局部用头孢他啶和氨基糖苷类药物联合治疗难治性铜绿假单胞菌角膜炎。
The combination of topical ceftazidime and aminoglycosides in the treatment of refractory pseudomonal keratitis.
作者信息
Robinson A, Kremer I, Avisar R, Gaton D, Savir H, Yassur Y
机构信息
Department of Ophthalmology, Rabin Medical Center, Petach-Tikva, Israel.
出版信息
Graefes Arch Clin Exp Ophthalmol. 1999 Mar;237(3):177-80. doi: 10.1007/s004170050215.
BACKGROUND
Pseudomonal keratitis is a serious and potentially blinding infection.
METHODS
We treated 12 patients with culture-positive fulminant pseudomonal keratitis with a topical combination of ceftazidime ophthalmic solution (50 mg/ml) and aminoglycosides (14 mg/ml). None of these patients had responded to the standard initial therapy with topical fortified gentamicin or tobramycin (14 mg/ml) combined with cefazolin (50 mg/ml).
RESULTS
Substitution of cefazolin by ceftazidime achieved a remarkable clinical improvement during the first 24-48 h of administration in all cases. The average time of healing after initiation of the combination of ceftazidime and fortified aminoglycosides was 21+/-15 days. No serious side effects accompanied ceftazidime administration. In vitro susceptibility testing showed resistance to gentamicin or tobramycin in 33% of cases (4/12) and sensitivity to ceftazidime in all cases.
CONCLUSIONS
The combination of ceftazidime, in a 5% solution, and fortified aminoglycosides (1.4%) may be a useful, safe and effective topical therapy for the treatment of pseudomonal keratitis resistant to aminoglycosides.
背景
铜绿假单胞菌角膜炎是一种严重且可能致盲的感染。
方法
我们使用头孢他啶眼药水（50毫克/毫升）和氨基糖苷类药物（14毫克/毫升）局部联合治疗12例培养阳性的暴发性铜绿假单胞菌角膜炎患者。这些患者均对局部强化使用庆大霉素或妥布霉素（14毫克/毫升）联合头孢唑林（50毫克/毫升）的标准初始治疗无反应。
结果
在所有病例中，用头孢他啶替代头孢唑林后，在给药后的最初24至48小时内临床症状有显著改善。开始联合使用头孢他啶和强化氨基糖苷类药物后的平均愈合时间为21±15天。使用头孢他啶未出现严重副作用。体外药敏试验显示，33%的病例（4/12）对庆大霉素或妥布霉素耐药，所有病例对头孢他啶敏感。
结论
5%溶液的头孢他啶与强化氨基糖苷类药物（1.4%）联合使用可能是治疗对氨基糖苷类耐药的铜绿假单胞菌角膜炎的一种有用、安全且有效的局部治疗方法。
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