Moxifloxacin: a review of the microbiological, pharmacological, clinical and safety features

Antimicrobial agents are used to treat patients with infectious diseases. Initial antimicrobial compounds originated from natural sources and were generally deemed to be narrow in spectrum. Today, we are in the era of designer drugs that have been specifically developed with current issues in infectious diseases in mind. For example, some new compounds require once daily dosing, have minimal side effects, are active against resistant pathogens and, for some, have a lower propensity for selecting for antimicrobial resistance during patient therapy.     

莫西沙星与左氧氟沙星治疗呼吸道感染的Meta分析

目的比较莫西沙星与左氧氟沙星在治疗呼吸道感染的有效性和安全性。方法应用RevMan5软件对国内1998—2008年发表的运用莫西沙星治疗呼吸道感染的随机对照试验进行meta分析,左氧氟沙星为对照组,结果指标包括临床总有效率、细菌清除率、不良反应发生率。结果检索到18个试验,包括1392例患者。莫西沙星总有效率优于对照组[RR2.24,95%CI（1.64,3.07）;P〈0.00001];细菌清除率优于对照组[RR2.35,95%CI（1.58,3.49）;P〈0.0001];不良反应发生率可能少于对照组。结论现有的证据表明,莫西沙星在治疗呼吸道感染的疗效优于左氧氟沙星。不良反应可能少于左氧氟沙星或两者无差异。     

莫西沙星与左氧氟沙星治疗细菌性感染懿细菌学疗效比较的Meta分析

目的分析比较莫西沙星与左氧氟沙星治疗细菌性感染的细菌学疗效。方法应用RevMan4．2软件对国内2000年至2007年13项莫西沙星和左氧氟沙星治疗细菌性感染的研究进行同质性检验和合并效应量的估计。结果同质性检验X^2=11．05,自由度为10,P=0．35;合并效应量的估计OR合并=2．08,0R合并95％可信限为1．26-3．45;OR合并的检验Z=2．87,P〈0．01。结论莫西沙星治疗细菌性感染的细菌学疗效优于左氧氟沙星。     

莫西沙星与左氧氟沙星治疗下呼吸道感染的对照研究

目的 评价莫西沙星片剂治疗下呼吸道感染的临床疗效及安全性.方法 将77例患者随机分为治疗组（38例,口服莫西沙星片400mg,1次/d）与对照组（39例,口服左氧氟沙星片200 mg,2次/d）,两组疗程均为7～14 d.结果 莫西沙星和左氧氟沙星治疗下呼吸道感染的有效率分别为89.5%和84.6%,细菌清除率分别为92.9%和90.3%,不良反应发生率分别为10.5%和12.8%,两组比较均无显著性差异（P＞0.05）.结论 莫西沙星片剂治疗下呼吸道感染的疗效、安全性与左氧氟沙星相似.     

司帕沙星与氧氟沙星治疗老年呼吸道细菌感染

目的:对照研究司帕沙星(SPFX)与氧氟沙星(OFLX)治疗老年患者呼吸道细菌感染(RTBI)的临床疗效及安全性。方法:将120例呼吸道细菌感染的老年患者随机分入试验(T)组和对照(C)组。试验组给予司帕沙星口服300mg,1次/d,对照组给予氧氟沙星口服200mg,2次/d。疗程均为7～10d。结果:试验组的综合疗效显著优于对照组(P<0.01),试验组痊愈率为71.7%,有效率为95.0%,均显著高于对照组(均P<0.05);试验组不良反应为3.33%,对照组不良反应为6.67%。结论:司帕沙星治疗老年患者呼吸道细菌感染疗效肯定、安全。     

Gemifloxacin: a new fluoroquinolone

Gemifloxacin is a dual targeted fluoroquinolone with potent in vitro activity against Gram-positive, -negative and atypical human pathogens – pathogens considered to be important causes of community-acquired respiratory tract infections. Gemifloxacin demonstrates impressive minimal inhibitory concentrations (MIC₉₀) values against clinical isolates of Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Chlamydia pneumoniae and Legionella spp., with MIC₉₀ values reported to be 0.016 – 0.06, < 0.0008 – 0.06, 0.008 – 0.3, 0.25, 0.125 and 0.016 – 0.07 μg/ml, respectively. Gemifloxacin is also active in vitro against a broad range of Gram-negative bacilli with MIC₉₀ values against the Enterobacteriaceae in the range of 0.016 to > 16 μg/ml (Escherichia coli and Providencia stuartii, respectively), with the majority of the genus having MIC₉₀ drug concentrations < 0.5 μg/ml. The in vitro activity of gemifloxacin against anaerobic organisms is variable. The MIC values for gemifloxacin are not affected by β-lactamase production nor by penicillin or macrolide resistance in S. pneumoniae. Gemifloxacin is approved by the FDA to be clinically efficacious against multi-drug resistant S. pneumoniae. The pharmacokinetics of gemifloxacin are such that the drug can be administered orally once-daily to yield or achieve sustainable drug concentrations exceeding the MIC values of clinically important organisms. Gemifloxacin has been shown to target both DNA gyrase (preferred target) and topoisomerase IV (secondary target) – enzymes critical for DNA replication and organism survival – against clinical isolates of S. pneumoniae. This dual targeting activity is thought to be important for reducing the likelihood for selecting for quinolone resistance. Gemifloxacin has been investigated and approved for therapy in patients with community-acquired pneumonia (CAP) and acute exacerbations of chronic bronchitis. In one study, more patients receiving gemifloxacin compared to clarithromycin remained free of exacerbations for longer periods of time (p < 0.016) and gemifloxacin had a shorter time to eradication of H. influenzae than did clarithromycin (p < 0.02). From efficacy studies, gemifloxacin was found to have an adverse profile that was comparable with other compounds. The most frequent side effects were diarrhoea, abdominal pain and headache. Gemifloxacin is a welcomed addition to currently available agents for the treatment of community-acquired lower respiratory tract infections. Other potential indications appear to be within the spectrum of this compound.     

A review of clinical trials with fluoroquinolones with an emphasis on new agents

This review aims to provide a comparison between the antimicrobial spectra, pharmacokinetics and clinical efficacy of the newer fluoroquinolones with older agents in this class, as well as other antibiotics used to treat lower respiratory and urinary tract infections (LRTIs and UTIs) respectively. Increasing antimicrobial resistance among common uro- and respiratory pathogens has focused attention on the development of fluoroquinolones, which have a broad spectrum of activity and improved tissue penetration. The new and developmental quinolones can be administered on a once-daily basis and exhibit high oral bioavailability, which reduces the need for parenteral therapy in hospitalised patients and may therefore potentially reduce the need for hospitalisation. These attributes, coupled with their expanded spectrum suggest that the newer fluoroquinolones are so far the most ideal agents for the empirical treatment of many common infections.     

左氧氟沙星与头孢哌酮/舒巴坦治疗社区获得性下呼吸道感染的对照研究

目的 探讨左氧氟沙星和头孢哌酮／舒巴坦治疗社区获得性下呼吸道感染的疗效及费用。方法 采用前瞻开放性随机对照研究方法。选取符合社区获得性下呼吸道感染的病例180例，随机进入实验组和对照组各90例，实验组给予左氧氟沙星注射液（300mg／100ml）静脉滴注，每日1次，疗程5～14d；对照组给予头孢哌酮／舒巴坦（4g）静脉滴注，每日1次，疗程5～14d。结果 实验组和对照组痊愈率分别为74．4％和78．9％；总有效率分别为92．2％和93．3％，两组痊愈率和有效率差异无显著性（P〉0．05）。实验组细菌清除率和阴转率均为89．7％，对照组细菌清除率和阴转率均为90．0％，两组比较无统计学差别（P〉0．05）。实验组平均疗程为（8．7±2．1）d，与对照组疗程（8．2±2．3）d比较，没有统计学差别（P〉0．05）。两组不良反应发生率也无统计学意义，但医疗费用实验组（387．2±93．5）元，远低于对照组（615±172．5）元，具有统计学意义（P〈0．05）。结论左氧氟沙星与头孢哌酮／舒巴坦具有相同的疗效，且医疗费用低，是治疗社区获得性下呼吸道感染安全有效的药物。     

注射用帕珠沙星治疗细菌性感染111例的临床随机对照研究

目的:评价国产注射用帕珠沙星治疗细菌性感染的疗效和安全性。方法:采用多中心、随机、单盲、平行对照试验设计。选择细菌性感染病人227例,其中呼吸系统感染113例,泌尿系统感染114例。所有病人随机分为试验组111例,给予帕珠沙星0.3g,iv,gtt,bid;对照组116例,给予左氧氟沙星0.2g,iv,gtt,bid;疗程均为7～10d。结果:2组人口学指标差异无统计学意义,资料具有可比性。临床综合疗效试验组和对照组的痊愈率分别为72.6%和67.8%,有效率分别为97.4%和91.5%(P>0.05)。细菌清除率分别为99%和98.0%(P>0.05)。试验组与对照组的不良反应发生率分别为12.0%和12.6%(P>0.05),主要表现为恶心、静脉炎等。结论:注射用帕珠沙星治疗呼吸系统和泌尿系统细菌性感染疗效好,使用安全。     

Gatifloxacin: a new fluoroquinolone

Gatifloxacin is a new 8-methoxy-fluoroquinoline antimicrobial agent. It has enhanced activity against Gram-positive and atypical agents, while retaining broad-spectrum antiGram-negative activity. For example, the MIC₉₀ values for respiratory tract pathogens are less than or equal to 0.5 μg/ml for organisms such as Streptococcus pneumoniae (regardless of penicillin susceptibility), Haemophilus influenzae (β-lactamase positive or negative), Moraxella catarrhalis (β-lactamase positive or negative), Legionella species, Mycoplasma pneumoniae, methicillin-sensitive Staphylococcus aureus, β-haemolytic Streptococci (macrolide sensitive or resistant), Neisseria species, most Enterobacteriaceae, Neisseria gonorrhoeae, Neisseria meningitidis, Pasteurella species, _{species and}Yersinia enterocolitica. For methicillin-resistant S. aureus, ciprofloxacin-resistant S. aureus, Citrobacter freundii, Providencia species, Serratia species, Pseudomonas aeruginosa and other non-fermentative Gram-negative bacilli, the MIC₉₀ are elevated. Gatifloxacin is bactericidal and exhibits a post-antibiotic effect against Gram-positive and -negative bacteria. The standard dose is 400 mg once daily and is available in both oral and iv. formulation. Gatifloxacin appears to have a low propensity for the selection of resistant mutants. Clinical trial data supports the use of gatifloxacin for treatment of patients with respiratory tract, urinary tract, skin and soft tissue infections. The side effect profile for gatifloxacin is similar to that with other agents.     

莫西沙星治疗下呼吸道感染的疗效观察

目的观察莫西沙星治疗下呼吸道感染的疗效及安全性。方法选择我科收治的下呼吸道感染患者120例,随机分为对照组及治疗组,每组各60例。对照组给予左氧氟沙星治疗;治疗组给予莫西沙星治疗。观察两组临床综合疗效、细菌性疗效及不良反应情况。结果两组疗效比较差异无统计学意义(P>0.05);治疗组细菌清除率及药物敏感率方面显著优于对照组,差异有统计学意义(P<0.05);两组不良反应轻微,均能耐受,不良反应比较差异无统计学意义(P>0.05)。结论莫西沙星治疗下呼吸道感染效果肯定,可有效缓解症状,抗菌作用强,安全有效。     

Terbinafine: a pharmacological and clinical review

Terbinafine (TRB) is an allylamine antifungal agent that has been available for more than a decade. It is now used for the treatment of dermatophytic infections and onychomycosis. Despite several studies having demonstrated the efficacy of terbinafine against nondermatophytic infections including azole-resistant candidiasis, invasive aspergillosis, disseminated fusariosis and scedosporiosis, the role of TRB in the management of these infections remains greatly underappreciated. A brief review of pharmacodynamic, pharmacokinetic, in vitro and in vivo data and published case reports provides insight into the use of terbinafine as a potential adjunct in combination with azoles, polyenes or echinocandins in the management of severe drug-resistant or refractory mycoses. Despite the lack of intrinsic fungicidal activity against several nondermatophytes, when used in combination, particularly with azoles, TRB has demonstrated good antifungal efficacy that could be exploited in clinical practice. As comprehensive human clinical studies are not feasible with the rare occurence of these mycoses, experiments using animal models are essential to evaluate the in vivo efficacy of drug combinations. In summary, terbinafine has established itself as a drug of choice for dermatophytic infections; it must be considered in combination with other antifungal agents for the management of nondermatophytic refractory or resistant yeast/mold infections as well.     

利复星与奥复星治疗老年人下呼吸道细菌感染的临床对照观察

目的：对照研究利复星（LVFX）与奥复星（OFLX）治疗老年人下呼吸道细菌感染的临床疗效及安全性。方法：将90例下呼吸道细菌感染的老年患者随机分为两组。A组46例，给予利复星200mg，静脉滴注，每日2次，7－14d；B组44例，给予奥复星200mg，静脉滴注，每日2次，7－14d。结果：A组症状、体征改善时间明显短于B组（P＜0．01，＜0．05）；A组治愈率明显高于B组（P＜0．05）。两组在总有效率和细菌清除率方面差异无显著性（P＞0．05），均无明显不良反应.结论：利复星是一种十分有效和安全的治疗老年人下呼吸道细菌感染的药物。     

舒美特治疗下呼吸道感染的疗效和安全性观察

观察舒美特在治疗下呼吸道感染中的临床疗效，体外药物敏感率及病原菌清除情况，了解其在治疗中引起的不良反应。采用舒美特（５００ｍｇ－日１次，连用３天）口服治疗，用药前后对病人进行痰液细菌学，肝肾功能及相应实验室检查，记录治疗前后病人症状体征的变化情况及用药过程中出现的不良反应。治疗后总有效率为９３．３％，细菌清除率为８１．８１％，不良反应较少。结果表明舒美特在轻、中度下呼吸道感染治疗中是一种有效的抗生素，用药方便，安全，不良反应较少。     

Epidemiological analysis of the spread of pathogens from a urological ward using genotypic,phenotypic and clinical parameters

Surveillance studies using molecular typing methods help clinicians assess the rate of potential spread of pathogens. The rate of cross transmission of uropathogens among patients on a urological ward was investigated. Urine samples were collected from 144 patients with urinary catheters and a significant bacteriuria. In a subgroup of 54 of these patients, cultures from a rectal swab were also made. Typing by PFGE, RAPD or bacteriocins showed that 41% of uropathogens were related and represented by 38 typing patterns. Endogenous infection was present in 30% and exogenous infection in 38% of isolates. Altogether, there was a high rate of clonal relationship amongst uropathogens in our urological ward and we conclude that hygienic means and measures are far from being optimal.     

巴洛沙星片治疗泌尿系统细菌性感染的多中心随机双盲对照临床试验

目的评价巴洛沙星片治疗泌尿系统急性细菌性感染的安全性和有效性。方法采用多中心、双盲双模拟、随机、阳性药物平行对照试验设计。共入选221例,其中可评价疗效病例209例,巴洛沙星组102例,左氧氟沙星组107例。巴洛沙星组予巴洛沙星片200 mg,hid,左氧氟沙星组予左氧氟沙星片200 mg,bid,2组疗程均为7～14 d。结果巴洛沙星组临床总有效率和痊愈率分别为98.0%和87.2%,细菌清除率为100%;左氧氟沙星组临床总有效率和痊愈率分别为100.0%和87.9%,细菌清除率为100%。巴洛沙星组和左氧氟沙星组药物不良反应发生率分别为4.8%和0.9%。2组比较均无显著差异(P>0.05)。结论巴洛沙星治疗急性细菌性泌尿系统感染安全、有效。     

莫西沙星注射液治疗呼吸道细菌性感染的临床研究

目的观察莫西沙星注射液治疗呼吸道细菌性感染的临床疗效与安全性。方法将60例呼吸道细菌性感染患者随机分为治疗组和对照组各30例。治疗组给予莫西沙星注射液静脉滴注;对照组给予左氧氟沙星注射液静脉滴注,疗程均为7～14d。结果治疗组临床总有效率为93.3%,高于对照组的76.7%;细菌清除率为92.0%,高于对照组的80.8%,差异均有统计学意义(P<0.05)。治疗组和对照组不良反应发生率分别为13.3%、16.7%,差异无统计学意义(P>0.05)。结论莫西沙星注射液治疗呼吸道细菌性感染疗效显著,值得临床推广应用。     

注射用盐酸多西环素随机对照治疗细菌性感染的疗效与安全性

目的评价国产注射用盐酸多西环素治疗细菌性感染的疗效和安全性。方法采用随机双盲对照临床观察,以阿奇霉素为对照药,共103例患呼吸道或泌尿道感染的病人入组,纳入疗效分析100例,安全性分析103例。结果注射用多西环素和阿奇霉素的痊愈率分别为63.46%(33/52)、66.67%(34/51),有效率分别为90.38%(47/52)、88.24%(45/51),细菌清除率分别为91.30%(42/46)和90.70%(39/43),不良反应发生率分别为34.62%(18/52)和50.98%(26/51)。经统计学分析无显著差异(P>0.05)。结论国产注射用盐酸多西环素治疗呼吸道感染和泌尿道感染的疗效和安全性与注射用阿奇霉素相仿。     

近10年拜复乐治疗感染性疾病的文献分析

目的了解近10年拜复乐(盐酸莫西沙星)在临床中对不同感染性疾病的治疗效果。方法检索各种学术数据库中2002年～2011年对拜复乐临床应用的报道,筛选符合条件的病例进行统计分析。结果共有929例感染性疾病患者接受了拜复乐治疗,其痊愈率>70%;感染部位不同,其疗效稍有差异,总有效率>93%。不良反应多表现为胃肠道不适、头晕、头昏、精神兴奋等。结论拜复乐治疗感染性疾病的痊愈率和总有效率较高,不良反应症状较轻。