CLINDAMYCIN VS PENICILLIN FOR ANAEROBIC LUNG INFECTIONS - HIGH-RATE OF PENICILLIN FAILURES ASSOCIATED WITH PENICILLIN-RESISTANT BACTEROIDES-MELANINOGENICUS

被引:78
作者
GUDIOL, F
MANRESA, F
PALLARES, R
DORCA, J
RUFI, G
BOADA, J
ARIZA, X
CASANOVA, A
VILADRICH, PF
机构
[1] HOSP BELLVITGE PRINCEPS ESPANYA,RESP SERV,BARCELONA,SPAIN
[2] HOSP BELLVITGE PRINCEPS ESPANYA,MICROBIOL SERV,BARCELONA,SPAIN
[3] UNIV BARCELONA,BARCELONA 7,SPAIN
关键词
D O I
10.1001/archinte.150.12.2525
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Thirty-seven adult patients with anaerobic lung infections (27 lung abscesses and 10 necrotizing pneumonias) were submitted to transthoracic needle aspiration and/or bronchoscopic specimen brush cultures before therapy and thereafter in all cases considered to be failures. Patients were randomly assigned to receive either clindamycin, 600 mg intravenously every 6 hours, or penicillin G, 2 million U every 4 hours for no less than 8 days, until clinical and radiological improvement became apparent. Treatment was continued orally with clindamycin, 300 mg every 6 hours, or penicillin V, 750 mg every 6 hours, until completing a minimum of 4 weeks. Ten of the 47 anaerobes initially isolated from the lung (nine Bacteroides melaninogenicus and one Bacteroides capillosus) were resistant to penicillin, but none were resistant to clindamycin. Five of the nine patients harboring these penicillin-resistant Bacteroides received penicillin, and all failed to respond to therapy. Overall, eight of the 18 patients in the penicillin group and one of 19 in the clindamycin group failed to respond to therapy. These drugs were equally well tolerated in both groups. The presence of penicillin-resistant Bacteroides is a frequent cause of penicillin failure in patients with anaerobic lung infections. In this setting, clindamycin appears to be the current therapy of choice for initial treatment.
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收藏
页码:2525 / 2529
页数:5
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