阿米卡星与利福霉素钠注射液联合作为经验性治疗院外细菌性肺部感染首选方案的临床研究

目的　观察阿米卡星与利福霉素钠联合治疗院外细菌性肺部感染的疗效。方法　经临床确诊并有细菌性感染征象的院外肺部感染 3 0 0例 ,分为 3组 :治疗组 12 0例 ,予阿米卡星与利福霉素钠静脉滴注 ,每天 1次 ;对照 1组 80例 ,予青霉素与左氧氟沙星联合静脉滴注 ,每日 1次 ;对照 2组 10 0例 ,予青霉素与氨苄西林联合静脉滴注 ,每日 1次。观察有效率、显效所需时间及细菌清除率。结果　有效率治疗组为 98.3 3 % ,与对照 1组的88 75 %和对照 2组的 70 .0 0 %比较差异显著 (P均 <0 .0 1) ;显效时间治疗组为 (4.5± 2 .0 )天 ,对照 1组为 (6.5±3 .0 )天 ,对照 2组为 (8.0± 3 .0 )天 ,治疗组与后 2组相比差异显著 (P <0 .0 1) ;细菌清除率治疗组为 97.2 % ,对照 1组为 80 .0 % ,对照 2组为 72 .0 % ,治疗组与后 2组比较差异显著 (P <0 .0 1)。各组副作用均较小。结论　阿米卡星与利福霉素钠治疗院外细菌性肺部感染疗效好、疗程短、细菌清除率高、副作用小 ,可作为治疗院外细菌性肺部感染的首选经验方案     

尿中某些酶测定在丁胺卡那肾毒性监测中的应用

探讨药物致肾损伤早期诊断方法。用酶法测定碱性磷酸酶（ＡＬＰ）。速率法测γ－谷氨酰转肽酶（ＧＧＴ）,Ｎ－乙酰－β－Ｄ氨基葡萄糖苷酶（ＮＡＧ）、β－半乳糖苷酶（Ｇａｌ）及肌肝（ＵＣｒ）,磺柳酸法测尿蛋白（Ｐｒｏ）。结果：尿酶升高均早于尿蛋白的出现,特别是ＮＡＧ于用药后第３天即有显著升高,Ｇａｌ则在用药后３ｄ内持续升高,尿酶,特别是ＮＡＧ是药物引起肾损伤早期诊断指标。     

硫酸奈替米星注射液与硫酸丁胺卡那注射液临床疗效及安全性的比较

为评价硫酸奈替米星的临床疗效及安全性,在１７０例急性细菌感染性病人中作多中心临床研究。结果显示：硫酸奈替米星的有效率（９５．３％）显著高于对照药硫酸丁胺卡那的有效率（８４．１％）,试验组病人咳痰和腰痛症状的平均下降显著高于对照组;硫酸奈替米星治疗后细菌清除率达９７．２％;２组病人不良反应发生率均为４．８％,对照组中有２例（３．２％）出现耳鸣、１例（１．６％）听力减退,但试验组病人用药后未发现听力异常。结论：硫酸奈替米星临床疗效优于硫酸丁胺卡那且较少耳毒性。     

高效液相色谱—间接光度检测法同时测定血清和尿中5种氨基苷类抗生素

目的：建立一种直接分离测定体液中庆大霉素、丁胺卡那霉素、妥布霉素、西梭霉素和乙基西梭霉素等５种氨基苷类抗生素的高效液相色谱－间接光度检测（ＨＰＬＣ－ＩＰＤ）法。方法：在流动相中加入具有紫外检测响应的检测剂烟酰胺,用紫外检测器直接测定紫外吸收很差的上述５种药物。Ｃ１８固定相,流动相为含烟酰胺０５ｍｍｏｌ·Ｌ－１、庚烷磺酸钠５ｍｍｏｌ·Ｌ－１和磷酸００５ｍｏｌ·Ｌ－１的甲醇－乙腈－水（２７∶１８∶５５）混合溶液。结果：血清和尿样平均回收率均大于９６％,日内和日间ＲＳＤ均小于６％。并测定了肌注此类药物病人的血清和尿样品。结论：该法适于体液中氨基苷类药物检测。     

硫酸阿米卡星含量及有关物质的HPLC-ELSD测定

建立了高效液相色谱-蒸发光散射检测器法测定硫酸阿米卡星及有关物质的含量.采用Extend C18色谱柱,以水-氨水-冰醋酸(96:3.6:0.4,pH10.0)为流动相,流速0.8ml/min,漂移管温度110℃,氮气流速3L/min.在0.05～2.5mg/ml浓度范围内线性关系良好(r=0.9998),方法回收率99.6%～101.2%.     

噬菌体生物扩增法检测结核分枝杆菌阿米卡星耐药性方法的建立及应用评价

目的 建立结核分枝杆菌阿米卡星(Am)耐药性的噬菌体生物扩增法(PhaB)快速检测技术,并探讨其临床应用价值。 方法 通过不同菌量及药物浓度的筛选,建立PhaB测定结核分枝杆菌阿米卡星药敏检测方法;用该方法对108株结核分枝杆菌临床分离株进行了阿米卡星药敏检测,同步进行Bactec MGIT 960的Am药敏检测,对2种方法的检测结果进行比较分析。结果不符合的菌株测定其Am的最低抑茵浓度(MIC)。 结果 以细菌接种量10^-3 mg／ml、药物浓度2 μg／ml、37℃作用48-h为药敏最佳检测条件,噬菌体检测108株结核分枝杆菌临床分离株阿米卡星敏感82株、耐药26株,Bactec MGIT 960检测敏感80株、耐药28株;2法测定均为敏感79株、均为耐药25株。以Bactec MGIT 960测定结果为判断标准,则PhaB的敏感性、特异性、阳性和阴性预测值及符合率分别为89.3%、98.8%、96.2%、96.3%、96.3%。 结论 PhaB检测结核分枝杆菌的Am耐药性有较高的敏感性、特异性和准确性,整个检测只需3 d,且操作简单、不需特殊仪器设备,可作为 M .TB临床分离株Am药敏快速检测备选方法之一。     

A Comparative Study on Aztreonam,Ceftazidime and Amikacin in the Treatment of Complicated Urinary Tract Infections

Summary

In a prospective, randomized trial, aztreonam (1 g intravenously or intramuscularly, twice daily) was compared with ceftazidime (1 g intravenously or intramuscularly, twice daily) and amikacin (500 mg intravenously or intramuscularly, twice daily) in 76 patients aged 24 to 84 years (mean, 59.7 years) with complicated urinary tract infections. Initial pathogens included Escherichia coli (47.5%), Pseudomonas aeruginosa (22.5%), Klebsiella spp. (9%), Proteus spp. (7.5%) and Enterobacter spp (6%). In four patients initial urine cultures yielded more than one organism. All pathogens were sensitive to the three study drugs. Including performance of 4- to 6-week follow-up cultures, eradication of the pathogens occurred in 72% of patients treated with aztreonam, in 74% of those treated with ceftazidime and in 71% treated with amikacin (p>0.05). Clinical success was observed in 84% of patients treated with aztreonam, in 82% of those treated with ceftazidime and in 85% treated with amikacin (p>0.05). All drugs were well tolerated. It is concluded that aztreonam, ceftazidime and amikacin are equally effective and safe for the treatment of complicated urinary tract infections due to susceptible organisms.     

Meta-analysis: combination of meropenem vs ceftazidime and amikacin for empirical treatment of cancer patients with febrile neutropenia

Background:Meropenem monotherapy vs ceftazidime plus amikacin have been approved for use against febrile neutropenia. To assess the effectiveness and safety of them for empirical treatment of cancer patients with febrile neutropenia, we conducted a meta-analysis of randomized controlled trial.Methods:Randomized controlled trials on ceftazidime plus amikacin, or/and monotherapy with meropenem for the treatment of cancer patients with febrile neutropenia were identified by searching Cochrane Library, PubMed, Science Direct, Wiley Online, Science Citation Index, Google (scholar), National Center for Biotechnology Information, and China National Knowledge Infrastructure. Data on interventions, participants’ characteristics and the outcomes of therapy, were extracted for statistical analysis. Seven trials fulfilled the inclusion criteria.Result:The treatment with ceftazidime plus amikacin was more effective than meropenem (OR = 1.17; 95% CI 0.93–1.46; 1270 participants). However, the treatment effects of the 2 therapy methods were almost parallel in adults (OR = 1.15; 95% CI 0.91–1.46; 1130 participants older than 16). Drug-related adverse effects afflicted more patients treated with ceftazidime plus amikacin (OR = 0.78; 95% CI 0.52–1.15; 1445 participants). The common responses were nausea, diarrhea, rash, and increased in serum glutamic oxaloacetic transaminase, serum glutamic pyruvic transaminase and bilirubin.Conclusion:Ceftazidime plus amikacin should be the first choice for empirical treatment of cancer patients with febrile neutropenia, and meropenem may be chosen as a last defense against pathogenic bacteria.