COPDAE併有呼吸衰竭只用oral baktar, 或是oral ciproxin，效果一樣?

突尼西亞(tunisia)是北非的國家，可以相信嗎?
看看就好……
人家台大COPDAE c resp failure ->用ceftazidime說

Which Antibiotic for Acute Exacerbations of Chronic Obstructive Pulmonary Disease?

Ciprofloxacin offered no benefit over an old standby, trimethoprim-sulfamethoxazole.

Although exacerbations of chronic obstructive pulmonary disease (COPD) often do not require antibiotic therapy, when a COPD patient is sick enough for intensive care unit (ICU) admission and intubation, an antibiotic is always indicated. But which one?

In a blinded double-dummy study, Tunisian researchers randomized 170 adults with acute exacerbations of COPD and respiratory failure to receive either oral ciprofloxacin or oral trimethoprim-sulfamethoxazole (TMP-SMX) for 10 days, in addition to standard ICU care. Most patients were men, and all were heavy smokers; none was febrile or had radiologic evidence of pneumonia. Mortality during hospitalization was similar in both groups (<10%), as was perceived antibiotic failure that required a different agent (<10%). Respiratory pathogens were isolated from 73 patients; 20 (13 from the TMP-SMX group and 7 from the ciprofloxacin group) were resistant to the assigned antibiotic, but no correlation was found between antibiotic resistance and treatment failure.

Comment: In most studies of COPD exacerbations in which older antibiotics (e.g.,TMP-SMX, doxycycline) have been compared with newer agents (e.g., amoxicillin-clavulanate, cephalosporins, quinolones), no real advantage has emerged for the newer drugs, and this study joins their ranks. Whether the newest quinolones, with their expanded gram-positive spectrum and retained antipseudomonal coverage, have anything additional to offer over older alternatives, including the older quinolones, is not addressed by the current study.

— Abigail Zuger, MD

Published in Journal Watch General Medicine August 5, 2010
Citation(s):

Nouira S et al. Standard versus newer antibacterial agents in the treatment of severe acute exacerbation of chronic obstructive pulmonary disease: A randomized trial of trimethoprim-sulfamethoxazole versus ciprofloxacin. Clin Infect Dis 2010 Jul 15; 51:143. (http://dx.doi.org/10.1086/653527)

* Medline abstract (Free)

https://docs.google.com/fileview?id=0B278nGJMQBk7MjFhNzVjODQtMWRiOS00MDNjLWI0MDUtZWYxNWM0ZWFlNWYy&hl=zh_TW

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