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目的:对于具有较高感染非易感性链球菌肺炎(NSSP)风险的单纯性急性中耳炎(AOM)患儿,国家正式推荐的治疗方法是大剂量的阿莫西林[80-90 mg/ (kg·d)]。事实上,如果本地的NSSP感染率并不高,大剂量治疗没有必要。本研究的目的是了解患急性上呼吸道感染的儿童中NSSP的流行情况,进而探讨作为一线经验治疗药物的阿莫西林的推荐剂量。方法:笔者在密苏里州的圣路易斯市的7个社区的儿科部门做了一次具有代表性的流行病学研究。从<7岁的急性中耳炎、非特异性上呼吸道感染、咳嗽、急性鼻窦炎、咽炎患儿的鼻咽拭子中分离出肺炎双球菌。4周内使用过抗生素的儿童被排除在本研究之外。被研究的患儿的父母亲及庇护人填写了有关评价其患NSSP的风险因素的简单问卷调查。根据国家临床用药标准,青霉素的最小抑菌浓度≥0.12 mg/L被列为对青霉素不敏感,最小抑菌浓度≥2 mg/L被列为对标准剂量阿莫西林[35-45 mg/ (kg·d);NSSP-A]不敏感。结果:对212例患儿的鼻咽部进行肺炎双球菌分离,85例(40%)呈阳性,(95%CI 33%-47%);在85例中,41(85%)例分离出NSSP (95%CI 37%-59%),6例(7%)分离出NSSP-A (95%CI 1.5%-13%)。在所有被研究的212例患儿
OBJECTIVE: For children with simple acute otitis media (AOM) who have a higher risk of developing non-susceptible Streptococcus pneumoniae (NSSP) infection, the nationally recommended regimen is high-dose amoxicillin [80-90 mg / (kg · d)]. In fact, high-dose treatment is not necessary if the rate of local NSSP infection is not high. The purpose of this study was to understand the prevalence of NSSP in children with acute upper respiratory tract infection and to explore the recommended dose of amoxicillin as a first-line treatment experience. Methods: I conducted a representative epidemiological study in the pediatric department of seven communities in St. Louis, Missouri. Pneumococci were isolated from nasopharyngeal swabs in children <7 years old with acute otitis media, non-specific upper respiratory tract infection, cough, acute sinusitis, and pharyngitis. Children who had used antibiotics within 4 weeks were excluded from the study. Parents and patrons of the children under study completed a simple questionnaire about evaluating the risk factors for developing NSSP. According to the national clinical medication standards, the minimum inhibitory concentration of penicillin ≥ 0.12 mg / L is not sensitive to penicillin, the minimum inhibitory concentration ≥ 2 mg / L is listed as the standard dose of amoxicillin [35-45 mg / ( kg · d); NSSP-A] insensitive. Results: Nasopharyngeal isolates from 212 children were positive for pneumococci (85%, 40%) (95% CI 33% -47%); in 85 of 41 (85%) cases, NSSP (95% CI 37% -59%) and NSSP-A (95% CI 1.5% -13%) were isolated in 6 cases (7%). Among all the 212 children studied