
Cefmetazole Cefuroxime
Cefalor Cefuroxime
above the diaphragm cefuroximebelow the diaphragm cefmetazole (cephamycins B fragilis) Cefmatazole ESBL-producing Enterobacteriaceae
Third generation
Cefoperazone Cefotaxime Ceftazidime Ceftriaxone Flumarin
Cefixime Cefpodoxime ceftibuten
Resistant Gram-negative microorganisms ( Nosocomial infections ) Serratia Citrobacter Enterobacter Pseudomonas β-lactamase producing H influenzaeBetter BBB penetration among cephalosporins (except cefoperazone)Indication nosocomial infections (mainly GNB) GNB meningitis
Fourth Generation
Cefepime Cefpirome
Good anti-pseudomonal effectGood CNS penetrationPreserve antimicrobial effect to G(+) bacteria
Adverse effects of cephalosporins
Cefamandole cefmetazole cefoperazone cefotetan vitamin K-dependent clotting factor metabolism
Monobactam Monobactam (Aztreonam(Aztreonam)) Only gram-negative aerobes Alternative in penicillin- and
cephalosporin- allergic patients
Sulfonamides and trimethoprim Inhibit folic acid metabolism Treatment of PCP Nocardia
Toxaplasma Sternotrophomonus Aderverse effect cholestatic jaudice
bone marrow suppression severe hypersensitivity (Stevens-Johnson syndrome)
CarbapenemGroup Classification
Group 1 Broad-spectrum carbapenems with limited activity against non-fermentative Gram-negative bacilli (NFGNB eg Pseudomonas Acinetobacter) that are particularly suitable for community-acquired infections (eg ertapenem)
Group 2 Broad-spectrum carbapenems with activity against non-
fermentative Gram-negative bacilli (eg Pseudomonas
Acinetobacter) that are particularly suitable for nosocomial infections (eg imipenem and meropenem)
Group3 Carbapenems with clinical activity against Methicillin-
Resistant Staphylococcus (eg In development)
J Antimicrob Chemotherapy
Side effect of Carbapenems Anaphylaxis Interstitial nephritis Anemia Leukopenia Precipitate seizure activity
especially old patients CRI preexisting seizure disorder or CNS pathology
AminoglycosidesAminoglycosides
Antimicrobial Spectrum Antimicrobial Spectrum - All Gram negative bacilli
- Staphylococcus aureus Dosage Dosage - Gentamicin loading ~ 2 mgkg maintenance ~ 3-5 mgkgday Amikacin loading ~ 75 mgkg maintenance ~ 5 mgkg Q8H or 75
mgkg q12H Exacin 8mgskgday Single daily (once-daily) dosing (SDD) Short course (3-5 days)
Adverse effects of Adverse effects of aminoglycosidesaminoglycosides Nephrotoxicity Ototoxicity Neuromuscular paralysis ~ High doseinfrequent administration
DECREASES the rate of tissue uptake mdash DELAY the onset
of toxicity doesnrsquot prevent it from happening ~ All patients if treated for a long enough time
will eventually develop toxicity
Fluoroquinolones
Group I
- Nalidixic acid
- Enteric or urinary tract infections Group II
- Ciprofloxacin Ofloxacin Levofloxacin
- GNR (P aeruginosa) S pneumoniae atypicals Group III
- Moxifloxacin Gemifloxacin
- GPB ( S pneumoniaeuarr) atypicals anaerobes GNR
(P aeruginosadarr)
- Respiratory tract infections
GlycopeptidesGlycopeptides
Vancomycin amp Teicoplanin
Non-β-lactam cell wall synthesis inhibitor
Spectrum GPC amp GPB
Avoid oral use except AAC (antibiotic-associated colitis)
Tetracyclines
STD
- Chlamydial
diseases
- Gonorrhea
(doxycycline +
ceftriaxone)
- Syphilis
Rickettsial diseases
Brucellosis
Tularemia
Relapsing fever
Tigecycline (a new class Glycylcyclines)Gram-positive BacteriaGram-positive Bacteria Staphylococcus MRSA
MRSE VRE E faecium E faecalis Streptococcus agalactiae S treptococcus anginosus
group Streptococcus pyogenes
AnaerobesAnaerobes B fragilis group Prevotella spp Peptostreptococcus spp C perfringensAtypicalAtypical Chlamydia pneumoniae Mycoplasma pneumoniae Legionella
Gram-negative BacteriaGram-negative Bacteria E coli (including ESBLs) Kl ebsiella pneumoniae (including ESBLs) K oxytoca Acinetobacter baumannii (Resistant strains)Resistant strains) Citrobacter freundii Enterobacter cloacae Enterobacter aerogenes Stenotrophomonas
maltophilia
Does not have good activity Does not have good activity againstagainst P aeruginosa Proteus Providencia
Colistimethate sodium Colistimethate sodium Pseudomonas
aeruginosa infections in cystic fibrosis multidrug-resistant Acinetobacter infection
E-coli Klebsiella sp ( ESBL) Enterobacter Colomycin 1000000 units = 80 mg
colistimethate 6 to 12 mgkg colistimethate sodium per
day 60 kg man recommended dose for
Colomycin is 240 to 480 mg of colistimethate sodium
Nephrotoxicity (damage to the kidneys) and neurotoxicity
抗生素使用常見的五大錯誤
Antibiotic = scanol (antipyretic) S vs R (susceptible vs resistant) 4 gt 3 gt2 gt 1 Treat colonization Vancomycin+ imipenem(atomic
bomb)
Colonization
Positive culture for sputum urine bile stool and skin swab without symptoms or signs of infection Not recommend for using antibiotics
Except asymptomatic bacteriuria before urological work up and in pregnancy should be treated
抗生素使用的適應症
明顯的細菌感染 極可能的細菌感染 敗血症 白血球過低合併發燒 懷疑急性心內膜炎 細菌性腦膜炎 壞死性筋膜炎
常見感染症之抗生素療程 ( 一 )
感染症療程 ( 天 )
菌血症 敗血症 14
肝膿瘍 21
軟組織感染 7-10
急性腎炎 14
細菌性腦膜炎 10
常見感染症之抗生素療程 ( 二 )感染症療程 ( 天 )
1048729
肺炎雙球菌肺炎 14 ()
革蘭氏陰性桿菌肺炎1048729
21 ()
退伍軍人協會症1048729
21
奴卡氏菌肺炎1048729
180-360
感染性心內膜炎 28-42
抗生素治療失敗之原因
選用藥物不恰當 藥物交互作用 降低療效 異異物阻塞或膿瘍未引流 病人免疫力太差 分離菌之判讀錯誤 新的院內感染
理想的抗生素 Maximal damage to the bacteria minimal damage to the host ndashselective toxicity Single use High effectiveness Low cost No side-effect
Principles of antibiotic therapy Host factors Allergy history Age Body weight Renalliver function Immune status Site of infection pathogen route of
antibiotics Disease severity Pregnancy
Empirical therapy must be adjusted after culture become available
Definite antimicrobial therapy ndashchange broad- spectrum coverage to specific pathogen
De-escalating therapy
Pathogens of community-acquired infection Pulmonary
S pneumoniae H influenzae M catarrhalis Skin amp soft tissue Streptococci Staphylococci
Enterobacterioceae Intraabdomen Enterobacterioceae Anaerobes Enterococci CNS S pneumoniae H influenzae N meningitidis
Pathogens of community-acquired infection
Pulmonary S pneumoniae H influenzae M catarrhalis Skin amp soft tissue Streptococci Staphylococci
Enterobacterioceae Intraabdomen Enterobacterioceae Anaerobes Enterococci CNS S pneumoniae H influenzae N meningitidis
Pathogens of nosocmial infection
Pulmonary Enterobacterioceae Pseudomonas Acinetobacter MRSA Intraabdomen Enterobacterioceae Pseudomonas Anaerobes Enterococci Candida CNS MRSA Pseudomonas
Allergic reactions to antibiotics Fixed drug eruption Skin rash (maculopapular) Exfoliativedermatitis Stevens-Johnson Syndrome (Toxic epidermal necrolysis) Anaphylactic shock
Fixed rug eruption
Skin rash (maculopapular)
Stevens-Johnson Syndrome (Toxic epidermal necrolysis)
Antibiotics
Penicillins Beta-lactmase
inhibitors Cephalosporins Carbapenems Monobactams Sulfonamides amp
trimethoprim
Aminoglycosides Quinolones Tetracycline Metronidazole Macrolides Tigecycline Glycopeptide Colistimethate
sodium
Penicillins
Natural PCNsPenicillin G Penicillin V benzathine
PCN Penicillinase-resistant PCNs
Oxacillin Prostaphylin Amionopenicillins
Amoxicillin Ampicillin Anti-pseudomonal PCNs
Ticarcillin Piperacillin
Antimicrobial spectrum of Penicillin-G Streptococcus spp Anaerobes Neisseria spp (Meningococcus
Gonococcus) Actinomycosis Animal bite (Pasteurella multocida) 螺旋體 Syphilis Leptospirosis
Penicillinase-resistant Penicillins oxacillin Penicillinase (β-lactamase) inhibitor Anti-staphylococcal penicillins Less active than penicillin-G against
all other penicillin-susceptible microorganisms
Adverse effects-PCNs
Anaphylaxis anemia leukopenia Oxacillin hepatitis Ticarcillin coagulation abnormality
bleeding
Beta-lactambeta-lactamatase inhibitor
Sulbactam Ampicillin + Sulbactam
Clavulanic acid Amoxycillin + ClavulanateTicarcillin + Clavulanate
Tazobactam Piperacillin + Tazobactam
Antipseudomonal Penicillins Piptazo Ticarcillin + Clavulanate Pseudomonas species Many strains of Enterobacter Anaerobics except β-lactamase
producing Bacteroides species Less active against gram positive
isolates
Adverse effects of penicillin Anaphylaxis anemia leukopenia Oxacillin hepatitis Ticarcillin coagulation abnormality
bleeding
Sulbactam (Maxtam)
Sulbactam is an irreversible inhibitor of beta-lactamase
Combinations of sulbactam with beta-lactam antibiotics
Dose 05 ~ 10 gm 6 ~ 8 with other antibiotics not
gt 40 gmday Cefoperazonesulbactam Ampicillinsulbactam
Cephalosporins
First generation Second generation Third generation Fourth generation
Cephalosporins
Against GPC 1st gt 2nd gt cephamycins gt 3rd Against GNB 1st lt 2nd lt cephamycins lt 3rd
First Generation
Cefazolin Cefadroxil Ceflexin Cephradine
StreptococcusStaphylococcus (methicillin-susceptible)E coliP mirabilisK pneumoniae
Second Generation
Cefmetazole Cefuroxime
Cefalor Cefuroxime
above the diaphragm cefuroximebelow the diaphragm cefmetazole (cephamycins B fragilis) Cefmatazole ESBL-producing Enterobacteriaceae
Third generation
Cefoperazone Cefotaxime Ceftazidime Ceftriaxone Flumarin
Cefixime Cefpodoxime ceftibuten
Resistant Gram-negative microorganisms ( Nosocomial infections ) Serratia Citrobacter Enterobacter Pseudomonas β-lactamase producing H influenzaeBetter BBB penetration among cephalosporins (except cefoperazone)Indication nosocomial infections (mainly GNB) GNB meningitis
Fourth Generation
Cefepime Cefpirome
Good anti-pseudomonal effectGood CNS penetrationPreserve antimicrobial effect to G(+) bacteria
Adverse effects of cephalosporins
Cefamandole cefmetazole cefoperazone cefotetan vitamin K-dependent clotting factor metabolism
Monobactam Monobactam (Aztreonam(Aztreonam)) Only gram-negative aerobes Alternative in penicillin- and
cephalosporin- allergic patients
Sulfonamides and trimethoprim Inhibit folic acid metabolism Treatment of PCP Nocardia
Toxaplasma Sternotrophomonus Aderverse effect cholestatic jaudice
bone marrow suppression severe hypersensitivity (Stevens-Johnson syndrome)
CarbapenemGroup Classification
Group 1 Broad-spectrum carbapenems with limited activity against non-fermentative Gram-negative bacilli (NFGNB eg Pseudomonas Acinetobacter) that are particularly suitable for community-acquired infections (eg ertapenem)
Group 2 Broad-spectrum carbapenems with activity against non-
fermentative Gram-negative bacilli (eg Pseudomonas
Acinetobacter) that are particularly suitable for nosocomial infections (eg imipenem and meropenem)
Group3 Carbapenems with clinical activity against Methicillin-
Resistant Staphylococcus (eg In development)
J Antimicrob Chemotherapy
Side effect of Carbapenems Anaphylaxis Interstitial nephritis Anemia Leukopenia Precipitate seizure activity
especially old patients CRI preexisting seizure disorder or CNS pathology
AminoglycosidesAminoglycosides
Antimicrobial Spectrum Antimicrobial Spectrum - All Gram negative bacilli
- Staphylococcus aureus Dosage Dosage - Gentamicin loading ~ 2 mgkg maintenance ~ 3-5 mgkgday Amikacin loading ~ 75 mgkg maintenance ~ 5 mgkg Q8H or 75
mgkg q12H Exacin 8mgskgday Single daily (once-daily) dosing (SDD) Short course (3-5 days)
Adverse effects of Adverse effects of aminoglycosidesaminoglycosides Nephrotoxicity Ototoxicity Neuromuscular paralysis ~ High doseinfrequent administration
DECREASES the rate of tissue uptake mdash DELAY the onset
of toxicity doesnrsquot prevent it from happening ~ All patients if treated for a long enough time
will eventually develop toxicity
Fluoroquinolones
Group I
- Nalidixic acid
- Enteric or urinary tract infections Group II
- Ciprofloxacin Ofloxacin Levofloxacin
- GNR (P aeruginosa) S pneumoniae atypicals Group III
- Moxifloxacin Gemifloxacin
- GPB ( S pneumoniaeuarr) atypicals anaerobes GNR
(P aeruginosadarr)
- Respiratory tract infections
GlycopeptidesGlycopeptides
Vancomycin amp Teicoplanin
Non-β-lactam cell wall synthesis inhibitor
Spectrum GPC amp GPB
Avoid oral use except AAC (antibiotic-associated colitis)
Tetracyclines
STD
- Chlamydial
diseases
- Gonorrhea
(doxycycline +
ceftriaxone)
- Syphilis
Rickettsial diseases
Brucellosis
Tularemia
Relapsing fever
Tigecycline (a new class Glycylcyclines)Gram-positive BacteriaGram-positive Bacteria Staphylococcus MRSA
MRSE VRE E faecium E faecalis Streptococcus agalactiae S treptococcus anginosus
group Streptococcus pyogenes
AnaerobesAnaerobes B fragilis group Prevotella spp Peptostreptococcus spp C perfringensAtypicalAtypical Chlamydia pneumoniae Mycoplasma pneumoniae Legionella
Gram-negative BacteriaGram-negative Bacteria E coli (including ESBLs) Kl ebsiella pneumoniae (including ESBLs) K oxytoca Acinetobacter baumannii (Resistant strains)Resistant strains) Citrobacter freundii Enterobacter cloacae Enterobacter aerogenes Stenotrophomonas
maltophilia
Does not have good activity Does not have good activity againstagainst P aeruginosa Proteus Providencia
Colistimethate sodium Colistimethate sodium Pseudomonas
aeruginosa infections in cystic fibrosis multidrug-resistant Acinetobacter infection
E-coli Klebsiella sp ( ESBL) Enterobacter Colomycin 1000000 units = 80 mg
colistimethate 6 to 12 mgkg colistimethate sodium per
day 60 kg man recommended dose for
Colomycin is 240 to 480 mg of colistimethate sodium
Nephrotoxicity (damage to the kidneys) and neurotoxicity
抗生素使用常見的五大錯誤
Antibiotic = scanol (antipyretic) S vs R (susceptible vs resistant) 4 gt 3 gt2 gt 1 Treat colonization Vancomycin+ imipenem(atomic
bomb)
Colonization
Positive culture for sputum urine bile stool and skin swab without symptoms or signs of infection Not recommend for using antibiotics
Except asymptomatic bacteriuria before urological work up and in pregnancy should be treated
抗生素使用的適應症
明顯的細菌感染 極可能的細菌感染 敗血症 白血球過低合併發燒 懷疑急性心內膜炎 細菌性腦膜炎 壞死性筋膜炎
常見感染症之抗生素療程 ( 一 )
感染症療程 ( 天 )
菌血症 敗血症 14
肝膿瘍 21
軟組織感染 7-10
急性腎炎 14
細菌性腦膜炎 10
常見感染症之抗生素療程 ( 二 )感染症療程 ( 天 )
1048729
肺炎雙球菌肺炎 14 ()
革蘭氏陰性桿菌肺炎1048729
21 ()
退伍軍人協會症1048729
21
奴卡氏菌肺炎1048729
180-360
感染性心內膜炎 28-42
抗生素治療失敗之原因
選用藥物不恰當 藥物交互作用 降低療效 異異物阻塞或膿瘍未引流 病人免疫力太差 分離菌之判讀錯誤 新的院內感染
Principles of antibiotic therapy Host factors Allergy history Age Body weight Renalliver function Immune status Site of infection pathogen route of
antibiotics Disease severity Pregnancy
Empirical therapy must be adjusted after culture become available
Definite antimicrobial therapy ndashchange broad- spectrum coverage to specific pathogen
De-escalating therapy
Pathogens of community-acquired infection Pulmonary
S pneumoniae H influenzae M catarrhalis Skin amp soft tissue Streptococci Staphylococci
Enterobacterioceae Intraabdomen Enterobacterioceae Anaerobes Enterococci CNS S pneumoniae H influenzae N meningitidis
Pathogens of community-acquired infection
Pulmonary S pneumoniae H influenzae M catarrhalis Skin amp soft tissue Streptococci Staphylococci
Enterobacterioceae Intraabdomen Enterobacterioceae Anaerobes Enterococci CNS S pneumoniae H influenzae N meningitidis
Pathogens of nosocmial infection
Pulmonary Enterobacterioceae Pseudomonas Acinetobacter MRSA Intraabdomen Enterobacterioceae Pseudomonas Anaerobes Enterococci Candida CNS MRSA Pseudomonas
Allergic reactions to antibiotics Fixed drug eruption Skin rash (maculopapular) Exfoliativedermatitis Stevens-Johnson Syndrome (Toxic epidermal necrolysis) Anaphylactic shock
Fixed rug eruption
Skin rash (maculopapular)
Stevens-Johnson Syndrome (Toxic epidermal necrolysis)
Antibiotics
Penicillins Beta-lactmase
inhibitors Cephalosporins Carbapenems Monobactams Sulfonamides amp
trimethoprim
Aminoglycosides Quinolones Tetracycline Metronidazole Macrolides Tigecycline Glycopeptide Colistimethate
sodium
Penicillins
Natural PCNsPenicillin G Penicillin V benzathine
PCN Penicillinase-resistant PCNs
Oxacillin Prostaphylin Amionopenicillins
Amoxicillin Ampicillin Anti-pseudomonal PCNs
Ticarcillin Piperacillin
Antimicrobial spectrum of Penicillin-G Streptococcus spp Anaerobes Neisseria spp (Meningococcus
Gonococcus) Actinomycosis Animal bite (Pasteurella multocida) 螺旋體 Syphilis Leptospirosis
Penicillinase-resistant Penicillins oxacillin Penicillinase (β-lactamase) inhibitor Anti-staphylococcal penicillins Less active than penicillin-G against
all other penicillin-susceptible microorganisms
Adverse effects-PCNs
Anaphylaxis anemia leukopenia Oxacillin hepatitis Ticarcillin coagulation abnormality
bleeding
Beta-lactambeta-lactamatase inhibitor
Sulbactam Ampicillin + Sulbactam
Clavulanic acid Amoxycillin + ClavulanateTicarcillin + Clavulanate
Tazobactam Piperacillin + Tazobactam
Antipseudomonal Penicillins Piptazo Ticarcillin + Clavulanate Pseudomonas species Many strains of Enterobacter Anaerobics except β-lactamase
producing Bacteroides species Less active against gram positive
isolates
Adverse effects of penicillin Anaphylaxis anemia leukopenia Oxacillin hepatitis Ticarcillin coagulation abnormality
bleeding
Sulbactam (Maxtam)
Sulbactam is an irreversible inhibitor of beta-lactamase
Combinations of sulbactam with beta-lactam antibiotics
Dose 05 ~ 10 gm 6 ~ 8 with other antibiotics not
gt 40 gmday Cefoperazonesulbactam Ampicillinsulbactam
Cephalosporins
First generation Second generation Third generation Fourth generation
Cephalosporins
Against GPC 1st gt 2nd gt cephamycins gt 3rd Against GNB 1st lt 2nd lt cephamycins lt 3rd
First Generation
Cefazolin Cefadroxil Ceflexin Cephradine
StreptococcusStaphylococcus (methicillin-susceptible)E coliP mirabilisK pneumoniae
Second Generation
Cefmetazole Cefuroxime
Cefalor Cefuroxime
above the diaphragm cefuroximebelow the diaphragm cefmetazole (cephamycins B fragilis) Cefmatazole ESBL-producing Enterobacteriaceae
Third generation
Cefoperazone Cefotaxime Ceftazidime Ceftriaxone Flumarin
Cefixime Cefpodoxime ceftibuten
Resistant Gram-negative microorganisms ( Nosocomial infections ) Serratia Citrobacter Enterobacter Pseudomonas β-lactamase producing H influenzaeBetter BBB penetration among cephalosporins (except cefoperazone)Indication nosocomial infections (mainly GNB) GNB meningitis
Fourth Generation
Cefepime Cefpirome
Good anti-pseudomonal effectGood CNS penetrationPreserve antimicrobial effect to G(+) bacteria
Adverse effects of cephalosporins
Cefamandole cefmetazole cefoperazone cefotetan vitamin K-dependent clotting factor metabolism
Monobactam Monobactam (Aztreonam(Aztreonam)) Only gram-negative aerobes Alternative in penicillin- and
cephalosporin- allergic patients
Sulfonamides and trimethoprim Inhibit folic acid metabolism Treatment of PCP Nocardia
Toxaplasma Sternotrophomonus Aderverse effect cholestatic jaudice
bone marrow suppression severe hypersensitivity (Stevens-Johnson syndrome)
CarbapenemGroup Classification
Group 1 Broad-spectrum carbapenems with limited activity against non-fermentative Gram-negative bacilli (NFGNB eg Pseudomonas Acinetobacter) that are particularly suitable for community-acquired infections (eg ertapenem)
Group 2 Broad-spectrum carbapenems with activity against non-
fermentative Gram-negative bacilli (eg Pseudomonas
Acinetobacter) that are particularly suitable for nosocomial infections (eg imipenem and meropenem)
Group3 Carbapenems with clinical activity against Methicillin-
Resistant Staphylococcus (eg In development)
J Antimicrob Chemotherapy
Side effect of Carbapenems Anaphylaxis Interstitial nephritis Anemia Leukopenia Precipitate seizure activity
especially old patients CRI preexisting seizure disorder or CNS pathology
AminoglycosidesAminoglycosides
Antimicrobial Spectrum Antimicrobial Spectrum - All Gram negative bacilli
- Staphylococcus aureus Dosage Dosage - Gentamicin loading ~ 2 mgkg maintenance ~ 3-5 mgkgday Amikacin loading ~ 75 mgkg maintenance ~ 5 mgkg Q8H or 75
mgkg q12H Exacin 8mgskgday Single daily (once-daily) dosing (SDD) Short course (3-5 days)
Adverse effects of Adverse effects of aminoglycosidesaminoglycosides Nephrotoxicity Ototoxicity Neuromuscular paralysis ~ High doseinfrequent administration
DECREASES the rate of tissue uptake mdash DELAY the onset
of toxicity doesnrsquot prevent it from happening ~ All patients if treated for a long enough time
will eventually develop toxicity
Fluoroquinolones
Group I
- Nalidixic acid
- Enteric or urinary tract infections Group II
- Ciprofloxacin Ofloxacin Levofloxacin
- GNR (P aeruginosa) S pneumoniae atypicals Group III
- Moxifloxacin Gemifloxacin
- GPB ( S pneumoniaeuarr) atypicals anaerobes GNR
(P aeruginosadarr)
- Respiratory tract infections
GlycopeptidesGlycopeptides
Vancomycin amp Teicoplanin
Non-β-lactam cell wall synthesis inhibitor
Spectrum GPC amp GPB
Avoid oral use except AAC (antibiotic-associated colitis)
Tetracyclines
STD
- Chlamydial
diseases
- Gonorrhea
(doxycycline +
ceftriaxone)
- Syphilis
Rickettsial diseases
Brucellosis
Tularemia
Relapsing fever
Tigecycline (a new class Glycylcyclines)Gram-positive BacteriaGram-positive Bacteria Staphylococcus MRSA
MRSE VRE E faecium E faecalis Streptococcus agalactiae S treptococcus anginosus
group Streptococcus pyogenes
AnaerobesAnaerobes B fragilis group Prevotella spp Peptostreptococcus spp C perfringensAtypicalAtypical Chlamydia pneumoniae Mycoplasma pneumoniae Legionella
Gram-negative BacteriaGram-negative Bacteria E coli (including ESBLs) Kl ebsiella pneumoniae (including ESBLs) K oxytoca Acinetobacter baumannii (Resistant strains)Resistant strains) Citrobacter freundii Enterobacter cloacae Enterobacter aerogenes Stenotrophomonas
maltophilia
Does not have good activity Does not have good activity againstagainst P aeruginosa Proteus Providencia
Colistimethate sodium Colistimethate sodium Pseudomonas
aeruginosa infections in cystic fibrosis multidrug-resistant Acinetobacter infection
E-coli Klebsiella sp ( ESBL) Enterobacter Colomycin 1000000 units = 80 mg
colistimethate 6 to 12 mgkg colistimethate sodium per
day 60 kg man recommended dose for
Colomycin is 240 to 480 mg of colistimethate sodium
Nephrotoxicity (damage to the kidneys) and neurotoxicity
抗生素使用常見的五大錯誤
Antibiotic = scanol (antipyretic) S vs R (susceptible vs resistant) 4 gt 3 gt2 gt 1 Treat colonization Vancomycin+ imipenem(atomic
bomb)
Colonization
Positive culture for sputum urine bile stool and skin swab without symptoms or signs of infection Not recommend for using antibiotics
Except asymptomatic bacteriuria before urological work up and in pregnancy should be treated
抗生素使用的適應症
明顯的細菌感染 極可能的細菌感染 敗血症 白血球過低合併發燒 懷疑急性心內膜炎 細菌性腦膜炎 壞死性筋膜炎
常見感染症之抗生素療程 ( 一 )
感染症療程 ( 天 )
菌血症 敗血症 14
肝膿瘍 21
軟組織感染 7-10
急性腎炎 14
細菌性腦膜炎 10
常見感染症之抗生素療程 ( 二 )感染症療程 ( 天 )
1048729
肺炎雙球菌肺炎 14 ()
革蘭氏陰性桿菌肺炎1048729
21 ()
退伍軍人協會症1048729
21
奴卡氏菌肺炎1048729
180-360
感染性心內膜炎 28-42
抗生素治療失敗之原因
選用藥物不恰當 藥物交互作用 降低療效 異異物阻塞或膿瘍未引流 病人免疫力太差 分離菌之判讀錯誤 新的院內感染
Empirical therapy must be adjusted after culture become available
Definite antimicrobial therapy ndashchange broad- spectrum coverage to specific pathogen
De-escalating therapy
Pathogens of community-acquired infection Pulmonary
S pneumoniae H influenzae M catarrhalis Skin amp soft tissue Streptococci Staphylococci
Enterobacterioceae Intraabdomen Enterobacterioceae Anaerobes Enterococci CNS S pneumoniae H influenzae N meningitidis
Pathogens of community-acquired infection
Pulmonary S pneumoniae H influenzae M catarrhalis Skin amp soft tissue Streptococci Staphylococci
Enterobacterioceae Intraabdomen Enterobacterioceae Anaerobes Enterococci CNS S pneumoniae H influenzae N meningitidis
Pathogens of nosocmial infection
Pulmonary Enterobacterioceae Pseudomonas Acinetobacter MRSA Intraabdomen Enterobacterioceae Pseudomonas Anaerobes Enterococci Candida CNS MRSA Pseudomonas
Allergic reactions to antibiotics Fixed drug eruption Skin rash (maculopapular) Exfoliativedermatitis Stevens-Johnson Syndrome (Toxic epidermal necrolysis) Anaphylactic shock
Fixed rug eruption
Skin rash (maculopapular)
Stevens-Johnson Syndrome (Toxic epidermal necrolysis)
Antibiotics
Penicillins Beta-lactmase
inhibitors Cephalosporins Carbapenems Monobactams Sulfonamides amp
trimethoprim
Aminoglycosides Quinolones Tetracycline Metronidazole Macrolides Tigecycline Glycopeptide Colistimethate
sodium
Penicillins
Natural PCNsPenicillin G Penicillin V benzathine
PCN Penicillinase-resistant PCNs
Oxacillin Prostaphylin Amionopenicillins
Amoxicillin Ampicillin Anti-pseudomonal PCNs
Ticarcillin Piperacillin
Antimicrobial spectrum of Penicillin-G Streptococcus spp Anaerobes Neisseria spp (Meningococcus
Gonococcus) Actinomycosis Animal bite (Pasteurella multocida) 螺旋體 Syphilis Leptospirosis
Penicillinase-resistant Penicillins oxacillin Penicillinase (β-lactamase) inhibitor Anti-staphylococcal penicillins Less active than penicillin-G against
all other penicillin-susceptible microorganisms
Adverse effects-PCNs
Anaphylaxis anemia leukopenia Oxacillin hepatitis Ticarcillin coagulation abnormality
bleeding
Beta-lactambeta-lactamatase inhibitor
Sulbactam Ampicillin + Sulbactam
Clavulanic acid Amoxycillin + ClavulanateTicarcillin + Clavulanate
Tazobactam Piperacillin + Tazobactam
Antipseudomonal Penicillins Piptazo Ticarcillin + Clavulanate Pseudomonas species Many strains of Enterobacter Anaerobics except β-lactamase
producing Bacteroides species Less active against gram positive
isolates
Adverse effects of penicillin Anaphylaxis anemia leukopenia Oxacillin hepatitis Ticarcillin coagulation abnormality
bleeding
Sulbactam (Maxtam)
Sulbactam is an irreversible inhibitor of beta-lactamase
Combinations of sulbactam with beta-lactam antibiotics
Dose 05 ~ 10 gm 6 ~ 8 with other antibiotics not
gt 40 gmday Cefoperazonesulbactam Ampicillinsulbactam
Cephalosporins
First generation Second generation Third generation Fourth generation
Cephalosporins
Against GPC 1st gt 2nd gt cephamycins gt 3rd Against GNB 1st lt 2nd lt cephamycins lt 3rd
First Generation
Cefazolin Cefadroxil Ceflexin Cephradine
StreptococcusStaphylococcus (methicillin-susceptible)E coliP mirabilisK pneumoniae
Second Generation
Cefmetazole Cefuroxime
Cefalor Cefuroxime
above the diaphragm cefuroximebelow the diaphragm cefmetazole (cephamycins B fragilis) Cefmatazole ESBL-producing Enterobacteriaceae
Third generation
Cefoperazone Cefotaxime Ceftazidime Ceftriaxone Flumarin
Cefixime Cefpodoxime ceftibuten
Resistant Gram-negative microorganisms ( Nosocomial infections ) Serratia Citrobacter Enterobacter Pseudomonas β-lactamase producing H influenzaeBetter BBB penetration among cephalosporins (except cefoperazone)Indication nosocomial infections (mainly GNB) GNB meningitis
Fourth Generation
Cefepime Cefpirome
Good anti-pseudomonal effectGood CNS penetrationPreserve antimicrobial effect to G(+) bacteria
Adverse effects of cephalosporins
Cefamandole cefmetazole cefoperazone cefotetan vitamin K-dependent clotting factor metabolism
Monobactam Monobactam (Aztreonam(Aztreonam)) Only gram-negative aerobes Alternative in penicillin- and
cephalosporin- allergic patients
Sulfonamides and trimethoprim Inhibit folic acid metabolism Treatment of PCP Nocardia
Toxaplasma Sternotrophomonus Aderverse effect cholestatic jaudice
bone marrow suppression severe hypersensitivity (Stevens-Johnson syndrome)
CarbapenemGroup Classification
Group 1 Broad-spectrum carbapenems with limited activity against non-fermentative Gram-negative bacilli (NFGNB eg Pseudomonas Acinetobacter) that are particularly suitable for community-acquired infections (eg ertapenem)
Group 2 Broad-spectrum carbapenems with activity against non-
fermentative Gram-negative bacilli (eg Pseudomonas
Acinetobacter) that are particularly suitable for nosocomial infections (eg imipenem and meropenem)
Group3 Carbapenems with clinical activity against Methicillin-
Resistant Staphylococcus (eg In development)
J Antimicrob Chemotherapy
Side effect of Carbapenems Anaphylaxis Interstitial nephritis Anemia Leukopenia Precipitate seizure activity
especially old patients CRI preexisting seizure disorder or CNS pathology
AminoglycosidesAminoglycosides
Antimicrobial Spectrum Antimicrobial Spectrum - All Gram negative bacilli
- Staphylococcus aureus Dosage Dosage - Gentamicin loading ~ 2 mgkg maintenance ~ 3-5 mgkgday Amikacin loading ~ 75 mgkg maintenance ~ 5 mgkg Q8H or 75
mgkg q12H Exacin 8mgskgday Single daily (once-daily) dosing (SDD) Short course (3-5 days)
Adverse effects of Adverse effects of aminoglycosidesaminoglycosides Nephrotoxicity Ototoxicity Neuromuscular paralysis ~ High doseinfrequent administration
DECREASES the rate of tissue uptake mdash DELAY the onset
of toxicity doesnrsquot prevent it from happening ~ All patients if treated for a long enough time
will eventually develop toxicity
Fluoroquinolones
Group I
- Nalidixic acid
- Enteric or urinary tract infections Group II
- Ciprofloxacin Ofloxacin Levofloxacin
- GNR (P aeruginosa) S pneumoniae atypicals Group III
- Moxifloxacin Gemifloxacin
- GPB ( S pneumoniaeuarr) atypicals anaerobes GNR
(P aeruginosadarr)
- Respiratory tract infections
GlycopeptidesGlycopeptides
Vancomycin amp Teicoplanin
Non-β-lactam cell wall synthesis inhibitor
Spectrum GPC amp GPB
Avoid oral use except AAC (antibiotic-associated colitis)
Tetracyclines
STD
- Chlamydial
diseases
- Gonorrhea
(doxycycline +
ceftriaxone)
- Syphilis
Rickettsial diseases
Brucellosis
Tularemia
Relapsing fever
Tigecycline (a new class Glycylcyclines)Gram-positive BacteriaGram-positive Bacteria Staphylococcus MRSA
MRSE VRE E faecium E faecalis Streptococcus agalactiae S treptococcus anginosus
group Streptococcus pyogenes
AnaerobesAnaerobes B fragilis group Prevotella spp Peptostreptococcus spp C perfringensAtypicalAtypical Chlamydia pneumoniae Mycoplasma pneumoniae Legionella
Gram-negative BacteriaGram-negative Bacteria E coli (including ESBLs) Kl ebsiella pneumoniae (including ESBLs) K oxytoca Acinetobacter baumannii (Resistant strains)Resistant strains) Citrobacter freundii Enterobacter cloacae Enterobacter aerogenes Stenotrophomonas
maltophilia
Does not have good activity Does not have good activity againstagainst P aeruginosa Proteus Providencia
Colistimethate sodium Colistimethate sodium Pseudomonas
aeruginosa infections in cystic fibrosis multidrug-resistant Acinetobacter infection
E-coli Klebsiella sp ( ESBL) Enterobacter Colomycin 1000000 units = 80 mg
colistimethate 6 to 12 mgkg colistimethate sodium per
day 60 kg man recommended dose for
Colomycin is 240 to 480 mg of colistimethate sodium
Nephrotoxicity (damage to the kidneys) and neurotoxicity
抗生素使用常見的五大錯誤
Antibiotic = scanol (antipyretic) S vs R (susceptible vs resistant) 4 gt 3 gt2 gt 1 Treat colonization Vancomycin+ imipenem(atomic
bomb)
Colonization
Positive culture for sputum urine bile stool and skin swab without symptoms or signs of infection Not recommend for using antibiotics
Except asymptomatic bacteriuria before urological work up and in pregnancy should be treated
抗生素使用的適應症
明顯的細菌感染 極可能的細菌感染 敗血症 白血球過低合併發燒 懷疑急性心內膜炎 細菌性腦膜炎 壞死性筋膜炎
常見感染症之抗生素療程 ( 一 )
感染症療程 ( 天 )
菌血症 敗血症 14
肝膿瘍 21
軟組織感染 7-10
急性腎炎 14
細菌性腦膜炎 10
常見感染症之抗生素療程 ( 二 )感染症療程 ( 天 )
1048729
肺炎雙球菌肺炎 14 ()
革蘭氏陰性桿菌肺炎1048729
21 ()
退伍軍人協會症1048729
21
奴卡氏菌肺炎1048729
180-360
感染性心內膜炎 28-42
抗生素治療失敗之原因
選用藥物不恰當 藥物交互作用 降低療效 異異物阻塞或膿瘍未引流 病人免疫力太差 分離菌之判讀錯誤 新的院內感染
Pathogens of community-acquired infection Pulmonary
S pneumoniae H influenzae M catarrhalis Skin amp soft tissue Streptococci Staphylococci
Enterobacterioceae Intraabdomen Enterobacterioceae Anaerobes Enterococci CNS S pneumoniae H influenzae N meningitidis
Pathogens of community-acquired infection
Pulmonary S pneumoniae H influenzae M catarrhalis Skin amp soft tissue Streptococci Staphylococci
Enterobacterioceae Intraabdomen Enterobacterioceae Anaerobes Enterococci CNS S pneumoniae H influenzae N meningitidis
Pathogens of nosocmial infection
Pulmonary Enterobacterioceae Pseudomonas Acinetobacter MRSA Intraabdomen Enterobacterioceae Pseudomonas Anaerobes Enterococci Candida CNS MRSA Pseudomonas
Allergic reactions to antibiotics Fixed drug eruption Skin rash (maculopapular) Exfoliativedermatitis Stevens-Johnson Syndrome (Toxic epidermal necrolysis) Anaphylactic shock
Fixed rug eruption
Skin rash (maculopapular)
Stevens-Johnson Syndrome (Toxic epidermal necrolysis)
Antibiotics
Penicillins Beta-lactmase
inhibitors Cephalosporins Carbapenems Monobactams Sulfonamides amp
trimethoprim
Aminoglycosides Quinolones Tetracycline Metronidazole Macrolides Tigecycline Glycopeptide Colistimethate
sodium
Penicillins
Natural PCNsPenicillin G Penicillin V benzathine
PCN Penicillinase-resistant PCNs
Oxacillin Prostaphylin Amionopenicillins
Amoxicillin Ampicillin Anti-pseudomonal PCNs
Ticarcillin Piperacillin
Antimicrobial spectrum of Penicillin-G Streptococcus spp Anaerobes Neisseria spp (Meningococcus
Gonococcus) Actinomycosis Animal bite (Pasteurella multocida) 螺旋體 Syphilis Leptospirosis
Penicillinase-resistant Penicillins oxacillin Penicillinase (β-lactamase) inhibitor Anti-staphylococcal penicillins Less active than penicillin-G against
all other penicillin-susceptible microorganisms
Adverse effects-PCNs
Anaphylaxis anemia leukopenia Oxacillin hepatitis Ticarcillin coagulation abnormality
bleeding
Beta-lactambeta-lactamatase inhibitor
Sulbactam Ampicillin + Sulbactam
Clavulanic acid Amoxycillin + ClavulanateTicarcillin + Clavulanate
Tazobactam Piperacillin + Tazobactam
Antipseudomonal Penicillins Piptazo Ticarcillin + Clavulanate Pseudomonas species Many strains of Enterobacter Anaerobics except β-lactamase
producing Bacteroides species Less active against gram positive
isolates
Adverse effects of penicillin Anaphylaxis anemia leukopenia Oxacillin hepatitis Ticarcillin coagulation abnormality
bleeding
Sulbactam (Maxtam)
Sulbactam is an irreversible inhibitor of beta-lactamase
Combinations of sulbactam with beta-lactam antibiotics
Dose 05 ~ 10 gm 6 ~ 8 with other antibiotics not
gt 40 gmday Cefoperazonesulbactam Ampicillinsulbactam
Cephalosporins
First generation Second generation Third generation Fourth generation
Cephalosporins
Against GPC 1st gt 2nd gt cephamycins gt 3rd Against GNB 1st lt 2nd lt cephamycins lt 3rd
First Generation
Cefazolin Cefadroxil Ceflexin Cephradine
StreptococcusStaphylococcus (methicillin-susceptible)E coliP mirabilisK pneumoniae
Second Generation
Cefmetazole Cefuroxime
Cefalor Cefuroxime
above the diaphragm cefuroximebelow the diaphragm cefmetazole (cephamycins B fragilis) Cefmatazole ESBL-producing Enterobacteriaceae
Third generation
Cefoperazone Cefotaxime Ceftazidime Ceftriaxone Flumarin
Cefixime Cefpodoxime ceftibuten
Resistant Gram-negative microorganisms ( Nosocomial infections ) Serratia Citrobacter Enterobacter Pseudomonas β-lactamase producing H influenzaeBetter BBB penetration among cephalosporins (except cefoperazone)Indication nosocomial infections (mainly GNB) GNB meningitis
Fourth Generation
Cefepime Cefpirome
Good anti-pseudomonal effectGood CNS penetrationPreserve antimicrobial effect to G(+) bacteria
Adverse effects of cephalosporins
Cefamandole cefmetazole cefoperazone cefotetan vitamin K-dependent clotting factor metabolism
Monobactam Monobactam (Aztreonam(Aztreonam)) Only gram-negative aerobes Alternative in penicillin- and
cephalosporin- allergic patients
Sulfonamides and trimethoprim Inhibit folic acid metabolism Treatment of PCP Nocardia
Toxaplasma Sternotrophomonus Aderverse effect cholestatic jaudice
bone marrow suppression severe hypersensitivity (Stevens-Johnson syndrome)
CarbapenemGroup Classification
Group 1 Broad-spectrum carbapenems with limited activity against non-fermentative Gram-negative bacilli (NFGNB eg Pseudomonas Acinetobacter) that are particularly suitable for community-acquired infections (eg ertapenem)
Group 2 Broad-spectrum carbapenems with activity against non-
fermentative Gram-negative bacilli (eg Pseudomonas
Acinetobacter) that are particularly suitable for nosocomial infections (eg imipenem and meropenem)
Group3 Carbapenems with clinical activity against Methicillin-
Resistant Staphylococcus (eg In development)
J Antimicrob Chemotherapy
Side effect of Carbapenems Anaphylaxis Interstitial nephritis Anemia Leukopenia Precipitate seizure activity
especially old patients CRI preexisting seizure disorder or CNS pathology
AminoglycosidesAminoglycosides
Antimicrobial Spectrum Antimicrobial Spectrum - All Gram negative bacilli
- Staphylococcus aureus Dosage Dosage - Gentamicin loading ~ 2 mgkg maintenance ~ 3-5 mgkgday Amikacin loading ~ 75 mgkg maintenance ~ 5 mgkg Q8H or 75
mgkg q12H Exacin 8mgskgday Single daily (once-daily) dosing (SDD) Short course (3-5 days)
Adverse effects of Adverse effects of aminoglycosidesaminoglycosides Nephrotoxicity Ototoxicity Neuromuscular paralysis ~ High doseinfrequent administration
DECREASES the rate of tissue uptake mdash DELAY the onset
of toxicity doesnrsquot prevent it from happening ~ All patients if treated for a long enough time
will eventually develop toxicity
Fluoroquinolones
Group I
- Nalidixic acid
- Enteric or urinary tract infections Group II
- Ciprofloxacin Ofloxacin Levofloxacin
- GNR (P aeruginosa) S pneumoniae atypicals Group III
- Moxifloxacin Gemifloxacin
- GPB ( S pneumoniaeuarr) atypicals anaerobes GNR
(P aeruginosadarr)
- Respiratory tract infections
GlycopeptidesGlycopeptides
Vancomycin amp Teicoplanin
Non-β-lactam cell wall synthesis inhibitor
Spectrum GPC amp GPB
Avoid oral use except AAC (antibiotic-associated colitis)
Tetracyclines
STD
- Chlamydial
diseases
- Gonorrhea
(doxycycline +
ceftriaxone)
- Syphilis
Rickettsial diseases
Brucellosis
Tularemia
Relapsing fever
Tigecycline (a new class Glycylcyclines)Gram-positive BacteriaGram-positive Bacteria Staphylococcus MRSA
MRSE VRE E faecium E faecalis Streptococcus agalactiae S treptococcus anginosus
group Streptococcus pyogenes
AnaerobesAnaerobes B fragilis group Prevotella spp Peptostreptococcus spp C perfringensAtypicalAtypical Chlamydia pneumoniae Mycoplasma pneumoniae Legionella
Gram-negative BacteriaGram-negative Bacteria E coli (including ESBLs) Kl ebsiella pneumoniae (including ESBLs) K oxytoca Acinetobacter baumannii (Resistant strains)Resistant strains) Citrobacter freundii Enterobacter cloacae Enterobacter aerogenes Stenotrophomonas
maltophilia
Does not have good activity Does not have good activity againstagainst P aeruginosa Proteus Providencia
Colistimethate sodium Colistimethate sodium Pseudomonas
aeruginosa infections in cystic fibrosis multidrug-resistant Acinetobacter infection
E-coli Klebsiella sp ( ESBL) Enterobacter Colomycin 1000000 units = 80 mg
colistimethate 6 to 12 mgkg colistimethate sodium per
day 60 kg man recommended dose for
Colomycin is 240 to 480 mg of colistimethate sodium
Nephrotoxicity (damage to the kidneys) and neurotoxicity
抗生素使用常見的五大錯誤
Antibiotic = scanol (antipyretic) S vs R (susceptible vs resistant) 4 gt 3 gt2 gt 1 Treat colonization Vancomycin+ imipenem(atomic
bomb)
Colonization
Positive culture for sputum urine bile stool and skin swab without symptoms or signs of infection Not recommend for using antibiotics
Except asymptomatic bacteriuria before urological work up and in pregnancy should be treated
抗生素使用的適應症
明顯的細菌感染 極可能的細菌感染 敗血症 白血球過低合併發燒 懷疑急性心內膜炎 細菌性腦膜炎 壞死性筋膜炎
常見感染症之抗生素療程 ( 一 )
感染症療程 ( 天 )
菌血症 敗血症 14
肝膿瘍 21
軟組織感染 7-10
急性腎炎 14
細菌性腦膜炎 10
常見感染症之抗生素療程 ( 二 )感染症療程 ( 天 )
1048729
肺炎雙球菌肺炎 14 ()
革蘭氏陰性桿菌肺炎1048729
21 ()
退伍軍人協會症1048729
21
奴卡氏菌肺炎1048729
180-360
感染性心內膜炎 28-42
抗生素治療失敗之原因
選用藥物不恰當 藥物交互作用 降低療效 異異物阻塞或膿瘍未引流 病人免疫力太差 分離菌之判讀錯誤 新的院內感染
Pathogens of community-acquired infection
Pulmonary S pneumoniae H influenzae M catarrhalis Skin amp soft tissue Streptococci Staphylococci
Enterobacterioceae Intraabdomen Enterobacterioceae Anaerobes Enterococci CNS S pneumoniae H influenzae N meningitidis
Pathogens of nosocmial infection
Pulmonary Enterobacterioceae Pseudomonas Acinetobacter MRSA Intraabdomen Enterobacterioceae Pseudomonas Anaerobes Enterococci Candida CNS MRSA Pseudomonas
Allergic reactions to antibiotics Fixed drug eruption Skin rash (maculopapular) Exfoliativedermatitis Stevens-Johnson Syndrome (Toxic epidermal necrolysis) Anaphylactic shock
Fixed rug eruption
Skin rash (maculopapular)
Stevens-Johnson Syndrome (Toxic epidermal necrolysis)
Antibiotics
Penicillins Beta-lactmase
inhibitors Cephalosporins Carbapenems Monobactams Sulfonamides amp
trimethoprim
Aminoglycosides Quinolones Tetracycline Metronidazole Macrolides Tigecycline Glycopeptide Colistimethate
sodium
Penicillins
Natural PCNsPenicillin G Penicillin V benzathine
PCN Penicillinase-resistant PCNs
Oxacillin Prostaphylin Amionopenicillins
Amoxicillin Ampicillin Anti-pseudomonal PCNs
Ticarcillin Piperacillin
Antimicrobial spectrum of Penicillin-G Streptococcus spp Anaerobes Neisseria spp (Meningococcus
Gonococcus) Actinomycosis Animal bite (Pasteurella multocida) 螺旋體 Syphilis Leptospirosis
Penicillinase-resistant Penicillins oxacillin Penicillinase (β-lactamase) inhibitor Anti-staphylococcal penicillins Less active than penicillin-G against
all other penicillin-susceptible microorganisms
Adverse effects-PCNs
Anaphylaxis anemia leukopenia Oxacillin hepatitis Ticarcillin coagulation abnormality
bleeding
Beta-lactambeta-lactamatase inhibitor
Sulbactam Ampicillin + Sulbactam
Clavulanic acid Amoxycillin + ClavulanateTicarcillin + Clavulanate
Tazobactam Piperacillin + Tazobactam
Antipseudomonal Penicillins Piptazo Ticarcillin + Clavulanate Pseudomonas species Many strains of Enterobacter Anaerobics except β-lactamase
producing Bacteroides species Less active against gram positive
isolates
Adverse effects of penicillin Anaphylaxis anemia leukopenia Oxacillin hepatitis Ticarcillin coagulation abnormality
bleeding
Sulbactam (Maxtam)
Sulbactam is an irreversible inhibitor of beta-lactamase
Combinations of sulbactam with beta-lactam antibiotics
Dose 05 ~ 10 gm 6 ~ 8 with other antibiotics not
gt 40 gmday Cefoperazonesulbactam Ampicillinsulbactam
Cephalosporins
First generation Second generation Third generation Fourth generation
Cephalosporins
Against GPC 1st gt 2nd gt cephamycins gt 3rd Against GNB 1st lt 2nd lt cephamycins lt 3rd
First Generation
Cefazolin Cefadroxil Ceflexin Cephradine
StreptococcusStaphylococcus (methicillin-susceptible)E coliP mirabilisK pneumoniae
Second Generation
Cefmetazole Cefuroxime
Cefalor Cefuroxime
above the diaphragm cefuroximebelow the diaphragm cefmetazole (cephamycins B fragilis) Cefmatazole ESBL-producing Enterobacteriaceae
Third generation
Cefoperazone Cefotaxime Ceftazidime Ceftriaxone Flumarin
Cefixime Cefpodoxime ceftibuten
Resistant Gram-negative microorganisms ( Nosocomial infections ) Serratia Citrobacter Enterobacter Pseudomonas β-lactamase producing H influenzaeBetter BBB penetration among cephalosporins (except cefoperazone)Indication nosocomial infections (mainly GNB) GNB meningitis
Fourth Generation
Cefepime Cefpirome
Good anti-pseudomonal effectGood CNS penetrationPreserve antimicrobial effect to G(+) bacteria
Adverse effects of cephalosporins
Cefamandole cefmetazole cefoperazone cefotetan vitamin K-dependent clotting factor metabolism
Monobactam Monobactam (Aztreonam(Aztreonam)) Only gram-negative aerobes Alternative in penicillin- and
cephalosporin- allergic patients
Sulfonamides and trimethoprim Inhibit folic acid metabolism Treatment of PCP Nocardia
Toxaplasma Sternotrophomonus Aderverse effect cholestatic jaudice
bone marrow suppression severe hypersensitivity (Stevens-Johnson syndrome)
CarbapenemGroup Classification
Group 1 Broad-spectrum carbapenems with limited activity against non-fermentative Gram-negative bacilli (NFGNB eg Pseudomonas Acinetobacter) that are particularly suitable for community-acquired infections (eg ertapenem)
Group 2 Broad-spectrum carbapenems with activity against non-
fermentative Gram-negative bacilli (eg Pseudomonas
Acinetobacter) that are particularly suitable for nosocomial infections (eg imipenem and meropenem)
Group3 Carbapenems with clinical activity against Methicillin-
Resistant Staphylococcus (eg In development)
J Antimicrob Chemotherapy
Side effect of Carbapenems Anaphylaxis Interstitial nephritis Anemia Leukopenia Precipitate seizure activity
especially old patients CRI preexisting seizure disorder or CNS pathology
AminoglycosidesAminoglycosides
Antimicrobial Spectrum Antimicrobial Spectrum - All Gram negative bacilli
- Staphylococcus aureus Dosage Dosage - Gentamicin loading ~ 2 mgkg maintenance ~ 3-5 mgkgday Amikacin loading ~ 75 mgkg maintenance ~ 5 mgkg Q8H or 75
mgkg q12H Exacin 8mgskgday Single daily (once-daily) dosing (SDD) Short course (3-5 days)
Adverse effects of Adverse effects of aminoglycosidesaminoglycosides Nephrotoxicity Ototoxicity Neuromuscular paralysis ~ High doseinfrequent administration
DECREASES the rate of tissue uptake mdash DELAY the onset
of toxicity doesnrsquot prevent it from happening ~ All patients if treated for a long enough time
will eventually develop toxicity
Fluoroquinolones
Group I
- Nalidixic acid
- Enteric or urinary tract infections Group II
- Ciprofloxacin Ofloxacin Levofloxacin
- GNR (P aeruginosa) S pneumoniae atypicals Group III
- Moxifloxacin Gemifloxacin
- GPB ( S pneumoniaeuarr) atypicals anaerobes GNR
(P aeruginosadarr)
- Respiratory tract infections
GlycopeptidesGlycopeptides
Vancomycin amp Teicoplanin
Non-β-lactam cell wall synthesis inhibitor
Spectrum GPC amp GPB
Avoid oral use except AAC (antibiotic-associated colitis)
Tetracyclines
STD
- Chlamydial
diseases
- Gonorrhea
(doxycycline +
ceftriaxone)
- Syphilis
Rickettsial diseases
Brucellosis
Tularemia
Relapsing fever
Tigecycline (a new class Glycylcyclines)Gram-positive BacteriaGram-positive Bacteria Staphylococcus MRSA
MRSE VRE E faecium E faecalis Streptococcus agalactiae S treptococcus anginosus
group Streptococcus pyogenes
AnaerobesAnaerobes B fragilis group Prevotella spp Peptostreptococcus spp C perfringensAtypicalAtypical Chlamydia pneumoniae Mycoplasma pneumoniae Legionella
Gram-negative BacteriaGram-negative Bacteria E coli (including ESBLs) Kl ebsiella pneumoniae (including ESBLs) K oxytoca Acinetobacter baumannii (Resistant strains)Resistant strains) Citrobacter freundii Enterobacter cloacae Enterobacter aerogenes Stenotrophomonas
maltophilia
Does not have good activity Does not have good activity againstagainst P aeruginosa Proteus Providencia
Colistimethate sodium Colistimethate sodium Pseudomonas
aeruginosa infections in cystic fibrosis multidrug-resistant Acinetobacter infection
E-coli Klebsiella sp ( ESBL) Enterobacter Colomycin 1000000 units = 80 mg
colistimethate 6 to 12 mgkg colistimethate sodium per
day 60 kg man recommended dose for
Colomycin is 240 to 480 mg of colistimethate sodium
Nephrotoxicity (damage to the kidneys) and neurotoxicity
抗生素使用常見的五大錯誤
Antibiotic = scanol (antipyretic) S vs R (susceptible vs resistant) 4 gt 3 gt2 gt 1 Treat colonization Vancomycin+ imipenem(atomic
bomb)
Colonization
Positive culture for sputum urine bile stool and skin swab without symptoms or signs of infection Not recommend for using antibiotics
Except asymptomatic bacteriuria before urological work up and in pregnancy should be treated
抗生素使用的適應症
明顯的細菌感染 極可能的細菌感染 敗血症 白血球過低合併發燒 懷疑急性心內膜炎 細菌性腦膜炎 壞死性筋膜炎
常見感染症之抗生素療程 ( 一 )
感染症療程 ( 天 )
菌血症 敗血症 14
肝膿瘍 21
軟組織感染 7-10
急性腎炎 14
細菌性腦膜炎 10
常見感染症之抗生素療程 ( 二 )感染症療程 ( 天 )
1048729
肺炎雙球菌肺炎 14 ()
革蘭氏陰性桿菌肺炎1048729
21 ()
退伍軍人協會症1048729
21
奴卡氏菌肺炎1048729
180-360
感染性心內膜炎 28-42
抗生素治療失敗之原因
選用藥物不恰當 藥物交互作用 降低療效 異異物阻塞或膿瘍未引流 病人免疫力太差 分離菌之判讀錯誤 新的院內感染
Pathogens of nosocmial infection
Pulmonary Enterobacterioceae Pseudomonas Acinetobacter MRSA Intraabdomen Enterobacterioceae Pseudomonas Anaerobes Enterococci Candida CNS MRSA Pseudomonas
Allergic reactions to antibiotics Fixed drug eruption Skin rash (maculopapular) Exfoliativedermatitis Stevens-Johnson Syndrome (Toxic epidermal necrolysis) Anaphylactic shock
Fixed rug eruption
Skin rash (maculopapular)
Stevens-Johnson Syndrome (Toxic epidermal necrolysis)
Antibiotics
Penicillins Beta-lactmase
inhibitors Cephalosporins Carbapenems Monobactams Sulfonamides amp
trimethoprim
Aminoglycosides Quinolones Tetracycline Metronidazole Macrolides Tigecycline Glycopeptide Colistimethate
sodium
Penicillins
Natural PCNsPenicillin G Penicillin V benzathine
PCN Penicillinase-resistant PCNs
Oxacillin Prostaphylin Amionopenicillins
Amoxicillin Ampicillin Anti-pseudomonal PCNs
Ticarcillin Piperacillin
Antimicrobial spectrum of Penicillin-G Streptococcus spp Anaerobes Neisseria spp (Meningococcus
Gonococcus) Actinomycosis Animal bite (Pasteurella multocida) 螺旋體 Syphilis Leptospirosis
Penicillinase-resistant Penicillins oxacillin Penicillinase (β-lactamase) inhibitor Anti-staphylococcal penicillins Less active than penicillin-G against
all other penicillin-susceptible microorganisms
Adverse effects-PCNs
Anaphylaxis anemia leukopenia Oxacillin hepatitis Ticarcillin coagulation abnormality
bleeding
Beta-lactambeta-lactamatase inhibitor
Sulbactam Ampicillin + Sulbactam
Clavulanic acid Amoxycillin + ClavulanateTicarcillin + Clavulanate
Tazobactam Piperacillin + Tazobactam
Antipseudomonal Penicillins Piptazo Ticarcillin + Clavulanate Pseudomonas species Many strains of Enterobacter Anaerobics except β-lactamase
producing Bacteroides species Less active against gram positive
isolates
Adverse effects of penicillin Anaphylaxis anemia leukopenia Oxacillin hepatitis Ticarcillin coagulation abnormality
bleeding
Sulbactam (Maxtam)
Sulbactam is an irreversible inhibitor of beta-lactamase
Combinations of sulbactam with beta-lactam antibiotics
Dose 05 ~ 10 gm 6 ~ 8 with other antibiotics not
gt 40 gmday Cefoperazonesulbactam Ampicillinsulbactam
Cephalosporins
First generation Second generation Third generation Fourth generation
Cephalosporins
Against GPC 1st gt 2nd gt cephamycins gt 3rd Against GNB 1st lt 2nd lt cephamycins lt 3rd
First Generation
Cefazolin Cefadroxil Ceflexin Cephradine
StreptococcusStaphylococcus (methicillin-susceptible)E coliP mirabilisK pneumoniae
Second Generation
Cefmetazole Cefuroxime
Cefalor Cefuroxime
above the diaphragm cefuroximebelow the diaphragm cefmetazole (cephamycins B fragilis) Cefmatazole ESBL-producing Enterobacteriaceae
Third generation
Cefoperazone Cefotaxime Ceftazidime Ceftriaxone Flumarin
Cefixime Cefpodoxime ceftibuten
Resistant Gram-negative microorganisms ( Nosocomial infections ) Serratia Citrobacter Enterobacter Pseudomonas β-lactamase producing H influenzaeBetter BBB penetration among cephalosporins (except cefoperazone)Indication nosocomial infections (mainly GNB) GNB meningitis
Fourth Generation
Cefepime Cefpirome
Good anti-pseudomonal effectGood CNS penetrationPreserve antimicrobial effect to G(+) bacteria
Adverse effects of cephalosporins
Cefamandole cefmetazole cefoperazone cefotetan vitamin K-dependent clotting factor metabolism
Monobactam Monobactam (Aztreonam(Aztreonam)) Only gram-negative aerobes Alternative in penicillin- and
cephalosporin- allergic patients
Sulfonamides and trimethoprim Inhibit folic acid metabolism Treatment of PCP Nocardia
Toxaplasma Sternotrophomonus Aderverse effect cholestatic jaudice
bone marrow suppression severe hypersensitivity (Stevens-Johnson syndrome)
CarbapenemGroup Classification
Group 1 Broad-spectrum carbapenems with limited activity against non-fermentative Gram-negative bacilli (NFGNB eg Pseudomonas Acinetobacter) that are particularly suitable for community-acquired infections (eg ertapenem)
Group 2 Broad-spectrum carbapenems with activity against non-
fermentative Gram-negative bacilli (eg Pseudomonas
Acinetobacter) that are particularly suitable for nosocomial infections (eg imipenem and meropenem)
Group3 Carbapenems with clinical activity against Methicillin-
Resistant Staphylococcus (eg In development)
J Antimicrob Chemotherapy
Side effect of Carbapenems Anaphylaxis Interstitial nephritis Anemia Leukopenia Precipitate seizure activity
especially old patients CRI preexisting seizure disorder or CNS pathology
AminoglycosidesAminoglycosides
Antimicrobial Spectrum Antimicrobial Spectrum - All Gram negative bacilli
- Staphylococcus aureus Dosage Dosage - Gentamicin loading ~ 2 mgkg maintenance ~ 3-5 mgkgday Amikacin loading ~ 75 mgkg maintenance ~ 5 mgkg Q8H or 75
mgkg q12H Exacin 8mgskgday Single daily (once-daily) dosing (SDD) Short course (3-5 days)
Adverse effects of Adverse effects of aminoglycosidesaminoglycosides Nephrotoxicity Ototoxicity Neuromuscular paralysis ~ High doseinfrequent administration
DECREASES the rate of tissue uptake mdash DELAY the onset
of toxicity doesnrsquot prevent it from happening ~ All patients if treated for a long enough time
will eventually develop toxicity
Fluoroquinolones
Group I
- Nalidixic acid
- Enteric or urinary tract infections Group II
- Ciprofloxacin Ofloxacin Levofloxacin
- GNR (P aeruginosa) S pneumoniae atypicals Group III
- Moxifloxacin Gemifloxacin
- GPB ( S pneumoniaeuarr) atypicals anaerobes GNR
(P aeruginosadarr)
- Respiratory tract infections
GlycopeptidesGlycopeptides
Vancomycin amp Teicoplanin
Non-β-lactam cell wall synthesis inhibitor
Spectrum GPC amp GPB
Avoid oral use except AAC (antibiotic-associated colitis)
Tetracyclines
STD
- Chlamydial
diseases
- Gonorrhea
(doxycycline +
ceftriaxone)
- Syphilis
Rickettsial diseases
Brucellosis
Tularemia
Relapsing fever
Tigecycline (a new class Glycylcyclines)Gram-positive BacteriaGram-positive Bacteria Staphylococcus MRSA
MRSE VRE E faecium E faecalis Streptococcus agalactiae S treptococcus anginosus
group Streptococcus pyogenes
AnaerobesAnaerobes B fragilis group Prevotella spp Peptostreptococcus spp C perfringensAtypicalAtypical Chlamydia pneumoniae Mycoplasma pneumoniae Legionella
Gram-negative BacteriaGram-negative Bacteria E coli (including ESBLs) Kl ebsiella pneumoniae (including ESBLs) K oxytoca Acinetobacter baumannii (Resistant strains)Resistant strains) Citrobacter freundii Enterobacter cloacae Enterobacter aerogenes Stenotrophomonas
maltophilia
Does not have good activity Does not have good activity againstagainst P aeruginosa Proteus Providencia
Colistimethate sodium Colistimethate sodium Pseudomonas
aeruginosa infections in cystic fibrosis multidrug-resistant Acinetobacter infection
E-coli Klebsiella sp ( ESBL) Enterobacter Colomycin 1000000 units = 80 mg
colistimethate 6 to 12 mgkg colistimethate sodium per
day 60 kg man recommended dose for
Colomycin is 240 to 480 mg of colistimethate sodium
Nephrotoxicity (damage to the kidneys) and neurotoxicity
抗生素使用常見的五大錯誤
Antibiotic = scanol (antipyretic) S vs R (susceptible vs resistant) 4 gt 3 gt2 gt 1 Treat colonization Vancomycin+ imipenem(atomic
bomb)
Colonization
Positive culture for sputum urine bile stool and skin swab without symptoms or signs of infection Not recommend for using antibiotics
Except asymptomatic bacteriuria before urological work up and in pregnancy should be treated
抗生素使用的適應症
明顯的細菌感染 極可能的細菌感染 敗血症 白血球過低合併發燒 懷疑急性心內膜炎 細菌性腦膜炎 壞死性筋膜炎
常見感染症之抗生素療程 ( 一 )
感染症療程 ( 天 )
菌血症 敗血症 14
肝膿瘍 21
軟組織感染 7-10
急性腎炎 14
細菌性腦膜炎 10
常見感染症之抗生素療程 ( 二 )感染症療程 ( 天 )
1048729
肺炎雙球菌肺炎 14 ()
革蘭氏陰性桿菌肺炎1048729
21 ()
退伍軍人協會症1048729
21
奴卡氏菌肺炎1048729
180-360
感染性心內膜炎 28-42
抗生素治療失敗之原因
選用藥物不恰當 藥物交互作用 降低療效 異異物阻塞或膿瘍未引流 病人免疫力太差 分離菌之判讀錯誤 新的院內感染
Allergic reactions to antibiotics Fixed drug eruption Skin rash (maculopapular) Exfoliativedermatitis Stevens-Johnson Syndrome (Toxic epidermal necrolysis) Anaphylactic shock
Fixed rug eruption
Skin rash (maculopapular)
Stevens-Johnson Syndrome (Toxic epidermal necrolysis)
Antibiotics
Penicillins Beta-lactmase
inhibitors Cephalosporins Carbapenems Monobactams Sulfonamides amp
trimethoprim
Aminoglycosides Quinolones Tetracycline Metronidazole Macrolides Tigecycline Glycopeptide Colistimethate
sodium
Penicillins
Natural PCNsPenicillin G Penicillin V benzathine
PCN Penicillinase-resistant PCNs
Oxacillin Prostaphylin Amionopenicillins
Amoxicillin Ampicillin Anti-pseudomonal PCNs
Ticarcillin Piperacillin
Antimicrobial spectrum of Penicillin-G Streptococcus spp Anaerobes Neisseria spp (Meningococcus
Gonococcus) Actinomycosis Animal bite (Pasteurella multocida) 螺旋體 Syphilis Leptospirosis
Penicillinase-resistant Penicillins oxacillin Penicillinase (β-lactamase) inhibitor Anti-staphylococcal penicillins Less active than penicillin-G against
all other penicillin-susceptible microorganisms
Adverse effects-PCNs
Anaphylaxis anemia leukopenia Oxacillin hepatitis Ticarcillin coagulation abnormality
bleeding
Beta-lactambeta-lactamatase inhibitor
Sulbactam Ampicillin + Sulbactam
Clavulanic acid Amoxycillin + ClavulanateTicarcillin + Clavulanate
Tazobactam Piperacillin + Tazobactam
Antipseudomonal Penicillins Piptazo Ticarcillin + Clavulanate Pseudomonas species Many strains of Enterobacter Anaerobics except β-lactamase
producing Bacteroides species Less active against gram positive
isolates
Adverse effects of penicillin Anaphylaxis anemia leukopenia Oxacillin hepatitis Ticarcillin coagulation abnormality
bleeding
Sulbactam (Maxtam)
Sulbactam is an irreversible inhibitor of beta-lactamase
Combinations of sulbactam with beta-lactam antibiotics
Dose 05 ~ 10 gm 6 ~ 8 with other antibiotics not
gt 40 gmday Cefoperazonesulbactam Ampicillinsulbactam
Cephalosporins
First generation Second generation Third generation Fourth generation
Cephalosporins
Against GPC 1st gt 2nd gt cephamycins gt 3rd Against GNB 1st lt 2nd lt cephamycins lt 3rd
First Generation
Cefazolin Cefadroxil Ceflexin Cephradine
StreptococcusStaphylococcus (methicillin-susceptible)E coliP mirabilisK pneumoniae
Second Generation
Cefmetazole Cefuroxime
Cefalor Cefuroxime
above the diaphragm cefuroximebelow the diaphragm cefmetazole (cephamycins B fragilis) Cefmatazole ESBL-producing Enterobacteriaceae
Third generation
Cefoperazone Cefotaxime Ceftazidime Ceftriaxone Flumarin
Cefixime Cefpodoxime ceftibuten
Resistant Gram-negative microorganisms ( Nosocomial infections ) Serratia Citrobacter Enterobacter Pseudomonas β-lactamase producing H influenzaeBetter BBB penetration among cephalosporins (except cefoperazone)Indication nosocomial infections (mainly GNB) GNB meningitis
Fourth Generation
Cefepime Cefpirome
Good anti-pseudomonal effectGood CNS penetrationPreserve antimicrobial effect to G(+) bacteria
Adverse effects of cephalosporins
Cefamandole cefmetazole cefoperazone cefotetan vitamin K-dependent clotting factor metabolism
Monobactam Monobactam (Aztreonam(Aztreonam)) Only gram-negative aerobes Alternative in penicillin- and
cephalosporin- allergic patients
Sulfonamides and trimethoprim Inhibit folic acid metabolism Treatment of PCP Nocardia
Toxaplasma Sternotrophomonus Aderverse effect cholestatic jaudice
bone marrow suppression severe hypersensitivity (Stevens-Johnson syndrome)
CarbapenemGroup Classification
Group 1 Broad-spectrum carbapenems with limited activity against non-fermentative Gram-negative bacilli (NFGNB eg Pseudomonas Acinetobacter) that are particularly suitable for community-acquired infections (eg ertapenem)
Group 2 Broad-spectrum carbapenems with activity against non-
fermentative Gram-negative bacilli (eg Pseudomonas
Acinetobacter) that are particularly suitable for nosocomial infections (eg imipenem and meropenem)
Group3 Carbapenems with clinical activity against Methicillin-
Resistant Staphylococcus (eg In development)
J Antimicrob Chemotherapy
Side effect of Carbapenems Anaphylaxis Interstitial nephritis Anemia Leukopenia Precipitate seizure activity
especially old patients CRI preexisting seizure disorder or CNS pathology
AminoglycosidesAminoglycosides
Antimicrobial Spectrum Antimicrobial Spectrum - All Gram negative bacilli
- Staphylococcus aureus Dosage Dosage - Gentamicin loading ~ 2 mgkg maintenance ~ 3-5 mgkgday Amikacin loading ~ 75 mgkg maintenance ~ 5 mgkg Q8H or 75
mgkg q12H Exacin 8mgskgday Single daily (once-daily) dosing (SDD) Short course (3-5 days)
Adverse effects of Adverse effects of aminoglycosidesaminoglycosides Nephrotoxicity Ototoxicity Neuromuscular paralysis ~ High doseinfrequent administration
DECREASES the rate of tissue uptake mdash DELAY the onset
of toxicity doesnrsquot prevent it from happening ~ All patients if treated for a long enough time
will eventually develop toxicity
Fluoroquinolones
Group I
- Nalidixic acid
- Enteric or urinary tract infections Group II
- Ciprofloxacin Ofloxacin Levofloxacin
- GNR (P aeruginosa) S pneumoniae atypicals Group III
- Moxifloxacin Gemifloxacin
- GPB ( S pneumoniaeuarr) atypicals anaerobes GNR
(P aeruginosadarr)
- Respiratory tract infections
GlycopeptidesGlycopeptides
Vancomycin amp Teicoplanin
Non-β-lactam cell wall synthesis inhibitor
Spectrum GPC amp GPB
Avoid oral use except AAC (antibiotic-associated colitis)
Tetracyclines
STD
- Chlamydial
diseases
- Gonorrhea
(doxycycline +
ceftriaxone)
- Syphilis
Rickettsial diseases
Brucellosis
Tularemia
Relapsing fever
Tigecycline (a new class Glycylcyclines)Gram-positive BacteriaGram-positive Bacteria Staphylococcus MRSA
MRSE VRE E faecium E faecalis Streptococcus agalactiae S treptococcus anginosus
group Streptococcus pyogenes
AnaerobesAnaerobes B fragilis group Prevotella spp Peptostreptococcus spp C perfringensAtypicalAtypical Chlamydia pneumoniae Mycoplasma pneumoniae Legionella
Gram-negative BacteriaGram-negative Bacteria E coli (including ESBLs) Kl ebsiella pneumoniae (including ESBLs) K oxytoca Acinetobacter baumannii (Resistant strains)Resistant strains) Citrobacter freundii Enterobacter cloacae Enterobacter aerogenes Stenotrophomonas
maltophilia
Does not have good activity Does not have good activity againstagainst P aeruginosa Proteus Providencia
Colistimethate sodium Colistimethate sodium Pseudomonas
aeruginosa infections in cystic fibrosis multidrug-resistant Acinetobacter infection
E-coli Klebsiella sp ( ESBL) Enterobacter Colomycin 1000000 units = 80 mg
colistimethate 6 to 12 mgkg colistimethate sodium per
day 60 kg man recommended dose for
Colomycin is 240 to 480 mg of colistimethate sodium
Nephrotoxicity (damage to the kidneys) and neurotoxicity
抗生素使用常見的五大錯誤
Antibiotic = scanol (antipyretic) S vs R (susceptible vs resistant) 4 gt 3 gt2 gt 1 Treat colonization Vancomycin+ imipenem(atomic
bomb)
Colonization
Positive culture for sputum urine bile stool and skin swab without symptoms or signs of infection Not recommend for using antibiotics
Except asymptomatic bacteriuria before urological work up and in pregnancy should be treated
抗生素使用的適應症
明顯的細菌感染 極可能的細菌感染 敗血症 白血球過低合併發燒 懷疑急性心內膜炎 細菌性腦膜炎 壞死性筋膜炎
常見感染症之抗生素療程 ( 一 )
感染症療程 ( 天 )
菌血症 敗血症 14
肝膿瘍 21
軟組織感染 7-10
急性腎炎 14
細菌性腦膜炎 10
常見感染症之抗生素療程 ( 二 )感染症療程 ( 天 )
1048729
肺炎雙球菌肺炎 14 ()
革蘭氏陰性桿菌肺炎1048729
21 ()
退伍軍人協會症1048729
21
奴卡氏菌肺炎1048729
180-360
感染性心內膜炎 28-42
抗生素治療失敗之原因
選用藥物不恰當 藥物交互作用 降低療效 異異物阻塞或膿瘍未引流 病人免疫力太差 分離菌之判讀錯誤 新的院內感染
Fixed rug eruption
Skin rash (maculopapular)
Stevens-Johnson Syndrome (Toxic epidermal necrolysis)
Antibiotics
Penicillins Beta-lactmase
inhibitors Cephalosporins Carbapenems Monobactams Sulfonamides amp
trimethoprim
Aminoglycosides Quinolones Tetracycline Metronidazole Macrolides Tigecycline Glycopeptide Colistimethate
sodium
Penicillins
Natural PCNsPenicillin G Penicillin V benzathine
PCN Penicillinase-resistant PCNs
Oxacillin Prostaphylin Amionopenicillins
Amoxicillin Ampicillin Anti-pseudomonal PCNs
Ticarcillin Piperacillin
Antimicrobial spectrum of Penicillin-G Streptococcus spp Anaerobes Neisseria spp (Meningococcus
Gonococcus) Actinomycosis Animal bite (Pasteurella multocida) 螺旋體 Syphilis Leptospirosis
Penicillinase-resistant Penicillins oxacillin Penicillinase (β-lactamase) inhibitor Anti-staphylococcal penicillins Less active than penicillin-G against
all other penicillin-susceptible microorganisms
Adverse effects-PCNs
Anaphylaxis anemia leukopenia Oxacillin hepatitis Ticarcillin coagulation abnormality
bleeding
Beta-lactambeta-lactamatase inhibitor
Sulbactam Ampicillin + Sulbactam
Clavulanic acid Amoxycillin + ClavulanateTicarcillin + Clavulanate
Tazobactam Piperacillin + Tazobactam
Antipseudomonal Penicillins Piptazo Ticarcillin + Clavulanate Pseudomonas species Many strains of Enterobacter Anaerobics except β-lactamase
producing Bacteroides species Less active against gram positive
isolates
Adverse effects of penicillin Anaphylaxis anemia leukopenia Oxacillin hepatitis Ticarcillin coagulation abnormality
bleeding
Sulbactam (Maxtam)
Sulbactam is an irreversible inhibitor of beta-lactamase
Combinations of sulbactam with beta-lactam antibiotics
Dose 05 ~ 10 gm 6 ~ 8 with other antibiotics not
gt 40 gmday Cefoperazonesulbactam Ampicillinsulbactam
Cephalosporins
First generation Second generation Third generation Fourth generation
Cephalosporins
Against GPC 1st gt 2nd gt cephamycins gt 3rd Against GNB 1st lt 2nd lt cephamycins lt 3rd
First Generation
Cefazolin Cefadroxil Ceflexin Cephradine
StreptococcusStaphylococcus (methicillin-susceptible)E coliP mirabilisK pneumoniae
Second Generation
Cefmetazole Cefuroxime
Cefalor Cefuroxime
above the diaphragm cefuroximebelow the diaphragm cefmetazole (cephamycins B fragilis) Cefmatazole ESBL-producing Enterobacteriaceae
Third generation
Cefoperazone Cefotaxime Ceftazidime Ceftriaxone Flumarin
Cefixime Cefpodoxime ceftibuten
Resistant Gram-negative microorganisms ( Nosocomial infections ) Serratia Citrobacter Enterobacter Pseudomonas β-lactamase producing H influenzaeBetter BBB penetration among cephalosporins (except cefoperazone)Indication nosocomial infections (mainly GNB) GNB meningitis
Fourth Generation
Cefepime Cefpirome
Good anti-pseudomonal effectGood CNS penetrationPreserve antimicrobial effect to G(+) bacteria
Adverse effects of cephalosporins
Cefamandole cefmetazole cefoperazone cefotetan vitamin K-dependent clotting factor metabolism
Monobactam Monobactam (Aztreonam(Aztreonam)) Only gram-negative aerobes Alternative in penicillin- and
cephalosporin- allergic patients
Sulfonamides and trimethoprim Inhibit folic acid metabolism Treatment of PCP Nocardia
Toxaplasma Sternotrophomonus Aderverse effect cholestatic jaudice
bone marrow suppression severe hypersensitivity (Stevens-Johnson syndrome)
CarbapenemGroup Classification
Group 1 Broad-spectrum carbapenems with limited activity against non-fermentative Gram-negative bacilli (NFGNB eg Pseudomonas Acinetobacter) that are particularly suitable for community-acquired infections (eg ertapenem)
Group 2 Broad-spectrum carbapenems with activity against non-
fermentative Gram-negative bacilli (eg Pseudomonas
Acinetobacter) that are particularly suitable for nosocomial infections (eg imipenem and meropenem)
Group3 Carbapenems with clinical activity against Methicillin-
Resistant Staphylococcus (eg In development)
J Antimicrob Chemotherapy
Side effect of Carbapenems Anaphylaxis Interstitial nephritis Anemia Leukopenia Precipitate seizure activity
especially old patients CRI preexisting seizure disorder or CNS pathology
AminoglycosidesAminoglycosides
Antimicrobial Spectrum Antimicrobial Spectrum - All Gram negative bacilli
- Staphylococcus aureus Dosage Dosage - Gentamicin loading ~ 2 mgkg maintenance ~ 3-5 mgkgday Amikacin loading ~ 75 mgkg maintenance ~ 5 mgkg Q8H or 75
mgkg q12H Exacin 8mgskgday Single daily (once-daily) dosing (SDD) Short course (3-5 days)
Adverse effects of Adverse effects of aminoglycosidesaminoglycosides Nephrotoxicity Ototoxicity Neuromuscular paralysis ~ High doseinfrequent administration
DECREASES the rate of tissue uptake mdash DELAY the onset
of toxicity doesnrsquot prevent it from happening ~ All patients if treated for a long enough time
will eventually develop toxicity
Fluoroquinolones
Group I
- Nalidixic acid
- Enteric or urinary tract infections Group II
- Ciprofloxacin Ofloxacin Levofloxacin
- GNR (P aeruginosa) S pneumoniae atypicals Group III
- Moxifloxacin Gemifloxacin
- GPB ( S pneumoniaeuarr) atypicals anaerobes GNR
(P aeruginosadarr)
- Respiratory tract infections
GlycopeptidesGlycopeptides
Vancomycin amp Teicoplanin
Non-β-lactam cell wall synthesis inhibitor
Spectrum GPC amp GPB
Avoid oral use except AAC (antibiotic-associated colitis)
Tetracyclines
STD
- Chlamydial
diseases
- Gonorrhea
(doxycycline +
ceftriaxone)
- Syphilis
Rickettsial diseases
Brucellosis
Tularemia
Relapsing fever
Tigecycline (a new class Glycylcyclines)Gram-positive BacteriaGram-positive Bacteria Staphylococcus MRSA
MRSE VRE E faecium E faecalis Streptococcus agalactiae S treptococcus anginosus
group Streptococcus pyogenes
AnaerobesAnaerobes B fragilis group Prevotella spp Peptostreptococcus spp C perfringensAtypicalAtypical Chlamydia pneumoniae Mycoplasma pneumoniae Legionella
Gram-negative BacteriaGram-negative Bacteria E coli (including ESBLs) Kl ebsiella pneumoniae (including ESBLs) K oxytoca Acinetobacter baumannii (Resistant strains)Resistant strains) Citrobacter freundii Enterobacter cloacae Enterobacter aerogenes Stenotrophomonas
maltophilia
Does not have good activity Does not have good activity againstagainst P aeruginosa Proteus Providencia
Colistimethate sodium Colistimethate sodium Pseudomonas
aeruginosa infections in cystic fibrosis multidrug-resistant Acinetobacter infection
E-coli Klebsiella sp ( ESBL) Enterobacter Colomycin 1000000 units = 80 mg
colistimethate 6 to 12 mgkg colistimethate sodium per
day 60 kg man recommended dose for
Colomycin is 240 to 480 mg of colistimethate sodium
Nephrotoxicity (damage to the kidneys) and neurotoxicity
抗生素使用常見的五大錯誤
Antibiotic = scanol (antipyretic) S vs R (susceptible vs resistant) 4 gt 3 gt2 gt 1 Treat colonization Vancomycin+ imipenem(atomic
bomb)
Colonization
Positive culture for sputum urine bile stool and skin swab without symptoms or signs of infection Not recommend for using antibiotics
Except asymptomatic bacteriuria before urological work up and in pregnancy should be treated
抗生素使用的適應症
明顯的細菌感染 極可能的細菌感染 敗血症 白血球過低合併發燒 懷疑急性心內膜炎 細菌性腦膜炎 壞死性筋膜炎
常見感染症之抗生素療程 ( 一 )
感染症療程 ( 天 )
菌血症 敗血症 14
肝膿瘍 21
軟組織感染 7-10
急性腎炎 14
細菌性腦膜炎 10
常見感染症之抗生素療程 ( 二 )感染症療程 ( 天 )
1048729
肺炎雙球菌肺炎 14 ()
革蘭氏陰性桿菌肺炎1048729
21 ()
退伍軍人協會症1048729
21
奴卡氏菌肺炎1048729
180-360
感染性心內膜炎 28-42
抗生素治療失敗之原因
選用藥物不恰當 藥物交互作用 降低療效 異異物阻塞或膿瘍未引流 病人免疫力太差 分離菌之判讀錯誤 新的院內感染
Skin rash (maculopapular)
Stevens-Johnson Syndrome (Toxic epidermal necrolysis)
Antibiotics
Penicillins Beta-lactmase
inhibitors Cephalosporins Carbapenems Monobactams Sulfonamides amp
trimethoprim
Aminoglycosides Quinolones Tetracycline Metronidazole Macrolides Tigecycline Glycopeptide Colistimethate
sodium
Penicillins
Natural PCNsPenicillin G Penicillin V benzathine
PCN Penicillinase-resistant PCNs
Oxacillin Prostaphylin Amionopenicillins
Amoxicillin Ampicillin Anti-pseudomonal PCNs
Ticarcillin Piperacillin
Antimicrobial spectrum of Penicillin-G Streptococcus spp Anaerobes Neisseria spp (Meningococcus
Gonococcus) Actinomycosis Animal bite (Pasteurella multocida) 螺旋體 Syphilis Leptospirosis
Penicillinase-resistant Penicillins oxacillin Penicillinase (β-lactamase) inhibitor Anti-staphylococcal penicillins Less active than penicillin-G against
all other penicillin-susceptible microorganisms
Adverse effects-PCNs
Anaphylaxis anemia leukopenia Oxacillin hepatitis Ticarcillin coagulation abnormality
bleeding
Beta-lactambeta-lactamatase inhibitor
Sulbactam Ampicillin + Sulbactam
Clavulanic acid Amoxycillin + ClavulanateTicarcillin + Clavulanate
Tazobactam Piperacillin + Tazobactam
Antipseudomonal Penicillins Piptazo Ticarcillin + Clavulanate Pseudomonas species Many strains of Enterobacter Anaerobics except β-lactamase
producing Bacteroides species Less active against gram positive
isolates
Adverse effects of penicillin Anaphylaxis anemia leukopenia Oxacillin hepatitis Ticarcillin coagulation abnormality
bleeding
Sulbactam (Maxtam)
Sulbactam is an irreversible inhibitor of beta-lactamase
Combinations of sulbactam with beta-lactam antibiotics
Dose 05 ~ 10 gm 6 ~ 8 with other antibiotics not
gt 40 gmday Cefoperazonesulbactam Ampicillinsulbactam
Cephalosporins
First generation Second generation Third generation Fourth generation
Cephalosporins
Against GPC 1st gt 2nd gt cephamycins gt 3rd Against GNB 1st lt 2nd lt cephamycins lt 3rd
First Generation
Cefazolin Cefadroxil Ceflexin Cephradine
StreptococcusStaphylococcus (methicillin-susceptible)E coliP mirabilisK pneumoniae
Second Generation
Cefmetazole Cefuroxime
Cefalor Cefuroxime
above the diaphragm cefuroximebelow the diaphragm cefmetazole (cephamycins B fragilis) Cefmatazole ESBL-producing Enterobacteriaceae
Third generation
Cefoperazone Cefotaxime Ceftazidime Ceftriaxone Flumarin
Cefixime Cefpodoxime ceftibuten
Resistant Gram-negative microorganisms ( Nosocomial infections ) Serratia Citrobacter Enterobacter Pseudomonas β-lactamase producing H influenzaeBetter BBB penetration among cephalosporins (except cefoperazone)Indication nosocomial infections (mainly GNB) GNB meningitis
Fourth Generation
Cefepime Cefpirome
Good anti-pseudomonal effectGood CNS penetrationPreserve antimicrobial effect to G(+) bacteria
Adverse effects of cephalosporins
Cefamandole cefmetazole cefoperazone cefotetan vitamin K-dependent clotting factor metabolism
Monobactam Monobactam (Aztreonam(Aztreonam)) Only gram-negative aerobes Alternative in penicillin- and
cephalosporin- allergic patients
Sulfonamides and trimethoprim Inhibit folic acid metabolism Treatment of PCP Nocardia
Toxaplasma Sternotrophomonus Aderverse effect cholestatic jaudice
bone marrow suppression severe hypersensitivity (Stevens-Johnson syndrome)
CarbapenemGroup Classification
Group 1 Broad-spectrum carbapenems with limited activity against non-fermentative Gram-negative bacilli (NFGNB eg Pseudomonas Acinetobacter) that are particularly suitable for community-acquired infections (eg ertapenem)
Group 2 Broad-spectrum carbapenems with activity against non-
fermentative Gram-negative bacilli (eg Pseudomonas
Acinetobacter) that are particularly suitable for nosocomial infections (eg imipenem and meropenem)
Group3 Carbapenems with clinical activity against Methicillin-
Resistant Staphylococcus (eg In development)
J Antimicrob Chemotherapy
Side effect of Carbapenems Anaphylaxis Interstitial nephritis Anemia Leukopenia Precipitate seizure activity
especially old patients CRI preexisting seizure disorder or CNS pathology
AminoglycosidesAminoglycosides
Antimicrobial Spectrum Antimicrobial Spectrum - All Gram negative bacilli
- Staphylococcus aureus Dosage Dosage - Gentamicin loading ~ 2 mgkg maintenance ~ 3-5 mgkgday Amikacin loading ~ 75 mgkg maintenance ~ 5 mgkg Q8H or 75
mgkg q12H Exacin 8mgskgday Single daily (once-daily) dosing (SDD) Short course (3-5 days)
Adverse effects of Adverse effects of aminoglycosidesaminoglycosides Nephrotoxicity Ototoxicity Neuromuscular paralysis ~ High doseinfrequent administration
DECREASES the rate of tissue uptake mdash DELAY the onset
of toxicity doesnrsquot prevent it from happening ~ All patients if treated for a long enough time
will eventually develop toxicity
Fluoroquinolones
Group I
- Nalidixic acid
- Enteric or urinary tract infections Group II
- Ciprofloxacin Ofloxacin Levofloxacin
- GNR (P aeruginosa) S pneumoniae atypicals Group III
- Moxifloxacin Gemifloxacin
- GPB ( S pneumoniaeuarr) atypicals anaerobes GNR
(P aeruginosadarr)
- Respiratory tract infections
GlycopeptidesGlycopeptides
Vancomycin amp Teicoplanin
Non-β-lactam cell wall synthesis inhibitor
Spectrum GPC amp GPB
Avoid oral use except AAC (antibiotic-associated colitis)
Tetracyclines
STD
- Chlamydial
diseases
- Gonorrhea
(doxycycline +
ceftriaxone)
- Syphilis
Rickettsial diseases
Brucellosis
Tularemia
Relapsing fever
Tigecycline (a new class Glycylcyclines)Gram-positive BacteriaGram-positive Bacteria Staphylococcus MRSA
MRSE VRE E faecium E faecalis Streptococcus agalactiae S treptococcus anginosus
group Streptococcus pyogenes
AnaerobesAnaerobes B fragilis group Prevotella spp Peptostreptococcus spp C perfringensAtypicalAtypical Chlamydia pneumoniae Mycoplasma pneumoniae Legionella
Gram-negative BacteriaGram-negative Bacteria E coli (including ESBLs) Kl ebsiella pneumoniae (including ESBLs) K oxytoca Acinetobacter baumannii (Resistant strains)Resistant strains) Citrobacter freundii Enterobacter cloacae Enterobacter aerogenes Stenotrophomonas
maltophilia
Does not have good activity Does not have good activity againstagainst P aeruginosa Proteus Providencia
Colistimethate sodium Colistimethate sodium Pseudomonas
aeruginosa infections in cystic fibrosis multidrug-resistant Acinetobacter infection
E-coli Klebsiella sp ( ESBL) Enterobacter Colomycin 1000000 units = 80 mg
colistimethate 6 to 12 mgkg colistimethate sodium per
day 60 kg man recommended dose for
Colomycin is 240 to 480 mg of colistimethate sodium
Nephrotoxicity (damage to the kidneys) and neurotoxicity
抗生素使用常見的五大錯誤
Antibiotic = scanol (antipyretic) S vs R (susceptible vs resistant) 4 gt 3 gt2 gt 1 Treat colonization Vancomycin+ imipenem(atomic
bomb)
Colonization
Positive culture for sputum urine bile stool and skin swab without symptoms or signs of infection Not recommend for using antibiotics
Except asymptomatic bacteriuria before urological work up and in pregnancy should be treated
抗生素使用的適應症
明顯的細菌感染 極可能的細菌感染 敗血症 白血球過低合併發燒 懷疑急性心內膜炎 細菌性腦膜炎 壞死性筋膜炎
常見感染症之抗生素療程 ( 一 )
感染症療程 ( 天 )
菌血症 敗血症 14
肝膿瘍 21
軟組織感染 7-10
急性腎炎 14
細菌性腦膜炎 10
常見感染症之抗生素療程 ( 二 )感染症療程 ( 天 )
1048729
肺炎雙球菌肺炎 14 ()
革蘭氏陰性桿菌肺炎1048729
21 ()
退伍軍人協會症1048729
21
奴卡氏菌肺炎1048729
180-360
感染性心內膜炎 28-42
抗生素治療失敗之原因
選用藥物不恰當 藥物交互作用 降低療效 異異物阻塞或膿瘍未引流 病人免疫力太差 分離菌之判讀錯誤 新的院內感染
Stevens-Johnson Syndrome (Toxic epidermal necrolysis)
Antibiotics
Penicillins Beta-lactmase
inhibitors Cephalosporins Carbapenems Monobactams Sulfonamides amp
trimethoprim
Aminoglycosides Quinolones Tetracycline Metronidazole Macrolides Tigecycline Glycopeptide Colistimethate
sodium
Penicillins
Natural PCNsPenicillin G Penicillin V benzathine
PCN Penicillinase-resistant PCNs
Oxacillin Prostaphylin Amionopenicillins
Amoxicillin Ampicillin Anti-pseudomonal PCNs
Ticarcillin Piperacillin
Antimicrobial spectrum of Penicillin-G Streptococcus spp Anaerobes Neisseria spp (Meningococcus
Gonococcus) Actinomycosis Animal bite (Pasteurella multocida) 螺旋體 Syphilis Leptospirosis
Penicillinase-resistant Penicillins oxacillin Penicillinase (β-lactamase) inhibitor Anti-staphylococcal penicillins Less active than penicillin-G against
all other penicillin-susceptible microorganisms
Adverse effects-PCNs
Anaphylaxis anemia leukopenia Oxacillin hepatitis Ticarcillin coagulation abnormality
bleeding
Beta-lactambeta-lactamatase inhibitor
Sulbactam Ampicillin + Sulbactam
Clavulanic acid Amoxycillin + ClavulanateTicarcillin + Clavulanate
Tazobactam Piperacillin + Tazobactam
Antipseudomonal Penicillins Piptazo Ticarcillin + Clavulanate Pseudomonas species Many strains of Enterobacter Anaerobics except β-lactamase
producing Bacteroides species Less active against gram positive
isolates
Adverse effects of penicillin Anaphylaxis anemia leukopenia Oxacillin hepatitis Ticarcillin coagulation abnormality
bleeding
Sulbactam (Maxtam)
Sulbactam is an irreversible inhibitor of beta-lactamase
Combinations of sulbactam with beta-lactam antibiotics
Dose 05 ~ 10 gm 6 ~ 8 with other antibiotics not
gt 40 gmday Cefoperazonesulbactam Ampicillinsulbactam
Cephalosporins
First generation Second generation Third generation Fourth generation
Cephalosporins
Against GPC 1st gt 2nd gt cephamycins gt 3rd Against GNB 1st lt 2nd lt cephamycins lt 3rd
First Generation
Cefazolin Cefadroxil Ceflexin Cephradine
StreptococcusStaphylococcus (methicillin-susceptible)E coliP mirabilisK pneumoniae
Second Generation
Cefmetazole Cefuroxime
Cefalor Cefuroxime
above the diaphragm cefuroximebelow the diaphragm cefmetazole (cephamycins B fragilis) Cefmatazole ESBL-producing Enterobacteriaceae
Third generation
Cefoperazone Cefotaxime Ceftazidime Ceftriaxone Flumarin
Cefixime Cefpodoxime ceftibuten
Resistant Gram-negative microorganisms ( Nosocomial infections ) Serratia Citrobacter Enterobacter Pseudomonas β-lactamase producing H influenzaeBetter BBB penetration among cephalosporins (except cefoperazone)Indication nosocomial infections (mainly GNB) GNB meningitis
Fourth Generation
Cefepime Cefpirome
Good anti-pseudomonal effectGood CNS penetrationPreserve antimicrobial effect to G(+) bacteria
Adverse effects of cephalosporins
Cefamandole cefmetazole cefoperazone cefotetan vitamin K-dependent clotting factor metabolism
Monobactam Monobactam (Aztreonam(Aztreonam)) Only gram-negative aerobes Alternative in penicillin- and
cephalosporin- allergic patients
Sulfonamides and trimethoprim Inhibit folic acid metabolism Treatment of PCP Nocardia
Toxaplasma Sternotrophomonus Aderverse effect cholestatic jaudice
bone marrow suppression severe hypersensitivity (Stevens-Johnson syndrome)
CarbapenemGroup Classification
Group 1 Broad-spectrum carbapenems with limited activity against non-fermentative Gram-negative bacilli (NFGNB eg Pseudomonas Acinetobacter) that are particularly suitable for community-acquired infections (eg ertapenem)
Group 2 Broad-spectrum carbapenems with activity against non-
fermentative Gram-negative bacilli (eg Pseudomonas
Acinetobacter) that are particularly suitable for nosocomial infections (eg imipenem and meropenem)
Group3 Carbapenems with clinical activity against Methicillin-
Resistant Staphylococcus (eg In development)
J Antimicrob Chemotherapy
Side effect of Carbapenems Anaphylaxis Interstitial nephritis Anemia Leukopenia Precipitate seizure activity
especially old patients CRI preexisting seizure disorder or CNS pathology
AminoglycosidesAminoglycosides
Antimicrobial Spectrum Antimicrobial Spectrum - All Gram negative bacilli
- Staphylococcus aureus Dosage Dosage - Gentamicin loading ~ 2 mgkg maintenance ~ 3-5 mgkgday Amikacin loading ~ 75 mgkg maintenance ~ 5 mgkg Q8H or 75
mgkg q12H Exacin 8mgskgday Single daily (once-daily) dosing (SDD) Short course (3-5 days)
Adverse effects of Adverse effects of aminoglycosidesaminoglycosides Nephrotoxicity Ototoxicity Neuromuscular paralysis ~ High doseinfrequent administration
DECREASES the rate of tissue uptake mdash DELAY the onset
of toxicity doesnrsquot prevent it from happening ~ All patients if treated for a long enough time
will eventually develop toxicity
Fluoroquinolones
Group I
- Nalidixic acid
- Enteric or urinary tract infections Group II
- Ciprofloxacin Ofloxacin Levofloxacin
- GNR (P aeruginosa) S pneumoniae atypicals Group III
- Moxifloxacin Gemifloxacin
- GPB ( S pneumoniaeuarr) atypicals anaerobes GNR
(P aeruginosadarr)
- Respiratory tract infections
GlycopeptidesGlycopeptides
Vancomycin amp Teicoplanin
Non-β-lactam cell wall synthesis inhibitor
Spectrum GPC amp GPB
Avoid oral use except AAC (antibiotic-associated colitis)
Tetracyclines
STD
- Chlamydial
diseases
- Gonorrhea
(doxycycline +
ceftriaxone)
- Syphilis
Rickettsial diseases
Brucellosis
Tularemia
Relapsing fever
Tigecycline (a new class Glycylcyclines)Gram-positive BacteriaGram-positive Bacteria Staphylococcus MRSA
MRSE VRE E faecium E faecalis Streptococcus agalactiae S treptococcus anginosus
group Streptococcus pyogenes
AnaerobesAnaerobes B fragilis group Prevotella spp Peptostreptococcus spp C perfringensAtypicalAtypical Chlamydia pneumoniae Mycoplasma pneumoniae Legionella
Gram-negative BacteriaGram-negative Bacteria E coli (including ESBLs) Kl ebsiella pneumoniae (including ESBLs) K oxytoca Acinetobacter baumannii (Resistant strains)Resistant strains) Citrobacter freundii Enterobacter cloacae Enterobacter aerogenes Stenotrophomonas
maltophilia
Does not have good activity Does not have good activity againstagainst P aeruginosa Proteus Providencia
Colistimethate sodium Colistimethate sodium Pseudomonas
aeruginosa infections in cystic fibrosis multidrug-resistant Acinetobacter infection
E-coli Klebsiella sp ( ESBL) Enterobacter Colomycin 1000000 units = 80 mg
colistimethate 6 to 12 mgkg colistimethate sodium per
day 60 kg man recommended dose for
Colomycin is 240 to 480 mg of colistimethate sodium
Nephrotoxicity (damage to the kidneys) and neurotoxicity
抗生素使用常見的五大錯誤
Antibiotic = scanol (antipyretic) S vs R (susceptible vs resistant) 4 gt 3 gt2 gt 1 Treat colonization Vancomycin+ imipenem(atomic
bomb)
Colonization
Positive culture for sputum urine bile stool and skin swab without symptoms or signs of infection Not recommend for using antibiotics
Except asymptomatic bacteriuria before urological work up and in pregnancy should be treated
抗生素使用的適應症
明顯的細菌感染 極可能的細菌感染 敗血症 白血球過低合併發燒 懷疑急性心內膜炎 細菌性腦膜炎 壞死性筋膜炎
常見感染症之抗生素療程 ( 一 )
感染症療程 ( 天 )
菌血症 敗血症 14
肝膿瘍 21
軟組織感染 7-10
急性腎炎 14
細菌性腦膜炎 10
常見感染症之抗生素療程 ( 二 )感染症療程 ( 天 )
1048729
肺炎雙球菌肺炎 14 ()
革蘭氏陰性桿菌肺炎1048729
21 ()
退伍軍人協會症1048729
21
奴卡氏菌肺炎1048729
180-360
感染性心內膜炎 28-42
抗生素治療失敗之原因
選用藥物不恰當 藥物交互作用 降低療效 異異物阻塞或膿瘍未引流 病人免疫力太差 分離菌之判讀錯誤 新的院內感染
Antibiotics
Penicillins Beta-lactmase
inhibitors Cephalosporins Carbapenems Monobactams Sulfonamides amp
trimethoprim
Aminoglycosides Quinolones Tetracycline Metronidazole Macrolides Tigecycline Glycopeptide Colistimethate
sodium
Penicillins
Natural PCNsPenicillin G Penicillin V benzathine
PCN Penicillinase-resistant PCNs
Oxacillin Prostaphylin Amionopenicillins
Amoxicillin Ampicillin Anti-pseudomonal PCNs
Ticarcillin Piperacillin
Antimicrobial spectrum of Penicillin-G Streptococcus spp Anaerobes Neisseria spp (Meningococcus
Gonococcus) Actinomycosis Animal bite (Pasteurella multocida) 螺旋體 Syphilis Leptospirosis
Penicillinase-resistant Penicillins oxacillin Penicillinase (β-lactamase) inhibitor Anti-staphylococcal penicillins Less active than penicillin-G against
all other penicillin-susceptible microorganisms
Adverse effects-PCNs
Anaphylaxis anemia leukopenia Oxacillin hepatitis Ticarcillin coagulation abnormality
bleeding
Beta-lactambeta-lactamatase inhibitor
Sulbactam Ampicillin + Sulbactam
Clavulanic acid Amoxycillin + ClavulanateTicarcillin + Clavulanate
Tazobactam Piperacillin + Tazobactam
Antipseudomonal Penicillins Piptazo Ticarcillin + Clavulanate Pseudomonas species Many strains of Enterobacter Anaerobics except β-lactamase
producing Bacteroides species Less active against gram positive
isolates
Adverse effects of penicillin Anaphylaxis anemia leukopenia Oxacillin hepatitis Ticarcillin coagulation abnormality
bleeding
Sulbactam (Maxtam)
Sulbactam is an irreversible inhibitor of beta-lactamase
Combinations of sulbactam with beta-lactam antibiotics
Dose 05 ~ 10 gm 6 ~ 8 with other antibiotics not
gt 40 gmday Cefoperazonesulbactam Ampicillinsulbactam
Cephalosporins
First generation Second generation Third generation Fourth generation
Cephalosporins
Against GPC 1st gt 2nd gt cephamycins gt 3rd Against GNB 1st lt 2nd lt cephamycins lt 3rd
First Generation
Cefazolin Cefadroxil Ceflexin Cephradine
StreptococcusStaphylococcus (methicillin-susceptible)E coliP mirabilisK pneumoniae
Second Generation
Cefmetazole Cefuroxime
Cefalor Cefuroxime
above the diaphragm cefuroximebelow the diaphragm cefmetazole (cephamycins B fragilis) Cefmatazole ESBL-producing Enterobacteriaceae
Third generation
Cefoperazone Cefotaxime Ceftazidime Ceftriaxone Flumarin
Cefixime Cefpodoxime ceftibuten
Resistant Gram-negative microorganisms ( Nosocomial infections ) Serratia Citrobacter Enterobacter Pseudomonas β-lactamase producing H influenzaeBetter BBB penetration among cephalosporins (except cefoperazone)Indication nosocomial infections (mainly GNB) GNB meningitis
Fourth Generation
Cefepime Cefpirome
Good anti-pseudomonal effectGood CNS penetrationPreserve antimicrobial effect to G(+) bacteria
Adverse effects of cephalosporins
Cefamandole cefmetazole cefoperazone cefotetan vitamin K-dependent clotting factor metabolism
Monobactam Monobactam (Aztreonam(Aztreonam)) Only gram-negative aerobes Alternative in penicillin- and
cephalosporin- allergic patients
Sulfonamides and trimethoprim Inhibit folic acid metabolism Treatment of PCP Nocardia
Toxaplasma Sternotrophomonus Aderverse effect cholestatic jaudice
bone marrow suppression severe hypersensitivity (Stevens-Johnson syndrome)
CarbapenemGroup Classification
Group 1 Broad-spectrum carbapenems with limited activity against non-fermentative Gram-negative bacilli (NFGNB eg Pseudomonas Acinetobacter) that are particularly suitable for community-acquired infections (eg ertapenem)
Group 2 Broad-spectrum carbapenems with activity against non-
fermentative Gram-negative bacilli (eg Pseudomonas
Acinetobacter) that are particularly suitable for nosocomial infections (eg imipenem and meropenem)
Group3 Carbapenems with clinical activity against Methicillin-
Resistant Staphylococcus (eg In development)
J Antimicrob Chemotherapy
Side effect of Carbapenems Anaphylaxis Interstitial nephritis Anemia Leukopenia Precipitate seizure activity
especially old patients CRI preexisting seizure disorder or CNS pathology
AminoglycosidesAminoglycosides
Antimicrobial Spectrum Antimicrobial Spectrum - All Gram negative bacilli
- Staphylococcus aureus Dosage Dosage - Gentamicin loading ~ 2 mgkg maintenance ~ 3-5 mgkgday Amikacin loading ~ 75 mgkg maintenance ~ 5 mgkg Q8H or 75
mgkg q12H Exacin 8mgskgday Single daily (once-daily) dosing (SDD) Short course (3-5 days)
Adverse effects of Adverse effects of aminoglycosidesaminoglycosides Nephrotoxicity Ototoxicity Neuromuscular paralysis ~ High doseinfrequent administration
DECREASES the rate of tissue uptake mdash DELAY the onset
of toxicity doesnrsquot prevent it from happening ~ All patients if treated for a long enough time
will eventually develop toxicity
Fluoroquinolones
Group I
- Nalidixic acid
- Enteric or urinary tract infections Group II
- Ciprofloxacin Ofloxacin Levofloxacin
- GNR (P aeruginosa) S pneumoniae atypicals Group III
- Moxifloxacin Gemifloxacin
- GPB ( S pneumoniaeuarr) atypicals anaerobes GNR
(P aeruginosadarr)
- Respiratory tract infections
GlycopeptidesGlycopeptides
Vancomycin amp Teicoplanin
Non-β-lactam cell wall synthesis inhibitor
Spectrum GPC amp GPB
Avoid oral use except AAC (antibiotic-associated colitis)
Tetracyclines
STD
- Chlamydial
diseases
- Gonorrhea
(doxycycline +
ceftriaxone)
- Syphilis
Rickettsial diseases
Brucellosis
Tularemia
Relapsing fever
Tigecycline (a new class Glycylcyclines)Gram-positive BacteriaGram-positive Bacteria Staphylococcus MRSA
MRSE VRE E faecium E faecalis Streptococcus agalactiae S treptococcus anginosus
group Streptococcus pyogenes
AnaerobesAnaerobes B fragilis group Prevotella spp Peptostreptococcus spp C perfringensAtypicalAtypical Chlamydia pneumoniae Mycoplasma pneumoniae Legionella
Gram-negative BacteriaGram-negative Bacteria E coli (including ESBLs) Kl ebsiella pneumoniae (including ESBLs) K oxytoca Acinetobacter baumannii (Resistant strains)Resistant strains) Citrobacter freundii Enterobacter cloacae Enterobacter aerogenes Stenotrophomonas
maltophilia
Does not have good activity Does not have good activity againstagainst P aeruginosa Proteus Providencia
Colistimethate sodium Colistimethate sodium Pseudomonas
aeruginosa infections in cystic fibrosis multidrug-resistant Acinetobacter infection
E-coli Klebsiella sp ( ESBL) Enterobacter Colomycin 1000000 units = 80 mg
colistimethate 6 to 12 mgkg colistimethate sodium per
day 60 kg man recommended dose for
Colomycin is 240 to 480 mg of colistimethate sodium
Nephrotoxicity (damage to the kidneys) and neurotoxicity
抗生素使用常見的五大錯誤
Antibiotic = scanol (antipyretic) S vs R (susceptible vs resistant) 4 gt 3 gt2 gt 1 Treat colonization Vancomycin+ imipenem(atomic
bomb)
Colonization
Positive culture for sputum urine bile stool and skin swab without symptoms or signs of infection Not recommend for using antibiotics
Except asymptomatic bacteriuria before urological work up and in pregnancy should be treated
抗生素使用的適應症
明顯的細菌感染 極可能的細菌感染 敗血症 白血球過低合併發燒 懷疑急性心內膜炎 細菌性腦膜炎 壞死性筋膜炎
常見感染症之抗生素療程 ( 一 )
感染症療程 ( 天 )
菌血症 敗血症 14
肝膿瘍 21
軟組織感染 7-10
急性腎炎 14
細菌性腦膜炎 10
常見感染症之抗生素療程 ( 二 )感染症療程 ( 天 )
1048729
肺炎雙球菌肺炎 14 ()
革蘭氏陰性桿菌肺炎1048729
21 ()
退伍軍人協會症1048729
21
奴卡氏菌肺炎1048729
180-360
感染性心內膜炎 28-42
抗生素治療失敗之原因
選用藥物不恰當 藥物交互作用 降低療效 異異物阻塞或膿瘍未引流 病人免疫力太差 分離菌之判讀錯誤 新的院內感染
Penicillins
Natural PCNsPenicillin G Penicillin V benzathine
PCN Penicillinase-resistant PCNs
Oxacillin Prostaphylin Amionopenicillins
Amoxicillin Ampicillin Anti-pseudomonal PCNs
Ticarcillin Piperacillin
Antimicrobial spectrum of Penicillin-G Streptococcus spp Anaerobes Neisseria spp (Meningococcus
Gonococcus) Actinomycosis Animal bite (Pasteurella multocida) 螺旋體 Syphilis Leptospirosis
Penicillinase-resistant Penicillins oxacillin Penicillinase (β-lactamase) inhibitor Anti-staphylococcal penicillins Less active than penicillin-G against
all other penicillin-susceptible microorganisms
Adverse effects-PCNs
Anaphylaxis anemia leukopenia Oxacillin hepatitis Ticarcillin coagulation abnormality
bleeding
Beta-lactambeta-lactamatase inhibitor
Sulbactam Ampicillin + Sulbactam
Clavulanic acid Amoxycillin + ClavulanateTicarcillin + Clavulanate
Tazobactam Piperacillin + Tazobactam
Antipseudomonal Penicillins Piptazo Ticarcillin + Clavulanate Pseudomonas species Many strains of Enterobacter Anaerobics except β-lactamase
producing Bacteroides species Less active against gram positive
isolates
Adverse effects of penicillin Anaphylaxis anemia leukopenia Oxacillin hepatitis Ticarcillin coagulation abnormality
bleeding
Sulbactam (Maxtam)
Sulbactam is an irreversible inhibitor of beta-lactamase
Combinations of sulbactam with beta-lactam antibiotics
Dose 05 ~ 10 gm 6 ~ 8 with other antibiotics not
gt 40 gmday Cefoperazonesulbactam Ampicillinsulbactam
Cephalosporins
First generation Second generation Third generation Fourth generation
Cephalosporins
Against GPC 1st gt 2nd gt cephamycins gt 3rd Against GNB 1st lt 2nd lt cephamycins lt 3rd
First Generation
Cefazolin Cefadroxil Ceflexin Cephradine
StreptococcusStaphylococcus (methicillin-susceptible)E coliP mirabilisK pneumoniae
Second Generation
Cefmetazole Cefuroxime
Cefalor Cefuroxime
above the diaphragm cefuroximebelow the diaphragm cefmetazole (cephamycins B fragilis) Cefmatazole ESBL-producing Enterobacteriaceae
Third generation
Cefoperazone Cefotaxime Ceftazidime Ceftriaxone Flumarin
Cefixime Cefpodoxime ceftibuten
Resistant Gram-negative microorganisms ( Nosocomial infections ) Serratia Citrobacter Enterobacter Pseudomonas β-lactamase producing H influenzaeBetter BBB penetration among cephalosporins (except cefoperazone)Indication nosocomial infections (mainly GNB) GNB meningitis
Fourth Generation
Cefepime Cefpirome
Good anti-pseudomonal effectGood CNS penetrationPreserve antimicrobial effect to G(+) bacteria
Adverse effects of cephalosporins
Cefamandole cefmetazole cefoperazone cefotetan vitamin K-dependent clotting factor metabolism
Monobactam Monobactam (Aztreonam(Aztreonam)) Only gram-negative aerobes Alternative in penicillin- and
cephalosporin- allergic patients
Sulfonamides and trimethoprim Inhibit folic acid metabolism Treatment of PCP Nocardia
Toxaplasma Sternotrophomonus Aderverse effect cholestatic jaudice
bone marrow suppression severe hypersensitivity (Stevens-Johnson syndrome)
CarbapenemGroup Classification
Group 1 Broad-spectrum carbapenems with limited activity against non-fermentative Gram-negative bacilli (NFGNB eg Pseudomonas Acinetobacter) that are particularly suitable for community-acquired infections (eg ertapenem)
Group 2 Broad-spectrum carbapenems with activity against non-
fermentative Gram-negative bacilli (eg Pseudomonas
Acinetobacter) that are particularly suitable for nosocomial infections (eg imipenem and meropenem)
Group3 Carbapenems with clinical activity against Methicillin-
Resistant Staphylococcus (eg In development)
J Antimicrob Chemotherapy
Side effect of Carbapenems Anaphylaxis Interstitial nephritis Anemia Leukopenia Precipitate seizure activity
especially old patients CRI preexisting seizure disorder or CNS pathology
AminoglycosidesAminoglycosides
Antimicrobial Spectrum Antimicrobial Spectrum - All Gram negative bacilli
- Staphylococcus aureus Dosage Dosage - Gentamicin loading ~ 2 mgkg maintenance ~ 3-5 mgkgday Amikacin loading ~ 75 mgkg maintenance ~ 5 mgkg Q8H or 75
mgkg q12H Exacin 8mgskgday Single daily (once-daily) dosing (SDD) Short course (3-5 days)
Adverse effects of Adverse effects of aminoglycosidesaminoglycosides Nephrotoxicity Ototoxicity Neuromuscular paralysis ~ High doseinfrequent administration
DECREASES the rate of tissue uptake mdash DELAY the onset
of toxicity doesnrsquot prevent it from happening ~ All patients if treated for a long enough time
will eventually develop toxicity
Fluoroquinolones
Group I
- Nalidixic acid
- Enteric or urinary tract infections Group II
- Ciprofloxacin Ofloxacin Levofloxacin
- GNR (P aeruginosa) S pneumoniae atypicals Group III
- Moxifloxacin Gemifloxacin
- GPB ( S pneumoniaeuarr) atypicals anaerobes GNR
(P aeruginosadarr)
- Respiratory tract infections
GlycopeptidesGlycopeptides
Vancomycin amp Teicoplanin
Non-β-lactam cell wall synthesis inhibitor
Spectrum GPC amp GPB
Avoid oral use except AAC (antibiotic-associated colitis)
Tetracyclines
STD
- Chlamydial
diseases
- Gonorrhea
(doxycycline +
ceftriaxone)
- Syphilis
Rickettsial diseases
Brucellosis
Tularemia
Relapsing fever
Tigecycline (a new class Glycylcyclines)Gram-positive BacteriaGram-positive Bacteria Staphylococcus MRSA
MRSE VRE E faecium E faecalis Streptococcus agalactiae S treptococcus anginosus
group Streptococcus pyogenes
AnaerobesAnaerobes B fragilis group Prevotella spp Peptostreptococcus spp C perfringensAtypicalAtypical Chlamydia pneumoniae Mycoplasma pneumoniae Legionella
Gram-negative BacteriaGram-negative Bacteria E coli (including ESBLs) Kl ebsiella pneumoniae (including ESBLs) K oxytoca Acinetobacter baumannii (Resistant strains)Resistant strains) Citrobacter freundii Enterobacter cloacae Enterobacter aerogenes Stenotrophomonas
maltophilia
Does not have good activity Does not have good activity againstagainst P aeruginosa Proteus Providencia
Colistimethate sodium Colistimethate sodium Pseudomonas
aeruginosa infections in cystic fibrosis multidrug-resistant Acinetobacter infection
E-coli Klebsiella sp ( ESBL) Enterobacter Colomycin 1000000 units = 80 mg
colistimethate 6 to 12 mgkg colistimethate sodium per
day 60 kg man recommended dose for
Colomycin is 240 to 480 mg of colistimethate sodium
Nephrotoxicity (damage to the kidneys) and neurotoxicity
抗生素使用常見的五大錯誤
Antibiotic = scanol (antipyretic) S vs R (susceptible vs resistant) 4 gt 3 gt2 gt 1 Treat colonization Vancomycin+ imipenem(atomic
bomb)
Colonization
Positive culture for sputum urine bile stool and skin swab without symptoms or signs of infection Not recommend for using antibiotics
Except asymptomatic bacteriuria before urological work up and in pregnancy should be treated
抗生素使用的適應症
明顯的細菌感染 極可能的細菌感染 敗血症 白血球過低合併發燒 懷疑急性心內膜炎 細菌性腦膜炎 壞死性筋膜炎
常見感染症之抗生素療程 ( 一 )
感染症療程 ( 天 )
菌血症 敗血症 14
肝膿瘍 21
軟組織感染 7-10
急性腎炎 14
細菌性腦膜炎 10
常見感染症之抗生素療程 ( 二 )感染症療程 ( 天 )
1048729
肺炎雙球菌肺炎 14 ()
革蘭氏陰性桿菌肺炎1048729
21 ()
退伍軍人協會症1048729
21
奴卡氏菌肺炎1048729
180-360
感染性心內膜炎 28-42
抗生素治療失敗之原因
選用藥物不恰當 藥物交互作用 降低療效 異異物阻塞或膿瘍未引流 病人免疫力太差 分離菌之判讀錯誤 新的院內感染
Antimicrobial spectrum of Penicillin-G Streptococcus spp Anaerobes Neisseria spp (Meningococcus
Gonococcus) Actinomycosis Animal bite (Pasteurella multocida) 螺旋體 Syphilis Leptospirosis
Penicillinase-resistant Penicillins oxacillin Penicillinase (β-lactamase) inhibitor Anti-staphylococcal penicillins Less active than penicillin-G against
all other penicillin-susceptible microorganisms
Adverse effects-PCNs
Anaphylaxis anemia leukopenia Oxacillin hepatitis Ticarcillin coagulation abnormality
bleeding
Beta-lactambeta-lactamatase inhibitor
Sulbactam Ampicillin + Sulbactam
Clavulanic acid Amoxycillin + ClavulanateTicarcillin + Clavulanate
Tazobactam Piperacillin + Tazobactam
Antipseudomonal Penicillins Piptazo Ticarcillin + Clavulanate Pseudomonas species Many strains of Enterobacter Anaerobics except β-lactamase
producing Bacteroides species Less active against gram positive
isolates
Adverse effects of penicillin Anaphylaxis anemia leukopenia Oxacillin hepatitis Ticarcillin coagulation abnormality
bleeding
Sulbactam (Maxtam)
Sulbactam is an irreversible inhibitor of beta-lactamase
Combinations of sulbactam with beta-lactam antibiotics
Dose 05 ~ 10 gm 6 ~ 8 with other antibiotics not
gt 40 gmday Cefoperazonesulbactam Ampicillinsulbactam
Cephalosporins
First generation Second generation Third generation Fourth generation
Cephalosporins
Against GPC 1st gt 2nd gt cephamycins gt 3rd Against GNB 1st lt 2nd lt cephamycins lt 3rd
First Generation
Cefazolin Cefadroxil Ceflexin Cephradine
StreptococcusStaphylococcus (methicillin-susceptible)E coliP mirabilisK pneumoniae
Second Generation
Cefmetazole Cefuroxime
Cefalor Cefuroxime
above the diaphragm cefuroximebelow the diaphragm cefmetazole (cephamycins B fragilis) Cefmatazole ESBL-producing Enterobacteriaceae
Third generation
Cefoperazone Cefotaxime Ceftazidime Ceftriaxone Flumarin
Cefixime Cefpodoxime ceftibuten
Resistant Gram-negative microorganisms ( Nosocomial infections ) Serratia Citrobacter Enterobacter Pseudomonas β-lactamase producing H influenzaeBetter BBB penetration among cephalosporins (except cefoperazone)Indication nosocomial infections (mainly GNB) GNB meningitis
Fourth Generation
Cefepime Cefpirome
Good anti-pseudomonal effectGood CNS penetrationPreserve antimicrobial effect to G(+) bacteria
Adverse effects of cephalosporins
Cefamandole cefmetazole cefoperazone cefotetan vitamin K-dependent clotting factor metabolism
Monobactam Monobactam (Aztreonam(Aztreonam)) Only gram-negative aerobes Alternative in penicillin- and
cephalosporin- allergic patients
Sulfonamides and trimethoprim Inhibit folic acid metabolism Treatment of PCP Nocardia
Toxaplasma Sternotrophomonus Aderverse effect cholestatic jaudice
bone marrow suppression severe hypersensitivity (Stevens-Johnson syndrome)
CarbapenemGroup Classification
Group 1 Broad-spectrum carbapenems with limited activity against non-fermentative Gram-negative bacilli (NFGNB eg Pseudomonas Acinetobacter) that are particularly suitable for community-acquired infections (eg ertapenem)
Group 2 Broad-spectrum carbapenems with activity against non-
fermentative Gram-negative bacilli (eg Pseudomonas
Acinetobacter) that are particularly suitable for nosocomial infections (eg imipenem and meropenem)
Group3 Carbapenems with clinical activity against Methicillin-
Resistant Staphylococcus (eg In development)
J Antimicrob Chemotherapy
Side effect of Carbapenems Anaphylaxis Interstitial nephritis Anemia Leukopenia Precipitate seizure activity
especially old patients CRI preexisting seizure disorder or CNS pathology
AminoglycosidesAminoglycosides
Antimicrobial Spectrum Antimicrobial Spectrum - All Gram negative bacilli
- Staphylococcus aureus Dosage Dosage - Gentamicin loading ~ 2 mgkg maintenance ~ 3-5 mgkgday Amikacin loading ~ 75 mgkg maintenance ~ 5 mgkg Q8H or 75
mgkg q12H Exacin 8mgskgday Single daily (once-daily) dosing (SDD) Short course (3-5 days)
Adverse effects of Adverse effects of aminoglycosidesaminoglycosides Nephrotoxicity Ototoxicity Neuromuscular paralysis ~ High doseinfrequent administration
DECREASES the rate of tissue uptake mdash DELAY the onset
of toxicity doesnrsquot prevent it from happening ~ All patients if treated for a long enough time
will eventually develop toxicity
Fluoroquinolones
Group I
- Nalidixic acid
- Enteric or urinary tract infections Group II
- Ciprofloxacin Ofloxacin Levofloxacin
- GNR (P aeruginosa) S pneumoniae atypicals Group III
- Moxifloxacin Gemifloxacin
- GPB ( S pneumoniaeuarr) atypicals anaerobes GNR
(P aeruginosadarr)
- Respiratory tract infections
GlycopeptidesGlycopeptides
Vancomycin amp Teicoplanin
Non-β-lactam cell wall synthesis inhibitor
Spectrum GPC amp GPB
Avoid oral use except AAC (antibiotic-associated colitis)
Tetracyclines
STD
- Chlamydial
diseases
- Gonorrhea
(doxycycline +
ceftriaxone)
- Syphilis
Rickettsial diseases
Brucellosis
Tularemia
Relapsing fever
Tigecycline (a new class Glycylcyclines)Gram-positive BacteriaGram-positive Bacteria Staphylococcus MRSA
MRSE VRE E faecium E faecalis Streptococcus agalactiae S treptococcus anginosus
group Streptococcus pyogenes
AnaerobesAnaerobes B fragilis group Prevotella spp Peptostreptococcus spp C perfringensAtypicalAtypical Chlamydia pneumoniae Mycoplasma pneumoniae Legionella
Gram-negative BacteriaGram-negative Bacteria E coli (including ESBLs) Kl ebsiella pneumoniae (including ESBLs) K oxytoca Acinetobacter baumannii (Resistant strains)Resistant strains) Citrobacter freundii Enterobacter cloacae Enterobacter aerogenes Stenotrophomonas
maltophilia
Does not have good activity Does not have good activity againstagainst P aeruginosa Proteus Providencia
Colistimethate sodium Colistimethate sodium Pseudomonas
aeruginosa infections in cystic fibrosis multidrug-resistant Acinetobacter infection
E-coli Klebsiella sp ( ESBL) Enterobacter Colomycin 1000000 units = 80 mg
colistimethate 6 to 12 mgkg colistimethate sodium per
day 60 kg man recommended dose for
Colomycin is 240 to 480 mg of colistimethate sodium
Nephrotoxicity (damage to the kidneys) and neurotoxicity
抗生素使用常見的五大錯誤
Antibiotic = scanol (antipyretic) S vs R (susceptible vs resistant) 4 gt 3 gt2 gt 1 Treat colonization Vancomycin+ imipenem(atomic
bomb)
Colonization
Positive culture for sputum urine bile stool and skin swab without symptoms or signs of infection Not recommend for using antibiotics
Except asymptomatic bacteriuria before urological work up and in pregnancy should be treated
抗生素使用的適應症
明顯的細菌感染 極可能的細菌感染 敗血症 白血球過低合併發燒 懷疑急性心內膜炎 細菌性腦膜炎 壞死性筋膜炎
常見感染症之抗生素療程 ( 一 )
感染症療程 ( 天 )
菌血症 敗血症 14
肝膿瘍 21
軟組織感染 7-10
急性腎炎 14
細菌性腦膜炎 10
常見感染症之抗生素療程 ( 二 )感染症療程 ( 天 )
1048729
肺炎雙球菌肺炎 14 ()
革蘭氏陰性桿菌肺炎1048729
21 ()
退伍軍人協會症1048729
21
奴卡氏菌肺炎1048729
180-360
感染性心內膜炎 28-42
抗生素治療失敗之原因
選用藥物不恰當 藥物交互作用 降低療效 異異物阻塞或膿瘍未引流 病人免疫力太差 分離菌之判讀錯誤 新的院內感染
Penicillinase-resistant Penicillins oxacillin Penicillinase (β-lactamase) inhibitor Anti-staphylococcal penicillins Less active than penicillin-G against
all other penicillin-susceptible microorganisms
Adverse effects-PCNs
Anaphylaxis anemia leukopenia Oxacillin hepatitis Ticarcillin coagulation abnormality
bleeding
Beta-lactambeta-lactamatase inhibitor
Sulbactam Ampicillin + Sulbactam
Clavulanic acid Amoxycillin + ClavulanateTicarcillin + Clavulanate
Tazobactam Piperacillin + Tazobactam
Antipseudomonal Penicillins Piptazo Ticarcillin + Clavulanate Pseudomonas species Many strains of Enterobacter Anaerobics except β-lactamase
producing Bacteroides species Less active against gram positive
isolates
Adverse effects of penicillin Anaphylaxis anemia leukopenia Oxacillin hepatitis Ticarcillin coagulation abnormality
bleeding
Sulbactam (Maxtam)
Sulbactam is an irreversible inhibitor of beta-lactamase
Combinations of sulbactam with beta-lactam antibiotics
Dose 05 ~ 10 gm 6 ~ 8 with other antibiotics not
gt 40 gmday Cefoperazonesulbactam Ampicillinsulbactam
Cephalosporins
First generation Second generation Third generation Fourth generation
Cephalosporins
Against GPC 1st gt 2nd gt cephamycins gt 3rd Against GNB 1st lt 2nd lt cephamycins lt 3rd
First Generation
Cefazolin Cefadroxil Ceflexin Cephradine
StreptococcusStaphylococcus (methicillin-susceptible)E coliP mirabilisK pneumoniae
Second Generation
Cefmetazole Cefuroxime
Cefalor Cefuroxime
above the diaphragm cefuroximebelow the diaphragm cefmetazole (cephamycins B fragilis) Cefmatazole ESBL-producing Enterobacteriaceae
Third generation
Cefoperazone Cefotaxime Ceftazidime Ceftriaxone Flumarin
Cefixime Cefpodoxime ceftibuten
Resistant Gram-negative microorganisms ( Nosocomial infections ) Serratia Citrobacter Enterobacter Pseudomonas β-lactamase producing H influenzaeBetter BBB penetration among cephalosporins (except cefoperazone)Indication nosocomial infections (mainly GNB) GNB meningitis
Fourth Generation
Cefepime Cefpirome
Good anti-pseudomonal effectGood CNS penetrationPreserve antimicrobial effect to G(+) bacteria
Adverse effects of cephalosporins
Cefamandole cefmetazole cefoperazone cefotetan vitamin K-dependent clotting factor metabolism
Monobactam Monobactam (Aztreonam(Aztreonam)) Only gram-negative aerobes Alternative in penicillin- and
cephalosporin- allergic patients
Sulfonamides and trimethoprim Inhibit folic acid metabolism Treatment of PCP Nocardia
Toxaplasma Sternotrophomonus Aderverse effect cholestatic jaudice
bone marrow suppression severe hypersensitivity (Stevens-Johnson syndrome)
CarbapenemGroup Classification
Group 1 Broad-spectrum carbapenems with limited activity against non-fermentative Gram-negative bacilli (NFGNB eg Pseudomonas Acinetobacter) that are particularly suitable for community-acquired infections (eg ertapenem)
Group 2 Broad-spectrum carbapenems with activity against non-
fermentative Gram-negative bacilli (eg Pseudomonas
Acinetobacter) that are particularly suitable for nosocomial infections (eg imipenem and meropenem)
Group3 Carbapenems with clinical activity against Methicillin-
Resistant Staphylococcus (eg In development)
J Antimicrob Chemotherapy
Side effect of Carbapenems Anaphylaxis Interstitial nephritis Anemia Leukopenia Precipitate seizure activity
especially old patients CRI preexisting seizure disorder or CNS pathology
AminoglycosidesAminoglycosides
Antimicrobial Spectrum Antimicrobial Spectrum - All Gram negative bacilli
- Staphylococcus aureus Dosage Dosage - Gentamicin loading ~ 2 mgkg maintenance ~ 3-5 mgkgday Amikacin loading ~ 75 mgkg maintenance ~ 5 mgkg Q8H or 75
mgkg q12H Exacin 8mgskgday Single daily (once-daily) dosing (SDD) Short course (3-5 days)
Adverse effects of Adverse effects of aminoglycosidesaminoglycosides Nephrotoxicity Ototoxicity Neuromuscular paralysis ~ High doseinfrequent administration
DECREASES the rate of tissue uptake mdash DELAY the onset
of toxicity doesnrsquot prevent it from happening ~ All patients if treated for a long enough time
will eventually develop toxicity
Fluoroquinolones
Group I
- Nalidixic acid
- Enteric or urinary tract infections Group II
- Ciprofloxacin Ofloxacin Levofloxacin
- GNR (P aeruginosa) S pneumoniae atypicals Group III
- Moxifloxacin Gemifloxacin
- GPB ( S pneumoniaeuarr) atypicals anaerobes GNR
(P aeruginosadarr)
- Respiratory tract infections
GlycopeptidesGlycopeptides
Vancomycin amp Teicoplanin
Non-β-lactam cell wall synthesis inhibitor
Spectrum GPC amp GPB
Avoid oral use except AAC (antibiotic-associated colitis)
Tetracyclines
STD
- Chlamydial
diseases
- Gonorrhea
(doxycycline +
ceftriaxone)
- Syphilis
Rickettsial diseases
Brucellosis
Tularemia
Relapsing fever
Tigecycline (a new class Glycylcyclines)Gram-positive BacteriaGram-positive Bacteria Staphylococcus MRSA
MRSE VRE E faecium E faecalis Streptococcus agalactiae S treptococcus anginosus
group Streptococcus pyogenes
AnaerobesAnaerobes B fragilis group Prevotella spp Peptostreptococcus spp C perfringensAtypicalAtypical Chlamydia pneumoniae Mycoplasma pneumoniae Legionella
Gram-negative BacteriaGram-negative Bacteria E coli (including ESBLs) Kl ebsiella pneumoniae (including ESBLs) K oxytoca Acinetobacter baumannii (Resistant strains)Resistant strains) Citrobacter freundii Enterobacter cloacae Enterobacter aerogenes Stenotrophomonas
maltophilia
Does not have good activity Does not have good activity againstagainst P aeruginosa Proteus Providencia
Colistimethate sodium Colistimethate sodium Pseudomonas
aeruginosa infections in cystic fibrosis multidrug-resistant Acinetobacter infection
E-coli Klebsiella sp ( ESBL) Enterobacter Colomycin 1000000 units = 80 mg
colistimethate 6 to 12 mgkg colistimethate sodium per
day 60 kg man recommended dose for
Colomycin is 240 to 480 mg of colistimethate sodium
Nephrotoxicity (damage to the kidneys) and neurotoxicity
抗生素使用常見的五大錯誤
Antibiotic = scanol (antipyretic) S vs R (susceptible vs resistant) 4 gt 3 gt2 gt 1 Treat colonization Vancomycin+ imipenem(atomic
bomb)
Colonization
Positive culture for sputum urine bile stool and skin swab without symptoms or signs of infection Not recommend for using antibiotics
Except asymptomatic bacteriuria before urological work up and in pregnancy should be treated
抗生素使用的適應症
明顯的細菌感染 極可能的細菌感染 敗血症 白血球過低合併發燒 懷疑急性心內膜炎 細菌性腦膜炎 壞死性筋膜炎
常見感染症之抗生素療程 ( 一 )
感染症療程 ( 天 )
菌血症 敗血症 14
肝膿瘍 21
軟組織感染 7-10
急性腎炎 14
細菌性腦膜炎 10
常見感染症之抗生素療程 ( 二 )感染症療程 ( 天 )
1048729
肺炎雙球菌肺炎 14 ()
革蘭氏陰性桿菌肺炎1048729
21 ()
退伍軍人協會症1048729
21
奴卡氏菌肺炎1048729
180-360
感染性心內膜炎 28-42
抗生素治療失敗之原因
選用藥物不恰當 藥物交互作用 降低療效 異異物阻塞或膿瘍未引流 病人免疫力太差 分離菌之判讀錯誤 新的院內感染
Adverse effects-PCNs
Anaphylaxis anemia leukopenia Oxacillin hepatitis Ticarcillin coagulation abnormality
bleeding
Beta-lactambeta-lactamatase inhibitor
Sulbactam Ampicillin + Sulbactam
Clavulanic acid Amoxycillin + ClavulanateTicarcillin + Clavulanate
Tazobactam Piperacillin + Tazobactam
Antipseudomonal Penicillins Piptazo Ticarcillin + Clavulanate Pseudomonas species Many strains of Enterobacter Anaerobics except β-lactamase
producing Bacteroides species Less active against gram positive
isolates
Adverse effects of penicillin Anaphylaxis anemia leukopenia Oxacillin hepatitis Ticarcillin coagulation abnormality
bleeding
Sulbactam (Maxtam)
Sulbactam is an irreversible inhibitor of beta-lactamase
Combinations of sulbactam with beta-lactam antibiotics
Dose 05 ~ 10 gm 6 ~ 8 with other antibiotics not
gt 40 gmday Cefoperazonesulbactam Ampicillinsulbactam
Cephalosporins
First generation Second generation Third generation Fourth generation
Cephalosporins
Against GPC 1st gt 2nd gt cephamycins gt 3rd Against GNB 1st lt 2nd lt cephamycins lt 3rd
First Generation
Cefazolin Cefadroxil Ceflexin Cephradine
StreptococcusStaphylococcus (methicillin-susceptible)E coliP mirabilisK pneumoniae
Second Generation
Cefmetazole Cefuroxime
Cefalor Cefuroxime
above the diaphragm cefuroximebelow the diaphragm cefmetazole (cephamycins B fragilis) Cefmatazole ESBL-producing Enterobacteriaceae
Third generation
Cefoperazone Cefotaxime Ceftazidime Ceftriaxone Flumarin
Cefixime Cefpodoxime ceftibuten
Resistant Gram-negative microorganisms ( Nosocomial infections ) Serratia Citrobacter Enterobacter Pseudomonas β-lactamase producing H influenzaeBetter BBB penetration among cephalosporins (except cefoperazone)Indication nosocomial infections (mainly GNB) GNB meningitis
Fourth Generation
Cefepime Cefpirome
Good anti-pseudomonal effectGood CNS penetrationPreserve antimicrobial effect to G(+) bacteria
Adverse effects of cephalosporins
Cefamandole cefmetazole cefoperazone cefotetan vitamin K-dependent clotting factor metabolism
Monobactam Monobactam (Aztreonam(Aztreonam)) Only gram-negative aerobes Alternative in penicillin- and
cephalosporin- allergic patients
Sulfonamides and trimethoprim Inhibit folic acid metabolism Treatment of PCP Nocardia
Toxaplasma Sternotrophomonus Aderverse effect cholestatic jaudice
bone marrow suppression severe hypersensitivity (Stevens-Johnson syndrome)
CarbapenemGroup Classification
Group 1 Broad-spectrum carbapenems with limited activity against non-fermentative Gram-negative bacilli (NFGNB eg Pseudomonas Acinetobacter) that are particularly suitable for community-acquired infections (eg ertapenem)
Group 2 Broad-spectrum carbapenems with activity against non-
fermentative Gram-negative bacilli (eg Pseudomonas
Acinetobacter) that are particularly suitable for nosocomial infections (eg imipenem and meropenem)
Group3 Carbapenems with clinical activity against Methicillin-
Resistant Staphylococcus (eg In development)
J Antimicrob Chemotherapy
Side effect of Carbapenems Anaphylaxis Interstitial nephritis Anemia Leukopenia Precipitate seizure activity
especially old patients CRI preexisting seizure disorder or CNS pathology
AminoglycosidesAminoglycosides
Antimicrobial Spectrum Antimicrobial Spectrum - All Gram negative bacilli
- Staphylococcus aureus Dosage Dosage - Gentamicin loading ~ 2 mgkg maintenance ~ 3-5 mgkgday Amikacin loading ~ 75 mgkg maintenance ~ 5 mgkg Q8H or 75
mgkg q12H Exacin 8mgskgday Single daily (once-daily) dosing (SDD) Short course (3-5 days)
Adverse effects of Adverse effects of aminoglycosidesaminoglycosides Nephrotoxicity Ototoxicity Neuromuscular paralysis ~ High doseinfrequent administration
DECREASES the rate of tissue uptake mdash DELAY the onset
of toxicity doesnrsquot prevent it from happening ~ All patients if treated for a long enough time
will eventually develop toxicity
Fluoroquinolones
Group I
- Nalidixic acid
- Enteric or urinary tract infections Group II
- Ciprofloxacin Ofloxacin Levofloxacin
- GNR (P aeruginosa) S pneumoniae atypicals Group III
- Moxifloxacin Gemifloxacin
- GPB ( S pneumoniaeuarr) atypicals anaerobes GNR
(P aeruginosadarr)
- Respiratory tract infections
GlycopeptidesGlycopeptides
Vancomycin amp Teicoplanin
Non-β-lactam cell wall synthesis inhibitor
Spectrum GPC amp GPB
Avoid oral use except AAC (antibiotic-associated colitis)
Tetracyclines
STD
- Chlamydial
diseases
- Gonorrhea
(doxycycline +
ceftriaxone)
- Syphilis
Rickettsial diseases
Brucellosis
Tularemia
Relapsing fever
Tigecycline (a new class Glycylcyclines)Gram-positive BacteriaGram-positive Bacteria Staphylococcus MRSA
MRSE VRE E faecium E faecalis Streptococcus agalactiae S treptococcus anginosus
group Streptococcus pyogenes
AnaerobesAnaerobes B fragilis group Prevotella spp Peptostreptococcus spp C perfringensAtypicalAtypical Chlamydia pneumoniae Mycoplasma pneumoniae Legionella
Gram-negative BacteriaGram-negative Bacteria E coli (including ESBLs) Kl ebsiella pneumoniae (including ESBLs) K oxytoca Acinetobacter baumannii (Resistant strains)Resistant strains) Citrobacter freundii Enterobacter cloacae Enterobacter aerogenes Stenotrophomonas
maltophilia
Does not have good activity Does not have good activity againstagainst P aeruginosa Proteus Providencia
Colistimethate sodium Colistimethate sodium Pseudomonas
aeruginosa infections in cystic fibrosis multidrug-resistant Acinetobacter infection
E-coli Klebsiella sp ( ESBL) Enterobacter Colomycin 1000000 units = 80 mg
colistimethate 6 to 12 mgkg colistimethate sodium per
day 60 kg man recommended dose for
Colomycin is 240 to 480 mg of colistimethate sodium
Nephrotoxicity (damage to the kidneys) and neurotoxicity
抗生素使用常見的五大錯誤
Antibiotic = scanol (antipyretic) S vs R (susceptible vs resistant) 4 gt 3 gt2 gt 1 Treat colonization Vancomycin+ imipenem(atomic
bomb)
Colonization
Positive culture for sputum urine bile stool and skin swab without symptoms or signs of infection Not recommend for using antibiotics
Except asymptomatic bacteriuria before urological work up and in pregnancy should be treated
抗生素使用的適應症
明顯的細菌感染 極可能的細菌感染 敗血症 白血球過低合併發燒 懷疑急性心內膜炎 細菌性腦膜炎 壞死性筋膜炎
常見感染症之抗生素療程 ( 一 )
感染症療程 ( 天 )
菌血症 敗血症 14
肝膿瘍 21
軟組織感染 7-10
急性腎炎 14
細菌性腦膜炎 10
常見感染症之抗生素療程 ( 二 )感染症療程 ( 天 )
1048729
肺炎雙球菌肺炎 14 ()
革蘭氏陰性桿菌肺炎1048729
21 ()
退伍軍人協會症1048729
21
奴卡氏菌肺炎1048729
180-360
感染性心內膜炎 28-42
抗生素治療失敗之原因
選用藥物不恰當 藥物交互作用 降低療效 異異物阻塞或膿瘍未引流 病人免疫力太差 分離菌之判讀錯誤 新的院內感染
Beta-lactambeta-lactamatase inhibitor
Sulbactam Ampicillin + Sulbactam
Clavulanic acid Amoxycillin + ClavulanateTicarcillin + Clavulanate
Tazobactam Piperacillin + Tazobactam
Antipseudomonal Penicillins Piptazo Ticarcillin + Clavulanate Pseudomonas species Many strains of Enterobacter Anaerobics except β-lactamase
producing Bacteroides species Less active against gram positive
isolates
Adverse effects of penicillin Anaphylaxis anemia leukopenia Oxacillin hepatitis Ticarcillin coagulation abnormality
bleeding
Sulbactam (Maxtam)
Sulbactam is an irreversible inhibitor of beta-lactamase
Combinations of sulbactam with beta-lactam antibiotics
Dose 05 ~ 10 gm 6 ~ 8 with other antibiotics not
gt 40 gmday Cefoperazonesulbactam Ampicillinsulbactam
Cephalosporins
First generation Second generation Third generation Fourth generation
Cephalosporins
Against GPC 1st gt 2nd gt cephamycins gt 3rd Against GNB 1st lt 2nd lt cephamycins lt 3rd
First Generation
Cefazolin Cefadroxil Ceflexin Cephradine
StreptococcusStaphylococcus (methicillin-susceptible)E coliP mirabilisK pneumoniae
Second Generation
Cefmetazole Cefuroxime
Cefalor Cefuroxime
above the diaphragm cefuroximebelow the diaphragm cefmetazole (cephamycins B fragilis) Cefmatazole ESBL-producing Enterobacteriaceae
Third generation
Cefoperazone Cefotaxime Ceftazidime Ceftriaxone Flumarin
Cefixime Cefpodoxime ceftibuten
Resistant Gram-negative microorganisms ( Nosocomial infections ) Serratia Citrobacter Enterobacter Pseudomonas β-lactamase producing H influenzaeBetter BBB penetration among cephalosporins (except cefoperazone)Indication nosocomial infections (mainly GNB) GNB meningitis
Fourth Generation
Cefepime Cefpirome
Good anti-pseudomonal effectGood CNS penetrationPreserve antimicrobial effect to G(+) bacteria
Adverse effects of cephalosporins
Cefamandole cefmetazole cefoperazone cefotetan vitamin K-dependent clotting factor metabolism
Monobactam Monobactam (Aztreonam(Aztreonam)) Only gram-negative aerobes Alternative in penicillin- and
cephalosporin- allergic patients
Sulfonamides and trimethoprim Inhibit folic acid metabolism Treatment of PCP Nocardia
Toxaplasma Sternotrophomonus Aderverse effect cholestatic jaudice
bone marrow suppression severe hypersensitivity (Stevens-Johnson syndrome)
CarbapenemGroup Classification
Group 1 Broad-spectrum carbapenems with limited activity against non-fermentative Gram-negative bacilli (NFGNB eg Pseudomonas Acinetobacter) that are particularly suitable for community-acquired infections (eg ertapenem)
Group 2 Broad-spectrum carbapenems with activity against non-
fermentative Gram-negative bacilli (eg Pseudomonas
Acinetobacter) that are particularly suitable for nosocomial infections (eg imipenem and meropenem)
Group3 Carbapenems with clinical activity against Methicillin-
Resistant Staphylococcus (eg In development)
J Antimicrob Chemotherapy
Side effect of Carbapenems Anaphylaxis Interstitial nephritis Anemia Leukopenia Precipitate seizure activity
especially old patients CRI preexisting seizure disorder or CNS pathology
AminoglycosidesAminoglycosides
Antimicrobial Spectrum Antimicrobial Spectrum - All Gram negative bacilli
- Staphylococcus aureus Dosage Dosage - Gentamicin loading ~ 2 mgkg maintenance ~ 3-5 mgkgday Amikacin loading ~ 75 mgkg maintenance ~ 5 mgkg Q8H or 75
mgkg q12H Exacin 8mgskgday Single daily (once-daily) dosing (SDD) Short course (3-5 days)
Adverse effects of Adverse effects of aminoglycosidesaminoglycosides Nephrotoxicity Ototoxicity Neuromuscular paralysis ~ High doseinfrequent administration
DECREASES the rate of tissue uptake mdash DELAY the onset
of toxicity doesnrsquot prevent it from happening ~ All patients if treated for a long enough time
will eventually develop toxicity
Fluoroquinolones
Group I
- Nalidixic acid
- Enteric or urinary tract infections Group II
- Ciprofloxacin Ofloxacin Levofloxacin
- GNR (P aeruginosa) S pneumoniae atypicals Group III
- Moxifloxacin Gemifloxacin
- GPB ( S pneumoniaeuarr) atypicals anaerobes GNR
(P aeruginosadarr)
- Respiratory tract infections
GlycopeptidesGlycopeptides
Vancomycin amp Teicoplanin
Non-β-lactam cell wall synthesis inhibitor
Spectrum GPC amp GPB
Avoid oral use except AAC (antibiotic-associated colitis)
Tetracyclines
STD
- Chlamydial
diseases
- Gonorrhea
(doxycycline +
ceftriaxone)
- Syphilis
Rickettsial diseases
Brucellosis
Tularemia
Relapsing fever
Tigecycline (a new class Glycylcyclines)Gram-positive BacteriaGram-positive Bacteria Staphylococcus MRSA
MRSE VRE E faecium E faecalis Streptococcus agalactiae S treptococcus anginosus
group Streptococcus pyogenes
AnaerobesAnaerobes B fragilis group Prevotella spp Peptostreptococcus spp C perfringensAtypicalAtypical Chlamydia pneumoniae Mycoplasma pneumoniae Legionella
Gram-negative BacteriaGram-negative Bacteria E coli (including ESBLs) Kl ebsiella pneumoniae (including ESBLs) K oxytoca Acinetobacter baumannii (Resistant strains)Resistant strains) Citrobacter freundii Enterobacter cloacae Enterobacter aerogenes Stenotrophomonas
maltophilia
Does not have good activity Does not have good activity againstagainst P aeruginosa Proteus Providencia
Colistimethate sodium Colistimethate sodium Pseudomonas
aeruginosa infections in cystic fibrosis multidrug-resistant Acinetobacter infection
E-coli Klebsiella sp ( ESBL) Enterobacter Colomycin 1000000 units = 80 mg
colistimethate 6 to 12 mgkg colistimethate sodium per
day 60 kg man recommended dose for
Colomycin is 240 to 480 mg of colistimethate sodium
Nephrotoxicity (damage to the kidneys) and neurotoxicity
抗生素使用常見的五大錯誤
Antibiotic = scanol (antipyretic) S vs R (susceptible vs resistant) 4 gt 3 gt2 gt 1 Treat colonization Vancomycin+ imipenem(atomic
bomb)
Colonization
Positive culture for sputum urine bile stool and skin swab without symptoms or signs of infection Not recommend for using antibiotics
Except asymptomatic bacteriuria before urological work up and in pregnancy should be treated
抗生素使用的適應症
明顯的細菌感染 極可能的細菌感染 敗血症 白血球過低合併發燒 懷疑急性心內膜炎 細菌性腦膜炎 壞死性筋膜炎
常見感染症之抗生素療程 ( 一 )
感染症療程 ( 天 )
菌血症 敗血症 14
肝膿瘍 21
軟組織感染 7-10
急性腎炎 14
細菌性腦膜炎 10
常見感染症之抗生素療程 ( 二 )感染症療程 ( 天 )
1048729
肺炎雙球菌肺炎 14 ()
革蘭氏陰性桿菌肺炎1048729
21 ()
退伍軍人協會症1048729
21
奴卡氏菌肺炎1048729
180-360
感染性心內膜炎 28-42
抗生素治療失敗之原因
選用藥物不恰當 藥物交互作用 降低療效 異異物阻塞或膿瘍未引流 病人免疫力太差 分離菌之判讀錯誤 新的院內感染
Antipseudomonal Penicillins Piptazo Ticarcillin + Clavulanate Pseudomonas species Many strains of Enterobacter Anaerobics except β-lactamase
producing Bacteroides species Less active against gram positive
isolates
Adverse effects of penicillin Anaphylaxis anemia leukopenia Oxacillin hepatitis Ticarcillin coagulation abnormality
bleeding
Sulbactam (Maxtam)
Sulbactam is an irreversible inhibitor of beta-lactamase
Combinations of sulbactam with beta-lactam antibiotics
Dose 05 ~ 10 gm 6 ~ 8 with other antibiotics not
gt 40 gmday Cefoperazonesulbactam Ampicillinsulbactam
Cephalosporins
First generation Second generation Third generation Fourth generation
Cephalosporins
Against GPC 1st gt 2nd gt cephamycins gt 3rd Against GNB 1st lt 2nd lt cephamycins lt 3rd
First Generation
Cefazolin Cefadroxil Ceflexin Cephradine
StreptococcusStaphylococcus (methicillin-susceptible)E coliP mirabilisK pneumoniae
Second Generation
Cefmetazole Cefuroxime
Cefalor Cefuroxime
above the diaphragm cefuroximebelow the diaphragm cefmetazole (cephamycins B fragilis) Cefmatazole ESBL-producing Enterobacteriaceae
Third generation
Cefoperazone Cefotaxime Ceftazidime Ceftriaxone Flumarin
Cefixime Cefpodoxime ceftibuten
Resistant Gram-negative microorganisms ( Nosocomial infections ) Serratia Citrobacter Enterobacter Pseudomonas β-lactamase producing H influenzaeBetter BBB penetration among cephalosporins (except cefoperazone)Indication nosocomial infections (mainly GNB) GNB meningitis
Fourth Generation
Cefepime Cefpirome
Good anti-pseudomonal effectGood CNS penetrationPreserve antimicrobial effect to G(+) bacteria
Adverse effects of cephalosporins
Cefamandole cefmetazole cefoperazone cefotetan vitamin K-dependent clotting factor metabolism
Monobactam Monobactam (Aztreonam(Aztreonam)) Only gram-negative aerobes Alternative in penicillin- and
cephalosporin- allergic patients
Sulfonamides and trimethoprim Inhibit folic acid metabolism Treatment of PCP Nocardia
Toxaplasma Sternotrophomonus Aderverse effect cholestatic jaudice
bone marrow suppression severe hypersensitivity (Stevens-Johnson syndrome)
CarbapenemGroup Classification
Group 1 Broad-spectrum carbapenems with limited activity against non-fermentative Gram-negative bacilli (NFGNB eg Pseudomonas Acinetobacter) that are particularly suitable for community-acquired infections (eg ertapenem)
Group 2 Broad-spectrum carbapenems with activity against non-
fermentative Gram-negative bacilli (eg Pseudomonas
Acinetobacter) that are particularly suitable for nosocomial infections (eg imipenem and meropenem)
Group3 Carbapenems with clinical activity against Methicillin-
Resistant Staphylococcus (eg In development)
J Antimicrob Chemotherapy
Side effect of Carbapenems Anaphylaxis Interstitial nephritis Anemia Leukopenia Precipitate seizure activity
especially old patients CRI preexisting seizure disorder or CNS pathology
AminoglycosidesAminoglycosides
Antimicrobial Spectrum Antimicrobial Spectrum - All Gram negative bacilli
- Staphylococcus aureus Dosage Dosage - Gentamicin loading ~ 2 mgkg maintenance ~ 3-5 mgkgday Amikacin loading ~ 75 mgkg maintenance ~ 5 mgkg Q8H or 75
mgkg q12H Exacin 8mgskgday Single daily (once-daily) dosing (SDD) Short course (3-5 days)
Adverse effects of Adverse effects of aminoglycosidesaminoglycosides Nephrotoxicity Ototoxicity Neuromuscular paralysis ~ High doseinfrequent administration
DECREASES the rate of tissue uptake mdash DELAY the onset
of toxicity doesnrsquot prevent it from happening ~ All patients if treated for a long enough time
will eventually develop toxicity
Fluoroquinolones
Group I
- Nalidixic acid
- Enteric or urinary tract infections Group II
- Ciprofloxacin Ofloxacin Levofloxacin
- GNR (P aeruginosa) S pneumoniae atypicals Group III
- Moxifloxacin Gemifloxacin
- GPB ( S pneumoniaeuarr) atypicals anaerobes GNR
(P aeruginosadarr)
- Respiratory tract infections
GlycopeptidesGlycopeptides
Vancomycin amp Teicoplanin
Non-β-lactam cell wall synthesis inhibitor
Spectrum GPC amp GPB
Avoid oral use except AAC (antibiotic-associated colitis)
Tetracyclines
STD
- Chlamydial
diseases
- Gonorrhea
(doxycycline +
ceftriaxone)
- Syphilis
Rickettsial diseases
Brucellosis
Tularemia
Relapsing fever
Tigecycline (a new class Glycylcyclines)Gram-positive BacteriaGram-positive Bacteria Staphylococcus MRSA
MRSE VRE E faecium E faecalis Streptococcus agalactiae S treptococcus anginosus
group Streptococcus pyogenes
AnaerobesAnaerobes B fragilis group Prevotella spp Peptostreptococcus spp C perfringensAtypicalAtypical Chlamydia pneumoniae Mycoplasma pneumoniae Legionella
Gram-negative BacteriaGram-negative Bacteria E coli (including ESBLs) Kl ebsiella pneumoniae (including ESBLs) K oxytoca Acinetobacter baumannii (Resistant strains)Resistant strains) Citrobacter freundii Enterobacter cloacae Enterobacter aerogenes Stenotrophomonas
maltophilia
Does not have good activity Does not have good activity againstagainst P aeruginosa Proteus Providencia
Colistimethate sodium Colistimethate sodium Pseudomonas
aeruginosa infections in cystic fibrosis multidrug-resistant Acinetobacter infection
E-coli Klebsiella sp ( ESBL) Enterobacter Colomycin 1000000 units = 80 mg
colistimethate 6 to 12 mgkg colistimethate sodium per
day 60 kg man recommended dose for
Colomycin is 240 to 480 mg of colistimethate sodium
Nephrotoxicity (damage to the kidneys) and neurotoxicity
抗生素使用常見的五大錯誤
Antibiotic = scanol (antipyretic) S vs R (susceptible vs resistant) 4 gt 3 gt2 gt 1 Treat colonization Vancomycin+ imipenem(atomic
bomb)
Colonization
Positive culture for sputum urine bile stool and skin swab without symptoms or signs of infection Not recommend for using antibiotics
Except asymptomatic bacteriuria before urological work up and in pregnancy should be treated
抗生素使用的適應症
明顯的細菌感染 極可能的細菌感染 敗血症 白血球過低合併發燒 懷疑急性心內膜炎 細菌性腦膜炎 壞死性筋膜炎
常見感染症之抗生素療程 ( 一 )
感染症療程 ( 天 )
菌血症 敗血症 14
肝膿瘍 21
軟組織感染 7-10
急性腎炎 14
細菌性腦膜炎 10
常見感染症之抗生素療程 ( 二 )感染症療程 ( 天 )
1048729
肺炎雙球菌肺炎 14 ()
革蘭氏陰性桿菌肺炎1048729
21 ()
退伍軍人協會症1048729
21
奴卡氏菌肺炎1048729
180-360
感染性心內膜炎 28-42
抗生素治療失敗之原因
選用藥物不恰當 藥物交互作用 降低療效 異異物阻塞或膿瘍未引流 病人免疫力太差 分離菌之判讀錯誤 新的院內感染
Adverse effects of penicillin Anaphylaxis anemia leukopenia Oxacillin hepatitis Ticarcillin coagulation abnormality
bleeding
Sulbactam (Maxtam)
Sulbactam is an irreversible inhibitor of beta-lactamase
Combinations of sulbactam with beta-lactam antibiotics
Dose 05 ~ 10 gm 6 ~ 8 with other antibiotics not
gt 40 gmday Cefoperazonesulbactam Ampicillinsulbactam
Cephalosporins
First generation Second generation Third generation Fourth generation
Cephalosporins
Against GPC 1st gt 2nd gt cephamycins gt 3rd Against GNB 1st lt 2nd lt cephamycins lt 3rd
First Generation
Cefazolin Cefadroxil Ceflexin Cephradine
StreptococcusStaphylococcus (methicillin-susceptible)E coliP mirabilisK pneumoniae
Second Generation
Cefmetazole Cefuroxime
Cefalor Cefuroxime
above the diaphragm cefuroximebelow the diaphragm cefmetazole (cephamycins B fragilis) Cefmatazole ESBL-producing Enterobacteriaceae
Third generation
Cefoperazone Cefotaxime Ceftazidime Ceftriaxone Flumarin
Cefixime Cefpodoxime ceftibuten
Resistant Gram-negative microorganisms ( Nosocomial infections ) Serratia Citrobacter Enterobacter Pseudomonas β-lactamase producing H influenzaeBetter BBB penetration among cephalosporins (except cefoperazone)Indication nosocomial infections (mainly GNB) GNB meningitis
Fourth Generation
Cefepime Cefpirome
Good anti-pseudomonal effectGood CNS penetrationPreserve antimicrobial effect to G(+) bacteria
Adverse effects of cephalosporins
Cefamandole cefmetazole cefoperazone cefotetan vitamin K-dependent clotting factor metabolism
Monobactam Monobactam (Aztreonam(Aztreonam)) Only gram-negative aerobes Alternative in penicillin- and
cephalosporin- allergic patients
Sulfonamides and trimethoprim Inhibit folic acid metabolism Treatment of PCP Nocardia
Toxaplasma Sternotrophomonus Aderverse effect cholestatic jaudice
bone marrow suppression severe hypersensitivity (Stevens-Johnson syndrome)
CarbapenemGroup Classification
Group 1 Broad-spectrum carbapenems with limited activity against non-fermentative Gram-negative bacilli (NFGNB eg Pseudomonas Acinetobacter) that are particularly suitable for community-acquired infections (eg ertapenem)
Group 2 Broad-spectrum carbapenems with activity against non-
fermentative Gram-negative bacilli (eg Pseudomonas
Acinetobacter) that are particularly suitable for nosocomial infections (eg imipenem and meropenem)
Group3 Carbapenems with clinical activity against Methicillin-
Resistant Staphylococcus (eg In development)
J Antimicrob Chemotherapy
Side effect of Carbapenems Anaphylaxis Interstitial nephritis Anemia Leukopenia Precipitate seizure activity
especially old patients CRI preexisting seizure disorder or CNS pathology
AminoglycosidesAminoglycosides
Antimicrobial Spectrum Antimicrobial Spectrum - All Gram negative bacilli
- Staphylococcus aureus Dosage Dosage - Gentamicin loading ~ 2 mgkg maintenance ~ 3-5 mgkgday Amikacin loading ~ 75 mgkg maintenance ~ 5 mgkg Q8H or 75
mgkg q12H Exacin 8mgskgday Single daily (once-daily) dosing (SDD) Short course (3-5 days)
Adverse effects of Adverse effects of aminoglycosidesaminoglycosides Nephrotoxicity Ototoxicity Neuromuscular paralysis ~ High doseinfrequent administration
DECREASES the rate of tissue uptake mdash DELAY the onset
of toxicity doesnrsquot prevent it from happening ~ All patients if treated for a long enough time
will eventually develop toxicity
Fluoroquinolones
Group I
- Nalidixic acid
- Enteric or urinary tract infections Group II
- Ciprofloxacin Ofloxacin Levofloxacin
- GNR (P aeruginosa) S pneumoniae atypicals Group III
- Moxifloxacin Gemifloxacin
- GPB ( S pneumoniaeuarr) atypicals anaerobes GNR
(P aeruginosadarr)
- Respiratory tract infections
GlycopeptidesGlycopeptides
Vancomycin amp Teicoplanin
Non-β-lactam cell wall synthesis inhibitor
Spectrum GPC amp GPB
Avoid oral use except AAC (antibiotic-associated colitis)
Tetracyclines
STD
- Chlamydial
diseases
- Gonorrhea
(doxycycline +
ceftriaxone)
- Syphilis
Rickettsial diseases
Brucellosis
Tularemia
Relapsing fever
Tigecycline (a new class Glycylcyclines)Gram-positive BacteriaGram-positive Bacteria Staphylococcus MRSA
MRSE VRE E faecium E faecalis Streptococcus agalactiae S treptococcus anginosus
group Streptococcus pyogenes
AnaerobesAnaerobes B fragilis group Prevotella spp Peptostreptococcus spp C perfringensAtypicalAtypical Chlamydia pneumoniae Mycoplasma pneumoniae Legionella
Gram-negative BacteriaGram-negative Bacteria E coli (including ESBLs) Kl ebsiella pneumoniae (including ESBLs) K oxytoca Acinetobacter baumannii (Resistant strains)Resistant strains) Citrobacter freundii Enterobacter cloacae Enterobacter aerogenes Stenotrophomonas
maltophilia
Does not have good activity Does not have good activity againstagainst P aeruginosa Proteus Providencia
Colistimethate sodium Colistimethate sodium Pseudomonas
aeruginosa infections in cystic fibrosis multidrug-resistant Acinetobacter infection
E-coli Klebsiella sp ( ESBL) Enterobacter Colomycin 1000000 units = 80 mg
colistimethate 6 to 12 mgkg colistimethate sodium per
day 60 kg man recommended dose for
Colomycin is 240 to 480 mg of colistimethate sodium
Nephrotoxicity (damage to the kidneys) and neurotoxicity
抗生素使用常見的五大錯誤
Antibiotic = scanol (antipyretic) S vs R (susceptible vs resistant) 4 gt 3 gt2 gt 1 Treat colonization Vancomycin+ imipenem(atomic
bomb)
Colonization
Positive culture for sputum urine bile stool and skin swab without symptoms or signs of infection Not recommend for using antibiotics
Except asymptomatic bacteriuria before urological work up and in pregnancy should be treated
抗生素使用的適應症
明顯的細菌感染 極可能的細菌感染 敗血症 白血球過低合併發燒 懷疑急性心內膜炎 細菌性腦膜炎 壞死性筋膜炎
常見感染症之抗生素療程 ( 一 )
感染症療程 ( 天 )
菌血症 敗血症 14
肝膿瘍 21
軟組織感染 7-10
急性腎炎 14
細菌性腦膜炎 10
常見感染症之抗生素療程 ( 二 )感染症療程 ( 天 )
1048729
肺炎雙球菌肺炎 14 ()
革蘭氏陰性桿菌肺炎1048729
21 ()
退伍軍人協會症1048729
21
奴卡氏菌肺炎1048729
180-360
感染性心內膜炎 28-42
抗生素治療失敗之原因
選用藥物不恰當 藥物交互作用 降低療效 異異物阻塞或膿瘍未引流 病人免疫力太差 分離菌之判讀錯誤 新的院內感染
Sulbactam (Maxtam)
Sulbactam is an irreversible inhibitor of beta-lactamase
Combinations of sulbactam with beta-lactam antibiotics
Dose 05 ~ 10 gm 6 ~ 8 with other antibiotics not
gt 40 gmday Cefoperazonesulbactam Ampicillinsulbactam
Cephalosporins
First generation Second generation Third generation Fourth generation
Cephalosporins
Against GPC 1st gt 2nd gt cephamycins gt 3rd Against GNB 1st lt 2nd lt cephamycins lt 3rd
First Generation
Cefazolin Cefadroxil Ceflexin Cephradine
StreptococcusStaphylococcus (methicillin-susceptible)E coliP mirabilisK pneumoniae
Second Generation
Cefmetazole Cefuroxime
Cefalor Cefuroxime
above the diaphragm cefuroximebelow the diaphragm cefmetazole (cephamycins B fragilis) Cefmatazole ESBL-producing Enterobacteriaceae
Third generation
Cefoperazone Cefotaxime Ceftazidime Ceftriaxone Flumarin
Cefixime Cefpodoxime ceftibuten
Resistant Gram-negative microorganisms ( Nosocomial infections ) Serratia Citrobacter Enterobacter Pseudomonas β-lactamase producing H influenzaeBetter BBB penetration among cephalosporins (except cefoperazone)Indication nosocomial infections (mainly GNB) GNB meningitis
Fourth Generation
Cefepime Cefpirome
Good anti-pseudomonal effectGood CNS penetrationPreserve antimicrobial effect to G(+) bacteria
Adverse effects of cephalosporins
Cefamandole cefmetazole cefoperazone cefotetan vitamin K-dependent clotting factor metabolism
Monobactam Monobactam (Aztreonam(Aztreonam)) Only gram-negative aerobes Alternative in penicillin- and
cephalosporin- allergic patients
Sulfonamides and trimethoprim Inhibit folic acid metabolism Treatment of PCP Nocardia
Toxaplasma Sternotrophomonus Aderverse effect cholestatic jaudice
bone marrow suppression severe hypersensitivity (Stevens-Johnson syndrome)
CarbapenemGroup Classification
Group 1 Broad-spectrum carbapenems with limited activity against non-fermentative Gram-negative bacilli (NFGNB eg Pseudomonas Acinetobacter) that are particularly suitable for community-acquired infections (eg ertapenem)
Group 2 Broad-spectrum carbapenems with activity against non-
fermentative Gram-negative bacilli (eg Pseudomonas
Acinetobacter) that are particularly suitable for nosocomial infections (eg imipenem and meropenem)
Group3 Carbapenems with clinical activity against Methicillin-
Resistant Staphylococcus (eg In development)
J Antimicrob Chemotherapy
Side effect of Carbapenems Anaphylaxis Interstitial nephritis Anemia Leukopenia Precipitate seizure activity
especially old patients CRI preexisting seizure disorder or CNS pathology
AminoglycosidesAminoglycosides
Antimicrobial Spectrum Antimicrobial Spectrum - All Gram negative bacilli
- Staphylococcus aureus Dosage Dosage - Gentamicin loading ~ 2 mgkg maintenance ~ 3-5 mgkgday Amikacin loading ~ 75 mgkg maintenance ~ 5 mgkg Q8H or 75
mgkg q12H Exacin 8mgskgday Single daily (once-daily) dosing (SDD) Short course (3-5 days)
Adverse effects of Adverse effects of aminoglycosidesaminoglycosides Nephrotoxicity Ototoxicity Neuromuscular paralysis ~ High doseinfrequent administration
DECREASES the rate of tissue uptake mdash DELAY the onset
of toxicity doesnrsquot prevent it from happening ~ All patients if treated for a long enough time
will eventually develop toxicity
Fluoroquinolones
Group I
- Nalidixic acid
- Enteric or urinary tract infections Group II
- Ciprofloxacin Ofloxacin Levofloxacin
- GNR (P aeruginosa) S pneumoniae atypicals Group III
- Moxifloxacin Gemifloxacin
- GPB ( S pneumoniaeuarr) atypicals anaerobes GNR
(P aeruginosadarr)
- Respiratory tract infections
GlycopeptidesGlycopeptides
Vancomycin amp Teicoplanin
Non-β-lactam cell wall synthesis inhibitor
Spectrum GPC amp GPB
Avoid oral use except AAC (antibiotic-associated colitis)
Tetracyclines
STD
- Chlamydial
diseases
- Gonorrhea
(doxycycline +
ceftriaxone)
- Syphilis
Rickettsial diseases
Brucellosis
Tularemia
Relapsing fever
Tigecycline (a new class Glycylcyclines)Gram-positive BacteriaGram-positive Bacteria Staphylococcus MRSA
MRSE VRE E faecium E faecalis Streptococcus agalactiae S treptococcus anginosus
group Streptococcus pyogenes
AnaerobesAnaerobes B fragilis group Prevotella spp Peptostreptococcus spp C perfringensAtypicalAtypical Chlamydia pneumoniae Mycoplasma pneumoniae Legionella
Gram-negative BacteriaGram-negative Bacteria E coli (including ESBLs) Kl ebsiella pneumoniae (including ESBLs) K oxytoca Acinetobacter baumannii (Resistant strains)Resistant strains) Citrobacter freundii Enterobacter cloacae Enterobacter aerogenes Stenotrophomonas
maltophilia
Does not have good activity Does not have good activity againstagainst P aeruginosa Proteus Providencia
Colistimethate sodium Colistimethate sodium Pseudomonas
aeruginosa infections in cystic fibrosis multidrug-resistant Acinetobacter infection
E-coli Klebsiella sp ( ESBL) Enterobacter Colomycin 1000000 units = 80 mg
colistimethate 6 to 12 mgkg colistimethate sodium per
day 60 kg man recommended dose for
Colomycin is 240 to 480 mg of colistimethate sodium
Nephrotoxicity (damage to the kidneys) and neurotoxicity
抗生素使用常見的五大錯誤
Antibiotic = scanol (antipyretic) S vs R (susceptible vs resistant) 4 gt 3 gt2 gt 1 Treat colonization Vancomycin+ imipenem(atomic
bomb)
Colonization
Positive culture for sputum urine bile stool and skin swab without symptoms or signs of infection Not recommend for using antibiotics
Except asymptomatic bacteriuria before urological work up and in pregnancy should be treated
抗生素使用的適應症
明顯的細菌感染 極可能的細菌感染 敗血症 白血球過低合併發燒 懷疑急性心內膜炎 細菌性腦膜炎 壞死性筋膜炎
常見感染症之抗生素療程 ( 一 )
感染症療程 ( 天 )
菌血症 敗血症 14
肝膿瘍 21
軟組織感染 7-10
急性腎炎 14
細菌性腦膜炎 10
常見感染症之抗生素療程 ( 二 )感染症療程 ( 天 )
1048729
肺炎雙球菌肺炎 14 ()
革蘭氏陰性桿菌肺炎1048729
21 ()
退伍軍人協會症1048729
21
奴卡氏菌肺炎1048729
180-360
感染性心內膜炎 28-42
抗生素治療失敗之原因
選用藥物不恰當 藥物交互作用 降低療效 異異物阻塞或膿瘍未引流 病人免疫力太差 分離菌之判讀錯誤 新的院內感染
Cephalosporins
First generation Second generation Third generation Fourth generation
Cephalosporins
Against GPC 1st gt 2nd gt cephamycins gt 3rd Against GNB 1st lt 2nd lt cephamycins lt 3rd
First Generation
Cefazolin Cefadroxil Ceflexin Cephradine
StreptococcusStaphylococcus (methicillin-susceptible)E coliP mirabilisK pneumoniae
Second Generation
Cefmetazole Cefuroxime
Cefalor Cefuroxime
above the diaphragm cefuroximebelow the diaphragm cefmetazole (cephamycins B fragilis) Cefmatazole ESBL-producing Enterobacteriaceae
Third generation
Cefoperazone Cefotaxime Ceftazidime Ceftriaxone Flumarin
Cefixime Cefpodoxime ceftibuten
Resistant Gram-negative microorganisms ( Nosocomial infections ) Serratia Citrobacter Enterobacter Pseudomonas β-lactamase producing H influenzaeBetter BBB penetration among cephalosporins (except cefoperazone)Indication nosocomial infections (mainly GNB) GNB meningitis
Fourth Generation
Cefepime Cefpirome
Good anti-pseudomonal effectGood CNS penetrationPreserve antimicrobial effect to G(+) bacteria
Adverse effects of cephalosporins
Cefamandole cefmetazole cefoperazone cefotetan vitamin K-dependent clotting factor metabolism
Monobactam Monobactam (Aztreonam(Aztreonam)) Only gram-negative aerobes Alternative in penicillin- and
cephalosporin- allergic patients
Sulfonamides and trimethoprim Inhibit folic acid metabolism Treatment of PCP Nocardia
Toxaplasma Sternotrophomonus Aderverse effect cholestatic jaudice
bone marrow suppression severe hypersensitivity (Stevens-Johnson syndrome)
CarbapenemGroup Classification
Group 1 Broad-spectrum carbapenems with limited activity against non-fermentative Gram-negative bacilli (NFGNB eg Pseudomonas Acinetobacter) that are particularly suitable for community-acquired infections (eg ertapenem)
Group 2 Broad-spectrum carbapenems with activity against non-
fermentative Gram-negative bacilli (eg Pseudomonas
Acinetobacter) that are particularly suitable for nosocomial infections (eg imipenem and meropenem)
Group3 Carbapenems with clinical activity against Methicillin-
Resistant Staphylococcus (eg In development)
J Antimicrob Chemotherapy
Side effect of Carbapenems Anaphylaxis Interstitial nephritis Anemia Leukopenia Precipitate seizure activity
especially old patients CRI preexisting seizure disorder or CNS pathology
AminoglycosidesAminoglycosides
Antimicrobial Spectrum Antimicrobial Spectrum - All Gram negative bacilli
- Staphylococcus aureus Dosage Dosage - Gentamicin loading ~ 2 mgkg maintenance ~ 3-5 mgkgday Amikacin loading ~ 75 mgkg maintenance ~ 5 mgkg Q8H or 75
mgkg q12H Exacin 8mgskgday Single daily (once-daily) dosing (SDD) Short course (3-5 days)
Adverse effects of Adverse effects of aminoglycosidesaminoglycosides Nephrotoxicity Ototoxicity Neuromuscular paralysis ~ High doseinfrequent administration
DECREASES the rate of tissue uptake mdash DELAY the onset
of toxicity doesnrsquot prevent it from happening ~ All patients if treated for a long enough time
will eventually develop toxicity
Fluoroquinolones
Group I
- Nalidixic acid
- Enteric or urinary tract infections Group II
- Ciprofloxacin Ofloxacin Levofloxacin
- GNR (P aeruginosa) S pneumoniae atypicals Group III
- Moxifloxacin Gemifloxacin
- GPB ( S pneumoniaeuarr) atypicals anaerobes GNR
(P aeruginosadarr)
- Respiratory tract infections
GlycopeptidesGlycopeptides
Vancomycin amp Teicoplanin
Non-β-lactam cell wall synthesis inhibitor
Spectrum GPC amp GPB
Avoid oral use except AAC (antibiotic-associated colitis)
Tetracyclines
STD
- Chlamydial
diseases
- Gonorrhea
(doxycycline +
ceftriaxone)
- Syphilis
Rickettsial diseases
Brucellosis
Tularemia
Relapsing fever
Tigecycline (a new class Glycylcyclines)Gram-positive BacteriaGram-positive Bacteria Staphylococcus MRSA
MRSE VRE E faecium E faecalis Streptococcus agalactiae S treptococcus anginosus
group Streptococcus pyogenes
AnaerobesAnaerobes B fragilis group Prevotella spp Peptostreptococcus spp C perfringensAtypicalAtypical Chlamydia pneumoniae Mycoplasma pneumoniae Legionella
Gram-negative BacteriaGram-negative Bacteria E coli (including ESBLs) Kl ebsiella pneumoniae (including ESBLs) K oxytoca Acinetobacter baumannii (Resistant strains)Resistant strains) Citrobacter freundii Enterobacter cloacae Enterobacter aerogenes Stenotrophomonas
maltophilia
Does not have good activity Does not have good activity againstagainst P aeruginosa Proteus Providencia
Colistimethate sodium Colistimethate sodium Pseudomonas
aeruginosa infections in cystic fibrosis multidrug-resistant Acinetobacter infection
E-coli Klebsiella sp ( ESBL) Enterobacter Colomycin 1000000 units = 80 mg
colistimethate 6 to 12 mgkg colistimethate sodium per
day 60 kg man recommended dose for
Colomycin is 240 to 480 mg of colistimethate sodium
Nephrotoxicity (damage to the kidneys) and neurotoxicity
抗生素使用常見的五大錯誤
Antibiotic = scanol (antipyretic) S vs R (susceptible vs resistant) 4 gt 3 gt2 gt 1 Treat colonization Vancomycin+ imipenem(atomic
bomb)
Colonization
Positive culture for sputum urine bile stool and skin swab without symptoms or signs of infection Not recommend for using antibiotics
Except asymptomatic bacteriuria before urological work up and in pregnancy should be treated
抗生素使用的適應症
明顯的細菌感染 極可能的細菌感染 敗血症 白血球過低合併發燒 懷疑急性心內膜炎 細菌性腦膜炎 壞死性筋膜炎
常見感染症之抗生素療程 ( 一 )
感染症療程 ( 天 )
菌血症 敗血症 14
肝膿瘍 21
軟組織感染 7-10
急性腎炎 14
細菌性腦膜炎 10
常見感染症之抗生素療程 ( 二 )感染症療程 ( 天 )
1048729
肺炎雙球菌肺炎 14 ()
革蘭氏陰性桿菌肺炎1048729
21 ()
退伍軍人協會症1048729
21
奴卡氏菌肺炎1048729
180-360
感染性心內膜炎 28-42
抗生素治療失敗之原因
選用藥物不恰當 藥物交互作用 降低療效 異異物阻塞或膿瘍未引流 病人免疫力太差 分離菌之判讀錯誤 新的院內感染
Cephalosporins
Against GPC 1st gt 2nd gt cephamycins gt 3rd Against GNB 1st lt 2nd lt cephamycins lt 3rd
First Generation
Cefazolin Cefadroxil Ceflexin Cephradine
StreptococcusStaphylococcus (methicillin-susceptible)E coliP mirabilisK pneumoniae
Second Generation
Cefmetazole Cefuroxime
Cefalor Cefuroxime
above the diaphragm cefuroximebelow the diaphragm cefmetazole (cephamycins B fragilis) Cefmatazole ESBL-producing Enterobacteriaceae
Third generation
Cefoperazone Cefotaxime Ceftazidime Ceftriaxone Flumarin
Cefixime Cefpodoxime ceftibuten
Resistant Gram-negative microorganisms ( Nosocomial infections ) Serratia Citrobacter Enterobacter Pseudomonas β-lactamase producing H influenzaeBetter BBB penetration among cephalosporins (except cefoperazone)Indication nosocomial infections (mainly GNB) GNB meningitis
Fourth Generation
Cefepime Cefpirome
Good anti-pseudomonal effectGood CNS penetrationPreserve antimicrobial effect to G(+) bacteria
Adverse effects of cephalosporins
Cefamandole cefmetazole cefoperazone cefotetan vitamin K-dependent clotting factor metabolism
Monobactam Monobactam (Aztreonam(Aztreonam)) Only gram-negative aerobes Alternative in penicillin- and
cephalosporin- allergic patients
Sulfonamides and trimethoprim Inhibit folic acid metabolism Treatment of PCP Nocardia
Toxaplasma Sternotrophomonus Aderverse effect cholestatic jaudice
bone marrow suppression severe hypersensitivity (Stevens-Johnson syndrome)
CarbapenemGroup Classification
Group 1 Broad-spectrum carbapenems with limited activity against non-fermentative Gram-negative bacilli (NFGNB eg Pseudomonas Acinetobacter) that are particularly suitable for community-acquired infections (eg ertapenem)
Group 2 Broad-spectrum carbapenems with activity against non-
fermentative Gram-negative bacilli (eg Pseudomonas
Acinetobacter) that are particularly suitable for nosocomial infections (eg imipenem and meropenem)
Group3 Carbapenems with clinical activity against Methicillin-
Resistant Staphylococcus (eg In development)
J Antimicrob Chemotherapy
Side effect of Carbapenems Anaphylaxis Interstitial nephritis Anemia Leukopenia Precipitate seizure activity
especially old patients CRI preexisting seizure disorder or CNS pathology
AminoglycosidesAminoglycosides
Antimicrobial Spectrum Antimicrobial Spectrum - All Gram negative bacilli
- Staphylococcus aureus Dosage Dosage - Gentamicin loading ~ 2 mgkg maintenance ~ 3-5 mgkgday Amikacin loading ~ 75 mgkg maintenance ~ 5 mgkg Q8H or 75
mgkg q12H Exacin 8mgskgday Single daily (once-daily) dosing (SDD) Short course (3-5 days)
Adverse effects of Adverse effects of aminoglycosidesaminoglycosides Nephrotoxicity Ototoxicity Neuromuscular paralysis ~ High doseinfrequent administration
DECREASES the rate of tissue uptake mdash DELAY the onset
of toxicity doesnrsquot prevent it from happening ~ All patients if treated for a long enough time
will eventually develop toxicity
Fluoroquinolones
Group I
- Nalidixic acid
- Enteric or urinary tract infections Group II
- Ciprofloxacin Ofloxacin Levofloxacin
- GNR (P aeruginosa) S pneumoniae atypicals Group III
- Moxifloxacin Gemifloxacin
- GPB ( S pneumoniaeuarr) atypicals anaerobes GNR
(P aeruginosadarr)
- Respiratory tract infections
GlycopeptidesGlycopeptides
Vancomycin amp Teicoplanin
Non-β-lactam cell wall synthesis inhibitor
Spectrum GPC amp GPB
Avoid oral use except AAC (antibiotic-associated colitis)
Tetracyclines
STD
- Chlamydial
diseases
- Gonorrhea
(doxycycline +
ceftriaxone)
- Syphilis
Rickettsial diseases
Brucellosis
Tularemia
Relapsing fever
Tigecycline (a new class Glycylcyclines)Gram-positive BacteriaGram-positive Bacteria Staphylococcus MRSA
MRSE VRE E faecium E faecalis Streptococcus agalactiae S treptococcus anginosus
group Streptococcus pyogenes
AnaerobesAnaerobes B fragilis group Prevotella spp Peptostreptococcus spp C perfringensAtypicalAtypical Chlamydia pneumoniae Mycoplasma pneumoniae Legionella
Gram-negative BacteriaGram-negative Bacteria E coli (including ESBLs) Kl ebsiella pneumoniae (including ESBLs) K oxytoca Acinetobacter baumannii (Resistant strains)Resistant strains) Citrobacter freundii Enterobacter cloacae Enterobacter aerogenes Stenotrophomonas
maltophilia
Does not have good activity Does not have good activity againstagainst P aeruginosa Proteus Providencia
Colistimethate sodium Colistimethate sodium Pseudomonas
aeruginosa infections in cystic fibrosis multidrug-resistant Acinetobacter infection
E-coli Klebsiella sp ( ESBL) Enterobacter Colomycin 1000000 units = 80 mg
colistimethate 6 to 12 mgkg colistimethate sodium per
day 60 kg man recommended dose for
Colomycin is 240 to 480 mg of colistimethate sodium
Nephrotoxicity (damage to the kidneys) and neurotoxicity
抗生素使用常見的五大錯誤
Antibiotic = scanol (antipyretic) S vs R (susceptible vs resistant) 4 gt 3 gt2 gt 1 Treat colonization Vancomycin+ imipenem(atomic
bomb)
Colonization
Positive culture for sputum urine bile stool and skin swab without symptoms or signs of infection Not recommend for using antibiotics
Except asymptomatic bacteriuria before urological work up and in pregnancy should be treated
抗生素使用的適應症
明顯的細菌感染 極可能的細菌感染 敗血症 白血球過低合併發燒 懷疑急性心內膜炎 細菌性腦膜炎 壞死性筋膜炎
常見感染症之抗生素療程 ( 一 )
感染症療程 ( 天 )
菌血症 敗血症 14
肝膿瘍 21
軟組織感染 7-10
急性腎炎 14
細菌性腦膜炎 10
常見感染症之抗生素療程 ( 二 )感染症療程 ( 天 )
1048729
肺炎雙球菌肺炎 14 ()
革蘭氏陰性桿菌肺炎1048729
21 ()
退伍軍人協會症1048729
21
奴卡氏菌肺炎1048729
180-360
感染性心內膜炎 28-42
抗生素治療失敗之原因
選用藥物不恰當 藥物交互作用 降低療效 異異物阻塞或膿瘍未引流 病人免疫力太差 分離菌之判讀錯誤 新的院內感染
First Generation
Cefazolin Cefadroxil Ceflexin Cephradine
StreptococcusStaphylococcus (methicillin-susceptible)E coliP mirabilisK pneumoniae
Second Generation
Cefmetazole Cefuroxime
Cefalor Cefuroxime
above the diaphragm cefuroximebelow the diaphragm cefmetazole (cephamycins B fragilis) Cefmatazole ESBL-producing Enterobacteriaceae
Third generation
Cefoperazone Cefotaxime Ceftazidime Ceftriaxone Flumarin
Cefixime Cefpodoxime ceftibuten
Resistant Gram-negative microorganisms ( Nosocomial infections ) Serratia Citrobacter Enterobacter Pseudomonas β-lactamase producing H influenzaeBetter BBB penetration among cephalosporins (except cefoperazone)Indication nosocomial infections (mainly GNB) GNB meningitis
Fourth Generation
Cefepime Cefpirome
Good anti-pseudomonal effectGood CNS penetrationPreserve antimicrobial effect to G(+) bacteria
Adverse effects of cephalosporins
Cefamandole cefmetazole cefoperazone cefotetan vitamin K-dependent clotting factor metabolism
Monobactam Monobactam (Aztreonam(Aztreonam)) Only gram-negative aerobes Alternative in penicillin- and
cephalosporin- allergic patients
Sulfonamides and trimethoprim Inhibit folic acid metabolism Treatment of PCP Nocardia
Toxaplasma Sternotrophomonus Aderverse effect cholestatic jaudice
bone marrow suppression severe hypersensitivity (Stevens-Johnson syndrome)
CarbapenemGroup Classification
Group 1 Broad-spectrum carbapenems with limited activity against non-fermentative Gram-negative bacilli (NFGNB eg Pseudomonas Acinetobacter) that are particularly suitable for community-acquired infections (eg ertapenem)
Group 2 Broad-spectrum carbapenems with activity against non-
fermentative Gram-negative bacilli (eg Pseudomonas
Acinetobacter) that are particularly suitable for nosocomial infections (eg imipenem and meropenem)
Group3 Carbapenems with clinical activity against Methicillin-
Resistant Staphylococcus (eg In development)
J Antimicrob Chemotherapy
Side effect of Carbapenems Anaphylaxis Interstitial nephritis Anemia Leukopenia Precipitate seizure activity
especially old patients CRI preexisting seizure disorder or CNS pathology
AminoglycosidesAminoglycosides
Antimicrobial Spectrum Antimicrobial Spectrum - All Gram negative bacilli
- Staphylococcus aureus Dosage Dosage - Gentamicin loading ~ 2 mgkg maintenance ~ 3-5 mgkgday Amikacin loading ~ 75 mgkg maintenance ~ 5 mgkg Q8H or 75
mgkg q12H Exacin 8mgskgday Single daily (once-daily) dosing (SDD) Short course (3-5 days)
Adverse effects of Adverse effects of aminoglycosidesaminoglycosides Nephrotoxicity Ototoxicity Neuromuscular paralysis ~ High doseinfrequent administration
DECREASES the rate of tissue uptake mdash DELAY the onset
of toxicity doesnrsquot prevent it from happening ~ All patients if treated for a long enough time
will eventually develop toxicity
Fluoroquinolones
Group I
- Nalidixic acid
- Enteric or urinary tract infections Group II
- Ciprofloxacin Ofloxacin Levofloxacin
- GNR (P aeruginosa) S pneumoniae atypicals Group III
- Moxifloxacin Gemifloxacin
- GPB ( S pneumoniaeuarr) atypicals anaerobes GNR
(P aeruginosadarr)
- Respiratory tract infections
GlycopeptidesGlycopeptides
Vancomycin amp Teicoplanin
Non-β-lactam cell wall synthesis inhibitor
Spectrum GPC amp GPB
Avoid oral use except AAC (antibiotic-associated colitis)
Tetracyclines
STD
- Chlamydial
diseases
- Gonorrhea
(doxycycline +
ceftriaxone)
- Syphilis
Rickettsial diseases
Brucellosis
Tularemia
Relapsing fever
Tigecycline (a new class Glycylcyclines)Gram-positive BacteriaGram-positive Bacteria Staphylococcus MRSA
MRSE VRE E faecium E faecalis Streptococcus agalactiae S treptococcus anginosus
group Streptococcus pyogenes
AnaerobesAnaerobes B fragilis group Prevotella spp Peptostreptococcus spp C perfringensAtypicalAtypical Chlamydia pneumoniae Mycoplasma pneumoniae Legionella
Gram-negative BacteriaGram-negative Bacteria E coli (including ESBLs) Kl ebsiella pneumoniae (including ESBLs) K oxytoca Acinetobacter baumannii (Resistant strains)Resistant strains) Citrobacter freundii Enterobacter cloacae Enterobacter aerogenes Stenotrophomonas
maltophilia
Does not have good activity Does not have good activity againstagainst P aeruginosa Proteus Providencia
Colistimethate sodium Colistimethate sodium Pseudomonas
aeruginosa infections in cystic fibrosis multidrug-resistant Acinetobacter infection
E-coli Klebsiella sp ( ESBL) Enterobacter Colomycin 1000000 units = 80 mg
colistimethate 6 to 12 mgkg colistimethate sodium per
day 60 kg man recommended dose for
Colomycin is 240 to 480 mg of colistimethate sodium
Nephrotoxicity (damage to the kidneys) and neurotoxicity
抗生素使用常見的五大錯誤
Antibiotic = scanol (antipyretic) S vs R (susceptible vs resistant) 4 gt 3 gt2 gt 1 Treat colonization Vancomycin+ imipenem(atomic
bomb)
Colonization
Positive culture for sputum urine bile stool and skin swab without symptoms or signs of infection Not recommend for using antibiotics
Except asymptomatic bacteriuria before urological work up and in pregnancy should be treated
抗生素使用的適應症
明顯的細菌感染 極可能的細菌感染 敗血症 白血球過低合併發燒 懷疑急性心內膜炎 細菌性腦膜炎 壞死性筋膜炎
常見感染症之抗生素療程 ( 一 )
感染症療程 ( 天 )
菌血症 敗血症 14
肝膿瘍 21
軟組織感染 7-10
急性腎炎 14
細菌性腦膜炎 10
常見感染症之抗生素療程 ( 二 )感染症療程 ( 天 )
1048729
肺炎雙球菌肺炎 14 ()
革蘭氏陰性桿菌肺炎1048729
21 ()
退伍軍人協會症1048729
21
奴卡氏菌肺炎1048729
180-360
感染性心內膜炎 28-42
抗生素治療失敗之原因
選用藥物不恰當 藥物交互作用 降低療效 異異物阻塞或膿瘍未引流 病人免疫力太差 分離菌之判讀錯誤 新的院內感染
Second Generation
Cefmetazole Cefuroxime
Cefalor Cefuroxime
above the diaphragm cefuroximebelow the diaphragm cefmetazole (cephamycins B fragilis) Cefmatazole ESBL-producing Enterobacteriaceae
Third generation
Cefoperazone Cefotaxime Ceftazidime Ceftriaxone Flumarin
Cefixime Cefpodoxime ceftibuten
Resistant Gram-negative microorganisms ( Nosocomial infections ) Serratia Citrobacter Enterobacter Pseudomonas β-lactamase producing H influenzaeBetter BBB penetration among cephalosporins (except cefoperazone)Indication nosocomial infections (mainly GNB) GNB meningitis
Fourth Generation
Cefepime Cefpirome
Good anti-pseudomonal effectGood CNS penetrationPreserve antimicrobial effect to G(+) bacteria
Adverse effects of cephalosporins
Cefamandole cefmetazole cefoperazone cefotetan vitamin K-dependent clotting factor metabolism
Monobactam Monobactam (Aztreonam(Aztreonam)) Only gram-negative aerobes Alternative in penicillin- and
cephalosporin- allergic patients
Sulfonamides and trimethoprim Inhibit folic acid metabolism Treatment of PCP Nocardia
Toxaplasma Sternotrophomonus Aderverse effect cholestatic jaudice
bone marrow suppression severe hypersensitivity (Stevens-Johnson syndrome)
CarbapenemGroup Classification
Group 1 Broad-spectrum carbapenems with limited activity against non-fermentative Gram-negative bacilli (NFGNB eg Pseudomonas Acinetobacter) that are particularly suitable for community-acquired infections (eg ertapenem)
Group 2 Broad-spectrum carbapenems with activity against non-
fermentative Gram-negative bacilli (eg Pseudomonas
Acinetobacter) that are particularly suitable for nosocomial infections (eg imipenem and meropenem)
Group3 Carbapenems with clinical activity against Methicillin-
Resistant Staphylococcus (eg In development)
J Antimicrob Chemotherapy
Side effect of Carbapenems Anaphylaxis Interstitial nephritis Anemia Leukopenia Precipitate seizure activity
especially old patients CRI preexisting seizure disorder or CNS pathology
AminoglycosidesAminoglycosides
Antimicrobial Spectrum Antimicrobial Spectrum - All Gram negative bacilli
- Staphylococcus aureus Dosage Dosage - Gentamicin loading ~ 2 mgkg maintenance ~ 3-5 mgkgday Amikacin loading ~ 75 mgkg maintenance ~ 5 mgkg Q8H or 75
mgkg q12H Exacin 8mgskgday Single daily (once-daily) dosing (SDD) Short course (3-5 days)
Adverse effects of Adverse effects of aminoglycosidesaminoglycosides Nephrotoxicity Ototoxicity Neuromuscular paralysis ~ High doseinfrequent administration
DECREASES the rate of tissue uptake mdash DELAY the onset
of toxicity doesnrsquot prevent it from happening ~ All patients if treated for a long enough time
will eventually develop toxicity
Fluoroquinolones
Group I
- Nalidixic acid
- Enteric or urinary tract infections Group II
- Ciprofloxacin Ofloxacin Levofloxacin
- GNR (P aeruginosa) S pneumoniae atypicals Group III
- Moxifloxacin Gemifloxacin
- GPB ( S pneumoniaeuarr) atypicals anaerobes GNR
(P aeruginosadarr)
- Respiratory tract infections
GlycopeptidesGlycopeptides
Vancomycin amp Teicoplanin
Non-β-lactam cell wall synthesis inhibitor
Spectrum GPC amp GPB
Avoid oral use except AAC (antibiotic-associated colitis)
Tetracyclines
STD
- Chlamydial
diseases
- Gonorrhea
(doxycycline +
ceftriaxone)
- Syphilis
Rickettsial diseases
Brucellosis
Tularemia
Relapsing fever
Tigecycline (a new class Glycylcyclines)Gram-positive BacteriaGram-positive Bacteria Staphylococcus MRSA
MRSE VRE E faecium E faecalis Streptococcus agalactiae S treptococcus anginosus
group Streptococcus pyogenes
AnaerobesAnaerobes B fragilis group Prevotella spp Peptostreptococcus spp C perfringensAtypicalAtypical Chlamydia pneumoniae Mycoplasma pneumoniae Legionella
Gram-negative BacteriaGram-negative Bacteria E coli (including ESBLs) Kl ebsiella pneumoniae (including ESBLs) K oxytoca Acinetobacter baumannii (Resistant strains)Resistant strains) Citrobacter freundii Enterobacter cloacae Enterobacter aerogenes Stenotrophomonas
maltophilia
Does not have good activity Does not have good activity againstagainst P aeruginosa Proteus Providencia
Colistimethate sodium Colistimethate sodium Pseudomonas
aeruginosa infections in cystic fibrosis multidrug-resistant Acinetobacter infection
E-coli Klebsiella sp ( ESBL) Enterobacter Colomycin 1000000 units = 80 mg
colistimethate 6 to 12 mgkg colistimethate sodium per
day 60 kg man recommended dose for
Colomycin is 240 to 480 mg of colistimethate sodium
Nephrotoxicity (damage to the kidneys) and neurotoxicity
抗生素使用常見的五大錯誤
Antibiotic = scanol (antipyretic) S vs R (susceptible vs resistant) 4 gt 3 gt2 gt 1 Treat colonization Vancomycin+ imipenem(atomic
bomb)
Colonization
Positive culture for sputum urine bile stool and skin swab without symptoms or signs of infection Not recommend for using antibiotics
Except asymptomatic bacteriuria before urological work up and in pregnancy should be treated
抗生素使用的適應症
明顯的細菌感染 極可能的細菌感染 敗血症 白血球過低合併發燒 懷疑急性心內膜炎 細菌性腦膜炎 壞死性筋膜炎
常見感染症之抗生素療程 ( 一 )
感染症療程 ( 天 )
菌血症 敗血症 14
肝膿瘍 21
軟組織感染 7-10
急性腎炎 14
細菌性腦膜炎 10
常見感染症之抗生素療程 ( 二 )感染症療程 ( 天 )
1048729
肺炎雙球菌肺炎 14 ()
革蘭氏陰性桿菌肺炎1048729
21 ()
退伍軍人協會症1048729
21
奴卡氏菌肺炎1048729
180-360
感染性心內膜炎 28-42
抗生素治療失敗之原因
選用藥物不恰當 藥物交互作用 降低療效 異異物阻塞或膿瘍未引流 病人免疫力太差 分離菌之判讀錯誤 新的院內感染
Third generation
Cefoperazone Cefotaxime Ceftazidime Ceftriaxone Flumarin
Cefixime Cefpodoxime ceftibuten
Resistant Gram-negative microorganisms ( Nosocomial infections ) Serratia Citrobacter Enterobacter Pseudomonas β-lactamase producing H influenzaeBetter BBB penetration among cephalosporins (except cefoperazone)Indication nosocomial infections (mainly GNB) GNB meningitis
Fourth Generation
Cefepime Cefpirome
Good anti-pseudomonal effectGood CNS penetrationPreserve antimicrobial effect to G(+) bacteria
Adverse effects of cephalosporins
Cefamandole cefmetazole cefoperazone cefotetan vitamin K-dependent clotting factor metabolism
Monobactam Monobactam (Aztreonam(Aztreonam)) Only gram-negative aerobes Alternative in penicillin- and
cephalosporin- allergic patients
Sulfonamides and trimethoprim Inhibit folic acid metabolism Treatment of PCP Nocardia
Toxaplasma Sternotrophomonus Aderverse effect cholestatic jaudice
bone marrow suppression severe hypersensitivity (Stevens-Johnson syndrome)
CarbapenemGroup Classification
Group 1 Broad-spectrum carbapenems with limited activity against non-fermentative Gram-negative bacilli (NFGNB eg Pseudomonas Acinetobacter) that are particularly suitable for community-acquired infections (eg ertapenem)
Group 2 Broad-spectrum carbapenems with activity against non-
fermentative Gram-negative bacilli (eg Pseudomonas
Acinetobacter) that are particularly suitable for nosocomial infections (eg imipenem and meropenem)
Group3 Carbapenems with clinical activity against Methicillin-
Resistant Staphylococcus (eg In development)
J Antimicrob Chemotherapy
Side effect of Carbapenems Anaphylaxis Interstitial nephritis Anemia Leukopenia Precipitate seizure activity
especially old patients CRI preexisting seizure disorder or CNS pathology
AminoglycosidesAminoglycosides
Antimicrobial Spectrum Antimicrobial Spectrum - All Gram negative bacilli
- Staphylococcus aureus Dosage Dosage - Gentamicin loading ~ 2 mgkg maintenance ~ 3-5 mgkgday Amikacin loading ~ 75 mgkg maintenance ~ 5 mgkg Q8H or 75
mgkg q12H Exacin 8mgskgday Single daily (once-daily) dosing (SDD) Short course (3-5 days)
Adverse effects of Adverse effects of aminoglycosidesaminoglycosides Nephrotoxicity Ototoxicity Neuromuscular paralysis ~ High doseinfrequent administration
DECREASES the rate of tissue uptake mdash DELAY the onset
of toxicity doesnrsquot prevent it from happening ~ All patients if treated for a long enough time
will eventually develop toxicity
Fluoroquinolones
Group I
- Nalidixic acid
- Enteric or urinary tract infections Group II
- Ciprofloxacin Ofloxacin Levofloxacin
- GNR (P aeruginosa) S pneumoniae atypicals Group III
- Moxifloxacin Gemifloxacin
- GPB ( S pneumoniaeuarr) atypicals anaerobes GNR
(P aeruginosadarr)
- Respiratory tract infections
GlycopeptidesGlycopeptides
Vancomycin amp Teicoplanin
Non-β-lactam cell wall synthesis inhibitor
Spectrum GPC amp GPB
Avoid oral use except AAC (antibiotic-associated colitis)
Tetracyclines
STD
- Chlamydial
diseases
- Gonorrhea
(doxycycline +
ceftriaxone)
- Syphilis
Rickettsial diseases
Brucellosis
Tularemia
Relapsing fever
Tigecycline (a new class Glycylcyclines)Gram-positive BacteriaGram-positive Bacteria Staphylococcus MRSA
MRSE VRE E faecium E faecalis Streptococcus agalactiae S treptococcus anginosus
group Streptococcus pyogenes
AnaerobesAnaerobes B fragilis group Prevotella spp Peptostreptococcus spp C perfringensAtypicalAtypical Chlamydia pneumoniae Mycoplasma pneumoniae Legionella
Gram-negative BacteriaGram-negative Bacteria E coli (including ESBLs) Kl ebsiella pneumoniae (including ESBLs) K oxytoca Acinetobacter baumannii (Resistant strains)Resistant strains) Citrobacter freundii Enterobacter cloacae Enterobacter aerogenes Stenotrophomonas
maltophilia
Does not have good activity Does not have good activity againstagainst P aeruginosa Proteus Providencia
Colistimethate sodium Colistimethate sodium Pseudomonas
aeruginosa infections in cystic fibrosis multidrug-resistant Acinetobacter infection
E-coli Klebsiella sp ( ESBL) Enterobacter Colomycin 1000000 units = 80 mg
colistimethate 6 to 12 mgkg colistimethate sodium per
day 60 kg man recommended dose for
Colomycin is 240 to 480 mg of colistimethate sodium
Nephrotoxicity (damage to the kidneys) and neurotoxicity
抗生素使用常見的五大錯誤
Antibiotic = scanol (antipyretic) S vs R (susceptible vs resistant) 4 gt 3 gt2 gt 1 Treat colonization Vancomycin+ imipenem(atomic
bomb)
Colonization
Positive culture for sputum urine bile stool and skin swab without symptoms or signs of infection Not recommend for using antibiotics
Except asymptomatic bacteriuria before urological work up and in pregnancy should be treated
抗生素使用的適應症
明顯的細菌感染 極可能的細菌感染 敗血症 白血球過低合併發燒 懷疑急性心內膜炎 細菌性腦膜炎 壞死性筋膜炎
常見感染症之抗生素療程 ( 一 )
感染症療程 ( 天 )
菌血症 敗血症 14
肝膿瘍 21
軟組織感染 7-10
急性腎炎 14
細菌性腦膜炎 10
常見感染症之抗生素療程 ( 二 )感染症療程 ( 天 )
1048729
肺炎雙球菌肺炎 14 ()
革蘭氏陰性桿菌肺炎1048729
21 ()
退伍軍人協會症1048729
21
奴卡氏菌肺炎1048729
180-360
感染性心內膜炎 28-42
抗生素治療失敗之原因
選用藥物不恰當 藥物交互作用 降低療效 異異物阻塞或膿瘍未引流 病人免疫力太差 分離菌之判讀錯誤 新的院內感染
Fourth Generation
Cefepime Cefpirome
Good anti-pseudomonal effectGood CNS penetrationPreserve antimicrobial effect to G(+) bacteria
Adverse effects of cephalosporins
Cefamandole cefmetazole cefoperazone cefotetan vitamin K-dependent clotting factor metabolism
Monobactam Monobactam (Aztreonam(Aztreonam)) Only gram-negative aerobes Alternative in penicillin- and
cephalosporin- allergic patients
Sulfonamides and trimethoprim Inhibit folic acid metabolism Treatment of PCP Nocardia
Toxaplasma Sternotrophomonus Aderverse effect cholestatic jaudice
bone marrow suppression severe hypersensitivity (Stevens-Johnson syndrome)
CarbapenemGroup Classification
Group 1 Broad-spectrum carbapenems with limited activity against non-fermentative Gram-negative bacilli (NFGNB eg Pseudomonas Acinetobacter) that are particularly suitable for community-acquired infections (eg ertapenem)
Group 2 Broad-spectrum carbapenems with activity against non-
fermentative Gram-negative bacilli (eg Pseudomonas
Acinetobacter) that are particularly suitable for nosocomial infections (eg imipenem and meropenem)
Group3 Carbapenems with clinical activity against Methicillin-
Resistant Staphylococcus (eg In development)
J Antimicrob Chemotherapy
Side effect of Carbapenems Anaphylaxis Interstitial nephritis Anemia Leukopenia Precipitate seizure activity
especially old patients CRI preexisting seizure disorder or CNS pathology
AminoglycosidesAminoglycosides
Antimicrobial Spectrum Antimicrobial Spectrum - All Gram negative bacilli
- Staphylococcus aureus Dosage Dosage - Gentamicin loading ~ 2 mgkg maintenance ~ 3-5 mgkgday Amikacin loading ~ 75 mgkg maintenance ~ 5 mgkg Q8H or 75
mgkg q12H Exacin 8mgskgday Single daily (once-daily) dosing (SDD) Short course (3-5 days)
Adverse effects of Adverse effects of aminoglycosidesaminoglycosides Nephrotoxicity Ototoxicity Neuromuscular paralysis ~ High doseinfrequent administration
DECREASES the rate of tissue uptake mdash DELAY the onset
of toxicity doesnrsquot prevent it from happening ~ All patients if treated for a long enough time
will eventually develop toxicity
Fluoroquinolones
Group I
- Nalidixic acid
- Enteric or urinary tract infections Group II
- Ciprofloxacin Ofloxacin Levofloxacin
- GNR (P aeruginosa) S pneumoniae atypicals Group III
- Moxifloxacin Gemifloxacin
- GPB ( S pneumoniaeuarr) atypicals anaerobes GNR
(P aeruginosadarr)
- Respiratory tract infections
GlycopeptidesGlycopeptides
Vancomycin amp Teicoplanin
Non-β-lactam cell wall synthesis inhibitor
Spectrum GPC amp GPB
Avoid oral use except AAC (antibiotic-associated colitis)
Tetracyclines
STD
- Chlamydial
diseases
- Gonorrhea
(doxycycline +
ceftriaxone)
- Syphilis
Rickettsial diseases
Brucellosis
Tularemia
Relapsing fever
Tigecycline (a new class Glycylcyclines)Gram-positive BacteriaGram-positive Bacteria Staphylococcus MRSA
MRSE VRE E faecium E faecalis Streptococcus agalactiae S treptococcus anginosus
group Streptococcus pyogenes
AnaerobesAnaerobes B fragilis group Prevotella spp Peptostreptococcus spp C perfringensAtypicalAtypical Chlamydia pneumoniae Mycoplasma pneumoniae Legionella
Gram-negative BacteriaGram-negative Bacteria E coli (including ESBLs) Kl ebsiella pneumoniae (including ESBLs) K oxytoca Acinetobacter baumannii (Resistant strains)Resistant strains) Citrobacter freundii Enterobacter cloacae Enterobacter aerogenes Stenotrophomonas
maltophilia
Does not have good activity Does not have good activity againstagainst P aeruginosa Proteus Providencia
Colistimethate sodium Colistimethate sodium Pseudomonas
aeruginosa infections in cystic fibrosis multidrug-resistant Acinetobacter infection
E-coli Klebsiella sp ( ESBL) Enterobacter Colomycin 1000000 units = 80 mg
colistimethate 6 to 12 mgkg colistimethate sodium per
day 60 kg man recommended dose for
Colomycin is 240 to 480 mg of colistimethate sodium
Nephrotoxicity (damage to the kidneys) and neurotoxicity
抗生素使用常見的五大錯誤
Antibiotic = scanol (antipyretic) S vs R (susceptible vs resistant) 4 gt 3 gt2 gt 1 Treat colonization Vancomycin+ imipenem(atomic
bomb)
Colonization
Positive culture for sputum urine bile stool and skin swab without symptoms or signs of infection Not recommend for using antibiotics
Except asymptomatic bacteriuria before urological work up and in pregnancy should be treated
抗生素使用的適應症
明顯的細菌感染 極可能的細菌感染 敗血症 白血球過低合併發燒 懷疑急性心內膜炎 細菌性腦膜炎 壞死性筋膜炎
常見感染症之抗生素療程 ( 一 )
感染症療程 ( 天 )
菌血症 敗血症 14
肝膿瘍 21
軟組織感染 7-10
急性腎炎 14
細菌性腦膜炎 10
常見感染症之抗生素療程 ( 二 )感染症療程 ( 天 )
1048729
肺炎雙球菌肺炎 14 ()
革蘭氏陰性桿菌肺炎1048729
21 ()
退伍軍人協會症1048729
21
奴卡氏菌肺炎1048729
180-360
感染性心內膜炎 28-42
抗生素治療失敗之原因
選用藥物不恰當 藥物交互作用 降低療效 異異物阻塞或膿瘍未引流 病人免疫力太差 分離菌之判讀錯誤 新的院內感染
Adverse effects of cephalosporins
Cefamandole cefmetazole cefoperazone cefotetan vitamin K-dependent clotting factor metabolism
Monobactam Monobactam (Aztreonam(Aztreonam)) Only gram-negative aerobes Alternative in penicillin- and
cephalosporin- allergic patients
Sulfonamides and trimethoprim Inhibit folic acid metabolism Treatment of PCP Nocardia
Toxaplasma Sternotrophomonus Aderverse effect cholestatic jaudice
bone marrow suppression severe hypersensitivity (Stevens-Johnson syndrome)
CarbapenemGroup Classification
Group 1 Broad-spectrum carbapenems with limited activity against non-fermentative Gram-negative bacilli (NFGNB eg Pseudomonas Acinetobacter) that are particularly suitable for community-acquired infections (eg ertapenem)
Group 2 Broad-spectrum carbapenems with activity against non-
fermentative Gram-negative bacilli (eg Pseudomonas
Acinetobacter) that are particularly suitable for nosocomial infections (eg imipenem and meropenem)
Group3 Carbapenems with clinical activity against Methicillin-
Resistant Staphylococcus (eg In development)
J Antimicrob Chemotherapy
Side effect of Carbapenems Anaphylaxis Interstitial nephritis Anemia Leukopenia Precipitate seizure activity
especially old patients CRI preexisting seizure disorder or CNS pathology
AminoglycosidesAminoglycosides
Antimicrobial Spectrum Antimicrobial Spectrum - All Gram negative bacilli
- Staphylococcus aureus Dosage Dosage - Gentamicin loading ~ 2 mgkg maintenance ~ 3-5 mgkgday Amikacin loading ~ 75 mgkg maintenance ~ 5 mgkg Q8H or 75
mgkg q12H Exacin 8mgskgday Single daily (once-daily) dosing (SDD) Short course (3-5 days)
Adverse effects of Adverse effects of aminoglycosidesaminoglycosides Nephrotoxicity Ototoxicity Neuromuscular paralysis ~ High doseinfrequent administration
DECREASES the rate of tissue uptake mdash DELAY the onset
of toxicity doesnrsquot prevent it from happening ~ All patients if treated for a long enough time
will eventually develop toxicity
Fluoroquinolones
Group I
- Nalidixic acid
- Enteric or urinary tract infections Group II
- Ciprofloxacin Ofloxacin Levofloxacin
- GNR (P aeruginosa) S pneumoniae atypicals Group III
- Moxifloxacin Gemifloxacin
- GPB ( S pneumoniaeuarr) atypicals anaerobes GNR
(P aeruginosadarr)
- Respiratory tract infections
GlycopeptidesGlycopeptides
Vancomycin amp Teicoplanin
Non-β-lactam cell wall synthesis inhibitor
Spectrum GPC amp GPB
Avoid oral use except AAC (antibiotic-associated colitis)
Tetracyclines
STD
- Chlamydial
diseases
- Gonorrhea
(doxycycline +
ceftriaxone)
- Syphilis
Rickettsial diseases
Brucellosis
Tularemia
Relapsing fever
Tigecycline (a new class Glycylcyclines)Gram-positive BacteriaGram-positive Bacteria Staphylococcus MRSA
MRSE VRE E faecium E faecalis Streptococcus agalactiae S treptococcus anginosus
group Streptococcus pyogenes
AnaerobesAnaerobes B fragilis group Prevotella spp Peptostreptococcus spp C perfringensAtypicalAtypical Chlamydia pneumoniae Mycoplasma pneumoniae Legionella
Gram-negative BacteriaGram-negative Bacteria E coli (including ESBLs) Kl ebsiella pneumoniae (including ESBLs) K oxytoca Acinetobacter baumannii (Resistant strains)Resistant strains) Citrobacter freundii Enterobacter cloacae Enterobacter aerogenes Stenotrophomonas
maltophilia
Does not have good activity Does not have good activity againstagainst P aeruginosa Proteus Providencia
Colistimethate sodium Colistimethate sodium Pseudomonas
aeruginosa infections in cystic fibrosis multidrug-resistant Acinetobacter infection
E-coli Klebsiella sp ( ESBL) Enterobacter Colomycin 1000000 units = 80 mg
colistimethate 6 to 12 mgkg colistimethate sodium per
day 60 kg man recommended dose for
Colomycin is 240 to 480 mg of colistimethate sodium
Nephrotoxicity (damage to the kidneys) and neurotoxicity
抗生素使用常見的五大錯誤
Antibiotic = scanol (antipyretic) S vs R (susceptible vs resistant) 4 gt 3 gt2 gt 1 Treat colonization Vancomycin+ imipenem(atomic
bomb)
Colonization
Positive culture for sputum urine bile stool and skin swab without symptoms or signs of infection Not recommend for using antibiotics
Except asymptomatic bacteriuria before urological work up and in pregnancy should be treated
抗生素使用的適應症
明顯的細菌感染 極可能的細菌感染 敗血症 白血球過低合併發燒 懷疑急性心內膜炎 細菌性腦膜炎 壞死性筋膜炎
常見感染症之抗生素療程 ( 一 )
感染症療程 ( 天 )
菌血症 敗血症 14
肝膿瘍 21
軟組織感染 7-10
急性腎炎 14
細菌性腦膜炎 10
常見感染症之抗生素療程 ( 二 )感染症療程 ( 天 )
1048729
肺炎雙球菌肺炎 14 ()
革蘭氏陰性桿菌肺炎1048729
21 ()
退伍軍人協會症1048729
21
奴卡氏菌肺炎1048729
180-360
感染性心內膜炎 28-42
抗生素治療失敗之原因
選用藥物不恰當 藥物交互作用 降低療效 異異物阻塞或膿瘍未引流 病人免疫力太差 分離菌之判讀錯誤 新的院內感染
Monobactam Monobactam (Aztreonam(Aztreonam)) Only gram-negative aerobes Alternative in penicillin- and
cephalosporin- allergic patients
Sulfonamides and trimethoprim Inhibit folic acid metabolism Treatment of PCP Nocardia
Toxaplasma Sternotrophomonus Aderverse effect cholestatic jaudice
bone marrow suppression severe hypersensitivity (Stevens-Johnson syndrome)
CarbapenemGroup Classification
Group 1 Broad-spectrum carbapenems with limited activity against non-fermentative Gram-negative bacilli (NFGNB eg Pseudomonas Acinetobacter) that are particularly suitable for community-acquired infections (eg ertapenem)
Group 2 Broad-spectrum carbapenems with activity against non-
fermentative Gram-negative bacilli (eg Pseudomonas
Acinetobacter) that are particularly suitable for nosocomial infections (eg imipenem and meropenem)
Group3 Carbapenems with clinical activity against Methicillin-
Resistant Staphylococcus (eg In development)
J Antimicrob Chemotherapy
Side effect of Carbapenems Anaphylaxis Interstitial nephritis Anemia Leukopenia Precipitate seizure activity
especially old patients CRI preexisting seizure disorder or CNS pathology
AminoglycosidesAminoglycosides
Antimicrobial Spectrum Antimicrobial Spectrum - All Gram negative bacilli
- Staphylococcus aureus Dosage Dosage - Gentamicin loading ~ 2 mgkg maintenance ~ 3-5 mgkgday Amikacin loading ~ 75 mgkg maintenance ~ 5 mgkg Q8H or 75
mgkg q12H Exacin 8mgskgday Single daily (once-daily) dosing (SDD) Short course (3-5 days)
Adverse effects of Adverse effects of aminoglycosidesaminoglycosides Nephrotoxicity Ototoxicity Neuromuscular paralysis ~ High doseinfrequent administration
DECREASES the rate of tissue uptake mdash DELAY the onset
of toxicity doesnrsquot prevent it from happening ~ All patients if treated for a long enough time
will eventually develop toxicity
Fluoroquinolones
Group I
- Nalidixic acid
- Enteric or urinary tract infections Group II
- Ciprofloxacin Ofloxacin Levofloxacin
- GNR (P aeruginosa) S pneumoniae atypicals Group III
- Moxifloxacin Gemifloxacin
- GPB ( S pneumoniaeuarr) atypicals anaerobes GNR
(P aeruginosadarr)
- Respiratory tract infections
GlycopeptidesGlycopeptides
Vancomycin amp Teicoplanin
Non-β-lactam cell wall synthesis inhibitor
Spectrum GPC amp GPB
Avoid oral use except AAC (antibiotic-associated colitis)
Tetracyclines
STD
- Chlamydial
diseases
- Gonorrhea
(doxycycline +
ceftriaxone)
- Syphilis
Rickettsial diseases
Brucellosis
Tularemia
Relapsing fever
Tigecycline (a new class Glycylcyclines)Gram-positive BacteriaGram-positive Bacteria Staphylococcus MRSA
MRSE VRE E faecium E faecalis Streptococcus agalactiae S treptococcus anginosus
group Streptococcus pyogenes
AnaerobesAnaerobes B fragilis group Prevotella spp Peptostreptococcus spp C perfringensAtypicalAtypical Chlamydia pneumoniae Mycoplasma pneumoniae Legionella
Gram-negative BacteriaGram-negative Bacteria E coli (including ESBLs) Kl ebsiella pneumoniae (including ESBLs) K oxytoca Acinetobacter baumannii (Resistant strains)Resistant strains) Citrobacter freundii Enterobacter cloacae Enterobacter aerogenes Stenotrophomonas
maltophilia
Does not have good activity Does not have good activity againstagainst P aeruginosa Proteus Providencia
Colistimethate sodium Colistimethate sodium Pseudomonas
aeruginosa infections in cystic fibrosis multidrug-resistant Acinetobacter infection
E-coli Klebsiella sp ( ESBL) Enterobacter Colomycin 1000000 units = 80 mg
colistimethate 6 to 12 mgkg colistimethate sodium per
day 60 kg man recommended dose for
Colomycin is 240 to 480 mg of colistimethate sodium
Nephrotoxicity (damage to the kidneys) and neurotoxicity
抗生素使用常見的五大錯誤
Antibiotic = scanol (antipyretic) S vs R (susceptible vs resistant) 4 gt 3 gt2 gt 1 Treat colonization Vancomycin+ imipenem(atomic
bomb)
Colonization
Positive culture for sputum urine bile stool and skin swab without symptoms or signs of infection Not recommend for using antibiotics
Except asymptomatic bacteriuria before urological work up and in pregnancy should be treated
抗生素使用的適應症
明顯的細菌感染 極可能的細菌感染 敗血症 白血球過低合併發燒 懷疑急性心內膜炎 細菌性腦膜炎 壞死性筋膜炎
常見感染症之抗生素療程 ( 一 )
感染症療程 ( 天 )
菌血症 敗血症 14
肝膿瘍 21
軟組織感染 7-10
急性腎炎 14
細菌性腦膜炎 10
常見感染症之抗生素療程 ( 二 )感染症療程 ( 天 )
1048729
肺炎雙球菌肺炎 14 ()
革蘭氏陰性桿菌肺炎1048729
21 ()
退伍軍人協會症1048729
21
奴卡氏菌肺炎1048729
180-360
感染性心內膜炎 28-42
抗生素治療失敗之原因
選用藥物不恰當 藥物交互作用 降低療效 異異物阻塞或膿瘍未引流 病人免疫力太差 分離菌之判讀錯誤 新的院內感染
Sulfonamides and trimethoprim Inhibit folic acid metabolism Treatment of PCP Nocardia
Toxaplasma Sternotrophomonus Aderverse effect cholestatic jaudice
bone marrow suppression severe hypersensitivity (Stevens-Johnson syndrome)
CarbapenemGroup Classification
Group 1 Broad-spectrum carbapenems with limited activity against non-fermentative Gram-negative bacilli (NFGNB eg Pseudomonas Acinetobacter) that are particularly suitable for community-acquired infections (eg ertapenem)
Group 2 Broad-spectrum carbapenems with activity against non-
fermentative Gram-negative bacilli (eg Pseudomonas
Acinetobacter) that are particularly suitable for nosocomial infections (eg imipenem and meropenem)
Group3 Carbapenems with clinical activity against Methicillin-
Resistant Staphylococcus (eg In development)
J Antimicrob Chemotherapy
Side effect of Carbapenems Anaphylaxis Interstitial nephritis Anemia Leukopenia Precipitate seizure activity
especially old patients CRI preexisting seizure disorder or CNS pathology
AminoglycosidesAminoglycosides
Antimicrobial Spectrum Antimicrobial Spectrum - All Gram negative bacilli
- Staphylococcus aureus Dosage Dosage - Gentamicin loading ~ 2 mgkg maintenance ~ 3-5 mgkgday Amikacin loading ~ 75 mgkg maintenance ~ 5 mgkg Q8H or 75
mgkg q12H Exacin 8mgskgday Single daily (once-daily) dosing (SDD) Short course (3-5 days)
Adverse effects of Adverse effects of aminoglycosidesaminoglycosides Nephrotoxicity Ototoxicity Neuromuscular paralysis ~ High doseinfrequent administration
DECREASES the rate of tissue uptake mdash DELAY the onset
of toxicity doesnrsquot prevent it from happening ~ All patients if treated for a long enough time
will eventually develop toxicity
Fluoroquinolones
Group I
- Nalidixic acid
- Enteric or urinary tract infections Group II
- Ciprofloxacin Ofloxacin Levofloxacin
- GNR (P aeruginosa) S pneumoniae atypicals Group III
- Moxifloxacin Gemifloxacin
- GPB ( S pneumoniaeuarr) atypicals anaerobes GNR
(P aeruginosadarr)
- Respiratory tract infections
GlycopeptidesGlycopeptides
Vancomycin amp Teicoplanin
Non-β-lactam cell wall synthesis inhibitor
Spectrum GPC amp GPB
Avoid oral use except AAC (antibiotic-associated colitis)
Tetracyclines
STD
- Chlamydial
diseases
- Gonorrhea
(doxycycline +
ceftriaxone)
- Syphilis
Rickettsial diseases
Brucellosis
Tularemia
Relapsing fever
Tigecycline (a new class Glycylcyclines)Gram-positive BacteriaGram-positive Bacteria Staphylococcus MRSA
MRSE VRE E faecium E faecalis Streptococcus agalactiae S treptococcus anginosus
group Streptococcus pyogenes
AnaerobesAnaerobes B fragilis group Prevotella spp Peptostreptococcus spp C perfringensAtypicalAtypical Chlamydia pneumoniae Mycoplasma pneumoniae Legionella
Gram-negative BacteriaGram-negative Bacteria E coli (including ESBLs) Kl ebsiella pneumoniae (including ESBLs) K oxytoca Acinetobacter baumannii (Resistant strains)Resistant strains) Citrobacter freundii Enterobacter cloacae Enterobacter aerogenes Stenotrophomonas
maltophilia
Does not have good activity Does not have good activity againstagainst P aeruginosa Proteus Providencia
Colistimethate sodium Colistimethate sodium Pseudomonas
aeruginosa infections in cystic fibrosis multidrug-resistant Acinetobacter infection
E-coli Klebsiella sp ( ESBL) Enterobacter Colomycin 1000000 units = 80 mg
colistimethate 6 to 12 mgkg colistimethate sodium per
day 60 kg man recommended dose for
Colomycin is 240 to 480 mg of colistimethate sodium
Nephrotoxicity (damage to the kidneys) and neurotoxicity
抗生素使用常見的五大錯誤
Antibiotic = scanol (antipyretic) S vs R (susceptible vs resistant) 4 gt 3 gt2 gt 1 Treat colonization Vancomycin+ imipenem(atomic
bomb)
Colonization
Positive culture for sputum urine bile stool and skin swab without symptoms or signs of infection Not recommend for using antibiotics
Except asymptomatic bacteriuria before urological work up and in pregnancy should be treated
抗生素使用的適應症
明顯的細菌感染 極可能的細菌感染 敗血症 白血球過低合併發燒 懷疑急性心內膜炎 細菌性腦膜炎 壞死性筋膜炎
常見感染症之抗生素療程 ( 一 )
感染症療程 ( 天 )
菌血症 敗血症 14
肝膿瘍 21
軟組織感染 7-10
急性腎炎 14
細菌性腦膜炎 10
常見感染症之抗生素療程 ( 二 )感染症療程 ( 天 )
1048729
肺炎雙球菌肺炎 14 ()
革蘭氏陰性桿菌肺炎1048729
21 ()
退伍軍人協會症1048729
21
奴卡氏菌肺炎1048729
180-360
感染性心內膜炎 28-42
抗生素治療失敗之原因
選用藥物不恰當 藥物交互作用 降低療效 異異物阻塞或膿瘍未引流 病人免疫力太差 分離菌之判讀錯誤 新的院內感染
CarbapenemGroup Classification
Group 1 Broad-spectrum carbapenems with limited activity against non-fermentative Gram-negative bacilli (NFGNB eg Pseudomonas Acinetobacter) that are particularly suitable for community-acquired infections (eg ertapenem)
Group 2 Broad-spectrum carbapenems with activity against non-
fermentative Gram-negative bacilli (eg Pseudomonas
Acinetobacter) that are particularly suitable for nosocomial infections (eg imipenem and meropenem)
Group3 Carbapenems with clinical activity against Methicillin-
Resistant Staphylococcus (eg In development)
J Antimicrob Chemotherapy
Side effect of Carbapenems Anaphylaxis Interstitial nephritis Anemia Leukopenia Precipitate seizure activity
especially old patients CRI preexisting seizure disorder or CNS pathology
AminoglycosidesAminoglycosides
Antimicrobial Spectrum Antimicrobial Spectrum - All Gram negative bacilli
- Staphylococcus aureus Dosage Dosage - Gentamicin loading ~ 2 mgkg maintenance ~ 3-5 mgkgday Amikacin loading ~ 75 mgkg maintenance ~ 5 mgkg Q8H or 75
mgkg q12H Exacin 8mgskgday Single daily (once-daily) dosing (SDD) Short course (3-5 days)
Adverse effects of Adverse effects of aminoglycosidesaminoglycosides Nephrotoxicity Ototoxicity Neuromuscular paralysis ~ High doseinfrequent administration
DECREASES the rate of tissue uptake mdash DELAY the onset
of toxicity doesnrsquot prevent it from happening ~ All patients if treated for a long enough time
will eventually develop toxicity
Fluoroquinolones
Group I
- Nalidixic acid
- Enteric or urinary tract infections Group II
- Ciprofloxacin Ofloxacin Levofloxacin
- GNR (P aeruginosa) S pneumoniae atypicals Group III
- Moxifloxacin Gemifloxacin
- GPB ( S pneumoniaeuarr) atypicals anaerobes GNR
(P aeruginosadarr)
- Respiratory tract infections
GlycopeptidesGlycopeptides
Vancomycin amp Teicoplanin
Non-β-lactam cell wall synthesis inhibitor
Spectrum GPC amp GPB
Avoid oral use except AAC (antibiotic-associated colitis)
Tetracyclines
STD
- Chlamydial
diseases
- Gonorrhea
(doxycycline +
ceftriaxone)
- Syphilis
Rickettsial diseases
Brucellosis
Tularemia
Relapsing fever
Tigecycline (a new class Glycylcyclines)Gram-positive BacteriaGram-positive Bacteria Staphylococcus MRSA
MRSE VRE E faecium E faecalis Streptococcus agalactiae S treptococcus anginosus
group Streptococcus pyogenes
AnaerobesAnaerobes B fragilis group Prevotella spp Peptostreptococcus spp C perfringensAtypicalAtypical Chlamydia pneumoniae Mycoplasma pneumoniae Legionella
Gram-negative BacteriaGram-negative Bacteria E coli (including ESBLs) Kl ebsiella pneumoniae (including ESBLs) K oxytoca Acinetobacter baumannii (Resistant strains)Resistant strains) Citrobacter freundii Enterobacter cloacae Enterobacter aerogenes Stenotrophomonas
maltophilia
Does not have good activity Does not have good activity againstagainst P aeruginosa Proteus Providencia
Colistimethate sodium Colistimethate sodium Pseudomonas
aeruginosa infections in cystic fibrosis multidrug-resistant Acinetobacter infection
E-coli Klebsiella sp ( ESBL) Enterobacter Colomycin 1000000 units = 80 mg
colistimethate 6 to 12 mgkg colistimethate sodium per
day 60 kg man recommended dose for
Colomycin is 240 to 480 mg of colistimethate sodium
Nephrotoxicity (damage to the kidneys) and neurotoxicity
抗生素使用常見的五大錯誤
Antibiotic = scanol (antipyretic) S vs R (susceptible vs resistant) 4 gt 3 gt2 gt 1 Treat colonization Vancomycin+ imipenem(atomic
bomb)
Colonization
Positive culture for sputum urine bile stool and skin swab without symptoms or signs of infection Not recommend for using antibiotics
Except asymptomatic bacteriuria before urological work up and in pregnancy should be treated
抗生素使用的適應症
明顯的細菌感染 極可能的細菌感染 敗血症 白血球過低合併發燒 懷疑急性心內膜炎 細菌性腦膜炎 壞死性筋膜炎
常見感染症之抗生素療程 ( 一 )
感染症療程 ( 天 )
菌血症 敗血症 14
肝膿瘍 21
軟組織感染 7-10
急性腎炎 14
細菌性腦膜炎 10
常見感染症之抗生素療程 ( 二 )感染症療程 ( 天 )
1048729
肺炎雙球菌肺炎 14 ()
革蘭氏陰性桿菌肺炎1048729
21 ()
退伍軍人協會症1048729
21
奴卡氏菌肺炎1048729
180-360
感染性心內膜炎 28-42
抗生素治療失敗之原因
選用藥物不恰當 藥物交互作用 降低療效 異異物阻塞或膿瘍未引流 病人免疫力太差 分離菌之判讀錯誤 新的院內感染
Side effect of Carbapenems Anaphylaxis Interstitial nephritis Anemia Leukopenia Precipitate seizure activity
especially old patients CRI preexisting seizure disorder or CNS pathology
AminoglycosidesAminoglycosides
Antimicrobial Spectrum Antimicrobial Spectrum - All Gram negative bacilli
- Staphylococcus aureus Dosage Dosage - Gentamicin loading ~ 2 mgkg maintenance ~ 3-5 mgkgday Amikacin loading ~ 75 mgkg maintenance ~ 5 mgkg Q8H or 75
mgkg q12H Exacin 8mgskgday Single daily (once-daily) dosing (SDD) Short course (3-5 days)
Adverse effects of Adverse effects of aminoglycosidesaminoglycosides Nephrotoxicity Ototoxicity Neuromuscular paralysis ~ High doseinfrequent administration
DECREASES the rate of tissue uptake mdash DELAY the onset
of toxicity doesnrsquot prevent it from happening ~ All patients if treated for a long enough time
will eventually develop toxicity
Fluoroquinolones
Group I
- Nalidixic acid
- Enteric or urinary tract infections Group II
- Ciprofloxacin Ofloxacin Levofloxacin
- GNR (P aeruginosa) S pneumoniae atypicals Group III
- Moxifloxacin Gemifloxacin
- GPB ( S pneumoniaeuarr) atypicals anaerobes GNR
(P aeruginosadarr)
- Respiratory tract infections
GlycopeptidesGlycopeptides
Vancomycin amp Teicoplanin
Non-β-lactam cell wall synthesis inhibitor
Spectrum GPC amp GPB
Avoid oral use except AAC (antibiotic-associated colitis)
Tetracyclines
STD
- Chlamydial
diseases
- Gonorrhea
(doxycycline +
ceftriaxone)
- Syphilis
Rickettsial diseases
Brucellosis
Tularemia
Relapsing fever
Tigecycline (a new class Glycylcyclines)Gram-positive BacteriaGram-positive Bacteria Staphylococcus MRSA
MRSE VRE E faecium E faecalis Streptococcus agalactiae S treptococcus anginosus
group Streptococcus pyogenes
AnaerobesAnaerobes B fragilis group Prevotella spp Peptostreptococcus spp C perfringensAtypicalAtypical Chlamydia pneumoniae Mycoplasma pneumoniae Legionella
Gram-negative BacteriaGram-negative Bacteria E coli (including ESBLs) Kl ebsiella pneumoniae (including ESBLs) K oxytoca Acinetobacter baumannii (Resistant strains)Resistant strains) Citrobacter freundii Enterobacter cloacae Enterobacter aerogenes Stenotrophomonas
maltophilia
Does not have good activity Does not have good activity againstagainst P aeruginosa Proteus Providencia
Colistimethate sodium Colistimethate sodium Pseudomonas
aeruginosa infections in cystic fibrosis multidrug-resistant Acinetobacter infection
E-coli Klebsiella sp ( ESBL) Enterobacter Colomycin 1000000 units = 80 mg
colistimethate 6 to 12 mgkg colistimethate sodium per
day 60 kg man recommended dose for
Colomycin is 240 to 480 mg of colistimethate sodium
Nephrotoxicity (damage to the kidneys) and neurotoxicity
抗生素使用常見的五大錯誤
Antibiotic = scanol (antipyretic) S vs R (susceptible vs resistant) 4 gt 3 gt2 gt 1 Treat colonization Vancomycin+ imipenem(atomic
bomb)
Colonization
Positive culture for sputum urine bile stool and skin swab without symptoms or signs of infection Not recommend for using antibiotics
Except asymptomatic bacteriuria before urological work up and in pregnancy should be treated
抗生素使用的適應症
明顯的細菌感染 極可能的細菌感染 敗血症 白血球過低合併發燒 懷疑急性心內膜炎 細菌性腦膜炎 壞死性筋膜炎
常見感染症之抗生素療程 ( 一 )
感染症療程 ( 天 )
菌血症 敗血症 14
肝膿瘍 21
軟組織感染 7-10
急性腎炎 14
細菌性腦膜炎 10
常見感染症之抗生素療程 ( 二 )感染症療程 ( 天 )
1048729
肺炎雙球菌肺炎 14 ()
革蘭氏陰性桿菌肺炎1048729
21 ()
退伍軍人協會症1048729
21
奴卡氏菌肺炎1048729
180-360
感染性心內膜炎 28-42
抗生素治療失敗之原因
選用藥物不恰當 藥物交互作用 降低療效 異異物阻塞或膿瘍未引流 病人免疫力太差 分離菌之判讀錯誤 新的院內感染
AminoglycosidesAminoglycosides
Antimicrobial Spectrum Antimicrobial Spectrum - All Gram negative bacilli
- Staphylococcus aureus Dosage Dosage - Gentamicin loading ~ 2 mgkg maintenance ~ 3-5 mgkgday Amikacin loading ~ 75 mgkg maintenance ~ 5 mgkg Q8H or 75
mgkg q12H Exacin 8mgskgday Single daily (once-daily) dosing (SDD) Short course (3-5 days)
Adverse effects of Adverse effects of aminoglycosidesaminoglycosides Nephrotoxicity Ototoxicity Neuromuscular paralysis ~ High doseinfrequent administration
DECREASES the rate of tissue uptake mdash DELAY the onset
of toxicity doesnrsquot prevent it from happening ~ All patients if treated for a long enough time
will eventually develop toxicity
Fluoroquinolones
Group I
- Nalidixic acid
- Enteric or urinary tract infections Group II
- Ciprofloxacin Ofloxacin Levofloxacin
- GNR (P aeruginosa) S pneumoniae atypicals Group III
- Moxifloxacin Gemifloxacin
- GPB ( S pneumoniaeuarr) atypicals anaerobes GNR
(P aeruginosadarr)
- Respiratory tract infections
GlycopeptidesGlycopeptides
Vancomycin amp Teicoplanin
Non-β-lactam cell wall synthesis inhibitor
Spectrum GPC amp GPB
Avoid oral use except AAC (antibiotic-associated colitis)
Tetracyclines
STD
- Chlamydial
diseases
- Gonorrhea
(doxycycline +
ceftriaxone)
- Syphilis
Rickettsial diseases
Brucellosis
Tularemia
Relapsing fever
Tigecycline (a new class Glycylcyclines)Gram-positive BacteriaGram-positive Bacteria Staphylococcus MRSA
MRSE VRE E faecium E faecalis Streptococcus agalactiae S treptococcus anginosus
group Streptococcus pyogenes
AnaerobesAnaerobes B fragilis group Prevotella spp Peptostreptococcus spp C perfringensAtypicalAtypical Chlamydia pneumoniae Mycoplasma pneumoniae Legionella
Gram-negative BacteriaGram-negative Bacteria E coli (including ESBLs) Kl ebsiella pneumoniae (including ESBLs) K oxytoca Acinetobacter baumannii (Resistant strains)Resistant strains) Citrobacter freundii Enterobacter cloacae Enterobacter aerogenes Stenotrophomonas
maltophilia
Does not have good activity Does not have good activity againstagainst P aeruginosa Proteus Providencia
Colistimethate sodium Colistimethate sodium Pseudomonas
aeruginosa infections in cystic fibrosis multidrug-resistant Acinetobacter infection
E-coli Klebsiella sp ( ESBL) Enterobacter Colomycin 1000000 units = 80 mg
colistimethate 6 to 12 mgkg colistimethate sodium per
day 60 kg man recommended dose for
Colomycin is 240 to 480 mg of colistimethate sodium
Nephrotoxicity (damage to the kidneys) and neurotoxicity
抗生素使用常見的五大錯誤
Antibiotic = scanol (antipyretic) S vs R (susceptible vs resistant) 4 gt 3 gt2 gt 1 Treat colonization Vancomycin+ imipenem(atomic
bomb)
Colonization
Positive culture for sputum urine bile stool and skin swab without symptoms or signs of infection Not recommend for using antibiotics
Except asymptomatic bacteriuria before urological work up and in pregnancy should be treated
抗生素使用的適應症
明顯的細菌感染 極可能的細菌感染 敗血症 白血球過低合併發燒 懷疑急性心內膜炎 細菌性腦膜炎 壞死性筋膜炎
常見感染症之抗生素療程 ( 一 )
感染症療程 ( 天 )
菌血症 敗血症 14
肝膿瘍 21
軟組織感染 7-10
急性腎炎 14
細菌性腦膜炎 10
常見感染症之抗生素療程 ( 二 )感染症療程 ( 天 )
1048729
肺炎雙球菌肺炎 14 ()
革蘭氏陰性桿菌肺炎1048729
21 ()
退伍軍人協會症1048729
21
奴卡氏菌肺炎1048729
180-360
感染性心內膜炎 28-42
抗生素治療失敗之原因
選用藥物不恰當 藥物交互作用 降低療效 異異物阻塞或膿瘍未引流 病人免疫力太差 分離菌之判讀錯誤 新的院內感染
Adverse effects of Adverse effects of aminoglycosidesaminoglycosides Nephrotoxicity Ototoxicity Neuromuscular paralysis ~ High doseinfrequent administration
DECREASES the rate of tissue uptake mdash DELAY the onset
of toxicity doesnrsquot prevent it from happening ~ All patients if treated for a long enough time
will eventually develop toxicity
Fluoroquinolones
Group I
- Nalidixic acid
- Enteric or urinary tract infections Group II
- Ciprofloxacin Ofloxacin Levofloxacin
- GNR (P aeruginosa) S pneumoniae atypicals Group III
- Moxifloxacin Gemifloxacin
- GPB ( S pneumoniaeuarr) atypicals anaerobes GNR
(P aeruginosadarr)
- Respiratory tract infections
GlycopeptidesGlycopeptides
Vancomycin amp Teicoplanin
Non-β-lactam cell wall synthesis inhibitor
Spectrum GPC amp GPB
Avoid oral use except AAC (antibiotic-associated colitis)
Tetracyclines
STD
- Chlamydial
diseases
- Gonorrhea
(doxycycline +
ceftriaxone)
- Syphilis
Rickettsial diseases
Brucellosis
Tularemia
Relapsing fever
Tigecycline (a new class Glycylcyclines)Gram-positive BacteriaGram-positive Bacteria Staphylococcus MRSA
MRSE VRE E faecium E faecalis Streptococcus agalactiae S treptococcus anginosus
group Streptococcus pyogenes
AnaerobesAnaerobes B fragilis group Prevotella spp Peptostreptococcus spp C perfringensAtypicalAtypical Chlamydia pneumoniae Mycoplasma pneumoniae Legionella
Gram-negative BacteriaGram-negative Bacteria E coli (including ESBLs) Kl ebsiella pneumoniae (including ESBLs) K oxytoca Acinetobacter baumannii (Resistant strains)Resistant strains) Citrobacter freundii Enterobacter cloacae Enterobacter aerogenes Stenotrophomonas
maltophilia
Does not have good activity Does not have good activity againstagainst P aeruginosa Proteus Providencia
Colistimethate sodium Colistimethate sodium Pseudomonas
aeruginosa infections in cystic fibrosis multidrug-resistant Acinetobacter infection
E-coli Klebsiella sp ( ESBL) Enterobacter Colomycin 1000000 units = 80 mg
colistimethate 6 to 12 mgkg colistimethate sodium per
day 60 kg man recommended dose for
Colomycin is 240 to 480 mg of colistimethate sodium
Nephrotoxicity (damage to the kidneys) and neurotoxicity
抗生素使用常見的五大錯誤
Antibiotic = scanol (antipyretic) S vs R (susceptible vs resistant) 4 gt 3 gt2 gt 1 Treat colonization Vancomycin+ imipenem(atomic
bomb)
Colonization
Positive culture for sputum urine bile stool and skin swab without symptoms or signs of infection Not recommend for using antibiotics
Except asymptomatic bacteriuria before urological work up and in pregnancy should be treated
抗生素使用的適應症
明顯的細菌感染 極可能的細菌感染 敗血症 白血球過低合併發燒 懷疑急性心內膜炎 細菌性腦膜炎 壞死性筋膜炎
常見感染症之抗生素療程 ( 一 )
感染症療程 ( 天 )
菌血症 敗血症 14
肝膿瘍 21
軟組織感染 7-10
急性腎炎 14
細菌性腦膜炎 10
常見感染症之抗生素療程 ( 二 )感染症療程 ( 天 )
1048729
肺炎雙球菌肺炎 14 ()
革蘭氏陰性桿菌肺炎1048729
21 ()
退伍軍人協會症1048729
21
奴卡氏菌肺炎1048729
180-360
感染性心內膜炎 28-42
抗生素治療失敗之原因
選用藥物不恰當 藥物交互作用 降低療效 異異物阻塞或膿瘍未引流 病人免疫力太差 分離菌之判讀錯誤 新的院內感染
Fluoroquinolones
Group I
- Nalidixic acid
- Enteric or urinary tract infections Group II
- Ciprofloxacin Ofloxacin Levofloxacin
- GNR (P aeruginosa) S pneumoniae atypicals Group III
- Moxifloxacin Gemifloxacin
- GPB ( S pneumoniaeuarr) atypicals anaerobes GNR
(P aeruginosadarr)
- Respiratory tract infections
GlycopeptidesGlycopeptides
Vancomycin amp Teicoplanin
Non-β-lactam cell wall synthesis inhibitor
Spectrum GPC amp GPB
Avoid oral use except AAC (antibiotic-associated colitis)
Tetracyclines
STD
- Chlamydial
diseases
- Gonorrhea
(doxycycline +
ceftriaxone)
- Syphilis
Rickettsial diseases
Brucellosis
Tularemia
Relapsing fever
Tigecycline (a new class Glycylcyclines)Gram-positive BacteriaGram-positive Bacteria Staphylococcus MRSA
MRSE VRE E faecium E faecalis Streptococcus agalactiae S treptococcus anginosus
group Streptococcus pyogenes
AnaerobesAnaerobes B fragilis group Prevotella spp Peptostreptococcus spp C perfringensAtypicalAtypical Chlamydia pneumoniae Mycoplasma pneumoniae Legionella
Gram-negative BacteriaGram-negative Bacteria E coli (including ESBLs) Kl ebsiella pneumoniae (including ESBLs) K oxytoca Acinetobacter baumannii (Resistant strains)Resistant strains) Citrobacter freundii Enterobacter cloacae Enterobacter aerogenes Stenotrophomonas
maltophilia
Does not have good activity Does not have good activity againstagainst P aeruginosa Proteus Providencia
Colistimethate sodium Colistimethate sodium Pseudomonas
aeruginosa infections in cystic fibrosis multidrug-resistant Acinetobacter infection
E-coli Klebsiella sp ( ESBL) Enterobacter Colomycin 1000000 units = 80 mg
colistimethate 6 to 12 mgkg colistimethate sodium per
day 60 kg man recommended dose for
Colomycin is 240 to 480 mg of colistimethate sodium
Nephrotoxicity (damage to the kidneys) and neurotoxicity
抗生素使用常見的五大錯誤
Antibiotic = scanol (antipyretic) S vs R (susceptible vs resistant) 4 gt 3 gt2 gt 1 Treat colonization Vancomycin+ imipenem(atomic
bomb)
Colonization
Positive culture for sputum urine bile stool and skin swab without symptoms or signs of infection Not recommend for using antibiotics
Except asymptomatic bacteriuria before urological work up and in pregnancy should be treated
抗生素使用的適應症
明顯的細菌感染 極可能的細菌感染 敗血症 白血球過低合併發燒 懷疑急性心內膜炎 細菌性腦膜炎 壞死性筋膜炎
常見感染症之抗生素療程 ( 一 )
感染症療程 ( 天 )
菌血症 敗血症 14
肝膿瘍 21
軟組織感染 7-10
急性腎炎 14
細菌性腦膜炎 10
常見感染症之抗生素療程 ( 二 )感染症療程 ( 天 )
1048729
肺炎雙球菌肺炎 14 ()
革蘭氏陰性桿菌肺炎1048729
21 ()
退伍軍人協會症1048729
21
奴卡氏菌肺炎1048729
180-360
感染性心內膜炎 28-42
抗生素治療失敗之原因
選用藥物不恰當 藥物交互作用 降低療效 異異物阻塞或膿瘍未引流 病人免疫力太差 分離菌之判讀錯誤 新的院內感染
GlycopeptidesGlycopeptides
Vancomycin amp Teicoplanin
Non-β-lactam cell wall synthesis inhibitor
Spectrum GPC amp GPB
Avoid oral use except AAC (antibiotic-associated colitis)
Tetracyclines
STD
- Chlamydial
diseases
- Gonorrhea
(doxycycline +
ceftriaxone)
- Syphilis
Rickettsial diseases
Brucellosis
Tularemia
Relapsing fever
Tigecycline (a new class Glycylcyclines)Gram-positive BacteriaGram-positive Bacteria Staphylococcus MRSA
MRSE VRE E faecium E faecalis Streptococcus agalactiae S treptococcus anginosus
group Streptococcus pyogenes
AnaerobesAnaerobes B fragilis group Prevotella spp Peptostreptococcus spp C perfringensAtypicalAtypical Chlamydia pneumoniae Mycoplasma pneumoniae Legionella
Gram-negative BacteriaGram-negative Bacteria E coli (including ESBLs) Kl ebsiella pneumoniae (including ESBLs) K oxytoca Acinetobacter baumannii (Resistant strains)Resistant strains) Citrobacter freundii Enterobacter cloacae Enterobacter aerogenes Stenotrophomonas
maltophilia
Does not have good activity Does not have good activity againstagainst P aeruginosa Proteus Providencia
Colistimethate sodium Colistimethate sodium Pseudomonas
aeruginosa infections in cystic fibrosis multidrug-resistant Acinetobacter infection
E-coli Klebsiella sp ( ESBL) Enterobacter Colomycin 1000000 units = 80 mg
colistimethate 6 to 12 mgkg colistimethate sodium per
day 60 kg man recommended dose for
Colomycin is 240 to 480 mg of colistimethate sodium
Nephrotoxicity (damage to the kidneys) and neurotoxicity
抗生素使用常見的五大錯誤
Antibiotic = scanol (antipyretic) S vs R (susceptible vs resistant) 4 gt 3 gt2 gt 1 Treat colonization Vancomycin+ imipenem(atomic
bomb)
Colonization
Positive culture for sputum urine bile stool and skin swab without symptoms or signs of infection Not recommend for using antibiotics
Except asymptomatic bacteriuria before urological work up and in pregnancy should be treated
抗生素使用的適應症
明顯的細菌感染 極可能的細菌感染 敗血症 白血球過低合併發燒 懷疑急性心內膜炎 細菌性腦膜炎 壞死性筋膜炎
常見感染症之抗生素療程 ( 一 )
感染症療程 ( 天 )
菌血症 敗血症 14
肝膿瘍 21
軟組織感染 7-10
急性腎炎 14
細菌性腦膜炎 10
常見感染症之抗生素療程 ( 二 )感染症療程 ( 天 )
1048729
肺炎雙球菌肺炎 14 ()
革蘭氏陰性桿菌肺炎1048729
21 ()
退伍軍人協會症1048729
21
奴卡氏菌肺炎1048729
180-360
感染性心內膜炎 28-42
抗生素治療失敗之原因
選用藥物不恰當 藥物交互作用 降低療效 異異物阻塞或膿瘍未引流 病人免疫力太差 分離菌之判讀錯誤 新的院內感染
Tetracyclines
STD
- Chlamydial
diseases
- Gonorrhea
(doxycycline +
ceftriaxone)
- Syphilis
Rickettsial diseases
Brucellosis
Tularemia
Relapsing fever
Tigecycline (a new class Glycylcyclines)Gram-positive BacteriaGram-positive Bacteria Staphylococcus MRSA
MRSE VRE E faecium E faecalis Streptococcus agalactiae S treptococcus anginosus
group Streptococcus pyogenes
AnaerobesAnaerobes B fragilis group Prevotella spp Peptostreptococcus spp C perfringensAtypicalAtypical Chlamydia pneumoniae Mycoplasma pneumoniae Legionella
Gram-negative BacteriaGram-negative Bacteria E coli (including ESBLs) Kl ebsiella pneumoniae (including ESBLs) K oxytoca Acinetobacter baumannii (Resistant strains)Resistant strains) Citrobacter freundii Enterobacter cloacae Enterobacter aerogenes Stenotrophomonas
maltophilia
Does not have good activity Does not have good activity againstagainst P aeruginosa Proteus Providencia
Colistimethate sodium Colistimethate sodium Pseudomonas
aeruginosa infections in cystic fibrosis multidrug-resistant Acinetobacter infection
E-coli Klebsiella sp ( ESBL) Enterobacter Colomycin 1000000 units = 80 mg
colistimethate 6 to 12 mgkg colistimethate sodium per
day 60 kg man recommended dose for
Colomycin is 240 to 480 mg of colistimethate sodium
Nephrotoxicity (damage to the kidneys) and neurotoxicity
抗生素使用常見的五大錯誤
Antibiotic = scanol (antipyretic) S vs R (susceptible vs resistant) 4 gt 3 gt2 gt 1 Treat colonization Vancomycin+ imipenem(atomic
bomb)
Colonization
Positive culture for sputum urine bile stool and skin swab without symptoms or signs of infection Not recommend for using antibiotics
Except asymptomatic bacteriuria before urological work up and in pregnancy should be treated
抗生素使用的適應症
明顯的細菌感染 極可能的細菌感染 敗血症 白血球過低合併發燒 懷疑急性心內膜炎 細菌性腦膜炎 壞死性筋膜炎
常見感染症之抗生素療程 ( 一 )
感染症療程 ( 天 )
菌血症 敗血症 14
肝膿瘍 21
軟組織感染 7-10
急性腎炎 14
細菌性腦膜炎 10
常見感染症之抗生素療程 ( 二 )感染症療程 ( 天 )
1048729
肺炎雙球菌肺炎 14 ()
革蘭氏陰性桿菌肺炎1048729
21 ()
退伍軍人協會症1048729
21
奴卡氏菌肺炎1048729
180-360
感染性心內膜炎 28-42
抗生素治療失敗之原因
選用藥物不恰當 藥物交互作用 降低療效 異異物阻塞或膿瘍未引流 病人免疫力太差 分離菌之判讀錯誤 新的院內感染
Tigecycline (a new class Glycylcyclines)Gram-positive BacteriaGram-positive Bacteria Staphylococcus MRSA
MRSE VRE E faecium E faecalis Streptococcus agalactiae S treptococcus anginosus
group Streptococcus pyogenes
AnaerobesAnaerobes B fragilis group Prevotella spp Peptostreptococcus spp C perfringensAtypicalAtypical Chlamydia pneumoniae Mycoplasma pneumoniae Legionella
Gram-negative BacteriaGram-negative Bacteria E coli (including ESBLs) Kl ebsiella pneumoniae (including ESBLs) K oxytoca Acinetobacter baumannii (Resistant strains)Resistant strains) Citrobacter freundii Enterobacter cloacae Enterobacter aerogenes Stenotrophomonas
maltophilia
Does not have good activity Does not have good activity againstagainst P aeruginosa Proteus Providencia
Colistimethate sodium Colistimethate sodium Pseudomonas
aeruginosa infections in cystic fibrosis multidrug-resistant Acinetobacter infection
E-coli Klebsiella sp ( ESBL) Enterobacter Colomycin 1000000 units = 80 mg
colistimethate 6 to 12 mgkg colistimethate sodium per
day 60 kg man recommended dose for
Colomycin is 240 to 480 mg of colistimethate sodium
Nephrotoxicity (damage to the kidneys) and neurotoxicity
抗生素使用常見的五大錯誤
Antibiotic = scanol (antipyretic) S vs R (susceptible vs resistant) 4 gt 3 gt2 gt 1 Treat colonization Vancomycin+ imipenem(atomic
bomb)
Colonization
Positive culture for sputum urine bile stool and skin swab without symptoms or signs of infection Not recommend for using antibiotics
Except asymptomatic bacteriuria before urological work up and in pregnancy should be treated
抗生素使用的適應症
明顯的細菌感染 極可能的細菌感染 敗血症 白血球過低合併發燒 懷疑急性心內膜炎 細菌性腦膜炎 壞死性筋膜炎
常見感染症之抗生素療程 ( 一 )
感染症療程 ( 天 )
菌血症 敗血症 14
肝膿瘍 21
軟組織感染 7-10
急性腎炎 14
細菌性腦膜炎 10
常見感染症之抗生素療程 ( 二 )感染症療程 ( 天 )
1048729
肺炎雙球菌肺炎 14 ()
革蘭氏陰性桿菌肺炎1048729
21 ()
退伍軍人協會症1048729
21
奴卡氏菌肺炎1048729
180-360
感染性心內膜炎 28-42
抗生素治療失敗之原因
選用藥物不恰當 藥物交互作用 降低療效 異異物阻塞或膿瘍未引流 病人免疫力太差 分離菌之判讀錯誤 新的院內感染
Colistimethate sodium Colistimethate sodium Pseudomonas
aeruginosa infections in cystic fibrosis multidrug-resistant Acinetobacter infection
E-coli Klebsiella sp ( ESBL) Enterobacter Colomycin 1000000 units = 80 mg
colistimethate 6 to 12 mgkg colistimethate sodium per
day 60 kg man recommended dose for
Colomycin is 240 to 480 mg of colistimethate sodium
Nephrotoxicity (damage to the kidneys) and neurotoxicity
抗生素使用常見的五大錯誤
Antibiotic = scanol (antipyretic) S vs R (susceptible vs resistant) 4 gt 3 gt2 gt 1 Treat colonization Vancomycin+ imipenem(atomic
bomb)
Colonization
Positive culture for sputum urine bile stool and skin swab without symptoms or signs of infection Not recommend for using antibiotics
Except asymptomatic bacteriuria before urological work up and in pregnancy should be treated
抗生素使用的適應症
明顯的細菌感染 極可能的細菌感染 敗血症 白血球過低合併發燒 懷疑急性心內膜炎 細菌性腦膜炎 壞死性筋膜炎
常見感染症之抗生素療程 ( 一 )
感染症療程 ( 天 )
菌血症 敗血症 14
肝膿瘍 21
軟組織感染 7-10
急性腎炎 14
細菌性腦膜炎 10
常見感染症之抗生素療程 ( 二 )感染症療程 ( 天 )
1048729
肺炎雙球菌肺炎 14 ()
革蘭氏陰性桿菌肺炎1048729
21 ()
退伍軍人協會症1048729
21
奴卡氏菌肺炎1048729
180-360
感染性心內膜炎 28-42
抗生素治療失敗之原因
選用藥物不恰當 藥物交互作用 降低療效 異異物阻塞或膿瘍未引流 病人免疫力太差 分離菌之判讀錯誤 新的院內感染
抗生素使用常見的五大錯誤
Antibiotic = scanol (antipyretic) S vs R (susceptible vs resistant) 4 gt 3 gt2 gt 1 Treat colonization Vancomycin+ imipenem(atomic
bomb)
Colonization
Positive culture for sputum urine bile stool and skin swab without symptoms or signs of infection Not recommend for using antibiotics
Except asymptomatic bacteriuria before urological work up and in pregnancy should be treated
抗生素使用的適應症
明顯的細菌感染 極可能的細菌感染 敗血症 白血球過低合併發燒 懷疑急性心內膜炎 細菌性腦膜炎 壞死性筋膜炎
常見感染症之抗生素療程 ( 一 )
感染症療程 ( 天 )
菌血症 敗血症 14
肝膿瘍 21
軟組織感染 7-10
急性腎炎 14
細菌性腦膜炎 10
常見感染症之抗生素療程 ( 二 )感染症療程 ( 天 )
1048729
肺炎雙球菌肺炎 14 ()
革蘭氏陰性桿菌肺炎1048729
21 ()
退伍軍人協會症1048729
21
奴卡氏菌肺炎1048729
180-360
感染性心內膜炎 28-42
抗生素治療失敗之原因
選用藥物不恰當 藥物交互作用 降低療效 異異物阻塞或膿瘍未引流 病人免疫力太差 分離菌之判讀錯誤 新的院內感染
Colonization
Positive culture for sputum urine bile stool and skin swab without symptoms or signs of infection Not recommend for using antibiotics
Except asymptomatic bacteriuria before urological work up and in pregnancy should be treated
抗生素使用的適應症
明顯的細菌感染 極可能的細菌感染 敗血症 白血球過低合併發燒 懷疑急性心內膜炎 細菌性腦膜炎 壞死性筋膜炎
常見感染症之抗生素療程 ( 一 )
感染症療程 ( 天 )
菌血症 敗血症 14
肝膿瘍 21
軟組織感染 7-10
急性腎炎 14
細菌性腦膜炎 10
常見感染症之抗生素療程 ( 二 )感染症療程 ( 天 )
1048729
肺炎雙球菌肺炎 14 ()
革蘭氏陰性桿菌肺炎1048729
21 ()
退伍軍人協會症1048729
21
奴卡氏菌肺炎1048729
180-360
感染性心內膜炎 28-42
抗生素治療失敗之原因
選用藥物不恰當 藥物交互作用 降低療效 異異物阻塞或膿瘍未引流 病人免疫力太差 分離菌之判讀錯誤 新的院內感染
抗生素使用的適應症
明顯的細菌感染 極可能的細菌感染 敗血症 白血球過低合併發燒 懷疑急性心內膜炎 細菌性腦膜炎 壞死性筋膜炎
常見感染症之抗生素療程 ( 一 )
感染症療程 ( 天 )
菌血症 敗血症 14
肝膿瘍 21
軟組織感染 7-10
急性腎炎 14
細菌性腦膜炎 10
常見感染症之抗生素療程 ( 二 )感染症療程 ( 天 )
1048729
肺炎雙球菌肺炎 14 ()
革蘭氏陰性桿菌肺炎1048729
21 ()
退伍軍人協會症1048729
21
奴卡氏菌肺炎1048729
180-360
感染性心內膜炎 28-42
抗生素治療失敗之原因
選用藥物不恰當 藥物交互作用 降低療效 異異物阻塞或膿瘍未引流 病人免疫力太差 分離菌之判讀錯誤 新的院內感染
常見感染症之抗生素療程 ( 一 )
感染症療程 ( 天 )
菌血症 敗血症 14
肝膿瘍 21
軟組織感染 7-10
急性腎炎 14
細菌性腦膜炎 10
常見感染症之抗生素療程 ( 二 )感染症療程 ( 天 )
1048729
肺炎雙球菌肺炎 14 ()
革蘭氏陰性桿菌肺炎1048729
21 ()
退伍軍人協會症1048729
21
奴卡氏菌肺炎1048729
180-360
感染性心內膜炎 28-42
抗生素治療失敗之原因
選用藥物不恰當 藥物交互作用 降低療效 異異物阻塞或膿瘍未引流 病人免疫力太差 分離菌之判讀錯誤 新的院內感染
常見感染症之抗生素療程 ( 二 )感染症療程 ( 天 )
1048729
肺炎雙球菌肺炎 14 ()
革蘭氏陰性桿菌肺炎1048729
21 ()
退伍軍人協會症1048729
21
奴卡氏菌肺炎1048729
180-360
感染性心內膜炎 28-42
抗生素治療失敗之原因
選用藥物不恰當 藥物交互作用 降低療效 異異物阻塞或膿瘍未引流 病人免疫力太差 分離菌之判讀錯誤 新的院內感染
抗生素治療失敗之原因
選用藥物不恰當 藥物交互作用 降低療效 異異物阻塞或膿瘍未引流 病人免疫力太差 分離菌之判讀錯誤 新的院內感染