头孢曲松与头孢克肟序贯治疗下呼吸道感染的临床疗效及安全性研究

目的探讨头孢曲松与头孢克肟序贯治疗下呼吸道感染临床疗效。方法选择我院2010年1月至2012年6月下呼吸道感染患者共100例,随机分为观察组和对照组。观察组应用头孢曲松和头孢克肟序贯治疗。对照组应用头孢曲松治疗。结果观察组总有效率为96.0%,对照组总有效率为94.0%,观察组治疗后总有效率与对照组相似,差异无统计学意义(P>0.05)。结论头孢曲松与头孢克肟序贯治疗下呼吸道感染临床疗效显著,未发生严重不良反应,用药安全有效,且治疗成本低,值得借鉴。     

Ceftriaxone: a third-generation cephalosporin

Ceftriaxone is a new third-generation cephalosporin with excellent activity against many gram-negative, and reasonable activity against most gram-positive microorganisms. Clinical studies have demonstrated its efficacy and safety in patients with bacterial meningitis; respiratory tract, urinary tract, soft tissue, bone and joint infections; and gonorrhea. Ceftriaxone has been well tolerated except for diarrhea, which in most cases has not required a change in therapy. The long elimination half-life of ceftriaxone has allowed twice- and once-daily administration, the latter potentially resulting in substantial cost savings. Because of its documented efficacy, safety, and convenient dosing schedule, ceftriaxone may become the preferred third-generation cephalosporin for the treatment of a variety of serious infections.     

Ceftriaxone-induced acute reversible encephalopathy in a patient with enteric fever

Ceftriaxone is a commonly used, third-generation cephalosporin. Encephalopathy is a rare side effect of third- and fourth-generation cephalosporins. Renal failure and previous disease of the central nervous system predispose to this neurotoxicity. We describe a case of acute transient encephalopathy in a patient treated with ceftriaxone for enteric fever infection. Early detection of this complication is relevant given that stopping the drug usually reverts the neurological syndrome.     

Treatment of complicated urinary tract infections with the long acting cephalosporin, ceftriaxone

Ceftriaxone, a new broad spectrum cephalosporin with a long biological half-life has been used on a single intravenous daily dosage regimen over a five day period to treat complicated urinary tract infection. Bacteriological analysis of urine up to six weeks after such treatment, indicated that ceftriaxone was successful in 13 out of 15 cases treated compared with two out of 15 cases treated with cefuroxime given three times daily over the five day treatment period.     

头孢曲松和头孢哌酮钠舒巴坦钠治疗下呼吸道感染的效果分析

目的探讨头孢曲松和头孢哌酮钠舒巴坦钠治疗下呼吸道感染的临床疗效。方法将89例下呼吸道感染患者随机分为两组,对照组44例给予头孢曲松钠治疗,实验组45例给予头孢哌酮钠舒巴坦钠治疗,对比分析两组患者的临床疗效及不良反应发生率。结果对照组、实验组总有效率分别为81.82%、95.56%,实验组总有效率高于对照组,两组差异存在统计学意义(P<0.05);对照组、实验组不良反应发生率分别为15.91%、11.11%,两组不良反应发生率差异不明显,无统计学意义(P>0.05)。结论头孢曲松与头孢哌酮钠舒巴坦钠在下呼吸道感染治疗中均发挥重要作用,但头孢哌酮钠舒巴坦钠的疗效更明显,更值得在临床医学中推广使用。     

荟萃分析在头孢三嗪治疗下呼吸道感染中的应用

目的 :系统评价头孢三嗪治疗下呼吸道感染的疗效。方法 :采用meta -analysis的分析方法对头孢三嗪、头孢噻肟和头孢呋辛治疗下呼吸道感染的疗效进行评价。结果与结论 :头孢三嗪治疗下呼吸道感染时疗效较好 ,且成本较低 ,值得临床推荐使用。     

国产头孢三嗪治疗82例细菌感染的临床评价和随机对照观察

应用国产头孢三嗪治疗临床各类感染82例,包括呼吸系统感染、腹腔感染、伤寒、败血症、宫腔感染、尿路感染和急性淋病。大多数患者具有严重原发疾病,部分患者为医院内感染和免疫缺陷者感染,经头孢三嗪治疗后总有效率为91.5％,细菌清除率为87.7％。临床应用中不良反应轻微,不良反应发生率为6.1％。头孢三嗪和哌拉西林联合庆大霉素随机对照治疗呼吸系统和腹腔感染共55例,头孢三嗪组有效率(93.3％)高于对照组(68％)(P<0.05)。两组不良反应发生率的差别无显著意义。     

儿童静脉滴注头孢曲松钠出现急性溶血性贫血

1例1．5岁男孩首次静脉滴注头孢曲松钠1．0g治疗上呼吸道感染时出现寒战、发热，而后转入我院。入院时精神萎靡、面色苍黄。血常规示：Hb92g／L，RBC4．21×10^12／L，红细胞平均体积（MCV）68．4fl，红细胞压积（PCV）0．288，网织红细胞（Ret）0．01。入院第2天再次给予头孢曲松钠1．0g加入5％葡萄糖注射液100ml静脉滴注。5h后，患儿全身皮肤黄染，又2h后出现酱油色尿，T39℃。实验室检测：Hb45g／L，RBC1、83×10^12／L，PCV0．12，Ret0．03，直接Coombs试验（＋）。诊断为急性溶血性贫血，立即停药。患者经静脉注射地塞米松、静脉注射丙种球蛋白及输注红细胞后，上述症状缓解，实验室检测示：RBC3．60×10^12／L，Hb91g／L，PCV0、289，Ret0．036。     

Ceftriaxone: an update of its use in the management of community-acquired and nosocomial infections

Ceftriaxone is a parenteral third-generation cephalosporin with a long elimination half-life which permits once-daily administration. It has good activity against Streptococcus pneumoniae, methicillin-susceptible staphylococci, Haemophilus influenzae, Moraxella catarrhalis and Neisseria spp. Although active against Enterobacteriaceae, the recent spread of derepressed mutants which hyperproduce chromosomal beta-lactamases and extended-spectrum beta-lactamases has diminished the activity of all third-generation cephalosporins against these pathogens necessitating careful attention to sensitivity studies. Extensive data from randomised clinical trials confirm the efficacy of ceftriaxone in serious and difficult-to-treat community-acquired infections including meningitis, pneumonia and nonresponsive acute otitis media. Ceftriaxone also has efficacy in other community-acquired infections including uncomplicated gonorrhoea, acute pyelonephritis and various infections in children. In the nosocomial setting, extensive data also confirm the efficacy of ceftriaxone with or without an aminoglycoside in serious Gram-negative infections, pneumonia, spontaneous bacterial peritonitis and as surgical prophylaxis. Outpatient use of ceftriaxone, either as part of a step-down regimen or parenterally, is a distinguishing feature of the data gathered on the agent over the last decade. The review focuses on new applications of the drug and its use in infections in which the causative pathogens or their resistance patterns have changed over the past decade. Ceftriaxone has a good tolerability profile, the most common events being diarrhoea, nausea, vomiting, candidiasis and rash. Ceftriaxone may cause reversible biliary pseudolithiasis, notably at higher dosages of the drug (>/=2 g/day); however, the incidence of true lithiasis is <0.1%. Injection site discomfort or phlebitis can occur after intramuscular or intravenous administration. CONCLUSIONS: As a result of its strong activity against S. pneumoniae, ceftriaxone holds an important place, either alone or as part of a combination regimen, in the treatment of invasive pneumococcal infections, including those with reduced beta-lactam susceptibility. Its once-daily administration schedule allows simplification of otherwise complex regimens in a hospital setting and has also contributed to its popularity as a parenteral agent in an ambulatory setting. These properties, together with a well characterised tolerability profile, mean that ceftriaxone is likely to retain its place as an important third-generation cephalosporin in the treatment of serious community-acquired and nosocomial infections.     

Treatment of typhoid fever in children with a flexible-duration of ceftriaxone,compared with 14-day treatment with chloramphenicol

Although the efficacy of ceftriaxone in typhoid fever is well documented, the precise duration of ceftriaxone therapy in children with typhoid fever is not established and varies from 3 to 14 days in the literature. In a prospective, randomized study ceftriaxone was compared with chloramphenicol for treatment of 72 children who had bacteriologically confirmed typhoid fever. Ceftriaxone was given at a dose of 75 mg/kg per day (maximally 2 g/day) intravenously, in two doses until defervescence and continued 5 days after that time. Chloramphenicol was given at a dose of 75 mg/kg per day (maximally 2 g/day) in four doses for 14 days. Mean defervescence time was in 5.4 days in the ceftriaxone group and 4.2 days in the chloramphenicol group (P=0.04). Clinical cure without complications was achieved in all patients in both groups. No patient relapsed in the ceftriaxone group, and four patients relapsed in the chloramphenicol group (P=0.048). The overall results of this study suggest that a flexible-duration of ceftriaxone therapy given until defervescence time, followed by an additional 5 days of therapy is a reasonable alternative to conventional 14-day chloramphenicol treatment in children with typhoid fever.     

三种头孢菌素类抗生素治疗下呼吸道感染的成本-效果分析

目的评价3种头孢菌素类抗生素治疗下呼吸道感染的成本与效果。方法将126例下呼吸道感染患者随机分成A、B、C3组。A组给予头孢呋辛钠1．5g,iv gtt,tid;B组给予头孢曲松钠2．0g,iv gtt,qd;C组给予头孢哌酮钠2．0g,iv gtt,bid;疗程均为7d。观察3组的临床疗效,并进行成本-效果分析。结果A、B、C3组的有效率分别为83．33％、84．09％和82．50％,差异无统计学意义（P〉0．05）;3组的治疗成本分别为760．20圆、701．40圆和1128．40圆;成本-效果比分别为9．12、8．34和13．68。结论头孢曲松钠（2．0g,iv gtt,qd）是治疗下呼吸道感染的较佳方案。     

Ceftriaxone. A review of its antibacterial activity, pharmacological properties and therapeutic use

Ceftriaxone is a new 'third generation' semisynthetic cephalosporin with a long half-life which has resulted in a recommended once daily administration schedule. It is administered intravenously or intramuscularly and has a broad spectrum of activity against Gram-positive and Gram-negative aerobic, and some anaerobic, bacteria. The activity of ceftriaxone is generally greater than that of the 'first' and 'second generation' cephalosporins against Gram-negative bacteria, but less than that of the earlier generations of cephalosporins against many Gram-positive bacteria. Although ceftriaxone has some activity against Pseudomonas aeruginosa, on the basis of present evidence it cannot be recommended as sole antibiotic therapy in pseudomonal infections. Ceftriaxone has been effective in treating infections due to other 'difficult' organisms such as multidrug-resistant Enterobacteriaceae. Ceftriaxone was effective in complicated and uncomplicated urinary tract infections, lower respiratory tract infections, skin, soft tissue, bone and joint infections, bacteraemia/septicaemia, and paediatric meningitis due to susceptible organisms. In most of these types of infections once-daily administration appears efficacious. Results were also encouraging in a few patients with ear, nose and throat, intra-abdominal, obstetric and gynaecological infections, and adult meningitis, but conclusions are not yet possible as to the efficacy of the drug in these indications due to limited experience. A single intramuscular dose of ceftriaxone has been compared with standard therapy for gonorrhoea due to non-penicillinase-producing and penicillinase-producing strains of Neisseria gonorrhoeae and shown to be highly effective. In a few small trials the comparative efficacy of ceftriaxone and other antibacterials has been assessed in other types of infections and in perioperative prophylaxis in patients undergoing surgery. Few significant differences in response rates were found between therapeutic groups in these comparative studies, but larger well-designed studies are needed to more clearly assess the comparative efficacy of ceftriaxone and other antimicrobials, especially the aminoglycosides and other 'third generation' cephalosporins, and to confirm the apparent lack of serious side effects with ceftriaxone. If more widespread use confirms the safety and efficacy of ceftriaxone, it will offer an important alternative, particularly for the treatment of serious infections due to multidrug-resistant Gram-negative bacteria and in situations where the long half-life of the drug could result in worthwhile convenience and cost benefits.     

Folic acid hypersensitivity and fever: a case report

An apparent case of folic acid hypersensitivity and fever in a 36-year-old anephric man is reported. The patient first experienced pruritus when he received 1 mg of folic acid daily; the drug subsequently was discontinued. Three months later, after administration of 1 mg of folic acid daily, the patient became febrile and pruritic. Fever, generalized pain, chills, urticaria and pruritus persisted despite administration of acetaminophen/oxycodone tablets. Leukocytosis was not present. Challenge with a 10-mg/ml folic acid solution intradermally revealed the patient was hypersensitive to folic acid. Previous reports of folic acid-induced hypersensitivity are reviewed. Hypersensitivity to folic acid should be suspected if a patient experiences fever or rash, or both, while receiving folic acid and if neither symptom can be attributed to infection or other pathologic state.     

Pharmacokinetics of intravenous and intraperitoneal ceftriaxone in chronic ambulatory peritoneal dialysis

Summary The kinetics of ceftriaxone was investigated in 8 patients without infection, who were receiving continuous ambulatory peritoneal dialysis (CAPD). Ceftriaxone 1 g was injected i.v. and 1 g was given intraperitoneally in the CAPD fluid during a 4-h dwell time. Ceftriaxone was assayed by HPLC. After intravenous administration, the kinetic parameters of ceftriaxone were: plasma t_1/2, 12.3 h, total plasma clearance, 14.0 ml/min, volume of distribution at steady state 0.18 l/kg, and peritoneal clearance 0.59 ml/min. Over 72 hours only 5.5% of the dose was eliminated by the peritoneal route. After intraperitoneal administration, ceftriaxone rapidly appeared in serum; the absorption t_1/2 was 1.1 h and the mean peak concentration was 38.8 µg/ml. The absorption of ceftriaxone from the peritoneal space was 39%. A single 1.0 g IP dose led to serum and dialysate concentrations of ceftriaxone above the minimum inhibitory concentration for susceptible pathogens for 24 hours.     

头孢曲松钠与环丙沙星治疗急性泌尿系感染的疗效比较

目的：验证头孢曲松钠对急性非复杂性泌尿系感染的临床疗效。方法：采用随机对照的实验设计,符合入选标准的４０例中、重度泌尿系感染病人进入本研究。研究组给予头孢曲松钠１ｇ／ｄ,对照组给予环丙沙星０．４ｇ／ｄ。对两组在临床表现、血常规、尿常规、细菌清除率等方面的变化进行比较。结果：研究组的有效率与细菌清除率均高于对照组;对血尿中白细胞的影响以及临床体征的改善等效果也明显优于对照组,尤其在用药３天时其差别有     

Pregabalin hypersensitivity in a patient treated for postherpetic neuralgia

Drug hypersensitivity syndrome is characterized by fever, skin rash and internal organ involvement. It is commonly seen with aromatic group of anticonvulsants viz. phenytoin, carbamazepine and phenobarbitone. Here, we report a case of hypersensitivity reaction to pregabalin, used for treating postherpetic neuralgia.KEY WORDS: Drug hypersensitivity, liver enzymes, Naranjo scale, pregabalin     

Nevirapine-induced rash with eosinophilia and systemic symptoms (DRESS)

Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is an adverse reaction commonly occurring with antiepileptic agents. It was earlier referred to by various names such as dilantin hypersensitivity syndrome and anticonvulsant hypersensitivity syndrome. It is characterized by the triad of fever, skin eruption, and systemic involvement. DRESS syndrome has also been reported with a number of other drugs including allopurinol, minocycline, terbinafine, sulfonamides, azathioprine, dapsone, and antiretroviral agents such as abacavir and nevirapine. We describe a rare case of nevirapine-induced hypersensitivity syndrome that was successfully treated with oral steroids.KEY WORDS: Drug reaction with eosinophilia and systemic symptoms syndrome, drug rash, hypersensitivity, nevirapine     

Phenytoin-induced hypersensitivity reactions

A case of phenytoin-induced hepatitis with mononucleosis is reported, and syndromes associated with phenytoin hypersensitivity reactions are discussed. A 23-year-old black woman with a two-month history of seizure disorder was admitted to a hospital with nausea, vomiting, fever, lymphadenopathy, diffuse maculopapular rash, left-upper-quadrant tenderness, and hepatomegaly. She was receiving phenytoin sodium 300 mg/day; carbamazepine 200 mg four times daily had been discontinued four days before admission because of leukopenia. Phenytoin was discontinued after admission; however, phenytoin 1 g i.v. was given for a tonic-clonic seizure two days after admission, after which swelling of the face and legs and pruritus developed. Over the next few days, signs and symptoms of hepatotoxicity progressed, and she became comatose. Seizures were treated with diazepam. She began to recover after 10 days of supportive therapy and was discharged several weeks later on primidone therapy. Serious phenytoin hypersensitivity reactions may appear as dermatologic, lymphoid, or hepatic syndromes. Fever, rash, and lymphadenopathy often accompany hepatic injury. Encephalopathy and death may occur. Proposed mechanisms for phenytoin hypersensitivity include antigen-antibody reactions, alteration of lymphocyte function, and an enzyme abnormality causing the production of toxic metabolites. Treatment is supportive; phenobarbital and carbamazepine may be used with caution as alternate anticonvulsant therapy. The possibility of phenytoin hypersensitivity reactions should be considered when patients receiving phenytoin have unusual symptoms, particularly fever, rash, and lymphadenopathy.