左氧氟沙星序贯疗法治疗细菌性感染214例的临床评价

目的：评价左氧氟沙星序贯疗法治疗细菌性下呼吸道感染和尿路感染的有效性及安全性。方法：以左氧氟沙星静脉滴注继以口服为治疗组用药，以头孢曲松静脉滴注继以头孢克肟口服为对照组用药，对两者治疗下呼吸道和尿路感染病例的疗效和安全性进行随机对照观察。两种药物的给药方案分别为左氧氟沙星注射液300mg静脉滴注2次／d，用药3～5d后，改片剂300mg口服，2次／d，总疗程10～14d；头孢曲松2g静脉滴注，1次／d，3～5d后．改头孢克肟200mg，2次/d总疗程10～14d。结果：本研究共入选214例患者，可评价患者192例，治疗组92例．对照组100例。治疗组和对照组的临床总有效率分别为93．5％(86／92)和95．0％(95／100)。痊愈率分别为77．2％(71／92)和82.0％(82／100)；细菌清除率分别为93．0％(53／57)和97．1％(66／68)。上述结果经统计学处理差异无显著性。不良反应发生率治疗组和对照组分别为16．0％(17/106)和4．6％(5／108)，治疗组高于对照组(P=0．012)；前者的不良反应主要为失眠等中枢神经系统反应以及恶心等消化道反应，后者主要为消化道反应；两组的不良反应均轻微，呈一过性。实验室检查异常发生率治疗组为12．3％(13／106)，对照组为13．0％(14／108)，主要为血清氨基转移酶升高，两组相仿。结论：本研究结果显示左氧氟沙星静脉滴注序贯继以口服治疗下呼吸道和尿路感染的疗效良好，与头孢曲松静脉滴注序贯继以头孢克肟口服相仿，不良反应发生率治疗组虽高于对照组,但程度轻微，呈一过性，患者可耐受。

Clinical evaluation of levofloxacin sequential therapy in the treatment of 214 patients with bacterial infections

Objective: To compare the efficacy and safety of intravenous and oral levofloxacin versus ceftriaxone and cefixime in treatment of lower respiratory tract infections(LRTI) and urinary tract infections(UTI). Methods:A prospective, randomized, multicenter, comparative study was carried out in LRTI and UTI patients. Patients received either levofloxacin 300 mg twice daily intravenously followed by the same dosage orally or ceftriaxone 2.0 g once daily intravenously followed by oral cefixime 200 mg three times daily for 10-14 days. Results:Two hundred and fourteen patients were enrolled this study, 192 patients were evaluable, 92 in levofloxacin group with 54 cases of LRTI and 38 UTI; 100 patients in ceftriaxone followed by cefixime group with 59 cases of LRTI and 41 UTI. Clinical cure rates and total effective rates were 77.2%(71/92) and 93.5%(86/92) in levofloxacin group, 82.0%(82/100) and 95.0%(95/100) in control group; the bacterial eradication rates being 93.0%(53/57) and 97.1%(66/68) respectively. The clinical adverse effect rates were 16.0%(17/106) and 4.6%(5/108), while abnormal laboratory tests being 12.3%(13/106) and 13.0%(14/108) in the two groups respectively. No significant difference of the above figures between the two groups were found, however, the adverse effect rates in levofloxacin group was higher than that of control group (P=0.012). Conclusions:Levofloxacin sequential therapy is as effective as parenteral ceftriaxone followed by oral cefixime in the treatment of lower respiratory tract infections and urinary tract infections, adverse effects are mild and transient in both groups but more frequent in levofloxacin group than in control group.