社区获得性肺炎抗生素的合理使用

The Reasonable Using of Antibiotics in Therapy of Community-acquired Pneumonia

目的:本文通过三个不同抗生素对细菌性社区获得性肺炎(CAP)的疗效比较,探讨目前婴幼儿CAP治疗中抗生素的合理使用。方法:将2007年在本科收治的年龄在1个月至2岁间的肺炎患儿83例随机分成三组,1组用头孢曲松,2组用青霉素,3组用头孢呋辛进行抗感染,并同时配合常规对症支持治疗,观察不同抗生素治疗社区获得性肺炎的退热时间、治愈时间情况。结果:三组患儿入院前病程、年龄、性别比例均无明显差异。三组平均退热时间(h)及治愈时间(d)分别为1组27.33±18h,8.93±1.63d;两组16.7±12.58 h,6.60±2.61d;3组18.47±17.5h,7.75±3.47d,两组比1组退热时间、治愈时间明显缩短(P<0.05),3组与1、两组比较均无明显差异(P>0.05)。但在治疗中发现,1组院内感染比例47%、两组7.5%、3组7.14%,1组较2.3组明显增多。结论:青霉素作为第一线抗生素治疗社区获得性肺炎的疗效是肯定的,而强效的抗生素也非万能,且其引起正常菌群失调、二重感染及耐药菌株的危害不容忽视。

Objective： To evaluate the reasonable using of antibiotics in infants suffering from bacterial community-acquired pneumonia（CAP） by comparing the therapeutic effects of three different antibiotics.Method： 83 cases 1 to 48 months old infants who suffered from CAP in our hospital in 2007 were randomly designated into three groups： group 1 treated with ceftriaxone,group 2 treated with penicillin,group 3 treated with cefuroxime.All patients in three groups received similar adjuvant therapy.The mean pyretolysis time（hour） and cure time（day） were studied.Result： There was no significant differences in pathogenesis,ages and genders among these three groups.The mean pyretolysis time（hours） and cure time（days） were 27.33±18 hours and 8.93 ±1.63 days in group 1;16.7 ± 12.58 hours and 6.60 ±2.61 days in group 2;18.47 ±17.5 hours and 7.75 ±3.47 days in group 3 respectively.The pyretolysis time and healing time of group 2 was significantly shorter（P 0.05） than those of group 1.meanwhile,comparing group1-2 with group 3,there is no significant differences（P 0.05）.However,during the treatment we found that the proportion of nosocomial infection in group 1（47%） was significantly more than group 2-3（7.5% in group 2 and 7.14% in group 3 respectively）.Conclusion： Penicillin as a first-line antibiotic treatment had certain efficacy of treating community-acquired pneumonia.while the powerful antibiotics were not omnipotent because of its normal flora imbalance,superinfection,and the harm from strains of drug-resistant which could never be ignored.