Neu H C, Chick T W
Columbia University College of Physicians and Surgeons, New York.
Chest. 1993 Nov;104(5):1393-9. doi: 10.1378/chest.104.5.1393.
Clarithromycin is a new acid-stable, 14-membered macrolide active against many of the organisms responsible for lower respiratory tract infections. It has been administered to over 5,000 patients worldwide and has been shown to be a safe and effective treatment for acute bacterial exacerbations of chronic bronchitis and bacterial pneumonia when given twice daily (250 to 500 mg). Cefixime is an amino-thiazolyl cephalosporin with an extended spectrum of antibacterial activity inhibiting beta-lactamase-producing respiratory pathogens. It has a long half-life, allowing once-daily administration.
This randomized, double-blind multicenter study compared clarithromycin and cefixime as treatment for patients with community-acquired lower respiratory tract infections (n = 213). Patients had bacterial pneumonia (clarithromycin, 19 percent; cefixime, 21 percent) or acute bacterial exacerbation of chronic bronchitis or asthmatic bronchitis (clarithromycin, 81 percent; cefixime, 79 percent). Patients received 500 mg of clarithromycin twice daily (n = 103) or 400 mg of cefixime once daily (n = 110) for 7 to 14 days.
Clinical cure or improvement occurred in 86 percent of the clarithromycin-treated patients and 88 percent of the cefixime-treated patients. When only patients with identified infections with Haemophilus influenzae, Moraxella catarrhalis, or Streptococcus pneumoniae were considered, clinical success rates were 97 percent for clarithromycin and 96 percent for cefixime; the rate of bacteriologic eradication was 91 percent for clarithromycin and 90 percent for cefixime. Adverse events occurred in 29 percent of the clarithromycin-treated patients and 23 percent of the cefixime-treated patients.
This study demonstrates that clarithromycin and cefixime are effective treatments for pneumonia and acute bacterial exacerbations of bronchitis of mild to moderate severity caused by the most common infecting organisms.
克拉霉素是一种新型的耐酸14元大环内酯类抗生素，对许多引起下呼吸道感染的病原体具有活性。它已在全球5000多名患者中使用，并且已证明，当每日给药两次（250至500毫克）时，它是治疗慢性支气管炎急性细菌加重和细菌性肺炎的一种安全有效的方法。头孢克肟是一种氨基噻唑基头孢菌素，具有广泛的抗菌活性，可抑制产生β-内酰胺酶的呼吸道病原体。它的半衰期长，允许每日给药一次。
这项随机、双盲多中心研究比较了克拉霉素和头孢克肟对社区获得性下呼吸道感染患者（n = 213）的治疗效果。患者患有细菌性肺炎（克拉霉素组19%；头孢克肟组21%）或慢性支气管炎或哮喘性支气管炎急性细菌加重（克拉霉素组81%；头孢克肟组79%）。患者接受每日两次500毫克克拉霉素治疗（n = 103）或每日一次40O毫克头孢克肟治疗（n = 110），疗程为7至14天。
克拉霉素治疗组86%的患者临床治愈或改善，头孢克肟治疗组为88%。仅考虑确诊为流感嗜血杆菌、卡他莫拉菌或肺炎链球菌感染的患者时，克拉霉素的临床成功率为97%，头孢克肟为96%；细菌清除率克拉霉素为91%，头孢克肟为90%。克拉霉素治疗组29%的患者和头孢克肟治疗组23%的患者出现不良事件。
本研究表明，克拉霉素和头孢克肟是治疗由最常见感染病原体引起的轻至中度肺炎和支气管炎急性细菌加重的有效方法。
