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临床抗菌药物的合理使用 上王镇卫生院 董小利. 抗菌药物的合理使用. 目前用于临床的抗菌药物已有 200 余种。 感染性疾病遍布临床各科,其中细菌性感染最常见,抗菌药物是临床应用最广泛的药物之一,也是滥用最严重的一类药物。. 抗微生物药 (anti-microbialagents) : 抗菌药( 抗菌素,抗生素, antibiotics ) 抗真菌药 抗病毒药. 英国细菌学家亚历山大 · 弗莱明 ,他在 1928 年发明了青霉素 ,1945 年用于临床. 中国是世界上乱用抗菌药物的国家之一. - PowerPoint PPT Presentation
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(anti-microbialagents) antibiotics 200
1928,1945
390%78002259743.1%
1 2 3 4
-
(drug resistance ).G- PNMDR60%
PN:19451976301971198515linezolid20004FDA5-12521079%,100%30%
chemotherapeutic index LD50/ ED50 LD5/ ED95 post antibiotic effectPAE
PAE PAE 23PAE ADRADR PAE PAE
antibacterial spectrum) -
MIC: -:PAE
SN + + + +PN+SD +PN+
1. 2. 3. 4.
RNA BDNA
1. 2.3.4.5.6.7.
- - -
1. XFGK Gpenicillin G U
imc.s.f G+G+G 1.
2. 3. 4. 5. 6.
1. 2. 3.iv 4.
1.V 2. 3. ampicillin amoxicillin 4. carbenicillin piperacillin
cephalosporinsC7-ACA
- PGG+ > 23 G- G+ < = 1G- >1 12
G+ G- >3
-
5%10%
- imipenemDHP-1 tienamcilastatin meropenemCNS
cepharmycins G+G- cefoxitin cefmetazole
oxacephalosporins SO latamoxef flomoxef
monobactams G+G- aztreonam carumonam
clavulanic acidsulbactamtazobactam
1.14 2.15 3.16
1.G+ 2. 3. 4. 5. 6. 7.ADR:
EM1958401985RTMAZMCTMDTMFTMEM G+
erythromycin
10
5%
clarithromycin
azithromycin > G- 10100 1
1.,PAE12 2. G- 3. 4. 5.ADR:()
1.
2.
3. ACh
4. G
. . .
tetracyclineterramycinG+G-
H2 Fe2+Ca2Mg2+AI3+
DNA
1. 2.
3. 4.
210
minocycline
chloramphenicolchloromycetin
G+G- 45%99%
1. 70S
1. 2. 3.Q 4. 5.
2. 3.4.
lincomycin clindamycin 48G+G-
5
G+
vancomycin norvancomycin teicoplanin G+
t1/2 G+-
:1500ml11014
Teicoplanin471VanB
-FosfomycinMRSA2g60/
quinolones 4-DNADNA gyrase
nalidixic acid1962pipemidic acid1979norfloxacinfluoroquinolones
norfloxacinciprofloxacinofloxacinlevofloxacinlomefloxacinfleroxacinsparfloxacinmoxifloxacin
. .Du68090
DNADNA gyraseDNA topoisomerase DNA
14%30%G-
1. 2. 3. 4.
1. 2.CNS P63 3. 4.
5.6.7.
sulfonamides 1. SD
19321935DomagkSN
2. 3. SMLSD-Ag G+G-A
PABAPABA
SD SDSMZ
1. 2. 3. 4. 5.
1. sulfadiazineSD 45%80%
SMZ (TMP)1012hSD2. SASP5-
3. SML
SD-Ag SD SA
trimethoprim,TMP
t1/210SMZTMPSMZSDTMP
nitrofurantoinfuradantinGG-
furazolidonemetronidazole
-B
2/31/2
ADR1.NSSN2.SN-3.APN4.SN5SSN6.
antifungal agents
Bamphotericin B >
nystatin B
grifulvin DNADNA >
P450P450
ketoconazole
itraconazole 5100 fluconazole 520
terbinafine flucytosine DNAB
51RP 8U6 8U/2/d 5%500 ml 3 20mg 3 1/ d
702
2.0g 0.9%NS 100ml iv qd*10d
65 5% GS 250ml+0.5 iv qd 0.9% NS 250ml+0.6iv q12h
50s
?? 1946 40 1956 400