Hernández J M, Sides G D, Conforti P M, Smietana M G
Clinical Investigation Department, Lilly S.A., Madrid, Spain.
Clin Ther. 1996 Nov-Dec;18(6):1128-38. doi: 10.1016/s0149-2918(96)80067-1.
Dirithromycin is a new macrolide antimicrobial drug with a long half-life (44 hours) that reaches high tissue concentrations, thus permitting once-daily oral dosing and shorter courses of therapy. Soon after absorption, dirithromycin enters the tissue so rapidly that serum concentrations are comparatively low. It could be hypothesized that these low serum levels could endanger the outcome in patients with bacteremic pneumonia. We reviewed the database on dirithromycin pneumonia (consisting of 1108 patients randomized to receive dirithromycin or erythromycin in two double-masked trials) to ascertain its efficacy in patients with community-acquired pneumonia and concomitant bacteremia. Fourteen (2.5%) of 555 dirithromycin-treated patients and 10 (1.8%) of 553 erythromycin-treated patients had bacteremia. A favorable clinical response posttherapy was observed in 92.3% and 88.9% of these patients with a response assigned, respectively. Overall, favorable response rates were comparable between the two groups in the bacteremic subsets: patients with pneumococcal bacteremia, patients with nonbacteremic pneumococcal pneumonia, and all patients enrolled with acute pneumonia who had a posttherapy clinical response. In the treatment of patients with mild or moderate community-acquired pneumonia, including those with unsuspected and incidental bacteremia, dirithromycin is an effective macrolide antimicrobial drug.
地红霉素是一种新型大环内酯类抗菌药物，半衰期长（44小时），能在组织中达到较高浓度，因此允许每日一次口服给药且疗程较短。吸收后不久，地红霉素迅速进入组织，导致血清浓度相对较低。可以推测，这些低血清水平可能危及菌血症性肺炎患者的治疗结果。我们回顾了地红霉素治疗肺炎的数据库（由1108例患者组成，在两项双盲试验中随机接受地红霉素或红霉素治疗），以确定其对社区获得性肺炎合并菌血症患者的疗效。555例接受地红霉素治疗的患者中有14例（2.5%）发生菌血症，553例接受红霉素治疗的患者中有10例（1.8%）发生菌血症。在这些有反应记录的患者中，分别有92.3%和88.9%在治疗后观察到良好的临床反应。总体而言，在菌血症亚组中，两组的良好反应率相当：肺炎球菌菌血症患者、非菌血症性肺炎球菌肺炎患者以及所有纳入的有治疗后临床反应的急性肺炎患者。在治疗轻度或中度社区获得性肺炎患者时，包括那些未被怀疑和偶然发生菌血症的患者，地红霉素是一种有效的大环内酯类抗菌药物。
