替考拉宁与万古霉素治疗老年人耐甲氧西林金葡菌肺部感染的评价

目的：比较糖肽类抗生素—替考拉宁与万古霉素治疗老年人耐甲氧西林金葡菌(MRSA)肺部感染的疗效和安全性。方法：对35例应用万古霉素和29例应用替考拉宁治疗的老年人MRSA肺部感染患者进行治疗前后的临床症状、细菌清除情况、以及不良反应的统计分析,并将临床分离菌分别进行替考拉宁和万古霉素的体外药敏试验。结果：两药治宁老年人MRSA感染均有较高的疗效。万古霉素临床有效率为82．9％,替考拉宁为79．3％;万古霉素的。MRSA清除率为91．4％,替考拉宁为89．7％,两者无明显差异;万古霉素和替考拉宁对两组患者痰培养所得的64株MRSA均敏感;另外,两组均有少量胃肠道不良反应;万古霉素组有1例发生红人综合征,与药物滴注速度过快有关;两药均有一定的肾毒性,万古霉素组发生略多,似与药物的血浆谷浓度高有一定关系。结论：合理的应用糖肽类抗生素治疗老年人MRSA肺部感染疗效强,并且安全可靠。在高龄老年患者中使用万古霉素推荐以每日1次为理想。

Clinical Evaluation of Teicoplanin and Vancomycin in the Elderly Patients with Lung Infection of MRSA

Objective: To compare efficacy and safety of glycopeptide antibiotics teicoplanin and vancomycin in elderly patients with lung infection with MRSA. Methods: Thirty-five elderly patients with lung infection with methicittin resistant Staphy lococcus aureus(MRSA) were treated with Vancomycin, twenty-nine patients were treated with Teicoplanin. The therapeutic effect, clearance rate of pathogens, and side effects were compared. In vitro sensitivity test to two glycopeptide antibiotics were assayed in 64 strains of pathogens. Results: The clinical effective rate of Vancomycin group was 82.9%, Teicoplanin group was 79.3%. Teicoplanin was as effective as Vancomycin(P>0.05). The clearance rate of MRSA in Vancomycin accounted for 91.4%, Teicoplanin accounted for 89.7%. The clearance rates of pathogens of two drugs were similar (P>0.05). In vitro, the sensitivity test of 64 strains of pathogens showed that the sensitivity strains to Teicoplanin and Vancomycin both were 100%. In addition, these drugs have less side effects of gastrointestinal tract. Vancomycin group cause a case of "red man" syndrome. The syndrome was correlative with a rapid dripping. Teicoplanin and vancomycin both had a few nephrotoxicity. Nephrotoxicity of Vancomycin was slight high. It seems to correlate with valley concentration. Conclusion: It is high efficacy and safety so that glycopeptide antibiotics are reasonably applied in the elderly patients with lung infection with MRSA. Vancomycin is recommend to drip once a day in the senile patients.