Komarova V P, Belousov Iu B, Sokolov A V, Tishchenkova I F, Efremenkova O V
Russian State Medical University, Moscow.
Antibiot Khimioter. 1997;42(12):19-24.
Sixty outpatients at the age of 65 to 75 years with exacerbated chronic bronchitis were treated with antibiotics: amoxycillin/clavulanic acid (20 patients), cefaclor (20 patients) and ciprofloxacin (20 patients). The treatment course in all the cases was 5 days. Bacteriological tests of the sputum specimens and estimation of the isolate antibiotic susceptibility by the disk diffusion method were applied to all the patients before and after the treatment. 73 per cent of the patients had mixed infection. The microflora mainly included various species of streptococci highly susceptible to the drugs (54 per cent) as well as highly susceptible strains of pneumococci and hemophilic bacilli (33 and 17 per cent respectively). Atypical microflora was detected in 10 per cent of the cases. Pseudomonas aeruginosa strains were isolated in 2 cases. Acinetobacter sp. slightly susceptible only to ciprofloxacin was isolated in 1 case. Citrobacter sp. slightly susceptible to cefaclor and moderately susceptible to ciprofloxacin was detected in 1 case. Enterobacter sp. moderately susceptible only to ciprofloxacin was isolated in 1 case. A positive factor was moderate susceptibility of Proteus mirabilis to all the three drugs. In 24 patients (the average age of 54.7 years) the pharmacokinetics of ofloxacin administered under 2 different regimens was studied. The drug was used in a single dose of 400 mg once a day (group 1) or in a dose of 200 mg twice a day (group II) followed by estimation of the drug concentration in the blood and sputum. The pathogen eradication was stated in 61.5 and 72.7 per cent of the patients in groups I and II, respectively. By the results of the treatment with the use of the above mentioned antibiotics in the elderly patients fluoroquinolones should be considered preferable from the clinical and pharmacoeconomic viewpoints.
60名年龄在65至75岁之间、慢性支气管炎急性加重的门诊患者接受了抗生素治疗：阿莫西林/克拉维酸（20例患者）、头孢克洛（20例患者）和环丙沙星（20例患者）。所有病例的疗程均为5天。对所有患者在治疗前后均进行了痰液标本的细菌学检测，并采用纸片扩散法评估分离菌的抗生素敏感性。73%的患者存在混合感染。微生物群落主要包括对这些药物高度敏感的各种链球菌（54%）以及肺炎球菌和嗜血杆菌的高度敏感菌株（分别为33%和17%）。10%的病例中检测到非典型微生物群落。2例分离出铜绿假单胞菌菌株。1例分离出仅对环丙沙星轻度敏感的不动杆菌属。1例检测到仅对头孢克洛轻度敏感且对环丙沙星中度敏感的柠檬酸杆菌属。1例分离出仅对环丙沙星中度敏感的肠杆菌属。一个积极因素是奇异变形杆菌对所有三种药物均呈中度敏感。对24例患者（平均年龄54.7岁）研究了两种不同给药方案下氧氟沙星的药代动力学。药物采用每日一次400mg单剂量给药（第一组）或每日两次200mg给药（第二组），随后评估血液和痰液中的药物浓度。第一组和第二组患者的病原体清除率分别为61.5%和72.7%。从临床和药物经济学观点来看，对于老年患者使用上述抗生素进行治疗的结果表明，氟喹诺酮类药物应被视为更优选择。
