头孢噻肟在恶性血液病合并感染患者体内杀菌效价及临床疗效比较

目的 对比观察头孢噻肟（ＣＴＸ）与其他两种抗菌药物治疗方案对３０例血液病合并感染患者杀 菌活性（ＳＢＡ）及临床疗效。方法ＳＢＡ采用微量稀释法测定，临床疗效根据临床治疗登记表按三 级标准判定。结果与结论 头孢噻肟的临床反应最佳，杀菌作用时间维持较长，但对绿脓假单胞 菌和阴沟肠杆菌杀菌作用较差；呱拉西林（ＰＩＰ）与阿米卡星（ＡＮ）方案的抗菌谱广，但ＰＩＰ杀菌 作用时间较短，可考虑缩短给药间期，而ＡＮ可按一日一次给全日量的方案，以提高疗效减少不 良反应；头孢哌酮（ＣＰＺ）可主要用于绿脓假单胞菌感染，也可用于其它细菌的混合感染，但给药 间隔时间以一日三次为宜。     

阿米卡星与利福霉素钠注射液联合作为经验性治疗院外细菌性肺部感染首选方案的临床研究

目的　观察阿米卡星与利福霉素钠联合治疗院外细菌性肺部感染的疗效。方法　经临床确诊并有细菌性感染征象的院外肺部感染 3 0 0例 ,分为 3组 :治疗组 12 0例 ,予阿米卡星与利福霉素钠静脉滴注 ,每天 1次 ;对照 1组 80例 ,予青霉素与左氧氟沙星联合静脉滴注 ,每日 1次 ;对照 2组 10 0例 ,予青霉素与氨苄西林联合静脉滴注 ,每日 1次。观察有效率、显效所需时间及细菌清除率。结果　有效率治疗组为 98.3 3 % ,与对照 1组的88 75 %和对照 2组的 70 .0 0 %比较差异显著 (P均 <0 .0 1) ;显效时间治疗组为 (4.5± 2 .0 )天 ,对照 1组为 (6.5±3 .0 )天 ,对照 2组为 (8.0± 3 .0 )天 ,治疗组与后 2组相比差异显著 (P <0 .0 1) ;细菌清除率治疗组为 97.2 % ,对照 1组为 80 .0 % ,对照 2组为 72 .0 % ,治疗组与后 2组比较差异显著 (P <0 .0 1)。各组副作用均较小。结论　阿米卡星与利福霉素钠治疗院外细菌性肺部感染疗效好、疗程短、细菌清除率高、副作用小 ,可作为治疗院外细菌性肺部感染的首选经验方案     

尿中某些酶测定在丁胺卡那肾毒性监测中的应用

探讨药物致肾损伤早期诊断方法。用酶法测定碱性磷酸酶（ＡＬＰ）。速率法测γ－谷氨酰转肽酶（ＧＧＴ）,Ｎ－乙酰－β－Ｄ氨基葡萄糖苷酶（ＮＡＧ）、β－半乳糖苷酶（Ｇａｌ）及肌肝（ＵＣｒ）,磺柳酸法测尿蛋白（Ｐｒｏ）。结果：尿酶升高均早于尿蛋白的出现,特别是ＮＡＧ于用药后第３天即有显著升高,Ｇａｌ则在用药后３ｄ内持续升高,尿酶,特别是ＮＡＧ是药物引起肾损伤早期诊断指标。     

硫酸奈替米星注射液与硫酸丁胺卡那注射液临床疗效及安全性的比较

为评价硫酸奈替米星的临床疗效及安全性,在１７０例急性细菌感染性病人中作多中心临床研究。结果显示：硫酸奈替米星的有效率（９５．３％）显著高于对照药硫酸丁胺卡那的有效率（８４．１％）,试验组病人咳痰和腰痛症状的平均下降显著高于对照组;硫酸奈替米星治疗后细菌清除率达９７．２％;２组病人不良反应发生率均为４．８％,对照组中有２例（３．２％）出现耳鸣、１例（１．６％）听力减退,但试验组病人用药后未发现听力异常。结论：硫酸奈替米星临床疗效优于硫酸丁胺卡那且较少耳毒性。     

高效液相色谱—间接光度检测法同时测定血清和尿中5种氨基苷类抗生素

目的：建立一种直接分离测定体液中庆大霉素、丁胺卡那霉素、妥布霉素、西梭霉素和乙基西梭霉素等５种氨基苷类抗生素的高效液相色谱－间接光度检测（ＨＰＬＣ－ＩＰＤ）法。方法：在流动相中加入具有紫外检测响应的检测剂烟酰胺,用紫外检测器直接测定紫外吸收很差的上述５种药物。Ｃ１８固定相,流动相为含烟酰胺０５ｍｍｏｌ·Ｌ－１、庚烷磺酸钠５ｍｍｏｌ·Ｌ－１和磷酸００５ｍｏｌ·Ｌ－１的甲醇－乙腈－水（２７∶１８∶５５）混合溶液。结果：血清和尿样平均回收率均大于９６％,日内和日间ＲＳＤ均小于６％。并测定了肌注此类药物病人的血清和尿样品。结论：该法适于体液中氨基苷类药物检测。     

高效液相色谱-蒸发光散射检测法测定硫酸阿米卡星

目的:建立HPLC-ELSD法测定氨基糖苷类抗生素硫酸阿米卡星。方法:采用Zorbax Extend C18(150 mm×4.6mm,5μm)柱;以水-氨水-冰醋酸(96:3.6:0.4)为流动相,流速为0.4 mL·min-1;柱温:30℃;蒸发光散射检测,检测器漂移管温度:40℃,雾化气体压力:350 kPa。结果:硫酸阿米卡星在49.94-3995.5μg·mL-1范围内线性关系良好,r=0.9991;平均回收率为101.8％;系统精密度RSD=0.8％。同时阿米卡星与已知杂质A能良好分离。结论:本方法操作简便,快速,方法的精密度、准确性、重现性均能很好地满足质量控制的要求,是一种比较理想的阿米卡星含量测定分析方法。     

硫酸阿米卡星含量及有关物质的HPLC-ELSD测定

建立了高效液相色谱-蒸发光散射检测器法测定硫酸阿米卡星及有关物质的含量.采用Extend C18色谱柱,以水-氨水-冰醋酸(96:3.6:0.4,pH10.0)为流动相,流速0.8ml/min,漂移管温度110℃,氮气流速3L/min.在0.05～2.5mg/ml浓度范围内线性关系良好(r=0.9998),方法回收率99.6%～101.2%.     

A Comparative Study on Aztreonam,Ceftazidime and Amikacin in the Treatment of Complicated Urinary Tract Infections

Summary

In a prospective, randomized trial, aztreonam (1 g intravenously or intramuscularly, twice daily) was compared with ceftazidime (1 g intravenously or intramuscularly, twice daily) and amikacin (500 mg intravenously or intramuscularly, twice daily) in 76 patients aged 24 to 84 years (mean, 59.7 years) with complicated urinary tract infections. Initial pathogens included Escherichia coli (47.5%), Pseudomonas aeruginosa (22.5%), Klebsiella spp. (9%), Proteus spp. (7.5%) and Enterobacter spp (6%). In four patients initial urine cultures yielded more than one organism. All pathogens were sensitive to the three study drugs. Including performance of 4- to 6-week follow-up cultures, eradication of the pathogens occurred in 72% of patients treated with aztreonam, in 74% of those treated with ceftazidime and in 71% treated with amikacin (p>0.05). Clinical success was observed in 84% of patients treated with aztreonam, in 82% of those treated with ceftazidime and in 85% treated with amikacin (p>0.05). All drugs were well tolerated. It is concluded that aztreonam, ceftazidime and amikacin are equally effective and safe for the treatment of complicated urinary tract infections due to susceptible organisms.     

Meta-analysis: combination of meropenem vs ceftazidime and amikacin for empirical treatment of cancer patients with febrile neutropenia

Background:Meropenem monotherapy vs ceftazidime plus amikacin have been approved for use against febrile neutropenia. To assess the effectiveness and safety of them for empirical treatment of cancer patients with febrile neutropenia, we conducted a meta-analysis of randomized controlled trial.Methods:Randomized controlled trials on ceftazidime plus amikacin, or/and monotherapy with meropenem for the treatment of cancer patients with febrile neutropenia were identified by searching Cochrane Library, PubMed, Science Direct, Wiley Online, Science Citation Index, Google (scholar), National Center for Biotechnology Information, and China National Knowledge Infrastructure. Data on interventions, participants’ characteristics and the outcomes of therapy, were extracted for statistical analysis. Seven trials fulfilled the inclusion criteria.Result:The treatment with ceftazidime plus amikacin was more effective than meropenem (OR = 1.17; 95% CI 0.93–1.46; 1270 participants). However, the treatment effects of the 2 therapy methods were almost parallel in adults (OR = 1.15; 95% CI 0.91–1.46; 1130 participants older than 16). Drug-related adverse effects afflicted more patients treated with ceftazidime plus amikacin (OR = 0.78; 95% CI 0.52–1.15; 1445 participants). The common responses were nausea, diarrhea, rash, and increased in serum glutamic oxaloacetic transaminase, serum glutamic pyruvic transaminase and bilirubin.Conclusion:Ceftazidime plus amikacin should be the first choice for empirical treatment of cancer patients with febrile neutropenia, and meropenem may be chosen as a last defense against pathogenic bacteria.