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。     

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。     

盐酸莫西沙星治疗吸入性肺炎的临床观察

目的：探讨盐酸莫西沙星治疗吸入性肺炎的临床疗效.方法：将本院120 例吸入性肺炎住院患者采用随机分为治疗组（ 盐酸莫西沙星组） 和对照组（ 头孢他啶联合克林霉素组）,每组60 例,观察两组患者临床疗效、细菌清除率及不良反应.结果：治疗组和对照组的临床有效率分别为91.67%和71.67%,细菌清除率分别为84.00%和64.58%,不良反应发生率分别为6.67%和21.67%,两组各项指标比较差异均有统计学意义（P〈0.05）.结论：盐酸莫西沙星治疗吸入性肺炎疗效确切,且安全,可广泛应用于吸入性肺炎的治疗.     

社区获得性肺炎抗菌药物治疗的临床观察

目的对比观察莫西沙星、左氧氟沙星和头孢哌酮/舒巴坦在社区获得性肺炎抗感染治疗中的临床疗效及安全性,以降低感染率。方法将180例社区获得性肺炎患者随机分成A、B、C 3组,每组各60例,分别给予莫西沙星、左氧氟沙星、头孢哌酮/舒巴坦静脉滴注治疗,比较3组的临床疗效及安全性。结果 3组的总有效率分别为95.00%、80.00%和78.33%,3组比较差异有统计学意义(P<0.05),莫西沙星组的总有效率高于左氧氟沙星组(χ2=6.17,P<0.05)及头孢哌酮/舒巴坦组(χ2=7.21,P<0.05);3组的细菌清除率分别为93.33%、74.42%和70.45%,3组比较差异有统计学意义(P<0.05),莫西沙星组的细菌清除率均高于其余两组,差异均有统计学意义(P<0.05),不良反应发生率分别为5.00%、8.33%和6.67%,3组比较差异无统计学意义。结论莫西沙星治疗社区获得性肺炎安全、有效,值得临床推广应用。     

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。     

莫西沙星治疗恶性肿瘤合并医院获得性肺炎的疗效观察

目的观察莫西沙星治疗恶性肿瘤合并医院获得性肺炎(HAP)的临床效果和安全性。方法 102例恶性肿瘤合并HAP病例,随机分为治疗组52例、对照组50例;治疗组应用莫西沙星治疗,对照组应用左氧氟沙星治疗,观察其临床效果和安全性。结果治疗组及对照组总有效率分别是80.8%和58.0%,痊愈率分别为50.0%和32.0%,两组共分离出细菌121株,细菌清除率分别为80.3%和58.3%、不良反应发生率分别为3.9%和10.0%,差异均有统计学意义(P<0.05)。结论莫西沙星治疗恶性肿瘤合并HAP患者临床疗效较好,细菌清除率高、优于左氧氟沙星,临床使用安全。     

莫西沙星治疗社区获得性肺炎的疗效观察

目的观察莫西沙星治疗社区获得性肺炎的临床疗效及安全性。方法将130例老年社区获得性肺炎患者随机分成治疗组和对照组,每组各65例,治疗组患者给予莫西沙星注射液静脉滴注,对照组患者给予左氧氟沙星静脉滴注,治疗12周后比较两组患者的临床疗效。结果治疗组60例有效,总有效率为92.3%,对照组44例有效,总有效率67.7%,治疗组总有效率明显高于对照组,差异有统计学意义(P<0.05);治疗组的细菌清除率为84.6%,显著高于对照组的55.4%,差异有统计学意义(P<0.05);治疗组有4例出现轻度恶心,药物不良反应的发生率为6.2%,对照组2例出现轻度恶心、4例出现皮疹,药物不良反应的发生率为9.2%,治疗组药物不良反应的发生率低于对照组,但差异无统计学意义。结论莫西沙星组的治疗有效率和细菌清除率明显优于左氧氟沙星,且更安全有效;莫西沙星治疗社区获得性肺炎在临床治疗中是优选方案,值得临床推广应用。     

阿奇霉素治疗社区获得性肺炎的临床疗效

目的：探讨阿奇霉素治疗社区获得性肺炎的临床疗效。方法：获得性肺炎患者共100例,随机分为观察组与对照组,各50例。在对症治疗基础上,观察组使用阿奇霉素治疗,对照组使用头孢呋辛,观察两组临床疗效与不良反应。结果：观察组的总有效率是94．00％,高于对照组（74．00％）,差异具有统计学意义（P〈0．05）;在不良反应方面,观察组（12．00％）与对照组（10．00％）差异没有统计学意义（P〉0．05）。结论：阿奇霉素治疗社区获得性肺炎的临床疗效好,值得推广。     

莫西沙星治疗社区获得性肺炎的临床观察

目的探讨莫西沙星治疗社区获得性肺炎的临床疗效和安全性。方法 48例符合社区获得性肺炎诊断标准的患者,在基础治疗的上加用盐酸莫西沙星氯化钠注射液静脉滴注,400mg,每天1次,疗程为7～14d,观察患者症状变化及药物不良反应。结果 48例患者显效33例、有效9例和无效6例,总有效率为87.50%;治疗期间,2例出现皮疹、瘙痒,2例患者出现口干、恶心,不良反应发生率为8.33%。结论莫西沙星治疗社区获得性肺炎敏感性高,安全性好,患者易耐受,值得临床推广应用。     

莫西沙星治疗老年卒中相关性肺炎疗效调查

目的 评估莫西沙星治疗老年卒中相关性肺炎的有效性及安全性,为治疗老年卒中相关性肺炎选择安全、有效的抗菌药物.方法 将2008年1月-2010年12月在医院呼吸内科住院的63例老年卒中相关性肺炎患者随机分为两组,治疗组33例给予莫西沙星,对照组30例给予头孢他啶,观察临床疗效及其不良反应.结果 治疗组与对照组临床有效率、细菌清除率分别为87.87％、88.00％和73.33％、64.29％;两组临床有效率和细菌清除率差异有统计学意义(P＜0.05);治疗组的不良反应为9.09％.结论 莫西沙星治疗老年卒中相关性肺炎效果满意,不良反应少,是治疗老年卒中相关性肺炎安全、有效的抗菌药物.     

左氧氟沙星与头孢噻肟治疗下呼吸道感染的疗效比较

目的比较左氧氟沙星注射液与头孢噻肟针剂治疗社区获得性下呼吸道感染的临床疗效、细菌清除率和安全性. 方法将60例社区获得性下呼吸道感染的患者随机分为左氧氟沙星治疗组和头孢噻肟治疗组,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,总有效率93.3%,细菌清除率 91.7%,不良反应发生率为3.3%.头孢噻肟治疗组30例患者,总有效率90.0%,细菌清除率88.7%,不良反应发生率为3.3%. 结论左氧氟沙星和头孢噻肟治疗社区获得性下呼吸道感染的临床疗效、细菌清除率和安全性差异无显著性.     

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.     

13--Antibiotic therapy of community-acquired pneumonia (CAP) caused by atypical agents

Macrolides, fluoroquinolones, doxycycline, and ketolides show a good intrinsic activity against intracellular pathogens which are responsible for a variable percentage of community-acquired pneumonia (CAP). These therapeutic agents all seem effective in treating most cases of CAP caused by Mycoplasma pneumoniae, Chlamydia pneumoniae, or Legionella spp. Among quinolones, the more recent fluoroquinolones, such as gemifloxacin or moxifloxacin, generally show a better intrinsic activity than the older ones. Among macrolides, azithromycin, and clarithromycin show a better pharmacokinetic profile. Both of them are available in intravenous form. It is quite common for M. pneumoniae and C. pneumoniae to continue to be shed in respiratory secretions, weeks after an effective therapy. The clinical relevance of this finding is not clear since most of these patients have a good outcome. Azithromycin, due to its advantageous pharmacokinetic profile, seems the best option when antibiotic prophylaxis is considered in some epidemiological settings. It has been proved effective in closed M. pneumoniae outbreaks.     

哌拉西林钠舒巴坦钠注射液治疗31例社区获得性肺炎临床疗效分析

目的探讨观察哌拉西林钠舒巴坦钠注射液治疗社区获得性肺炎(CAP)的临床效果,总结其临床意义。方法选取我院2009年7月-2011年10月期间收治的社区获得性肺炎患者62例,随机将其分为观察组和对照组各31例,观察组使用哌拉西林钠舒巴坦钠注射液治疗,对照组使用五水头孢唑林钠治疗,观察对比两组患者的临床治疗效果。结果观察组痊愈17例,显效13例,有效1例,不良反应有1例,总有效率为96.8%,对照组痊愈13例,显效11例,有效5例,无效2例,不良反应6例,总有效率为77.4%,两组疗效及不良反应比较差异显著(P<0.05),具有统计学意义。结论使用哌拉西林钠舒巴坦钠注射液治疗CAP的临床疗效显著,能够有效缓解临床症状,且不良反应小,安全可靠,值得临床推广使用。     

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.

     

成人社区及医院获得性肺炎病原菌及耐药性差异

 目的 比较非呼吸机相关医院获得性肺炎（NV-HAP）、呼吸机相关肺炎（VAP）与社区获得性肺炎（CAP）感染病原菌分布及耐药性。方法 回顾性调查2017年10月-2019年9月某院肺炎患者病历资料,按NV-HAP、VAP、CAP定义将患者分别列为NV-HAP组、VAP组、CAP组。收集三组患者痰、支气管肺泡灌洗液、血标本培养病原菌及药敏试验结果,分析三组患者感染病原菌构成和耐药性差异。结果 共纳入肺炎患者4 391例,NV-HAP组1 080例,VAP组126例,CAP组3 185例,各组分别检出病原菌841、191、1 440株,均以革兰阴性（G^-）菌为主,依次占72.77%、84.82%和61.18%,三组患者检出病原菌分布比较,差异有统计学意义（χ²=64.037,P<0.001）。鲍曼不动杆菌对头孢吡肟、头孢哌酮/舒巴坦、亚胺培南、庆大霉素、妥布霉素、左氧氟沙星、环丙沙星和复方磺胺甲口恶唑耐药率,铜绿假单胞菌对头孢哌酮/舒巴坦和亚胺培南耐药率,肺炎克雷伯菌对常用抗菌药物耐药率,三组比较差异均有统计学意义（均P<0.05）;金黄色葡萄球菌对红霉素、克林霉素和环丙沙星的耐药率比较,CAP组高于NV-HAP组（P<0.05）。结论 NV-HAP、VAP和CAP在病原菌分布及细菌耐药性方面均存在差异,在制定临床治疗方案时,要区别对待不同感染类型的肺炎。     

A randomized prospective study to compare cefotetan with cefuroxime plus metronidazole as prophylaxis in elective colorectal surgery.

This study compares the efficacy of cefotetan with the combination of cefuroxime plus metronidazole as antibiotic prophylaxis in elective colorectal surgery when given over the first 24 h postoperatively. There was no significant difference in wound infection rates between the two groups (14.7% for cefotetan and 13.9% for cefuroxime plus metronidazole), or the rates of other infective complications. Adverse reactions occurred with equal frequency in both treatment groups and no serious side effects occurred. Cefotetan is a safe and effective antibiotic for use as prophylaxis in elective colorectal surgery. Its advantages are that it is a single agent with a spectrum covering both aerobic Gram-negative rods and anaerobic organisms and, because of its long half-life, needs only to be given at 12-hourly intervals.     

烟台市272例老年社区获得性肺炎住院患者的病原学特点分析

目的 了解60岁以上老年社区获得性肺炎（CAP）住院患者的病原谱构成、影响因素及主要病原体耐药情况。方法 采用系统随机抽样的方法抽取烟台市两所综合性医疗机构2017年全年收治的老年CAP住院患者272例,对其临床资料及病原学检测结果进行回顾性分析,并对计数资料进行χ2检验。结果 （1）在采集标本中共检出16种呼吸道病原体,阳性率54.41%（148/272）,各类病原体中以乙型流感病毒（58/272）、肺炎克雷伯菌（48/272）、肺炎支原体（22/272）分别居病毒、细菌、非典型病原体的首位,病原体混合感染率18.38%（50/272）;（2）不同年龄组中肺炎克雷伯菌、流感嗜血杆菌及肺炎支原体的检出率存在差异（P<0.05）,10-12月发病的患者其病原阳性率（69/101）明显高于其他月份（χ2=30.629,P<0.001）;（3）患者中检出的肺炎克雷伯菌对氨苄西林（100.00%）、哌拉西林（58.33%）、头孢唑林（45.83%）等药物耐药率较高,肺炎链球菌对克林霉素（80.65%）、红霉素（100.00%）、四环素（77.42%）等药物耐药率较高。结论 烟台市60岁以上老年CAP住院患者的主要病原体是流感病毒,混合感染占比高并且组成形式复杂,主要致病细菌对常用抗生素有较高的耐药性,对老年CAP住院患者应进行多病原学联合检测以为临床治疗提供依据。     

阿奇霉素联合头孢曲松治疗社区获得性肺炎

[目的]探讨阿奇霉素联合头孢曲松治疗社区获得性肺炎(CAP)的疗效及其它影响。[方法]300例CAP患者随机分成AC组和CE组各150例,每组中伴有肺炎衣原体(Cpn)感染16例。AC组给予阿齐霉素和头孢曲松钠治疗,CE给予头孢曲松钠治疗。用微量免疫荧光法检测抗Cpn抗体效价,胶体金法(DIGFA)快速定量测定C-反应蛋白(CRP)。[结果]治疗后AC组Cpn-IgM抗体滴度下降(P0.05)、Cpn-IgM阳性率下降(P=0.051);两组CRP均下降;AC与CE组总有效率类似(分别为98.0%和95.3%);细菌总清除率也类似(分别为88.1%和86.8%)。[结论]AC与CE组治疗CAP都有良好疗效,阿奇霉素对伴有Cpn急性感染者疗效较好。