培氟沙星治疗伤寒的临床研究

为评价培氟沙星治疗伤寒的疗效，对１３０例伤寒进行随机分组双盲对照观察培氟沙星与诺氟沙星的疗效，另有２７例伤寒用沙星治疗作开放试验。培氟沙星治疗９０例伤寒的显效率为诺氟沙星的疗效，另有２７例伤寒用培氟沙星治疗作开放试验。培氟沙星治疗９０例伤寒的显效率为９８．９％，体温恢复正常平均时间为４．２１±１．１９天。盲对照试验表明培氟沙星临床疗效优于诺氟沙星。药敏试验证实培氟沙星对伤寒杆菌均有良好杀菌活性，而     

氟康唑治疗全身真菌病随机双盲对照研究

为观察国产氟康唑对全身性真菌病的临床疗效和安全性，采用国产氟康唑与酮康唑随机双盲对照和开放治疗全身真菌病共２２２例，其中随机双盲对照试验１２４例，包括氟康唑组６４例，酮康唑组６０例；开放组９８例。氟康唑治疗根据病情分首剂４００ｍｇ及２００ｍｇ，以后２００ｍｇ及１００ｍｇ，每日１次，疗程１－８周；阴道真菌病１５０ｍｇ单剂；酮康唑每次２００ｍｇ，每天２次，疗效１－８周，阴道真菌病疗程５天。氟康唑和酮康     

甲磺酸培氟沙星治疗泌尿系统感染的临床疗效

目的评价甲磺酸培氟沙星对泌尿系统感染的疗效。方法对46例细菌性泌尿系统感染患者给予甲磺酸培氟沙星400mg/次，ivgtt，bid，疗程7-10d。结果治愈率为63．0％，有效率为91．3％，只有2例出现了轻微的不良反应。结论甲磺酸培氟沙星适用于泌尿系统感染。     

植物油乳治疗胃溃疡的实验与临床研究

目的：对两种植物油乳──鸦胆子油乳（简称鸦乳）和豆油乳治疗胃溃疡的作用进行观察。方法：首先观察鸦乳对四种胃溃疡动物模型的疗效，进而探讨其对动物胃粘膜内源性PGE2、MDA、SOD活性和氧自由基相对含量的影响，然后通过开放性临床观察和随机双盲对照试验观察其临床疗效。结果：鸦乳对四种胃溃疡动物模型均有疗效（P＜0．01）；豆油乳对应激性胃溃疡动物模型亦有疗效，作用与鸦乳比较，差异无显著性（P＞0．05）；鸦乳增加动物及人体胃粘膜内源性PGE2（P＜0．01），降低动物胃粘膜SOD活性（P＜0．01），减低动物胃粘膜MDA和氧自由基相对含量（P＜0．01）。开放性临床观察及随机双盲对照临床观察均显示，鸦乳治疗胃溃疡的8周有效率＞91．62％，8周愈合率＞75％，疗效优于对照剂西咪替丁（国产）和石蜡油乳（P＜0.01），未发现不良反应。结论：鸦乳和豆油乳治疗胃溃疡的疗效是肯定的，其主要作用机理是增加胃粘膜内源性PGE2、减轻氧自由基对胃粘膜的损害。     

卡托普利对急性心肌梗死伴糖尿病患者的疗效观察

目的 观察糖尿病患者发生急性心肌梗死的临床特点及卡托普利对其的近期疗效。方法 本试验共纳入１４６６６例患者,分为糖尿病组和非糖尿病组,其中ＡＭＩ伴糖尿病患者１３７６例,多中心随机双盲安慰剂对照临床试验分为对照临床试验分为对照组７０７例,治疗组６６９例,口服卡托普利或安慰剂,治疗４周。结果 糖尿病ＡＭＩ组４周病死率为１４．７５％,明显高于非糖尿病ＡＭＩ８．８９％。     

普米克令舒、万托林联合雾化吸入治疗小儿喘息性肺炎31例疗效观察

目的探讨普米克令舒、万托林治疗小儿喘息性肺炎的临床疗效。方法将我院住院62例小儿喘息性肺炎采用随机双盲对照试验,分为两组,在常规治疗基础上,观察组患儿加用普米克令舒、万托林雾化吸入治疗,对治疗后症状、体征消失时间以及治愈率进行比较。结果观察组治愈率、咳嗽消失、缓解喘憋及缩短肺部哕音时间均明显优于对照组,两组比较有显著性差异（P〈0．05）。治疗组治愈率为90．32％,对照组治愈率为70．96％。结论氧气驱动普米克令舒（布地奈德）混悬液及万托林溶液雾化治疗在小儿喘息性肺炎的治疗中疗效确切,值得临床推广应用。     

甲磺酸多沙唑嗪片治疗轻中度原发性高血压的临床试验研究

目的探讨甲磺酸多沙唑嗪片在治疗轻中度原发性高血压中的临床效果。方法根据试验设计标准选择40例轻中度原发性高血压患者，随机分成试验组与对照组（n试验组=20，n对照组=20）。采用双盲对照的方法。试验组与对照组分别应用甲磺酸多沙唑嗪片和盐酸特拉唑嗪片，疗程均为8周，判断其疗效。结果入选双盲试验病例40例，完成39例（1例脱落）。两组用药前后收缩压、舒张压组间比较均无差异（P〉0．05），而组内比较均有显著性差异（P〈0．01）。试验组与对照组降压总有效率分别为95％与100％。试验组与对照组不良反应有头晕、头痛、轻度心动过速等，患者均能耐受。结论甲磺酸多沙唑嗪片与盐酸特拉唑嗪片疗效相似，是治疗轻中度原发性高血压安全、有效的药物。     

天智颗粒治疗老年人血管性痴呆的随机双盲临床对照研究

目的对中药天智颗粒治疗血管性痴呆（VD）的疗效进行观察。方法采用随机平行双盲双模拟对照试验的研究方法，对120例VD患者按计划分组投药，治疗组70例（口服天智颗粒），对照组50例（口服都可喜），疗程为60d。并在治疗前后分别采用简易精神状态检查表（MMSE）和Blessed行为量表（BBS）对认知功能和行为能力进行评估。结果中药天智颗粒和都可喜均可以明显改善血管性痴呆患者的各项认知功能和行为能力的积分（P〈0．01）。对痴呆的总体疗效，两药物效果相近（P〉0．05）。两药对记忆认知的作用也近似（P〉0．05）。对行为能力的改善方面，中药天智颗粒的作用明显优于都可喜（P〈0．05）。结论中药：天智颗粒对痴呆有确切的疗效。同时在改善全身机能状况和减轻周边症状方面有明显作用，可以提高患者的生存质量。     

自拟益脑灵汤治疗老年期痴呆32例临床观察

目的探讨自拟益脑灵汤治疗老年期痴呆症的临床疗效。方法将62例老年期痴呆症病人随机分为治疗组（32例）与对照组（30例），治疗组以自拟益脑灵汤，对照组用吡拉西坦（脑复康），采用随机双盲给药；按长谷川痴呆量表统计评分。结果治疗组总有效率为81．3％明显优于对照组的50．0％（P〈0．05）；治疗组在记忆能力的提高和认知功能的改善方面均明显优于对照组。结论自拟益脑灵汤治疗老年期痴呆优于脑复康。     

欣麦通胶囊治疗脑梗死恢复期证候和疗效的临床研究

目的观察欣麦通胶囊针对脑梗死恢复期的疗效以及中医证候的演变规律。方法选择已批准上市的同类功效药物为阳性对照，评价欣麦通胶囊治疗中医中风病中经络（恢复期）风痰瘀阻证的随机、双盲单模拟、平行对照、安全性、有效性的Ⅲ期临床试验。结果欣麦通胶囊治疗脑梗死恢复期病人综合疗效中愈显率为53.6％，对照组为20．0％％；中医证候疗效评价：欣麦通试验组愈显率32.1％，对照组为20．0％；偏身感觉异常疗效两组比较差别有统计学意义（P〈0.05）。结论欣麦通胶囊治疗脑梗死恢复期在改善病人神经功能缺损评分、生活能力方面与对照药同样有效。并在改善偏身感觉异常的统计学方面优于对照药物。     

Oral administration of fluoroquinolones in the treatment of typhoid fever and paratyphoid fever in Japan

OBJECTIVE: To study the adverse reactions and therapeutic effects of fluoroquinolones to investigate whether they can be used for the treatment of patients with typhoid fever and paratyphoid fever. METHODS: The adverse reactions and therapeutic effects of fluoroquinolones were studied retrospectively in patients with typhoid fever and paratyphoid fever. PATIENTS: 58 patients (54 Japanese) with typhoid fever, 42 patients (41 Japanese) with paratyphoid fever, and 1 Japanese patient with both typhoid fever and paratyphoid fever, who were admitted in hospitals in Tokyo, Kawasaki, Yokohama, Kyoto, and Osaka from 1995 to 1998 and treated with fluoroquinolones. RESULTS: Almost 80% of the patients were treated with tosufloxacin (TFLX) and the remaining 20 % were treated with norfloxacin, ciprofloxacin, levofloxacin, or sparofloxacin. Side effects (nausea, urticaria, aphthous stomatitis) and elevation of serum amylase were found in 3.6% and 8.3 % of patients treated with TFLX, respectively, but these adverse reactions disappeared in all of these cases either with or without a change in the drug used. No adverse reactions were found in patients treated with the other fluoroquinolones. The clinical and bacteriological effects of these drugs were adequate. CONCLUSION: Though further studies still need to be performed on the fluoroquinolones other than TFLX, we can preliminarily conclude that fluoroquinolones are safe drugs and they can be recommended for the initial therapy of patients with typhoid fever and paratyphoid fever.     

Prevalence of typhoid fever in febrile patients with symptoms clinically compatible with typhoid fever in Cameroon

Typhoid fever is difficult to differentiate from other causes of infection such as malaria because their signs and symptoms often overlap. There has been an unprecedented increase in the number of typhoid fever cases diagnosed in Cameroon. Febrile patients are often treated for malaria and typhoid fever simultaneously. This cross-sectional study was carried out to determine the prevalence of typhoid fever in 200 consecutive patients with fever and symptoms clinically compatible with typhoid fever to verify recent estimates of a high prevalence of typhoid fever in Cameroon. Patients were enrolled in three of the 10 provinces of Cameroon. Blood culture, thick and thin blood smears and Widal tests using acute sera were performed in all cases; stool culture for 120 patients. Typhoid fever was confirmed in only 2.5% as evidenced either by culture (four cases) or high salmonella antibody titres (one case); malaria was diagnosed in 94 (47%) patients. Typhoid fever is not as endemic in Cameroon as recently feared.     

Efficacy of ofloxacin in treating typhoid fever

We studied 75 patients (36 males and 39 females), suffering from typhoid fever. 64 patients were treated with ofloxacin and 11 with amikacin, dosage regimens of the two drugs were 300 mg and 300-400 mg twice daily. Clinical effective rate was 100% with ofloxacin and 36.4% with amikacin. A total of 72 strains of salmonella typhi was isolated from all the patients of both groups. Bacteriological elimination rate was 100% with ofloxacin after treatment. Sensitive rates for S. Typhi isolated was 100% with ofloxacin, norfloxacin and ceftriaxone, 98.6% with amikacin and 20-21.4% with chloramphenicol, ampicillin and sulfamethoxazole Co. There were fewer adverse reactions and better acceptance, one had skin rash and one had gastrointestinal disturbance. In amikacin group, abnormality of urine routine and serum creatinine was observed. Ofloxacin was well absorbed orally. Its high bioavailability, satisfactory therapeutic efficacy excellent tolerability and convenience for use make it a very useful medication in the therapy of typhoid fever resulted from multiresistant strains.     

Clinical effect and laboratory observation of ofloxacin in the treatment of typhoid fever, bacillary dysentery and gonorrhea]

Ofloxacin was used in the treatment of 20 cases of typhoid fever, 32 cases of bacillary dysentery and 50 cases of gonococcal infection. Altogether 102 cases were treated, 53 being male and 49 female. The daily dosage was 400 mg to 600 mg, divided into two times. The result showed that the clinical effective rate for typhoid fever, bacillary dysentery and gonococcal infections was 100%, 97% and 94% respectively, while the bacterial eradication rate was 100%, 100% and 94% respectively. the bacterial eradication rate was 100%, 97% and 94% respectively. The side effects were mild in degree. The authors are of the opinion that since ofloxacin can be administered orally with only two times a day, its absorption is nearly complete and the cure rate is high, it should be considered as the drug of choice in the treatment of typhoid fever, bacillary dysentery and gonorrhea, especially in the drug resistant cases. It is suggested that this drug be used more widely.     

Typhoid fever complicated by intestinal perforation: a persisting fatal disease requiring surgical management

In Bangladesh, clinical records of 323 patients with typhoid fever were reviewed to study the incidence, fatality, and optimal therapy of the complication of intestinal perforation. Fifteen patients (4.6%) developed intestinal perforation. Case-fatality rates were six of nine patients treated medically and one of four patients treated surgically for whom the postoperative courses were known. A literature review of 57,864 cases of typhoid fever in developing countries in the antibiotic era revealed that perforation developed in 2.5% of patients, a percentage that was similar to the incidence of 2.8% reported in the preantibiotic era. The median of case-fatality rates in these reports was 43% and the proportion of all reported typhoid deaths attributable to perforation was 25%. The case-fatality rates for patients with perforation were 70% for 410 patients managed medically and 26% for 1,835 patients managed surgically. Although some reports were biased toward placing patients at lower risk into surgical treatment, the large number of patients treated successfully by surgery suggests real improvement in surgical techniques in countries with endemic typhoid fever. These results indicate that intestinal perforation persists as a major cause of death in cases of typhoid fever in developing countries in the antibiotic era and that surgical treatment with use of antibiotic therapy is optimal for this complication.     

Salmonella typhi infections in the United States, 1975-1984: increasing role of foreign travel

To explore changes in the epidemiology of typhoid fever in the United States, cases reported to the Morbidity and Mortality Weekly Report (MMWR) and typhoid case report forms submitted by state and local governments are reviewed. The incidence of typhoid fever in the United States fell from one case per 100,000 population in 1955 to 0.2 cases per 100,000 in 1966 and has since remained fairly stable. Review of case report forms for 2,666 cases of acute typhoid fever that occurred between 1975 and 1984 showed that 62% were imported, in contrast to only 33% during 1967-1972. The proportion of cases imported has continued to rise, reaching 69% in 1984. The major sources of the 1975-1984 cases were Mexico (39%) and India (14%). The case-fatality rate was 1.3%. Antimicrobial resistance was a minor problem, and large outbreaks were unusual. Further decline in the incidence of typhoid fever in the United States probably must await the advent of an effective vaccine with minimal adverse effects for use by travelers.     

Urine bactericidal activity of pefloxacin versus norfloxacin in healthy female volunteers after a single 800-mg oral dose

Summary In an open randomised crossover study the antibacterial activity of pefloxacin and norfloxacin was assessed in the urine after a single 800-mg oral dose in 14 healthy female volunteers. Pefloxacin demonstrated lower peak concentrations in the urine than norfloxacin (mean, 217.2 mg/l versus 492.9 mg/l as determined by the microbiological assay) but pefloxacin was present over a longer period of time in sufficient concentrations than norfloxacin. Mean urine levels of at least 2 mg/l were present for 7 days after pefloxacin administration and 2 days after norfloxacin administration as determined by the microbiological assay. Overall, the urinary recovery of pefloxacin and norfloxacin amounted to 49.3% and 25.1%, respectively, of the total administered dose. The average urine bactericidal activity against the five test organisms was as follows: against reference strainEscherichia coli ATCC 25922 susceptible to nalidixic acid (Nal-S) for 5 days with pefloxacin and 2 days with norfloxacin; against three clinical isolates, one strain each ofE. coli resistant to nalidixic acid (Nal-R),Klebsiella pneumoniae Nal-R, andStaphylococcus saprophyticus, for 3 days with pefloxacin and 24 h with norfloxacin; and against a clinical isolate ofEnterococcus faecalis for 2 days with pefloxacin and 12 h with norfloxacin. In conclusion, pefloxacin as a single dose proved to have sufficiently high and long-lasting urine bactericidal activity against urinary pathogens. These findings support the results of a meta-analysis of seven clinical trials in patients with uncomplicated lower UTI, demonstrating a single oral dose of 800 mg pefloxacin to be as effective as a conventional treatment with comparative drugs [21].     

Clinical research on patients with typhoid and paratyphoid fever (1984-1987). Research Group for Infectious Enteric Diseases, Japan

Patients with typhoid or paratyphoid fever, admitted to 14 hospitals for infectious diseases during 1984-1987, were epidemically and clinically studied. Of the total number of 183 typhoid, 49 paratyphoid fever patients, those infected overseas was 44.3% and 71.4% respectively, giving an overall annual decrease, yet marking an increased ratio of overseas infection. Patients aged 20s-30s and males were dominant. One hundred and seventy six cases (96.2%) of typhoid and all the paratyphoid fever cases were bacteriologically diagnosed. The period from the onset to the diagnosis was around 14 days in most cases, but beyond 29 days in over 10% of the cases. We would like to emphasize that enteric fever, focusing on high fever, bradycardia, roseola, hepatosplenomegaly, leukopenia, elevated serum-GOT GPT and LDH, can be easily diagnosed by blood/stool culture before beginning chemotherapy. Intestinal bleeding was recognized in 24 cases (13.1%) of typhoid and 4 (8.2%) of paratyphoid fever, intestinal perforation in 2 (1.1%) and death in 1 (0.5%) of typhoid fever. CP was most commonly used in chemotherapy. Bacteriological relapse was recognized in 7/127 cases (5.5%) of typhoid, 6/48 (13.0%) of paratyphoid fever those followed beyond 3 weeks, though eradication was attained by retreatment. One strain of S. typhi resistant to CP.ABPC.KM.SM was isolated in 1986 from a patient infected overseas. New quinolones seem reliable in our preliminary studies.     

Pefloxacin versus chloramphenicol in the therapy of typhoid fever

Summary An open, randomized clinical study was carried out to compare the clinical efficacy and safety of pefloxacin with that of chloramphenicol in the treatment of typhoid fever. Sixty hospitalized patients (40 men and 20 women, aged from 17 to 64 years), affected by severe proven typhoid sepsis, were randomly assigned to treatment with pefloxacin at a daily dose of 1,200 mg for 15 days (Group A) or with chloramphenicol at a daily dose of 2 g for 15 days (Group B). The two groups of patients were statistically homogeneous regarding both age and sex and all patients were followed for 30 days after the end of therapy. In Group A all the patients completely recovered from infection and all the isolated strains ofSalmonella typhi were eradicated by pefloxacin treatment. In Group B two patients had a relapse, two patients became chronic enteric carriers ofS. typhi and only 26 patients recovered from infection with complete eradication of the pathogen. The results indicate that pefloxacin is as active as chloramphenicol in the therapy of typhoid fever and that pefloxacin could be a valid antibacterial agent to be used together with appropriate hygienic measures for an eradication program of typhoid fever in the endemic countries.

---

Pefloxacin im Vergleich zu Chloramphenicol bei Typhus

Zusammenfassung Zum Vergleich der klinischen Wirksamkeit und Sicherheit einer Behandlung mit Pefloxacin und Chloramphenicol in der Therapie des Typhus wurde eine offene, randomisierte klinische Studie durchgeführt. 60 hospitalisierte Patienten (40 Männer, 20 Frauen im Alter von 17 bis 64 Jahren) mit schwerem septischen Typhus erhielten nach Randomplan eine Behandlung mit Pefloxacin in einer Tagesdosis von 1.200 mg für 15 Tage (Gruppe A) oder mit Chloramphenicol in einer Tagesdosis von 2 g für 15 Tage (Gruppe B). Die beiden Patientengruppen waren hinsichtlich Alter und Geschlecht homogen, und alle Patienten wurden bis 30 Tage nach Therapieende nachkontrolliert. In der Gruppe A erholten sich alle Patienten vollständig von der Infektion. Alle isolierten Stämme vonSalmonella typhi waren nach Behandlung mit Pefloxacin eradiziert. In der Gruppe B traten bei zwei Patienten Rezidive auf, zwei Patienten wurden chronische Träger vonS. typhi und nur 26 Patienten waren nach der Erholung vollständig erregerfrei. Die Ergebnisse zeigten, daß Pefloxacin ebenso aktiv wie Chloramphenicol in der Behandlung des Typhus ist und ein wertvolles Antibiotikum darstellt, das zusammen mit Hygienemaßnahmen eingesetzt werden kann, um in den endemischen Ländern ein Eradikationsprogramm für Typhus durchzuführen.

     

Use of norfloxacin to treat chronic typhoid carriers

High relapse rates and low tolerability to ampicillin characterize present therapy for carriers of Salmonella typhi. Norfloxacin, a carboxyquinolone with a 90% minimum inhibitory concentration for S. typhi of less than or equal to 0.5 micrograms/mL, is a promising alternative. Carriers of S. typhi were treated in a double-blind trial with either norfloxacin (400 mg) or matching placebo given every 12 h for 28 d. Twelve assessable individuals were treated in each group. After therapy, 11 of 12 individuals treated with norfloxacin had negative stool and bile cultures for S. typhi. All placebo-treated carriers still had positive cultures immediately after therapy. Subsequently, 11 individuals were treated openly with norfloxacin. S. typhi was eradicated in seven of 11. Overall, the eradication rate for 23 individuals treated with norfloxacin was 78%. Eighteen individuals were followed up for one year, and their stool and/or bile cultures remained negative. From our results, norfloxacin is an effective and well-tolerated antimicrobial agent for eradicating the chronic typhoid carrier state.