Tuesday, May 26, 2015

Cephalosporin အသံုးမ်ားပိုးသတ္ေဆး

1st gen:  cephalosporin 
 Spectrum(staph,strep(not enterococcus),E.coli,proteus,Kleb:)
-Parental route(cefazolin,cephalothin)
-Oral route(cephalaxin,cefadroxil,cephradine)

2nd gen: cephalosporin 
Spectrum(1st gen: spectrum+H.influ(including beta-lactamase)
-Parental route(cefuroxime ,cefamanole)
-Oral route(cefaclor,cefuroxime,cefprozil)


2nd gen: cephalosporin 
Spectrum(above mention+bacteroides)
-Parental route(cefoxitin)
3rd gen: cephalosporin 
Spectrum(2nd gen: spectrum+most G(-) bacilli except pseudo)
-Parentral route(cefotaxime,ceftriazone)
-Oral route(cefpodoxime,Cefixime,ceftibuten)
3rd&4th gen: cephalosporin 
Spectrum(above+pseudo)
-Parentral route(ceftazidime,cefepime,cefpirome)
-all are active most strep. Except enterococcus 
-but they have no activity for listeria or methicillin resistance staph.
-3rd gen: have lower activity for staph than 1st&2nd
-It should be avoided if definite h/o of pen. Allergy
1st gen:
>alternative for staph. and strep.
>skin &soft tissue as well as strep. Pharyngitis
>not indicated empirical treatment of otitis media or sinusitis
>limited used in UTI(due to active in some E.coli,Kleb&proteus)
2nd gen:
>G(-) bacteria(H.influ,N.meningitis,M.catarrhalis)
>useful in URTI& LRTI ,sinusitis,otitis media)
>suitable for UTI
>cefoxitin is prophylaxis against GI surgery
3rd gen:
>most enteric G(-),salmonella ,shigella
>excellent against strep. Pneumonia
>active against N.gonorrhoea
>should only be used 1st choice drug failed
Oral 3rd gen:
>against N.gonorrhoea but not staph
>no activity in enterococcus ,pseudo,campylobacter
(ဘယ္ oral ceph မွ pen resistance pneumococcusမွာ Amoxilထက္ မေကာင္း)
>no advantage in sinusitis,otitis media,tonsillitis than amoxicillin
4th gen:
>cefipime (more for pseudomonas )
>cefpirome(more for pneumococcus)
Cabapenem
>imipenem/cilastatin
(imipenem is one of broadest A/B available)
-combine with cilastatin in renal tubular dehydropeptidase
-it lack against methicillin resistance staph,clostridium
-treatment of life threatening infection by highly resistance
>meropenem
-not required combination
-little effect of G(+) than imipenem
-alternative of ceftriazone or cefotaxime
ေဒါက္တာ ေအးမင္းထူး
၉.၄.၁၃

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