Ceftazidime in Overwhelming Pediatric Infections

Ceftazidime應用於小兒重症感染之臨床評估

劉清泉(Ching-Chuan Liu) ； 洪俊源(Jin-Yang Hong) ； 李慶雲(Chin-Yun Lee) ； 林凱信(Kai-Hsin Lin) ； 李明鎮(Ming-Jenn Lee) ； 許靜瑛(Ching-Ying Hsu) ； 林奏延(Tzou-Yien Lin) ； 黃立民(Li-Min Huang) ； 林國信(Kuo-Sin Lin)

《Acta Paediatrica Sinica》 28卷6期 (1987/12) Pp. 420-429

摘要

從民國74年7月至民國76年6月期間，作者於北部地區四家大醫院，以ceftazidime使用於小兒重症感染，包括敗血症，蜂窩組織炎，肺炎，腹膜炎及腦膜炎等，在24例新生兒，幼兒或免疫功能不全兒童的感染，以ceftazidime靜脈注射做為單一藥物治療，或在使用其他Beta-lactam抗生素和aminoglycoside治療失敗之後使用ceftazidime。
臨床試驗對象分為三組：第一組為免疫功能正常之幼兒9例，其中新生兒4例，1~6個月嬰兒4例，及1例22個月幼兒；第二組為免疫功能不全併有嗜中性白血球過低症之兒童共10例，其中7例為急性白血病，1例為惡性畸胎瘤，1例為Leiner’s disease，另1例為腎病症候羣，都接受過免疫抑制治療；第三組為骨髓移植之兒童，共5例。
分離出來之病原菌包括膿桿菌12例，1例為綠膿桿菌併有金黃色葡萄球菌，大腸桿菌2例，Klebsiella pneumoniae2例，Enterobacter aerogenes l例，另1例為由綠膿桿菌、大腸桿菌和Bacteroides fragilis引起的多菌性混合感染。
試驗結果，對免疫功能正常之幼兒，ceftazidime單一藥物之治癒率達89%；在15例免疫功能不全及嗜中性白血球過低症的病人中，有10例治癒，4例在臨床上有改善，但其中2例死於繼發性感染，1例失敗。對全部病患之治癒率或改善率達91.7%，在治療過程中，並無嚴重副作用產生，且耐受性極佳。
臨床試驗結果和國外文獻顯示，新生兒、幼兒及免疫功能不全併有嗜中性白血球過低症之兒童所引起之重症感染，以革蘭氏陰性桿菌感染最多，尤其在懷疑或證賓遭受綠膿桿菌感染時，ceftazidime為一安全有效之抗生素。

並列摘要

An experience with ceftazidime in the treatment of newborns, young infants, and immunocompromised or neutropenic children is presented. A total of 24 seriously ill pediatric Patients with septicemia, cellulitis, pneumonia, peritonitis or meningitis were selected for the study. Patients were treated with dosages ranging between 90 and 150mg/kg per day for 7 to 50 days.
The patients were divided into three groups: Group 1 comprised nine normal hosts, including four newborns and five infants; Group 2 included ten compromised or neutropenic hosts after immunosuppressive treatments; seven of them were acute leukemia, one malignant teratoma, one Leiner's disease, and one nephrotic syndrome; Group 3 were five febrile neutropenic bone marrow transplant patients.
Bacteriologic etiologies were Pseudomonas aeruginosa in 12 episodes, P. aeruginosa plus Staphylococcus aureus in 1, E. coli in 2, Klebsiella pneumoniae in 2, Enterobacter aerogenes in 1, and one episode of polymicrobial infection with P. aeruginosa plus E. coli and Bacteroides fragilis. No microorganism isolation was found in five of the patients. The clinical efficacy in normal hosts with ceftazidime monotherapy was 89 percent, with only one failure due to polymicrobial infection. Among the 15 compromised or neutropenic hosts, 12 (80 percent) were cured or improved with bacterial eradication, 2 improved initially but died of superinfection subsequently and 1 died of pneumonia with empyema due to a resistant strain of P. aeruginosa.
The overall cure or improvement rate was 83.4 percent (two superinfections ercluded). It is important to emphasize that 11 (91.7%) of 12 cases with P. aeruginosa infection were cured (9 cases) or improved (2 cases) after ceftazidime treatment. No significant toxicities were noted.
These data suggest that ceftazidime is safe and effective in the treatment of aerobic gram-negative, especially P. aeruginosa, infections in newborns, young infants and immunocompromised or neutropenic children.

並列關鍵字

Ceftazidime ； neonatal infections ； immunocompromised host ； febrile neutropenic patient ； Pseudomonas aeruginosa