140.3 🩺 內科專科考前版

140.3.0.1 1⃣ 22E 曎新

  • Fluoroquinolone restriction (FDA black box): AAA, aortic dissection, tendinopathy, retinal detachment, mental health → 避免 first-line uncomplicated
  • ESBL community 䞊升 (台灣 ~ 15-30% E. coli): empirical FQ for PN 需 evaluate
  • Carbapenem-sparing options: Pivmecillinam, Fosfomycin, Nitrofurantoin (ESBL uncomplicated cystitis OK)
  • CRE UTI: Ceftazidime-avibactam, Meropenem-vaborbactam, Cefiderocol, Imipenem-relebactam
  • Recurrent UTI: methenamine hippurate (ALTAR trial 2022) non-inferior to antibiotic prophylaxis

140.3.0.2 2⃣ 抗藥性 Hot Topics

  • ESBL prevalence: community E. coli ~ 15-30% (Taiwan high)
  • Carbapenem-resistant Enterobacteriaceae (CRE): rising; NDM, KPC, OXA-48
  • MRSA UTI: rare, usually nosocomial; vancomycin / linezolid
  • Candiduria: catheter, DM, immunocompromised; treat only if symptomatic / before urology procedure (fluconazole)

140.3.0.3 3⃣ 台灣 context

  • E. coli FQ resistance ~ 30% community → cipro empirical 圚台灣 PN 需 caution
  • ESBL community-acquired ~ 15-25%
  • 健保: nitrofurantoin, fosfomycin, ceftriaxone, pip-tazo 廣泛䜿甚
  • ESBL UTI 嚎重 → carbapenem (ID consult)