采用合理用药国际指标干预和评估我院甲状腺切除围术期应用抗菌药物

目的:探讨采用合理用药国际指标干预和评估我院甲状腺切除围术期合理应用抗菌药物的可行性。方法:在我院普外科设立干预组和非干预组,参考合理用药国际指标对干预前(2007年3～8月)和干预后(2008年3～8月)同期出院的甲状腺手术患者进行对照研究。结果:干预后,干预组预防性应用抗菌药物平均持续时间由6.83d缩短至2.50d,平均住院时间由8.24d缩短至7.15d,平均住院药费由1895.99元下降至1375.26元,抗菌药物费用由852.11元下降至538.53元,抗菌药物费用占住院药费的比例有所下降;非干预组在同期各项指标变化不大。结论:采用合理用药国际指标干预和评估围术期合理应用抗菌药物具有有效性和可操作性。     

2011年1～12月我院门诊抗菌药物应用分析

目的了解该院抗菌药物应用情况及趋势,为临床合理用药提供参考。方法采用限定日剂量法,对该院2011年1～12月抗菌药物的应用数量、销售金额、用药频度、日均费用等进行统计、分析。结果头孢类和青霉素类抗菌药物使用频度较高,但人均费用相对较低。结论该院抗菌药物应用基本趋于合理,但有待提高。     

Enhancing drugs absorption through third-degree burn wound eschar

Antimicrobial therapy remains the most important method of wound infection treatment. Systemically administered antimicrobials may not achieve therapeutic levels in wound. On the other hand, some topically applied antimicrobials cannot penetrate eschar well enough. Therefore, an attempt has been made here to increase permeation of topically applied drugs through eschar using the so-called skin penetration enhancers. To perform this investigation, effects of different potential penetration enhancers on permeation of chlorhexidine, silver sulfadiazine and nitroglycerin through human third-degree burn eschar was evaluated. Results showed that water, glycerin, saline, sodium lauryl sulphate (SDS) and ethanol tend to reduce permeation of chlorhexidine through burn eschar. But, water, glycerin, hexane:ethanol and ethyl acetate:ethanol were able to increase permeation of silver sulfadiazine significantly by about 1.2-1.8 times, while saline, SDS and dimethyl sulfoxide were not able to change its permeation. Glycine showed 2.7 times enhancement toward permeation of nitroglycerin, followed by water, hexane:ethanol mixture, saline and SDS with enhancement ratios of 1.8-2.3. Urea, ethanol and citral were not able to increase permeation of nitroglycerin through eschar. This study shows that permeation of drugs through burn eschar can be improved by penetration enhancement including hydration; the effect depends on the nature of the penetrant.     

普外科围手术期患者应用抗菌药物调查与分析

目的 调查普外科围手术期抗菌药物的应用情况,评价其用药合理性.方法 随机抽取2005年10月～2006年3月出院病历133份,对抗菌药物的种类、用药时间、用药频度、药物利用及药物联用等进行调查与分析.结果 使用抗菌药物的病例132例,使用率达99.24%,其中单一用药占49.62%,二联占37.59%,三联及以上占12.03%;抗菌药物品种有10种,头孢菌素类最多,喹诺酮类和硝基咪唑类次之;围手术期存在用药疗程过长、用药起点偏高、个别联用欠妥等不合理用药情况.结论 强化临床医师合理应用抗菌药物的意识,加强围手术期抗菌药物应用管理,进一步提高合理应用抗菌药物知识水平.     

Alterations of growth,biofilm-forming,and gene expression of Bordetella pertussis by antibiotics at sub-minimum inhibitory concentrations

Bordetella pertussis is the primary agent of the acute respiratory disease pertussis. It has been reported that the disease has recently become more common, especially in adults and adolescents, and adaptation of the pathogen is thought to have an important influence on the recurrence of the disease. This study aims to determine the effect of erythromycin, azithromycin, and trimethoprim-sulfamethoxazole used in the treatment of pertussis on the virulence gene expressions (prn, ptxS1, fhaB), biofilm-forming and growth of B. pertussis. In this study, the minimum inhibitory concentration (MIC) values of azithromycin and erythromycin in B. pertussis local strain Saadet were determined to be 0.09 μg/mL and 0.3 μg/mL, respectively. However, the Tohama-I and Saadet strains were resistant to trimethoprim-sulfamethoxazole (MIC>32 μg/mL). The biofilm-forming of the Saadet strain decreased with the increase in antibiotic doses. It was observed that 1/32MIC erythromycin and 1/32MIC azithromycin upregulated the expression of fhaB in Tohama-I, whereas the expression of ptxS1 and prn significantly decreased in sub-MICs of erythromycin. In the Saadet strain, only ptxS1 was highly expressed at 1/16MIC azithromycin and erythromycin (p > 0.05). This is the first study to investigate the effect of sub-MIC antibiotics on the expression of virulence genes and biofilm-forming of B. pertussis.