Omidvari K, de Boisblanc B P, Karam G, Nelson S, Haponik E, Summer W
Louisiana State University Medical Center, New Orleans 70112, USA.
Respir Med. 1998 Aug;92(8):1032-9. doi: 10.1016/s0954-6111(98)90351-1.
Our objective was to compare therapeutic outcome and analyse cost-benefit of a 'conventional' (7-day course of i.v. antibiotic therapy) vs. an abbreviated (2-day i.v. antibiotic course followed by 'switch' to oral antibiotics) therapy for in-patients with community-acquired pneumonia (CAP). We used a multicenter prospective, randomized, parallel group with a 28 day follow-up, at the University-based teaching hospitals: The Medical Center of Louisiana in New Orleans, LA and hospitals listed in the acknowledgement. Ninety-five patients were randomized to receive either a 'conventional' course of intravenous antibiotic therapy with cefamandole 1 g i.v. every 6 h for 7 days (n = 37), or an abbreviated course of intravenous therapy with cefamandole (1 g i.v. every 6 h for 2 days) followed by oral therapy with cefaclor (500 mg every 8 h for 5 days). No difference was found in the clinical courses, cure rates, survival or the resolution of the chest radiograph abnormalities among the two groups. The mean duration of therapy (6.88 days for the conventional group compared to 7-30 days for the early oral therapy group) and the frequencies of overall symptomatic improvement (97% vs. 95%, respectively) were similar in both groups. Patients who received early oral therapy had shorter hospital stays (7.3 vs. 9.71 days, P = 0.01), and a lower total cost of care ($2953 vs. $5002, P < 0.05). It was concluded that early transition to an oral antibiotic after an abbreviated course of intravenous therapy in CAP is substantially less expensive and has comparable efficacy to conventional intravenous therapy. Altering physicians' customary management of hospitalized patients with CAP can reduce costs with no appreciable additional risk of adverse patient outcome.
我们的目标是比较“传统”（静脉注射抗生素治疗7天疗程）与简化（静脉注射抗生素2天疗程后“换用”口服抗生素）疗法对社区获得性肺炎（CAP）住院患者的治疗效果，并分析成本效益。我们在大学附属医院进行了一项多中心前瞻性随机平行组研究，随访28天，这些医院包括位于路易斯安那州新奥尔良的路易斯安那医学中心以及致谢中列出的医院。95例患者被随机分为两组，一组接受“传统”静脉注射抗生素疗程，即每6小时静脉注射头孢孟多1g，共7天（n = 37）；另一组接受简化静脉注射疗程，即每6小时静脉注射头孢孟多1g，共2天，随后口服头孢克洛（每8小时500mg，共5天）。两组在临床病程、治愈率、生存率或胸部X线异常的消散方面均未发现差异。两组的平均治疗持续时间（传统组为6.88天，早期口服治疗组为7 - 30天）和总体症状改善频率（分别为97%和95%）相似。接受早期口服治疗的患者住院时间较短（7.3天对9.71天，P = 0.01），护理总成本较低（2953美元对5002美元，P < 0.05）。得出的结论是，CAP患者在简化静脉注射疗程后早期换用口服抗生素成本大幅降低，且疗效与传统静脉注射疗法相当。改变医生对CAP住院患者的常规管理方式可以降低成本，而不会给患者带来明显的额外不良后果风险。
