l**********1
发帖数: 5204 | 1 Mulet X et al.
Antagonistic interactions of Pseudomonas aeruginosa antibiotic resistance
mechanisms in planktonic but not biofilm growth.
Antimicrob Agents Chemother. 55: 4560-8.
Abstract
Pseudomonas aeruginosa has an extraordinary capacity to evade the activity
of antibiotics through a complex interplay of intrinsic and mutation-driven
resistance pathways, which are, unfortunately, often additive or synergistic
, leading to multidrug (or even pandrug) resistance. However, we show that
one of th... 阅读全帖 |
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L*****r
发帖数: 722 | 2
Aztreonam 的一个主要特色，是anti-pseudomonas 作用比levaquin强，且耐药性低。
当前抗生素应用的一个最常见的难点，是anti-pseudomonas，因为越来越多的multi-
drug resistance出现. Anti-pseudomonas antibiotics 如下:
1.Antipseudomonal penicillins (ticarcillin, piperacillin) , usually
plus beta-lactamase inhibitor (ticarcillin-clavulanate, piperacillin-tazobactam)
2.Third generation cephalosporins (ceftazidime, cefoperazone [not available in the United States])
3.Fourth generation cephalosporins (cefepime)
4.Monobactam (aztreonam)
... 阅读全帖 |
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x****6
发帖数: 4339 | 3 很好奇，这个MCR-1抗性基因是一个lactamase,按道理只对青霉素等lactam类的抗生素
有效；如果换另一类性的如氯霉素,庆打霉素等分子结构和/或抗生机制完全不同于
lactam类的，难道不能解决问题吗？ |
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a*****8
发帖数: 2115 | 5 for your second questions:
Lets put aside the fast kill or slow kill issue.
1. we are treating potential sepsis right, but where is the source, is it
skin-soft tissue or osteo, or bacteremia or pneumonia, cause the organisms
you want to cover may be different.
2. I am assuming pt has been in the hospital or LTCF for a long time, in
that case we do want to cover broadly
3. If we are treating skin and soft tissue infection due to his ulcer, it
usually gram positive directed, but if he is at a hig... 阅读全帖 |
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b******n
发帖数: 4225 | 6 这篇发表在the lancet infectious disease杂志上的文章我看了，说说我的看法。
目前还只是一种关联分析，携带这个基因(NDM-1)的细菌（Gram-negative
Enterobacteriaceae，包括大肠杆菌，Klebsiella pneumoniae）跟多种抗性有很大关
联。但是这个基因本身只编码对于beta-lactam（一种抗生素）抗性有关的蛋白。对于
另外的抗生素该基因应该不起作用。也就是说多种抗性中的一种抗性来源于该基因，至
于其他抗性应该来源于细菌本身其他抗性基因。这种关联分析就像我们说韩国人多半眯
缝眼，但是不是眯缝眼造就了韩国人一样。
比较吓人的是这种基因可以在一种可转移性的DNA中存在，于是从一种细菌转到另外一
种细菌。这篇文章证实了这种转移的可能性，但是遗憾的是没有报道转移后是不是让另
外的细菌有了多种抗生素抗性。
稍微能安心的是毕竟还是有两种抗生素对这种多抗细菌有效，tigecycline和colistin
。所以临床上最重要的是诊断，然后对症下药。至于今后这两种救命抗生素能否继续有
效就只能祈求上苍帮忙了。
现今的多抗细菌（sup |
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c**********d
发帖数: 389 | 7 I work in a company focus on anti-microbial drugs. Large pharma companies
are indeed shifting away from this area because of less profitability.
However, there are still smaller players like us.
This NDM-1 is a gene that could help a lot of gram-negative bacteria to
build resistance over beta-lactam drugs (such as penicillin), but it is not
as bad as it described. There are other families of antibiotics avilable. |
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r********3
发帖数: 306 | 8 http://www.newsrx.com/newsletters/Pain-and-Central-Nervous-Syst
Amphetamines
Research Data from Mayo Clinic Update Understanding of Amphetamines
Published in Pain and Central Nervous System Week, July 2nd, 2012
2012 JUL 2 (NewsRx) -- By a News Reporter-Staff News Editor at Pain &
Central Nervous System Week -- Data detailed on Amphetamines have been
presented. According to news reporting originating in Rochester, Minnesota,
by NewsRx journalists, researchers stated "Glutamate signaling plays an
... 阅读全帖 |
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l******k
发帖数: 27533 | 9 来了来了：）
acute pharyngitis如果有咳嗽，conjunctivitis(眼角红，发炎）一般就是病毒的，不
要用抗生素，没用的，除了破坏自身normal flora。如果喉咙痛就吃点acetaminiphen
好了，还有上个楼里大家给你的tips。
如果有发烧，头疼，那就可能是strep A infection.要用抗生素。beta-lactam就是
drug of choice。penicillin, amoxicillin, bactrium, first generation
cephalosporins...
inflammation是人体自身对外来侵入的反应的表现，发红，发肿，疼痛。。。
infection是microorganism（virus, bacteria, parasite, fungi)对人体的感染.
你懂的，给大包子吧，嘻嘻
对了，我前段时间才练习给病人写strep A acute pharyngitis 的病例。你要是经常被
这个病折磨，我把最新的临床guideline发给你，你自己看看，非常全面，从怎么诊断
，到治疗和预防都有指导，久病就成... 阅读全帖 |
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l******k
发帖数: 27533 | 10 第一，病人可能得的是hospital acquired pneumonia（HAP）
Acinetobactor species是常引起late onset HAP的细菌。
问问医院有没有查pseudomonas和MRSA，这也是常引起HAP的病菌，在治疗方案中也常常
对用上抗pseudomonas的抗生素。pseudomonas或者MRSA感染后果可能会比较严重，而且
只有某些抗生素才能抑制这些细菌。一定要问医院有没有查这两个细菌感染的可能性。
非常震撼！医院居然把病人直接送回家让自己康复？ HAP的死亡率是20-50%，如果
empiric antibiotics 没选对，死亡率对增加2-3倍！只听你说病史，还有细菌的确认
结果，多半就是HAP。病人有其他的症状吗？发热？白细胞数量变化？氧饱和率？是确
诊了还是怀疑HAP感染？
第二，用药问题。你问这个药不是推荐治疗HAP的用药。美国传染病学最权威的
guideline在
IDSA上。
对HAP治疗的guideline地址如下：
http://www.idsociety.org/uploadedFiles/IDSA/Guidelin... 阅读全帖 |
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j**e
发帖数: 582 | 11 哪边可以找到关于“lactam IV-
administered cephalosporine-derived antibiotics that is in clinical trial
for ALS”的更多数据？ |
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n*********m
发帖数: 38 | 12 Look his publication
Conversion of D-ribulose 5-phosphate to D-xylulose 5-phosphate: new insights
from structural and biochemical studies on human RPE.
Liang W, Ouyang S, Shaw N, Joachimiak A, Zhang R, Liu ZJ.
FASEB J. 2011 Feb;25(2):497-504. Epub 2010 Oct 5.
PMID:
20923965
[PubMed - indexed for MEDLINE]
Related citations
2.
Structural basis for the inhibition of human 5,10-methenyltetrahydrofolate
synthetase by N10-substituted folate analogues.
Wu D, Li Y, Song G, Cheng C, Zhang R, Joac... 阅读全帖 |
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S*****P
发帖数: 323 | 13 http://news.sciencemag.org/scienceinsider/2011/06/sequence-yiel
DNA Sequence Yields Clues to Germany's 'Super Toxic' E. coli outbreak
by Martin Enserink on 2 June 2011, 5:50 PM |
Just from the high number of deaths and severe cases, scientists and public
health experts battling Germany's massive E. coli outbreak knew they were up
against something unusual. Now, early results from sequencing projects of
the enterohemorrhagic Escherichia coli (EHEC) strain appear to confirm that
a never-before-see... 阅读全帖 |
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l**********1
发帖数: 5204 | 14 //www.ncbi.nlm.nih.gov/pubmed/21050804
浮黴菌門
Isosphaera屬
//hamap.expasy.org/proteomes/ISOPI.html
Species: Isosphaera pallida (strain ATCC 43644 / DSM 9630 / IS1B)
Species code: ISOPI
Taxonomy: Bacteria; Planctomycetes; Planctomycetia; Planctomycetales; Planctomycetaceae; Isosphaera
(TaxID: 575540) [NEWT/ NCBI]
Description: Isosphaera pallida strain IS1B was isolated from a hot spring in Kah-nee-tah, Oregon, USA.
It is the only budding bacterium known to glide and the only heterotrophic bacteriu... 阅读全帖 |
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z*******g
发帖数: 54 | 15 holton是靠最后一步的β-lactam技术应用于taxol半合成发的大财，KCN最后一步copy
holton的，因此挣不到钱
关键是全合成一般没有实用价值，不像工业界的分子，只有最好的技术才能生存 |
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B*****n
发帖数: 654 | 16 Thank you
Detection of Open-Chain Intermediates in the Formation of -Lactams from
Ketenes and Azomethines
Angewandte Chemie International Edition in English
Volume 7, Issue 10, Date: October 1968, Pages: 826-827
w*****[email protected] |
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B*****n
发帖数: 654 | 17 Asymmetric synthesis of β-lactams
authors: Czesław Bełżecki and Ewa Rogalska
J. Chem. Soc., Chem. Commun., 1981, 57-58
DOI: 10.1039/C39810000057 , Paper |
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g*****j
发帖数: 1211 | 21 MRSA - methicillin resistant staphylococcus aureus
It is resistant to most beta-lactam class of antibiotics. There are still
several antibiotics we can use to kill it. |
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w**********9
发帖数: 242 | 22 This is indeed a big problem in China.
Staphylococcus aureus (MRSA) resistant to lactam penicillin and
cephalosporinsis is a long standing issue. It has a long history. However,
it is not that serious, because we have many other types of antibiotics that
can effectively treat infections caused by MRSA.
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C****o
发帖数: 994 | 23 it's used for b-lactam-resistant staph infection. |
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y******7
发帖数: 17 | 24 The following is what I collected when I was a student doing capstone in a
local hospital. Not sure if it is useful.
Lidocaine topical is a amide-type local anesthetic. for production of
topical anesthesia, relief of pain associated with postherpetic neuralgia,
reduction of gagging during dental procedures, prevention and control of
urethral pain, anesthetic lubricant for endotracheal intubation, and relief
of hemorrhoidal pain.
Polyethylene glycol(Miralax) is a nonabsorbed solution used to trea... 阅读全帖 |
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a*****8
发帖数: 2115 | 25 I thought it is 25-50 mg/kd/day in divided doses every 12 hours.
if it is otitis media 80-90 mg/kd/day divided every 12 hours
400 mg bid seems ok to me for kid weight 36 lb. I thought beta-lactam
killing are time above MIC, so I would rather dose more frequently than big
dose once daily though. |
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l******k
发帖数: 27533 | 26 I agree that for the time dependent ABX like beta lactams, it's better to
have frequent doses to maintain adequate concentration for most time.
However, there are several amoxicillin regimens used for strep throat as my
ID professor introduced in the class. I think either one is ok since there'
s evidence for it.
It's also possible that there's new guideline or clinical study to prefer
the QD amoxicillin regimen over others, which is very interesting:)
big |
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l******k
发帖数: 27533 | 27 大家围绕这个case多讨论讨论挺好的，相互share ideas, 也算是课外不错的learning
process吧：）
理论来说，BID还是比QD能cover更多的时间above MIC的
one time large dose对beta lactams确实不常见
不过你说的easy dosing for kids是个很好的理由：） |
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a*****8
发帖数: 2115 | 28 totally agree.
Will need to look at entire clinic picture:
how is blood pressure, any sepsis suspicion?
How is WBC, any change in chest X Ray?
Was patient intubated? can there be aspiration?
Any culture data?
Intra-crainal bleeding are likely to cause central fever. Lots of neuro surg
patient will develop this with no obvious cause of infection.
Beta-lactam have been shown to cause drug fever especially zosyn, it can
happen 3-7 days into treatment. |
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a*****8
发帖数: 2115 | 29 Things cover pseudomonas:
beta-lactam: zosyn, cefepime and ceftazidime (for ceph), carbapenem (except
ertapenem), monobactam (azetreonam)
FQN: except for moxi
aminoglycoside
colistin
--Cephalosporin does not cover entercoccus
--Cipro does not cover strep (that's why not a respiratory FQN)
--MRSA: vancomycin, dapto, linezolid, bactrim, clindamycin, doxycycline
--FQN very broad spectrum cover most gram +, gram - and anaerobes (except B.
Frag)
先看是gram+ 还是 gram -，再想药。
比如说： UTI，主要是gram -，所以3rd gener... 阅读全帖 |
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l******k
发帖数: 27533 | 30 师姐有空来教教呀～
1. UTI: 如果culture sensitive to cefazolin, 决定给keflex，是 500 mg BID 还是
TID OR QID for 7 days or 5 days？今天一个PA说她学的是QID. 但uptodate 和
micromedex都是BID,快速看了idsa uti guideline，没提到keflex dosing，只有
提到证据不充分，也不知道是resistance problem 还是 lack of efficacy...
2. 今天进来那个巨臭的人，在床上躺了半年没人管，背上ulcer流得稀里哗啦，一想到
就噁心。。。anyway，admitted for hyperkalemia, renal failure, sepsis,
hyponatremia. 然后呢，allergic to penicillin, cipro. 病人无法说话，不知道具
体是啥allergic reactions. 在ED就得上ABX了，preceptor就问我啦，该用啥呢，我觉
得vanco加aztreonam不错呀，但prec... 阅读全帖 |
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a*****8
发帖数: 2115 | 31 第一个问题：What is the mic to cefazolin? Like fiorio said, beta-lactam PD
is time above MIC which means the longer time above MIC the better efficacy.
That being said, in general, if the target attainment is approximately 50%,
it will have a good efficacy. Based on the PK data, in average person, Cmax
after 250 or 500 mg dose is 9 and 15 respectively, and it will decline to 1
.6 and 3.4 mg/L after 3 hour of the dosing. Since I am not sure what bug it
is, and whether it is cystitis or uncomplicated UT... 阅读全帖 |
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a*****8
发帖数: 2115 | 32 Also if you think about it, who would do a clinic trial on beta lactam cross
reactivity. you won't find good solid trial for that. mostly are from case
series or report, maybe retrospective study and from chemistry journal. |
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L****e
发帖数: 499 | 33 我也试过这种 flashcard，不过对我好像用处不大，看过如果不能跟其它联系起来记忆
的话，没半秒就忘记了。
这些天在记常用抗生素
sulfonamide
fluoroquinolone
b-lactam: penicillin; cephalosporin
bind to bacterial 30S rRNA: aminoglycoside
tetracycline
bind to bacterial 50S rRNA: lincosamide
chloramphenicol
macrolide
这后面三种有时候怎么都回想不起来，后来我就这样记：林妙可穿绿衣服胸很大 （
林妙可 lincosamide; 绿衣服，绿霉素 chloramphenicol , macro 代表胸大。 一
想到穿绿衣服胸很大的林妙可，我立刻就想起了这三种抗生素。 |
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u*******s
发帖数: 688 | 34 来总结一下常见的(不完全的）需要renal dosing的药物吧~
allopurinol, colchicine
aminoglycosides, beta-lactams, fluoroquinolone, bactrim, vanco, macrolide,
azoles, some antivirals
digoxin, dabigatran, lovenox
tramadol, gabapentin, pregabalin, morphine
venlafaxine
metoclopramide
以下是肾功能较严重不足就要注意避免的一些药物：
metformin
duloxetine
nitrofurantoin
NSAIDs
K-sparing diuretics
lithium
xarelto
bisphosphonate
CKD的病人如果有高血压或者糖尿病，应该使用ACEI/ARB，不过医生好像常常忽略~ 药
剂师在做chart review的时候不要忘记检查哦。同时还要记得monitor serum
creatinine and K+. |
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a*****8
发帖数: 2115 | 35 Amoxicillin is the drug of choice here as first line therapy. However, for
recurrent strep throat, it may be beta-lactam resistant and also strep tend
to cause toxin, so using clindamycin would be beneficial. 20 mg/kg/day
divided to 3-4 doses per day. Most side effects are associated with GI. |
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