Cholestatic hepatitis with intravenous ceftriaxone

Drug-induced liver injury is a major health problem. Its predominant forms include acute hepatitis, cholestasis, and a mixed pattern. Ceftriaxone is a third-generation cephalosporin and is widely used in the postoperative period due to its wider spectrum, longer half-life, and better tissue penetrability. Earlier cases of high aminotransferase levels and hepatitis have also been reported with the use of ceftriaxone. Here we report a case of cholestatic hepatitis with intravenous ceftriaxone.     

Validation of an HPLC-UV method for the determination of ceftriaxone sodium residues on stainless steel surface of pharmaceutical manufacturing equipments

In pharmaceutical industry, an important step consists in the removal of possible drug residues from the involved equipments and areas. The cleaning procedures must be validated and methods to determine trace amounts of drugs have, therefore, to be considered with special attention. An HPLC-UV method for the determination of ceftriaxone sodium residues on stainless steel surface was developed and validated in order to control a cleaning procedure. Cotton swabs, moistened with extraction solution (50% water and 50% mobile phase), were used to remove any residues of drugs from stainless steel surfaces, and give recoveries of 91.12, 93.8 and 98.7% for three concentration levels. The precision of the results, reported as the relative standard deviation (RSD), were below 1.5%. The method was validated over a concentration range of 1.15-6.92 μg ml(-1). Low quantities of drug residues were determined by HPLC-UV using a Hypersil ODS 5 μm (250×4.6 mm) at 50 °C with an acetonitrile:water:pH 7:pH 5 (39-55-5.5-0.5) mobile phase at flow rate of 1.5 ml min(-1), an injection volume of 20 μl and were detected at 254 nm. A simple, selective and sensitive HPLC-UV assay for the determination of ceftriaxone sodium residues on stainless steel surfaces was developed, validated and applied.     

头孢曲松钠结晶诱导期的测定及其晶体生长机理的辨识

采用透射光强法实验测定了288.15K时头孢曲松钠在丙酮-水体系中的结晶诱导期,考察了溶液组成对其结晶诱导期的影响.基于经典的均相成核理论,通过实验测定的诱导期,计算出了头孢曲松钠在丙酮-水体系结晶过程中晶体与母液之间的表面张力和表面熵因子.表面熵因子表明从丙酮-水体系中生长的头孢曲松钠晶体表面粗糙,呈连续生长模式.     

Ceftriaxone associated nephrolithiasis: a prospective study in 284 children

Urinary tract calculi have been reported to account for between 1 in 1,000 and 1 in 7,600 hospital admissions in children in the USA. The annual incidence of urolithiasis in patients older than 10 years is 109 per 100,000 of the population in men and 36 per 100,000 of the population in women in Minnesota. The use of various medications is considered to be one of the etiologic factors of nephrolithiasis. Ceftriaxone is a widely used third-generation cephalosporin that is generally considered very safe, but complications such as biliary pseudolithiasis, and rarely, nephrolithiasis have been reported in children. There is limited information about urolithiasis as a side effect of ceftriaxone. The aim of this study was evaluation of the incidence of nephrolithiasis following ceftriaxone therapy in children. This quasi-experimental before and after study was conducted in Mofid Children’s Hospital between 2003 and 2005. All patients were treated with 75 mg/kg intravenous ceftriaxone. Diagnosis of pyelonephritis was based on standard criteria. The first renal ultrasonography was performed on the first or second day of admission and was repeated on the last day of treatment. We also evaluated complicated patients for the third time with renal ultrasonography 3 months after treatment. Stone-forming patients underwent metabolic kidney stone risk factor evaluation. We evaluated 284 patients with pyelonephritis, 185 girls and 99 boys. The first ultrasonography was normal in all of our patients. On the second ultrasonography renal stones were reported in 4 out of 284 cases (1.4% and CI = 0.96–1.83%). Underlying metabolic risk factors could not be identified in stone-forming patients. Follow-up ultrasonography 3 months later was normal. The results of our study suggest that ceftriaxone-treated patients may be at an increased risk of kidney stone formation. Stones passed spontaneously in all affected patients so the use of this effective drug can be safely continued. Close monitoring of ceftriaxone-treated patients with regard to kidney stone formation is recommended.     

头孢曲松钠生产工艺与色级的关系

头孢曲松钠属于第三代半合成头孢菌素类抗生素,在抗生素药物中占有非常重要的地位。质量是企业的生命,保证质量是企业神圣的职责,目前头孢曲松钠生产工艺比较完善,生产出的头孢曲松钠含量较高,收率好,符合药典要求,相关物质也符合标准,只是色级不稳定,时间长了色级有升高的趋势,无法满足用户需求,而且退货不但影响企业声誉,还给企业增加了成本,为从根本上解决这个问题,重新设计工艺参数,通过改变工艺条件,正交设计,优化试验,得到了一个工艺稳定的路线,基本解决了这个问题。     

头孢曲松钠致迟缓过敏性哮喘1例

头孢曲松钠为临床常用的第三代头孢菌素类抗生素,变态反应是其不良反应之一,过敏性反应后继发过敏性哮喘是其较为严重的变态反应。该药与青霉素有部分交叉变态反应,因此青霉素过敏史慎用,头孢曲松钠过敏者禁用。本例患儿无青霉素过敏史,头孢曲松钠皮试阴性,可能与药品不纯或低分子杂质及其降解产物与机体蛋白质结合形成变应元,使机体致敏发生Ⅰ型变态反应有关。     

头孢曲松对肺炎链球菌和流感嗜血杆菌体外抗菌活性的研究

使用K-B法和E-test法最低抑菌浓度（MIC）测定,检测头孢曲松（罗氏芬）等5种抗生素对100株肺炎链球菌（SP）和100株菌感嗜血杆菌（HI）的体外抗菌活性。结果显示SP对青霉素耐药率35.7%,头孢曲松耐药率4%,头孢噻酚、头孢呋辛、红霉素耐药率分别为19.6%,23.5%和88.2%。HI对氨苄青霉素耐药率12%,而对头孢曲松,头孢呋辛100%敏感,红霉素耐药则达96%。提示头孢曲松对儿童急性呼吸道感染（ARTIs）常见病原菌依然保护良好抗菌活性。     

3种抗生素治疗同一种疾病的药物经济学研究

目的介绍药物经济学在医院临床实践中发挥的作用。方法运用药物经济学原理,比较3种抗生素治疗下呼吸道感染的疗效和费用。回顾性研究我院2006年10月到2007年9月应用3种抗生素治疗下呼吸道感染84例临床资料,分析其药物利用及成本消耗情况。结果通过疗效—成本分析表明,三组间的疗效没有显著性差异,但是通过药物经济学分析发现了治疗费用却有着非常显著的差异。结论药物经济学已经渗透到临床工作的各个方面,在规范临床用药和控制药品费用增长速度过快中引入药物经济学概念具有重要意义。     

儿童社区获得性肺炎的临床特点和治疗

目的：探讨儿童社区获得性肺炎的临床特点和治疗预后。方法儿童社区获得性肺炎480例采用抽签成组方法分为治疗组与对照组,各240例,对照组给予头孢曲松钠治疗,治疗组在此基础上加用炎琥宁注射液进行治疗,比较两组的治疗效果。结果治疗组的总有效率为96.7%,对照组总有效率为89.2%,两组比较差异具有统计学意义(P<0.05)。治疗组的咳嗽、啰音、发热消失时间都明显少于对照组,对比差异有统计学意义(P<0.05)。两组治疗前血浆C-反应蛋白(CRP)与白介素(IL-6)值对比,差异无统计学意义(P>0.05),治疗后上述值在组内与组间对比差异均有统计学意义(P<0.05)。结论儿童社区获得性肺炎采用炎琥宁注射液结合抗生素进行治疗能有效提高疗效,缓解临床症状,其作用与降低血浆CRP与IL-6水平有明显相关性。     

临床药师参与1例不完全性肠梗阻患者的药学监护

目的:探讨对不完全性肠梗阻患者药学监护的内容和模式。方法:结合不完全性肠梗阻的治疗原则及具体病例,给予患者胃肠减压、抗感染、灌肠、补液等对症处理;同时,临床药师为该患者制订相应的全程化药学监护。结果:患者症状逐渐好转,复查腹部站立位平片未见明显异常。结论:临床药师可以把药品遴选、配伍禁忌、不良反应、注意事项、超说明书用药等方面作为此类患者药学监护的要点。临床药师参与查房,开展药学监护已经成为医疗过程中不可缺失的一部分,"医、药、护"相互协作服务于患者,体现了临床药师的价值。