Management of nonsevere pneumonia in military trainees with the urinary antigen test for Streptococcus pneumoniae:: An innovative approach to targeted therapy
Management of nonsevere pneumonia in military trainees with the urinary antigen test for Streptococcus pneumoniae:: An innovative approach to targeted therapy
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DOI：
10.1086/429919
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发表时间：
2005-06-01
影响因子：
11.8
通讯作者：
Stratchounski, LS
中科院分区：
文献类型：
--
作者：
Guchev, IA;Yu, VL;Stratchounski, LS
背景。治疗肺炎链球菌感染的首选药物通常是青霉素（包括阿莫西林）。然而，靶向治疗很少使用，因为肺炎的明确诊断测试结果要几天后才能获得。因此，广谱抗生素用于肺炎的经验治疗，以涵盖典型和非典型病原体。我们的目的是根据肺炎链球菌快速尿抗原检测的结果来评估靶向抗菌治疗策略的有效性。方法。患有肺炎的军训学员前瞻性地被分为2组：尿抗原检测结果阳性的患者接受阿莫西林（1000 mg，每天3次）治疗，尿抗原检测结果阴性的患者接受克拉霉素（500 mg，每天2次）治疗。两组的治疗持续时间均为5-10天。 结果。共有 219 名可评估患者参加了该研究。肺炎最常见的原因是肺炎链球菌、肺炎衣原体和肺炎支原体。尿抗原检测结果呈阳性的患者在进入研究时患有更严重的疾病。 22%的患者尿抗原检测结果呈阳性（即阿莫西林组），78%的患者尿抗原检测结果呈阴性（即克拉霉素组）。克拉霉素组的临床成功率为 94%，阿莫西林组的临床成功率为 90%（P = 不显着）。被归类为治疗失败的患者均未死亡。对于尿抗原检测结果呈阳性的肺炎球菌肺炎患者，其临床表现的缓解速度较慢。结论。尿抗原测试允许对患有非严重社区获得性肺炎的免疫功能正常的年轻个体有针对性地使用青霉素（阿莫西林）。克拉霉素对肺炎链球菌肺炎和非典型病原体引起的肺炎均高度有效。
Background. The drug of choice for treatment of Streptococcus pneumoniae infection is generally a penicillin (including amoxicillin). Targeted therapy is, however, rarely used, because results of definitive diagnostic tests for pneumonia are not available for several days. Thus, broad-spectrum antibiotics are used for empirical treatment of pneumonia to cover both typical and atypical pathogens. Our purpose was to assess the usefulness of a strategy of targeted antimicrobial therapy based on the results of a rapid urinary antigen test for S. pneumoniae.Methods. Military trainees with pneumonia were prospectively assigned to 2 groups: patients with positive urinary antigen test results who were treated with amoxicillin (1000 mg 3 times per day), and patients with negative urinary antigen test results who were treated with clarithromycin ( 500 mg 2 times per day). The duration of therapy was 5-10 days for both groups.Results. A total of 219 evaluable patients were enrolled in the study. The most common causes of pneumonia were S. pneumoniae, Chlamydia pneumoniae, and Mycoplasma pneumoniae. Patients with positive urinary antigen test results had illness of greater severity at the time of study entry. Twenty-two percent of patients had positive urinary antigen test results (i.e., the amoxicillin group), and 78% had negative urinary antigen test results (i.e., the clarithromycin group). The clinical success rates were 94% for the clarithromycin group and 90% for the amoxicillin group (P = not significant). None of the patients who were classified as having treatment failure died. Resolution of clinical manifestations was slower for patients with pneumococcal pneumonia defined by a positive urinary antigen test result.Conclusions. The urine antigen test allowed targeted use of a penicillin (amoxicillin) for young immunocompetent individuals with nonsevere, community-acquired pneumonia. Clarithromycin was highly effective against both S. pneumoniae pneumonia and pneumonia due to atypical pathogens.