氨溴索对肺耐甲氧西林金黄色葡萄球菌感染患者肺部万古霉素浓度的影响

Effects of ambroxol on lung concentrations of vancomycin in patients with lung MRSA infection

目的:研究氨溴索对肺部耐甲氧西林金黄色葡萄球菌(MRSA)感染患者血液与肺部万古霉素浓度的影响,评价两药联用的合理性。方法:44例肺部MRSA感染患者经纳入后随机分为2组:A组患者入组后即给万古霉素1.0g,ivd,q12h。B组患者入组后即给药万古霉素1.0g,ivd,q12h,联合使用氨溴索60 mg,iv,q12h。于第4个万古霉素给药剂量之前以咳痰或负压吸痰采集痰液样本,同时收集患者血清。采用荧光偏振免疫法(FPIA法)测定万古霉素浓度。结果:A组、B组患者痰液中万古霉素质量浓度分别为(1.8±2.1)μg.mL-1,(3.6±3.1)μg.mL-1,2组差异有显著性(P<0.05);A组、B组患者万古霉素血药质量浓度分为(15.7±2.5)μg.mL-1,(14.7±2.8)μg.mL-1,2组差异无显著性(P>0.05)。结论:万古霉素与氨溴索联合使用可增加肺部MRSA感染患者痰液中万古霉素浓度,不影响血液中万古霉素的浓度。

To study the impact of ambroxol on the concentration of vancomycin of sputum in patients with pul-monary MRSA infection and evaluate the rationality of the combined administration of the two drugs. METHODS 44 cases of MRSA infection in the lung were randomly divided into two groups of A and B. Group A were treated with vaneomycin of 1.0 g ivgtt q12h, and Group B were treated with vancomycin of 1.0g ivgtt q12h and ambroxol of 60mg ivgtt q12h. Sputum sam- ples were collected by cough or the negative pressure suction, meanwhile serum samples were collected before the fourth dose of vancomycin. Vancomycin concentration was determined by fluorescence polarization immunoassay （FPIA）. RESULTS The vancomycin sputum concentration of Group A and B were 1.80±2. 09μg.mL-1 ,3.57 ±3.13μg.mL-1 （P〈0. 05）, respective- ly. The vancomycin plasma concentration of Group A and B were 15.67±2. 51μg. mL- 1,14. 68 ＋ 2. 79μg. mL- 1, （P〉0. 05）, respectively. CONCLUSION The combined use with ambroxol may remarkably increase the concentration of vancomycin in sputum in patients with pulmonary MRSA infection, but there were no significant difference for concentration of vancomycin in plasma between the two groups.