Poole Michael D
Department of Otolaryngology-Head and Neck Surgery, University of Texas Health Science Center, Houston, USA.
Otolaryngol Head Neck Surg. 2004 Jan;130(1 Suppl):46-50. doi: 10.1016/j.otohns.2003.12.002.
The therapeutic outcomes model (TOM) provides a logical and consistent manner in which bacteriologic and clinical efficacy can be predicted and calculated. It not only allows antibiotics to be ranked in efficacy, it gives precise estimates of the magnitude of differences in efficacy, which is typically lacking in older antimicrobial guidelines. The TOM identifies the major variables that need to be considered in accurately estimating outcome and places those variables into the appropriate relationships and formulas so that outcomes will be automatically calculated. In the case of rhinosinusitis, the major variables are (1) likelihood of spontaneously resolving nonbacterial cause, (2) likelihood of nonresolving nonbacterial cause, (3) prevalence of subcauses (eg, different species of bacteria), (4) the spontaneous resolution rates of each subcause, (5) the antibacterial efficacy of the treatment (eg, antibiotic) against each of the subcauses, and (6) the compliance rate of the treatment recommended. Minor variables, such as prior antibiotic use, patient age, or bacterial vaccination status, affect the efficacy of a given agent by modifying the value of one or more of the major variables. The TOM is a superior mechanism for ranking and evaluating relative antibiotic efficacy than previous methodologies.
治疗结果模型（TOM）提供了一种逻辑连贯的方式，可据此预测和计算细菌学及临床疗效。它不仅能对抗生素的疗效进行排序，还能精确估计疗效差异的大小，而这在以往的抗菌指南中通常是欠缺的。TOM确定了在准确估计结果时需要考虑的主要变量，并将这些变量纳入适当的关系和公式中，以便自动计算出结果。就鼻窦炎而言，主要变量包括：（1）非细菌性病因自发缓解的可能性；（2）非细菌性病因无法缓解的可能性；（3）亚病因（如不同种类的细菌）的流行率；（4）每种亚病因的自发缓解率；（5）治疗（如抗生素）针对每种亚病因的抗菌疗效；以及（6）推荐治疗的依从率。次要变量，如既往抗生素使用情况、患者年龄或细菌疫苗接种状况，通过改变一个或多个主要变量的值来影响特定药物的疗效。与以往的方法相比，TOM是一种更优越的对相对抗生素疗效进行排序和评估的机制。
