预防复发性尿路感染：呋喃妥因，非磺胺类药物或越橘汁

蓝鱼o_0

Prophylaxis for Recurrent Urinary Tract Infections: Nitrofurantoin, Not Trimethoprim-Sulfamethoxazole or Cranberry Juice Burke A. Cunha, MD
I read with interest the article by Beerepoot et al1 on urinary tract infection (UTI) prophylaxis, which raises important points that merit comment. From a resistance perspective, the article re-emphasizes that trimethoprim-sulfamethoxazole (TMP-SMX) is a "high resistance potential" antibiotic that predisposes to resistance among uropathogens. Clinicians should be reminded that resistance is not related to antibiotic volume, duration, or class per se, but rather is associated with individual agents from all antibiotic classes.2 Nitrofurantoin does not predispose to uropathogen resistance for prophylaxis and therapy of short or long duration.3 Another point deserving re-emphasis is that antibiotics with a high resistance potential not only predispose to increased resistance during treatment but such resistant uropathogens may persist in fecal flora for up to 3 months following therapy. Clinicians should take great care in selecting an appropriate antibiotic with a low resistance potential, both to minimize the resistance potential and to prevent prolonged carriage of resistant uropathogens in the fecal flora.2 The study was intended to determine if cranberry juice had antibacterial effects. However, the most important take home message is to avoid TMP-SMX for prophylaxis or therapy of recurrent UTIs.1 Instead, use nitrofurantoin, which is effective against most common uropathogens but does not predispose to resistance. Nitrofurantoin is effective against common uropathogens except Proteus species and Pseudomonas aeruginosa. Nitrofurantoin inhibits bacterial growth at 3 different loci in the Kreb's cycle of susceptible uropathogens.3 Nitrofurantoin, rather than TMP-SMX, is ideal for prophylaxis of recurrent lower UTIs and acute complicated cystitis in female patients.4 Another concern in the study is timing and duration of prophylaxis for recurrent UTIs. Excluding relapsing UTIs, reinfecting recurrent UTIs are best treated episodically with a "low resistance potential" antibiotic, eg, nitrofurantoin. It is preferable to treat a few episodes of cystitis per year as needed rather than to use prolonged prophylaxis with TMP-SMX with its associated costs and risks of adverse effects, eg, drug fever, Steven-Johnson syndrome, folate deficiency, cost of resistance, and prolonged carriage of uropathogens in the fecal flora. In my clinical experience, nitrofurantoin has been useful for empirical initial prophylaxis and treatment of recurrent lower UTIs in women. The adverse effects of nitrofurantoin occur mainly with prolonged therapy with chronic renal insufficiency. Nitrofurantoin is a cost-effective and safe alternative to TMP-SMX and does not predispose to resistance.2, 5 Clinicians should carefully consider the resistance potential of antibiotics selected for recurrent UTIs. Better alternatives than TMP-SMX, eg, nitrofurantoin, are available and have a long record of effectiveness and lack of resistance.

细菌耐药

最新的文献，谢谢蓝鱼版主，这么早就在线啊，辛苦了!

朱德权

辛苦了,这么早提供新的资料,祝您龙年身体健康工作顺利全家幸福!

洋葱头

谢谢蓝鱼版主，辛苦了,这么早提供新的资料,祝您龙年身体健康工作顺利全家幸福!

汇原果汁

英文它能看懂我，可是我看不懂它耶，不过还是谢谢老师~~祝春节愉快~

小人物

谢谢老师，先给你拜个年。英文我看不懂，有翻译就更好了。

天天，天蓝

能否翻译过来，以免英文基础差的人能够学习。

toto

Cranberry Juice 这是什么？？？算是药？越橘汁？？？求解？

fd_daisy

Cranberry Juice是指蔓越莓汁，蔓越莓含有丰富的苯甲酸（天然防腐剂）和丰富的维生素C，它具有非常强的抗氧化作用。

它被越来越多的医学研究发现有以下功能：

赶走泌尿道的感染

长久以来，蔓越莓最广为人知的功能是：预防泌尿道感染，一天喝十盎司的蔓越莓汁作为预防措施。

蔓越莓汁为什么会有这样的功效？秘密在於蔓越莓里的多酚类---和维生素Ａ相关的浓缩丹宁，它们可能包围大肠杆菌，让细菌无法攀附於尿道内侧的感受体上。再不然，丹宁也可以堵住感受体本身，使细菌根本毫无空间侵入。

不管它们利用哪一种方法，结果都是细菌只能悄悄的滑过，无法逗留下来制造感染。因此你不用像服用抗生素那样，必须先设法增强抵抗力。

蔓越莓唯一的问题是，一旦感染的情况发生了，它的作用就不那么大了。除非是感染初期，也就是细菌很微弱的黏上尿道壁时，蔓越莓才有所助益。随着感染情况越来越严重，细菌附着的程度也越来越稳固，那就只有抗生素可以击倒他们了。

以此类推，假使蔓越莓能够阻止大肠杆菌黏上尿道壁，那么应该也可以阻止口腔里的细菌附着在牙齿上，防止牙菌斑的形成。至少有一项以色列研究得出这样的结论。说不定蔓越莓在实验里的功效，也会发生在人体身上呢，谁知道？也许有一天蔓越莓萃取物会被添加在牙膏或漱口水里。

排除泌尿道感染

美国加州尔湾市的加州大学研究结果显示，蔓越莓汁还可以抵御其他种类的细菌，包括葡萄球菌和沙门氏菌的感染。台拉维夫大学的科学家则发现，蔓越莓萃取物可以阻绝引起胃溃疡的幽门螺旋杆菌。蔓越莓还可以防止心脏疾病的发生。根据威斯康辛大学拉可诺斯分校的实验，具有抗氧化功效的红色青花素，似乎能阻止「坏」胆固醇的氧化作用。实验中，花青素减少了血小板的凝结。这很重要，因为使血液变稀的效果，就能降低血液凝块的风险，减少心脏病发作。

蔓越莓甚至有助於预防乳癌。在动物实验中，已发现蔓越梅含有一种最强的抗癌成份：没食子酸盐（EGCG）。科学家说，只要很少的份量，它就能起很大的作用。

学感控

谢谢版主,下载了准备好好学习,借此来提高自己的英文阅读水平!