英国南安普顿大学Beth Stuart团队研究了呼吸道感染延迟开抗生素处方对患者临床预后的影响。2021年4月28日，该研究发表在《英国医学杂志》上。
为了评估延迟抗生素处方对社区呼吸道感染患者平均症状严重程度的总体影响，并确定任何改变这种影响的因素，研究组在Cochrane对照试验中央注册中心、Ovid Medline、科学引文索引等大型数据库中检索在社区环境中进行的随机对照试验和观察性队列研究，筛选出比较延迟与不开抗生素处方，以及延迟与立即开抗生素处方的研究，并进行系统回顾和荟萃分析。主要结局是初次会诊后2至4天的平均症状严重程度，采用7项量表（从正常到最坏）。次要结局是初次会诊后的疾病持续时间、导致入院或死亡的并发症、相同或恶化疾病的再次会诊以及根据Likert量表评定的患者满意度。
研究组共纳入了9项随机对照试验和4项观察研究，共55682名患者。延迟使用抗生素与立即使用抗生素的随访症状严重程度（七分制）无显著差异，延迟使用与不使用抗生素相比亦无差异。延迟给予抗生素组的症状持续时间为11.4天，略微长于立即给予抗生素组（10.9天）；但延迟给予抗生素组与未给予抗生素组的症状持续时间相似。
延迟使用抗生素组与不使用抗生素组相比，住院或死亡的并发症发生率较低，优势比为0.62；延迟使用抗生素组与立即使用抗生素组相比，住院或死亡的并发症发生率亦较低，优势比为0.78。延迟使用抗生素组与不使用抗生素组相比，再治愈率显著降低（优势比为0.72），但患者满意度显著提高。
延迟使用抗生素与立即使用抗生素和延迟使用抗生素与不使用抗生素相比，疗效均不受先前病程、发热、共病或症状严重程度的影响。5岁以下儿童延迟使用抗生素的随访症状严重程度略高于立即使用抗生素组，但老年组的严重程度没有增加。
研究结果表明，延迟开抗生素处方对包括高危人群在内的大多数患者来说，是一种安全有效的治疗策略。延迟使用抗生素与不开抗生素处方的症状持续时间相似，并且不太可能导致比立即开抗生素处方更差的症状控制。延迟开抗生素可能会降低再发病率，并且不太可能与症状或疾病持续时间增加有关，但幼儿除外。
附：英文原文
Title: Delayed antibiotic prescribing for respiratory tract infections: individual patient data meta-analysis
Author: Beth Stuart, Hilda Hounkpatin, Taeko Becque, Guiqing Yao, Shihua Zhu, Pablo Alonso-Coello, Attila Altiner, Bruce Arroll, Dankmar Bhning, Jennifer Bostock, Heiner C Bucher, Jennifer Chao, Mariam de la Poza, Nick Francis, David Gillespie, Alastair D Hay, Timothy Kenealy, Christin Lffler, David P McCormick, Gemma Mas-Dalmau, Laura Muoz, Kirsty Samuel, Michael Moore, Paul Little
Issue&Volume: 2021/04/28
Abstract:
Objective To assess the overall effect of delayed antibiotic prescribing on average symptom severity for patients with respiratory tract infections in the community, and to identify any factors modifying this effect.
Design Systematic review and individual patient data meta-analysis.
Data sources Cochrane Central Register of Controlled Trials, Ovid Medline, Ovid Embase, EBSCO CINAHL Plus, and Web of Science.
Eligibility criteria for study selection Randomised controlled trials and observational cohort studies in a community setting that allowed comparison between delayed versus no antibiotic prescribing, and delayed versus immediate antibiotic prescribing.
Main outcome measures The primary outcome was the average symptom severity two to four days after the initial consultation measured on a seven item scale (ranging from normal to as bad as could be). Secondary outcomes were duration of illness after the initial consultation, complications resulting in admission to hospital or death, reconsultation with the same or worsening illness, and patient satisfaction rated on a Likert scale.
Results Data were obtained from nine randomised controlled trials and four observational studies, totalling 55682 patients. No difference was found in follow-up symptom severity (seven point scale) for delayed versus immediate antibiotics (adjusted mean difference 0.003, 95% confidence interval 0.12 to 0.11) or delayed versus no antibiotics (0.02, 0.11 to 0.15). Symptom duration was slightly longer in those given delayed versus immediate antibiotics (11.4 v 10.9 days), but was similar for delayed versus no antibiotics. Complications resulting in hospital admission or death were lower with delayed versus no antibiotics (odds ratio 0.62, 95% confidence interval 0.30 to 1.27) and delayed versus immediate antibiotics (0.78, 0.53 to 1.13). A significant reduction in reconsultation rates (odds ratio 0.72, 95% confidence interval 0.60 to 0.87) and an increase in patient satisfaction (adjusted mean difference 0.09, 0.06 to 0.11) were observed in delayed versus no antibiotics. The effect of delayed versus immediate antibiotics and delayed versus no antibiotics was not modified by previous duration of illness, fever, comorbidity, or severity of symptoms. Children younger than 5 years had a slightly higher follow-up symptom severity with delayed antibiotics than with immediate antibiotics (adjusted mean difference 0.10, 95% confidence interval 0.03 to 0.18), but no increased severity was found in the older age group.
Conclusions Delayed antibiotic prescribing is a safe and effective strategy for most patients, including those in higher risk subgroups. Delayed prescribing was associated with similar symptom duration as no antibiotic prescribing and is unlikely to lead to poorer symptom control than immediate antibiotic prescribing. Delayed prescribing could reduce reconsultation rates and is unlikely to be associated with an increase in symptoms or illness duration, except in young children.
DOI: 10.1136/bmj.n808
Source: https://www.bmj.com/content/373/bmj.n808
BMJ-British Medical Journal:《英国医学杂志》，创刊于1840年。隶属于BMJ出版集团，最新IF：93.333
官方网址：http://www.bmj.com/
投稿链接：https://mc.manuscriptcentral.com/bmj
本期文章：《英国医学杂志》：Online/在线发表
