Antimicrobial chemotherapy for Legionnaires disease:: Levofloxacin versus macrolides
Antimicrobial chemotherapy for Legionnaires disease:: Levofloxacin versus macrolides
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DOI：
10.1086/428049
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发表时间：
2005-03-15
影响因子：
11.8
通讯作者：
Huerta, FH
中科院分区：
文献类型：
--
作者：
Garrido, RMB;Parra, FJE;Huerta, FH
背景据我们所知，2001年7月发生在西班牙穆尔西亚的军团菌病社区暴发是有史以来报道的最大规模的暴发，这为比较左氧氟沙星治疗军团菌肺炎患者与大环内酯类治疗患者的临床反应提供了一个难得的机会，并确定利福平联合左氧氟沙星治疗重症军团菌病的作用。我们进行了一项观察性、前瞻性、非随机研究，涉及292名在我们医院就诊的患者。Morales Meseguer”;穆尔西亚，西班牙），他在穆尔西亚爆发期间被诊断为军团菌肺炎。为了比较两种抗生素治疗方案（大环内酯类与左氧氟沙星），患者按肺炎严重程度分层。记录发热持续时间、临床结果、并发症、副作用和住院时间。为评价利福平辅助治疗的潜在疗效，对45例左氧氟沙星联合利福平治疗的慢性乙型肝炎患者进行了评价，并与45例单用左氧氟沙星治疗的对照组进行了比较。除2例死亡外，其余均治愈。治疗组间轻中度肺炎患者的临床结局无显著差异。然而，在重症肺炎患者中，左氧氟沙星发挥了上级活性;它与较少的并发症（3.4%接受左氧氟沙星治疗的患者发生并发症，相比之下，27.2%接受大环内酯类药物治疗的患者发生并发症;）和较短的平均住院时间（5.5 vs. 11.3天;）相关。将利福平添加至Pp. 02页。结论：左氧氟沙星对重症肺炎患者的治疗方案没有额外的益处。我们的研究结果有力地表明，单用左氧氟沙星是一种安全有效的治疗军团病，包括严重的疾病患者。在这些患者中，左氧氟沙星似乎比克拉霉素更有效。
Background. The community outbreak of legionnaires disease that occurred in Murcia, Spain, in July 2001 to our knowledge, the largest such outbreak ever reported - afforded an unusual opportunity to compare the clinical response of patients with Legionella pneumonia treated with levofloxacin with that of patients treated with macrolides and to determine the role of rifampicin combined with levofloxacin in treating severe legionellosis.Methods. An observational, prospective, nonrandomized study was conducted involving 292 patients seen at our hospital ( Hospital "J. M. Morales Meseguer"; Murcia, Spain) who received a diagnosis of Legionella pneumonia during the Murcia outbreak. To compare both antibiotic regimens ( macrolides vs. levofloxacin), patients were stratified by the severity of pneumonia. Duration of fever, clinical outcome, complications, side effects, and length of hospital stay were recorded. To assess the potential effects of adjuvant therapy with rifampicin, 45 case patients treated with levofloxacin plus rifampicin were evaluated and compared with 45 control pairs who were treated with levofloxacin alone.Results. With the exception of 2 patients who died, all patients were cured. There were no significant differences between treatment groups in clinical outcome for patients with mild-to-moderate pneumonia. Nevertheless, in patients with severe pneumonia, levofloxacin exerted superior activity; it was associated with fewer complications ( 3.4% of patients receiving levofloxacin experienced complications, compared with 27.2% of patients receiving macrolides;) and shorter mean hospital stays ( 5.5 vs. 11.3 days;). Addition of rifampicin to the Pp. 02 Pp. 04 treatment regimen for patients receiveing levofloxacin for severe pneumonia provides no additional benefit.Conclusions. Our findings strongly suggest that monotherapy with levofloxacin is a safe and effective treatment for legionnaires disease, including in patients with severe disease. In these patients, levofloxacin appears to be more effective than clarithromycin.