2016-02-02 02:35
ANTIBIOTICS FOR SOFT TISSUE INFECTION/ NECROTIZING FASCIITIS
2017-03-02 海洋弧菌 Vibrio vulnioficus infection in patient with viral hepatitis, alcoholism, hemochromatosis, diabetes mellitus, thalassemia major, chronic renal disease, use of TNF inhibitors, and lymphoma
http://www.emnote.org/emnotes/vibrio-sepsis-in-cirrhotic-patients
張志華主任說
肝病併發海洋弧菌敗血症的重點
1. Necrotizing fasciitis
2. Antibiotic: doxycycline + ceftazidime
註：在未排除Gr. A beta-hemolytic strep之前，要加penicillin(+/- clindamycin)
如果是 GAS: Clindamycin may be more effective in invasive infections. Unlike with penicillin, the efficacy of clindamycin is unaffected by the size of the inoculum and the stage of bacterial growth. In addition, clindamycin inhibits the production of toxin by streptococci.
Antibiotic: doxycycline + ceftazidime + penicillin
... to cover vibrio and GAS.
黃醫師發問
1.台灣沒penicillin iv了
2.doxycycline只有口服 即使此抗生素bioavailability很高 但重症病患消化不好 無法預估吸收多少 君不見surviving sepsis campaign告訴各位 sepsis時 抗生素應iv 通常這種complicated skin and soft tissue infection 都是sepsis了
3.好 那IV minocycline可行吧? 台灣也沒有iv minocycline了 QQ
ANTIBIOTICS CHOICE FOR SOFT TISSUE INFECTION/ NECROTIZING FASCIITIS
Treatment recommendations based on Gram stain result
Gram-positive cocci in chains:
· Penicillin 1-4 million U IV q4h or ampicillin-sulbactam 1.5-3 g IV q6-8h plus
· Clindamycin 600-900 mg/kg IV q8h
Gram-positive rods:
· Clindamycin 600 mg/kg IV q8h or
· Ampicillin-sulbactam 1.5-3 g IV q6h
Gram-negative rods or gram-positive cocci in clusters or mixed:[10]
· Ampicillin-sulbactam 1.5-3 g IV q6-8h plus clindamycin 600-900 mg/kg IV q8h plus ciprofloxacin 400 mg IV q12h or
· Piperacillin-tazobactam 3.375 g IV q6-8h plus clindamycin 600-900 mg/kg IV q8h plus ciprofloxacin 400 mg IV q12h or
· Imipenem-cilastatin 1 g IV q6-8h or
· Meropenem 1 g IV q8h or
· Ertapenem 1 g IV q24h or
· Cefotaxime 2 g IV q6h plus ( metronidazole 500 mg IV q6h or clindamycin 600-900 mg/kg IV q8h)
· Since none of the above covers MRSA, in appropriate clinical situations consider vancomycin 1 g IV q12h, daptomycin 6-10 mg/kg IV q24h, [11] or linezolid 600 mg IV q12h
Treatment recommendations for penicillin-allergic patients
See the list below:
· Clindamycin 600 mg/kg IV q8h plus ( vancomycin 15 mg/kg IV q12h orlinezolid 600 mg PO or IV q12h) plus ( aztreonam 1-2 g IV q6-8h orgentamicin 3-5 mg/kg/day IV in 3 divided doses or ciprofloxacin 400 mg IV q12h)
Guidelines
The Infectious Diseases Society of America recently updated their guidelines for the diagnosis and management of skin and soft tissue infections. For the full guidelines, see Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America.[12, 13]
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