Sephadex G-10凝胶色谱系统测定头孢西丁钠中高分子聚合物

目的:建立测定头孢西丁钠中高分子聚合物的含量.方法采用Sephadex G-10凝胶色谱系统.色谱柱:葡聚糖凝胶G-10色谱柱;流动相A:pH 7.0的0.1 mol·L-1磷酸盐缓冲液[0.1 mol·L-1磷酸氢二钠溶液-0.1 mol·L-1磷酸二氢钠溶液(61:39)],流动相B:超纯水;流速:1.0 mL·min-1,检测波长:254 nm.结果:头孢西丁钠高分子聚合物在5～70 g·L-1的范围内线性关系良好,r=0.994 3.结论:本方法专属性强,准确度高、重现性好,可作为头孢西丁钠中高分子聚合物含量的测定方法.     

持续高产AmpC酶的检测及其临床意义

目的调查持续高产AmpC酶在大肠埃希菌、肺炎克雷伯菌和鲍曼不动杆菌中的携带率和流行趋势。方法用头孢西丁药敏纸片法(K-B法)和头孢西丁三维试验作AmpC酶的筛选、确证试验,对AmpC酶阳性者进行质粒接合试验。结果11种抗生素中亚胺培南的抗菌活性最强,耐药率仅为1.1%。头孢西丁纸片筛选法阳性率为84.4%,三维试验阳性率为32.2%。与三维试验相比,纸片筛选法总的假阳性率为54.4%,两种方法差异具有高度显著性(P<0.001)。AmpC酶、超广谱β-内酰胺酶(ESBLs)、AmpC酶+ESBLs阳性率分别为24.4%、54.4%和7.8%,其中以肺炎克雷伯菌AmpC酶阳性率最高,达33.3%。大肠埃希菌ESBLs阳性率最高,达70.0%。29株AmpC酶阳性菌中,5株耐药质粒转移成功。结论AmpC酶可由染色体或质粒介导,但以染色体介导为主。头孢西丁三维试验可准确检出持续高产AmpC酶,对指导临床用药有积极意义。     

用阿奇霉素与头孢西丁治疗盆腔炎的疗效比较

目的评价阿奇霉素与头孢西丁分别联合甲硝唑治疗盆腔炎中的临床疗效。方法采用随机分组、双盲、对照的研究方法。结果试验组有效率90%,对照组70%,两组有效率差异有统计学意义。试验组不良反应发生率为8%,对照组10%,两组不良反应发生率无统计学意义差异。结论表明用阿奇霉素治疗盆腔炎疗效优于头孢西丁,并且用药时间短,安全性好。     

头孢西丁和苯唑西林检测耐甲氧西林金黄色葡萄球菌的比较

目的比较头孢西丁和苯唑西林两种抗生素检测耐甲氧西林金黄色葡萄球菌(meticillin-resistant-Staphylococcus aureus, MRSA)的阳性率差异,并对91株MRSA进行临床调查,为临床诊断和控制该类菌引起感染的提供依据. 方法苯唑西林及头孢西丁分别采用K-B法和MIC法鉴定213株金黄色葡萄球菌中的MRSA阳性率. 结果 213株金黄色葡萄球菌中对苯唑西林耐药的有99株(46.5%);用头孢西丁纸片法和MIC法检测结果一致,耐药菌株有91株(42.7%);以头孢西丁检测方法作为标准,苯唑西林检测方法的假阳性率为8.1%,假阴性率为0%;MRSA的高发病区为重症监护病房(ICU)和呼吸科;MRSA对10种抗生素的耐药率高于MSSA. 结论检测MRSA头孢西丁法优于苯唑西林法;MRSA具有多重耐药的特性,应严格控制MRSA医院感染.     

头孢美唑和头孢西丁预防阑尾术后感染的药物经济学评价

目的比较头孢西丁和头孢美唑预防阑尾术后感染的疗效,并进行药物成本-效应分析,为临床合理用药提供依据。方法回顾性分析比较头孢美唑与头孢西丁预防阑尾术后感染的疗效,运用药物经济学方法进行成本-效果分析。结果头孢美唑与头孢西丁预防阑尾术后感染的总有效率分别为96.00%和95.80%,二者差异无统计学意义(P>0.05);治疗成本分别为496.8元和693.95元,差异有统计学意义(P<0.05)。结论头孢美唑和头孢西丁预防阑尾术后感染的疗效确切,可作为阑尾手术预防用药;头孢美唑的成本-效果比优于头孢西丁,为较优的治疗方案。     

毛细管气相色谱法检测头孢西丁钠原料药中的残留溶剂

目的建立气相色谱法测定头孢西丁钠原料药中的有机残留溶剂乙醇、丙酮及乙酸乙酯。方法色谱柱为HP-5(30m×0.53mm×1.5μm),载气为氮气,进样器温度为180℃,火焰离子检测器(FID)温度为250℃,柱温为50℃,以水为溶剂,进样量1μl。结果乙醇、丙酮及乙酸乙酯的线性关系r分别为0.9998、0.999及0.997,平均回收率分别为98.6%、102.6%及101.9%,最小检出量分别为6.0E～4ng、2.9E～4ng及3.1E～4ng。3批样品中均检测出丙酮残留,而未检出乙醇和乙酸乙酯。结论该方法高效、灵敏、准确,适用于同时检测头孢西丁钠原料药中有机残留溶剂乙醇、丙酮及乙酸乙酯的含量。     

中药灌肠联合西药治疗盆腔炎随机平行对照研究

[目的]观察中药灌肠联合西药治疗盆腔炎疗效。[方法]使用随机平行对照方法,将68例住院患者按掷骰子法随机分为两组。对照组34例奥硝唑,0．5g／次,2次／d,静注。0．5g头孢西丁钠＋100mL0．9％氯化钠,1次／8h,静滴。治疗组34例中药灌肠（红藤、白花蛇舌草、败酱草、香附各30g,元胡、制附子、茯苓各20g,桂枝、桃仁、牡丹皮、蒲公英、木香各15g;寒湿阻滞加赤芍20g;寒热不显加红花、当归、白术各20g;湿热蕴结加白头翁、马齿苋各20g）。1剂／d,水煎100mL,睡前取右侧卧位,灌肠末端涂抹少量润滑油,缓慢插入肛门15cm,药液滴入肛门内,保留约2h,月经期停止用药。治疗期间确保足够睡眠,多饮水,多食清淡,忌辛辣,注意个人卫生,经期禁性生活。西药治疗同对照组。连续治疗7d为1疗程。观测临床症状、B超、不良反应。治疗1疗程,判定疗效。[结果]治疗组显效32例,有效2例,无效0例,有效率94．12％。对照组显效28例,有效6例,无效0例,有效率82．35％。治疗组疗效优于对照组（P〈0．05）。[结论]中药灌肠联合西药治疗盆腔炎效果显著,值得推广。     

Pharmacokinetics of three-dose cefoxitin prophylaxis in caesarean section

A pharmacokinetic analysis of cefoxitin in women undergoing caesarean section under general anaesthesia, was performed. In order to prevent infections postoperatively three doses of cefoxitin -2,1 and 1 g, respectively — were given as a 3-min intravenous infusion at 6-h intervals.In vitro growth of most pathogens is inhibited at a cefoxitin concentration of 16 g/ml. In the sera of the patients, this antibiotic level was maintained for a period of 90–100 min after the first administration (2 g) and 45–50 min after the second and the third administration of cefoxitin (1 g). The period of subinhibitory antibiotic concentrations lasted 270 and 315 min, respectively. How can one reach prolonged antibiotic coverage? In order to minimize antibiotic pressure on hospital flora it is advisable not to increase the total amount of antibiotic (4 g) administered. By starting a 310 mg/h infusion after the initial 2 g bolus injection, the serum concentration of cefoxitin can be maintained at a minimum level of 16 g/ml during a period of 6.5 h. The improvement of antibiotic administration suggested requires further clinical testing.Part of this work was published inZiekenhuisfarmacie (ref. 12).     

Evaluation of a cefoxitin disk diffusion test for the routine detection of methicillin-resistant Staphylococcus aureus

Two oxacillin disk methods were compared with a cefoxitin disk diffusion test for detection of methicillin-resistant Staphylococcus aureus (MRSA), with PCR for mecA as the reference method. When tested with 115 MRSA and 350 methicillin-susceptible S. aureus isolates, the cefoxitin disk test (specificity 100%, sensitivity 96.5%) was superior to the oxacillin disk methods (specificity 99.1%, sensitivity 90.4%). Testing with both oxacillin and cefoxitin disks would give better sensitivity (100%) than the cefoxitin test alone, but at the expense of specificity (99.1%). The cefoxitin disk test required no special test conditions and would improve the reliability of routine tests for detection of MRSA.