你們在看診的時候有沒有和畜主說: "放心, 我們會用最好的抗生素." 又或者說: "我們會用很強的抗生素去殺菌." 有時候為了讓客人安心, 再加上一些客人對抗生素的了解不足, 這樣的說話還未至於太差.
然而, 某天我看完一個診後, 問一名見習生:"為甚麼我要用這種抗生素?"
殊不知來的回答是:"因為這個比較強啊."
每次聽到這種回答, 我一定會發飆的...那次我按下來, 就說:"抗生素沒有強弱, 只有有效和無效的分別."
唸書的時候, 又或醫院見習的時候, 很多時候都有做CULTURE & SENSITIVITY來決定該用甚麼抗生素. 然而, 問題是我們在等待CULTURE的時候, 該怎麼作EDUCATED GUESS, 決定先用甚麼抗生素, 還有除了CULTURE以外, 一般開業獸醫又有甚麼方法幫助自己去選擇適當的抗生素?
還有細菌培養屬IN VITRO TEST, 有時候還會愚弄獸醫做出錯誤的判定. 所以不要以為做了細菌培養就甚麼都OK, 就像做了SKIN BIOPSY, 也不代表診斷正確, 可以正確無誤的下藥.
在這裡, 先問三個各位最常遇到的問題 - 當各位遇到皮膚感染, 皮膚創傷, 和上呼吸道感染的時候, 會選擇用甚麼抗生素? 為甚麼?
(待續)
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普通科臨床獸醫的養成計劃
追蹤者
網誌清單
參考網站
- American Academy of Veterinary Dermatology
- Animal Diseases Database
- Armed Forces Institute if Pathology
- DVM 360 Newsmagazine
- The CUSP - Veterinary Dentistry
- The Veterinarian - Magazine from Australasia
- The Veterinary Acupuncture Page
- Vet Students Abroad
- Veterinary Radiology - teaching and learning about veterinary diagnostic imaging
- VetGo Cardiology
參考書目
- A Colour Handbook of Skin Diseases in the Dog and Cat: A Problem-oriented Approach to Diagnosis and Management
- A Guide to Canine and Feline Orthopaedic Surgery
- Abdominal Radiology for the Small Animal Practitioner
- Allen's Fertility & Obstetrics in the Dog
- An Atlas of Surgical Approaches to the Bones and Joints of the Dog and Cat
- Atlas of Small Animal Reconstructive Surgery
- Basic & Clinical Pharmacology
- Blackwell's Five-Minute Veterinary Consult Clinical Companion Small Animal Dentistry
- Brinker, Piermattei and Flo's Handbook of Small Animal Orthopedics and Fracture Repair
- BSAVA Manual of Small Animal Ophthalmology
- Canine Medicine and Therapeutics
- Cardiorespiratory Diseases of the Dog and Cat
- Clinical Textbook for Veterinary Technicians
- Clinical Veterinary Advisor: Dogs and Cats
- Color Atlas of Dermatopathology
- Color Atlas of Veterinary Histology
- Color Atlas of Veterinary Pathology: General Morphological Reactions of Organs and Tissues
- Colour Atlas of Clinical Anatomy of the Dog and Cat
- Consultations in Feline Internal Medicine
- Current Techniques in Small Animal Surgery
- Dellmann's Textbook of Veterinary Histology
- Dermatology for the Small Animal Practitioner
- Dermatology: 2-Volume Set
- Diagnostic Atlas of Veterinary Ophthalmology
- Diagnostic Cytology and Hematology of the Dog and Cat
- Diagnostic Radiology and Ultrasonography of the Dog and Cat
- Diagnostic Ultrasound in the Dog and Cat
- Duncan and Prasse's Veterinary Laboratory Medicine: Clinical Pathology
- Ear Diseases of the Dog and Cat
- Ear, Nose, Throat and Tracheobronchial Diseases in Dogs and Cats
- ECG for the Small Animal Practitioner
- Emergency Procedures for the Small Animal Veterinarian
- Essentials of Veterinary Ophthalmology
- Exotic Animal Formulary
- Ferrets, Rabbits and Rodents: Clinical Medicine and Surgery
- Five-Minute Veterinary Consult: Canine and Feline
- Guide to the Dissection of the Dog
- Lumb & Jones' Veterinary Anesthesia and Analgesia
- Manual of Clinical Procedures in the Dog, Cat, & Rabbit
- Manual of Small Animal Internal Medicine
- Muller and Kirk's Small Animal Dermatology
- Neurology for the Small Animal Practitioner
- Ophthalmology for the Veterinary Practitioner
- Plumb's Veterinary Drug Handbook
- Pocket Companion to Veterinary Medicine
- Practical Diagnostic Imaging for the Veterinary Technician
- Practical Small Animal Internal Medicine
- Practical Transfusion Medicine for the Small Animal Practitioner
- Practical Veterinary Dermatopathology for the Small Animal Clinician
- Problem-Based Feline Medicine
- Reptile Medicine and Surgery
- Review of Medical Physiology
- Roitt's Essential Immunology
- Saunders Handbook of Veterinary Drugs
- Skin Diseases of Exotic Pets
- Small Animal Cardiovascular Medicine
- Small Animal Dermatology: A Color Atlas and Therapeutic Guide
- Small Animal Diagnostic Ultrasound
- Small Animal Ear Diseases: An Illustrated Guide
- Small Animal Internal Medicine
- Small Animal Oncology
- Small Animal Physical Diagnosis and Clinical Procedures
- Small Animal Surgery
- Small Animal Toxicology
- Textbook of Medical Physiology
- Textbook of Rabbit Medicine
- Textbook of Small Animal Medicine
- Textbook of Veterinary Anatomy
- Textbook of Veterinary Diagnostic Radiology
- The 5-Minute Veterinary Consult Clinical Companion: Small Animal Dermatology
- The Feline Patient
- The Merck Veterinary Manual
- The Merck Veterinary Manual
- The The Only EKG Book You'll Ever Need
- The Veterinary Formulary
- Thoracic Radiology for the Small Animal Practitioner
- Two Dimensional and M-Mode Echocardiography: For the Small Animal Practitioner
- Veterinary Clinical Examination and Diagnosis
- Veterinary Emergency and Critical Care Procedures
- Veterinary Emergency Critical Care Manual
- Veterinary Medicine: A textbook of the diseases of cattle, horses, sheep, pigs and goats
- Veterinary Ophthalmology
- Veterinary Parasitology: Reference Manual
- Veterinary Pharmacology and Therapeutics
- Veterinary Technician's Daily Reference Guide
- Withrow and MacEwen's Small Animal Clinical Oncology
- Zoonoses and Communicable Diseases Common to Man and Animals
- Zoonoses: Recognition, Control, and Prevention
4 則留言:
上次提到, 遇到皮膚感染, 皮膚創傷, 和上呼吸道感染的時候, 會選擇用甚麼抗生素? 為甚麼?
其實其中一題, 是我剛畢業回來, 找第一份臨床工作的面試題目. 當時我回答得很”鳥”…
某診所老闆: What antibiotics would you prefer in respiratory infection?
我: I’d like to choose antibiotics according to culture and sensitivity result.
某診所老闆: You need at least several days for pending culture and sensitivity. What’s your empirical choice?
我: Hmm…Errr….Amoxicillin or baytril®.
某診所老闆: Why?
我: I remembered that many clinicians in VTH use baytril when pending culture report. And the clinical outcomes aren’t bad.
某診所老闆: Okay. Anyway, if you can’t persuade yourself why this antibiotics work, how could you explain to the client and show confident that your treatment is on the right path? I hope you have to spend some time to take a look on the use of antibiotics in any drug handbooks or medical text.
後來自己進入臨床行列的第一天, 就拿了一本舊版的Antimicrobial Therapy in Veterinary Medicine來, 把各系統的EMPIRICAL CHOICE都摘錄出來, 然後沒多久就去看診應用. 隨著經驗和知識的增長, 不斷的發現自己每天都會開的藥物 – 抗生素, 原來一直都用得那麼爛. 藥理教科書上寫的PK/PD, PAE, SPECTRUM OF ACTIVITY; 甚至HALF LIFE和METABOLISM, 全部都和我們選擇的抗生素有關. 做得越久, 看的書反而是藥理, 生理, 解剖, 病理的書;
真是少壯不努力, 老大徒傷悲! 有點後悔以前常蹺課…
還沒有人回應, 多等一天吧….
學長你好 我想要請問你有關臨床上選用抗生素的相關知識有推薦甚麼書嘛?? 很想要和學長討論但其實我一點知識也沒有 希望學長可以給一些建議(皮膚可以給cephalosporin累的藥物嗎??因為感覺大多是G+ 然後好像此類藥物在皮膚的濃度也不錯)
其實很多參考資料..
如果你有買彩內的話,可以看CHAPTER 98 PRACTICAL ANTIMICROBIAL CHEMOTHERAPY, 這一章可以給你一點指引.
然後藥理的書也能給你們基礎的知識!
:P
好耶哈哈學弟不才用印得所以沒仔細看 謝謝!
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