北京地区中耳炎有效抗生素的筛选

Screening for effective antibiotics in chronic suppurative otitis media

目的:探讨中耳炎预防和控制感染的有效抗生素的筛选,为临床合理使用抗生素奠定理论基础。方法:取198例中耳炎患者的中耳脓性分泌物做细菌培养及药敏试验,根据临床是否常用、是否有耳毒性等因素筛选中耳炎抗感染的一线和二线药,并总结用药的疗效。结果:198例中21例无普通细菌生长;177株中最常见的致病菌是凝固酶阴性葡萄球菌36株(20.34%)(利奈唑胺、万古霉素、头孢呋辛、左氧氟沙星、复方新诺明、利福平等敏感),铜绿假单胞菌30株(16.95%)(美洛培南、亚胺培南、头孢他啶、阿米卡星、哌拉西林等敏感),金黄色葡萄球菌26株(14.69%)(利奈唑烷、万古霉素、苯唑西林、庆大霉素、左旋氧氟沙星、环丙沙星、莫西沙星等敏感)。经验性用药:局部用左氧氟沙星滴耳液,哌拉西林、莫西沙星(成人)作为一线药,二线头孢他定。术后有3例感染,经全身、局部敏感药物和换药痊愈。结论:根据细菌培养和药敏试验合理筛选有效抗生素有利于减少中耳炎术后感染并发症。

Objective：To explore the method of screening effective antibiotics in active stage of otitis media,in order to lay ground for rational clinical application of antibiotics in this scenario.Method：The clinical data of 198 patients diagnosed as otitis media were analyzed.Based on the results of bacterial culture and drug sensitivity test of middle ear secretion,the clinical availability and the ototoxicity of corresponding drugs,first-and second-line drugs were screened to control infection.The therapeutic effect of drugs was summarized.Result：In 21 out of 198 cases,there was no growth of common bacteria;while in the remaining 177 cases,there were 36cases（20.34%）of coagulase negative staphylococcus,which was sensitive to linezolid,vancomycin,cefuroxime,levofloxacin,SMZ-TMP,and rifampin;30cases（16.95%）of pseudomonas aeruginosa,which was sensitive to meropenem,imipenem,ceftazidime,amikacin,and piperacillin;and 26cases（14.69%）of staphylococcus aureus,which was sensitive to linezolid,vancomycin,oxacilin,gentamycin,levofloxacin,ciprofloxacin,moxifloxacin.Drugs that were administrated based on experience including：local use of levofloxacin eardrops,cefuroxime and moxifloxacin as first line oral antibiotics,and ceftazidime as second line oral antibiotics.There were 3cases of post-operational infection,which recovered after systemic and local use of sensitive drugs and dressing.Conclusion：In otitis media,sensitive antibiotics chosen from results of bacterial culture and drug sensitivity test,are useful in reducing the complication of infection after surgery.