利福昔明片治疗急性细菌性肠道感染疗效和不良反应评价

目 的 评价 利 福昔 明片 治 疗急 性细 菌 性肠 道感 染 疗效 和不 良 反应 。方 法 采 用随 机 双盲 双模 拟平 行对 照研 究 。利 福昔 明 片组 ，第１、３次各 口 服 利 福昔 明 片０．２ ｇ＋环 丙 沙 星模 拟 片０．５ ｇ剂 量，第２、４次 各口 服 利 福昔 明片０．２ ｇ，每天４次 ，疗 程３ ｄ；对 照 环丙 沙星 片 组，第１、３次各 口 服环 丙沙 星０．５ ｇ＋利 福 昔明 模拟 片０．２ ｇ，第２、４次各 口服 利福 昔 明模 拟片０．２ ｇ，每 天４次 ，疗 程３ ｄ。 结果 利福 昔明 片 组疗 急性 腹 泻１１６例 ，止 泻率８７．９％ ；对 照环 丙沙 星 片组 治 疗 急 性腹 泻１１２例 ，止 泻 率８９．３％ ；两 组 间 疗 效差 异 无 显 著性 （Ｌｏｇｒａｎｋ 检 验 ，Ｐ＝０．７２２１），两 药 不 良 反 应发 生率 差 异无 显著 性 （Ｆｉｓｈｅｒ，Ｐ＝１．０００），均未 观 察到 严重 不 良事 件。结 论 在治 疗急 性 细菌 性肠 道 感染 方面 ，利 福昔 明片 具有 环 丙沙 星片 同 等的 疗效 和 安全 性。     

利福昔明预防自发性细菌性腹膜炎有效性和安全性的Meta分析

目的评价利福昔明预防自发性细菌性腹膜炎(SBP)的有效性及安全性。方法通过计算机检索中国知网、万方数据、中国生物医学数据库、PubMed、Embase、Cochrane图书馆建库至2020年7月5日发表的有关利福昔明预防SBP的随机对照研究(RCT)、队列研究,根据纳入和排除标准对文献进行筛选,并对文献进行提取数据和质量评估,采用RevMan 5.3软件进行Meta分析。结果最终纳入13项研究,共2207例患者,其中6项为RCT,7项为队列研究。Meta分析结果显示,与无预防组相比,利福昔明组的SBP发病率(OR=0.36,95%CI:0.14~0.96,P=0.04)、死亡率(OR=0.59,95%CI:0.37~0.95,P=0.03)均明显下降;与诺氟沙星组相比,利福昔明组的SBP发病率(OR=0.39,95%CI:0.25~0.62,P<0.001)、死亡率(OR=0.55,95%CI:0.34~0.92,P=0.02)、不良反应(OR=0.36,95%CI:0.22~0.59,P<0.001)均明显降低,根据预防类型进行亚组分析,两组在初级预防无显著差异(OR=0.56,95%CI:0.23~1.35,P=0.20),二级预防时利福昔明组的SBP发病率(OR=0.18,95%CI:0.08~0.43,P<0.001)明显降低。此外,还发现利福昔明可以明显降低肝肾综合征(OR=0.34,95%CI:0.15~0.77,P=0.01)和肝性脑病(OR=0.55,95%CI:0.32~0.95,P=0.03)的发生风险。结论利福昔明对SBP初级预防和二级预防安全有效,在二级预防时,利福昔明优于诺氟沙星,但仍需高质量多中心RCT进行验证。     

Changes in Fecal Calprotectin After Rifaximin Treatment in Patients With Nonconstipated Irritable Bowel Syndrome

Background

Fecal calprotectin, an indicator of colonic inflammation, is associated with nonconstipated irritable bowel syndrome. Rifaximin is an antibiotic used to treat nonconstipated irritable bowel syndrome. We performed a retrospective review of patient charts to investigate the changes in fecal calprotectin levels and intestinal symptoms following treatment with rifaximin in patients with nonconstipated irritable bowel syndrome with elevated fecal calprotectin.

Efficacy of levofloxacin and rifaximin based quadruple therapy in Helicobacter pylori associated gastroduodenal disease: a double-blind, randomized controlled trial

The aim of this study was to evaluate the efficacy of levofloxacin and rifaximin based quadruple regimen as first-line treatment for Helicobacter pylori infection. A prospectively randomized, double-blinded, parallel group, comparative study was performed. Three hundred consecutive H. pylori positive patients were randomized to receive: omeprazole, amoxicillin, clarithromycin (OAC); omeprazole, amoxicillin, levofloxacin (OAL); and omeprazole, amoxicillin, levofloxacin, rifaximin (OAL-R). The eradication rates in the intention to treat (ITT) and per protocol (PP) analyses were: OAC, 77.8% and 85.6%; OAL, 65.3% and 73.6%; and OAL-R, 74.5% and 80.2%. The eradication rate achieved with OAC was higher than with OAL on the ITT (P = 0.05) and PP analysis (P = 0.04). OAL-R regimen was not inferior to OAC. The frequency of moderate to severe adverse effects was significantly higher in OAC treatment group. Especially, diarrhea was most common complaint, and there was a significantly low rate of moderate to severe diarrhea with the rifaximin containing regimen. In conclusion, the levofloxacin and rifaximin based regimen comes up to the standard triple therapy, but has a limited efficacy in a Korean cohort. The rifaximin containing regimen has a very high safety profile for H. pylori eradication therapy.     

Recent and currently emerging medical treatment options for the treatment of alcoholic hepatitis

Patients with severe alcoholic hepatitis (AH) need to be treated with specific treatment for better outcome.Currently available specific treatment modalities are use of corticosteroids or pentoxifylline.However,the response rate to these drugs is only about 50%-60%.Hence,there is an urgent need for better and more effective treatment options.Tumor necrosis factor plays an important role in the pathogenesis of AH.However,agents blocking the action of tumor necrosis factor have not been found to be effective.Rather the randomized studies evaluating these agents showed an adverse effect and more infections in treated patients.Critical role of tumor necrosis factor in hepatic regen-eration explaining this contrast is discussed.Oxidative stress and inflammation derived from gut bacteria ate two main components in the pathogenesis of AH laying foundation for the role of antioxidants,probiotics,and antibiotics in the management of AH.This article reviews the current data and status of these newer agents for the treatment of AH.Of the various options available,Vitamin E and N-acetylcysteine (NAC) have shown great promise for clinical use as adjunct to corticosteroids.With these encouraging data,future well designed studies are suggested to assess Vitamin E and NAC before their routine use in clinical practice in the management of AH.     

Efficacy of rifaximin compared with ciprofloxacin for the treatment of acute infectious diarrhea: a randomized controlled multicenter study

Background/Aims

Ciprofloxacin has been widely prescribed for acute infectious diarrhea. However, the resistance to this drug is increasing. Rifaximin is a novel but poorly absorbed rifamycin derivative. This study evaluated and compared the efficacies of rifaximin and ciprofloxacin for the treatment of acute infectious diarrhea.

Methods

We performed a randomized controlled multicenter study in Korea. Patients with acute diarrhea were enrolled and randomized to receive rifaximin or ciprofloxacin for 3 days. The primary efficacy endpoint was the time to last unformed stool (TLUS). Secondary endpoints were enteric wellness (reduction of at least 50% in the number of unformed stools during 24-hour postenrollment intervals), general wellness (subjective feeling of improvement), and proportion of patients with treatment failure.

Results

Intent-to-treat analysis (n=143) showed no significant difference between the rifaximin and ciprofloxacin groups in the mean TLUS (36.1 hours vs 43.6 hours, p=0.163), enteric wellness (49% vs 57%, p=0.428), general wellness (67% vs 78%, p=0.189), or treatment failure rate (9% vs 12%, p=0.841). The adverse events did not differ significantly between the two groups.

Conclusions

These results suggest that rifaximin is as safe and effective as ciprofloxacin in the treatment of acute infectious diarrhea.     

In vitro activity of rifaximin against isolates from patients with small intestinal bacterial overgrowth

Rifaximin, a non-absorbable rifamycin derivative, has published clinical efficacy in the alleviation of symptoms in patients with irritable bowel syndrome (IBS). Small intestinal bacterial overgrowth (SIBO) is associated with the pathogenesis of IBS. This study describes for the first time the antimicrobial effect of rifaximin against SIBO micro-organisms from humans. Fluid was aspirated from the third part of the duodenum from 567 consecutive patients; quantitative cultures diagnosed SIBO in 117 patients (20.6%). A total of 170 aerobic micro-organisms were isolated and the in vitro efficacy of rifaximin was studied by (i) minimum inhibitory concentration (MIC) testing by a microdilution technique and (ii) time–kill assays using bile to simulate the small intestinal environment. At a breakpoint of 32 μg/mL, rifaximin inhibited in vitro 85.4% of Escherichia coli, 43.6% of Klebsiella spp., 34.8% of Enterobacter spp., 54.5% of other Enterobacteriaceae spp., 82.6% of non-Enterobacteriaceae Gram-negative spp., 100% of Enterococcus faecalis, 100% of Enterococcus faecium and 100% of Staphylococcus aureus. For the time–kill assays, 11 E. coli, 15 non-E. coli Gram-negative enterobacteria and three E. faecalis isolates were studied. Rifaximin produced a >3 log₁₀ decrease in the starting inoculum against most of the tested isolates at 500 μg/mL after 24 h of growth. The results indicate that rifaximin has a potent effect on specific small bowel flora associated with SIBO. This conclusion should be regarded in light of the considerable time–kill effect at concentrations lower than those achieved in the bowel lumen after administration of conventional doses in humans.     

Sex is associated with differences in gut microbial composition and function in hepatic encephalopathy

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利福昔明-金双歧序贯治疗腹泻型肠易激综合征临床观察

目的 观察利福昔明-金双歧序贯疗法治疗腹泻型肠易激综合征疗效.方法 80例IBS-D病人按照随机原则分为A组（利福昔明-金双歧序贯组）、B组（益生菌组）、C组（对照组）治疗,疗程均4周,记录治疗前后患者胃肠道主要症状评分.统计分析采用SPSS17.0软件,P＜0.05为差异有统计学意义.结果 治疗4周后,A组患者较同组治疗前及C组同期腹痛、腹胀程度和频度、排便次数及大便性状和总评分均显著下降（P＜0.05）,具有统计学意义;A组较B组同期腹痛程度和频度、腹胀程度、排便次数及大便性状和总评分均显著下降（P＜0.05）,具有统计学意义.B组患者治疗后腹痛程度和频度、腹胀频度、大便性状及总评分显著下降（P＜0.05）,具有统计学意义.C组患者治疗后症状评分下降不明显（P＞0.05）.结论 利福昔明-金双歧序贯治疗腹泻型肠易激综合征有效,可有效改善临床症状,且作用优于单用益生菌治疗,值得临床推广应用.