Mensa J, Moreno A, Segura F, Escofet C, Serrate G, Bagà R, Bedós R, Jiménez de Anta M T, Trilla A, García San Miguel J
Med Clin (Barc). 1989 Jul 1;93(5):161-8.
In a prospective randomized study we have evaluated the influence of co-trimoxazole and mecillinam on the clinical outcome and the fecal Salmonella sp carrier status in 134 adult patients with acute non-typhi Salmonella sp enteritis. The patients were distributed in three groups on the basis of predefined clinical and biological criteria, depending on their risk of bacteremia or severe complications of it, or on the enteroinvasive character of the causative organism. The inclusion in any group determined the treatment. Seventy-six patients received mecillinam (1.200 mg/day p.o.), 36 co-trimoxazole (1.600 mg/day p.o.), both during five days, and 22 only diet. The patients were investigated after 1, 3 and 6 weeks until stool culture was negative. The isolated Salmonella strains, either in stool or blood culture, had a sensitivity of 98.3% to mecillinam and 96.9% to cotrimoxazole. Resistance did not develop during therapy. All patients had a favorable outcome, including the six with bacteremia. No differences were found regarding clinical features (diarrhea, abdominal pain, fever) or the rate of positive stool cultures in the three therapeutic groups in any of the follow-up controls. It was concluded that the administration of mecillinam or co-trimoxazole to patients with Salmonella sp enteritis is not associated with a prolongation of the state of fecal carrier or with the development of resistant strains.
在一项前瞻性随机研究中，我们评估了复方新诺明和美西林对134例成年急性非伤寒沙门氏菌肠炎患者临床结局及粪便沙门氏菌携带状态的影响。根据预先确定的临床和生物学标准，依据患者发生菌血症或其严重并发症的风险，或致病生物体的肠侵袭特性，将患者分为三组。分到任何一组即决定了相应的治疗方案。76例患者接受美西林治疗（口服，每日1200mg），36例接受复方新诺明治疗（口服，每日1600mg），疗程均为5天，22例仅接受饮食治疗。在第1、3和6周进行检查，直至粪便培养呈阴性。从粪便或血培养中分离出的沙门氏菌菌株，对美西林的敏感性为98.3%，对复方新诺明的敏感性为96.9%。治疗期间未出现耐药情况。所有患者预后良好，包括6例菌血症患者。在任何一次随访对照中，三个治疗组在临床特征（腹泻、腹痛、发热）或粪便培养阳性率方面均未发现差异。得出的结论是，对沙门氏菌肠炎患者使用美西林或复方新诺明治疗，与粪便携带状态的延长或耐药菌株的产生无关。
