鉴定急性鼻炎可能受益于抗生素的儿童:随机临床试验
Nader Shaikh1, Alejandro Hoberman1, Timothy R Shope1
1Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.
在没有检测到细菌病原体的儿童中,急性鼻炎的抗生素治疗提供了最小的益处. 鉴定特定的细菌可能有助于减少儿童鼻炎中不必要的抗生素使用.
科学领域:
- 儿童传染病
- 临床微生物学
- 基于证据的医学
背景情况:
- 急性鼻炎的症状通常与上呼吸道病毒感染重叠.
- 在患有急性鼻炎的儿童中使用抗生素可能并不总是有益的.
- 鉴定受益于抗生素的子组对于抗菌管理至关重要.
研究的目的:
- 评估急性鼻炎儿童的特定亚组是否可以停止抗生素治疗.
- 评估抗生素治疗对鼻病原体和鼻水颜色的影响.
主要方法:
- 一项随机临床试验,涉及515名被诊断患有急性鼻炎的2至11岁儿童.
- 参与者接受了口服阿莫西林克拉夫兰酸或安慰剂10天.
- 细分群是由Streptococcus pneumoniae,Haemophilus influenzae或Moraxella catarrhalis的存在以及鼻水的颜色来定义的.
主要成果:
- 与安慰剂相比,阿莫西西林- 克拉夫兰酸导致症状得分显著降低 (平均差异为-1. 69) 和症状缓解速度更快 (7 vs 9 天).
- 没有检测到鼻病原体的儿童比具有病原体的儿童 (平均分数差异- 0. 88) 获得的抗生素益处较小 (平均分数差异- 1.95).
- 有色鼻水的存在没有显著改变抗生素治疗的疗效.
结论:
- 对于没有可检测的鼻细菌病原体的儿童,急性鼻炎的抗生素治疗提供了最小的益处.
- 鼻水的颜色不是对儿童急性鼻炎抗生素有效性的可靠指标.
- 在呈现时检测特定的细菌病原体可以指导抗生素的使用,并减少儿童不必要的处方.
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