Antibiotic associated colitis (AAC)

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• ???????????????????????????
• ????????????????????????????
• ???????????/????????/????????????

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???????????????????????

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• ???????
• 1.????????????????????????
• 2.???????????????????????????????????????????????
  ?
• 3.??????????????????? ???????????????????????????
  ?????????????

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Antibiotic associated colitis (AAC)

• ??????? Clostridium difficle toxin
• ????? ????????,???????
• ?????? overgrowth ???????? Clostridium difficle
• ????????? ampicillin,clindamycin,cephalosporin
• ???????? Vancomycin

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Antibiotic associated colitis (AAC)
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Antibiotic associated colitis (AAC)
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Antibiotic associated colitis (AAC)
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Stevens-Johnson syndrome

• ???????????????
• ??????????? penicillin, sulfonamides
• ??????????????????????????????????????????????????
  ?????,??
• ?????????????

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Stevens-Johnson syndrome
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Toxic-epidermal necrolysis

• ????????????????????????????????????
• ??????????? penicillin, sulfonamides
• ????????????????????????????????

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Toxic-epidermal necrolysis
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Toxic-epidermal necrolysis
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ANAPHYLAXIS

• Rash, angioedema
• Bronchospasm
• Shock

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• ???????????????????????????????
• ????????????????????????????
• ???????????????????????????????????????

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• Methicillin-Resistant Staphylococus aureus ( MRSA
  )
• Penicillin-Resistant Streptococus pneumoniae (
  PRSP )
• Vancomycin-Resistant Enterococci (VRE)
• Extended Spectrum Beta-lactamase producing
  bacteria ( ESBL )
• Multidrug Resistant (MDR) Acinetobacter and
  Klebsiella

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National Antimicrobial Resistance Surveillance,
Thailand ( NARST )

• Acinetobacter
• 1998 98 susceptible to imipenem
• 2006 only 43 susceptible to imipenem
• E.coli
• 1999 90 susceptible to ceftriaxone
• 2006 only 68 susceptible to ceftriaxone
• Pseudomonas aeroginosa
• 1998 77 susceptible to ceftazidime
• 2006 only 70 susceptible to ceftazidime

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Mariana bridi
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• ????????????????????????????????????

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????????????

• ?????????????????????????????????????????????? 6
  ??????? ?????????????????????????????????????

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???????????(?????? antibiotic)

• ??????????????????????????????????????????????????
  ?
• ??????????????????????
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  ??????????????????????????????
• ??????????????????????????????????????????????????
  ??? ???????, ????????, ??????
• ?????????????????????????????

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?????????????????????????????????????? (???
antibiotic)

• ???????????????????????
• ????????????????? ???? ????????????????????
• ??????????
• ???????????????????
• ??????????????????????, ?????????????????????????,
  ???????????????????????????, ????????????????????
  ????????? ??????????????????????????????????????
  ?? steroid

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???????????????????????

• ??????????????????????????????????????????????????
  ????????
• ???????????????????????????????????
• ???????????????????????????????????? ???? ??????
• ??????????????????????????????????????????????????
  ???????, ????????, ??????
• ??? Antibiotic Amoxicillin/clavulonic acid

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??????????????????????????????????????????????????
????????

• ??????????????????????????????????????????????????
  ?????????? ?????????????? 48 ???????
• ???????? 48 ??????? ??????????????????????????????
  ???

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???????????????????????????????

• ??????????
• ???????????????????
• ?????????????????
• ??????????????????????, ?????????????????????????,
  ???????????????????????????, ????????????????????
  ????????? ??????????????????????????????????????
  ?? steroid
• ??????????? Dicloxacillin
• Dose 250 mg qid ac 2 ???
• ???? 125 mg qid ac or 25-50 mg/kg/day 2
  ???

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???????????????????????

• ?????????????????????????????
• Amoxicillin/clavulonic acid (Augmentin)
• 375 mg tid pc or 625 mg bid pc 2 ???
• ???? 156 mg tid pc 2 ???

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• ????????????????????????????????????????????

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• ??????????????????????????????????????????????????
  ????????????????? 5.6
• ??????????????????????????????????????????????????
  ? Campylobacter jejuni ??? Shigella ????????
• ????????????????????????????????????????
• ??? 38ºC ?????? ???
• ??????????????????????????????????????????????????
  ??????????????????????????????

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??????????????????????

• Norfloxacin 400 mg bid ac 5 ???
• ????????????? 15-20 mg/kg/day bid ac 5 ???
• ??????????????????? Co-trimoxazole ???
  tetracycline ??????????? 10 ??????????????????
• ???????????????? ???? Activated charcoal
  ?????????????????? 1-2 ???? ????? 4 ?????

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• ?????????????????????????????????????????????????

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???????????????????????????

• ???????? ????????? ??????????? ??????? ????????
  ????? ???????????? ?????????????? ???????? ?????
• ???????????????????????????????????????????????

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???????????????????????

• ????????????????????????????? ????????????????????
  ? ?????????????????????? ?????????????
  ????????????????????????
• ?????????????????? Group A Beta hemolytic
  Streptococcus

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Viral pharyngitis
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????????????????

• Penicillin V
• 500 mg tid ac 10 ???
• ???? 250 mg tid ac 10 ???
• Amoxicillin
• 500 mg tid pc 10-14 ???
• ???? 25-50 mg/kg/day tid ac 10-14 ???
• Roxithromycin
• 150 mg bid pc or 300 mg od pc 10-14 ???
• ???? 100 mg bid pc 10-14 ??? ???????
  Erythromycin 30-50 mg/kg/day qid ac

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