Objective: To achieve optimal effect with beta-lactam antibiotics, regimens with frequent dosages have been found necessary. However, if compliance is negatively influenced by more frequent dosages, this might hamper ...Objective: To achieve optimal effect with beta-lactam antibiotics, regimens with frequent dosages have been found necessary. However, if compliance is negatively influenced by more frequent dosages, this might hamper the effect of the treatments. Therefore, we have studied whether the numbers of daily dosages influence the compliance with prescribed flucloxacillin regimens. Design: A prospective interview study of patients with different dosing regimens of flucloxacillin. Setting: In the study, 200 patients with different dosing regimens of flucloxacillin underwent structured telephone interviews in order to reveal their compliance with the medication. Of these, 13 were prescribed twice-daily doses, 163 three times daily and 24 patients four times daily regimens. Results: There were no statistically significant differences between missed doses and prescribed numbers of daily doses. There was, however, a significant difference in the number of daily doses and experiences associated with the medication. Conclusions: This study shows that patients comply well with regimens of up to four daily doses of flucloxacillin, despite experiencing increasing difficulties with regimens of more frequent dosages.展开更多
Background:Staphylococcus aureus bacteremia is associated with high mortality.Whether cefazolin or an antistaphylococcal penicillin should be preferred for the treatment of methicillin-susceptible S.aureus bacteremia ...Background:Staphylococcus aureus bacteremia is associated with high mortality.Whether cefazolin or an antistaphylococcal penicillin should be preferred for the treatment of methicillin-susceptible S.aureus bacteremia is unclear.Methods:In an ongoing international Bayesian adaptive platform trial,we conducted an open-label,randomized comparison of cefazolin with an antistaphylococcal penicillin(flucloxacillin or cloxacillin)in adult patients with penicillin-resistant,methicillin-susceptible S.aureus bacteremia.The primary outcome,which was evaluated with a hierarchical Bayesian logistic-regression model,was death from any cause within 90 days after enrollment in the platform.We assessed the posterior probability of the noninferiority of cefazolin to flucloxacillin or cloxacillin(with the criterion for noninferiority prespecified as an adjusted odds ratio of<1.2,which approximates an absolute difference in mortality of<2.5 percentage points if mortality in the antistaphylococcal-penicillin group is 15%),as well as the posterior probability of superiority(with the criterion of an adjusted odds ratio of<1.0).Secondary safety outcomes included the development of acute kidney injury within 14 days.Results:This domain of the ongoing trial was conducted between February 17,2022,and August 7,2024,by which time the criterion for noninferiority had been met.Mortality at 90 days among adults who could be evaluated was 15.0%(97 deaths among 645 patients)in the cefazolin group and 17.0%(109 deaths among 642 patients)in the antistaphylococcal-penicillin group(adjusted odds ratio,0.81;95%credible interval,0.59 to 1.12;probability of noninferiority,99.2%;probability of superiority,89.8%).Acute kidney injury occurred in 92 of 660 patients(13.9%)in the cefazolin group,as compared with 127 of 648(19.6%)in the antistaphylococcal-penicillin group(adjusted odds ratio,0.67;95%credible interval,0.50 to 0.89;probability of superiority,99.7%).Conclusions:In patients with methicillin-susceptible S.aureus bacteremia,cefazolin was noninferior to flucloxacillin or cloxacillin with respect to 90-day mortality and was associated with a lower incidence of acute kidney injury.(Funded by the National Health and Medical Research Council and others;SNAP ClinicalTrials.gov number,NCT05137119.).展开更多
目的研究抗生素氟氯西林钠的关键中间体3-(2′-氯-6′-氟苯基)-5-甲基-4-异噁唑甲酰氯的合成方法,使之适合工业化生产。方法以2-氯-6-氟苯甲醛为原料,经肟化、氯化、环合、水解、酰氯化等步骤制得目标化合物。结果合成产物的化学结构经I...目的研究抗生素氟氯西林钠的关键中间体3-(2′-氯-6′-氟苯基)-5-甲基-4-异噁唑甲酰氯的合成方法,使之适合工业化生产。方法以2-氯-6-氟苯甲醛为原料,经肟化、氯化、环合、水解、酰氯化等步骤制得目标化合物。结果合成产物的化学结构经IR,1H-NMR,13C-NMR and MS确证,总收率为60.2%。结论此方法收率高,成本低,适合工业化生产。展开更多
目的观察剖宫产患者术后口服氟氯西林预防感染的效果。方法将剖宫产患者566例分为治疗组301例和对照组265例。治疗组术前30 m in内静脉注射头孢曲松1.0 g,术后给予口服氟氯西林胶囊0.5 g,b id,共5 d;对照组术前30 m in内静脉注射头孢曲...目的观察剖宫产患者术后口服氟氯西林预防感染的效果。方法将剖宫产患者566例分为治疗组301例和对照组265例。治疗组术前30 m in内静脉注射头孢曲松1.0 g,术后给予口服氟氯西林胶囊0.5 g,b id,共5 d;对照组术前30 m in内静脉注射头孢曲松1.0 g,术后给予静脉注射头孢曲松1.0 g,qd,共3 d。其他处理两组相同。比较两组产褥感染的情况。结果治疗组和对照组产褥感染分别为34,19例,差异无显著性(P>0.05),且均无严重不良反应。结论无感染的剖宫产术后患者可口服氟氯西林预防感染,减少全身用药对母婴的影响,降低医疗费用。展开更多
摘要Objective: To achieve optimal effect with beta-lactam antibiotics, regimens with frequent dosages have been found necessary. However, if compliance is negatively influenced by more frequent dosages, this might hamper the effect of the treatments. Therefore, we have studied whether the numbers of daily dosages influence the compliance with prescribed flucloxacillin regimens. Design: A prospective interview study of patients with different dosing regimens of flucloxacillin. Setting: In the study, 200 patients with different dosing regimens of flucloxacillin underwent structured telephone interviews in order to reveal their compliance with the medication. Of these, 13 were prescribed twice-daily doses, 163 three times daily and 24 patients four times daily regimens. Results: There were no statistically significant differences between missed doses and prescribed numbers of daily doses. There was, however, a significant difference in the number of daily doses and experiences associated with the medication. Conclusions: This study shows that patients comply well with regimens of up to four daily doses of flucloxacillin, despite experiencing increasing difficulties with regimens of more frequent dosages.
摘要Background:Staphylococcus aureus bacteremia is associated with high mortality.Whether cefazolin or an antistaphylococcal penicillin should be preferred for the treatment of methicillin-susceptible S.aureus bacteremia is unclear.Methods:In an ongoing international Bayesian adaptive platform trial,we conducted an open-label,randomized comparison of cefazolin with an antistaphylococcal penicillin(flucloxacillin or cloxacillin)in adult patients with penicillin-resistant,methicillin-susceptible S.aureus bacteremia.The primary outcome,which was evaluated with a hierarchical Bayesian logistic-regression model,was death from any cause within 90 days after enrollment in the platform.We assessed the posterior probability of the noninferiority of cefazolin to flucloxacillin or cloxacillin(with the criterion for noninferiority prespecified as an adjusted odds ratio of<1.2,which approximates an absolute difference in mortality of<2.5 percentage points if mortality in the antistaphylococcal-penicillin group is 15%),as well as the posterior probability of superiority(with the criterion of an adjusted odds ratio of<1.0).Secondary safety outcomes included the development of acute kidney injury within 14 days.Results:This domain of the ongoing trial was conducted between February 17,2022,and August 7,2024,by which time the criterion for noninferiority had been met.Mortality at 90 days among adults who could be evaluated was 15.0%(97 deaths among 645 patients)in the cefazolin group and 17.0%(109 deaths among 642 patients)in the antistaphylococcal-penicillin group(adjusted odds ratio,0.81;95%credible interval,0.59 to 1.12;probability of noninferiority,99.2%;probability of superiority,89.8%).Acute kidney injury occurred in 92 of 660 patients(13.9%)in the cefazolin group,as compared with 127 of 648(19.6%)in the antistaphylococcal-penicillin group(adjusted odds ratio,0.67;95%credible interval,0.50 to 0.89;probability of superiority,99.7%).Conclusions:In patients with methicillin-susceptible S.aureus bacteremia,cefazolin was noninferior to flucloxacillin or cloxacillin with respect to 90-day mortality and was associated with a lower incidence of acute kidney injury.(Funded by the National Health and Medical Research Council and others;SNAP ClinicalTrials.gov number,NCT05137119.).
摘要目的研究抗生素氟氯西林钠的关键中间体3-(2′-氯-6′-氟苯基)-5-甲基-4-异噁唑甲酰氯的合成方法,使之适合工业化生产。方法以2-氯-6-氟苯甲醛为原料,经肟化、氯化、环合、水解、酰氯化等步骤制得目标化合物。结果合成产物的化学结构经IR,1H-NMR,13C-NMR and MS确证,总收率为60.2%。结论此方法收率高,成本低,适合工业化生产。