Curative effect of antibiotic de-escalation therapy on severe pneumonia / 中国基层医药

ABSTRACT

Objective:To investigate the clinical efficacy and safety of antibiotic de-escalation therapy in the treatment of severe pneumonia.Methods:Sixty patients with severe pneumonia who received treatment in The First People's Hospital of Yongkang,China from January 2015 to January 2018 were included in this study.They were randomly assigned to receive either conventional antibiotic therapy (control group, n = 30) or antibiotic de-escalation therapy (observation group, n = 30).The clinical efficacy,symptom relief time,antibiotic treatment time,length of hospital stay,pulmonary ventilation function index,serum levels of inflammatory factors and the incidence of adverse reactions were compared between the control and observation groups. Results:Total effective rate in the observation group was significantly higher than that in the control group [93.33% (28/30) vs.73.33% (22/30), χ2 = 4.320, P < 0.05].The time to disappearance of cough,fever and abnormal lung sounds in the observation group was (2.10 ± 1.25) d,(2.19 ± 1.24) d,(2.01 ± 0.56) d,respectively,which was significantly shorter than that in the control group [(3.73 ± 1.92) d,(3.68 ± 1.70) d,(3.36 ± 0.78) d, t = 3.897,3.878,7.701,all P < 0.05].The antibiotic treatment time and length of hospital stay in the observation group were (2.89 ± 1.06) d and (4.08 ± 1.23) d,respectively,which were shorter those in the control group [(4.27 ± 1.45) d and (5.76 ± 1.69) d, t = 4.208 and 4.402,both P < 0.05].The forced expiratory volume in one second (FEV 1) and the ratio of FEV 1 to forced vital capacity (FVC) in the observation group were (2.09 ± 0.69) L and (58.94 ± 15.67)%,respectively,which were significantly higher than those in the control group [(1.43 ± 0.57) L,(43.12 ± 11.03)%, t = 4.039 and 4.522,both P < 0.05).Serum levels of C-reactive protein,interleukin-6 and procalcitonin in the observation group were (5.84 ± 2.09) mg/L,(20.05 ± 2.76) ng/L,(2.18 ± 0.78) ng/L respectively,which were significantly lower than those in the control group [(8.50 ± 2.67) mg/L,(23.24 ± 3.07) ng/L,(3.11 ± 0.97) ng/L, t = 4.297,4.232,4.092,all P < 0.05].There was no significant difference in the incidence of adverse reactions between the observation and control groups (6.67% vs.10.00%, χ2 = 0.218, P > 0.05). Conclusion:Antibiotic de-escalation therapy for the treatment of severe pneumonia can shorten the time of disappearance of clinical symptoms,improve pulmonary ventilation function,and inhibit systemic inflammatory reaction without increasing adverse reactions.