呼吸道感染在感染性疾病中占有重要地位，细菌性肺炎是呼吸道感染中的主要代表性疾病，最重要的治疗措施是抗菌治疗，用药选择及方法正确与否直接影响治疗的成败。同时如何降低医疗费用也是临床医生需要考虑的棘手问题。据国外文献报道在英国每年约有5亿张以上的抗微生物药物处方，其中住院处方中约40％为静脉制剂，而我国住院静脉制剂的处方比例则更高。医疗费用的增加部分与静脉用药过多有关。为寻求解决临床治疗与医疗费用之间的矛盾，选择高效、低毒、廉价的抗菌药物，1987年Quintiliani等[1]首先提出了抗生素序贯疗法（sequential therapy）的概念，即在经过相对短疗程（48～72 h）静脉抗菌药物治疗，临床症状基本稳定或改善后，改为口服抗菌药物治疗。口服的抗菌药物可以是与前者完全相同的口服剂型，也可以是同一类或抗菌谱相似的同一级药物，后也有人称之为"转换治疗"（switch therapy）、"降级治疗"（step-down therapy）。据国外文献报道，住院的社区获得性肺炎（CAP）应用序贯疗法者因早期出院每位患者节约费用293~1393美元[2-4]。
Citation：
LIU Jin,CHEN Baiyi. Sequential therapy for respiratory infection. Chinese Journal of Respiratory and Critical Care Medicine, 2008, 08(1): 12-14. doi:
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Ramirez JA，Srinath L，Ahkee S，et al.Early switch from intravenous to oral cephalosporins in the treatment of hospitalized patients with community-acquired pneumonia.Arch Intern Med，1995，155：1273-1276.
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Paladino JA，Sperry HE，Backes JM，et al.Clinical and economic evaluation of oral ciprofloxacin after an abbreviated course of intravenous antibiotics.Am J Med，1991，91：462-470.
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Aujesky D，Auble TE，Yealy DM，et al.Prospective comparison of three validated prediction rules for prognosis in community-acquired pneumonia.Am J Med，2005，118：384-392.
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| 6. |
Ramirez JA，Srinath L，Ahkee S，et al.Early switch from intravenous to oral cephalosporins in the treatment of hospitalized patients with community-acquired pneumonia.Arch Intern Med，1995，155：1273-1276.
|
| 7. |
Ramirez JA.Switch therapy in community-acquired pneumonia.Diagn Microbiol Infect Dis，1995，22：219-223.
|
| 8. |
Kollef MH，Sherman G，Ward S，et al．Inadequate antimicrobial treatment of infections：a risk factor for hospital mortality among critically ill patients．Chest，1999，115：462-474.
|
| 9. |
Ibrahim EH，Sherman G，Ward S，et al．The influence of inadequate antimicrobial treatment of bloodstream infections on patient outcomes in the ICU setting.Chest，2000，118：146-155.
|
| 10. |
贾东岗，雷招宝.抗生素的序贯疗法及其研究进展.药物实践杂志，2004，22：144-148.
|
- 1. Quintiliani R，Cooper BW，Briceland LL，et al.Economic impact of streamlining antibiotic administration.Am J Med，1987，82：391-394.
- 2. Ramirez JA，Srinath L，Ahkee S，et al.Early switch from intravenous to oral cephalosporins in the treatment of hospitalized patients with community-acquired pneumonia.Arch Intern Med，1995，155：1273-1276.
- 3. Khan F，Karnik A.Clinical uses of sequential IV/PO ciprofloxacin vs ceftazidime in serious bacterial infections [abstract 139].Abstracts of the Ninth Mediterranean Congress on Chemother，Milan，Italy，1994.
- 4. Paladino JA，Sperry HE，Backes JM，et al.Clinical and economic evaluation of oral ciprofloxacin after an abbreviated course of intravenous antibiotics.Am J Med，1991，91：462-470.
- 5. Aujesky D，Auble TE，Yealy DM，et al.Prospective comparison of three validated prediction rules for prognosis in community-acquired pneumonia.Am J Med，2005，118：384-392.
- 6. Ramirez JA，Srinath L，Ahkee S，et al.Early switch from intravenous to oral cephalosporins in the treatment of hospitalized patients with community-acquired pneumonia.Arch Intern Med，1995，155：1273-1276.
- 7. Ramirez JA.Switch therapy in community-acquired pneumonia.Diagn Microbiol Infect Dis，1995，22：219-223.
- 8. Kollef MH，Sherman G，Ward S，et al．Inadequate antimicrobial treatment of infections：a risk factor for hospital mortality among critically ill patients．Chest，1999，115：462-474.
- 9. Ibrahim EH，Sherman G，Ward S，et al．The influence of inadequate antimicrobial treatment of bloodstream infections on patient outcomes in the ICU setting.Chest，2000，118：146-155.
- 10. 贾东岗，雷招宝.抗生素的序贯疗法及其研究进展.药物实践杂志，2004，22：144-148.
