抗生素使用指南 (英文)Simple Antibiotic Guide
2022妇产科围术期抗生素的使用全文
[6]SiChuan Pharmacy Administration andQuality Control Center . Implementation R ules of Perioperative Prophylactic Application of Antibiotics in Sichuan Province (四川省围手术期预 防性应用抗菌药物实施细则)
[M ]. Beijing:People's Medical Publishing House , 2015 .
[5]Ministry of Health of the People'ASIs R epublic of
China . No . 84r
Ministry of Health on revising the home page of inpatient medical
（中华妇产科杂志），2011 ,3 （ 46 ） : 230-233 .
[2]IORIOA ,SPENCER F A , FALAVIGNA Mletal . Use of G R ADE for assessment of evidence about prognosis : rating confidence in es
水囊引产术推茬的Bi防用药为第一、二代头抱IIjf土甲硝K（推柞强度：强 推荐；证据质M： B）,对于布.头胞菌素过敏史患者,可选用氨内幡件类土 甲硝畔（推荐强度：强推荐；证据质#t： C）
抗生素使用指南 (英文)Simple Antibiotic Guide
What about other antibiotics?
• Aminoglycosides - Macrolides – Tetracyclines- Clindamycin
Which brings us to the issue of Cidal vs Static antibiotics (and synergy also)
WHAT is Inhibitory (static)?
• In a test tube there is no change over time
Flagyl
CIDAL
Pharmakokinetics & Pharmakodynamics (Is more better?)
• peak level (ie concentration) = rate of kill (aminoglycosides, quinolones)
• Time > MIC (duration) = rate of kill (beta lactams, clindamycin, macrolides)
All inhibit protein synthesis via ribosomes
• Quinolones block DNA synthesis
• Daptomycin blocks AA transport
What is Synergy and when do you want it?
Additive is: 2 + 2 = 4 Synergy is: 2 + 2 = 7
--抗生素(英文PPT)
Bacteroides
Enterococcus
Pseudomonas
Staphylococcus
Haemophilus Neisseria
E.coli Other coliforms
Coventry and Warwickshire Pathology
Gram Positives vs Gram Negatives
– Glycopeptides
• Vancomycin, (Teicoplanin) IV
– Tetracyclines
• Doxycycline PO
– Others
• Trimethoprim, Nitrofurantoin PO • Rifampicin, Clindamycin PO/IV • Ciprofloxacin PO
Antibiotics
James Clayton Consultant Microbiologist
Coventry and Warwickshire Pathology
Antibiotic groups
• β-Lactams
– Penicillins
• Penicillin, Amoxicillin, Flucloxacillin PO/IV
Streptococci
• Group A streptococci
– Skin & soft tissue infection – Necrotising fasciitis – Tonsillitis – Toxic shock, sepsis
• Group B streptococci
– Neonatal infection, UTI
Pseudomonas
抗生素中相关杂质质量标准制定的指导原则【中英】
30 June 2012EMA/CHMP/CVMP/QWP/199250/2009 corrCommittee for Medicinal Products for Human Use (CHMP)/ Committee for Medicinal Products for Veterinary Use (CVMP)Guideline on setting specifications for related impurities in antibiotics抗生素中相关杂质质量标准制定的指导原则Final 定稿学习之名（译注）Table of contents 目录Executive summary1. Introduction (background)2. Scope3. Legal basis4. General requirements5. Impurity profiling and reporting, identification and qualification thresholds6. New applications and variations7. Specifications for medicinal products8. Analytical proceduresDefinitionsAnnex 1: Explanatory note regarding thresholds.Annex 2: ThresholdsAnnex 3: Example of “fingerprint chromatogram” approach to control very complex impurity profiles 概要1、背景介绍2、范围3、法规依据4、一般要求5、杂质分布以及报告、鉴别和界定阈值6、新申请和变更7、制剂产品质量标准8、分析方法定义附件1：关于阈值的注释附件2：阈值附件3：利用基于“指纹图谱”的方法对非常复杂的杂质分布进行控制举例Executive summary 概要Antibiotics active substances currently on the market are produced by fermentation, by fermentation followed by one or more synthetic steps (semi-synthetic substances) or by chemical synthesis. Fermentation processes are, in comparison to synthetic processes, more variable and less controllable, so the impurity profile of an active substance whose manufacturing process involves fermentation may be more complex and less predictable than that of a purely synthetic product. For this reason fermentation products and semi-synthetic substances are not included in the scope of the ICH Q3 and the VICH GL10/GL11 guidelines, which set thresholds for the identification, reporting and qualification of related impurities in active substances manufactured by chemical synthesis.目前上市的抗生素类活性物质是由发酵、发酵加一步或几步合成步骤（半合成）、化学合成制得。
抗生素英文
抗生素英文Antibiotics are a type of medication used to treat bacterial infections. They work by killing or inhibiting the growth of bacteria, thus preventing the spread of infection. Antibiotics come in many different forms, including pills, capsules, creams, and injections. They are one of the most widely used medications in the world, and have saved countless lives since their discovery in the early 20th century. In this article, we will discuss the history of antibiotics, their mechanism of action, and the different types of antibiotics.History of antibioticsThe discovery of antibiotics is often attributed to Alexander Fleming, who in 1928 noticed that a mold called Penicillium notatum could prevent the growth of bacteria. He was awarded the Nobel Prize in Medicine in 1945 for his discovery. However, the use of natural substances to treat infections dates back thousands of years. For example, ancient Egyptians used moldy bread to treat wounds, and ancient Chinese texts describe the use of moldy soybeans to treat infected wounds.After Fleming's discovery, other researchers began searching for other natural substances with antibiotic properties. In the 1930s, the German chemist Gerhard Domagk discovered the first synthetic antibiotic, sulfanilamide. This was followed by the discovery of streptomycin in 1943 by researchers at Rutgers University, which is a type of antibiotic called an aminoglycoside.Since then, many different types of antibiotics have been discovered, each with their own unique mechanism of action.Mechanism of actionAntibiotics work by targeting the structures or processes that are unique to bacteria. This is important, as antibiotics need to be able to kill bacteria without harming the patient's own cells.One common target of antibiotics is the bacterial cell wall. Most bacteria have a cell wall made of peptidoglycan, a complex molecule that provides structural support to the cell. Antibiotics such as penicillin and cephalosporins target this cell wall, causing it to weaken and ultimately burst, killing the bacteria.Another target of antibiotics is the bacterial ribosome. Ribosomes are responsible for synthesizing proteins in the cell, and antibiotics such as tetracyclines and macrolides inhibit this process, preventing the bacteria from being able to grow and divide.Other antibiotics target the DNA or RNA of the bacterial cell, preventing it from being able to replicate or transcribe genes.Types of antibioticsThere are many different types of antibiotics, each with their own unique mechanism of action and spectrum of activity. Some common types of antibiotics include:1. Penicillins – These are one of the oldest and most widely used types of antibiotics. They work by targeting the bacterial cell wall, and are effective against many different types of bacteria.2. Cephalosporins – These are similar to penicillins in their mechanism of action, but are more resistant to bacterial enzymes that can break down penicillins. They are often used to treat more serious infections.3. Macrolides – These antibiotics inhibit bacterial protein synthesis by binding to the bacterial ribosome. They are often used to treat respiratory and skin infections.4. Tetracyclines – These antibiotics also inhibit bacterial protein synthesis, but by a different mechanism than macrolides. They are often used to treat acne, as well as respiratory and urinary tract infections.5. Aminoglycosides – These antibiotics also inhibit bacterial protein synthesis, but by a different mechanism than macrolides and tetracyclines. They are often used to treat serious infections such as sepsis and endocarditis.There are many other types of antibiotics as well, including fluoroquinolones, sulfonamides, and carbapenems.ConclusionAntibiotics are a powerful tool in the fight against bacterial infections, but they must be used responsibly to avoid the development of antibiotic-resistant bacteria. This occurs when bacteria evolve mechanisms to resist the effects of antibiotics, making them harder to treat. It is important to use antibiotics only when necessary, and to always complete the full course of treatment, even if you feel better before the prescription is finished. Overuse of antibiotics can cause more harm than good, so it is important to always follow the instructions of your healthcare provider when taking antibiotics.。
如何合理使用抗生素
0%
20%
死亡率 40% 60%
80%
100%
(1,342 severe sepsis and septic shocks LENERCEPT study)
100
Survival of patients with sepsis
Survival (probability) (%) adequate
75
3.3
2.1 2.4 3.9 2.4
11.9 11.5
7.5 6.4 11.6 12
12.7
王佩芬、郑小河：汕头大学医学院第一附属医院2008年细菌耐药监测
汕大附一院2008年G-菌对抗生素的敏感性
2008年主要革兰氏阴性杆菌对抗生素的敏感率（％）
100 90 80 70 60 50 40 30 20 10 0
耐 药 率 (%)
2007年广州地区 G-细菌耐药性监测
236株嗜麦芽窄食单胞菌的耐药率(%)
耐 药 率 (%)
2007年广州地区 G-细菌耐药性监测
万古霉素对金黄色葡萄球菌的MIC值呈逐年上升趋势
近年来，万古霉素对70%金黄色葡萄球菌的MIC值≥1µg/mL*
100
MIC ≤0.5
MIC = 1
三代头孢：ESBL， AmpC； IMP：金属酶，真菌
Correct antibiotics Correct dosage Correct route of administration
重视病原学标本采集
Pneumoniae diplococcus
重视病原学标本采集
Klebsiella pneumoniae
*一项自2000年1月至2004年12月UCLA医学中心对6003例临床分离金黄色葡萄球菌菌株进行的分析监测结果
疼痛科中抗生素使用(英文PPT)Antibiotics and Pain Control
• Somalia
– Pseudomonas and polymicrobial
• Russian Afghanistan Experience
– Clostridial
» Recommended PCN, Rifampin, Metronidazole, or Ceftriaxone
review • 32 comparing outcome, 7 comparing
pharmacokinetics & cost.
The EAST Practice Management Guidelines (cont)
• Looking mostly at Class 1 articles:
– More successful regiments included :
• cefoxin • clindamycin with gentamycin • tobramycin with clindamycin • cefotetan • cefamandole • aztreonam • gentamycin
• Early Immobilizatio
n of Fractures
– Soft tissue damage
Antibiotics
• Finite period of time in which infection can be prevented.
– Miles, Burke.
• How early, not how long.
• Waterborne Ops
– Sea Water – Vibrio
• Overwhelming Gm Neg sepsis – 50% mortality
抗生素合理应用(全)
PUMC Hospital
目前临床使用抗生素的现状
Bid=q12h Tid=q8h
青霉素400万u,bid 青霉素200万u,q6h 头孢噻肟2.0g, Bid 头孢噻肟2.0g, q8h 头孢拉定6.0g, qd/3.0,Bid 头孢拉定2.0g, q6h 医护人员认知不足： •各种药物的特性 •规范用药的重要性 头孢呋辛1.5g, Bid/3.0g, qd 头孢呋辛1.5g, q8h
1克静脉注射
头孢呋辛 头孢噻肟
头孢孟多 头孢甲肟 头孢西丁 0 1 2 3 4 5 6 7 8 Knothe et al., 1984
T½
9小时
PUMC Hospital
头孢曲松PD/PK特点
半衰期长(8h)
蛋白结合率高(90%)，但容易饱和，随着剂量 增加，游离浓度增加，单次给药可产生相对
较高的游离浓度
• “经得起时间考验的”抗生素
应该经受5年以上时间的考验 有足够的时间广泛了解药物（尤其副作用） 对患者而言，价格相对便宜
没有一个患者愿意一天用3次药以上； 没有一个患者愿意进行5天以上的连续治疗； 没有一个患者愿意用使他们感到病情加重的药物； 没有一个患者愿意为一昂贵的处方付钱。
• 普遍、大量、长时间、不规范地预防性使用抗 菌药物，药物资源浪费巨大
• 不重视、不了解抗生素药物的药动学/药效学， 随意制订给药剂量、途径、分配方案和疗程， 使很多抗菌药物没有发挥应有的作用 • 抗菌药物滥用，不但是造成医药费用增加的重 要原因，同时还可引发大量耐药菌产生，对社 会造成危害
Dep. of Emergency Medicine【粉乖留爪】
减少病人个体携带耐药菌数
减少耐药菌的传播
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How do β-lactams kill ?
How do β-lactams kill ?
• Inhibit the production of bacterial cell wall • Therefore they don’t kill our cells, but they
Flagyl
BACTERIOCIDAL or STATIC ???
Beta lactams
CIDAL
Aminoglycosides
CIDAL
Quinolones
CIDAL
Tetracyclines
BACTERIOSTATIC
Azithromycin, Clindamycin BOTH it depends
Example of synergy: cell wall active drug + protein inhibitor
How do β-lactams kill the enterococcus?
How do β-lactams kill the enterococcus?
Trick question- it doesn’t . Only inhibits their growth………………
Which brings us to the issue of Cidal vs Static antibiotics (and synergy also)
WHAT is Inhibitory (static)?
• In a test tube there is no change over time
So is it ever important to use a cidal antibiotic?
• Yes - for Endocarditis always always always (is that clear???)
• No - for almost everything else • Maybe (for those of you that can’t decide)-
*** Remember there is going to be a twist to this answer later on
CIDAL or STATIC ???
Beta lactams CIDAL Aminoglycosides CIDAL too Quinolones
CIDAL or STATIC ???
don’t kill mycoplasma or chlamydia either (they lack a cell wall….remember ?)
What about other antibiotics?
• Aminoglycosides - Macrolides – Tetracyclines- Clindamycin
4.5 B 3 B
2BΒιβλιοθήκη 1-0.5 B300 M
History of Bacteria and
for neutropenic patients in treatment of meningitis for osteomyelitis
CIDAL or STATIC ???
Beta lactams
CIDAL or STATIC ???
Beta lactams Aminoglycosides
CIDAL ****
Flagyl
CIDAL
Pharmakokinetics & Pharmakodynamics (Is more better?)
• peak level (ie concentration) = rate of kill (aminoglycosides, quinolones)
• Time > MIC (duration) = rate of kill (beta lactams, clindamycin, macrolides)
Beta lactams Aminoglycosides Quinolones Tetracyclines
CIDAL CIDAL CIDAL
BACTERIOCIDAL or STATIC ???
Beta lactams Aminoglycosides Quinolones Tetracyclines Azithromycin
CIDAL CIDAL CIDAL STATIC
BACTERIOCIDAL or STATIC ???
Beta lactams
CIDAL
Aminoglycosides
CIDAL
Quinolones
CIDAL
Tetracyclines
STATIC
Azithromycin, Clindamycin BOTH
= MIC
What is CIDAL ?
DEAD ? ALMOST DEAD ? MOSTLY DEAD? EVENTUALY DEAD ?
What is CIDAL ?
In 24 hours 99.9% of the buggers are DEAD
So is it ever important to use a cidal antibiotic?
MIC
Dose interval
History of Bacteria and
BIG BANG
Antibiotics
4.5 B 3 B
2B
1-0.5 B
300 M
History of Bacteria and
BIG BANG
Antibiotics
Anaerobic bacteria appear O2 & the emergence of Aerobes
All inhibit protein synthesis via ribosomes
• Quinolones block DNA synthesis
• Daptomycin blocks AA transport
What is Synergy and when do you want it?
Additive is: 2 + 2 = 4 Synergy is: 2 + 2 = 7