实证性抗生素治疗中度至重症社区肺炎:系统性审查和网络元分析
Maryam Ghadimi1, Reed A C Siemieniuk2, Mark Loeb3
1Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
概括
这一网络分析没有发现有说服力的证据表明任何抗生素治疗方案对于治疗中度至重程度的社区获得性肺炎 (CAP) 是优越的. 需要进一步的研究来确定最佳的经验性抗生素治疗CAP.
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.
- 临床医学 临床医学
背景情况:
- 适度至严重的社区获得性肺炎 (CAP) 的最佳经验抗生素治疗方案仍然不确定.
- 这种不确定性会影响临床决策和患者的治疗结果.
研究的目的:
- 为了比较各种实证抗生素疗法对中度至重度CAP的有效性.
- 通过网络元分析,综合随机对照试验 (RCT) 的证据.
主要方法:
- 在多个数据库 (Medline,EMBASE,Cochrane CENTRAL,科学网,CINAHL) 进行了全面的文献搜索.
- 包括涉及中度至重度CAP成人的RCT,比较不同的经验性抗生素疗法.
- 使用GRADE方法评估偏差风险和证据确定性.
主要成果:
- 分析了143个具有29157名参与者的RCT.
- 青素,头素 (单独或与宏化物一起) 在治疗失败方面可能低于诺 (低确定性证据).
- 对于其他治疗方案,就治疗失败,死亡率,住院或不良事件 (低至非常低的确定性证据) 观察到很少或没有差异.
结论:
- 没有任何抗生素治疗方案证明了在中度至重度的CAP实证治疗中具有优越疗效的令人信服的证据.
- 目前的证据表明,对于关键患者的关键结果,常用的抗生素疗法之间存在有限的重要差异.
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