阿奇霉素替代激素治疗婴幼儿喘息性支气管炎临床研究

目的评价阿奇霉素治疗婴幼儿喘息性支气管炎的疗效并探讨其作用机制。方法婴幼儿喘息性支气管炎60例,随机分为2组,各30例,A组用阿奇霉素治疗,B组用地塞米松治疗,分别观察3d后的临床疗效;2组均测定其外周血清IL-4,IFN-γ浓度变化,并与15例健康婴幼儿（对照组）血清IL-4,IFN-γ浓度对比。结果A组与B组临床总有效率差异无统计学意义;整个喘息性支气管炎组与正常对照组相比IFN-γ和IL-4值差异均有统计学意义,IFN-γ下降,IL-4升高;各组治疗前与治疗后相比差异均有统计学意义,A组治疗后血清IFN-γ浓度增高、IL-4浓度下降;B组治疗后血清IFN-γ浓度下降、IL-4浓度也下降,且2组IFN-γ/IL-4值均显著升高。结论阿奇霉素治疗婴幼儿喘息性支气管炎有较好的疗效,能与地塞米松有同样的调节TH1及TH2细胞因子使之趋于平衡,并且有更好的促进细胞免疫作用。     

Failure of intravenous infusions in neonates

The median life expectancy (survival) of 286 peripheral intravenous infusion sites in 105 babies in a children's intensive care unit was 36 h. Unadjusted univariate survival analysis revealed that dextrose infusions and the initial infusions received by a baby had longer survival than total parenteral nutrition (TPN) infusions and later infusions respectively. Also infusions with cloxacillin and penicillin survived for longer than average while infusions with phenytoin had reduced survival. Gestational age, weight, infusion site, other drugs, co-infusion of Intralipid with TPN solutions and neutralization of TPN did not influence survival of infusions. Multivariate survival analysis confirmed the findings for TPN and penicillin but not for cloxacillin, phenytoin or later infusions. Multivariate analysis also suggested that survival was improved with ampicillin and aminophylline and worse for leg sites, for older babies and for infusions in which the fluids were given at greater rates. It also indicated that neutralization of TPN improved survival.     

Macrolide–lincosamide–streptogramin B resistance phenotypes and genotypes among Staphylococcus aureus clinical isolates in Japan

In total, 269 methicillin-resistant Staphylococcus aureus (MRSA) and 434 methicillin-susceptible S. aureus (MSSA) isolates were investigated to determine their macrolide-lincosamide-streptogramin B (MLS(B)) resistance phenotypes and genotypes. The constitutive phenotype (61.3% in MRSA, 1.3% in MSSA) and erm(A) gene predominated among the 261 erythromycin-resistant MRSA isolates, while the inducible phenotype (38.7% in MRSA, 94.0% in MSSA) and erm(C) gene were more prevalent among the 150 erythromycin-resistant MSSA isolates. There was a higher incidence of the MLS(B) inducible phenotype compared with other countries, perhaps because MLS(B) antibiotics are not recommended as first-line agents against S. aureus in Japan.     

金黄色葡萄球菌儿童株耐药性分析

目的 了解儿童中金黄色葡萄球菌所致疾病的分布及其对常用抗生素的敏感情况。方法 收集连续12个月的临床致病株，根据菌落形态、革兰染色特点和乳胶凝集实验对金黄色葡萄球菌进行初步筛选，用细菌自动鉴定系统Vitek GPI卡和GPS-101卡进行菌株鉴定和药敏试验。结果 分离到金黄色葡萄球菌145株，其中来自呼吸道感染患儿痰或咽拭子培养109株，占75．17％，来自血培养16株，占11．03％，来自脓液、阴道分泌物培养分别占6．21％和5．51％。药敏试验显示92．4l％的菌株产生β-内酰胺酶，96．55％的菌株对青霉素耐药，但耐苯唑西林的仅占6．21％。99．31％和100％的菌株分别对利福平和万古霉素敏感，对环丙沙星、阿莫西林／棒酸、头孢唑林、复方新诺明、庆大霉素和林可霉素的敏感率分别为95．86％、93．10％、92．41％、86．21％、84．83％和80．69％，37．93％的菌株对红霉素耐药。结论金黄色葡萄球菌常引起儿童呼吸道感染，对苯唑西林的耐药率低．该药仍是治疗小儿会黄色葡萄球菌感染的有效药物。     

临床医师处方抗菌药物前需思考的几个问题

2001年和2003年卫生部全国医院感染监测网调查结果均显示,医院横断面抗菌药物的平均使用率在54%以上,联合用药较为普遍.国内监测结果也表明细菌耐药性日益严重.针对上述问题,提出临床医师在面对病人开处方抗菌药物之前,须思考的问题:是否有使用抗菌药物的适用症?是否了解选用的抗菌药物,选用何种药物?是否有联合使用抗菌药物的指征?采用何种给药途径、给药剂量、给药时间?是否属于特殊宿主或针对特殊病原体的感染使用抗菌药物?密切观察抗菌药物治疗是否有效?针对局部感染是否需要穿刺或外科手术引流病灶?是否已出现抗菌药物的不良反应?是否存在药物相互作用?是否存在不合理使用抗菌药物情况?并且针对每个问题提出了建议.     

Effect of ponsinomycin on cyclosporin pharmacokinetics

Summary The influence of treatment with ponsinomycin, a new macrolide antibiotic, on the pharmacokinetics of cyclosporin A has been studied in 10 renal transplant patients. The pharmacokinetics of cyclosporin A was investigated at steady state, before and during treatment with ponsinomycin.On average, the blood levels of cyclosporin A were doubled by the macrolide, possibly due to a decrease in elimination or/and to an increase in absorption.Ponsinomycin should be use very carefully in patients treated with cyclosporin A.     

医院内携带的葡萄球菌对8种抗生素的敏感度

测定216株葡萄球菌(126株金葡菌,90株凝固酶阴性葡萄球菌)对8种临床常用抗生素药敏。结果为:医院内携带的金葡菌对青霉素G、红霉素、林可霉素耐药率分别为76.42%、61.36%、27.26%,对头孢噻啶、利福霉素敏感性较好。医院内表葡菌对青霉素G、红霉素、林可霉素耐药率分别达65.29%、58.82%、50%。故治疗医院内金葡菌、表葡菌感染时要选用有效药物。医院内携带的金葡菌产酶率81.40%,CNS产酶率71.11%,绝大多数产酶株对青霉素G耐药,头孢噻啶对产酶株有良好的抗菌活性。     

CASE REPORT: Antibiotic-associated haemorrhagic colitis

Antibiotic-associated haemorrhagic colitis is an uncommon cause of bloody diarrhoea in patients taking penicillin or penicillin-related antibiotics. Symptoms of abdominal pain and bloody diarrhoea occur within 1 week of antibiotic use and resolve without specific therapy within days of discontinuing the offending antibiotic. There is an apparent increased incidence of the disease in patients of Oriental ethnicity. The pathogenesis is unknown. We present two cases of haemorrhagic colitis in patients taking penicillin-related antibiotics who presented within 4 months of each other. One of the patients was being treated for Helicobacter pylori infection. The published literature is reviewed with particular emphasis on the histology and pathogenesis of the condition.     

Nontoxic concentration of antibiotics for intravitreal use — evaluated by human in-vitro ERG

The effects of penicillin G (PC-G) sodium, procaine PC-G, cloxacillin sodium (MCIPC), disodium sulbenicillin (SBPC), cefazolin sodium (CEZ), gentamicin sulfate (GM) and fosfomycin sodium (FOM) on the electroretinogram (ERG) of the human in-vitro eye-cup were studied. The oscillatory potentials (OPs) were selectively and greatly suppressed by 1.0mM PC-G sodium. The OPs and c-wave were suppressed by 0.85mM procaine PC-G. The b-wave and OPs were slightly suppressed by 1.0mM MCIPC. The a-wave, b-wave, OPs and c-wave were not deteriorated by 1.0mM SBPC. The OPs appeared to be selectively suppressed by 1.0mM CEZ. The b-wave was suppressed and the peak latencies of the OPs were delayed by 184g/ml (approximately 0.4mM) GM. The amplitudes of the a-wave and c-wave were slightly enhanced and their peak latencies were slightly delayed by 184g/ml GM. The a-wave, b-wave, OPs and c-wave were not deteriorated by 1.0mM FOM. The results of the present study on the human retina were comparable to those on the albino rabbit retina in our previous studies.     

Atracurium and vecuronium interaction with gentamicin and tobramycin

Drug interactions between the aminoglycosides (tobramycin and gentamicin) and atracurium and vecuronium were studied prospectively in 44 patients. Twenty-two patients had therapeutic serum levels of tobramycin or gentamicin and 22 served as controls. Onset time, clinical duration, and time to spontaneous recovery of T4/T1 ratio of 0.70 after atracurium or vecuronium injection were measured. No statistically significant differences were found in onset time, but clinical duration and time to recovery were significantly longer in patients receiving tobramycin or gentamicin and paralyzed with vecuronium than for controls (P less than 0.01 for clinical duration and P less than 0.0005 for recovery). The neuromuscular block produced by atracurium was not significantly influenced by the presence of therapeutic serum levels of tobramycin or gentamicin. We conclude that for patients treated with these antibiotics, atracurium may present some advantages over vecuronium when a prolonged block is not desired.