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JAMA Pediatr:肺炎住院儿童:β-内酰胺联合大环内酯类真比单药效果好?

2018-01-08 王淳 环球医学资讯

一直以来,很多医生认为β-内酰胺抗菌药联合大环内酯类对肺炎住院儿童的疗效比β-内酰胺单药疗法更好,但缺少相关研究。2017年12月,发表在《JAMA Pediatr》的一项由美国科学家进行的多中心、前瞻性、基于人群的研究,考察了β-内酰胺单药疗法vs大环内酯类联合疗法对肺炎住院儿童的有效性。

一直以来,很多医生认为β-内酰胺抗菌药联合大环内酯类对肺炎住院儿童的疗效比β-内酰胺单药疗法更好,但缺少相关研究。2017年12月,发表在《JAMA Pediatr》的一项由美国科学家进行的多中心、前瞻性、基于人群的研究,考察了β-内酰胺单药疗法vs大环内酯类联合疗法对肺炎住院儿童的有效性。

重要性:β-内酰胺单药疗法和β-内酰胺+大环内酯类联合疗法是肺炎住院儿童常见的经验性治疗策略,但较少研究评估这2种治疗方法的有效性。

目的:在一个肺炎住院儿童队列中,比较β-内酰胺单药疗法vs β-内酰胺+大环内酯类联合疗法的有效性。

设计、环境和受试者:研究人员分析了社区肺炎病因学研究(一项于2010年1月1日~2012年6月30日在美国田纳西州纳什维尔、孟菲斯和犹他州盐湖城的3所儿童医院中进行的多中心、前瞻性、基于人群的研究)的数据。本研究纳入所有经影像学确诊且接受过β-内酰胺单药治疗或β-内酰胺+大环内酯类药物联合治疗的肺炎儿童(<18岁)。数据分析于2017年4月完成。

主要结局和测试:研究定义β-内酰胺单药疗法,包括单独口服或肠外使用第二代或第三代头孢菌素、青霉素、氨苄西林、氨苄西林-舒巴坦、阿莫西林或阿莫西林-克拉维酸。使用β-内酰胺联合口服或肠外大环内酯类(阿奇霉素或克拉霉素)作为对照组。采用多变量Cox比例风险回归构建这些组和患者住院时间之间的相关性。协变量包括人口统计学、临床和放射影像学变量。研究人员在一个倾向性匹配的队列中进一步评估接受联合疗法的住院时间。在一个未匹配的队列中,采用逻辑回归评估次要结局,包括入住重症监护室、再住院和随访期内自我报道恢复。

结果:研究纳入1418名儿童(693名女孩和725名男孩),中位年龄是27个月(四分位差,12~69个月)。这一研究占了社区肺炎病因学研究纳入的2358名儿童的60.1%;其中1019名(71.9%)接受β-内酰胺单药疗法,399名(28.1%)接受β-内酰胺+大环内酯类联合疗法。在未匹配的队列中,接受β-内酰胺单药疗法和联合疗法的儿童之间住院时间无显着差异(中位数,55 vs 59 h;调整风险比,0.87;95% 置信区间[ CI],0.74~1.01)。倾向评分匹配的队列(n=560,39.5%)显示出相似的结果。治疗组间的次要结局也无显着差异。

结论和意义:对于社区获得性肺炎住院儿童,经验性大环内酯类联合疗法不优于β-内酰胺单药疗法。本研究的结果引出对这类人群常规经验性使用大环内酯类联合疗法的疑问。

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    2018-04-13 feather89
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    2018-04-23 lsndxfj
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    2018-01-11 vcochan

    学习了.

    0

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    2018-01-08 hhh678

    henhao

    0

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    2018-01-08 1e0f8808m18(暂无匿称)

    学习了.谢谢分享.

    0

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    2018-01-08 神功盖世

    0

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