Burcu KARABOĞA, Aykut ÇİLLİ

Toplumda gelişen pnömoninin tedavisinde ampisilin-sulbaktam/ makrolid kombinasyonu ile tek başına florokinolon tedavilerinin karşılaştırılması

Giriş: Toplumda gelişen pnömoni (TGP) tedavisinde ampirik olarak en sık kullanılan ampisilin-sulbaktam ve makrolid (AS+M) kombinasyonu ile florokinolon (F) tedavilerinin sonuçları tartışmalıdır. Bu araştırmanın amacı hospitalizasyon gereken TGPli hastalarda AS + M kombinasyonu ile F tedavilerinin etkinliklerini değerlendirmektir. Hastalar ve Metod: Bu amaçla Akdeniz Üniversitesi Tıp Fakültesi, Göğüs Hastalıkları Kliniği'nde Ekim 2009 - Mayıs 2013 tarihleri arasında yatarak tedavi gören TGPli tüm hastalar retrospektif olarak değerlendirildi. Bulgular: TGP tanısı alan ve çalışma kriterlerini taşıyan 198 hasta çalışmada yer aldı. 198 olgunun 123ü AS + M (%54.6) ve 75 (%33.3)'i F tedavisi almıştı. Hastaların 68 (%34.3)i kadın, 130 (%65.7)u erkekti ve yaş ortalaması 62 idi. En sık komorbid durumlar diabetes mellitus, kronik obstrüktif akciğer hastalığı, konjestif kalp yetmezliği ve koroner arter hastalığı idi. Başvurudaki hastalık ağırlığı, yaş, cinsiyet, komorbid hastalıklar, sigara içme durumu, laboratuvar bulguları, CURB-65 ve PSI skorları her iki grupta da benzerdi. Klinik başarı oranları açısından F kullanan ve AS + M kullanan hastalar arasında bir farklılık saptanmadı (sırasıyla %88, %82.1, p= 0.314). Hastane içi mortalite AS + M grubunda %5.6, F grubunda %6.6; 30 günlük mortalite AS + M grubunda %8.1, F grubunda %8; 90 günlük mortalite AS + M grubunda %20.3, F grubunda %19; 1 yıllık mortalite AS + M grubunda %31.7, F grubunda ise %26.9 idi. Ortalama yatış maliyeti (sırası ile 1.963 ± 3.723 TL, 1.965 ± 7.172 TL), yatış süreleri (AS + M grubunda 5.6 ± 3.9 gün, F grubunda 5.9 ± 3.9 gün) ve mortalite oranlarında bir farklılık saptanmadı. Sonuç: Sonuç olarak, hastanede yatan TGP hastalarında AS + M ve F grupları arasında yaş, komorbid hastalıklar, PSI ve CURB-65 skorları, tedavi etkinliği, erken ve geç mortalite oranı, hastanede yatış süresi ve tedavi maliyetleri açısından gruplar arasında bir farklılık saptanmadı.

Comparison of ampicillin-sulbactam/macrolide dual therapy versus fluoroquinolone monotherapy in hospitalized patients with community-acquired pneumonia

Introductıon: For hospitalized patients, monotherapy with a respiratory Fluoroquinolone (F) and dual therapy combination a ampicilline-sulbactam + a macrolide (AS+M) are extensively used in the treatment of community-acquiredpneumonia (CAP). In this study, empirical AS + M combination therapy versus F monotherapy was compared in hospitalized adult CAP patients. Patients and Methods: This retrospective study, patients with CAP hospitalized in Akdeniz University Hospital, Pulmonology Clinic between October 2009 and May 2013 were included in the study. Results: During the study period, 123 patients received AS + M and 75 received F. Mean age was 66 years. The most frequent comorbidities were diabetes mellitus, chronic obstructive pulmonary disease and cardiovascular disease. Disease severity, age, sex, comorbid diseases, smoking history, laboratory findings, CURB-65 and PSI scores were similar for the two treatment groups at admission. The clinical success rate cure was similar for both groups (82.1% vs 88%; p= 0.314). Length of hospital stay (5.6 ± 3.9 days vs 5.9 ± 3.9 days, p= 0.223) and hospital cost (1.963 ± 3.723 TL vs 1.965 ± 7.172 TL, p= 0.975) were also nonsignificant in both groups. In-hospital, 30-day and 90-day mortality rates were not different in AS + M and F group (5.6% vs 6.6; 8.1% vs 8%; 20.3% vs 19%; 31.7% vs 26.9%, respectively). Conclusions: In conclusion, our study has showed ampicilline-sulbactam and macrolide combination and fluoroquinolone monotherapy have comparable clinical efficacy as well as mortality rates in hospitalized patients with CAP

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