"제 6장. 비뇨기계 항생제 사용법"의 두 판 사이의 차이

Urowki
둘러보기로 이동 검색으로 이동
497번째 줄: 497번째 줄:
  
 
(Ref> 2013 EAU guideline, 요로생식기감염)
 
(Ref> 2013 EAU guideline, 요로생식기감염)
 +
{| class="wikitable"
 +
!Class, Agent, Name
 +
!total dosage per day
 +
|-
 +
|'''Cephalosporins'''
 +
 +
cefotaxime
 +
 +
ceftazidime
 +
 +
ceftibuten
 +
 +
cefixime
 +
 +
cefuroxime axetil
 +
 +
cefpodoxime proxetil
 +
 +
cefaclor
 +
 +
Cephalexin
 +
 +
Ceftriaxone
 +
| -
 +
100-200mg/kg (청소년3-6g) IV
 +
 +
100-150mg/kg (청소년2-6g) IV
 +
 +
9mg/kg (청소년 0.4g) po
 +
 +
8-12mg/kg (청소년 0.4g) po
 +
 +
20-30mg/kg (청소년 0.5-1g) po
 +
 +
8-10mg/kg (청소년 0.4g) po
 +
 +
50-100mg/kg (청소년 1.5-4g) po
 +
 +
50-100mg/kg
 +
 +
50-100mg/kg
 +
|-
 +
|'''Aminopenicillins'''
 +
ampicillin
 +
 +
amoxicillin
 +
 +
amoxicillin-clavulanate
 +
 +
-
 +
| -
 +
100-200mg/kg (청소년 3-6g) IV
 +
 +
50-100mg/kg (청소년 1.5-6g) po
 +
 +
60-100mg/kg (청소년3.6-6.6g) IV
 +
 +
45-60mg/kg (청소년 1500+375mg) po
 +
|-
 +
|'''Aminoglycosides'''
 +
 +
tobramycin
 +
 +
Gentamycin
 +
| -
 +
5mg/kg (청소년3-5mg/kg, 최대 0.4g) IV
 +
 +
5mg/kg (청소년3-5mg/kg, 최대 0.4g) IV
 +
|-
 +
|'''기타'''
 +
Trimethoprim
 +
| -
 +
6mg/kg po
 +
|}
  
 
=신기능에 따른 용량 조정 (Ref> 2013 EAU guideline)=
 
=신기능에 따른 용량 조정 (Ref> 2013 EAU guideline)=
 +
{| class="wikitable"
 +
!Antibiotic
 +
! colspan="3" |GFR (mL/min)
 +
!Comments
 +
|-
 +
|
 +
|'''Mild'''
 +
 +
50-20
 +
|'''Moderate'''
 +
20-10
 +
|'''Severe'''
 +
< 10
 +
|
 +
|-
 +
|*Aciclovir
 +
|Normal dose every 12h
 +
|normal dose every 24h
 +
|50% of normal dose every 24h
 +
|Give postHD
 +
|-
 +
|Aciclovir po
 +
|normal
 +
|Herpes simplex: normal Herpes zoster: 800mg Total Dissolved Solids tds
 +
|Herpes simplex: 200mg bid Herpes zoster: 800 mg bd
 +
|Give postHD
 +
|-
 +
|Amikacin
 +
|5-6mg/kg 12h
 +
|3-4mg/ kg 24h HD: 5mg/ kg post HD and monitor levels
 +
|2mg/kg 24-48h
 +
|Give post-HD Monitor preand 1h postdose levels after 3rd dose and adjust dose as required
 +
|-
 +
|Amoxicillin po
 +
|normal
 +
|normal
 +
|250mg 8h (normal)
 +
|Give postHD
 +
|-
 +
|Amphotericin
 +
|normal
 +
|normal
 +
|normal
 +
|
 +
|-
 +
|(Liposonal+ lipid complex)
 +
| colspan="3" |Amphotericin is highly NEPHROTOXIC. Consider using liposomal/lipid complex amphotericin. Daily monitoring of renal function (GFR) essential.
 +
|
 +
|-
 +
|Ampicillin IV
 +
|normal 
 +
|250-500mg 6h
 +
|250mg 6h (500mg 6h)
 +
|Give postHD
 +
|-
 +
|Benzylpenicillin
 +
|Normal 
 +
|75% 
 +
|0-50% Max. 3.6g/ day (1.2g qds)
 +
|Give postHD Refer to microbiology for dosing in SBE
 +
|-
 +
|Caspofungin
 +
|normal
 +
|normal
 +
|normal
 +
|
 +
|-
 +
|Cefotaxime
 +
|normal
 +
|normal
 +
|1g stat then 50%
 +
|Give postHD
 +
|-
 +
|Cefradine
 +
|normal
 +
|normal
 +
|250mg 6h
 +
|Give postHD
 +
|-
 +
|Ceftazidime
 +
|1g 12h
 +
|1g 24h
 +
|500mg 24h (1g 24h)
 +
|Give postHD
 +
|-
 +
|Ceftriaxone
 +
|normal
 +
|normal
 +
|normal Max. 2g/day
 +
|
 +
|-
 +
|Cefuroxime IV
 +
|normal
 +
|750mg-1.5g 12h
 +
|750mg 24h (750mg 12h)
 +
|Give postHD
 +
|-
 +
|Ciproflazin IV+po
 +
|normal
 +
|50%
 +
|50%
 +
|
 +
|-
 +
|Clarithromycin IV+po
 +
|normal
 +
|normal
 +
|50%
 +
|Give postHD
 +
|-
 +
|Clindamycin IV+po
 +
|normal
 +
|normal
 +
|normal
 +
|
 +
|-
 +
|Coamoxiclav IV (Augmentin)
 +
|normal
 +
|1.2 stat then 50% 12h (1.2g 12h)
 +
|1.2 stat then 50% 24h (1.2g stat then 600mg 12h)
 +
|Give postHD
 +
|-
 +
|Coamoxiclav po (Augmentin)
 +
|normal
 +
|375-625mg 12h (375mg 8h)
 +
|375mg 12h (375mg 8h)
 +
|Give postHD
 +
|-
 +
|Cotrimoxazole IV
 +
|normal
 +
|Normal for 3/7 then 50%
 +
|50%
 +
|Give postHD
 +
|-
 +
|Doxycycline contraindicated
 +
|normal
 +
|normal
 +
|normal
 +
|All other tetracyclines contraindicated in renal impairment
 +
|-
 +
|Erythromycin IV+po
 +
|normal
 +
|normal
 +
|normal Max. 1.5g/ day (500mg qds) *
 +
|
 +
|-
 +
|*Ethambutol
 +
|normal
 +
|24-36h
 +
|48h
 +
|Give postHD
 +
|-
 +
|
 +
| colspan="3" |Monitor levels if GFR < 30mL/min (contact Mirco)
 +
|
 +
|-
 +
|Flucloxacillin IV+po
 +
|normal
 +
|normal
 +
|normal Max. 4g/day
 +
|
 +
|-
 +
|Fluconazole
 +
|normal
 +
|normal
 +
|50%
 +
|Give post-HD No adjustments in single-dose therapy required
 +
|-
 +
|*Flucytosine
 +
|50mg/kg 12h
 +
|50mg/kg 24h
 +
|50mg/kg stat thendose according to levels
 +
|Give post-HD Levels should be monitored predialysis.
 +
|-
 +
|Fusidic acid
 +
|normal
 +
|normal
 +
|normal
 +
|
 +
|-
 +
|1) Gentamicin ONCE DAILY
 +
| colspan="2" |'''GFR 10-40mL/min'''
 +
 +
3mg/kg stat (max. 300mg) Check pre-dose levels 18- 24h after
 +
 +
first dose
 +
 +
Redose only when level < 1mg/L
 +
|'''GFR < 10mL/ min'''
 +
 +
2mg/kg (max. 200mg) redose according to levels
 +
|BOTH METHODS Give postHD
 +
 +
Monitor blood levels:
 +
|-
 +
|2) Gentamicin CONVENTIONAL
 +
| colspan="2" |80mg 12h 80mg 48h 
 +
|80mg 24h HD: 1-2mg/ kg
 +
Post-HD: redose according to levels
 +
|Once daily: pre only
 +
 +
Conventional: pre and 1 h post level required.
 +
|-
 +
|Imipenem
 +
|500mg 8-12h
 +
|250-500mg bid
 +
|Risk of convulsions - use Meropenem: see ''below''
 +
|Give postHD
 +
|-
 +
|Isoniazid
 +
|normal
 +
|normal
 +
|200-300mg 24h
 +
|Give postHD
 +
|-
 +
|Itraconazole
 +
|normal
 +
|normal
 +
|normal
 +
|
 +
|-
 +
|Levoflaxacin
 +
|500mg stat then 250mg bid**
 +
|500mg stat then 125mg bid**
 +
|500mg stat then 125mg od
 +
|**Applies if full dose is 500 mg bid If full dose is 500 mg od, five reduced doses daily
 +
|-
 +
|Linezolid
 +
|normal
 +
|normal
 +
|normal
 +
|Give postHD
 +
|-
 +
|Meropenem
 +
|12h
 +
|50% 12h
 +
|50% 24h
 +
|Give postHD
 +
|-
 +
|Metronidazole
 +
|normal
 +
|normal
 +
|12h (normal)
 +
|Give postHD
 +
|-
 +
|Nitrofurantoin
 +
| colspan="2" |Do '''NOT''' use in renal impairment
 +
|
 +
|
 +
|-
 +
|Penicillin V
 +
|normal
 +
|normal
 +
|normal
 +
|Give postHD
 +
|-
 +
|Piperacillin/ Tazobactam (Tazocin)
 +
|4.5g 8h
 +
|4.5g 12h
 +
|4.5g 12h
 +
|Give postHD
 +
|-
 +
|Pyrazinamide
 +
|normal
 +
|normal
 +
|normal
 +
|
 +
|-
 +
|Rifampicin
 +
|normal
 +
|normal
 +
|50-100%
 +
|
 +
|-
 +
|*Teicoplanin
 +
|100% 48h
 +
|100% 72h
 +
|100% 72h
 +
|Dose reduction after day 3 of therapy
 +
|}
  
 
=Asymptomatic bacteriuria=
 
=Asymptomatic bacteriuria=

2019년 5월 22일 (수) 06:33 판

항생제 사용법 요약

급성 단순방광염의 경험적 항생제 요법

(2016 단순요로감염가이드라인.대한요로생식기감염학회.)

항생제  용법 (경구)  기간 
Fosfomycin trometamol  3g qd  1 day 
Pivmecillinam*  400mg tid  3 days 
Nitrofurantoin macrocrystal* 100mg bid  5 to 7 days 
Beta-Lactams 
Amoxicillin-clavulanate  250/125mg tid

500/125mg bid

7 days 
Cefaclor  250mg tid 7 days 
Cefdinir  100mg tid 5 to 7 days 
Cefcapene pivoxil  100mg tid 5 to 7 days 
Cefpodoxime prexetil  100mg tid 5 to 7 days 
Fluoroquinolones
Ciprofloxacin**  500mg bid

500mg 서방정 qd

3 days 
Tosufloxacin** 150mg bid 3 days 

* ; 현재, 국내 사용불가

** ; 임신부 사용불가

폐경전 여성에서 단순 급성신우신염의 초기 경험요법

(2016 단순요로감염가이드라인.대한요로생식기감염학회.)

경구요법: 경도 및 중등도 단순 급성 신우신염

항생제 용량  치료기간 
Ciprofloxacin1) 500-750mg bid  7-10일
Levofloxacin1)  250-500mg qd  7-10일
Levofloxacin 750mg qd  5일 
대체약제 (임상적으로 fluoroquinolone 과 동등한 효과를 보이지만, 세균학적 효과 동등성은 입증되지 못함)
Cefpodoxime proxetil  200mg bid  10일 
Ceftibuten  400mg bid  10일 
항생제 감수성 검사가 시행된 경우 (일차 치료로는 적절하지 않음)
Trimethoprimsulphamethoxazole 160/800mg bid  14일
Co-amoxiclav2),3)  0.5/0.125g tid  14일
* 1) 저용량은 연구되었으나 고용량은 전문가의 견해, 2) 단순 급성 신우신염의 치료로서 단독사용 연구는 없음, 3) 그람양성균 에서 주로 사용 

비경구요법: 중증 단순급성 신우신염

• 증상이 호전된 후 경구요법으로 전환할 수 있으며 1-2주간 치료를 지속한다. 본 표에서는 용량만 표기

항생제  용량 
Ciprofloxacin  400mg bid 
Levofloxacin1)  250-500mg qd 
Levofloxacin  750mg qd 
대체약제 
Cefotaxime2)  2g tid 
Ceftriaxone1),4)  1-2g qd 
Ceftazidime2) 1-2g tid 
Cefepime1),4)  1-2g bid 
Co-amoxiclav2),3)  1.5g tid
Piperacillin/tazobactam1),4)  2.5-4.5g tid
Gentamicin2)  5mg/kg qd 
Amikacin2)  15mg/kg qd
Ertapenem4)  1g qd 
Imipenem/cilastatin4)  0.5/0.5g tid
Meropenem4)  1g tid
Doripenem4)  0.5g tid 
1) 저용량은 연구되었으나 고용량은 전문가의 견해

2) 단순 급성 신우신염의 치료로서 단독사용 연구는 없음

3) 그람양성 균에서 주로 사용

4) 단순 급성 신우신염 및 복잡성 요로감염 동일 권고안 

항생제 사용 용량

(Ref> 2012 Stanford guide to antimicrobial therapy 42nd ed.)

Class, Agent, Name Usual adult dosage Preg risk
Natural penicillins

Benzathine penicillin G

Penicillin G

-

600,000-1.2 million units IM q2-4wks

Low: 600,000-1.2 million units IM per day

B

B

-

Penicillin V

High: ≥20 million units IV q 24hrs

500 mg p.o bid, tid

B
Aminopenicillins

amoxicillin

amoxicillin-ER

amoxicillin-clavulanate

Ampicillin

-

ampicillin-sulbactam

-

250mg-1g po tid

One 775mg tab po q D

500/125, 875/125 1tab po bid

250mg-500mg po q 6hr

50-200mg/kg IV/day

1.5-3g IV q 6hr

B

B

B

B

B

Extended spectrum

penicillins piperacillin

-

-

3-4g IV q 4-6hr (max 24g/day)

for urinary tract infection: 2g IV q 6hr

B
Antipseudomonal penicillins

piperacillin-tazobactam

-

-

-

-

standard dose (no pseudomonas)

3.375g IV q 6hr or 4.5g IV q 8hr

standard dose (pseudomonas)

3.375g IV q 4hr or 4.5g IV q 6hr

B
Carbapenems

Doripenem

-

Ertapenem

Imipenem+cilastatin

Meropenem

-

intra abdominal, complicated UTI

500mg IV q 8hr (1hr infusion)

1g IV/IM q 24hr

0.5g IV q 6hr

0.5-1g IV q 8hr

B

B

C

B

Cephalosporins

1세대

Cefazolin

Cefadroxil

Cephalexin

2세대

cefotetan

cefoxitin

cefuroxime

cefaclor

cefprozil

-

-

1-1.5g IV/IM q 8hr (max 12g/day)

0.5-1g po q 12hr

0.25-1g po q 6hr (max 4g/day)

-

1-3g IV/IM q 12hr

1g q 8hr-2g IV/IM q 6-8hr

0.75-1.5g IV/IM q 8hr

0.25-0.5 g po q 8hr

0.25-0.5 g po q 12hr

B

B

B

B

B

B

B

B

cefuroxime axetil

3세대

cefoperazone-sulbactam

cefotaxime

ceftazidime

ceftizoxime

ceftriaxone

cefdinir

cefditoren pivoxil

cefixime

cefpodoxime proxetil

ceftibuten

0.125-0.5 g po q 12hr

-

1-2g IV q 12hr

1g q8-12hr to 2g IV q 4hr

1-2g IV/IM q 8-12hr

1-2g IV q 8-12hr

1-2g once daily

300mg po q 12hr or 600 mg q2 4hr

400mg po bid

400mg po bid

0.1-0.2g po q 12hr

0.4g po q 24hr

B

B

B

B

B

B

B

B

B

B

B

Macrolide

Azithromycin

Clarithromycin

-

0.5g IV per day (oral 제제는 질병에 따라 변동)

0.5g po q 12hr

B

C

Tetracyclines

Doxycycline

-

0.1 g po/IV q 12hr

B
Fluoroquinolones

ciprofloxacin

gemifloxacin

levofloxacin

moxifloxacin

ofloxacin

-

250mg po bid/400mg IV q 12hr

320mg po q 24hr

250, 500, 750mg po/IV q 24hr

400mg po/IV 24hr

200-400mg po bid

C

C

C

C

C

Amnioglycoside

Amikacin

Gentamycin

-

15mg/kg/day IV

3mg/kg q 8hr IV

D

D

기타

fosfomycin

metronidazole

-

-

3g with water po times 1 dose

Anaerobic infection: IV 7.5mg/kg q 6hr

oral dose 1g qd

B

B

Preg risk: 임신시 사용가능여부 FDA category

12세 이하 UTI 항생제 사용법

(Ref> 2013 EAU guideline, 요로생식기감염)

Class, Agent, Name total dosage per day
Cephalosporins

cefotaxime

ceftazidime

ceftibuten

cefixime

cefuroxime axetil

cefpodoxime proxetil

cefaclor

Cephalexin

Ceftriaxone

-

100-200mg/kg (청소년3-6g) IV

100-150mg/kg (청소년2-6g) IV

9mg/kg (청소년 0.4g) po

8-12mg/kg (청소년 0.4g) po

20-30mg/kg (청소년 0.5-1g) po

8-10mg/kg (청소년 0.4g) po

50-100mg/kg (청소년 1.5-4g) po

50-100mg/kg

50-100mg/kg

Aminopenicillins

ampicillin

amoxicillin

amoxicillin-clavulanate

-

-

100-200mg/kg (청소년 3-6g) IV

50-100mg/kg (청소년 1.5-6g) po

60-100mg/kg (청소년3.6-6.6g) IV

45-60mg/kg (청소년 1500+375mg) po

Aminoglycosides

tobramycin

Gentamycin

-

5mg/kg (청소년3-5mg/kg, 최대 0.4g) IV

5mg/kg (청소년3-5mg/kg, 최대 0.4g) IV

기타

Trimethoprim

-

6mg/kg po

신기능에 따른 용량 조정 (Ref> 2013 EAU guideline)

Antibiotic GFR (mL/min) Comments
Mild

50-20

Moderate

20-10

Severe

< 10

*Aciclovir Normal dose every 12h normal dose every 24h 50% of normal dose every 24h Give postHD
Aciclovir po normal Herpes simplex: normal Herpes zoster: 800mg Total Dissolved Solids tds Herpes simplex: 200mg bid Herpes zoster: 800 mg bd Give postHD
Amikacin 5-6mg/kg 12h 3-4mg/ kg 24h HD: 5mg/ kg post HD and monitor levels 2mg/kg 24-48h Give post-HD Monitor preand 1h postdose levels after 3rd dose and adjust dose as required
Amoxicillin po normal normal 250mg 8h (normal) Give postHD
Amphotericin normal normal normal
(Liposonal+ lipid complex) Amphotericin is highly NEPHROTOXIC. Consider using liposomal/lipid complex amphotericin. Daily monitoring of renal function (GFR) essential.
Ampicillin IV normal  250-500mg 6h 250mg 6h (500mg 6h) Give postHD
Benzylpenicillin Normal  75%  0-50% Max. 3.6g/ day (1.2g qds) Give postHD Refer to microbiology for dosing in SBE
Caspofungin normal normal normal
Cefotaxime normal normal 1g stat then 50% Give postHD
Cefradine normal normal 250mg 6h Give postHD
Ceftazidime 1g 12h 1g 24h 500mg 24h (1g 24h) Give postHD
Ceftriaxone normal normal normal Max. 2g/day
Cefuroxime IV normal 750mg-1.5g 12h 750mg 24h (750mg 12h) Give postHD
Ciproflazin IV+po normal 50% 50%
Clarithromycin IV+po normal normal 50% Give postHD
Clindamycin IV+po normal normal normal
Coamoxiclav IV (Augmentin) normal 1.2 stat then 50% 12h (1.2g 12h) 1.2 stat then 50% 24h (1.2g stat then 600mg 12h) Give postHD
Coamoxiclav po (Augmentin) normal 375-625mg 12h (375mg 8h) 375mg 12h (375mg 8h) Give postHD
Cotrimoxazole IV normal Normal for 3/7 then 50% 50% Give postHD
Doxycycline contraindicated normal normal normal All other tetracyclines contraindicated in renal impairment
Erythromycin IV+po normal normal normal Max. 1.5g/ day (500mg qds) *
*Ethambutol normal 24-36h 48h Give postHD
Monitor levels if GFR < 30mL/min (contact Mirco)
Flucloxacillin IV+po normal normal normal Max. 4g/day
Fluconazole normal normal 50% Give post-HD No adjustments in single-dose therapy required
*Flucytosine 50mg/kg 12h 50mg/kg 24h 50mg/kg stat thendose according to levels Give post-HD Levels should be monitored predialysis.
Fusidic acid normal normal normal
1) Gentamicin ONCE DAILY GFR 10-40mL/min

3mg/kg stat (max. 300mg) Check pre-dose levels 18- 24h after

first dose

Redose only when level < 1mg/L

GFR < 10mL/ min

2mg/kg (max. 200mg) redose according to levels

BOTH METHODS Give postHD

Monitor blood levels:

2) Gentamicin CONVENTIONAL 80mg 12h 80mg 48h  80mg 24h HD: 1-2mg/ kg

Post-HD: redose according to levels

Once daily: pre only

Conventional: pre and 1 h post level required.

Imipenem 500mg 8-12h 250-500mg bid Risk of convulsions - use Meropenem: see below Give postHD
Isoniazid normal normal 200-300mg 24h Give postHD
Itraconazole normal normal normal
Levoflaxacin 500mg stat then 250mg bid** 500mg stat then 125mg bid** 500mg stat then 125mg od **Applies if full dose is 500 mg bid If full dose is 500 mg od, five reduced doses daily
Linezolid normal normal normal Give postHD
Meropenem 12h 50% 12h 50% 24h Give postHD
Metronidazole normal normal 12h (normal) Give postHD
Nitrofurantoin Do NOT use in renal impairment
Penicillin V normal normal normal Give postHD
Piperacillin/ Tazobactam (Tazocin) 4.5g 8h 4.5g 12h 4.5g 12h Give postHD
Pyrazinamide normal normal normal
Rifampicin normal normal 50-100%
*Teicoplanin 100% 48h 100% 72h 100% 72h Dose reduction after day 3 of therapy

Asymptomatic bacteriuria

Uncomplicated UTI

Complicated UTI in DM

Complicated UTI associated with Foley catheter

Complicated UTI associated with urinary tract obstruction

Prostatitis

Urethritis

Syphilis

Chancroid

Simple genital herpes

Condylomata acuminata (Genital warts)

Orchitis & epididymitis

Others

임신중 항생제 사용

예방적 항생제의 사용

원본 주소 "http://www.urowiki.or.kr/wiki/index.php?title=제_6장._비뇨기계_항생제_사용법&oldid=2226"