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抗生素使用原則格蘭氏染色(GramStain)陽性陰性球菌桿菌經驗性抗生素原則ThePrinciplesforChoiceofAntibiotics抗生素藥物選擇原則Ching-TaiHuang,M.D.,Ph.D.黃景泰醫師InfectiousDiseases,Internal

Medicine,CGMH長庚紀念醫院內科部感染醫學科August2,2004PenicillinsCephalosporinsFluoroquinolone抗Amino-抗厭氧強非典型雜原型廣效抗抗综合一代二代三代四代老新更新GPCglycosides葡萄綠膿綠膿PCNAMOX

PIPAM/SBCFCXMCROCAZCFPCIPLEVMOXVAGMANCCMTZIPMEMTCSXTTICAM/CVKflorCTXTEICMERAZICFXAZM(FLM)CLRGPCStreptStaphOSSAORS

A&ConSEnterococcusGNBCommunity-AcquiredH.influenzaNosocomialPseudomonasAnaerobesAboveDiaphragmBelowDiaphragmMiscellaneousMycoplasmaLegionellaCh

lamydiaRickettsia經驗性抗生素原則◼Cellulitis◼UTI◼BTI◼Bacterialmeningitis◼Anaerobicinfection◼GPCvsGNB◼PRSP◼Enterococcus◼VRSA◼Ps.aeruginosa◼ESBLpro

ducingstrain◼PDR-ABCellulitis◼Streptococcus◼Penicillin◼Staphylococcus◼Oxacillin◼第一代頭孢子素Cefazolin等◼MRSArisk

(+)◼Vancomycin，Teicoplanin◼E.coli、K.pneumoniae◼第一代頭孢子素Cefazolin等UTI&BTI◼UTI、BTI◼以E.coli、K.pneumoniae等腸

內革蘭氏陰性桿菌為主◼以Cefazolin+Gentamicin治療，◼Liverabscess◼以K.pneumoniae為主◼Removetheinfectionfocus◼needleaspiration◼drainage◼Ceftriaxone等三代頭孢子素◼Ceftri

axone部分由膽道排泄，liver內濃度高BacterialMeningitis◼Streptococcus◼Penicillin300萬單位q4h◼Staphylococcus◼MSSA◼Oxacillin2gmq

4h◼MRSA◼Vancomycin1gmq12h(infusion＞1hr)◼NOTTeicoplanin◼腸內革蘭氏陰性桿菌E.coli、K.p.等◼Ceftriaxone2gmq12h◼Pseudomonu

saeruginosa◼Ceftazidime2gmq8hBacterialMeningitis◼劑量均較sepsis加倍◼因通過BBB只有不到一半劑量◼無法通過BBB，不可使用的抗生素（即使invitro有效）◼ㄧ代及二代Cephalosporins◼Cefazolin

◼Cefuroxime◼Gentamicin、Amikacin◼Aztreonam◼Ciproxin◼Teicoplanin厭氧菌治療◼時機◼牙齒感染◼facialcellulitis◼aspirationpneumonia◼腸胃道外科手術後◼Vascularinsufficiency◼DMfo

ot◼Arterialocclusivedisease◼藥物◼Penicillin◼Clindamycin◼Metronidazole◼Bacteroidesfragilis◼常見於橫隔膜以下之厭氧感染◼通常只有Metronidazole有效GPCv

sGNB◼Cephalosporins◼Gm(+)球菌第一代最佳◼(一代＞二代＞三代)◼Gm(-)桿菌第三代最佳◼(一代＜二代＜三代)Pseudomonasaeruginosa◼有效藥物◼Ceftazidime、Cefepime◼Gentamicin、A

mikacin◼Aztreonam◼Ciproxin◼Imipenem、Menopenem◼Piperacillin宜合併aminoglycosidePenicillinResistantStreptococcuspneumoniae(PRSP)◼有效藥物◼Ceftria

xone、Cefotaxime◼Vancomycin、Teicoplanin◼口服◼Moxifloxacin◼LevofloxacinEnterococcus腸球菌◼對Ampicillin敏感◼Ampicillin◼加GM有加成效果◼對Ampicillin有抗藥性◼Vancom

ycin或Teicoplanin◼可加GM◼對Vancomycin、Teicoplanin有抗藥性◼Linezoid◼可能使platelet下降，有bleeding副作用VancomycinResistantStaphylococcusaureus◼以Linezoid治療Exten

dedSpectrumβ-LactamaseESBLProducingStrains◼有抗藥性◼1-3代Cephalosporin◼Aztreonam◼宜使用◼Flomoxef◼Ciprofloxacin◼Im

ipenem◼MenopenemPan-DrugResistantAcinetobacterbaumanniiPDRAB◼有抗藥性◼第三代Cephalosporins◼Carbapenam◼Imipenem◼Meropenem◼Ciproxin◼GM&Amikacin◼應採接觸隔離避免

傳播◼可使用◼ImipenemorMenopenem+Unasyn◼Unasyn◼Ampicillin1.5gm◼Sulbactam0.5gm◼Ciproxin+(GMorAmikacin)◼ImipenemorMenopenem

+(GMorAmikacin)2004年本院細菌抗藥性（林口院區）格蘭氏陽性球菌Gm(+)cocci◼Streptococcuspneumoniae◼Penicillin50%◼Ceftriaxone10%◼Vancomycin0%◼Viridansstreptococcus◼P

enicillin10%◼Ceftriaxone4%◼Staphylococcusaureus◼Oxacillin60%◼Enterococcusfaecium◼Ampicillin70%◼Vancomycin10%◼Teicoplanin10%格蘭氏陽性球菌Gm(+)cocci◼Aci

netobacterbaumannii◼Amikacin60%◼Ceftazidime60%◼Ciprofloxacin60%◼Imipenem20%◼Pseudomonasaeruginosa◼Ceftazidime8%◼C

iproxin16%◼Imipenem8%◼Gentamicin20%◼Amikacin6%格蘭氏陰性桿菌Gm(-)bacilli格蘭氏陰性桿菌Gm(-)bacilli◼Salmonellacholeraesuis◼Ampicilli

n90%◼Baktar90%◼Ciprofloxacin90%◼Ceftriaxone3％