抗生素在哮喘当中的应用一直备受争议。近年的研究主要集中于大环内酯类抗生素(Macrolides)的非抗菌效应，已有研究发现l4元环和l5元环的大环内酯类抗生素具有类激素样抗炎活性[1]。作为新一代大环内酯类衍生物的泰利霉素(Telithromycin)由于其独特的抗细菌耐药性，一问世便受到广泛关注，而近期公布的TELICAST试验(The Telithromycin，Chlamydophila，and Asthma Trial)中关于其在哮喘急性加重疗效方面的结果更是令人振奋。该试验发现，对已确诊的哮喘急性加重期患者，在指南推荐的常规治疗基础上加用为期10 d的泰利霉素口服(800 mg／d)，可使哮喘症状评分明显下降，肺功能指标改善，但其发挥疗效的机制尚不十分清楚[2]。
Objective To evaluate the efficacy of long-term inhaled salmeterol / fluticasone combined with low-dose oral erythromycin in patients with bronchiectasis. Methods Sixty-two patients with bronchiectasis after exacerbation and maintained stable were randomly divided into three groups. Group A was treated with low-dose oral erythromycin, group B inhaled salmeterol/fluticasone, and group C inhaled salmeterol/fluticasone plus low-dose oral erythromycin. The study duration lasted for 6 months. The clinical symptoms, dyspnea scale, exacerbation frequency, and pulmonary function parameters were measured and compared. Results Fifty-four patients completed the whole study and 8 cases withdrew. The results showed that 6 months of low-dose erythromycin therapy can improve the clinical symptoms, whille exacerbation frequency was also decreased. Inhaled salmeterol/fluticasone improved lung function, however, had no effect on cough, expectoration and exacerbation frequency. Inhaled salmeterol/fluticasone combined with erythromycin was more significantly effective in improving lung functions as well as symptoms. Conclusions Long-terminhaled salmeterol/fluticasone combined with low-dose oral erythromycin can improve the clinical symptoms and lung function, decrease the frequency of exacerbation in patients with bronchiectasis. It may be as an alternative to the maintenance treatment of bronchiectasis.
Objective To systematically evaluate the effectiveness and safety of macrolides in the prevention of COPD exacerbation. Methods The literatures concerning both randomized controlled trials ( RCTs ) and clinical control study of COPD were searched in PUBMED, EMBASE, Chinese National Knowledge Infrastructure ( CNKI) ,Wanfang, and Chinese Science and Technology Journal Full-text Database ( VIP) ( last updated in September 2012) . The quality assessment and data extraction for RCTs were conducted by two reviewers independently.Meta-analyses were conducted with the Cochrane Collaboration’s RevMan 4. 2 software. Results In all trials, the results indicated that the frequency of acute exacerbation in the macrolide treatment group was decreased compared with the control group [ RR= 0. 63, 95% CI( 0. 50, 0. 79) ] . The frequency of acute exacerbation treated with macrolides was significantly decreased in Asians [ RR= 0. 58, 95% CI ( 0. 44, 0. 75) ] but not in Caucasians [ RR = 0. 79, 95% CI ( 0. 47, 1. 31) ] . The frequency of acute exacerbation treated with roxithromycin was significantly decreased compared with the control group [ RR=0. 54,95% CI( 0. 32, 0. 91) ] . In addition, the macrolides treatment had no side effects except for a few and mild gastrointestinal adverse effects. Conclusion Macrolides may be an effective drug to prevent COPD exacerbation.
Objective To explore whether hospitalized elderly patients with severe communityacquired pneumonia ( SCAP) have better outcomes if they are treated with dual-therapy consisting of a β-lactam/macrolide or fluoroquinolone.Methods A prospective study was conducted in patients with SCAP aged 65 years or older between January 2007 and January 2012. These patients were assigned to a combination therapy group or a β-lactam monotherapy group by the attending physicians. Time to clinical stability( TCS) and total mortality were calculated. Prognostic factors for death were analyzed. Results Among the 232 patients, 153 patients were given β-lactam/macrolide or β-lactam/ fluoroquinolone ( macrolide in 67 patients and fluoroquinolone in 86) , while 79 were treated with β-lactam monotherapy. Compared with the monotherapy group, the combination therapy group was associated with significant decreased TCS ( median TCS, 10 days vs. 13 days) , and lower overall in-hospital mortality( 24.2% vs. 43.0%, P lt;0. 01) . Compared with fluoroquinolone, macrolide use was associated with lower ICU mortality ( 14.9% vs. 31.4% , P lt;0. 01) . Simplified acute physiology score Ⅱ, pneumonia severity index, mutilobar infiltration, and β-lactam monotherapy were confirmed as independent predictors of death. Conclusion β-lactam/macrolide or β-lactam/ fluoroquinolone combination therapy, especially with macrolide, has superiority over β-lactam monotherapy in elderly patients with SCAP, and should be recommended.
ObjectiveTo investigate the efficacy of macrolide antibiotics on patients with lower respiratory tract infection. MethodsA total of 146 patients with lower respiratory tract infections were selected from January 2011 to January 2014 in the Department of Respiratory Medicine of our hospital and divided into low risk and high risk group. Based on the clinical characteristics of the patients, low risk treatment plan was erythromycin capsule 0.25 g once, 3 times/day plus compound liquorice mixture, followed by clarithromycin 0.25 g once, 2-3 times/day plus compound liquorice mixture or clarithromycin 0.25 g once, 2-3 times/day plus compound liquorice mixture; high risk group treatment was macrolide antibiotics (erythromycin, clarithromycin) 0.25 g once, 3 times/day and second generation cephalosporins (cefaclor or cefuroxime) 0.25 g once, 3 times/day plus compound liquorice decoction. ResultsThe clinical seven-day curing rate was 54.1%, and the total effective rate was 93.1%. For low risk treatment regimen, the sevenday curing rate was 63.6%, and the total effective rate was 94.9%; for high risk treatment regimen, the seven-day curing rate was 34.0%, and the total effective rate was 89.4%. Acute bronchitis had high curing rate which was 70.1%. ConclusionMacrolide antibiotics (erythromycin, clarithromycin) oral administration in the treatment of lower respiratory tract infection is reliable and effective, which is worth promoting in clinical application.
ObjectiveTo explore drug resistance, resistant mechanisms and resistant phenotypes of staphylococcus aureus (SA) isolated from wound secretion to macrolides-lincosamides-streptogramins (MLS). MethodsA retrospective design was used to collect clinical data and antimicrobial resistance profiles of SA in the First Affiliated Hospital and the Second Affiliated Hospital of Fujian Medical University and Anxi County Hospital from June, 2008 to October, 2015. SPSS 19.0 software was used for data analysis. ResultsA total of 127 isolates were included. The distribution of four resistant phenotypes of SA to MLS were all susceptibility(S) type (n=48, 37.8%), ML type (n=41, 32.3%), M/iCR+ type (n=22, 17.3%) and MLS type (n=16, 12.6%), respectively; There were three kinds of phenotypes caused by target changing including ML type, M/iCR+ type and MLS type, respectively. Moreover, no moxicaxin, linezolid or tigecyline resistant strain was detected, while quinolons and tetracyclines showed low-level resistant. ConclusionCompared with the different samples, the resistant phenotypes of SA isolated from wound secretion to MLS are few, and the total resistance ratio is low.
ObjectiveTo systematically review the efficacy and safety of respiratory fluoroquinolones monotherapy versus β-lactams plus macrolides combination therapy for non-ICU hospitalized community acquired pneumonia (CAP) patients. MethodsWe searched databases including PubMed, the Cochrane Library (Issue 3, 2015), EMbase, CNKI, WanFang Data, VIP and CBM to identify randomized controlled trials (RCTs) involving the comparison of fluoroquinolones monotherapy with β-lactams plus macrolides combination treatment for the non-ICU hospitalized patients with CAP up to April 2015. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, assessed the risk bias of included studies, and then meta-analysis was performed using the RevMan 5.0 software. ResultsA total of 17 RCTs involving 5 423 patients were included. The results of meta-analysis showed that there was no significant difference between the two therapy groups on the mortality. For the clinical treatment success rates, no significant differences between the two groups were found based on the data of intention-to-treat (ITT) and per-protocol (PP) analyses. However, respiratory fluoroquinolones monotherapy was associated with higher clinical treatment success rates based on the data that it was unclear whether ITT or PP analysis was used (RR=1.08, 95% CI 1.01 to 1.18, P=0.02), especially in Asians (RR=1.10, 95%CI 1.02 to 1.18, P=0.01). Additionally, respiratory fluoroquinolones monotherapy was associated with less adverse events (RR=0.81, 95%CI 0.73 to 0.90, P<0.000 1), especially in Caucasians (RR=0.64, 95%CI 0.36 to 1.14, P=0.13). ConclusionCurrent evidence shows that the efficacy of respiratory fluoroquinolones monotherapy may be similar to β-lactams plus macrolides combination treatment for non-ICU hospitalized CAP patients. Since the limitation of quantity and quality of included studies, large-scale high-quality RCTs are needed to verify the above conclusion.
Objective To overview the systematic reviews about the efficacy and safety of respiratory fluoroquinolones for community-acquired pneumonia (CAP). Methods We electronically searched databases including China National Knowledge Internet, WanFang Data, VIP, PubMed, Embase and The Cochrane Library to collect systematic reviews or Meta-analyses about respiratory fluoroquinolones for CAP from inception to November 2, 2017. Two reviewers independently screened literatures, extracted data, and then AMSTAR tool was used to assess the methodological quality of included studies. Results A total of 18 systematic reviews/Meta-analyses were included. The results of quality assessment indicated the scores ranged from 5 to 10. Among the 11 items, the item 1 of " Was an ‘a priori’ design provided” and item 4 " Was the status of publication (i.e. grey literature) used as an inclusion criterion” appeared to be the most problematic. The results of overview suggested that: the efficacy of respiratory fluoroquinolones might be similar to β-lactams plus macrolides combination treatment for CAP. However, respiratory fluoroquinolones might be more safety. In addition, the efficacy of respiratory fluoroquinolones sequential therapy for CAP was similar to that of continuous intravenous therapy, but the adverse reactions of the former were fewer. Conclusions Respiratory fluoroquinolones might be similar in efficacy for CAP to other antibiotics recommended by the guidelines with less adverse reactions. However, it can increase multi-drug resistance and potential tuberculosis drug resistance, we should strictly follow the principle of rational use of antibiotics to avoid abuse.