SEPSIS

OSTEOARTRITAE

ENDOCARDITA
Strepto pyogen Strepto pneum-S Staf- meti-S Staf meti- R Enteroc faecium GONOCOC MENINGOCOC

Clostridium spp Bacillus antrach

TEGUM + TES MOI + ANTIBIOPROFILAXIA

AMINO PENICILINE

MENINGITA MENINGOCOCICA Inf ORL PNEUMONIE PNEUMOCOCICA PENI - I / S Endocardita - pneumococica - enterococica -profilaxie

PENICILINA G +

Enterococ fecalis Enterococ faecium

Gonococ

Stafilcoc Bacteroides Bordetella pertusis Vibrio cholerae Clostridium spp Bacillus antrach Haemophilus infl non B si tip B Enterobacterii Fusobacterium

Infectii LISTERIA Alte infectii ENTEROCICE Boala LYME std I

PENICILINE NATURALE
ERIZIPEL ERIZIPELOID ROSENBACH SCARLATINA GANGRENA GAZOASA
ANGINA - STREPTOCOCICA - PLAUT - VINCENT

Peptostreptococ

Streptococ pyogen Meningococ Enterococ faecium STAF

Bacillus anthracis Coryne diphterie Listeria Erysipelothrix r.

Pasteurella multoc Majorit BGN

Clostridium B T- P difficile Actinomices israeli Fusobacterium necro. Bacteroides

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 +

Infectii BGN mai ales piocianic in asoc cu AG

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

ITU joase necomplicate

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

ACTINOMYCES BACTEROIDES spp

CFS II

INF ORL comunitare INF bronhopulmonare comunitare

CFS I + BGN anaerobi

INF cutanate parti moi

activit superioara pe BGN aerobi rezistenta la - lactamaze

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

INF CUTANATE PARTI MOI ENDOCARDITE

STREPTO PNEUMO peni-S / Peni-R STAF meti- S

MENIGOCOC GONOCOC MORAX catha

ACTINOMYCES

ITU

GONOREE BOALA LYME FEBRA TIFOIDA ANTIBIOTICO- PROFILAXIE IN CHIRURGIE

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

STENOTROFOMONAS MALTOPHILIA BURKOLDERIA CEPACIA

CFS spectru larg

STREPTO PNEUMO peni-S / Peni-R STAF meti- S

MENIGOCOC GONOCOC MORAX catha

Borrelia burgdorf

Inf abdominale (+ metronidazol )

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

ACTINOMYCES BACTEROIDES spp

STENOTROFOMONAS MALTOPHILIA BURKOLDERIA CEPACIA

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

INF prin muscaturi de animal /om

AMOXI / AMPI + IBL

TICARCILINA / PIPER + IBL

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

CGP ( enterococ /Faecium

STAF-metiR MENINGITE , ABCESE CEREBRALE cerebrale

STAF -MR

CGN Legionella Nocardia ( moraxella )

Klebsiella pneum

BGP aerobi ( listeria)

BACTEROIDES spp

INF RESPIRATORII ENDOCARDITE

INF OSOASE

INF ABDOMINALE BGN Aer si ana(piocianic) Legionella Citrobacter jeikeium

ACINETOBACT

INF URO-GENIT

INF SEVERE LOCALIZATE / GENERALIZATE - germeni multirezistentiSTARI FEBRILE LA NEUTROPENICI

STENOTROFOMONAS MALTOPHILIA BURKOLDERIA CEPACIA MYCOPLASMA CHLAMYDIA RICKETTSIA MYCOBACTERIUM

GRUPUL MLSK Macrolide

IACRI -bronsite cr acutiz -Pn Mycopl Chlamyd Legionella

ANGINE, + a.difterica ACNEE INF STAFILOCOCICE ORL -cutanat

PEPTOSTREPT

STAF MS / MR PNEUMOCOC STREPTOCOC E.faecium

MENINGO moraxella c. GONOCOC

INF DIGESTIVE -Cryptosporid -Campylobacter -Helicobater pylori URETRITE CERVICITE non-gonococ

B. anthracis CORIN.diphter LISTERIA E.rhusiopathiae RHODOCOC CLOSTRID perfr

BORDETELLA HELICOBACT p CAMPYLOBAC LEGIONELLA H. inflUENZAE VIBRIO ENTEROBA-CEE PSEUDOMONSA ACINETOBACT

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

INF cavitatea bucala INF parti moi

PEPTOSTRPTO

STAF MS / MR

INF osteo-articulare

PNEUMOCOC STREPTOCOC ENTEROCOCI

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

H.influenzae ENTEROBAC-CEE PSEUDOMONSA PASTEURELAA LEGIONELLA

PREVOTELLA BACTEROIDES FUSOBACTERIUM

MYCOPLASMA hominis / pneumonie CHLAMYDIA trachomatis UREAPLASMA U.

Clindamicina :
TOXOPLASMA gondii BABESIA microti PLASMODIUM spp PNEUMOCYSTIS carnii

AMINOGLICOZIDE

10

gen I - KANA - STREPTO -

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

CHINOLONE RESPIRATORII = CHINOLONE URINARE CHINOLONE SISTEMICE +

ANAEROBI

ANAEROBI NU Cl difficile
STREPTO : - PYOGENES - VIRIDANS - PNEUMCOC + /- MRSA

CGP

CGN

E.COLI PROTEUS v si m ENTEROBACTER

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

STAF MS STREPTO pyoge STAF MRS PNEUMOCOC ENTEROCOC NEISSERIA MORAXELLA C.

NOCARDIA LISTERIA

ENTEROBACTERI CAMPYLOBACT LEGIONELLA VIBRIO spp ACINETOBACT PIOCIANIC

S : MICOBACTERII ATIPICE R : UREAPLASMA urealyticum anaerobi

Absorbtie digestiva : foarte buna

12

CHINOLONE SISTEMICE / RESPIRATORII

1. MENINGITE PURULENTE SECUNDARE + CFS III Q respiratorii 7. Acutizari bronsite cronice Pneumonii : - comunitare /nosocomiale 2.OCULAR Q respiratorii 3.ORL : sinuzite, otite

8. OSTEOARTICULAR + lincosamide /RIFA

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

MEDICAMENT CIPRO PEFLOX OFLOX MOXI LEVO GATI GEMI

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

MENINGOCOC ST STREPTO STAFILO MORAXELLA

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

+ LEPTOSPIRA BORRELIA MYCOPLASMA CHLAMYDIA RICKETTSIA BRUCELLA

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

BACILLUS spp LISTERIA

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.

Boala Crohn : salazopirina Nocardioza Toxoplasmaoza Dermatita herpetiforma

+ MYCOBATERIUM LEPRAE TOXOPLASMA GERMENI INTERMEDIARI

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

MYCOPLASMA spp CHLAMYDIA spp SPIROCHETE

17

RIFAMICINE

RIFAMPICINA
1. MENINGITE TBC / non-TB 2. TBC pulmonar / extra ( + alte anti-TB )

3. INF OSTEOARTIC STAFILOCOCICE 4. ENDOCARDITA STAFILOCOCICA ( + VANCO ) 5. SEPSIS

CGP

CGN

BGP
( + clostridii diffcile)

BACTEROIDES HAEMOPHIL infl LEGIONELLA spp Majorit BGN

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

MYCOBACTERIUM - tuberculosis - avium-intracellular (MAC ) alte mycobacterii atipice

INDICATII - inf cu MAC ( + CLARITO / AZITRO ) - inf cu Mycobacter TB la pac care primesc TARV cu INNRT / IP - profilaxie MAC

19

BENZIMIDAZOLI -metronidazolulANAEROBI Bacterii strict AEROBE

PEPTOSTREPTO

VEILONELLA BACTEROIDES PREVOTELLA FUSOBACTERIUM MOBIULUNCUS

CLOSTRIDIUM CAMPYLBACTER H. PYLORI EUBACTERIUM BIFIDOBACTERIUM ACTINOMYCES PROPIONIBACTERIUM

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

1. PNEUMONII severe nosocomiale cu STAF MR m pneumococi rezistenti

2. INFECTII severe PARTI MOI

PEPTOSTRPTOCOC

Concentrare superioara in plaman fata de vanco !!!

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

BACTEROIDES fragilis FUSOBACTERIUM 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

ENTEROBAC-cee Exceptie : SERRATIA PROTEUS PROVIDENCIA PIOCIANIC HEAMOPH. Infl PASTEURELLA m

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

ENTEROBAC-cee -SALMONELLA -SHIGELLA -E. coli EP

Inf digestive non-invazive: - bacteriene - parazitare + AMOEBE TRICHOMONAS

NITROFURANI - cu utilizare urinara -

STAFILOCOCI ENTEROCOCI

PROTEUS indol SALMONELLA E. COLI

Inf URINARE: - Joase - Necomplicate - Femeia grav

23

ACIDUL FUSIDIC

1. -

INF STAFILOCOCICE localizate generalizate

PEPTOSTRPTOCOC

STAF - MS/ MR STREPTOCOC pyogenes

CGN

2. COLITA PSEUDOMEMBR
CORYNEBACT LISTERIA NOCARDIA CLOSTRIDIUM CLOSTRIDIUM ACTYNOMICES

3. PROFILAXIA INF : - osoase - parti moi 4. INF CU ANAEROBI GRAM +

24

FOSFOMICINA

1.

2. INF OSTEOARTICUL cu BGN rezistenti + CFS III/ carbapeneme/ CIPRO

INF MENINGIENE cu: - BGN rezistenti + CFS III/ carbapeneme/ CIPRO - STAF + CFS III

ANAEROBI

STAF - MS / MR PNEUMOCOC ENTEROCOC faecalis / faecium

NEISSERIA spp

3. ITU joase, necomplicatemonodoza

STREPTOCOC Gr A, B, D

ENTEROBAC- cee SERRATIA PSEUDOMONAS PROVIDENCIA

4. INF SISTEMICE cu STAF MS + Pen M

PROTEUS m. ACINETOBACTE

LINCOSAMIDE

25

Absorbtie digestiva : T: Leg proteine plasm : Difuziune tisulara Eliminare Efecte adverse

26