7.常用抗菌药物及应用注意事项PPT.ppt

Linezolid Linezolid is highly activity against the major gram-positive pathogens, including MSSA, MRSA, VSE, and VRE. Unlike vancomycin, linezolid does not increase E.faecium (VRE) prevalence. Because linezolid is eliminated by hepatic mechanisms, no dosing adjustment is necessary in renal insufficiency. Linezolid Recognize that the bioavailability of linezolid is 100%, i.e., Linezolid is equally efficacious when administered via the oral or the Ⅳ route. Linezolid is one of the few antibiotics that can be used orally to treat CNS infections due to susceptible gram-pathogens. Linezolid may be used to treat gram-positive infections in patients with pencilin or betalactam allergy. 用药注意事项 利奈唑胺药物不良反应以腹泻（8.3％）、恶心（4.3％）为主，其次为头痛、味觉改变、阴道念珠菌病和其他真菌感染、腹痛、血尿、便血、寒战、咳嗽、发热、音嘶、阴道搔痒、腰痛、尿痛、排尿困难、气急、出血或溃疡和倦怠乏力等。 不良反应多为轻至中度，一般不影响治疗，在机体适应药物后自行消失。 因不良反应而停药者仅占4％。 Daptomycin Daptomycin is more active against MSSA/MRSA than Group D enterococci ( VSE/VRE). If daptomycin is used to treat VRE or VSE, a higher-than-usual dosage for the type of infection being treated maybe required. Daptomycin is inactivated by calcium in alveolar surfactant fluid and should not be used for pneumonias. Tigecycline Tigecycline may be given safely to patients with penicilin or sulfa drug allergy. Avoid in patients with tetracycline allergy. Tigecycline dosage does not need to be adjusted in renal insufficiency since it is eliminated via hepatobiliary mechanisms. Tigecycline is not a substrate or inhibitor of the cytochrome p450 system and is particularly useful in patients on multiple cardiac or HIV drugs. Tigecycline 常见副作用为恶心、呕吐，孕妇使用Tygacil可能会引起致命损害，18岁以下患者或哺乳期妇女使用Tygacil的安全性和有效性尚未确定。 在牙齿发育期使用Tygacil可能引起永久性的牙齿变色。 鉴于几乎所有抗感染药都有伪膜性结肠炎的报告，所以Tygacil作为单一疗法使用时要慎用于肠穿孔患者。 二、化学合成抗菌药物 喹诺酮类（Quinolones ) 喹诺酮类是60年代以来开发的新型合成抗菌药物，具有抗菌谱广，抗菌作用强、用药方便等特点，是目前临床上应用广泛、发展非常迅速的一类抗菌药物。  产品分布 Ⅰ代：60年代开发，如萘啶酸等，由于作用差，副作 用大，已不用。 Ⅱ代：70年代开发，如吡哌酸，主要对革兰氏阴性菌 有抗菌作用，加之生物利用度差，主用于肠道 感染及