哌拉西林/他唑巴坦与头孢哌酮/舒巴坦治疗细菌性感染疗效的Meta分析

目的系统评价头孢哌酮/舒巴坦与哌拉西林/他唑巴坦治疗细菌性感染的有效性和安全性。 方法检索4个中文数据库及外文期刊数据库,共筛查到8篇比较头孢哌酮-舒巴坦与哌拉西林-他唑巴坦治疗细菌性感染疗效的随机临床试验研究,采用RevMan 5.3和Stata 12.1软件进行Meta分析。 结果采用固定效应模式进行数据统计,头孢哌酮/舒巴坦与哌拉西林/他唑巴坦治疗细菌性感染的治愈率计算OR值（95%CI）为0.91（0.62～1.33）,有效率计算OR值（95%CI）为1.00（0.60～1.67）,不良反应率计算OR值（95%CI）为0.80（0.35～1.85）,清除率计算OR值（95%CI）为1.85（1.05～3.26）,合并效应量检验P值分别为0.62、0.99、0.61和0.03;Egger线性回归法得出P = 0.90,95%CI：-0.59～0.66。 结论哌拉西林/他唑巴坦治疗细菌性感染的有效性和安全性并不逊于头孢哌酮/舒巴坦。     

Clinical study of cefclidin on bacterial prostatitis]

Cefclidin (CFCL), a new injectable cephem antibiotic, was used in the treatment of bacterial prostatitis. Concentration in prostatic fluid (PF): One hour after the i.v. administration of 1 g of CFCL the concentration of PF was 0.84 +/- 0.72 micrograms/ml (n = 4), the ratio of PF/serum being 2.24%. CFCL was administered at a dose of 1-2 g a day for 6.5 days on average. In acute bacterial prostatitis, the efficacy was evaluated as excellent or moderate in all 7 cases (100%), but in chronic cases, the effectiveness rate was as low as one out of 4 cases (25%). In safety profile, transient skin eruption was seen in one patient, but did not require further treatment. Besides this case, no side reactions or abnormal clinical values were encountered. In conclusion, CFCL was evaluated to be very useful in the treatment of acute bacterial prostatitis, caused by gram negative rods.     

Ⅲ度烫伤家兔应用头孢哌酮后的局部药代动力学变化

采用家兔１０％～１５％Ⅲ度烫伤模型，将２１只纯种家兔随机分为痂下给药Ⅰ、Ⅱ组和静脉给药组。每只兔分三期给药（２５ｍｇ／ｋｇ）。分别采用高效液相色谱法（ＨＰＬＣ）和微生物法（ＭＢＰＤ）对照检测头孢哌酮（ＣＰＺ）局部和血中药浓度，并以电子计算机处理药代动力学参数。结果表明：①烫伤后痂下ＣＰＺ浓度痂下给药组比静脉给药组明显增高（２６８１／２８ｍｇ／Ｌ）；②烫伤后立即痂下给药组消除相半衰期明显延长；③烫伤后９大的创面静脉给药组痂下未检测出药浓度，而痂下给药组局部药浓度消除相半衰期延长；④烫伤后立即痂下给药血中出现两次具有治疗意义的药峰，可以相当两次静脉给药；⑤痂下给药组在直径１３ｃｍ的周边区，烫伤早期注药后２４ｈ和烫伤后第９天注药后３６ｈＣＰＺ药浓度一直大于最小抑菌浓度（ＭＩＣ）５～８倍。提示：痂下给药是治疗和预防Ⅲ度焦痂下感染的有效方法之一。     

III度烫伤家兔应用头孢哌酮后的局部药代动力学变化

采用家兔10％～15％III度烫伤模型,将21只纯种家兔随机分为痂下给药I、II组和静脉给药组。每只兔分三期给药(25mg/kg)。分别采用高效液相色谱法(HPLC)和微生物法(MBPD)对照检测头孢哌酮(CPZ)局部和血中药浓度,并以电子计算机处理药代动力学参数。结果表明:①烫伤后痂下CPZ浓度痂下给药组比静脉给药组明显增高(2681/28mg/L);②烫伤后立即痂下给药组消除相半衰期明显延长;③烫伤后9天的创面静脉给药组痂下未检测出药浓度,而痂下给药组局部药浓度消除相半衰期延长;④烫伤后立即痂下给药血中出现两次具有治疗意义的药峰,可以相当两次静脉给药;⑤痂下给药组在直径13cm的周边区,烫伤早期注药后24h和烫伤后第9天注药后36hCPZ药浓度一直大于最小抑菌浓度(MIC)5～8倍。提示:痂下给药是治疗和预防III度焦痂下感染的有效方法之一。     

Clinical and bacteriological study of sparfloxacin on bacterial prostatitis]

Sparfloxacin (SPFX), a new oral quinolone antimicrobial, was studied for the bacterial response, pharmacokinetics and clinical efficacy in the treatment of bacterial prostatitis. The minimum inhibitory concentration (MIC) values for 48 strains isolated from expressed prostatic secretion were measured. The values for 8 out of 12 strains of S. epidermidis were below 0.05 microgram/ml and those for all 6 strains of E. coli were below 0.025 microgram/ml. The SPFX concentrations in prostatic fluid (PF) were 0.33 to 0.49 microgram/ml at 1 to 3 hours after oral administration of 200 mg, the PF/serum ratio being 1.15 to 1.47. SPFX was administered at a dose of 200 to 400 mg daily for an average of 14.1 days to 14 patients with prostatitis (5, acute: 9, chronic). The clinical efficacy judged by physician in charge was effective in 12 cases with an efficacy rate of 85.7%. The bacterial eradication rate was 93.3% (14/15 strains), and eradication was complete in all 7 cases infected with gram-negative rods. SPFX-related abnormal laboratory values were observed in one case with transient increase of glutamic-oxalacetic transaminase, glutamic-pyruvic transaminase and alkaliphosphatase activities, and decrease of platelet. As side effects, one case with gastrointestinal symptoms and the other case with photosensitivity skin rash accompanied by sensory abnormality of palms were observed. The abnormal values or side effects in these patients recovered to normal or disappeared after completion of the treatment without any treatments. In view of the higher concentrations in PF than the MIC values with long remaining in the tissues, SPFX is considered to be effective in the treatment of bacterial prostatitis.(ABSTRACT TRUNCATED AT 250 WORDS)     

Effect of cefoperazone on acute prostatitis and epididymitis

Cefoperazone (CPZ) was intravenously administered to rabbits and the concentration of CPZ in the accessory male genitals was determined. The epididymis, prostate and testicles had a high enough concentration of CPZ to kill various kinds of bacteria. Therefore, CPZ was applied to 11 clinical cases of acute epididymitis and 4 cases of acute prostatitis, but clinical effects were not so satisfactory in the cases of acute epididymitis.     

Diffusion of sulbactam and cefoperazone into the prostatic tissue

Diffusion of sulperazone (SBT) and cefoperazone (CPZ) into the prostatic tissue was studied in 20 cases. Two g of SBT/CPZ was injected intravenously and 1 hour later, prostatic tissue was obtained surgically and venous blood was drawn simultaneously. The serum concentration of CPZ (58.0 micrograms/ml +9.2) was higher than that of SBT (25.9 micrograms/ml +/- 9.3) and the prostatic tissue concentration of CPZ (14.9 micrograms/ml +/- 6.1) was higher than that of SBT (10.9 micrograms +/- 6.1). However, the SBT concentration ratio of prostatic tissue to serum level (P/S ratio) was significantly higher (42.5%) than that of CPZ (25.9%). The SBT concentration in the prostatic tissue was high enough to enhance the antibacterial activity of CPZ. SBT/CPZ was appraised to be an effective chemotherapeutic agent for infections of prostate caused by susceptible organisms, especially by beta-lactamase producing bacteria.     

The penetration of cefoperazone and sulbactam into the lumbar intervertebral discs

Six patients received 1 g and six other patients received 2 g of cefoperazone and sulbactam 15 minutes before lumbar disc surgery. Liquid chromatographic analysis of disc tissue revealed that only patients receiving the 2-g dose had mean tissue levels above the minimum inhibitory concentration for Staphylococcus aureus and epidermidis.     

不同治疗方法对动物慢性细菌性前列腺炎前列腺分泌功能的影响

目的：探讨不同治疗方法对实验动物慢性细菌性前列腺炎(CBP)前列腺分泌功能的影响。方法：①选用健康雄性大白兔，依文献方法，通过后尿道反复灌注大肠埃希菌制备CBP动物模型；②将CBP动物随机分为3个治疗组，1个对照组，分别予口服氧氟沙星、口服氧氟沙星和特拉唑嗪、在B超引导下行前列腺局部穿刺注射氧氟沙星和地塞米松，同时以注射生理盐水作为对照组；③应用原子吸收光谱方法测定前列腺组织中锌、钙离子浓度，应用α—萘酚磷酸法测定前列腺组织中酸性磷酸酶活性，借以评价不同治疗方法对前列腺外分泌功能的影响。结果：3种治疗方法均可改善前列腺分泌功能，而且三者相比差异无显著性意义。结论：口服氧氟沙星加特拉唑嗪，用于治疗CBP具有良好效果；前列腺穿刺注射氧氟沙星和地塞米松对于CBP前列腺分泌功能的改善效果无明显优势。     

Acute bacterial prostatitis and chronic prostatitis/chronic pelvic pain syndrome: andrological implications

There is a consensus on the diagnostic management of bacterial prostatitis (acute and chronic). In chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) the diagnostic approach remains unclear, because inflammatory and noninflammatory CP/CPPS might be one entity with varying findings over time. The WHO definition of male accessory gland infection does not differentiate between prostatitis, epididymitis, and other inflammatory alterations of the urethral compartment. The definition therefore cannot be further accepted as a rational tool for the diagnosis of prostatitis and related diseases in urological andrology. Therapy in infectious prostatitis is standardised and antibiotics are the primary agents. Andrological implications are well defined, side-effects are minimal. CP/CPPS therapy has the goal to reduce pelvic pain. However, treatment regimens are not as standardised. Andrological side-effects are well defined and mainly due to the functional background of these agents.     

Clinical studies on chronic prostatitis and prostatitis-like syndrome. (3). Clinical re-examination of chronic bacterial prostatitis using the criteria for clinical evaluation

In accordance with the criteria for clinical evaluation, established by the UTI research group, 43 cases of chronic bacterial prostatitis were retrospectively analyzed. The subjective symptoms were "resolved" in 18.5%, "improved" in 46.5%, and "persisted" in 34.9%. The white blood cells were "cleared" in 34.9%, "decreased" in 37.2%, and "unchanged" in 27.9%. The bacteria were "eliminated" in 51.2%, "decreased" in 16.2%, "replaced" in 11.6%, and "unchanged" in 21.0%. Overall clinical efficacy was "excellent" in 51.2%, "moderate" in 39.5%, and "poor" in 27.9%, with an overall effectiveness rate of 72.1%. Bacteria (isolated bacteria: 8 species, 52 strains) were "eradicated" in 69.2% (GNR 71.4%, GPC 66.7%), and "persisted" in 30.8%. The bacterial eradication rate was 87.5% for E. coli, 58.3% for S. epidermidis, and 75.0% for E. faecalis. The analytical results of the clinical effects, classified by characteristic factor, showed significantly better results, in the excellence rate (p less than 0.05) and the overall effectiveness rate (p less than 0.01) of primary cases as compared with relapse cases. Among the isolated bacterial species, GNR showed more favorable results in comparison with GPC but without any significant difference. Further, the results of 81.3% for E. coli, 66.7% for S. epidermidis, and 62.5% for E. faecalis, indicates no significant difference between respective bacterial species. The new quinolones showed a favorable rate of 92%, followed by 80% of ST (sulfamethoxazole-trimethoprim), and 78% of tetracyclines, with a significant difference (p less than 0.01) in comparison with the mean overall effectiveness rates of cephems, penicillins, and old quinolones.(ABSTRACT TRUNCATED AT 250 WORDS)     

米诺环素与头孢哌酮/舒巴坦联合应用对多重耐药鲍曼不动杆菌体外抗菌活性的研究

目的探讨米诺环素与头孢哌酮,舒巴坦联合应用对多重耐药鲍曼不动杆菌的疗效,为有效治疗多重耐药鲍曼不动杆菌（MDR-ABA）感染提供理论依据。方法常规方法培养分离细菌共54株,获得纯培养后用VITEK-2全自动分析仪鉴定鲍曼不动杆菌,应用纸片扩散法进行多种抗菌药物的药敏试验,确定其中34株为多重耐药鲍曼不动杆菌。随机选取30株采用微量肉汤稀释法测定米诺环素和头孢哌酮／舒巴坦（1：1）的单药MIC值。再采用棋盘法测定米诺环素和头孢哌酮街巴坦（1：1）的联用MIC值。计算FIC指数并进行相关统计学分析。结果米诺环素与头孢哌酮,舒巴坦联合应用F1c指数0～0．5者占35-3％,0．5～1者占58．8％,1～2者占5．9％。结论米诺环素与头孢哌酮／舒巴坦联合应用具有协同和叠加作用,二者之间无拮抗作用,临床上治疗由MDR-ABA引起的重症感染,可根据药敏试验结果选择联合用药。     

Clinical studies on chronic prostatitis and prostatitis-like syndrome. (5) Evaluation of prostatitis complicated by anal disease]

We analyzed the incidence of anal disease in patients with nonbacterial prostatitis (NBP) or with prostatitis-like syndrome (PLS), and evaluated the clinical efficacy. The complicated rate of anal disease in these patients was 29.7% (31.8% for NBP and 28.1% for PLS), and the overall incidence of active anal disease was 15.4% (16.2% for NBP and 14.8% for PLS), it yielded a significantly higher complicated rate than other urological disease (p less than 0.01). The most common type of anal disease was hemorrhoids, especially piles. The clinical cure rate for anal disease in NBP patients was 71.4%, and in PLS patients was 58.2%. The high incidence of hemorrhoids (especially piles) was in these patients by clinico-statistical observation suggests that the development of anal disease may be etiologically correlated with NBP and PLS. Furthermore, we noted that Kampo treatment (Keisibukuryogan) was useful in the treatment of prostatitis complicated by anal disease, especially when combined with anti-hemorrhoidal suppositories against active anal disease in PLS patients (p less than 0.05).     

A case of acute bacterial prostatitis caused by gram positive cocci]

This report describes our experience with sulbactam/cefoperazone in the treatment of a 36-year-old man with acute prostatitis (complicated with bilateral epididymitis) caused by S. salivarius. The patient had no past history suggesting the relationship between this organism and the route of infection. The isolated strain exhibited a high susceptibility to the drug and symptoms subsided after treatment with a daily dose of 4 g sulbactam/cefoperazone for 7 days. Usually, the most causative bacteria of acute prostatitis are either GNR or E. faecalis. However, as in the present case, there may be very few cases in which the infection has been caused by a strain of Streptococcus species.     

不同治疗方法对动物慢性细菌性前列腺炎前列腺中TGF-β1胶原Ⅰ和ⅢmRNA表达的影响

目的：通过动物试验以口服氧氟沙星、口服氧氟沙星和α1受体阻滞剂特拉唑嗪及前列腺内注射氧氟沙星和地塞米松3种治疗方法治疗慢性细菌性前列腺炎(CBP)，判定前列腺穿刺注射药物治疗方法对局部组织胶原代谢的影响，探讨局部穿刺后前列腺是否有瘢痕化倾向。方法：①选用健康雄性大白兔，依文献方法，通过后尿道反复灌注大肠埃希菌制备CBP动物模型；②分别予CBP组动物行药物治疗，随机分为1个对照组和3个治疗组，治疗组分别予口服氧氟沙星，口服氧氟沙星和特拉唑嗪，在B超引导下行前列腺局部穿刺注射氧氟沙星和地塞米松，同时以注射生理盐水作为注射对照组；②应用半定量RT—PCR方法判定经不同治疗方法前列腺组织中TGF—β1、原胶原Ⅰ、原胶原Ⅲ的mRNA量的变化，推断不同治疗方法对胶原代谢的影响，判定前列腺穿刺注药是否有致前列腺瘢痕化的危险。结果：半定量RT—PCR分析结果显示3种治疗方法均可抑制CBP前列腺组织中TGF—β1、原胶原ⅠmRNA的表达，对原胶原ⅢmRNA的影响差异无显著性意义，而穿刺注药治疗并未显示有明显致瘢痕的副作用。结论：前列腺穿刺局部注射氧氟沙星和地塞米松无明显致瘢痕形成倾向。     

Clinical study of levofloxacin (DR-3355) on uro-genital infections--with special reference to usefulness for chronic prostatitis]

The clinical usefulness of levofloxacin, an optical active isomer of ofloxacin, was investigated on uro-genital infections. Patients who were treated with the drug included 2 with complicated urinary tract infections (UTI), 29 with chronic prostatitis and 3 with chronic non-chlamydial epididymitis. Levofloxacin was given to each patient at a dose of 300 mg or 400 mg a day for 7-14 days (average 12.0 +/- 0.5 days). In 2 cases of chronic UTI, infected by P. aeruginosa in one case and P. stutzeri in another case, the isolates were eradicated, and the clinical efficacy was moderate or excellent. For evaluating the effectiveness on chronic prostatitis, the patients were divided into 2 groups; group I (G-I) was chronic bacterial (number of isolates including GNR or E. faecalis, greater than or equal to 10(4) ml) and group II (G-II) was chronic non-bacterial prostatitis (number of isolates including GPC less than or equal to 10(3)/ml). A complete bacteriological response was obtained in all 7 cases, classified in G-I, but in 20 of the 27 isolates, (74.1%) in G-II. In 3 cases of chronic non-chlamydial epididymitis, the response was moderate. In safety profile, there were slight elevations in the laboratory values of glutamic oxaloacetic transaminase (GOT), and glutamic pyruvic transaminase (GPT) in one case, and that of GOT in another case. As for side effects, a 69-year-old male complained of dizziness, and anorexia after 10 days on the drug, but recovered 2 days after discontinuance of the drug.