JAPhA Pharmacotherapy最新文献

Safety of prolonged thrice-weekly high-dose daptomycin in a hemodialysis patient with prosthetic valve endocarditis 在一名患有人工瓣膜心内膜炎的血液透析患者中长期使用每周三次大剂量达托霉素的安全性

JAPhA Pharmacotherapy

Pub Date : 2024-06-06 DOI: 10.1016/j.japhar.2024.100008

Michael Bosco, Nadeem Baalbaki

Background

Daptomycin (DAP) is a cyclic lipopeptide antibiotic with in vitro, concentration-dependent bactericidal activity against many clinically relevant gram-positive organisms including Staphylococcus spp. and Enterococcus spp. High-dose DAP (i.e., > 9 mg/kg) has been associated with improved survival outcomes in patients with invasive enterococci infections. Although generally well tolerated, DAP is associated with myopathy and rhabdomyolysis. Limited data regarding the safety of high-dose DAP in hemodialysis (HD) patients, especially with doses ≥ 12 mg/kg, are available. Here, we describe the safety outcomes in a HD patient who received prolonged, thrice-weekly, high-dose DAP. To the best of our knowledge, this is the first case report looking at the safety of long-term DAP doses up to 18 mg/kg.

Case summary

A 65-year-old male with a medical history significant for end-stage renal disease on intermittent HD was diagnosed as having prosthetic valve endocarditis secondary to vancomycin-resistant Enterococcus faecium (VRE). He was deemed a poor surgical candidate and the decision was made for conservative management. DAP was continued for approximately 4 months at a dose of 12 mg/kg on 48-hour interdialytic days and 18 mg/kg on the 72-hour interdialytic day. Creatine phosphokinase (CPK) was monitored once or twice weekly. Average CPK during therapy was 92.3 U/L ± 38.9. Overall, DAP was well tolerated and the patient did not experience any signs or symptoms of myopathy or rhabdomyolysis based on daily review of systems.

Practice implications

Although more data are needed to assess the safety of this particular dosing strategy, our case findings suggest that prolonged DAP doses ≥ 12 mg/kg can be safely considered in those receiving intermittent HD, especially when aggressive treatment is needed for invasive VRE infection.

背景达托霉素（DAP）是一种环状脂肽类抗生素，对许多临床相关的革兰氏阳性菌（包括葡萄球菌属和肠球菌属）具有体外浓度依赖性杀菌活性。虽然一般耐受性良好，但 DAP 与肌病和横纹肌溶解症有关。目前有关血液透析（HD）患者使用大剂量 DAP（尤其是剂量≥ 12 mg/kg）安全性的数据有限。在此，我们描述了一名长期接受每周三次大剂量 DAP 的血液透析患者的安全性结果。据我们所知，这是第一份研究长期使用剂量高达 18 毫克/千克的 DAP 的安全性的病例报告。病例摘要一位 65 岁的男性患者因终末期肾病而接受间歇性 HD 治疗，被诊断为继发于耐万古霉素肠球菌（VRE）的人工瓣膜心内膜炎。他被认为不适合手术治疗，因此决定采取保守治疗。DAP 持续使用了约 4 个月，剂量为 48 小时间歇日 12 毫克/千克，72 小时间歇日 18 毫克/千克。每周监测一到两次肌酸磷酸激酶（CPK）。治疗期间的平均 CPK 为 92.3 U/L ± 38.9。虽然还需要更多数据来评估这种特殊给药策略的安全性，但我们的病例结果表明，对于接受间歇性 HD 的患者，尤其是需要积极治疗侵袭性 VRE 感染的患者，可以安全地考虑将 DAP 剂量延长至≥ 12 mg/kg。

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引用次数: 0

Proportion of intensive care unit patients receiving sedation after rapid sequence intubation with rocuronium 使用罗库溴铵快速插管后接受镇静治疗的重症监护病房患者比例

JAPhA Pharmacotherapy

Pub Date : 2024-04-08 DOI: 10.1016/j.japhar.2024.100007

Joanna Dukes, Preeyaporn Sarangarm, Nicole Murtagh, Kevin A. Kaucher

Background

Rocuronium has a longer duration of action than the sedative effects of induction agents used during rapid sequence intubation (RSI), introducing a potential window for inadequate sedation. When rocuronium is used for paralysis in the emergency department, delays in sedation have been observed, but have not been described in intensive care units (ICUs).

Objectives

The primary objective is the proportion of patients in the ICU who received sedation within 15 minutes after intubation using rocuronium. Secondary objectives include (1) time to sedation (minutes), (2) time to sedation between ICUs (minutes), (3) time to sedation between provider specialties (minutes), (4) time to sedation by Glasgow coma scale (GCS), and (5) first-hour versus second-hour Sedation Intensity Score (SIS) after RSI.

Methods

This is a retrospective review at a single academic tertiary care center of patients intubated in an ICU between July 2019 and August 2020. Inclusion criteria were age 18 to 89 years, intubation using rocuronium, and intubation in an ICU. Exclusion criteria were sedative exposure before intubation, no charted induction agent or charting delays from paralytic, incomplete charting, intubation outside an ICU, intubation during cardiac arrest, pregnancy, or incarceration.

Results

A total of 192 intubations using rocuronium were included and 77 (40.1%) received sedation within 15 minutes of induction agent administration. There was no difference in proportion of patients receiving sedation by GCS ≤ 8 and GCS > 8 before intubation (38.1% vs. 41.1%, P = 0.69). Using a SIS to describe amount of sedative administered, more sedation was administered in the second hour after intubation than the first hour (median score 5.5 [interquartile range {IQR} 0-20] vs. 4.5 [IQR 0-12.5], P < 0.001).

Conclusion

In this single-center analysis, a large proportion of patients intubated in ICUs with rocuronium did not receive additional sedation within 15 minutes of induction, exposing them to risk of awareness while paralyzed.

背景与快速顺序插管（RSI）过程中使用的诱导剂相比，罗库溴铵的作用时间更长，因此可能会出现镇静不足的情况。在急诊科使用罗库溴铵进行麻痹时，曾观察到镇静延迟的情况，但在重症监护病房（ICU）中尚未发现。次要目标包括：(1) 镇静时间（分钟）；(2) ICU 之间的镇静时间（分钟）；(3) 提供者专科之间的镇静时间（分钟）；(4) 格拉斯哥昏迷量表（GCS）显示的镇静时间；(5) RSI 后第一小时与第二小时镇静强度评分（SIS）。纳入标准为年龄在 18 至 89 岁之间、使用罗库溴铵插管且在 ICU 插管。排除标准为插管前接触过镇静剂、无诱导剂记录或因麻痹而延迟记录、记录不完整、在 ICU 外插管、心脏骤停期间插管、怀孕或监禁。结果共纳入了 192 例使用罗库溴铵的插管，其中 77 例（40.1%）在使用诱导剂后 15 分钟内接受了镇静。插管前 GCS ≤ 8 和 GCS > 8 患者接受镇静的比例没有差异（38.1% vs. 41.1%，P = 0.69）。结论在这项单中心分析中，重症监护病房中使用罗库溴铵插管的大部分患者在诱导后 15 分钟内未接受额外镇静，使他们在瘫痪期间面临意识风险。

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引用次数: 0

Effect of loperamide on heart rhythm: Randomized, double-blind, controlled study in healthy adults 洛哌丁胺对心律的影响：在健康成年人中进行的随机、双盲、对照研究

JAPhA Pharmacotherapy

Pub Date : 2024-04-04 DOI: 10.1016/j.japhar.2024.100006

Iolanda Cirillo, Jay Ariyawansa, Saberi Rana Ali, Evren Atillasoy

Background

Excessively high doses of loperamide (of up to 792 mg/day) have recently been associated with reports of cardiac events. However, no data currently demonstrate a direct effect of high doses of loperamide on the occurrence of cardiovascular abnormalities.

Objectives

This study aimed to assess the effects of loperamide on QT/corrected QT (QTc) intervals, electrocardiogram (ECG) morphology, and overall safety and tolerability at therapeutic and supratherapeutic exposures in healthy adults.

Methods

This randomized, double-blind, 4-way-crossover study enrolled 65 healthy adults to receive loperamide 8 mg (therapeutic dose), loperamide 48 mg (supratherapeutic dose), moxifloxacin 400 mg (positive control), and placebo. Least square (LS) mean difference in change from baseline in Fridericia-corrected QT (ΔQTcF) intervals between loperamide (8 mg and 48 mg) and placebo with the 2-sided 90% CI was calculated for each time point. A noninferiority criterion of mean difference in ΔQTcF of 10 ms evaluated whether loperamide was noninferior to placebo. Treatment safety was assessed throughout the study.

Results

Most participants were female (66.2%) and white (95.4%). The age was 36.4 years (SD 9.77). The highest upper limit of the 2-sided 90% CI for LS mean difference in ΔQTcF between loperamide and placebo was 3.39 ms for the therapeutic dose and 9.28 ms for the supratherapeutic dose of loperamide, which were below the 10 ms threshold, thereby demonstrating noninferiority of loperamide to placebo. There were no statistically significant morphologic ECG changes after loperamide administration. There were no deaths, serious adverse events, or severe treatment-emergent adverse events.

Conclusion

Single-dose loperamide at therapeutic (8 mg) and supratherapeutic (48 mg) doses do not show evidence of QTc prolongation of clinical concern in healthy participants. No new safety findings were identified.

背景过高剂量的洛哌丁胺（高达 792 毫克/天）最近与心脏事件报告有关。本研究旨在评估洛哌丁胺对健康成人的 QT/校正 QT（QTc）间期、心电图（ECG）形态以及治疗和超治疗剂量下的总体安全性和耐受性的影响。方法这项随机、双盲、4 向交叉研究招募了 65 名健康成人，分别服用洛哌丁胺 8 毫克（治疗剂量）、洛哌丁胺 48 毫克（超治疗剂量）、莫西沙星 400 毫克（阳性对照）和安慰剂。计算每个时间点洛哌丁胺（8 毫克和 48 毫克）与安慰剂之间弗里德里西亚校正 QT（ΔQTcF）间期与基线相比变化的最小平方（LS）平均差及 90% 的双侧 CI。以ΔQTcF的平均差为10毫秒的非劣效性标准来评估洛哌丁胺是否不劣于安慰剂。在整个研究过程中对治疗安全性进行了评估。结果大多数参与者为女性（66.2%）和白人（95.4%）。年龄为 36.4 岁（SD 9.77）。洛哌丁胺与安慰剂的LS平均差异ΔQTcF的双侧90% CI的最高上限为：治疗剂量3.39毫秒，超治疗剂量9.28毫秒，均低于10毫秒的阈值，从而证明洛哌丁胺与安慰剂相比无劣效性。服用洛哌丁胺后，心电图没有出现统计学意义上的明显形态变化。结论单剂量洛哌丁胺治疗剂量（8 毫克）和超治疗剂量（48 毫克）在健康参与者中未显示出引起临床关注的 QTc 延长的证据。没有发现新的安全性问题。

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引用次数: 0

Advances in recognizing, treating, and preventing mpox infection 识别、治疗和预防水痘感染的进展

JAPhA Pharmacotherapy

Pub Date : 2023-12-27 DOI: 10.1016/j.japhar.2023.100004

C. Tyler Pitcock, Nicholas Van Sickels, Frank Romanelli

Background

Monkeypox (mpox) was first isolated in 1958, and since that time, only sporadic human cases have been reported. Mpox is a double-stranded DNA poxvirus of the Orthopox genus whose natural animal reservoir is small rodents. Classification of the virus is divided into clades I and II, with clade II being further subdivided into IIa and IIb. Transmission is most often accomplished through large respiratory droplets or skin-to-skin contact with infectious lesions. Infection typically proceeds in 3 distinct phases (incubation, prodrome, and rash), with the course of the illness extending 2 to 4 weeks. Lymphadenopathy is often a distinguishing finding.

Objective

The emergence and re-emergence of mpox infections in the United States and beyond have underscored the need for continued awareness of transmission patterns, clinical presentation, treatment, and preventative strategies.

Methods

A literature search was conducted for published literature using the keywords "Mpox", "Monkeypox" or "Monkeypox virus", between 1950 and 2023. All manuscript types were included and reviewed for relevant information related to Money pox and its management.

Results

In 2022 and after a span of decades, mpox cases re-emerged in the United States coinciding with reported outbreaks in Europe among men who have sex with men. The 2022 outbreak was distinguished by a pattern of rash where lesions were very commonly sequestered to genital and perianal regions. The clinical course of disease can be complicated by pre-existing immunocompromise including human immunodeficiency virus infection. Although no Food and Drug Administration–approved treatment for mpox exists, some antiviral options are available including tecovirimat. Other less studied but promising alternatives include brincidofovir and vaccinia immune globulin intravenous. Currently, 2 vaccine products are available for the prevention of mpox infection.

Conclusion

The appearance of new mpox infections in 2022 and lingering cases in 2023 underscore the need for continued vigilance against this and other zoonotic disease.

背景猴痘（mpox）于 1958 年首次被分离出来，此后仅有零星的人类病例报告。猴痘病毒是一种双链 DNA 痘病毒，属于正痘病毒属，其天然动物库为小型啮齿类动物。该病毒分为 I 支系和 II 支系，其中 II 支系又分为 IIa 和 IIb。最常见的传播途径是通过大量呼吸道飞沫或与传染性病灶的皮肤接触。感染通常分为三个不同的阶段（潜伏期、前驱期和皮疹期），病程持续 2 到 4 周。淋巴腺肿大通常是一个显著的发现。目的在美国及其他地区出现和再次出现的猴痘感染凸显了对传播模式、临床表现、治疗和预防策略持续认识的必要性。结果2022年，在时隔几十年之后，美国再次出现猴痘病例，与欧洲报道的男男性行为者中爆发的猴痘病例不谋而合。2022 年的疫情以皮疹模式为特征，皮损通常集中在生殖器和肛周区域。疾病的临床过程可能因原有的免疫力低下（包括人类免疫缺陷病毒感染）而变得复杂。尽管目前尚无食品和药物管理局批准的麻风腮治疗方法，但已有包括替考韦利马特在内的一些抗病毒药物可供选择。其他研究较少但前景看好的替代品包括布林昔多福韦和疫苗免疫球蛋白静脉注射。结论 2022 年出现新的麻风腮感染病例，2023 年出现持续感染病例，这突出表明有必要继续对这种疾病和其他人畜共患病保持警惕。

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引用次数: 0

Does phenobarbital reduce the hospital length of stay for patients suffering from severe alcohol withdrawal? A retrospective comparison of phenobarbital to lorazepam infusions 苯巴比妥能缩短严重酒精戒断患者的住院时间吗？苯巴比妥与劳拉西泮输液的回顾性比较

JAPhA Pharmacotherapy

Pub Date : 2023-11-19 DOI: 10.1016/j.japhar.2023.100003

Vicente J. Jaramillo, Meghan L. Fletcher, Toby Chiu, Preeyaporn Sarangarm

Introduction

Data suggest that phenobarbital is as effective as benzodiazepines at managing withdrawal via its direct activation of the gamma-aminobutyric acid receptor and modulating glutamate-mediated stimulation of the N-methyl-D-aspartate receptor. There are little data evaluating the effect of phenobarbital on severe withdrawal syndromes.

Objective

The purpose of this study was to evaluate the effect of phenobarbital compared with protocolized, symptom-driven, benzodiazepine administration on hospital length of stay (LOS) in patients experiencing severe withdrawal.

Methods

This is a retrospective chart review of patients evaluated in the emergency department for the treatment of severe alcohol withdrawal syndrome, defined as a Clinical Institute Withdrawal Assessment for Alcohol – Revised score of 20 or greater during their visit. The primary outcome measure was the difference in hospital LOS between those receiving phenobarbital and those receiving continuous lorazepam infusions. Secondary outcomes include intensive care unit (ICU) admission, ICU LOS, need for mechanical ventilation, and incidence of oversedation.

Results

In all, 298 patients met inclusion, with 131 treated with phenobarbital and 167 initiated on a lorazepam infusion. Hospital LOS was found to be statistically significantly greater in the lorazepam infusion cohort (7.6 ± 5.3 vs. 5.2 ± 4.5 days, P < 0.001) than the phenobarbital cohort. Patients treated with lorazepam were found to have increased admissions to the ICU (risk ratio [RR] 1.79 [95% CI 1.27–2.92]) and higher rates of oversedation (RR 1.71 [95% CI 2.09–4.25]). There were no differences in ICU LOS and need for mechanical ventilation.

Conclusion

Data from this study suggest that phenobarbital may be associated with a decrease in hospital LOS in severe alcohol withdrawal and should be considered as an alternative to benzodiazepine infusions in these patients.

导言：有数据表明，苯巴比妥通过直接激活γ-氨基丁酸受体和调节谷氨酸介导的N-甲基-D-天冬氨酸受体刺激，在控制戒断方面与苯二氮卓类药物一样有效。本研究的目的是评估苯巴比妥与苯二氮卓类药物在严重戒断患者住院时间（LOS）上的效果。方法这是一项回顾性病历审查，对象是在急诊科接受评估以治疗严重酒精戒断综合征的患者，严重酒精戒断综合征的定义是在就诊期间临床研究所酒精戒断评估-修订版评分达到或超过 20 分。主要研究结果是接受苯巴比妥治疗和持续输注劳拉西泮治疗的患者的住院时间差异。次要结果包括重症监护室（ICU）入院率、重症监护室住院时间、机械通气需求和过度镇静发生率。结果共有 298 名患者符合纳入条件，其中 131 人接受苯巴比妥治疗，167 人开始输注劳拉西泮。输注劳拉西泮患者的住院时间（7.6 ± 5.3 天 vs. 5.2 ± 4.5 天，P < 0.001）明显高于苯巴比妥患者。使用劳拉西泮治疗的患者入住重症监护室的次数增加（风险比 [RR] 1.79 [95% CI 1.27-2.92]），过度惊厥的发生率也更高（RR 1.71 [95% CI 2.09-4.25]）。结论本研究的数据表明，苯巴比妥可缩短严重酒精戒断患者的住院时间，因此应考虑将其作为苯二氮卓类药物输注的替代方案。

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引用次数: 0

Changes in serum potassium with concomitant administration of renin-angiotensin system agents and potassium-sparing diuretics: U.S. cohort study using electronic health record data 同时使用肾素-血管紧张素系统药物和保钾利尿剂时血清钾的变化:使用电子健康记录数据的美国队列研究

JAPhA Pharmacotherapy

Pub Date : 2023-09-20 DOI: 10.1016/j.japhar.2023.100002

M. Sakil Syeed, Ainhoa Gomez-Lumbreras, Malinda Tan, Daniel C. Malone

Background

Potassium-sparing diuretics (KSDs) and renin-angiotensin system (RAS) agents (including angiotensin-converting enzyme inhibitors [ACEIs] and angiotensin II receptor blockers [ARBs]) are commonly prescribed for the management of hypertension, cardiovascular diseases, and diabetic nephropathy. However, there is a concern of developing hyperkalemia when these drugs are concomitantly used. This study investigates the change in serum potassium during concomitant administration of RAS agents (ACEI or ARB) and KSD.

Methods

This is a retrospective observational study using the Cerner Health Facts database. Electronic health records from unique patient hospitalization encounters were used to compare change in the serum potassium among 5 different cohorts (ACEI, ARB, KSD, ACEI-KSD, and ARB-KSD) and a non-RAS non-KSD exposed one (acetaminophen [APAP] cohort). Descriptive data of the cohorts and the risk of increase in potassium serum were estimated by generalized linear regression.

Results

A total of 5816 patients’ unique encounters were analyzed. After admission, 5.2% (N = 303) had serum potassium greater than 5.5 mmol/L. Results showed a significant increase in serum potassium during concomitant use of KSD and RAS agents and when only using KSD compared with the control APAP group (all P < 0.05). Other significant predictors of increased serum potassium levels included male (P = 0.002), black race (P < 0.001), and individuals with low estimated glomerular filtration rate (P < 0.001).

Conclusions

This study found no evidence of hyperkalemia when combining KSD and other medications that may increase potassium levels, even when controlling for other potential factors that may affect serum potassium levels, for patients within institutional settings. Warnings concerning excessive potassium levels when a KSD is prescribed with a medication that may affect potassium should be limited to patients with pre-existing higher levels of potassium.

背景:保钾利尿剂(KSDs)和肾素-血管紧张素系统(RAS)药物(包括血管紧张素转换酶抑制剂[ACEIs]和血管紧张素II受体阻滞剂[ARBs])通常用于高血压、心血管疾病和糖尿病肾病的治疗。然而，当这些药物同时使用时，有可能出现高钾血症。本研究探讨RAS药物(ACEI或ARB)和KSD同时使用时血清钾的变化。方法采用Cerner Health Facts数据库进行回顾性观察性研究。使用来自独特患者住院的电子健康记录来比较5个不同队列(ACEI、ARB、KSD、ACEI-KSD和ARB-KSD)和非ras -非KSD暴露组(对乙酰氨基酚[APAP]队列)的血清钾变化。用广义线性回归估计队列的描述性数据和血清钾升高的风险。结果共分析了5816例患者的特殊遭遇。入院后，5.2% (N = 303)患者血清钾大于5.5 mmol/L。结果显示，与APAP对照组相比，同时使用KSD和RAS药物以及仅使用KSD时血清钾显著升高(P <0.05)。血清钾水平升高的其他显著预测因素包括男性(P = 0.002)、黑人(P <0.001)，以及估计肾小球滤过率低的个体(P <0.001)。结论:本研究发现，即使在控制其他可能影响血清钾水平的潜在因素的情况下，在机构设置的患者中，当KSD和其他可能增加钾水平的药物联合使用时，没有证据表明高钾血症。当KSD与可能影响钾的药物一起开处方时，有关钾水平过高的警告应仅限于已存在较高钾水平的患者。

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引用次数: 0

Effect of combination antibiotic therapy on clinical failure rate for skin and soft tissue infections 抗生素联合治疗对皮肤软组织感染临床失败率的影响

JAPhA Pharmacotherapy

Pub Date : 2023-09-14 DOI: 10.1016/j.japhar.2023.100001

Colton Whiteside, Meghan L. Fletcher, Lauren A. Schluenz-Roehl, Preeyaporn Sarangarm

Background

Despite guideline recommendations for skin and soft tissue infection (SSTI) consisting of empirical single antibiotic therapy, multiple studies have evaluated the use of a first-generation cephalosporin and sulfamethoxazole-trimethoprim or clindamycin to optimize coverage for staphylococcal and streptococcal species. No studies have evaluated a tetracycline with a cephalosporin for this indication.

Objective

This study evaluated combination therapy with doxycycline plus cephalexin compared with cephalexin or doxycycline alone in SSTI.

Methods

This retrospective, single-center cohort study, conducted at an academic medical center, included consecutive adults who visited the emergency department (ED) with an SSTI, identified with ICD-10 codes, and received a prescription for cephalexin, doxycycline, or both. Admitted patients or those with antibiotics in the previous 30 days or wound care for chronic infections were excluded. The primary outcome was clinical failure defined as documented worsening of infection or incision and drainage (I&D) on follow-up, change in antibiotic, or subsequent hospitalization. Chi-square test was used for the primary outcome.

Results

Patients (N = 419) were predominately white, Hispanic, males with a mean age of 46 ± 16 years, and consistent between groups. History of intravenous drug use was present in 23% of patients, most often in the doxycycline (30%) or combination groups (30%). Clinical failure occurred in 49 patients (12%). There was no difference in clinical failure between cephalexin and combination therapy (17 vs. 13, P = 0.45) or doxycycline versus combination therapy (19 vs. 13, P = 0.27). The predominant reason for clinical failure was worsening of infection (31), followed by change in antibiotic (18) and hospitalization (16). I&D predominately occurred in the doxycycline (44%) and combination groups (30%), with methicillin-resistant Staphylococcus aureus being the most commonly identified organism (15).

Conclusion

In ED patients with SSTI, single antibiotic therapy did not result in increased incidence of clinical failure compared with combination therapy with a first-generation cephalosporin and tetracycline.

背景尽管皮肤和软组织感染（SSTI）的指南建议由经验单一抗生素治疗组成，但多项研究评估了第一代头孢菌素和磺胺甲恶唑甲氧苄啶或克林霉素的使用，以优化葡萄球菌和链球菌的覆盖范围。没有任何研究评估四环素和头孢菌素的适应症。目的评价多西环素联合头孢氨苄与头孢氨苄或多西环肽联合治疗SSTI的疗效。方法这项在学术医疗中心进行的回顾性单中心队列研究，包括连续的成年患者，他们因SSTI就诊于急诊科（ED），通过ICD-10代码进行识别，并接受了头孢氨苄、多西环素或两者兼有的处方。排除入院患者或在过去30天内使用抗生素或因慢性感染进行伤口护理的患者。主要结果是临床失败，定义为随访、抗生素更换或随后住院时感染或切开引流（I&；D）的恶化。卡方检验用于主要结果。结果患者（N=419）主要为白人、西班牙裔、男性，平均年龄46±16岁，各组间一致。23%的患者有静脉注射药物使用史，最常见的是多西环素组（30%）或联合用药组（30%）。49名患者（12%）出现临床失败。头孢氨苄与联合治疗（17对13，P=0.45）或多西环素与联合治疗之间的临床失败率没有差异（19对13，P=0.027）。临床失败的主要原因是感染恶化（31），其次是抗生素的变化（18）和住院治疗（16）。我&；D主要发生在多西环素组（44%）和联合用药组（30%），耐甲氧西林金黄色葡萄球菌是最常见的生物体（15）。结论在患有SSTI的ED患者中，与第一代头孢菌素和四环素的联合治疗相比，单一抗生素治疗不会增加临床失败的发生率。

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