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Моксифлоксацин при обострении хронической обструктивной болезни легких
Моксифлоксацин при обострении хронической обструктивной болезни легких
И.А.Гучев. Моксифлоксацин при обострении хронической обструктивной болезни легких. Consilium Medicum. Пульмонология (Прил.). 2010; 1: 3-6.
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Полный текст
Список литературы
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3. Страбыкина П.Е. Эффективность скринингового метода обследования для выявления нарушений бронхиальной проходимости. Бюл. СО РАМН. 2006; 122 (4): 168–71.
4. Pelkonen M, Notkola IL, Nissinen A et al.. Thirty-year cumulative incidence of chronic bronchitis and COPD in relation to 30-year pulmonary function and 40-year mortality: a follow-up in middle-aged rural men. Chest 2006; 130 (4): 1129–37.
5. Donaldson GC, Seemungal TA, Bhowmik A, Wedzicha JA. Relationship between exacerbation frequency and lung function decline in chronic obstructive pulmonary disease. Thorax 2002; 57 (10): 847–52.
6. Makris D, Moschandreas J, Damianaki A et al. Exacerbations and lung function decline in COPD: new insights in current and ex-smokers. Respirat Med 2007; 101 (6): 1305–12.
7. Niewoehner DE. Relation of Chronic Obstructive Pulmonary Disease Exacerbations to FEV (1) – An Intricate Tango. Respiration 2008.
8. Patel IS, Seemungal TA, Wilks M et al. Relationship between bacterial colonisation and the frequency, character, and severity of COPD exacerbations. Thorax 2002; 57 (9): 759–64.
9. Wilkinson TM, Donaldson GC, Johnston SL et al. Respiratory syncytial virus, airway inflammation, and FEV1 decline in patients with chronic obstructive pulmonary disease. Am J Respirat Critical Care Med 2006; 173 (8): 871–6.
10. Langsetmo L, Platt RW, Ernst P, Bourbeau J. Underreporting exacerbation of chronic obstructive pulmonary disease in a longitudinal cohort. Am J Respirat Critical Care Med 2008; 177 (4): 396–401.
11. Donaldson GC, Seemungal TA, Patel IS et al. Airway and systemic inflammation and decline in lung function in patients with COPD. Chest 2005; 128 (4): 1995–2004.
12. Dusser D. Chronic obstructive pulmonary disease exacerbations and their impact on the long-term natural history of the disease. Presse Med 2008.
13. Dusser D. Prevention of chronic obstructive pulmonary disease exacerbations. Presse Med 2008.
14. Puhan MA, Vollenweider D, Steurer J et al. Wh ere is the supporting evidence for treating mild to moderate chronic obstructive pulmonary disease exacerbations with antibiotics? A systematic review. BMC Med 2008; 6: 28.
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16. Balter MS, La Forge J, Low DE et al. Canadian guidelines for the management of acute exacerbations of chronic bronchitis: executive summary. Can Respir J 2003; 10 (5): 248–58.
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18. Blasi F, Ewig S, Torres A, Huchon G. A review of guidelines for antibacterial use in acute exacerbations of chronic bronchitis. Pulmon Pharmacol Ther 2006; 19 (5): 361–9.
19. Anthonisen NR, Manfreda J, Warren CP et al. Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease. Ann Inter Med 1987; 106 (2): 196–204.
20. Alvarez F, Bouza E, Garcia-Rodriguez JA et al. Second consensus report on the use of antimicrobial agents in exacerbations of chronic obstructive pulmonary disease. Arch Bronconeumol 2003; 39 (6): 274–82.
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25. Ball P. Epidemiology and treatment of chronic bronchitis and its exacerbations. Chest 1995; 108 (2 Suppl.): 43S–52S.
26. Alvarez-Sala JL, Kardos P, Martinez-Beltran J et al. Clinical and bacteriological efficacy in treatment of acute exacerbations of chronic bronchitis with cefditoren-pivoxil versus cefuroxime-axetil. Antimicrob Agents Chemother 2006; 50 (5): 1762–7.
27. Авдеев С.Н., Шанина А.Г., Чучалин А.Г. Бактериальная инфекция у больных ХОБЛ с острой дыхательной недостаточностью. Клин. микробиол. антимикроб. химиотер. 2005; 7 (3): 245–54.
28. Дворецкий Л.И., Дубровская Н.В., Грудинина С.А и др. Левофлоксацин и макролиды при обострении хронического бронхита. Результаты длительного мониторинга больных. Инф. и антимикроб. тер. 2005; 7 (1).
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30. Pfaller MA, Ehrhardt AF, Jones RN. Frequency of pathogen occurrence and antimicrobial susceptibility among community-acquired respiratory tract infections in the respiratory surveillance program study: microbiology from the medical office practice environment. Am J Med 2001; 111 (Suppl. 9A): 4S–12S.
31. Murphy TF, Sethi S, Klingman KL et al. Simultaneous respiratory tract colonization by multiple strains of nontypeable haemophilus influenzae in chronic obstructive pulmonary disease: implications for antibiotic therapy. J Infect Diseas 1999; 180 (2): 404–9.
32. Zervos M, Martinez FJ, Amsden GW et al. Efficacy and safety of 3-day azithromycin versus 5-day moxifloxacin for the treatment of acute bacterial exacerbations of chronic bronchitis. Intern J Antimicrob Agents 2007; 29 (1): 56–61.
33. File TM Jr, Monte SV, Schentag JJ et al. A disease model descriptive of progression between chronic obstructive pulmonary disease exacerbations and community-acquired pneumonia: roles for underlying lung disease and the pharmacokinetics/pharmacodynamics of the antibiotic. Int J Antimicrob Agents 2008.
34. Ram FS, Rodriguez-Roisin R, Granados-Navarrete A et al. Antibiotics for exacerbations of chronic obstructive pulmonary disease. Cochrane Datab System Rev (Online). 2006 (2): CD004403.
35. Roede BM, Bresser P, El Moussaoui R et al. Three vs. 10 days of amoxycillinclavulanic acid for type 1 acute exacerbations of chronic obstructive pulmonary disease: a randomised, double-blind study. Clin Microbiol Infect 2007; 13 (3): 284–90.
36. Sayiner A, Okyay N, Unsal I, Colpan N. Infective exacerbations of COPD. Chest 1999; 115 (5): 1481.
37. Lode H, Allewelt M, Balk S et al. A prediction model for bacterial etiology in acute exacerbations of COPD. Infection 2007; 35 (3): 143–9.
38. Jones RN, Fritsche TR, Sader HS. Antimicrobial activity of DC-159a, a new fluoroquinolone, against 1,149 recently collected clinical isolates. Antimicrob Agents Chemother 2008; 52 (10): 3763–75.
39. Karlowsky JAJMETCEATYYCSDF. Stable Antimicrobial Susceptibility Rates for Clinical Isolates of Pseudomonas aeruginosa from the 2001–2003 Tracking Resistance in the United States Today Surveillance Studies. Clin Infec Dis 2005; 40: S89–S98.
40. Woodhead M, Blasi F, Ewig S et al. Guidelines for the management of adult lower respiratory tract infections. Eur Respir J 2005; 26 (6): 1138–80.
41. Wilson R, Jones P, Schaberg T et al. Antibiotic treatment and factors influencing short and long term outcomes of acute exacerbations of chronic bronchitis. Thorax 2006; 61 (4): 337–42.
42. Monso E, Garcia-Aymerich J, Soler N et al. Bacterial infection in exacerbated COPD with changes in sputum characteristics. Epidemiol Infect 2003; 131 (1): 799–804.
43. Grassi C, Salvatori E, Rosignoli MT, Dionisio P. Randomized, double-blind study of prulifloxacin versus ciprofloxacin in patients with acute exacerbations of chronic bronchitis. Respiration 2002; 69 (3): 217–22.
44. Anzueto A, Niederman MS, Tillotson GS. Etiology, susceptibility, and treatment of acute bacterial exacerbations of complicated chronic bronchitis in the primary care setting: ciprofloxacin 750 mg b.i.d. versus clarithromycin 500 mg b.i.d. Bronchitis Study Group. Clin Therapeut 1998; 20 (5): 885–900.
45. Soler N, Torres A, Ewig S et al. Bronchial microbial patterns in severe exacerbations of chronic obstructive pulmonary disease (COPD) requiring mechanical ventilation. Am J Respirat Critical Care Med 1998; 157 (5 Pt 1): 1498–505.
46. Sethi S. Infectious exacerbations of chronic bronchitis: diagnosis and management. J Antimicrob Chemother 1999; 43 (Suppl. A): 97–105.
47. Diederen BM, van der Valk PD, Kluytmans JA et al. The role of atypical respiratory pathogens in exacerbations of chronic obstructive pulmonary disease. Eur Respir J 2007; 30 (2): 240–4.
48. Stockley RA, O'Brien C, Pye A, Hill SL. Relationship of sputum color to nature and outpatient management of acute exacerbations of COPD. Chest 2000; 117 (6): 1638–45.
49. Lindenauer PK, Pekow P, Gao S et al. Quality of care for patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease. Ann Intern Med 2006; 144 (12): 894–903.
50. Allegra L, Blasi F, de Bernardi B et al. Antibiotic treatment and baseline severity of disease in acute exacerbations of chronic bronchitis: a re-evaluation of previously published data of a placebo-controlled randomized study. Pulmonary Pharmacol Therapeut 2001; 14 (2): 149–55.
51. Roede BM, Bindels PJ, Brouwer HJ et al. Antibiotics and steroids for exacerbations of COPD in primary care: compliance with Dutch guidelines. Br J Gen Pract 2006; 56 (530): 662–5.
52. Nouira S, Marghli S, Belghith M et al. Once daily oral ofloxacin in chronic obstructive pulmonary disease exacerbation requiring mechanical ventilation: a randomised placebo-controlled trial. Lancet 2001; 358 (9298): 2020–5.
53. Pauwels RA, Buist AS, Calverley PM et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary. Am J Respirat Critical Care Med 2001; 163 (5): 1256–76.
54. Celli BR, MacNee W. Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. Eur Respir J Jun 2004; 23 (6): 932–46.
55. Destache CJ, Dewan N, O'Donohue WJ et al. Clinical and economic considerations in the treatment of acute exacerbations of chronic bronchitis. J Antimicrob Chemother 1999; 43 (Suppl. A): 107–13.
56. Georgopoulos A, Borek M, Ridl W. Randomized, double-blind, doubledummy study comparing the efficacy and safety of amoxicillin 1 g bd with amoxycillin 500 mg tds in the treatment of acute exacerbations of chronic bronchitis. J Antimicrob Chemother 2001; 47 (1): 67–76.
57. Canut A, Martin-Herrero JE, Labora A, Maortua H. What are the most appropriate antibiotics for the treatment of acute exacerbation of chronic obstructive pulmonary disease? A therapeutic outcomes model. J Antimicrob Chemother 2007; 60 (3): 605–12.
58. Siempos, II, Dimopoulos G, Korbila IP et al. Macrolides, quinolones, and amoxicillin/clavulanate for chronic bronchitis: a meta-analysis. Eur Respir J 2007; 29 (6): 1127–37.
59. Llor C, Naberan K, Cots JM et al. Risk factors for increased cost of exacerbations of chronic bronchitis and chronic obstructive pulmonary disease. Arch Bronconeumol 2006; 42 (4): 175–82.
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2. Jemal A, Ward E, Hao Y, Thun M. Trends in the leading causes of death in the United States, 1970–2002. JAMA 2005; 294 (10): 1255–9.
3. Страбыкина П.Е. Эффективность скринингового метода обследования для выявления нарушений бронхиальной проходимости. Бюл. СО РАМН. 2006; 122 (4): 168–71.
4. Pelkonen M, Notkola IL, Nissinen A et al.. Thirty-year cumulative incidence of chronic bronchitis and COPD in relation to 30-year pulmonary function and 40-year mortality: a follow-up in middle-aged rural men. Chest 2006; 130 (4): 1129–37.
5. Donaldson GC, Seemungal TA, Bhowmik A, Wedzicha JA. Relationship between exacerbation frequency and lung function decline in chronic obstructive pulmonary disease. Thorax 2002; 57 (10): 847–52.
6. Makris D, Moschandreas J, Damianaki A et al. Exacerbations and lung function decline in COPD: new insights in current and ex-smokers. Respirat Med 2007; 101 (6): 1305–12.
7. Niewoehner DE. Relation of Chronic Obstructive Pulmonary Disease Exacerbations to FEV (1) – An Intricate Tango. Respiration 2008.
8. Patel IS, Seemungal TA, Wilks M et al. Relationship between bacterial colonisation and the frequency, character, and severity of COPD exacerbations. Thorax 2002; 57 (9): 759–64.
9. Wilkinson TM, Donaldson GC, Johnston SL et al. Respiratory syncytial virus, airway inflammation, and FEV1 decline in patients with chronic obstructive pulmonary disease. Am J Respirat Critical Care Med 2006; 173 (8): 871–6.
10. Langsetmo L, Platt RW, Ernst P, Bourbeau J. Underreporting exacerbation of chronic obstructive pulmonary disease in a longitudinal cohort. Am J Respirat Critical Care Med 2008; 177 (4): 396–401.
11. Donaldson GC, Seemungal TA, Patel IS et al. Airway and systemic inflammation and decline in lung function in patients with COPD. Chest 2005; 128 (4): 1995–2004.
12. Dusser D. Chronic obstructive pulmonary disease exacerbations and their impact on the long-term natural history of the disease. Presse Med 2008.
13. Dusser D. Prevention of chronic obstructive pulmonary disease exacerbations. Presse Med 2008.
14. Puhan MA, Vollenweider D, Steurer J et al. Wh ere is the supporting evidence for treating mild to moderate chronic obstructive pulmonary disease exacerbations with antibiotics? A systematic review. BMC Med 2008; 6: 28.
15. Amsden GW, Baird IM, Simon S, Treadway G. Efficacy and safety of azithromycin vs levofloxacin in the outpatient treatment of acute bacterial exacerbations of chronic bronchitis. Chest 2003; 123 (3): 772–7.
16. Balter MS, La Forge J, Low DE et al. Canadian guidelines for the management of acute exacerbations of chronic bronchitis: executive summary. Can Respir J 2003; 10 (5): 248–58.
17. Balter MS, La Forge J, Low DE et al. Canadian guidelines for the management of acute exacerbations of chronic bronchitis. Can Respir J 2003; 10 (Suppl B): 3B–32.
18. Blasi F, Ewig S, Torres A, Huchon G. A review of guidelines for antibacterial use in acute exacerbations of chronic bronchitis. Pulmon Pharmacol Ther 2006; 19 (5): 361–9.
19. Anthonisen NR, Manfreda J, Warren CP et al. Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease. Ann Inter Med 1987; 106 (2): 196–204.
20. Alvarez F, Bouza E, Garcia-Rodriguez JA et al. Second consensus report on the use of antimicrobial agents in exacerbations of chronic obstructive pulmonary disease. Arch Bronconeumol 2003; 39 (6): 274–82.
21. Vogel F, Scholz H, Nawas B et al. Rational use of oral antibiotics. Findings of an expert commission of the Paul Ehrlich Society for Chemotherapy. Medizin Monats Pharmazeut 2002; 25: 193–204.
22. Miravitlles M, Espinosa C, Fernandez-Laso E et al. Relationship between bacterial flora in sputum and functional impairment in patients with acute exacerbations of COPD. Study Group of Bacterial Infection in COPD. Chest 1999; 116 (1): 40–6.
23. Reynolds AY. Chronic bronchitis and acute infectious exacerbations. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and practice of infectious diseases. 5th ed. New York: Churchill Livingstone; 2000.
24. Camargo CA, Jr, Ginde AA, Clark S et al. Viral pathogens in acute exacerbations of chronic obstructive pulmonary disease. Intern Emerg Med 2008.
25. Ball P. Epidemiology and treatment of chronic bronchitis and its exacerbations. Chest 1995; 108 (2 Suppl.): 43S–52S.
26. Alvarez-Sala JL, Kardos P, Martinez-Beltran J et al. Clinical and bacteriological efficacy in treatment of acute exacerbations of chronic bronchitis with cefditoren-pivoxil versus cefuroxime-axetil. Antimicrob Agents Chemother 2006; 50 (5): 1762–7.
27. Авдеев С.Н., Шанина А.Г., Чучалин А.Г. Бактериальная инфекция у больных ХОБЛ с острой дыхательной недостаточностью. Клин. микробиол. антимикроб. химиотер. 2005; 7 (3): 245–54.
28. Дворецкий Л.И., Дубровская Н.В., Грудинина С.А и др. Левофлоксацин и макролиды при обострении хронического бронхита. Результаты длительного мониторинга больных. Инф. и антимикроб. тер. 2005; 7 (1).
29. van Zanten AR, Oudijk M, Nohlmans-Paulssen MK et al. Continuous vs. intermittent cefotaxime administration in patients with chronic obstructive pulmonary disease and respiratory tract infections: pharmacokinetics/pharmacodynamics, bacterial susceptibility and clinical efficacy. Br J Clin Pharmacol 2007; 63 (1): 100–9.
30. Pfaller MA, Ehrhardt AF, Jones RN. Frequency of pathogen occurrence and antimicrobial susceptibility among community-acquired respiratory tract infections in the respiratory surveillance program study: microbiology from the medical office practice environment. Am J Med 2001; 111 (Suppl. 9A): 4S–12S.
31. Murphy TF, Sethi S, Klingman KL et al. Simultaneous respiratory tract colonization by multiple strains of nontypeable haemophilus influenzae in chronic obstructive pulmonary disease: implications for antibiotic therapy. J Infect Diseas 1999; 180 (2): 404–9.
32. Zervos M, Martinez FJ, Amsden GW et al. Efficacy and safety of 3-day azithromycin versus 5-day moxifloxacin for the treatment of acute bacterial exacerbations of chronic bronchitis. Intern J Antimicrob Agents 2007; 29 (1): 56–61.
33. File TM Jr, Monte SV, Schentag JJ et al. A disease model descriptive of progression between chronic obstructive pulmonary disease exacerbations and community-acquired pneumonia: roles for underlying lung disease and the pharmacokinetics/pharmacodynamics of the antibiotic. Int J Antimicrob Agents 2008.
34. Ram FS, Rodriguez-Roisin R, Granados-Navarrete A et al. Antibiotics for exacerbations of chronic obstructive pulmonary disease. Cochrane Datab System Rev (Online). 2006 (2): CD004403.
35. Roede BM, Bresser P, El Moussaoui R et al. Three vs. 10 days of amoxycillinclavulanic acid for type 1 acute exacerbations of chronic obstructive pulmonary disease: a randomised, double-blind study. Clin Microbiol Infect 2007; 13 (3): 284–90.
36. Sayiner A, Okyay N, Unsal I, Colpan N. Infective exacerbations of COPD. Chest 1999; 115 (5): 1481.
37. Lode H, Allewelt M, Balk S et al. A prediction model for bacterial etiology in acute exacerbations of COPD. Infection 2007; 35 (3): 143–9.
38. Jones RN, Fritsche TR, Sader HS. Antimicrobial activity of DC-159a, a new fluoroquinolone, against 1,149 recently collected clinical isolates. Antimicrob Agents Chemother 2008; 52 (10): 3763–75.
39. Karlowsky JAJMETCEATYYCSDF. Stable Antimicrobial Susceptibility Rates for Clinical Isolates of Pseudomonas aeruginosa from the 2001–2003 Tracking Resistance in the United States Today Surveillance Studies. Clin Infec Dis 2005; 40: S89–S98.
40. Woodhead M, Blasi F, Ewig S et al. Guidelines for the management of adult lower respiratory tract infections. Eur Respir J 2005; 26 (6): 1138–80.
41. Wilson R, Jones P, Schaberg T et al. Antibiotic treatment and factors influencing short and long term outcomes of acute exacerbations of chronic bronchitis. Thorax 2006; 61 (4): 337–42.
42. Monso E, Garcia-Aymerich J, Soler N et al. Bacterial infection in exacerbated COPD with changes in sputum characteristics. Epidemiol Infect 2003; 131 (1): 799–804.
43. Grassi C, Salvatori E, Rosignoli MT, Dionisio P. Randomized, double-blind study of prulifloxacin versus ciprofloxacin in patients with acute exacerbations of chronic bronchitis. Respiration 2002; 69 (3): 217–22.
44. Anzueto A, Niederman MS, Tillotson GS. Etiology, susceptibility, and treatment of acute bacterial exacerbations of complicated chronic bronchitis in the primary care setting: ciprofloxacin 750 mg b.i.d. versus clarithromycin 500 mg b.i.d. Bronchitis Study Group. Clin Therapeut 1998; 20 (5): 885–900.
45. Soler N, Torres A, Ewig S et al. Bronchial microbial patterns in severe exacerbations of chronic obstructive pulmonary disease (COPD) requiring mechanical ventilation. Am J Respirat Critical Care Med 1998; 157 (5 Pt 1): 1498–505.
46. Sethi S. Infectious exacerbations of chronic bronchitis: diagnosis and management. J Antimicrob Chemother 1999; 43 (Suppl. A): 97–105.
47. Diederen BM, van der Valk PD, Kluytmans JA et al. The role of atypical respiratory pathogens in exacerbations of chronic obstructive pulmonary disease. Eur Respir J 2007; 30 (2): 240–4.
48. Stockley RA, O'Brien C, Pye A, Hill SL. Relationship of sputum color to nature and outpatient management of acute exacerbations of COPD. Chest 2000; 117 (6): 1638–45.
49. Lindenauer PK, Pekow P, Gao S et al. Quality of care for patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease. Ann Intern Med 2006; 144 (12): 894–903.
50. Allegra L, Blasi F, de Bernardi B et al. Antibiotic treatment and baseline severity of disease in acute exacerbations of chronic bronchitis: a re-evaluation of previously published data of a placebo-controlled randomized study. Pulmonary Pharmacol Therapeut 2001; 14 (2): 149–55.
51. Roede BM, Bindels PJ, Brouwer HJ et al. Antibiotics and steroids for exacerbations of COPD in primary care: compliance with Dutch guidelines. Br J Gen Pract 2006; 56 (530): 662–5.
52. Nouira S, Marghli S, Belghith M et al. Once daily oral ofloxacin in chronic obstructive pulmonary disease exacerbation requiring mechanical ventilation: a randomised placebo-controlled trial. Lancet 2001; 358 (9298): 2020–5.
53. Pauwels RA, Buist AS, Calverley PM et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary. Am J Respirat Critical Care Med 2001; 163 (5): 1256–76.
54. Celli BR, MacNee W. Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. Eur Respir J Jun 2004; 23 (6): 932–46.
55. Destache CJ, Dewan N, O'Donohue WJ et al. Clinical and economic considerations in the treatment of acute exacerbations of chronic bronchitis. J Antimicrob Chemother 1999; 43 (Suppl. A): 107–13.
56. Georgopoulos A, Borek M, Ridl W. Randomized, double-blind, doubledummy study comparing the efficacy and safety of amoxicillin 1 g bd with amoxycillin 500 mg tds in the treatment of acute exacerbations of chronic bronchitis. J Antimicrob Chemother 2001; 47 (1): 67–76.
57. Canut A, Martin-Herrero JE, Labora A, Maortua H. What are the most appropriate antibiotics for the treatment of acute exacerbation of chronic obstructive pulmonary disease? A therapeutic outcomes model. J Antimicrob Chemother 2007; 60 (3): 605–12.
58. Siempos, II, Dimopoulos G, Korbila IP et al. Macrolides, quinolones, and amoxicillin/clavulanate for chronic bronchitis: a meta-analysis. Eur Respir J 2007; 29 (6): 1127–37.
59. Llor C, Naberan K, Cots JM et al. Risk factors for increased cost of exacerbations of chronic bronchitis and chronic obstructive pulmonary disease. Arch Bronconeumol 2006; 42 (4): 175–82.
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Авторы
И.А.Гучев
Военный госпиталь №421 Московского военного округа Министерства обороны Российской Федерации, Смоленск
Военный госпиталь №421 Московского военного округа Министерства обороны Российской Федерации, Смоленск
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