e5吸科耐药革兰阴性杆菌与治疗策略—培训课件.ppt

COPD, chronic obstructive pulmonary disease. a Erythromycin, azithromycin, or clarithromycin. b That is, the patient was given a course of antibiotic(s) for treatment of any infection within the past 3 months, excluding the current episode of infection. Such treatment is a risk factor for drug-resistant Streptococcus pneumoniae and possibly for infection with gram-negative bacilli. Depending on the class of antibiotics recently given, one or another of the suggested options may be selected. Recent use of a .uoroquinolone should dictate selection of a non.uoroquinolone regimen, and vice versa. c Moxi.oxacin , gati.oxacin, levo.oxacin, or gemi.oxacin (oral gemi.oxacin only, which was approved by the U.S. Food and Drug Administration on 4 April 2003 and which is the only .uoroquinolone approved for multidrug-resistant S. pneumoniae; not yet marketed). d Azithromycin or clarithromycin. e Dosage, 1 g PO tid. f Dosage, 2 g PO bid. g High-dose amoxicillin, high-dose amoxicillin-clavulanate, cefpodoxime, cefprozil, or cefuroxime. h Cefotaxime, ceftriaxone, ampicillin-sulbactam, or ertapenem; ertapenem was recently approved for such use (in once-daily parenteral treatment), but there is little experience thus far. i The antipseudomonal agents chosen re.ect this concern. Risk factors for Pseudomonas infection include severe structural lung disease (e.g., bronchiectasis) and recent antibiotic therapy or stay in hospital (especially in the ICU). For patients with CAP in the ICU, coverage for S. pneumoniae and Legionella species must always be assured. Piperacillin-tazobactam, imipenem, meropenem, and cefepime are excellent -lactams and are adequate for most S. pneumoniae and Haemophilus in.uenzae infections. They may be preferred when there is concern for relatively unusual CAP pathogens, such as Pseudomonas aeruginosa, Klebsiella species, and other gram-negative bacteria. j Piperacillin, piperacillin-tazobactam, imipenem, meropenem, or cefepime. k Data suggest that older adult