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Κεφαλοσπορίνες Κ.Κανελλακοπούλου PowerPoint PPT Presentation


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Κεφαλοσπορίνες Κ.Κανελλακοπούλου. Η χημική δομή της πενικιλλίνης G. Δακτύλιος β-λακτάμης Δακτύλιος θειαζολιδίνης. Η βασική χημική δομή των κεφαλοσπορινών. Α=Δακτύλιος β-λακτάμης Β=Δακτύλιος διυδροθειαζίνης. Ποιές είναι οι β- λακτάμες ;. Πενικιλλίνες (Αμινοπενικιλλίνες

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Κεφαλοσπορίνες Κ.Κανελλακοπούλου

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.

= -

=


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- ;

(

-

)

()


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4

.


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  • :

    • MRSA MRSE

    • ( )


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S. O. S.

- * (-, ) in vitro .

* MRSA: Methicillin Resistant Staphylococcus aureus

MRSE: Methicillin Resistant Staphylococcus epidermidis


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* 60%


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*


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( )

  • :

    (.. Augmentin) 3

  • (!)


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!

( .. Zinadol, Procef, Moxacef, Lorbef Ceftoral) , .

: 40%


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PK, PD

  • PBPs

  • (time dependent) 4-5 MIC


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Cmax

-

AUC

g/ml

MIC

T>MIC


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:

f > C 40% of dosing interval

Crandon et al. AAC 2009

Bulik et al. AAC 2010


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  • Cefixime - CEFTORAL

  • Cefditorenpivoxil SPECTRACEF

  • Ceftriaxone - ROCEPHIN (IV, IM)

  • Cefotaxime - CLAFORAN (IV)

  • Ceftazidime - SOLVETAN (IV)

  • ( )-MAXIPIME (IV)


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Gram : ,

:

Ceftoral

Gram


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()

:

1. :

-

- (MRSA)

- ( )

2. - : ( 1 2 ).

3. .


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:

4. .

5. (. Enterobacter cloacae, Pseudomonas aeruginosa) .

6. : (250-500mg) .


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(-- )

(!)

3

( & ) ?


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3 ;

(ceftoral)

(spectracef)


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In vitro efficacy of cefditoren against recent isolates of Streptococcus pneumoniae in GreeceG. Poulakou,et al. 17th ECCMID 2007. (P. 2029)

  • Cefditoren MIC90:1mg/L (: 0.008-4mg/L).

  • 137 PEN- MIC90 cefditoren0.034mg/L(: 0.008-0.5mg/L).

  • PEN- (n=47) MIC90 cefditoren1mg/L(: 0.008-4mg/L)

  • :specracef


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:

  • ( ).

  • Gram

  • (Spectracef);


Pseudomonas aeruginosa

pseudomonas aeruginosa


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:


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Tem 1

TEM-1

, - (-1), 50 E. coli , Temoniera.


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ESBL ESBL;


O 400

o -(> 400 )

  • :

    • 1 2 3 4

  • , ,


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  • ESBL :

    • -

Pitout JD, et al. J Antimicrob Chemother. 2005;56:52-59.


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resistance to ceftazidimeAll clinical specimens(July - December 2013)

Medical Wards


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1

  • 77 , 10

  • , / E. coli


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.coli

  • mpicillin: A

  • Cephalothin:A

  • Augmentin: E

  • Cefoxitin: E

  • Ceftazidime:

  • Cefotaxime: A

  • Imipenem: E

  • Gentamicin: E

  • Amikacin: E

  • Nalidixic Acid:E

  • Norfloxacin: E


1 pattern

1: pattern ;

- TEM-1

MBL(-- .)

ESBL ( - CTX-M)


Esbls

ESBLs

  • ESBL

  • , .


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;

  • -


Esbls1

ESBLs

  • .

  • ,

    , ,

    , ,

    .

  • .

  • .


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2010:

CLSI breakpoints


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A)

-?


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-?

B)


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;;


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-

  • ( )

  • Lyme:, ,

  • (, Single-dose )

  • HACEK


Ceftazidime

Ceftazidime

  • P. aeruginosa( ).

  • ESBLs AmpC-lactamases -


S pneumoniae ceftriaxone cefotaxime

S. pneumoniae Ceftriaxone Cefotaxime

  • Kanavaki S, et al. Eur J ClinMicrobiol Infect Dis. 2005;24:693-6.

    0,36%

  • Paraskakis I, et al. ClinMicrobiol Infect. 2006;12:490-3.

    1,2%

  • Poulakou G, et all. Int J Antimicrob Agents. 2007;30:87-92

    1%


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- ;


Shock

shock

Anand Kumar, et al.

Crit Care Med.2010;38:1773-1785.


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:

Coombs (+)

:

:

,

:,,(1-7% 7-10 )


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  • G.

  • 5% .


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( )


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