【病例学习第16期】Community-Acquired Pneumonia（社区获得性肺炎）

From Pharmacy Times(www.pharmacytimes.com)
Thanks to the author Craig I. Coleman, PharmD(Dr. Coleman is an assistant professor of pharmacy practice and director of the pharmacoeconomics and outcomes studies group at the University of Connecticut School of Pharmacy.)

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Community-Acquired Pneumonia

SP is a 42-year-old man who goes to the emergency department (ED) complaining of a fever and shortness of breath. SP has a medical history significant for type 2 diabetes and hypertension. He is currently taking metformin, glipizide, and lisinopril. SP has a documented allergy to cephalosporins (described as facial swelling) in his chart. While in the ED, SP is diagnosed with community-acquired pneumonia (CAP) and his doctor decides that he can be treated on an outpatient basis. As part of his discharge instructions, SP is given a prescription for levofloxacin 750 mg daily for 7 days.

Is SP being treated appropriately for CAP?

ANSWER
Community-Acquired Pneumonia
Although the same bacterial organisms typically cause most outpatient CAP (Streptococcus pneumoniae, Mycoplasma pneumoniae, Haemophilus influenzae, Chlamydophila pneumoniae), treatment in most patients is empiric. Current treatment guidelines for CAP (Clin Infect Dis. 2007;44[suppl 2]:S45) recommend that outpatients with comorbid heart, lung, liver, or renal disease, diabetes, alcoholism, or cancer, or who are immunosuppressed, or have received antibiotics in the past 3 months should receive a respiratory fluoroquinolone (eg, moxifloxacin or levofloxacin) or a ß-lactam antibiotic plus a macrolide antibiotic. Because SP has diabetes and a cephalosporin allergy, the use of levofloxacin would be prudent. Patients being treated for outpatient CAP, but without comorbidities, can be treated with a macrolide such as azithromycin.

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社区获得性肺炎

SP,男性,42岁,因发热,气促来急诊部就诊. 有2型糖尿病和高血压病.目前用药:二甲双胍,格列吡嗪和赖诺普利.他的[医疗记录]本上写有对头孢类过敏(表现为面部水肿). 在急诊部,SP诊断为:社区获得性肺炎(CAP),医生决定门诊治疗.离开前, SP还拿到了张标明左氧氟沙星 750mg, 1/日, 连服7天的用药处方.  SP按照CAP治疗合适吗?

答案
虽然同样细菌导致大多数门诊典型CAP(肺炎链球菌,肺炎支原体,流感嗜血杆菌,肺炎衣原体),大多数患者是经验治疗.目前CAP的治疗指南(临床感染性疾病.2007;44[增刊2]; S45)推荐合并有心,肺,肝或肾疾病,糖尿病,酒精中毒,或癌症,或者免疫力低下,或过去3个月内使用过抗生素的,这些患者应给予呼吸氟喹诺酮类(如,莫西沙星或左氧氟沙星)或β-内酰胺类抗生素加一种大环内酯类抗生素。因为SP患有糖尿病且对头孢类过敏，使用左氧氟沙星应该是对的。对于门诊CAP(但无并发病)患者，可给予大环内酯类如阿奇霉素。

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a respiratory fluoroquinolone 如何翻译好

喹诺酮类药物治疗呼吸系统疾病疗效很好，又称为呼吸喹诺酮类药物

疗程为7天（连服7天的用药处方），
对于没有其他合并症的CAP门诊患者，可给予大环内酯类药物如：阿奇霉素治疗

学习了，怎么最近没有人更新该板块内容呢

是啊，去哪里收集英文病例？

如果我会翻译，我一定帮大家翻译出来。。。

学习了，还要更加努力