Ufuk YILMAZ, Enver YALNIZ, Gülay UTKANER, Özlem YALNIZ, Ünver KAMALI, Osman KAFTAN

Toplumsal kökenli pnömoni ve KOAH'ın akut infeksiyöz alevlenmesinin hastanede klaritromisin ile ardışık tedavisi

Bir antibiyotiğin önce intravenöz (IV), ardından oral yoldan verilmesine dayanan ardışık tedavinin birçok avantajları vardır. Bu çalışmada toplumsal kökenli pnömoni (TKP) ve kronik obstrüktif akciğer hastalığı (KOAH)'nın akut infeksiyöz alevlenmesinde klaritromisin 3 gün IV (1000 mg/gün, 2 kerede) ve 7 gün oral (1000 mg/gün) verilerek, klaritromisinin etkinliği klinik iyileşmeye göre araştırılmıştır. Çalışmaya 31'i TKP ve 14'ü KOAH'ın akut infeksiyöz alevlenmesi olarak hastaneye yatan 45 olgu dahil edilmiştir. TKP ve KOAH'ın akut infeksiyöz alevlenmesindeki klinik iyileşme intravenöz (IV) tedaviden orale geçişten önceki dönemde ve tedavinin sonlandırıldığı günde değerlendirilmiştir. TKP'de, tedavinin 3. günündeki klinik iyileşme %90.3, tedavi sonrası klinik iyileşme %96.8 idi. KOAH'ın akut alevlenmesinde, tedavinin 3. gününde ve tedavi sonrası klinik iyileşme %92.9 idi. İlaca bağlı yan etkilerin çoğunun gastrointestinal sisteme ait olduğu ve IV formunda, 5 olguda (%11.1) ilacın verildiği damarda flebit geliştiği gözlenmiştir. Sonuç olarak, TKP ve KOAH'ın akut alevlenmesinde ardışık klaritromisin tedavisinin başarı oranının yüksek olduğu ve ilacın iyi tolere edildiği belirlenmiştir.

Sequential therapy with clarithromycin in the hospital management of community-acquired pneumonia and acute bacterial exacerbation of chronic obstructive pulmonary disease

Sequential therapy, which based on giving an antibiotic parenteral firstly then switched to oral route, has many advantages. In this study, clarithromycin was given parenterally (500 mg/day) for 3 days and orally for 7 days (1 g/day) in community acquired pneumonia and acute exacerbation of chronic obstructive pulmonary disease, effectiveness of clarithromycin was assessed according to clinical improvement. 31 with CAP and 14 with acute exacerbation of COPD, totally 45 cases who were interned in the hospital enrolled in this study. Clinical response in CAP and acute exacerbation of COPD was assessed just before changing from IV to oral therapy and when completed the therapy. In CAP, clinical response was 90.3% at the 3rd day, and 96.8% after completing the therapy. In acute exacerbation of COPD, clinical response was 92.9% at the 3rd day and in the completing of the therapy. Gastrointestinal system was the major organ system involved, accounting for the drug-related adverse effects. In the vessel, which was used to give the drug, thrombophlebitis developed in 5 cases (11.1%). As a result, sequential therapy with clarithromycin in CAP and acute exacerbation of COPD was successfull and the drug was well tolerated.

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