Paterson D L, Playford E G
Infectious Disease Section, Veterans Affairs Medical Center, Pittsburgh, PA 15240, USA.
Med J Aust. 1998 Apr 6;168(7):344-8. doi: 10.5694/j.1326-5377.1998.tb138964.x.
The choice of empirical treatment for community-acquired pneumonia (CAP) is highly controversial. Our survey of 42 Australian emergency department doctors showed that monotherapy with a third-generation cephalosporin was the preferred regimen for severe CAP (14/42; 33%). We argue that cheaper regimens with a narrower spectrum are likely to be just as effective as third-generation cephalosporins and will have fewer adverse effects on the microbial ecology of hospitals. We suggest penicillin or ampicillin (to cover pneumococci--even if penicillin "resistant"--and Haemophilus influenzae), plus a macrolide (e.g., azithromycin or erythromycin; to cover Legionella and other "atypical" pathogens), plus a single large dose of an aminoglycoside (e.g., gentamicin; to cover gram-negative bacilli such as Klebsiella pneumoniae) as empirical therapy for severe CAP.
社区获得性肺炎（CAP）经验性治疗的选择极具争议。我们对42名澳大利亚急诊科医生的调查显示，第三代头孢菌素单药治疗是重症CAP的首选方案（14/42；33%）。我们认为，抗菌谱较窄且成本更低的治疗方案可能与第三代头孢菌素同样有效，并且对医院微生物生态的不良影响更少。我们建议，使用青霉素或氨苄西林（覆盖肺炎球菌——即使是“耐青霉素”的——以及流感嗜血杆菌），加用一种大环内酯类药物（如阿奇霉素或红霉素；覆盖军团菌和其他“非典型”病原体），再加用单次大剂量的氨基糖苷类药物（如庆大霉素；覆盖革兰氏阴性杆菌，如肺炎克雷伯菌）作为重症CAP的经验性治疗。
