BACKGROUND & AIMS: :Essentials Prophylaxis is the standard of care for congenital factor XIII-A (FXIII-A) deficiency. Six children with FXIII-A deficiency received once-monthly prophylaxis with recombinant FXIII-A. Prophylaxis was well tolerated and no anti-FXIII antibodies were detected. Prophylaxis was effective with an annualized bleeding rate of zero. SUMMARY:Background Factor XIII deficiency is a rare, severe congenital bleeding disorder. Monthly prophylaxis with recombinant FXIII A-Subunit (rFXIII) has demonstrated favorable safety and efficacy in patients aged ≥ 6 years, and may similarly benefit younger children. Objective To evaluate the long-term safety and efficacy of rFXIII in children aged < 6 years with congenital FXIII A-subunit deficiency. Patients/methods Six children, who had previously completed a single-dose pharmacokinetic trial of rFXIII, received 35 IU kg-1 rFXIII every 28 days (± 2 days) for a minimum of 52 weeks, and were evaluated for bleeding and adverse events. The Berichrom FXIII activity assay was used to monitor FXIII activity. Results The children, three girls and three boys, had an average age of 3.0 years (range: 1-4 years) at enrollment. The total treatment duration was 1.8-3.5 years, giving a total of 16.6 patient-years. No antibody development, thromboembolic events or allergic reactions occurred. There were 93 mild and seven moderate adverse events. Two adverse events (lymphopenia and gastroenteritis) were reported as probably or possibly related to rFXIII in two children. Two serious adverse events, unrelated to rFXIII, were reported in a single child, each related to head injury, and neither resulting in intracranial hemorrhage. The geometric mean FXIII activity trough was 0.19 IU mL-1 . No bleeding episodes requiring treatment with an FXIII-containing hemostatic agent occurred during the trial; thus, the annualized bleeding rate was 0. Conclusions Consistent with data from older age groups, prophylaxis with rFXIII appears to be safe and effective in young children with congenital FXIII A-subunit deficiency.

背景与目标：

BACKGROUND & AIMS: :The prevention of venous thromboembolism is a major concern in cancer patients undergoing pelvic surgery. Radical retropubic prostatectomy is a common treatment for localized prostate cancer and has been identified as a high risk procedure for postoperative venous thromboembolism. However, most patients diagnosed with prostate cancer in the current era have clinically localized, low volume disease and the risk of venous thromboembolism is very low. Multiple guidelines exist for the prevention of venous thromboembolism in patients undergoing radical retropubic prostatectomy and pharmacological venous thromboembolism prophylaxis is recommended. Most urological surgeons in the USA however, do not routinely utilize pharmacological prophylaxis. A major concern arises when radical retropubic prostatectomy is performed with a concomitant pelvic lymphadenectomy. Pharmacological prophylaxis is known to increase the rate of lymph drainage and the rate of lymphocele formation. Evidence suggests that lymphocele may be an independent risk factor for venous thromboembolism in the postoperative period. These factors raise concern over current guidelines calling for routine use of pharmacological venous thromboembolism prophylaxis in radical retropubic prostatectomy especially when lymphadenectomy is performed simultaneously.

背景与目标： : 预防静脉血栓栓塞是接受骨盆手术的癌症患者的主要关注点。耻骨后前列腺根治术是局部前列腺癌的常见治疗方法，已被确定为术后静脉血栓栓塞的高风险手术。但是，当今时代诊断为前列腺癌的大多数患者都具有临床局限性，低体积的疾病，并且发生静脉血栓栓塞的风险非常低。在接受根治性耻骨后前列腺切除术的患者中，有多种预防静脉血栓栓塞的指南，建议使用药物预防静脉血栓栓塞。然而，美国大多数泌尿外科医生并不常规使用药物预防。当进行根治性耻骨后前列腺切除术并同时进行盆腔淋巴结清扫术时，会引起主要关注。已知药物预防会增加淋巴引流率和淋巴囊肿形成率。有证据表明，淋巴囊肿可能是术后静脉血栓栓塞的独立危险因素。这些因素引起了人们对当前指南的关注，该指南要求在根治性耻骨后前列腺切除术中常规使用药理学静脉血栓栓塞预防，尤其是同时进行淋巴结清扫术时。

BACKGROUND & AIMS: BACKGROUND:Optimal prophylaxis against cytomegalovirus (CMV) disease for organ transplant patients at risk for primary infection (donor seropositive, recipient seronegative, D+R-) remains to be determined. We hypothesized that prolonged oral ganciclovir therapy following intravenous therapy would provide increased protection. METHODS:A total of 155 evaluable D+R- organ transplant recipients from 13 transplant centers were entered into the study: all received intravenous ganciclovir (5 mg/kg/day) for 5-10 days and then either oral acyclovir (400 mg tid) or oral ganciclovir (1 g tid) for an additional 12 weeks. Patients were assigned to their treatment groups at a central randomization site, with a separate randomization scheme for each of the organs transplanted (kidney, heart, or liver). In the case of kidney transplants, the patients were stratified according to source of the kidney (living related vs. cadaveric donor). The primary endpoint was the incidence of CMV disease in the first six months post-transplant. RESULTS:Treatment with oral ganciclovir was associated with a significant decrease in the incidence of symptomatic disease or viremia when compared with the oral acyclovir group (32% vs. 50%, P<0.05). This difference was most marked in terms of tissue invasive disease: only 3 of 15 symptomatic patients in the ganciclovir group vs. 10 of 21 in the acyclovir group developed tissue-invasive infection (P<0.05). There was a significant difference in the time to CMV disease or viremia in the two groups: mean time 212+/-17 days post-transplant for the acyclovir group vs. 291+/-13 days for the ganciclovir group (P<0.001). The incidence of allograft rejection was 34% in the ganciclovir group and 46% in the acyclovir group (P=NS). Leukopenia was more common in the ganciclovir group (P<0.05), but in no case did it require drug discontinuation. Ganciclovir resistance did not develop in this study. CONCLUSION:Prophylaxis with oral ganciclovir following a brief course of intravenous ganciclovir provides useful protection against primary CMV disease.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:The authors conducted an in vivo study to determine if low-speed handpiece motors can become contaminated with oral flora when used with prophylaxis angles. METHODS:This crossover study involved 20 subjects, two types of handpieces and three prophylaxis angles. The authors used each handpiece/prophylaxis angle system to polish teeth. They then collected samples, spiral-plated the specimens and incubated them at 37 degrees C anaerobically and aerobically (with 5 percent carbon dioxide). After incubation, the authors examined the plates for the presence of bacterial colonies. RESULTS:At least 75 percent of the handpiece/prophylaxis angle systems used on the 20 subjects had bacterial contamination for at least one cultured area. Of the 420 specimens, 258 (61.4 percent) produced bacterial growth. Contamination varied from zero to 6,300 colony-forming units per milliliter. CONCLUSIONS:These data suggest that the internal surfaces of low-speed handpieces can become microbially contaminated during use with prophylaxis angles. CLINICAL IMPLICATIONS:Unless low-speed handpieces are sterilized properly after each use, they pose a risk for crossinfection.

背景与目标：

BACKGROUND & AIMS: :One of the most common reasons for failure of primary total knee arthroplasty and need for revision surgery is periprosthetic infection. Antibiotics are one of the mainstays of treatment to address prosthetic joint infections, but the route of administration and timing of delivery to optimize patient outcomes are debated. This article reviews the use and attributes of commonly used oral antibiotics, especially extended or long-term utilization, as prophylaxis and treatment for prosthetic joint infections in a primary or revision total knee arthroplasty, which include debridement, antibiotics, and implant retention, one-stage and two-stage exchange arthroplasty.

背景与目标： : 初次全膝关节置换术失败和需要翻修手术的最常见原因之一是假体周围感染。抗生素是治疗假体关节感染的主要手段之一，但给药途径和给药时机以优化患者预后仍存在争议。本文回顾了常用的口服抗生素的用途和属性，尤其是长期或长期使用，作为预防和治疗原发性或翻修全膝关节置换术中的假体关节感染，包括清创术，抗生素和植入物保留，一阶段和两阶段交换关节置换术。

BACKGROUND & AIMS: :Our aim was to investigate the correlation among antibiotic prophylaxis, difficulty of extraction, and postoperative complications in the removal of lower 3rd molars. A total of 1222 such extractions in 890 patients between January 2010 and January 2012 were analysed retrospectively. The difficulty of extraction measured by Pederson's index, antibiotic prophylaxis with cefditoren, and postoperative complications were recorded. The difficulty of extraction was significantly associated with postoperative complications (p=0.03). There were no significant associations between antibiotic prophylaxis and postoperative complications in groups of equal difficulty ("easy" group (class I) p=1.00; "moderate" group (class II) p=1.00; and "difficult" group (class III) p=0.65). There was a small but insignificant increase in the number of dry sockets and infections in class III cases. In conclusion, this study provides further evidence that antibiotic prophylaxis for the prevention of postoperative inflammatory complications is unnecessary for extraction of 3rd molars.

背景与目标： : 我们的目的是研究抗生素预防，拔除困难和术后并发症之间的相关性。回顾性分析了2010年1月和2012年1月之间的890例患者中的1222例此类提取物。记录peterson指数测量的提取难度，头孢托仑预防抗生素和术后并发症。拔除困难与术后并发症显著相关 (p = 0.03)。在同等困难的组 (“轻松” 组 (I类) p = 1.00; “中度” 组 (II类) p = 1.00; 和 “困难” 组 (III类) p = 0.65) 中，抗生素预防与术后并发症之间没有显着关联。在III类病例中，干插座和感染的数量略有增加，但微不足道。总之，这项研究提供了进一步的证据，表明抗生素预防预防术后炎症并发症对于拔除第三磨牙是不必要的。

BACKGROUND & AIMS: :The emergence of fluoroquinolone-resistant gram-negative organisms has been demonstrated in patients given fluoroquinolone prophylaxis. To prevent increases in resistant bacteria, we restricted prophylactic use of fluoroquinolones. The spectrum and susceptibility patterns of isolates causing bloodstream infection (BSI) were assessed in patients receiving chemotherapy during periods of routine prophylaxis (period A: October 2001 to May 2003) and restricted prophylaxis (period B: June 2003 to January 2005). The total number of patients receiving chemotherapy was 442 during period A and 365 during period B. No significant differences were seen between periods with respect to patient characteristics. BSI was identified in 42 patients (44 episodes) during period A and 69 patients (74 episodes) during period B. Incidence of BSI increased significantly from 10.0% (44/442) during period A to 20.3% (74/365) during period B (P < 0.0001). Rate of Enterobacteriaceae BSI increased significantly, from 2.0% (9/442) during period A to 8.2% (30/365) during period B (P < 0.0001). For all BSI episodes, the proportion of BSI with gram-positive cocci decreased from 63.6% (28/44) during period A to 44.6% (33/74) during period B (P = 0.045), while the proportion of BSI with Enterobacteriaceae increased from 20.5% (9/44) to 40.5% (30/74) (P < 0.0001). The proportion of fluoroquinolone-resistant Enterobacteriaceae BSI for all Enterobacteriaceae BSI decreased from 75% (9/12) during period A to 17% (5/30) during period B (P = 0.0078). Restriction of fluoroquinolone prophylaxis affects the etiology of BSI and reduces the proportion of drug-resistant organisms.

背景与目标： : 在给予氟喹诺酮预防的患者中，已经证实出现了对氟喹诺酮类耐药的革兰氏阴性生物。为了防止耐药细菌增加，我们限制了氟喹诺酮类药物的预防性使用。在常规预防 (A期: 2003年5月2001年10月) 和限制性预防 (B期: 2005年1月2003年6月) 期间接受化疗的患者中，评估了引起血流感染 (BSI) 的分离株的谱和易感性模式。接受化疗的患者总数在A期442，在B期365。就患者特征而言，不同时期之间没有显著差异。在A期42例患者 (44次发作) 和B期69例患者 (74次发作) 中鉴定出BSI。BSI的发生率从A期的10.0% (44/442) 显着增加到B期的20.3% (74/365) (P <0.0001)。肠杆菌科BSI的比率显着增加，从A期的2.0% (9/442) 增加到B期的8.2% (30/365) (P <0.0001)。对于所有BSI发作，具有革兰氏阳性球菌的BSI比例从A期的63.6% (28/44) 降至B期的44.6% (33/74) (P = 0.045)，而BSI与肠杆菌科的比例从20.5% (9/44) 增加到40.5% (30/74) (P <0.0001)。所有肠杆菌科BSI中耐氟喹诺酮的肠杆菌科BSI的比例从A期的75% (9/12) 降至B期的17% (5/30) (P = 0.0078)。氟喹诺酮预防的限制会影响BSI的病因并降低耐药生物的比例。

BACKGROUND & AIMS: :Intrauterine fetal death and maternal shock occurred as a result of a type-1 hypersensitivity reaction following antibiotic prophylaxis in a cesarean section. Amniotic fluid embolism may mimic the condition. The ability to diagnose and treat such an event as early as possible is necessary in all maternity centers. The selection of antibiotic regimen and the type of anesthesia should be individualized depending upon the existing facilities and the patient's profile, especially in a resource-scarce developing country.

背景与目标： : 剖宫产术后使用抗生素预防后，由于1型超敏反应而导致宫内胎儿死亡和产妇休克。羊水栓塞可能模仿这种情况。所有产科中心都必须具备尽早诊断和治疗此类事件的能力。抗生素方案的选择和麻醉类型应根据现有设施和患者的情况进行个性化选择，尤其是在资源稀缺的发展中国家。

BACKGROUND & AIMS: :Although acyclovir prophylaxis against varicella zoster virus (VZV) infection for ≥1 year is recommended after allogeneic hematopoietic cell transplantation (HCT), the emergence of acyclovir-resistant viruses and adverse drug effects cannot be ignored. We investigated the cumulative incidence of VZV infection after allogeneic HCT in children receiving a shorter duration of acyclovir prophylaxis than recommended and evaluated the appropriateness of the short duration of acyclovir prophylaxis.Medical records of 217 children who received allogeneic HCT were retrospectively reviewed until a median of 25 months (range = 1-59 months) after HCT. Acyclovir prophylaxis was given for a median of 9 weeks (range = 3-24 weeks) after HCT.VZV infection was diagnosed in 33 (15.2%) children at a median time of 5 months (range = 2-41 months) after HCT. The 1-year and 2-year cumulative incidences of VZV infection after allogeneic HCT were 11.2% and 15.5%, respectively. These incidences were between the previously reported 1-year incidence of 25% to 30% in patients not receiving prophylaxis and 1-year incidence of 4% to 5% in patients receiving ≥1 year duration of prophylaxis. Male sex and older age were significantly associated with VZV infection after allogeneic HCT. Only 1 chickenpox patient experienced severe complications because of VZV infection, and there were no deaths attributable to VZV infection.In conclusion, a shorter duration of acyclovir prophylaxis may be appropriate for children receiving allogeneic HCT, based on the rare occurrence of severe complications because of VZV infection and the expected discomfort because of daily oral medication for a long time.

背景与目标： : 尽管异基因造血细胞移植 (HCT) 后建议使用阿昔洛韦预防水痘带状疱疹病毒 (VZV) 感染 ≥ 1年，但阿昔洛韦耐药病毒的出现和药物不良反应不容忽视。我们调查了接受阿昔洛韦预防时间比推荐时间短的儿童在异基因HCT后VZV感染的累积发生率，并评估了阿昔洛韦预防时间短的适当性。回顾性回顾了接受异基因HCT的217名儿童的病历，直到中位数为25个月 (范围   = 1-59个月)) 在HCT之后。在HCT后的中位时间为9周 (范围   =   3-24周) 给予阿昔洛韦预防治疗。在HCT后的中位时间为5个月 (范围   =   2-41个月) 的33 (15.2%) 名儿童中诊断出VZV感染。异基因HCT后VZV感染的1年和2年累积发生率分别为11.2% 和15.5%。这些发生率介于先前报道的未接受预防的患者1年25% 至30% 的发生率和接受 ≥ 1年预防持续时间的患者1年4% 至5% 的发生率之间。同种异体HCT后，男性和年龄较大与VZV感染显着相关。只有1名水痘患者因VZV感染而出现严重并发症，并且没有因VZV感染而导致的死亡。总之，较短的阿昔洛韦预防时间可能适合接受同种异体HCT的儿童。基于因VZV感染而罕见的严重并发症的发生，以及因长期每日口服药物而预期的不适。

BACKGROUND & AIMS: INTRODUCTION:Chemotherapy-induced nausea and vomiting (CINV) can be a serious and debilitating adverse effect that is highly feared by cancer patients. For patients receiving moderately emetogenic chemotherapy regimens at our institution in the ambulatory infusion center, palonosetron was selected as the preferred serotonin (5-HT3) antagonist for CINV prophylaxis per the 2016 NCCN Guidelines, when a neurokinin1 antagonist was not included in the prophylactic regimen. The purpose of this study was to evaluate the efficacy of dexamethasone and palonosetron versus granisetron for the prevention of CINV in patients receiving moderately emetogenic chemotherapy regimens. METHODS:This study is an Institutional Review Board-approved, single-center retrospective review of electronic health records including patients who received moderately emetogenic chemotherapy regimens with CINV prophylaxis with dexamethasone and either palonosetron or granisetron. RESULTS:A total of 268 eligible patients were included in the study. Eighty-eight patients received palonosetron and 180 patients received granisetron as their 5-HT3 receptor antagonist between October 31, 2014 and October 31, 2016. There were no statistically significant differences between the two antiemetic groups for the primary outcome of presence of any change in day 1 intravenous prophylactic antiemetics. Nine (10.23%) palonosetron patients and 15 (8.33%) granisetron patients required a change in their day 1 intravenous prophylactic antiemetics (P = 0.610). CONCLUSIONS:Despite palonosetron's better efficacy, longer half-life, and higher binding affinity, the results of this retrospective review demonstrates that the choice of serotonin antagonist, palonosetron or granisetron, did not result in a change in day 1 intravenous prophylactic antiemetics or antiemetic outpatient medications for patients undergoing moderately emetogenic chemotherapy regimens.

背景与目标：

BACKGROUND & AIMS: :The objective of this study was to elucidate factors that predicted the initiation of HIV postexposure prophylaxis (PEP) for blood or body fluid exposures evaluated at Rhode Island emergency departments (EDs). The study involved a retrospective review of patient visits to all civilian Rhode Island EDs for these exposures from 1995 to mid-2001. Multivariate logistic regression models were created to evaluate predictors of the offering and the acceptance and receipt of HIV PEP from 1996 to 2001. The search identified 3622 patients who sustained a blood or body fluid exposure. Of these, 43.8% were health care workers (HCWs) and 57.2% were not HCWs. Most (52.0%) of the exposures were nonsexual. HIV PEP was offered to 21.0% and accepted and received by 9.4% of all patients. HIV PEP was offered more often after significant exposures, exposures to known HIV-infected sources, when time elapsed after the exposure was shorter, if the patients were HCWs, adults, presented to a teaching hospital, presented during the latter years of the study, or sustained nonsexual exposures. Once offered HIV PEP, patients who were male, adult, sustained a significant exposure, knew the source was HIV infected, sustained a nonsexual exposure, or were HCWs had a greater odds of accepting and receiving HIV PEP. Even when controlling for exposure significance, HIV status, and time elapsed since the exposure, several factors such as gender and type of hospital that are unrelated to the exposure appeared to influence the initiation of HIV PEP. ED providers should ensure that these factors do not inappropriately restrict its initiation.

背景与目标： : 这项研究的目的是阐明在罗德岛急诊科 (EDs) 评估的血液或体液暴露中预测HIV暴露后预防 (PEP) 开始的因素。该研究涉及对所有与2001年中1995年的暴露情况的患者访问罗德岛所有平民EDs的回顾性审查。建立了多变量逻辑回归模型，以评估产品的预测因素以及对HIV PEP 1996年2001年的接受和接受。搜索确定了3622名持续暴露于血液或体液的患者。其中，43.8% 是卫生保健工作者 (hcw)，57.2% 不是hcw。大多数 (52.0%) 暴露是非性行为。HIV PEP被提供给21.0%，并被所有患者的9.4% 接受和接受。HIV PEP在大量暴露，暴露于已知的HIV感染来源后，暴露时间较短，如果患者是HCWs，成人，被送往教学医院，在研究的后期进行，或持续的无性暴露后更频繁地提供。一旦提供了HIV PEP，男性，成年，持续大量暴露，知道来源是HIV感染，持续无性暴露或HCWs接受和接受HIV PEP的可能性更大。即使在控制暴露的重要性，HIV状态和暴露后经过的时间时，与暴露无关的几个因素 (例如性别和医院类型) 似乎也会影响HIV PEP的启动。ED提供者应确保这些因素不会不适当地限制其启动。

BACKGROUND & AIMS: BACKGROUND:Many patients with aggressive B-cell lymphomas and high clinical risk score still die of lymphoma after conventional R-CHOP chemoimmunotherapy. We hypothesized that intensified chemoimmunotherapy including systemic central nervous system (CNS) prophylaxis improves outcome and reduces the incidence of CNS-related events. PATIENTS AND METHODS:Inclusion criteria were age 18-65 years, primary diffuse large B-cell lymphoma or grade III follicular lymphoma without clinical signs of CNS disease and negative cerebrospinal fluid cytology, age-adjusted International Prognostic Index 2-3 and WHO performance score 0-3. Treatment consisted of six courses of R-CHOEP-14 followed by a course of high-dose cytarabine and a course of high-dose methotrexate. Primary end point was failure-free survival (FFS) at 3 years. RESULTS:A total of 156 eligible patients with a median age of 54 years (range 20-64) were included. Three toxic deaths were observed. Three-year overall survival (OS) and FFS rates (median observation time 52 months for survivors) were 81% and 65%, respectively. Seven patients experienced CNS relapse, all within 6 months. CONCLUSIONS:The results are promising with favorable 3-year OS and FFS rates, a low toxic death rate and a lower than expected number of CNS events. CNS progression might be further reduced by earlier CNS prophylaxis. CinicalTrials.gov. identifier NCT01502982.

背景与目标：

BACKGROUND & AIMS: OBJECTIVES:Proton pump inhibitors (PPIs) and H2-receptor antagonists (H2RAs) present varying pharmacological efficacy in preventing stress ulcer bleeding (SUB) in intensive care units. The literature also reports disparate rates of ventilator-assisted pneumonia (VAP) as side effects of these treatments. We compared the cost-effectiveness of these two prophylactic pharmacological options. METHODS:We constructed a decision tree with a 60-day time horizon for patients at high risk for developing SUB, receiving either PPIs or H2RAs. For each treatment strategy, patients could be in one of three states of health: SUB, VAP, or no complication. Contemporary, clinically relevant probabilities were obtained from a broad literature search. Costs were estimated by using a representative US countrywide database. A third-party payer perspective was adopted. Cost-effectiveness and univariate and multivariate sensitivity analyses were performed. RESULTS:Probabilities of SUB and VAP were 1.3% and 10.3% for PPIs versus 6.6% and 10.3% for H2RAs, respectively. Lengths of stay and per diem costs were 24 days and US $2764 for SUB, 42 days and US $3310 for VAP, and 14 days and US $2993 for patients without complications. Average costs per no complication were US $58,700 for PPIs and US $63,920 for H2RAs. The H2RA strategy was dominated by PPIs. Sensitivity analysis showed that these findings were sensitive to VAP rates but PPIs remain cost-effective. The acceptability curve shows the stability of the probabilistic results according to varying willingness-to-pay values. CONCLUSION:PPI prophylaxis is the most efficient prophylactic strategy in patients at high risk of developing SUB when compared with using H2RAs.

背景与目标：

BACKGROUND & AIMS: :Malaria causes illness or death in unprotected travelers. Primaquine prevents malaria by attacking liver-stage parasites, a property distinguishing it from most chemoprophylactics and obviating 4-week postexposure dosing. A daily adult regimen of 30 mg primaquine prevented malaria caused by Plasmodium falciparum and P. vivax for 20 weeks in 95 of 97 glucose-6-phosphate dehydrogenase (G6PD)-normal Javanese transmigrants in Papua, Indonesia. In comparison, 37 of 149 subjects taking placebo in a parallel trial became parasitemic. The protective efficacy of primaquine against malaria was 93% (95% confidence interval [CI] 71%-98%); against P. falciparum it was 88% (95% CI 48%-97%), and >92% for P. vivax (95% CI >37%-99%). Primaquine was as well tolerated as placebo. Mild methemoglobinemia (mean of 3.4%) returned to normal within 2 weeks. Blood chemistry and hematological parameters revealed no evidence of toxicity. Good safety, tolerance, and efficacy, along with key advantages in dosing requirements, make primaquine an excellent drug for preventing malaria in nonpregnant, G6PD-normal travelers.

背景与目标： : 疟疾导致未受保护的旅行者生病或死亡。Primaquine通过攻击肝期寄生虫来预防疟疾，这种特性使其与大多数化学预防药物区分开来，并避免了暴露后4周的剂量。每天服用30 mg伯喹的成人方案可预防由恶性疟原虫和间日疟原虫引起的疟疾，持续20周，在印度尼西亚巴布亚的97种葡萄糖-6-磷酸脱氢酶 (G6PD) 正常爪哇人转运中，有95种。相比之下，在平行试验中服用安慰剂的149名受试者中有37名成为寄生虫。93% 了primaquine对疟疾的保护作用 (95% 置信区间 [CI] 71%-98%); 对恶性疟原虫的保护作用是88% 的 (95% CI 48%-97%)，并且> 92% 对间日疟原虫 (95% CI >37%-99%)。伯喹的耐受性与安慰剂一样好。轻度高铁血红蛋白血症 (平均3.4%) 在2周内恢复正常。血液化学和血液学参数未显示毒性证据。良好的安全性，耐受性和有效性，以及在剂量要求方面的关键优势，使primaquine成为预防非孕妇，G6PD-normal旅行者疟疾的出色药物。

BACKGROUND & AIMS: OBJECTIVES:Although the usefulness of antimicrobial prophylaxis for clean-contaminated surgery has been recognized, only a few randomized controlled studies on the duration of administration after hepatectomy have been performed. We investigated the duration of antimicrobial prophylaxis after hepatectomy. METHODS:The subjects were 180 patients who underwent hepatectomy without reconstruction of the biliary or intestinal tract between April 2003 and March 2006 at our department. The patients were randomly allocated to groups to be treated with flomoxef sodium as antimicrobial prophylaxis for 2 days (89 patients) or 5 days (91 patients), including the operation day. The presence or absence of systemic inflammatory response syndrome (SIRS) and infections was investigated. RESULTS:No significant differences were noted in patient background between the two groups. Infections occurred in seven and six patients in the 2 day and 5 day treatment groups (7.9% and 6.6%), respectively, showing no significant difference between the two groups. No significant difference was noted when the cases were divided into surgical site infections and remote infections. The positive rate of SIRS was significantly higher in the 2 day treatment group than in the 5 day treatment group on days 2 and 3 after surgery. The risk factors in patients who developed infections were blood loss, operation time and the complication of biliary fistula. CONCLUSIONS:Two day administration of flomoxef sodium may be sufficient for antimicrobial prophylaxis after hepatectomy. However, when SIRS is positive on post-operative day 2, and induction of liver failure is of concern, it may be safer to continue antimicrobial drug administration until SIRS is eliminated.

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