头孢羟氨苄治疗细菌感染性皮肤病的临床疗效观察

目的 观察头孢羟氨苄治疗细菌感染性皮肤病的疗效和安全性。方法 采用开放、随机对照临床试验方法。试验组使用头孢羟氨苄胶囊，口服，每次0.5g，每日2次；对照组使用羟氨苄青霉素胶囊，口服，每次0.25g，每日4次。两组疗程均为7d。结果 共治疗104例，其中试验组56例，总有效率89.3%，细菌清除率86．0％；对照组48例，总有效率72．9％，细菌清除率67．5％，两组总有效率和细菌清除率比较均有显性差异（P＜0．05）。两组药物不良反应少而轻。结论 头孢羟氨苄是一种治疗细菌感染性皮肤病安全有效的药物。     

阿莫西林/克拉维酸钾治疗尿路感染的临床研究

目的：研究阿莫西林／克拉维酸钾治疗尿路感染的临床疗效。方法：治疗组41例 尿路感染患给予阿莫西林／克拉维酸钾0．25g，每日3次口服，疗程7d；对照组29例尿路感染患给予阿莫西林0．5g，每日3次口服或乳酸左氧氟沙星0．1g，每日2次口服，疗程7d。观察两组患症状、体征及实验室检查。结果：治疗组治疗后总有效率为95．12％，对照组治疗后总有效率为75．86％。结论：用阿莫西林／克拉维酸钾治疗尿路感染安全有效，节省卫生资源。     

复方海螵蛸泡腾片的鉴别含量溶出度测定实验研究

目的　建立复方海螵蛸泡腾片的化学鉴别、含量测定、溶出度测定方法 ,以控制该药的制剂质量。方法　应用化学鉴别法、薄层层析法对所含中药成分进行鉴别。采用HPLC法对所含阿莫西林、甲硝唑进行鉴别试验及含量测定 ,流动相为磷酸盐缓冲液 (pH5 .0 ) -乙腈 (96∶4 ) ;流速为 1ml/min ;检测波长为 2 5 4nm。用药典方法对药物的溶出度进行测定。结果　化学鉴别碳酸钙和延胡索中的生物碱反应为 (+) ,甘草与对照品甘草次酸钠薄层层析结果相符。含量测定 :阿莫西林的标准曲线方程为 :A1=1.6 34× 10 5C - 6 .2 4 2× 10 3 ,r =0 .9997(n =5 ) ;甲硝唑的标准曲线方程为 :A2 =1.2 19× 10 5C +1.5 6 1× 10 3 ,r =0 .994 6 (n =5 ) ;两者在 2 .5～ 30 μg·ml-1范围内线性关系良好。甲硝唑的平均回收率为 98.7% ,RSD 1.4 7% ,阿莫西林的平均回收率为 98.3% ,RSD0 .6 9%。结论　本文建立的三项检查方法 ,快速、简便 ,可以控制复方海螵蛸泡腾片的制剂质量     

短程三联疗法对功能性消化不良幽门螺杆菌感染的根除效果

目的　观察短程三联疗法对功能性消化不良 (FD)Helicobacterpylori感染的根除效果。方法　 73例H .pylori阳性的FD患者被随机分为A、B 2个治疗组 ,A组 (n =3 6) :奥美拉唑 2 0mgbid ,阿莫西林 1 0bid ,甲硝唑 0 4bid ,疗程 1周 ;B组 (n =3 7) :雷尼替丁 0 15bid ,阿莫西林 1 0bid ,甲硝唑 0 4bid ,疗程 1周 ;疗程结束时记录每组病人症状缓解情况 ,疗程结束后 1个月复查H .py lori。结果　H .pylori根除率分别为A组 5 2 8% (19/ 3 6)、B组 43 2 % (16/ 3 7) ,两组比较无统计学差异 (P >0 0 5 ) ,疗程结束时症状缓解率分别为A组 66 7% (2 4/ 3 6) ,B组 5 1 3 % (19/ 3 7) ,无统计学差异 (P >0 0 5 )。结论　本实验短程三联疗法对FD的H .pylori根除率及症状缓解率过低 ,不适合用于FD的H .pylori根治治疗     

奥美拉唑和克拉霉素及阿莫西林三联疗法治疗肝源性溃疡疗效观察

目的观察奥美拉唑、克拉霉素、阿莫西林三联疗法治疗肝源性溃疡的疗效。方法经胃镜确诊的肝源性溃疡患者58例,随机分为治疗组(31例)和对照组(27例)。两组患者均给予综合治疗。治疗组患者给予奥美拉唑20mg,口服,2次/d;克拉霉素500mg,口服,2次/d;阿莫西林1000mg,口服,2次/d。对照组单用奥美拉唑20mg,口服,2次/d。十二指肠溃疡治疗2周,胃溃疡治疗3周。疗程结束后,用内窥镜观察溃疡愈合情况。结果治疗组和对照组溃疡愈合率分别为87.0%和55.5%,差异有统计学意义(P<0.01);治疗后6个月和12个月,治疗组溃疡复发率分别为14.8%和18.5%,对照组分别为33.3%和40.0%,差异均有统计学意义(P<0.01)。结论奥美拉唑、克拉霉素、阿莫西林三联疗法治疗肝源性溃疡临床效果显著。     

Respiratory quinolones can eradicate amoxicillin-induced mature biofilms and nontypeable Haemophilus influenzae in biofilms

ObjectivesBiofilm is thought to be involved in the persistent bacterial infections caused by nontypeable Haemophilus influenzae (NTHi). This study aims to evaluate the efficacy of antibiotics against NTHi biofilms.MethodsA 96-wells pin replicator assay was applied for evaluation of antimicrobial efficacies against NTHi biofilms. The NTHi IH-202 strain for the standard and 10 clinical strains were evaluated, as well as the viability of NTHi in biofilms after antimicrobial exposures.ResultsBiofilms formed by IH-202 strain accumulated during incubation. AMPC if not high concentrations, neither reduce or inhibit biofilm formation, nor eradicate matured NTHi biofilms. The NTHi in matured biofilm were alive after exposure to amoxicillin (AMPC). Even high concentration of AMPC produced live NTHi after suspension of exposure, while tosufloxacin and garenoxacin inhibited biofilm formation of NTHi and eradicated matured biofilms. The respiratory quinolones, but not AMPC, killed NTHi in biofilms even at sub-MIC.ConclusionsNTHi persists in biofilms, even after exposure to AMPC. These findings may eventually lead to a better understanding of effective use of antibiotics to eradicate NTHi growing as biofilms, or even to the development of novel therapeutic agents for treating patients with mucosal NTHi biofilm infections. Meanwhile, respiratory quinolones are attractive agents in reducing NTHi biofilm formation and destroying established biofilm.     

Substitutions in Penicillin-Binding Protein 1 in Amoxicillin-Resistant Helicobacter pylori Strains Isolated from Korean Patients

Background/Aims

A worldwide increase in amoxicillin resistance in Helicobacter pylori is having an adverse effect on eradication therapy. In this study, we investigated the mechanism of the amoxicillin resistance of H. pylori in terms of amino acid substitutions in penicillin-binding protein 1 (PBP1).

Methods

In total, 150 H. pylori strains were isolated from 144 patients with chronic gastritis, peptic ulcers, or stomach cancer. The minimum inhibitory concentrations (MICs) of the strains were determined with a serial 2-fold agar dilution method. The resistance breakpoint for amoxicillin was defined as >0.5 µg/mL.

Results

Nine of 150 H. pylori strains showed amoxicillin resistance (6%). The MIC values of the resistant strains ranged from 1 to 4 µg/mL. A PBP1 sequence analysis of the resistant strains revealed multiple amino acid substitutions: Val16→Ile, Val45→Ile, Ser414→Arg, Asn562→Tyr, Thr593→Ala, Gly595→Ser, and Ala599→Thr. The natural transformation of these mutated genes into amoxicillin-sensitive strains was performed in two separate pbp1 gene segments. A moderate increase in the amoxicillin MIC was observed in the segment that contained the penicillin-binding motif of the C-terminal portion, the transpeptidase domain.

Conclusions

pbp1 mutation affects the amoxicillin resistance of H. pylori through the transfer of the penicillin-binding motif.     

Acute interstitial nephritis presenting as presumed minimal change nephrotic syndrome

Nephrotic syndrome (NS) secondary to drug-induced acute interstitial nephritis (AIN) is well described in adult but is very rare in children. We report an unusual case of AIN mimicking prototypical childhood minimal change NS. A 2-year-old girl on long-standing amoxicillin therapy for vesicoureteral reflux presented with the acute onset of generalized edema, proteinuria, hypoalbuminemia, hypercholesterolemia, and an inactive urinary sediment. She was placed on empiric steroid therapy for presumed minimal change NS. When she did not respond to steroids, a renal biopsy was performed and revealed AIN. Her NS resolved completely with cessation of her amoxicillin therapy and concomitant tapering of her steroids. This patient demonstrates that the association of AIN with NS should be carefully considered in children on antimicrobials who develop NS, even in the absence of the classic clinical features of AIN. In addition to the usual work-up and care of a child with NS, in these patients consideration may also need to be given to withdrawal of the potential precipitating agent. Received September 23, 1997; received in revised form February 3, 1998; accepted February 4, 1998