Cantón Rafael, Lode Harmut, Graninger Wolfgang, Milkovich Gary
Servicio de Microbiología, Hospital Universitario Ramón y Cajal, Madrid, Spain.
Int J Antimicrob Agents. 2006 Sep;28 Suppl 2:S115-27. doi: 10.1016/j.ijantimicag.2006.06.001. Epub 2006 Aug 14.
Two of the most serious respiratory tract infections are community-acquired pneumonia (CAP) and acute exacerbations of chronic bronchitis (AECB). The most common pathogens found in patients with these infections are Haemophilus influenzae and Streptococcus pneumoniae. Pseudomonas aeruginosa is also relatively common, particularly in elderly patients with AECB. S. pneumoniae and P. aeruginosa are also of concern in relation to the development of resistance to antimicrobial drugs. The administration of antibiotics at doses that result in concentrations exceeding the mutant prevention concentration at the site of infection is one strategy to prevent the development of drug-resistant pathogens. AECB is associated with a high risk of in-hospital mortality, particularly in patients treated in the intensive care unit. CAP is also associated with significant risks and often requires treatment under hospital supervision. Several patient-related factors help identify those patients who are most at risk of mortality and morbidity. Treatment should be tailored towards the severity of the disease. The fluoroquinolones, such as levofloxacin, are an effective treatment option for AECB and CAP. Compared with many other antibiotics, resistance to levofloxacin remains low for most infecting pathogens. The oral bioavailability of levofloxacin is over 99%, enabling simple switching from intravenous to oral therapy during treatment. It is also preferentially distributed to compartments in the lung, thus achieving high concentrations at the site of respiratory tract infections. Combined with cover of the major infecting pathogens found in patients with AECB and CAP, and a cost-effective treatment compared with many alternative therapies, levofloxacin is an attractive option for the treatment of at-risk patients with these respiratory tract infections.
两种最严重的呼吸道感染是社区获得性肺炎（CAP）和慢性支气管炎急性加重（AECB）。这些感染患者中最常见的病原体是流感嗜血杆菌和肺炎链球菌。铜绿假单胞菌也相对常见，尤其是在患有AECB的老年患者中。肺炎链球菌和铜绿假单胞菌在对抗菌药物产生耐药性方面也令人担忧。以导致感染部位浓度超过突变预防浓度的剂量使用抗生素是预防耐药病原体产生的一种策略。AECB与高住院死亡率风险相关，尤其是在重症监护病房接受治疗的患者中。CAP也伴有重大风险，通常需要在医院监督下进行治疗。一些与患者相关的因素有助于识别那些死亡和发病风险最高的患者。治疗应根据疾病的严重程度进行调整。氟喹诺酮类药物，如左氧氟沙星，是治疗AECB和CAP的有效选择。与许多其他抗生素相比，大多数感染病原体对左氧氟沙星的耐药性仍然较低。左氧氟沙星的口服生物利用度超过99%，使得在治疗期间能够简单地从静脉治疗转换为口服治疗。它还优先分布到肺部各腔室，从而在呼吸道感染部位达到高浓度。结合对AECB和CAP患者中发现的主要感染病原体的覆盖，以及与许多替代疗法相比具有成本效益的治疗，左氧氟沙星是治疗这些呼吸道感染高危患者的一个有吸引力的选择。
