Escolar Documentos
Profissional Documentos
Cultura Documentos
50
1
1
5
6
6
1
4
www.antimicrob.net
..
. ..
-
XX
,
,
-
(P. Periti , 1997)
160
100 000
140
120
100
80
60
40
20
0
1930 1940 1950 1960 1970 1980 1990 2000
[, 2014]
CDC
( )
Acinetobacter MDR
Clostridium difficile Campylobacter MDR
Enterobacteriaceae Carb-R Enterobacteriaceae ESBLs
Neisseria gonorrhoeae Streptococcus pneu MDR
P.aeruginosa MDR
VRE
MRSA
Candida Fluconazole-R
VRSA Salmonella MDR
Streptococci gr. A Erythro-R Shigella MDR
Streptococci gr. B Clinda-R Tuberculosis drug-R
/ R
() 2005 CRE, Acinetobacter MDR -
() 2007 Enterobacteriaceae, + -
P.aeruginosa
() 2008 MRSA - +/-
() 2010 MRSA - +/-
() 2014 MRSA + -
() 2014 MRSA + -
() 2014 MRSA, VRE + +/-
/ 2015 / P.aeruginosa -
()
/ 2016 / CRE -
()
2017 Clostridium difficile + -
()
XXI
25000
1,5
[ECDC/EMEA, 2009]
23000
- $ 20 [CDC 2013]
[CDC, WHO]
Klebsiella pneumoniae Streptococcus pneumoniae
Acinetobacter baumanii Escherichia coli
MRSA Neisseria gonorrhoeae
Pseudomonas aeruginosa Mycobacterium tuberculosis
, ( 50%
)
(, )
,
(,
),
,
(, )
, ,
, ,
-
: , ,
,
: ( ,
, .), ,
, ,
: ,
,
: Candida
: Aspergillus
(-, , .)
- (S.aureus, )
()
P.aeruginosa
( )
S.pneumoniae
( )
( >38C <36C; L >12 109/ <4 109/; > 20/; >90/)
= *
(, , , , , )
( <90 Hg )
:
:
> 0,5 /
:
- > 24 /
, -
(Community-acquired) (Healthcare-associated)
-
-
-
-
-
(Streptococcus pneumoniae)
S. pneumoniae
[EARS-Net, 2013]
2011 2013
> 20%
Streptococcus pneumoniae
( EUCAST)
.., . 2014, 2
Streptococcus pneumoniae
( EUCAST)
, /,
1- ,
2-
.., /,
. 2014, 2
3-
-
(/)
,
14-. 15-. 16-.
R R R
(erm-)
R R S
(mef-)
14-. 15-. 16-.
14- 15-
R (,
R R
)
(erm-)
()
R R S
- /
-
(mef-)
H.pylori
()
,
,
/
-
-
(, ,
)
( , )
( QT, ,
)
(, )
()
()
, , ,
FDA
,
,
!
QT (
, )
, ,
(43
1 )
. , QT:
, , , , ,
FDA 2013
, QT,
:
, ,
, QT
: - (,
), 16- ()
:
3- ( )
- () 3-
, 1- ()
:
2016
1- :
2- *: /,
3- **: ()
* -, , ,
** -,
3-4
( )
, , , , .
*
( )
*
( )
: 1 12
1
:
( , )
500 500
95% 70%
125 3 = 375
1. :
2.
3.
(0-5 ),
-
4. (UNICEF 2011)
1. . ., , 2006; 15 (4): 14
2. . ., .., 2008; 2: 73-80
3. .., .. , 2014, 6, . 4-5.
4. www.unicef.org/supply/files/Dispersible_tablets.pdf
UNICEF (2011)
[Pocket book of hospital care for children, Geneva, WHO, 2005]
[www.unicef.org/supply/files/Dispersible_tablets.pdf]
48-72
-
, ,
< 0,5 / 90%
< 24 / 90%
5-7
:
Staphylococcus aureus
14-28
> 14
, , ,
10
,
(9-12 109/)
- -
1.
2.
4
[Little, P., et al. BMJ. 2001]
1
[Little, P., et al. BMJ. 1997]
1.5
[Heikkinen, T. and A. Jarvinen 2003. Lancet]
2.5
[Williamson, I. G., et al. JAMA 2007]
3
[Little, P., et al. JAMA 2005]
-
-
,
, ,
=
[Ball P. JAC 2002;49:31. Snow V. Ann Int Med 2001;134:487]
[Jefferson & Tyrrell. Cochrane Database Syst Rev. 2001;(3):CD002743]
- = - =
(, )
(, )
, ,
;
( NICE - National Institute for Clinical
Excellence 2008)
40% !
[Little P, e.a. BMJ 2014;348:g1606]
Streptococcus pneumoniae
Haemophilus influenzae .
Mycoplasma pneumoniae
Streptococcus pyogenes ()
Streptococci Viridans
S.epidermidis,
- ()
!
- - -
( - 60-99%, - 95-100%)
25-30%
< 10%
McIsaak
> 38 1
1
/ 1
1
: 15 1
15-45 0
45 -1
:
0 1
2
3-5
-
() ()
NB!
[Lindbaek e.a.]
> 10 /
(3 81%, 66%)
:
Streptococcus pneumoniae
60-80%
Haemophilus influenzae
:
1- : ()
2- *: / ()
()
-
, ,
,
* -, , , .
(30%)
, .
-