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Objective To observe the therapeutic effects of the drugs alternation multiple stages and long term therapy in elderly patients with recurrent urinary tract infection.Methods The patients were divided into elderly group (age≥65 years,n=30) and non-elderly group (n=48).The multiple effective antibiotics were selected for alternate use.The treatment included four periods as follows:(1)Treatment period:the regular dose of antibiotic was maintained until the urine routine test result became normal;(2)Consolidation period:the dosage of antibiotic was reduced;(3)Maintenance period:the dosage of antibiotic was reduced to once every night and the treatment should be kept for three months;(4)Observation period:the patients were observed for six months after withdrawal of antibiotics.During the treatment,if the urine routine test became abnormal repeatedly,the patient should return to the previous treatment period.During the treatment and consolidation period,each medication should be applied for one week alternatively.Results Among 78 patients,69 cases (88.5%) were cured,7 cases (8.9%) were effective,and two cases (2.56%) were invalid.There were 28 cured cases,1 effective case and 1 invalid case in elderly group.The corresponding data were 41,6 and 1 in non-elderly group,respectively.There was no difference in cure rate between the two groups (F= 0.469).Compared with non-elderly group,the overall treatment time [(54.8± 16.2)weeks vs.(44.5± 13.7) weeks,t= 2.8467,P＜0.01],treatment period [( 34.3± 15.2) weeks vs.(26.2±14.8) weeks,t=2.2081,P＜0.05] and consolidation period [(5.7±2.6) weeks vs.(4.1±0.2) weeks,t=3.9369,P＜0.01] were all prolonged in elderly group.But there was no difference in maintenance period [(14.8±4.6) weeks vs.(14.2±3.1) weeks,t=0.6480,P＞0.05].There were no markedly changes in blood routine,liver and kidney function during the course of treatment.Conclusions For the elderly patients with recurrent urinary tract infection,the drugs alternation,multiple stages and long-term treatment has a high cure rate and no adverse effect on blood routine,liver and renal function.
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OBJECTIVE To compare mycophenolate mofetil(MMF) with azathioprine(AZA) addition to ciclosporin-prednisone protocol after kidney transplantation in aspect of infections,and to study the etiology of pulmonary infection and urinary tract infection in the two groups.METHODS Totally 249 patients with kidney transplantation were analyzed retrospectively.These patients were divided into two groups according to the immunosuppressive regimen: AZA group(89 patients),and MMF group(160 patients).The various infectious complications were analyzed during a 1-year follow-up,and the etiology of pulmonary infection and urinary tract infection was studied in the two groups.RESULTS The total incidence of the infections,the incidences of the pulmonary infection,urinary tract infecion,wound infection,and so on,during a 1-year follow-up,were equivalent between the two groups.But the incidence of ARDS and the mortality of patients with lung infection was significantly different.The etiology of pulmonary infection was different between the two groups.Cytomegalovirous and fungal infections were higher in MMF group than those in AZA group.Also the etiology of urinary tract infection was different,the incidences of Gram-positive bacterial and fungal infections were higher in MMF group than those in AZA group.CONCLUSIONS Comparing with AZA,MMF increased the opportunity of serious lung infection.The incidences of opportunistic infection and fungal and viral infections increased obviously in MMF group.So therapy should be individualized and aimed.
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Objective To evaluate the clinical value of two-hour post-dose cyclosporine (CsA) level (C 2) monitoring in renal transplantation (RTx) recipients with functional renal allograft more than one year.Methods 126 RTx recipients with functional renal allograft more than one year treated with CsA-microemulsion-based triple therapy immunosuppression were enrolled. Whole blood samples were collected 2?h after CsA administration and the CsA level was measured by fluorescence polarization immunoassay (TDx).Results C 2 levels at 3 month and 1 year following RTx were 0.830 ? 0.307 ??mol/L and 0.678 ? 0.306 ??mol/L respectively, average C 2 level between 1 to 5 years was 0.609 ? 0.195 ??mol/L,and after 5 and 10 years, C 2 levels decreased to 0.546 ? 0.163 ??mol/L and 0.547 ? 0.227 ??mol/L respectively. Adequate C 2 level in the first 5 years after RTx was correlated with improved allograft renal function and there was a significant relationship between C 2 level and CsA dose. Variation of C 2 level became greater in long-term survival RTx recipients.Conclusion In long term maintenance phase of RTx recipients, C 2 concentration was also useful in the CsA therapeutic monitoring, but the variation became greater in such patients.