β内酰胺类和大环内酯类药物联合应用治疗社区获得性肺炎
社区获得性肺炎；,肺炎链球菌；,β内酰胺类；,大环内酯类；,联合用药,,社区获得性肺炎；,肺炎链球菌；,β内酰胺类；,大环内酯类；,联合用药,1CAP的病原体流行病学调查,2社区获得性肺炎的临床治疗现状,3理论基础及实验研究,参考文献
摘要： 社区获得性肺炎(community acquired pneumonia，CAP)仍然是威胁人群健康的重要疾病。目前肺炎链球菌可能仍是CAP最重要的病原体，且耐药肺炎链球菌在全世界范围内的流行持续增长，与此同时非典型病原体发生率和多重感染率逐渐升高，这些都给社区获得性肺炎的经验性治疗带来很大的困扰。各国CAP的诊断和治疗指南中几乎都提到了联合应用β内酰胺类和大环内酯类药物对社区获得性肺炎进行经验性治疗，并且世界各地的临床研究报道也表明，依据指南迟早做经验性治疗，可减少患者的护理费用、住院时间、可能产生的抗菌药物的耐药倾向，降低死亡率。虽然β内酰胺类与大环内酯类抗生素联合应用可以扩大抗菌谱，但与传统的快速杀菌剂和快速抑菌剂不能联合应用的理论有矛盾，且国内、外的一些关于β内酰胺类与大环内酯类抗生素联合应用的体内、外抗菌活性研究并未得出一致的结论，因此还有待更多的实验研究来验证。关键词： 社区获得性肺炎； 肺炎链球菌； β内酰胺类； 大环内酯类； 联合用药
The combination of βlactams and macrolides for the treatment of community acquired pneumonia
Liu Jianhua and Liu Yong
(The Second Affiliated Hospital of China Medical University, Shenyang 110004)
ABSTRACT Community acquired pneumonia (CAP) remains a serious disease that threatens healthy people. Streptococcus pneumoniae may be the commonest cause of the CAP. Recently, drug resistant Streptococcus pneumoniae continuously increased throughout the whole world. Meanwhile, incidence rates of atypical pathogen and multiple infection have been increased. All these take more trouble to empirical therapy of CAP. As the reports related to clinical studies around the world have shown that patients treated with the recommended βlactams and macrolides reduced the overall costs, inpatient days, case fatality rates and the trend of generating the drugresistance than those receiving alternative treatment. Although this treatment can extremely coveraged the main pathogenic bacteria, perhaps it is not rational to traditional pharmacology because a baterial inhibitor may inhibit the bactericidal effects of rapid bactericidal agents. Several investigators tested the combination of βlactams and macrolides in vitro and in vivo for antimicrobial activity against S.pneumoniae, but they reported the results nonuniformly, and further evidences are warranted. ......
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