在社区获得的肺炎患者的抗生素治疗:系统性审查
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
概括
早期开始服用抗生素 (4-8小时) 和特定药物选择,如β-乳酸/巨组合剂或诺,可能会降低社区获得性肺炎的死亡率. 对IV转为口服的客观标准也得到了支持.
科学领域:
- 传染性疾病
- 药理学
- 危急护理医学
背景情况:
- 在社区获得的肺炎 (CAP) 需要迅速有效的抗生素治疗.
- 优化抗生素治疗时间,选择和施用途径对于患者的结果至关重要.
研究的目的:
- 评估抗生素治疗的关键方面与住院成人中短期死亡率之间的关联.
- 评估开始服用抗生素的时间,初步选择抗生素以及输入口服的转变标准对死亡率的影响.
主要方法:
- 对MEDLINE,EMBASE和Cochrane数据库进行了系统的文献审查.
- 包括在1995年至2015年间发表的,涉及成年人放射性证实CAP的研究.
- 分析了17项观察性研究和3项随机试验的数据.
主要成果:
- 在较大的观察性研究中,在住院4-8小时内开始服用抗生素与死亡率的降低有关.
- 观察数据显示,与单独治疗的β- 乳酸相比,结合治疗或单独治疗的诺与较低的死亡率有关.
- 一项随机试验使用客观的临床标准支持从静脉注射到口服抗生素的转换,没有显示治疗失败的差异.
结论:
- 早期的抗生素 (4-8小时) 和特定的疗法 (β-乳/ 巨或诺) 可能与CAP的短期死亡率降低有关.
- 支持这些关联的证据主要来自低质量的观察性研究.
- 建议客观的临床标准作为CAP管理中的IV-口服抗生素转换的指导.
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