Peterson Lance R
Evanston Northwestern Healthcare Research Institute, Division of Microbiology, Department of Pathology and Laboratory Medicine, Northwestern University, Evanston, IL, USA.
Clin Infect Dis. 2006 Jan 15;42(2):224-33. doi: 10.1086/497594. Epub 2005 Dec 13.
The rate of in vitro bacterial resistance to antimicrobial agents is escalating among pathogens that cause the most serious respiratory tract infections. Many reports published during the past few years suggest that this has direct clinical implications. In particular, resistance of Streptococcus pneumoniae to beta-lactam antibiotic therapy has assumed a prominent role in the evolution of guidelines for the initial treatment of respiratory tract infection.
I conducted a critical review of the published medical literature.
There is only a single report of documented microbiologic failure of parenteral penicillin-class antibiotics in the treatment of pneumococcal pneumonia in patients with or without bacteremia, whereas there are numerous well-documented reports of treatment failure with quinolone-class (n > or = 21) and macrolide-class (n > or = 33) antibiotics in the treatment of pneumococcal pneumonia.
The recommended optimal in-hospital therapy for community-acquired pneumonia should continue to be a beta-lactam antibiotic (penicillin, aminopenicillin, cefotaxime, or ceftriaxone) administered with a macrolide or a fluoroquinolone agent for adjunctive treatment of infection with potential atypical pathogens.
在引起最严重呼吸道感染的病原体中，抗菌药物的体外细菌耐药率正在上升。过去几年发表的许多报告表明，这具有直接的临床意义。特别是，肺炎链球菌对β-内酰胺类抗生素治疗的耐药性在呼吸道感染初始治疗指南的演变中发挥了重要作用。
我对已发表的医学文献进行了批判性综述。
仅有一份报告记录了静脉注射青霉素类抗生素治疗有或无菌血症的肺炎球菌肺炎时微生物学治疗失败的情况，而有大量记录良好的报告显示，喹诺酮类（n≥21）和大环内酯类（n≥33）抗生素治疗肺炎球菌肺炎时存在治疗失败的情况。
社区获得性肺炎推荐的最佳院内治疗方案应继续采用β-内酰胺类抗生素（青霉素、氨基青霉素、头孢噻肟或头孢曲松）联合大环内酯类或氟喹诺酮类药物，用于辅助治疗可能的非典型病原体感染。
