【摘要】 目的 探讨莫西沙星对急性重症胆管炎(ACST)的有效性及安全性。方法 采用前瞻性多中心方案，选择哈尔滨医科大学和黑龙江省医院6个普通外科病房2008年1~6月ACST病人50例，在外科干预同时给予莫西沙星400mg，每日1次静脉点滴，观察入院、用药后3d和7d病人体温、WBC、谷丙转氨酶（ALT）、总胆红素（TBIL）、碱性磷酸酶(AKP)、γ-谷氨酰转肽酶(GGT)及病原菌的变化情况。结果 50例病人中1例因用药后出现肝功能异常被剔除试验，其余49例在用药后3d有42例体温和WBC明显下降，肝功能各项指标在3d时也较入院时下降，差异有统计学意义（P<0.01），临床有效率85.7%。49例中有30例培养出细菌42株，其中混合感染11例(占36.7%),分离出大肠埃希氏菌22株(占73.3%)，其次肺炎克雷伯杆菌8株，肠球菌5株，用药后7d有35株致病菌菌消失或转阴,清除率达83.3%(35/42)。结论 大肠埃希氏菌、肺炎克雷伯杆菌、肠球菌是胆道感染主要致病菌。莫西沙星可有效清除胆道内病原菌，安全有效治疗ACST。

Clinical efficacy and safety of moxifloxacin for acute cholangitis of severe type--A prospective multi-centric study YIN Da-long*, LU Zhao-yang, LIU Lian-xin, et al. *The First Affiliated Hospital,Haerbin Medical University ,Haerbin 150001,China Corresponding author: LIU Lian-xin,E-mail:liulianxin@medmail.com.cn Abstract Objective To investigate the clinical efficacy and safety of moxifloxacin for acute cholangitis of severe type(ACST). Methods In this prospective, single-blind, multi-centric study a total of 50 consecutive patients from January 2008 to June 2008 with ACST were included the current clinical trial. The efficacy and safety of moxifloxacin 400 mg by intravenous infusion once daily were evaluated to treat ACST accompanying surgery or endoscopy. The clinical and bacteriologic response at different intervals after administration were observed, as well as body temperature, leucocytes, alanine aminotransferase, total bilirubin, alkaline phosphate andγ-glutamyltransferase. Results The temperature and leucocytes of 42 in 49 patients were markedly decreased at 3 days after treatment compared to those at admission . There were significant decrease (P<0.01) in alanine aminotransferase, total bilirubin, alkaline phosphate and γ-glutamyltransferase at 3 days comparable with those at admission, respectively. Clinical success rates at test-of-cure were 85.7% (42 of 49) for moxifloxacin. Pathogens were isolated from bile or blood cultures in all patients. Thirty out of 49 patients had positive bile and/or blood cultures, including 11(36.7%) patients with mixed infection with several species. The predominant strains were E.coli (22/49), Klebsiella species (8/49) and Enterococcus species (5/49). Bacterial eradication rates were 83.3%(35/42) for moxifloxacin at 7 days after administration.Conclusion E.coli, Klebsiella species and Enterococcus species were the most common bacteria isolated from bile or blood from patients with ACST and a mixed infection with several species was observed. Moxifloxacin evidently showed high clinical and bacteriological efficacies and safety in the hospitalized patients with ACST.