Vogel F
Krankenhaus Hofheim, Hofheim im Taunus, Germany.
Drugs. 1995 Jul;50(1):62-72. doi: 10.2165/00003495-199550010-00006.
Acute bronchitis is usually a viral infection which, unless there is a special disposition, does not require antibiotic therapy. For the initial oral chemotherapy of bacterial infections of the lower respiratory tract (chronic bronchitis, pneumonia) the effective and well tolerated cephalosporins, macrolides and amoxicillin plus beta-lactamase-inhibitor are recommended. In complicated cases with severe underlying disease, longer history or frequent exacerbations, quinolones should be given if Gram-negative infections are suspected or if initial therapy with other substances has failed. If Legionella, Mycoplasma or Chlamydia spp., so-called 'atypical' pathogens, are involved, macrolide antibiotics are the therapy of first choice. Special attention should be given to the increase in resistance against cotrimoxazole (trimethoprim-sulfamethoxazole) and tetracyclines. In hospitals where primary pneumonias are treated preferentially by intravenous medication, therapy should be switched to oral antibiotics as soon as feasible (follow-up therapy). For severely ill patients with secondary pneumonia and underlying disease, second generation cephalosporins with aminoglycosides, or monotherapy with third generation cephalosporins are recommended. In very severe, high-risk cases, third generation cephalosporins, combinations with high-dosage quinolones or ureidopenicillins plus beta-lactamase-inhibitors are suitable. Future development in the antibiotic treatment of respiratory infections will follow the current trend of lower dosages, with the clear objective of shortening treatment periods and achieving earlier discharge from hospital.
急性支气管炎通常是一种病毒感染，除非有特殊情况，一般不需要抗生素治疗。对于下呼吸道细菌感染（慢性支气管炎、肺炎）的初始口服化疗，推荐使用有效且耐受性良好的头孢菌素、大环内酯类抗生素以及阿莫西林加β-内酰胺酶抑制剂。在伴有严重基础疾病、病史较长或频繁加重的复杂病例中，如果怀疑革兰氏阴性菌感染或初始使用其他药物治疗失败，应给予喹诺酮类药物。如果涉及嗜肺军团菌、支原体或衣原体等所谓的“非典型”病原体，大环内酯类抗生素是首选治疗药物。应特别关注对复方新诺明（甲氧苄啶-磺胺甲恶唑）和四环素耐药性的增加。在优先通过静脉用药治疗原发性肺炎的医院，应尽快将治疗改为口服抗生素（后续治疗）。对于患有继发性肺炎和基础疾病的重症患者，推荐使用第二代头孢菌素联合氨基糖苷类药物，或使用第三代头孢菌素进行单药治疗。在非常严重的高危病例中，第三代头孢菌素、与高剂量喹诺酮类药物联合使用或脲基青霉素加β-内酰胺酶抑制剂是合适的。呼吸道感染抗生素治疗的未来发展将遵循当前低剂量的趋势，明确目标是缩短治疗周期并实现早日出院。
