Becker L, Glazier R, McIsaac W, Smucny J
Lafayette Family Medicine Residency, 2394 Route 11, Lafayette, NY 13084, USA.
Cochrane Database Syst Rev. 2000(2):CD000245. doi: 10.1002/14651858.CD000245.
Antibiotic treatment of acute bronchitis, which is one of the most common illnesses seen in primary care, is controversial. Most clinicians prescribe antibiotics in spite of expert recommendations against this practice.
People with acute bronchitis may show little evidence of bacterial infection. If effective, antibiotics could shorten the course of the disease. However if they are not effective, the risk of antibiotic resistance may be increased. The objective of this review was to assess the effects of antibiotic treatment for patients with a clinical diagnosis of acute bronchitis.
We searched Medline, Embase, reference lists of articles and the authors' personal collections up to 1996, and Scisearch from 1989 to 1996.
Randomised trials comparing any antibiotic therapy with placebo in acute bronchitis.
At least two reviewers extracted data and assessed trial quality.
Eight trials involving 750 patients aged eight to over 65 and including smokers and non-smokers were included. The quality of the trials was variable. A variety of outcome measures were assessed. In many cases, only outcomes that showed a statistically significant difference between groups were reported. Overall, patients receiving antibiotics had slightly better outcomes than did those receiving placebo. They were less likely to report feeling unwell at a follow up visit (odds ratio 0.42, 95% confidence interval 0.22 to 0.82), to show no improvement on physician assessment (odds ratio 0.43; 0.23 to 0.79), or to have abnormal lung findings (odds ratio 0.33, 95% confidence interval 0.13 to 0.86), and had a more rapid return to work or usual activities (weighted mean difference 0.7 days earlier, 95% confidence interval 0.2 to 1. 3). Antibiotic-treated patients reported significantly more adverse effects (odds ratio 1.64; 1.05 to 2.57) such as nausea, vomiting, headache, skin rash or vaginitis.
REVIEWER'S CONCLUSIONS: Antibiotics appear to have a modest beneficial effect in the treatment of acute bronchitis, with a corresponding small risk of adverse effects. The benefits of antibiotics may be overestimated in this analysis because of the tendency of published reports to include complete data on only the outcomes found to be statistically significant.
急性支气管炎是基层医疗中最常见的疾病之一，其抗生素治疗存在争议。尽管有专家反对，但大多数临床医生仍会开具抗生素。
急性支气管炎患者可能几乎没有细菌感染的证据。如果有效，抗生素可以缩短病程。然而，如果无效，可能会增加抗生素耐药性的风险。本综述的目的是评估临床诊断为急性支气管炎的患者使用抗生素治疗的效果。
我们检索了截至1996年的Medline、Embase、文章参考文献列表以及作者的个人藏书，并检索了1989年至1996年的Scisearch。
比较急性支气管炎中任何抗生素治疗与安慰剂的随机试验。
至少两名审阅者提取数据并评估试验质量。
纳入了八项试验，涉及750名年龄在8岁至65岁以上的患者，包括吸烟者和非吸烟者。试验质量参差不齐。评估了多种结局指标。在许多情况下，仅报告了组间有统计学显著差异的结局。总体而言，接受抗生素治疗的患者结局略好于接受安慰剂的患者。他们在随访时报告感觉不适的可能性较小（比值比0.42，95%置信区间0.22至0.82），医生评估无改善的可能性较小（比值比0.43；0.23至0.79），肺部检查异常的可能性较小（比值比0.33，95%置信区间0.13至0.86），并且恢复工作或日常活动的速度更快（加权平均差早0.7天，95%置信区间0.2至1.3）。接受抗生素治疗的患者报告的不良反应明显更多（比值比1.64；1.05至2.57），如恶心、呕吐、头痛皮疹或阴道炎。
抗生素在急性支气管炎治疗中似乎有适度的有益效果，同时伴有相应的小不良反应风险。由于已发表报告倾向于仅纳入有统计学显著意义的结局的完整数据，本分析中抗生素的益处可能被高估了。
