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OSTEOARTRITAE
ENDOCARDITA
Strepto pyogen Strepto pneum-S Staf- meti-S Staf meti- R Enteroc faecium GONOCOC MENINGOCOC
AMINO PENICILINE
MENINGITA MENINGOCOCICA Inf ORL PNEUMONIE PNEUMOCOCICA PENI - I / S Endocardita - pneumococica - enterococica -profilaxie
PENICILINA G +
Gonococ
Stafilcoc Bacteroides Bordetella pertusis Vibrio cholerae Clostridium spp Bacillus antrach Haemophilus infl non B si tip B Enterobacterii Fusobacterium
PENICILINE NATURALE
ERIZIPEL ERIZIPELOID ROSENBACH SCARLATINA GANGRENA GAZOASA
ANGINA - STREPTOCOCICA - PLAUT - VINCENT
Peptostreptococ
RAA SIFILIS LEPTOSPIROZA INF ANAEROBI (Nu Bacteroides ) ACTINOMICOZA 12. PROFILAXIA MUSCATURA ANIMAL SPIROCHETE : TREPONEMA spp LEPTOSPIRA BORELLIA spp SPIRILIUM Mycoplasma Chlamydia Rickettsia Mycobacterium spp
CARBOXIPENICILINE
AMINO P +
Pseudomona aerug Enterobacter Proteus indol+ Morganella spp Serratia spp Providencia spp Alti vibrio
Activitate mai decat AMPI pe: enterococi , streptococi , pneumococi (> 30 % ) Incidenta crescuta a BGN rezistenti la TICARCILINA : Enterobacter ,E. coli, Pseudomonas.
UREIDO-PENICILINE
AMINO P +
MENINGITE cu BGN
INF SISTEMICE cu germeni sensibili STAF PNEUMO peni-R ANTIBIOPROFILAXIE chirurg colorectala / gineco . GONOCOC
PSEUDOM aer ENTEROBAC sp KLEBSIELA spp SERRATIA CITROBACTER H. INFLUENZ Pseudomonas non ACINETOBACT
BACTEROIDES
CEFALOSPORINE
Nu : - LISTERIA - ENTEROCOCIS - STAFILOCOC meti- R - CLOSTRIDIUM difficile - MYCOPLASMA spp, CHLAMYDIA spp , RICKETTSIA spp
CFS I
INF ORL comunitare INF bronsice comunitare
INF cutanate
STREPTO PNEUMO peni-s/ peni R STAF meti- S
GONOCOC
CORINEBACT difteriae
Antibio-profilaxie In chirurgie
E. coli PROTEUS mirA SALMONELLA SHIGELLA PASTEURELLA H. infl -lactamazo negativi ENTEROBACT SERRATIA CITROBACTER PROVIDENCIA MORGANELLA PROTEUS V. PSEUDOMO Alti ACINETOBACT
CFS II
Antibio-profilaxie in chirurgie INF ginecologice INF urinare INF mixte aerobi si anaerobi pt cefamicine
CFS III
MENINGITE INF ORL INF RESPIRATORII INF PNEUMO -R
ACTINOMYCES
ITU
E. coli PROTEUS mir, vulgaris SALMONELLA SHIGELLA PASTEURELLA H. influenzae Providencia Citrobacter Klebsiella Morganella Borrellia burg. ENTEROBACT Citrobacter feund SERRATIA Yersinia Klebsiella pneum Pseudomonas aer LEGIONELLA ACINETOBACT
BACTEROIDES spp
Borrelia burgdorf
Inf de focar / sistemice urinare, parti moi Inf bacteriene severe la Ne- penici + AG
E.coli Proeus mir,vulg Salmonella Shigella Enterobacter Pasteurella H. infl Providencia Piocianic Serratia Citrobacter Klebsiella Morganella ACINETOBACT Klebsiella pneum Legionella
Spectru : CFS exrema stg + centru Activit superoara pe streptococi si piocianic (fata de CFS III ) Stabilit mai mare la act lactaze cls I si ESBL- uri
-lactamine + IBL
AMOXI + IBL
INF ORL + stomatologice INF RESPIRATORII INF CUTANATE PARTI MOI
AMPI+ sulbactam
+ INF INTRAABDOMIMALE, PERITONITA ,peritonita TICAR+ CLAVULANAT + BGN rezistenti la alte L + INF NEUTRIPENICI ( + alte AB) PIPER+ tazobactam CEFOPER+ sulbactam + inf SEVRE PLURIMICROBIENE cu germeni multiR (+ piocianic) +INF NEUTRIPENICI ( + alte AB)
ITU si genitale
STREPTO PNEUMO peni-S / Peni-R si I STAF meti- S Enterococ faecium STAF -MR
CGN
STREPTO PNEUMO peni-S / peni I si R STAF meti- S Enterococ / faecium STAF-MR ACINETOBACTER BACTEROIDES spp
CGN
BGP
E.coli Klebsiella pneum Proteus Salmonella Shigella Enterobacter Pasteurella H. infl Campilobacter V. cholerae Rezistenti : Chlamydia, Rickettsia, MycobacteriumCapnocytophaga Providencia Piocianic Serratia Citrobacter Morganella Yersinia Legionella Nocardia
BGP
E.coli (piper) E,coli (ticar ) Proteus Salmonella Shigella Enterobacter Pasteurella H. infl Providencia Piocianic ACINETOBACT Serratia Citrobacter Klebsiella Morganella
BACTEROIDES spp
CARBAPENEME
Klebsiella pneum
BACTEROIDES spp
INF OSOASE
INF URO-GENIT
BACTEROIDES FUSOBACTERIUM
NOCARDIA ERIZIPELOID TOXOPLASMA IN SARCINA TOXOPLASMA CEREBRALA Inf CU MAC ANGIOMATOZA BACILARA Alternativa la pac alergici la penicilina (sifilis, RAA)
LEPTOSPIRA spp BORELLIA burgdorferi TREPONEMA MYCOPLASMA pn CHLAMYDIA UREAPLASMA U. RICKETSSIA BARTONELLA henselae
LINCOSAMIDE
STAF MS / MR
INF osteo-articulare
NEISSERIA MORAXELLA
INF cu ANAEROBI indifer de localizare ( exceptie : meninge ) Alte INF STAFILOCOCICE TOXOPLASMOZA CEREBRALA in SIDA ( + pirimetamina ) INF ORL, PROFILAXIE ENDOCARDITA (alergici la peniciline/BL)
B. anthracis / cereus CORIN.diphter / jeikeium E.rhusiopathiae CLOSTRID perfr ACTYNOMICES EUBACTERIUM CLOSTRID difficile NOCARDIA LISTERIA
Clindamicina :
TOXOPLASMA gondii BABESIA microti PLASMODIUM spp PNEUMOCYSTIS carnii
AMINOGLICOZIDE
10
gen II
GENTA TOBRAMICINA SISOMICINA
TBC, pesta, tularemie, bruceloza, inf enterococica SPECTINO uretrita gonococica NEOMICINA decontam tub dig preoperator coma hepatica, otite ext PAROMOMICINA
Spectru : AMIKA fara PSUEDOMONAS ACINETOBACTER (exceptie TOBRA) MYCOBACTERII Indicatii: ENDOCARDITE INF(+ BL, VANCO) INF SEVERE loc /gen cu STAF INF URINARE INF cu LISTERIA ( + aminoP) Rezistenti : Anaerobi Pneumococ STAF meti-R Germeni intracelulari Leptospire
KANA ( nerecomandata in prezent) - CGP (pneumococ) - CGN - BGN H. infl Serratia Morganella Klebsiella E.coli Yersinia treponeme Vibrio cholerae Brucella
gen III
AMIKA NETILMICINA ISEPAMICINA DIBEKAMICINA
AMIKA, ISEPA Spectru KANA + LISTERIA ACINETOBACTER CITROBACTER PIOCIANIC PROVIDENCIA AEROMONAS MYCOBACTERII ATIPICE + / - PNEUMOCOC Indicatii : INF SEVERE germeni multirezist + BL /FQ / GP TBC germeni multiR INF mycobacterii atipice NETILMICINA, DIBEKA ~ GENTA
Mecanism : fix pe subunit 30S ribozomala inhiba sinteza proteinelor - Concentrare masiva intrabacteriana : permeabiliz, transport activ dep de metabolismul aerob - Bactericide, conc-dependente - Efect post-antibiotic - Doza unica, zilnica Mecanism rezistenta: enzimatic impermeabilitate mutatii tinta Cele mai vechi : mai putin active GENTA : mai activa pe Serratia, Bartonella TOBRA: cea mai activa pe PIOCIANIC, ACINETOBACTER AMIKA : Nocardia
CHINOLONE
11
ANAEROBI
ANAEROBI NU Cl difficile
STREPTO : - PYOGENES - VIRIDANS - PNEUMCOC + /- MRSA
CGP
CGN
CHINOLONE SISTEMICE Mecanism act: - act la niv enz ADN giraza si topoizomeraza IV inhiba sinteza ADN Bctericide Conc-dependente Efect postAB : 2 4 ore
ANAEROBI
NOCARDIA LISTERIA
12
1. MENINGITE PURULENTE SECUNDARE + CFS III Q respiratorii 7. Acutizari bronsite cronice Pneumonii : - comunitare /nosocomiale 2.OCULAR Q respiratorii 3.ORL : sinuzite, otite
4.INF DIGESTIVE -febra tifoida -dizenterie bact -holera -diaree calatori 5. INF urinare joase / inalte 6. INF GENITALE -uretrite, prostatite -gonoree -salpingita -boala inflam pelvina -limfogranulomat veneriana benigna
9. INF SISTEMICE 10. ANTRAX 11. FEBRA Q 12. INF MAC la pac HIV 13. PROFILAXIE : -portaj nazofaring meningococ -diaree calatori
Chinolone urinare
MEDICAMENT Ac nalidixic NORFLOX LOMEFLOX ADULT 30 50 mg/kg/zi 800 mg/zi 400 800 mg/zi DOZE COPIL 6 ore p.o. 12 ore p.o. 12 ore, p.o. ADM
DOZE ADULT /zi 1 1.5 g - po 0.4 1.2 g - i.v. 800 mg 400 800 mg 400 mg 500 mg 400 mg 320 mg
ADM 12 ore 12 ore; p.o / i.v. 12 ore; p.o. Priza unica ; p.o. / i.v.
CICLINE
13
1. Inf genitale Chlamydia 2. Ricketssioze - febra Q - febra butonoasa - alte 3. Holera 4. Bruceloza 5. boala Lyme 6. Febra recurenta 7. Inf cu Mycobacterium fortuitum 8. Ehrichioza 9. Malarie 10.Inf cu Balantidium coli
PEPTOSTRPTOCOC PROPIONEBACTER
LISTERIA
H inflenzae VIBRIO cholerae PASTEURELLA FRANCISELLA t LEGIINELLA pn BRUCELLA spp ENTEROB- cee ENTEROBACTER PROTEUS PSEUDOMONAS SERRATIA YERSINIA spp MICOBACTERII
C B
Alternative pt : 1. Pneumonii comunitare reduse / medii 2. Leptospiroza 3. Pasteurelloza 4. Inf digestive dizenterie 5. Tularemie 6. Pesta 7. Inf cu Mycoplasma pn / Ureaplasma u. 8. Boala Lyme ( cardita ) 9. Inf cu Mycobacterium marinum 10.Acnee 11. Actinomicoza 12.Antrax cutanat 13.Angiomatoza bacilara 14. Nocardioza pulmonara 15.Sifilis 16. Febra muscaturii de sobolan 17. Malarie- profilaxie
Mecanism actiune : - fix subunit ribozomala 30 S ihiba sisnteza proteica Mecanism rezistenta - acces tinta : transport activ / eflux activ - Modificari ribozomale - Inactivare chimica
FENICOLI
14
Infectii severe cu germeni sensibili dk nu sunt accesbile alte AB : - meningite purulente - abces cerebral
PEPTOSTREPTOCOC
supuratie pulmonara
O
STREPTO spp ENTEROCOC STAFILOCOC NEISSERIA spp
BACTEROIDES FUSOBACTERIUM
Ricketssioze - alternativa
+ CHLAMYDIA spp MYCOPLASMA spp RICKETSSIA spp MYCOBACTERII
HAEMOPHILUS infl. SALMONELLA SHIGELLA YERSINIA FRANCISELLA t BURKOL. Cepacia S. maltophilia BRUCELLA VIBRIOS spp PROTEUS KLEBSIELLA PSEUDOMONAS SERRATIA PROVIDENCIA
ACTYNOMICES CLOSTRDIUM
SULFAMIDE
15
ANAEROBI
CGP
CGN
BGP
NOCARDIA
Majorit BGN
H.influenzae ENTERO-cee Shigella E.coli
1. 2. 3. 4.
16
SULFAMIDE ASOCIATE
ANAEROBI
1. ACUTIZARI BRONSITE CR
STAF AUREUS STAF epidermid ENTEROCOC 2. BOLI DIAREICE LISTERIA NOCARDIA 5. SANCRU MOALE 3. ITU - cistita acuta necomplic - profilax cistite recidiv 4. PROSTATITA ACUTA
NEISSERIA spp
PROTEUS SALMONELLA SHIGELLA H. influenzae E. coli KLEBSIELLA ENTEROBACTER PROVIDENCIA VIBRIO CAMPYLOBACT BRUCELLA LEGIONELLA
+
6. TOXOPLASMOZA ( CTX ) 7. PNEUMOCISTOZA ( CTX ) 8.NOCARDIOZA 9.MALARIE ( fansidar )
+
PNEUMOCISTIS CARINII TOXOPLASMA GONDI
17
RIFAMICINE
RIFAMPICINA
1. MENINGITE TBC / non-TB 2. TBC pulmonar / extra ( + alte anti-TB )
CGP
CGN
BGP
( + clostridii diffcile)
6. LEPRA 7. BRUCELOZA 8. STERILIZ PORTAJ NAZO-FARINGIAN - menigococ, H. influenzae, stafilococ, streptococ 9. LEGIONELOZA 10. PROFILAX SECUND INF MATERIALE PROTETICE 11. LEISHMANIOZA CUTANATA 12.INF ANAEROBI 13. PROFILAXIE infectii cu MAC la imunD (RIFABUTIN )
+
MYCOPLASMA spp CHLAMYDIA spp BRUCELLA spp MYCOBACTERIUM spp
18
RIFAMICINE RIFABUTIN
INDICATII - inf cu MAC ( + CLARITO / AZITRO ) - inf cu Mycobacter TB la pac care primesc TARV cu INNRT / IP - profilaxie MAC
19
PEPTOSTREPTO
1. 2. 3. 4. 5. 6. 7. 8. 9. 10.
INF cu ANAEROBI COITA PSEUDOMEMBRANOASA TETANOS INF H. pylori- trat ulcer gastric AMIBIAZA INTESTINALA si HEPATICA GIARDIOZA TRIHOMONIAZA ACNEE ROZACEE VAGINOZA PROFIL inf anaerobi in interv pe tub diges /prostata
OXAZOLIDINDIONE
20
PEPTOSTRPTOCOC
STREPTO STAF ms / mr visa / gisa ENTEROCOC faecalis, faecium PNEUMOCOC ps / pr BACILLUS spp CROYNEBAC LISTERIA m ERYSIPELOTHRIX RHODOCOCUS equi MORAXELLA BORDETELLA HAEMOPHIL. Infl ENTEROBACT-cee PSEUDOMONAS spp
CLOSTRIDIUM spp
3. INFECTII SISTEMICE cu: - enterococi Vanco-R , - STAF metiR - Vanco -R 4. INF cu Mycobacterii (dk prima inie nu poate fi utilizata
POLIPEPTIDE CICLICE
21
1. 2.
INF URINARE cu BGN multi-R (inclusiv Piocianic) Topic : - aerosoli: MUCOVISCIDOZA - oral : DECONTAMINARE DIGESTIVA - inra-articular - intra-tecal - intra-conjunctival - auricular : OTITE EXTERNE - inf CUTANATE
DOZE ADM ADULT COPIL POLIMIXINA E 150-200 MU /kg/zi : p.o. 6 8 ore = COLIMICINA= 50 -100 MU/kg/zi : i.m / i.v. 8 12 ore POLIMIXINE B se administreaza numai local : colir, unguent, pomada
MEDICAMENT
NITROFURANI
22
- cu utilizare digestiva -
CGP
STAFILOCOCI ENTEROCOCI
23
ACIDUL FUSIDIC
1. -
PEPTOSTRPTOCOC
CGN
2. COLITA PSEUDOMEMBR
CORYNEBACT LISTERIA NOCARDIA CLOSTRIDIUM CLOSTRIDIUM ACTYNOMICES
24
FOSFOMICINA
1.
INF MENINGIENE cu: - BGN rezistenti + CFS III/ carbapeneme/ CIPRO - STAF + CFS III
ANAEROBI
NEISSERIA spp
STREPTOCOC Gr A, B, D
PROTEUS m. ACINETOBACTE
LINCOSAMIDE
25
Absorbtie digestiva : T: Leg proteine plasm : Difuziune tisulara Eliminare Efecte adverse
26