57.林小妹6歲，因綠膿桿菌引起之尿道感染，醫師開立口服levofloxacin，藥師建議為何？
(A)價格低廉，故建議使用
(B)不可使用於兒童
(C)用於此情況弊多於利，不建議使用
(D)用於此情況利多於弊，建議使用

回樓上，uncomplicated UTI 建議口服治療，只有cipro 跟levo 可以抗Pseudo 又可以口服

UpToDate 舊的分類裡面，nosocomial UTI 的確是complicated UTI，而Pseudo 也的確是nosocomial UTI 最常見的致病菌；不過complicated UTI 主要是根據是否上行到腎臟、是否有結構異常、是否有其他易引起complication 的危險因子 (immunosuppresion、DM、pregnancy、nosocomial infection、catheter 等等)，不是直接看致病菌。現在的分類則主要是看症狀。

另外，如果其他選項都是注射治療的話，FDA核准cipro PO 用在小兒UTI，但是levo 沒有。

在這題目沒有描述清楚的情況下，以complicated UTI 來進行治療也是可以的；不過在醫師開口服的情況下，大概是在門診而且醫師評估沒有太嚴重的症狀 (如果都收住院了還開levo PO 我也是醉了)，住院一個禮拜注射治療治療UTI 有點太高級，我可能會傾向建議cipro，但是levo 我可能也是不會請醫師改啦。

We categorize UTI as either acute simple cystitis or acute complicated UTI based on the extent and severity of infection (signs or symptoms that suggest extension of infection beyond the bladder: fever (>99.9°F/37.7°C), chills, rigors, significant fatigue or malaise beyond baseline, or other features of systemic illness, flank pain, costovertebral angle tenderness, pelvic or perineal pain in men.)

Complicated UTI has been defined, for the purposes of treatment trials, as cystitis or pyelonephritis in a patient with underlying urologic abnormalities or other significant comorbidities. Individuals who do not fit into either category have often been treated as having a complicated UTI by default.

We do not automatically consider patients with underlying urologic abnormalities (such as nephrolithiasis, strictures, stents, or urinary diversions), immunocompromising conditions (such as neutropenia or advanced HIV infection), or poorly controlled diabetes mellitus to have a complicated UTI if they have no concerning symptoms for upper tract or systemic infection. However, such patients can be at higher risk for more serious infection and have not traditionally been included in studies evaluating the antibiotic regimens we typically use for acute simple cystitis. Thus, we follow such patients more closely and/or have a low threshold to manage them as complicated UTI (eg, if they have subtle symptoms other than those listed above that could be suggestive of more extensive infection).

UpToDate Our approach to categorizing UTI in adults and adolescents

The American Academy of Pediatrics (AAP) Committee on Infectious Diseases recommends that the use of ciprofloxacin for UTI in children be limited to UTI caused by Pseudomonas aeruginosa or other multidrug-resistant, gram-negative bacteria.

UpToDate Urinary tract infections in infants older than one month and young children: Acute management, imaging, and prognosis

The American Academy of Pediatrics recommends that the use of systemic fluoroquinolones in children be limited to the treatment of infections for which no safe and effective alternative exists or in situations in which oral fluoroquinolone therapy is a reasonable alternative to parenteral therapy using a different class of antibiotics. 

UpToDate Fluoroquinolones

回樓上

第一，綠膿桿菌引起的UTI是complicated UTI而非uncomplicated 

第二，題目沒有說一定要開口服

我只是私心覺得有更好的選擇啦..畢竟FQ用在小孩身上還是有爭議在