布鲁菌病抗菌药物不同联合治疗方案的效果观察

Comparison of curative effects of different combination treatment regimens of antibacterial drugs in treatment of Brucellosis

目的探究布鲁菌病患儿在使用抗菌药物不同联合治疗后的治疗效果。方法选取2014年10月~2015年5月布鲁菌病患儿45例研究对象,根据2012年10月8日卫生部办公厅通知印发《布鲁氏菌病诊疗指南(试行)》卫办医政发(2012)11号文件,并结合儿童肝肾代谢的特点及药物禁忌症,按年龄及有否合并G6PD缺乏划分为,治疗1组(>8岁)、治疗2组(>2月龄,<8岁,且无合并G6PD缺陷病)及治疗3组(<8岁且合并G6PD或2月龄以下)。14例治疗1组采用利福平+多西环素治疗,有合并症时联合静滴头孢三代;27例治疗2组采用利福平+复方磺胺甲唑,有合并症联合静滴头孢三代治疗;4例治疗3组使用利福平+头孢克肟治疗,有合并症时则先给予静脉使用头孢哌三代再予口服头孢克肟序贯治疗。探讨实施不同治疗对治疗效果、不良反应及出院阳性率的影响。结果治疗1组在治疗总有效率上(100.00%)与治疗2组(100.00%)、治疗3组(100.00%)比较差异无统计学意义(P>0.05),而在不良反应发生率上,治疗1组(28.57%)与治疗2组(62.96%)、治疗3组(50.00%)比较差异无统计学意义(χ^2=0.113,P>0.05),而在出院后3月随访,治疗3组复发率(25.00%)显著比治疗1组(0)、治疗2组(0)高(χ^2=10.483,P<0.05),且经过后调整治疗未复发。结论布鲁菌病患儿采用不同模式治疗后,均能达到较好的治疗效果,不良反应发生率随着患儿年龄的增大而相对降低,在利福平+复方磺胺甲噁唑组要注意监测血色素。在利福平+头孢治疗时会有复发的发生,需更多临床数据验证,使用该组治疗时需适当延长疗程及做好随访指导,防止复发。

Objective To explore curative effects of different combination treatment regimens of antibacterial drugs in treatment of children with brucellosis. Methods Forty-five children with brucellosiswho were admitted to our hospital from October 2014 to May 2015 were selected as research objects. According to the notice“ Guidelines for the Diagnosis and Treatment of Brucellosis (try out)”(2012) No. 11 documentissued by General Office of the Ministry of Healthon October 8, 2012 combined with the characteristics of children’s liver and kidney metabolism and drug contraindications, they were divided into treatment group 1 (> 8 years old), treatment group 2 (> 2 months old,< 8 years old, and no G6PD deficiency disease) and treatment group 3 (< 8 years old and combined G6PD or below 2 months old) according to age and whether there was a combined G6PD deficiency. Fourteen patients in the treatment group 1 were treated with rifampicin and doxycycline. They were also given 3rd generation of cephalosporinby intravenous drip when there were complications. Twenty-seven patients in the treatment group 2 were treated with rifampicin and compound sulfamethoxazole. They were also given 3rd generation of cephalosporin by intravenous drip when there were complications. Four patients in the treatment group 3 were treated with rifampicin and cefixime.They were also given sequential treatment by oral cefixime after 3rd generation of cephalosporin by intravenous drip. Effects of different treatments on curative effects, adverse reactions and positive discharge rateswere explored. Results There was no significant difference in the total effective rate (100.00%) between the treatment group 1 and the treatment group 2 (100.00%) and the treatment group 3 (100.00%)( P > 0.05). In the incidence of adverse reactions, there was no significant difference between treatment group 1 (28.57%) and treatment group 2 (62.96%) and treatment group 3 (50.00%)(χ^2=0.113, P > 0.05). During follow-up at 3 months after discharge, the recurrence rate (25.00%) in the treatment group3 was significantly higher than that in the treatment group 1(0) and the treatment group 2(0)(χ^2=10.483, P < 0.05). There was no recurrence after adjustment. Conclusion Children with brucellosis can achieve better curative effects after treatment with different modes. The incidence of adverse reactions is relatively reduced as the age of the child increases. In the rifampicin and compound sulfamethoxazole group, attention should be paid to monitoring hemoglobin. There are recurrences during rifampicin and cephalosporin treatment, and more clinical data validation is needed. When using this treatment mode, it is necessary to extend the course of treatment and follow-up guidance to prevent recurrence.