抗生素使用指南 (英文)Simple Antibiotic Guide
2022妇产科围术期抗生素的使用全文
[6]SiChuan Pharmacy Administration andQuality Control Center . Implementation R ules of Perioperative Prophylactic Application of Antibiotics in Sichuan Province (四川省围手术期预 防性应用抗菌药物实施细则)
[M ]. Beijing:People's Medical Publishing House , 2015 .
[5]Ministry of Health of the People'ASIs R epublic of
China . No . 84r
Ministry of Health on revising the home page of inpatient medical
（中华妇产科杂志），2011 ,3 （ 46 ） : 230-233 .
[2]IORIOA ,SPENCER F A , FALAVIGNA Mletal . Use of G R ADE for assessment of evidence about prognosis : rating confidence in es
水囊引产术推茬的Bi防用药为第一、二代头抱IIjf土甲硝K（推柞强度：强 推荐；证据质M： B）,对于布.头胞菌素过敏史患者,可选用氨内幡件类土 甲硝畔（推荐强度：强推荐；证据质#t： C）
抗生素使用指南 (英文)Simple Antibiotic Guide
What about other antibiotics?
• Aminoglycosides - Macrolides – Tetracyclines- Clindamycin
Which brings us to the issue of Cidal vs Static antibiotics (and synergy also)
WHAT is Inhibitory (static)?
• In a test tube there is no change over time
Flagyl
CIDAL
Pharmakokinetics & Pharmakodynamics (Is more better?)
• peak level (ie concentration) = rate of kill (aminoglycosides, quinolones)
• Time > MIC (duration) = rate of kill (beta lactams, clindamycin, macrolides)
All inhibit protein synthesis via ribosomes
• Quinolones block DNA synthesis
• Daptomycin blocks AA transport
What is Synergy and when do you want it?
Additive is: 2 + 2 = 4 Synergy is: 2 + 2 = 7
--抗生素(英文PPT)
Bacteroides
Enterococcus
Pseudomonas
Staphylococcus
Haemophilus Neisseria
E.coli Other coliforms
Coventry and Warwickshire Pathology
Gram Positives vs Gram Negatives
– Glycopeptides
• Vancomycin, (Teicoplanin) IV
– Tetracyclines
• Doxycycline PO
– Others
• Trimethoprim, Nitrofurantoin PO • Rifampicin, Clindamycin PO/IV • Ciprofloxacin PO
Antibiotics
James Clayton Consultant Microbiologist
Coventry and Warwickshire Pathology
Antibiotic groups
• β-Lactams
– Penicillins
• Penicillin, Amoxicillin, Flucloxacillin PO/IV
Streptococci
• Group A streptococci
– Skin & soft tissue infection – Necrotising fasciitis – Tonsillitis – Toxic shock, sepsis
• Group B streptococci
– Neonatal infection, UTI
Pseudomonas
抗生素中相关杂质质量标准制定的指导原则【中英】
30 June 2012EMA/CHMP/CVMP/QWP/199250/2009 corrCommittee for Medicinal Products for Human Use (CHMP)/ Committee for Medicinal Products for Veterinary Use (CVMP)Guideline on setting specifications for related impurities in antibiotics抗生素中相关杂质质量标准制定的指导原则Final 定稿学习之名（译注）Table of contents 目录Executive summary1. Introduction (background)2. Scope3. Legal basis4. General requirements5. Impurity profiling and reporting, identification and qualification thresholds6. New applications and variations7. Specifications for medicinal products8. Analytical proceduresDefinitionsAnnex 1: Explanatory note regarding thresholds.Annex 2: ThresholdsAnnex 3: Example of “fingerprint chromatogram” approach to control very complex impurity profiles 概要1、背景介绍2、范围3、法规依据4、一般要求5、杂质分布以及报告、鉴别和界定阈值6、新申请和变更7、制剂产品质量标准8、分析方法定义附件1：关于阈值的注释附件2：阈值附件3：利用基于“指纹图谱”的方法对非常复杂的杂质分布进行控制举例Executive summary 概要Antibiotics active substances currently on the market are produced by fermentation, by fermentation followed by one or more synthetic steps (semi-synthetic substances) or by chemical synthesis. Fermentation processes are, in comparison to synthetic processes, more variable and less controllable, so the impurity profile of an active substance whose manufacturing process involves fermentation may be more complex and less predictable than that of a purely synthetic product. For this reason fermentation products and semi-synthetic substances are not included in the scope of the ICH Q3 and the VICH GL10/GL11 guidelines, which set thresholds for the identification, reporting and qualification of related impurities in active substances manufactured by chemical synthesis.目前上市的抗生素类活性物质是由发酵、发酵加一步或几步合成步骤（半合成）、化学合成制得。
抗生素英文
抗生素英文Antibiotics are a type of medication used to treat bacterial infections. They work by killing or inhibiting the growth of bacteria, thus preventing the spread of infection. Antibiotics come in many different forms, including pills, capsules, creams, and injections. They are one of the most widely used medications in the world, and have saved countless lives since their discovery in the early 20th century. In this article, we will discuss the history of antibiotics, their mechanism of action, and the different types of antibiotics.History of antibioticsThe discovery of antibiotics is often attributed to Alexander Fleming, who in 1928 noticed that a mold called Penicillium notatum could prevent the growth of bacteria. He was awarded the Nobel Prize in Medicine in 1945 for his discovery. However, the use of natural substances to treat infections dates back thousands of years. For example, ancient Egyptians used moldy bread to treat wounds, and ancient Chinese texts describe the use of moldy soybeans to treat infected wounds.After Fleming's discovery, other researchers began searching for other natural substances with antibiotic properties. In the 1930s, the German chemist Gerhard Domagk discovered the first synthetic antibiotic, sulfanilamide. This was followed by the discovery of streptomycin in 1943 by researchers at Rutgers University, which is a type of antibiotic called an aminoglycoside.Since then, many different types of antibiotics have been discovered, each with their own unique mechanism of action.Mechanism of actionAntibiotics work by targeting the structures or processes that are unique to bacteria. This is important, as antibiotics need to be able to kill bacteria without harming the patient's own cells.One common target of antibiotics is the bacterial cell wall. Most bacteria have a cell wall made of peptidoglycan, a complex molecule that provides structural support to the cell. Antibiotics such as penicillin and cephalosporins target this cell wall, causing it to weaken and ultimately burst, killing the bacteria.Another target of antibiotics is the bacterial ribosome. Ribosomes are responsible for synthesizing proteins in the cell, and antibiotics such as tetracyclines and macrolides inhibit this process, preventing the bacteria from being able to grow and divide.Other antibiotics target the DNA or RNA of the bacterial cell, preventing it from being able to replicate or transcribe genes.Types of antibioticsThere are many different types of antibiotics, each with their own unique mechanism of action and spectrum of activity. Some common types of antibiotics include:1. Penicillins – These are one of the oldest and most widely used types of antibiotics. They work by targeting the bacterial cell wall, and are effective against many different types of bacteria.2. Cephalosporins – These are similar to penicillins in their mechanism of action, but are more resistant to bacterial enzymes that can break down penicillins. They are often used to treat more serious infections.3. Macrolides – These antibiotics inhibit bacterial protein synthesis by binding to the bacterial ribosome. They are often used to treat respiratory and skin infections.4. Tetracyclines – These antibiotics also inhibit bacterial protein synthesis, but by a different mechanism than macrolides. They are often used to treat acne, as well as respiratory and urinary tract infections.5. Aminoglycosides – These antibiotics also inhibit bacterial protein synthesis, but by a different mechanism than macrolides and tetracyclines. They are often used to treat serious infections such as sepsis and endocarditis.There are many other types of antibiotics as well, including fluoroquinolones, sulfonamides, and carbapenems.ConclusionAntibiotics are a powerful tool in the fight against bacterial infections, but they must be used responsibly to avoid the development of antibiotic-resistant bacteria. This occurs when bacteria evolve mechanisms to resist the effects of antibiotics, making them harder to treat. It is important to use antibiotics only when necessary, and to always complete the full course of treatment, even if you feel better before the prescription is finished. Overuse of antibiotics can cause more harm than good, so it is important to always follow the instructions of your healthcare provider when taking antibiotics.。
如何合理使用抗生素
0%
20%
死亡率 40% 60%
80%
100%
(1,342 severe sepsis and septic shocks LENERCEPT study)
100
Survival of patients with sepsis
Survival (probability) (%) adequate
75
3.3
2.1 2.4 3.9 2.4
11.9 11.5
7.5 6.4 11.6 12
12.7
王佩芬、郑小河：汕头大学医学院第一附属医院2008年细菌耐药监测
汕大附一院2008年G-菌对抗生素的敏感性
2008年主要革兰氏阴性杆菌对抗生素的敏感率（％）
100 90 80 70 60 50 40 30 20 10 0
耐 药 率 (%)
2007年广州地区 G-细菌耐药性监测
236株嗜麦芽窄食单胞菌的耐药率(%)
耐 药 率 (%)
2007年广州地区 G-细菌耐药性监测
万古霉素对金黄色葡萄球菌的MIC值呈逐年上升趋势
近年来，万古霉素对70%金黄色葡萄球菌的MIC值≥1µg/mL*
100
MIC ≤0.5
MIC = 1
三代头孢：ESBL， AmpC； IMP：金属酶，真菌
Correct antibiotics Correct dosage Correct route of administration
重视病原学标本采集
Pneumoniae diplococcus
重视病原学标本采集
Klebsiella pneumoniae
*一项自2000年1月至2004年12月UCLA医学中心对6003例临床分离金黄色葡萄球菌菌株进行的分析监测结果
疼痛科中抗生素使用(英文PPT)Antibiotics and Pain Control
• Somalia
– Pseudomonas and polymicrobial
• Russian Afghanistan Experience
– Clostridial
» Recommended PCN, Rifampin, Metronidazole, or Ceftriaxone
review • 32 comparing outcome, 7 comparing
pharmacokinetics & cost.
The EAST Practice Management Guidelines (cont)
• Looking mostly at Class 1 articles:
– More successful regiments included :
• cefoxin • clindamycin with gentamycin • tobramycin with clindamycin • cefotetan • cefamandole • aztreonam • gentamycin
• Early Immobilizatio
n of Fractures
– Soft tissue damage
Antibiotics
• Finite period of time in which infection can be prevented.
– Miles, Burke.
• How early, not how long.
• Waterborne Ops
– Sea Water – Vibrio
• Overwhelming Gm Neg sepsis – 50% mortality
抗生素合理应用(全)
PUMC Hospital
目前临床使用抗生素的现状
Bid=q12h Tid=q8h
青霉素400万u,bid 青霉素200万u,q6h 头孢噻肟2.0g, Bid 头孢噻肟2.0g, q8h 头孢拉定6.0g, qd/3.0,Bid 头孢拉定2.0g, q6h 医护人员认知不足： •各种药物的特性 •规范用药的重要性 头孢呋辛1.5g, Bid/3.0g, qd 头孢呋辛1.5g, q8h
1克静脉注射
头孢呋辛 头孢噻肟
头孢孟多 头孢甲肟 头孢西丁 0 1 2 3 4 5 6 7 8 Knothe et al., 1984
T½
9小时
PUMC Hospital
头孢曲松PD/PK特点
半衰期长(8h)
蛋白结合率高(90%)，但容易饱和，随着剂量 增加，游离浓度增加，单次给药可产生相对
较高的游离浓度
• “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； 没有一个患者愿意用使他们感到病情加重的药物； 没有一个患者愿意为一昂贵的处方付钱。
• 普遍、大量、长时间、不规范地预防性使用抗 菌药物，药物资源浪费巨大
• 不重视、不了解抗生素药物的药动学/药效学， 随意制订给药剂量、途径、分配方案和疗程， 使很多抗菌药物没有发挥应有的作用 • 抗菌药物滥用，不但是造成医药费用增加的重 要原因，同时还可引发大量耐药菌产生，对社 会造成危害
Dep. of Emergency Medicine【粉乖留爪】
减少病人个体携带耐药菌数
减少耐药菌的传播
合理使用抗生素 ppt课件
ppt课件
4
一、抗生素分类
• ß-内酰胺类抗生素：青霉素类、头孢类 和其他ß-内酰胺类抗生素、 ß-内酰胺酶 抑制剂 • 氨基糖苷类 林可霉素类 大环类脂类 多肽类抗生素 氯霉素类 四环素类 • 氟喹若酮类 抗分支杆菌药
• 其他类：磺胺类、呋喃类、磷霉素、利 奈唑胺
ppt课件 5
ß-内酰胺类抗生素 (ß-lactam antibiotics）
ppt课件 10
ß-内酰胺类抗生素
• 第一代头孢类作用于特点临床应用： 1.肾毒性较第二、三代大。 2.对B-内酰胺酶较稳定，对革兰氏阴性 杆菌的作用不及第二、三代。 3.主要用于革兰氏阳性球菌菌感染及敏 感菌引起的呼吸道、泌尿道感染等
ppt课件
11
ß-内酰胺类抗生素
• 二代头孢： • 注射制剂：头孢呋新，头孢孟多，头孢 替安，头孢尼西，头孢雷特 • 口服制剂：氯碳头孢，头孢克洛，头孢 丙烯，头孢呋新酯，头孢替安酯
细菌学检查结果和药物敏感实验结 果选择药物： • 在体外药物敏感实验报告之前实行经验 性用药 • 体外药物敏感实验与临床的实际符合率 为75%左右 • 两次或多次药敏实验提示某一药物敏感 或耐药的可靠性较大。
ppt课件 40
4、经验性治疗
• 危重患者在未获知病原菌及药敏结果前， 可根据患者的发病情况、发病场所、原 发病灶、基础疾病及实验室检查结果等 等推断最可能的病原菌，并结合当地细 菌耐药状况先给予抗菌药物经验治疗， 获知细菌培养及药敏结果后，对疗效不 佳的患者调整给药方案。
ppt课件 37
1、抗生素使用的适应症
6.流脑流行季节与病人密切接触者 7.密切接触开放性肺结核者（3岁以下未接 种卡价苗） 8.不明原因昏迷 9.哮喘持续状态者 10.必须长期使用广谱抗生素者应预防霉菌 感染。
新生儿预防性应用抗生素指南
• 常见致病菌：
➢ GBS和大肠埃希菌（占2/3）： ✓大部分GBS-EOS发生于足月儿(73%)。 ✓大部分大肠埃希菌感染见于早产儿(81%)。
➢ 单核细胞增多性李斯特菌：罕见、散发，但危险性高。
提纲
• 预防性应用抗生素的基本概念 • EOS基本概念 • 围产期感染高危因素 • 实践指南
哪些是新生儿早发型感染高危因素？
0.34, 0.89/1,000) • 绒毛膜羊膜炎母亲所生新生儿的血培养阳性
EOS发生率 4.0/1,000 (95% CI 0.50, 7.5/1,000) • 对绒毛膜羊膜炎母亲所生婴儿使用抗生素的
比例为7-76%(不同医院存在差异)
Am J Perinatol. 2016 Jan;33(2):143-50.
。
• 两组各有约半数存在胎盘中性粒细胞浸润性炎症，使用头孢 西汀对中性粒细胞浸润程度没有明显影响。
• 与没有胎盘炎症的相比，有胎盘炎症的孕妇发热发生率更高 (33/144 vs 73/158 ， P < 0.001）
• 两组新生儿结局无明显差异，两组均无一例诊断新生儿败血 症。无新生儿死亡。
• 硬膜外镇痛时的发热和胎盘炎症有关，但使用抗生素并没有 减少发热和胎盘炎症的发生率。
● 5分钟Apgar评分≤6分
● 有胎儿窘迫的证据？
●
羊水胎粪污染？
Low Rate of Perinatal Sepsis in Term Infants of Mothers with Chorioamnionitis.
足月母亲绒毛膜羊膜炎时新生儿脓毒血症的发生率
•Braun等，2010年回顾性队列研究（加利福 尼亚kaisa医疗集团，13个医疗中心） • GA≥35w，n = 31112。 •回顾分析：母亲体温、产时抗生素应用，新 生儿抗生素治疗。
合理利用抗生素英文作文
合理利用抗生素英文作文Antibiotics are powerful medications that are used to treat bacterial infections. They work by killing or inhibiting the growth of bacteria, and have been instrumental in saving countless lives since their discovery. However, their overuse and misuse have led to the development of antibiotic-resistant bacteria, which pose a serious threat to public health. Therefore, it is crucial to use antibiotics responsibly to preserve their effectiveness for future generations.One way to use antibiotics responsibly is to only take them when they are prescribed by a healthcare professional. It is important to follow the prescribed dosage and complete the entire course of treatment, even if symptoms improve before the medication is finished. This helps to ensure that all the bacteria are killed and reduces therisk of antibiotic resistance developing.Another important aspect of responsible antibiotic useis to never share antibiotics with others or use leftover antibiotics from a previous illness. Each antibiotic is specific to the type of bacteria it targets, and taking thewrong medication can be ineffective or even harmful. Additionally, it is important to never take antibiotics for viral infections, such as the common cold or flu, as they are not effective against viruses.In addition to taking antibiotics as prescribed, it is important to practice good hygiene to prevent the spread of bacterial infections. This includes washing hands regularly, covering the mouth and nose when coughing or sneezing, and avoiding close contact with people who are sick. By preventing infections in the first place, the need for antibiotics can be reduced.Furthermore, the use of antibiotics in agriculture and animal husbandry should also be carefully regulated to prevent the spread of antibiotic-resistant bacteria. This includes limiting the use of antibiotics in healthy animals for growth promotion, and only using them to treat diagnosed infections under the guidance of a veterinarian. Additionally, efforts should be made to improve animal welfare and hygiene practices to reduce the need for antibiotics in the first place.In conclusion, it is important to use antibiotics responsibly to preserve their effectiveness for future generations. This includes taking them only when prescribed, following the prescribed dosage, practicing good hygiene, and limiting their use in agriculture and animal husbandry. By working together to use antibiotics responsibly, we can help prevent the spread of antibiotic-resistant bacteriaand protect public health.合理使用抗生素是非常重要的。
抗生素耐药的机理(英文)
• Trigger membrane associated autolytic enzymes that destroy cell wall
• Inhibit bacterial endopeptidase and glycosidase enzymes which are involved in cell wall growth
Clin. Microbiol. Rev.10:781-791, J.Infect.Dis.162:705-710
Result
• All PBPs in S.aureus become redundant –MRSA is resistant to all ß-lactams
Mutation by Recombination with Foreign DNA
– Reduced affinity to beta lactams
• Seen as penicillin resistant Pneumococci
Beta Lactam Activity Against 100 Penicillin Resistant Pneumococci from Spain
CHз
HO
o
Carbapenems 1976-
SR N
COOH
HO
o
N
o
Clavulanic acid 1976 COOH
Mobactams
R
R-CONH
o
Monobactam 1981-
N
R
Mechanisms of Action
抗生素与耐药(英文PPT)Antibiotics and Resistance
Questions
????
Antibiotic Resistance is the ability to resist the harmful effects of antibiotics by…
Alteration of target receptor proteins Prevention of entry into the cell Destruction of antibiotic upon entry Association with antibiotic which blocks entry Pump antibiotic out of cell before activation Bypass affected step in the metabolic pathway It is rare for a bacterium to possess more than 1,
Resistance can be prevented by taking all of your prescribed antibiotics, taking multiple antibiotics at one time, and restricting antibiotic use to individuals with weakened immune systems.
Antibiotic Resistance is the ability to resist the harmful effects of antibiotics.
Resistance is acquired through genetic mutation, the ingestion of genetic material for resistance, or continuous exposure to low doses of antibiotics.
医学英语 抗生素滥用中英文课件ppt
In both circumstances,the improper dosing will fail to eliminate the disease agent completely and will,furthermore,encourage,growth of the most resistant strains,which may later produce hard-to-treat disorders. 在两种情况下， 在两种情况下，不正确的剂量不能完全消除 病因，此外有可能促进更多的耐药菌株生长， 病因，此外有可能促进更多的耐药菌株生长， 然后可能产生极难治疗的疾病。 然后可能产生极难治疗的疾病。
THANK l to finish the full course of treatment.Patients then stockpile the leftover doses and medicate themselves,or their family and friends,in less than therapeutic amounts. 人们经常完成不了整个疗程， 人们经常完成不了整个疗程，然后患者 把剩下的药物贮存起来， 把剩下的药物贮存起来，用于这些少于 治疗剂量的药治疗他们自己或者他们的 家人和朋友。 家人和朋友。
•At a seminar I conducted,more than 80 percent of the physicians present admitted to having written antibiotic prescriptions on demand against their better judgment. •在我安排的讨论会上，超过80%出席的医 在我安排的讨论会上，超过 在我安排的讨论会上 出席的医 生承认他们是因为需要而不是更好的判断 开出抗生素处方。 开出抗生素处方。
抗生素的分级管理及使用原则
抗生素的分级管理及使用原则英文回答：Antibiotics are classified into different categories based on their spectrum of activity and mechanism of action. The classification system helps healthcare professionals choose the most appropriate antibiotic for treatingspecific infections. The principles of antibiotic use are also important to ensure their effectiveness and minimize the development of antibiotic resistance.The classification of antibiotics is mainly based on their spectrum of activity, which refers to the range of bacteria that a particular antibiotic can target. Broad-spectrum antibiotics are effective against a wide range of bacteria, including both Gram-positive and Gram-negative bacteria. Examples of broad-spectrum antibiotics include fluoroquinolones, cephalosporins, and carbapenems. On the other hand, narrow-spectrum antibiotics are only effective against specific types of bacteria. Penicillin anderythromycin are examples of narrow-spectrum antibiotics.Another important factor in antibiotic classificationis their mechanism of action. Antibiotics can target bacteria by interfering with their cell wall synthesis, protein synthesis, DNA replication, or other essential processes. For example, penicillin inhibits cell wall synthesis, while tetracycline inhibits protein synthesis. Understanding the mechanism of action is crucial in selecting the appropriate antibiotic for a particular infection.The principles of antibiotic use include appropriate selection, proper dosing, and duration of treatment. The selection of antibiotics should be based on the susceptibility of the bacteria causing the infection. This can be determined through laboratory testing, such as culture and sensitivity tests. It is important to choose the narrowest spectrum antibiotic that is effective against the identified pathogen to minimize the risk of resistance.Proper dosing is also crucial to ensure that theantibiotic reaches therapeutic levels in the body. Underdosing may result in suboptimal treatment, while overdosing can lead to toxicity. The dose of antibiotics should be adjusted based on factors such as age, weight, renal function, and severity of the infection.The duration of antibiotic treatment should be appropriate to effectively eliminate the infection. In some cases, a short course of antibiotics is sufficient, while in others, a longer duration may be necessary. It is important to complete the full course of antibiotics as prescribed, even if symptoms improve, to prevent the development of antibiotic resistance.In conclusion, antibiotics are classified intodifferent categories based on their spectrum of activity and mechanism of action. The principles of antibiotic use include appropriate selection, proper dosing, and duration of treatment. Following these principles is essential to ensure the effectiveness of antibiotics and to minimize the development of antibiotic resistance.中文回答：抗生素根据其抗菌谱和作用机制进行分类。
霍普金斯大学抗生素用药手册
Amoxicillin/Clavulanate (Augmentin ®)74 – 90%Azithromycin *38 – 83%Cephalexin 90%Cefpodoxime *41 – 50%Clindamycin 90%Doxycycline 90 – 100%Fluconazole >90%
Antibiotic Management Program
Intranet: /amp Internet: /amp
Osler 425
(443) 287-4570 (7-4570)
© Copyright 2009 by The Johns Hopkins Hospital Antibiotic Management Program. All rights reserved. No part of this publication may be reproduced without permission in writing from The Johns Hopkins Hospital Antibiotic Management Program.
Oral antimicrobial use in hospitalized patients
When using an agent that is considered to be bioequivalent (no
significant difference in rate and extent of absorption of the therapeutic ingredient) via the parenteral and oral route, the oral formulation is
抗生素合理应用
而不降低疗效。 碳氢酶烯类中旳亚胺培南、美罗培南等对繁殖期和静止期细菌都有强大
旳杀菌活性，又显示较长旳PAE，所以临床可合适延长给药时间间隔， 采用1-2次/日旳给药方案
氨基糖苷类旳PD特征与给药方案
•氨基糖苷类为浓度-依赖性旳抗生素，它们旳浓度越高 杀菌作用越强。
•连续长久旳药效及PAE及PALE
•PK/PD评价参数为Cmax/MIC, 对常见细菌旳期望值应在 8-10以上。
•PAE也具有浓度依赖性
•提议一日单次足量给药：耳、肾细胞对该类药物旳摄 取具有饱和性，增长药物浓度不会再增长摄取量，一日 屡次或连续静滴时，尽管Cmax相对低，但维持时间长， 有较高百分比旳药物被肾皮质摄取，易造成蓄积中毒
抗生素合理应用精华
有关咳痰标本
在抗生素应用前采集痰标本; 标本采集后1～2h内必须立即进行试验室处理； 咳痰标本应用最早且广泛，但也是最受争议旳标本 ; 取标本前应摘去牙托，清洁口腔如刷牙和漱口; 深咳，采集标本过程中要有专业旳医务人员指导; 无痰可用3％～5％NaCl 5ml雾吸约5min导痰； 也可用物理疗法、体位引流、鼻导管抽吸等法取痰； 对于细菌性肺炎，痰标本送检每天1次，连续2～3天。
药动学
感染
生
物
部位
效
浓度
应
Pharmacodynamics 药效学
药代动力学 （Pharmacokinetic，PK）
经典定义：是机体对药物旳作用（What the body
does to the drug）即药物体内过程，A.D.M.E。
Distribution
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How do β-lactams kill ?
How do β-lactams kill ?
• Inhibit the production of bacterial cell wall • Therefore they don’t kill our cells, but they
Flagyl
BACTERIOCIDAL or STATIC ???
Beta lactams
CIDAL
Aminoglycosides
CIDAL
Quinolones
CIDAL
Tetracyclines
BACTERIOSTATIC
Azithromycin, Clindamycin BOTH it depends
Example of synergy: cell wall active drug + protein inhibitor
How do β-lactams kill the enterococcus?
How do β-lactams kill the enterococcus?
Trick question- it doesn’t . Only inhibits their growth………………
Which brings us to the issue of Cidal vs Static antibiotics (and synergy also)
WHAT is Inhibitory (static)?
• In a test tube there is no change over time
So is it ever important to use a cidal antibiotic?
• Yes - for Endocarditis always always always (is that clear???)
• No - for almost everything else • Maybe (for those of you that can’t decide)-
*** Remember there is going to be a twist to this answer later on
CIDAL or STATIC ???
Beta lactams CIDAL Aminoglycosides CIDAL too Quinolones
CIDAL or STATIC ???
don’t kill mycoplasma or chlamydia either (they lack a cell wall….remember ?)
What about other antibiotics?
• Aminoglycosides - Macrolides – Tetracyclines- Clindamycin
4.5 B 3 B
2BΒιβλιοθήκη 1-0.5 B300 M
History of Bacteria and
for neutropenic patients in treatment of meningitis for osteomyelitis
CIDAL or STATIC ???
Beta lactams
CIDAL or STATIC ???
Beta lactams Aminoglycosides
CIDAL ****
Flagyl
CIDAL
Pharmakokinetics & Pharmakodynamics (Is more better?)
• peak level (ie concentration) = rate of kill (aminoglycosides, quinolones)
• Time > MIC (duration) = rate of kill (beta lactams, clindamycin, macrolides)
Beta lactams Aminoglycosides Quinolones Tetracyclines
CIDAL CIDAL CIDAL
BACTERIOCIDAL or STATIC ???
Beta lactams Aminoglycosides Quinolones Tetracyclines Azithromycin
CIDAL CIDAL CIDAL STATIC
BACTERIOCIDAL or STATIC ???
Beta lactams
CIDAL
Aminoglycosides
CIDAL
Quinolones
CIDAL
Tetracyclines
STATIC
Azithromycin, Clindamycin BOTH
= MIC
What is CIDAL ?
DEAD ? ALMOST DEAD ? MOSTLY DEAD? EVENTUALY DEAD ?
What is CIDAL ?
In 24 hours 99.9% of the buggers are DEAD
So is it ever important to use a cidal antibiotic?
MIC
Dose interval
History of Bacteria and
BIG BANG
Antibiotics
4.5 B 3 B
2B
1-0.5 B
300 M
History of Bacteria and
BIG BANG
Antibiotics
Anaerobic bacteria appear O2 & the emergence of Aerobes
All inhibit protein synthesis via ribosomes
• Quinolones block DNA synthesis
• Daptomycin blocks AA transport
What is Synergy and when do you want it?
Additive is: 2 + 2 = 4 Synergy is: 2 + 2 = 7