Kaminski N, Bogomolski V, Stalnikowicz R
Department of Internal Medicine, Hadassah University Hospital, Mount-Scopus, Jerusalem, Israel.
J Accid Emerg Med. 1994 Sep;11(3):168-71. doi: 10.1136/emj.11.3.168.
Empiric treatment with ciprofloxacin and norfloxacin has been recommended recently for patients with acute diarrhoeal disease. In a retrospective 6-month study period the results of stool cultures from 209 patients with acute diarrhoea admitted to the emergency room were analysed. Seventy-eight cultures (37%) were positive for one or more bacteria. Shigella was the most commonly isolated pathogen (68%). Shigella sonnei comprised 72% and Shigella flexneri 19% of all the bacterial isolates. While no antimicrobial resistance to ciprofloxacin was found for both Shigella species, only 36 and 26% of the Shigella isolates were sensitive to ampicillin and trimethoprim-sulfamethoxazole (TMP-SMZ), respectively. These findings point out to the emergence of drug resistance to commonly used antimicrobial drugs. Shigella's high sensitivity to the newer quinolones should make this the treatment of choice for the very sick patient, although physicians should be cautioned to the fact that indiscriminate use of this drug could result in the emergence of resistance similar to that noted with ampicillin and TMP-SMZ.
最近有人建议对急性腹泻病患者采用环丙沙星和诺氟沙星进行经验性治疗。在一项为期6个月的回顾性研究中，分析了209名因急性腹泻入住急诊室患者的粪便培养结果。78份培养物（37%）有1种或多种细菌呈阳性。志贺菌是最常分离出的病原体（68%）。所有分离出的细菌中，宋内志贺菌占72%，福氏志贺菌占19%。虽然两种志贺菌对环丙沙星均未发现耐药性，但志贺菌分离株中分别只有36%和26%对氨苄西林和甲氧苄啶-磺胺甲恶唑（TMP-SMZ）敏感。这些发现指出了对常用抗菌药物耐药性的出现。志贺菌对新型喹诺酮类药物的高敏感性应使其成为重病患者的首选治疗药物，不过应提醒医生，不加区分地使用这种药物可能会导致出现与氨苄西林和TMP-SMZ类似的耐药性。
