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μâ“π®ÿ≈™’扥â√—∫°“√¢π“ππ“¡«à“ ç¬“ª“Ø‘À“√‘¬åé (miracle drug À√◊Õ wonder drug) ‡π◊ËÕß®“°‡ªìπ¬“∑’Ë∑”„Àâ¡πÿ…¬å®”π«π

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μâ“π®ÿ≈™’æ∑’Ë¡’ª√– ‘∑∏‘º≈¥’·≈–ª≈Õ¥¿—¬„π°“√√—°…“‚√§μ‘¥

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Carbapenem-Resistant Enterobacteriaceae, Extreme Drug-Resistant Pseudomonas aeruginosa, Extreme Drug-Resistant Acinetobacter baumannii

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μâ“π®ÿ≈™’æ°Á “¡“√∂™—°π”‡™◊ÈÕ‡À≈à“π—Èπ„Àâ¥◊ÈÕ¬“μâ“π®ÿ≈™’扥â

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®“°‰«√—  √–¬–‡«≈“¢Õß°“√„™â¬“μâ“π®ÿ≈™’æ —ÈπÀ√◊Õπ“π‡°‘π‰ª)

√«¡∑—Èß°“√„™â¬“μâ“π®ÿ≈™’æ„π°‘®°√√¡Õ◊ËππÕ°‡Àπ◊Õ®“°°“√

√—°…“‚√§„π¡πÿ…¬å (‡™àπ °“√„™â¬“μâ“π®ÿ≈™’æ„π —μ«å‡æ◊ËÕ‡æ‘Ë¡

°“√‡®√‘≠‡μ‘∫‚μ¢Õß —μ«å) °Á∑”„À⇙◊ÈÕ¥◊ÈÕ¬“μâ“π®ÿ≈™’æÕ¬à“ß

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penicillin ·μà‡™◊ÈÕ°Áæ—≤π“®π¥◊ÈÕ penicillin ¥â«¬°“√ √â“ß

‡ÕÁπ‰´¡å beta-lactamase ¡“∑”≈“¬ penicillin ®÷ß¡’¬“μâ“π

®ÿ≈™’æ∑’Ë∑πμàÕ beta-lactamase ‰¥â (‡™àπ cloxacillin) ‡™◊ÈÕ°Á æ—≤π“ºπ—߇´≈å„Àâ®—∫°—∫¬“‡À≈à“π’ȉ«â®π¬“‡À≈à“π’ȉ¡à “¡“√∂

ÕÕ°ƒ∑∏‘ω¥â °≈“¬‡ªìπ‡™◊ÈÕ Methicillin-Resistant S.aureus (MRSA) ®÷ß¡’¬“μâ“π®ÿ≈™’æ∑’Ë¡’°≈‰°°“√ÕÕ°ƒ∑∏‘Ï∑’ˇª≈’Ë¬π‰ª (‡™àπ vancomycin) ‡™◊ÈÕ°Áæ—≤π“ à«π∑’ˬ“ÕÕ°ƒ∑∏‘Ï„Àâ∑π À√◊Õ¥◊ÈÕ¬“π’È °≈“¬‡ªìπ‡™◊ÈÕ Vancomycin-Intermediately- resistant S.aureus (VISA) ·≈– Vancomycin-Resistant S.aureus (VRSA)

Enterobacteriaceae (‡™àπ Escherichia coli ·≈–

Klebsiella pneumoniae) ‡ªìπ·∫§∑’‡√’¬°√—¡≈∫∑’Ë°àÕ‚√§μ‘¥

‡™◊ÈÕ‰¥â∫àÕ¬¡“° ‡™◊ÈÕ°≈ÿà¡π’ȇ§¬‰«μàÕ ampicillin ·≈– co- trimoxazole ‡¡◊ËÕÀ≈“¬ ‘∫ªï°àÕπ ‡¡◊ËÕ„™â¬“‡À≈à“π’È¡“°¢÷È𠇙◊ÈÕ

°≈ÿà¡π’È°Áæ—≤π“®π¥◊ÈÕ¬“¥—ß°≈à“« ®÷ß¡’¬“ ”À√—∫‡™◊ÈÕ∑’Ë¥◊ÈÕ¬“¥—ß

°≈à“« §◊Õ aminoglycosides, cephalosporins, fluoro- quinolones ®”π«πÀ≈“¬ ‘∫¢π“𠇙◊ÈÕ°≈ÿà¡π’È°Áæ—≤π“®π

¥◊ÈÕ¬“¥—ß°≈à“«Õ’° ®÷ß¡’¬“°≈ÿà¡ carbapenems ´÷Ë߉«μàÕ‡™◊ÈÕ∑’Ë

¥◊ÈÕ¬“∑—Èß “¡°≈ÿà¡¥—ß°≈à“« ‡™◊ÈÕ°≈ÿà¡π’È°Áæ—≤π“®π¥◊ÈÕ carba- penems ‡æ‘Ë¡¡“°¢÷Èπμ—Èß·μà æ.». ÚııÚ

·∫§∑’‡√’¬¥◊ÈÕ¬“μâ“π®ÿ≈™’æ∑’Ë ”§—≠·≈–æ∫∫àÕ¬„π ª√–‡∑»‰∑¬ ‰¥â·°à

°. ·∫§∑’‡√’¬°àÕ‚√§μ‘¥‡™◊ÈÕ„π™ÿ¡™π (community-ac- quired infections) §◊Õ S.aureus, Streptococcus pneumoniae, Neisseria gonorrheae, Salmonella spp., Shigella spp., Campylobacter spp., Enterobacteriaceae, Mycobacterium tuberculosis

¢. ·∫§∑’‡√’¬°àÕ‚√§μ‘¥‡™◊ÈÕ„π‚√ß欓∫“≈ (hospital-ac- quired infections) §◊Õ MRSA, Vancomycin-Resistant Enterococci (VRE), Extended Spectrum Beta- Lactamase (ESBL)-producing Enterobacteriaceae, Carbapenem-Resistant P. aeruginosa, Carbapenem- Resistant A.baumannii

¢π“¥¢Õߪí≠À“·≈–§«“¡ ”§—≠¢Õß°“√¥◊ÈÕ¬“μâ“π

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‚√§μ‘¥‡™◊ÈÕ∑’ˇ°‘¥„π™ÿ¡™π °≈à“«§◊Õ‚√§μ‘¥‡™◊ÈÕ∑’ˇ°‘¥„π‚√ß æ¬“∫“≈¡’§«“¡™ÿ°‡©≈’ˬ¢Õ߇™◊ÈÕ¥◊ÈÕ¬“μâ“π®ÿ≈™’æÀ≈“¬¢π“π

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302

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¥—ß°≈à“« ‡™à𠬓°≈ÿà¡ polymyxins (colistin, polymyxin B)

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μâ“π®ÿ≈™’æ°≈ÿà¡ beta-lactams ‚¥¬À¬¥‡¢â“À≈Õ¥‡≈◊Õ¥¥”π“π Ù ™—Ë«‚¡ßÀ√◊Õμ≈Õ¥‡«≈“ Õ“®¡’ª√– ‘∑∏‘º≈„π°“√√—°…“‚√§

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‡æ’¬ßæÕ ‡™àπ °“√©’¥¬“°≈ÿà¡ polymyxins ‡¢â“™àÕ߇¬◊ËÕÀÿâ¡

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Ò.Ú °“√√—°…“Õ◊Ëπ

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§. °“√„™â “√™’«¿“æ ‡™àπ probiotics „πºŸâªÉ«¬

Clostridium difficile associated colitis

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®ÿ≈™’æ ‚¥¬‡©æ“–Õ¬à“߬‘Ëß„π ∂“π°“√≥å¢Õß°“√√–∫“¥¢Õß

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√“¬ß“πºŸâ‡°’ˬ«¢âÕß∑—π∑’∑’Ëæ∫‡π◊ËÕß®“°‡™◊ÈÕ‡À≈à“π’È¡’¬“∑’Ë„™â

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 ∂“π欓∫“≈·≈–Àπ૬ߓπ∑’ˇ°’ˬ«¢âÕߧ«√æ—≤π“

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ªØ‘∫—μ‘ (Clinical Practice Guidelines) °“√μ√«® Õ∫

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¬“μâ“π®ÿ≈™’æ¡’®”Àπà“¬πÕ° ∂“π欓∫“≈ (‡™àπ

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(‡™àπ «—§´’πªÑÕß°—π‚√§μ‘¥‡™◊ÈÕ S.pneumoniae) ‚√§μ‘¥‡™◊ÈÕ

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‡π◊ËÕß®“°‰¡à¡’¬“μâ“π®ÿ≈™’æ  à«π¬ÿ§¬“μâ“π®ÿ≈™’æ (Antibiotic Era) ‡™◊ÈÕ‚√§¡—°‰¡à¥◊ÈÕ¬“μâ“π®ÿ≈™’æ‚¥¬ºŸâμ‘¥‡™◊ÈÕÀ“¬®“°

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‡Õ° “√·≈–∞“π¢âÕ¡Ÿ≈ª√–°Õ∫

1. Infectious Diseases Society of America. Combating antimicrobial resistance: policy recommendations to save lives. Clin Infect Dis 2011;52 (Suppl 5):S397-428.

2. Carlet J, Collignon P, Goldmann D, Goossens H, Gyssens IC, Harbarth S, et al. Societyûs failure to protect a precious resource:

antibiotics. Lancet 2011;378:369-71.

3. Kollef MH, Golan Y, Micek ST, Shorr AF, Restrepo MI. Apprais- ing contemporary strategies to combat multidrug resistant gram- negative bacterial infections-proceedings and data from the gram- negative resistance summit. Clin Infect Dis 2011;53 (Suppl 2):

S33-55.

4. Wernli D, Haustein T, Conly J, Carmeli Y, Kickbusch I, Harbarth S. A call for action: the application of The International Health Regulations to the global threat of antimicrobial resistance. PLoS Med 2011;8(4):e1001022.

5. Peleg AY, Hooper DC. Hospital-acquired infections due to gram- negative bacteria. N Engl J Med 2010;362:1804-13.

6. World Health Organization. WHO global strategy for containment of antimicrobial resistance, 2001. http://www.who.int/csr/resources/

publications/drugresist/WHO_CDS_CSR_DRS_2001_ 2_EN/en/

7. WHO Regional Office for South-East Asia. Jaipur Declaration on Antimicrobial Resistance, 2011. http://www.searo.who.int/LinkFiles/

RC64_JD.pdf

8. World Health Organization. The evolving threat of antimicrobial resistance: Options for action. 2012. http://www.who.int/patientsafety/

implementation/amr/publication/en/

9. π‚¬∫“¬·Ààß™“μ‘¥â“𬓠æ.». ÚııÙ ·≈–¬ÿ∑∏»“ μ√å°“√æ—≤π“

√–∫∫¬“·Ààß™“μ‘ æ.». Úııı - Úıı˘. http://drug.fda.moph.go.th/

NDP/files/8th%20Proof%20Drug%202.pdf

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®–𔉪 Ÿà¬ÿ§À≈—߬“μâ“π®ÿ≈™’æ (Post-antibiotic Era) „π Õπ“§μÕ—π„°≈â §◊Õ ‡™◊ÈÕ‚√§¥◊ÈÕ¬“μâ“π®ÿ≈™’æ·∑∫∑ÿ°™π‘¥·≈–

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