tailieunhanh - Otolaryngolog Head and Neck Surgery - part 6

Chloramphenicol và sulfonamides (bao gồm trimethoprim-sulfamethoxazole) có thể gây tán huyết ở những bệnh nhân với thiếu hụt glucose-6-phosphate dehydrogenase, một hệ thống men gan là chưa trưởng thành trong bào thai và trẻ sơ sinh. Vì vậy, sulfonamides cho gần hạn có thể đóng góp vào sự phát triển của vàng da | Tetracycline can cause inhibition of fetal bone growth congenital limb abnormalities cataracts and staining and hypoplasia of the baby teeth when administered during pregnancy. Chloramphenicol and sulfonamides including trimethoprim-sulfamethoxazole can cause hemolysis in patients with deficiency of glucose-6-phosphate dehydrogenase a liver enzyme system that is immature in the fetus and newborn. Therefore sulfonamides given near term may contribute to development of kernicterus of the newborn and chloramphenicol used in high doses or in premature infants can produce death with the gray baby syndrome. The aminoglycosides such as gentamicin may cause fetal neural arch and renal abnormalities when given early in pregnancy and nephro ototoxicity when given late in pregnancy. The estolate preparation of erythromycin offers a higher risk of hepatitis in pregnant women. Griseofulvin and rifampin are teratogenic in rodents. Section of Drugs for Intracranial Infections DIFFUSION OF ANTIMICROBIALS INTO THE CEREBROSPINAL FLUID Excellent with or without inflammation of meninges Good only with inflammation of meninges Minimal nil or unpredictable Chloramphenicol Metronidazole Rifampin Sulfonamides Trimethoprim-sulfa Ampicillin Aztreonam Cefepime Cefotaxime Ceftazidime Ceftriaxone Cefuroxime Ciprofloxacin Fluconazole flucytosine Gatifloxacin Imipenem seizure risk Levofloxacin Meropenem Nafcillin Penicillin G high doses Piperacillin Ticarcillin Timentin Amikacin Amphotericin B Benzathine penicillin Cefazolin Cefoxitin Erythro clarithro azithromycin Gentamicin Imipenem Moxifloxacin Polymyxins Tetracyclines Tobramycin Vancomycin high doses Insufficient for pseudomonas. Good only if protein is high therefore not predictable. In bacterial meningitis prompt treatment is essential and antimicrobial drugs should not be withheld until laboratory studies are completed. Dexamethasone is also indicated. The organisms most commonly encountered are H. influenzae S. pneumoniae