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JAMA Intern Med:社区获得性肺炎的更佳抗生素治疗时间已确定

2016-07-27 MedSci MedSci原创

到目前为止,社区获得性肺炎(CAP)患者进行抗生素治疗的最佳持续时间还没有得到很好的建立。该研究的目的是验证美国传染病协会-美国胸科学会对于住院CAP患者进行抗生素治疗时间的指南。原始出处:Ane Uranga,Pedro P. España,Amaia Bilbao,et al.Duration of Antibiotic Treatment in Community-Acquired Pneu

到目前为止,社区获得性肺炎(CAP)患者进行抗生素治疗的最佳持续时间还没有被确定。

该研究的目的是验证美国传染病协会-美国胸科学会对于住院CAP患者进行抗生素治疗时间的指南。

本研究是一项多中心、非劣效性随机临床试验,于2012年1月1日至2013年8月31日在西班牙的4所教学医院开展。共有312例诊断为CAP的住院患者参与此研究。研究人员在2014年1月1日至2015年2月28日期间进行了数据分析。

患者于住院第5天时被随机分配到干预组和对照组。干预组的患者用抗生素治疗最少5天,如果他们的体温持续48小时为37.8℃或以下时,则抗生素治疗在此点结束,这些患者的CAP相关临床不稳定性标志不超过1个。在对照组中的抗生素治疗的持续时间是由医师决定的。

主要检测指标为从入院开始的第10天和第30天时的临床成功率;以及在第5天和第10天时的CAP相关症状,通过18项CAP症状调查问卷进行评估,评分范围为0-90;得分越高表明症状越严重。

该研究共包括312例患者,对照组和干预组分别有150和162例患者。对照组和干预组患者的平均(SD)年龄分别为66.2(17.9)岁和64.7(18.7)岁。对照组有95名男性(63.3%)和55名女性(36.7%),干预组有101名男性(62.3%)和61名女性(37.7%)。在意向性治疗分析中,在第10天时,对照组和干预组的临床成功率分别为48.6%(71/150 )和56.3%(90/162)(P=0.18),在第30天时对照组和干预组的临床成功率分别为88.6%(132/150)和91.9%(147/162)(P=0.33)。在第5天时,平均(SD)CAP症状问卷得分分别为24.7(11.4) vs 27.2(12.5)(P=0.10),在第10天时得分分别为18.6(9.0) vs 17.9(7.6)(P=0.69)。在按照方案分析中,在第10天时对照组和干预组的临床成功率分别为50.4%(67/137)和59.7%(86/146)(P=0.12),在第30天时对照组和干预组的临床成功率分别为92.7%(126/137 )和94.4%(136/146)(P=0.54)。平均(SD)CAP症状问卷得分在第5天时为24.3(11.4) vs 26.6(12.1)(P=0.16),第10天时分别为18.1(8.5) vs  17.6(7.4)(P=0.81)。

美国传染病学会/美国胸科协会根据临床稳定标准制定的抗生素疗程指南可以安全地在住院CAP患者中实施。

原始出处:

Ane Uranga,Pedro P. España,Amaia Bilbao,et al.Duration of Antibiotic Treatment in Community-Acquired Pneumonia,JAMA Intern Med,2016.7.26

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    2016-09-18 1e10c84am36(暂无匿称)

    不错哦继续关注

    0

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    2016-08-01 忠诚向上

    好好学习

    0

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