老年急性下呼吸道感染患者的抗生素序贯治疗

Sequential Antibiotic Therapy in Elderly Inpatients with Acute Lower Respiratory Tract Infection

目的探讨抗菌药物序贯疗法在老年急性下呼吸道感染患者的合理应用。方法采用前瞻性、随机对照临床干预研究设计和药物经济学中的最小成本分析法,对老年急性下呼吸道感染患者的两种治疗方案:静脉、口服序贯治疗组(序贯组)及连续静脉治疗组(对照组)进行了临床疗效对比,同时对两组患者细菌清除率、静脉治疗时间、住院日等进行比较,对两组的抗菌药物医疗费用进行药物经济学评价。结果两种疗法的临床疗效相同,患者细菌清除率、体温、血像、胸片恢复正常的时间相似,差异无显著性(P>0.05),但序贯治疗组的静脉用药时间、平均住院日和抗菌药物费用明显低于连续静脉治疗组(P<0.05)。结论对老年急性下呼吸感染患者抗菌药物序贯治疗是安全的、有效的,而且有更加合理的成本、效果比,由静脉治疗转换口服治疗的最佳时间约为7 d。

OBJECTIVE To discuss the rational use of sequential antibiotic therapy in the elderly inpatients with acute lower respiratory tract infection. METHODS Using a clinical prospective intervention study of random sample contrast and minimum cost analysis of pharmacoeconomics to compare the clinical curative effect of two kinds of therapy methods including intravenous-oral sequential therapy group （sequential group） and continuous intravenous infusion therapy group （intravenous group）. Meanwhile, the differences of two groups in the bacterial clearance rate, treatment time of intravenous infusion and length of hospitalization day were also investigated. Furthermore the costs of antibiotics of two groups were evaluated as well in the pharmacoeconomics. RESULTS Compared with two therapies, they have shown equivalence in bacteriology and clinical outcome, pharmacodynamics of them were nearly the same, no significant difference（P〉0.05）. In the clinical curative effect, two therapies＇ bacteria clearance, the times of restoring to normal of temperature, blood routine examination and chest X-ray were practically closed to each other, difference was insignificant（P〉0. 05）. However, the time of intravenous infusion therapy time and the length of hospitalization day had notable difference, and antibacterial cost of sequential group was obviously lower than that of intravenous group, difference was significant （P〈0. 001）. CONCLUSIONS Sequential therapy is safe, operable, and has more reasonable cost-effect ratio in treating the elderly with acute lower respiratory tract infection. Moreover the optimum time from intravenous infusion therapy switching to oral antibiotics therapy is about seven days.