婴幼儿抗生素相关性腹泻的影响因素及其防治
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摘要
目的分析婴幼儿抗生素相关性腹泻的影响因素,观察地衣芽孢杆菌活菌制剂在预防抗生素相关性腹泻中的疗效。方法选择大连医科大学附属二院2016年11月至2017年2月因支气管肺炎应用广谱抗生素治疗的265例婴幼儿患者,随机分成实验组(140例)和对照组(125例)。实验组患儿从应用抗生素治疗第1天开始预防性口服地衣芽孢杆菌(0.25g/次,3次/d)直至停用抗生素;对照组患儿出现腹泻后加用地衣芽孢杆菌治疗,用药至腹泻缓解,剂量和用法与实验组一致。观察两组患儿抗生素相关性腹泻出现的例数,腹泻出现时间,持续时间,大便次数及性状。分析年龄、抗生素应用时间、是否联合应用抗生素与抗生素相关性腹泻之间的关系。结果 (1)年龄小于1岁、应用抗生素时间大于7d和联合应用抗生素均是婴幼儿发生抗生素相关性腹泻的高危因素。(2)预防性使用地衣芽孢杆菌后,实验组患儿腹泻发生率明显低于对照组,腹泻出现时间晚于对照组,腹泻持续时间短于对照组,平均大便次数少于对照组,差异均有统计学意义(P<0.05)。结论 (1)婴幼儿长时间应用抗生素和联合应用抗生素易导致抗生素相关性腹泻的发生。(2)预防性应用地衣芽孢杆菌活菌制剂可以有效减轻抗生素相关性腹泻的发生及其严重程度。
Objective To analyze the influencing factors of antibiotic associated diarrhea(ADD)in infants and observe the efficacy of Bacillus licheniformis in preventing ADD.Methods 265 pediatric patients(3 months-3 years old)treated with broad-spectrum antibiotics for bronchopneumonia in our hospital from November 2016 to February 2017 were randomly divided into the observation group(n=140)or control group(n=125),and treated with antibiotics.The observation group was additional given prophylactic Bacillus licheniformis(0.25 g tid)from the first day of the antibiotic administration until the antibiotics were stopped,while the control group was given the same dosage of Bacillus licheniformis only from when diarrhea appeared until the diarrhea was alleviated.The occurrence of antibiotic associated diarrhea,the time to the appearance and the duration of diarrhea,the frequency and characteristics of defecation in both groups were observed.The relations between the incidence of antibiotic associated diarrhea and age,time length of antibiotic administration and combination of antibiotics were analyzed.Results(1)Age less than 1 year,time length of antibiotic administration>7 days,and combined use of antibiotics were the high risk factors of antibiotic associated diarrhea in infants.(2)After prophylactic use of Bacillus licheniformis,the incidence of diarrhea in the observation group was lower,diarrhea appeared later and lasted shorter,and the average frequency of defecation was less than in the control group,respectively,with significant differences.Conclusions(1)Infants,long time use of antibiotics and combined use of antibiotics easily lead to the occurrence of diarrhea associated with antibiotics.(2)Prophylactic use of Bacillus licheniformis can effectively reduce the incidence and severity of antibiotic associated diarrhea.
Objective To analyze the influencing factors of antibiotic associated diarrhea(ADD)in infants and observe the efficacy of Bacillus licheniformis in preventing ADD.Methods 265 pediatric patients(3 months-3 years old)treated with broad-spectrum antibiotics for bronchopneumonia in our hospital from November 2016 to February 2017 were randomly divided into the observation group(n=140)or control group(n=125),and treated with antibiotics.The observation group was additional given prophylactic Bacillus licheniformis(0.25 g tid)from the first day of the antibiotic administration until the antibiotics were stopped,while the control group was given the same dosage of Bacillus licheniformis only from when diarrhea appeared until the diarrhea was alleviated.The occurrence of antibiotic associated diarrhea,the time to the appearance and the duration of diarrhea,the frequency and characteristics of defecation in both groups were observed.The relations between the incidence of antibiotic associated diarrhea and age,time length of antibiotic administration and combination of antibiotics were analyzed.Results(1)Age less than 1 year,time length of antibiotic administration>7 days,and combined use of antibiotics were the high risk factors of antibiotic associated diarrhea in infants.(2)After prophylactic use of Bacillus licheniformis,the incidence of diarrhea in the observation group was lower,diarrhea appeared later and lasted shorter,and the average frequency of defecation was less than in the control group,respectively,with significant differences.Conclusions(1)Infants,long time use of antibiotics and combined use of antibiotics easily lead to the occurrence of diarrhea associated with antibiotics.(2)Prophylactic use of Bacillus licheniformis can effectively reduce the incidence and severity of antibiotic associated diarrhea.
引文
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[9]YI Anni,ZHANG Huiye,LIU Bin,et al.The modulation effect of different prebiotics on intestinal flora of mice with dysbacteriosis induced by antibiotics[J].Chin J Microecol,2012,24(4):318-320.(in Chinese)易安妮,张慧晔,刘宾,等.益生元对抗生素引起的肠道菌群失调的作用[J].中国微生态学杂志,2012,24(4):318-320.
[10]Szajewska H,Canani RB,Guarino A,et al.Probiotics for the prevention of antibiotic-associated diarrhea in children[J].JPediatr Gastroenterol Nutr,2016,62(3):495-506.
[11]Jones K,Probiotics:Preventing antibiotic-associated diarrhea[J].J Spec Prdiatr Nurs,2010,15(2):160-162.
[12]Varughese CA,Vakil NH,Phillips KM,et al.Antibiotic-associated diarrhea:A refresher on causes and possible prevention with probioticscontinuing education article[J].J Pharm Pract,2013,26(5):476-482.
[13]REN Naigang,CHEN Wei,PENG Bo,et al.Mechanism and clinical application of live Bacillus licheniformis preparation[J].Chin J Clin Pharmacol,2013,29(9):716-718.(in Chinese)任乃刚,陈伟,彭勃,等.整肠生的作用机制及临床应用[J].中国临床药理学杂志,2013,29(9):716-718.
[14]CHEN Xiaosa,HU Wenhui.Curative effect and security analysis of Live Bacillus Licheniformis Granules on infants′secondary diarrhea due to respiratory tract infection[J].Chin Med Herald,2014,11(5):70-74.(in Chinese)陈晓飒,胡文辉.地衣芽孢杆菌活菌胶囊治疗婴幼儿呼吸道感染继发腹泻等效果及安全性分析[J].中国医药导报,2014,11(5):70-74.
[2]Hempel S,Newberry SJ,Maher AR,et al.Probiotics for the prevention and treatment of antibiotic-associated diarrhea:a systematic review and meta-analysis[J].J Am Med Associat,2012,307(18):1959-1969.
[3]酪酸杆菌二联活菌散剂预防肺炎儿童抗生素相关性腹泻研究协作组.酪酸杆菌二联活菌散剂预防肺炎儿童抗生素相关性腹泻的多中心随机对照临床试验[J].中华儿科杂志,2012,50(10):732-736.
[4]Sreenivasan P,Nujum ZT,Purushothaman KK.Clinical response to antibiotics among children with bloody diarrhea[J].Indian Pediatr,2013,50(3):340-341.
[5]Amos AV,Bally F.Role of probiotics in the treatment and prevention ot antibiotics-associated diarrhea[J].Rev Med Suisse,2012,8(357):1907-1910.
[6]WANG Wenjian,ZHENG Yuejie.The determinants of early acquisition of intestinal microbiota in children[J].Chin J Microecol,2013,25(6):727-730.(in Chinese)王文建,郑跃杰.儿童肠道菌群的建立及影响因素研究进展[J].中国微生态学杂志,2013,25(6):727-730.
[7]刘作义,程茜.儿科抗生素相关性腹泻[J].中国实用儿科杂志,2010,25(7):499-501.
[8]郑跃杰,黄志华,刘作义,等.微生态制剂儿科应用专家共识[J].中国实用儿科杂志,2011,26(1):20-23.
[9]YI Anni,ZHANG Huiye,LIU Bin,et al.The modulation effect of different prebiotics on intestinal flora of mice with dysbacteriosis induced by antibiotics[J].Chin J Microecol,2012,24(4):318-320.(in Chinese)易安妮,张慧晔,刘宾,等.益生元对抗生素引起的肠道菌群失调的作用[J].中国微生态学杂志,2012,24(4):318-320.
[10]Szajewska H,Canani RB,Guarino A,et al.Probiotics for the prevention of antibiotic-associated diarrhea in children[J].JPediatr Gastroenterol Nutr,2016,62(3):495-506.
[11]Jones K,Probiotics:Preventing antibiotic-associated diarrhea[J].J Spec Prdiatr Nurs,2010,15(2):160-162.
[12]Varughese CA,Vakil NH,Phillips KM,et al.Antibiotic-associated diarrhea:A refresher on causes and possible prevention with probioticscontinuing education article[J].J Pharm Pract,2013,26(5):476-482.
[13]REN Naigang,CHEN Wei,PENG Bo,et al.Mechanism and clinical application of live Bacillus licheniformis preparation[J].Chin J Clin Pharmacol,2013,29(9):716-718.(in Chinese)任乃刚,陈伟,彭勃,等.整肠生的作用机制及临床应用[J].中国临床药理学杂志,2013,29(9):716-718.
[14]CHEN Xiaosa,HU Wenhui.Curative effect and security analysis of Live Bacillus Licheniformis Granules on infants′secondary diarrhea due to respiratory tract infection[J].Chin Med Herald,2014,11(5):70-74.(in Chinese)陈晓飒,胡文辉.地衣芽孢杆菌活菌胶囊治疗婴幼儿呼吸道感染继发腹泻等效果及安全性分析[J].中国医药导报,2014,11(5):70-74.