儿童非重症肺炎，三天抗生素治疗已经足够

三剑客

这是丁香园里的一篇文章，感谢发表的作者shihui8091
Three Days of Antibiotics May Suffice for Treatment of Nonsevere Pneumonia in Children

April 24, 2008 — A short course (3 days) of antibiotic therapy is equally as effective as a longer treatment (5 days) of nonsevere, community-acquired pneumonia in children, according to the results of a review published in the April 16 Cochrane Database of Systematic Reviews.

"Treatment of pneumonia requires an effective antibiotic used in adequate doses for an appropriate duration," write Batool A. Haider, from the Aga Khan University in Karachi, Pakistan, and colleagues. "Recommended duration of treatment ranges between 7 and 14 days, but this is not based on any empirical evidence. Shorter duration of therapy, if found to be effective, could be particularly important in resource-poor settings where there is a high risk of death, poor access to medicines and health care, and limited budgets for medicines."

The goal of this review was to compare the efficacy of a short vs a long course of treatment with the same antibiotic for nonsevere, community-acquired pneumonia in children 2 to 59 months of age.

The reviewers searched The Cochrane Central Register of Controlled Trials (CENTRAL), the Database of Abstracts of Reviews of Effects (The Cochrane Library, 2007, Issue 3), MEDLINE (OVID; January 1966 to September 2007), EMBASE (Embase.com; 1974 to September 2007), and LILACS (1982 to September 2007), looking for all randomized controlled trials (RCTs) comparing the efficacy of a short vs a long course of treatment of the same antibiotic for nonsevere, community-acquired pneumonia in children. Two reviewers independently evaluated the quality of the studies and extracted data.

There were 3 studies identified meeting inclusion criteria; these enrolled a total of 5763 children with nonsevere pneumonia. Comparing 3 days vs 5 days of treatment with the same antibiotic showed no significant differences in the rates of clinical cure at the end of treatment (relative risk [RR], 0.99; 95% confidence interval [CI], 0.97 - 1.01), treatment failure at the end of treatment (RR, 1.07; 95% CI, 0.92 - 1.25), and relapse after 7 days of clinical cure (RR, 1.09; 95% CI, 0.83 - 1.42).

There were no significant differences for these outcomes with different durations of therapy with different antibiotics, based on subgroup analysis. When data were categorized based on antibiotics used, which included amoxicillin and cotrimoxazole, the differences remained nonsignificant.

Limitations of this review include small number of studies available, lack of data on other secondary outcomes (eg, mortality rate at 1 month and additional interventions), and use of a simplified definition of pneumonia according to the World Health Organization (WHO).

"The evidence of this review suggests that a short course (three days) of antibiotic therapy is as effective as a longer treatment (five days) for non-severe pneumonia in children under five years of age," the review authors write. "However, there is a need for more well-designed RCTs to support our review findings."

Cochrane Database Syst Rev. Published online April 16, 2008.
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儿童非重症肺炎，三天抗生素治疗已经足够
2008-04-24――

根据一篇发表在Cochrane Database of Systematic Reviews上的一篇综述结果，对于儿童非重症社区获得性肺炎短期三天的抗生素治疗的疗效等效于较长时间（５天）的治疗。
“肺炎的治疗需要选择一种有效的抗生素，它的应用需要足够的剂量以及合适的疗程，”巴基斯坦喀拉蚩Aga Khan大学的Batool A. Haider及其同事认为：“目前应用的7-14天的治疗并没有基于任何循证学证据。如果短期的治疗被发现同样有效，那么对于那些高风险死亡率并且缺少医疗设备、缺乏医药资源和卫生保健的地区以及节约医疗开支具有特别重要的意义”。
这篇综述的目的是将2-59月的非重症社区获得性肺炎儿童患者应用同一种抗生素短程治疗和长程治疗进行疗效的对比。
作者搜索了Cochrane中心注册的临床试验、Cochrane图书馆2007年第3版效应综述摘要数据库、1966年1月至2007年9月MEDLINE、1982年至2007年9月LILACS四个数据库中对儿童非重症社区获得性肺炎患者应用同一种抗生素短疗程、长疗程治疗的随机对照试验。2名作者对相关研究的质量以及所引出的数据进行了独立的评估把关。
总共有3项研究报道被确认为符合纳入标准；
这3项研究总共纳入5763名非重症儿童肺炎患者。对比同种抗生素治疗3天和5天，在治疗终了临床治愈率（相对危险性，0.99；95%可信区间 0.97 - 1.01）、治疗失败（相对危险性，1.07；95%可信区间 0.92 - 1.25）以及临床治愈7天以后的复发（相对危险性，1.09；95%可信区间 0.83 - 1.42）方面均没有显著差异。

基于亚组分析，对于不同抗生素的短、长疗程对于治疗结果并没有显著差异。对于按照抗生素不同进行分析，应用阿莫西林和磺胺甲基异恶唑同样没有显著差异。
这篇综述的不足之处主要有：
包含的研究数量较少，缺少较为长期的随访数据（比如1月的死亡率、临床附加干预），根据WHO简单定义进行了肺炎的认定。

作者认为：“这篇综述的相关数据表明，对于年龄小于5岁的儿童非重症肺炎患者应用3天短期抗生素治疗与5天长疗程抗生素治疗具有相同疗效，但是，今后仍需要更多精心设计的临床随机试验来证实这样的发现。”
Cochrane Database Syst Rev. Published online April 16, 2008.

星火

这样的循证可以说明合理使用抗菌药物与时间的关系,我国不合理使用抗菌药物的比例高,需要借鉴国外的经验!!:handshake

鹊翔阿亮

谢谢！:loveliness: :loveliness: :loveliness: :loveliness: