Muth L, Edén T
Acta Chir Scand. 1981;147(5):339-46.
Tobramycin in combination with clindamycin or lincomycin were used as systemic antibiotics in the treatment of 20 consecutive patients with septic peritonitis or intraabdominal sepsis, 10 of which were in septic shock. Doses were: tobramycin 1.5 mg/kg body weight every 8 hours, with prolonged dosage interval in patients with reduced renal function, clindamycin 0.9 g every 8 hours and lincomycin 1.2 g every 8 hours. Therapy was monitored by means of tobramycin serum concentration determinations and renal function tests. Eventual cure of the infection was obtained in 19 patients. In 2 of these, the effects of the antibiotics were doubtful. Side effects were observed on 8 occasions: One patient had a slight and temporary subjective hearing loss, coinciding with raised trough levels of tobramycin. Diarrhoea occurred in 3 cases and skin reactions in 3 cases. Superinfection with Candida albicans fungemia occurred in one patient. From the overall results it is concluded that the antibiotic regimen is of value in serious life-threatening infections. Although the tobramycin dose was higher than customarily used in Scandinavia at the time, 0 hour and 1 hour serum concentrations remained stable during therapy in patients whose renal function was normal at onset of therapy. Serum creatinine (S-Cr) levels in these patients were also essentially unchanged. Temporary reductions in osmolality (Osm) ratio Osm-urine/Osm-serum occurred in 11 patients despite normal S-Cr, but it was hard to attribute these impairments of renal function to tobramycin specifically. It was also doubtful whether tobramycin further aggravated renal function in those patients where it was impaired at onset of therapy. Thus, no conclusive evidence of clinically important tobramycin-induced nephrotoxicity were found. We suggest that the dosage schedule of tobramycin used in this study is applied when treating serious intraabdominal infections.
妥布霉素联合克林霉素或林可霉素被用作全身抗生素，用于连续治疗20例患有化脓性腹膜炎或腹腔内脓毒症的患者，其中10例处于感染性休克状态。剂量为：妥布霉素每8小时1.5mg/kg体重，肾功能减退患者剂量间隔延长；克林霉素每8小时0.9g；林可霉素每8小时1.2g。通过测定妥布霉素血清浓度和进行肾功能测试来监测治疗情况。19例患者最终感染得到治愈。其中2例患者抗生素疗效存疑。共观察到8次副作用：1例患者出现轻微且短暂的主观听力丧失，同时妥布霉素谷浓度升高。腹泻发生3例，皮肤反应3例。1例患者发生白色念珠菌血症二重感染。从总体结果得出结论，该抗生素方案对严重危及生命的感染有价值。尽管当时妥布霉素剂量高于斯堪的纳维亚地区的常规用量，但在治疗开始时肾功能正常的患者中，治疗期间0小时和1小时血清浓度保持稳定。这些患者的血清肌酐（S-Cr）水平也基本未变。11例患者尽管S-Cr正常，但尿渗透压（Osm）与血清渗透压比值（Osm-urine/Osm-serum）出现暂时降低，不过很难将这些肾功能损害具体归因于妥布霉素。对于治疗开始时肾功能已受损的患者，也难以确定妥布霉素是否会进一步加重肾功能损害。因此，未发现有确凿证据表明妥布霉素会引起具有临床重要意义的肾毒性。我们建议在治疗严重腹腔内感染时采用本研究中使用的妥布霉素给药方案。
