我院93例头孢菌素类药物不良反应报告分析

目的:探讨药品不良反应(ADR)发生的特点及规律。方法:采用描述性研究方法,对我院2008年1月～2009年12月上报的93例头孢菌素类药物ADR报告进行统计、分析。结果:皮试液的选择有3种情况,分别为采用1种头孢菌素类药物皮试,采用拟用品种(原数)进行皮试、不作皮试或用其它药物皮试。涉及ADR的头孢菌素类药品共18个,发生频率排在前3位的是头孢哌酮/舒巴坦、头孢哌酮和头孢替安。ADR的主要临床表现以皮肤及其附件损害为主,有72例(77.42%)。结论:临床应规范皮试液的选择;重视ADR监测与报告、定期分析报告数据,为临床及时提供药品安全信息,以减少或避免ADR的重复发生。     

我院治疗小儿支气管肺炎的用药分析

目的:分析我院治疗小儿支气管肺炎的用药情况,促进临床合理用药。方法:回顾性分析我院2005年7月～2006年3月确诊的150例支气管肺炎儿科病例,将其分为5组,每组30例。各组给予不同的抗菌药物治疗,在痊愈出院的前提下,比较分析各组住院时间和住院所发生费用,用PEMS统计软件处理。结果:杀菌药青霉素类或头孢菌素类分别与抑菌药红霉素类/克林霉素联用,会降低杀菌效果,且增加患者经济负担。青霉素类和头孢菌素类联用治疗小儿支气管肺炎疗效好、住院时间短、费用低。结论:我院治疗小儿支气管肺炎用药基本合理。     

头孢菌素类抗生素在临床使用中发生的不良反应情况以及应急对策

目的：探讨分析头孢菌素类抗生素在临床使用中发生的不良反应情况以及应急对策。方法：从2009年10月到2012年12月期间本院收治的使用头孢菌素类抗生素致不良反应的患者中随机选取450例,这450例患者主要服用的头孢菌素类抗生素包括头孢呋辛钠、头孢他啶、头孢曲松钠和头孢噻啶等,分析这些抗生素的不良反应情况、发生率及临床采取的应急对策。结果：临床观察显示经服用头孢菌素类抗生素,所有患者的感染情况均得到一定的控制,但是发生不良反应的患者有13例,发生率为2.89%,包括变态反应、胃肠道反应、血液系统反应、肾毒性和肝毒性等,其中以变态反应的发生率最高7例,占53.8%,胃肠道反应3例,占23.1%,血液系统疾病和肝肾毒性则很少发生。发生不良反应时应及时停药或静滴地塞米松加维生素C来解决。结论：在临床使用抗生素时要结合患者自身病情对症用药,尽量减少应用抗生素出现的不良反应,一旦出现不良反应时应立即停药,并给与对症治疗。     

Safety and pharmacokinetics of subcutaneous ceftriaxone administered with or without recombinant human hyaluronidase (rHuPH20) versus intravenous ceftriaxone administration in adult volunteers

Abstract

Objective:

To compare pharmacokinetics and safety of recombinant human hyaluronidase (rHuPH20)-facilitated subcutaneous (SC) ceftriaxone administration versus SC ceftriaxone preceded by SC saline placebo or intravenous (IV) ceftriaxone administration.     

Challenging issues in neonatal candidiasis

Abstract

In an era of quality improvement and ‘getting to zero (infections and/or related mortality),’ neonatal candidiasis is ripe for evidence-based initiatives. Knowledge of each institution’s invasive Candida infection (ICI) incidence and infection-related mortality is critical to evaluate disease burden and effective interventions. Evidenced-based interventions include: antifungal prophylaxis, starting with appropriate dosing, and prompt removal of central venous catheters (CVC). There is A-I evidence supporting antifungal prophylaxis with fluconazole, and it should be considered in every neonatal intensive care unit (NICU). The literature supports targeting infants <1000?g and/or ≤27 weeks, because this group has high infection-related mortality and neurodevelopmental impairment in 57% of survivors. Antifungal prophylaxis has been shown to nearly eliminate infection-related mortality. Interventions start with prenatal initiatives, with women being treated for vaginal candidiasis, especially with preterm labor or complications. Targeting modifiable risk factors, including restriction policies for use of third- and fourth-generation cephalosporins, carbapenems, H2-antagonists, proton pump inhibitors, and postnatal steroids; guidelines for CVC care and removal; and feeding practices, with promotion of early feedings and breast milk, may also reduce risk. A few studies have emerged on empiric antifungal therapy with sepsis evaluations for preterm infants <1500?g and other high-risk patients that have shown favorable effects of eliminating mortality, but these have not been compared to appropriate antifungal therapy and central line removal. Further study of empiric therapy, prospective treatment studies with higher targeted dosing of amphotericin B preparations, fluconazole, and new antifungals with prompt CVC removal may contribute to a 100% survival rate for those infants >1000?g and ≥28 weeks not receiving antifungal prophylaxis. Evaluation of ICI incidence and mortality by gestational age and birth week should be followed in each NICU, to evaluate infection control and prevention.     

热毒宁注射液在不同溶媒中稳定性及与头孢类药物的配伍研究

目的探究热毒宁注射液于各种溶媒里的稳态情况,通过实验观察分析其同头孢类抗生素配伍的注意事项,为临床用药提供依据。方法观察热毒宁注射液在0．9％氯化钠注射液、5％葡萄糖和10％葡萄糖3种溶媒里的形态、酸度、吸光强度、紫外光谱和微粒的不同;观察头孢拉啶、头孢呋辛酯和头孢他啶3种头孢类抗生素同热毒宁注射液配伍后的变化。结果热毒宁注射液在3种溶媒中形态无显著变化,微粒有增多,随着时间推移可降低。以5％葡萄糖和0．9％氯化钠注射液做溶媒酸度和有效成分均无明显改变,以10％葡萄糖做溶媒pH增加有统计学意义（P〈0．05）。同头孢类抗生素配伍有生成物。结论热毒宁注射液与10％葡萄糖有配伍禁忌,0．9％氯化钠注射液和5％葡萄糖应注意微粒的增多,同头孢类抗生素有配伍禁忌。     

Calcium pectate gel beads for cell entrapment. 6. Morphology of stabilized and hardened calcium pectate gel beads with cells for immobilized biotechnology

The structure of standard and stabilized calcium pectate gel (CPG) beads has been examined by scanning (SEM) and transmission (TEM) electron microscopy. A two-stage crosslinking procedure with polyethyleneimine (PEI) and glutaraldehyde (GA) led to the formation of a more compact layer on the bead surface. On the other hand, the stabilization procedure did not significantly change either gel bead interior or morphologic properties, vitality and biotransformation activity of immobilized bacterial cells (Nocardia tartaricans) against cis-epoxysuccinate as well as yeast cells (Trigonopsis variabilis) against cephalosporin C. The structure of these cells within the calcium pectate matrix remained unchanged. Moreover, the two-step chemical stabilization of CPG containing T. variabilis or N. tartaricans had a favourable effect on storage and operational stability at semi-continuous and continuous processing in stirred batch and packed-bed reactors. The most valuable effect of stabilization was the fact that the hardened CPG comprising the cells N. tartaricans resisted, for a long time (360 days and more), the destructive effects of the product (such strong sequestering reagent as L-(+)-tartaric acid) at high concentrations (up to 1M). Non-hardened CPG was destroyed after 21 h. The reference materials, hardened and non-hardened calcium alginate gels (CAG), were destroyed over 3h or 30 min, respectively.     

临床常见病原菌对喹诺酮类及头孢菌素类的耐药分析

目的：了解医院常见病原菌对喹诺酮类及头孢菌素类抗菌药物的耐药状况,指导临床医生选择合适的抗菌药物。方法：将本医院１９９９年４月－２０００年２月临床分离出的３０５株常见病原菌对头孢菌素类及喹诺酮类抗菌药物的耐药性进行分析。结果：喹诺酮类中以环丙沙星抗菌作用仍然较强。常见病原菌中以大肠艾希菌对喹诺酮类抗生素耐药性最高;阴沟肠杆菌对头孢菌素类抗生素耐药性最高,第三代头孢菌素中,头孢他啶耐药率最低,头孢曲松耐药率较高,头孢噻肟也有所上升＾「２」。结论：合理使用抗生素是控制细菌耐药性增长、延长抗生素使用寿命和降低医院感染率的关键。     

医院2009年抗菌药物临床应用情况分析

目的分析总结医院2009年抗菌药物的临床应用情况。方法采用回顾性分析方法,分析2638份抗菌药物药品的出库资料和相关病历资料。结果共涉及8大类51个药品种类,以β-内酰胺类占58.3%、大环内酯类占14.0%、氨基糖苷类占12.7%为主;数量最多的前10位为头孢呋辛酯占13.3%、头孢哌酮/舒巴坦占11.8%、依替米星占8.8%、头孢唑肟占6.8%、左氧氟沙星占5.9%、克拉霉素占5.0%、阿莫西林占4.2%、头孢呋辛占3.2%、头孢西丁占2.8%和哌拉西林/他唑巴坦占2.5%;使用抗菌药物最多的3个科室为呼吸科占16.1%I、CU占14.9%和普外科占9.4%,临床用途主要是抗感染治疗占53.1%、预防感染占29.2%和预防+治疗占17.7%。结论加强抗菌药物的临床应用管理,对提高抗菌药物的合理应用具有重要意义。     

医院“以药养医”不改变,药品降价措施效果难以惠及患者:以医院头孢类药品使用为例

目的:分析上海地区样本医院购药前100位中的头孢类药品用药现况,反映降价措施下医院头孢类药品用药的变化趋势;方法:对2000-2008年长江流域用药系统上海地区样本医院购药前100位中头孢类药品销售额、销售额占抗感染类药品比例、销售数量、加权价、剂型规格以及同药品同剂型同规格不同价位药品销售情况等进行统计分析;结果和讨论:单纯的药品降价政策下,医院通过追求并使用高价品种、高价剂型和规格等用药行为,使得单纯的药品降价政策难以惠及百姓。在此情况下,唯有实施支付方式改革如总额预付制的引入,激发医院的主动节约成本意识,有效切断医疗机构与药品之间的经济关联,方能从根本上解决药价虚高等问题,恢复药品市场的正常秩序,实现医院和药品领域的双赢。