地域 の 肺 炎 で 病院 に 入っ て いる 成人 の ため の 抗生物質 療法:体系 的 な 検討
Jonathan S Lee1, Daniel L Giesler2, Walid F Gellad3
1Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania2Now with Division of General Internal Medicine, Department of Medicine, University of California, San Francisco.
JAMA
|February 12, 2016
まとめ
早期の抗生物質投与 (4~8時間) とベータ・ラクタム/マクロライド・コンボやフルオロキノロンなどの特定の薬剤の選択は,地域感染性肺炎における死亡率を低下させる可能性があります. IV 経口への切り替えのための客観的な基準も支持されています.
科学分野:
- 感染症
- 薬理学について
- クリティカル ケア 医療
背景:
- コミュニティで得られた肺炎 (CAP) は,迅速かつ効果的な抗生物質治療を必要とします.
- 抗生物質治療のタイミング,選択,投与経路を最適化することは,患者の結果にとって極めて重要です.
研究 の 目的:
- 抗生物質治療の重要な側面とCAPの入院成人における短期死亡率との関連を評価する.
- 抗生物質の投与開始のタイミング,初期抗生物質の選択,そしてIVから口服への移行基準が死亡率に与える影響を評価する.
主な方法:
- MEDLINE,EMBASE,およびコクランデータベースの体系的な文献レビューが行われました.
- 1995年から2015年の間に発表された研究で,放射線検査でCAPが確認された成人を対象としたものです.
- 17件の観察研究と3件のランダム化試験のデータを分析した.
主要な成果:
- 大規模な観察研究では,入院後4~8時間以内に抗生物質の投与を開始することが死亡率の減少と関連していました.
- ベータ・ラクタム/ マクロライド併用療法またはフルオロキノロン単独治療は,ベータ・ラクタム単独治療と比較して死亡率が低いとの関連を示した.
- 一つのランダム化試験は,静脈内投与から経口投与の抗生物質への移行の客観的な臨床基準を用いて支持され,治療失敗の違いは示されなかった.
結論:
- 早期の抗生物質投与 (4~8時間) と特定の治療法 (ベータラクトーム/マクロライドまたはフルオロキノロン) は,CAPにおける短期死亡率の低下と関連している可能性があります.
- これらの関連性を裏付ける証拠は,主に低品質の観察研究から得られています.
- CAPの管理において,IVから経口への抗生物質の切り替えを導くために客観的な臨床的基準が推奨されています.
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