头孢三代菌素在肺部感染的应用

THIRD GENERATION CEPHALOSPORINS AND PULMONARY INFECTIONS

我院资料说明,社会获得性肺部感染一般对青霉素、庆大霉素(近三年为丁胺卡那霉素)是敏感的.原有肺部慢性疾患—慢性支气管炎、阻塞性肺气肿、肺心病、肺间质纤维化等患者在社会上或住院过程中发生继发肺部感染时,痰培养多为C^-杆菌,先锋霉素v、氧哌嗪青霉素、氨苄青霉素、羧苄青霉素等大都有效。对一些重症患者或应用其他抗生素无效患者,则给予头孢三代菌素治疗.使用最多者为头孢氧哌唑,一般应用总量为4g/d.极重患者为6g/d,总的来说,疗效较好,对G^-杆菌包括绿脓杆菌、部分球菌均为有效.头孢三嗪噻肟、头孢氨噻肟疗效较一般.对G^-杆菌特别是绿脓杆菌,最为有效的是头孢噻甲羧肟,总量为4g/d.该药从1985年我们开始应用,据不完全统计,已有20例肺部感染患者使用该药、有12例患者系绿脓杆菌感染,使用丁氨卡那霉素、氧哌嗪青霉素、羧苄青霉素个别患者甚至应用头孢氧哌唑后无效的情况下,使用头孢噻甲羧肟而有显著疗效,但头孢噻甲羧肟对球菌效果不大.应用头孢噻甲羧肟要有严格的适应症,特别是高龄、或伴有糖尿病、或使用肾上腺皮质激素患者,应注意付作用的产生。

The data of our hospital revealed that; community-acquiredpulmonary infections were usually sensitive to penicillin, gentamycin (in recent 3 yearswere amikacin).Secondary pulmonary infections usually developed in association with priorrespiratory diseases, such as chronic bronchitis, obstructive emphysema, corpulmonale. pulmonary interstitial fibrosis and so on. In hospital, the common organismsinvolved were gram-negative bacteria. The third generation cephalosporins have beenclaimed to be effective in serious pulminary infections and in patients unsuccessfully treatedwith other antibiotics. Among the cephalosporins, cefoperazone most has been used.Thedose used was 4g/day, sometimes 6g / day.It was proved effective in pulmonary infec- tions caused by gram-negative bacteria (including pseudomonas aeruginosa) and somespecies of cocci. The clinical effect of ceftriaxone and cefotaxime was up to theaverage. Ceftazidime was the best for the treatment or pulmonary infections caused bygram-negative bacteria especially Pseudomonas aeruginosa. The dose used was4g/day.Ceftazidime has been used since 1985 in 20 cases with pulmonary infections.Sever-al cascs. of pseudomonas aeruginosa infections treated with amikacin, piperacillin,carbenilcilin especially cefoperazone gave no favourable results, but the clinical effect ofceftazidime was exccllent, one has to be cautious for the side-effect in the use ofceftazidime in the aged. patients with diabetes mellitus and patients using corticosteroids.