Wise R
Department of Medical Microbiology, Dudley Road Hospital, Birmingham, England.
Am J Med. 1991 Dec 30;91(6A):67S-70S. doi: 10.1016/0002-9343(91)90313-m.
Sputum samples are easy to obtain; however, their use in therapeutic decision making is not without problems. Today, with the availability of more sophisticated endoscopic procedures, it is possible to determine antimicrobial concentrations at various sites within the respiratory tract. Fiber-optic bronchoscopy makes it possible to obtain samples of bronchial mucosa, bronchial epithelial lining fluid (ELF), and alveolar macrophages (AMs). Antimicrobial concentration measurements from the bronchial mucosa, ELF, and AM may be better predictors of successful antimicrobial therapy than sputum samples. In general, fluoroquinolones penetrate well into lung tissue, including bronchial mucosa, ELF, and AM, resulting in concentrations higher than corresponding serum levels. Temafloxacin, a new fluoroquinolone, attains high bronchial concentrations that are well above the 90% minimal inhibitory concentration (MIC90) for many of the common respiratory pathogens, including Streptococcus pneumoniae (MIC90 = 0.5 micrograms/mL). Early clinical trials confirm the clinical efficacy and safety of temafloxacin in the treatment of many common respiratory tract infections. The penetration of temafloxacin into the bronchial mucosa, AM, and ELF along with its antimicrobial spectrum supports the use of temafloxacin against common respiratory pathogens, including S. pneumoniae.
痰液样本易于获取；然而，将其用于治疗决策并非没有问题。如今，随着更先进的内镜检查程序的出现，有可能测定呼吸道内不同部位的抗菌药物浓度。纤维支气管镜检查使得获取支气管黏膜、支气管上皮衬液（ELF）和肺泡巨噬细胞（AMs）的样本成为可能。来自支气管黏膜、ELF和AMs的抗菌药物浓度测量结果可能比痰液样本更能预测抗菌治疗的成功与否。一般来说，氟喹诺酮类药物能很好地渗透到肺组织中，包括支气管黏膜、ELF和AMs，其浓度高于相应的血清水平。替马沙星是一种新型氟喹诺酮类药物，在支气管中达到的高浓度远高于许多常见呼吸道病原体的90%最低抑菌浓度（MIC90），包括肺炎链球菌（MIC90 = 0.5微克/毫升）。早期临床试验证实了替马沙星治疗许多常见呼吸道感染的临床疗效和安全性。替马沙星对支气管黏膜、AMs和ELF的渗透及其抗菌谱支持将其用于对抗包括肺炎链球菌在内的常见呼吸道病原体。
