OI

,
' ,

2009

:
& ( )
18 . . ,
. 210 6603400 fax 210 6039956 http://www.ifet.gr e-mail: publications@ifet.gr
:


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, ,

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.

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, , .
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.

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6
6
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14
18
18
20
24
26
28
30

- -
-

30
31
32
33

34

35
35
36

38

40

38
39

,
(.. , ):
.

, ,
:


.

V, 1.5 . iu
6-8 x 10 po
(
)
. 10
.
500mg/12 x 10 po
.
150mg/12 x 10 po
.
500mg/24 x 5 po
1g/24 x 3 po
v.
600mg/8 x 10 po
v.
500mg x 24 x 10 po

1. < 15% - . > 80% .

2.
.. Strept test ( ). V po,

.
6

3. Centor,
: ) , ) , )
, ) ,
:
( ),
. Strept test.
4. .
5. , ,
.
6. po 5 ( 10)
(evidence based) .
7. po
-
.. + (625mg x 3 1000mg x 3) (600mg x 3) .
8. ,

( V, ), po (600mg x 3) +
(1000mg x 3) +
(375mg x 3). .
9.
Sccharomyces bulardii po
(Ultralevure 500mg x 3 po)
.
10. -
30%.
7

( ) CT .

> 38C

( 4 )

1g x 3po
. 8

500mg x 2 po

500mg / 24 5 . po
1 g / 24 3 . po

150mg x 2 po

600mg x 3 po

500mg / 24 po
:
K 1g x 3po
500mg x 2po
500mg x 2po

400mg x 2po

100mg x 2 po
,
( 400 mg x 1
po 750 mg
x 1 po)
x 10
8

(, ,
, )
7

( 5-12
)

(1-4
> 4 / )

(> 12 )

C/T

+
1000 mg x 3 po

:
500mg x 2po
600mg x 3po

x 4-6

( )

1. . ,
, , 7 , .
2.
.
3.
.
4. ()
.
5.

.
6. ( )
, ,
.
7. ( ) .
8.
(>30%)
.

O
1 g x 3po
+ 625
mg x 3po ( 1000 mg x 3 po)
' po (
)
500 mg x 2. 8

A 500 mg/24. 8

1. .
2. ( 30 mg/kg/8 po)
3. 10 ( 6).
4. : Streprococcus pneumoniae, Haemophilus influenzae,
Moraxella catarrhalis.
5. (I)
, (II)
.
6.
Pseudomonas aeruginosa
( ).
7. ( ) po ' (),

in vitro.
8.
(>30%)
.
10

()
[Global
Initiative for Chronic Obstructive Lung Disease (GOLD) 2006]

FEV1/FVC < 0,70
FEV1 80% predicted

M (moderate)
FEV1/FVC < 0,70
50% FEV1 < 80% predicted

(severe)
FEV1/FVC < 0,70
30% FEV1 < 50% predicted

(very severe)
FEV1 < 30% predicted
FEV1 < 50% predicted +

11

1. , / XA,

(GOLD 2006).
2. H 3
Anthonisen, , ,
. E ,

(Anthonisen NR et al, Ann Intern Med 1987; 106: 196204). .
3. :
(30-50%), (40-50%)
(5-10%)
4. ,
: Streptococcus pneumoniae, Haemophilus spp, Moraxella
catarrhalis
5. Pseudomonas spp
: B, FEV1 <35%, ME, , .
6.
3 , ,

.
7. H 7 .
8. H
, . , , (GOLD II, updated 2006).
9.

12

1g/ 6 po

/ 1g/ 8 po

500 mg/ 12 po

500 mg/ 12 po

400 mg/ 12 po

100 mg/ 12 po

750 mg/ 24 po

400 mg/ 24 po

750 mg/ 12 po (
Pseudomonas spp)

, -,

(>40%)

13

'

.


3

(1g/6 po)

Mycoplasma
pneumoniae Chlamydia pneumoniae

500 mg/24 po 500 mg/12 po 1000 mg/24 po (2 500 mg ).

3.
3, ( 750 mg/24 po 400 mg/24 po),
3 ( ).

14

7-10 .

'

.

, 3
, , ,
,

,
(1g/6 po)

+
M

/
/
' +

500 mg/24 po 500 mg/12 po 1000 mg/24 po (2 500 mg )

500 mg/12 po.

3.

750 mg/24 po 400 mg/24 po

(12 g)
15

1. 7-10 5 0,5 g/24 po

3 1 g/24 po
2. :
Streptococcus pneumoniae
Mycoplasma pneumoniae
Haemophilus influenzae
Chlamydia pneumoniae
Moraxella catarrhalis
Legionella spp ( )
(, , , , , .. )
Staphylococcus aureus (
: )
I [ , (RSV)]
3. (-)
in vitro , ,
.
' , Streptococcus pneumoniae (MIC > 4 g/ml)
. (
shock) -

(MIC >4g/ml) - 3.

16

CURB-65

>40 mg/dl
A 30/min
< 90 mmHg 60 mmHg
65

01

1

(1,5%)

2

(9,2%)

3

(22%)

'

,
4 5

, . CURB-65
(Confusion, lood Urea, Respiratory rate, Blood pressure)
65 . , '
.
.

(8), .
17

OIMEI OYPOTIKOY
.

:
2-3

E 6

,

:
3

N
(N 400mg x 2po O
200mg x 2po 250mg x 2 po)
T- (960mg x 2 po)
( )

:
7

A (1g x 3 po) ( )
N (100mg x 3 po)
(' ' )

A

A

18

.
O
M
K
: / , ,
,
< 60
,

E A (
3-5 ):
- 240mg/24
- N 300mg/24
- T 240mg/24
- A 1000mg/24

E K
:
K 1g x 3
K 750mg x 2
K 1g x 2
K 1g x 3

po (750mg x 2)

A .

po .
19

.

K
E 3

E
3
6,

A
(, , ):

A
(, , ):

1. Y
( 2 6 3 ' )
) (> 95% )
K :T- x 3 x 7 (
).
20

: E
sex, sex-
(.. 50mg 240mg - sex).
E 6:
6-12 50mg/
24, - 240-480mg/
24, 200mg/24 100 mg/
24 125 mg/24 (
) .
) (>95% )
:
-, , ,
A : 14 . 12

: 6 . 12
.
2. O
: 10 ( po
). , .
3. X
E . K 12 24 . T 4-6
( : -, ).
4. A (
)
A:

Y - ()
()
E -
21

( - )
E :
2-3 . E ,
.
5. E
K: B 5 po .
/15.
E .
E (50mg/24) (500mg/24).
Y: O .
: .
B-: E 3 . E 23 -
(S.O.S >3 ).
A : X (3) .
Foley ( ).
H
Foley ( ) .
: 24-48 ( ). 3-5 ( 7 ).
6. K :

1. A ( )
2. M
3. N
4. T- ( )
22

5. K (, ) (
)
6. A + +
7. K (, , -, , )
8. -T-N-A
9. (--).
.
10. K ()

H .

23

KOITI

Candida albicans

Trichomonas vaginalis

(Gardnerella vaginalis)

X



E

p < 4,5

K, ,

p > 4,5

M
2 g
500mg/12 po
7

O


'
p > 4,5

500 mg/12 po 7 .

300 mg/12 po 7 .

( 4 /)

400 mg/
12 po 5 .

200 mg/12 po 1 .
200 mg/24 po 3.

200mg po
24

gel
5 .,

7 .

3 .

1.

2.

3.

4.

5.

6.

7.

9.

T Gram- (.. Escherichia coli, Proteus spp, Klebsiella

spp, Pseudomonas spp)
.
E Trichomonas vaginalis,

.A
Candida albicans ( ), .
(i) Gram , (ii)
clue cells Gram ( Gram ).
: Gardnerella vaginalis (90%) Prevotella sp, Mycoplasma sp, Bacteroides sp >40
(250
mg/8 po 7 ) (300 mg/12 po 7 )
( )
.
, ,
.

, , .

, 14
po + 150 mg 6 + Candida [..
Candida glabrata
.
(600 mg/24 x 6 ) ( - 2004)].
: , , Candida non albicans,
(.. , )
, Chlamydia,
Neisseria gonorrhoea, HPV HSV.
E ( / ).
25

OYPHPITI

M-

1. Chlamydia trachomatis
2. Ureaplasma urealyticum
X

Gram(-)

Gram

X


Gram
(>5)

K
125mg
K
500mg im
K
400mg po

2g im

100mg
x 2 po x 7
M

N 7

500mg po

400mg po

250mg po
A

100mg x 2po x 7
1g po
( X
/ O)
26

500mg x 4po x 7
K
500mg x 2po x 7
P
150mg x 2po x 7
A
1g po

(, , ) x 7

1. T Gram- (.. K, , K, )
.
2. E

3. O Chlamydia trachomatis .
4. , ,
.
HIV .
5. E
3-7 .
6. E ,
.
7.
.
8.
.

27

POTATITI

Y
-
-

Stamey-Meares

(Escherichia coli)

M
(X O)

T-
(960mg x 2 per os)
K
N
400mg x 2

500mg x 2
O
200mg x 2

500mg po x 1

4-6
28

100mg x 2
K
500mg x 2
K
4-6

E

(3-5 )



(.. )



Stamey-Meares
( 1)

(
)

H1

1. International Prostatitis Colaborative Network, 4

:
: . .
: .

.
: . :
EPS VB3
, :
EPS VB3.
.
IV: .
/ , ,
EPS VB3, . ( ..
Ca ) .
2. E .
3. E .
E 1: Stamey-Mears
VB2
K

(~200ml)

(10ml)

OYPHPA

EPS

VB1

(10ml)

VB3

(10ml)

VB1=Voided Bladder 1, VB2= Voided Bladder 2, EPS=Expressed Prostate Secretions,

VB3= Voided Bladder 3 ( )

: EPS / VB3 > VB2 VB1

1 log .
29

- -
: Staphylococcus aureus

(
1g 3po)
500mg 3po
600mg 3po

1.
2. Staphylococcus aureus, . S.aureus :
. Mupirocin 7 (2-3 / 24)
.
.

().
3.
(. )
5-14 ).
30

-
()
()
: - , C G
Staphylococcus aureus ( 10%)

V ( ) 1.5 ui 4po
+
625mg 3po ( 1000 mg x
3 po)
600mg 3 po
( 4)
150mg 2po
500mg 2po
500mg/24
250mg 2 po
: 10
(
).

(Penadur) 2.4-3.6 .
ui IM [1.2-1.8 . ui
] 3

( > 12-18 )].
:
V 1,5 . iu po,
12
( )
12-18
( 3)

1. ,
(.. , ),
(.. ) IV.
E .
2. - .
3. (, , ) MRSA MRSA.
4.
- .
31

-
A (90%)

Staphylococcus aureus (10%)

K
: ( ):
(B ).
(10 )

V M po
(B )

A +
625mg x 3po
A +
375mg x 3po
K 600mg x 3po

A , ,
.
32

(Flesh eating disease)
K

: -
(super-antigens).
S.O.S. , , . shock ( 80-100%)

:
X
G + IV
V 400 mg / kg / 24 x 5

1.
, , Staphylococcus aureus.
2.
,



,
( )
3. .
33

OIMEI AO HMATA ANPN KAI ZN

(
)
A + 1 g x 3po x 7
E
400mg x 1 po T + M
O A T
I T

Td
TIG

T
Td
TIG

OXI

OXI

OXI

< 3

NAI

NAI

NAI

OXI

E 5 .
E 10 .
T (<6 ), , , .
Td: - .
TIG: .

1. T
.
2. Y .T Pasteurella multocida (
), Staphylococcus aureus, Streptococcus spp. Capnocytophaga
spp. [Gram (+) , Fusobacterium spp.
Gram (-) ].
3. O (
24) H2O2
.
4. T

.
34



. : Staphylococcus aureus, Streptococcus spp, Staphyloccus epidermidis.
IV Pseudomonas aeruginosa
Salmonella sp
,TKE, CRP,
3 CT MRI

99mTc-MDP

(
)

(-)

(-)

6 ( 1)

CRP

35

TKE, CRP , CT, MRI

3
99Tc - MDP

(>3)
.
. 3
.
: ,
, , ,
.
, (. 15).

1:

/ (960mg/12 po)
(600mg/8 po)
( )
1g/8 po
Na (500mg/8 po).

[900mg (600+300)/24 po]. 2
.

36

1. H .
-
2. H o
.

37

IAPPOKO

(Turista)

(
)

Clostridium
difficile ( Elisa)

Escherichia coli

960mg x 2 po
:

500mg x 2po
O
200mg x 2po
N
400mg x 2po

(. 2)

M
500mg x 3po

:
B
125mg x 4po
x 8

x 3

1. E

po (
).
38

YNPOMO
( 4 )
Y

()

Campylobacter
spp ( 3)

(. 2,3)

1.
2. A
HIV
3. M

HIV (+)
.

1. E :
K
K
Isospora belli
M
2.
( )
3.
4. CMV

2. E (1)
, (2) , (3) , (4) , (5) < 60
, ,
K po
. E
+
:
- T- 960mg x 2po x 10
( ) :
- 750mg x 2po x 10
- O 200mg x 2po x 10.
3. E. coli 0157:7 . Campylobacter spp

39

BPOYKEH
A. O
( )
1.
100mg/12 6 po
+

0.5mg/12 im x 3
( 3
)

2.
100mg/12 po
+
P
600mg/12 po x 6

B. M

O
1. 100mg/12 po
+
2. P 600mg/12 po
+
3. T- 960mg/8 po

4-6
E


( T +
IV)



.
O
:
, 6-12

1.

E Wright Wright-Coombs

!

2. O - , ( 3 ).
40

3. H
( )
, 70-90%
> 60%
.
4. H
, . H ( , ),
(99mTc 67Ga citrate)

5. : 400mg/12 po,
750mg 1g/12 po.

41

, (, , , ,
, , )

7
(
)
( , )
(
, )
90% (strep test )
( <10
, , )
,
,

(.. ).
(.. E. coli,
Enterococcus, lebsiella )

:
, :
1)
55
2) 55
3)
4)
.

............................................
42


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