What Is Involved in Antimicrobial Chemotherapy?

Anti-microbial: It is a general term that includes sterilization, sterilization, disinfection, bacteriostasis, mildew resistance, and antisepsis. The process of using chemical or physical methods to kill bacteria or hinder their growth and reproduction. Is a general term for sterilization and bacteriostasis.

Antibacterial

Anti-microbial: is a generic term that includes

Anti-microbial (anti-microbial): is a generic term, including bactericidal, antibacterial.

Sterilization (sterilization): refers to all microorganisms in the system to be treated including microbial

One. Reasonable use of antibiotics. Select appropriate antibiotics under clear indications, and use appropriate dosages and treatments to kill pathogens and control infections. At the same time, take various corresponding measures to enhance patients' immunity and prevent adverse reactions. , Especially to avoid the development of bacterial resistance.

two. Various aspects of unreasonable use of antibiotics: Use drugs that are ineffective against pathogenic bacteria or infections and have poor efficacy; insufficient or excessive doses; continue to use drugs after pathogenic bacteria become resistant; premature drug withdrawal or infection control for many days without timely drug withdrawal ; Do not switch to other effective drugs when there is a double infection of drug-resistant bacteria; incorrect route of administration; continue medication when severe or allergic reactions occur; improper combined application of antibiotics; rely on the antibacterial effect of antibiotics and neglect necessary surgical treatment ; No indications or weak indications for preventive medication; neglecting the efficacy / price ratio.

three. Issues involved in rational drug use: indications for the use of antibiotics and combination drugs; pharmacokinetics and pharmacodynamics of antibiotics; empirical drugs for anti-infection; dosages, courses and methods of administration of antibiotics; adverse reactions and prevention of antibiotics; bacterial resistance Changes and prevention of medicinal properties; application of antibiotics under special circumstances, etc.

four. Basic principles of antibiotic application:

1. Establish the etiology of infectious diseases early.

2. Familiar with the indications, antibacterial activity, pharmacokinetics and adverse reactions of the selected drugs.

3 Reasonable medication according to the patient's physiology, pathology, and immune status.

4 Reasonable use of commonly used antibiotics.

5. Choose the appropriate dosing regimen, dosage and course of treatment.

6. The application of antibiotics should be strictly controlled or avoided as far as possible: preventive medication, topical medications for skin and mucous membranes; those with unknown reasons for viral infection or fever; and combined use of antibacterial drugs.

7. Stress the importance of comprehensive treatment measures;

Fives. Empirical application of antibiotics: When the pathogen is unknown, early application of antibiotics for empirical anti-infective treatment is very important; use broad-spectrum antibiotics and try to use bactericides; in severe infections, often use combined drugs, commonly used bactericides include - Lactams, aminoglycosides, fluoroquinolones, peptides, etc .; in specific infections: sulfa drugs, clindamycin, metronidazole, and rifa are more widely used. In the empirical application of antibiotics, antibiotics should be selected based on clinical data to determine possible pathogens. Different types of broad-spectrum antibacterial drugs have differences in antibacterial activity. Antibiotics should be selected based on factors such as the indications, antibacterial activity, and changes in drug resistance. Antibacterial activity of commonly used antibiotics: Penicillin: Gram-positive and Gram-negative cocci, Haemophilus, and various pathogenic Borrelia and most cattle actinomycetes. Classification: Penicillin G, phenoxypenicillin, mold-resistant penicillin (oxacillin), broad-spectrum penicillin (ampicillin, oxypiperazine penicillin), penicillin (methicillin and temocillin) acting on gram-negative bacteria Cephalosporins: strong antibacterial effect, resistance to penicillinase, high clinical efficacy, low toxicity, and low allergic reactions, can be divided into four generations: the first generation is mainly used for the infection of Gram-positive bacteria and some Gram-negative bacteria , Poor tolerance to -LA. The second generation is stable to most -LA, has a broader antibacterial spectrum than the first generation, and has a stronger effect on Gram-negative bacteria, but has less activity against Enterobacter and Pseudomonas aeruginosa. The third generation is stable to most -LA and has strong activity against Gram-negative bacteria, but it has less effect on G + cocci than the first and second generations. Among them, cefoperazone and ceftazidime have good effects on Pseudomonas aeruginosa, and the half-life of ceftriazine is long, reaching 8 hours. The fourth-generation cephalosporins include cefpirome, cefepime, and cefazolin. The antibacterial effect is fast, the antibacterial activity is stronger than that of the third generation, and it is quite active against G + cocci, including acid-producing Staphylococcus aureus. Pairs of G-bacilli including Pseudomonas aeruginosa are similar to the third generation. It is more active against resistant strains than the third generation. Cefpirome is superior to ceftazidime on G-bacteria including Pseudomonas aeruginosa, Serratia, and Clostridium cloacae. Cefepime has a significantly enhanced effect on G + cocci, and is sensitive to this product except for Flavobacterium and anaerobic bacteria. More stable to -lactamase. Cephamycins: Cefoxitin has strong activity against Gram-positive, negative and anaerobic or aerobic bacteria, and is highly stable to -LA. Monocyclic -lactam antibiotics: aztreonam, which has a strong effect on Gram-negative bacteria, is stable to enzymes, and has a low incidence of cross-allergy. Aminoglycosides: Good activity against Staphylococcus and aerobic Gram-negative bacilli, some have effects on Mycobacterium tuberculosis and other mycobacteria, cross-resistance may exist between different species, and ear and kidney toxicity , And can have the blocking effect of neuromuscular junctions, and the after-effects of antibiotics. Tetracyclines: minocycline, doxycycline, tetracycline, oxytetracycline. Broad antibacterial spectrum, convenient for oral administration. Sensitive to Rickettsia, Mycoplasma, Atypical Mycobacterium and Amoeba. Chloramphenicol: Chloramphenicol. Macrolides: Mainly act on Gram-positive and Gram-negative bacteria and anaerobic bacteria, Legionella, Mycoplasma, Chlamydia. Tissue concentration is high. There is incomplete cross-resistance. Lincomycin and clindamycin: Gram-positive and anaerobic bacteria. Polypeptides: vancomycin and norvancomycin. It has strong antibacterial effects on various Gram-positive bacteria: MRSA, MRSE and Enterococcus. Fluoroquinolones: first generation: nalidixic acid; second generation: picolinic acid; third generation: enoxacin, ofloxacin, pefloxacin, ciprofloxacin, lomefloxacin, etc. Features: Broad spectrum, good antibacterial activity against multi-drug resistance (other antibiotics), wide body distribution, high tissue concentration, low protein binding rate (14-30%), mostly excreted by the kidney, high urine concentration, long half-life , Oral absorption is good, there are follow-up effects of antibiotics. There is a certain cross-resistance among the varieties.

six. Preventive medicine for surgery:

1. Indications for preventive medication after surgery: Significant infection in the surgical field of vision; large scope, long time, and great opportunity for infection, foreign body implantation surgery, such as: artificial heart valve transplantation; surgery involves important organs, and is prone to serious consequences due to infection; Elderly or immunocompromised patients.

2. Antibiotic selection conditions for preventive medication: safe and effective; less adverse reactions; easy to administer; low price.

3 Antibiotic administration time: Intravenous within 30 minutes before surgery or at the beginning of anesthesia.

4 Duration of medication: <24 hours.

5. Antibiotic selection during different organ and tissue surgery: antibacterials; targeting the main possible pathogens.

Seven. Combination therapy with antibiotics: Indications for combination therapy: Stricter than single medications: Severe infections of unknown etiology; Severe infections that cannot be controlled by a single antibiotic; Mixed infections that cannot be effectively controlled by a single antibiotic; Bacteria that have been used for longer periods of time have drug resistance Possibility; combined use reduces the dose of more viral drugs. Classification of antibiotics: Reproductive fungicides: penicillins, cephalosporins, vancomycin, Taineng, fluoroquinolones, static bactericides: aminoglycosides, polymyxins, fast-acting bacteriostatic agents: Tetracycline, chloramphenicol, macrolides, clindamycin slow-acting bacteriostats: sulfa drugs combined results: Category 1 + Category 2: Synergy Category 1 + Category 3: Antagonism? Type 2 + Type 3: Accumulation or Synergy Type 1 + Type 4: Additive effect? Type III + Type IV: Cumulative effect Type II + Type IV: Cumulative effect?

Eight. Bacterial drug resistance changes and their prevention: Significance of monitoring resistance to common pathogens:

1. Antibiotics for clinical use.

2. Control the development of bacterial resistance. Anti-infection faces the seriousness of bacterial resistance: 1 1. Staphylococcus aureus (MRSA) and Staphylococcus epidermidis (MRSE) resistant to oxacillin. Vancomycin-resistant enterococci (MRE, VRE) 3 3. Penicillin-resistant pneumococcus (PRSP) 4 G-Bacillus extended-spectrum -lactamase (ESBL) and inducible enzyme (I 5. Vancomycin-resistant Staphylococcus (VIRS) drug resistance mechanism: production of inactivated enzymes; changes in membrane permeability; effects Changes in target position; anti-pump mechanism of resistance generation: endogenous resistance: natural resistance; exogenous resistance: acquired resistance: 1) chromosomal mutation; 2) plasmid-mediated. The pressure-selective effect of antibiotics: the use of -lactam antibiotics can promote bacteria: -lactamase; produce a large number of chromosomal -lactamase; generate plasmid-mediated -lactamase; produce a broad-spectrum variant -lactamase. The resistance of community-borne respiratory infection pathogens has constituted a serious threat. The main drug-resistant bacteria are: Streptococcus pneumoniae: changes in the target site of penicillin-binding protein (PBP2b). 2. Haemophilus influenzae: -lactamase production. Moraxella catarrhalis: -lactamase production. The main pathogens of respiratory infections in the community (outpatient): Pathogens account for the total isolates (%) Streptococcus pneumoniae Haemophilus catarrhalis catarrhalis Staphylococcus aureus. About the prevalence of drug resistance to Streptococcus pneumoniae (PRSP): PRSP was first cultured in Sydney Hospital, Australia, in 1967; the presence of PRSP was found in many countries in the 1970s; and severe drug resistance, DRSP, was found. The incidence of drug resistance has increased rapidly since the 1980s: Spain: 6% 44%; France: 0.3% 12.4%; Mexico:?% 50%;