Five days of ceftriaxone to treat spontaneous bacterial peritonitis in cirrhotic patients

Background. The aim of this study was to determine whether a short course of ceftriaxone was sufficient to cure spontaneous bacterial peritonitis (SBP) in cirrhotic patients. Methods. We studied 33 cirrhotic patients with SBP. All of them were treated with ceftriaxone, 1.0 g IV, every 12 h for 5 days. Twenty-one variables were recorded to evaluate their relationship to the resolution of SBP. Results. The mean age of the patients was 45 years. Twenty-three were males and 10 females. The etiology of cirrhosis was alcoholic in 42% of the patients, and 82% of the patients belonged to Child-Pugh Class C. Hepatic encephalopathy was present in 39% of the patients. The most frequent organism causing SBP was Escherichia coli (60%). Resolution of SBP on day 5 of treatment was achieved in 73% of the patients. Total resolution of SBP after prolonged therapy with ceftriaxone or another agent, selected according to antibiotic susceptibility, was achieved in 94% of the patients. Hospital mortality was 12%. Multivariate analysis showed no factor that was significantly related to the resolution of SBP, but univariate analysis showed that renal impairment and positive culture tended to be related. Conclusions. A short course (5 days) of ceftriaxone is useful therapy for SBP. If the polymorphonuclear differential count in ascitic fluid is less than 250 cells/mm³ on day 5 of treatment, the antibiotic can be discontinued. Received: April 2, 2001 / Accepted: August 10, 2001     

头孢三嗪治疗胆道感染的实验研究

 目的：为预防和治疗胆道感染提供合理使用抗生素的依据。方法：测定头孢三嗪在犬胆汁中药动学，并与血中药动学做比较。结果：犬静脉注射1g头孢三嗪15min后，胆汁中浓度迅速上升，60min达到峰值，其峰值浓度为2191μg·ml^-1，是血清中浓度的3倍～8倍；半衰期为50.33h，清除率为6.21ml·^-1；表观分布容积为450ml。结论：静脉注射头孢三嗪后，药物能在胆汁中长时间维持在高浓度状态，所以对治疗胆道感染头孢三嗪是非常理想的抗生素之一。     

头孢曲松钠在胆汁中的浓度测定和药动学的实验研究

 目的研究头孢曲松钠在胆汁中的浓度及其药动学,为预防和治疗胆系感染用药提供参考和依据。方法家兔行胆总管造瘘术,静脉注射头孢曲松钠后不同时间采集胆汁标本,采用高效液相色谱法测定胆汁中的药物浓度。用上海宏能药动学软件分析并得出药动学参数。结果家兔静脉注射头孢曲松钠后迅速分布,在胆汁中t_max为(0.036±0.094)h;ρ_max为(1509.20±584.60)mg·L^-1;消除相t_1/2为(3.31±0.59)h。8 h胆汁中药物浓度为(43.86±12.65)mg·L^-1,远超过胆道常见致病菌的MIC₉₀。结论头孢曲松钠有大量原形药物经胆道排泄,在胆汁中具有很高浓度,可作为预防和治疗胆道感染的优选药物。     

以甲硝唑为基础配伍的2组抗胆道感染药物的稳定性研究

目的　探讨甲硝唑葡萄糖注射液 (甲硝唑G)与头孢唑啉钠、头孢曲松钠配伍的稳定性及贮存期。方法　借紫外分光光度法测定甲硝唑、头孢唑啉钠、头孢曲松钠的含量 ;用经典恒温法、留样观察法考察甲硝唑G 头孢唑啉钠及甲硝唑G 头孢曲松钠配伍液的含量、pH值及外观的变化。结果　甲硝唑、头孢唑啉钠、头孢曲松钠的线性范围分别为 2 0 1～ 2 0 0 8mg·L-1、5 0 7～ 30 4 2mg·L-1、4 0 3～ 2 0 16mg·L-1;平均回收率依次为 (99 5 8± 1 6 3) %、(99 78± 1 2 3) %、(99 93± 0 96 ) % ;70℃ ,8h内的热分解产物不干扰测定。恒温加速试验时 ,配伍液中甲硝唑稳定 ;头孢唑啉钠、头孢曲松钠降解均遵循一级动力学反应 ,2 0℃的T0 9分别为 2 6 0 8d和 6 0 7d ,T1/ 2 为 171 5 4d和 39 95d ;溶液颜色有随温度、时间递增而加深的趋势。室温 (2 0℃±1℃ ) ,0～ 12 0h内留样观察 ,配伍前后药物残存率 >95 % ,pH值、外观均无明显改变。 结论　高温 (5 0、6 0、70℃ )下 ,甲硝唑稳定 ,头孢唑啉钠、头孢曲松钠随温度、时间递增而逐渐降解 ;室温下 ,0～ 12 0h内 ,2组配伍液的含量变化在允许范围内 (<5 % ) ,pH值、外观无明显变化 ,可以配伍使用     

应用药物利用评估软件开展药学服务

目的：为了在中国医院开展临床药学工作．提高医院对病人的服务水平。方法：以药物利用评估程序作为开展临床药学的工具．介绍了吉林高新博华医院选择使用头孢曲松钠的10名病人为例，开展药物利用评估程序的过程。结果：通过实施药物利用评估程序，可以发现医院工作中好的方面：(1)10名病人在使用药物前均测定了白细胞总数；(2)病人在使用抗生素时都遵循抗生素使用原则。不理想的方面：(1)仅有2名病人测量了体重；(2)儿童的剂量没有根据体重计算；(3)仅一名病人在使用头孢曲松钠之前使用过其他抗生素。针对上述问题提出具体的改进措施。结论：药物利用评估程序可以给医疗、护理、药局以及医院的管理者和社会提供有用的药物使用信息。随着人们对药学服务质量要求的提高。药物利用评估程序将变得越来越重要．最终被社会和病人所接受。     

头孢曲松钠治疗早期梅毒临床效果评价

目的：探讨头孢曲松钠治疗早期梅毒的临床效果。方法：选择80例患者,随机分为观察组和对照组,观察组用头孢曲松钠治疗,对照组用苄星青霉素治疗,比较两组疗效和不良反应。结果：两组治疗有效率差异无统计学意义（P〉0．05）,但观察组症状消失时间要明显短于对照组,差异有统计学意义（P〈0．05）;观察组不良反应比较差异并无统计学意义（P〉0．05）。结论：应用头孢曲松钠治疗早期梅毒见效快,疗效好,值得在临床推广应用。     

A multidrug-resistant Stenotrophomonas maltophilia clinical isolate from Kamuzu Central Hospital,Malawi

BackgroundStenotrophomonas maltophilia is a significant opportunistic pathogen that is associated with high mortality in immunocompromised individuals. In this study, we describe a multidrug-resistant (MDR) S. maltophilia clinical isolate from Kamuzu Central Hospital (KCH), Lilongwe, Malawi.MethodsA ceftriaxone and meropenem nonsusceptible isolate (Sm-MW08), recovered in December 2017 at KCH, was referred to the National Microbiology Reference Laboratory for identification. In April 2018, we identified the isolate using MALDI Biotyper mass spectrometry and determined its antimicrobial susceptibility profile using microdilution methods. Sm-MW08 was analysed by S1-PFGE, PCR, and Sanger sequencing, in order to ascertain the genotypes that were responsible for the isolate''s multidrug-resistance (MDR) phenotype.ResultsSm-MW08 was identified as S. maltophilia and exhibited resistance to a range of antibiotics, including all β-lactams, aminoglycosides (except arbekacin), chloramphenicol, minocycline, fosfomycin and fluoroquinolones, but remained susceptible to colistin and trimethoprim-sulfamethoxazole. The isolate did not harbour any plasmid but did carry chromosomally-encoded bla_L1 metallo-β-lactamase and bla_L2 β-lactamase genes; this was consistent with the isolate''s resistance profile. No other resistance determinants were detected, suggesting that the MDR phenotype exhibited by Sm-MW08 was innate.ConclusionHerein, we have described an MDR S. maltophilia from KCH in Malawi, that was resistant to almost all locally available antibiotics. We therefore recommend the practice of effective infection prevention measures to curtail spread of this organism.     

Antibacterial activity of ceftriaxone

In this study the author reports the main in vitro characteristics of ceftriaxone, a new aminothiazolyl methoxy-iminocephalosporin. The relationship between its structure and the antibacterial activity compared with cefotaxime reveals an expected longer antibacterial efficacy due to a long elimination half-life (8 h). It has been shown that ceftriaxone is highly stable against most either plasmid or chromosome-mediated beta-lactamases. Several studies demonstrated that the spectrum of ceftriaxone included Gram-positive cocci as well as most Gram-negative bacilli even beta-lactamase producers; a variable in vitro activity against Gram-negative aerobic bacteria (Pseudomonas sp., Acinetobacter sp.) has been proved, with a frequent synergistic bactericidal activity when combined with aminoglycosides, or with other beta-lactam antibiotics (carbenicillin, piperacillin). Multiple PBPs targets have been identified, including PBP1b, 2 and 3, leading to filamentation of E. coli, Ps. aeruginosa and Haemophilus cells. As a result, ceftriaxone displays a high intrinsic in vitro activity against troublesome strains and might be considered as a promising new cephalosporin for treatment of severe infections.