我国示范乡镇卫生院基本药物循证评价与遴选之六:社区获得性肺炎  

Evidence-Based Evaluation and Selection of Essential Medicine for Township Health Centre in China: 6.Community-Acquired Pneumonia

作　　者：王应强[1] 李鸿浩[1] 李幼平[1] 李萃萃[1] 杨宗霞[1] 沈建通[1] 李筱[1] 杨晓妍[1] 王莉[1] 李向莲[1] 

机构地区：[1]四川大学华西医院中国循证医学中心,成都610041

出　　处：《中国循证医学杂志》2012年第8期895-906,共12页Chinese Journal of Evidence-based Medicine

基　　金："十一五"国家科技支撑计划重点项目"不同类型乡镇卫生院科技综合示范及相关产品开发"--"乡镇卫生院药物配置与物流关键技术研究与产品开发"课题(编号:2008BAI65B22)

摘　　要：目的基于疾病负担,循证评价与遴选我国乡镇卫生院治疗社区获得性肺炎(CAP)的药物。方法按照本系列研究之二制定的方法、标准和流程,参考国内外循证或权威指南的推荐意见,并结合国内相关临床研究证据,循证评价并推荐治疗CAP药物。数据处理采用RevMan 5.1、GRADEpro 3.6等软件。结果①共纳入指南12个(国外10个,国内2个),其中10个为循证制定,2个为结合专家意见制定;②阿莫西林克拉维酸钾治疗CAP有效率77.1%,不良反应发生率18.8%,主要为胃肠道反应、皮疹;哌拉西林/他唑巴vs.头孢呋辛有效率和细菌清除率分别为92.1%vs.89%和88.9%vs.85.5%;阿奇霉素与头孢呋辛的疗效无差异[RR=0.98,95%CI(0.9,1.06)],但阿奇霉素退热时间[MD=–0.98,95%CI(–1.24,–0.55)]和咳嗽消失时间[MD=–1.36,95%CI(–1.94,–0.78)]更快;头孢曲松、头孢噻肟、莫西沙星和左氧氟沙星有效率均>80%,且莫西沙星疗效更优[RR=1.08,95%CI(1.02,1.13),P=0.004];美罗培南有效率和细菌清除率为90%和83.3%,不良反应发生率为3.33%,主要为腹泻。结论①强推荐阿莫西林、阿莫西林克拉维酸钾、氨苄西林舒巴坦、哌拉西林/他唑巴坦、多西环素、阿奇霉素、克拉霉素、头孢呋辛、头孢曲松、头孢噻肟、左氧氟沙星、莫西沙星、厄他培南、美罗培南、亚胺培南和万古霉素;②弱推荐青霉素G、环丙沙星和红霉素;③建议针对常见病原菌,当地抗生素敏感性标准,CAP严重程度及患者危险因素选择最优抗生素。Objective To evaluate and select essential medicine for community-acquired pneumonia（CAP） using evidence-based methods based on the burden of disease.Methods By means of the approaches,criteria,and workflow set up in the second article of this series,we referred to the recommendations of evidence-based or authority guidelines from inside and outside China,collected relevant evidence from domestic clinical studies,and recommended essential medicine based on evidence-based evaluation.Data were analyzed by Review Manager（RevMan） 5.1 and GRADE profiler 3.6 to evaluate quality of evidence.Results （1） Eleven guidelines were included（nine foreign guidelines,two domestic guidelines;nine based on evidence,two based on expert consensus）.For CAP,amoxicillin ＆ clavulanate potassium had efficiencies of 77.1% and an incidence of 18.8% as to adverse reaction that mainly included gastrointestinal reaction,skin rashes,etc.Piperacillin/tazobactam had an efficiency of 92.1% and a bacterial clearance rate of 88.9%.Cefuroxime had an efficiency of 89% and a bacterial clearance rate of 85.5%.There was no statistical significance between azithromycin and cefuroxime for CAP（RR=0.98,95%CI 0.9 to 1.06）;however,azithromycin was superior to cefuroxime in shortening fever-relief time（MD=–0.98,95%CI –1.24 to –0.55） and cough-relief time（MD=–1.36,95%CI –1.94 to –0.78）.Efficiencies of ceftriaxone,cefotaxime,moxifloxacin and lavofloxacin were all more than 80% and among the three,moxifloxacin was the most efficient（RR=1.08,95%CI 1.02 to 1.13,P=0.004）.Meropenem had an efficiency of 90%,a bacterial clearance rate of 83.3% and an incidence of 3.33% as to adverse reaction that mainly included diarrhea.Conclusion （1） We offer a strong recommendation for antibiotics such as amoxicillin,amoxicillin ＆ clavulanate potassium,ampicillin/sulbactam,piperacillin/tazobactam,doxycycline,azithromycin,clarithromycin,cefuroxim,ceftriaxone,cefotaxime,lavofloxacin,moxifloxacin,ertapenem,meropenem,imipenem and vancoc

关 键 词：乡镇卫生院 基本药物 循证评价与遴选 社区获得性肺炎 

分 类 号：R974[医药卫生—药品]