摘要
目的探讨部分喹诺酮及硝基咪唑衍生物类抗生素在急性重症胆管炎患者(acute cholangitis of severetype,ACST)胆汁中的代谢特点,为临床抗胆道感染合理用药提供实验依据。方法通过临床行逆行胰胆管造影+鼻胆管外引流,直接获取胆汁,分别给予环丙沙星、洛美沙星、甲硝唑、替硝唑,利用高效液相色谱法动态监测胆汁中各种抗生素的浓度变化和代谢特点。结果喹诺酮类抗生素以环丙沙星达峰时间短、达峰浓度高、半衰期长;硝基咪唑衍生物类抗生素给药0.25 h后两种抗生素在胆汁内即可达到有效杀菌浓度,替硝唑在胆汁内药物浓度较平稳,但峰浓度不如甲硝唑高,在16 h内两种抗生素胆汁内浓度高于有效杀菌浓度,16 h后药物浓度有回升现象。结论环丙沙星、甲硝唑、替硝唑均具有在ACST患者胆汁内达峰时间短、达峰浓度高、半衰期长的特点,药物代谢动力学特点利于抗胆道感染,可结合临床细菌培养及药敏试验结果选择作为胆道感染的最佳抗生素,对重症患者可增加给药次数,提高疗效。
Objective To investigate the metabolism characteristic of some antibiotics in acute cholangitis of severe type （ACST） in human bile, and to provide the laboratory reference for selecting antibiotic rationally in clinic. Methods Bile samples of ACST patients were obtained by unified endoscopic retrograde cholangiopancreatography （ERCP） and endoscopic naso-biliary drainage-（ENBD） methods. Ciproftoxacin, lomefloxacin, metronidazole and tinidazole were applied and measured by high performance liquid chromatography （HPLC） method in the human bile. Results 0. 25 - 1.5 hours after taking antibiotics, the contents of all antibiotics increased in bile. Changes of ciprofloxacin, metronidazole and tinidazole were significant （P〈0. 01）, and had higher peak concentration than other antibiotics. Conclusion Ciprofloxacin, metronidazole and tinidazole have less peak time, higher peak concentration and longer half life in the bile of ASCT patients. Their pharmacokinetics characteristics are helpful for anti-biliary-infection. They can be options for anti-biliary-infection based on the clinical results of bacterium culture and drug sensitivity test. Treatment effects can be improved for patients with serious disease by increasing the times of adminstration.
出处
《华南国防医学杂志》
CAS
2009年第3期54-56,共3页
Military Medical Journal of South China
关键词
胆管炎
喹诺酮
硝基咪唑衍生物
胆汁
鼻胆管引流
Cholangitis
Quinolone
Nitroimidazol derivatives
Bile
Endoscopic naso-biliary drainage
