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1、Latest antibiotic treatment on respiratory tract infections and respiratory tract infection pathogens,Antibiotic therapy in community acquired infections: strategies for optimal outcomes and minimized resistance emergence,Antibiotic use only in bacterial infections (!) Adequate the antimicrobial tre
2、atment strategy to - the etiology - local susceptibility profiles Attempt maximal reduction in bacterial load, with the ultimate aim of bacterial eradication Avoidance of selection processes Antibiotic used based in PK/PD (pharmacokinetic/ pharmacodynamic) knowledge,Ball et al. J Antimicrob Chemothe
3、r 2002; 49:31-40,These recommendations are not out of date,November, 18th,Antibiotic therapy in community acquired infections: strategies for optimal outcomes and minimized resistance emergence,Antibiotic use only in bacterial infections (!) Adequate the antimicrobial treatment strategy to - the eti
4、ology - local susceptibility profiles Attempt maximal reduction in bacterial load, with the ultimate aim of bacterial eradication Avoidance of selection processes Antibiotic used based in PK/PD (pharmacokinetic/ pharmacodynamic) knowledge,Ball et al. J Antimicrob Chemother 2002; 49:31-40,These recom
5、mendations are not out of date,M. pneumoniae C. pneumoniae L. pneumophila,S. pneumoniae H. influenzae M. catarrhalis P. aeruginosa,With resistance problems,Without resistance problems,Respiratory tract infection pathogens,RTI pathogens: Streptococcus pneumoniae,Europe 30:546-50 Reinert et al. Clin M
6、icrobiol Infect 2009; 15 (Suppl 3):7-11,Streptococcus pneumoniae,2000,2008,Invasive isolates Penicillin resistance (I+R),http:/www.rivm.nl/earss/,S. pneumoniae,Decrease of penicillin (I + R) resistance,http:/www.rivm.nl/earss/,2000 2008 I 21.6 15.7 R 11.0 7.1 TOTAL 32.6 22.8,SPAIN,Streptococcus pneu
7、moniae,Local studies (Spain, SAUCE surveillance study, 1996-2007),Prez-Trallero et al. Antimicrob Agents Chemother 2005; 49: 1965-72 Sauce 4. Study. GSK. Data on file,RTI pathogens: Streptococcus pneumoniae,Regional trends of penicillin resistance (PROTEKT Study),China, Hong Kong, Japan, South Korea
8、 and Taiwan,Felmingham, Cantn, Jenkins. J Infec 2007; 55:111-8,RTI pathogens: Streptococcus pneumoniae,Regional trends of erythromycin resistance (PROTEKT Study),Felmingham, Cantn, Jenkins. J Infec 2007; 55:111-8,RTI pathogens: Streptococcus pneumoniae,Antibacterial susceptibility prevalence (PROTEK
9、T study) among penicillin-R (PRSP; n=1696) and erythromycin-R (ERSP; n=2638) S. pneumoniae,Felmingham, Cantn, Jenkins. J Infec 2007; 55:111-8,Felmingham, Cantn, Jenkins. J Infec 2007; 55, 111e118,RTI pathogens: Streptococcus pneumoniae,Macrolide resistance mechanisms among erythromycin-R S. pneumoni
10、ae isolates collected in selected countries during the PROTEKT study,Dispersion of specific clonal complexes,RTI pathogens: Streptococcus pneumoniae,Resistance profiles in Shanghai (China),High penicillin and erythromycin resistance rates (2004-2005) High rate (42%) of isolates with dual erythromyci
11、n-R genes Absence of fluoroquinolone resistance Population structure: - 75% of the isolates belonging to 19F, 14, 23F, 6B and 19A serotypes - dispersion of international resistant clonal complexes: - Taiwan19F-14 - Spain23F-1, - Spain6B-2 - Taiwan23F-15,Yang et Int J Antimicrob Agenst Chemother 2008
12、; 32:386-91,RTI pathogens: Streptococcus pneumoniae,GLOBAL* Surveillance study,*Global Landscape On the Bactericidal Activity of Levofloxacin,CLSI breakpoints (M100-S17),Local studies (Spain, SAUCE surveillance study, 2006-2007),Haemophillus influenzae,RTI pathogens: Haemophillus influenzae,GLOBAL*
13、Surveillance study,*Global Landscape On the Bactericidal Activity of Levofloxacin,CLSI breakpoints (M100-S17): *29.8% -lactamase (+); 0.8 amp-R -lactamase (-),RTI pathogens: Pseudomonas aeruginosa,GLOBAL* Surveillance study,*Global Landscape On the Bactericidal Activity of Levofloxacin,Antibiotic th
14、erapy in community acquired infections: strategies for optimal outcomes and minimized resistance emergence,Antibiotic use only in bacterial infections (!) Adequate the antimicrobial treatment strategy to - the etiology - local susceptibility profiles Attempt maximal reduction in bacterial load, with
15、 the ultimate aim of bacterial eradication Avoidance of selection processes Antibiotic used based in PK/PD (pharmacokinetic/ pharmacodynamic ) knowledge,Ball et al. J Antimicrob Chemother 2002; 49:31-40,These recommendations are not out of date,Bacterial inoculum and RTI,Why is so important the redu
16、ction of the bacterial load or the bacterial erradication for the clinical outcome in RTI?, the acute exacerbation of chronic bronchitis model,Sethi and Murphy. Clin Microbiol Rew 2001; 14:336-63 Miravitlles. Eur Respir J 2002; 20 (Suppl 36):9-19 Mensa (Suppl 3):42-54,Bacterial inoculum and RTI,Mensa (Suppl 3):42-54,Vicious Cycle,Bacterial inoculum and RTI,Meta-analysis: 12 studies, 16 antibiotics R=0.83,Rate of eradication failure,% of clinical failure,Pe
