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编号:159244
Inexpensive Treatment Of Common But Severe Bacteri
http://www.100md.com 2001年9月6日 中国医学论坛表
     Antimicrobial treatments are loaded with dogmata which often are not based on scientific data. This fact is emphasized when one treats severe infections such as septicemia, meningitis, peritonitis, osteoarticular or cardiovascular infections, severe pneumonia, or other invasive bacterial diseases. Neonatal infections and those of immunocompromised patients pose problems of their own. Only after the clinician has answered all the questions listed below, he/she has fully understood why so many new antimicrobials are developed, why treatments only increase in price, why resistance problems expand, and why many patients are treated suboptimally - and not only in poor countries.

    1.Why antimicrobic at all?

    l Respiratory infections, esp. URI and otitis media

    2.Why not inexpensive penicillin G, sulphonamides etc.?

    3.90% of patients need 1 agent only

    l Unexpected etiology very rare

    l Additive/synergetic effect rare

    l You realize interactions?

    4.Why not orally?

    l I cephalosporins

    l Clindamycin

    l Metronidazol

    l Ofloxacin

    l Chloramphenicol

    5.Why so large dose?

    l Eagle effect

    l Would probenecid be of value?

    6.Why so long course?

    l UTI (3-5 days)

    l Meningitis (4-7 days)

    l Osteomyelitis (3 wks)

    l Septic arthritis (2 wks)

    l Acute otitis (3-5 d vs. 1 dose vs nihil), http://www.100md.com