小児急性鼻炎におけるアモキシチリン・クラヴルナートとアモキシチルの治療失敗と有害事象
Timothy J Savage1,2,3, Matthew P Kronman4, Sushama Kattinakere Sreedhara1
1Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
JAMA
|September 18, 2023
まとめ
アモキシシリン・クラヴルナートとアモキシシリンは,小児期の急性鼻炎の治療に類似した効果を示しています. しかし,アモキシシリン・クラヴルナートは小児患者の胃腸疾患と酵母菌感染症のリスクを高めます.
科学分野:
- 小児感染症
- 臨床薬理学
- 根拠に基づいた医療
背景:
- 急性鼻炎は子供に抗生物質を処方する原因の1つである.
- 急性鼻炎に対する最適な経験的抗生物質の選択については,コンセンサスが欠けている.
研究 の 目的:
- アムキシシリン・クラヴルナートとアムキシシリンの有効性と安全性を比較する.
主な方法:
- 全国保健医療データベースを利用した遡及的なコホート研究.
- 急性鼻炎と診断された子供と青少年 (≤17歳) を含めた.
- 混同要因を制御するために,傾向スコアマッチングが採用されました.
主要な成果:
- アモキシシリン・クラヴルナートとアモキシシリンの間の治療失敗率の有意な違いは観察されなかった.
- アモキシシリン・クラブラン酸は,胃腸症状と酵母菌感染症のリスクを高めました.
- 年齢別分析では,治療失敗の差は認められなかったが,アモキシチリン・クラヴルナートによる有害事象のリスクはより高かった.
結論:
- アモキシシリン・クラヴルナートは,外科医の小児急性鼻炎では,アモキシシリンに比べて治療失敗率が優れているわけではありません.
- アモキシシリン・クラヴルナートの使用は,胃腸障害と二次酵母菌感染症の発生率が高いと関連しています.
- 効果と潜在的な有害事象の両方を考慮して,急性鼻炎に対する抗生物質の選択を根拠にしています.
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