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抗菌药物的临床合理应用 PowerPoint PPT Presentation


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抗菌药物的临床合理应用. 广州开发区医院药剂科 浦锡娟 2013 年 4 月. 处方管理办法. 中华人民共和国卫生部第 53 号令 《 处方管理办法 》 ,自 2007 年 5 月 1 日起施行。 处方:是指由注册的执业医师和执业助理医师在诊疗活动中为患者开具的、由取得药学专业技术职务任职资格的药学专业技术人员(简称药师)审核、调配、核对,并作为患者用药凭证的医疗文书。. 处方管理办法. 处方管理的一般规定: 1. 患者一般情况、 临床诊断 填写清晰、完整,并与 病历 记载相一致。 2. 字迹清楚,不得涂改;如需修改,应在修改处签名并注明修改日期。

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抗菌药物的临床合理应用

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20134


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  • 53200751


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  • 1.

  • 2.

  • 3.


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  • 4.55

  • 5.

  • 6.

  • 7.


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  • 8.


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  • 9.

  • 10.

  • 11.21-2


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  • 12.

  • 13.

  • 14.


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  • 15.

  • 16.

  • 17.123


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  • 18.

  • 1

  • 2


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  • 2012213201281


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  • 2012 1


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  • 30%

  • 40%

  • 50%

  • 75%


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  • 1.

  • 2.

  • 3.

  • 4.

  • 5.


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  • (anti-infective agents)

  • (anti-microbial agents)


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(antibiotics)

(antibacterial agents):


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DNA

mRNA

RNA

DNA

DNA

30S

50s

-

B

BE


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WHO50%25%


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30%20%22%

1997

70%

80%

90%


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  • 2

  • 0.51/360%

  • 0.2%-2.9%2%


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*

*


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A

A

Ref: Distribution of infection in the

immuocompromised host.


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  • 510

  • 50


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B


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60y

+


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(1)

  • 3040pH

    <50


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(2)


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(3)

  • :

  • SMZTMP

  • :

  • :


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*

*

*

*

*


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  • Celis: 120

    36.6%

    30.5%

    91.6%

  • Torres: 78

    23

    52


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*

MRSAMRSE

ESBLS

G-


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G+


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-

  • -


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G

  • G +++

  • ++ +++

  • ++ ++ ++

  • ++ ++ +++ +++


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  • 0.50.5

  • ++ ++ 16.7 8

  • +++ ++ 18.2 9.1

  • ++++ ++ 23.8

  • +++~++++ ++

  • G ++++ +


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  • G+

  • G-

  • Cefuroxime

  • Cefotian

  • Cefamandole


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2g mg l

2g(mg/L)

  • CSF CSF/

  • 3.06 15.59

  • 4.08 17.23

  • 2.21 24.05

  • 5.36 3.73


Cefodizime

cefodizime

  • CD4+

  • T1/2b 2h88%

  • 1~4g1~2


Cefepime

cefepime

  • b-

  • ( I )

  • T1/2b 2h<5%

  • 2~4g2

  • (G-)


Cefpirome

cefpirome

  • T1/2b 2h

  • 1~4g1~2


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  • Cefaclor

  • 36~52%

  • Cefixime

  • Ceftibuten

  • (75~90%)


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-

  • -


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  • Cefoxitin

  • Cefmetazole

  • Cefotetan


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  • ++ +++

  • ++ +++

  • +++ ++-++

  • 1g 22.5mg/l 90.1mg/l

  • 1g 124.8mg/l 354.5mg/l

  • CSF ++ +


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  • Moxalactam

  • Flomoxef


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  • Aztreonam


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  • TDM()


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  • 8

  • 18


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  • A

  • B

  • C

  • D

  • X


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  • b-


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b-


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SMZ+TMP*

B

**

***


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  • 2/3~1/2

  • 1/2~1/5

  • 1/5~1/10


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G-

G+


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  • , , , ,


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C

A D


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MIC-


Relationship between time above mic and bacterial eradication with lactams in otitis media

100

80

60

Bacterial eradication (%)

40

PSSP

PISP-PRSP

20

H. influenzae

0

0

20

40

60

80

100

Time above MIC (% of dosing interval)

Relationship between Time above MIC and bacterial eradication with -lactams in otitis media

Craig & Andes, Pediatr Infect Dis J, 1996

Dagan et al studies


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8

7

6

5

Control

4

0.5MIC

1 MIC

3

4 MIC

16MIC

2

64MIC

1

6

0

2

4

6

0

2

4

6

8

0

2

4

Effect of increasing concentrations of Tobramycin(a), Ciprofloxacin(b) and Ticarcillin(c) on the bacterial activity against Pseudomonas Aeruginosa

(a)

(c)

(b)

9

Log10cfu/ml

Time(h)


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  • Cmax/MIC >10AUC24/MIC>125


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  • MIC4-5MIC

  • MIC40%-50%60%-70%

  • -


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  • MICs


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  • PK/PD


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PK/PD

PDMIC


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I

II

+

+

+

+

+


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  • 4: ; ; ;

  • + , + ,

  • ,,,


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  • G-1

    1 G-

    /

    -+ +++ + -

    + ++ ++ -

    - -/++* -/++* -/++*

    -+ ++ ++ -

    + + +++ -

    *


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  • -() ,,,,,

    Chin J Respir Crit Care Med ,July 2005 ,Vol14 ,No14


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  • 3710%2510%5%pH<4)210%249.57%18.4%pH3.2-5.5pH


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  • /3h50%pH1.2g/100ml2520-30


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  • 2


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  • 0.9%

  • B6


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  • 725.5%94.5%pHpH4-85%GSpH=42h31%10%GSpH=3.22h51%10ml20ml0.5g

    .200319949


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  • pH

    .2002195417


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  • Ca2+Fe2+Al3+Bi3+Zn2+Mg2+4-20AUC3-102


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  • (P > 0. 05) , (P < 0. 05)

    , 1997 (17 )9 :389-391


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  • ,

    , 1999 (8 )4 :217-219


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  • ()()()()


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  • , ,


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