在患有肺炎的儿童中,门诊抗生素的使用和治疗失败
Daniel J Shapiro1, Matt Hall2, Mark I Neuman3
1Division of Pediatric Emergency Medicine, University of California, San Francisco.
在没有抗生素治疗的肺炎儿童中,近20%的儿童经历了治疗失败风险的微小增加. 在这两组中,严重的结局是罕见的,这表明有些孩子可能不需要抗生素.
科学领域:
- 儿童传染病 儿童传染病
- 临床有效性研究研究临床有效性研究
- 抗生素管理局 抗生素管理局
背景情况:
- 病毒感染是儿童肺炎的常见原因,但抗生素处方仍然很常见.
- 在门诊环境中治疗儿童肺炎的抗生素的疗效尚未得到充分证实.
研究的目的:
- 为了比较诊断为肺炎的儿童接受口服抗生素与未接受口服抗生素的治疗结果.
主要方法:
- 对被诊断患有肺炎的医疗补助保险儿童 (≤17岁) 的回顾性队列研究.
- 利用多州索赔数据库 (2017-2019) 与倾向性得分匹配,以控制混因素.
- 在诊断后2-14天内分析治疗失败和严重后果.
主要成果:
- 在103,854名儿童中,有19.7%的儿童在诊断后1天内没有服用抗生素.
- 在倾向性得分匹配分析 (40,454名儿童) 中,治疗失败率在没有抗生素的组略高 (10.7%对比8.7%).
- 在这两组中,严重的结局不常见 (1.1%没有抗生素vs0.7%服用抗生素).
结论:
- 很大一部分患有肺炎的儿童没有接受抗生素治疗,仅与治疗失败风险的轻微增加有关.
- 严重的结局是罕见的,无论使用抗生素,这表明在特定的儿科肺炎病例中,抗生素降级的可能性很大.
- 需要进一步的前性研究来确定可以在没有抗生素的情况下安全管理的儿童.
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