呼吸内科常用抗生素分类——甜甜糯糯米（Classification of antibiotics commonly used in respiratory department -- sweet waxy glutinous rice）

呼吸内科常用抗生素分类——甜甜糯糯米（Classification of antibiotics commonly used in respiratory department -- sweet waxy glutinous rice） 呼吸内科常用抗生素分类——甜甜糯糯米(Classification of antibiotics commonly used in respiratory department -- sweet waxy glutinous rice) The clinical commonly used antibiotics including beta lactams, aminoglycosides, macrolides, Lincosamides, peptides, quinolones, sulfonamides, anti tuberculosis drugs, antifungal drugs and other antibiotics. 1.1 beta lactams such fungicides belongs to the breeding period. Its characteristics are: high blood concentration, wide antibacterial spectrum and low toxicity. Including the preparation of penicillins, cephalosporins, new beta lactam and beta lactams and beta lactamase inhibitors. (1) penicillins including not acid penicillin (penicillin G, penicillin G, penicillin V potassium tablets), acid (penicillin, oxacillin, cloxacillin, dicloxacillin and flucloxacillin), broad-spectrum anti not Pseudomonas (ampicillin, amoxicillin), broad-spectrum anti Pseudomonas (carbenicillin furan, ampicillin and ticarcillin, piperacillin, Alosi Lin, mezlocillin) and anti - bacteria (G Mei Xilin, for Mo Xilin). The <1> of penicillin G is mainly used for the treatment of hemolytic streptococcus and pneumococcus, anaerobic bacteria, Staphylococcus aureus and Bacillus flu most of its resistance. Penicillin G procaine penicillin half-life is long. Penicillin V potassium tablets orally, acid resistance, easy to use. The acid production of penicillin resistant G <2> dicloxacillin Staphylococcus aureus had the best antibacterial activity. For other G + S.aureus G difference of penicillin, methicillin resistant Staphylococcus aureus (MRSA) is invalid. <3> amoxicillin and ampicillin with similar antimicrobial spectrum, pneumococcus, Streptococcus, Enterococcus and influenza bacilli were sensitive to the drug, the antibacterial effect is better than that of ampicillin, but not pseudomonas. <4> broad-spectrum anti Pseudomonas G + aureus antibacterial effect and penicillin was similar to that of G on G (such as Escherichia coli, Bacillus Proteus, influenza Bacillus) has a strong antibacterial effect and Pseudomonas, especially piperacillin, mezlocillin and azlocillin stronger antibacterial activity. <5> anti G - bacteria for anti G - invalid for G + bacillus, Pseudomonas and Staphylococcus aureus. (2) the genus cephalosporins broad-spectrum antibiotics, four generation. The first, second generation of Pseudomonas aeruginosa is invalid, the third generation and the four generation of some species of Pseudomonas aeruginosa, the drug is invalid for Mycoplasma and legionella. <1> first generation cephalosporin including cephalothin, cephalexin, cefazolin, cefradine. The acid production of Staphylococcus aureus, Streptococcus pneumoniae, hemolytic streptococcus aureus G + antibacterial activity compared to the second, third generation of strong G - bacilli is far inferior to the second, third generation, only a minority of enteric bacilli. The beta lactamase stability, has a certain effect on kidney. Of Pseudomonas aeruginosa, Proteus and Acinetobacter is invalid. Including cefazolin, Cefradine commonly used. <2> second generation cephalosporins including cefuroxime, cefaclor, cefamandole, cefotiam, Cefmetazole, cefoxitin etc.. For G + cocci including acid producing Staphylococcus aureus antibacterial activity with the first generation of similar or slightly weaker, than the first generation of G - was strong, but not as good as the third generation, has a strong antibacterial activity against influenza bacillus, especially cefuroxime and cefamandole, Pseudomonas aeruginosa, Serratia, Enterobacter cloacae coli, Acinetobacter is invalid. In addition to cefamandole, the beta lactamase stable. <3> third generation cephalosporins including ceftazidime, cefotaxime three triazine, cefotaxime, cefoperazone, cefodizime, cefmenoxime, cefixime etc.. Have a certain activity on acid production of Staphylococcus aureus, but compared with the first, second generation of G is weak, including Bacillus Serratia, Pseudomonas aeruginosa has strong antibacterial activity, including ceftazidime and wide antibiotic spectrum, anti Pseudomonas aeruginosa was the strongest, followed by cefoperazone. Cefodizime invalid of Pseudomonas aeruginosa, Acinetobacter, enterococcus. In addition to cefoperazone, beta lactamase, renal toxicity of rare. <4> fourth generation cephalosporins include cefpirome, cefepime, cefuzonam etc.. The antibacterial effect of the antibacterial activity, compared with the third generation of strong, For G + cocci including acid producing Staphylococcus aureus have considerable activity. The G - bacteria including Pseudomonas aeruginosa and third similar. The resistance strains activity for more than third generations. Of cefpirome including Pseudomonas aeruginosa, Serratia, Enterobacter cloacae, Bacillus G - function is better than that of ceftazidime. Effect of cefepime on G + cocci increased significantly, in addition to Flavobacterium and anaerobic bacteria, were sensitive to this product. The beta lactamase is more stable. (4) the new beta lactams including carbapenems (imipenem, meropenem, panipenem) and monobactams (aztreonam, carumonam). Imipenem cilastatin (imipenem he) broad antibacterial spectrum of G coli, G + cocci and anaerobic bacteria, including other antibiotic resistant Pseudomonas aeruginosa, Staphylococcus aureus, Streptococcus faecalis, Bacteroides fragilis has strong antibacterial activity, the most resistant activity for more than third generations cephalosporin. All kinds of beta lactamase highly stable. Aztreonam for most G - Bacillus including antibacterial were Enterobacteriaceae and Pseudomonas aeruginosa, but not G + cocci and anaerobic bacteria, the beta lactamase stable. Beta lactamase inhibitors and beta lactam compound composed of beta lactamase inhibitors and bacteria produce beta lactamase for Dutch act combined, so as to protect the beta lactam by beta lactamase hydrolysis, continue to exert antimicrobial effects. The common clinical beta lactamase inhibitor clavulanic acid, Shubatan and his sulbactam, and beta lactam compound preparation of resistant strains can enhance the sterilization effect, and can make the enlarged antimicrobial spectrum, commonly used varieties of Augmentin (amoxicillin plus clavulanic acid) and Timentin (ticarcillin plus clavulanic acid), Unasyn (ampicillin and sulbactam), sulperazone (cefoperazone and sulbactam) and piperacillin tazobactam (piperacillin sulbactam plus he). This is the 1.2 aminoglycoside inactive fungicides. The commonly used Amikacin, tobramycin, gentamicin, netilmicin, sisomicin and streptomycin. The main anti - G bacteria, including Pseudomonas aeruginosa, enterobacter, Serratia, Acinetobacter etc.. Amikacin had the strongest effect. Anti G + cocci have certain activity, but not as good as the first, second generation cephalosporins. The antibacterial activity on Staphylococcus aureus with netilmicin was the strongest, the best of Mycobacterium tuberculosis with streptomycin. Invalid on anaerobic bacteria. These drugs are toxic to the auditory nerve and kidney, use limited. The 1.3 is a narrow spectrum of macrolide available antibacterial agents, antibacterial spectrum and penicillin was similar to that of G, mainly for the aerobic G + coccus, G - bacteria and anaerobic bacteria. Legionella bacteria, mycoplasma and chlamydia and flu bacilli were sensitive to these drugs. Invalid of Pseudomonas aeruginosa, most enterobacteriaceae. New macrolides including roxithromycin, clarithromycin and azithromycin, compared with erythromycin, antibacterial spectrum did not significantly expanded, but improved pharmacokinetics and reduce the side effects is its obvious progress. Effect of azithromycin on G + cocci than erythromycin, G - bacilli is stronger than erythromycin, especially for community-acquired pneumonia (CAP) of the common pathogenic bacteria, influenza bacillus, mycoplasma, chlamydia and Legionella has good antibacterial activity, can be used as the first choice in the treatment of CAP. 1.4 genera of tetracycline antibiotics. Because of the common pathogenic bacteria have resistance, now only for Mycoplasma and chlamydia, Rickettsia and Legionella infection, doxycycline and minocycline and tetracycline antibiotic spectrum, but the antibacterial effect is 5 times stronger than tetracycline, the latter effect is stronger, effective for most MRSA. 1.5 lincomycins including lincomycin, clindamycin, antibacterial spectrum is narrow, the antibacterial effect of erythromycin, clindamycin antimicrobial activity than clindamycin 4 ~ 8 times, mainly for Staphylococcus aureus and anaerobic bacteria infection. 1.6 polypeptides including polymyxin B and polymyxin E, vancomycin, norvancomycin and vancomycin wall. Polymyxin B and E, renal toxicity and poor curative effect, Only for serious resistance to G infection. Vancomycin and norvancomycin belong to breed fungicides, have high antimicrobial activity against multi resistant Staphylococcus aureus and hemolytic streptococcus, pneumococcus and Streptococcus aureus resistant to most G +, G -. The wall is similar to fosfomycin antibacterial spectrum antibacterial effect with vancomycin against Staphylococcus epidermidis, but little difference, the stronger than vancomycin Enterococcus and Clostridium difficile. 1.7 quinolones including norfloxacin, ciprofloxacin, ofloxacin, levofloxacin, ofloxacin, fleroxacin, lomefloxacin, Yi Luo, Gray, levofloxacin, sparfloxacin and clinafloxacin rufloxacin balofloxacin, trovafloxacin etc.. The antibacterial spectrum is similar to the third generation cephalosporins and wide antibacterial activity compared to G - G + coccus strong bacillus, compared with ciprofloxacin, ofloxacin, new quinolones in maintaining the original G - Bacillus good antibacterial activity at the same time, the G + enhanced antibacterial activity to Staphylococcus aureus, clinafloxacin, trovafloxacin is strongest for G +; anaerobic bacteria antibacterial activity also increased, including trovafloxacin than metronidazole more than 10 times, is currently considered to quinolones G + anaerobic bacteria had the best antibacterial activity; antibacterial activity of other common pathogens in Department of respiration have different degrees of increase, such as sparfloxacin on Mycobacterium tuberculosis with strong antibacterial activity of ciprofloxacin 4 ~ 8 times on the other, are of considerable activity of Mycobacterium, Legionella, mycoplasma and chlamydia and MRSA. Clinically in nosocomial infection, especially resistant to other antibiotics G coli and MRSA infection. In recent years, the rate of bacterial resistance is increasing, especially in Escherichia coli, MRSA and Pseudomonas aeruginosa was the most significant. This kind of medicine can make the bacteria produce cross resistance among cultivars, and to other antibiotics, such as beta lactam drug resistance. The choice should pay attention to the choice of indications. A new classification method of quinolones is the original first, second generation as the first generation, representative drug, nalidixic acid, Pipemidic Acid, antibacterial spectrum for G coli, for urinary tract and intestinal infection; comparison of fluoroquinolones. The early development of the second generation representative drug ofloxacin, ciprofloxacin, antibacterial spectrum. As for the system of G - bacilli infection; third generation anti G + cocci increased activity based on the second generation, representative drug sparfloxacin, pazufloxacin, antibacterial spectrum including G coli and G + cocci infection, for the system; the fourth generation is the increase in anti anaerobic activity based on the third generation, representative drug trovafloxacin and moxifloxacin, antibacterial spectrum including G coli, G + cocci and anaerobic bacteria infection for the system. The third, fourth and second generation, mainly to increase the antibacterial activity of G+ bacteria, anaerobic bacteria, mycoplasma, Mycobacterium tuberculosis, Legionella bacteria, can be used as a first-line treatment for CAP. 1.8 sulfonamides are commonly used cotrimoxazole, for mild to moderate bacterial infection and Chlamydia infection, is the drug of choice for Pneumocystis carinii disease. 1.9 anti tuberculosis drugs Commonly used with isoniazid, rifampicin and pyrazinamide, streptomycin and ethambutol. Isoniazid is anti tuberculosis drug of choice, is a cell inside and outside the TB total fungicide, good for breeding bacteria effect on quiescent bacteria effect. Rifampicin has a strong antibacterial activity against Mycobacterium tuberculosis, role in cell proliferation and resting inside and outside of the cell is full of fungicide. Is a potent intracellular bactericidal agent of pyrazinamide and ethambutol in acidic environment, had inhibitory effect on the breeding of bacteria. Isoniazid, rifampicin and pyrazinamide is the main drug initial short term chemotherapy, ethambutol (or streptomycin) which can participate in the short term chemotherapy. The combined application of these drugs, can increase the curative effect, delaying drug resistance. 1.10 antifungal drugs including amphotericin B, fluconazole, itraconazole and flucytosine 5- etc.. Amphotericin B is the strongest broad-spectrum antifungal drugs, despite its side effects, but the drug of choice for deep fungal infection is one of the, Have strong antibacterial activity against Cryptococcus neoformans, Histoplasma capsulatum and Coccidioides, Candida and Aspergillus. Fluconazole is a broad-spectrum antifungal agent for most Candida and Cryptococcus spore bacteria such as bending and efficient, but not for aspergillus. Itraconazole oral absorption, wide antibacterial spectrum, also has obvious activity against Aspergillus, toxicity. 5- fluorocytosine narrow antimicrobial spectrum, strong antibacterial activity against Cryptococcus neoformans, Candida albicans, also have certain effect on some Aspergillus, combined with fluconazole or amphotericin B, can improve the curative effect, prevent the generation of drug resistance. 1.11 other antimicrobial agents such as fosfomycin, wide antibacterial spectrum, but the antibacterial effect is not strong, low toxicity. Metronidazole, tinidazole, has a strong bactericidal effect of obligate anaerobic bacteria, curative effect is obviously superior to lincomycin on aerobic or facultative anaerobic bacteria is invalid, with other antibiotics combined application in treatment of mixed infection.