社区获得性肺炎-英文课件.pptVIP

Antibiotic Use Empiric oral vs.. parenteral Loading dose Dosing Speed of delivery Switch to oral from IV Duration of therapy Delivery Time vs. Mortality Meehan TP, et al. JAMA 1997;278(23)2080-2085 Case 23 year old college student with one day of severe myalgias, cough, and fever with shortness of breath 103 degrees Scattered rhonchi Answer 1. Strep pneumonia 2. Klebsiella 3. Chlamydia 4. Legionella 5. Influenza 6. Mycobacteria Case 72 year old Russian woman with 2 months of cough, fatigue, night sweats Poor response to amoxicillin, tetracycline Answer 1. Pertussis 2. Strep pneumonia 3. Pseudomonas 4. Mycobacteria 5. Legionella 6. Viral Case 56 year old smoker with “the flu” for 4-5 days Some sputum production, fatigue No antibiotics New chill and fever (103) with pleuritic chest pain Answer 1. Legionella 2. Virus 3. Hemophilus influenza 4. Staph aureus 5. Strep pneumonia 6. Mycobacteria Case 52 year old with cough, fever, dyspnea evolving 3 weeks after a trip to the Southwestern United States Poor resonse to azithromycin and levoquin Answer 1. Strep pneumonia 2. Mycoplasma 3. Pertussis 4. Hantavirus 5. Coccidiomycosis IDSA Empirical Antibiotic Selection for Patients with C.A.P. Outpatients Generally preferred: macrolides, fluoroquinolones, or doxycycline Hospitalized - general medicine Generally preferred: b-lactam with or without a macrolide or a fluoroquinolone (alone) Alternatives: cefuroxime with or without a macrolide or azithromycin (alone) Hospitalized in the intensive care unit Generally preferred: erythromycin, azithromycin, or a fluoroquinolone plus cefotaxime, ceftriaxone, or a b-lactam/b-lactamase inhibitor Bartlett JG, et al. Clin Inf Dis 1998;26:811-38 Recommendations for Initial Empirical Antibiotic Therapy Country Nonseverely Ill Patient Severely Ill Patient France Amoxicillin or macrolide Amoxicillin/clavulanic acid + (macrolide or (1991) fluoroquinolone) or cephalosporin III + (macrolide or floroquinolone) Italy Ampicil