Management of community-acquired pneumonia in the era of pneumococcal resistance -: A report from the Drug-Resistant Streptococcus pneumoniae Therapeutic Working Group
Management of community-acquired pneumonia in the era of pneumococcal resistance -: A report from the Drug-Resistant Streptococcus pneumoniae Therapeutic Working Group
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DOI：
10.1001/archinte.160.10.1399
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发表时间：
2000-05-22
影响因子：
--
通讯作者：
Whitney, CG
中科院分区：
文献类型：
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作者：
Heffelfinger, JD;Dowell, SF;Whitney, CG
目的：为社区获得性肺炎的管理和耐药肺炎链球菌（DRSP）的监测提供建议。方法：我们解决了以下问题：（1）肺炎球菌对β-内酰胺类抗生素的耐药性是否会影响肺炎的治疗？(2)DRSP时代社区获得性肺炎的门诊治疗有哪些合适的经验性抗菌药物方案！(3)在DRSP时代，什么是适合治疗社区获得性肺炎住院患者的经验性抗菌药物方案？以及（4）临床实验室应如何报告肺炎链球菌的抗生素敏感性模式，以及如果社区获得性肺炎是感兴趣的综合征，应将哪些药物纳入监测？肺炎管理专家和DRSP治疗工作组（包括临床医生、学者和公共卫生从业人员）于1998年3月在疾病控制和预防中心开会，讨论DRSP时代的肺炎管理。已发表和未发表的数据来自科学文献和参与者的经验。在小组介绍和背景材料的审查，小组，主席准备了草案的回应，这是作为一个group.Conclusions：当涉及肺炎的情况下，肺炎链球菌应被认为是敏感的，如果青霉素最低抑菌浓度（MIC）不大于1 μ g/mL，中间敏感性，如果MIC为2 μ g/ Int，和耐药，如果MIC不低于4 μ g/mL。对于社区获得性肺炎的门诊治疗，合适的经验性口服抗菌药物包括大环内酯类抗生素（红霉素、克拉霉素、阿奇霉素）、用于8岁或8岁以上儿童的多西环素（或四环素），或对肺炎球菌具有良好活性的口服β-内酰胺（例如，头孢呋辛酯、阿莫西林或阿莫西林和克拉维酸钾的组合）。用于住院患者肺炎的合适的经验性抗微生物方案包括静脉内β-内酰胺，例如头孢呋辛、头孢曲松钠、头孢噻肟钠或氨苄西林钠和舒巴坦钠加大环内酯的组合。新的氟喹诺酮类药物对肺炎的活性提高，也可用于治疗成人社区获得性肺炎。为了限制氟喹诺酮类耐药菌株的出现，新氟喹诺酮类药物应仅限于（1）上述方案之一已经失败的成人，（2）对替代药物过敏的成人，或（3）有记录的高度耐药肺炎球菌感染（例如，青霉素MIC大于或等于4 μ g/mL）的成人。盐酸万古霉素通常不适用于治疗社区获得性肺炎或DRSP引起的肺炎。
Objective: To provide recommendations for the management of community-acquired pneumonia and the surveillance of drug-resistant Streptococcus pneumoniae (DRSP).Methods: We addressed the following questions: (1) Should pneumococcal resistance to beta-lactam antimicrobial agents influence pneumonia treatment? (2) What are suitable empirical antimicrobial regimens for outpatient treatment of community-acquired pneumonia in the DRSP era! (3) What are suitable empirical antimicrobial regimens for treatment of hospitalized patients with community-acquired pneumonia in the DRSP era! and (4) How should clinical laboratories report antibiotic susceptibility patterns for S pneumoniae, and what drugs should be included in surveillance if community-acquired pneumonia is the syndrome of interest? Experts in the management of pneumonia and the DRSP Therapeutic Working Group, which includes clinicians, academicians, and public health practitioners, met at the Centers for Disease Control and Prevention in March 1998 to discuss the management of pneumonia in the era of DRSP. Published and unpublished data were summarized from the scientific literature and experience of participants. After group presentations and review of background materials, subgroup, chairs prepared draft responses, which were discussed as a group.Conclusions: When implicated in cases of pneumonia, S pneumoniac should be considered susceptible if penicillin minimum inhibitory concentration (MIC) is no greater than 1 mu g/mL, of intermediate susceptibility if MIC is 2 mu g/ Int, and resistant if MIC is no less than 4 mu g/mL. For outpatient treatment of community-acquired pneumonia, suitable empirical oral antimicrobial agents include a macrolide leg, erythromycin, clarithromycin, azithromycin), doxycycline (or tetracycline) for children aged 8 years or older, or an oral beta-lactam with good activity against pneumococci (eg, cefuroxime axetil, amoxicillin, or a combination of amoxicillin and clavulanate potassium). Suitable empirical antimicrobial regimens for inpatient pneumonia include an intravenous beta-lactam, such as cefuroxime, ceftriaxone sodium, cefotaxime sodium, or a combination of ampicillin sodium and sulbactam sodium plus a macrolide. New fluoroquinolones with improved activity against 5 pneumoniae can also be used to treat adults with community-acquired pneumonia. To limit the emergence of fluoroquinolone-resistant strains, the neu fluoroquinolones should he limited to adults (1) for whom one of the above regimens has already failed, (2) who are allergic to alternative agents, or (3) who have a documented infection with highly drug-resistant pneumococci (eg, penicillin MIC greater than or equal to 4 mu g/mL). Vancomycin hydrochloride is not routinely indicated for the treatment of community-acquired pneumonia or pneumonia caused by DRSP.