抗生素治疗布鲁氏菌病效果观察

目的:研究抗生素联合用药对布鲁氏菌病(布病)的治疗效果。方法:根据世界卫生组织(WHO)推荐的抗生素联合治疗方案"利福平+强力霉素"、"利福平+链霉素"对296例各期布病患者进行治疗,治疗结束后观察治疗效果。结果:结果表明联合用药治疗效果较好,有效率100%,近期治愈率达74.66%。结论:抗生素联合应用治疗布病效果较好。     

阿德福韦酯联合干扰素治疗HBeAg阳性慢性乙型肝炎成本-疗效分析

目的评价阿德福韦酯联合干扰素治疗HBeAg阳性慢性乙型肝炎所产生的经济效果。方法对本院收治的89例HBeAg阳性慢性乙型肝炎分成2种药物治疗方案,即联合用药组(阿德福韦酯+干扰素)、单用药组(阿德福韦酯)。应用药物经济学观点进行成本-效果比较分析。结果联合用药组和单用药组治疗总有效率为74.47%和42.86%,药品成本-疗效(C/E)为23.14和31.50。结论阿德福韦酯联合干扰素治疗慢性乙型肝炎效果良好,成本-疗效较低,值得在临床上推广。     

盐酸氨基葡萄糖胶囊联合利福平治疗膝关节渗出性滑膜炎临床观察

目的探讨利福平治疗渗出性滑膜炎的临床疗效。方法共观察130例患者,治疗组67例,对照组63例,治疗组除一般治疗外加用利福平0.75,1次/d治疗。治疗2周。观察两组的治疗效果。结果治疗组治愈率和总有效率分别为73.13%和85.07%,对照组分别为6.34%、17.46%。结论盐酸氨基葡萄糖胶囊联合利福平治疗膝关节渗出性滑膜炎疗效较好,值得推广应用。     

三联疗法治疗上消化道出血临床疗效观察

观察上消化道出血行三联疗法治疗的疗效。选择2015年9月~2016年9月于我院医治的124例上消化道出血患者临床资料,按用药方案不同分2组,各62例,对照组行奥美拉唑+垂体后叶素治疗,观察组行奥美拉唑+善宁治疗,对比组间疗效及止血时间。观察组治疗总疗效率96.77%比对照组80.65%高(P0.05);观察组止血时间短于对照组,平均输血量少于对照组(P0.05);观察组用药期间未见明显不良反应,对照组不良反应率12.90%。奥美拉唑联合善宁治疗上消化道出血的效果更为显著,可加快止血,减少输血量,且无不良反应,安全有效。     

二甲双胍联合达英-35治疗多囊卵巢综合征不孕症的临床效果分析

目的二甲双胍联合达英-35治疗多囊卵巢综合征不孕症的效果。方法选择盘锦市中心医院2013-05—2015-05收治的多囊卵巢综合征不孕症患者110例,按照治疗方案的不同分为观察组和对照组,各55例。对照组患者直接给予促排卵方案治疗,观察组给予二甲双胍联合达英-35治疗,观察两组治疗效果。结果两组卵泡刺激素(FSH)、促黄体生成素(LH)、睾酮(T)、LH/FSH、雌二醇(E_2)、E2/T水平均较治疗前明显改善,但观察组FSH、LH、T、LH/FSH下降幅度更为显著,优于对照组,P0.05;观察组总有效率83.6%,对照组总有效率63.6%,观察组排卵率80.0%,对照组排卵率58.2%,观察组妊娠率54.5%,对照组妊娠率38.2%,观察组均优于对照组,组间比较,差异有统计学意义,P0.05。结论二甲双胍、达英-35联合用药可以调整患者机体内分泌功能,改善高雄激素状态,具有更全面的治疗效果。     

利福平联合左氧氟沙星治疗肺结核的临床效果

目的探究利福平联合左氧氟沙星治疗肺结核的临床效果。方法将2013年7月~2014年12月在我中心结核病门诊治疗的56例肺结核患者作为本次研究对象,按门诊编号将患者分为对照组和观察组各28例,对照组给予利福平治疗,观察组给予利福平联合左氧氟沙星治疗,比较两组患者的治疗效果以及使用药物后出现的不良反应。结果观察组总有效率为85.71%,对照组总有效率为60.17%,对照组总有效率明显低于观察组,对照组不良反应(23.91%)明显高于观察组不良反应(3.57%),差异均具有统计学意义(P0.05)。结论利福平联合左氧氟沙星治疗肺结核效果显著,不良反应较少,安全性较高,值得临床推广。     

沙格列汀联合二甲双胍对初发2型糖尿病的疗效和安全性探讨

目的评估将二甲双胍+沙格列汀联合使用于初发2型糖尿病治疗中的效果及用药安全性。方法选出2017年1月～2018年3月因初发2型糖尿病而进入本院就诊的92例病人为对象,依据用药治疗方案的不同将以上病人分成观察组47例和对照组45例,观察组予以二甲双胍+沙格列汀联合治疗,对照组予以二甲双胍+阿卡波糖联合治疗;评估、记录两组患者临床治疗疗效、血糖指标与体质指数改善情况以及用药不良反应出现率。结果观察组的治疗总有效率为97.87%,高于对照组的80.00%,差异有统计学意义(P0.05);治疗前,两组血糖指标及体质指数比较无显著性差异(P0.05),治疗后,观察组各项血糖指标及体质指数都显著优于对照组,差异有统计学意义(P0.05);两组患者用药期间不良反应发生率比较差异无统计学意义(P0.05)。结论联合使用二甲双胍+沙格列汀治疗初发2型糖尿病的临床疗效确切,能改善患者血糖水平及体质指数,且药物不良反应比较少,值得推荐运用。     

雷贝拉唑、替普瑞酮、阿莫西林、克拉霉素四联疗法治疗难治性消化性溃疡的疗效

将2014年1月~2015年4月100例难治性消化性溃疡病例分为两组各50例。对照组患者采取奥美拉唑+替普瑞酮+阿莫西林+克拉霉素四联用药方案,观察组采取雷贝拉唑+替普瑞酮+阿莫西林+克拉霉素四联用药方案。对比两组治疗效果。结果观察组患者的Hp根除率96.0%,明显高于对照组的66.0%(P0.05)。观察组患者的治疗总有效率94.0%,显著高于对照组的68.0%(P0.05)。两组均未出现明显药物不良反应。雷贝拉唑、替普瑞酮、阿莫西林、克拉霉素四联用药方案用于难治性消化性溃疡效果满意,HP清除率以及溃疡愈合率明高,不良反应少,值得推广应用。     

联合用药方案在咳嗽变异性哮喘中的应用效果观察研究

选取72例咳嗽变异性哮喘患儿且根据门诊就诊顺序,按照单双号法将其分为观察组和对照组各36例。对照组给予常规治疗方案、观察组给予联合用药方案,且对两种方案应用效果、患儿症状和体征改善或消失时间以及三个月生活质量随访活动进行观察和对比、研究。结果观察组治疗总有效率达91.67%,高于对照组,咳嗽改善起效3.50±1.20d、咳嗽消失7.00±2.00d、气喘消失3.80±1.30d、哮鸣音消失4.50±1.20d、平均住院时间9.50±1.00d,均较对照组缩短,且观察组生活质量评分7.28±1.50分、高于对照组(P<0.05)。联合用药方案在咳嗽变异性哮喘治疗中应用效果显著,值得推广。     

吸入糖皮质激素联合茶碱与联合长效β_2受体激动剂治疗支气管哮喘的效果对比

为了改善支气管哮喘患者的肺功能并提高临床治疗效果,研究和探讨治疗过程中应用吸入糖皮质激素联合茶碱与联合长效β2受体激动剂治疗的价值和意义。按照随机原则从2014年5月~2016年5月来我院治疗的支气管哮喘患者中选取56例作为研究对象并通过抛硬币的方法将其分为对照组和观察组各28例,对照组患者治疗方案选取吸入糖皮质激素联合茶碱,而观察组患者治疗方案选取吸入糖皮质激素联合长效β2受体激动剂,比较不同治疗方案疗效的差异及对患者肺功能的影响。经过研究发现,观察组以及对照组患者用药后均取得一定治疗效果,但观察组的总有效率27(96.73%)和对照组21(75.00%)相比明显提高,且两组比较差异具有统计学意义(P<0.05);用药后观察组和对照组患者用药后的肺功能指标(FEV1、FVC、VC、PEF等)和用药前相比均有所改善,但观察组组患者用药后改善更显著,两组比较差异具有统计学意义(P<0.05)。支气管哮喘患者治疗过程中选取吸入糖皮质激素联合茶碱与联合长效β2受体激动剂都能够改善肺功能,减轻患者的临床症状,但糖皮质激素联合长效β2受体激动剂效果更占优势,且安全性高,副反应轻,值得推广和借鉴。     

Efficacy of several antibiotic combinations against Brucella melitensis Rev 1 experimental infection in BALB/c mice

OBJECTIVES: The objective of the present study was to compare the efficacy of gentamicin given alone or combined with doxycycline with that of standard combination therapies in BALB/c mice experimentally infected with the Brucella melitensis vaccine strain Rev 1. METHODS: A standard broth microdilution method was applied to determine the susceptibility of strain Rev 1 to the clinically most relevant aminoglycosides. Eight groups of BALB/c mice were inoculated intraperitoneally (ip) with 1 x 10(6) cfu/mouse of strain Rev 1. While one group remained untreated, the other seven groups were treated 10 days later once a day for 14 days with (i) doxycycline given orally at 2 mg/day; (ii) streptomycin given ip at 0.4 mg/day; (iii) gentamicin given ip at 0.4 mg/day; (iv) rifampicin given orally at 0.5 mg/day; (v) doxycycline plus streptomycin; (vi) doxycycline plus gentamicin; and (vii) doxycycline plus rifampicin. The number of cfu per spleen and clearance of Rev 1 were assessed 34 days after inoculation. RESULTS: With the exception of streptomycin, strain Rev 1 was susceptible to all aminoglycosides tested. As expected, the combination doxycycline/streptomycin was ineffective against Rev 1 infection. In contrast, the combinations doxycycline/gentamicin and doxycycline/rifampicin were effective in the clearance of Rev 1 infection, but only the former improved significantly the therapeutic efficacy as compared with that of the antibiotics given alone. CONCLUSIONS: Gentamicin may be used along with doxycycline when the classical combination is considered the first choice in the treatment of patients with brucellosis due to B. melitensis vaccine strain Rev 1.     

Evaluation of ceftriaxone, vancomycin and rifampicin alone and combined in an experimental model of meningitis caused by highly cephalosporin-resistant Streptococcus pneumoniae ATCC 51916

OBJECTIVES: The aim of the study was to assess the in vitro and in vivo efficacy of ceftriaxone, vancomycin and rifampicin alone and combined against Streptococcus pneumoniae ATCC 51916 (MIC of ceftriaxone: 32 mg/L). METHODS: In vitro killing curves were performed with clinically achievable CSF antibiotic concentrations. In the rabbit model of pneumococcal meningitis, we studied the efficacy of and effects on inflammation of treatment with ceftriaxone 100 mg/kg/day, vancomycin 30 mg/kg/day and rifampicin 15 mg/kg/day, alone and combined, over a 26 h period. RESULTS: Time-kill curves showed that vancomycin was bactericidal, and ceftriaxone and rifampicin produced a bacteriostatic effect. An additive effect was observed when combinations of ceftriaxone plus vancomycin were studied at subinhibitory concentrations. Emergence of resistance to rifampicin was detected both when rifampicin was studied alone and when combined with ceftriaxone or vancomycin. In the rabbit meningitis model, ceftriaxone was bacteriostatic, whereas rifampicin and vancomycin were bactericidal at 24 h. Although not synergistic, the combinations of ceftriaxone plus vancomycin or rifampicin, and vancomycin plus rifampicin, improved the efficacy of any antibiotic tested alone--all combinations were bactericidal from 6 h--and significantly decreased inflammatory parameters in CSF compared with control and ceftriaxone groups. CONCLUSION: Ceftriaxone plus vancomycin, and vancomycin plus rifampicin appeared to be effective in the therapy of experimental pneumococcal meningitis caused by highly cephalosporin-resistant strains such as ATCC 51916. Our results provide an experimental basis for using these combinations as empirical therapy for pneumococcal meningitis, regardless of the degree of cephalosporin resistance of the causative strain.     

Comparison of three different regimens in the treatment of acute brucellosis: a multicenter multinational study

The present study was undertaken to evaluate efficacy, safety and patient acceptability of three antibiotic regimens for the treatment of acute brucellosis. Six different centres were involved: three in France, one in Greece and two in Spain. The regimens were: oral rifampicin 900 mg/day plus oral doxycycline 200 mg/day for 45 days (A), oral doxycycline 200 mg/day for 45 days plus im streptomycin 1 g/day for 21 days (regimen B) [corrected] and the WHO regimen (C) combining oral tetracycline 2 g/day for 21 days plus im streptomycin, 1 g/day, for 14 days. Regimens A and B were randomly allocated in all centres, while regimen C was allocated only in two centres. All patients were suffering from acute brucellosis clinically and biologically proven. 143 patients were allocated for treatment and analysed. Their mean age was 41 years (range 13-70), 49 were female and 94 male, and their mean weight was 64 kg (range 35-98). Among these patients, 14% had localized disease (nine orchitis, eight osteo-articular involvement and one pleural effusion), but there was no statistical difference between the three regimens in regard to this localized disease. Forty-five per cent of the patients had positive blood cultures. The cure rate with regimen A was 95%, 96% with regimen B and 59% with regimen C. Thus regimen A presented the same efficacy rate as regimen B, but regimen C cannot be regarded as the treatment of choice for acute brucellosis.     

Antibiotics for the eradication of Propionibacterium acnes biofilms in surgical infection

OBJECTIVES: Propionibacterium acnes is increasingly recognized as a cause of delayed infection after spinal instrumentation or shunting for hydrocephalus. Biofilm development by this organism has recently been demonstrated. We therefore investigated the effect of two different courses of three antibiotics (penicillin, rifampicin and linezolid) on mature P. acnes biofilms in vitro. Outcomes were eradication or regrowth after withdrawal of antibiotics, simulating successful treatment and relapse. METHODS: P. acnes biofilms were grown on titanium discs for 6 days until mature, then exposed to the antibiotics for either 7 or 14 days before sonication and culture. Further, discs were similarly exposed, but after each course, they were reincubated for a further 9 days to check for regrowth. RESULTS: Penicillin, linezolid and linezolid plus rifampicin eradicated P. acnes biofilms after 14 days, but only penicillin had this effect after 7 days. 'Relapse' was prevented only by 14 day courses of penicillin or linezolid plus rifampicin, but not by linezolid alone. CONCLUSIONS: For P. acnes spinal instrumentation infections, either penicillin or linezolid plus rifampicin might be equally effective. For shunt infections, as penicillin does not give therapeutic cerebrospinal fluid concentrations, rifampicin plus linezolid might be the treatment of choice. Linezolid alone appears not to be as effective as penicillin against P. acnes biofilms.     

Failure of a short-term antibiotic therapy for human brucellosis using ciprofloxacin. A study on in vitro susceptibility of Brucella strains

BACKGROUND: Human brucellosis is characterized byfocal complications, chronic courses, and therapeutic failures. METHODS: In a relapsed case of brucellosis after short-term antibiotic therapy using doxycycline and ciprofloxacin two Brucella strains were isolated, before and after treatment.In vitro susceptibilities of both isolates were determined by E tests including a great variety of antibiotics. In a killing rate experiment the bactericidal activities of doxycycline, streptomycin, rifampin and ciprofloxacin as single agents and in combinations were determined. RESULTS: Lowest MIC values were measured for doxycycline and ciprofloxacin. MICs did not change under therapy. Streptomycin alone exhibited the most effective killing within 6 h, whereas the other single agents did not show bactericidal activity. Doxycycline plus ciprofloxacin was the most active combination in vitro. CONCLUSION: Routine susceptibility testing of Brucellae is not obligatory as most of the 'traditional' anti-Brucella antibiotics are active in vitro and bactericidal efficacy may differ in vivo.     

In-vitro studies of antibiotic combinations for multiply-resistant coagulase-negative staphylococci

Coagulase-negative staphylococci are being implicated as pathogens with increasing frequency and this may in part be due to their development of resistance to a wide variety of antibiotics. Because vancomycin is the only drug generally available for treating these multiply resistant organisms, we have tested several combinations of antibiotics for activity in vitro against these organisms. These in-vitro studies suggested that rifampicin combined with either gentamicin or cefamandole might occasionally provide an efficacious alternative to vancomycin, while the novobiocin plus rifampicin combination might be an effective oral regimen against methicillin-resistant coagulase negative staphylococci. Resistance to co-trimoxazole was found in nearly all isolates tested.     

Ceftriaxone in the treatment of acute and subacute human brucellosis

A total of 14 adults were diagnosed as having brucellosis by clinical means, serology and blood culture. The first patient to be treated failed to respond to 2 g/day intravenous ceftriaxone, therefore, subsequent patients were treated intravenously, twice daily with 2 g ceftriaxone. Immediate clinical response was seen in nine (69.2%) of the patients. Therapy was changed to tetracycline plus streptomycin in the remaining four (30.8%) patients because of lack of response after 5 days. It is concluded that ceftriaxone may be considered a second-line therapy for brucellosis in patients who cannot be given conventional therapy. Further evaluation of ceftriaxone, either alone or preferably in combination with streptomycin or rifampicin on a larger scale, is indicated.     

Recurrent symptomatic hypocalcemia during rifampicin therapy for brucellosis

Drug-associated hypocalcemia is rare, but may occur during routinely administered drugs. We reported a case of vertebral brucellosis, which developed two hypocalcemic episodes associated with hypokalemic alkalosis with two drug combinations including rifampicin. Possible underlying mechanisms of hypocalcemia were discussed. The patient had carpopedal spasm at both hypocalcemic presentations. Laboratory analysis revealed hypocalcemia, hypokalemia, alkalosis with hypercalciuria, and low-normal parathormone (PTH) at first and elevated PTH at the second admission. The patient improved with cessation of drugs and appropriate management of hypocalcemia and hypokalemia with calcium, vitamin D, magnesium, and potassium replacement. The underlying mechanism of hypocalcemia in this patient seemed to be due to tubular damage resulting with Bartter-like syndrome, which is well defined with aminogylcosides. But the recurrence of hypocalcemia with an aminoglycoside-free antibiotic combination including rifampicin suggests a possible role of rifampicin on hypocalcemia associated Bartter-like syndrome that has never been reported before.     

The effect of rifampicin on the in-vitro activity of cefpirome or ceftazidime in combination with aminoglycosides against Pseudomonas aeruginosa

The in-vitro activity of cefpirome and ceftazidime when combined with aminoglycosides (gentamicin, amikacin, and tobramycin) in the presence and in the absence of rifampicin was evaluated against 32 isolates of Pseudomonas aeruginosa by two methods. Agar dilution susceptibilities demonstrated a marked reduction in synergy (FIC less than or equal to 0.5) when rifampicin was added to the combination. Synergy rates decreased from 59.4-84.4% without to 3.1-9.4% with the addition of rifampicin. In contrast, kill curve tests performed on two P. aeruginosa strains demonstrated synergy at 24 h when rifampicin was added to cefpirome, ceftazidime, gentamicin or a beta-lactam agent plus gentamicin combination. The addition of rifampicin to the combinations of cefpirome or ceftazidime plus gentamicin achieved a 2-log10 lower bacterial count at 24 h than that of the beta-lactam and gentamicin combination alone. When rifampicin was added to the combination cefpirome or ceftazidime plus gentamicin at different times during incubation, a greater bactericidal effect was observed when rifampicin was added at 0 and 1 h of incubation than when added later. No antagonism was observed with rifampicin when used in combination with beta-lactam agents and/or aminoglycosides.     

Citywide emergence of Pseudomonas aeruginosa strains with reduced susceptibility to polymyxin B

OBJECTIVES: To determine the prevalence of Pseudomonas aeruginosa isolates with reduced susceptibility to polymyxin B, and to assess the in vitro activity of antibiotic combinations. METHODS: All unique patient isolates of P. aeruginosa were collected from 11 Brooklyn, NY hospitals during a three month period in 2003. Isolates with reduced susceptibility to polymyxin B (MIC > 2 mg/L) underwent ribotyping. The activity of polymyxin B combined with rifampicin, azithromycin and/or imipenem was tested by the chequerboard and time-kill methods against a subset of isolates. RESULTS: Of 527 isolates, only 61% were susceptible to imipenem. Twenty-five isolates (5%), from 8/11 hospitals, had reduced susceptibility to polymyxin B (MICs 4-8 mg/L), compared with 0/691 isolates collected in 2001. Ten of 25 were resistant to multiple other antibiotic classes. Ribotyping of the isolates revealed 19 unique types. Chequerboard testing of the 10 multiresistant isolates demonstrated synergy for the combinations of polymyxin B with azithromycin, imipenem and rifampicin in 6, 2, and 1 isolates, respectively. Time-kill studies revealed bactericidal activity for the following antibiotics when combined with polymyxin B: imipenem plus rifampicin against all 10 isolates, rifampicin in 9/10 isolates, imipenem in 8/10 isolates and azithromycin in 4/10 isolates. MICs of bacteria surviving incubation in polymyxin B alone rose for 4/9 isolates (MIC range 12-48 mg/L). CONCLUSIONS: P. aeruginosa with reduced susceptibility to polymyxin B have emerged in multiple strains in Brooklyn, NY. Combinations of polymyxin B with rifampicin and/or imipenem are bactericidal. The clinical utility of these combinations remains to be determined.