Nelson E A, O'Meara S, Golder S, Dalton J, Craig D, Iglesias C
School of Healthcare, University of Leeds, Leeds, UK.
Diabet Med. 2006 Apr;23(4):348-59. doi: 10.1111/j.1464-5491.2006.01785.x.
Foot ulcers in diabetes are associated with increased mortality, illness and reduced quality of life. Ulcer infection impairs healing and antimicrobial interventions may cure infection, aid healing and reduce amputation rates.
To systematically review the evidence for antimicrobial interventions for foot ulcers in diabetes.
We searched 16 databases, 11 Internet sites, three books, conference proceedings, a journal and bibliographies in November 2002. We included randomized controlled trials (RCTs) or controlled clinical trials (CCTs).
Twenty-three studies investigated the effectiveness or cost-effectiveness of antimicrobial agents: intravenous antibiotics (n = 8); oral antibiotics (n = 5); topical antimicrobials (n = 4); subcutaneous granulocyte-colony stimulating factor (G-CSF) (n = 4); Ayurvedic preparations (n = 1): and sugar vs. antibiotics vs. standard care (n = 1). The trials were small and too dissimilar to be pooled. There is no strong evidence for any particular antimicrobial agent for the prevention of amputation, resolution of infection, or ulcer healing. Pexiganan cream may be as effective as oral ofloxacin for resolution of infection. Ampicillin and sulbactam cost less than imipenem/cilastatin, G-CSF cost less than standard care and cadexomer iodine dressings may cost less than daily dressings.
The evidence is too weak to recommend any particular antimicrobial agent. Large studies are needed of the effectiveness and cost-effectiveness of antimicrobial interventions.
糖尿病足部溃疡与死亡率增加、疾病发生及生活质量下降相关。溃疡感染会阻碍愈合，抗菌干预措施可能治愈感染、促进愈合并降低截肢率。
系统评价糖尿病足部溃疡抗菌干预措施的证据。
2002年11月，我们检索了16个数据库、11个互联网站点、三本书、会议论文集、一本期刊及参考文献。我们纳入了随机对照试验（RCT）或对照临床试验（CCT）。
23项研究调查了抗菌药物的有效性或成本效益：静脉用抗生素（n = 8）；口服抗生素（n = 5）；局部用抗菌药（n = 4）；皮下注射粒细胞集落刺激因子（G-CSF）（n = 4）；阿育吠陀制剂（n = 1）；以及糖与抗生素及标准护理的对比（n = 1）。这些试验规模较小且差异过大，无法进行汇总分析。没有强有力的证据支持使用任何一种特定抗菌药物来预防截肢、解决感染或促进溃疡愈合。聚维酮碘乳膏在解决感染方面可能与口服氧氟沙星同样有效。氨苄西林和舒巴坦的成本低于亚胺培南/西司他丁，G-CSF的成本低于标准护理，而卡地姆碘敷料的成本可能低于每日换药。
证据过于薄弱，无法推荐任何一种特定抗菌药物。需要开展大型研究，以评估抗菌干预措施的有效性和成本效益。
