头孢曲松联合阿奇霉素治疗小儿急性下呼吸道感染疗效观察

Clinical efficacy of ceftriaxone combined with azithromycin in treatment of acute lower respiratory tract infections in infants

目的观察头孢曲松联合阿奇霉素治疗小儿急性下呼吸道感染的临床效果。方法研究对象为2009年6月-2011年10月在儿科住院的96例患儿,随机分为治疗组与对照组,两组采用止咳、平喘、雾化吸入、支持等对症处理的基础上,治疗组48例以头孢曲松50～80㎎/㎏,加入0.9%氯化钠注射液或5%葡萄糖注射液50～100ml,静脉滴注,每日1次,疗程5～7d,1～2h后再用阿奇霉素10mg/kg,加入5%葡萄糖中,浓度为1mg/ml,静脉滴注,疗程5d;对照组48例以头孢曲松50～80mg/kg,加入0.9%氯化钠注射液或5%葡萄糖注射液50～100ml,静脉滴注,每日1次,疗程5～7d,分别观察、记录患儿症状(咳嗽、喘息)、肺部啰音消失时间、体温恢复时间、平均住院时间及不良反应。结果头孢曲松联合阿奇霉素治疗组患者咳嗽消失时间、喘息消失时间、体温恢复正常时间、平均住院时间与头孢曲松对照组比较差异有统计学意义(t值分别为1.786、2.107、2.080、1.812,P<0.05),肺部啰音消失时间比较差异有统计学意义(t=2.443,P<0.01);头孢曲松联合阿奇霉素治疗组总有效率为89.58%,头孢曲松对照组总有效率为72.92%,头孢曲松联合阿奇霉素治疗组总有效率高于头孢曲松对照组,两组差异有统计学意义(χ2=4.37,P<0.05);头孢曲松联合阿奇霉素治疗组与头孢曲松对照组不良反应比较差异无统计学意义。结论头孢曲松联合阿奇霉素治疗小儿急性下呼吸道感染,具有杀菌作用强、疗效好,临床症状、体征消失快、住院时间缩短、使用次数少,使用1次/d,维持时间长,不良反应不明显,使用安全、简便、易于小儿及家长接受,值得注意的是,抗菌药物应用前应做痰细菌培养,根据药敏试验选择抗菌药物,以免产生细菌耐药。

OBJECTIVE To observe the clinical efficacy of ceftriaxone combined with azithromycin in treatment of acute lower respiratory tract infections in infants. METHODS From Jun 2009 to Oct 2011, 96 cases of inpatients in the pediatrics department were randomly divided into the treatment group and the control group. On the basis of the symptomatic treatment including antitussive, antiasthmatie, aerosol inhalation and support, the treatment group （n=48） was given ceftriaxone 50-80 mg/kg, adding 0.9Gsodium chloride injection or 5% glucose injection 50-100 ml, static drop, once per day, 5-7days, 1-2 hours later, using azithromycin 10 mg/kg, adding into 5% glucose, concentration was 1 mg/ml, static drop, 5 days. The control group （n：48） was given eeftriaxone 50-80 mg/kg, adding 0.9% sodium chloride injection or 5% glucose injection 50-100 ml, static drop, once per day, 5-7 days. The symptoms （cough, wheeze）, time of disappearance of pulmonary tales, time of recovery of temperature, average hospitalization duration, and incidence of adverse reactions of the infants were observed and recorded. RESULTS Compared with the control group and the treatment group, the difference in the time of disappearance of cough or wheeze, the time of recovery of temperature, or average hospitalization duration was statistically significant （t values were 1. 786, 2. 107, 2. 080, and 1. 812, respectively, P〈0.05） , the difference in the time of disappearance of pulmonary rales was extremely significant （t=2. 443, P〈0.01） ; the total effective rate of the treatment group was 89.58%, significantly higher than 72.92% of the control group, the difference was statistically significant （X^2 = 4.37, P〈0.05） ; the difference in the incidence of adverse reactions between the treatment group and the control group was not statistically significant. CONCLUSION Ceftriaxone combined with azithromycin can be used in the treatment of acute lower respiratory tract infections in the infants, with bactericid-al effect strong, curative effect good, clinical symptoms and signs disappearing quickly, hospitalization duration being shortened, use less frequent, frequency once per day, maintenance time long, and adverse reactions untypi-cal. It is safe, simple, and easily acceptable. It is worth paying attention to the bacterialculture of sputum before the use of antibiotics and to the use of antibiotics on basis of drug susceptibility testing so ＇as to prevent the bacteri-al resistance.