免疫缺陷的急性气管炎患者应用抗生素无益

海内知己

Antibiotics Not Useful for Acute Bronchitis in Immunocompromised Patients
免疫缺陷的急性气管炎患者应用抗生素无益
NEW YORK (Reuters Health) Nov 28 - Even individuals with compromised immunity do not require antibiotics for acute bronchitis, according a paper in the November 8th issue of Thorax.
It is well known that in Western countries, antibiotics are overused in immunocompetent patients with acute bronchitis, but whether recommendations to avoid antibiotics for this condition are also relevant in developing countries and in immunocompromised populations has not been clear.
纽约(Reuters Health)11月28日-根据11月8日版Thorax上发表的一篇论文显示即使是免疫缺陷的急性气管炎患者也不需要抗生素治疗。
众所周知，一直存在对免疫功能正常的急性气管炎患者过度应用抗生素的现状。但是，目前是否任何指南去避免类似情况在发展中国家或是免疫缺陷人群中发生仍未明确。
In Nairobi, Kenya, a multinational team led by Dr. Craig R. Cohen of the University of California, San Francisco conducted a randomized, triple-blind equivalence trial of amoxicillin vs placebo in 660 adults with acute bronchitis and no chronic lung disease.
在肯尼亚，内罗毕，一项由来自旧金山的加里佛利亚大学的Dr. Craig R. Cohen主持的多国研究团队进行了一项随机的，三盲的平衡试验。该项试验对660名患急性气管炎或无慢性肺疾病的成人随即应用阿莫西林或安慰剂。
Clinical cure, the primary endpoint, was defined as a reduction of at least 75% on the Acute Bronchitis Severity Score at 14 days. Equivalence was defined as a difference of 8% or less between the study arms.
研究的基本终止点即临床治愈的评判标准为14天后至少75%的患者的急性气管严重度评分降低。等价的评判标准为两组患者的差异小于等于8%。
In their intent-to-treat analysis, clinical cure rates were 81.7% in the amoxicillin arm and 84.0% in the placebo group.
在他们的意向性治疗分析结果中，应用阿莫西林组患者81.7%患者获得临床治愈，而安慰剂组为84.0%。
In the 131 subjects with HIV infection, clinical cure rates were 77.2% with amoxicillin and 83.8% with placebo. In participants without HIV infection, the difference in cure rates narrowed to 1.6%.
Dr. Cohen pointed out to Reuters Health that this was not only the largest-ever placebo-controlled trial of antibiotic treatment for acute bronchitis but also the first to study patients in the developing world and to include patients with HIV infection.
在131例合并HIV感染的患者中，应用阿莫西林组患者临床治愈率为77.2%，而安慰剂组为83.8%。在没有HIV感染的受试者中，两组的治愈差异小于1.6%。Dr. Cohen向Reuters Health指出这项针对抗生素治疗急性气管炎的研究不仅是最大规模的安慰剂对照实验，而且首次将发展中国家和合并HIV感染的患者纳为研究对象。
It was also the first study of antibiotic treatment for acute bronchitis to be designed as an equivalence trial, which as he and his colleagues explain is "intended and powered to prove equivalent treatment effects as opposed to the lack of a significant difference in effects."
这项试验也是首个设计等量试验来研究抗生素治疗急性气管炎的试验，而这正是Dr. Cohen及其同事所说的“在缺乏显著的有效性差别时，预期的和有力的等价治疗效果的证明”。
"Whether it be in the United States or the rest of the world, antibiotics are frequently being prescribed for acute bronchitis, but there's really no benefit," Dr. Cohen said.
Dr. Cohen 说“无论是美国还是在其他国家，人们通常应用抗生素治疗急性气管炎，但是这没有任何益处”。
He added, "I think clinicians in this country are just bombarded by their patients," who demand antibiotics when they have bronchitis.
"Results from this and other trials need to influence not only treatment guidelines, but also patient awareness, in order to guide more responsible antibiotic use in the treatment of respiratory tract infections," the team concludes.
他同时还说“我认为我们国家的医生经常处于患者的围攻中”当这些患有气管炎的患者要求应用抗生素时。
研究团队认为：“从这项试验以及其他试验所得的结果需要影响的不仅是治疗指南，还有患者的意识，而这将有助于规范合理应用抗生素治疗呼吸道感染”
Thorax 2008;63:999-1005 （转自丁香园）

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