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適當使用抗生素 抗微生物製劑使用指引

適當使用抗生素 抗微生物製劑使用指引. 感 控 室. 八種感染症之抗微生物製劑使用指引 台灣感染症醫學會. 1. 肺炎 : J Microbiol Immunol Infect. 2007;40:279-283. 2. 深層性黴菌症 : J Microbiol Immunol Infect 2006;39:523-525. 3. 發熱性嗜中性球減少症 : J Microbiol Immunol Infect 2005;38:455-457. 4. 肺結核治療 : J Microbiol Immunol Infect 2004;37:382-384.

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適當使用抗生素 抗微生物製劑使用指引

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  1. 適當使用抗生素抗微生物製劑使用指引 感 控 室

  2. 八種感染症之抗微生物製劑使用指引台灣感染症醫學會八種感染症之抗微生物製劑使用指引台灣感染症醫學會 1. 肺炎: J Microbiol Immunol Infect. 2007;40:279-283. 2. 深層性黴菌症: J Microbiol Immunol Infect 2006;39:523-525. 3. 發熱性嗜中性球減少症: J Microbiol Immunol Infect 2005;38:455-457. 4. 肺結核治療: J Microbiol Immunol Infect 2004;37:382-384.

  3. 八種感染症之抗微生物製劑使用指引台灣感染症醫學會八種感染症之抗微生物製劑使用指引台灣感染症醫學會 5. 外科手術預防性抗生素使用指引: J Microbiol Immunol Infect 2004;37:71-74. 6. 急性上呼吸道感染: J Microbiol Immunol Infect 2002;35:272-273. 7. 抗HIV治療: J Microbiol Immunol Infect 2001;34:224-226. 8. 泌尿道感染: J Microbiol Immunol Infect 2000;33:271-272.

  4. 肺炎 1. Guideline / IDST (IDSA) 1999 2. Taiwan Society of Pulmonary & Critical Medicine 2001: HAP, VAP 3. IDST consensus 2005 / 2006 (1) CAP: OPD & IPD (mild / moderate & severe / intensive) (2) NP: early-onset & late-onset

  5. Content • Target therapy: S. pneumoniae, H. influenzae, M. catarrhalis, Legionella spp., M. pneumoniae, C. pneumoniae • Empiric therapy: (1) CAP: OPD vs IPD & mild-to-moderate vs severe / ICU (2) HAP: risk factor (MDRO, P. aeruginosa) & early vs late-onset (3) VAP: P. aeruginosa, Acinetobacter spp., MRSA 3. Recommendation of parenteral antibiotic therapy of HAP in adults

  6. 深層性黴菌症 (IFI) • Essential for survival: aggressive dx approach & institution of anti-fungal therapy • Conventional amphotericin B & drug-related adverse effects • Symposium 2006: limited to candidiasis, aspergillosis, zygomycosis, cryptococcosis • Principles: acadmic, local pathogen / resistance patterns, marketed in Taiwan

  7. Content • Candidiasis: candidemia, chronic invasive candidiasis, intra-abdominal, urinary, oropharyngeal, esophageal • Aspergillosis: pulmonary, ENT, disseminated, cerebral • Zygomycosis: rhino-cerebral, disseminated, pulmonary • Cryptococcosis: pulmonary, CNS / disseminated • Mx of IICP: keep opening pressure <200mmH2O) & repeat drainage / VP shunt

  8. 肺結核治療 • Incidence / prevalence of MTb in Taiwan: 64.84 / 5.56 per 100,000 in 2001 • Consensus meeting 2004: (1) viewpoint of primary care physicians (2) already marketed in Taiwan (3) based on academic principles, but not regulations of BNHI 3. excluded: HIV co-infected, drug-durg interaction, treatment of pediatrics, lack of rifabutin, cycloserine

  9. Content 1. pulmonary TB: (1) new case: standard regimen & fixed-dose combinations (2) re-treatemnt: relapse, default, faiIure (3) drug resistance: 1 & >1 (4) intolerance (5) sepcial situations: LC, ESRD, pregnancy

  10. Content 2. extra-pulmonary TB: (1) pleurisy, lymphadenitis, peritonitis, pericarditis, GU tract dz (2) bone / joint dz, pleural empyema (3) meningitis, CNS dz 3. Dosage of anti-TB agents (adults)

  11. 外科手術預防性抗生素使用 • 目的: selection pressure, cost & quality • Indication: clean-contaminated wound • Antibiotic prophylaxis should be used in close proximity to surgical procedure; exception: C/S • Single dose of antibiotic before OP is sufficient prophylaxis for most procedures & re-used is indicated for longer procedures (every t1/2) • Problem: inappropriate timing of administration & prolonged use post-OP => consensus 2003

  12. Content • site/procedure == likely pathogens == recommened antibiotics == duration • Included: large skin; oto-naso-larynx procedures; cardiovascular; thoracic; orthopedics; neurosurgery; colorectal; GS; urology; Gyn/Obs

  13. 急性上呼吸道感染 • Widespread resistance to 1st line antibiotic and made primary care physicians in treating their pts appropriately • NHRI data: OPD 65.4% for RTI and 1/3 for URI • 2002 symposium for URIs: acute sinusitis, acute otitis media, acute pharyngo-tonsilitis, acute epiglottis, acute bronchitis, common cold, influenza

  14. 泌尿道感染 1. consensus: 1999 => 2000 2. including: (1) for primary care physicians (2) already marketed in Taiwan (3) based on academic principles, but not NHRI (4) local epidemiology (pathogen & resistance patterns) (5) prophylactic antibiotic usage

  15. Content • Asymptomatic bacteriuria • Acute bacterial cystitis • Acute complicated / uncomplicated pyelonephritis • Acute / chronic prostatitis • Others: nosocomial / catheter-related UTI, UTI in pregnancy, UTI in children, recurrent UTI

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