1641株临床分离病原菌的分布及耐药分析

目的了解重庆市涪陵中心医院2006～2008年临床分离病原菌的分布情况及常见细菌的耐药现状。方法对2006～2008年临床科室送检的培养标本,采用MicroScan A/s-4自动细菌鉴定及药敏测试仪进行鉴定和药敏试验,并对其结果进行统计分析。结果 4621份标本共分离出的病原菌占34.93%,其中以革兰阴性杆菌为主。检出前5位的病原菌依次为大肠埃希菌、铜绿假单胞菌、肺炎克雷伯菌、金黄色葡萄球菌、鲍曼不动杆菌。送检标本主要以痰、血液、脓、尿液为主。耐甲氧西林的金黄色葡萄球菌(MRSA)的检出率为55.74%;产超广谱β-内酰胺酶(ESBLs)的大肠埃希菌和肺炎克雷伯菌的检出率分别为36.55%、26.38%;铜绿假单胞菌和鲍曼不动杆菌是多重耐药菌株,对多种抗菌药物耐药。结论本院分离的细菌耐药水平高且多重耐药,加强病原菌的耐药性监测,有利于合理使用抗菌药物和减缓多重耐药菌株的形成。     

医院病原菌分布及耐药趋势分析

目的为临床医师合理使用抗生素提供参考依据，减少耐药菌株的产生。方法用回顾性调查的方法对我院2002年-2004年临床送检标本中培养分离的2012株病原菌的种类、药物敏感性进行分析。结果革兰氏阴性杆茼对亚胺培南、头孢吡肟和美洛培南敏感性较好，对环丙沙星、哌拉西林、红霉素敏感性稳定，对其余14种抗生素敏感性呈下降趋势。革兰氏阳性球菌中应首选去甲万古霉素。结论临床医师应根据药敏实验结果，正确、合理地使用抗生素。     

抗心律失常药导致室性心律失常187例临床分析

目的分析抗心律失常药导致室性心律失常的原因。方法应用动态心电图分析187例抗心律失常药致室性心律失常。结果各种抗心律失常药都有不同程度致心律失常不良反应,尤其Ic类抗心律失常药致室心律失常作用较强。结论当左室射血分数降低(LVEF40%),联合应用利尿剂及/或地高辛,和/或应用抗精神类药物,用药后QT间期离散度增加等都可出现致室性心律失常不良反应。     

医师-药师协作模式在门诊药物咨询实践中的应用

目的 通过对我院药物咨询的实践与分析评价,进一步提升药学服务质量。方法 对我院药物咨询服务流程进行分析;收集我院2018年药物咨询情况,进行回顾性分析。结果 开展医师-药师协作模式,将药学服务融入诊疗服务中,有助于提升患者的依从性和治疗效果;独立的药物咨询室可进一步提升患者的体验和保障患者隐私;基于HIS的用药指导系统,可进一步加强医师与药师的联系,对患者进行精细化指导;在药物咨询患者中,男性患者稍高于女性患者,以中老年为主,平均50.78±15.79岁,以呼吸科（59.81%）、内镜中心（17.57%）患者为主,咨询药品主要是消化系统药物1625例（47.74%）,呼吸系统药物1270例（37.31%）,咨询内容主要为用法用量2303例（71.46%）,注意事项447（13.87%）,不良反应与禁忌345例（10.70%）。结论 我院信息系统化的医师-药师协作的药物咨询服务模式能更好为患者提供药学服务,通过分析评价药物咨询的内容,有助于提高药学服务质量,对我院合理用药具有重要意义。     

635株鲍曼不动杆菌的分布及耐药性分析

目的分析南京第一医院鲍曼不动杆蒯的分布及对抗菌药物的耐药情况,指导临床合理用药。方法时南京第一医院2006年10月至2009年5月检出的635株鲍曼不动杆菌的分布及药敏结果作回顾性分析。结果共分离到革兰阴性非发酵菌2472株,其中鲍曼不动杆菌635株,占25．69％,是非发酵菌中仅次于铜绿假单胞菌位于第2位的感染菌,标本主要来源于痰液（85．04％）,病房集中于ICU（51．34％）。该菌对头孢哌酮／舒巴坦的敏感性较高,而对其他抗菌药物耐药严重,并出现多重耐药的菌株。结论南京第一医院鲍曼不动杆菌所占比例越来越大,应定期监测其分布和耐药情况,为临床合理使用抗菌药物提供依据。     

尼群地平对阿替洛尔在健康志愿者体内药代动力学影响

目的探讨在健康人体内联用尼群地平和阿替洛尔时，尼群地平对阿替洛尔药代动力学的影响。方法24名健康受试者随机分成A、B、C三组，每组8人，A组口服阿替洛尔片40mg，B组同时口服尼群地平片20mg和阿替洛尔片40mg，C组口服复方尼群地平片4片（每片含尼群地平5mg，阿替洛尔10mg）。用高效液相色谱法测定血浆阿替洛尔的浓度。结果A组与B组比较，尼群地平使阿替洛尔的AUC0-∞降低了11．7％，Cmax降低了8．6％；A组与C组比较，尼群地平使阿替洛尔的AUC0-∞升高了4．4％，Cmax升高了8．4％；其余药代动力学参数均无明显变化。结论在健康受试者体内单次服药时，尼群地平未对阿替洛尔的药代动力学参数产生显著性影响。     

Clinical application of mefloquine pharmacokinetics in the treatment of P falciparum malaria

Summary— Malaria remains a major public health problem in large areas of the world. One of the major factors responsible for the resurgence is the emergence of Plasmodium falciparum, resistant to available antimalarials. An antimalarial, mefloquine, has been considered since its introduction as a promising alternative antimalarial drug to overcome the situation of widespread multidrug resistant P falciparum. Pharmacokinetic studies of mefloquine have been investigated in several groups of subjects either as mefloquine alone or as combined regimens. The oral absorption of mefloquine is relatively rapid, reaching peak concentrations within 24 hours. Metabolism takes place in the liver, with carboxymefloquine as a major metabolite. Mefloquine has a large apparent volume of distribution of 200 L and is highly bound (98%) to plasma proteins. The elimination is slow; the terminal half-life is 13 10 to 14 days in Thai patients with falciparum malaria. Vomiting within 1 hour of drug administration has an influence on blood concentrations of mefloquine and this may result in treatment failure. The whole blood concentrations of mefloquine on the first two days of treatment are important determinants of parasitological response. There appear to be no pharmacokinetic interactions between mefloquine and the other two components of Fansimef^R in patients with uncomplicated falciparum malaria. The advantage of this combination over mefloquine alone in multidrug resistant P falciparum is still debatable. However, recent data seem to support the higher efficacy of Fansimef^R over mefloquine alone. Concurrent administration of antibiotics, ie ampicillin and tetracycline with mefloquine results in a significant increase in maximum concentration, reduction of the apparent volume of distribution and shortening of the terminal elimination half-life of mefloquine. An antiemetic drug metoclopramide accelerates the absorption of mefloquine and increases the maximum concentration. In contrast, mefloquine concentrations are decreased in the presence of an antimalarial, artesunate. Primaquine has no effect on the pharmacokinetics of mefloquine when given concurrently.     

老年高血压病患者遵医服药行为的调查研究

目的 了解老年高血压患遵医服药行为，并提出相应对策。方法 采用问卷调查法对驻甬老年高血压患的遵医行为进行调查。结果 42．03％患存在不遵医服药行为。其中自行停药占25.00％。不按时服药占51.85％，自行更换药物占9．26％，经常吃错药物占13．89％；血压控制欠佳中有83.33％与不遵医服药有关。结论 加强老年患及家属的高血压知识宣教、培养专职的心血管护理人员、适当设立家庭病房可改善不遵医服药行为。     

临床常见革兰阳性球菌的耐药性分析

目的了解临床常见革兰阳性球菌的耐药性,指导临床合理使用抗菌药物。方法对2009～2011年临床分离常见革兰阳性球菌进行药敏试验,并用WHONET 5.4软件进行数据分析。结果金黄色葡萄球菌、表皮葡萄球菌、溶血葡萄球菌、肺炎链球菌、粪肠球菌的分离率分别为36.95%、23.56%、17.14%、12.18%、10.17%;耐甲氧西林金黄色葡萄球菌(MRSA)为45.65%,耐苯唑西林表皮葡萄球菌、耐甲氧西林凝固酶阴性葡萄球菌(MRC-NS)分别为78.13%、64.77%,青霉素不敏感肺炎链球菌(PNSP)为51.65%,常见革兰阳性球菌未发现耐万古霉素。结论临床常见革兰阳性球菌的感染已经变得非常普遍,MRSA、MRCNS、PNSP和粪肠球菌对于常用抗菌药物出现了较高的耐药率,依据药敏试验的结果合理选用抗菌药物非常必要。     

氟喹诺酮类抗菌药物不良反应分析

目的 分析我院临床使用的12种氟喹诺酮类抗菌药物(FQNS)的不良反应,为临床用药提供信息.方法 搜集2007年3月至2011年3月门、急诊及住院部使用12种FQNS(诺氟沙星、氧氟沙星、左氧氟沙星、环丙沙星、洛美沙星、培氟沙星、氟罗沙星、莫昔沙星、加替沙星、芦氟沙星、司帕沙星、伊诺沙星)患者的病历资料,分析不良反应.结果 本组192例中男性患者113例(58.9%),高于女性患者79例(41.1%),31～40岁年龄段ADR发生率最高(35.4%),差异有统计学意义(P＜0.05);共涉及12种FQNs,不良反应主要表现在神经、循环、皮肤、泌尿、消化、呼吸、血液等,其中以神经、循环、皮肤系统症状较多也较突出;引起ADR的主要给药途径为静脉给药,共137例(71.4%).结论 FQNS的不良反应在临床使用中应该引起高度重视.     

On the Policy of the Italian Government in the Discovery,Development, and Access to Medicines

This commentary outlines how discovery, development, and access to medicines are regulated and promoted in Italy by the government through the Ministry of University and Research, the Ministry of Health, and the Italian Medicines Agency. We describe and comment on the existing research programs stimulating preclinical, translational, and clinical research and how access to medicines and their pricing is regulated by Italy's National Health Service both at the national and regional levels. Finally, we describe the current scenario of industrial research and medicines manufacturing. The resulting picture shows a country in which high-level competitive research on medicines is promoted alongside an excellent national health system working toward fairness of access to health care services for all citizens and fiscal solidarity as a fundamental form of system financing. Critical challenges still exist, including the relative scarcity of public funding for research and the non-uniform access to the benefits of the National Health Service across Italian regions.     

Diffusion-controlled drug delivery systems: calculation of the required composition to achieve desired release profiles

The aim of this study was to investigate the effect of the composition of diffusion-controlled release devices (type and amount of plasticizer, type of polymer) on the drug diffusivity and the resulting release kinetics in a quantitative way. Diltiazem hydrochloride and theophylline were investigated in ethyl cellulose (EC) and Eudragit^® RS 100, plasticized with various amounts of acetyltributyl citrate (ATBC), acetyltriethyl citrate (ATEC), dibutyl phthalate (DBP), dibutyl sebacate (DBS), diethyl phthalate (DEP), and tributyl citrate (TBC). Thin drug-containing films (monolithic solutions) were used to determine the diffusion coefficients experimentally. The effect of the type and amount of plasticizer on the drug diffusivity was found to be significant, whereas the chain length of the polymer only played a minor rule in the investigated systems. Interestingly, a quantitative relationship between the diffusion coefficient of the drug and the plasticizer level could be established. Based on these results, the release kinetics of diffusion-controlled drug delivery systems could be predicted. In this study, the release patterns from microparticles were calculated and the significant effect of the composition of the device on the resulting release rate was simulated. The latter could be effectively modified by varying the type and amount of plasticizer. Independent experiments verified the theoretical predictions. The practical benefit of the presented method is to calculate the required composition of diffusion-controlled drug delivery systems (monolithic solutions) to achieve desired release profiles.     

130例不良反应报告分析及合理用药建议

目的:对130例临床药物不良反应报告进行回顾性分析,得出我院不良反应发生的特点,并对合理用药进行建议,以减少我院不良反应发生率。方法:对130例不良反应从性别、年龄、给药途径、药物分类等方面进行统计分析。结果:我院不良反应特点是在老年人和儿童中发生率较高,分别为33.08%和16.15%;女性(66.15%)多于男性(33.85%);发生不良反应最高的药物种类依次为抗菌药物(38.46%)、中成药(37.69%)及营养药物(6.92%),发生率较高品种为阿奇霉素、头孢呋辛、血塞通、生脉、痰热清、热毒宁,且20岁以下抗菌药物不良反应发生率高(42.00%),育龄期妇女中成药不良反应发生率高(30.61%)。结论:在合理用药中,建议我院应重点监护儿童中抗菌药物使用,育龄期女性中成药使用,老年人中成药和抗菌药物使用,并对阿奇霉素、头孢呋辛、血塞通、生脉、热毒宁、痰热清、疏血通7个品种建立重点监测制度,降低不良反应发生率。     

昆明医科大学第二附属医院感染菌分布及耐药性分析?

目的：了解昆明医科大学第二附属医院临床感染菌的分布及耐药情况,为细菌性感染的治疗提供依据。方法回顾性分析2013年1~12月该院临床分离菌4802株,采用 VITEK-2 Compact 细菌鉴定系统鉴定,纸片扩散法进行抗菌药物药敏试验,按美国临床实验室标准化协会(CLSI)2013年标准进行判定,并以 WHONET5.6软件统计分析。结果菌株主要分离自尿液、痰液、血液、分泌物和脓液,分别占31.7%、21.4%、19.7%、11.7%、7.0%。分离菌中革兰阴性菌占55.8%,以大肠埃希菌(26.3%)为主;革兰阳性菌占31.7%,以凝固酶阴性葡萄球菌(15.0%)为主;真菌占3.1%,以白色假丝酵母菌为主。大肠埃希菌、肺炎克雷伯菌对碳青霉烯类药物最敏感,耐药率均小于10.0%。大肠埃希菌和肺炎克雷伯菌产超广谱β内酰胺酶(ESBLs)的检出率分别为61.1%、49.1%。非发酵革兰阴性菌中,除铜绿假单胞菌对阿米卡星有较好的敏感性外,铜绿假单胞菌和鲍曼不动杆菌对绝大多数抗菌药物都呈现很强的耐药性(耐药率大于50.0%)。在革兰阳性菌中,耐甲氧西林金黄色葡萄球菌和耐甲氧西林凝固酶阴性葡萄球菌检出率分别为42.3%和65.6%。屎肠球菌对大部分抗菌药物耐药性较高,除利奈唑胺和替考拉宁外,屎肠球菌对其他抗菌药物的耐药率均高于粪肠球菌,检出1株耐万古霉素的屎肠球菌。结论细菌耐药监测对指导临床合理使用抗菌药物,减少细菌耐药性有积极意义。     

Current status of malaria chemotherapy and the role of pharmacology in antimalarial drug research and development

Antimalarial drugs have played a mainstream role in controlling the spread of malaria through the treatment of patients infected with the plasmodial parasites and controlling its transmissibility. The inadequate armory of drugs in widespread use for the treatment of malaria, development of strains resistant to currently used antimalarials, and the lack of affordable new drugs are the limiting factors in the fight against malaria. In addition, other problems with some existing agents include unfavorable pharmacokinetic properties and adverse effects/toxicity. These factors underscore the continuing need of research for new classes of antimalarial agents, and a re-examination of the existing antimalarial drugs that may be effective against resistant strains. In recent years, major advances have been made in the pharmacology of several antimalarial drugs both in pharmacokinetics and pharmacodynamics aspects. These include the design, development, and optimization of appropriate dosage regimens of antimalarials, basic knowledge in metabolic pathways of key antimalarials, as well as the elucidation of mechanisms of action and resistance of antimalarials. Pharmacologists have been working in close collaboration with scientists in other disciplines of science/biomedical sciences for more understanding on the biology of the parasite, host, in order to exploit rational design of drugs. Multiple general approaches to the identification of new antimalarials are being pursued at this time. All should be implemented in parallel with focus on the rational development of new agents directed against newly identified parasite targets. With major advances in our understanding of malaria parasite biology coupled with the completion of the malaria genome, has presented exciting opportunities for target-based antimalarial drug discovery.