- 期刊
Sulfamethoxazole-Trimethoprim Versus Ampicillin in Treatment of Shigellosis
使用Sulfamethoxazole-Trimethoprim及Ampicillin治療赤痢症之比較
摘要
自民國68年9月起到69年8月止，因急性腹瀉來三軍總醫院求診，住院後，糞便細菌培養證實爲痢疾菌屬感染之病童共35例，以隨機取樣方式將病人分成兩級：一組給以Ampicillin，每天每公斤體重給100mg，每6小時肌肉或血管注射；另一組給以Sulfamethoxazole-Trimethoprim (SXT)，每天每公斤體重給10mg Trimethoprim與50mg Sulfamethoxazole，每12小時口服使用，各組連續治療5天，以比較兩種抗生素之效果。從臨床觀察得知，15名病童使用SXT治療，其體溫下降，症狀減輕，排便次數減少，糞便中細菌陽性變陰等，其治療結果均與用Ampicillin治療組中之14名病童其致病痢疾菌為對Ampicillin具感受性者，同具有卓越的治療效果。進一步分析，在SXT治療組中有5例是由帶Ampicillin抵抗菌引起的赤痢菌症，經SXT治療，效果良好。但相對而言，在Ampicillin治療組中。有6例是由帶Ampicillin抵抗所引起赤痢菌症，其中3例經3天Ampicillin治療後，臨床症狀與細菌培養均顯示無效，後再改用SXT治療才漸癒。從實驗中我們發現，在這35株痢疾菌屬中，31株屬於Shigella sonnei約佔88%，另外4株為Shigella flexneri。抗生素感受性方面，對於Ampicillin具抗藥性者有11株，佔31%，全部對於SXT均有感受性，另再以瓊脂平板稀釋方法來分別就Sulfamethoxazole與Trimethoprim單獨與20:1之混合比例時，對於這35株痢疾菌測定其最小抑制濃度，並計算其藥物混合效果，我們得知這兩種藥物混合時有很強的相乘作用，對於這35株細菌，其Fractional inhibitory concentration index均小於0.35，顯示有很高的相乘作用。由以上臨床及賓驗室結果，得知SXT對於赤痢菌症之治療有卓越的效果，尤其是在Ampicillin抵抗菌普遍的地區，SXT是治療此病最佳選擇。
關鍵字
無資料並列摘要
Thirty-five infants and children hospitalized for severe shigellosis were randomly treated either with ampicillin or with sulfamethoxazole-trimethoprim for five days. Among the 35 isolated Shigella strains, 31 were S. sonnei (88%) and 4 were S. flexneri (12%), and 31.4% of the total strains, were ampicillin resistant. Fifteen patients treated with sulfamethoxazole-trimethoprim and 14 patients with ampicillinsusceptible Shigella treated with ampicillin responded comparably well to the therapy. Five of the patients successfully treated with sulfamethoxazole-trimethoprim had ampicillin-resistant Shigella infection. Three of them failed to respond to ampicillin during the first 72 hours of therapy but subsequently responded to sulfamethoxazole-trimethoprim. In vitro susceptibility studies showed good synergistic effects of sulfamethoxazole and trimelhoprim against the Shigella isolated. Judged from the present in vitro susceptibility studies and clinical experiences sulfamethoxazole-trimethoprim appears to be a highly effective drug in treating patients with shigellosis and the drug of choice in areas where ampicillin-resistant Shigella infection is common.