149.3 🩺 內科專科考前版

149.3.0.1 1⃣ 22E 新 Antibiotics

藥 䞊垂幎 適應症
Ceftazidime-avibactam 2015 CRE, MDR Pseudomonas
Ceftolozane-tazobactam 2014 MDR Pseudomonas
Meropenem-vaborbactam 2017 CRE (KPC)
Imipenem-relebactam 2019 CRE, MDR Pseudomonas
Cefiderocol 2019 CRE, MDR Pseudomonas, Acinetobacter
Sulbactam-durlobactam 2023 MDR Acinetobacter
Plazomicin 2018 CRE (aminoglycoside)
Eravacycline 2018 MDR GN (intra-abdominal)
Tedizolid 2014 MRSA SSTI (once daily)
Omadacycline 2018 MRSA SSTI / CAP
Lefamulin 2019 CAP (pleuromutilin)
Letermovir 2017 CMV prophy HSCT
Maribavir 2021 Refractory CMV
Fidaxomicin 2011 CDI (now first-line)
Bezlotoxumab 2016 CDI recurrence prevention
Dalbavancin / Oritavancin 2014 SSTI long-acting (single dose)

149.3.0.2 2⃣ Antimicrobial Stewardship

  • 栞心 elements: leadership, ID consult, formulary restriction, pharmacy support, education, monitoring, reporting
  • Bundle: PCT-guided, de-escalation, oral switch (e.g., POET, OVIVA), shorter courses (STOP-IT, FOCUS, etc.)
  • Empirical → culture-directed in 48-72 hr
  • Hospital antibiogram essential

149.3.0.3 3⃣ PK/PD 现節 (Specialist)

  • Vancomycin: target AUC₂₄ 400-600 (newer); replaced trough 15-20
  • β-lactam continuous infusion for MDR Pseudomonas in critical care
  • Therapeutic drug monitoring (TDM): vancomycin, aminoglycoside, voriconazole, posaconazole