Hoepelman I M, Rozenberg-Arska M, Verhoef J
Department of Internal Medicine, University Hospital, Utrecht, The Netherlands.
Chemotherapy. 1988;34 Suppl 1:21-9. doi: 10.1159/000238643.
To assess the efficacy of once daily monotherapy relative to standard combination antibiotic therapy for the initial management of patients suspected of serious bacterial infections, we conducted a randomized trial comparing ceftriaxone (Rocephin) with a combination of cefuroxime plus gentamicin. Of 105 patients, 53 were treated with ceftriaxone alone and 52 with the combination; 13 patients were considered not evaluable. 42 of 53 patients given ceftriaxone and 33 of 52 given cefuroxime plus gentamicin responded to treatment (p = 0.07). Three patients given ceftriaxone and 6 who received gentamicin plus cefuroxime died (p = 0.28). Definite bacterial infections were identified in 67 patients; of the evaluable patients with a definite infection 27 of 29 who received ceftriaxone and 21 of 31 who were treated with the combination were cured (p = 0.01). No difference was found in the number of side effects. However, therapy had to be discontinued due to treatment failure, an adverse effect or death in 1 of 33 patients given ceftriaxone and in 11 of 34 given the combination (p = 0.002). Ceftriaxone was found to have an impact on the count of E. coli in intestinal microflora. Changes in normal bacterial composition did not lead to the overgrowth with resistant Enterobacteriaceae or Pseudomonas, however, colonization by yeast was observed. Using ceftriaxone reduced the cost of antimicrobial therapy per patient by 107 pounds (US$ 183). Moreover, the total time save per patient due to decreased nursing and drug administration time per day was 40 min.(ABSTRACT TRUNCATED AT 250 WORDS)
为评估每日一次单药治疗与标准联合抗生素治疗对疑似严重细菌感染患者初始治疗的疗效，我们进行了一项随机试验，比较头孢曲松（罗氏芬）与头孢呋辛加庆大霉素联合用药。105例患者中，53例单独接受头孢曲松治疗，52例接受联合用药治疗；13例患者被认为不可评估。接受头孢曲松治疗的53例患者中有42例、接受头孢呋辛加庆大霉素治疗的52例患者中有33例对治疗有反应（p = 0.07）。接受头孢曲松治疗的3例患者和接受庆大霉素加头孢呋辛治疗的6例患者死亡（p = 0.28）。67例患者确诊为细菌感染；在确诊感染的可评估患者中，接受头孢曲松治疗的29例中有27例治愈，接受联合用药治疗的31例中有21例治愈（p = 0.01）。副作用数量无差异。然而，由于治疗失败、不良反应或死亡，接受头孢曲松治疗的33例患者中有1例、接受联合用药治疗的34例患者中有11例不得不停止治疗（p = 0.002）。发现头孢曲松对肠道微生物群中的大肠杆菌数量有影响。正常细菌组成的变化未导致耐药肠杆菌科或假单胞菌过度生长，然而，观察到有酵母菌定植。使用头孢曲松使每位患者的抗菌治疗费用降低了107英镑（183美元）。此外，由于每天护理和给药时间减少，每位患者节省的总时间为40分钟。（摘要截短至250字）
