头孢曲松、头孢呋辛酯序贯治疗老年肺部感染的临床研究

目的：比较头孢曲松静滴和头孢曲松静滴与头孢呋辛酯口服序贯治疗老年社区获得性肺炎和慢性支气管炎急性发作的临床疗效、安全性和药物经济学特点。方法：采用随机、开放、对照研究的方法，86例患者分为对照组41例和试验组45例。对照组予头孢曲松1．0g，静滴，qd；试验组予头孢曲松1．0g，静滴，qd，病情稳定后，改为口服头孢呋辛酯0．5g，bid，疗程7～14d，评价临床和细菌学疗效。采用药物经济学中最小成本分析法对药物的治疗成本进行评价。结果：对照组总有效率87。8％（36／41），试验组82．2％（37／45）；细菌清除率分别为对照组90．0％（18／20），试验组87．5％（21／24）。两组临床疗效和细菌学疗效统计学上无显著差别（P〉0．05）。头孢曲松静滴后头孢呋辛酯口服序贯治疗的医疗总费用和抗生素费用低于单用头孢曲松静滴（P〈0．05）。结论：两组具有相同的临床疗效及安全性。但试验组比对照组更经济。

Clinical evaluation of ceftriaxone/cefuroxime sequential antibiotic therapy for the elder patients with lung infection

Objective: To compare the safety, efficacy and cost-effectiveness analysis of intravenous ceftriaxone versus the sequential antibiotic therapy (SAT) with intravenous ceftriaxone and then oral cefuroxime for hospitalized elder patients with community-acquired pneumonia (CAP) and acute bacterial exacerbation of chronic bronchitis (AECB). Methods: This study was a randomized, open-label and comparison controlled clinical study. A total of 86 in-patients with SAT or AECB were enrolled in this study and randomized to administer with either ceftriaxone 1.0g (n =41) for intravenous injection once daily or ceftriaxone 1.0g (n = 44 ) for intravenous injection once daily for 3 -4 days and subsequently oral cefuroxime 500 mg twice daily when the patients were stable. The total duration of therapy was for 7-14 days. The efficacy and bacterial eradication as well as cost-effective analysis were compared between two therapeutic groups. Results: The overall efficacy of ceftriaxone alone and sequential antibiotic therapy was 87. 8% ( 36/41) versus 82. 2% (37/45 ) , and the bacterial eradication rate was 90. 0% (18/20) versus 87. 5% (21/24) , respectively; the results showed no statistical difference between both groups ( P > 0. 05 ). The cost of SAT was markedly lower than ceftriaxone alone ( P < 0. 05 ). Conclusion: The SAT with the therapeutic equivalence to mono-therapy offered an economic superiority in the treatment of elderly patients with CAP and AECB.