Bacterii Test.docx

8/16/2019 Bacterii Test.docx

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S. aureus – coc Gram pozitiv

I. Meticilino – sensibil

1. Oxacilina – adult: 2-4 g/zi po(6h)/iv im (4-12h)

- copil 50-100 mg/zi

2. Carbapeneme – Meropenem – adult 3 g/zi iv -copil 40 mg/kg/doza

3. Cefalosporine

A. generatia 1 – Cefazolin – adult 1-6 g/zi iv, im (6-8h) -copil 60 mg/kg/zi (8h)

B. generatia 2 – Cefuroxim – adult 1.5 – 4.5 g/zi iv, im -copil 50 mg/kg iv (8h) / 10-15 mg/kg x2 po

C. generatia 3 – Ceftriaxona – adult 2g/zi (65 ani)

-copil 50-75 mg/kg/zi

D. generatia 4 – Cefepime – adult 2-4 g/zi iv

-copil 150 mg/kg/zi (8h)

E. generatia 5 – Ceftarolin – activ pe MRSA!

4. Lincosamide – Clindamicina – adult – 0.6-2.4 g/zi po,iv,im -copil – 8-25 mg/kg po / 15-40 mg/kg iv

5. Aminoglicozide – Gentamicina – adult – 3 mg/kg/zi

-copil – 2-4 mg/kg/zi - Amikacina – 15 mg/kg/zi

6. Macrolide – Claritromicina – adult 0.5-2 g/zi, po -copil 300-600 mg/zi - Azitromicina – adult 500 mg/zi po - copil 10 mg/kg/zi - Pristinamicina (MRSA ) – adult 3 g/zi, po - copil 50-100 mg/kg/zi

7. Cloramfenicol - >28 zile – 12.5-25 mg/kg la 6h

-copii mari si adulti fara meningita – 50 mg/kg la 6h -copii mari si adulti cu meningita – 100 mg/kg la 6h

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8. Ketolide – Telitromicina – 800 mg/zi9. Sulfonamide – Sulfametoxazol + Trimetoprim – 400/80 mg

II. Meticilino – rezistent (MRSA)

1. Glicopeptide - Vancomicina – adult 1.5-2 g/zi iv (12h)

-copil 30 zile – 10 mg/kg/zi

2. Cefalosporine generatia 5 – Ceftarolin3. Oxazolidinone – Linezolid – 600 mg/2x/zi sau 25 mg/kg/zi4. Quinupristin/Dalfopristin – 7.5 mg/kg iv (la 8h)5. Fosfomicina – adulti 8-12 mg/zi iv


6. Lipopeptide – Daptomicina – 4-6 mg/kg/zi iv7. Macrolide – Sinergistine - Pristinamicina8. Glicilciclinele – Tigeciclina9. Rifampicina – 20 mg/kg/zi

III. Vancomicin – rezistent (VRSA) / intermediar rezistent (VISA)

1. Oxazolidinone - Linezolid 600 mg/2x/zi sau 25 mg/kg/zi (VISA)2. Lipopeptide – Daptomicina 4-6 mg/kg/zi (VRSA)



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S. pneumoniae – coc Gram pozitiv

I. Penicilino – sensibil

1. Aminopeniciline – Ampicilina (de electie-cea mai mica CMI) – adult 2-4

g/zi po - copil 100-300 mg/zi -Amoxicilina – adult 1-8 g/zi po,im,iv -copil 50-100 mg/kg/zi

2. Cefalosporine – toate generatiile

3. Quinolone – Grupa III (spectru extins) – Levofloxacin 250-500 mg/zi iv

4. Peniciline naturale – Penicilina G – adult 1-20 milioane UI im/iv 4/6/12 h

-copil 50 000-200 000 UI/kg

-Penicilina V – adult 3-4 milioane UI po la 6/8 h -copil 50 000-100 000 UI/kg

5. Peniciline anti-pseudomonas – Piperacilina – adult 4.5-13.5 g/zi -copil 100-300 mg/kg/zi

6. Carbapeneme – Meropenem7. Macrolide – Sinergistine - Pristinamicina8. Cloramfenicol9. Ketolide – telitromicina10. Sulfametoxazol + trimetoprim11. Lincosamide - clindamicina

II. Penicilino – rezistent (PRP)

1. Glicopeptide – vancomicina2. Quinupristin/ Dalfopristin3. Oxalidinone – Linezolid

S. pyogenes (Streptococ beta-hemolitic grup A) – coc Gram pozitiv



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99% -> Penicilino – sensibil – se da penicilina atata timp cat nu exista alergiemajora!

1. Peniciline naturale – Penicilina G/V2. Aminopeniciline - Amoxicilina (mai putin activa decat penicilina G)3. Macrolide – Claritromicina/Azitromicina - de electie in caz de alergie

la penicilina

4. Lincosamide – clindamicina – a doua optiune dupa macrolid5. Ketolide – telitromicina6. Peniciline anti-pseudomonas – Piperacilina7. Carbapeneme – meropenem8. Cefalosporinele – toate generatiile9. Quinolone grupa III spectru extins - Levofloxacin10. Sulfametoxazol + trimetoprim

11. Rifampicina

S pyogenes rezistent la eritromicina -> 1. Lincosamide – Clindamicina 2.Ketolide- Telitromicina

Enterococcus – coc Gram pozitiv



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I. Penicilino – sensibil

1. Aminopeniciline – Amoxicilina – de electie in monoterapie cand NU eendocardita; atunci se asociaza cu vancomicina.

2. Amoxi + Acid clavulanic – rezistenta prin producere de beta-lactamaze3. Glicopeptide - Vancomicina – in caz de alergie la penicilina4. Carbapeneme – Imipenem – E. faecalis – adult 2g/zi iv

-copil 30-60 mg/kd/d

5. Quinupristin/Dalfopristin – E. faecium6. Sulfametoxazol + Trimetoprim – E. faecalis7. Peniciline anti-pseudomonas – Piperacilina

II. Penicilino – rezistent

1. Glicopeptide – vancomicina

III. Vancomicin – rezistent (VRE)

1. Oxazolidinone – Linezolid2. Lipopeptide – Daptomicina3. Glicilcicline - Tigeciclina

Neisseria gonorrhoeae – coc Gram negativ

Tratament de electie – Ceftriaxona (CFS 3G)



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- Levofloxacin 250-500 mg/zi iv

2. Sufametoxazol + Trimetoprim 400/80 mg

3. CFS 3G – Ceftriaxona – adulti - 2 mg(65 ani) -copil – 50-75 mg/kg/zi

4. Carbapeneme – Meropenem – adulti 3g/zi

-copil 40 mg/kg/doza

5. Monobactam – Aztreonam – adulti 3-8 g/zi


6. Aminoglicozide – Amikacina – adult/copil 15 mg/kg/zi

7. CFS 2G – inconstant sensibile – Cefuroxim – adult 1,5-4,5 g/zi -copil 50 mg/kg la 8 h

8. CFS 4G – Cefepime – adult - 2-4 g/zi

-copil – 150 mg/kg/zi

9. Cloramfenicol – 12, 5-25/50/100 mg/kg/zi

10. Fosfomicina – adult 8-12g/zi


11. Glicilcicline – Tigeciclina

12. Polimixine – Colistin – 100 000 UI/6h po // 50 000 UI/zi im // 30 000 UI/zi

iv

Anaerobi (GP – Clostridii, Peptostreptococcus, Actinomyces, Lactobacillus, Propionibacterium // GN – Bacteroides fragilis/melaninogenicus,

Fusobacterium)

1. Carbapeneme – Meropenem (Clostridium, Peptostreptococcus, Bacteroides)



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2. Lincosamide – Clindamicina – adult - 0,6-2,4 g/zi -copii – 15-40 mg/kg, parenteral

3. FQ cu spectru extins – Levofloxacin

4. Metronidazo l – doza anaerobi – 15 mg/kg/6h -> 7.5 mg/kg/6h iv SAU 1-2 g/zi

po

5. Macrolide – Sinergistine – Pristinamicina – activa pe anaerobi GP

-adult 3g/zi -copil 50-100 mg/kg/zi

6. Cicline – Doxiciclina – Propionibacterium acnes

-adult 200 mg (1 zi) apoi 100 mg/zi -copii 2-4 mg/kg/zi

7. Vancomicina – Clostridium difficile

8. Cloramfenicol – activ pe clostridii, Propionibacterium acnés, Actinomyces

israelii , Peptostreptococcus

9. CFS 2G – Cefoxitin – activitate moderata pe B. fragilis

10. Penicilinele naturale – active pe clostridii (mai putin C. difficile ) si

Peptostreptococcus

Penicilina G – adult 1-20 mil UI 4/6/12h -copil 50 000 – 200 000 UI/kg Penicilina V – adult 3-4 mil UI po 6/8h -copil 50 000 – 100 000 UI/kg

11. Aminopenicilinele – mai putin active decat Penicilina G pe clostridii.12. Penicilinele anti-pseudomonas – Piperacilina – activa pe B. fragilis

-adulti 4,5-13,5 g/zi -copii 100-300 mg/kg/zi

13. Quinupristin/Dalfopristin – active pe Lactobacillus spp, Bacteroides spp14. Glicilcicline – Tigeciclina15. Rifampicina – Clostridium difficile, Peptostreptococcus, Propionibacterium

acnes

Bacterii intracelulare

Facultativ intracelulare:



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Salmonella typhi -> febra tifoida -> Ampicilina / Cloramfenicol / Biseptol

Brucella -> bruceloza -> Doxiciclina + Streptomicina (adulti); Biseptol + Strepto (copii) Legionella pneumophila -> Azitromicina iv / Levofloxacina / Doxiciclina Mycobacterium tuberculosis -> TB Nocardia -> Biseptol (sulfametoxazol + trimetoprim) Yersinia -> ciuma -> Streptomicina Neisseria meningitidis -> Ceftriaxona Listeria monocytogenes -> Ampicilina + Gentamicina (sinergism)

Bartonella henselae Francisella tularensis Obligatoriu intracelulare:

Chlamydia -> pneumonie/cervicita -> Claritromicina / Doxiciclina / FQ

Rickettsia -> febra butunoasa, tifos exantematic Tetraciclina >8 ani ; Cloramfenicol < 8 ani Coxiella -> febra Q -> Tetraciclina > 8 ani; Cloramfenicol pneumonie interstitiala -> Azitromicina / Levofloxacin Treponema pallidum -> Penicilina Borrelia -> Boala Lyme -> precoce Amoxi/Doxiciclina; avansat Ceftriaxona Leptospira -> f usoare/medii – Amoxi; f grave – Penicilina G Certain species of Mycobacterium such as Mycobacterium leprae -> Dapsona


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Bacterii Test.docx