头孢他啶不同给药频次对于复杂尿路感染的疗效比较及成本效果分析

目的探讨头孢他啶不同给药频次对于复杂尿路感染的疗效比较及成本效果分析。 方法选择肾内科收治的复杂尿路感染患者153例，随机分为A、B、C组，每组51例。A组给予注射用头孢他啶1 g（静脉滴注，12 h/次）；B组给予注射用头孢他啶1 g（静脉滴注，8 h/次）；C组给予注射用头孢他啶2g（静脉滴注， 12 h/次）。3组均以1周为1个治疗周期。观察3组患者临床疗效、实验室检查、中段尿细菌培养转阴率、不良反应发生率，通过成本-效果分析法对3种治疗方案进行药物经济学评价。 结果对3组临床疗效总有效率比较，差异无统计学意义（P＞0.05）；秩和检验结果显示，3组临床疗效比较差异有统计学意义（P＜0.05）；B组的临床症状消退时间、尿检白细胞转阴时间和退热时间显著低于A组和C组，且C组低于A组（P＜0.05）；治疗后3组的降钙素原（procalcitonin，PCT）、白细胞介素（interleukin，IL）-6、血清超敏C反应蛋白（serum hypersensitive C-reactive protein，hs-CRP）和IL-8水平明显降低（P＜0.05），其中B组的水平最低，C组次之，A组最高；A组的中段尿细菌培养转阴率为88.24%，B组为94.12%，C组为90.20%；3组的头孢他啶PK/PD达标率分别为72.55%、84.31%、76.47%；3组不良反应发生率比较差异无统计学意义（P＞0.05）；对3组治疗方案进行成本-效果分析后，得出B组治疗方案最佳，3组的增量成本-效果分析结果显示B组根据优势，若药品价格下降15%，敏感度分析结果支持成本-效果分析结果。 结论头孢他啶给药剂量为1 g、8 h/次给药频次的临床疗效最好，机体炎症反应显著减轻，且临床症状消退时间、尿检白细胞转阴时间和退热时间最低，尿培养转阴率最高，成本-效果优势最好，为最佳治疗方案。

Comparison of the efficacy of different administration frequency of ceftazidime for complicated urinary tract infections and cost-effectiveness analysis

ObjectiveTo explore the efficacy comparison and cost-effectiveness analysis of different administration frequency of ceftazidime for complicated urinary tract infections(UTI). MethodsA total of 153 patients with complicated UTI admitted to the Department of Nephrology were randomly divided into groups A, B, and C, with 51 cases in each group. Group A was given 1 g of ceftazidime for injection by intravenous infusion every 12 h, group B was given 1 g of ceftazidime for injection intravenously every 8 h, and group C was given 2 g of ceftazidime for injection intravenously every 12 h. Each group was treated for 1 week as a course of treatment. The clinical efficacy, laboratory examination, negative conversion rate of midstream urine bacteria culture and adverse reaction rate of the three groups were observed. The pharmacoeconomics of three treatment schemes was evaluated by cost-effectiveness analysis. ResultsThere was no statistically significant difference in the total effective rate of the three groups in terms of clinical efficacy(P＞0.05); the rank sum test showed that the difference in the clinical efficacy of the three groups was statistically significant(P＜0.05). The time to clinical symptom resolution, negative conversion time of white blood cell in urine test and antifebrile time were significantly shorter in group B than in group A and group C, and shorter in group C than in group A(P＜0.05). After treatment, the levels of procalcitonin(PCT), interleukin-6(IL-6), serum hypersensitive C-reactive protein(hs-CRP) and interleukin-8(IL-8) in three groups were significantly decreased(P＜0.05), among which the level of group B was the lowest, followed by group C, and group A. The negative conversion rate of midstream urine bacteria culture was 88.24% in group A, 94.12% in group B and 90.20% in group C. The PK/PD compliance rates of ceftazidime in groups A, B, and C were 72.55%, 84.31%, and 76.47%, respectively. There was no statistically significant difference in the incidence of adverse reactions among three groups(P＞0.05). After the cost-effectiveness analysis of the three treatment options, it was concluded that group B had the optimal treatment options. The results of incremental cost-effectiveness analysis in the three groups showed that, according to the advantages of group B, if the drug price dropped by 15%, the results of sensitivity analysis supported the cost-effectiveness analysis results. ConclusionThe optimal clinical efficacy can be achieved at a dose of 1g ceftazidime and administration frequency of every 8 h, when the body's inflammatory response is significantly reduced, and the time to clinical symptom resolution, negative conversion time of white blood cell in urine test and antifebrile time are the shortest, with the highest negative conversion rate of urine culture. Therefore, it is the optimal treatment plan.