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Antibiotics ´ëÀå°æ Á¤¸®

1. Ç×»ýÁ¦ÀÇ ºÐ·ù

1) cell wallÇÕ¼º¾ïÁ¦: ¥â-lactam(penicillin, cephalosporin), vancomycin, bacitracin

2) proteinÇÕ¼º¾ïÁ¦

50S ribosome¿¡ ÀÛ¿ë: macrolide, lincosamide(clindamycin, lincomycin), chloramphenicol

30S ribosome¿¡ ÀÛ¿ë: aminoglycoside, tetracycline

3) DNAÇÕ¼º ¾ïÁ¦: rifampin, metronidazole, quinolone, novobiocin

4) cell membrane¿¡ ÀÛ¿ë: polymyxin, gramicidine

5) ¼¼±ÕÀÇ folateÇÕ¼º ¾ïÁ¦: sulfonamide, trimethoprim

2. bactericidal drug: ¥â-lactam, aminoglycoside, DNAÇÕ¼º¾ïÁ¦Á¦(rifampin, metronidazole,

quinolone), glycopeptide

bacteriostatic drug: tetracycline, 50S ribosome¿¡ ¾ïÁ¦Á¦(macrolide, clindamycin,

chloramphenicol)

3. ¥â-lactam°è Ç×»ýÁ¦ÀÇ ³»¼º±âÀü

i) ¥â-lactamase»ý¼ºÀ» ÅëÇÑ drug inactivation : S. aureus, P. aeruginosa,

Enterobacteriaceae

ii) PBP(penicillin-binding protein)ÀÇ º¯È­¸¦ ÅëÇÑ target insensitivity : MRSA,

S. pneumoniae

iii) permeability¡é : P. aeruginosa, Enterobacteriaceae

4. cephalosporin ³»¼º±Õ 3°¡Áö: MRSA, PRSP, enterococcus

5. aminoglycoside¿¡ ÀÇÇÑ ³»¼ºÈ¹µæ±âÀü

i) mc Mx : aminoglycoside modifying enzyme»ý¼ºÀ¸·Î drug inactivation

ii) 2nd, uncommon: antibiotic uptake¡é(d/t outer membraneÀÇ º¯È­)

iii) target ribosomal change

6. VREÀÇ ¹ß»ý±âÀü : target alteration(peptidoglycan subunitÀÇ terminal a.aÀÇ substitution)

7. VRE ¹ß»ýÀÇ À§ÇèÀÎÀÚ

Àå±â ICUÀÔ¿ø, °ú°Å cephalosporinÅõ¿©, °ú°Å °æ±¸ vancomycinÅõ¿©, Ç×Çø±â Ç×±ÕÁ¦ »ç¿ë

8. enterococcusÀÇ vancomycin³»¼º ȹµæ

- van A, van BÀÇ genetic element¿¡ ÀÇÇØ ¸Å°³µÈ´Ù.

- van B type gene cluster°¡ vancomycin¿¡ ´ëÇÑ ³»¼ºÀ» ³ªÅ¸³½´Ù.

- van B typeÀº vancomycin¿¡´Â ³»¼ºÀ» ³ªÅ¸³»Áö¸¸, teicoplanin¿¡´Â °¨¼ö¼ºÀ» ³ªÅ¸³½´Ù.

9. ESBL(extended spectrum ¥â-lactamase)

- ÁÖ·Î K. pneumoniae¿¡¼­ º¸°íµÇ¾ú´Ù.

- ceftazidime, aztreonam¿¡´Â high level resistance¸¦ º¸ÀÌ¸ç ´Ù¸¥ 3¼¼´ë cepha¿¡µµ

°¨¼ö¼ºÀÌ ¶³¾îÁø´Ù.

- imipenem ¹× cephamycin°è(cefoxitin, cefotetan)¿¡´Â È¿°ú°¡ ¾ø¾î °¨¼ö¼ºÀ̸ç

¥â-lactamase inhibitor¿¡ ÀÇÇÏ¿© ¾ïÁ¦µÇ´Â Ư¡À» ³ªÅ¸³½´Ù.

10. °æ±¸»ýüÀÌ¿ë·üÀÌ ³ôÀº ¾à: fluoroquinolone, rifampin, cotrimoxazole, clindamycin,

metronidazole, fluconazole

°æ±¸»ýüÀÌ¿ë·üÀÌ ³·Àº ¾à: aminoglycoside, vancomycin, aztreonam, amphotericin

(Àü½Å°¨¿°ÁõÀÏ °æ¿ì ¹Ýµå½Ã ÁÖ»ç)

11. penicillinÅõ¿©ÈÄ ½Ã°£°æ°ú¿¡ µû¸¥ Ç÷Àå³» ¾à¹° ³óµµ

G IM > V PO > G PO > procaine > benzathine

12. Ç×±ÕÁ¦¸¦ ¹Ýµå½Ã ÁÖ»çÇØ¾ß ÇÏ´Â °æ¿ì

i) À§Àå°ü¿¡¼­ Èí¼öµÇÁö ¾Ê´Â Ç×±ÕÁ¦¿¡ ÀÇÇÑ Àü½Å°¨¿°ÁõÀÇ Ä¡·á: aminoglycoside,

vancomycin, amphotericin, aztreonam

ii) Èí¼öÀå¾Ö: shock, ±¸Åä, À§ÀýÁ¦, short bowel syndrome

iii) ºü¸¥ Ä¡·áÈ¿°ú¸¦ ¿äÇÒ ¶§: sepsis, neutropenic fever, CNS infection

iv) Ä¡·á¿¡ ³ôÀº ³óµµÀÇ Ç×±ÕÁ¦°¡ ÇÊ¿äÇÑ °æ¿ì: endocarditis, CNS infection,

endophthalmitis, prosthesis-related infection

13. ÀÓ½ÅÁß 1st & 2nd trimester¿¡´Â »ç¿ëÇÒ¼ö ÀÖÀ¸³ª 3rd trimester¿¡ ±Ý±âÀÎ ¾à

(¸ðÀ¯·Î ºÐºñµÇ¹Ç·Î): CM, nitrofurantoin, sulfonamides

14. Ç×»ýÁ¦¸¦ º´¿ëÅõ¿©ÇÏ´Â ÀÌÀ¯? "È¥Áß³»»óµ¶"

i) È¥ÇÕ°¨¿°(polymicrobial infection)

ii) ÁßÁõ°¨¿°ÀÇ ÃʱâÄ¡·á

iii) ³»¼ºÃâÇö¹æÁö

iv) »ó½ÂÀÛ¿ë(synergistic effect)

v) µ¶¼º°¨¼Ò

cf. ¥â-lactam + ¥â-lactamÀÇ º´¿ëÀº ¥â-lactamase¸¦ À¯µµÇÑ´Ù.

¿¹> cefoxitin + imipenem

15. infective endocarditis¿¡¼­ Enterococcus faecalis°¡ ¹è¾ç.

penicillin¿¡ ³»¼º, vancomycin¿¡ °¨¼ö¼ºÀ» º¸¿© gentamicin°úÀÇ º´ÇÕ¿ä¹ýÀ» ÇÏ·Á°í ÇÒ¶§

À̸¦ À§ÇØ ½ÃÇàÇØ¾ß ÇÒ °Ë»ç?

high level aminoglycoside resistance¿©ºÎ È®ÀÎ

16. PAE(post-antibiotic effect)

protein ÇÕ¼º ¾ïÁ¦Á¦, DNAÇÕ¼º ¾ïÁ¦Á¦´Â G(-)¿¡ ´ëÇØ PAE°¡ ±æ´Ù.

¥â-lactam°è, vancomycin µîÀº G(-)¿¡ ´ëÇØ PAE°¡ ª´Ù.

G(+)¿¡ ´ëÇØ¼­´Â ´ëºÎºÐÀÇ Ç×±ÕÁ¦°¡ ±ä PAE¸¦ º¸ÀδÙ.

17. Eagle effect

±Õ¼ö°¡ ¸¹À¸¸é Ȱ¹ßÈ÷ Áõ½ÄÇÏ´ø ±ÕµéÀÌ stationary phase·Î µé¾î°£´Ù. ÀÌ Çö»óÀ»

" eagle effect"¶ó ÇÑ´Ù.

À̶§´Â cell wall ÇÕ¼º ¾ïÁ¦Á¦´Â È¿°ú°¡ ¶³¾îÁö°í, clindamycin°°Àº protein ÇÕ¼º ¾ïÁ¦Á¦°¡

È¿°ú°¡ ÀÖ´Ù.

18. concentration dependent killing: aminoglycoside, quinolone, metronidazole

time dependent killing: ¥â-lactam, vancomycin(PAE°¡ ªÀ¸¹Ç·Î ¿©·¯¹ø °è¼Ó ÁÖ»çÇØ¾ß

ÇÑ´Ù).

19. aminoglycoside¸¦ ÇÏ·ç¿¡ Çѹø Åõ¿©ÇÏ´Â ÀÌÀ¯

i) post-antibiotic effect

ii) concentration dependent killing

iii) nephrotoxicity°¨¼Ò

iv) adaptive post-exposure resistance

20. vancomycin»ç¿ëÀÌ ÀûÀýÇÑ °æ¿ì

i) ¥â-lactam¿¡ ³»¼ºÀÌ ÀÖ´Â G(+)±Õ¿¡ ÀÇÇÑ ½É°¢ÇÑ °¨¿°Áõ

ii) ÁßÁõ ¥â-lactam allergy°¡ Àִ ȯÀÚ¿¡¼­ G(+)±Õ¿¡ ÀÇÇÑ °¨¿°Áõ

iii) metronidazole¿¡ ¹ÝÀÀÇÏÁö ¾Ê´Â antibiotic-associated colitis

iv) ½É³»¸·¿° ¿¹¹æ¿ä¹ý(¹Ì±¹½ÉÀåÇÐȸ ±Ç°í¿¡ µû¸¥)

v) MRSA¿¡ ÀÇÇÑ °¨¿°À§ÇèÀÌ ³ôÀº º´¿ø¿¡¼­ ÁÖ¿ä¼ö¼ú½Ã ¿¹¹æ¿ä¹ý

21. vancomycin»ç¿ëÀÌ ºÎÀûÀýÇÑ °æ¿ì

i) ¥â-lactam allergy°¡ ¾ø´Â ȯÀÚ¿¡¼­ ¼ö¼ú½Ã ÀÏ»óÀûÀÎ ¿¹¹æ¿ä¹ý

ii) neutropenic fever¿¡¼­ °æÇèÀû ¿ä¹ý(G(+)±Õ¿¡ ÀÇÇÑ °¨¿°À§ÇèÀÌ ³ôÁö ¾ÊÀº »óÅ¿¡¼­)

iii) Ç÷¾×¹è¾ç¿¡¼­ coagulase-negative staphylococcus°¡ Çѹø ÀÚ¶õ °æ¿ì

iv) Ç÷°ü³» Ä«Å×ÅÍ ÀåÂø, Åõ¼®È¯ÀÚ ¶Ç´Â ±ØÀúüÁ߾ƿ¡¼­ ¿¹¹æ¿ä¹ý

v) selective intestinal decontamination

vi) MRSA º¸±ÕÀÚÀÇ Ä¡·á

vii) Ç×»ýÁ¦ °ü·Ã Àå¿°ÀÇ 1Â÷ ¿ä¹ý

viii) ½Å±â´É Àå¾Ö ȯÀÚ¿¡¼­ Åõ¿©¿ä¹ýÀÇ Æí¸®¼º ¶§¹®¿¡ Åõ¿©ÇÏ´Â °æ¿ì

ix) vancomycinÀ» ÀÌ¿ëÇÑ ±¹¼ÒµµÆ÷ ¶Ç´Â ¼¼Ã´

22. Ç×»ýÁ¦ Ä¡·á ½ÇÆÐ½Ã °í·Á»çÇ×

Áø´ÜÀ߸ø, ¾à¿ë·®ºÎÁ·, drug fever, superinfection, ±Õ±³´ë°¨¿°, ³»¼º±ÕÁÖ ÃâÇö,

ÀüÀ̼º ³ó¾ç, host defense mx¡é

23. ½Å±â´ÉÀå¾Ö½Ã Ç×»ýÁ¦ ¿ë·®Á¶Àý

- penicillin, erythromycinÀº ¿ë·®Á¶ÀýÀÌ ÇÊ¿ä¾ø´Ù.

- amphotericin-B´Â ½ÅÀåÀ¸·Î ¹è¼³µÇÁö ¾Ê¾Æ ½ÅºÎÀü½Ã ¿ë·®Á¶ÀýÀÌ ÇÊ¿ä¾ø´Ù.

±×·¯³ª ½Åµ¶¼ºÀÌ ÀÖÀ¸¹Ç·Î »ç¿ëµµÁß Cr»ó½Â½Ã Åõ¿©°£°ÝÀ» ´Ã¸°´Ù.

- quinoloneÀº ÁÖ·Î ½ÅÀåÀ¸·Î ¹è¼³µÇ¹Ç·Î ½Å±â´É¿¡ µû¶ó ¿ë·®Á¶ÀýÀÌ ÇÊ¿äÇÏ´Ù.

24. Àå³»¿¡¼­ vit K-dependent carboxylase¸¦ °æÀïÀûÀ¸·Î ¾ïÁ¦ÇÏ¿© ÃâÇ÷¼º °æÇâÀ» Áõ°¡

½Ãų¼ö ÀÖ´Â Ç×»ýÁ¦: cefamandole, cefoperazone, cefotetan, cefmetazole,

moxalactam, cefmenoxime(ŸÁ¹, ¸¸µ¹, Á¸, ÅןÀº vitK¾ïÁ¦)

25. metronidazole µ¶¼º°ú °¡Àå °ü°èÀÖ´Â °Í: mutagenecity & carcinogenecity

26. vancomycinÅõ¿©¿¡ ÀÇÇÑ redman syndrome: vancomycin-induced histamine release

27. vancomycinÀº ³ú¸·ÀÇ ¿°ÁõÀÌ ÀÖÀ» ¶§ BBB¸¦ Åë°úÇϳª teicoplaninÀº ³ú¸·ÀÇ ¿°ÁõÀÌ

À־ BBB¸¦ Åë°úÇÏÁö ¸øÇÑ´Ù.

28. ¿¹¹æÀû Ç×±Õ¿ä¹ý: Àΰø»ðÀÔ¹°ÀÌ µé¾î°¡´Â ¸ðµç û°áâ»ó + û°á-¿À¿°Ã¢»ó

* û°áâ»óÁß¿¡ ¿¹¿ÜÀûÀ¸·Î ¿¹¹æÀû Ç×±ÕÁ¦¸¦ Åõ¿©ÇÏ´Â °æ¿ì

: cardiac, vascular, neurologic, or orthopedic surgery

29. ¿¹¹æÀû Ç×±Õ¿ä¹ýÀÇ ¿¹

1) nonsurgical

¨ç infective endocarditisÀ§Ç豺 - amoxicillin(½Ã¼úÀüÈÄ)

¨è recurrent S. aureus infection - mupirocin(Bactroban) 5ÀÏ

¨é meningococcal meningitisȯÀÚ¿Í Á¢Ã˽à - rifampin 2ÀÏ or quinolone 1ȸ

¨ê bite wound : penicillin V or augmentin 3-5ÀÏ

¨ë recurrent cystitis - Bactrim ÁÖ3ȸ 1³â or sexual intercourseÈÄ

2) surgical

¨ç clean(cardiac, vascular, neurologic, or orthopedic surgery) - cefazolin(vancomycin)

½Ã¼úÀü

¨è clean-contaminated(H/N, high-risk gastroduodenal or biliary surgery; C-sec,

hysterectomy)

- cefazolin(or clindamycin for H/N) ½Ã¼úÀü & µ¿¾È

¨é clean-contaminated(colorectal surgery or appendectomy) - cefoxitin or

cefotetan(add oral

neomycin + erythromycin for colorectal) ½Ã¼úÀü & µ¿¾È

¨ê dirty(ruptured viscus) - cefoxitin or cefotetan ¡¾ gentamicin ½Ã¼úÀü & ½Ã¼úÈÄ 3-5ÀÏ

¨ë dirty(traumatic wound) - cefazolin Àü & ÈÄ 3-5ÀÏ