埃索美拉唑和阿奇霉素联合治疗幽门螺杆菌感染的疗效观察

【目的】观察埃索美拉唑和阿奇霉素联合治疗，幽门螺杆菌（Hp）感染的疗效。【方法】120例Hp阳性患者，随机分为治疗组（A组）和对照组（B组）。A组给予埃索美拉唑20mg，阿奇霉素0．25g，均2；k／d，共7d；B组给予经典Hp根除治疗方案：奥美拉唑20mg，阿莫西林1．0g，替硝唑0．4g，均2；k／d，共7d；7d后分别继续单独使用埃索美拉唑或奥美拉唑20mg，1；k／d，连续7d。于用药前1d，用药后d1，d3，d7，按标准对上腹痛，反酸进行评分，其中上腹痛从严重程度和发作频率两个方面进行评估。记录患者有无出现不良反应。治疗结束后4周做^14C—UBT检查，了解Hp根除情况。【结果】A组上腹痛消失率用药d1为56．1％，d3为89.4％；B组用药d1为21.4％，d。为60．7％，两组比较差异有显著性（P〈0．05）；A组反酸消失率用药d1为59．6％，d3为93．0％；对照组用药d1为19.6％，d3为64．3％，两组比较差异有显著性（P〈0.05）；服药d7，A组上腹痛、反酸消失率分别为98．2％、98.2％，B组亦分别为96．4％、94.6％，两组比较差异无显著性（P〉0.05）。A组、B组HP根除率分别为91．2％（52／57）、91．1％（51／56）（P〉0．05）。不良反应发生率两组分别为8.7％（5／57），10．7％（6／56），所有患者均未出现明显不良反应。【结论】埃索美拉唑和阿奇霉素二联疗法是一种高效、安全、经济的根除HP方案。     

3种临床用药方案治疗社区获得性肺炎的成本-效果分析

目的探讨3种不同的临床治疗方案用于社区获得性肺炎的经济效果。方法运用药物经济学成本-效果分析法对A组（左氧氟沙星静脉滴注）、B组（阿奇霉素静脉滴注）、C组（左氧氟沙星＋阿奇霉素静脉滴注）进行回顾性分析评价。结果3种药物治疗方案成本分别为46．2元、70．0元、81．2元；细菌清除率分别为84．6％、80．O％、92．6％（P〉0．05）；痊愈率分别为64．5％、58．1％、77．4％（P〉0．05）；成本-效果比分别为（细菌清除率）0．55、0．87、0．88；（痊愈率）0．40、0．72、0．63；有效率分别为87．1％、74．2％、93．5％（P〈0．05）；3种方案治疗社区获得性肺炎在痊愈率、细菌清除率上无显著差异，在有效率上有显著差异。结论综合考虑C方案为较佳方案。     

Azithromycin maintenance therapy in patients with cystic fibrosis: a dose advice based on a review of pharmacokinetics, efficacy, and side effects

Azithromycin maintenance therapy results in improvement of respiratory function in patients with cystic fibrosis (CF). In azithromycin maintenance therapy, several dosing schemes are applied. In this review, we combine current knowledge about azithromycin pharmacokinetics with the dosing schedules used in clinical trials in order to come to a dosing advise which could be generally applicable. We used data from a recently updated Cochrane meta analysis (2011), the reports of clinical trials and pharmacokinetic studies. Based on these data, it was concluded that a dose level of 22-30 mg/kg/week is the lowest dose level with proven efficacy. Due to the extended half-life in patients with CF, the weekly dose of azithromycin can be divided in one to seven dosing moments, depending on patient preference and gastro-intestinal tolerance. No important side effects or interactions with other CF-related drugs have been documented so far.     

阿奇霉素对斑马鱼心脏毒性的初步研究

目的建立阿奇霉素诱导斑马鱼幼鱼心脏毒性的模型,为后续抗菌类药物心脏毒性的机理研究奠定基础。方法以受精后2 d发育正常的斑马鱼胚胎作为模型,以不同浓度的阿奇霉素处理斑马鱼胚胎3 d后,观察斑马鱼胚胎心脏形态并计算其心率和心搏量以评价斑马鱼胚胎心脏的功能。结果 0.3和1 mm浓度的阿奇霉素作用3 d后,可见斑马鱼胎心明显毒性。与正常对照组比较,模型组斑马鱼胎心肿大,心率减慢和心搏量减小。结论阿奇霉素对斑马鱼胎心有明显毒性作用,且与阿奇霉素的浓度正相关,该模型可以用于后续抗生素类药物引起的心脏毒性的机理研究。     

In vitro antimicrobial susceptibility of Porphyromonas gingivalis to azithromycin, a novel macrolide

The in vitro antimicrobial susceptibility of Porphyromonas gingivalis to azithromycin, a new macrolide antibiotic of a new class known as azalides, was investigated by the agar dilution method on Brucella agar. Eighty-two P. gingivalis strains, 79 recent oral isolates, 1 nonoral isolate and 2 reference strains were included in the study. Azithromycin was highly effective against P. gingivalis. All strains were inhibited at 1.0 μg/ml of azithromycin or less. The minimal inhibitory concentrations were 0.25 μg/ml for 50% and 0.5 μg/ml for 90%. These in vitro data as well as the favorable pharmacokinetics of azithromycin indicate that this new oral macrolide might be a good candidate for future clinical trials aiming to eradicate P. gingivalis from refractory periodontitis.     

Disseminated Bartonella infection following liver transplantation.

Bartonella henselae has not only been identified as the causative agent of cat scratch disease, but it is also associated with other significant infectious syndromes in the immunocompromised population. We describe two cases of B. henselae associated diseases in liver transplant recipients who both had contact with cats. The first recipient developed localized skin manifestation of bacillary angiomatosis in association with granulomatous hepatitis. He tested positive for Immunoglobulin G (IgG) antibodies against B. henselae. The second patient developed axillary lymphadenopathy, with biopsy showing necrotizing granulomatous inflammation and polymerase chain reaction studies were positive for B. henselae DNA. Her serology for bartonellosis showed a fourfold rise in antibody titers during her hospitalization. Both patients responded to treatment with Azithromycin in combination with Doxycycline. These were the only cases within a series of 467 consecutive liver transplants performed in 402 patients performed during a 4-year period. Although bartonellosis is a rare infection in liver transplantation recipients, it should always be included in the differential diagnosis of patients presenting with fever, central nervous system (CNS) symptoms, skin lesions, lymphadenopathy, and hepatitis especially if prior contact with cats is reported.     

中西医结合与阿奇霉素治疗沙眼衣原体感染性尿道炎的疗效比较

目的　探讨中西医结合治疗衣原体感染性尿道炎之疗效。方法　选择单一衣原体感染性尿道炎随机分成中西医结合治疗组与阿奇霉素治疗组 ,采用追踪观察方式 ,中西医结合组口服土霉素片 (OxytetracyclinTablets) 0 .5gqid(首剂加倍 ) ,共 14d ;同时自拟中药方剂 ,1剂 /d ,煎服 ,亦服 14d。阿奇霉素组口服阿奇霉素片 (AzithromycinTablets)第 1天 1.0g顿服 ,第 2日起每日 0 .5g ,顿服 ,共 7d。结果　中西医结合组治愈率为 87.9% (5 1/ 5 8) ;阿奇霉素组治愈率 85 .5 % (4 7/ 5 5 )。结论　中西医结合与阿奇霉素治疗衣原体感染性尿道炎 ,治愈率相比无统计学差异(P >0 .0 5 ) ,但中西医结合疗法更经济更实惠     

Possible azithromycin-associated hiccups

OBJECTIVE: To report a case of persistent hiccups associated by azithromycin therapy. CASE SUMMARY: A 76-year-old man presented with persistent hiccups after beginning azithromycin for the treatment of pharyngitis. Hiccups were persistent and exhausting. Discontinuation of azithromycin and therapy with baclofen finally resolved hiccups. No organic cause of hiccups was identified despite extensive investigation. DISCUSSION: Pharmacotherapeutic agents have been uncommonly associated with hiccups. Corticosteroids (dexamethasone and methylprednisolone), benzodiazepines (midazolam) and general anaesthesia have been the specific agents mentioned most frequently in the literature as being associated with the development of hiccups. Few cases of drug-induced hiccups have been reported related to macrolide antimicrobials. Using the Naranjo adverse effect reaction probability scale this event could be classified as possible (score 5 points), mostly because of the close temporal sequence, previous reports on this reaction with other macrolides and the absence of any alternative explanation for hiccups. Our hypothesis is that a vagal mechanism mediated by azithromycin could be the pathogenesis of hiccups in our patient. CONCLUSIONS: Diagnosis of drug-induced hiccups is difficult and often achieved only by a process of elimination. However, macrolide antimicrobials have been reported to be associated with hiccups and vagal mechanism could explain the development of this side-effect.