Antibiotics in chronic obstructive pulmonary disease
Antibiotics in chronic obstructive pulmonary disease
复制标题
抗生素治疗慢性阻塞性肺疾病
作者：
H. Hosker;N. Cooke;P. Hawkey
慢性阻塞性肺疾病患者经常发生呼吸道感染。偶尔，增加的痰量和脓液在适当的抗生素疗程后无法消除，通常需要住院治疗。如果患者仍有喘息和喘息的不适，则推定为持续呼吸道感染。患者经常接受反复疗程的抗生素治疗，这会扰乱口咽菌群，并促进不同微生物或原始组织的抗药性菌株在肺部的定居或入侵。然而，在高达40%的患者中，痰培养没有显示出增长。1即使从痰中分离出一种微生物，其致病重要性也可能不确定，临床对适当抗生素的反应往往令人失望。有时发现不止一种生物体，每一种生物体的重要性都很难确定。医生经常不得不在经验性抗生素治疗和进一步尝试做出微生物学诊断之间做出选择。
流感嗜血杆菌和肺炎链球菌是慢性阻塞性肺疾病急性加重期痰中最常见的细菌，在一项研究中，1，3分别占阳性培养的43%和25%。1.慢性阻塞性肺疾病患者常定植有流感嗜血杆菌，4，5，而且病情加重经常与内源性或…重合
Patients with chronic obstructive pulmonary disease frequently develop respiratory infections. Occasionally the increased sputum volume and purulence fail to resolve after a course of an appropriate antibiotic, and hospital admission is often required. If the patient remains unwell with breathlessness and wheeze, continuing respiratory infection is presumed. Patients often receive repeated courses of antibiotics, which disturb the oropharyngeal flora and facilitate colonisation or invasion of the lung by different organisms or antibiotic resistant strains of the original organism.In up to 40% of patients, however, sputum cultures show no growth.1 Even when an organism is isolated from sputum its pathogenic importance may be uncertain, and the clinical response to an appropriate antibiotic is often disappointing.2. Sometimes more than one type of organism is found, and the importance of each is difficult to determine. Doctors often have to choose between empirical antibiotic treatment and further attempts to make a microbiological diagnosis.
Haemophilus influenzae and Streptococcus pneumoniae are the commonest organisms identified in the sputum during exacerbations of chronic obstructive pulmonary disease,1,3 accounting for 43% and 25% of positive cultures respectively in one study.1 Patients with the condition are often colonised with H influenzae,4,5 and exacerbations frequently coincide with endogenous or …