在社区居住的老年人中评估与长时间抗生素治疗相关的危害:使用仪器变量分析的队列研究
Bradley J Langford1,2, Kevin A Brown1,2, Cindy Lau3
1Public Health Ontario, Toronto, Ontario, Canada.
概括
对于老年人来说,较长的抗生素疗程与较短的抗生素疗程相比,在危害或益处方面没有显著差异. 这项研究分析了现实世界的数据,以评估抗生素持续时间的影响.
科学领域:
- 传染性疾病 传染性疾病
- 药理学 药理学是指药理学的学科.
- 老年病的医生 老年病的医生
背景情况:
- 建议使用较短的抗生素疗程,以减少抗生素暴露.
- 观察性研究在评估抗生素治疗持续时间对现实世界的影响时面临偏见.
- 这项研究评估了老年人服用较长或较短的抗生素疗程的危害和益处.
研究的目的:
- 为了确定较长的抗生素治疗疗程 (8-14天) 与较短的疗程 (3-7天) 相比,在老年人中与增加的危害或益处有关.
- 通过使用仪器变量分析来解决观察性研究中的偏差.
- 为了为临床指南提供有关老年患者最佳抗生素处方持续时间的信息.
主要方法:
- 基于人口的队列研究,使用来自加拿大安大略省的行政卫生数据.
- 包括66-110岁的门诊患者,他们被处方阿莫西西林,塞法莱克辛或西普罗夫洛克萨.
- 使用长期使用抗生素的处方者比例来减轻偏差的仪器变量分析.
主要成果:
- 在较长和较短的阿莫西西林,塞法列辛或西普罗夫洛克萨疗程之间,与抗生素相关的初级危害 (不良反应,C. difficile感染,耐药性) 没有显著差异.
- 二次安全结果,包括重复处方,住院和死亡率,在较长和较短的抗生素疗程之间也是相似的.
- 调整后的几率比率和95%置信区间并不表明抗生素持续时间较长的风险增加.
结论:
- 较长的抗生素疗程与社区居住的老年人中较短的疗程相比,与益处或危害的增加无关.
- 研究结果表明,目前的抗生素持续时间建议可能不需要根据年龄和常见抗生素类型进行调整.
- 使用仪表变量进行现实数据分析,支持较短的抗生素疗程的安全性.
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