pulmoПульмонологияPULMONOLOGIYA0869-01892541-9617Scientific and Practical Journal “PULMONOLOGIYA” LLC10.18093/0869-0189-2007-0-3-93-98pulmo-1937Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL STUDIESЭффективность коротких курсов азитромицина при нетяжелой внебольничной пневмонииEfficacy of short course asythromycin in non-severe community-acquired pneumoniaЧучалинА. Г.ChuchalinA. G.

г. Москва

АвдеевС. Н.AvdeevS. N.

г. Москва

ЦареваН. А.TsarevaN. A.

г. Москва

ФГУ НИИ пульмонологии РосздраваРоссия200728062007039398Copyright © Чучалин А.Г., Авдеев С.Н., Царева Н.А., 20072007Чучалин А.Г., Авдеев С.Н., Царева Н.А.Chuchalin A.G., Avdeev S.N., Tsareva N.A.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.pulmonology.ru/pulm/article/view/1937

Цель — оценить клиническую эффективность, безопасность и переносимость 3 дневного курса азитромицина (Зитролид форте) по сравнению со стандартным курсом (7-10 дней) амоксициллина (Флемоксин Солютаб) у больных с внебольничной пневмонией легкого течения. Больные, включенные в исследование, были рандомизированы в 2 группы: 1) больные, получавшие Зитролид (20 человек — 15 мужчин и 5 женщин, средний возраст 40,7 ± 18,4 года); 2) больные, получавшие амоксициллин (20 человек — 13 мужчин, 7 женщин, средний возраст 39,8 ± 12,5 года). 1 я группа больных получала Зитролид по 500 мг в сутки в течение 3 дней, 2-я группа больных получала Флемоксин по 500 мг 3 раза в сутки в течение 7-10 дней. У всех больных пневмония была подтверждена рентгенологически, тяжесть пневмо нии оценивалась по шкале Fine; в 1 й группе к I классу Fine были отнесены 12 (60 %) больных, ко II классу — 8 (40 %) больных; во 2-й группе к I классу Fine — 13 (65 %), ко II классу — 7 (35 %) больных. В 1-й группе, получающей Зитролид, положительная динамика кли нических и лабораторных симптомов отмечалась уже на 3-й день терапии, и полное выздоровление наступало на 7-й день. Во 2-й группе, получающей амоксициллин, улучшение клинических и лабораторных показателей наблюдалось лишь на 7-й день терапии, и полное выздоровление было зафиксировано на 14-й день. Микробиологическая эффективность препаратов была сходной (100 %). По числу раз вития побочных эффектов сравниваемые препараты также не различались. У больных с легкой внебольничной пневмонией 3 дневные курсы азитромицина по своей эффективности сравнимы с традиционной (7-10 дневной) терапией амоксициллином. Азитромицин (Зитролид форте) хорошо переносился больными, не было отмечено развития серьезных побочных реакций, требующих отмены препарата.

The study was aimed to evaluate clinical efficacy, safety, and tolerability of 3 day course of azythromycin (Zitrolid forte) in comparison with a stan dard 7 to 10 day therapy with amoxicillin (Flemoxin solutab) in patients with mild community acquired pneumonia (CAP). Included patients were randomized in 2 groups: 1) 20 patients taking Zitrolid 500 mg daily for 3 days (15 males, 5 females, mean age, 40.7 ± 18.4 yrs); 2) 20 patients taking amoxicillin 500 mg t.i.d. for 7 to 10 days (13 males, 7 females, mean age, 39.8 ± 12.5 yrs). Pneumonia was confirmed by chest X ray in all the patients. Severity of pneumonia was assessed with PSI score. In the 1st group, 12 (60 %) of patients had PSI class I and 8 (40 %) had PSI class II. In the 2nd group, there were 13 (65 %) and 7 (35 %), respectively. In the 1st group patients, improvement in clinical signs and laboratory parame ters was noted at the 3rd day of therapy and complete recovery was detected at the 7th day. The 2nd group patients demonstrated similar dynamics at the 7th and the 14th days, respectively. Microbiological efficacy of the drugs was equal (100 %). The drugs did not differ in rate of adverse events. Therefore, 3 day course of azythromycin in patients with mild CAP were as effective as standard (7 to 10 days) therapy with amoxicillin. Azythromycin (Zitrolid forte) was well tolerated with no serious adverse events requiring interruption the treatment.

ReferencesHuchon G., Woodhead M. Management of adult communi ty acquired lower respiratory tract infections. Eur. Respir. Rev. 1998; 8: 391–426.Huchon G., Woodhead M. Management of adult communi ty acquired lower respiratory tract infections. Eur. Respir. Rev. 1998; 8: 391–426.Чучалин А.Г., Синопальников А.И., Страчунский Л.С. и др. Внебольничная пневмония у взрослых: практические рекомендации по диагностике, лечению и профилак тике. М.: издательский дом "М Вести"; 2006.Чучалин А.Г., Синопальников А.И., Страчунский Л.С. и др. Внебольничная пневмония у взрослых: практические рекомендации по диагностике, лечению и профилак тике. М.: издательский дом "М Вести"; 2006.Oosterheert J.J., Bonten M.J., Hak E. et al. How good is the evidence for the recommended empirical antimicrobial treatment of patients hospitalized because of community acquired pneumonia? A systematic review. J. Antimicrob. Chemother. 2003; 52 (4): 555–563.Oosterheert J.J., Bonten M.J., Hak E. et al. How good is the evidence for the recommended empirical antimicrobial treatment of patients hospitalized because of community acquired pneumonia? A systematic review. J. Antimicrob. Chemother. 2003; 52 (4): 555–563.Woodhead M. Community acquired pneumonia in Europe: causative pathogens and resistance patterns. Eur. Respir. J. 2002; 20: 20s–27s.Woodhead M. Community acquired pneumonia in Europe: causative pathogens and resistance patterns. Eur. Respir. J. 2002; 20: 20s–27s.Blasi F. Atypical pathogens and respiratory tract infections. Eur. Respir. J. 2004; 24: 171–181.Blasi F. Atypical pathogens and respiratory tract infections. Eur. Respir. J. 2004; 24: 171–181.Contopoulos1loannidis D.G., Ioannidis J.P.A., Chewc P., Law J. Meta analysis of randomized controlled trials on the com parative efficacy and safety of azithromycin against other antibiotics for lower respiratory tract infections. J. Antimicrob. Chemother. 2001; 48: 691–703.Contopoulos1loannidis D.G., Ioannidis J.P.A., Chewc P., Law J. Meta analysis of randomized controlled trials on the com parative efficacy and safety of azithromycin against other antibiotics for lower respiratory tract infections. J. Antimicrob. Chemother. 2001; 48: 691–703.Dukes M.N.G. (eds.). Meyler's side effects of drugs. 13th ed. Elsevier Science; 1996.Dukes M.N.G. (eds.). Meyler's side effects of drugs. 13th ed. Elsevier Science; 1996.Козлов Р.С., Сивая О.В., Шпынев К.В. и др. Антибиоти корезистентность Streptococcus pneumoniae в России в 1999–2005 гг.: результаты многоцентровых проспек тивных исследований ПеГАС I и ПеГАС II. Клин. микробиол. антимикроб. химиотер. 2006; 8: 33–47.Козлов Р.С., Сивая О.В., Шпынев К.В. и др. Антибиоти корезистентность Streptococcus pneumoniae в России в 1999–2005 гг.: результаты многоцентровых проспек тивных исследований ПеГАС I и ПеГАС II. Клин. микробиол. антимикроб. химиотер. 2006; 8: 33–47.Schonwald S., Skerk Vю, Petricevic I. et al. Comparison of three day and five day courses of azithromycin in the treat ment of atypical pneumonia. Eur. J. Clin. Microbiol. Infect. Dis. 1991; 10: 877–880.Schonwald S., Skerk Vю, Petricevic I. et al. Comparison of three day and five day courses of azithromycin in the treat ment of atypical pneumonia. Eur. J. Clin. Microbiol. Infect. Dis. 1991; 10: 877–880.Schonwald S., Barsic B., Klinar I., Gunjaca M. Three day azithromycin compared with ten day roxithromycin treat ment of atypical pneumonia. Scand. J. Infect. Dis. 1994; 26: 706–710.Schonwald S., Barsic B., Klinar I., Gunjaca M. Three day azithromycin compared with ten day roxithromycin treat ment of atypical pneumonia. Scand. J. Infect. Dis. 1994; 26: 706–710.Rizzato G., Montemurro L., Fraioli P. et al. Efficacy of a three days course of azithromycin in moderately severe communi ty acquired pneumonia. Eur. Respir. J. 1995; 8: 398–402.Rizzato G., Montemurro L., Fraioli P. et al. Efficacy of a three days course of azithromycin in moderately severe communi ty acquired pneumonia. Eur. Respir. J. 1995; 8: 398–402.Bohte R., van't Wout J.W., Lobatto S. et al. Efficacy and safe ty of azithromycin in community acquired pneumonia. Eur. J. Clin. Microbiol. Infect. Dis. 1995; 14: 182–187.Bohte R., van't Wout J.W., Lobatto S. et al. Efficacy and safe ty of azithromycin in community acquired pneumonia. Eur. J. Clin. Microbiol. Infect. Dis. 1995; 14: 182–187.Roord J.J., Wolf B.H., Gossens M.M., Kimpen J.L. Prospective open randomized study comparing efficacies and safeties of a 3 day course of azithromycin and a 10 day course of erythromycin in children with community acquired acute lower respiratory tract infections. Anti microb. Agents Chemother. 1996; 40: 2765–2768.Roord J.J., Wolf B.H., Gossens M.M., Kimpen J.L. Prospective open randomized study comparing efficacies and safeties of a 3 day course of azithromycin and a 10 day course of erythromycin in children with community acquired acute lower respiratory tract infections. Anti microb. Agents Chemother. 1996; 40: 2765–2768.Hoepelman I.M., Mollers M.J., van Schie M.H. et al. A short (3 day) course of azithromycin tablets versus a 10 day course of amoxycillin clavulanic acid (co amoxiclav) in the treatment of adults with lower respiratory tract infections and effects on long term outcome. Intern. J. Antimicrob. Agents 1998; 9: 141–146.Hoepelman I.M., Mollers M.J., van Schie M.H. et al. A short (3 day) course of azithromycin tablets versus a 10 day course of amoxycillin clavulanic acid (co amoxiclav) in the treatment of adults with lower respiratory tract infections and effects on long term outcome. Intern. J. Antimicrob. Agents 1998; 9: 141–146.O'Doherty B., Muller O., the Azithromycin Study Group. Randomized, multicentre study of the efficacy and tolerance of azithromycin versus clarithromycin in the treatment of adults with mild to moderate community acquired pneumo nia. Eur. J. Clin. Microbiol. Infect. Dis. 1998; 17: 828–833.O'Doherty B., Muller O., the Azithromycin Study Group. Randomized, multicentre study of the efficacy and tolerance of azithromycin versus clarithromycin in the treatment of adults with mild to moderate community acquired pneumo nia. Eur. J. Clin. Microbiol. Infect. Dis. 1998; 17: 828–833.Rahav G., Fidel J., Gibor Y., Shapiro M. Azithromycin versus comparative therapy for the treatment of community acquired pneumonia. Intern. J. Antimicrob. Agents 2004; 24: 181–184.Rahav G., Fidel J., Gibor Y., Shapiro M. Azithromycin versus comparative therapy for the treatment of community acquired pneumonia. Intern. J. Antimicrob. Agents 2004; 24: 181–184.Guay D.R.P. Short course antimicrobial therapy of respira tory tract infections. Drugs 2003; 63: 2169–2184.Guay D.R.P. Short course antimicrobial therapy of respira tory tract infections. Drugs 2003; 63: 2169–2184.Fine M.J., Auble T.E., Yealy D.M. et al. A prediction rule to identify low risk patients with community acquired pneu monia. N. Engl. J. Med. 1997; 336: 243–250.Fine M.J., Auble T.E., Yealy D.M. et al. A prediction rule to identify low risk patients with community acquired pneu monia. N. Engl. J. Med. 1997; 336: 243–250.Beam T.R., Gilbert D.N., Kunin C.M. (eds.). Европейское руководство клинической оценки антимикробных препаратов. Пер. с англ. Смоленск: Амипресс; 1996.Beam T.R., Gilbert D.N., Kunin C.M. (eds.). Европейское руководство клинической оценки антимикробных препаратов. Пер. с англ. Смоленск: Амипресс; 1996.Murray P.R., Washington J.A. Microscopic and bacteriolog ic analysis of expectorated sputum. Mayo Clin. Proc. 1975; 50: 339–344.Murray P.R., Washington J.A. Microscopic and bacteriolog ic analysis of expectorated sputum. Mayo Clin. Proc. 1975; 50: 339–344.National Committee for Clinical Laboratory Standards. Performance standards for antimicrobial susceptibility test ing (Vol. 17). Philadelphia, PA: NCCLS 1997; 1: M57–M100.National Committee for Clinical Laboratory Standards. Performance standards for antimicrobial susceptibility test ing (Vol. 17). Philadelphia, PA: NCCLS 1997; 1: M57–M100.Blasi F., Tarsia P. Value of short course antimicrobial ther apy in community acquired pneumonia. Intern. J. Antimicrob. Agents 2005; 26 (suppl. 3): S148–S155.Blasi F., Tarsia P. Value of short course antimicrobial ther apy in community acquired pneumonia. Intern. J. Antimicrob. Agents 2005; 26 (suppl. 3): S148–S155.Kardas R. Patient compliance with antibiotic treatment for respiratory tract infections. J. Antimicrob. Chemother. 2002; 49: 897–903.Kardas R. Patient compliance with antibiotic treatment for respiratory tract infections. J. Antimicrob. Chemother. 2002; 49: 897–903.Reyes H., Guiscafre H., Munoz O. et al. Antibiotic noncom pliance and waste in upper respiratory infections and acute diarrhea. J. Clin. Epidemiol. 1997; 50: 1297–304.Reyes H., Guiscafre H., Munoz O. et al. Antibiotic noncom pliance and waste in upper respiratory infections and acute diarrhea. J. Clin. Epidemiol. 1997; 50: 1297–304.Dunbar L.M., Wunderink R.G., Habib M.P. et al. High dose, short course levoftoxacin for community acquired pneu monia: a new treatment paradigm. Clin. Infect. Dis. 2003; 37: 752–760.Dunbar L.M., Wunderink R.G., Habib M.P. et al. High dose, short course levoftoxacin for community acquired pneu monia: a new treatment paradigm. Clin. Infect. Dis. 2003; 37: 752–760.Tellier G., Niederman M.S., Nusrat R. et al. Clinical and bac teriological efficacy and safety of 5 and 7 day regimens of telithromycin once daily compared with a 10 day regimen of clarithromycin twice daily in patients with mild to moderate community acquired pneumonia. J. Antimicrob. Chemother. 2004; 54: 515–523.Tellier G., Niederman M.S., Nusrat R. et al. Clinical and bac teriological efficacy and safety of 5 and 7 day regimens of telithromycin once daily compared with a 10 day regimen of clarithromycin twice daily in patients with mild to moderate community acquired pneumonia. J. Antimicrob. Chemother. 2004; 54: 515–523.el Moussaoui R., de Borgie C.A.J.M., van den Broek P. et al. Effectiveness of discontinuing antibiotic treatment after three days versus eight days in mild to moderate severe com munity acquired pneumonia: randomised, double blind study. Br. Med. J. 2006; 332: 1355.el Moussaoui R., de Borgie C.A.J.M., van den Broek P. et al. Effectiveness of discontinuing antibiotic treatment after three days versus eight days in mild to moderate severe com munity acquired pneumonia: randomised, double blind study. Br. Med. J. 2006; 332: 1355.Schrag S.J., Pefla C., Fernandez J. et al. Effect of short course, high dose amoxicillin therapy on resistant pneumo coccal carriage: a randomized trial. J. Am. Med. Assoc. 2001; 286: 49–56.Schrag S.J., Pefla C., Fernandez J. et al. Effect of short course, high dose amoxicillin therapy on resistant pneumo coccal carriage: a randomized trial. J. Am. Med. Assoc. 2001; 286: 49–56.

The authors declare that there are no conflicts of interest present.