Antibiotics for community acquired pneumonia in adult outpatients

  • Review
  • Intervention

Authors


Abstract

Background

Community-acquired pneumonia (CAP), the sixth most common cause of death worldwide, is a common condition representing a significant disease burden for the community, particularly in the elderly. Antibiotics are helpful in treating CAP and are the standard treatment. CAP contributes significantly to antibiotic use, which is associated with the development of bacterial resistance and side-effects. Several studies have been published concerning treatment for CAP. Available data arises mainly hospitalized patients studies. This is an update of our 2004 Cochrane Review.

Objectives

To summarize current evidence from randomized controlled trials (RCTs) concerning the efficacy of different antibiotic treatments for CAP in participants older than 12.

Search methods

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2009, issue 1) which contains the Cochrane Acute Respiratory Infections Group's Specialized Register; MEDLINE (January 1966 to February week 2, 2009), and EMBASE (January 1974 to February 2009).

Selection criteria

RCTs in which one or more antibiotics were tested for the treatment of CAP in ambulatory adolescents or adults. Studies testing one or more antibiotics and reporting the diagnostic criteria as well as the clinical outcomes achieved, were considered for inclusion.

Data collection and analysis

Two review authors (LMB, TJMV) independently assessed study reports in the first publication. In this update, LMB performed study selection, which was checked by TJMV and MMK. Study authors were contacted to resolve any ambiguities in the study reports. Data were compiled and analyzed. Differences between review authors were resolved by discussion and consensus.

Main results

Six RCTs assessing five antibiotic pairs (1857 participants aged 12 years and older diagnosed with CAP) were included. The study quality was generally good, with some differences in the extent of the reporting. A variety of clinical, radiological and bacteriological diagnostic criteria and outcomes were reported. Overall, there was no significant difference in the efficacy of the various antibiotics.

Authors' conclusions

Currently available evidence from RCTs is insufficient to make evidence-based recommendations for the choice of antibiotic to be used for the treatment of CAP in ambulatory patients. Pooling of study data was limited by the very low number of studies assessing the same antibiotic pairs. Individual study results do not reveal significant differences in efficacy between various antibiotics and antibiotic groups. Multi-drug comparisons using similar administration schedules are needed to provide the evidence necessary for practice recommendations.

摘要

背景

門診使用抗生素治療社區型肺炎的成人病患

社區型肺炎(CAP)是全球人口第六大死因﹐是社區健康的一大負擔,對老年人尤甚。抗生素有助於治療CAP,也是治療的標準做法。CAP使得抗生素使用量居高不下﹐也造成細菌抗藥性及藥物副作用等等問題。已有數篇關於CAP及治療之研究報告﹐但主要都是針對住院病人。本篇更新了2004年Cochrane回顧文章。

目標

凡研究門診12歲以上CAP病人抗生素療效的隨機對照試驗(RCTs)﹐總結其既有的實證結果。

搜尋策略

我們搜尋了Cochrane Central Register of Controlled Trials (CENTRAL)(Cochrane Library 2009年第1期)﹐其中包括了在Cochrane 急性呼吸道感染組登記註冊的試驗、MEDLINE(1966年1月至2009年2月第2週)、以及EMBASE (1974年1月至2009年2月)。

選擇標準

屬於隨機對照試驗﹐且使用抗生素治療門診CAP青少年或成人患者才納入。如果試驗討論抗生素效果、討論診斷標準與臨床效果﹐也考慮納入。

資料收集與分析

之前回顧是由兩位作者(LMB及TJMV)各自獨立評論研究論文。本次更新則由LMB選定納入的試驗﹐由TJMV與MMK來複檢。如果對研究論文有任何不清楚,則聯絡研究作者釐清有疑問的部分。彙編資料後進行分析。評論回顧文獻者如出現不同意見﹐藉由討論來形成共識。

主要結論

納入的6個RCT評估了5個抗生素治療組的效果(12歲以上CAP的病患共1857位)。研究品質還算不錯﹐呈現的成果多寡並不一致。有些研究討論了臨床診斷、放射學診斷及細菌學診斷準則及臨床療效評估。整體來說,不同抗生素之效益沒有顯著不同。

作者結論

現有RCTs證據不足﹐無法對門診CAP病人如何選用治療性抗生素提出建議。現有的相關研究太少,即使匯整所有資料仍不足。個別的研究結果並未發現不同抗生素及種類之間有何差別。有必要研究比較多種藥物﹐在相似時間投藥,以提供臨床建議所需的證據。

翻譯人

本摘要由慈濟醫院朱培元翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

肺炎或肺部相關感染﹐目前排名全球死因第六位。肺炎對老人及罹患可能影響免疫系統疾病的患者(如糖尿病)尤其可能致死。抗生素是肺炎最普遍的治療方式, 其療效及副作用因藥物而異。針對社區型肺炎且未住院治療的病患﹐本篇回顧研究抗生素的效益(在院內感染肺炎,及/或是在醫院接受肺炎治療者不納入這次回顧)。使用不同抗生素治療非住院的社區型肺炎患者之試驗結果不夠多﹐無法比較療效。

Plain language summary

Antibiotics for community acquired pneumonia in adolescent and adult outpatients

Pneumonia, or infection involving the lungs, is the sixth most common cause of death worldwide. Pneumonia is especially life-threatening in older people and people with other illnesses that may affect the immune system (such as diabetes). Antibiotics are the most commonly used treatment for pneumonia, and these can vary in their effectiveness and adverse effects. This review studied the effects of antibiotics for patients with pneumonia acquired and treated in the community (as opposed to people acquiring pneumonia while in hospital, and/or being treated for pneumonia in hospital). Unfortunately, there were not enough trials to compare the effects of different antibiotics for pneumonia acquired and treated in the community.