哌拉西林及三唑巴坦对β-内酰胺酶稳定性研究

比较哌拉西林,哌拉西林／三唑巴坦（８：１,４：１,２：１）,氨苄西林／阿莫西林／克拉维酸,替卡西林／克拉维酸和头孢哌酮／舒巴坦对３９株革兰氏阴性杆菌所产β－内酰胺酶的稳定性。以生物测定酶对抗生素的相对水解率,抑酶保护率。结果表明,β－内酰胺酶对哌拉西林／三唑巴坦（８：１）,的相对水解率明显低于单独使用的哌位西林及氨苄西林／舒巴坦,阿莫西林／克拉维酸,替卡西林／克拉维酸,有显著性差异,近似于头孢哌酮     

替卡西林/克拉维酸和头孢他啶治疗中重度感染41例

目的：比较替卡西林／克拉维酸和头孢他啶治疗中重度感染的疗效及安全性。方法：采用前瞻性随机，开放，对照试验，治疗组21例用替卡西林／克拉维酸3．2g,q8h,iv;对照组20例，用头孢他啶1g,q8h,iv,2组疗程为3－14d，结果：治疗组和对照组临床治疗总有效率分别为76％（16／21）和65％（13／20），无统计学差异（P＞0．05），细菌学清除率分别为71％（15／21）和55％（11／20），不良反应发生率分别为14％（3／21）和5％（1／20），结论：替卡西林／克拉维酸治疗中重度感染时疗效和不良反应与头孢他啶相似。     

哌拉西林/三唑巴坦和头孢噻肟治疗呼吸道细菌感染的临床研究

目的：评价哌拉西林／三唑巴坦的有效性和安全性。方法：采用随机对照试验，选择头孢噻肟为对照药物，共治疗呼吸道细菌感染患者60例，哌拉西林／三唑巴坦组和头孢噻肟组各30例，结果：哌拉西林／三唑巴坦组临床治愈率为86．7％（26／30），有效率为93．3％（28／30），细菌清除率为92．9％（26／28），而对照组分别为83．3％（25／30），90％（27／30）和92．3％（24／26），经统计学处理两组差异无显著性，两组不良反应发生率均为3．3％，结论：哌拉西林／三唑巴坦治疗呼吸道细菌的有效和安全性与头噻肟相似，是一种高效，广谱，安全的新型抗菌药。     

哌拉西林/三唑巴坦治疗下尿路及男性生殖系感染278例临床评价

目的 评价哌拉西林／三唑巴坦治疗下尿路及男性生殖系感染的疗效。方法 对278例下尿路及男性生殖系感染患者视病情给哌拉西林／三唑巴坦4.5—9．0g，疗程6—14d。结果 痊愈率47．84％，总有效率91．73％，不良反应发生率为3．60％。结论 哌拉西林／三唑巴坦具有抗菌谱广，疗效好，不良反应少等优点，对下尿路及男性生殖系感染是一种安全、有效的抗菌药物。     

替卡西林钠克拉维酸钾序贯疗法治疗老年社区获得性肺炎疗效观察

目的分析替卡西林钠克拉维酸钾序贯疗法治疗老年社区获得性肺炎的疗效。方法对100例老年社区获得性肺炎住院患者随机分为2组。对照组50例患者连续静脉滴注替卡西林钠克拉维酸钾治疗10～14d;治疗组50例患者静脉滴注替卡西林钠克拉维酸钾治疗5～7d,病情稳定后改为替卡西林钠克拉维酸钾颗粒剂口服治疗5～7d。观察2组临床疗效。结果2组临床疗效比较差异无统计学意义（P〉0.05）,除治疗组中2例出现皮疹外,无其他不良反应。结论采用替卡西林钠克拉维酸钾序贯疗法治疗老年社区获得性肺炎可获得良好疗效。     

哌拉西林/他唑巴坦治疗下呼吸道感染临床观察

目的观察应用哌拉西林／他唑巴坦治疗下呼吸道感染的疗效及不良反应。方法对32例诊断为下呼吸道感染患者采用哌拉西林／他唑巴坦治疗，剂量为每次4．5g，每8—12小时静脉滴注1次，疗程7，15d。结果治疗总有效率81．25％，细菌总清除率77．78％，不良反应发生率3．12％。结论哌拉西林／他唑巴坦可作为有效治疗下呼吸道感染的经验用药。     

哌拉西林/三唑巴坦(4:1)治疗急性细菌性感染多中心、随机、双盲对照临床研究

目的评价国产哌拉西林／三唑巴坦（4：1）治疗急性细菌性呼吸道感染和尿路感染的有效性和安全性。方法采用随机、双盲、平行对照临床试验设计，试验组哌拉西林／三唑巴坦（4：1）每次2．5g（2．0g／0．5g），对照纽哌拉西林／三唑巴坦（8：1），每次2．25g（2．0g／0．25g），用法均为每日2次静脉滴注，疗程均为5—14d。结果本试验共人选266例，纳入临床疗效FAS分析251例，试验组和对照组分别为124例和127例；纳入PPS分析248例，试验组和对照组分别为122例和126例，疗程结束时试验组和对照组的总痊愈率分别为61．48％和59．52％，有效率分别为87．70％和88．89％。两组总的细菌清除率分别为93．94％和92．10％；总的不良事件发生率分别为11．94％和12．88％，总的药物相关不良反应发生率分别为5．97％和9．09％。以上结果两组问比较无显著性差异（P〉0．05）。结论国产哌拉西林／三唑巴坦（4：1）治疗呼吸和泌尿系统急性细菌性感染的临床疗效确切，安全性较好。     

不同配比哌拉西林、他唑巴坦对β—内酰胺酶稳定性与抑酶增效作用研究

本文报告哌拉西林，哌拉西林／他唑巴坦（8：1，4：1）和替卡西林／克拉维酸（15：1）对39株革兰阴性杆菌所产β－内酰胺酰稳定的比较。以生物法测定酶对抗生素的相对水解率，抑酶保护率。结果表明：β－内酰胺酶对哌拉西林／他唑巴坦（8：1）的相对水解率明显低于单纯使用哌拉西林（P＜0．01）且优于替卡西林／克拉维酸（P＜0．05）。当哌拉西林／他唑巴坦为4：1时，相对水解率与8：1相比又有显著降低（P＜0．01），4：1明显优于8：1。说明他唑巴坦起到了增强哌拉西林对β－内酰胺酶的稳定性和抑酶保护的作用。     

哌拉西林/三唑巴坦治疗下呼吸道感染的临床疗效观察

哌拉西林／三唑巴坦（安迪泰）为钠与β-内酰胺酶抑制剂三唑巴坦的复方制剂，2004年10月-2005年10月对50例下呼吸道感染的患者给予哌拉西林／三唑巴坦治疗，进行疗效观察，并与哌拉西林钠进行比较。报告如下：     

国产哌拉西林-他唑巴坦治疗支气管扩张症合并感染的疗效观察

目的评价国产哌拉西林-他唑巴坦治疗支气管扩张症合并感染的疗效和安全性。方法98例支气管扩张症合并感染患者随机分为2组,组1（50例）静脉滴注哌拉西林-他唑巴坦（国产）;组2（48例）静脉滴注头孢哌酮钠-舒巴坦钠（合资）,疗程均为7d。结果两组治疗支气管扩张症合并感染的临床有效率和细菌清除率分别为90．00％对91．68％,87．18％对90．00％,不良反应发生率分别为6．00％和4．17％,两组相比差异均无统计学意义（P〉0．05）。结论国产哌拉西林-他唑巴坦治疗支气管扩张症合并感染的疗效和安全性与头孢哌酮钠-舒巴坦钠相当,安全有效。     

Piperacillin/tazobactam: a pharmacoeconomic review of its use in moderate to severe bacterial infections.

Piperacillin/tazobactam is a beta-lactam/beta-lactamase inhibitor combination with a broad spectrum of antibacterial activity against most Gram-positive and Gram-negative aerobic bacteria and anaerobic bacteria. Piperacillin/tazobactam is effective and well-tolerated in patients with lower respiratory tract infections (LRTI), intra-abdominal infections, skin and soft tissue infections, and febrile neutropenia. In comparative clinical trials against various other antibacterial regimens, piperacillin/tazobactam has shown higher clinical success rates, particularly in the treatment of patients with intra-abdominal infections and febrile neutropenia. Cost analyses of piperacillin/tazobactam have been variable, in part, because of differences in specific costs included. Three US cost analyses found that piperacillin/tazobactam had lower total medical costs than clindamycin plus gentamicin or imipenem/cilastatin in intra-abdominal infections, and ticarcillin/ clavulanic acid in community-acquired pneumonia. Piperacillin/tazobactam plus amikacin had lower total costs than ceftazidime plus amikacin in another cost analysis of patients with febrile neutropenic episodes modelled in nine European countries. However, piperacillin/tazobactam plus tobramycin was more costly than ceftazidime plus tobramycin in hospital-acquired pneumonia in a US cost analysis. In cost-effectiveness analyses, all studies of intra-abdominal infections, pneumonia and febrile neutropenic episodes consistently reported lower costs per unit of effectiveness versus comparators. Piperacillin/tazobactam was dominant (greater efficacy and lower costs) versus imipenem/cilastatin in intra-abdominal infections and ceftriaxone, ciprofloxacin or meropenem in pneumonia. Piperacillin/tazobactam plus amikacin was dominant over ceftazidime plus amikacin in the treatment of febrile neutropenic episodes. In a cost-effectiveness analysis of skin and soft tissue infection, piperacillin/tazobactam had lower costs per successfully treated patient than ceftriaxone or cefotaxime, but a slightly higher cost-effectiveness ratio than amoxicillin/clavulanic acid. All cost-effectiveness analyses were based on decision-analytical models. CONCLUSIONS: Piperacillin/tazobactam is likely to reduce overall treatment costs of moderate to severe bacterial infections by increasing initial treatment success, thereby reducing the length of hospital stay and the use of additional antibacterials. Piperacillin/tazobactam has shown clinical and economic advantages over standard antibacterial regimens in the treatment of intra-abdominal infections, LRTIs, febrile episodes in patients with neutropenia, and skin and soft tissue infections, although more complete published data are needed to confirm these results. Present data regarding clinical efficacy, bacterial resistance and costs would support the use of piperacillin/tazobactam as an empirical first-line option in moderate to severe bacterial infections.     

Piperacillin/tazobactam: an updated review of its use in the treatment of bacterial infections.

Piperacillin/tazobactam is a beta-lactam/beta-lactamase inhibitor combination with a broad spectrum of antibacterial activity encompassing most Gram-positive and Gram-negative aerobic bacteria and anaerobic bacteria, including many pathogens producing beta-lactamases. Evidence from clinical trials in adults has shown that piperacillin/tazobactam, administered in an 8:1 ratio, is an effective treatment for patients with lower respiratory tract, intra-abdominal, urinary tract, gynaecological and skin/soft tissue infections, and for fever in patients with neutropenia. Combination regimens of piperacillin/tazobactam plus an aminoglycoside are used to treat patients with severe nosocomial (hospital-acquired) infections. In clinical trials, piperacillin/tazobactam was significantly more effective than ticarcillin/clavulanic acid in terms of clinical and microbiological outcome in patients with community-acquired pneumonia. In patients with intra-abdominal infections, clinical and bacteriological response rates were significantly higher with piperacillin/tazobactam than with imipenem/cilastatin (administered at a dosage lower than is recommended in countries outside Scandinavia). Piperacillin/tazobactam in combination with amikacin was at least as effective as ceftazidime plus amikacin in the treatment of ventilator-associated pneumonia and was significantly more effective than ceftazidime plus amikacin in the empirical treatment of febrile episodes in patients with neutropenia or granulocytopenia. In other trials, the efficacy of piperacillin/tazobactam was similar to that of standard aminoglycoside-containing and other treatment regimens in patients with intra-abdominal, skin/soft tissue or gynaecological infections. Piperacillin/tazobactam is generally well tolerated. The most frequent adverse events are gastrointestinal symptoms (most commonly diarrhoea) and skin reactions. The incidence of adverse events with piperacillin/tazobactam is higher when the combination is given in combination with an aminoglycoside than when given as monotherapy. CONCLUSION: Because of the broad spectrum of antibacterial activity provided by piperacillin/tazobactam, it is useful for the treatment of patients with polymicrobial infections caused by aerobic or anaerobic beta-lactamase-producing bacteria. Piperacillin/tazobactam appears to have a particularly useful role in the treatment of patients with intra-abdominal infections and, in combination with amikacin, in the treatment of patients with febrile neutropenia, especially given the current prevalence of Gram-positive infections in this group.     

哌拉西林-三唑巴坦和头孢哌酮-舒巴坦治疗呼吸道细菌感染的疗效比较

目的 :评价国产哌拉西林 三唑巴坦治疗呼吸道中、重度细菌感染的有效性和安全性。方法 :采用随机对照试验方法 ,选择头孢哌酮 舒巴坦为对照药物 ,将 80例呼吸道中、重度细菌感染病人分为试验组和对照组(各 40例 ) ,试验组静脉滴注哌拉西林 三唑巴坦 4.5 g,q 8h或q1 2h× 7～ 1 4d,对照组静脉滴注头孢哌酮 舒巴坦 2 .0 g,q 8h或q 1 2h× 7～1 4d。结果 :试验组临床治愈率为 82 % (3 3 /40 ) ,有效率为 90 % (3 6/40 ) ,细菌清除率为 92 %(3 4/3 7)。而对照组分别为 85 % (3 4/40 ) ,92 %(3 7/40 )和 94% (3 4/3 6)。经统计学处理 2组差异无显著意义 (P >0 .0 5 )。 2组不良反应发生率均为5 %。结论 :哌拉西林 三唑巴坦在临床的有效性和安全性与头孢哌酮 舒巴坦相似 ,是一种高效、广谱、安全的新型抗菌药     

哌拉西林/他唑巴坦治疗下呼吸道感染的临床疗效

目的：评价哌拉西林／他唑巴坦(邦达)治疗下呼吸道感染的临床疗效。方法：68例患者，分为2组，治疗组予邦达4．5g，对照组予头孢他啶1．0g，均分别加入0．9％氯化钠注射液100ml中静滴，q8h，疗程均为7～14d。结果：治疗组有效率为94．0％，细菌清除率为93．0％，不良反应发生率为5．6％；对照组分别为91．0％，85．0％及3．1％。结论：哌拉西林／他唑巴坦对下呼吸道细菌感染，尤其是产酶菌引起的感染，临床疗效好，是一种高效、安全的抗菌药。     

In vitro activity of piperacillin/tazobactam against isolates from patients enrolled in clinical trials

The in vitro activity of piperacillin alone or titrated with a constant concentration of 4 mug/ml tazobactam was evaluated against 3962 baseline pathogens isolated from 1899 patients enrolled in 9 clinical trial studies in North America. Tazobactam increased susceptibility rates of piperacillin for Enterobacteriaceae from 81% to 96%, Staphylococcus (methicillin susceptible) spp. from 6% to 100%, Bacteroides fragilis group from 79% to >99% and Haemophilus from 85% to 98%. The excellent activity of piperacillin against Pseudomonas, Streptococcus and Enterococcus was maintained in the presence of tazobactam. Overall piperacillin/tazobactam had better activity than ticarcillin/clavulanic acid, ceftazidime, and in general equaled the activity of imipenem. The excellent in vitro, extended-spectrum activity of piperacillin/tazobactam suggests its utility for various infections.     

阿莫西林-克拉维酸(14∶1)片随机对照治疗呼吸道和中耳细菌性感染

目的 :评价阿莫西林 克拉维酸片 (14∶1)治疗常见致病菌引起呼吸道和中耳细菌感染性疾病的临床疗效和安全性。方法 :采用随机对照双盲平行试验设计 ,入选病例 5 4例。包括上呼吸道感染 2 7例 ,下呼吸道感染 2 4例 ,中耳炎 3例。试验组 (2 7例 )应用阿莫西林 克拉维酸片 (14∶1) 2片 ,po ,q 12h ,对照组 (2 7例 )应用阿莫西林 克拉维酸分散片(7∶1) 2片 ,po ,q 12h ,疗程均为 7～ 14d。结果 :试验药治疗的有效率为 93% ,与对照药 (96 % )比 ,差异无统计学意义 (P >0 .0 5 )。试验药细菌清除率为91% ,与对照药 (86 % )比 ,P >0 .0 5。试验药不良反应发生率为 7% (2 / 2 7) ,与对照药 (4 % )比 ,差异无统计学意义 ,P >0 .0 5。结论 :阿莫西林 克拉维酸片 (14∶1)对呼吸道和中耳常见感染临床疗效好 ,使用安全。     

哌拉西林/三唑巴坦与头孢哌酮/舒巴坦治疗呼吸道细菌感染的成本-效果分析

目的评价哌拉西林/三唑巴坦与头孢哌酮/舒巴坦治疗呼吸道细菌感染的成本-效果。方法参考有关文献,对分别采用哌拉西林/三唑巴坦(试验组)与头孢哌酮/舒巴坦(对照组)治疗80例呼吸道中、重度细菌感染者的效果进行药物经济学成本-效果分析。结果对照组、试验组成本分别为211.80、165.60元;有效率分别为92.5%、90%(P>0.05);成本-效果比分别为2.29、1.84;对照组相对于试验组的增量成本-效果比为18.48。结论哌拉西林/三唑巴坦治疗呼吸道细菌感染相对于头孢哌酮/舒巴坦具有明显的药物经济学优势。     

我院临床分离厌氧菌的分布特征及药敏谱型

目的 分析厌氧菌标本来源、科室、年龄分布特征及药敏试验结果，为临床经验性治疗和合理使用抗菌药物提供依据。方法 收集2015年1月-2017年11月承德医学院附属医院住院患者所有合格标本中的厌氧菌，经VITEK2 compact ANC进行菌株鉴定，所有菌株使用头孢硝噻吩法检测β-内酰胺酶，使用浓度梯度药敏实验方法检测菌株对13种抗菌药物的敏感性。结果 分离出厌氧菌260株，其中，厌氧消化链球菌94株(36.15%)、脆弱拟杆菌81株(31.15%)、艰难梭菌42株(16.15%)、普雷沃菌属16株(6.15%)、产气荚膜梭菌11株(4.23%)；除艰难梭菌标本来源为粪便外，其他厌氧菌主要分离自脓液；分离厌氧菌最多的科室为产科、老年病科及血液科。药敏结果显示，79株厌氧菌的β-内酰胺酶试验阳性，阳性率为30.4%；脆弱拟杆菌β-内酰胺酶87.6%为阳性，产酶率最高。厌氧消化链球菌对阿莫西林/克拉维酸、替卡西林/克拉维酸、哌拉西林/三唑巴坦100%敏感；脆弱拟杆菌对阿莫西林/克拉维酸、哌拉西林/三唑巴坦敏感率100%；艰难梭菌对氨苄西林/舒巴坦、哌拉西林/三唑巴坦敏感率100%；普雷沃菌属对阿莫西林/克拉维酸、氨苄西林/舒巴坦、替卡西林/克拉维酸敏感率100%；产气荚膜梭菌对青霉素、氨苄西林敏感率100%。甲硝唑对所有菌株均保持很高的敏感性。结论 厌氧菌引起的临床感染常见，不同厌氧菌的分布及药敏结果不尽相同，临床医生可根据菌株的分布特征及药敏结果对厌氧菌感染进行更有效的治疗。     

Evaluation of the in vitro activity of ertapenem and nine other comparator agents against 337 anaerobic bacteria

Ertapenem activity in vitro was compared with that of nine reference antibiotics against 337 anaerobes by determining minimal inhibition concentrations (MICs). Amongst 246 Gram-negative anaerobes, 4, 8, 3, 4, 7, 2 and 52 strains showed resistance to ertapenem, amoxicillin/clavulanic acid, ticarcillin/clavulanic acid, piperacillin/tazobactam, cefoxitin, imipenem and clindamycin, respectively, and all strains were inhibited by metronidazole. Ertapenem MIC(50) values were 0.5, 0.25, 0.06 and 相似文献