利复星治疗老年人中重度下呼吸道细菌感染疗效观察

新型广谱喹诺酮类抗生素利复星 (Levoloxacin ,LVFX)已在临床用于治疗多种细菌感染包括重度感染 ,效果良好 ,不良反应少而轻微。 2 0 0 1年 3月至 2 0 0 3年 2月 ,我们应用LVFX进行了治疗老年人中重度下呼吸道细菌感染的研究 ,效果良好。1　资料与方法1.1　研究对象　我院 5 4例 60～ 78岁患者 ,男 3 7例 ,女 17例。平均年龄 ( 69.2± 7.8)岁。支气管肺炎 14例 ,慢性支气管炎合并肺部感染 2 5例 ,吸入性肺炎 8例 ,阻塞性肺炎 4例 ,支气管肺癌合并肺部感染 3例。全部患者无肝、肾、神经系统、造血系统异常及肺结核 ,无正在使用免疫抑制剂…     

产超广谱β—内酰胺酶细菌感染29例分析

近年来肠杆菌科产超广谱 β 内酰胺酶 (ＥＳＢＬｓ)细菌感染的出现及其具有多重耐药性 ,使临床治疗颇为棘手。本文收集了我院从 1999年 4月至 2 0 0 0年 4月全部住院病人送检标本中肠杆菌科产ＥＳＢＬｓ细菌感染病例共 2 9例 ,对其耐药状态以及治疗成功经验进行了分析 ,现报告如下。临床资料一、一般资料　男 19例 ,女 10例 ,年龄 2 0～ 84岁 ,平均 5 3岁 ,院内感染 14例。基础疾病 :白血病及恶性淋巴瘤 8例 ,颅脑外伤 5例 ,泌尿系疾患 5例 ,慢性支气管炎 4例 ,其它慢性疾病或晚期肿瘤 5例 ,结缔组织病 1例 ,烧伤 1例。 2 9例病人中 ,脑外科…     

利复星与奥复星治疗老年人下呼吸道细菌感染的临床对照观察

目的：对照研究利复星（LVFX）与奥复星（OFLX）治疗老年人下呼吸道细菌感染的临床疗效及安全性。方法：将90例下呼吸道细菌感染的老年患者随机分为两组。A组46例，给予利复星200mg，静脉滴注，每日2次，7－14d；B组44例，给予奥复星200mg，静脉滴注，每日2次，7－14d。结果：A组症状、体征改善时间明显短于B组（P＜0．01，＜0．05）；A组治愈率明显高于B组（P＜0．05）。两组在总有效率和细菌清除率方面差异无显著性（P＞0．05），均无明显不良反应.结论：利复星是一种十分有效和安全的治疗老年人下呼吸道细菌感染的药物。     

北京地区临床分离致病金黄色葡萄球菌常用抗生素敏感性研究

金黄色葡萄球菌是临床常见感染疾患致病菌,了解金黄色葡萄球菌对临床常用的β-内酰胺类抗生素的敏感性,对合理使用抗生素及时控制金黄色葡萄球菌感染是十分重要的.本文报告了北京地区临床分离致病金黄色葡萄球菌209株对16个β-内酰胺类抗生素敏感性研究结果.比较了16个抗生素对金黄色葡萄球菌的MIC范围、MIC_(50)、MIC_(90)、NIC_(mode)、MIC_(GM),并用I_(50)的指标比较客观地反映出同类药之间抗菌作用的差异.研究结果表明:青霉素类Oxacillin、Cloxacillin抗金黄色葡萄球菌的作用最强,两药的MIC_(60)、MIC_(90)相同,分别为0.25、0.5mg/L,但Cloxacillin的I_(50)值为0.20mg/L铰Oxacillin的0.23mg/L稍低,表明Cooxacillin的抗茵作用较Oxacillin好.Ampicillin与PenicllinG的抗菌作用相似,由于PencillinG临床常用剂量血浓度不高,PenicillinG临床抗金黄色葡萄球菌的疗效可能不理想.四种酰脲类抗生素抗菌作用的强弱次序是Furbenicillin、Mezlocillin、Azlocillin、Piperacillin,在多种细菌混合感染时选用Furbenicillin可能更好.Carbenicillin抗金黄色葡萄球菌的作用最差.头孢菌素类抗生素,第一代头孢菌素Cephalothin、Cefazolin抗金黄色葡萄球菌的作用明显优于第三代头孢菌素,一、二、三代头孢菌素随抗革蓝氏阴     

50例老年人下呼吸道感染应用抗生素现状分析

随着中国人口老龄化趋势的加剧 ,作为一个特殊的群体 ,老年人使用抗生素的频率、数量相对较多 ,而且多为联合应用 ,不良反应发生率比年轻人高。因药源性疾病致死的人数 ,也逐年上升。我们调查了本院 2 0 0 1年 2～ 4月下呼吸道感染住院病历 5 0份 ,对抗生素的使用情况作出统计分析。1　资料与方法1.1　临床资料抽取本院呼吸内科 2 0 0 1年 2～ 4月全部下呼吸道感染住院病人 5 0例 ,(男 3 8;女 12 )年龄 4 5～ 85岁 ,其中 ,急性支气管肺炎 12例 ,慢性支气管炎 5例 ,慢性支气管炎急性发作 11例 ,下呼吸道感染伴其它疾病 (如 :阻塞性肺气肿、肺…     

加替沙星治疗急性下呼吸道细菌感染的研究

目的：研究加替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46例急性下呼吸道细菌感染患者,采用加替沙星0.2g,bid,6-8d静脉滴注,继之以0.4g,qd,4-7d,口服。结果：痊愈14例（30.43%）,显效28例（60.87%）,改善4例（8.70%）,总有效率为91.30%,细菌消除率为95.66%,总疗程为10-15d,平均（12.0±2.7）d,药物副作用较少,发生率为2.17%。结论：加替沙星序贯疗法治疗急性下呼吸道细菌性感染有效、安全。     

下呼吸道感染细菌产AmpC酶对常用抗生素的敏感性

目的 观察有基础疾病患者下呼吸道感染细菌产AmpC酶对常用抗生素的敏感性。方法 收集我院2002—01—2003—12下呼吸道标本分离的革兰阴性杆菌耐药株，用三维试验检测高产AmpC酶菌株，K—B纸片法测定产酶株对常用抗生素的敏感性。结果 AmpC酶高产株总检出率22．5％(84／374)。产酶株对第2，3代头孢菌素、头霉素类、单环内酰胺类以及含酶抑制剂复合制剂敏感率为0～28．6％，对亚胺培南、头孢吡肟、环丙沙星、阿米卡星的敏感率分别为98．8％，82．1％，72．6％，63．1％。混合其他细菌或／和真菌感染发生率36．9％(31／84)，且多为条件致病菌。结论 有严重基础疾病、且长期使用β内酰胺类抗生素，尤其是第3代头孢菌素患者，易致高产AmpC酶细菌感染，且常混合感染各种条件致病菌，病死率高。治疗该类产酶菌感染首选为亚胺培南，其次为头孢吡肟。     

左氧氟沙星治疗呼吸道细菌感染疗效分析

目的评价左氧氟沙星治疗呼吸道细菌感染的疗效和安全性。方法对2003年至2007年186例呼吸道细菌感染患者,采用左氧氟沙星静脉滴注200mg,2次/d,疗程5～10d。结果痊愈87例(46.77%),显效77例(41.39%),总有效率88.16%,细菌清除率85.7%,不良反应发生率4.9%。结论左氧氟沙星治疗呼吸道细菌感染有效、安全、不良反应小。     

司帕沙星治疗下呼吸道细菌感染52例

目的：观察司帕沙星治疗下呼吸道感染的临床疗效,并与氧氟沙星进行比较。方法：下呼吸道感染患者114例随机分为治疗组,用司帕沙星胶囊300mg,qd;对照组用氧氟沙星胶囊300mg,bid,疗程均为7－14d。结果：两组的临床有效率、细菌清除率、不良反应发生率经统计学处理均差异不显著（P＞0．05）。结论：司帕沙星用于下呼吸道细菌感染的治疗安全有效。     

In vitro susceptibility of bacterial isolates from patients with respiratory tract infections to beta-lactam antibiotics

In vitro susceptibilities of bacterial pathogens to beta-lactam antibiotics were determined. Bacterial pathogens examined included various isolates from the patients of respiratory tract infections at the hospitals of Kyoto-Shiga area in 1981 and 1983. Major organisms isolated from clinical specimens were Haemophilus spp., Klebsiella spp., Pseudomonas spp., S. aureus and Streptococcus spp. An increase in the isolation frequency of P. aeruginosa, a decrease in the isolation frequency of H. influenzae and no change in the isolation frequency of the other organisms were observed between the years 1981 and 1983. Data from susceptibility tests of clinical isolates confirmed that cefazolin (CEZ) and cefotiam (CTM) showed good antibacterial activity against S. aureus and cefmenoxime (CMX) was highly effective on Streptococcus spp., but that the susceptibilities of both organisms to CEZ, CTM, and cefmetazole (CMZ) in 1983 were lower than in 1981. Although CMX also showed good antibacterial activity against Klebsiella spp., there were no changes in the effectiveness of CTM, CMZ, and CEZ between the years 1981 and 1983. The in vitro antibacterial activities of CMX and cefoperazone against Haemophilus spp. were superior to those of the other beta-lactams tested, but there was a decline in the efficacy for CEZ. Although cefsulodin and piperacillin were highly active against Pseudomonas spp., declines in their effectiveness was observed between the years 1981 and 1983.     

Steady-state pharmacokinetics of rufloxacin in elderly patients with lower respiratory tract infections.

The pharmacokinetics of rufloxacin, after repeated doses, was evaluated in 12 elderly patients with lower respiratory tract infections. Patients were given a single loading dose of 400 mg on the first day of treatment and single daily maintenance doses of 200 mg for the next 6-9 days. Serum concentrations of the drug were determined by high-performance liquid chromatography (HPLC) at regular intervals during treatment and fitted to a one-compartment open model for repeated doses. The maximum serum concentration after the first dose was 6.46 +/- 1.06 (mean +/- SEM) micrograms/ml and was reached in 4.3 +/- 0.8 h after the first administration. The elimination half-life was 28.7 +/- 4.1 h. The area under the serum levels-time curve from 0 to 24 h was 103 +/- 14 micrograms/h/ml after the first dose. On the last day of observation it increased to 155 +/- 28 micrograms/h/ml, with a mean extent of accumulation of 2.3 +/- 0.3 times. The elimination half-life was comparable to those in other studies in healthy young subjects, while plasma levels were about 80% higher. These results suggest that in elderly patients elevated drug concentrations may be reached in the serum. Although no untoward reactions related either to the drug concentration in serum or the dose have been noted with rufloxacin, this patient population should nevertheless be monitored carefully for adverse effects.     

Susceptibility of bacteria isolated from the patients with lower respiratory tract infections to antibiotics (1985)

It has been more than 4 years since third-generation cephems were introduced into clinical practice. The range of our drug selection definitely tends to increase, because we today have more antibiotics with wider spectrum, antibiotics with strong activities only against Gram-negative strains, such as monobactams, and those with tremendously high activities such as quinolone carboxylic acid derivatives, in comparison to those we had in the past. Among isolates obtained mainly from sputa of 567 patients with lower respiratory tract infections at 16 institutions throughout Japan between September of 1985 and March of 1986, 741 strains were determined to be causative organisms. MIC's of various antimicrobial agents were determined against 67 strains of Staphylococcus aureus, 100 strains of Streptococcus pneumoniae, 199 strains of Haemophilus influenzae, 92 strains of non-mucoid Pseudomonas aeruginosa, 40 strains of mucoid P. aeruginosa, 29 strains of Klebsiella pneumoniae, 10 strains of Escherichia coli and for 42 strains of Branhamella catarrhalis out of the above 741 strains to determine their drug sensitivities. As for types of lower respiratory tract infections found in 1981--1983, 57.9--64.5% of the infections were chronic respiratory infections; i.e., chronic bronchitis, chronic bronchiolitis and bronchiectasis. These chronic infections, including diffuse panbronchiolitis (DPB), were found in 63.1% of lower respiratory tract infections in 1984. Their incidence dropped to 54.0% in 1985, even though DPB was included; i.e., the incidence of chronic bronchiolitis was 5.5%, that of DPB was 7.1%, and that of bronchial asthma associated with lower respiratory tract infections in 1985 was 8.8% which was twice as much as that found in 1981--1984. Although bacterial pneumonia was found in 24.8% of all the cases in 1981, its incidence was reduced to 11.0% in 1983, 15.1% in 1984, and 17.6% in 1985. This reduction seemed to have resulted from gradual decreases in the occurrence of bacterial pneumonia among the young population. As with usual years, a high incidence rate in a total lower respiratory tract infections in 1985 was found among older patients; namely, 73.5% was at the age of 50 or over (417/567). Next, we determined relationships between clinical isolates and isolates from respiratory infections, including chronic bronchitis, chronic bronchiolitis, bronchiectasis and DPB. H. influenzae was isolated from 50.5% of patients with these infections in 1981; however, the detection rate decreased by about 20% to 29.7% in 1985. P. aeruginosa was consistently isolated, between 24.1% and 30.4% every year.(ABSTRACT TRUNCATED AT 400 WORDS)     

Susceptibility of bacteria isolated from patients with lower respiratory tract infections to antibiotics (1986)

Enlisting the help of various research institutions across the nation, Ikemoto et al. have been pooling cultures of clinical isolates of respiratory tract infections and mapping out the correlations between patient backgrounds and the causative bacteria and the changes in the sensitivity spectra of the bacteria to various antibacterial and antibiotic agents annually since 1981. The following is a report of the 1986 findings. During the period from September, 1986 to March, 1987, 558 cases of respiratory infections were reported at 17 institutions across the nation and a total of 657 apparent causative strains were isolated from sputum samples. Of these strains, 75 strains of Staphylococcus aureus, 108 of Streptococcus pneumoniae, 150 of Haemophilus influenzae, 107 of Pseudomonas aeruiginosa (non-mucoid production type), 21 of P. aeruginosa (mucoid production type), 32 of Klebsiella pneumoniae, 8 of Escherichia coli, and 55 of Branhamella catarrhalis were subjected to MIC determination of various antibacterial and antibiotic agents to map drug sensitivities. In addition, diagnoses, age distributions by diagnoses, frequencies of infectious diseases, types of isolated bacteria, and usage statuses of the antibacterial and antibiotic agents the times of at isolation were also investigated. MIC determinations were carried out to investigate susceptibilities of causative organisms of respiratory tract infections to various antibacterial and antibiotic agents. From the 558 cases of respiratory tract infections, 657 strains were detected at concentrations not less than 10(4-6)/ml and identified to be the causative organisms. Of these strains, 603 could be used for MIC determination. An overwhelming majority of major causative bacteria, inclusive of H. influenzae and S. pneumoniae, showed sensitivity patterns similar to the sensitivity patterns found a year earlier, P. aeruginosa alone, however, showed some increase in its susceptibility to penicillin and cephem antibiotics. Regarding patient backgrounds, the age distribution was heavily biased towards the higher end of the scale, which patients with ages of 50 or higher accounting for 77.9%, compared to 73.5% in 1985. When the patients were classified by diagnoses, chronic bronchitis, bacterial pneumonia and bronchiectasis accounted for the majority of the infections: 28.7%, 23.3%, and 19.0%, respectively. The percentages of chronic bronchitis and bacterial pneumonia 28.7% and 23.3%, respectively, were somewhat higher in 1986 than in 1985. The disease which was comparatively frequent in all age groups was bronchiectasis, which accounted for 44.0% in patients with ages 29 years or lower, 18.4% in patients between 30 years and 69 years, and 16.7% in patients with ages 70 years or higher. The next most frequent infection was bacterial pneumonia.(ABSTRACT TRUNCATED AT 400 WORDS)     

Susceptibility of bacteria isolated from the patients with lower respiratory tract infections to antibiotics (1984)

Bacterial isolates from patients with pulmonary infections have been collected over the last 4 years in collaboration with investigators at 14 hospitals in various parts of Japan to study isolation frequency of pathogens from patients and drug susceptibilities of these isolates. Possible causative pathogens mainly isolated from sputum of patients with lower respiratory tract infections were collected during a period from September 1984 to March 1985. We first determined types of respiratory diseases and found that, between 1981 and 1983, 57.9 approximately 64.5% of the examined diseases were chronic respiratory infections such as chronic bronchitis, chronic bronchiolitis and bronchiectasis, and that these infections including diffuse panbronchiolitis accounted for 63.1% in 1984. Bacterial pneumonia was found to be 24.8% in 1981, but it was 11.0% in 1983 and 15.1% in 1984. These results seemed to reflect decreases in the occurrence of bacterial pneumonia in young population. We then investigated the correlations between these infections and isolates and found that distributions of causative organisms of chronic bronchitis and bronchiectasis during the 4 years were similar while the detection rate of Staphylococcus aureus from bacterial pneumonia increased in 1982 and 1983, and that of Gram-positive organisms such as Enterococcus faecalis rose in 1984. Branhamella catarrhalis was considered to be a non-pathogenic organism normally harbored in the upper respiratory tract. Recently, however, respiratory infections caused by this organism have been reported by some investigators. In our research also, this Gram-negative diplococcus was isolated as a causative organism of respiratory infections as 6 strains were found in 1983 and 29 strains in 1984, hence an increase was observed.     

Susceptibility of bacteria isolated from patients with lower respiratory tract infections to antibiotics (1985)

Collaborated studies on species of respiratory tract infection (RTI)-related organisms for their identification and drug susceptibilities have been carried out since 1981 at about 20 centers in Japan. On this occasion, the data obtained between 1982 and 1985 were reanalyzed to determine whether or not drug susceptibilities differed depending upon diseases, from which the organisms were isolated. The results summarized below were obtained in this study. 1. Among Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, Klebsiella pneumoniae and Pseudomonas aeruginosa examined, differences in drug susceptibilities according to different diseases were found among S. aureus and also mucoid strains of P. aeruginosa. 2. Susceptibility to beta-lactam antibiotics was definitely lower in S. aureus strains isolated from pneumonia than in those isolated from chronic bronchitis and bronchiectasia. 3. The isolation frequency of methicillin-and cefazolin-resistant strains of S. aureus was 30.3% and 25.9%, respectively, and was especially high among strains isolated from pneumonia. The antibiotic potency of minocycline against S. aureus, including methicillin resistant S. aureus, was the strongest among 9 drugs examined; S. aureus maintained relatively sufficient sensitivity to dicloxacillin among beta-lactam antibiotics. 4. Mucoid producing strains of P. aeruginosa isolated from chronic bronchitis had slightly lower drug susceptibility than those isolated from bronchiectasia. 5. When drug susceptibilities of H. influenzae were compared among groups separated according to diseases using MIC50, MIC80 and MIC90 as indicators, there were no clear differences. The isolation frequency of ampicillin (ABPC)-resistant strains, however, was clearly different among diseases; namely, resistant strains were the most and the least frequently isolated from chronic bronchitis and from pneumonia, respectively. In addition, the drug susceptibility of H. influenzae isolated in 1985 was analyzed in relation to the production of beta-lactamase. As a result, it was suspected that some factors, other than beta-lactamase, participated in the mechanism of ABPC-resistance. 6. These results suggest that drugs to be used for the chemotherapy of RTI should be selected considering the fact that drug susceptibilities of the pathogens differ, even among the same species, according to diseases.     

ICU患者下呼吸道感染的细菌分布和耐药性分析

目的探讨ICU患者下呼吸道感染细菌分布特征及耐药性分析。方法收集我院2008年10月至2010年10月间ICU病房患者240例痰液标本进行菌株鉴定和药敏实验。结果 240例患者痰液标本分离出病原菌210例,阳性率占75%。其中革兰阴性杆菌占70%,革兰阴性球菌占21%,真菌占9%,以铜绿假单胞菌居首位,其次为金黄色葡萄球菌,肺炎克雷伯氏菌,不动杆菌属和真菌。结论革兰阴性杆菌为ICU病房患者医院感染主要病原菌,对常用抗菌药呈高度耐药特征,并有上升趋势。根据细菌培养及药物敏感实验合理选用抗菌药物,是防止抗菌素滥用,控制院内感染病原传播的关键。     

Susceptibility of bacteria isolated from patients with lower respiratory tract infections to antibiotics (1987)

Since 1981, in cooperation with research institutions across the nation, Ikemoto, et al. have been collecting clinical isolates from patients with respiratory tract infections and conducting an annual retrospective survey of patients' background factors and of isolated strains and their sensitivities to various antibacterial agents and antibiotics. In the period from October, 1987 to September, 1988, 17 institutions participated in the survey and a total of 706 strains which were demonstrated to be causative organisms were isolated from 562 patients with respiratory tract infections. Strains were mostly isolated from the sputum. The taxonomic breakdown of these strains was: Staphylococcus aureus (69 strains), Streptococcus pneumoniae (120), Haemophilus influenzae (170), Mucoid-producing Pseudomonas aeruginosa (42), Non-mucoid-producing P. aeruginosa (87), Escherichia coli (11), Klebsiella pneumoniae (35), Brahamella catarrharis (72), etc. Of these strains, 629 were used to determine MICs of various antibacterial agents and antibiotics for susceptibility analyses. Relationships between patient backgrounds and diagnoses and between infections diseases and causative organisms were also investigated. Most of the major causative organisms, such as H. influenzae and P. aeruginosa, showed no substantial changes from previous years, with regard to their sensitivities to antibiotic agent, but S. aureus, particularly methicillin/cephem-resistant strains of S. aureus (MCRSA) showed somewhat lower sensitivity to beta-lactams, and as in recent years, to ofloxacin, a new quinolone drug, as well. Regarding background factors of patients, the age distribution was heavily concentrated in age brackets of 50 years and older, thus patients in these age group accounted for 75.2% of all the patients, which was comparable to 73.5% in 1985 and 77.9% in 1986. Among infections encountered, bacterial pneumonia was most frequent at 28.3%, followed by chronic bronchitis (27.2%) and bronchiectasis (16.0%). Bacterial pneumonia was actually the most frequent, throughout the entire age groups accounting for 34.3% of patients up to 29 years, 26.6% in the group of 30-69 years and 30.7% in patients aged 70 years and older. Chronic bronchitis was next most frequent and accounted for 20.0%, 26.4% and 30.7% among the three age groups, respectively. Breaking down clinical isolates by diagnosis, H. influenzae, S. pneumoniae and P. aeruginosa were isolated frequently from most of the infectious diseases.(ABSTRACT TRUNCATED AT 400 WORDS)     

呼吸内科患者下呼吸道感染病原菌及药敏分析

目的 了解下呼吸道感染病原菌分布、药敏情况.方法 回顾分析下呼吸道感染住院的细菌培养为阳性并做药敏试验的病历,统计病原菌分布、药敏情况.结果 本组71例患者共培养出病原菌118株,其中金黄色葡萄球菌16株,占13.56%;流感嗜血杆菌13株,占11.01%;鲍曼不动杆菌9株,占7.63%;肺炎克雷伯菌9株,占7.63%;大肠埃希菌7株,占5.93%;肺炎链球菌7株,占5.93%;铜绿假单胞菌6株,占5.08%;副流感嗜血杆菌6株,占5.08%.结论 对于下呼吸道感染患者在治疗中对抗生素的选择应根据当地病原体的特点制定当地经验治疗方案.     

New developments in antibacterial choice for lower respiratory tract infections in elderly patients

Elderly patients are at increased risk of developing lower respiratory tract infections compared with younger patients. In this population, pneumonia is a serious illness with high rates of hospitalisation and mortality, especially in patients requiring admission to intensive care units (ICUs). A wide range of pathogens may be involved depending on different settings of acquisition and patient's health status. Streptococcus pneumoniae is the most common bacterial isolate in community-acquired pneumonia, followed by Haemophilus influenzae, Moraxella catarrhalis and atypical pathogens such as Chlamydia pneumoniae, Legionella pneumophila and Mycoplasma pneumoniae. However, elderly patients with comorbid illness, who have been recently hospitalised or are residing in a nursing home, may develop severe pneumonia caused by multidrug resistant staphylococci or pneumococci, and enteric Gram-negative bacilli, including Pseudomonas aeruginosa. Moreover, anaerobes may be involved in aspiration pneumonia. Timely and appropriate empiric treatment is required in order to enhance the likelihood of a good clinical outcome, prevent the spread of antibacterial resistance and reduce the economic impact of pneumonia. International guidelines recommend that elderly outpatients and inpatients (not in ICU) should be treated for the most common bacterial pathogens and the possibility of atypical pathogens. The algorithm for therapy is to use either a selected beta-lactam combined with a macrolide (azithromycin or clarithromycin), or to use monotherapy with a new anti-pneumococcal quinolone, such as levofloxacin, gatifloxacin or moxifloxacin. Oral (amoxicillin, amoxicillin/clavulanic acid, cefuroxime axetil) and intravenous (sulbactam/ampicillin, ceftriaxone, cefotaxime) beta-lactams are agents of choice in outpatients and inpatients, respectively. For patients with severe pneumonia or aspiration pneumonia, the specific algorithm is to use either a macrolide or a quinolone in combination with other agents; the nature and the number of which depends on the presence of risk factors for specific pathogens. Despite these recommendations, clinical resolution of pneumonia in the elderly is often delayed with respect to younger patients, suggesting that optimisation of antibacterial therapy is needed. Recently, some new classes of antibacterials, such as ketolides, oxazolidinones and streptogramins, have been developed for the treatment of multidrug resistant Gram-positive infections. However, the efficacy and safety of these agents in the elderly is yet to be clarified. Treatment guidelines should be modified on the basis of local bacteriology and resistance patterns, while dosage and/or administration route of each antibacterial should be optimised on the basis of new insights on pharmacokinetic/pharmacodynamic parameters and drug interactions. These strategies should be able to reduce the occurrence of risk factors for a poor clinical outcome, hospitalisation and death.