van der Eerden M M, Vlaspolder F, de Graaff C S, Groot T, Bronsveld W, Jansen H M, Boersma W G
Department of Pulmonary Diseases, Medical Centre Alkmaar, Wilhelminalaan 12, 1815 JD, Alkmaar, the Netherlands.
Thorax. 2005 Aug;60(8):672-8. doi: 10.1136/thx.2004.030411.
There is much controversy about the ideal approach to the management of community acquired pneumonia (CAP). Recommendations differ from a pathogen directed approach to an empirical strategy with broad spectrum antibiotics.
In a prospective randomised open study performed between 1998 and 2000, a pathogen directed treatment (PDT) approach was compared with an empirical broad spectrum antibiotic treatment (EAT) strategy according to the ATS guidelines of 1993 in 262 hospitalised patients with CAP. Clinical efficacy was primarily determined by the length of hospital stay (LOS). Secondary outcome parameters for clinical efficacy were assessment of therapeutic failure on antibiotics, 30 day mortality, duration of antibiotic treatment, resolution of fever, side effects, and quality of life.
Three hundred and three patients were enrolled in the study; 41 were excluded, leaving 262 with results available for analysis. No significant differences were found between the two treatment groups in LOS, 30 day mortality, clinical failure, or resolution of fever. Side effects, although they did not have a significant influence on the outcome parameters, occurred more frequently in patients in the EAT group than in those in the PDT group (60% v 17%, 95% CI -0.5 to -0.3; p<0.001).
An EAT strategy with broad spectrum antibiotics for the management of hospitalised patients with CAP has comparable clinical efficacy to a PDT approach.
关于社区获得性肺炎（CAP）管理的理想方法存在诸多争议。建议从针对病原体的方法到使用广谱抗生素的经验性策略各不相同。
在1998年至2000年进行的一项前瞻性随机开放研究中，根据1993年美国胸科学会（ATS）指南，对262例住院CAP患者采用针对病原体的治疗（PDT）方法与经验性广谱抗生素治疗（EAT）策略进行了比较。临床疗效主要由住院时间（LOS）确定。临床疗效的次要结局参数包括抗生素治疗失败的评估、30天死亡率、抗生素治疗持续时间、发热消退情况、副作用和生活质量。
303例患者纳入研究；41例被排除，262例有可供分析的结果。两个治疗组在住院时间、30天死亡率、临床失败或发热消退方面未发现显著差异。副作用虽然对结局参数没有显著影响，但在EAT组患者中比PDT组更频繁出现（60%对17%，95%CI -0.5至-0.3；p<0.001）。
对于住院CAP患者，使用广谱抗生素的EAT策略与PDT方法具有相当的临床疗效。
