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Jingdong book

抗菌药物临床应用指导原则（2015年版）

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Jingdong book

抗菌药物临床应用指导原则（2015年版）

Name: 抗菌药物临床应用指导原则（2015年版）
Brand: Jingdong book
SKU: 3117134151
Price: 18.43 USD
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《抗菌药物临床应用指导原则（2015年版）》仍包括四部分，“抗菌药物临床应用的基本原则”，主要在“预防用药原则”增加了关于预防用药方案，以增加合理预防用药和相应监测、管理的可操作性。第二部分“抗菌药物临床应用管理”，主要根据卫计委制定的法规和技术规范，增加了“医疗机构建立抗菌药物临床应用管理体系”“注重综合措施，预防医院感染”两部分，强调科学化和常态化的抗菌药物管理。第三部分“各类抗菌药物的适应证和注意事项”增加一些临床常用的或近年来上市的抗菌药；增加抗菌药的耐药率数据，增加参数，为临床个体化用药提供指导。第四部分“各类细菌性感染的经验性抗菌治疗原则”，涉及直接指导临床医生选择治疗药物、剂量、疗程。该部分改动较多，其目的是希望我国临床上对于抗菌药物的使用更加规范。

Catalogue

关于印发《抗菌药物临床应用指导原则（2015年版）》的通知

第一部分抗菌药物临床应用的基本原则
抗菌药物治疗性应用的基本原则
抗菌药物预防性应用的基本原则
抗菌药物在特殊病理、生理状况患者中应用的基本原则
附表1 抗菌药物在预防非手术患者某些特定
感染中的应用
附表2 抗菌药物在围手术期预防应用的品种选择
附表3 特殊诊疗操作抗菌药物预防应用的建议

第二部分抗菌药物临床应用管理
一、医疗机构建立抗菌药物临床应用管理体系
二、抗菌药物临床应用实行分级管理
三、病原微生物检测
四、注重综合措施，预防医院感染
五、培训、评估和督查

第三部分各类抗菌药物的适应证和注意事项
青霉素类
头孢菌素类
头霉素类
β-内酰胺类／β-内酰胺酶抑制剂
碳青霉烯类
青霉烯类
单环β-内酰胺类
氧头孢烯类
氨基糖苷类
四环素类
甘氨酰环素类
氯霉素
大环内酯类
林可酰胺类
利福霉素类
糖肽类
多黏菌素类
环脂肽类
噁唑烷酮类
磷霉素
喹诺酮类
磺胺类
呋喃类
硝基咪唑类
抗分枝杆菌药
抗真菌药

第四部分各类细菌性感染的经验性抗菌治疗原则
急性细菌性上呼吸道感染
急性细菌性下呼吸道感染
尿路感染（膀胱炎、肾盂肾炎）
细菌性前列腺炎
急性感染性腹泻
细菌性脑膜炎及脑脓肿
血流感染及感染性心内膜炎
腹腔感染
骨、关节感染
皮肤及软组织感染
口腔、颌面部感染
眼部感染
阴道感染
宫颈炎
盆腔炎
性传播疾病
侵袭性真菌病
分枝杆菌感染
白喉
百日咳
猩红热
鼠疫
炭疽
破伤风
气性坏疽
伤寒和副伤寒等沙门菌感染
布鲁菌病
钩端螺旋体病
回归热
莱姆病
立克次体病
中性粒细胞缺乏伴发热

附录
附录一《抗菌药物临床应用管理办法》
附录二卫生部办公厅关于抗菌药物临床应用管理有关问题的通知
附录三 2011年全国抗菌药物临床应用专项整治活动方案
附录四 2012年全国抗菌药物临床应用专项整治活动方案
附录五 2013年全国抗菌药物临床应用专项整治活动方案
附录六国家卫生计生委办公厅关于做好2014年抗菌药物临床应用管理工作的通知
附录七关于进一步加强抗菌药物临床应用管理工作的通知
附录八关于应对我国抗生素使用诸多问题的专家观点

Book Abstract

《抗菌药物临床应用指导原则（2015年版）》：
利福霉素类
利福霉素类有利福平、利福霉素SV、利福喷汀及利福布汀。该类药物抗菌谱广，对分枝杆菌属、革兰阳性菌、革兰阴性菌和不典型病原体有效。
【适应证】
1.结核病及非结核分枝杆菌感染利福平与异烟肼、吡嗪酰胺、乙胺丁醇联合是各型肺结核短程疗法的基石。利福喷汀也可替代利福平作为联合用药之一。利福布汀可用于合并HIV患者的抗分枝杆菌感染的预防与治疗。
2.麻风利福平为麻风联合化疗中的主要药物之一。
3.预防用药利福平可用于脑膜炎奈瑟菌咽部慢性带菌者或与该菌所致脑膜炎患者密切接触者的预防用药；但不宜用于治疗脑膜炎奈瑟菌感染，因细菌可能迅速产生耐药性。
4.其他在个别情况下对MRSA、甲氧西林耐药凝固酶阴性葡萄球菌（MRCNS）所致的严重感染，可以考虑采用万古霉素联合利福平治疗。
【注意事项】
1.禁用于对本类药物过敏的患者和曾出现血小板减少性紫癜的患者。
2.妊娠3个月内患者应避免用利福平，妊娠3个月以上的患者有明确指征使用利福平时，应充分权衡利弊后决定是否采用。
3.肝功能不全、胆管梗阻、慢性酒精中毒患者应用利福平时应适当减量。
4.用药期间，应定期复查肝功能、血常规。
糖肽类
糖肽类抗菌药物有万古霉素、去甲万古霉素和替考拉宁等。所有的糖肽类抗菌药物对革兰阳性菌有活性，包括甲氧西林耐药葡萄球菌属、JK棒状杆菌、肠球菌属、李斯特菌属、链球菌属、梭状芽孢杆菌等。去甲万古霉素、替考拉宁的化学结构、作用机制及抗菌谱与万古霉素相仿。本类药物为时间依赖性杀菌剂，但其PK/PD评价参数为AUC/MIC。目前国内肠球菌属对万古霉素等糖肽类的耐药率＜5%，尚无对万古霉素耐药葡萄球菌的报道。
【适应证】
1.耐药革兰阳性菌所致的严重感染，包括MRSA或MRCNS、氨苄西林耐药肠球菌属及青霉素耐药肺炎链球菌所致感染：也可用于对青霉素类过敏患者的严重革兰阳性菌感染。替考拉宁不用于中枢神经系统感染。
2.粒细胞缺乏症并高度怀疑革兰阳性菌感染的患者。
3.万古霉素尚可用于脑膜炎败血黄杆菌感染治疗。
4.口服万古霉素或去甲万古霉素，可用于重症或经甲硝唑治疗无效的艰难梭菌肠炎患者。
5.万古霉素或去甲万古霉素通常不用于手术前预防用药。但在MRSA感染发生率高的医疗单位和（或）一旦发生感染后果严重的情况，如某些脑部手术、心脏手术、全关节置换术，也有主张（去甲）万古霉素单剂预防用药。
【注意事项】
1.禁用于对糖肽类过敏的患者。
2.不宜用于：①外科手术前常规预防用药；中心或周围静脉导管留置术的预防用药；持续腹膜透析或血液透析的预防用药；低体重新生儿感染的预防。②MRSA带菌状态的清除和肠道清洁。③粒细胞缺乏伴发热患者的经验治疗。④单次血培养凝固酶阴性葡萄球菌生长而不能排除污染可能者。⑤不作为治疗假膜性肠炎的首选药物。⑥局部冲洗。
3.本类药物具一定肾、耳毒性，用药期间应定期复查尿常规与肾功能，监测血药浓度，注意听力改变，必要时监测听力。
4.有用药指征的肾功能不全者、老年人、新生儿、早产儿或原有肾、耳疾病患者应根据肾功能减退程度调整剂量，同时监测血药浓度，疗程一般不超过14天。
5.糖肽类属妊娠期用药C类，妊娠期患者应避免应用。确有指征应用时，需进行血药浓度监测，据以调整给药方案。哺乳期患者用药期间应暂停哺乳。
……

Introduction

《抗菌药物临床应用指导原则》（简称指导原则）是指导我国抗菌药物临床应用的纲领性技术手册，在2004年首次发布以后，对临床医生规范使用抗菌药物起到了积极引领作用，同时也对延缓细菌耐药、安全合理用药做出了较大贡献。
2004年至今已逾十年，在此期间我国各种感染性疾病的致病原组成与耐药性已发生了显著的变化。G+球菌耐药性呈下降趋势，而对碳青霉烯耐药的肺炎克雷伯菌及鲍曼不动杆菌则成为临床难以处理的致病菌。同时，一些新抗菌药物相继在我国上市或广泛使用，其应用范围、剂量和疗程等也成为临床普遍的问题。更为重要的是，在此期间，卫生和计划生育委员会出台了一系列有关规范使用抗菌药物的法规、管理办法和技术规范，并进行了为期3年的专项整治活动，从行政层面为遏制细菌耐药、规范使用抗菌药物制定了方向；同时，我们也迫切需要从技术层面制定相应的指导原则，为长期、科学地管理及规范临床用药提供支撑。基于以上几方面，在卫生和计划生育委员会的组织下，由全国各领域的专家，历时两年多，完成了对2004年版指导原则的修订工作，并征求各领域近百名专家意见做了多次完善，成稿并将予以颁布。
新指导原则仍包括四部分，“抗菌药物临床应用的基本原则”，主要在“预防用药原则”增加了关于预防用药方案，以增加合理预防用药和相应监测、管理的可操作性。第二部分“抗菌药物临床应用管理”，主要根据卫计委制定的法规和技术规范，增加了“医疗机构建立抗菌药物临床应用管理体系”“注重综合措施，预防医院感染”两部分，强调科学化和常态化的抗菌药物管理。第三部分“各类抗菌药物的适应证和注意事项”增加一些临床常用的或近年来上市的抗菌药；增加抗菌药的耐药率数据，增加PK/PD参数，为临床个体化用药提供指导。第四部分“各类细菌性感染的经验性抗菌治疗原则”，涉及直接指导临床医生选择治疗药物、剂量、疗程。该部分改
动较多，其目的是希望我国临床上对于抗菌药物的使用更加
规范。
本指导原则编写过程中，得到了卫计委管理部门和临床医学、感染学、微生物学、药学等多学科专业人员的大力支持，在此一并表示诚挚的谢意。同时，由于部分章节可能仍存在一些学术争议，希望大家能提出宝贵意见，以便我们进一步改进。

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