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[对抗菌药物治疗的慢性支气管炎急性加重患者的临床微生物学监测]

[Clinicomicrobiological monitoring of patients with exacerbation of chronic bronchitis treated with antibacterial drugs].

作者信息

Dvoretskiĭ L I, Dubrovskaia N V, Grudinina S A, Filimonova O Iu, Iakovlev S V, Sergeeva E V, Sidorenko S V

出版信息

Ter Arkh. 2006;78(3):25-35.

Abstract

AIM

To compare clinical and microbiological efficacy of penicillines and macrolids in patients with exacerbation of chronic bronchitis (CB) basing on long-term follow-up after antibacterial treatment.

MATERIALS AND METHODS

Twenty patients with exacerbated CB or chronic obstructive pulmonary disease (COPD) received amoxicillin/clavulanic acid (augmentin) while 20 other patients were given macrolides (sumamed or clacide). Clinical efficacy was assessed by the rate of exacerbation regression and duration of recurrence-free period in the course of 12-month follow-up. Bacteriological examination was conducted 3-5 days, 1 month after the treatment and at recurrent exacerbation.

RESULTS

Patients on augmentin showed faster regression of exacerbation, earlier remission and higher quality of remission than patients on macrolides. Eradication of etiologically significant pathogens on day 3-5 after therapy with augmentin and macrolides was achieved in 92 and 30% patients, respectively, persistence--in 8 and 70%, respectively. Mean duration of remission was 263 +/- 107.1 and 164.9 +/- 112,2 days, respectively. A correlation was found between duration of recurrence-free period and frequency of eradication and persistence of the agents after antibacterial therapy of CB and COPD.

CONCLUSION

Augmentin promotes a significantly earlier regress of exacerbation symptoms and persistent remission. Eradication potential of augmentin in CB/COPD patients is higher than that of macrolides. Long-term post-exacerbation monitoring (12-month follow-up) discovered that recurrence-free period of augmentin-treated patients is much longer than in patients on macrolides.

摘要

目的

基于抗菌治疗后的长期随访,比较青霉素类和大环内酯类药物对慢性支气管炎(CB)急性加重患者的临床和微生物学疗效。

材料与方法

20例CB或慢性阻塞性肺疾病(COPD)急性加重患者接受阿莫西林/克拉维酸(奥格门汀)治疗,另外20例患者给予大环内酯类药物(舒美特或克拉仙)。通过12个月随访期间的急性加重消退率和无复发期持续时间评估临床疗效。在治疗后3 - 5天、1个月以及复发加重时进行细菌学检查。

结果

与使用大环内酯类药物的患者相比,使用奥格门汀的患者急性加重消退更快,缓解更早且缓解质量更高。使用奥格门汀和大环内酯类药物治疗后第3 - 5天,分别有92%和30%的患者根除了具有病因学意义的病原体,持续存在的比例分别为8%和70%。平均缓解持续时间分别为263±107.1天和164.9±112.2天。发现CB和COPD抗菌治疗后无复发期持续时间与病原体根除频率及持续存在情况之间存在相关性。

结论

奥格门汀能显著促进急性加重症状更早消退并实现持续缓解。奥格门汀在CB/COPD患者中的根除潜力高于大环内酯类药物。急性加重后的长期监测(12个月随访)发现,使用奥格门汀治疗的患者无复发期比使用大环内酯类药物的患者长得多。

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