主旨：臨床病理科微生物組最新整理抗生素可比照藥物通則，請參考。
說明：
一、 由於抗生素種類多，本科微生物檢驗室無法每一種藥物都測試，特別整理相近可比照的藥物使用通則如下：
For Gm(-) bacilli
Imipenem susceptibility may be used to predict the susceptibility to meropenem.
 
For Enterobactericeae
a、 Strains of Klebsiella pnenumoniae–ESBL, Klebsiella oxytoca–ESBL and E.coli-ESBL may be clinically non-responsive to therapy with penicillins, cephalosporins, or aztreonam, despite of in vitro susceptibility to some of these agents.
b、 For Salmonella spp. and Shigella spp., first- and second-generation cephalosporins are not effective clinically and should not be used.
c、 Enterobacter, Citrobacter, and Serratia may develop antibiotic resistance during therapy with third-generation cephalosporins for more than one week. Therefore, consultation of Infectious Disease specialists is recommended while treating these cases without satisfactory response.
d、 Ceftriaxone susceptibility may be used to predict the susceptibility to cefotaxime (Claforan), and flomoxef (Flumarin).
 
For Staphylococcus spp.
a、 Oxacillin-susceptible staphylococci are also susceptible to other beta-lactam antibiotics, including cefazolin, cephradine, and carbapenams (imepenem or meropenem).
b、 Oxacillin-resistant staphylococci are resistant to all currently available beta-lactams, includes all penicillins, cephems (such as 1st, 2nd and 3rd generation cephalosporins, e.g., cefazolin, ceftriaxone etc.), and beta-lactam and beta-lactam inhibitor combination (such as amoxicillin/clavulanic acid, ampicillin/sulbactam, and pipreacillin/tazobactam etc.).
 

For Enterococcus spp.

a、 Cephalosporins, aminoglycosides (except for high-level resistance screening), clindamycin, and trimethoprim/sulfamethoxazole may appear active in vitro but are not effective clinically.
b、 The "susceptible" category for penicillin or ampicillin implies the need for high-dose therapy for serious enterococcal infections. Enterococcal endocarditis requires combined therapy with high-dose penicillin or high-dose ampicillin, or vancomycin or teicoplanin plus gentamicin or streptomycin for bactericidal action.
c、 Synergy between ampicillin, penicillin, or vancomycin and an aminoglycoside can be predicted for enterococci by using a high-level aminoglycoside (gentamicin and streptomycin) screening test.
d、 Penicillin susceptibility may be used to predict the susceptibility to ampicillin, amoxicillin, ampicillin/sulbactam, amoxicillin/clavulanic acid, piperacillin, piperacillin/tazobactam.
 
For Haemophilus spp.
　 The results of ampicillin susceptibility tests should be used to predict the activity of amoxicillin.
 
For S pneumomiae
Susceptible to penicillin can be considered susceptible to ampicillin, amoxicillin, amoxicillin/ clavulanic acid, ampicillin/sulbactam, cefazolin, cefaclor, cefepime, cefixime, cefotaxime, ceftibuten, ceftriaxone, cefuroxime, imipenem, and meropenem.

If the susceptibility to penicillin is “I” (intermediate), cefazolin and cefuroxime are not recommended as their minimal inhibitory concentrations (MICs) are highly probable to be resistant. Ceftriaxone (or cefotaxime) or high dose of amoxicillin or penicillin should be considered. (適用於sputum and BAL isolates)

 
For Streptococcus spp.
Isolate that is susceptible to penicillin can be considered susceptible to ampicillin, amoxicillin, amoxicillin/clavulanic acid, ampicillin/sulbactam, cefazolin, cefepime, cefotaxime, ceftibuten (Group A streptococci only), ceftriaxone, cefuroxime, cephradine, imipenem, and meropenem for approved indications.
 
二、 若有其他有關微生物組藥物感受性試驗問題，請與本科顧問醫師李明勳(PHS：2490)聯絡。