Solunum yolu enfeksiyonlarında akılcı antibiyotik kullanımı

β-laktam ANTİBİYOTİKLERİN DOĞRU KULLANILMASI

Haluk VAHABOĞLU

TDK Büyük Türkçe Sözlük

TDK Büyük Türkçe Sözlük

1- akılcı

– 1. Akılcılıktan yana olan, usçu, rasyonalist (kimse)

– 2. Akılcılıkla ilgili

2- akılcı

– Akıl veren

1- akılcı

– 1. Akılcılıktan yana olan, usçu, rasyonalist (kimse)

– 2. Akılcılıkla ilgili

2- akılcı

– Akıl veren

Cilt 2, 2009 Kohran VeritabanıCilt 2, 2009 Kohran Veritabanı

1- 66 çalışma alınmış ► 51 (%77) 'sinde yarar1- 66 çalışma alınmış ► 51 (%77) 'sinde yarar

TanıTanı

1- Toplum kökenli pnömoni

– Ateş

– PA grafide infiltrasyon

2- Ventilatör ilişkili pnömoni

– Pürülan sekresyon

– Ilerleyen infiltrasyon

– Bozulan kan gazları

1- Toplum kökenli pnömoni

– Ateş

– PA grafide infiltrasyon

2- Ventilatör ilişkili pnömoni

– Pürülan sekresyon

– Ilerleyen infiltrasyon

– Bozulan kan gazları

American Journal of Infection Control

Volume 36, Issue 4, Supplement 1, May 2008, Pages S93-S100

Antibiyotik Duyarlılık Eşik DeğerleriAntibiyotik Duyarlılık Eşik Değerleri

1- The pharmacokinetic and pharmacodynamic properties of an antimicrobial agent

2- Data correlating individual MIC results with patient outcomes

1- The pharmacokinetic and pharmacodynamic properties of an antimicrobial agent

2- Data correlating individual MIC results with patient outcomes

MMWR Morb. Mortal. Wkly. Rep. 2008 Dec 19;57(50):1353-1355.

Doz – Canlı bakteriDoz – Canlı bakteri

0 1 2 3 4 5 6 7 8 90

1

2

3

4

5

6

7

8

9

MIC

PK/PDPK/PD

Antimicrobial susceptibility breakpoints

Antimicrobial susceptibility breakpoints

1- The pharmacokinetic and pharmacodynamic properties of an antimicrobial agent

– MIC for penicillin (µg/mL)● ≤ 0.06, ● 0.12--1 ● ≥ 2

1- The pharmacokinetic and pharmacodynamic properties of an antimicrobial agent

– MIC for penicillin (µg/mL)● ≤ 0.06, ● 0.12--1 ● ≥ 2

Clinical and Laboratory Standards Institute (CLSI)

Arch Intern Med. 2000;160:1399-1408

Antimicrobial susceptibility breakpoints

Antimicrobial susceptibility breakpoints

1- The pharmacokinetic and pharmacodynamic properties of an antimicrobial agent

2- Data correlating individual MIC results with patient outcomes

1- The pharmacokinetic and pharmacodynamic properties of an antimicrobial agent

2- Data correlating individual MIC results with patient outcomes

MMWR Morb. Mortal. Wkly. Rep. 2008 Dec 19;57(50):1353-1355.

CAN PNEUMONIA CAUSED BY PENICILLIN-RESISTANT Streptococcus pneumoniae BE TREATED WITH

PENICILLIN?

CAN PNEUMONIA CAUSED BY PENICILLIN-RESISTANT Streptococcus pneumoniae BE TREATED WITH

PENICILLIN?

1- In children with pneumonia, infection with penicillin-resistant pneumococci does not result in higher morbidity or mortality compared to infection with penicillin-susceptible strains (Grade A)

2- High-dose mono-therapy with penicillin or ampicillin is effective for the treatment of pneumococcal pneumonia caused by intermediate resistant as well as high-level resistant strains up to a minimum inhibitory concentration (MIC) of 2.0 μg/ml (Grade B)

3- Infections with high-level resistant pneumococci with an MIC of 4.0 μg/ml or greater should be treated with alternative antibiotics (Grade D)

1- In children with pneumonia, infection with penicillin-resistant pneumococci does not result in higher morbidity or mortality compared to infection with penicillin-susceptible strains (Grade A)

2- High-dose mono-therapy with penicillin or ampicillin is effective for the treatment of pneumococcal pneumonia caused by intermediate resistant as well as high-level resistant strains up to a minimum inhibitory concentration (MIC) of 2.0 μg/ml (Grade B)

3- Infections with high-level resistant pneumococci with an MIC of 4.0 μg/ml or greater should be treated with alternative antibiotics (Grade D)

Arch Dis Child January 2010 Vol 95 No 1

Antimicrobial susceptibility breakpoints

Antimicrobial susceptibility breakpoints

1- The pharmacokinetic and pharmacodynamic properties of an antimicrobial agent

2- Data correlating individual MIC results with patient outcomes

1- The pharmacokinetic and pharmacodynamic properties of an antimicrobial agent

2- Data correlating individual MIC results with patient outcomes

MMWR Morb. Mortal. Wkly. Rep. 2008 Dec 19;57(50):1353-1355.

Antimicrobial susceptibility breakpoints

Antimicrobial susceptibility breakpoints

1- The pharmacokinetic and pharmacodynamic properties of an antimicrobial agent

– MIC for penicillin ≤ 0.06, 0.12--1, ≥ 2 µg/mL

2- Data correlating individual MIC results with patient outcomes

– IV penicillin MIC ≤ 2, 4, and ≥ 8 µg/mL

1- The pharmacokinetic and pharmacodynamic properties of an antimicrobial agent

– MIC for penicillin ≤ 0.06, 0.12--1, ≥ 2 µg/mL

2- Data correlating individual MIC results with patient outcomes

– IV penicillin MIC ≤ 2, 4, and ≥ 8 µg/mL

MMWR Morb. Mortal. Wkly. Rep. 2008 Dec 19;57(50):1353-1355.

Clinical and Laboratory Standards Institute (CLSI)

Doğan O, Gülmez D, Hasçelik G.

Effect of new breakpoints proposed by Clinical and Laboratory Standards Institute in 2008 for evaluating

penicillin resistance of Streptococcus pneumoniae in a Turkish University Hospital.

Microb. Drug Resist. 2010 Mar;16(1):39-41.

Doğan O, Gülmez D, Hasçelik G.

Effect of new breakpoints proposed by Clinical and Laboratory Standards Institute in 2008 for evaluating

penicillin resistance of Streptococcus pneumoniae in a Turkish University Hospital.

Microb. Drug Resist. 2010 Mar;16(1):39-41.

1- Resistance rates decreased from 6.1% to 0.5%1- Resistance rates decreased from 6.1% to 0.5%

SON SÖZSON SÖZ

1- Klinik veriler belirleyici

2− β-laktam antibiyotikler zamana bağımlı öldürüyor

– Doz aralığı önemli

3- Uyum sorunu var

– Yatarak IV tedavi

1- Klinik veriler belirleyici

2− β-laktam antibiyotikler zamana bağımlı öldürüyor

– Doz aralığı önemli

3- Uyum sorunu var

– Yatarak IV tedavi