目的评价应用Bristol大便分型量表(BSFS)指导不同肠道准备方案后对提升整体人群肠道准备质量的效果,及2 L+2 L聚乙二醇电解质溶液(PEG-ES)作为Bristol大便性状1型及2型患者个性化方案的效果及耐受性。方法采用前瞻性研究方法,将拟行结...目的评价应用Bristol大便分型量表(BSFS)指导不同肠道准备方案后对提升整体人群肠道准备质量的效果,及2 L+2 L聚乙二醇电解质溶液(PEG-ES)作为Bristol大便性状1型及2型患者个性化方案的效果及耐受性。方法采用前瞻性研究方法,将拟行结肠镜检查的患者随机分为A、B两组,使用BSFS分辨出两组中Bristol大便性状1型、2型患者及3~7型患者并记录,其中A组中Bristol大便性状1型、2型患者肠道准备方案为2 L+2 L PEG-ES,3~7型患者为2 L PEG-ES方案;B组全部患者肠道准备方案均为2 L PEG-ES。结果本研究共纳入310例门诊患者,A组中肠道准备成功率、Boston肠道准备评分量表(BBPS)评分、息肉发现率、盲肠插管率均高于B组(P<0.05);A组中Bristol大便分型1型及2型患者的排便次数多于B组(P<0.05),但两组中该类人群的不良反应发生率及重复准备意愿无明显差异(P>0.05)。结论应用BSFS分辨出具有肠道准备不足风险的患者,通过指导个性化肠道准备方案,可使整体人群的肠道准备质量得到有效提升;同时,2 L+2 L PEG-ES方案作为该类患者的个性化肠道准备方案具有良好的清肠效果及耐受性。展开更多
Background: Single- dose ciprofloxacin is effective for the treatment of severe cholera in adults. We assessed whether single- dose ciprofloxacin would be as effective as 3- day, 12- dose erythromycin in achieving cli...Background: Single- dose ciprofloxacin is effective for the treatment of severe cholera in adults. We assessed whether single- dose ciprofloxacin would be as effective as 3- day, 12- dose erythromycin in achieving clinical cure in children with severe cholera. Methods: We did a randomised, open label, controlled trial in children age 2- 15 years with V cholerae O1 or O139 present in stool on dark- field microscopy. Children received either a single 20 mg/kg dose of ciprofloxacin (n = 90) or 12.5 mg/kg of erythromycin (n = 90) every 6 h for 3 days, and remained in hospital for 5 days. The primary outcome was clinical success of treatment, defined as cessation of watery stools within 48 h of start of drug treatment. Analysis was per protocol. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN00142272. Findings: Of 10 children randomised 162 completed the study. Treatment was clinically successful in 60% (47/78) of children treated with ciprofloxacin and in 55% (46/84) of those treated with erythromycin (difference 5% 95% CI - 10 to 21). Children receiving ciprofloxacin vomited less often (58% vs 74% ; difference 16% 2 to 30), had fewer stools (15 vs 21; 6 0 to 9), and less stool volume (152 vs 196 mL/kg; 43 mL/kg 13 to 87) than those receiving erythromycin. Bacteriological failure was more common in ciprofloxacin- treated patients (58% vs 30% ; 28% 13 to 43) than erythromycin- treated patients. Interpretation: Single- dose ciprofloxacin achieves clinical outcomes similar to, or better than, those achieved with 12- dose erythromycin treatment in childhood cholera, but is less effective in eradicating V cholerae from stool.展开更多
BACKGROUND: Single-dose azithromycin is effective in the treatment of severe cholera in children, but its effectiveness in adults has not been evaluated. METHODS: We conducted a double-blind, randomized trial comparin...BACKGROUND: Single-dose azithromycin is effective in the treatment of severe cholera in children, but its effectiveness in adults has not been evaluated. METHODS: We conducted a double-blind, randomized trial comparing the equivalence of azithromycin and ciprof loxacin (each given in a single 1-g dose of two 500-mg tablets) among 195 men with severe cholera caused by Vibrio cholerae O1 or O139. Patients were hospitalized for five days. A stool culture was performed daily. Primary outcome measures were clinical success (the cessation of watery stools within 48 hours after drug administration) and bacteriologic success (the inability to isolate V. cholerae after 48 hours). RESULTS: Therapy was clinically successful in 71 of 97 patients receiving azithromycin (73 percent) and in 26 of 98 patients receiving ciprofloxacin (27 percent) (P < 0.001) and bacteriologically successful in 76 of 97 patients receiving azithromycin (78 percent) and in 10 of 98 patients receiving ciprofloxacin (10 percent) (P< 0.001). Patients who were treated with azithromycin had a shorter duration of diarrhea than did patients treated with ciprofloxacin (median, 30 vs. 78 hours); a lower frequency of vomiting (43 percent vs. 67 percent); fewer stools (median, 36 vs. 52); and a lower stool volume (median, 114 vs. 322 ml per kilogram of body weight). The median minimal inhibitory concentration of ciprofloxacin for the 177 isolates of V. cholerae O1 was 0.25 μg per milliliter, which was 11 to 83 times as high as that in previous studies at this site. CONCLUSIONS: Single-dose azithromycin was effective in the treatment of severe cholera in adults. The lack of efficacy of ciprofloxacin may result from its diminished activity against V. cholerae O1 strains currently circulating in Bangladesh.展开更多
文摘目的评价应用Bristol大便分型量表(BSFS)指导不同肠道准备方案后对提升整体人群肠道准备质量的效果,及2 L+2 L聚乙二醇电解质溶液(PEG-ES)作为Bristol大便性状1型及2型患者个性化方案的效果及耐受性。方法采用前瞻性研究方法,将拟行结肠镜检查的患者随机分为A、B两组,使用BSFS分辨出两组中Bristol大便性状1型、2型患者及3~7型患者并记录,其中A组中Bristol大便性状1型、2型患者肠道准备方案为2 L+2 L PEG-ES,3~7型患者为2 L PEG-ES方案;B组全部患者肠道准备方案均为2 L PEG-ES。结果本研究共纳入310例门诊患者,A组中肠道准备成功率、Boston肠道准备评分量表(BBPS)评分、息肉发现率、盲肠插管率均高于B组(P<0.05);A组中Bristol大便分型1型及2型患者的排便次数多于B组(P<0.05),但两组中该类人群的不良反应发生率及重复准备意愿无明显差异(P>0.05)。结论应用BSFS分辨出具有肠道准备不足风险的患者,通过指导个性化肠道准备方案,可使整体人群的肠道准备质量得到有效提升;同时,2 L+2 L PEG-ES方案作为该类患者的个性化肠道准备方案具有良好的清肠效果及耐受性。
文摘Background: Single- dose ciprofloxacin is effective for the treatment of severe cholera in adults. We assessed whether single- dose ciprofloxacin would be as effective as 3- day, 12- dose erythromycin in achieving clinical cure in children with severe cholera. Methods: We did a randomised, open label, controlled trial in children age 2- 15 years with V cholerae O1 or O139 present in stool on dark- field microscopy. Children received either a single 20 mg/kg dose of ciprofloxacin (n = 90) or 12.5 mg/kg of erythromycin (n = 90) every 6 h for 3 days, and remained in hospital for 5 days. The primary outcome was clinical success of treatment, defined as cessation of watery stools within 48 h of start of drug treatment. Analysis was per protocol. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN00142272. Findings: Of 10 children randomised 162 completed the study. Treatment was clinically successful in 60% (47/78) of children treated with ciprofloxacin and in 55% (46/84) of those treated with erythromycin (difference 5% 95% CI - 10 to 21). Children receiving ciprofloxacin vomited less often (58% vs 74% ; difference 16% 2 to 30), had fewer stools (15 vs 21; 6 0 to 9), and less stool volume (152 vs 196 mL/kg; 43 mL/kg 13 to 87) than those receiving erythromycin. Bacteriological failure was more common in ciprofloxacin- treated patients (58% vs 30% ; 28% 13 to 43) than erythromycin- treated patients. Interpretation: Single- dose ciprofloxacin achieves clinical outcomes similar to, or better than, those achieved with 12- dose erythromycin treatment in childhood cholera, but is less effective in eradicating V cholerae from stool.
文摘BACKGROUND: Single-dose azithromycin is effective in the treatment of severe cholera in children, but its effectiveness in adults has not been evaluated. METHODS: We conducted a double-blind, randomized trial comparing the equivalence of azithromycin and ciprof loxacin (each given in a single 1-g dose of two 500-mg tablets) among 195 men with severe cholera caused by Vibrio cholerae O1 or O139. Patients were hospitalized for five days. A stool culture was performed daily. Primary outcome measures were clinical success (the cessation of watery stools within 48 hours after drug administration) and bacteriologic success (the inability to isolate V. cholerae after 48 hours). RESULTS: Therapy was clinically successful in 71 of 97 patients receiving azithromycin (73 percent) and in 26 of 98 patients receiving ciprofloxacin (27 percent) (P < 0.001) and bacteriologically successful in 76 of 97 patients receiving azithromycin (78 percent) and in 10 of 98 patients receiving ciprofloxacin (10 percent) (P< 0.001). Patients who were treated with azithromycin had a shorter duration of diarrhea than did patients treated with ciprofloxacin (median, 30 vs. 78 hours); a lower frequency of vomiting (43 percent vs. 67 percent); fewer stools (median, 36 vs. 52); and a lower stool volume (median, 114 vs. 322 ml per kilogram of body weight). The median minimal inhibitory concentration of ciprofloxacin for the 177 isolates of V. cholerae O1 was 0.25 μg per milliliter, which was 11 to 83 times as high as that in previous studies at this site. CONCLUSIONS: Single-dose azithromycin was effective in the treatment of severe cholera in adults. The lack of efficacy of ciprofloxacin may result from its diminished activity against V. cholerae O1 strains currently circulating in Bangladesh.
