Levine M M, Hornick R B
Antimicrob Agents Chemother. 1975 Nov;8(5):581-4. doi: 10.1128/AAC.8.5.581.
Antibiotic-resistant shigella are increasingly prevalent. Lactulose, a non-absorbable disaccharide, was investigated as an alternative therapy for shigella infection on the hypothesis that the short-chain fatty acids (inhibitory to shigella) resulting from metabolism of lactulose by normal colonic flora would diminish shigella excretion. A long-term antibiotic-refractory carrier (large bowel) excreting 10(4) to 10(7)Shigella sonnei/g of feces was given two courses of lactulose (of 24 and 16 days duration). During lactulose therapy, excretion of shigella was greatly diminished (24-day course) or suppressed below detectable levels (16-day course), but returned to pretreatment levels upon discontinuation of lactulose. The volunteers who developed induced shigellosis during an efficacy test of oral Shigella flexneri 2a vaccine were randomly given oral ampicillin, lactulose, or placebo in double-blind fashion. Daily rectal cultures were taken. After 4 days of therapy, cultures were still positive in four out of four men on lactulose, three of three on placebo and none of three on ampicillin. Mean stool pH of men receiving lactulose (6.1) was significantly lower than those getting ampicillin (7.4), P < 0.01, or placebo (7.0), P < 0.05. Only in the lactulose group was mean stool pH during therapy significantly decreased compared with the level off therapy (6.1 versus 7.1), P < 0.02. Lactulose shows promise for the treatment of shigella carriers but appears ineffective in treatment of acute shigellosis.
耐抗生素的志贺氏菌越来越普遍。乳果糖是一种不可吸收的二糖，被作为志贺氏菌感染的替代疗法进行研究，其假设是正常结肠菌群对乳果糖的代谢产生的短链脂肪酸（对志贺氏菌有抑制作用）会减少志贺氏菌的排泄。一名长期对抗生素难治的携带者（大肠），每克粪便排泄10⁴至10⁷宋内志贺氏菌，接受了两个疗程的乳果糖治疗（疗程分别为24天和16天）。在乳果糖治疗期间，志贺氏菌的排泄大幅减少（24天疗程）或被抑制到检测水平以下（16天疗程），但在停止使用乳果糖后又恢复到治疗前水平。在口服弗氏志贺氏菌2a疫苗疗效试验期间发生人工感染志贺氏菌病的志愿者被随机双盲给予口服氨苄青霉素、乳果糖或安慰剂。每天进行直肠培养。治疗4天后，接受乳果糖治疗的4名男性中有4人的培养物仍为阳性，接受安慰剂治疗的3人中有3人阳性，接受氨苄青霉素治疗的3人无一阳性。接受乳果糖治疗的男性的平均粪便pH值（6.1）显著低于接受氨苄青霉素治疗的男性（7.4），P<0.01，也低于接受安慰剂治疗的男性（7.0），P<0.05。只有在乳果糖组中，治疗期间的平均粪便pH值与治疗前相比显著降低（6.1对7.1），P<0.02。乳果糖对志贺氏菌携带者的治疗显示出前景，但对急性志贺氏菌病的治疗似乎无效。
