Verghese A, Ismail H M
Section of Infectious Disease, Texas Tech University Regional Academic Health Center School of Medicine, El Paso.
Postgrad Med. 1994 Dec;96(8):75-6, 79-82, 87-9.
Although antimicrobial agents from a number of classes have been used with a good degree of clinical success for acute bacterial exacerbations of chronic bronchitis, the incidence of resistance by beta-lactamase-producing strains to certain penicillins and cephalosporins continues to increase and represents a growing clinical problem. There also have been reports of significant resistance by Streptococcus pneumoniae to tetracyclines and of treatment failures caused by this organism among patients receiving fluoroquinolones. The emergence of penicillin-resistant pneumococci in North America also is of concern. Although first-generation cephalosporins are no longer regarded as first-line therapy or optimal alternatives for acute exacerbations of chronic bronchitis, more recently developed agents of this class have better activity against the primary pathogens, and their efficacy and safety have been demonstrated in a number of clinical trials. Newer macrolide agents probably should be reserved for infections caused by atypical organisms.
尽管多种类别的抗菌药物在慢性支气管炎急性细菌感染的临床治疗中已取得了较好的成效，但产β-内酰胺酶菌株对某些青霉素类和头孢菌素类药物的耐药率仍在持续上升，这已成为一个日益严重的临床问题。也有报告称肺炎链球菌对四环素类药物存在显著耐药性，且在接受氟喹诺酮类药物治疗的患者中，该病菌导致了治疗失败。北美地区耐青霉素肺炎球菌的出现也令人担忧。虽然第一代头孢菌素不再被视为慢性支气管炎急性加重期的一线治疗药物或最佳替代药物，但该类药物中较新开发的制剂对主要病原体具有更好的活性，并且其疗效和安全性已在多项临床试验中得到证实。新型大环内酯类药物可能应留作非典型病原体所致感染的治疗用药。
