Medical Director Kentucky Pediatric and Adult Research, 201 S. 5th St Bardstown, KY 40004, USA.
Expert Rev Anti Infect Ther. 2010 Jan;8(1):15-21. doi: 10.1586/eri.09.115.
Common community-acquired infections include those of the upper respiratory tract. In the 1990s, the antimicrobial treatment of upper respiratory tract infections focused on penicillin-resistant Streptococcus pneumoniae. However, following the introduction of a pneumococcal conjugate vaccine, a decrease in invasive pneumococcal disease occurred, and in the case of otitis media a shift towards Haemophilus influenzae as the predominant causative pathogen was observed. Future antimicrobial therapy for outpatient upper respiratory tract infections may need to focus on pathogens such as penicillin-susceptible S. pneumoniae, beta-lactamase-producing H. influenzae, beta-lactamase-negative amoxicillin-resistant H. influenzae and Moraxella catarrhalis. In these circumstances, third-generation oral cephalosporins, such as cefixime and cefdinir, could be increasingly used as an optional first-line therapy in community practice for upper respiratory tract infections suspected to be caused by these key pathogens, as an alternative to amoxicillin-clavulanate.
常见的社区获得性感染包括上呼吸道感染。20 世纪 90 年代，上呼吸道感染的抗菌治疗主要针对耐青霉素肺炎链球菌。然而，在肺炎球菌结合疫苗问世后，侵袭性肺炎球菌病的发病率有所下降，在中耳炎的情况下，观察到流感嗜血杆菌成为主要病原体。未来针对门诊上呼吸道感染的抗菌治疗可能需要关注青霉素敏感肺炎链球菌、产β-内酰胺酶流感嗜血杆菌、产β-内酰胺酶但对阿莫西林耐药的流感嗜血杆菌和卡他莫拉菌等病原体。在这些情况下，第三代口服头孢菌素，如头孢克肟和头孢地尼，可作为社区实践中治疗疑似由这些关键病原体引起的上呼吸道感染的一种可选一线治疗药物，替代阿莫西林-克拉维酸。
