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V 1.500.000 iu x 2 10

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150 mg x 2 300 mg x 1 10

500 mg x 1 1g x 1 5 3

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4 Strep-test

( 10) ("evidence based") - .

11. po - - .. + (1000 mg x 2) - (600 mg x 3) .

12. - - 20%-30%.

1. Casey JR., Pichichero ME. Meta-analysis of cephalosporins versus penicillin fortreatment of group A streptococcal tonsillopharyngitis in adults. Clin Infect Dis2004; 38:1526-34.

2. Malli E, Tatsidou E, Damani A, et al. Macrolide-resistant Streptococcuspyogenes in Central Greece: prevalence; mechanism and molecularidentification. Int J Antimicrob Agents 2010; 35:614-5.

3. Shulman ST, Bisno AL, Clegg HW, et al. Clinical Practice Guideline for theDiagnosis and Management of Group A Streptococcal Pharyngitis: 2012Update by the Infectious Diseases Society ofAmerica. Clin Infect Dis 2012; 55: e86102.

9

8

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6. ASTO. . ( - , - ) - 3.

7. , , - ( Strep-test) - - 3.

8. .9. , -

, .

10. po 5-

3: -- .

300 mg x 3 10

- 1000 mg x 2 10

V 1.5 . iu x 4 10 600 mg x 1 4

4 : . : 4 -, . : 5-12 , . - : 1-4 >4 , . : >12 .

10

1. : , -, , , , - , , .

2. : >65 , - , 3, 5 , , .

3. .4. -

NaCl , . .

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3-5

3-5

5-7

7-10

7

10

O

13

1 g x 3 po

+ 1 g x 2 po

' po ( )

500 mg x 2 (. 8)

A 500 mg/24 (. 8

1. (. ).2. (

30 mg/kg/ 8 po).3. 10 (

6).4. : Streptococcus pneumoniae, Haemophilus influenzae, Moraxella

catarrhalis.5. (I)

, (II) - .

6. Pseudomonas aeruginosa - ( ). Pseudomonas aeruginosa - - (swimmers ear) (2%).

7. ( - ) po (- ), - in vitro.

8. (>30%) .

1. Cunningham M, Guardiani E, Kim HJ, et al. Otitis Media. FutureMicrobiol 2012 7; 733-53

2. Toll EC, Nunez DA. Diagnosis and treatment of acute otitis media: review.J Laryngol. Otol 2012 126; 976-83

10. - ( ) , , - .

11. .

1. Chow AW, Benninger MS, Brook I, et al. IDSA clinical practice guideline foracute bacterial rhinosinusitis in children and adults. Clin Infect Dis2012;54:e72112.

2. Grivea IN, Sourla A, Ntokou E, et al. Macrolide resistance determinants amongStreptococcus pneumoniae isolates from carriers in Central Greece. BMCInfect Dis 2012;12:255.

3. Maraki S, Mantadakis E, Samonis G. Serotype distribution and antimicrobialresistance of adult Streptococcus pneumoniae clinical isolates over the period2001-2008 in Crete, Greece. Chemotherapy 2010;56:325-332.

12

: .

/ 1g x 2, po 100mg x 2 200mg x 1, po 100mg x 2 200mg x 1, po 500mg x 1, po - 400mg x 1, po 500mg x 1, po 400mg x 1, po 750mg x 1, IV 400mg x 1, IV

2 g x 1, IV

15

()

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2. XA , - . -, , , (Gold II, updated 2006).

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.

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, . I: Enterobacteriaceae

Pseudomonas aeruginosa (Klebsiella pneumoniae,Escherichia coli, Proteus spp,Enterobacter spp, )

. II- IV: Pseudomonas aeruginosa

Pseudomonasaeruginosa *

FEV1/FVC < 0,70

FEV1 80%

M

FEV1/FVC < 0,70

50% FEV1 < 80%

FEV1/FVC < 0,70

30% FEV1 < 50%

V

FEV1 < 30%

FEV1 < 50% +

- (>40%) .

(FEVI< 50%, 4 , , 2 , po ) .

- (.. 250mg x1/24, - 250 mg x 1/ 6-12 )

1. Albert RK, Connett J, Bailey WC, et al. Azithromycin for prevention ofexacerbations of COPD. N Engl J Med 2011; 365: 689-98

2. Balter MS, La Forge J, Low DE, et al. Canadian Infectious Disease Society.Canadian guidelines for the management of acute exacerbations of chronic

bronchitis. Review. Can Respir J 2003; 10 (Suppl B): 3-32.3. Global Initiative for Obstructive Lung Disease. Global strategy for the

diagnosis, management, and prevention of chronic obstructive pulmonary

disease [executive summary]. Updated 2004.

17

Anthonisen, , . , . .

4. : (30-50%), (40-50%) (5-10%) (. ).

5. , : Streptococcus pneumoniae, Haemophilus spp, Moraxellacatarrhalis.

6. Pseudomonas spp: , FEVI < 35%, , , -.

7. 3 , , .

8. 7 .9. :

500 mg x 1 (x 3 ) po 500 mg x 2 po (ER) 1000 mg x 1 150 mg x 2 300 mg x 1 po 1g/8 po / 1g/12 po - 500 mg/12 po 500 mg/12 po 100mg/ 12 po 500 mg/24 po 400 mg/24 po 750 mg/12 po (

Pseudomonas aeruginosa) -

, -, - -

16

19

18

CURB-65 CRB-65

CURB-65:

> 40 mg/dlA 30/min < 90 mmHg 60 mmHg 65

0 1 2

1

(1,5%)

2

(9,2%)

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- -

3

3

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,

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1. > 65 2. 3. 30 / min4. < 90 mmHg, < 60 mmHg

0 1-2

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3 4

31%

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-

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, .. -)

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3. () - .

1. Mandell A, Wunderink RG, Anzueto A, et al., Management of CommunityAcquired Pneumonia In Adults, Clin Infect Dis 2007; 44: S27-72

2. The British Thoracic Society Guidelines for the Management of CommunityAcquired Pneumonia in Adults, Update 2009. Thorax 64: Supplement III

3. Watkins RR, Lemonovich TL. Diagnosis and Management of Community-Acquired Pneumonia in Adults, Am Fam Physic 2011; 83: 1299-306

21

500 mg/24 po 500 mg/12 po - 1000 mg/24 po (1 ). 3. (., , Legionella). - 3, - ( 750 mg/24 po 400 mg/24 po), 3 ( ) 400mg x 2 po. 7-10 , 5 (500mg/24 po).

20

/ ' +

(1g/6 po)

3

- 3

23

22

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: 15-30%

eisseria gonorrhoeae, Corynebacterium diphtheriae, Arcanobacteriumhaemolyticum,Yersinia spp,, Francisella tularensis

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27

OIMEI OYPOTIKOY

: E 1

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:3

:7

, ( 4)

A 2,3

E

K :

B 3

A

N : N 400mg x 2po O

200mg x 2po 500mg x 2po 500mg 1 po - 600mg x 1 po

- 960mg 2po ( )

- 3g

A 1g x 3 po ( -)

N 100mg x 3 po ' ' 400m x 2 po

: :

- B, gram(-) -, Staphylococcus aureus, HSV, CMV, Listeria

3 - 3 Streptococcus pneumoniae, RSV, Chlamydia, I

(nfluenza, uman etapneumovirus, ocavirus), Bordetellapertussis, Mycoplasma pneumoniae. .

3 -5 , S. pneumoniae, M. pneumoniae

> 5 S. pneumoniae, M. pneumoniae, Chlamydophila pneumoniae,

B. pertussis, Mycobacterium tuberculosis, MRSA PVL(+)/MSSA, Gram , , Legionella

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< 5 1 5 1 , -

-, /

, , , . , , .

1. Devitt M. PIDS and IDSA issue management guidelines for community-acquired pneumonia in infants and young children. Am Fam Physician 2012;86:196-202.

2. Lieberthal AS, Carroll AE, Chonmaitree T, et al. The diagnosis and managementof acute otitis media. Pediatrics 2013; 131:e964-99.

3. Schauner S, Erickson C, Fadare K, et al. Community-acquired pneumonia inchildren: a look at the IDSA guidelines. J Fam Pract 2013; 62:9-15.

4. Shulman ST, Bisno AL, Clegg HW. et al. Clinical practice guideline for thediagnosis and management of group A streptococcal pharyngitis: 2012 updateby the Infectious Diseases Society of America. Clin Infect Dis 2012; 55:1279-82.

26

29

28

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E ' - :- 1 g x 3 - 1,5 g x 2 - 1 g x 2 - 1 g x 3

- 750mg x 2 po - 750mg x 1 po - 600mg x 1 po

31

30

4. ( 2 6 3 )) (> 95% ) : --

x 3 x7 ( ), 400mg x 2 x7 , 3g po.

: sex, sex- (.. 50mg 240mg - sex) 12 .

6 - : - 6-12 50mg/24, -- 240mg/24 , 200mg/24 100mg/24 250mg/24 ( ).

) (>95% ). :

- (), -, ,

: 14 . 12

: 6 . 12

5. : 10 ( po ). ,

1. Guinto VT, Deguia B, Festin MR, et al. Different antibiotic regimens for treating

asymptomatic bacteriuria in pregnancy. Cochrane Database Syst Rev. 2010 (9):CD007855.

2. Gupta K, Hooton TM, Naber KG, et al. International clinical practice guidelinesfor the treatment of acute uncomplicated cystitis and pyelonephritis inwomen:A 2010 update by the Infectious Diseases Society of America and theEuropean Society for Microbiology and Infectious Diseases. Clin Infect Dis 2011;52e:103-20.

3. Nicolle LE, Bradley S, Colgan R, et al. Infectious Diseases Society of Americaguidelines for the diagnosis and treatment of asymptomatic bacteriuria inadults. Clin Infect Dis 2005; 40:64.

-). -. , - .

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)

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. /15. . - (50mg/24) (500mg/24)po .

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(3) . - Foley ( -). Foley ( - ) .

: 24-48 ( ). 3-5 .

M H - .

33

32

: -V (> 3 ) (2 6

3 )

-

T/ 2-3mg/kg TMP 5 mg/kg 2 /

1-2 mg/kg 1

2 10-12 mg/kg 1

1 < 2

A

-

-IV

-

2

2 -V .

A

, , , ,

(, , , -

) (

)

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; : 100.000 cfu/ml : 50.000 cfu/ml : > 50.000 cfu/ml

-

: - (2 3 , /, -, - )

(IV) (per os);: 1-3 per os , IV : 3-7

:

: 2 O : 21 : > 21

1. Urinary Tract Infection Steering Committee on Quality Improvement andManagement. Urinary tract infection: Clinical practice guideline for thediagnosis and management of the initial UTI in febrile infants and children 2to 24 months. Print, 0031-4005; Online, 1098-4275). (2011)www.pediatrics.org/cgi/doi/10.1542/peds. 2011-1330

2. Wald ER, Applegate KE, Bordley C, et al. American Academy of Pediatrics.Clinical practice guideline for the diagnosis and management of acute bacterialsinusitis in children aged 1 to 18 years. Pediatrics 2013; 132:e262-80.

KOITI

35

34

Candida albicans Trichomonas vaginalis ( )

- 7-14

- 100, 150,200 mg po 3

- - 100, 150, 200 mgpo - 6

- 150mgpo

- I 200mg/12 po x 1 200mg/24 po x 3

- -

500mg 300mg x 1 x3

1200mg 400mg x 1 x3

150mg

- 500mg/12 po 7

- 300mg/12 po 7

- x5

- - x 7

- - x 3

M 2g - 500mg /12 po 7 T 2g po

- 10-20% - 80-90% , ,, , , - , - , pH 4.5

- 10-50%

- 50-90% , ,, -, (70%), (10-30%), pH >4.5,

4 /

, - .

24-72 -

(600mg/24 x 15 ).9. ,

Chlamydia,Neisseria gonorrhoea, HPV HSV.

10. ( / - ).

1. Brocklehurst P, Gordon A, Heatly E, et al. Antibiotics for treating bacterialvaginosis in pregnancy. Cochrane Database Syst Rev. 2013;1:CD000262.

2. Sherrard J, Donders G,White D, et al. European (IUSTI/WHO) guideline onthe management of vaginal discharge, 2011. Int J STD AIDS 2011; 22: 421-9.

3. Workowski KA, Berman S. Sexually transmitted diseases treatment guidelines,2010. MMWR Recomm Rep 2010 Dec 17;59(RR-12):1-110.

37

1. : - , ( 4 /), - Candida non albicans, (.. , ).

2. Gram- (.. Escherichia coli, Proteus spp, Klebsiellaspp, Pseudomonas spp) .

3. Trichomonas vaginalis, . Candida albicans ( ).

4. Gram: (i) ( -), (ii) clue cells (- Gram -). : Gardnerella vaginalis (90%) Prevotella spp, Mycoplasma spp, Bacteroides spp >40 .

5. (250mg/8 po 7 ) (300mg/12 po 7 ) - ( ) .

6. , , - .

7. - , - , , .

8. , 14 po 150mg - 6 + Candida(.. Candida glabrata ).

36

39

OYPHPITI

38

1. Gram- (.. , , -,) .

2. - .

3. Chlamydiatrachomatis .

4. , , - . HIV .

5. 3-6 .

6. , .

7. .

8. - .

9. .. ( , - ), (Reiters, Behcets,Wegeners) .

10. 2 , .

11. ( ) - Ureaplasma urealyticum,Mycoplasma genitalium,Trichomonas vaginalis - (. ).

12. 30% , ( -).

1. Maldonado NG,Takhar SS. Update on Emerging Infections: ews from the Centers forDisease Control and Prevention. Update to the CDCs Sexually Transmitted DiseasesTreatment Guidelines, 2010: Oral cephalosporins no longer a recommended treatmentfor gonococcal infections. Ann Emerg Med 2013; 61:91-5

2. Workowski KA, Berman S. Sexually transmitted diseases treatment guidelines, 2010.MMWR Recomm Rep. 2010; 59 (RR-12):1-110

5-10% X ,

Gram(-)

- Gram

40% X

-

Gram (>5)

100mg x 2 po x 7 +

A 1 g po

(, -, )x 7

2g po +

A 1g po

M

1. Chlamydia trachomatis2. Ureaplasma urealyticum3. ycoplasma genitalium4.Trichomonas vaginalis

A 100mg x 2po x 7 - 1g po

( - X / O)

M-eisseria gonorrhoeae

125mg

K 400mg po

2g im

:> 5 Gram

> 10 1

41

POTATITI

40

1. International Prostatitis Colaborative Network, - 4 : I: . -. II: . . III: . III: EPS VB3 , III: - EPS VB3. - . IV: . / , , EPS VB3, . ( .. Ca ) -.

E 1: Stamey-Mears

VB1 VB2 EPS VB3

K

(~200ml)

(10ml)

(10ml)

(10ml)

VB1=Voided Bladder 1, VB2= Voided Bladder 2, EPS=Expressed Prostate Secretions,VB3= Voided Bladder 3 ( )

: EPS / VB3 > VB2 VB1 1 log .

OYPHPA

Y--

E -

(3-5 )

(.. ) -

Stamey-Meares

M (X

O )

T--(960mg x 2 per os)

KN 400mg x 2 500mg x 2 O 200mg x 2 500mg po x 2(600mg x 1)

4-6

4-6

H1

A

100mg x 2

K500mg x 2

K

Stamey-Meares

( 1)

( )

, , > 3

(Escherichia coli)

43

42

1. 2. Staphylo-

coccus aureus, -. S.aureus - :. Mupirocin 7 (2-3 / 24).

..

(-).

. 70C, , 48.

3. (. )

( 1g 3po)

500mg 3po 600mg 3po

- -

: Staphylococcus aureus

X - -

-

2. -.

3. .4. -

.5.

/ . -- - .

1. Cohen JM, Fagin AP, Hariton E, et al. Therapeutic intervention for chronicprostatitis/chronic pelvic pain syndrome (CP/CPPS): a systematic review andmeta-analysis. PLoS One 2012; 7 (8):e41941.

2. Grabe M, Bjerklund-Johansen TE, Botto H, et al. European Association ofUrology: Guidelines on urological infections. 2011.

45

-

44

A , - , .

( - )

(B ).

K

(10 )

- A (90%)

Staphylococcus aureus (10%)

Y

Y

V M po(B )

A + 1000mg x 2po

K 600mg x 3po

:

1. , (.. , ), (.. ) IV. E - .

2. - .3. (,

, ) MRSA (Methicillin Resistant Staphylococcus aureus) MRSA.

4. - (20%-30%).

() ()

: - , , C G Staphylococcus aureus ( 10%)

. .

V ( -) 1.5 ui 4po ( )

+ 1000 mg x 3 po

600mg 3 po ( 4)

150mg 2po 500mg 2po 500mg/24

: 10 ( )

2.4-3.6 . ui IM [1.2-

1.8 . ui 3

( 12-18 )].

: V 1,5 . iu po,

12 ( )

12-18 ( 3)

47

(Flesh eating disease)

46

OIMEI AO HMATA ANPN KAI ZN

- (

)

I T T

Td TIG Td TIG

3 OXI OXI OXI

< 3 NAI NAI NAI OXI

A + 1 g x 2 po x 5-7

E 400mg x 1 po T 100mg x 2 po +

M 500mg x 3 po

1. T .

2. Y .T Pasteurella multocida ( - ), Staphylococcus aureus, Streptococcus spp. Capnocytophaga spp. [Gram (+) ,Fusobacterium spp. Gram (-) ].

3. O ( 24) - .

4. T - .

O A T

E 5 . E 10 . T (

4948

(-)

(-)

6 ( 1) ( )

-

(

)

CRP

- (20% ). : Staphylococcus aureus, Streptococcus spp,

Staphyloccus epidermidis. IV Pseudomonas aeruginosa Salmonella spp

K , ,TKE, CRP, - 99mTc-MDP 3 , MRI CT MRI

:

, - , , . , - 1987. 2012 - , - . 30 - ( ), . . 100%, - . - ( ) :

) > 5min ( 15 min)

) ( - , , ) ( )

1. - .

2. - - .... (www.keelpno.gr)

3. - 24. ....

1. WHO 6 August 2010, 85th Year No. 32, 2010, 85, 3093202.

(www.keelpno.gr) 13 20133. May AK. Skin and soft tissue infections: the new surgical infection guidelines.

Surg infect 2011; 12:179-844. Moran GJ, Abrahamian FM, Lovecchio F, et al. Acute bacterial skin infections:

developments since 2005 Infectious Disease Society of America (IDSA)guidelines. J Emerg Med 2013; 44:e397-412

1. , -, , , - . , .... (. 15)

2. - . - - .

3. .

4. .. .. Brucella, Mycobacterium tuberculosis, - ( , ).

5150

TKE, CRP , CT, MRI 3

99Tc - MDP

(>3) . . 3 .

: gram-

1:

/ (960mg/12 po) (600mg/8 po) ( )

1g/8 po Na (500mg/8 po)

[900mg (600+300)/24 po]. 2 .

1. , .

2. .. .

3. iv - Gram (-) .

1. Liu C, Bayer A, Cosqrove SE, et al. Clinical Practice Guidelines by the InfectiousDiseases Society of America for the Treatment of Methicillin-ResistantStaphylococcus Aureus Infections in Adults and Children. Clin Infect Dis 2011;52: 285-92

2. Mathews CJ, Weston VC, Jones A, et al. Bacterial septic arthritis in adults.Lancet 2010; 375: 846-55

3. Osmon DR, Berbari EF, Berendt AR, et al. Diagnosis and Management ofProsthetic Joint Infection: Clinical Practice Guidelines by the InfectiousDiseases Society of America Clin Infect Dis 2013; 56:1-10

. : (45%), (15%). 88% - : , , , () .. : Gram (+) .

. : >50.000/mm , Gram , Ziehl Neelsen .

.: . MRI: - .

Gram (-) : (2g/24 IV) (2g/8 IV) (400 mg/8 IV).

Gram (+) : (1g/12 IV) (10mg/kg/24 IV) (6-8 mg/kg 24). - 3g/6 IV ( - ).

2 iv peros 2-4 .

52

53

Gram (+) (90%) Gram (-) Staphylococcus aureus (44%), Neisseria gonorrhoeae MycobacteriumStreptococcus pyogenes Neisseria meningitidis tuberculosisStreptococcus pneumoniae Pseudomonas aeruginosa Brucella spp

( )

54

YNPOMO

2. - , po (- ) . . -.

3. : 750 mg x 2po x 3 - 500 mg x 1po x 3.

4. Campylobacter jejuni: 500 mg x 1po x 3.5. E. Coli 0157:7 -

- .

55

+ 300mg x 1 po 1000mg x 1 po 500 mg x 4 po x 3

B -

(. 5)

1. 2.A

HIV3. M -

1. E -: K-

K

Isospora belli M-

2.

( 1)

3. -

4. CMV

I - -

Campylobacter

spp (. 3 4)

K

Y

()

:

HIV (+).

:

( 4 )

IAPPOKO

( 7 )

1. (I) , (2) , (3) , (4) , (5)

57

1. Cheng C, McDonald JR, Thielman NM. Infectious diarrhea in developed anddeveloping countries. J Clin Gastroenterol 2005; 39: 757-73

2. Guerrant RL, Gilder TV, Steiner TS, et al. Practice Guidelines for theMangement of Infectious Diarrhea. IDSA Guidelines, Clin Infect Dis 2001; 32:331-51

3. OMGE Practice Guideline: Acute diarrhea in adults. 2005http://www.omge.org/guides/

4. Thielman NM., Guerrant RL. Acute infectious diarrhea. N Eng J Med 2004;350:38-47

56

(. )

- - -

-

, , ,

, - -, / ( - ).

/

2//

( )

( / )

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1.

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90 mmHg 65mmHg

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70%

2. /

3. - (50%) , - .

4.

) / .

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) bolus . .

) : -

)

:

2

59

58

-

2 :

> 38C < 36C

> 90/

> 20/ PaCO2* 12.000/mm3 10% -

-

. :

: PaO2/FiO2** 2

: 1.5 : / . , -

.

< 90 mmHg , -

/

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1. Dellinger RP, Levy MM, Carlet JM, et al. Surviving Sepsis Campaign: Inter-national guidelines for management of severe sepsis and septic shock: 2008Crit Care Med 2008; 236: 296-327

2. Kumar A, Roberts D,Wood KE, et al. Duration of hypotension before initiationof effective antimicrobial therapy is the critical determinant of survival inhuman septic shock. Crit Care Med 2006; 34: 1589-96

3. Kumar A, Zarychanski R, Light B, et al. Early combination antibiotic therapyyields improved survival compared with monotherapy in septic shock: apropensity-matched analysis. Crit Care Med 2010; 38: 1773-85

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