微波联合抗生素治疗盆腔炎疗效观察

目的观察微波联合抗生素治疗盆腔炎的临床疗效。方法采用抗生素加微波治疗,对照组采用抗生素进行治疗,比较两组临床疗效。结果观察组30例治愈27例,好转2例。治愈率90．0％．总有效率96．67％。对照组30患者治愈24例,好转3倒,治愈率80．0％。总有效率90．0％。两组差异有统计学意义。结论微波联合抗生素治疗盆腔炎性的治疗效果肯定,值得基层医疗机构推广应用。     

Effect of antibiotics and bifiodobacterium preparations on the intestinal microflora of mice irradiated with gamma quanta

The treatment of CBA mice, irradiated in a dose of 700 Gy with antibiotics (penicillin V, oxytetracycline, streptomycin) in combination with bacterial therapy (B. bifidum, strain 75-41) or with antibiotics alone led to the increased percentage of survivors among them in comparison with the control animals. At the same time the medical prognosis was better in cases of the combined treatment with antibiotics and bifidobacteria. This circumstance was due to the fact that the combined treatment with antibiotics and bifidobacteria, considerably facilitated the normalization of the microbial picture of the intestine; in this case the "eubiosis" of the intestinal tract was almost completely restored by the 22nd day after the irradiation, whereas in the treatment with antibiotics alone the inhibitory effect on the development of the opportunistic flora at a later period of the development of dysbacteriosis was less pronounced, while the number of lactic acid bacteria remained at the same low level as in the untreated mice.     

Systemic candidiasis with meningeal involvement in a newborn infant

The newborn with sepsis (E. coli) and salmonellosis was described. After treatment with broad-spectrum antibiotics it was suffered from Candida albicans (Meningitis with Hydrocephalus internus, Chorioretinitis and Ostitis). The authors difficulties connected with diagnosis and anti-fungal therapy have showed. They have punctated the necessity of combined anti-mycotic therapy.     

伊曲康唑注射剂治疗伴有肺结核史的侵袭性真菌感染2例

目的报道2例伴有肺结核史的侵袭性真菌感染经伊曲康唑注射剂治疗经过,探讨伴有肺结核史患者的抗真菌治疗经验。方法例1为49岁＂支气管肺囊肿合并感染,陈旧性肺结核＂男性患者,诊断为侵袭性肺曲霉感染确诊病例。例2为51岁＂右侧自发性气胸,慢性阻塞性肺病,陈旧性肺结核＂男性患者,诊断为侵袭性肺念珠菌感染拟诊病例。均予伊曲康唑注射剂治疗2周结合抗细菌治疗,并作临床和真菌学疗效监测。结果治疗两周后两患者临床症状和体征均得到明显改善,标本真菌镜检转阴,培养仍为阳性。结论在有肺结核病史存在的侵袭性真菌感染抗真菌治疗时间可能需要延长。合理应用抗生素、激素,严格掌握用药指针、时机、剂量与疗程是控制真菌感染的重要因素。     

Intralymphatic administration of antibiotics in the complex treatment of suppurative complications in patients with neurosurgical pathology

The efficacy of endolymphatic route of gentamicin and ceporin administration was studied in 89 patients with neurosurgical pathological processes complicated by acute pneumonia (80 patients) and meningoencephalitis (9 patients) usually after ineffective antibiotic therapy according to the routine methods. The antibiotics were used in accordance with the antibiograms of the causative agents isolated from the bronchial tree or CSF. The endolymphatic use of gentamicin or ceporin once a day in doses of 80 mg or 1 g respectively provided rapid sanation and arresting of the inflammatory foci, lowering of the intoxication level, more rapid promotion of the positive time course of the clinico-roentgenological and laboratory indices and decreasing of the recovery periods by 1.5-2 times in 86 per cent of the patients with pneumonia. The endolymphatic administration of gentamicin in a dose of 80 mg twice a day or ceporin in a dose of 1 g twice a day allowed one to maintain the antibiotic therapeutic levels in the cerebrospinal fluid and to obtain satisfactory clinical results in the combined treatment of meningoencephalitis. The endolymphatic administration of the drugs was well tolerated by the patients and no adverse reactions were observed. This route of administration of antibiotics and in particular broad spectrum antibiotics may be recommended for urgent antibacterial therapy of especially severe neurosurgical patients with pyo-inflammatory complications and patients who did not respond to the routine antibiotic therapy.     

Study of the combined action of an antibiotic and an immunostimulator using mathematical modeling

A mathematical model of antibiotic and immunostimulator (IMS) combined effect on various elements of the immune system and general state of patients with infectious diseases is described. The model was constructed as a system including 6 usual differential equations of the 1st order. With the use of this model and a computer many diverse variants of infection development under conditions of treatment with IMS at the background of antibiotic therapy were modeled. Ii was shown that IMS-antibiotic complexes markedly improved the indices of antibiotic therapy as compared to the use of the antibiotics alone. In combined use of IMS and antibiotics it was possible to lower the antibiotic doses without lowering the antimicrobial effect. The use of IMS at the optimal period led to balanced activation of the host specific and nonspecific resistance factors at the background of antibacterial therapy. The results of the mathematical modeling corresponded to the data on protective effect of salmozan (IMS) and doxycycline (antibiotic) combination in animals (albino mice). It was concluded that the described mathematical model was adequate for validation and optimization of schemes for combined use of IMS and antibacterial agents.     

Antibiotic therapy of intestinal infections complicated by toxicosis and exicosis in children with immunodeficiency syndromes]

Clinical processes of acute intestinal infections complicated by toxicosis and exicosis and some host immunological parameters were studied in infants with secondary immunodeficiency. A special treatment scheme was developed including combined use of antibiotics, human immune globulin administered intravenously and cytochrome C. The scheme provided a decrease in the treatment duration by 8.6 +/- 1.1 days. Advanced and chronic diseases and fatal outcomes were absent. It was concluded that the developed scheme increased host immunological reactivity and efficacy of antibiotic therapy. It was recommended for wide clinical use in pediatric clinical care.     

Effect of antibiotic therapy and vaccine therapy on the phagocytic reaction in mice infected with Staphylococcus

The time course of changes in the activity, intensity and completeness of phagocytosis with leukocytes of the peritoneal exudate was studied on mice with experimental staphylococcal infection treated with rifampicin, lincomycin and inactivated staphylococcal vaccine used alone or in combination. It was shown that immunization of the animals with inactivated staphylococcal vaccine promoted stimulation of the phagocytic defense. Rifampicin and lincomycin applied therapeutically induced a decrease in the activity, intensity and completeness of phagocytosis. It should be noted that rifampicin had a less pronounced inhibitory effect than lincomycin. The combined use of vaccine and antibiotics with therapeutic purposes promoted an increase in phagocytosis as compared to the use of the antibiotics alone. The combined therapy sometimes resulted in completeness of phagocytosis making it reach the control values (the 10th and 15th days, rifampicin and vaccine). It should be noted that a more pronounced stimulation of the activity, intensity and completeness of the phagocytosis was observed with the use of the combination of rifampicin and the vaccine.     

Comparative effectiveness of various antibiotics in the treatment of patients with meningococcal meningitis]

The results of treating 322 patients with various forms of meningococcal infection accepted to a hospital within a year are presented. The patients were divided into 3 groups by the character of etiotropic therapy. The patients of group I were treated with benzylpenicillin and those of group 2 were treated with levomycetin sodium succinate. Group 3 included the patients, the therapy of whom with the above two antibiotics failed and they were subjected to treatment with cefazolin, cefotaxime, amikacin and other broad spectrum antibiotics. Benzylpenicillin generally proved to be the drug of choice in the antibacterial therapy of meningococcal infection. In comparison to levomycetin (chloramphenicol) it provide more rapid clinical recovery of the patients and normalization of the indices of the cerebrospinal fluid. Only failure of benzylpenicillin therapy was considered as an indication to the broad-spectrum antibiotics to be in the complex treatment of the patients. As additional methods for estimating the efficacy of antibacterial therapy it was recommended to employ calculation of the integral indices of hemograms (the leukocyte index of intoxication and the hematologic index of intoxication).     

Detection of persistent resistance to antibacterial drugs in various strains of Francisella tularensis]

Under natural conditions, the Francisella tularensis strains AE-261 and P-13864 capable of forming the persist type of resistance to antibacterial drugs and being the cause of the infection in laboratory animals not responding to monotherapy with antibiotics were detectable. The antibioticograms of strains AE-261 and P-13864 under the in vitro conditions did not differ from those of the other studied strains responding to the antibiotic therapy. The observed phenomenon could be associated with individual peculiarities of the strains and their phenotypic variation in the host. Combinations of aminoglycoside antibiotics (streptomycin, gentamicin and amikacin) with rifampicin were shown to be highly active in the treatment of general forms of the infection due to such strains. The combined therapy of tularemia was also considered promising because of its high efficacy when the treatment was started at late periods as well as because unlike the monotherapy with the aminoglycoside antibiotics it provided complete elimination of the pathogen from the host.     

儿童激素耐药型肾病综合征合并星形诺卡菌脑脓肿1例

本文报道1例激素耐药型肾病综合征儿童合并星形诺卡菌(Nocardia asteroides,N.asteroides)脑脓肿。患儿,男性,8岁,临床诊断为原发性肾病综合征(激素耐药型),病理诊断为局灶节段性肾小球硬化症(经典型)。肾穿后第4天患儿出现持续高热、抽搐,时有头痛,抗感染、抗凝治疗效果不佳。复查颅脑磁共振成像(magnetic resonance imaging,MRI)提示多发脑脓肿。头颅脓肿液经穿刺后培养显示为星形诺卡菌感染。予以多种抗生素联合糖皮质激素等治疗2个月,患儿体温正常,头痛缓解,脑脓肿范围明显缩小。因此,肾病综合征患儿在应用激素及免疫抑制剂治疗过程中如出现化脓性炎症,常规抗生素疗效差,应积极寻找病原,高度警惕诺卡菌病及其他机会性感染的可能。     

布拉氏酵母菌散剂联合三联疗法对 儿童幽门螺杆菌感染的治疗

目的观察布拉氏酵母菌散剂联合以质子泵抑制剂(PPI)为基础的标准三联疗法对儿童幽门螺杆菌(H.pylori)感染的疗效,以探索根除率高且不良反应少的H.pylori根除方案。方法采用前瞻性随机对照研究,从确诊为H.pylori感染的患儿中选取120例作为研究对象,再随机分为布拉氏组和标准三联疗法组,每组各60例。标准三联疗法组口服阿莫西林[50mg/(kg·d),饭后分两次服]、克拉霉素[20mg/(kg·d),饭后分两次服]和奥美拉唑[0.7～0.8mg/(kg·d),饭前半小时一次服完]治疗,布拉氏组在标准三联疗法的基础上加服布拉氏酵母菌散剂(250mg/次,2次/d)。两组患者均治疗14d,由患儿家属记录治疗过程中发生不良反应的情况。停药后4周内不再口服任何抗生素,后行14 C呼气试验以评估H.pylori根除情况。比较两组患者根除率及不良反应发生率。结果治疗后三联疗法组H.pylori根除率为76.7%(46/60),布拉氏组为90.0%(54/60),二者差异有统计学意义(P0.05)。治疗过程中布拉氏组患者腹泻发生率低于三联疗法组,差异有统计学意义(P0.05)。结论布拉酵母联合三联疗法能提高H.pylori的根除率,降低治疗过程中的不良反应。     

Beta-lactamases with a wide substrate spectrum in gram negative strictly anaerobic rods

This study was performed to determine the susceptibility of the clinical strains of Gram-negative strictly anaerobic rods to newer beta-lactam antibiotics. Also, the trial was undertaken to detect strains producing extended-spectrum beta-lactamases (ESBLs) and inducible beta-lactamases (IBLs) among Bacteroides spp. and Prevotella spp. rods isolated from hospitalized patients. One hundred strains of Gram-negative, obligatory anaerobic rods were applied in the study. The strains were identified in automatic ATB system using API 20 A strips. beta-lactamase-positive strains were determined with disc nitrocefin test. ESBL-producing strains were detected with double disc test according to Jarlier et al. (1988). Clavulanate was applied as the inhibitor of these beta-lactamases (AMO/CLAV disc). ESBL-positive strains were confirmed with the use of E test (TZ/TZL strip). Inducible beta-lactamases were determined by double disc method according to Sanders and Sanders (1979). Cefoxitin was the inducer of these beta-lactamases (FOX disc). Among 93 Bacteroides spp. strains and 7 Prevotella spp. strains, 91 strains (91%) produced beta-lactamases. Two ESBL-producing strains (2%) were detected. Strains producing inducible beta-lactamases (IBL) were not found. A high activity of the examined beta-lactam antibiotics against strains of Gram-negative anaerobes was found. The majority of strains were susceptible to piperacillin (95%), piperacillin combined with tazobactam (99%), ticarcillin combined with clavulanic acid (99%), meropenem (97%) and imipenem (99%). The obtained results indicate the necessity of ESBL determination among strains of the genus Bacteroides, isolated from clinical specimens. Newer beta-lactam antibiotics, especially penicillins in combination with beta-lactamase inhibitors and carbapenems, are useful in empiric therapy of infections caused by Bacteroides spp. and Prevotella spp. anaerobic rods.     

Efficacy of Mastoparan-AF alone and in combination with clinically used antibiotics on nosocomial multidrug-resistant Acinetobacter baumannii

Emergence of multidrug-resistant Acinetobacter baumannii (MDRAB) has become a critical clinical problem worldwide and limited therapeutic options for infectious diseases caused by MDRAB. Therefore, there is an urgent need for the development of new antimicrobial agents or alternative therapy to combat MDRAB infection. The aim of this study was to investigate effects of Mastoparan-AF (MP-AF), an amphipathic peptide isolated from the hornet venom of Vespa affinis with broad-spectrum antimicrobial activity, on MDRAB. As compared with clinical used antibiotics, MP-AF exhibited potent antimicrobial activity at 2–16 μg/ml against the reference strain A. baumannii ATCC 15151 and seven MDRAB clinical isolates, especially the colistin-resistant MDRAB, E0158. The synergistic antimicrobial combination study revealed that MP-AF acted synergistically with specific antibiotics, e.g., ciprofloxacin, trimethoprim/sulfamethoxazole (SXT) or colistin against some isolates of the MDRAB. It was noteworthy when MP-AF combined with SXT exhibited synergistic activity against all SXT-resistant MDRAB isolates. The synergistic combination of MP-AF and antibiotics could reduce the dosage recommended of each antimicrobial agent and improve the safety of medications with ignorable adverse effects, such as colistin with nephrotoxicity in therapeutic dose. Furthermore, MP-AF combined with antibiotics with different antimicrobial mechanisms could reduce selective pressure of antibiotics on bacteria and prevent the emergence of antimicrobial-resistant strains. Importantly, we are the first finding that MP-AF could make MDRAB from the original non-susceptibility to SXT become sensitivity. In conclusion, MP-AF alone or in combination with other antibiotics, especially SXT, is a potential candidate against MDRAB infection in clinical medicine.     

106例宫颈炎患者支原体检测及抗生素敏感性分析

目的：对本地区宫颈炎患者解脲脲原体（Uu）和人型支原体（Mh）进行监测,分析抗生素敏感情况,为临床诊疗提供实验依据。方法：无菌采集宫颈炎患者宫颈分泌物,用支原体培养、鉴定、药敏试剂盒进行培养和药敏试验。结果：支原体总检出率为71.70%。Uu检出率为52.83%,Uu合并Mh检出率16.04%,Mh检出率为2.83%。56例单纯Uu株体外抗生素敏感性显示：对四环素族多西环素100%、美满霉素98.21%高度敏感;对大环内酯类敏感性不一：克拉霉素96.43%,阿奇霉素91.07%,交沙霉素76.79%,红霉素67.86%,罗红霉素32.14%;对喹诺酮类如加替沙星83.93%较敏感,而对左氧氟沙星,司帕沙星敏感性差;对克林霉素和甲砜霉素不敏感;17例Uu合并Mh的抗生素敏感性为：美满霉素100%,多西环素100%,交沙霉素88.23%,加替沙星64.7%,对左氧氟沙星、司帕沙星、红霉素、阿奇霉素、克拉霉素,罗红霉素、甲砜霉素、克林霉素均不敏感。3株单纯Mh例数少未做统计。结论：宫颈炎患者中支原体检出率较高,其中单纯Uu检出率较Uu、Mh混合阳性率高,对四环素类、大环内酯类族中的多数抗生素敏感,治疗选择余地大。Uu、Mh混合敏感性抗生素种类少,应优先选择四环素类抗生素治疗。     

Use of vilozen and ketotifen combination for increasing the effectiveness and prevention of complications of antibiotic therapy of streptococcal infections]

The clinical efficacy of a vilozen and ketotifen (zaditen) combination in the treatment of streptococcal infections along with the routine therapy was studied. The use of the combination was shown advisable in the complex therapy and prevention of relapses in patients with streptococcal infections. The combined pharmacotherapy promoted better clinical indices, normalization of the immune status and a reduction in the incidence of allergic reactions to antibiotics and a decrease in sensitization to bacterial allergens.     

嗜酸乳杆菌S-层蛋白联合抗生素对Escherichia coli和Staphylococcus aureus的抑制作用研究

旨在检测嗜酸乳杆菌S-层蛋白以及S-层蛋白与抗生素联用对大肠杆菌(Escherichia coli)和金黄色葡萄球菌(Staphylococcus aureus)的抑制作用。采用液体发酵培养法获得嗜酸乳杆菌菌体,LiCl法提取S-层蛋白粗提物,凝胶过滤层析法纯化S-层蛋白,分别用E.coli和S.aureus处理Caco-2细胞2 h后,考察S-层蛋白在不同浓度和不同作用时间条件下对E.coli和S.aureus的抑制作用,并考察S-层蛋白联合抗生素对E.coli和S.aureus的抑制作用,实验分组:(1)空白对照;(2)嗜酸乳杆菌组;(3)S-层蛋白组;(4)抗生素组;(5)嗜酸乳杆菌+抗生素组;(6)S-层蛋白+抗生素组。结果显示,液体发酵得到嗜酸乳杆菌菌体,提取并纯化得到S-层蛋白;S-层蛋白对E.coli和S.aureus有很好的抑制效果,具有浓度依赖性,高浓度下抑制率达到42.2%和31.7%,差异极显著(P<0.01),且在E.coli和S.aureus作用的短时间内干预效果明显,0 h时的抑制率分别达到59.3%和48.4%;S-层蛋白联合抗生素的抑菌率分别达到81.7%和79.3%,差异极显著(P<0.01),效果优于单独使用抗生素。嗜酸乳杆菌S-层蛋白具有较强的抑菌作用,可以与抗生素联用,有望开发称为一种新型的抗菌药物。     

播散性马尔尼菲篮状菌病1例

患者,男,32岁,反复淋巴结肿大、发热伴皮疹2年,广谱抗生素、抗结核治疗无效,肺部CT提示两肺内多发结节,血γ干扰素抗体阳性,皮肤活检组织、淋巴结组织、肺穿刺活检组织均培养出马尔尼菲篮状菌,予两性霉素B脂质体联合伏立康唑治疗效果佳。     

Antibiotic therapy in children with pertussis]

The data accumulated within the last years required revision of the indications to the use of antibiotics in treatment of pertussis. One of the aims of antibiotic therapy in pertussis was to prevent colonization of B. pertussis in the respiratory tracts. With that end in view the choice of antibiotics should be limited by those, to which the pathogen is the most sensitive i.e. erythromycin, ampicillin and augmentin. Comparative efficacy of erythromycin and ampicillin during the first 2 weeks of the disease was studied in 79 infants at the age not older than 1 year with pertussis and it was shown that erythromycin was advantageous by its therapeutic activity and less side effects. Expedience of the antibiotic therapy during the spastic period for providing a preventive effect on development of bronchopulmonary complications was studied in 201 patients with pertussis. No preventive effect of the antibiotics on development of the bronchopulmonary complications defined by the secondary bacterial flora was recorded. In the group of the patients treated with the antibiotics prophylactically (group 1) the complications were 2.6 times more frequent than in the patients treated with pathogenetic agents alone (group 2). Intrahospital pneumonia developed in 8.9 per cent of the patients in group 1 and in 1.5 per cent of the patients in group 2. Therefore, antibiotics should not be used at the late periods of pertussis for prophylaxis of secondary bacterial complications.     

Mutagenic activity of antibiotics alone and in conjunction with alkanesulfonates

Differential and combined effects of 0.25 and 0.50% antibiotics (ampicillin, neomycin, furadentine) and alkylating agents (ethyl methanesulfonate, methyl ethanesulfonate, methyl methanesulfonate) were assayed on Phaseolus vulgaris L. (2 n = 22) at the M₂ generation for chlorophyll mutations. The general types scored were Albino, Xantha, Virescens and Maculata. Yellowish-green leaves having red mid-veins and veinlets were observed only amongst the progeny raised after treatment with 0.25% ethyl methanesulfonate or 0.25% methyl ethanesulfonate + 0.25% ampicillin. The frequency of chlorophyll mutation after combined treatments in general was higher than after differential treatments. Methyl methanesulfonate among alkanesulfonates and neomycin among antibiotics induced higher frequencies of chlorophyll mutations. No chlorophyll mutant was produced by ampicillin.Although antibiotics induced a lower frequency of chlorophyll mutation than alkylating agents, the frequency and pattern of spectra of chlorophyll mutants showed an action of antibiotics in inducing mutation similar to that of alkylating agents. Therefore, it is considered that antibiotics are potential mutagens.