Schreiner A
Scand J Infect Dis Suppl. 1984;43:56-61.
The majority of lower respiratory tract infections (LRTI) are treated "blindly" because the establishment of an aetiological diagnosis is not possible in most cases. The rational choice of therapy mainly rests upon the knowledge of the microbiological epidemiology of LRTI, and on the possible host-parasite relationship. In community-acquired pneumonia, there is general concensus that penicillin maintains its position as the first drug of choice, and that therapy can be changed to erythromycin or tetracycline in cases of therapeutic failure. Treatment of nosocomial pneumonia, and LRTI in immunocompromised patients, calls for antibiotics with a broader antimicrobial spectrum. Clindamycin has an antimicrobial spectrum which makes this antibiotic a possible alternative in community-acquired pneumonia, and its efficacy in pneumococcal pneumonia has been documented. However, as first choice therapy it should be reserved for cases of penicillin allergy, or cases of strongly suspected staphylococcal pneumonia. In aspiration pneumonia--nearly always caused by anaerobic bacteria--penicillin has long been the preferred therapy, even in cases with Bacteroides fragilis. However, recent publications have clearly documented that in primary lung abscess, clindamycin is superior to penicillin. These results are especially important since metronidazole has been shown to be less effective in such cases.
大多数下呼吸道感染（LRTI）的治疗都是“盲目”进行的，因为在大多数情况下无法做出病原学诊断。治疗方法的合理选择主要基于对LRTI微生物流行病学的了解以及可能的宿主-病原体关系。在社区获得性肺炎中，普遍的共识是青霉素仍然是首选药物，治疗失败时可改用红霉素或四环素。医院获得性肺炎以及免疫功能低下患者的LRTI治疗需要使用抗菌谱更广的抗生素。克林霉素的抗菌谱使其成为社区获得性肺炎的一种可能替代药物，并且其在肺炎球菌肺炎中的疗效已有文献记载。然而，作为首选治疗药物，它应仅用于青霉素过敏或高度怀疑葡萄球菌肺炎的病例。在吸入性肺炎（几乎总是由厌氧菌引起）中，即使在伴有脆弱拟杆菌的病例中，青霉素长期以来一直是首选治疗药物。然而，最近的出版物清楚地证明，在原发性肺脓肿中，克林霉素优于青霉素。这些结果尤为重要，因为甲硝唑在这些病例中已被证明效果较差。
