[임상약리]community-acquired pneumonia(지역사회획득폐렴)의 치료법

소개

폐렴중에 community-acquired pneumonia(지역사회획득폐렴)의 치료법을 정리했다. 배양검사를 통한 균의 검출이 이루어지기 전에 행해지는 경험적치료의 기준을 정리했고, 균 검출이 이루어진 이후 행해지는 각 균에 맞는 치료법에 대해서 설명했다. S. pneumoniae, S. aureus, H. influenzae, 등에 맞는 약에 대해서 정리했다. 현재 많이 사용되고 있는 약의 combination에 대해서 소개해주며 각 약물의 작용기전에 대해서 간략히 정리했다.

목차

1. Empirical treatment and drug resistance
1.1 Outpatient; no cardiopulmonary disease, no risk factors for DRSP infection
1.2 Outpatient; cardiopulmonary disease and/or ①risk factors for DRSP infection or ②high DRSP prevalence in community
1.3 병원 입원
1.4 ICU(Intensive care unit) : P. aeruginosa 위험 없음
1.5 ICU : P. aeruginosa 위험 없음
2. resistance
3. Treatment for S. pneumonia
3.1 IV에서 경구투여로 바꾸기
3.2 항생제 투여기간
4. Treatment for S. aureus
5. Treatment for H. influenza
6. Treatment for Legionnaires’ disease
7. Empiric antibiotic therapy prescribed in 37 Australian hospital emergency departments for patients with community-acquired pneumonia
8. Reasons for discordant antibiotic therapy for community-acquired pneumonia, according to pneumonia severity index class
9. 약물의 작용기전

본문내용

(1) Outpatient; no cardiopulmonary disease, no risk factors for DRSP infection
①Macrolide(e,g. clarithromycin 500mg bid PO X 10 days; or azithromycin 500mg PO once, then 250mg/d X 4 days)
② Doxycycline 100 mg bid PO X 10days
(2) Outpatient; cardiopulmonary disease and/or ①risk factors for DRSP infection or ②high DRSP prevalence in community
① Quinolone with enhanced activity against S. pneumonia
levoflaxin 500mg/d PO
or moxifloxacin 400mg/d PO
or gatifloxacin 400 mg/d PO
② beta-Lactam+macrolide or doxycycine
beta-Lactam:
cefpodoxime axetil 750mg
or amoxicillin 1000mg
③Telithromycin 800mg q24hr X 10 days
(3) 병원 입원 : ① + ②or③
① Cefuroxime 750mg q8hr IV or ceftriaxone 1g/d IV or ampicillin/sulbactam 1.5-3g q6h IV
② Azithromycin 1 g/d IC followed by 500mg/d IV
③ Quinolone with enhanced activity against S. pneumoniae
(4) ICU(Intensive care unit) : P. aeruginosa 위험 없음; ①+②or③or④
① Azithromycin 1g IV, then start 500mg IV 24hr later
② ceftriaxone 1g q12hr IV
③ Cefotaxime 2g q6ht IV
④ Quinilone IV

참고자료

· David J Maxwell etc., Empiric management of community-acquired pneumonia in Australian emergency departments
· Harrison, Harrison’s principles of internal medicine, Mc Graw-Hill
· File TM Jr, Garau J etc, Guidelines for empiric antimicrobial prescribing in community-acquired pneumonia.
· Fishman, Alfred P., Fishman`s pulmonary diseases and disorders, McGraw-Hill