Erard V, Lamy O, Bochud P-Y, Bille J, Cometta A, Calandra T
Division of Infectious Diseases, Centre Hospitalier Universitaire Vaudois, 1011, Lausanne, Switzerland.
Eur J Clin Microbiol Infect Dis. 2004 Feb;23(2):82-8. doi: 10.1007/s10096-003-1060-x. Epub 2004 Jan 15.
Most guidelines for the management of hospitalized patients with community-acquired pneumonia (CAP) recommend commencing therapy with intravenous antibiotics, primarily because of concern about absorption of oral antibiotics in acutely ill patients. However, patients who respond are rapidly switched to oral therapy, which has been shown to reduce costs and to shorten the length of stay. The aim of the present study was to determine whether a full course of oral antibiotics is as efficacious and as safe as intravenous-to-oral sequential antibiotic therapy for the treatment of hospitalized, non-ICU patients with CAP. In an open-labelled, controlled study, 129 hospitalized patients with CAP were randomly assigned in a 2:1 ratio to receive either a full course of oral levofloxacin (500 mg q12 h) or an intravenous-to-oral sequential therapy consisting of intravenous ceftriaxone (2 g q24 h) with or without clarithromycin (500 mg q12 h) followed by an oral antibiotic (a beta-lactam agent in the majority of patients). The primary study endpoint was the resolution of CAP; secondary endpoints included length of stay and overall mortality. CAP resolved in 72 of 79 (91.1%) patients in the levofloxacin group and in 34 of 37 (91.9%) patients in the intravenous-to-oral sequential therapy group (difference, -0.8%, 95%CI, -11.6-10.0). Median length of stay was 8 days (range, 2-74 days) in the levofloxacin group and 10 days (range, 3-29 days) in the intravenous-to-oral sequential therapy group ( P=0.28). Day 30 mortality rates were 1.3% (1 of 79) and 8.1% (3 of 37), respectively (difference, -6.8%, 95%CI, -16.0-2.3). Full-course oral levofloxacin is as efficacious and as safe as standard intravenous-to-oral sequential antibiotic therapy for the treatment of hospitalized patients with CAP.
大多数社区获得性肺炎（CAP）住院患者管理指南建议开始静脉使用抗生素治疗，主要是因为担心急性病患者口服抗生素的吸收情况。然而，有反应的患者会迅速转为口服治疗，这已被证明可降低成本并缩短住院时间。本研究的目的是确定对于住院的非重症监护病房（ICU）CAP患者，全程口服抗生素治疗与静脉-口服序贯抗生素治疗在疗效和安全性上是否相当。在一项开放标签的对照研究中，129例住院CAP患者按2:1的比例随机分组，分别接受全程口服左氧氟沙星（500毫克，每12小时一次）或静脉-口服序贯治疗，即静脉使用头孢曲松（2克，每24小时一次）加或不加克拉霉素（500毫克，每12小时一次），随后口服抗生素（大多数患者使用β-内酰胺类药物）。主要研究终点是CAP的缓解；次要终点包括住院时间和总死亡率。左氧氟沙星组79例患者中有72例（91.1%）CAP得到缓解，静脉-口服序贯治疗组37例患者中有34例（91.9%）CAP得到缓解（差异为-0.8%，95%可信区间为-11.6-10.0）。左氧氟沙星组的中位住院时间为8天（范围为2-74天），静脉-口服序贯治疗组为10天（范围为3-29天）（P=0.28）。30天死亡率分别为1.3%（79例中的1例）和8.1%（37例中的3例）（差异为-6.8%，95%可信区间为-16.0-2.3）。对于住院CAP患者，全程口服左氧氟沙星与标准静脉-口服序贯抗生素治疗在疗效和安全性上相当。
