Muller E L, Pitt H A, Thompson J E, Doty J E, Mann L L, Manchester B
Departments of Surgery, UCLA School of Medicine.
Surg Gynecol Obstet. 1987 Oct;165(4):285-92.
The combination of a penicillin and an aminoglycoside has been recommended as the initial treatment of choice for patients with infections of the biliary tract. However, elderly, septic, patients with jaundice have a high incidence of renal problems. For this reason, amingolycoside treatment of these patients must be reevaluated as newer less nephrotoxic agents become available. We, therefore, performed a prospective, randomized trial of ampicillin plus tobramycin, cefoperazone and piperacillin in patients with biliary tract infections. During a 20 month period, 106 patients with acute cholecystitis (53) or cholangitis (53), or both, received one of these antibiotic regimens for a minimum of five days. In patients with acute cholecystitis, ampicillin plus tobramycin, cefoperazone and piperacillin had clinical cure rates of 85, 95 and 95 per cent, respectively. In patients with cholangitis, however, cure rates for the three regimens were 85, 56 (p less than 0.05 versus ampicillin plus tobramycin) and 60 per cent (not significant versus ampicillin plus tobramycin), respectively. Moreover, 13 per cent of the patients receiving cefoperazone had an increased prothrombin time and three of 39 patients receiving this antibiotic had clinical problems with bleeding. Nephrotoxicity was greatest in patients with cholangitis receiving ampicillin plus tobramycin, 10 per cent, as compared with 3 per cent in those who did not receive an aminoglycoside. This difference, however, was not statistically significant. It was concluded that piperacillin should be considered for antibiotic management of patients with acute cholecystitis and that further studies are necessary in patients with cholangitis to determine whether or not newer agents should replace penicillin and aminoglycoside combinations.
青霉素与氨基糖苷类药物联合使用，已被推荐为胆道感染患者的初始治疗首选方案。然而，老年、败血症、黄疸患者出现肾脏问题的发生率较高。因此，随着更新的低肾毒性药物问世，必须重新评估对这些患者使用氨基糖苷类药物的治疗方案。为此，我们对氨苄西林加妥布霉素、头孢哌酮和哌拉西林治疗胆道感染患者进行了一项前瞻性随机试验。在20个月期间，106例急性胆囊炎（53例）或胆管炎（53例）或两者皆有的患者，接受了这些抗生素方案中的一种，疗程至少5天。在急性胆囊炎患者中，氨苄西林加妥布霉素、头孢哌酮和哌拉西林的临床治愈率分别为85%、95%和95%。然而，在胆管炎患者中，这三种方案的治愈率分别为85%、56%（与氨苄西林加妥布霉素相比，P<0.05）和60%（与氨苄西林加妥布霉素相比，无显著性差异）。此外，接受头孢哌酮治疗的患者中有13%凝血酶原时间延长，接受该抗生素治疗的39例患者中有3例出现临床出血问题。在接受氨苄西林加妥布霉素治疗的胆管炎患者中，肾毒性最大，为10%，而未接受氨基糖苷类药物治疗的患者为3%。然而，这种差异无统计学意义。得出的结论是，对于急性胆囊炎患者的抗生素治疗应考虑使用哌拉西林，对于胆管炎患者，有必要进一步研究以确定更新的药物是否应取代青霉素和氨基糖苷类药物的联合使用。
