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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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.


  • G.

  • -

  • .


.

= -

=


- ;

(

-

)

()


4

.


  • :

    • MRSA MRSE

    • ( )


S. O. S.

- * (-, ) in vitro .

* MRSA: Methicillin Resistant Staphylococcus aureus

MRSE: Methicillin Resistant Staphylococcus epidermidis



* 60%


*



( )

  • :

    (.. Augmentin) 3

  • (!)


!

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

: 40%


PK, PD

  • PBPs

  • (time dependent) 4-5 MIC


Cmax

-

AUC

g/ml

MIC

T>MIC


:

f > C 40% of dosing interval

Crandon et al. AAC 2009

Bulik et al. AAC 2010


  • Cefixime - CEFTORAL

  • Cefditorenpivoxil SPECTRACEF

  • Ceftriaxone - ROCEPHIN (IV, IM)

  • Cefotaxime - CLAFORAN (IV)

  • Ceftazidime - SOLVETAN (IV)

  • ( )-MAXIPIME (IV)


Gram : ,

:

Ceftoral

Gram


()

:

1. :

-

- (MRSA)

- ( )

2. - : ( 1 2 ).

3. .


:

4. .

5. (. Enterobacter cloacae, Pseudomonas aeruginosa) .

6. : (250-500mg) .


(-- )

(!)

3

( & ) ?


3 ;

(ceftoral)

(spectracef)


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


:

  • ( ).

  • Gram

  • (Spectracef);


pseudomonas aeruginosa


:





TEM-1

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


ESBL ESBL;


o -(> 400 )

  • :

    • 1 2 3 4

  • , ,



  • ESBL :

    • -

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


resistance to ceftazidimeAll clinical specimens(July - December 2013)

Medical Wards


1

  • 77 , 10

  • , / E. coli


.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 ;

- TEM-1

MBL(-- .)

ESBL ( - CTX-M)


ESBLs

  • ESBL

  • , .


;

  • -


ESBLs

  • .

  • ,

    , ,

    , ,

    .

  • .

  • .


2010:

CLSI breakpoints


A)

-?


-?

B)


;;


-

  • ( )

  • Lyme:, ,

  • (, Single-dose )

  • HACEK


Ceftazidime

  • P. aeruginosa( ).

  • ESBLs AmpC-lactamases -


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%


- ;


shock

Anand Kumar, et al.

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


:

Coombs (+)

:

:

,

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


  • G.

  • 5% .


( )



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