疼痛科中抗生素使用(英文PPT)Antibiotics and Pain Control
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--抗生素PPT课件(英文精品)Antibiotics and Pain
• Debridement
– excise devitalized tissue
• Irrigation
– high pressure, solution
• Eliminate Dead Space
– fluid, blood
• Delayed Primary Closure (DPC)
– 4 - 6 days
Vietnam
• Kell, 1991:
–“A single injection of a broadspectrum antibiotic with a long halflife should be given prophylactically to personnel on the battlefield to provide bactericidal coverage from the earliest moment after injury occurs.”
» Used penicillins
• Somalia
– Pseudomonas and polymicrobial
• Russian Afghanistan Experience
– Clostridial
» Recommended PCN, Rifampin, Metronidazole, or Ceftriaxone
– Fullen, et al.
• Both the timing and the choice are important.
– Thadepalli, et al.
What Bugs?
• Yom Kippur War
– Pseudomonas – 25.6% isolates – Gm Neg bacilli – 70% isolates overall
– excise devitalized tissue
• Irrigation
– high pressure, solution
• Eliminate Dead Space
– fluid, blood
• Delayed Primary Closure (DPC)
– 4 - 6 days
Vietnam
• Kell, 1991:
–“A single injection of a broadspectrum antibiotic with a long halflife should be given prophylactically to personnel on the battlefield to provide bactericidal coverage from the earliest moment after injury occurs.”
» Used penicillins
• Somalia
– Pseudomonas and polymicrobial
• Russian Afghanistan Experience
– Clostridial
» Recommended PCN, Rifampin, Metronidazole, or Ceftriaxone
– Fullen, et al.
• Both the timing and the choice are important.
– Thadepalli, et al.
What Bugs?
• Yom Kippur War
– Pseudomonas – 25.6% isolates – Gm Neg bacilli – 70% isolates overall
抗生素合理使用策略(英文PPT)Antibiotic stewardship in the Acute and Community setting
Why are antibiotics used inappropriately?
• Lack of knowledge of drug spectrum, dosing etc. • Lack of knowledge of adverse drug reactions and
resistance associated with antibiotics • Lack of access to diagnostic facilities
• Time pressure
– Quicker to write prescription than explain what a virus is
• Influence of pharmaceutical promotion • Habit
– The First Law of Therapeutics: “The patient is doing well; continue the antibiotics!”
Meticillin-Resistant S. aureus
• MRSA in New York*
– ineffective empiric treatment of bacterial infection at the time of its identification
– the wrong choice, dose or duration of therapy – use of an antibiotic to which the pathogen
• 75% questionable therapeutic value
Harrison and Lederberg, Antimicrobial Resistance 1998
抗生素PPT课件(英文精品) Antibiotics and Pain Control
– Fullen, et al.
• Both the timing and the choice are important.
– Thadepalli, et al.
What Bugs?
• Yom Kippur War
– Pseudomonas – 25.6% isolates – Gm Neg bacilli – 70% isolates overall
General Preventive Measures
• Adequate and Timely Resuscitation
• Early Wound Care • Antibiotics • Tetanus Immune Prophylaxis
Adequate and Timely Resuscitation
Why not?!
• Antibiotics not routinely given in the field by civilian pre-hospital personnel (EMT/paramedic model for
medic training).
• Combat medics don’t typically see wound infections during the time they care for them – may not appreciate their devastating effect.
• Debridement
– excise devitalized tissue
• Irrigation
– high pressure, solution
• Eliminate Dead Space
– fluid, blood
• Both the timing and the choice are important.
– Thadepalli, et al.
What Bugs?
• Yom Kippur War
– Pseudomonas – 25.6% isolates – Gm Neg bacilli – 70% isolates overall
General Preventive Measures
• Adequate and Timely Resuscitation
• Early Wound Care • Antibiotics • Tetanus Immune Prophylaxis
Adequate and Timely Resuscitation
Why not?!
• Antibiotics not routinely given in the field by civilian pre-hospital personnel (EMT/paramedic model for
medic training).
• Combat medics don’t typically see wound infections during the time they care for them – may not appreciate their devastating effect.
• Debridement
– excise devitalized tissue
• Irrigation
– high pressure, solution
• Eliminate Dead Space
– fluid, blood
抗生素PPT课件(英文精品) Proper Use of Antibiotics
Points to note when taking antibiotics (1)
➢ Follow your doctor’s instruction.
➢ Take the drugs on the right time at the right dose.
➢ If you miss one dose, take it as soon as you remember but never take a double dose.
Always consult your doctor for the use of antibiotics.
FAQ If I have fever, do I always need an antibiotic?
Fever is a common symptom for infections and not necessarily caused by bacterial infection.
抗生素PPT课件（英文精品） Proper Use of Antibiotics
Antibiotics
Antibiotics ≠ Anti-inflammatory drugs
Antibiotics ≠Panacea
Are there any risks for the use of antibiotics?
diarrhoea
Side effects of Antibiotics (2)
Allergic reaction - rash - itchiness - breathlessness
Antibiotic resistant bacteria
Predispose to the emergences of antibiotics resistant bacteria.
抗生素英文课件精品—— Anti-bacteria Medicine
Selection of a potential product
1、efficacy 2、metabolic characterization 3、toxicity and adverse effect 4、Potentiality of industrial production
Antibiotics: from strain isolation to clinical application
! Rifampicin must be given by a “cocktail” of drugs.
Problem of antibiotics which inhibit
protein synthesis
Antibiotics: From isolation of strain to clinical application
Antibiotics and drugs targeting nucleic acid biosynthesis and functions
3. Rifampicin (from rifamycin) subunit of DNA-primed RNA polymease
Antibiotics and drugs targeting nucleic acid biosynthesis and functions
Mechanism of resistance
Selection pressure ( not only in health institutions)
Genetic recombination ( especially conjugation mediated by plasmid)
Improper prescription of antibiotics
1、efficacy 2、metabolic characterization 3、toxicity and adverse effect 4、Potentiality of industrial production
Antibiotics: from strain isolation to clinical application
! Rifampicin must be given by a “cocktail” of drugs.
Problem of antibiotics which inhibit
protein synthesis
Antibiotics: From isolation of strain to clinical application
Antibiotics and drugs targeting nucleic acid biosynthesis and functions
3. Rifampicin (from rifamycin) subunit of DNA-primed RNA polymease
Antibiotics and drugs targeting nucleic acid biosynthesis and functions
Mechanism of resistance
Selection pressure ( not only in health institutions)
Genetic recombination ( especially conjugation mediated by plasmid)
Improper prescription of antibiotics
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» Used penicillins
• 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
– Fresh Water - Aeromonas
Our Environment
Our Environment
Tactical Field Care “What We Want in an Antibiotic”
Korea
• Scott, 1954:
–“In any tactical situation where the casualty cannot reach the aid station until 4-5 hours or longer after wounding, antibiotic therapy by the aidman in the field is most desirable”
• bridement
– excise devitalized tissue
• Irrigation
– high pressure, solution
• Eliminate Dead Space
– fluid, blood
• Delayed Primary Closure (DPC)
– 4 - 6 days
Examples
of Operational Need Stimulating Scientific
Innovation
Antibiotics and Pain Control
WW II
• Poole, 1944:
–“The greatest lesson learned from World War II may have been the benefit of the use of penicillin prophylactically in the surgical units close to the front.”
• A,B,C’s
• * Need to maintain a “nearly normal” arterial oxygen tension.
• Volume Expansion Considerations
Early Wound Care
• Sterile Dressing
– contamination, desiccation
– Fullen, et al.
• Both the timing and the choice are important.
– Thadepalli, et al.
What Bugs?
• Yom Kippur War
– Pseudomonas – 25.6% isolates – Gm Neg bacilli – 70% isolates overall
The EAST Practice Management Guidelines
• The Journal of Trauma - March 2000 • Meta-analysis - MEDLINE Search for
1976-1997 • After discrimination - 39 articles for
Why not?!
• Antibiotics not routinely given in the field by civilian pre-hospital personnel (EMT/paramedic model for
medic training).
• Combat medics don’t typically see wound infections during the time they care for them – may not appreciate their devastating effect.
General Preventive Measures
• Adequate and Timely Resuscitation
• Early Wound Care • Antibiotics • Tetanus Immune Prophylaxis
Adequate and Timely Resuscitation
• Not a “sexy” topic. • Ivory Tower arrogance….
Increased Risk of Infection in Trauma Patients
• Disruption of Mechanical Barriers
• Bacterial Contamination • Local Wound Factors • Invasive Interventions • Impaired Resistance
• 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
– Fresh Water - Aeromonas
Our Environment
Our Environment
Tactical Field Care “What We Want in an Antibiotic”
Korea
• Scott, 1954:
–“In any tactical situation where the casualty cannot reach the aid station until 4-5 hours or longer after wounding, antibiotic therapy by the aidman in the field is most desirable”
• bridement
– excise devitalized tissue
• Irrigation
– high pressure, solution
• Eliminate Dead Space
– fluid, blood
• Delayed Primary Closure (DPC)
– 4 - 6 days
Examples
of Operational Need Stimulating Scientific
Innovation
Antibiotics and Pain Control
WW II
• Poole, 1944:
–“The greatest lesson learned from World War II may have been the benefit of the use of penicillin prophylactically in the surgical units close to the front.”
• A,B,C’s
• * Need to maintain a “nearly normal” arterial oxygen tension.
• Volume Expansion Considerations
Early Wound Care
• Sterile Dressing
– contamination, desiccation
– Fullen, et al.
• Both the timing and the choice are important.
– Thadepalli, et al.
What Bugs?
• Yom Kippur War
– Pseudomonas – 25.6% isolates – Gm Neg bacilli – 70% isolates overall
The EAST Practice Management Guidelines
• The Journal of Trauma - March 2000 • Meta-analysis - MEDLINE Search for
1976-1997 • After discrimination - 39 articles for
Why not?!
• Antibiotics not routinely given in the field by civilian pre-hospital personnel (EMT/paramedic model for
medic training).
• Combat medics don’t typically see wound infections during the time they care for them – may not appreciate their devastating effect.
General Preventive Measures
• Adequate and Timely Resuscitation
• Early Wound Care • Antibiotics • Tetanus Immune Prophylaxis
Adequate and Timely Resuscitation
• Not a “sexy” topic. • Ivory Tower arrogance….
Increased Risk of Infection in Trauma Patients
• Disruption of Mechanical Barriers
• Bacterial Contamination • Local Wound Factors • Invasive Interventions • Impaired Resistance