阿奇霉素在儿童细菌性呼吸道感染中的地位1214.pptVIP

　　Mufson和Stanek等回顾研究了1978-1997年，美国西弗吉尼亚州，年龄大于15岁的肺炎球菌性肺炎患者的五年病例死亡率和抗生素使用情况。 　　研究发现总计有138名患者接受了青霉素或头孢菌素治疗。五年的死亡率逐年下降。95名接受任一种青霉素或头孢菌素联用除大环内酯类药物外的其他抗生素的患者。五年死亡率与单用青霉素或头孢菌素治疗相近。 ?　56名患者接受青霉素或头孢菌素联用一种大环内酯类药物，也可加用其他抗生素治疗。该治疗组五年死亡率较另两组低。分析整个20年研究结果发现后者的死亡率较其他两个治疗组明显降低(P0.001) Study of 2209 patients diagnosed with bacteremic pneumonia and admitted to the hospital; Streptococcus pneumoniae was identified in 38% of the blood culture isolates. When the effect of atypical coverage was stratified according to antibiotic class, only macrolides had a statistically significant association with any of the outcome measures. Patients treated with a macrolide had a lower adjusted risk of in-hospital mortality (OR 0.59), 30-day mortality (OR 0.61), and hospital readmission (OR 0.59).1 A retrospective cohort study of 515 patients hospitalized with a diagnosis of community-acquired pneumonia. Two hundred sixty-one patients received a β-lactam and macrolide (combination therapy) and 254 patients received quinolone monotherapy. Among patients with severe pneumonia (Pneumonia Severity Index V), the 14-day mortality rate was significantly lower for those receiving combination therapy versus those receiving monotherapy (8.2% versus 26.8%, respectively; P=0.02). The 30-day mortality rate also indicated a lower rate for the patients receiving combination therapy versus the patients receiving monotherapy (18.4% versus 36.6%, respectively; P=0.05).2 1. Metersky ML, Ma A, Houck PM, Bratzler DW. Antibiotics for bacteremic pneumonia: Improved outcomes with macrolides but not fluoroquinolones. Chest. 2007;131:466-473. 2. Lodise TP, Kwa A, Cosler L, Gupta R, Smith RP. Comparison of β-lactam and macrolide combination therapy versus fluoroquinolone monotherapy in hospitalized Veterans Affairs patients with community-acquired pneumonia. Antimicrob Agents Chemother. 2007;51:3977-3982. * 问题二 目前在流感嗜血杆菌治疗中的困惑？ A. 目前大部分抗生素对流感嗜血杆菌仍保持高度敏感，治疗满意 B. 不定型流感嗜血杆菌（NTHI）进入细胞内，成为胞内菌，导致持续感染与难治性感染 问题三