[醫學筆記] 抗生素使用Antibiotics part.2 FQ, anti-MRSA ... | 郭查理抗生素
Skiptocontent2018/07修正antifungal部分，區分Efc和Efm之前Tigecycline標錯atypicalpathogen，應該是susceptible(2017/02改)需要圖檔或ai檔請留下信箱，原本的綠色不是這種螢光綠啊，為什麼顏色會跑掉嗚嗚。
=Quinolone= GPCGNBPsAAnaeAtypCiprofloxacin–＋++–+Levofloxacin+＋+–+Moxifloxacin++＋–++PsA:Ciprofloxacin>Levofloxacin（anti-PsA裡唯一可口服！）S.pneumoniae:Ciprofloxacin
不過因為他抗菌譜廣又一天一針，真是急診的好朋友無誤。
又或者有時病人對β-lactam又過敏沒什麼藥好用只能選FQ。
總之用FQ不是不行，但使用前要謹慎評估病人是否有TB的風險(發燒？久咳？乾咳？體重掉？夜間盜汗？胸痛？immunestauts?contacthistory?CXR有無TB好發位置病灶？)，記得留個AFS。
Ciprofloxacin(IV,Ciproxin®)SpectrumGPCGNB:PsAbetterAtypicalMycobacterium=>PNA,IAI,Softtissue/bone,UTI,prostatitis,STD,Mycobac.Dosage400mgIVQ8-12HAEQTcprolongation(BaselineEKG!), BMsuppression, ∅ Pregnancyorage<16, Tendonrupture,MGChelation(Ca++,Mg++):toavoid,1hrbeforemealor2hrsaftermealLevofloxacin(IV,Cravit®)SpectrumGPCGNB:PsAAtypicalMycobacterium=> PNA,IAI,Softtissue/bone,UTI,prostatitis,STD,MycobacDosage250-750mgIV/POQDAEQTcprolongation(BaselineEKG!), BMsuppression, ∅ Pregnancyorage<16, Tendonrupture,MG Chelation(Ca++,Mg++):toavoid,1hrbeforemealor2hrsaftermealMoxifloxacin(IV,Avelox®)–RespiratoryFQSpectrumGPCGNB:PsAAnaerobesAtypicalMycobacterium=>PNA,IAI,Softtissue/bone,UTI,prostatitis,STD,MycobacDosage400mgIV/POQDAEQTcprolongation(BaselineEKG!), BMsuppression, ∅ Pregnancyorage<16, Tendonrupture,MG Chelation(Ca++,Mg++):toavoid,1hrbeforemealor2hrsaftermeal =Anti-MRSA=Vancomycin(IV,)SpectrumGPC:MRSA DosageLoadingdose25-30mg/kg->15-20mg/kgQ12HPeak :30-40mcg/mlTrough:5-15mcg/ml,15-20mcg/mlforseverinfection AEOtotoxicity,Nephrotoxicity,Redmansyndrome,drugfever Teicoplanin(IV,Targocid®)SpectrumGPC:MRSA DosageLoading12mg/kgX3doses->12mg/kgQD(400mgQ12HX3doses->400mgQD)AE BMsuppression,drugfever,skinrash,lessnephrotoxicity–TeicoplaninismorepotentagainstStreptococcusspp.–TeicoplaninismorepotentagainstEnterococcusspp.•Esp.forVanBphenotypeVRE–TeicoplaninhasslowerbactericidalactivityagainstGram-positivepathogensthanva
=Quinolone= GPCGNBPsAAnaeAtypCiprofloxacin–＋++–+Levofloxacin+＋+–+Moxifloxacin++＋–++PsA:Ciprofloxacin>Levofloxacin（anti-PsA裡唯一可口服！）S.pneumoniae:Ciprofloxacin
不過因為他抗菌譜廣又一天一針，真是急診的好朋友無誤。
又或者有時病人對β-lactam又過敏沒什麼藥好用只能選FQ。
總之用FQ不是不行，但使用前要謹慎評估病人是否有TB的風險(發燒？久咳？乾咳？體重掉？夜間盜汗？胸痛？immunestauts?contacthistory?CXR有無TB好發位置病灶？)，記得留個AFS。
Ciprofloxacin(IV,Ciproxin®)SpectrumGPCGNB:PsAbetterAtypicalMycobacterium=>PNA,IAI,Softtissue/bone,UTI,prostatitis,STD,Mycobac.Dosage400mgIVQ8-12HAEQTcprolongation(BaselineEKG!), BMsuppression, ∅ Pregnancyorage<16, Tendonrupture,MGChelation(Ca++,Mg++):toavoid,1hrbeforemealor2hrsaftermealLevofloxacin(IV,Cravit®)SpectrumGPCGNB:PsAAtypicalMycobacterium=> PNA,IAI,Softtissue/bone,UTI,prostatitis,STD,MycobacDosage250-750mgIV/POQDAEQTcprolongation(BaselineEKG!), BMsuppression, ∅ Pregnancyorage<16, Tendonrupture,MG Chelation(Ca++,Mg++):toavoid,1hrbeforemealor2hrsaftermealMoxifloxacin(IV,Avelox®)–RespiratoryFQSpectrumGPCGNB:PsAAnaerobesAtypicalMycobacterium=>PNA,IAI,Softtissue/bone,UTI,prostatitis,STD,MycobacDosage400mgIV/POQDAEQTcprolongation(BaselineEKG!), BMsuppression, ∅ Pregnancyorage<16, Tendonrupture,MG Chelation(Ca++,Mg++):toavoid,1hrbeforemealor2hrsaftermeal =Anti-MRSA=Vancomycin(IV,)SpectrumGPC:MRSA DosageLoadingdose25-30mg/kg->15-20mg/kgQ12HPeak :30-40mcg/mlTrough:5-15mcg/ml,15-20mcg/mlforseverinfection AEOtotoxicity,Nephrotoxicity,Redmansyndrome,drugfever Teicoplanin(IV,Targocid®)SpectrumGPC:MRSA DosageLoading12mg/kgX3doses->12mg/kgQD(400mgQ12HX3doses->400mgQD)AE BMsuppression,drugfever,skinrash,lessnephrotoxicity–TeicoplaninismorepotentagainstStreptococcusspp.–TeicoplaninismorepotentagainstEnterococcusspp.•Esp.forVanBphenotypeVRE–TeicoplaninhasslowerbactericidalactivityagainstGram-positivepathogensthanva