社区获得性肺炎药物治疗进展论文(2)

　　2　大环内酯类

　　新品种15元环阿奇霉素,14元环克拉霉素等在细菌细胞内浓度高,从而确定了用于治疗非典型性肺炎的重要地位。红霉素、14、15环的大环内酯抗生素能抑制生物被膜的形成,增强其它抗菌物对生物被膜的渗透性,从而提高抗菌作用。

　　3　氟喹诺酮类

　　90年代以后开发的司帕沙星[10.11]、莫西沙星[12]、加替沙星、吉林沙星等新喹诺酮类药物,有些共同特点:(1)以往以环丙沙星为代表的氟喹诺酮类主要作用于革兰阴性菌,故环丙沙星一般不作为院外获得性肺炎的经验性治疗药物,而新喹诺酮类对革兰阳性球菌的作用增强了。对肺炎链球菌、化脓性链球菌等的抗菌活性比环丙沙星提高了4~5倍。(2)对肺炎支原体、衣原体、立克次体的抗菌活性也较环丙沙星明显提高,而且易进入各种组织包括呼吸系统,并达到或超过许多常见致病菌的MIC。(3)一些新品种对厌氧菌活性如消化链球菌、艰难梭状菌的抗菌活性较甲硝唑显著提高。(4)具有口服吸收迅速,生物利用度高,半衰期长,1 d服用1次即可等特点。故有人提出,轻中度社区获得性肺炎采用新氟喹诺酮类药物治疗,既可提高病人服药的顺应性又可降低病人的负担。

　　4　多肽类

　　替考拉宁(ticoplanin)对革兰阳性球、杆菌如MRSA、PRSP、肠球菌,与万古霉素相似,均有强大的抗菌作用,对部分凝固酶阴性葡萄球菌的作用不如万古霉素,但耳、肾毒性等不良反应发生率较万古霉素低。

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