治疗社区获得性肺炎高剂量左氧氟沙星临床分析

目的:评价口服高剂量左氧氟沙星片治疗社区获得性肺炎(CAP)(CAP)的临床疗效及安全性.方法 :对27例CAP患者,口服左氧氟沙星片0.5g,每天1次,疗程7-14天.结果 :高剂量左氧氟沙星片治疗CAP临床有效率86%,细菌清除率87%,药物不良反应发生率10%,主要为轻度胃肠道反应.结论 :高剂量左氧氟沙星片口服治疗CAP疗效好,安全性高,而且能降低医疗费用和不良反应,值得临床推广.     

社区基本药物左氧氟沙星治疗社区获得性肺炎43例分析

目的探讨社区医院基本药物左氧氟沙星治疗社区获得性肺炎的临床疗效、安全性。方法应用社区基本药物左氧氟沙星治疗社区获得性肺炎43例,观察临床治疗效果、副作用。结果 43例患者,痊愈21例(48.8%),显效17例(39.5%),总有效率为88.3%,不良反应率6.97%,抗生素费用占住院总费用的2.59%。结论社区基本药物左氧氟沙星治疗社区获得性肺炎价廉有效。     

哌拉西林/他唑巴坦联合左氧氟沙星治疗重症肺炎的评价

目的评价哌拉西林/他唑巴坦联合左氧氟沙星对老年重症社区获得性肺炎的治疗效果。方法回顾性分析哌拉西林/他唑巴坦联合左氧氟沙星治疗156例老年重症社区获得性肺炎的临床疗效。结果平均疗程11.5d,细菌清除率达84.4%,临床有效率为92.9%,不良反应发生率7.0%,不良反应轻微,主要包括:胃肠道症状、皮疹、白细胞减少及肝功能异常等,均经停药或对症处理后缓解。结论哌拉西林/他唑巴坦联合左氧氟沙星治疗老年重症社区获得性肺炎临床效果肯定,不良反应小,可作为治疗老年重症社区获得性肺炎的经验性用药。     

盐酸莫西沙星片在门诊治疗社区获得性肺炎的临床观察

目的：观察莫西沙星片在门诊口服治疗社区获得性肺炎的疗效及安全性。方法：将87例社区获得性肺炎患者,随机分为治疗组（44例）和对照组（43例）,治疗组用莫西沙星片口服,400mg,1次/d,治疗12d,对照组用左氧氟沙星注射液400mg静滴,治疗12d,观察两组临床症状、体征、X线胸片、疗效和药物的不良反应。结果：治疗组与对照组的有显效率分别为95.45%和79.07%,两组比较差异有统计学意义（P〈0.05）;细菌清除率治疗组为93.14%,对照组为71.78%,差异有统计学意义（P〈0.05）。结论：莫西沙星在门诊给药高效、安全、方便、依从性好。     

单用左氧氟沙星与头孢呋辛联用阿奇霉素治疗社区获得性肺炎的对照研究

目的 比较左氧氟沙星与头孢呋辛联用阿奇霉素治疗社区获得性肺炎的临床疗效、细菌清除率和安全性。方法 将55例社区获得性肺炎患者,随机分为左氧氟沙星治疗组和头孢呋辛联用阿奇霉素治疗组,观察两组患者的临床疗效、细菌清除率和不良反应。结果 左氧氟沙星组30例患者,痊愈25例（83.3%）,显效3例（10.0%）,总有效率93.3%,细菌清除率85.7%,不良反应发生率3.3%;头孢呋辛联用阿奇霉素组25例患者,痊愈20例（80.0%）,显效3例（12.0%）,总有效率92.0%,细菌清除率88.9%,不良反应发生率4.0%。结论 左氧氟沙星与头孢呋辛联用阿奇霉素治疗社区获得性肺炎的临床疗效、细菌清除率和安全性差异无统计学意义。     

左氧氟沙星治疗老年社区获得性肺炎临床研究

目的评价左氧氟沙星治疗老年社区获得性肺炎的有效性和安全性. 方法以左氧氟沙星静脉滴注为治疗组,头孢曲松静脉滴注为对照组,对两组治疗老年社区获得性肺炎的疗效和安全性进行随机对照观察. 结果入选 318例病例,可评价病例 301例,治疗组可评价病例 148例,对照组 153例;治疗组和对照组的总有效率分别为95.3%和92.2%,治愈率分别为81.8%和77.8%;两组共分离细菌 162株,细菌清除率分别为88.8%和85.4%,不良反应发生率分别为7.5%和3.8%;实验室异常发生率分别为8.8%和10.0%;上述结果经统计学处理差异无显著性(P＞0.05). 结论左氧氟沙星静脉滴注治疗老年社区获得性肺炎疗效良好,不良反应发生较少且安全.     

左氧氟沙星治疗社区获得性肺炎的临床分析

目的?探讨左氧氟沙星治疗社区获得性肺炎的临床疗效及不良反应.方法?选择2009年1月—2011年12月前来我院就诊的社区获得性肺炎80例,随机分为治疗组和对照组各40例.治疗组给予左氧氟沙星,对照组给予莫西沙星.结果?治疗组总有效率90%,明显高于对照组的47.5%,差异有统计学意义(P<0.05);治疗组与对照组各有不良反应4例,差异无统计学意义(P>0.05).结论?左氧氟沙星治疗社区获得性肺炎疗效可靠,不良应用小,值得推广应用.     

左氧氟沙星序贯治疗老年社区获得性肺炎效果-成本评价

[目的]评价左氧氟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]对80例老年社区获得性肺炎患者先予以左氧氟沙星注射液400mg／250ml静脉滴注,每天1次,治疗3～5天,临床症状改善后,随机分成序贯组和对照组。序贯组40例换左氧氟沙星片剂200mg口服,每天2次,对照组继续使用左氧氟沙星注射液400mg／250ml静脉滴注,每天1次,2组总疗程最长14天,观察治疗效果、药物不良反应和治疗费用。[结果]2组治愈率、细菌清除率、不良反应均类似,序贯组抗生素费用、总医疗费用均低于对照组。[结论]左氧氟沙星序贯治疗老年社区获得性肺炎安全、有效、经济、方便。     

莫西沙星联合阿奇霉素治疗社区获得性肺炎的临床疗效

目的：评价莫西沙星注射液与阿奇霉素分散片联合治疗社区获得性肺炎的临床疗效和安全性。方法：收集90例社区获得性肺炎患者,随机分为2组进行随机对照试验。治疗组（45例）给予莫西沙星注射液,每次0.4g,静脉滴注,qd,疗程5~7d,同时口服阿奇霉素分散片,首日0.5g顿服,第2~5d,0.25g顿服。对照组给予左氧氟沙星注射液,每次0.2g,静脉滴注,b id,疗程5~7d,同时口服阿奇霉素分散片,首日0.5g顿服,第2~5d,0.25g顿服。结果：治疗结束后,治疗组临床疗效、细菌清除率与对照组比较,差异有统计学意义（P〈0.05）,药物不良反应发生率与对照组比较,差异无统计学意义（P〉0.05）。结论：莫西沙星联合阿奇霉素治疗社区获得性肺炎临床疗效确切,且安全性高,值得临床推广使用。     

莫西沙星与左氧氟沙星序贯治疗社区获得性肺炎的疗效对比

目的对比莫西沙星与左氧氟沙星序贯治疗社区获得性肺炎的临床疗效。方法将84例社区获得性肺炎患者随机分为对照组(n=42)和实验组(n=42),分别给予左氧氟沙星和莫西沙星序贯治疗,比较两组临床疗效和安全性。结果实验组抗感染总治疗时间和静脉治疗时间,显著短于对照组(P0.05),治疗3~5 d改成口服用药,比率显著高于对照组(P0.05);实验组总有效率显著高于对照组(97.6%VS78.6%,P0.05);实验组和对照组病原菌清除率高于对照组(91.3%VS61.5%,P0.05);实验组与对照组不良反应发生率比较,差异无统计学意义(P0.05)。结论莫西沙星治疗社区获得性肺炎用药时间更短、病原菌清除率更好,可在临床中推广使用。     

Acute community-acquired pneumonia. A review of clinical trials

Optimal antibiotic treatment of community-acquired pneumonia (CAP) remains controversial. The clinical impact of S. pneumoniae resistance to macrolides is well documented. By contrast high dosage amoxicillin (1 g tid) remains active against such strains and no failure has been reported. The aim of this paper was to review clinical trials in community-acquired pneumonia, published from January 1, 1999, to December 31, 2005. One hundred seventy-three articles were collected, using Medline, 35 of which were analyzed, and 16 finally used. Telithromycin and pristinamycin may be used in mild to moderate CAP. Anti-pneumococcal fluoroquinolones such as levofloxacin and moxifloxacin may be used in at risk patients, but levofloxacin has only been investigated in patients with severe CAP and patients with Legionnaire's disease. Amoxicillin 1 g tid remains the drug of choice for pneumococcal CAP.     

Community-Acquired Pneumonia and its Management

Community-acquired pneumonia (CAP) is a common cause of morbidity and mortality worldwide and places a large burden on medical and economic resources, particularly if hospitalization is required. Indeed, it has been estimated that annual costs of inpatient treatment of patients with CAP currently exceed $US6 billion in the US; a large proportion of this cost is directly related to the duration of hospital stay. Initial antibacterial therapy for CAP is usually empirical, as culture and antibacterial sensitivity test results are rarely available at initial diagnosis. Importantly, treatment must be initiated promptly to achieve the best patient outcome thereby potentially reducing healthcare costs, largely as a result of a decrease in hospitalisation. Any agent selected for empirical therapy should have good activity against pathogens associated with CAP, a favorable tolerability profile and be administered in a simple dosage regimen for good compliance. Streptococcus pneumoniae remains the most common causative pathogen in nonsevere and severe CAP, although the incidence of this organism varies widely. S. pneumoniae strains with decreased susceptibility to penicillin have become increasingly prevalent over the past 30 years and are now a serious problem worldwide. In addition, an increase in the prevalence of pneumococci resistant to macrolides has been observed in Europe over recent years. Mycoplasma pneumoniae and Chlamydia pneumoniae are among the most common atypical pathogens isolated from patients with CAP. Haemophilus influenzae, Staphylococcus aureus and Moraxella catarrhalis are less commonly identified as causative organisms.Because the spectrum of antibacterial activity of levofloxacin includes the pathogens associated with CAP, including penicillin-resistant S. pneumoniae, it is included in US guidelines as an option for the empirical therapy of patients with mild or more severe disease. Levofloxacin is recommended for the initial treatment of outpatients and inpatients with suspected penicillin-resistant S. pneumoniae infection and is particularly useful in geographical areas where there is a high incidence of drug-resistant pneumococci. Nevertheless, β-lactam antibacterial agents, in particular penicillin, remain agents of first choice for the treatment of CAP (caused by penicillin-susceptible pathogens) in many European countries.Levofloxacin monotherapy shows good efficacy in the treatment of patients with CAP and is generally well tolerated. Phototoxicity has been infrequently reported with levofloxacin (incidence 0.03% in 1 study) and occurs less commonly than with sparfloxacin (reported incidence 8%). In addition, the drug has a pharmacokinetic profile that allows a simple administration schedule and offers the potential for intravenous to oral sequential therapy. In randomized comparative trials, intravenous or oral levofloxacin was more effective than intravenous ceftriaxone and/or oral cefuroxime axetil, at least as effective as azithromycin plus ceftriaxone and similar in efficacy to both amoxicillin/clavulanic acid and gatifloxacin. Data comparing the efficacy of levofloxacin with other newer fluoroquinolones, such as moxifloxacin, are as yet unavailable.Levofloxacin was also a beneficial treatment for CAP from a pharmacoeconomic perspective. A critical pathway that used levofloxacin for the treatment of patients with CAP led to a decrease in healthcare resource costs compared with conventional management in a randomized controlled trial conducted in Canada. As a treatment for CAP, levofloxacin was less costly than intravenous ceftriaxone and was more cost effective than cefuroxime plus erythromycin, or ceftriaxone or ciprofloxacin.

Conclusions

Levofloxacin monotherapy is efficacious and shows pharmacoeconomic benefits when used as empirical treatment for adult patients with CAP. The drug has a broad spectrum of antibacterial activity, is administered in a simple dosage regimen and offers the potential for intravenous to oral sequential therapy; it is also well tolerated and is an option for patients allergic to penicillin or macrolides. Levofloxacin has a particularly useful role in the empirical treatment of patients with infections caused by S. pneumoniae in geographical areas where penicillin-resistant strains of pneumococci are prevalent.

     

左氧氟沙星治疗老年社区获得性肺炎临床观察

目的 了解左氧氟沙星治疗老年社区获得性肺炎(CAP)的临床有效性和不良反应的发生情况.方法 老年CAP患者36例,均应用左氧氟沙星治疗,每日1次0.5 g静脉滴注,疗程5～14 d.结果 22例痰培养检出多药耐药的肺炎链球菌,8例检出铜绿假单胞菌,6例检出流感嗜血杆菌,临床有效率为75.0%;细菌清除率为82.1%;相关腹泻、皮疹、肾损害各2例,占16.7%.结论 左氧氟沙星治疗老年CAP疗效好,不良反应发生率相对较低.     

Comparative Analysis of Length of Stay, Total Costs, and Treatment Success between Intravenous Moxifloxacin 400 mg and Levofloxacin 750 mg among Hospitalized Patients with Community-Acquired Pneumonia

Objective:  This study aimed to evaluate the length of stay (LOS), costs, and treatment consistency among patients hospitalized with community-acquired pneumonia (CAP) initially treated with intravenous (IV) moxifloxacin 400 mg or IV levofloxacin 750 mg.
Methods:  Adults with CAP receiving IV moxifloxacin or IV levofloxacin for ≥3 days were identified in the Premier Perspective comparative database. Primary outcomes were LOS and costs. Secondary outcomes included treatment consistency, which was defined as 1) no additional IV moxifloxacin or levofloxacin after ≥1 day off study drug; 2) no switch to another IV antibiotic; and 3) no addition of another IV antibiotic.
Results:  A total of 7720 patients met inclusion criteria (6040 receiving moxifloxacin; 1680 receiving levofloxacin). Propensity matching created two cohorts (1300 patients each) well matched for demographic, clinical, hospital, and payor characteristics. Before the patients were matched, mean LOS (5.87 vs. 5.46 days; P  = 0.0004) and total costs per patient ($7302 vs. $6362; P  < 0.0001) were significantly greater with moxifloxacin. After the patients were matched, mean LOS (5.63 vs. 5.51 days; P  = 0.462) and total costs ($6624 vs. $6473; P  = 0.476) were comparable in both cohorts. Treatment consistency was higher for moxifloxacin before (81.0% vs. 78.9%; P  = 0.048) and after matching (82.8% vs. 78.0%; P  = 0.002).
Conclusions:  In-hospital treatment of CAP with IV moxifloxacin 400 mg or IV levofloxacin 750 mg was associated with similar hospital LOS and costs in propensity-matched cohorts.     

左氧氟沙星治疗急性下呼吸道细菌感染的疗效观察

目的 评价左氧氟沙星序贯疗法治疗急性下呼吸道细菌感染的疗效和安全性。方法 对38例急性下呼吸道细菌感染患者，采用左氧氟沙星0．3-0．68／d，6—8d静脉滴注，继之以0．2，bid，4—7d，po。结果 痊愈11例(28．95％)，显效24例(60．5％)，有效率92．11％，细菌消除率92．86％，总疗程10-15d(平均11．6d)，药物副作用较少(发生率2．63％)。结论 左氧氟沙星序贯疗法治疗急性下呼吸道常见细菌性感染有效、安全。     

小剂量戊酸雌二醇结合牡蛎碳酸钙咀嚼片治疗绝经后骨质疏松症的研究

目的 观察小剂量戊酸雌二醇结合牡蛎碳酸钙咀嚼片(盖天力)治疗绝经后骨质疏松症的临床疗效和安全性.方法 32例绝经后骨质疏松症患者口服戊酸雌二醇1 mg/d,盖天力150mg,每日3次,每个月后半程加服醋酸甲羟孕酮4mg/d,治疗6个月.结果 治疗后L1～4及左侧股骨骨密度均有明显提高(P<0.05).治疗后27例(84.4%)患者自觉腰背部及关节疼痛明显好转或消失,生活能自理,并能参加正常社会活动.4例患者治疗3个月内有少许不规则阴道出血,加服醋酸甲羟孕酮后好转,3例患者出现轻至中度的乳腺肿胀,1例患者出现白带增多,但均很快自然好转.结论 小剂量戊酸雌二醇结合盖天力治疗绝经后骨质疏松症可缓解疼痛,提高骨密度,预防骨丢失,效果明显,不良反应少.     

小剂量戊酸雌二醇结合牡蛎碳酸钙咀嚼片治疗绝经后骨质疏松症的研究

目的观察小剂量戊酸雌二醇结合牡蛎碳酸钙咀嚼片（盖天力）治疗绝经后骨质疏松症的临床疗效和安全性。方法32例绝经后骨质疏松症患者口服戊酸雌二醇1mg／d，盖天力150mg，每日3次，每个月后半程加服醋酸甲羟孕酮4mg／d，治疗6个月。结果治疗后L1-4。及左侧股骨骨密度均有明显提高（P〈0．05）。治疗后27例（84．4％）患者自觉腰背部及关节疼痛明显好转或消失，生活能自理，并能参加正常社会活动。4例患者治疗3个月内有少许不规则阴道出血，加服醋酸甲羟孕酮后好转，3例患者出现轻至中度的乳腺肿胀，1例患者出现白带增多，但均很快自然好转。结论小剂量戊酸雌二醇结合盖天力治疗绝经后骨质疏松症可缓解疼痛，提高骨密度，预防骨丢失，效果明显，不良反应少。     

三苯氧胺联合乳核散结片治疗乳腺增生症的临床观察

目的:观察三苯氧胺联合乳核散结片治疗乳腺增生症的疗效。方法:将152例乳腺增生症患者随机分为2组,观察组82例口服小剂量三苯氧胺联合乳核散结片,对照组70例单用常规剂量三苯氧胺,连续服药3个月,停药3个月后跟踪随访半年。观察两组的总有效率、不良反应发生率和复发率。结果:观察组总有效率为90.2%,高于对照组的71.4%(P<0.05);观察组复发率与不良反应发生率分别为4.9%和15.9%,低于对照组的20.0%和42.9%(P<0.05)。结论:三苯氧胺和乳核散结片结合治疗乳腺增生症疗效显著,副作用少。