Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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A Prospective Study for Comparing the Effects of Macrolide and Second-generation Cephalosporin on the Treatment of Pneumonia among Combat Policemen

전투경찰에서 발생한 폐렴에 있어서 Macrolide와 2세대 Cephalosporin의 치료 효과에 대한 전향적 비교 연구

  • Lee, Jae Il (Department of Internal Medicine National Police Hospital) ;
  • Yang, Byeong Yoon (Department of Internal Medicine National Police Hospital) ;
  • Moon, Chang Ki (Department of Internal Medicine National Police Hospital) ;
  • Jeong, Jae Hyeok (Department of Internal Medicine National Police Hospital) ;
  • Kim, Jong Su (Department of Internal Medicine National Police Hospital) ;
  • Lee, Jung Min (Department of Internal Medicine National Police Hospital) ;
  • Ahn, Seok Jin (Department of Internal Medicine National Police Hospital) ;
  • Jung, Jun-Oh (Department of Internal Medicine National Police Hospital) ;
  • Park, Sang-Joon (Department of Internal Medicine National Police Hospital) ;
  • Kim, Yun Kwon (Department of Internal Medicine National Police Hospital) ;
  • Kim, So Yon (Department of Internal Medicine National Police Hospital) ;
  • Kim, Young Jung (Department of Internal Medicine National Police Hospital) ;
  • Cho, Min Koo (Department of Internal Medicine National Police Hospital) ;
  • Lee, Gwon Jun (Department of Internal Medicine National Police Hospital) ;
  • Lee, Gyeong In (Department of Laboratory Medicine National Police Hospital)
  • Received : 2004.11.18
  • Accepted : 2005.01.26
  • Published : 2005.03.30
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Abstract

Background : The study of pneumonia among young men living in a group is rare. prospective study was conducted to determine the etiology, and compare the effects of macrolide and second-generation cephalosporin on the treatment of pneumonia among combat policemen. Patients and Methods : From January 2003 to April 2004, Fifty-two patients with pneumonia were treated with either azithromycin(n=25) or cefuroxime(n=27). In order to determine the cause of the pneumonia, culture studies and serologic tests for antibodies to Mycoplasma pneumoniae and Chlamydia pneumoniae were carried out. During the two weeks of medication, the Chest X-rays, blood tests and culture studies(if necessary) were followed weekly. A serologic study was followed at the end of the second week. Results : The main pathogens for pneumonia among combat policemen were Mycoplasma pneumoniae(50.0%), Chlamydia pneumoniae(10.8%), and Streptococcus pneumoniae(3.8%). The treatment was successful in most cases(51/52 cases, 98.1%). The effects of azithromycin and cefuroxime were similar (96.0% vs 100%, p>0.05). In one patient who had taken azithromycin, the clinical and radiological findings did not improved until intravenous second generation ce phalosporin had been infused. Conclusion : Atypical pathogens were the main causes of the pneumonia in the combat policemen, and the effects of macrolide and second generation cephalosporin for pneumonia were similar. However, further studies will be needed to determine if single therapy with macrolide is possible.

목 적 : 집단생활을 하는 젊은 성인에서 발생한 폐렴에 관한 연구는 매우 드물며, 국내 연구는 전무한 실정이다. 이에 저자들은 전경 대원에서 발생한 폐렴의 양상에 대해 알아보고 Macrolide와 2세대 Cephalosporin의 치료 효과를 비교하여 보고자 전향적 연구를 시행하였다. 방 법 : 2003년 1월부터 2004년 4월까지 국립 경찰병원을 방문한 52명의 폐렴 환자들을 무작위로 구분하여 Cefuroxime 또는 Azithromycin을 경구 투여하였다. 폐렴 원인균의 진단을 위해 각종 배양 검사와, Mycoplasma 및 Chlamydia 항체 검사를 시행하였고, 혈액 검사와 방사선 검사 등 환자에 대한 평가는 입원 이후 1주 간격으로 2주간 시행하였다. 치료시작 2주후, 항체검사를 반복하였다. 결 과 : 객담 배양 검사를 시행한 전체 52명의 환자 중 3예(5.8%)에서 양성소견을 보였으며, Streptococcus pneumoniae 2예, Klebsiella pneumoniae 1예가 배양되었다. Mycoplasma pneumoniae 항체 검사를 시행하였던 40예 중 양성으로 판정된 것은 20예(50.0%)였으며, Chlamydia pneumoniae의 경우 4예(10.8%)에서 양성 소견을 보였다. 임상 증세와 방사선 소견 모두 호전되어 치료 성공으로 간주될 수 있는 경우는 전체 52예 중 51예로서 전체적으로 98.1%의 치료 성공률을 보였으며, Azithromycin과 Cefuroxime의 치료 효과는 유의한 차이를 보이지 않았다(96.0% vs 100%, p>0.05). Azithromycin 군 환자 중 한 예에서 초기 항생제 투여 후 임상 증세 및 흉부 방사선 소견이 호전되지 않아 항생제 처방을 변경하였으며, 2세대 세팔로스포린을 정맥 투여한 뒤 호전되었다. 결 론 : 집단생활을 하는 젊고 건강한 성인에서 발생한 폐렴에서 비정형 병원균에 의한 폐렴이 대다수를 차지하였고, 그 치료를 위해 투여한 Macrolide와 2세대 Cephalosporin 간 치료효과의 차이는 보이지 않았다.

Keywords

References

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