急诊病房抗生素应用的临床审查英文PPTClinicalAuditoftheUseofAntibiot
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抗生素PPT课件(英文精品) Antibiotic Use in Care Homes
Whilst there have been many efforts to reduce the inappropriate use of antibiotics across the health care community it is still widely believed that practitioners are continuing to prescribe inappropriately despite evidence that more care needs to be taken in the prescription of antibiotics and the length of treatment
Antibiotic Use in Care Homes
An audit completed in 2009 by the Quality, Standards and Effectiveness Directorate
Presented by Rosalind Way
Infection Prevention and the Safe Environment Nursing Home Conference 16th March 2010 The Crofters Hotel, Garstang
It is therefore important that antibiotic guidelines are followed as closely as possible for the majority of patients
Whilst it is acknowledged that elderly patients may require multiple prescriptions (polypharmacy) the effects of these need to be closely monitored.
Antibiotic Use in Care Homes
An audit completed in 2009 by the Quality, Standards and Effectiveness Directorate
Presented by Rosalind Way
Infection Prevention and the Safe Environment Nursing Home Conference 16th March 2010 The Crofters Hotel, Garstang
It is therefore important that antibiotic guidelines are followed as closely as possible for the majority of patients
Whilst it is acknowledged that elderly patients may require multiple prescriptions (polypharmacy) the effects of these need to be closely monitored.
门诊病人抗生素的使用英文PPTOutpatientantibiotic
• Meds: Atripla, Bactrim. • PE: T=100, RR=22, HR=98, BP=110/70. Decrease
breath sounds and rales RLL. O2sat 94% RA. • Labs: PaO2 72. WBC=12. LDH=180.
• What is the likely diagnosis? • What would be your recommended therapy?
therapy.
– If no improvement after 7-10 days of symptomatic therapy, consider antibiotic therapy.
• If high-risk and severe symptoms, consider immediate antibiotic therapy.
• What is the diagnosis?
• What is antimicrobial should be given?
Acute sinusitis
ACP Guidelines
• High-risk (>50%) of bacterial sinusitis if 2 or more of the following present:
• The antibiotic of choice is Amoxicillin.
Assess the probability of bacterial sinusitis and treat if high and symptoms severe. Otherwise, defer antibiotic Rx.
• PE afebrile, lungs with few bilateral wheezes. O2 sat 99% RA before and after activity.
breath sounds and rales RLL. O2sat 94% RA. • Labs: PaO2 72. WBC=12. LDH=180.
• What is the likely diagnosis? • What would be your recommended therapy?
therapy.
– If no improvement after 7-10 days of symptomatic therapy, consider antibiotic therapy.
• If high-risk and severe symptoms, consider immediate antibiotic therapy.
• What is the diagnosis?
• What is antimicrobial should be given?
Acute sinusitis
ACP Guidelines
• High-risk (>50%) of bacterial sinusitis if 2 or more of the following present:
• The antibiotic of choice is Amoxicillin.
Assess the probability of bacterial sinusitis and treat if high and symptoms severe. Otherwise, defer antibiotic Rx.
• PE afebrile, lungs with few bilateral wheezes. O2 sat 99% RA before and after activity.
急诊抗生素应用医学PPTppt课件
PPT学习交流
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7. 大环内酯类
• 罗红霉素和阿奇霉素抗菌谱比红霉素广，包括 更多的呼吸道致病菌（尤其流感嗜血杆菌）
• 具有良好的抗支原体、衣原体、鸟衣原体复合 物、军团菌作用
• 阿奇霉素单剂量治疗无并发症的衣原体感染 • 最易与其他药物起相互反应：茶碱、地高辛、
阿司咪唑、麦角胺等
PPT学习交流
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急诊抗生素应用
PPT学习交流
1
一、急诊常用抗生素
PPT学习交流
2
急诊科医师应熟悉一些（并不需要太多）便宜而实用的——
“经得起时间考验的”抗生素
• 应该经受5年以上时间的考验 • 有足够的时间广泛了解药物（尤其副作用） • 对患者而言，价格相对便宜
没有一个患者愿意一天用3次药以上；
没有一个患者愿意进行5天以上的连续治疗；
头孢呋肟（￥ 420/4.5g） 头孢美唑 （￥ 240/3g）
PPT学习交流
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3. 抗厌氧菌抗生素应用
• 可选择甲硝唑 、克林霉素、 BL/BLI • 对外科、妇产科可能存在腹腔污染病例选用甲
硝唑——抗脆弱类杆菌（最常见结肠来源微生 物）具有优势 • 甲硝唑 (￥7/1g)治疗难辨梭菌最常用药物 • 克林霉素有潜在致死性抗生素相关难辨梭菌性 结肠炎副作用
促炎症细胞因子（TNF-α、IL-1）与抗炎症细 胞因子（IL-10等）失衡学说 动物基因敲除实验
PPT学习交流
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2. 当抗生素选择无把握时
• 第二代头孢菌是较好的选择
二代头孢菌素的抗菌谱覆盖包括G+， G-菌及严格厌氧菌。半衰期一般0.8~2.0h， 经典用法为静脉注射每8小时一次
• 价格*（日耗费）
没有一个患者愿意用使他们感到病情加重的药物；
抗生素的应用(英文PPT)
• 4 months - 4 years:
– NO ANTIBIOTICS FOR VIRAL INFECTION Amoxicillin (80-100 mg/kg/d divided tid) OR ampicillin 200 mg/kg/d divided q 6 hrs, OR cefuroxime or cefotaxime
– Staphylococcus aureus
– Haemophilus influenzae type b
– non-typable H. influenzae
McIntosh,K: NEJM 2002;346:429
Likelihood that the pneumonia is bacterial is greater if:
• Fever is > 39 degrees C • The patient “looks sick” • There are alveolar infiltrates on chest x-
ray • WBC is > 15,000 • NB: Blood culture is positive in about 10%
抗生素的应用（英文PPT）
Shorter courses?
• Approved by the FDA for 5-day regimen: – cefpodoxime (Vantin) – cefdinir (Omnicef) – azithromycin (Zithromax)
What about the penicillinallergic child?
What do you think is causing his pneumonia? How will you treat him?
– NO ANTIBIOTICS FOR VIRAL INFECTION Amoxicillin (80-100 mg/kg/d divided tid) OR ampicillin 200 mg/kg/d divided q 6 hrs, OR cefuroxime or cefotaxime
– Staphylococcus aureus
– Haemophilus influenzae type b
– non-typable H. influenzae
McIntosh,K: NEJM 2002;346:429
Likelihood that the pneumonia is bacterial is greater if:
• Fever is > 39 degrees C • The patient “looks sick” • There are alveolar infiltrates on chest x-
ray • WBC is > 15,000 • NB: Blood culture is positive in about 10%
抗生素的应用（英文PPT）
Shorter courses?
• Approved by the FDA for 5-day regimen: – cefpodoxime (Vantin) – cefdinir (Omnicef) – azithromycin (Zithromax)
What about the penicillinallergic child?
What do you think is causing his pneumonia? How will you treat him?
《急诊抗生素应》课件
抗生素临床应用指南与专家共识
临床应用指南
针对不同感染性疾病，制定相应 的抗生素临床应用指南，指导医
生合理选用抗生素。
专家共识
针对某些特殊情况或争议较大的 抗生素使用问题，由权威专家共 同制定专家共识，为临床提供参
考。
指南与共识更新
随着医学研究的进展，抗生素临 床应用指南和专家共识也会不断 更新和完善，以适应新的治疗需
免疫缺陷患者
针对免疫缺陷患者的感染 ，应选择对免疫系统影响 较小的抗生素，如碳青霉 烯类、氟喹诺酮类等。
孕妇和哺乳期妇女
针对孕妇和哺乳期妇女的 感染，应选择对胎儿和婴 儿影响较小的抗生素，如 青霉素、头孢菌素等。
肝肾功能不全患者
针对肝肾功能不全患者的 感染，应选择对肝肾功能 影响较小的抗生素，如青 霉素、头孢菌素等。
考虑抗生素的抗菌谱
了解各种抗生素的抗菌谱，根据感染的具体病原体种类和药 敏试验结果选择最合适的抗生素。
避免使用广谱抗生素
在未明确病原体种类的情况下，应尽量选择窄谱抗生素，避 免使用广谱抗生素，以免产生耐药菌株。
抗生素给药途径与剂量
给药途径
根据感染的部位和病情的严重程度，选择合适的给药途径，如口服、静脉注射 、肌肉注射等。
案例四：重症感染抗生素应用
总结词
重症感染的抗生素选择需根据病情严重程度和病原体类型进行，必要时采取联合用药。
详细描述
重症感染患者病情严重，进展迅速，抗生素选择应根据病情严重程度和病原体类型进行 。必要时可采取联合用药，以提高疗效，降低耐药性。同时，应注意观察病情变化，及
时调整治疗方案。
06
总结与展望
推广快速诊断技术
发展新型抗生素
利用微生物培养、分子诊断等快速诊断技 术，缩短抗生素使用前的诊断时间，提高 用药的准确性。
急诊门诊抗生素的合理应用课件
原因
医生对感染认识不足、患者自行购买使 用、利益驱动、医患关系紧张等。
VS
后果
细菌耐药性增加、药物不良反应增多、医 疗费用增加、患者生命安全受到威胁等。
抗生素合理使用的宣传教育与监管措施
宣传教育
加强对医生、患者及家属的宣传教育，提高 对抗生素合理使用的认识和意识。
监管措施
建立抗生素使用规范和监管制度，严格控制 抗生素的品种、剂量、使用时间等，同时加 大对抗生素滥用的处罚力度。
适应症
抗生素主要用于治疗各种感染性疾病，如肺炎、支气管炎、泌尿生殖系统感染 、皮肤软组织感染等。在使用抗生素时，应根据具体病情和医生的建议选择合 适的药物。
02
急诊门诊抗生素应用现状
急诊门诊感染性疾病的分布与特点
感染性疾病的分类
急诊门诊感染性疾病主要包括呼吸系 统、消化系统、皮肤软组织、泌尿系 统等感染。
抗生素治疗。
03
急诊门诊抗生素的合理应用
抗生素的合理选用
01 02
根据感染部位和性质选择
对于不同的感染部位和感染性质，应选择不同的抗生素，例如皮肤软组 织感染应选择针对G+球菌的抗生素，而上呼吸道感染则应选择针对病 毒或细菌的抗生素。
根据患者病情和身体状况选择
对于患者的不同病情和身体状况，应选择对病情和身体状况有益的抗生 素，例如对于肾功能不全的患者应选择肾毒性小的抗生素。
研究开发针对常见病原菌的新型抗生素，如β-内酰胺类抗 生素、大环内酯类抗生素等，以满足临床治疗需求。
耐药菌的抗生素
针对耐药菌的抗生素研发是未来发展的重点之一，如碳青 霉烯类抗生素、第四代头孢菌素等，以满足临床治疗耐药 菌感染的需求。
联合治疗
研究开发多肽类抗生素、抗真菌药物等，与现有抗生素联 合使用，提高治疗效果并延缓耐药性的产生。
急诊科抗生素合理应用ppt参考课件
Sepsis‡
†2N0a0t0io. n‡2Aa0nl2Cg0ue/4sn/t2De8Cr foert
Health al. Crit
Statistics, 2001. Care Med. 2001
§American
Cancer
Society,
2001.
*American
Heart
Associa8tion.
Cases/100,000
Deaths/Year
300
250
200
150
100
50
0
AIDS* Colon Breast CHF† Severe
Cancer§
Sepsis‡
250,000
200,000
150,000
100,000
50,000
0
AIDS* Breast AMI† Severe
Cancer§
2020/4/28
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全身性感染--发展趋势
➢ 人口老龄化（不仅限于西方国家） ➢ 医疗水平提高，生命支持治疗发展 ➢ 免疫功能低下（肿瘤治疗、器官移植） ➢ 介入性技术和装置推广应用 ➢ 细菌耐药性与院内感染增多
2020/4/28
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全身性感染: 与其它主要疾病相比
严重感染的发病率
严重感染的死亡率
2001
2025
年
600,000 500,000 400,000 300,000 200,000 100,000
2050
9
全身性感染的相关概念进展
2020/4/28
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ACCP/SCCM 联席会议定议
➢ 感染
• 对微生物的炎症反应, 或 • 微生物对正常无菌组织的
急诊科抗菌素的使用ppt课件
代谢或生物转化
(Metabolism or Biotransformation)
肝微粒体细胞色素P-450酶系统 是促进药物生物 转化的主要酶，称之肝药酶，现已发现70余种， 因遗传多态性和其他影响因素（如年龄、疾病、 营养），酶水平或活性的个体差异较大。
肝药酶易受药物的诱导或抑制或激活 如许多大环 内酯类（如红霉素）和氟喹诺酮类（如依诺沙星） 对肝药酶有抑制作用。利福平则有对肝药酶激活， 加速代谢。
• 抗生素后效应 指细菌与抗生素短暂接触后，当
抗生素浓度下降（低于MIC 或消失后），细菌生
剂 量 用 法
血 清 浓 度
感染 部位 浓度
生 物 效 应
Pharmacokinetics
Pharmacodynamic
药动学
药效学
抗菌药物的药动学与药效学
抗菌药物的体内过程
• 药物吸收
• 药物分布 • 药物代谢
• 3.抗微生物药物：与抗菌药物范围相似，
但抗蠕虫药物一般不包括在内。 • 4.化疗药：是化学治疗药物的简称，指应 用于临床一切具有化学结构的药物的统称。 • 误区：目前成为“抗肿瘤药物治疗”和 “抗生素治疗”的专用名词。
抗菌药物的作用机制
根据主要作用靶位不同，作用机制可分为:
– 干扰细菌细胞壁的合成，使细菌不能生长繁殖
易混淆的几个概念
• 2.抗感染药物：指具有杀灭或抑制各种病
原微生物的作用，可以口服、肌注、静注 等全身应用的各种抗生素、磺胺类和喹诺 酮类药以及其他化学合成药（异烟肼、硝 咪唑类、呋喃类等）。 • 不包括：消毒灭菌药如来苏儿、碘酊等。 • 与抗菌药物常彼此混淆，但抗感染药物的 范围较广。
易混淆的几个概念
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3 (75%) 20 (33.9%)
2 36 1 39 (66.1%)
Total
6 49 4 59 (100%)
The standard achieved in our unit
•66% (95% CI 54% -- 78%)
• Situation in other areas
– ‘……antibiotics were prescribed for 55.4% of the patients……Therapeutic use was considered inadequate in 27%......’
• Restriction in use
– Minimization of emergence of resistant strains
Objectives
• Audit the use of antibiotics in the following aspects
– Initiation of the use of antibiotics – Choice of initial & subsequent antibiotics – Duration of antibiotics – Dose of antibiotics – Route of administration
– 80%
Data collection and analysis
• Objective observation on the management of patients.
• Period – 7th July 2004 to 12th July 2004 • All acute admission to one male ward and one
a department of infectious diseases. Presse Med 2003 Aug 9:32(26):1208-12
• Two third appropriate
– ‘……67% appropriate at the primary level as opposed to 60% at the tertiary level……’ Thomas Molly,
•66% (95% CI 54% -- 78%)
• Situation in other areas
– ‘…… 105 prescriptions were analysed… 22 cases excessive, 8 cases unjustified and 5 cases inappropriate…’ Zahar JR, Ghaffari P. Audit on antibiotic prescriptions in
• Marie T, Frederique S et al. Appropriate use of restricted antimicrobial agents in hospitals: the importance of empirical therapy and assisted re-evaluation. J Antimicro Chemo (2000) 46: 501-508
8 (15.2%) Not appropriate
Results
Diagnosis Non-infection Infection Uncertain sepsis Total
Appropriateness [n (%)]
Not appropriate
Appropriate
ห้องสมุดไป่ตู้
4 (66.7%) 13 (26.5%)
Standards
• No international set criteria available for reference.
• Ideal situation
– 100% appropriateness in the antibiotic use for all patients
• Set standard
female ward • Daily assessment done on the management of
individual patient till discharge, transferred out or a maximum duration of seven days
106 admissions, 4 missing
Tuen Mun Hospital
Background
• Appropriateness in use of antibiotics directly affect the quality of care of patients.
• Patient care
– Morbidity – Mortality
I:
Indication
C:
Choices
R,D,D: Route, Duration, Dose
102 59 given antibiotics
Overall 34% Not
appropriate
54 C
47
I
7 (14.8%) Not appropriate
R,D,D
5 (8.5%)
Not appropriate
• Fonseca LG, Conterno Lde O. Audit of Antibiotic Use in a Brazilian University Hospital. Braz J Infect Dis 2004 Aug; 8(4): 272-80. Epub 2004 Nov 19
– ‘……73% of prescriptions conformed to guidelines, but adequacy varied from 93% for vancomycin to only 38% for ciprofloxacin……’
Clinical Audit of the Use of Antibiotics in Acute Medical Wards
Dr. Chan Kai Ming Microbiology / Infectious Disease Team Department of Pathology / Department of Medicine & Geriatrics
2 36 1 39 (66.1%)
Total
6 49 4 59 (100%)
The standard achieved in our unit
•66% (95% CI 54% -- 78%)
• Situation in other areas
– ‘……antibiotics were prescribed for 55.4% of the patients……Therapeutic use was considered inadequate in 27%......’
• Restriction in use
– Minimization of emergence of resistant strains
Objectives
• Audit the use of antibiotics in the following aspects
– Initiation of the use of antibiotics – Choice of initial & subsequent antibiotics – Duration of antibiotics – Dose of antibiotics – Route of administration
– 80%
Data collection and analysis
• Objective observation on the management of patients.
• Period – 7th July 2004 to 12th July 2004 • All acute admission to one male ward and one
a department of infectious diseases. Presse Med 2003 Aug 9:32(26):1208-12
• Two third appropriate
– ‘……67% appropriate at the primary level as opposed to 60% at the tertiary level……’ Thomas Molly,
•66% (95% CI 54% -- 78%)
• Situation in other areas
– ‘…… 105 prescriptions were analysed… 22 cases excessive, 8 cases unjustified and 5 cases inappropriate…’ Zahar JR, Ghaffari P. Audit on antibiotic prescriptions in
• Marie T, Frederique S et al. Appropriate use of restricted antimicrobial agents in hospitals: the importance of empirical therapy and assisted re-evaluation. J Antimicro Chemo (2000) 46: 501-508
8 (15.2%) Not appropriate
Results
Diagnosis Non-infection Infection Uncertain sepsis Total
Appropriateness [n (%)]
Not appropriate
Appropriate
ห้องสมุดไป่ตู้
4 (66.7%) 13 (26.5%)
Standards
• No international set criteria available for reference.
• Ideal situation
– 100% appropriateness in the antibiotic use for all patients
• Set standard
female ward • Daily assessment done on the management of
individual patient till discharge, transferred out or a maximum duration of seven days
106 admissions, 4 missing
Tuen Mun Hospital
Background
• Appropriateness in use of antibiotics directly affect the quality of care of patients.
• Patient care
– Morbidity – Mortality
I:
Indication
C:
Choices
R,D,D: Route, Duration, Dose
102 59 given antibiotics
Overall 34% Not
appropriate
54 C
47
I
7 (14.8%) Not appropriate
R,D,D
5 (8.5%)
Not appropriate
• Fonseca LG, Conterno Lde O. Audit of Antibiotic Use in a Brazilian University Hospital. Braz J Infect Dis 2004 Aug; 8(4): 272-80. Epub 2004 Nov 19
– ‘……73% of prescriptions conformed to guidelines, but adequacy varied from 93% for vancomycin to only 38% for ciprofloxacin……’
Clinical Audit of the Use of Antibiotics in Acute Medical Wards
Dr. Chan Kai Ming Microbiology / Infectious Disease Team Department of Pathology / Department of Medicine & Geriatrics