Division of Infectious Diseases, Department of Medicine, University of Ottawa, Ontario, Canada.
J Infect. 2011 Sep;63(3):187-99. doi: 10.1016/j.jinf.2011.06.009. Epub 2011 Jul 5.
Despite the availability of excellent antibiotics, the mortality from community-acquired pneumonia (CAP) remains substantial. Most deaths occur during the first week of hospitalization. Because antibiotics rapidly eradicate bacteria from pulmonary secretions, an ongoing inflammatory response may be responsible for the poor outcome, and treatment with immunomodulatory drugs might be beneficial in this setting. Macrolides and statins exert a broad range of anti-inflammatory effects. Although randomized control trials have not been done, clinical evidence favors the addition of a macrolide to a beta-lactam for the treatment of pneumococcal pneumonia and supports a role for macrolides in the treatment of all-cause CAP without regard to their anti-microbial activity. The weight of several retrospective studies suggests that statins be considered in treating acute CAP. Further support for the use of statins derives from the high association between pneumonia and acute myocardial infarction. Aspirin might also be of benefit in treating patients hospitalized for pneumonia because of its anti-inflammatory activity as well as its benefits in acute myocardial infarction. Treatment of CAP with corticosteroids has yielded mixed results and the value of this approach is not well established, although further research is currently underway. Ibuprofen is not of benefit in treating sepsis in humans and glitazones may increase the risk of severe pneumonia.
尽管有很好的抗生素可用，社区获得性肺炎（CAP）的死亡率仍然很高。大多数死亡发生在住院后的第一周。由于抗生素能迅速从肺部分泌物中消除细菌，持续的炎症反应可能是导致不良预后的原因，因此在这种情况下使用免疫调节药物可能是有益的。大环内酯类和他汀类药物具有广泛的抗炎作用。尽管没有进行随机对照试验，但临床证据支持在治疗肺炎球菌性肺炎时将大环内酯类药物与β-内酰胺类药物联合使用，并支持在不考虑其抗菌活性的情况下，将大环内酯类药物用于治疗所有病因的 CAP。几项回顾性研究的结果表明，应考虑使用他汀类药物治疗急性 CAP。另外，肺炎与急性心肌梗死之间存在高度相关性，这也为使用他汀类药物提供了进一步的支持。阿司匹林因其抗炎作用以及在急性心肌梗死中的益处，也可能对治疗因肺炎住院的患者有益。皮质类固醇治疗 CAP 的结果喜忧参半，其应用价值尚未得到充分确立，尽管目前正在进行进一步的研究。布洛芬对治疗人类脓毒症无益，而噻唑烷二酮类药物可能会增加患严重肺炎的风险。
