An overview of lefamulin for the treatment of community acquired bacterial pneumonia

ABSTRACT

Introduction

Lefamulin is a novel antibiotic that belongs to the pleuromutilin class with excellent activity against all microorganisms, including atypical pathogens, that cause community-acquired pneumonia (CAP).     

莫西沙星治疗社区获得性肺炎疗效观察

目的观察莫西沙星注射液治疗社区获得性肺炎(CAP)的临床疗效和不良反应。方法回顾性分析2006年1-12月非随机选择42例CAP入院治疗患者的临床资料。结果莫西沙星治疗CAP的总有效率为90.2%,细菌清除率为89.3%,不良反应发生率为4.8%。结论莫西沙星治疗CAP效果满意,不良反应少,是治疗CAP安全、有效的抗菌药物。     

抗生素序贯疗法治疗170例社区获得性肺炎疗效观察

目的:观察抗生素序贯疗法治疗社区获得性肺炎(CAP)的疗效。方法:将340例CAP患者随机分为序贯疗法组和对照组(常规疗法组),每组各170例。两组患者均给予退热、祛痰、平喘等对症治疗的基础上,对照组为经验性或者根据药敏试验结果给予β-内酰胺类、大环内酯类、喹诺酮类等抗菌药物持续静脉给药;序贯疗法组采用对照组方法选择相似同类抗生素,治疗3～4d,病情明显改善后,改用同类药物口服。两组总疗程均为10~15d。结果:对照组有效率93.53%(159/170)与序贯疗法组的92.35%(157/170)差异无统计学意义(P>0.05);对照组平均住院时间为(12.6±2.2)d,长于序贯疗法组的(6.6±2.4)d,差异无统计学意义(P<0.05);对照组有发生药物不良反应11.76%(20/170)高于序贯疗法组的2.94%(5/170)(P<0.05)。结论:应用抗生素序贯疗法治疗CAP,是1种有效、经济的治疗方法,具有临床可行性,但在临床应用中应考虑注意选择有效的口服抗生素,并掌握适用时机。     

Pharmacokinetics of oral vs. intravenous dexamethasone in patients hospitalized with community-acquired pneumonia

Aim

The use of corticosteroids as adjunctive therapy might be effective in patients with community-acquired pneumonia (CAP). Oral administration of dexamethasone is a practical and safer alternative to the intravenous route. Since patients hospitalized with pneumonia might have delayed gastric emptying, this study explored systemic exposure in terms of area under the concentration–time curve (AUC) of oral dexamethasone in patients hospitalized with CAP.

Methods

In this randomized, open label study, 30 patients admitted with CAP were randomized to receive either 4 mg intravenous or 6 mg oral dexamethasone for 4 consecutive days. Serial blood samples were obtained before and after drug administration.

Results

Median AUC to infinity was 626 μg l⁻¹ h (IQR 401–1161) for the intravenous group and 774 μg l⁻¹ h (IQR 618–1146) for the oral group. The AUC ratio of 6 mg oral and 4 mg intravenous dexamethasone was 1.22 (95% confidence interval (CI) 0.81, 1.82)_, which represents a bioavailability of 81% (95% CI 54, 121) after correction for differences in dexamethasone dose.

Conclusions

Bioavailability of oral dexamethasone in patients hospitalized with pneumonia is sufficient. This makes oral dexamethasone an appropriate alternative for intravenous administration in these patients.     

Pharmacotherapy for community-acquired pneumonia in the elderly

Introduction: Community-acquired pneumonia (CAP) is an increasing problem in the elderly that is associated with elevated morbidity and mortality. Given the expected increased life expectancy, this problem is only likely to worsen, so it has been considered that treatment effects must be examined separately in elderly adults with CAP.

Areas covered: In this narrative review, we give an update of the available data of antibiotics for elderly patients with CAP. Clinical features, drug pharmacokinetics and pharmacodynamics, adverse effects, and outcomes differ in CAP depending on patient age. Older age, for example, can affect the effect of specific antibiotic regimens on important CAP clinical outcomes. Current guidelines do not offer specific recommendations for the management of CAP in elderly patients.

Expert opinion: Most of our knowledge about the treatment of CAP in elderly patients has been gained from studies in young populations. However, elderly patients with CAP deserve special attention because there are several factors in this population that could influence their response to antibiotic regimens in CAP.     

大环内酯类抗生素在社区获得性肺炎治疗中的临床评价

目的:评价大环内酯类抗生素在社区获得性肺炎(CAP)治疗中的作用.方法:通过文献复习,对CAP常见病原体、大环内酯类抗生素特点、耐药性以及各国指南对大环内酯类抗生素治疗CAP的规定进行分析和讨论.结果与结论:应根据当地CAP病原体及耐药菌流行病学资料,合理选择使用大环内酯类抗生素.     

特发性肺间质纤维化合并社区获得性肺炎患者的药学监护实践

目的探讨特发性肺间质纤维化并社区获得性肺炎患者的药学监护模式。方法结合特发性肺间质纤维化治疗研究进展,介绍参与1例特发性肺间质纤维化并社区获得性肺炎患者药学监护的经验。结果临床药师与医师一同制定药物治疗方案,对患者进行药学监护,提供药学服务,提高了患者的治疗效果,减少了药物不良反应的发生。结论通过临床药师实施药学监护,可及时发现患者的药物治疗问题,促进临床合理用药,对延缓病程发展,提高患者生活质量有重要意义。     

社区获得性肺炎3种治疗方案的成本-效果分析

目的评价氨苄西林-舒巴坦组（A组）、头孢哌酮组（B组）、左氧氟沙星组（C组）三种方案对治疗社区获得性肺炎药物经济学成本与效果。方法采用回顾性研究方法，运用成本-效果分析法对三种治疗方案进行成本与效果分析。结果三种治疗方案中，A组、B组、C组总成本分别为1770．96元、1896．00元、1153．86元，治愈率分别为46．2％，61．5％，69．2％，每增加1个单位效果A组与B组比C组需多花成本分别为28．49元和52．45元。结论C组为治疗社区获得性肺炎的较佳治疗方案，通过成本-效果分析能优化治疗方案、指导合理用药，提高临床疗效。     

82例社区获得性肺炎病原体调查分析

目的调查社区获得性肺炎（CAP）的病原体分布,为本社区CAP的经验性治疗提供依据。方法收集2006年1月～2008年1月CAP患者共82例,分别留取呼吸道分泌物进行细菌培养,应用常规方法分离鉴定细菌,同时检测患者急性期和恢复期肺炎支原体、肺炎衣原体、嗜肺军团菌血清抗体。结果82例CAP患者48例（58．5％）病原学检查阳性。检出肺炎支原体14例;肺炎衣原体5例;嗜肺军团菌3例。分离出流感嗜血杆菌15例;肺炎链球菌10例;卡他莫拉菌5例;肺炎克雷伯杆菌2例;金黄色葡萄球菌2例。14例为混合感染。结论流感嗜血杆菌和肺炎链球菌仍是CAP的主要致病菌。非典型病原体在CAP中占有重要地位,且多为混合感染。     

无反应性社区获得性肺炎的诊治进展

摘要： 无反应性社区获得性肺炎 （CAP） 是指患者接受初始感染治疗后, 病情无好转或恶化, 其在 CAP 中的比例可达到 30%。目前, 对这类患者的诊断和治疗仍为 CAP 的难点。有关研究试图确定这部分患者的高危因素, 并提出进一步诊治方案。本文对目前无反应性 CAP 的病因和诊治进展进行综述。     

社区获得性肺炎两种治疗方案的成本-效果分析

目的评价两种治疗方案对治疗社区获得性肺炎的药物经济学效果,指导合理用药。方法对两种治疗方案运用成本-效果分析法进行分析。结果两种治疗方案中,单用莫西沙星（A组）总成本为4 092.75元,联合使用阿奇霉素和头孢呋辛（B组）总成本为3 306.83元;有效率分别为88.89%和85.71%;单位效果的增量成本分别为46.04元和38.58元。结论联合使用阿奇霉素和头孢呋辛治疗社区获得性肺炎更为经济合理。     

社区获得性肺炎210例临床分析

目的 探讨社区获得性肺炎患者的临床特征,指导CAP诊治。方法 分析笔者所在医院210例CAP患者的临床表现、X线表现、微生物学检查及治疗情况。结果 住院CAP患者以老年人(≥60岁)多见,肺炎的临床表现最主要的症状仍为咳嗽、咳痰、发热,但与年轻人相比,老年人易于出现呼吸困难和神志障碍,X线主要表现为片状影或间质渗出;痰培养可明确病原菌指导治疗;痰培养结果出来之前,经验治疗效果尚可。结论 社区获得性肺炎是一种呼吸内科常见病、多发病,临床诊治相对容易。但在部分老年人中症状重,且不典型,伴有基础疾病时可出现预后不良,需引起重视。     

Ceftobiprole medocaril for the treatment of community-acquired pneumonia

Introduction: Ceftobiprole is a novel broad-spectrum cephalosporin with excellent activity against a broad range of pathogens that are important in community-acquired pneumonia (CAP), including drug-resistant pneumococci, methicillin-resistant Staphylococcus aureus, and Pseudomonas aeruginosa.

Areas covered: This article reviews the spectrum of activity, the main pharmacological and pharmacodynamic characteristics of ceftobiprole as well its clinical efficacy and safety in the treatment of CAP in adult patients.

Expert opinion: Taking into account that the current treatment guidelines for CAP recommend the use of an adequate empirical therapy to improve its prognosis, ceftobiprole shows a profile of antimicrobial activity that would cover most etiological agents in patients with risk factors for infection caused by multidrug resistant organisms. The results of the pivotal clinical trial of patients hospitalized with CAP treated with ceftobiprole showed a high rate of clinical cure. The clinical tolerance of ceftobiprole in clinical trials was generally very good. These findings make ceftobiprole a good parenteral therapeutic alternative for the empirical treatment of CAP that requires hospitalization, especially in patients with risk factors for CAP caused by resistant microorganisms.     

New perspectives in aspiration community acquired Pneumonia

ABSTRACT

Introduction: Aspiration pneumonia is a subclass of community-acquired pneumonia that is expected to have an increasing contribution in mortality and morbidity, particularly in the elderly population over the next coming decades. While studies have revealed significant progress in identifying risk factors for aspiration pneumonia, the clinical presentation and diagnosis remain challenging to healthcare providers.

Areas covered: We conducted a broad literature review using the MeSH heading in PubMed/MEDLINE of ‘aspiration pneumonia’ from January 1970 to July 2019. The understanding of the microbiology of aspiration pneumonia has evolved from a possible shift in the causative organisms away from anaerobes to traditional community-acquired pneumonia organisms. The importance of this shift is not yet known, but it has questioned the pathogenic role of anaerobes, appropriate anaerobic testing and the role of these pathogens in the pulmonary microbiome in patients with pneumonia. The identification of risk factors led to strategies to prevent or minimize the risk of aspiration pneumonia with moderate success.

Expert opinion: Our expert opinion is that further research is needed to determine the role of the microbiome with aspiration pneumonia and patient risk factors. There is also a great need to develop clinical tools to help providers diagnose, treat, and prevent aspiration pneumonia.     

婴幼儿社区获得性肺炎支原体肺炎的临床特征

目的探讨婴幼儿社区获得性肺炎支原体（MP）肺炎的临床特征。方法对228例婴幼儿肺炎患儿血清采用ELISA法进行肺炎支原体抗体（MP-IgM）检测,MP—IgM阳性为MP感染组,MP—IgM阴性为对照组,并进行比较分析。结果感染组与对照组发病年龄差异有高度统计意义（P〈0．01）,发病季节无明显差异（P〉0．05）。2组患儿均有咳嗽、喘鸣及呼吸困难,感染组高热、肺部X线片状阴影、C反应蛋白（CRP）阳性、WBC升高、肺外并发症等均高于对照组,差异均有高度统计意义（P〈0．01）。结论MP感染的婴幼儿肺炎以高热为主,且持续时间较长;WBC和CRP增高,肺部X线有肺气肿伴单侧片状阴影;肺外表现多见。对高度怀疑MP感染的患儿,应及时做MP抗体的检查以确诊。     

从社区获得性肺炎经验性抗生素治疗方案看药学服务的重要性

目的：探讨对临床医师进行药学服务的必要性。方法：收集从2000年5月～2002年5月接受呼吸科医师和内科医师抗生素治疗社区获得性肺炎(CAP)的门诊病历426例。统计和分析首选抗生素种类和每日给药次数，并与我国《社区获得性肺炎诊断和治疗指南》进行对比。结果：呼吸科医师和内科医师治疗CAP的抗生素选择与《社区获得性肺炎诊断和治疗指南》有差距，以内科医师较为明显，表现为过多使用第三代头孢菌素，大环内酯类使用偏低，首选氨基糖苷类依然存在，且时间依赖型抗生素每日给药次数不合理。结论：为经济、合理、安全和有效使用药物，对临床医师开展药学服务指导十分重要。