医院内获得性肺炎抗菌药物的疗效和安全性比较

目的:比较头孢唑肟钠/莫西沙星,头孢哌酮钠/舒巴坦钠和头孢唑肟钠治疗医院内获得性肺炎(HAP)的有效性和安全性.方法:203例HAP患者随机分为Ⅰ、Ⅱ、Ⅲ组.Ⅰ组患者给予盐酸莫西沙星注射液400 mg,qd;注射用头孢唑肟钠2~4 g,bid.Ⅱ组患者给予注射用头孢哌酮钠舒巴坦钠(2:1)1~2 g,bid.Ⅲ组患者给予注射用头孢唑肟钠2~4 g,bid.主要疗效指标是在治疗期结束后患者的临床症状,次要观察指标为不良反应和细菌学反应.结果:头孢唑肟钠/莫西沙星、头孢哌酮钠舒巴坦钠、头孢唑肟钠的临床有效率分别为91.9%、89.7%和78.7%.治疗结束后,头孢唑肟钠/莫西沙星和头孢哌酮钠舒巴坦钠对痰液细菌的清除率显著高于头孢唑肟钠.3组药物的不良反应无明显差异.与头孢唑肟钠单独用药相比,头孢菌素联合喹诺酮类或β-内酰胺酶抑制剂的抗菌疗效更佳.结论:头孢菌素联合喹诺酮类药物或β-内酰胺酶抑制剂可作为临床治疗HAP的优选用药方案.

Comparison of efficacy and safety of antibacterials for hospital acquired pneumonia

OBJECTIVE To evaluate efficacy and safety of ceftizoxime sodium/moxifloxacin, cefoperazone sodium/sulbactam sodium and ceftizoxime sodium against hospital acquired pneumonia (HAP). METHODS A total of 203 cases of HAP patients were randomly divided into group I (moxifloxacin injection 400 mg, qd, ceftizoxime sodium 2-4 g, bid), group II(cefoperazone sodium/sulbactam sodium (2:1) 1-2 g, bid), group III (intravenous ceftizoxime sodium,2-4 g, bid). The primary endpoint was the clinical symptom at the end of treatment period, the secondary outcomes were adverse reactions and bacteriological response. RESULTS Clinical efficiencies of ceftizoxime sodium/moxifloxacin, cefoperazone sodium/sulbactam sodium and ceftizoxime sodium were 91.9%, 89.7% and 78.7%, respectively. After treatment, the bacterial clearance rates of ceftizoxime sodium/moxifloxacin and cefoperazone sodium/sulbactam sodium were significantly higher than ceftizoxime sodium. Adverse drug reactions in three groups had no significant difference. Compared with ceftizoxime monotherapy, the antibacterial efficacy was better when cephalosporins was combined with quinolone or β-lactamase inhibitor. CONCLUSION Cephalosporins combined with quinolone or β-lactamase inhibitor can be a preferred clinical therapeutic regimen against HAP.