老年急性下呼吸道感染患者的抗生素序贯治疗

目的 探讨抗生素序贯疗法在老年急性下呼吸道感染患者中的合理应用.方法 采用前瞻性、随机对照临床干预研究设计和药物经济学中的最小成本分析法,对老年急性下呼吸道感染患者进行两种治疗方案:静脉-口服序贯治疗组(序贯组)和连续静脉治疗组(静脉组)进行临床疗效对比,同时对两组患者的细菌清除率、静脉治疗时间、住院日等进行比较,对抗生素医疗费用进行药物经济学评价.结果 两种疗法的临床疗效相同,患者细菌清除率、体温、血象、胸部X线片恢复正常的时间相似,差异无统计学意义(P＞0.05),但序贯组的静脉用药时间、平均住院日和抗生素费用明显低于静脉组(P＜0.05).结论 对老年急性下呼吸道感染患者合理应用抗生素序贯治疗是安全的、有效,有更加合理的成本-效果比,由静脉治疗转换为口服治疗的最佳时间为7 d左右.

Antibiotic sequential therapy in the elderly hospitalized with acute lower respiratory tract infection

Objective To discuss the rational use of antibiotic sequential therapy in the elderly hospitalized with acute lower respiratory tract infection.Methods Using a clinical prospective intervention study of random sample contrast and minimum cost analysis of pharmacoeconomic compared the clinical curative effect of two kinds of therapy methods including intravenous-oral sequential therapy group(sequential group)and continuous intravenous infusion therapy group(intravenous group).Meanwhile,the differences of two groups in the bacterial clearance rate,treatment time of intravenous infusion and length of hospitalization day were also investigated. Furthermore the costs of antibiotics of two groups were evaluated as well in the pharmacoeconomic. Results Compared with two therapies,it was shown equivalence in bacteriology and clinical outcome. Pharmacoedynamics of them were nearly same. There was no significant difference(P＞0.05).In the clinical curative effect,two therapies' bacteria clearance,the times of restoring to normal of temperature,blood routine examination and chest X-ray were practically closed to each other,difference was in significant(P＞0.05).However,the time of intravenous infusion therapy time and the length of hospitalization day had notable difference,and antibacterial cost of sequential group Was obviously lower than those of intravenous group,there were significant difference(P＜0.05).Conclusion Sequential therapy was safe,operative,and had more reasonable cost-effect ratio in treating the elderly with acute lower respiratory tract infection. Moreover the optimum time from intravenous infusion therapy switching to oral antibiotics therapy was about 7 days.