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硫酸新霉素的作用优势与高效用药

发布时间：

2022-02-15

硫酸新霉素是一种氨基糖苷类抗生素。该品对葡萄球菌属(甲氧...

硫酸新霉素是一种氨基糖苷类抗生素。该品对葡萄球菌属(甲氧西林敏感株)、棒状杆菌属、大肠埃希菌、克雷伯菌属、变形杆菌属等肠杆菌科细菌有良好抗菌作用，对各组链球菌、肺炎链球菌、肠球菌属等活性差。铜绿假单胞菌、厌氧菌等对本品耐药。细菌对链霉素、新霉素和卡那霉素、庆大霉素间有部分或完全交叉耐药。新霉素全身用药有显著肾毒性和耳毒性，故目前仅限于口服或局部应用。

硫酸新霉素之所以被兽医和养殖者所青睐，主要是因为如下两个品种优势。

1无抗养殖的首选肠道药物。

针对家禽的治疗用药，其停药期只需5天；且停药5天之后，肌肉中几无任何药物残留（可理解为无抗）。

2对各种肠道疾病的治疗，高效又经济。

主要体现在，科学巧用和合理配伍使用条件下的"高效"治疗，以及药物本身比较便宜且物有效用量小的"经济"。

那么，好品质的硫酸新霉素，如何用好、用出"高效"的治疗效果呢？

这就需要了解硫酸新霉素的作用药理和抗菌谱，因为超出其有效作用和病原谱，再好的药物也会治疗无效的。

硫酸新霉素给畜禽口服给药，正常情况下其很少被吸收（在5%以内）。但是，若是连续口服较大剂量，尤其是当肠粘膜有溃疡或炎症时，畜禽胃肠道对硫酸新霉素仍可有相当量的吸收。特别是在畜禽肾功能减退时，进入机体内的硫酸新霉素排泄减慢，此时机体内的血药浓度可显著升高。

对于基层兽医和一线用药者来说，切记不要用硫酸新霉素注射全身给药，因为注射给药的硫酸新霉素具有显著的肾毒性，故目前硫酸新霉素仅限于口服，且口服的有效性和安全性已经在畜禽临床有了六七十年的使用历史了。

它是一种常用药。但是，很多人却没有把这个药的效果用出来和用出"高效"。

关键问题在于：大家在使用硫酸新霉素兽药产品的时候，必须联合配伍给药，开具处方时至少配伍两种以上的药物使用。

在治疗肠炎型的大肠杆菌，用新霉素配硫氰酸红霉素、酒石酸泰乐菌素或替米考星溶液等大环类药物。因为硫酸新霉素跟大环类药物共用时，它们之间会产生协同的作用可以增加药效；这个时候，若再加入TMP增效剂，则效果会来得更快。

具体到临床实际配方怎么确定，硫酸新霉素的有效治疗用量，按照1g硫酸新霉素兑水8~10斤；上述大环类药物，治疗则1g兑水10~15斤水；TMP有效用量的计算，核算方法是两药相加之和，增效按照药敏检测3:1、4:1或5:1来计算！

当然，上述硫酸新霉素的知识和使用技巧，只是一小部分。

硫酸新霉素较为独特的杀菌机制和作用靶点，使得其与目前兽医临床常见抗感染药物，基本不存在药理配伍禁忌。仅在理化作用方面，硫酸新霉素与头孢类抗感染药物有反应，需要在给药时，分开使用即可。

硫酸新霉素给鸡口服后，很少被胃肠道所吸收。特别是在肠粘膜完整的状态下，经内服被吸收进入血液的硫酸新霉素总量，尚不到总给药量的5％。

可是，一旦消化道粘膜有溃疡、或者表皮剥落、或者消化道粘膜有炎症等粘膜不完整的情况下，可有最大接近20%的内服硫酸新霉素，会透过通透性显著增加的消化道粘膜，进入机体内循环而被输布到肝脏、肾脏、心脏、肺部和腹腔等组织器官。

被吸收进入机体的硫酸新霉素，多浓集于有核细胞内，尤其是在白细胞内的含量最高。大部分通过肾脏被很快排出体外。但是，若肾功能不全时，硫酸新霉素的排泄将受阻、会减慢；而那些绝大部分未被吸收的硫酸新霉素，会随粪便排出体外。在24小时之内，哪些吸收进入体内的硫酸新霉素，约有12%～25%由肾脏排出体外，约有50%～90%由胆汁排出。

硫酸新霉素在抗菌谱方面，主要对革兰氏阴性菌作用最优，尤其是对大肠杆菌和沙门沙门氏菌的作用较强；大剂量的硫酸新霉素，对鸡支原体也具有较好的作用效果。但是，由于药物加大剂量会显著降低药品的经济价值，同时也会增加不良反应发生的概率。因此，兽医临床针对支原体的治疗，除了使用大环内酯类药物之外；在国外，更多的使用大观霉素。

然而，硫酸新霉素与青霉素类、头孢类、沙星类、磷霉素类、四环素类、大环内酯类等抗菌素之间的联合给药，对较为严重的细菌性全身感染和比较难治的呼吸道病，尤其在配伍克拉维酸钾、甲氧苄啶、舒巴坦等一些增效剂的时候，比单用硫酸新霉素具有更高、更好、更经济的应用价值。这是，为什么我们提倡老药新用的主要原因。

所以说，单用一个药治病，这都是按图索骥（按照说明书使用）、不需要啥本事、谁都会！但是，一旦一个药治不了疾病时，就说某个品质有保障的兽药产品不好，那是不对的。因为一个品质有保障的兽药产品，只是有效治疗的基础。

而如何通过联合配伍、协同增效、改变用法等技术能力和经验总结，把一个药（排除非法复方）单用、两个药机械相加等简单的传统治病思维，上升到把药理搞明白、把制剂特点搞清楚、把处方能力提起来，那才是真本事、大兽医!

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