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: 523525. 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.
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.
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
Content 1. Target therapy: S. pneumoniae, H. influenzae, M. catarrhalis, Legionella spp. , M. pneumoniae, C. pneumoniae 2. 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
深層性黴菌症 (IFI) 1. Essential for survival: aggressive dx approach & institution of anti-fungal therapy 2. Conventional amphotericin B & drugrelated adverse effects 3. Symposium 2006: limited to candidiasis, aspergillosis, zygomycosis, cryptococcosis 4. Principles: acadmic, local pathogen / resistance patterns, marketed in Taiwan
Content 1. Candidiasis: candidemia, chronic invasive candidiasis, intra-abdominal, urinary, oropharyngeal, esophageal 2. Aspergillosis: pulmonary, ENT, disseminated, cerebral 3. Zygomycosis: rhino-cerebral, disseminated, pulmonary 4. Cryptococcosis: pulmonary, CNS / disseminated 5. Mx of IICP: keep opening pressure <200 mm. H 2 O) & repeat drainage / VP shunt
肺結核治療 1. Incidence / prevalence of MTb in Taiwan: 64. 84 / 5. 56 per 100, 000 in 2001 2. 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
Content 1. pulmonary TB: (1) new case: standard regimen & fixeddose combinations (2) re-treatemnt: relapse, default, fai. Iure (3) drug resistance: 1 & >1 (4) intolerance (5) sepcial situations: LC, ESRD, pregnancy
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)
外科手術預防性抗生素使用 1. 目的: selection pressure, cost & quality 2. Indication: clean-contaminated wound 3. Antibiotic prophylaxis should be used in close proximity to surgical procedure; exception: C/S 4. Single dose of antibiotic before OP is sufficient prophylaxis for most procedures & re-used is indicated for longer procedures (every t 1/2) 5. Problem: inappropriate timing of administration & prolonged use post-OP => consensus 2003
Content 1. site/procedure == likely pathogens == recommened antibiotics == duration 2. Included: large skin; oto-naso-larynx procedures; cardiovascular; thoracic; orthopedics; neurosurgery; colorectal; GS; urology; Gyn/Obs
急性上呼吸道感染 1. Widespread resistance to 1 st line antibiotic and made primary care physicians in treating their pts appropriately 2. NHRI data: OPD 65. 4% for RTI and 1/3 for URI 3. 2002 symposium for URIs: acute sinusitis, acute otitis media, acute pharyngo-tonsilitis, acute epiglottis, acute bronchitis, common cold, influenza
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
Content 1. Asymptomatic bacteriuria 2. Acute bacterial cystitis 3. Acute complicated / uncomplicated pyelonephritis 4. Acute / chronic prostatitis 5. Others: nosocomial / catheter-related UTI, UTI in pregnancy, UTI in children, recurrent UTI
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