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Antibiotika dosering

Antibiotika dosering. Inga Odenholt, professor Infektionskliniken, Malmö SUS. K oncentration sberoende vs. tidsberoende avdödning. Concentration dependent killing of grepafloxacin against S. pneumoniae ATCC 6306. 10. 9. 8. 7. 2xMIC. 4xMIC. 8xMIC. 6. 16xMIX. 32xMIC. log10 cfu/ml.

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Antibiotika dosering

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  1. Antibiotika dosering Inga Odenholt, professor Infektionskliniken, Malmö SUS

  2. Koncentrationsberoende vs.tidsberoende avdödning

  3. Concentration dependent killing of grepafloxacin against S. pneumoniae ATCC 6306 10 9 8 7 2xMIC 4xMIC 8xMIC 6 16xMIX 32xMIC log10 cfu/ml 5 Control 4 3 2 1 0 h 0 3 6 9 12 15 18 21 24

  4. Tidsberoende avdödning av penicillin mot S. pyogenes 10 9 8 7 2xMIC 4xMIC 6 8xMIC log10 cfu/ml 16xMIC 5 64xMIC Control 4 3 2 1 h 0 3 6 9 12 15 18 21 24

  5. Intergration between pharmacokinetics/pharmacodynamics (PK/PD)

  6. Log konc PK/PD parametrar Cmax/MIC AUC/MIC T>MIC Cmax AUC= Ytan under konc. kurvan MIC T>MIC Tim

  7. ß-laktam antibiotika • Effekten beroende på T>MIC

  8. Antibiotika beroende av T>MIC • Penicilliner • Cefalosporiner • Karbapenemer • Monobaktamer • Makrolider • Klindamycin • Oxazolidinoner

  9. Relationship Between Time Above MIC90 andBacteriologic Cure for S. pneumoniae (pink) & H. influenzae (blue)

  10. Kinoloner och aminoglykosider • Effekten är beroende på peak/MIC och AUC/MIC

  11. Relationship between max. Peak/MIC ratio and the rate of clinical response for aminoglycosidesMoore et.al. J Infect Dis, 1987, 155: 93 Response rate, % Maximum Peak/MIC ratio

  12. Relationship Between 24-Hr AUC/MIC and Efficacy of Ciprofloxacin in 64 Patients with Serious Bacterial Infections

  13. Bensylpenicillin • SpektrumMIC-värden (nativa)mg/L • ß-hemolytiska • streptokocker grupp A 0.008-0.032 • S. pneumoniae 0.008-0.032 • Enterokocker 0.5-4 • P. multocida 0.016-0.125 • Meningokocker 0.016-0.125

  14. I S R

  15. MIC-gränser MIC gränser • Icke-artrelaterade MIC-gränser: 0.25/2 • Artrelaterade MIC-gränser: streptokocker (0.25/0.25), pneumokocker (0.06/2), enterokocker, H. influenzae (IE)

  16. Gentamicin • SpektrumMIC-värden (nativa)mg/L • E. coli 0.25-2 mg/l • Enterobacter spp 0.12-2 mg/l • P. aeruginosa 0.25-8 mg/l • S. aureus 0.25-2 mg/l

  17. I S R

  18. R I S

  19. R S I

  20. Cmax >MIC bör vara 8-10

  21. Ekvacillin • SpektrumMIC-värden (nativa)mg/L • ß-hemolytiska • streptokocker grupp A 0.032-0.125 • Stafylococcus aureus 0.125-0.5 • Koagulasnegativa • stafylokocker 0.125-1

  22. Cefotaxim • Spektrum MIC-värden (nativa)mg/L • ß-hemolytiska streptokocker 0.008-0.032 • pneumokocker 0.004-0.032 • H. influenzae 0.008-0.032 • M. catarrhalis 0. 032-0.125 • S. aureus 0.5-4 • E. faecalis 2->64 • E. coli 0.016-0.125 • Klebsiella 0.016-0.125 • P. mirabilis 0.008-0.032 • Enterobacter spp. 0.064-0.5 • Acinetobacter 0.5-8

  23. MIC-gränser • Farmakologiska MIC-gränser: 1/2 • Artrelaterade MIC-gränser: streptokocker, pneumokocker, H. influenzae, Enterobacteriaceae (1/2).

  24. S I R

  25. I R S

  26. Tazocin • Spektrum MIC-värden (nativa)mg/L • ß-hemolytiska streptokocker gr. A 0.016-0.064 • pneumokocker 0.008-0.032 • H. influenzae 0.016-0.064 • S. aureus 0.25-1 • E. faecalis 1-8 • E. coli 0.5-4 • Klebsiella 0.5-8 • P. mirabilis 0.125-1 • Enterobacter spp. 0.5-8 • P. aeruginosa 1-8 • Acinetobacter 1-16 • B. fragilis 0.5-8

  27. MIC-gränser Farmakologiska MIC-gränser: 8/16 Enterobacteriacae 8/16 Pseudomonas 16/16

  28. I S R

  29. S R

  30. Tienam • ß-hemolytiska streptokocker 0.004-0.016 • pneumokocker 0.004-0.016 • H. influenzae 0.064-0. 25 • M. catarrhalis 0. 064-0.5 • S. aureus 0.008-0.032 • E. faecalis 0.25-1 • E. coli 0.064-0.25 • Klebsiella 0.064-0.25 • P. mirabilis 0.125-0.25 • Enterobacter spp. 0.064-0.25 • Acinetobacter 0.032-0.125 • P. aeruginosa 0.25-1 • B. fragilis 0.016-0.125 • C. perfringens 0.016-0.125

  31. MIC-gränser • Farmakologiska MIC-gränser: 2/8 • Artrelaterade MIC-gränser: pneumokocker, H. influenzae, Enterobacteriaceae (2/8), pseudomonas (4/8), acinetobacter (2/8), enterokocker (4/8), Gramnegativa anaerober

  32. I R S

  33. R S I

  34. I R S

  35. Dosering 0.5 g x 3 ger T>MIC=50% för P.aeruginosa med MIC=2 mg/L; 0.5 g x 4 ger T>MIC=67%

  36. Ceftazidime • Spektrum MIC-värden (nativa)mg/L • ß-hemolytiska streptokocker 0.125-0.5 • pneumokocker 0.25-1 • H. influenzae 0.032-0.125 • S. aureus 4-16 • E. faecalis 16->64 • E. coli 0.125-1 • Klebsiella 0.125-1 • P. mirabilis 0.064-0.25 • Enterobacter spp. 0.125-1 • Acinetobacter 0.5-4 • P. aeruginosa 0.5-4

  37. MIC-gränser • Farmakologiska MIC-gränser: 4/8 • Artrelaterade MIC-gränser: streptokocker, pneumokocker, H. influenzae, Enterobacteriacae 1/8, pseudomonas 8/8

  38. R S I

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