社区获得性肺炎左氧氟沙星序贯疗法的临床评价与成本效果分析

目的 探讨左氧氟沙星序贯疗法治疗社区获得性肺炎的疗效.方法 将社区获得性肺炎有效病例134例分为序贯治疗组(68例)和对照组(66例),序贯治疗组采用左氧氟沙星序贯疗法,对照组采用静脉滴注疗法.结果 2组治愈率比较无显著性差异(P＞0.05),序贯治疗组治疗费用、不良反应均明显低于对照组(P＜0.01或0.05).结论 左氧氟沙星序贯疗法治疗社区获得性肺炎疗效确切,可缩短住院时间,降低医疗费用,减少不良反应发生,使患者依从性提高,是治疗社区获得性肺炎的理想疗法.     

莫西沙星序贯治疗老年人社区获得性肺炎的临床研究

目的探讨莫西沙星序贯治疗老年社区获得性肺炎的临床疗效，安全性和治疗费用。方法70例老年社区获得性肺炎患者先给予莫西沙星注射液400mg／250ml静脉滴注，每天1次，治疗5～7d。临床症状改善后，随机分成序贯组和对照组。序贯组35例换予莫西沙星片剂400mg口服，每天1次。对照组35例继续使用莫西沙星注射液400mg／250ml静脉滴注，每天1次。两组总疗程14d。观察治疗效果，药物的不良反应和治疗费用。结果两组的治愈率无明显差异（P〉0．05），分别为91．43％和94．29％。序贯组的治疗费用、不良反应均明显低于对照组（P〈0．01或P〈0．05）。结论莫西沙星序贯治疗老年社区获得性肺炎疗效确切，不良反应少，并可节省医疗费用。     

阿莫西林克拉维酸钾序贯疗法治疗小儿肺炎

目的探讨阿莫西林克拉维酸钾序贯疗法治疗小儿社区获得性肺炎的临床疗效,对比医疗费用及患儿依从性的差别。方法按随机双盲法将230例社区获得性肺炎患儿分为观察组(序贯疗法组)和对照组(静脉给药组),观察组给予静脉滴注抗生素3d后改为口服;对照组给予静脉滴注抗生素至病情痊愈。结果序贯序法组患儿的抗生素医疗费用为256.24±59.86元,静脉给药组为457.36±80.91元(P<0.05),序贯疗法组患儿抗生素医疗费用明显低于静脉给药组;序贯疗法组患儿失访率为3.36%,静脉给药组为10.81%(P<0.05),序贯疗法组患儿失访率明显低于静脉给药组。结论抗生素序贯疗法对保证疗效、降低医疗费用、减轻患儿痛苦更具有现实意义。     

序贯疗法治疗社区获得性肺炎的临床观察

目的探讨头孢菌素与左氧氟沙星序贯治疗在社区获得性肺炎患者中的合理应用。方法将符合入选条件的129例患者随机分为两组。序贯疗法组67例，静滴头孢噻肟钠与乳酸左氧氟沙星3d后改用口服头孢克洛胶囊和盐酸左氧氟沙星片7d，总疗程10d；对照组62例，采用头孢噻肟钠与盐酸左氧氟沙星连续静脉滴注10d。对两组患者临床疗效、细菌清除率、药物不良反应及医疗费用进行分析评价。结果贯序疗法组临床总有效率为88．06％，对照组为90．32％，两组总有效率间差异无统计学意义（P〉0.05）；贯序疗法组细菌清除率为92．71％，对照组为94．02％，差异无统计学意义（P〉0．05）；两组均未出现严重不良反应；住院总费用：序贯疗法组468．7元，对照组972．8元，差异有统计学意义（P〈0．05）。结论序贯疗法对治疗社区获得性肺炎安全有效，具有更加合理的效价比。     

莫西沙星治疗高龄社区获得性肺炎临床研究

目的探讨莫西沙星治疗高龄社区获得性肺炎临床疗效及安全性。方法研究对象选取我院收治高龄社区获得性肺炎患者共64例,以随机区组法分为对照组(32例)和治疗组(32例),分别采用左氧氟沙星和莫西沙星序贯治疗;比较两组患者临床疗效,临床症状体征消失时间、病原菌清除率、治疗前后免疫功能指标水平及不良反应发生率等。结果治疗组患者临床疗效、临床症状体征消失时间及病原菌清除率均显著优于对照组(P0.05);治疗组患者治疗后免疫功能指标均显著优于对照组、治疗前(P0.05);治疗组患者不良反应发生率显著低于对照组(P0.05)。结论莫西沙星治疗高龄社区获得性肺炎患者可有效改善临床疗效,缩短临床病程,提高机体免疫功能,并有助于降低不良反应发生风险。     

莫西沙星序贯治疗老年社区获得性肺炎45例临床观察

目的评价莫西沙星序贯疗法治疗社区获得性肺炎的临床疗效。方法对90例老年社区获得性肺炎（CAP）患者在人院时即随机分为A组和B组各45例,A组给予莫西沙星注射液静脉滴注400nag,1次／d,3～5d后给予莫西沙星片剂口服400mg,1次／d继续治疗。B组给予头孢呋辛静脉点滴1500mg,2次／d,治疗3～5d后改121服500mg,2次／d继续治疗;阿奇霉素静脉点滴500mg,1次／d。治疗3d后改口服500mg,1次／d继续治疗。观察两组临床疗效、细菌学检测结果及安全性。结果两组的治愈率无明显差异（P〉0．05）,分别为93．3％和82．2％。A组的住院天数和治疗天数、不良反应发生率低于B组（P〈0．01或P〈0．05）。结论莫西沙星序贯治疗老年社区获得性肺炎疗效确切,不良反应少,并可缩短住院和治疗时间。     

痰热清注射液联合左氧氟沙星治疗社区获得性肺炎的临床疗效观察

目的观察痰热清注射液联合左氧氟沙星治疗社区获得性肺炎的临床疗效。方法选取2014年2月—2015年11月开县安康医院收治的社区获得性肺炎患者92例,根据入院时间分为对照组和观察组,每组46例。对照组患者给予左氧氟沙星静脉滴注,观察组患者在对照组治疗基础上给予痰热清注射液静脉滴注;两组患者均连续治疗2个疗程(7 d为1个疗程)。比较两组患者临床疗效,发热、咳嗽、啰音消失时间,炎症病灶吸收情况及发热评分。结果观察组患者临床疗效优于对照组(P0.05)。观察组患者发热、咳嗽、啰音消失时间短于对照组,炎症病灶吸收率高于对照组,发热评分优于对照组(P0.05)。结论痰热清注射液联合左氧氟沙星治疗社区获得性肺炎的临床疗效确切,可快速、有效缓解患者临床症状。     

左氧氟沙星序贯疗法应用于老年2型糖尿病并社区获得性肺炎患者中的效果分析

目的探讨左氧氟沙星序贯疗法应用于老年2型糖尿病并社区获得性肺炎患者中的效果。方法选择2018年6月—2019年6月该院收治的老年2型糖尿病并社区获得性肺炎患者202例,以随机数表法将其分为对照组与研究组,各101例。在常规对症治疗的基础上,研究组应用左氧氟沙星序贯疗法,对照组应用阿奇霉素序贯治疗。观察两组患者临床疗效、治疗前后血糖指标变化、不良反应情况。结果研究组治疗的总有效率96.04%,高于对照组87.13%,差异有统计学意义(P0.05)。两组治疗前与治疗后空腹血糖、餐后2 h血糖指标对比差异无统计学意义(P0.05)。两组不良反应发生率对比差异无统计学意义(P0.05)。结论左氧氟沙星序贯疗法在老年2型糖尿病并社区获得性肺炎患者中具有显著的应用效果,值得临床推广。     

序贯机械通气治疗慢性阻塞性肺疾病合并呼吸衰竭疗效观察

目的探讨有创、无创序贯机械通气对慢性阻塞性肺疾病合并呼吸衰竭患者的临床治疗效果。方法笔者所在医院2001年5月—2010年10月慢性阻塞性肺疾病合并呼吸衰竭患者106例,随机将其分为对照组和治疗组。对照组53例患者给予有创机械通气治疗,治疗组53例患者给予有创、无创序贯机械通气。比较两组患者有创通气时间、住院时间、呼吸机相关性肺炎发生率等。结果有创、无创序贯机械通气对慢性阻塞性肺疾病合并呼吸衰竭患者的治疗效果显著,有创通气时间、住院时间均较对照组明显缩短,呼吸机相关性肺炎发生率明显降低,两组患者差异有统计学意义(P<0.05)。结论采用有创与无创序贯机械通气治疗慢性阻塞性肺疾病合并呼吸衰竭患者,可明显缩短患者的有创机械通气及住院时间,减少呼吸机相关性肺炎的发生率,提高临床治疗效果。     

序贯性机械通气治疗慢性阻塞性肺病撤机失败患者的临床研究

目的探讨有创一无创序贯性机械通气在慢性阻塞性肺病（COPD）呼吸衰竭有创机械通气患者出现撤机失败时的应用价值。方法将首次撤机失败的36例患者随机分成两组：序贯治疗组和对照组,比较两组患者血气分析、有创通气时间、总机械通气时间、总住院天数、呼吸机相关性肺炎（VAP）发生率、医疗费用、撤机成功率及病死率。结果序贯治疗组撤机成功率明显高于对照组（P〈0．01）;呼吸机相关性肺炎（VAP）发生率、有创通气时间、总机械通气时间、总住院天数、医疗费用及病死率均明显小于对照组（P〈0．05或P〈0．01）。结论序贯通气治疗明显降低呼吸机相关性肺炎（VAP）发生率,缩短了有创通气时间、总机械通气时间及住院时间、降低了医疗费用,减少病死率。COPD合并严重呼吸衰竭首次撤机失败时,采用序贯通气治疗是一种可行而有效的手段。     

厄他培南治疗老年社区获得性肺炎的疗效观察

目的比较厄他培南与莫西沙星治疗老年社区获得性肺炎的有效性和安全性。方法 80例老年(≥65岁)社区获得性肺炎患者随机分为两组,治疗组给予厄他培南注射液(商品名怡万之,默沙东公司),每次1g,每日一次静脉滴注,总疗程5天;对照组给予莫西沙星(商品名拜复乐,拜尔公司)注射液400mg/250ml静脉滴注,每日一次,总疗程5天。进行治疗前后两组间的疗效比较。结果厄他培南组40例,治疗有效率为90.0%,细菌清除率为83.3%;莫西沙星组40例,治疗有效率为81.7%,细菌清除率为72.1%;两组间差异有显著性;两组均无不良反应发生,差异无统计学意义。结论厄他培南相比莫西沙星能更好地改善临床症状,厄他培南治疗老年社区获得性肺炎疗效良好,安全性高,不良反应较少,是治疗老年社区获得性肺炎的理想药物。     

左氧氟沙星治疗老年糖尿病合并社区获得性肺炎疗效观察

目的评价左氧氟沙星400mg每天1次治疗老年糖尿病合并社区获得性肺炎的安全性和有效性。方法本研究采用对照研究的方法，实验组采用左氧氟沙星400mg／次，每天1次静脉滴注；对照组采用左氧氟沙星200mg／次，每天2次静脉滴注，总疗程均为10～14d。观察两组治疗老年糖尿病合并社区获得性肺炎的临床疗效和安全性。结果本研究共入选患者74例，可作临床疗效评价患者70例，实验组和对照组分别为36例和34例，实验组和对照组的基本情况、疾病类型、用药天数无显著性差异（P〉0．05）；两组临床有效率、痊愈率、细菌清除率，无统计学差异（P〉0．05）；两组不良反应率亦无显著性差异（P〉0．05）。结论左氧氟沙星400mg每天1次静脉滴注治疗老年糖尿病合并社区获得性肺炎疗效良好，不良反应程度较低，患者可耐受，每天1次给药，方便临床治疗。     

抗生素序贯治疗老年社区获得性肺炎的临床疗效及其对T 细胞亚群水平的影响

目的 观察抗生素序贯治疗老年社区获得性肺炎（CAP）的临床疗效及其对免疫功能的影响.方法 采用左氧氟沙星静脉滴注联合左氧氟沙星口服序贯治疗.70例老年CAP患者随机分为治疗组和对照组.对照组采用左氧氟沙星静脉滴注治疗,治疗组采用左氧氟沙星静脉滴注联合左氧氟沙星口服序贯治疗.治疗前后测定患者外周血 T 细胞亚群（CD＋3、CD＋4、CD＋8、CD＋4/CD＋8）水平,并评价疗效.结果 治疗组临床症状显著改善,且临床疗效总有效率显著高于对照组（P〈0.05）;治疗后,治疗组CD＋3、CD＋4、CD＋4/CD＋8水平显著上升,CD＋8水平显著下降（P〈0.01）.两组均无严重不良反应发生.结论 抗生素序贯治疗老年CAP能显著提高临床疗效,且安全可靠,并具有调节患者免疫功能的作用.     

莫西沙星治疗老年社区获得性肺炎中的疗效

目的评估莫西沙星治疗老年社区获得性肺炎的有效性及其安全性。方法将2008年1月至2009年3月在我科住院的老年社区获得性肺炎分治疗组和对照组,其中治疗组随机抽取40例患者,对照组随机抽取20例患者。治疗组给予莫西沙星400 mg静脉滴注qd;对照组给予左氧氟沙星300 mg静脉滴注qd,疗程为2周。观察临床疗效及其不良反应。结果治疗组有效率87.50%,细菌清除率为82.75%,不良反应12.50%。结论莫西沙星在老年社区获得性肺炎中有效率高,不良反应少。     

Moxifloxacin versus Standard Therapy in Patients with Pneumonia Hospitalized after Failure of Preclinical Anti-infective Treatment

Abstract The failure rate of primary empirical anti-infective treatment of community-acquired pneumonia is reported to range between 2 and 7%. These patients are subject to a greater risk of intensive medical treatment and a higher mortality rate than patients who respond to primary treatment. We investigated 63 patients in a “real life scenario” who were admitted to the hospital after failure of primary outpatient therapy for community-acquired pneumonia. Thirty-three patients received intravenous standard therapy (betalactam 14, macrolide 3, levofloxacin 6, doxycycline 1, combinations 9 patients) while 30 patients were treated with intravenous moxifloxacin. The oral antibiotic pretreatment that failed most frequently was clarithromycin (n = 25), followed by amoxicillin/clavulanic acid (n = 16), cefixime (n = 10), cefuroxime/axetil (n = 5), doxycycline (3), cefpodoxime, and ciprofloxacin (2 each). There were no differences between the two groups in respect of age, gender, numbers of patients in nursing homes, numbers of patients with different underlying diseases (chronic bronchitis, coronary heart disease, diabetes mellitus, smoking, etc.), severity of pneumonia at the time of admission, numbers of patients requiring intensive care, and lethality. The group that underwent standard therapy experienced failure of the empirical intra-hospital antibiotic therapy more often during therapy [10 (30%) patients vs 2 (6%) in the moxifloxacin group, p = 0.009] and clinical failure of treatment on day 28 after initiation of therapy [7 (21%) patients vs 2 (6%) in the moxifloxacin group, p = 0.003]. In cases of failure of empirical preclinical antibiotic treatment for community-acquired pneumonia, subsequent intrahospital treatment with moxifloxacin is more successful than standard therapy in our study reflecting a "real life scenario".     

近年来黄山地区老年社区获得性肺炎临床特征分析

目的探讨近年来黄山地区老年社区获得性肺炎的临床特征。方法收集住院的社区获得性肺炎患者120例,其中老年组60例,青中年组60例;回顾性分析两组临床特征如发病季节、首发症状、合并基础疾病、体征、辅助检查、治疗及预后等,比较两组间异同。结果老年社区获得性肺炎与青中年组临床特征比较有着明显不同,老年组:冬春季好发;首发症状不典型,呼吸系统症状不典型;并发症多;胸部影像中肺部炎症以多叶及双叶病变为主;白细胞升高不明显;致病菌为混合性,革兰氏阴性杆菌居多;病情重、疗程长;死亡率高。结论近年来本地区老年社区获得性肺炎临床特征发生了一些变化,应加强对该病的认识,及时正确的诊断并制定合理的治疗方案;从而提高治疗成功率,降低死亡率。     

Management of community-acquired pneumonia in the era of pneumococcal resistance: a report from the Drug-Resistant Streptococcus pneumoniae Therapeutic Working Group

OBJECTIVE: To provide recommendations for the management of community-acquired pneumonia and the surveillance of drug-resistant Streptococcus pneumoniae (DRSP). METHODS: We addressed the following questions: (1) Should pneumococcal resistance to beta-lactam antimicrobial agents influence pneumonia treatment? (2) What are suitable empirical antimicrobial regimens for outpatient treatment of community-acquired pneumonia in the DRSP era? (3) What are suitable empirical antimicrobial regimens for treatment of hospitalized patients with community-acquired pneumonia in the DRSP era? and (4) How should clinical laboratories report antibiotic susceptibility patterns for S pneumoniae, and what drugs should be included in surveillance if community-acquired pneumonia is the syndrome of interest? Experts in the management of pneumonia and the DRSP Therapeutic Working Group, which includes clinicians, academicians, and public health practitioners, met at the Centers for Disease Control and Prevention in March 1998 to discuss the management of pneumonia in the era of DRSP. Published and unpublished data were summarized from the scientific literature and experience of participants. After group presentations and review of background materials, subgroup chairs prepared draft responses, which were discussed as a group. CONCLUSIONS: When implicated in cases of pneumonia, S pneumoniae should be considered susceptible if penicillin minimum inhibitory concentration (MIC) is no greater than 1 microg/mL, of intermediate susceptibility if MIC is 2 microg/ mL, and resistant if MIC is no less than 4 microg/mL. For outpatient treatment of community-acquired pneumonia, suitable empirical oral antimicrobial agents include a macrolide (eg, erythromycin, clarithromycin, azithromycin), doxycycline (or tetracycline) for children aged 8 years or older, or an oral beta-lactam with good activity against pneumococci (eg, cefuroxime axetil, amoxicillin, or a combination of amoxicillin and clavulanate potassium). Suitable empirical antimicrobial regimens for inpatient pneumonia include an intravenous beta-lactam, such as cefuroxime, ceftriaxone sodium, cefotaxime sodium, or a combination of ampicillin sodium and sulbactam sodium plus a macrolide. New fluoroquinolones with improved activity against S pneumoniae can also be used to treat adults with community-acquired pneumonia. To limit the emergence of fluoroquinolone-resistant strains, the new fluoroquinolones should be limited to adults (1) for whom one of the above regimens has already failed, (2) who are allergic to alternative agents, or (3) who have a documented infection with highly drug-resistant pneumococci (eg, penicillin MIC > or =4 microg/mL). Vancomycin hydrochloride is not routinely indicated for the treatment of community-acquired pneumonia or pneumonia caused by DRSP.     

The efficacy of switch therapy in community-acquired pneumonia in Japan]

To evaluate the efficacy of Switch therapy for community-acquired pneumonia, we conducted a prospective randomized controlled study in thirty-two hospitalized patients. These cases corresponded to Fine's risk classes II to IV. Using a table of random numbers, sixteen patients were assigned to a Switch therapy group, and the other sixteen, to a clinical pathway group. Both groups initially received intravenous antimicrobials. Within the Switch therapy group, when all the patients were afebrile for more than sixteen hours, their intravenous antimicrobials were switched to oral, and the patients were discharged on the following day. For all patients in the clinical pathway group, the critical pathway was defined as an eight-day planned hospitalization, with a time-task matrix formatted for disease treatment, laboratory testing, physical examination, oxygen saturation monitoring, ambulation, diet, patient education and clinical outcome. Switch therapy reduced the period of intravenous antimicrobial administration from 7.6 days to 4.0 days (p < 0.0001). The period required to switch to oral antimicrobials decreased from 8.3 days to 4.8 days (p < 0.0001); hospital stay length, from 9.8 days to 6.5 days (p = 0.0001); and medical resource utilization, from 330, 373 to 227,768 Japanese yen (p = 0.0002). No patient from either group required readmission. In conclusion, Switch therapy was more efficient than management with a clinical pathway for mild to moderate community-acquired pneumonia in hospitalized patients.     

不同治疗方案在重症社区获得性肺炎患儿中的应用效果对比

目的比较不同治疗方案治疗重症儿童社区获得性肺炎的临床疗效。方法选择在我院治疗的重症社区获得性肺炎患儿82例,将所有患儿随机分为研究组(41例)和对照组(41例),对照组患者只进行静脉注射头孢呋辛钠,研究组患者在对照组患者的治疗方法上联合口服阿奇霉素干混悬液治疗。治疗5天后,测定两组患者治疗前后的C反应蛋白、IL-6和IL-10的水平,对两组患者的体温恢复、肺部啰音以及咳嗽等症状消失的时间。结果在患儿治疗后,研究组的IL-6水平、C反应蛋白低于对照组,IL-10水平高于对照组,(P0.05);治疗后,研究组的细菌检出率低于对照组,(P0.05);研究组肺部啰音消失时间、体温恢复正常时间、咳嗽消失时间少于对照组,住院天数少于对照组,(P0.05)。结论β-内酰胺类联合大环内酯类抗菌药物的治疗方法可以有效提高重症儿童社区获得性肺炎的治疗效果。