Loh Li-Cher, Quah Soong-Yuen, Khoo Sert-Kim, Vijayasingham Pillai, Thayaparan Tarmizi
IMU Lung Research, International Medical University, Kuala Lumpur, Malalysia.
Respirology. 2005 Jun;10(3):371-7. doi: 10.1111/j.1440-1843.2005.00704.x.
Current clinical practice guidelines, including those in south Asia, recommend the addition of a macrolide to a broad-spectrum antibiotic for the treatment of severe hospitalized community-acquired pneumonia (CAP). The aim of this study was to observe the influence of macrolide addition on clinical outcomes of hospitalized adult patients with CAP.
Over a 16-month period between 2002 and 2004, 141 eligible patients were prospectively recruited from an urban-based teaching hospital in Malaysia.
Of the 141 patients, 63 (44.7%) patients (age (standard deviation (SD)) 56 (20.0) years; 50.8% male) received a macrolide-containing antibiotic regimen, while 78 (55.3%; age (SD) 57 (20.2) years; 52.6% male) were on a single broad-spectrum antibiotic only. In total, 39 (27.7%) and 102 (72.3%) patients had severe and 'non-severe' pneumonia, respectively. Irrespective of whether they had severe or non-severe pneumonia, there were no significant differences in mortality (non-severe pneumonia, 6.5% vs. 5.4%, P = 0.804; severe pneumonia, 17.6% vs. 18.2%, P = 0.966), need of ventilation (non-severe pneumonia, 8.7% vs. 3.6%, P = 0.274; severe pneumonia, 23.5% vs. 13.6%, P = 0.425) or median length of hospital stay (non-severe pneumonia, 5.5 vs. 5 days, P = 0.954; severe pneumonia, 7 vs. 6 days, P = 0.401) between the two treatment regimens.
This observational, non-randomized study suggests that addition of a macrolide may not convey any extra clinical benefits in adult hospitalized patients with CAP.
当前的临床实践指南，包括南亚地区的指南，都推荐在广谱抗生素基础上加用大环内酯类药物来治疗重症住院社区获得性肺炎（CAP）。本研究的目的是观察加用大环内酯类药物对住院成年CAP患者临床结局的影响。
在2002年至2004年的16个月期间，从马来西亚一家城市教学医院前瞻性招募了141例符合条件的患者。
141例患者中，63例（44.7%）患者（年龄（标准差[SD]）56（20.0）岁；男性占50.8%）接受了含大环内酯类抗生素的治疗方案，而78例（55.3%；年龄（SD）57（20.2）岁；男性占52.6%）仅接受单一广谱抗生素治疗。总共有39例（27.7%）和102例（72.3%）患者分别患有重症和“非重症”肺炎。无论患者患有重症还是非重症肺炎，两种治疗方案在死亡率（非重症肺炎，6.5%对5.4%，P = 0.804；重症肺炎，17.6%对18.2%，P = 0.966）、通气需求（非重症肺炎，8.7%对3.6%，P = 0.274；重症肺炎，23.5%对13.6%，P = 0.425）或中位住院时间（非重症肺炎，5.5天对5天，P = 0.954；重症肺炎，7天对6天，P = 0.401）方面均无显著差异。
这项观察性、非随机研究表明，在成年住院CAP患者中加用大环内酯类药物可能不会带来任何额外的临床益处。
