Destache C J, Dewan N, O'Donohue W J, Campbell J C, Angelillo V A
School of Pharmacy & Allied Health Professions, Creighton University, Omaha, NE 68178, USA.
J Antimicrob Chemother. 1999 Mar;43 Suppl A:107-13. doi: 10.1093/jac/43.suppl_1.107.
Limited data exist to guide physicians in the cost-effective treatment of acute exacerbation of chronic bronchitis (AECB). Therefore, the main objective of this study was to determine the antimicrobial efficacy and related costs for patients with AECB. A retrospective review of 60 outpatient medical records with a diagnosis of chronic obstructive pulmonary disease (COPD) and chronic bronchitis episodes from a pulmonary clinic of a teaching institution was undertaken. The participating patients had a total of 224 episodes of AECB requiring antibiotic treatment. Before review, empirical antibiotic choices were divided into first-line (amoxycillin, co-trimoxazole, tetracyclines, erythromycin), second-line (cephradine, cefuroxime, cefaclor, cefprozil) and third-line (co-amoxiclav, azithromycin, ciprofloxacin) agents. Patients receiving first-line agents failed significantly more frequently than third-line agents (19% vs 7%, P < 0.05). Additionally, patients prescribed first-line agents were hospitalized significantly more often for AECB within 2 weeks of outpatient treatment as compared with patients prescribed third-line agents (18.0% vs 5.3% third-line agents; P < 0.02). Time between subsequent AECB episodes requiring treatment was significantly longer for patients receiving third-line agents compared with first-line and second-line agents (P < 0.005). Pharmacy costs were lowest with first-line agents (first-line US$10.30 +/- 8.76; second-line US$24.45 +/- 25.65; third-line US$45.40 +/- 11.11; P < 0.0001), but third-line agents showed a trend towards lower mean total costs of AECB treatment (first-line US$942 +/- 2173; second-line, US$563 +/- 2296; third-line, US$542 +/- 1946). The use of third-line antimicrobials, co-amoxiclav, ciprofloxacin or azithromycin, significantly reduced the failure rate and need for hospitalization, prolonged the time between AECB episodes, and showed a lower total cost for the management of AECB. Prospective studies are needed to confirm these findings.
目前可用于指导医生对慢性支气管炎急性加重期（AECB）进行经济有效治疗的数据有限。因此，本研究的主要目的是确定AECB患者的抗菌疗效及相关费用。对某教学机构肺部门诊60例诊断为慢性阻塞性肺疾病（COPD）并伴有慢性支气管炎发作的门诊病历进行了回顾性研究。参与研究的患者共有224次AECB发作需要抗生素治疗。在回顾之前，经验性抗生素选择分为一线药物（阿莫西林、复方新诺明、四环素、红霉素）、二线药物（头孢拉定、头孢呋辛、头孢克洛、头孢丙烯）和三线药物（阿莫西林克拉维酸、阿奇霉素、环丙沙星）。接受一线药物治疗的患者失败率显著高于三线药物治疗的患者（19%对7%，P<0.05）。此外，与接受三线药物治疗的患者相比，接受一线药物治疗的患者在门诊治疗后2周内因AECB住院的频率显著更高（一线药物治疗组为18.0%，三线药物治疗组为5.3%；P<0.02）。与一线和二线药物治疗的患者相比，接受三线药物治疗的患者后续需要治疗的AECB发作间隔时间显著更长（P<0.005）。一线药物的药房成本最低（一线药物为10.30美元±8.76美元；二线药物为24.45美元±25.65美元；三线药物为45.40美元±11.11美元；P<0.0001），但三线药物显示出AECB治疗平均总成本有降低的趋势（一线药物为942美元±2173美元；二线药物为563美元±2296美元；三线药物为542美元±1946美元）。使用三线抗菌药物，即阿莫西林克拉维酸、环丙沙星或阿奇霉素，可显著降低失败率和住院需求，延长AECB发作间隔时间，并显示出AECB管理的总成本更低。需要进行前瞻性研究来证实这些发现。
