67.下列何種抗生素醫囑最 不適當？
(A)ceftriaxone + doxycycline
(B)ampicillin/sulbactam + azithromycin
(C)clarithromycin + moxifloxacin
(D)levofloxacin

一般社區性肺炎→單用macrolides (azithromycin, clarithromycin or erythromyicn)或doxycycline 

有共病症（慢性心肺肝腎疾病、DM、酗酒、惡性腫瘤、免疫抑制、可能感染抗藥性肺炎鏈球菌）
→單用FQ (moxi-, gemi-, levo)或β-lactam + macrolide  
 

P.S.
使用macrolide通常是為了抗非典型肺炎（Mycoplasma黴漿菌）

FQ的抗菌範圍已經涵蓋非典型肺炎，所以FQ和macrolide通常不併用

（記：抗菌範圍FQ = β-lactam + macrolide）

4.下列何種藥品，較適合用於門診病人治療社區型肺炎感染？ 
(A)Ertapenem 
(B)Cefepime 
(C)Cefpirome 
(D)Levofloxacin

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5.下列何種藥品，不適合用於門診病人治療社區型肺炎感染？ 
(A)Piperacillin／tazobactam 
(B)Amoxicillin／clavulanate 
(C)Azithromycin 
(D)Doxycycline

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CAP社區肺炎（Community-acquired pneumonia常見細菌抗生素治療

       Streptococcus pneumoniae

                                 若penicilin MIC < 2 ug/ml 建議使用Penicillin , Ampicllin or Amoxicillin

                                 若penicilin MIC >4 ug/ml則考慮3° , 4° cephalosporins  ,  Vancomycin or Teicoplanin

                                 替代：New fluoroquinolones (Moxifloxacin, Levofloxacin 750mg/day,Gemifloxacin)

       Haemophilus influenzae     

              β-lactamase (-)  ： Ampicillin or amoxicillin

              β-lactamase (+) ： Ampicillin/sulbactam , Amoxicillin/clavulanate ,2°cephalosporins

                                替代：New macrolides(Azithromycin) , TMP/SMX , 3° cephalosporins ,fluoroquinolones

     Moraxella catarrhalis

                首選：2° cephalosporins ,Ampicillin/sulbactam , Amoxicillin/clavulanate

                替代：Erythromycin or new macrolidesc , 3° cephalosporins ,Fluoroquinolones

(Atypical CAP)    Legionella spp. , Mycoplasma pneumoniae , Chlamydia pneumoniae

                首選：Erythromycin or new macrolidesc , (Chlamydia可用Tetracyclines)

                替代：Tetracyclines , Fluoroquinolones

HAP院內肺炎（Hospital-acquired pneumonia)常見細菌抗生素治療

   考慮：GNB  K. pneumoniae,  P. aeruginosa ,  Acinetobacter spp.

            首選：3° cephalosporinse(抗綠膿Ceftazidine) or Ureidopenicillins ±Aminoglycosidesf ±Erythromycin or new macrolide

            替代：Timentin or Tazocin or 4°cephalosporins ±Aminoglycosidesf ±Erythromycin or new macrolide ,Fluoroquinolones

  考慮：GPC  MRSA

           首選：Vancomycin Teicoplanin or Linezolid

其他

 (for MDRAB)   ±Sulbactam

(for MDRPA or MDRAB)  ±Colistin

Ref:http://taxol76.pixnet.net/blog/post/26726162-%E8%82%BA%E7%82%8E%E6%8A%97%E7%94%9F%E7%B4%A0%E6%B2%BB%E7%99%82

FQ單用

beta+macrolides

Severity: Major

Interaction Effect:

Concurrent use of MOXIFLOXACIN and SELECTED QT PROLONGING DRUGS may result in increased risk of QT-interval prolongation.

資料來源：micromedex drug interactions