替考拉宁治疗医院获得性肺炎伴肾功能不全的临床疗效和安全性评价

目的评价替考拉宁治疗医院获得性肺炎伴肾功能不全患者的临床疗效及安全性。方法选择确诊为MRSA/MRSE感染的医院获得性肺炎伴肾功能不全患者76例,随机分为替考拉宁治疗组和万古霉素治疗组;依据内生肌酐清除率决定两药的给药量及给药间隔时间,并监测血药浓度,观察患者临床疗效、细菌学清除率、肾功能指标及不良反应情况。结果替考拉宁组的临床有效率和细菌学清除率分别为82.5%、84.8%,均高于万古霉素组,但差异无统计学意义;替考拉宁组的疗程为(13.5±2.7)d,明显短于万古霉素组,差异有统计学意义(P0.05);替考拉宁组不良反应发生率为10.0%,低于万古霉素组,差异无统计学意义;但替考拉宁组的肾毒性远低于万古霉素组,差异有统计学意义(P0.05)。结论替考拉宁用于治疗MRSA/MRSE所致的医院获得性肺炎伴肾功能不全的患者,疗效确凿,安全性高;采用维持剂量每次400 mg,每48~72 h给药1次是合理、安全的;对于革兰阳性球菌感染伴肾功能不全的医院获得性肺炎患者可优先选择替考拉宁。

Efficacy and Safety Evaluation of Teicoplanin on Hospital-acquired Pneumonia with Renal Dysfunction

OBJECTIVE To evaluate the efficacy and safety of teicoplanin for the treatment of patients with hospital acauired pneumonia with renal dysfunction.METHODS In the randomized,controlled clinical trial all 76 patients (males 54 and females 22 with mean of 76.5±14.3 years old)with established meticillin-resistant Sta phylococcus aureus (MRSA) and/or meticillin-resistant S.epidermidis (MRSE) infections were enrolled,and divided randomly into teicoplanin group and vancomycin group.Based on creatinine clearance(Ccr)to calculate the dose and the dosage interval,and serum concentrations of teicoplanin and varcomycin were monitored.Clinical effectiveness,bacteriologic eradication rate,renal functional parameters and adverse effects were evaluated.RESULTS The total clinical effectiveness and bacteriologic eradication rate were 82.5%and 84.8%,respectively for teicoplunin group νs 75%and 79.2%for vancomycin group,but without significant differences between them groups.However,the mean time of treatment course in teicoplanin group was significantly shorter than the vancomycin group(13.5±2.7 days νs 20.3±5.6 days),t=5,47,P=0.032.10% adverse drug reactions occurred in teicoplanin group and 16.7%in vancomycin group with out significant differences.But compared with nephrotoxicity exclusively,the teicoplanin group was significantly lower than the vancomycin group,χ~2＝5.9468,P=0.0147.CONCLUSIONS Teieoplanin is a very effective antibiotic for MRSA/MRSE infections in patients with renal dysfunction.It is rational and safe that teicoplanin should be administered at a maintaining dose of 400mg at 48-72h intervals in renal dysfunction patients.Teicoplanin may be a choice for initial empirical treatment on infections of MRSA/MRSE in patients with renal dysfunction.