【摘要】  目的  评价阿奇霉素联合头孢丙烯治疗儿童上呼吸道细菌性感染的疗效和安全性。方法  采用随机双盲对照的方法，入选条件为临床表现有发热（体温>37.5℃）、咽喉肿痛、咽、扁桃腺充血、咳嗽等，血白细胞总数>10×109/L，和/或中性粒细胞比例升高。分3组，每组40例，A组口服希舒美，10mg·kg-1·d-1，每日1次，连服3d；B组口服施复捷，15mg·kg-1·d-1，每日2次，连服10天；C组口服希舒美和施复捷，剂量和疗程同上。观察指标为体温、血白细胞数，疗效判断标准分为治愈、显效、进步和无效。结果  A组（希舒美组）治愈26例，显效5例，进步4例，无效5例，总有效率为77.5%，不良反应为腹泻、呕吐2例，不良反应发生率为5%。B组（施复捷组）治愈27例，显效5例，进步4例，无效4例，总有效率为80%，不良反应为腹泻1例，皮疹1例，不良反应发生率为5%。C组治愈34例，显效4例，进步1例，无效1例，总有效率为95%；不良反应为腹泻、呕吐2例，皮疹1例，不良反应发生率为7.5%。所有病例均未因不良反应而中断治疗。A组与B组之间疗效比较，χ2=0.08，P>0.05，差异无显著性；A组与C组之间疗效比较，χ2=5.16，P=0.023，差异有显著性；B组与C组之间疗效比较，χ2=4.11，P=0.0425，差异有显著性。C组不良反应发生率与A组或B组比较（A组和B组的不良反应发生率相同），χ2=0.17，P>0.05，差异无显著性。结论   阿奇霉素治疗儿童上呼吸道细菌性感染有效，头孢丙烯治疗儿童上呼吸道细菌性感染有效，阿奇霉素联合头孢丙烯治疗儿童上呼吸道细菌感染疗效更好，优于单药给药，不良反应并未因联合治疗而增多，安全性好。    【关键词】  阿奇霉素  头孢丙烯  联合治疗  儿童  上呼吸道感染    Effect of azithromycin combined with cefprozil on treatment with children’s upper respiratory infections    【Abstract】  Objective  To evaluate the effects and side effects of azithromycin(zithromax) combined with cefprozil( cefzil) on treatment with children’s upper respiratory infections.Methods  The patients who suffered from upper respiratory infections with body temperature over 37.5 ℃ as well as white blood cells over 10×109/L were selected for treatment randomly and double-blindedly. These cases were divided by 3 groups， each group having 40 cases.Cases of group A were administered with zithromax 10mg·kg-1·d-1，once a day， continued with 3 days. Cases of group B were administered with cefzil 15mg·kg-1·d-1， twice a day， with 10 days continuously. Cases of group C were administered with both zithromax and cefzil as the same dose and duration as group A and group B. Changes of body temperature and white blood cells were considered as index to judge the effects of treatment. The criteria of judgement were divided as cure， markedly improved ， improved and failed.Results  In group A， 26 of 40 cases being cured， 5 of 40 cases being markedly improved， 4 of 40 cases being improved， while 5 of 40 cases failed， the total efficacy rate of  treatment was 77.5%. The main side effects of zithromax were diarrhea and vomiting， 2 cases suffered， the side-effect rate being 5%. In group B， 27 of 40 cases being cured， 5 of 40 cases being markedly improved， 4 of 40 cases being improved， while 4 of 40 cases failed， the total efficacy rate  of treatment was 80%. The side effects of cefzil were diarrhea， vomiting and skin rash， 1 case complaining of diarrhea and vomiting， 1 case of skin rash， the side-effect rate being 5%. While in group C， 34 of 40 cases being cured， 4 of 40 cases being markedly improved， 1 case improved， only 1 case failed， the total efficacy rate of treatment was 95%. 2 cases complained of diarrhea and vomiting， 1 case of skin rash， the side-effect rate being 7.5%.  The efficacy differences between group A and group B were not significant， χ2=0.08，P>0.05; while the efficacy differences between group A and group C were significant，χ2=5.16，P=0.023; and the efficacy differences between group B and group C were also significant，χ2=4.11，P=0.0425.On the other hand，the side-effect rate between group C and group A or group B was not significant， χ2=0.17，P>0.05.Conclusion  Zithromax was effective on treatment with children suffered from upper respiratory infection. Cefzil had the same effect on treatment with children suffered from upper respiratory infection. The effect on treatment with children suffered from upper respiratory infection was much better than either zithromax or cefzil single when zithromax and cefzil were administered together， while the side effects being not increased.    【Key words】  azithromycin  cefprozil  combined treatment  children  upper respiratory infection    上呼吸道感染是最常见的儿科疾病，病毒是主要的病原，其次是细菌，近年支原体、衣原体感染所占比例增高。在治疗儿童上呼吸道感染中抗生素的应用应慎重，针对性选用对细菌敏感的疗效好的抗生素，以免滥用或误用。阿奇霉素是近年广泛使用的大环内酯类抗生素，头孢丙烯是第二代头孢类抗生素，本文拟选用阿奇霉素联合头孢丙烯治疗儿童上呼吸道细菌性感染。观察它们的疗效和不良反应。    1  材料与方法    1.1  病例选择  我院就诊的儿童，入选的120例中，男71例，女49例，年龄10个月～10岁，平均5.0岁，无中途退出治疗者。咽拭子细菌培养阳性15例，占12.5%，其中链球菌6例，肺炎克雷白杆菌4例，卡他莫那菌3例，流感嗜血杆菌1例，血浆凝固酶阴性葡萄球菌1例。支原体、衣原体抗体阳性16例，占13.3%，合并病毒感染15例，占12.5%。随机分3组，每组40例，男女不限