Caldwell J W, Singh S, Johnson R H
UCLA Department of Medicine, Kern Medical Center, Bakersfield, CA 93305, USA.
J Antimicrob Chemother. 1999 Mar;43 Suppl A:129-34.
A recent multicentre clinical study evaluated the safety and efficacy of i.v. ciprofloxacin therapy compared with imipenem-cilastatin in hospitalized patients with severe pneumonia. Monotherapy with i.v. ciprofloxacin was at least equivalent to imipenem in terms of bacteriological eradication and clinical response. In a single-centre, retrospective, post-therapy evaluation of persistent and subsequent infection, the incidence of gram-negative infections and associated costs were compared. The main elements of the economic analysis included costs of additional antimicrobial therapy and hospitalization. Thirty-two patients were randomized into the study, of whom 27 were efficacy-valid. The 13 patients randomized into the ciprofloxacin group were not significantly different from the 14 patients in the imipenem group in terms of clinical parameters. Clinical cure occurred in ten of 13 patients (77%) in the ciprofloxacin group and in seven of 14 (50%) in the imipenem group. Bacteriological eradication was achieved in 11 of 13 (85%) ciprofloxacin-treated and eight of 14 (57%) imipenem-treated patients. Five of 13 (38%) patients in the ciprofloxacin group and nine of 14 (64%) in the imipenem group experienced persistent or subsequent infection requiring post-treatment antimicrobials. In these five ciprofloxacin patients, three had cultures with gram-positive organisms only and two had cultures with both gram-positive and gram-negative organisms. In the nine imipenem-treated patients requiring post-study antimicrobials, all had gram-negative bacteria and three also had gram-positive organisms. The incidence of subsequent gram-negative infection in the two groups (15% vs 64%) was significantly different (P < 0.05). Pseudomonas aeruginosa was isolated from seven patients in the imipenem group but only one in the ciprofloxacin group (P < 0.05). Subsequent costs for post-therapy antimicrobials and hospital stay while receiving study and post-study drug therapy were evaluated; the cost per patient cure was US$29,000 for ciprofloxacin and US$76,000 for imipenem. Initial treatment of severe pneumonia with ciprofloxacin resulted in significantly less subsequent gram-negative infection and was associated with substantially lower curative costs.
一项近期的多中心临床研究评估了静脉注射环丙沙星与亚胺培南 - 西司他丁相比，在重症肺炎住院患者中的安全性和有效性。就细菌清除和临床反应而言，静脉注射环丙沙星单药治疗至少与亚胺培南相当。在一项单中心、回顾性、治疗后对持续性及后续感染的评估中，比较了革兰阴性菌感染的发生率及相关费用。经济分析的主要要素包括额外抗菌治疗和住院的费用。32名患者被随机纳入该研究，其中27名患者疗效有效。随机分配至环丙沙星组的13名患者与亚胺培南组的14名患者在临床参数方面无显著差异。环丙沙星组13名患者中有10名（77%）临床治愈，亚胺培南组14名患者中有7名（50%）临床治愈。环丙沙星治疗的13名患者中有11名（85%）实现细菌清除，亚胺培南治疗的14名患者中有8名（57%）实现细菌清除。环丙沙星组13名患者中有5名（38%），亚胺培南组14名患者中有9名（64%）经历了持续性或后续感染，需要治疗后使用抗菌药物。在这5名环丙沙星治疗的患者中，3名患者培养出仅革兰阳性菌，2名患者培养出革兰阳性菌和革兰阴性菌。在9名需要研究后使用抗菌药物的亚胺培南治疗患者中，所有患者均培养出革兰阴性菌，3名患者还培养出革兰阳性菌。两组后续革兰阴性菌感染的发生率（15%对64%）有显著差异（P<0.05）。亚胺培南组7名患者分离出铜绿假单胞菌，而环丙沙星组仅1名患者分离出该菌（P<0.05）。评估了治疗后抗菌药物及接受研究药物和研究后药物治疗期间住院的后续费用；环丙沙星治疗每位患者治愈的费用为29,000美元，亚胺培南为76,000美元。用环丙沙星初始治疗重症肺炎导致后续革兰阴性菌感染显著减少，且治愈费用大幅降低。
