Shimizu K, Orizu M, Kanno H, Kitamura S, Konishi T, Soma K, Nishitani H, Noguchi Y, Hasegawa S, Hasegawa H, Wada K
Institute of Medical Science, St. Marianna University School of Medicine.
Jpn J Antibiot. 1996 Aug;49(8):782-99.
We evaluated the effectiveness and safety of vancomycin (VCM) alone and in combination with beta-lactam antibiotics in the treatment of MRSA infections, and obtained the following results: 1. Effectiveness. (1) In cases of MRSA infections alone, the improvement rate was 71.4% (5/7 patients) with VCM alone and 77.8% (35/45) with VCM in combination with beta-lactam antibiotics. (2) In cases of polymicrobial infections, few cases were treated with VCM alone, but the improvement rate in combination use with beta-lactam antibiotics was 71.8% (28/39). 2. Bacteriological effect. (1) In cases of single infection with MRSA, the rate of bacterial eradication was 71.4% (5/7) with VCM alone and 68.2% (30/44) with VCM in combination with beta-lactam antibiotics. (2) In cases of polymicrobial infections, few cases were treated with VCM alone, but the rate of bacterial eradication in combination use with be ta-lactam antibiotics was 63.2% (24/38) against MRSA and 31.6% (12/38) against polymicrobial agents including MRSA. 3. Safety. Occurrences of adverse reactions and abnormal laboratory test values when VCM was used alone or when it is used in combination with another drug were about the same in these uses. As a whole, advance reactions were observed in 16 patients (9.5%). Main adverse reactions were whole body redness, drug eruption, and rash etc. Abnormal laboratory test values were observed mainly in hepatic functions, and renal functions. 4. VCM concentrations in blood was determined in 38 patients. Doses of 0.5 g and 1.0 g of VCM was administered by intravenous drip infusion over a period of 1 to 2 hours, and mean blood concentrations 1 to 2 hours after the completion of drip infusion were 25.4 micrograms/ml and 14.4 micrograms/ml, respectively. 5. Synergic effects between VCM and other antibiotics tested were observed in FIC index against all of the six MRSA strains isolated from six patients, and the clinical effects of improvement or better were obtained against five of them.
我们评估了单独使用万古霉素（VCM）以及联合β-内酰胺类抗生素治疗耐甲氧西林金黄色葡萄球菌（MRSA）感染的有效性和安全性，结果如下：1. 有效性。（1）仅针对MRSA感染病例，单独使用VCM的改善率为71.4%（5/7例患者），联合β-内酰胺类抗生素使用VCM的改善率为77.8%（35/45）。（2）针对混合感染病例，单独使用VCM治疗的病例较少，但联合β-内酰胺类抗生素使用的改善率为71.8%（28/39）。2. 细菌学效果。（1）在单纯MRSA感染病例中，单独使用VCM的细菌清除率为71.4%（5/7），联合β-内酰胺类抗生素使用VCM的细菌清除率为68.2%（30/44）。（2）在混合感染病例中，单独使用VCM治疗的病例较少，但联合β-内酰胺类抗生素使用时，针对MRSA的细菌清除率为63.2%（24/38），针对包括MRSA在内的混合病原体的细菌清除率为31.6%（12/38）。3. 安全性。单独使用VCM或与其他药物联合使用时，不良反应和实验室检查值异常的发生率在这些使用情况中大致相同。总体而言，16例患者（9.5%）出现了不良反应。主要不良反应为全身发红、药疹和皮疹等。实验室检查值异常主要出现在肝功能和肾功能方面。4. 对38例患者测定了血中VCM浓度。分别以0.5g和1.0g的剂量通过静脉滴注在1至2小时内给药，滴注结束后1至2小时的平均血药浓度分别为25.4微克/毫升和14.4微克/毫升。5. 针对从6例患者中分离出的所有6株MRSA菌株，在FIC指数中观察到VCM与其他测试抗生素之间的协同作用，其中5株获得了改善或更好的临床效果。
