慢阻肺如何应用抗生素.ppt

* * 要点： AECOPD最常见致病菌是流感嗜血杆菌、肺炎链球菌、卡他莫拉菌。 参考信息： Obaji 和 Sethi 2001年所做的一项回顾性研究，总结了14个关于AECOPD病原菌的研究，结果显示： 在培养阳性的细菌中：最主要的致病菌是流感嗜血杆菌，约占31.2％； 其他重要的致病菌包括：肺炎链球菌（均值14.2％）和卡他莫拉菌（均值14％） * * * Figure 3. Paired comparison of airway inflammation in pathogen-positive (pathogen＋, H. flu and M. catarrhalis) AECB with pathogen-negative (pathogen-)AECB (normal flora only). Lines connect the measured values from individual patients. Horizontal bars represent median values. The p values obtained with the Wilcoxon signed-rank test are shown. Figure 4. Correlation of free sputum elastase activity (NE) with the clinical score obtained during each exacerbation. Free sputum elastase activity is expressed on the y-axis, while the clinical score is expressed on the x-axis. The Spearman correlation coefficient (Rho [r]) and the orresponding p value are also shown. * * * * * Bactericidal assay results with 50 complement-resistant strains. Lines connect the measured values with preexacerbation and postexacerbation sera with a homologous H. influenzae strain. The serum concentration is 20% in all assays. The dotted lines in B represent four pairs of sera in which titration by twofold dilution demonstrated that the postexacerbation serum were able to kill the homologous strain at a fourfold lower concentration. A represents results with new strains, and B represents results obtained with preexisting strains. The dashed horizontal line at 50% kill represents the threshold value above which sera were regarded as having bactericidal activity. Seven assay results in A overlap in the preexacerbation (less than 5%) and postexacerbation (more than 95%) values. Thirteen assay results in B overlap in the preexacerbation (more than 95%) and postexacerbation (more than 95%) values. * * * * * * * * * * * * * * * AECOPD分组及抗生素选择 2005 ERS 组别 定义 口服抗生素 口服替代药 静脉用抗生素 A组 轻度COPD，无合并症 通常不需要，如需要：阿莫西林、四环素 阿莫西林/克拉维酸，大环内酯类，左旋氧氟沙星，莫昔沙星 B组 中、重度COPD，无铜绿假单胞菌的危险因素 阿莫西林、克拉维酸 左旋氧氟沙星、莫昔沙星 阿莫西林、克拉维酸、2或3代头孢菌素＊、左旋氧氟沙星、莫昔沙