1、抗生素使用原抗生素使用原則則格格蘭蘭氏染色氏染色 (Gram Stain)(Gram Stain)陽性陽性陰性陰性球菌球菌桿菌桿菌經驗性抗生素原則nCellulitisnUTInBTInBacterial meningitisnAnaerobic infectionnGPC vs GNBnPRSPnEnterococcusnVRSAnPs.aeruginosa nESBL producing strainnPDR-ABCellulitisCellulitisnStreptococcusnPenicillinnStaphylococcusnOxacillinn第一代頭孢子素Cefazolin等n
2、MRSA risk(+)nVancomycin,TeicoplaninnE.coli、K.pneumoniaen第一代頭孢子素Cefazolin等UTI&BTIUTI&BTInUTI、BTIn以 E.coli、K.pneumoniae等腸內革蘭氏陰性桿菌為主n以Cefazolin+Gentamicin治療,nLiver abscessn以 K.pneumoniae為主nRemove the infection focusnneedle aspirationndrainagenCeftriaxone等三代頭孢子素nCeftriaxone部分由膽道排泄,liver內濃度高Bacterial Men
3、ingitisBacterial Meningitis nStreptococcusnPenicillin 300萬單位 q4hnStaphylococcusnMSSAnOxacillin 2gm q4hnMRSAnVancomycin 1gm q12h(infusion 1hr)nNOT Teicoplaninn腸內革蘭氏陰性桿菌腸內革蘭氏陰性桿菌E.coli、K.p.等等nCeftriaxone 2gm q12hnPseudomonus aeruginosanCeftazidime 2gm q8hBacterial MeningitisBacterial Meningitisn劑量均較劑量
4、均較sepsis加倍加倍n因通過BBB只有不到一半劑量n無法通過無法通過BBB,不可使用的抗生素,不可使用的抗生素(即使即使in vitro有效有效)n代及二代CephalosporinsnCefazolinnCefuroximenGentamicin、AmikacinnAztreonamnCiproxinnTeicoplaninn時機時機n牙齒感染nfacial cellulitisnaspiration pneumonian腸胃道外科手術後nVascular insufficiencynDM footnArterial occlusive diseasen藥物藥物nPenicillinnC
5、lindamycinnMetronidazolenBacteroides fragilisn常見於橫隔膜以下之厭氧感染n通常只有Metronidazole有效GPC GPC vsvs GNB GNBnCephalosporinsnGm(+)球菌第一代最佳n(一代二代三代)nGm(-)桿菌第三代最佳n(一代二代三代)Pseudomonas Pseudomonas aeruginosaaeruginosan有效藥物有效藥物nCeftazidime、Cefepime nGentamicin、AmikacinnAztreonamnCiproxinnImipenem、MenopenemnPiperaci
6、llin宜宜合併合併aminoglycosidePenicillin Resistant Streptococcus pneumoniae(PRSP)n有效藥物有效藥物nCeftriaxone、CefotaximenVancomycin、Teicoplaninn口服口服nMoxifloxacinnLevofloxacin EnterococcusEnterococcus腸腸球菌球菌n對對Ampicillin敏感敏感nAmpicillinn加GM有加成效果 n對對Ampicillin有抗藥性有抗藥性nVancomycin或Teicoplaninn可加GM n對對Vancomycin、Teicop
7、lanin有抗藥性有抗藥性nLinezoidn可能使platelet下降,有bleeding副作用Vancomycin Resistant Staphylococcus aureusn以Linezoid治療Extended Spectrum-LactamaseESBL Producing Strainsn有抗藥性有抗藥性n1-3代CephalosporinnAztreonamn宜使用宜使用nFlomoxefnCiprofloxacinnImipenemnMenopenem Pan-Drug Resistant Acinetobacter baumanniiPDRAB n有抗藥性有抗藥性n第三代
8、Cephalosporins nCarbapenamnImipenemnMeropenemnCiproxinnGM&Amikacinn應採接觸隔離避免傳應採接觸隔離避免傳播播n可使用使用nImipenem or Menopenem+Unasyn nUnasynnAmpicillin 1.5gm nSulbactam 0.5gmnCiproxin+(GM or Amikacin)nImipenem or Menopenem+(GM or Amikacin)2004年本院細菌抗藥性年本院細菌抗藥性(林口院區)(林口院區)格蘭氏陽性球菌格蘭氏陽性球菌 Gm(+)coccinStreptococcus
9、 pneumoniaenPenicillin50%nCeftriaxone10%nVancomycin 0%nViridans streptococcusnPenicillin10%nCeftriaxone 4%nStaphylococcus aureusnOxacillin 60%nEnterococcus faeciumnAmpicillin70%nVancomycin10%nTeicoplanin10%格蘭氏陽性球菌格蘭氏陽性球菌 Gm(+)coccinAcinetobacter baumanniinAmikacin60%nCeftazidime60%nCiprofloxacin 60%nImipenem20%nPseudomonas aeruginosanCeftazidime 8%nCiproxin 16%nImipenem 8%nGentamicin 20%nAmikacin 6%格蘭氏陰性桿菌格蘭氏陰性桿菌 Gm(-)bacilli格蘭氏陰性桿菌格蘭氏陰性桿菌 Gm(-)bacillinSalmonella choleraesuisnAmpicillin90%nBaktar90%nCiprofloxacin 90%nCeftriaxone 3