辛伐他汀调脂疗效影响因素的调查分析

目的:了解影响辛伐他汀调脂疗效的影响因素,并为该药临床合理应用提供参考。方法:制定调脂疗效影响因素调查量表,并对176例使用辛伐他汀治疗的患者根据临床病例提供的数据填写,对包括年龄、性别、肝肾功能、合并症、合并用药等在内的14项因素进行单因素及多因素Logistic回归分析,找出影响调脂效果的要因。结果:在辛伐他汀疗效的影响因素中,年龄、肝肾功能、合并高血压为影响该药物调脂效果的要因。结论:年龄与辛伐他汀降脂疗效呈负相关,临床用药时应根据患者肝肾功能、并发症、合并用药的情况调整给药剂量,在保证疗效的同时降低不良反应发生率。     

钙通道阻滞药降压疗效影响因素分析

目的:对影响钙通道阻滞剂疗效的影响因素进行分析,为临床用药有效治疗高血压提供依据。方法:对86例使用钙通道阻滞药类降压药的患者制定影响降压疗效的影响因素调查量表,根据临床病例提供的数据填写调查量表,并进行包括年龄、性别、血压变化、肝肾功能等因素的Logistic多因素回归分析,找出影响疗效的要因。结果:在钙通道阻滞剂降压疗效的影响因素中,年龄、体质量、病史和吸烟史为要因,影响了钙通道阻滞剂的疗效。结论:临床使用钙通道阻滞剂治疗原发性高血压患者时,体质量正常的患者、病史5年以下的患者和无吸烟史的患者,能够收到更好的降压作用。     

影响氟喹诺酮类抗菌药物治疗效果的相关因素分析

目的:探究影响氟喹诺酮类药物治疗老年患者呼吸道感染效果的相关因素。方法:抽取2018年1月—2018年12月间收治的患有呼吸道感染且使用氟喹诺酮类抗菌药物治疗的老年患者180例资料,根据治疗效果的不同将其分为有效组142例和无效组38例;探究其影响药物疗效的可能危险因素进行多因素Logistic回归分析,分析影响抗感染疗效的主要因素。结果:有效组患者中,涉及吸烟、饮酒和肌酐及尿素氮升高的比例低于无效组(P<0.05),并经多因素Logistic回归分析结果显示吸烟、饮酒、肌酐、尿素氮是影响氟喹诺酮类药物治疗效果的独立危险因素(P<0.05)。结论:吸烟、饮酒和肌酐及尿素氮升高是影响氟喹诺酮类药物抗感染疗效的重要危险因素。     

关注氟喹诺酮类药品的严重不良反应

氟喹诺酮类药品是临床使用广泛的抗感染药,其抗菌谱广、疗效显著、使用方便,在抗茵治疗领域发挥着重要作用。近期,国内外监测机构陆续发布了氟喹诺酮类药品可能引起重症肌无力加重和周围神经病变的风险提示,并对氟喹诺酮类产品说明书进行了修订。最新病例报告和研究表明,部分氟喹诺酮类药品品种可能影响糖尿病患者的血糖控制水平。     

2009—2011年上海中医药大学附属龙华医院住院患者氟喹诺酮类药应用情况及耐药性分析

目的:回顾分析2009—2011年我院住院患者氟喹诺酮类药应用及耐药情况,促进合理用药。方法:调查2009—2011年我院氟喹诺酮类药用药量、用药金额、用药频度(DDDs)、耐药情况等,并进行统计分析。结果:帕珠沙星、左氧氟沙星、莫西沙星为我院目前使用最多的氟喹诺酮类药,氟喹诺酮类药对革兰阴性菌耐药情况严重,临床使用中存在诸多不合理用药。结论:氟喹诺酮类各品种有不同的特点,临床应根据药物特性合理选用。氟喹诺酮类药耐药情况严重,应进一步加强监管以促进合理用药。     

1例左氧氟沙星治疗耐碳青霉烯类肺炎克雷伯菌新生儿肺炎的病例分析及文献回顾

目的 探讨临床药师在耐碳青霉烯类肺炎克雷伯菌新生儿肺炎抗感染治疗中的作用。方法 回顾性分析临床药师参与1例左氧氟沙星治疗耐碳青霉烯类肺炎克雷伯菌新生儿肺炎抗感染治疗的案例。结果 临床药师通过对喹诺酮类药物用于新生儿感染的风险和益处进行评估,参与抗感染方案的调整,并对患儿的治疗过程进行药学监护。结论 在无安全有效的抗感染替代方案时,儿科患者使用氟喹诺酮类也是安全合理的,可根据氟喹诺酮类药物在儿科患者体内的药动学和药效学特征,确定合理的药物治疗方案,降低儿科患者耐碳青霉烯类革兰阴性菌重症感染的致死率。     

2007—2009年门诊和住院患者抗感染药应用分析

目的:分析北京大学深圳医院2007—2009年门诊和住院患者抗感染药应用的情况和趋势,评价本院这3年内抗感染药用药的合理性,为指导临床用药提供依据。方法:采用金额排序法和用药频度排序法回顾性分析我院2007—2009年的门诊和住院部患者的抗感染药用药情况。结果:从2007—2009年我院抗感染药销售金额占药品总销售金额的比例分别为23.62%、12.65%和12.41%;品种数最多的是头孢菌素;销售金额最大的是头孢菌素、氟喹诺酮和复方广谱抗生素类,占全院抗感染药总销售金额的70%以上;用药频度较大的是复方广谱抗生素、头孢菌素和氟喹诺酮类。结论:我院抗感染药使用基本合理,但仍需进一步加强监督和管理。     

氟喹诺酮类药物临床常见的不良反应分析

目的:分析氟喹诺酮类药物发生不良反应的特点,提出解决对策.方法:选择我院2016年1～12月收治的因氟喹诺酮类药物发生不良反应的患者30例,回顾性分析临床资料,找出引起氟喹诺酮类药物发生不良反应的原因,提出防范措施.结果:患者的年龄、性别等是影响氟喹诺酮类药物发生不良反应的因素,年龄越大、男性患者发生的几率越大,胃肠道不良反应是左氧氟沙星药物最为常见的不良反应.结论:只有充分了解氟喹诺酮类药物发生不良反应的因素,才能制定防范措施,降低不良反应发生率,保证用药安全性和治疗有效率.     

222例氟喹诺酮类抗菌药物致不良反应报告分析

目的:调查氟喹诺酮类抗菌药物不良反应的特点,为临床合理用药提供依据。方法:检索1979—2010年医学文献中收载的氟喹诺酮类抗菌药物不良反应的资料222例,对氟喹诺酮类抗菌药物的用法用量、不良反应发生的时间和临床特点进行分析。结果:222例患者中,男性113例,女性108例;氟喹诺酮类抗菌药物单用181例,与其他药物联用41例;静脉给药173例,口服给药43例,未知3例。结论:氟喹诺酮类抗菌药物不良反应的发生与患者的年龄、原患疾病、药物过敏史及联合用药等相关因素有关。     

药品不良反应信息通报（第58期）关注氟喹诺酮类药品的严重不良反应

氟喹诺酮类药品为人工合成的抗菌药,是抗感染药家族中的重要成员。目前临床广泛使用的氟喹诺酮类药品有左氧氟沙星、环丙沙星、氧氟沙星、莫西沙星等。此类药品因抗菌谱广、疗效显著、使用方便等特点,在抗菌治疗领域发挥着重要作用。     

药师对住院患者氟喹诺酮类药物相关严重心律失常的干预研究

目的通过对心脏科使用喹诺酮类药物的住院患者进行干预,减少住院患者氟喹诺酮类药物相关严重心律失常的发生。方法通过查阅相关文献和回顾2015年10-12月心脏科所有使用氟喹诺酮类药物的住院患者资料,获取QT间期延长发生的危险因素;临床药师对2016年2-4月心脏科所有使用氟喹诺酮类药物的入院患者进行入院医嘱重整,根据患者存在的致QT间期延长的危险因素进行评估,并进行相应的干预及用药监测,并与回顾病例进行比较,评价干预的效果。结果 2015年10-12月心脏科使用氟喹诺酮的住院患者共33例,QT间期延长12例,其中1例出现室速、2例出现室颤(其中1例死亡);2016年2-4月使用氟喹诺酮类药物的心脏科住院患者20例,QT间期延长7例,无1例出现心律失常。结论心脏科使用氟喹诺酮类药物的住院患者常合并多种致QT间期延长的危险因素,所以更容易发生严重的心律失常,因此在心内科使用氟喹诺酮类药物时,需密切监测,及时进行干预,保障患者用药安全。     

Clinical role of protein binding of quinolones

Protein binding of antibacterials in plasma and tissues has long been considered a component of their pharmacokinetic parameters, playing a potential role in distribution, excretion and therapeutic effectiveness. Since the beginning of the 'antibacterial era', this factor has been extensively analysed for all antibacterial classes, showing that wide variations of the degree of protein binding occur even in the same antibacterial class, as with beta-lactams. As the understanding of protein binding grew, the complexity of the binding system was increasingly perceived and its dynamic character described. Studies of protein binding of the fluoroquinolones have shown that the great majority of these drugs exhibit low protein binding, ranging from approximately 20 to 40% in plasma, and that they are bound predominantly to albumin. The potential role in pharmacokinetics-pharmacodynamics of binding of fluoroquinolones to plasma, tissue and intracellular proteins has been analysed, but it has not been established that protein binding has any significant direct or indirect impact on therapeutic effectiveness. Regarding the factors influencing the tissue distribution of antibacterials, physicochemical characteristics and the small molecular size of fluoroquinolones permit a rapid penetration into extravascular sites and intracellularly, with a rapid equilibrium being established between intravascular and extravascular compartments. The high concentrations of these drugs achieved in tissues, body fluids and intracellularly, in addition to their wide antibacterial spectrum, mean that fluoroquinolones have therapeutic effectiveness in a large variety of infections. The tolerability of quinolones has generally been reported as good, based upon long experience in using pefloxacin, ciprofloxacin and ofloxacin in clinical practice. Among more recently developed molecules, good tolerability has been reported for levofloxacin, moxifloxacin and gatifloxacin, but certain other new compounds have been removed from the market because of renal, hepatic and cardiac toxicity. To what extent the protein binding of fluoroquinolones can play a role in their tolerability is unclear. In terms of drug-drug interactions, the role of protein binding is questionable: several drug combinations can be responsible for toxicity, such as with beta-lactams, metronidazole, theophylline, nonsteroidal anti-inflammatory agents or a series of drugs used for cardiac diseases, but protein binding does not seem to be involved in these interactions. In conclusion, protein binding of fluoroquinolones appears to be a complex phenomenon, but has no clear role in therapeutic effectiveness or toxicity.     

Topical ocular delivery of fluoroquinolones

Introduction: Topical fluoroquinolones are used in ophthalmology to treat ocular infections. They are bactericidal and inhibit bacterial DNA replication by inhibiting DNA gyrase and topoisomerase. Fluoroquinolones possess two ionizable groups: a carboxylic group (pKa₁ = 5.5 – 6.34) and a heterocyclic group (pKa₂ = 7.6 – 9.3), in the nucleus, which acquire charge at pH above and below the isoelectric point (pI = 6.75 – 7.78). At isoelectric point, fluoroquinolones remain unionized and show enhanced corneal penetration but exhibit reduced aqueous solubility and the drug may precipitate from aqueous solution. Aqueous ophthalmic solutions of fluoroquinolones are obtained by using hydrochloride or mesylate salt which is acidic and irritating to the eyes. Hence, pH of the solution is kept between 5 and 7 to ensure aqueous solubility and minimum ocular irritation.

Areas covered: This review gives an overview of various physicochemical and formulation factors affecting the ocular delivery of fluoroquinolones and strategies for getting higher ocular bioavailability for ocular delivery of fluoroquinolones. These strategies could be employed to improve efficacy of fluoroquinolones in eye preparation.

Expert opinion: Broad-spectrum antibacterials, such as the ophthalmic fluoroquinolones, are powerful weapons for treating and preventing potentially sight-threatening infections. The fourth-generation fluoroquinolones have quickly assumed an outstanding place in the ophthalmic applications. Especially valuable for their broad-spectrum coverage against Gram-positive and Gram-negative organisms, these agents have become the anti-infective of preference for many ophthalmologists. Moxifloxacin seems to be a promising powerful molecule among all fluoroquinolones for treatment of bacterial infections.     

4种氟喹诺酮类抗生素水溶液的光稳定性研究

目的：探讨利用氟喹诺酮水溶液光降解动力学的特性，评价喹诺酮抗生素液体制剂的光稳定性。方法：比较4种氟喹诺酮水溶液在UVA光照下紫外光谱的变化；并根据HPLC法测定的光照过程中的含量，求出其光降解动力学参数t1/2。结果：3种氟喹诺酮的光降解过程符合一级动力学方程。溶液中光稳定性顺序为：司帕沙星，环丙沙星，左旋氧氟沙星，洛美沙星。结论：根据光降解动力学参数可较客观地评价喹诺酮抗生素液体制剂的光稳定性。     

社区获得性肺炎患者住院费用的影响因素探讨

目的:探讨影响社区获得性肺炎(CAP)住院费用的主要因素,为控制医疗费用不合理增长提供依据。方法:收集我院呼吸内科收治的社区获得性肺炎患者333例,填写CAP住院费用调查表,运用多元线性回归(步进法自变量筛选)进行分析。结果:总费用的影响因素及其排序为:年龄>WBC>AaDO2>脉率;药费为:年龄>WBC>AaDO2>体温;检查费为:收缩压>WBC>年龄;总样本量为333。结论:CAP医疗费用与年龄密切相关,加强老年CAP的诊断和规范治疗,对降低CAP医疗费用有积极作用。     

新氟喹诺酮类抗生素的不良反应

目的：综述新氟喹诺酮类抗生素的各种不良反应，为临床合理用药提供依据。方法：检索国内外文献，归纳有关新氟喹诺酮类抗生素不良反应报道。结果：新氟喹诺酮类抗生素耐受性好，最为常见的不良反应为胃肠道反应、中枢神经系统反应、变应性反应、光毒性和心血管毒性、肝毒性等。结论：新氟喹诺酮类抗生素虽然不良反应轻微，但仍应监测其不良反应。     

药物临床试验机构选择影响因素分析

目的：对药物临床试验研究机构选择影响因素进行筛选和排序，旨在为药物临床试验研究机构的选择提供参考。方法：运用"人机料法环"五因素理论和层次分析法进行分析。结果：药物临床试验研究机构选择的影响因素的重要性排序依次是人员因素、方法因素、设备因素、材料因素、环境因素。结论：影响因素的重要性排序结果可为药物临床试验发起者在研究机构选择时提供参考。     

A novel method of estimating cost of therapy by using patient population characteristics: analysis of fluoroquinolones in various populations with different distributions of renal function

INTRODUCTION: Formulary decisions regarding a given drug class are often made in the absence of patient outcome and/or sophisticated pharmacoeconomic data. Analyses that consider factors beyond simple acquisition costs may be useful in such situations. For example, the cost implications of using manufacturers' recommendations for dosing in patients with renal dysfunction may be important, depending on the distribution of various levels of renal function within a patient population. METHODS: Using four 1000-patient populations representing different renal function distributions and a fifth population of our medical center's distribution, we determined the costs of therapy for intravenous and oral levofloxacin, gatifloxacin, and moxifloxacin for a 10-day course of therapy for community-acquired pneumonia. Costs considered were average wholesale prices (AWPs), 50% of AWP, or same daily price, plus intravenous dose preparation and administration costs when applicable. Costs for each renal function distribution were examined for significant differences with an analysis-of-variance test. Also, costs of failing to adjust dosing regimens for decreased renal function were determined. RESULTS: Differences in fluoroquinolone costs (AWP, 50% AWP, or when matched as the same daily price) among the populations were found. When considering same daily prices, differences among populations ranged from about 35,000 dollars with intravenous gatifloxacin to more than 51,000 dollars for intravenous levofloxacin (all fluoroquinolones, p>0.05). Within a population, differences in costs among the intravenous fluoroquinolones ranged from 47,000-99,000 dollars. Rank orders of the drugs and population costs of therapy were affected by the pricing structure used and varied by the specific population and drug. Differences among the fluoroquinolones or populations were much smaller (<2100 dollars) when considering oral regimens. Costs potentially incurred by failing to adjust dosing for renal function were substantial. CONCLUSION: Formulary decisions can be facilitated by considering factors such as patient characteristics and related dosing in addition to simple acquisition costs. In our example, consideration of the distribution of renal function within a given patient population and related dosing for these fluoroquinolones revealed potentially important differences within the class.