• 成都軍區(qū)總醫(yī)院干部病房（成都，610083）;

【摘要】　目的　 探討左氧氟沙星聯(lián)合阿奇霉素治療老年難治性呼吸道感染的療效及安全性。　方法　 選擇2005年2月-2010年9月收治的高齡難治性呼吸道細(xì)菌感染患者68例，隨機分為治療組和對照組。治療組34例，給予左氧氟沙星聯(lián)合阿奇霉素；對照組34例，給予左氧氟沙星，兩組總療程皆為15 d。觀察兩組患者的臨床療效、細(xì)菌清除率和不良反應(yīng)。　結(jié)果　 治療組的總有效率為64.71%，對照組總有效率為32.35%，兩組差異有統(tǒng)計學(xué)意義（P lt;0.05） 。治療組細(xì)菌清除率為76.19%，對照組細(xì)菌清除率為36.36%，兩組差異有統(tǒng)計學(xué)意義（P lt;0.05） 。治療組和對照組的不良反應(yīng)發(fā)生率分別為5.88%和8.82%，差異無統(tǒng)計學(xué)意義（P gt;0.05）。結(jié)論　左氧氟沙星聯(lián)合阿奇霉素治療老年難治性呼吸道感染療效高， 能有效清除細(xì)菌， 不良反應(yīng)較少， 值得臨床推廣應(yīng)用。
【Abstract】　Objective　 To evaluate the efficacy and safety of levofloxacin combined with azithromycin on refractory respiratory infections in elder patients.　Methods　 A total of 68 elder patients with refractory respiratory infections in our hospital from February 2005 to September 2010 were randomly divided into two groups: treatment group (n=34) and control group (n=34). The patients in treatment group were treated with levofloxacin combined with azithromycin; while the patients in the control group were treated with levofloxacin alone. The total treatment periods of both groups were 15 days. The therapeutic efficacy, eradication rate of pathogens and the rate of aelverse reactions were observed.　Results　 The therapeutic effect rate was 64.71% in the treatment group and 32.35% in the control group, and the difference between the two groups was statistically significant (P lt;0.05). The eradication rate of pathogens was 76.19% in the treatment group and 36.36% in the control group, and the difference was significant (P lt;0.05). The rate of the adverse reaction was 5.88% in the treatment group and 8.82% in the control group, and there were no significant differences between the two groups (P gt;0.05).　Conclusion　 Levofloxacin combined with Azithromycin is effective on refractory respiratory tract infection in elder patients, which can effectively remove the bacteria with few adverse reaction.

引用本文： 李鴻雁,孫梅芹,肖欣榮,王煒,葉興蓉. 左氧氟沙星聯(lián)合阿奇霉素治療老年難治性呼吸道感染的臨床分析. 華西醫(yī)學(xué), 2010, 25(12): 2174-2176. doi: 復(fù)制

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9. 　聶大平, 董楓, 石宏宴. 左氧氟沙星、環(huán)丙沙星單用和聯(lián)合其他抗菌藥物對銅綠假單胞菌防突變濃度的研究[J]. 中國感染控制雜志，2007, 11(06). 397-400.
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13. 　Wozn Iak DJ, Keyser R. Effects of subinhibitory concentrations of macrolide antibiotics on Pseudomonas aeruginosa[J]. Chest, 2004, 125 (Suppl): 62-69.
14. 　唐義平, 陳平. 羅紅霉素聯(lián)合敏感抗生素治療銅綠假單胞菌生物被膜病的臨床研究[J]. 華西醫(yī)學(xué), 2008, 23(4): 801-803.
15. 　方向群, 劉又寧. 亞胺培南聯(lián)合羅紅霉素對銅綠假單胞菌生物被膜的作用[J]. 中國抗生素雜志, 2009, 34(11): 688-690.
  1. 1. 　穆魁津, 何權(quán)瀛. 肺部感染[M]. 北京: 北京醫(yī)科大學(xué)中國協(xié)和醫(yī)科大學(xué)聯(lián)合出版社, 1996: 647-649.
  2. 2. 　中國人民解放軍總后勤部衛(wèi)生部. 臨床疾病治愈診斷依據(jù)治愈好轉(zhuǎn)標(biāo)準(zhǔn)[S]. 2版. 北京: 人民軍醫(yī)出版社, 2002: 47-48.
  3. 3. 　馬壯. 老年肺炎的病原學(xué)特點與治療[J]. 解放軍保健醫(yī)學(xué)雜志, 2005, 7(2): 120-121.
  4. 4. 　李鴻雁, 夏前明. 細(xì)菌生物被膜與難治性呼吸道感染[J]. 中國抗感染化療雜志, 2004, 4(3): 190-192.
  5. 5. 　Flemming HC, Neu TR, Wozniak DJ. The EPS matrix: the"house of biofilm cells"[J]. J Bacteriol, 2007, 189(22): 7945-7947.
  6. 6. 　謝紅梅, 胡必杰, 周昭彥, 等. 銅綠假單胞菌生物膜形成影響因素的研究[J]. 中華醫(yī)院感染學(xué)雜志, 2007, 17(12): 1475-1477.
  7. 7. 　Musk DJ Jr, Hergenrother PJ. Chelated iron sources are inhibitors of Pseudomonas aeruginosa biofilms and distribute efficiently in an in vitro model of drug delivery to the human lung [J]. J Appl Microbiol, 2008, 105(2): 380-388.
  8. 8. 　王曉霞, 梅青, 黃維勝, 等. 國內(nèi)左氧氟沙星制劑的開發(fā)與臨床應(yīng)用[J]. 中國藥師, 2007, 10(3): 279.
  9. 9. 　聶大平, 董楓, 石宏宴. 左氧氟沙星、環(huán)丙沙星單用和聯(lián)合其他抗菌藥物對銅綠假單胞菌防突變濃度的研究[J]. 中國感染控制雜志，2007, 11(06). 397-400.
  10. 10. 　Hoffmann N, Lee B. Azithromycin blocks quorum sensing and alginate polymer formation and increases the sensitivity to serum and stationary growth-phase killing of Pseudomonas aeruginosa and attenuates chronic paeruginosa lung infection in Cftr mice [J]. Antimicrob Agents Chemother, 2007, 51(10): 3677-3687.
  11. 11. 　Rasmussen TB, Bjarnsholt T, Skindersoe ME, et al. Screening for quorum sensing inhibitors (QSI) by use of a novel genetic system, the QSI selector[J]. J Bacteriol, 2005, 187 (5): 1799-1814.
  12. 12. 　Martinez JA, Horcajada JP, Alemla M, et al. Addition of a macrolide to a beta lactam based empirical antibiotic regimenis associated with lower inhospital mortality for patients with bacteremic pneumococcal pneumonia[J]. Clin Infect Dis, 2003, 36(4): 389-395.
  13. 13. 　Wozn Iak DJ, Keyser R. Effects of subinhibitory concentrations of macrolide antibiotics on Pseudomonas aeruginosa[J]. Chest, 2004, 125 (Suppl): 62-69.
  14. 14. 　唐義平, 陳平. 羅紅霉素聯(lián)合敏感抗生素治療銅綠假單胞菌生物被膜病的臨床研究[J]. 華西醫(yī)學(xué), 2008, 23(4): 801-803.
  15. 15. 　方向群, 劉又寧. 亞胺培南聯(lián)合羅紅霉素對銅綠假單胞菌生物被膜的作用[J]. 中國抗生素雜志, 2009, 34(11): 688-690.