左氧氟沙星序贯疗法治疗社区获得性肺炎效果评价

目的探讨左氧氟沙星序贯治疗社区获得性肺炎(CAP)的临床价值。方法 84例CAP患者按就诊时间顺序分为观察组与对照组各42例,两组均给予止咳、化痰、解痉、平喘、吸氧、支持等常规治疗,观察组静脉滴注盐酸左氧氟沙星氯化钠注射液250mL,1次/天;对照组盐酸左氧氟沙星氯化钠注射液250mL静脉滴注,待咳嗽和气急症状好转、体温降至37.8℃以下至少8h、白细胞计数趋于正常时改为口服左氧氟沙星片0.4g,1次/天。结果两组CAP患者治疗过程中体温正常、咳嗽咳痰减轻、肺部罗音减少时间、两组治疗10~14d时总有效率比较差异无统计学意义(P>0.05);观察组左氧氟沙星静脉滴注时间(3.65±0.56)d、药物不良反应率(11.90%)低于对照组的静脉滴注时间(12.34±1.56)d、药物不良反应(33.33%),差异具有统计学意义(P<0.05)。结论左氧氟沙星序贯疗法治疗CAP是较经济、有效的治疗方法。     

阿奇霉素与左氧氟沙星序贯疗法治疗社区获得性肺炎的临床价值

目的：探讨阿奇霉素与左氧氟沙星序贯疗法对社区获得性肺炎（CAP）的治疗效果及临床价值。方法：将2010年1月—2011年7月诊治的40例社区获得性肺炎患者随机分为阿奇霉素组和左氧氟沙星组,各20例,两组给药时间均为2周,观察两组患者的临床疗效和不良反应。结果：阿奇霉素组15例痊愈,5例显效,总有效率为100.0%;左氧氟沙星组8例痊愈,10例显效,1例进步,1例无效,总有效率为90.0%。与左氧氟沙星组相比,阿奇霉素组的总有效率明显提高,差异有统计学意义（P〈0.05）。阿奇霉素组出现不良反应4例,其中表现为恶心以及腹上区不适等胃肠道症状2例,局部瘙痒1例,肝功异常1例。左氧氟沙星组出现不良反应5例,其中局部瘙痒2例,胃肠道不适症状2例,精神症状1例。但两组病例的不良反应发生率比较差异无统计学意义（P〉0.05）。结论：阿奇霉素与左氧氟沙星序贯疗法,可明显提高社区获得性肺炎的治疗效果。     

左氧氟沙星和头孢呋辛治疗成人社区获得性肺炎的药物经济学分析

目的：讨论不同抗生素治疗成人社区获得性肺炎的经济效果。方法：抽取本院50例社区获得性肺炎患者，随机分成两组，根据不同治疗方案（A组：左氧氟沙星；B组：头孢呋辛），运用药物经济学成本-效果分析方法进行评价。结果：A组和B组方案总成本分别为397．60元和658．00元，其效果分别为88．00%和98．00%（P〉0．05）。每增加一个单位效果A组较B组节省26．04元。结论：左氧氟沙星组的治疗方案为成人社区获得性肺炎治疗的较佳方案。     

左氧氟沙星序贯治疗社区获得性肺炎的疗效观察

目的评价左氧氟沙星序贯治疗社区获得性肺炎的疗效。方法将96例社区获得性肺炎患者随机分为两组,治疗组49例,给予左氧氟沙星注射3d后改为口服;对照组47例,给予头孢呋辛钠联合阿奇霉素注射3d后改为口服。两组疗程均为7～14d。观察临床症状、体征、胸部X线和实验室检查等指标。结果两组临床疗效差异无显著性（P〉0.05）,不良反应差异无显著性。结论左氧氟沙星序贯治疗社区获得性肺炎疗效确切,值得推广。     

阿奇霉素序贯疗法治疗社区获得性肺炎效果观察

目的探讨阿奇霉素序贯治疗社区获得性肺炎的临床价值。方法将社区获得性肺炎患者90例随机分为序贯组和常规组,每组各45例,两组均给予退热、止咳化痰、给氧、雾化吸入、加强营养支持、防止并发症等治疗,常规组应用阿奇霉素静滴,连用10～14 d;序贯组阿奇霉素静脉给药3～5 d,病情稳定改为口服阿奇霉素。结果序贯组治疗总有效率95.56%与常规组的97.78%比较无统计学差异(P>0.05);序贯组静脉给药时间(5.12±2.01)d短于常规组的(10.34±3.12)d(P<0.05),药物不良反应17.78%较常规组42.22%少(P<0.05)。结论阿奇霉素序贯治疗社区获得性肺炎不仅安全有效,而且可缩短静脉给药时间,降低医疗费用,是值得推广的一种治疗方法。     

阿奇霉素与左氧氟沙星序贯治疗社区获得性肺炎70例分析

目的 比较阿奇霉素与左氧氟沙星序贯治疗社区获得性肺炎的临床疗效.方法 回顾性分析我院2006年1月至2007年1月阿奇霉素与左氧氟沙星序贯治疗社区获得性肺炎患者的临床疗效.结果 共纳入患者79例,阿奇霉素组40例,左氧氟沙星组39例,两组在临床症状体征(咳嗽、咳痰、发热、胸痛、肺部啰音)以及X线胸片、痰细菌培养、血清支原体抗体检测等方面没有显著性差异.两组临床疗效比较,阿奇霉素组总有效率为70.0%,出现不良反应2例,表现为轻度恶心,上腹部不适;左氧氟沙星组总有效率为84.6%,出现不良反应3例,其中恶心等胃肠道反应1例,皮疹2例;两组临床疗效有显著性差异.结论 左氧氟沙星是经验性治疗社区获得性肺炎的有效、安全的抗生素,但是,应当注意氟喹诺酮有引起伪膜性肠炎的可能.     

阿奇霉素序贯疗法治疗社区获得性肺炎138例临床评价

目的 :评价阿奇霉素序贯疗法治疗社区获得性肺炎的疗效与安全性。方法 :本研究为多中心、开放、随机对照试验 ,社区获得性肺炎患者被随机分配为试验组接受阿奇霉素 ,对照组接受头孢呋辛 ,均先静脉给药继以口服序贯治疗 ,对照组中疑为非典型病原感染者需全程联合琥乙红霉素口服治疗。结果 :(1)试验组和对照组临床有效率分别为 88.9% (5 6 / 6 3)和92 .2 % (5 9/ 6 4 ) ,临床痊愈率分别为 79.4 % (5 0 / 6 3)和 6 5 .6 % (4 2 / 6 4 )。上述结果经统计学分析差异无显著性。但试验组疗程较对照组显著为短 (P <0 .0 1)。 (2 )试验组 6 3例中病原阳性者 38例 ,其中细菌培养阳性者 32例 ,非典型病原体检测阳性者14例 ,非典型病原体与细菌的混合感染 8例。对照组 6 4例中病原阳性者 4 2例 ,其中细菌培养阳性者 31例 ,非典型病原体检测阳性者 19例 ,非典型病原体与细菌的混合感染 8例。经治疗两组总的细菌清除率分别为 96 .8% (31/ 32 )和 96 .9% (30 /31) ,两组差异无显著性。 (3)试验组不良反应发生率为 2 6 .1% (18/ 6 9) ,显著高于对照组 (8.7% ,6 / 6 9) ,主要表现为试验组发生静脉注射部位局部反应者较多 (11/ 18) ,除 1例中途停药外 ,均系轻度 ,患者可耐受 ,且减缓静脉滴注速度后 ,局部反应明显减少。实     

左氧氟沙星序贯疗法治疗成人社区获得性肺炎112例临床疗效观察

目的:探讨左氧氟沙星序贯治疗社区获得性肺炎的疗效及安全性.方法:将112例社区获得性肺炎患者随机分成两组:治疗组给予静脉滴注左氧氟沙星3 d后改为口服;对照组给予头孢哌酮/舒巴坦 阿奇霉素静脉滴注3 d后改为口服头孢拉定 阿奇霉素片,疗程均为10 d,现察治愈率和药物不良反应.结果:治疗组有效率为85.7%(48/56),对照组为82.1%(46/56),差异无统计学意义(P>0.05);不良反应治疗组发生率为7.1%(4/56),对照组为8.9%(5/56),差异无统计学意义(P>0.05).结论:左氧氟沙星序贯治疗社区获得性肺炎疗效确切,不良反应少,可作为社区获得性肺炎的一线用药.     

莫西沙星与左氧氟沙星序贯治疗老年社区获得性肺炎效果比较

目的 比较莫西沙星与左氧氟沙星序贯治疗老年社区获得性肺炎的效果。方法 选取116例老年社区获得性肺炎患者,按照随机数字表法分组,每组各58例。将左氧氟沙星序贯治疗方案应用于对照组的患者,将莫西沙星序贯治疗方案用于观察组患者,对比两组患者的治疗效果、相关的临床症状消退时间及药物应用后出现的不良反应发生率、炎性细胞因子及肺功能指标。结果 观察组患者治疗有效率为94.83%,明显高于对照组的77.59%(P <0.05);观察组患者退热时间、咳嗽消失时间、咳痰消失时间、肺部湿啰音消失时间、住院时间均短于对照组,治疗3～5 d改口服用药比例高于对照组,消化道不适、静脉炎、皮疹等不良反应发生率低于对照组（均P <0.05）;两组患者治疗后降钙素原（PCT）、C反应蛋白（CRP）、可溶性髓样细胞表达的激发受体1(sTREM-1)、白细胞介素-6(IL-6)水平均低于治疗前,且观察组均低于对照组（均P <0.05）;两组患者治疗后肺功能指标均高于治疗前,且观察组高于对照组（P <0.05）。结论 莫西沙星序贯治疗老年社区获得性肺炎效果更好,症状缓解速度快,对炎症抑制力强,有助...     

头孢呋辛及头孢克洛序贯治疗社区获得性肺炎42例

序贯疗法（ｓｗｉｔｃｈｔｈｅｒａｐｙ）是指在临床症状改善的早期将静脉应用的抗菌药物转换成口服抗菌药物的一种疗法 ,其目的是在不影响或改善预后的前提下降低医疗费用 ［１］。作者对近两年来应用头孢呋辛及头孢克洛序贯治疗社区获得性肺炎（ＣＡＰ）的病例作一总结 ,现报道如下。１临床资料１．１一般资料本组４２例均来自我院２０００年２月～２００２年３月的门诊病人 ,其中男２９例 ,女１３例 ;年龄１５～６３岁 ,平均３８．６岁。ＣＡＰ的诊断按１９９９年中华医学会呼吸分会制定的诊断标准［２］ ,并符合以下条件 :（１）除外孕…     

A randomized controlled clinical trial of levofloxacin 750 mg versus 500 mg intravenous infusion in the treatment of community-acquired pneumonia

The objective of this study was to compare the efficacy and safety of levofloxacin 750 mg for 5 days versus 500 mg for 7–14 days intravenous (IV) in the treatment of community-acquired pneumonia (CAP). This clinical trial was the first of its kind conducted in Chinese people and also in Asian population. A total of 241 were enrolled and randomized to 750 mg group (n = 121) or 500 mg (n = 120) group from 10 study centers. The median treatment duration was 5.0 days in 750 mg and 9.0 days in 500 mg group. The median total dose was 3750 mg in 750 mg and 4500 mg in 500 mg group. The bacterial eradication rate was 100% in both groups. The overall efficacy rate in 750 mg group was 86.2% (94/109), and 84.7% (94/111), in 500 mg group of full analysis set visit 4, 95% confidence interval of 1.6% (−7.8–10.9%); the statistical results showed that 750 mg group was non-inferior to 500 mg group. The most common clinical adverse drug reactions were injection site adverse reactions in both 750 mg group and 500 mg group; the other common adverse drug reactions were insomnia, nausea, skin rash, etc. The most common drug-related laboratory abnormalities were neutrophil percentage decreased, decreased white blood cell count, alanine aminotransferase, and aspartate aminotransferase elevation in both 750 mg group and 500 mg group. Most of adverse drug reactions were mild in severity and well-tolerated. In summary, the regimen of levofloxacin 750 mg IV for 5 days was at least as effective and well tolerated as 500 mg IV for 7–14 days for the treatment of CAP.     

Integrated results of 2 phase 3 studies comparing tigecycline and levofloxacin in community-acquired pneumonia

Tigecycline (TGC), a glycylcycline, has expanded activity against Gram-positive and Gram-negative, anaerobic, and atypical bacteria. Two phase 3 studies were conducted. Hospitalized patients with community-acquired pneumonia (CAP) were randomized to intravenous (IV) TGC (100 mg followed by 50 mg bid) or IV levofloxacin (LEV) (500 mg bid). In 1 study, patients could be switched to oral LEV after at least 3 days intravenously. The coprimary efficacy end points were as follows: clinical response in clinically evaluable (CE) and clinical modified intent-to-treat (c-mITT) populations at test-of-cure (TOC). The secondary end points were as follows: microbiologic efficacy and susceptibility to TGC for CAP bacteria. Safety evaluations were included. Eight hundred ninety-one were patients screened: 846 mITT (TGC 424, LEV 422), 574 CE (TGC 282, LEV 292). Most patients had Fine Pneumonia Severity Index II to IV (80.7% TGC, 74.4% LEV, mITT). At TOC (CE), TGC cured 253/282 patients (89.7%) and LEV cured 252/292 patients (86.3%); the absolute difference of TGC-LEV was 3.4% (95% confidence interval [CI], -2.2 to 9.1, noninferior [P < 0.001]). In c-mITT, TGC cured 319/394 patients (81.0%) and LEV cured 321/403 patients (79.7%); the absolute difference of TGC-LEV was 1.3% (95% CI -4.5 to 7.1, noninferior [P < 0.001]). The drug-related adverse events (AEs) of nausea (20.8% TGC versus 6.6% LEV) and vomiting (13.2% TGC versus 3.3% LEV) were significantly higher in TGC; elevated alanine aminotransferase (2.8% TGC versus 7.3% LEV) and aspartate aminotransferase (2.6% TGC versus 6.9% LEV) were significantly higher in LEV. Discontinuations for AEs were low (TGC, 26 patients [6.1%]; LEV, 34 patients [8.1%]). TGC appeared safe and achieved cure rates similar to LEV in hospitalized patients with CAP.     

Efficacy of erythromycin compared to clarithromycin and azithromycin in adults or adolescents with community-acquired pneumonia: A Systematic Review and meta-analysis of randomized controlled trials

BackgroundIt is debatable whether erythromycin has similar efficacy to other macrolides in treating community-acquired pneumonia (CAP). The aim of this meta-analysis is to compare the efficacy of erythromycin with clarithromycin and azithromycin.MethodsWe performed this meta-analysis of randomized controlled trials (RCTs) of adults or adolescents with CAP which compared the efficacy of erythromycin monotherapy to either azithromycin or clarithromycin. We searched PubMed and EMBASE and Cochrane Library databases and three clinical trial registries up to November 02, 2021. We evaluated heterogeneity and used random-effects models to perform risk ratios with 95% confidence intervals.ResultsWe included four RCTs (total of 472 patients), which compared the clinical efficacy of erythromycin versus clarithromycin. No studies comparing monotherapy of erythromycin versus azithromycin were found. Erythromycin use was associated with significantly lower rates of clinical success (RR, 0.79; 95% CI, 0.64 to 0.98; P-value = 0.033; I² = 20.27%), clinical cure (RR,0.67; 95% CI, 0.48 to 0.92; P-value = 0.014; I² = 8.75%), and radiological success (RR, 0.84; 95% CI, 0.71 to 0.996; P-value = 0.045; I² = 20.12%) than clarithromycin.ConclusionErythromycin is less effective than clarithromycin as empiric treatment of CAP in adults and adolescents. Because of this and the higher rate of adverse reactions, erythromycin should not be used in the majority of CAP patients when azithromycin and clarithromycin are available.     

莫西沙星序贯治疗社区获得性肺炎临床研究

目的研究莫西沙星治疗社区获得性肺炎的临床疗效、安全性。方法216例轻中度社区获得性肺炎患者随机分为3组。A组（观察组）予莫西沙星序贯治疗,B组（对照组）予左氧氟沙星序贯治疗,C组（对照组）予头孢曲松钠／头孢泊肟酯联合阿奇霉素常规序贯治疗。结果①A组、B组和C组痊愈率分别为70．3％（52／74）、67．1％（47／70）和47．2％（34／72）,临床有效率分别为86．5％（64／74）、82．9％（58／70）和72．2％（52／72）,细菌清除率分别84．8％（28／33）、82．1％（23／28）和58．1％（18／31）,3个指标中,A、B两组间差异均无统计学意义,A、C两组间差异均有统计学意义;②A组、B组和C组静脉注射时间分别为（2．27±1．14）d、（2．33±1．15）d和（3．03±1．08）d,A、B两组间差异无统计学意义,A、C两组间差异有统计学意义;③A组、B组和C组不良反应发生率分别为5．4％（4／74）、5．7％（4／70）和13．9％（10／72）,A、B两组间差异无统计学意义,A、C两组间差异有统计学意义。结论莫西沙星序贯治疗社区获得性肺炎效果更为确切、安全。     

左氧氟沙星与头孢曲松联合阿奇霉素治疗社区获得性下呼吸道感染的对照研究

目的比较左氧氟沙星注射液与头孢曲松注射液＋口服阿奇霉素在治疗社区获得性下呼吸道感染中的疗效和安全性。方法采用随机、开放、对照研究，共入选88例患者，其中试验组43例，接受左氧氟沙星治疗，500mg每日1次静脉滴注；对照组45例，接受头孢曲松＋阿奇霉素治疗，头孢曲松2g每日1次静脉滴注，阿奇霉素口服，每日0．25g（首次0．5g）。治疗7～10d后评价临床和细菌学疗效。结果左氧氟沙星组的总有效率为86．0%，头孢曲松＋口服阿奇霉素组为84．4％；试验组细菌清除率为93．3％，对照组为92．9％，差异均无显著性（P〉0．05）。两组患者中发现非典型病原体感染共12例，其中5例为肺炎支原体，4例为肺炎衣原体，3例为嗜肺军团菌。所有12例非典型病原体感染患者均痊愈。患者对左氧氟沙星和头孢曲松＋口服阿奇霉素均有良好的耐受性。结论左氧氟沙星和头孢曲松＋口服阿奇霉素都可以作为治疗社区获得性下呼吸道感染的有效、安全的药物。     

莫西沙星短程治疗社区获得性肺炎

目的评价莫西沙星短程治疗社区获得性肺炎(CAP)的疗效及安全性。方法87例轻中度CAP患者随机分为两组。对照组(传统疗程组)予莫西沙星静脉治疗10 d;短程治疗组予莫西沙星静脉治疗5 d。结果①对照组和短程治疗组痊愈率分别为68.2%(30/44)和65.1%(28/43),临床有效率分别为90.9%(40/44)和88.4%(38/43),细菌清除率分别为88.2%(30/34)和87.9%(29/33);这三个指标中,两组间比较差异均无统计学意义。②对照组和短程治疗组不良反应发生率分别为9.1%(4/44)和7.0%(3/43),两组间比较差异无统计学意义。结论莫西沙星短程治疗社区获得性肺炎效果与莫西沙星传统疗程治疗相似,较安全。     

Early switch therapy from intravenous sulbactam/ampicillin to oral garenoxacin in patients with community-acquired pneumonia: a multicenter, randomized study in Japan

The switch from intravenous to oral antibiotic therapy is recommended for treating hospitalized patients with community-acquired pneumonia (CAP). We performed a multicenter, randomized study to assess the benefit of switching from intravenous sulbactam/ampicillin (SBT/ABPC) to oral garenoxacin (GRNX) in patients with CAP. Among adult CAP patients who must be hospitalized for intravenous antibiotic treatment, those with Pneumonia Patient Outcomes Research Team (PORT) scores of II–IV (mild to moderate) were initially treated with intravenous SBT/ABPC (6 g/day) for 3 days. A total of 108 patients who fulfilled the inclusion criteria (improved respiratory symptoms, CRP < 15 mg/dl, adequately improved oral intake, fever ≤ 38 °C for ≥ 12 h), were divided into two groups based on the antibiotic administered, the GRNX (switch to GRNX 400 mg/day) and SBT/ABPC groups (continuous administration of SBT/ABPC), for 4 days. Improvement in clinical symptoms, chest radiographic findings, and clinical effectiveness were evaluated by a central review board. Improvement in clinical symptoms was 96.3 and 90.2 % in the GRNX and SBT/ABPC groups, respectively. Improvement in chest radiographic findings was 94.4 and 90.2 % and clinical effectiveness was 94.4 and 90.2 % in the GRNX and SBT/ABPC groups, respectively. Microbiological efficacy was 90.9 and 69.2 % in the GRNX and SBT/ABPC groups, respectively. There were no significant differences between the groups. Converting to GRNX was as effective as continuous SBT/ABPC treatment in mild to moderate CAP patients in whom initial intravenous antibiotic treatment was successful.     

Mortality in ICU patients with bacterial community-acquired pneumonia: when antibiotics are not enough

Background  It remains uncertain why immunocompetent patients with bacterial community-acquired pneumonia (CAP) die, in spite of adequate antibiotics. Methods  This is a secondary analysis of the CAPUCI database which was a prospective observational multicentre study. Two hundred and twelve immunocompetent patients admitted to 33 Spanish ICUs for CAP were analyzed. Comparisons were made for lifestyle risk factors, comorbidities and severity of illness. ICU mortality was the principal outcome variable. Results  Bacteremic CAP (43.3 vs. 21.1%) and empyema (11.5 vs. 2.2%) were more frequent (P < 0.05) in patients with Streptococcus pneumoniae CAP. Higher rates of adequate empiric therapy (95.8 vs. 75.5%, P < 0.05) were observed in patients with S. pneumoniae CAP. Patients with non-pneumococcal CAP experienced more shock (66.7 vs. 50.8%, P < 0.05), and need for mechanical ventilation (83.3 vs. 61.5%, P < 0.05). ICU mortality was 20.7 and 28% [OR 1.49(0.74–2.98)] among immunocompetent patients with S. pneumoniae (n = 122) and non-pneumococci (n = 90), in spite of initial adequate antibiotic. Multivariable regression analysis in these 184 immunocompetent patients with adequate empirical antibiotic treatment identified the following variables as independently associated with mortality: shock (HR 13.03); acute renal failure (HR 4.79), and APACHE II score higher than 24 (HR 2.22). Conclusions  Mortality remains unacceptably high in immunocompetent patients admitted to the ICU with bacterial pneumonia, despite adequate initial antibiotics and comorbidities management. Patients with shock, acute renal failure and APACHE II score higher than 24 should be considered for inclusion in trials of adjunctive therapy in order to improve CAP survival. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users. This article is discussed in the editorial available at: doi:.