抗菌薬の考え方、使い方　ver.5　コロナの時代の差異

出版社： 中外医学社
著者：
発行日： 2022-04-01
分野： 臨床医学：内科  >  感染症/AIDS
ISBN： 9784498117181
電子書籍版： 2022-04-01 （5版1刷）
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未曾有のコロナ禍を経て，名著『抗菌薬の考え方，使い方』が装いも新たに登場！
各種抗菌薬・抗真菌薬・抗ウイルス薬・抗結核薬・抗寄生虫薬の使い勝手をDr.岩田がジャッジしながら解説するというver.4までの構成を踏襲しつつ，変化し続ける抗菌薬のトレンドの変化もフォロー．抗菌薬の「本質」はどこにあるのか？　目の前の多様な患者に対してどのような根拠で何を目的に使うのか？　をひたすら丁寧に解説します．

目次

  • 【１】学生，研修生のみなさんに，まずはここだけおさえとけば大丈夫，の10の掟
    　　おきて (1)　患者の重症度を把握しよう
    　　おきて (2)　必要な培養検査を採り，グラム染色を依頼しよう
    　　おきて (3)　血液培養の採り方を知ろう．カテ先培養は原則禁忌
    　　おきて (4)　腎機能をチェックしよう
    　　おきて (5)　 使用中の薬は全部チェックしよう，検査は時系列でチェックしよう
    　　おきて (6)　アセスメントを立てよう
    　　おきて (7)　最初は広域抗菌薬　培養結果を見てde-escalation
    　　おきて (8)　抗菌薬が効いてない，と思ったら抗菌薬を変えない
    　　おきて (9)　患者が良くなっているか，悪くなっているか，どちらでもないのか確認しよう
    　　おきて (10)　失敗症例から学ぼう

    【2】感染症診断のコツ
    　　A　時間と空間

    【3】空間と身体診察
    　　A　リンパ節腫脹の考え方
    　　B　関節痛・関節炎の考え方
    　　C　皮疹の考え方
    　　D　陰性所見も大事

    【4】グラム染色を活用しよう
    　　A　まずPK から
    　　B　Vd とタンパク結合能
    　　C　PD とタイムキルカーブ，そして薬剤感受性
    　　D　殺菌か，静菌か

    【5】臨床的微生物の理解の方法
    　　A　Inoculum effect
    　　B　Eagle effect

    【6】コンタミとコロニーの違い

    【7】臨床薬理学を考える

    【8】Inoculum effect とイーグル効果

    【9】ポストアンティビオティック　エフェクト（PAE）

    【10】シナジー効果

    【11】時間依存性と濃度依存性
    　　A　濃度依存性の抗菌薬
    　　B　時間依存性の抗菌薬

    【12】MICの縦読みにはご用心
    　　A　MIC を気にしなければならない代表的な感染症
    　　B　ブドウ球菌
    　　C　その他

    【13】βラクタマーゼ
    　　A　ESBLs
    　　B　Amp C　βラクタマーゼ量が大事

    【14】カルバペネム耐性腸内細菌科（CRE）

    【15】ビギナーとの違いがビビッ．抗菌薬の使い方が上手になる中級編の10 のステップ
    　　ステップ (1)　ESBL 産生菌にはセフメタゾールを使おう
    　　ステップ (2)　抗菌薬の終わり方をイメージしよう
    　　ステップ (3)　経口第三世代セフェムを使うのは止めよう
    　　ステップ (4)　治療効果判定のためのグラム染色
    　　ステップ (5)　エスカレーションをマスターしよう
    　　ステップ (6)　患者のパラメーターに齟齬が生じたときの対応法を学ぼう
    　　ステップ (7)　抗菌薬が「効いてない」ときの対応法を学ぼう
    　　ステップ (8)　エコノミカルな抗菌薬を選ぼう
    　　ステップ (9)　ローカルファクターを活用しよう
    　　ステップ (10)　最良の抗菌薬を選ぼう．モナドロジーのすすめ

    【16】抗菌薬の「変え方」

    【17】治療期間の問題

    【18】ペニシリン　すべての基本はここにあり
    　　A　ペニシリンの作用とは？
    　　B　ペニシリンの薬理作用
    　　C　おそるべし，βラクタマーゼ
    　　D　ペニシリンの分類を試みる
    　　E　ペニシリンG（点滴薬）の使い方
    　　F　 ペニシリンG が第一選択となりやすい病原体（マニアックなもの含む）
    　　G　筋注用ペニシリン（特にbenzathine penicillin について）
    　　H　ペニシリン系抗菌薬の副作用
    　　I　アミノペニシリン
    　　J　緑膿菌に効果のあるペニシリン
    　　K　βラクタマーゼに対抗する

    【19】セファロスポリン　ほとんど誤用されてます（涙）．正しく使えば強力な武器！
    　　A　セファロスポリンの魔
    　　B　セファロスポリンの基礎
    　　C　黄色ブドウ球菌やレンサ球菌に使えるセファロスポリン
    　　D　肺炎球菌，尿路感染を狙うセファロスポリン
    　　E　第3 のグループ，セファマイシン（セフメタゾール）
    　　F　第4 のセファロスポリン ─ 緑膿菌をたたけ！
    　　G　胆道移行性？　セフォペラゾン・スルバクタムの立ち位置とは

    【20】カルバペネム・アズトレオナム
    　　A　カルバペネム
    　　B　アズトレオナム ─ 副作用の少ないアミノグリコシド？

    【21】スルファメトキサゾール・トリメトプリム（ST合剤）
    　　A　ST 合剤とは
    　　B　サルファ剤の副作用
    　　C　ST 合剤に対する耐性のメカニズム
    　　D　尿路感染
    　　E　呼吸器感染
    　　F　皮膚軟部組織感染症（SSTI）
    　　G　その他のグラム陰性菌感染症
    　　H　ST 合剤とHIV 感染
    　　I　ウィップル病
    　　J　類鼻疽

    【22】ダプソン

    【23】キノロン系抗菌薬　─ フルオロキノロン
    　　A　フルオロキノロンの構造と作用
    　　B　フルオロキノロンの使い方
    　　C　フルオロキノロンの絞り込みを試みる
    　　D　Trovan(R) の栄光と失墜

    【24】マクロライド系抗菌薬
    　　A　マクロライド
    　　B　クリンダマイシン

    【25】グリコペプチドとリポペプチド，その他の抗MRSA薬
    　　A　バンコマイシン
    　　B　テイコプラニン
    　　C　ダプトマイシン
    　　D　リネゾリド
    　　E　テジゾリド
    　　F　キヌプリスチン─ダルフォプリスチン
    　　G　Oritavancin
    　　H　Delafloxacin
    　　I　Telavancin
    　　J　Lefamulin

    【26】ムピロシン

    【27】アミノグリコシド
    　　A　アミノグリコシドの薬理学
    　　B　アミノグリコシドの使い方
    　　C　アミノグリコシドと毒性

    【28】テトラサイクリン

    【29】チゲサイクリン

    【30】クロラムフェニコール

    【31】メトロニダゾール
    　　A　メトロニダゾール
    　　B　チニダゾール（チニダゾール「F」）

    【32】ホスホマイシン・コリスチン
    　　A　ホスホマイシン
    　　B　コリスチン（ポリミキシン）
    　　C　リファキシミン

    【33】抗真菌薬
    　　A　アゾール
    　　B　アムホテリシンB
    　　C　エキノカンディン
    　　D　フルシトシン
    　　E　テルビナフィン
    　　F　Isavuconazole

    【34】抗ウイルス薬
    　　A　抗インフルエンザ薬どう使うかは，悩ましい
    　　B　サイトメガロウイルス治療薬
    　　C　単純ヘルペスウイルス・帯状疱疹ウイルス感染症の薬
    　　D　肝炎ウイルスの治療薬

    【35】抗結核薬
    　　A　さて，前置きはこのくらいにして本題に入りましょう
    　　B　ファーストラインの抗結核薬
    　　C　セカンドラインの抗結核薬
    　　D　困った合併症

    【36】寄生虫の治療薬
    　　A　マラリア
    　　B　赤痢アメーバ
    　　C　ジアルジア症（ランブル鞭毛虫症）
    　　D　クリプトスポリジウム症
    　　E　サイクロスポラ，イソスポラ症
    　　F　 アフリカトリパノソーマ症，アメリカトリパノソーマ症，リーシュマニア症
    　　G　自由生活アメーバ症
    　　H　吸虫症
    　　I　条虫症
    　　J　エキノコッカス症
    　　K　回虫症
    　　L　鉤虫症
    　　M　鞭虫症
    　　N　蟯虫症
    　　O　旋毛虫症
    　　P　糞線虫症
    　　Q　顎口虫症
    　　R　フィラリア症
    　　S　トキソプラズマ症
    　　T　疥癬

    【37】ひとつギアを上げた，抗菌薬の考え方，使い方
    　　A　出てる菌全部カバーするの？
    　　B　Blaz 陰性でde-escalation できるか
    　　C　グラム陰性菌のIE？
    　　D　キーワードをつなげても物語はできない

    【38】新型コロナウイルス感染の治療

    【BonusTruck1】MALDI-TOF，マルチプレックスPCR，そして新型コロナの時代の抗菌薬の考え方，使い方
    　　A　抗体療法と感染症
    　　B　COVID-19 に対する抗体療法
    　　C　その将来性と懸念材料

    【BonusTruck2】新型コロナウイルスと抗体カクテル療法
    　　A　抗体療法と感染症
    　　B　COVID-19に対する抗体療法
    　　C　その将来性と懸念材料

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本参考文献は電子書籍掲載内容を元にしております。

[1] 学生, 研修生のみなさんに, まずはここだけおさえとけば大丈夫, の10の掟

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[4] グラム染色を活用しよう

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[5] 臨床的微生物の理解の方法

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[7] 臨床薬理学を考える

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[8] Inoculum effectとイーグル効果

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[9] ポストアンティビオティック エフェクト ( PAE )

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[10] シナジー効果

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[11] 時間依存性と濃度依存性

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[12] MICの縦読みにはご用心

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[13] βラクタマーゼ

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[14] カルバペネム耐性腸内細菌科 ( CRE )

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[15] ビギナーとの違いがビビッ. 抗菌薬の使い方が上手になる中級編の10のステップ

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[16] 抗菌薬の「変え方」

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[17] 治療期間の問題

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[18] ペニシリン すべての基本はここにあり

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[19] セファロスポリン

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[20] カルバペネム・アズトレオナム

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[21] スルファメトキサゾール・トリメトプリム ( ST合剤 )

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[23] キノロン系抗菌薬 - フルオロキノロン

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[24] マクロライド系抗菌薬

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[25] グリコペプチドとリポペプチド, その他の抗MRSA薬

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[26] ムピロシン

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[27] アミノグリコシド

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[28] テトラサイクリン

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[29] チゲサイクリン

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[31] メトロニダゾール

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[32] ホスホマイシン・コリスチン

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[33] 抗真菌薬

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[34] 抗ウイルス薬

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[35] 抗結核薬

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[36] 寄生虫の治療薬

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[38] 新型コロナウイルス感染の治療

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[BT 1] MALDI - TOF, マルチプレックスPCR, そして新型コロナの時代の抗菌薬の考え方, 使い方

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[BT 2] 新型コロナウイルスと抗体カクテル療法

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